32526 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices

DEPARTMENT OF EDUCATION

National Institute on Disability and

Rehabilitation Research; Notice of

Final Funding Priorities for Fiscal

Years 1998–1999 for Certain Centers

SUMMARY: The Secretary announces

funding priorities for three

Rehabilitation Research and Training

Centers (RRTCs) and four Rehabilitation

Engineering Research Centers (RERCs)

under the National Institute on

Disability and Rehabilitation Research

(NIDRR) for fiscal years 1998–1999. The

Secretary takes this action to focus

research attention on areas of national

need. These priorities are intended to

improve rehabilitation services and

outcomes for individuals with

disabilities.

EFFECTIVE DATE: This priority takes effect

on July 13, 1998.

FOR FURTHER INFORMATION CONTACT:

Donna Nangle. Telephone: (202) 205–

5880. Individuals who use a

telecommunications device for the deaf

(TDD) may call the TDD number at (202)

205–5516. Internet:

DonnalNangle@ed.gov

Individuals with disabilities may

obtain this document in an alternate

format (e.g., Braille, large print,

audiotape, or computer diskette) on

request to the contact person listed in

the preceding paragraph.

SUPPLEMENTARY INFORMATION: This

notice contains final priorities under the

Disability and Rehabilitation Research

Projects and Centers Program for three

RRTCs related to: aging with a

disability, arthritis rehabilitation, and

stroke rehabilitation. The notice also

contains final priorities for four RERCs

related to: prosthetics and orthotics,

wheeled mobility, technology transfer,

and telerehabilitation.

These final priorities support the

National Education Goal that calls for

every adult American to possess the

skills necessary to compete in a global

economy.

The authority for the Secretary to

establish research priorities by reserving

funds to support particular research

activities is contained in sections 202(g)

and 204 of the Rehabilitation Act of

1973, as amended (29 U.S.C. 761a(g)

and 762).

Note: This notice of final priorities does

not solicit applications. A notice inviting

applications is published in this issue of the

Federal Register.

Analysis of Comments and Changes

On March 3, 1998, the Secretary

published a notice of proposed

priorities in the Federal Register (62 FR

10428–10437). The Department of

Education received forty-five letters

commenting on the notice of proposed

priority by the deadline date. Technical

and other minor changes—and

suggested changes the Secretary is not

legally authorized to make under

statutory authority—are not addressed.

Rehabilitation Research and Training

Centers—General

Comment: One commenter suggested

that NIDRR should do more than

encourage all Centers to involve

individuals with disabilities as

recipients of research training and

clinical training. A second commenter

suggested that RRTCs should be

required to hire individuals with

disabilities.

Discussion: Involvement of

individuals with disabilities is one of

the general requirements that apply to

all RRTCs. All RRTCs must ‘‘involve

individuals with disabilities and, if

appropriate, their representatives, in

planning and implementing its research,

training, and dissemination activities,

and in evaluating the Center.’’

Applications for RRTCs are evaluated,

in part, on the extent to which the

applicant encourages individuals with

disabilities to apply for employment.

Changes: None.

Comment: NIDRR received a comment

in response to the proposed priority on

Arthritis Rehabilitation that suggested

that NIDRR require the RRTC to

collaborate with arthritis-related

organizations as well as other RRTCs.

Discussion: This comment prompted a

general review of all of the collaboration

and coordination requirements

contained in the proposed RRTC and

RERC priorities to determine their

appropriateness and consistency. That

review revealed some inconsistency in

language requiring clarification.

Changes: The RRTC priorities have

been revised to clarify that having met

the stated collaboration or coordination

requirements, each RRTC has the

authority to collaborate or coordinate

with other entities carrying out related

activities.

Comment: NIDRR received comments

in a preceding FY 98 RERC competition

that suggested that the requirements for

conducting a state-of-the-science

conference and publishing a final report

should be more flexible.

Discussion: As a result of this

comment, NIDRR revised the general

state-of-the-science conference and final

report requirement in the preceding

priority. The following reason was

provided for this change: ‘‘Information

from the state-of-the-science conference

will be used, in conjunction with

NIDRR’s programs reviews and other

inputs in the determination of future

research issues and as part of NIDRR’s

Government Performance Results Act

database. The budget planning process

requires this information to be available

during the fourth year of a five year

grant. As long as the report is available

in the fourth year of the grant, grantees

should have as much flexibility as

possible in regard to the scheduling of

the state-of-the-science conference.’’

Changes: To be consistent with the

state-of-the-science conference

requirement used in the previous

priority, it has been revised in the RRTC

and RERC priorities to allow grantees

total discretion in scheduling the

conference.

Priority 1: Aging With a Disability

Comment: Research and training on

aging with a disability should be

interdisciplinary.

Discussion: An applicant could

propose to carry out the RRTC’s

research and training activities using an

interdisciplinary model. The peer

review process will evaluate the merits

of the proposal. However, NIDRR has no

basis to determine that all applicants

should be prohibited from proposing

other models.

Changes: None.

Comment: The priority should

include health promotion and wellness

programs in the second activity on

reducing aging’s impact on health

status.

Discussion: An applicant could

propose to include health promotion

and wellness programs in the second

activity of the priority. The peer review

process will evaluate the merits of the

proposal. However, NIDRR has no basis

to determine that all applicants should

be required to include health promotion

and wellness programs in their efforts to

address reducing aging’s impact on

health status.

Changes: None.

Comment: The fourth activity on

psychosocial adjustment should be

expanded to include community

integration in order to address broader

community resource issues such as

access to health care and employment.

Discussion: NIDRR agrees that

expanding the scope of the fourth

activity to include community

integration will enable the RRTC to

address a wider range of important

issues. It will also provide applicants

with more discretion to propose

activities that address a wider range of

issues related to psychosocial

adjustment.

Changes: Community integration has

been added to the fourth activity of the

priority.
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices 32527

Priority 2: Arthritis Rehabilitation

Comment: The RRTC should study

managed care in order to enable persons

with expertise in arthritis to contribute

to this burgeoning field of interest.

Discussion: The impact of managed

care on the provision of services to

persons with arthritis is an important

area. However, it is not feasible,

considering the complexity of the topic,

for the RRTC to address managed care

in addition to the current requirements

in the priority.

Changes: None.

Priority 3: Stroke Rehabilitation

Comment: The RRTC should address

reducing the incidence and impact of

coexisting and secondary conditions on

stroke survivors. These conditions are

not only common in all age groups of

stroke survivors, but also have a

significant impact on the course, care,

and outcome of stroke rehabilitation

efforts.

Discussion: NIDRR agrees that

including coexisting and secondary

conditions within the activities of the

RRTC constitutes a more comprehensive

approach to stroke rehabilitation.

Changes: The first activity has been

revised to include coexisting and

secondary conditions.

Rehabilitation Engineering and

Research Centers—General

Comment: The priorities should be

broadened to include a field-initiated

activity for grants smaller in scope.

Discussion: NIDRR’s field-initiated

projects competition is held annually.

Therefore, including a field-initiated

activity within an RERC priority is

unnecessary.

Changes: None.

Priority 4: Prosthetics and Orthotics (P

and O)

Comment: The RERC should be

required to address the humantechnology interface.

Discussion: The second activity

requires the RERC to address selecting

and fitting prosthetic and orthotic

devices. The human-technology

interface is a required step in this

process. Therefore, an additional

requirement addressing humantechnology interface is unnecessary.

Changes: None.

Priority 5: Wheeled Mobility

Comment: Three commenters

suggested broadening the priority to

address new technologies in the area of

wheeled mobility. One commenter

specifically suggested requiring the

RRTC to investigate advanced electric

powered wheelchair controls and

develop new wheelchair technology to

increase performance and accessibility

while reducing cost and preventing

secondary disability.

Discussion: NIDRR agrees that

research on new technologies in the area

of wheeled mobility is needed. NIDRR

believes that applicants should have as

much discretion as possible in this

emerging area. Under the revised

priority (see below) an applicant could

propose to investigate advanced electric

powered wheelchair controls or develop

new wheelchair technology to increase

performance and accessibility while

reducing cost and preventing secondary

disability. The peer review process will

evaluate the merits of these proposals.

NIDRR also has no basis to determine

that all applicants should be required to

investigate advanced electric powered

wheelchair controls or develop new

wheelchair technology to increase

performance and accessibility while

reducing cost and preventing secondary

disability.

Changes: The priority has been

revised to require the RRTC to develop

and evaluate new technologies in the

area of wheeled mobility.

Comment: Thirteen commenters

expressed concern about the need for

continued research activities related to

wheelchair transportation safety issues.

Discussion: NIDRR agrees with the

commenters that issues remain to be

addressed in regard to wheelchair

transportation safety. An applicant

could propose to include wheelchair

transportation safety issues in the

activity to develop and evaluate new

technologies in the area of wheeled

mobility. The peer review process will

evaluate the merits of the proposal.

However, NIDRR has no basis to

determine that all applicants should be

required to carry out research on

wheelchair transportation safety issues.

Changes: None.

Comment: The fifth activity should be

expanded to include voluntary

performance standards for wheelchairs,

and the sixth activity should be

expanded to include outcome

measurement tools or quantifying

seating and mobility interventions.

Discussion: Expanding the fifth and

sixth activities as suggested by the

commenter is not necessary because an

applicant could propose the

commenter’s suggestions under the new

requirement to develop and evaluate

new technologies in the area of wheeled

mobility.

Changes: None.

Comment: Researchers have recently

demonstrated wheelchair control

systems that augment human motion

control. Given the relevance of this area

of research and the success of state-ofthe-art prototypes, it is recommended

that the commercialization of

augmented wheelchair control systems

be a requirement of this priority.

Discussion: The RERC can carry out

research on augmented wheelchair

control systems, however,

commercialization of augmented

wheelchair control systems is outside

the scope and purpose of the RERC.

Changes: None.

Comment: It may be unclear to

applicants why it is important to

integrate external devices with

wheelchairs. The priority could be

improved by adding the word ‘‘control’’

to the second activity.

Discussion: The background section

elaborates on the importance of control

systems for external devices. NIDRR

agrees that including ‘‘control’’ in the

second activity will clarify the purpose

of the second activity.

Changes: The second activity has

been revised to include control of

external devices.

Comment: A fundamental need before

outcome measures can be developed for

wheelchair seating is to develop the

standardized measures and terminology

that will define and allow

communication about the quantification

of the wheelchair seated posture. The

sixth activity regarding the development

and evaluation of outcome measurement

tools should be revised to include

standardized measures and terminology

of seated posture.

Discussion: An applicant could

propose to develop and evaluate

standardized measures and terminology

of seated posture under the sixth

activity of the priority. The peer review

process will evaluate the merits of this

proposal. However, NIDRR has no basis

to determine that all applicants should

be required to develop and evaluate

standardized measures and terminology

of seated posture.

Changes: None.

Comment: The RERC should be

required to investigate injury risk and

assess technologies and strategies that

will enhance wheelchair safety.

Discussion: An applicant could

propose to investigate injury risk and

assess technologies and strategies that

will enhance wheelchair safety under

the new requirement to develop and

evaluate new technologies in the area of

wheeled mobility. The peer review

process will evaluate the merits of the

proposal. However, NIDRR has no basis

to determine that all applicants should

be required to investigate injury risk and

assess technologies and strategies that

will enhance wheelchair safety.

Changes: None.
32528 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices

Priority 6: Technology Transfer

Comment: The background section

should be expanded to discuss

technology commercialization and

technology utilization.

Discussion: Commercialization and

technology utilization are key

components of technology transfer.

Commercialization and technology

utilization are referred to in a variety of

ways throughout the background

section.

Changes: None.

Comment: The words ‘‘technology

transfer’’ should be added to the third

and fourth activities in order to clarify

that the RERC is expected to address the

continuum of technology transfer

activities.

Discussion: The third and fourth

activities address specific development,

evaluation, design, and dissemination

tasks. It is not necessary to include the

words ‘‘technology transfer’’ in order to

understand these requirements or

ensure that the continuum of technology

transfer activities will be pursued by

applicants.

Changes: None.

Comment: The RERC should be

required to carry out demonstration

activities. Technology transfer needs to

be demonstrated using assistive

technology products that are consumer

and market responsive.

Discussion: As reflected in the

priority and the selection criteria that

will be used to evaluate applications,

the RERC is required to carry out

research, development, training,

dissemination, utilization, and technical

assistance activities. Having met the

requirements to complete these

activities, an applicant could propose to

carry out related demonstration

activities. However, NIDRR has no basis

to determine that all applicants should

be required to carry out demonstration

activities.

Changes: None.

Proposed Priority 7: Telerehabilitation

Comment: Four commenters feel the

priority should be broadened to include

the development of strategies and

techniques necessary to provide and

monitor vocational rehabilitation

services.

Discussion: The priority purposefully

refers to ‘‘rehabilitation services’’ in

general in order to be applicable to all

types of rehabilitation services.

Therefore, the RERC is expected to

address vocational rehabilitation

services as well as other rehabilitation

services.

Changes: None.

Comment: The four activities do not

contain the words ‘‘research,’’

‘‘engineering,’’ or ‘‘science’’ and could

be misinterpreted as simply calling for

demonstrations of existing technologies

without significantly advancing the

state-of-the-art. The wording of the

priority should be modified to

strengthen the commitment to scientific

and engineering investigation.

Discussion: NIDRR agrees that the

priority should be revised in order to

reinforce the RERC’s commitment to

scientific and engineering investigation.

Changes: An investigation

requirement has been added to the

second and third activities.

Comment: A new activity should be

added to require the RERC to serve as

the national focal point for

telerehabilitation and virtual reality

related to individuals with disabilities

and to maintain links with the much

larger international and national

telemedicine and virtual reality

communities.

Discussion: RERCs are national in

scope and expected to take a leadership

position within the field. The RERC is

also expected to communicate and

coordinate with other entities carrying

out related research and development

activities. Unless the RERC could not

achieve its purposes without a

requirement to coordinate or collaborate

with specific entities, NIDRR provides

applicants with the discretion to

propose the partners for coordination

and collaboration activities.

Changes: None.

Comment: Two commenters indicated

that, too often, patients in rural areas

who experience communication

disorders are unable to obtain state-ofthe-art speech and language therapy in

geographically accessible centers. These

commenters suggested that scope of this

RERC should be expanded to include

the rehabilitation of individuals with

communication disorders in rural

settings.

Discussion: Unless noted otherwise in

a priority, any NIDRR-funded project or

center must address the needs of all

persons with disabilities, including

those with communication disorders.

Changes: None.

Comment: Two commenters indicated

that the background statement mentions

‘‘spinal cord injury, stroke, and

traumatic brain injury’’ as examples of

disabling conditions to which

telerehabilitation techniques might

usefully be applied. To avoid ambiguity

and an unnecessarily narrow mandate,

the background statement should be

broadened to include a broad range of

disabilities.

Discussion: The fact that background

statement mentions ‘‘spinal cord injury,

stroke, and traumatic brain injury’’ as

examples of disabling conditions to

which telerehabilitation techniques

might usefully be applied, is not

intended to suggest that the RERC limit

its activities to these conditions. This

RERC is expected to address the

rehabilitation needs of all persons with

disabilities.

Changes: None.

Comment: Five commenters indicated

the priority focuses too narrowly on

individuals who lack easy access to

outpatient rehabilitation care due to

geographic remoteness. The commenters

pointed out that many people in

metropolitan areas have geographical

access problems due, in part, from a

lack of accessible transportation. The

commenters suggest that the first

activity be broadened to include all

consumers of rehabilitation services

who encounter barriers to receiving

continued care through conventional

means.

Discussion: The communication

systems that the RERC will identify and

evaluate to connect comprehensive

rehabilitation facilities with therapists,

individuals, and family members living

in remote areas will be applicable to all

consumers of rehabilitation and settings,

including metropolitan areas.

Changes: None.

Comment: Two commenters feel the

last sentence of the third paragraph in

the background statement appears to

limit monitoring capabilities to only

video and audio technologies. The

commenters suggested that the sentence

should be broadened to include a

variety of promising sensor

technologies.

Discussion: The RERC will include

sensor technologies in its activities, and

these technologies are referenced in the

second paragraph of the background

statement.

Changes: None.

Comment: The word ‘‘diagnostic’’ in

the second activity is too limiting and

should be replaced with either

‘‘assessment’’ or ‘‘evaluation.’’

Discussion: NIDRR agrees that

‘‘assessment’’ is a more appropriate

term.

Changes: The second activity has

been revised by substituting the word

‘‘assessment’’ for ‘‘diagnostic.’’

Comment: The second activity should

be expanded beyond rehabilitation to

include post-rehabilitation health

services.

Discussion: Having met all the

requirements of the priority, an

applicant could propose to include postrehabilitation health services within the

scope of its activities. The peer review

process will evaluate the merits of the

proposal. However, NIDRR has no basis
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices 32529

to determine that all applicants should

be required to include postrehabilitation health services within the

scope of the RERC’s activities.

Changes: None.

Comment: Managed care will have a

major impact on the extent to which

telerehabilitation will be used once

these technologies are developed.

Therefore, this RERC should be required

to coordinate its activities with the

NIDRR funded RRTC on Managed

Health Care for Individuals with

Disabilities.

Discussion: An applicant could

propose to coordinate with the RRTC on

Managed Health Care. The peer review

process will evaluate the merits of this

proposal. However, it is not necessary

for the RERC to coordinate with the

RRTC on Managed Health Care in order

to carry out its purposes.

Changes: None.

Comment: Three commenters

suggested that the priority should

identify relevant rehabilitation

disciplines such as occupational

therapy, physical therapy, speech

pathology and nursing. A fourth

commenter indicated that nurses are the

most common caregivers in the home

setting and suggested that nurses should

be included in the first activity.

Discussion: NIDRR agrees that the use

of the term ‘‘therapists’’ in the first

activity may be interpreted narrowly.

‘‘Providers of rehabilitation services’’ is

a broader category would clearly

include nurses.

Changes: The first activity has been

revised by substituting ‘‘providers of

rehabilitation services’’ for ‘‘therapists.’’

Comment: In regard to the second and

fourth activities, the RERC should

provide a testbed environment to

demonstrate concepts prior to

investment, including simulating

telecommunication links to test

bandwidth performance and simulating

new rehabilitation strategies and

devices in virtual reality software.

Specifically the RERC should:

demonstrate the application of tools via

pilot tests with regional rehabilitation

service partners; demonstrate the

application of technology to establish

on-line rehabilitation services

communities; and provide collaborative

virtual reality capabilities establishing

on-line communities via the Internet to

provide job postings, rehabilitation

news, tips and best practices, virtual

reality 3D chat rooms, push technology

features to reach remote users, and

education and training simulations.

Discussion: All of the proposals

contained in this comment are within

the scope of the priority and could be

proposed by an applicant to achieve the

purposes of the second and fourth

activity. The peer review process will

evaluate the merits of the proposals.

There is insufficient evidence to warrant

requiring all applicants to carry out the

activities suggested in the comment.

Changes: None.

Comment: Although telerehabilitation

and virtual reality are new technologies,

they have little in common. Virtual

reality is a therapy, while

telerehabilitation is a health care

delivery and educational system. The

fourth activity requiring the RERC to

investigate the use of virtual reality

should be deleted from this priority.

Virtual reality deserves a separate

priority.

Discussion: NIDRR disagrees that

virtual reality is a therapy. NIDRR

believes that it is an emerging

technology with significant therapeutic

potential. In light of substantial work

that is being supported elsewhere in the

public and private sector on virtual

reality applications, NIDRR believes that

authorizing this RERC to undertake one

activity investigating the use of virtual

reality in rehabilitation is a proper

course of action.

Changes: None.

Comment: The RERC should be

required to implement the concepts of

universal design and universal access in

all facets of their research.

Discussion: NIDRR supports the

promotion of universal design and

universal access through a variety of

research, training, technical assistance,

and information dissemination

activities. An applicant could propose

to carry out its activities consistent with

concepts of universal design and access.

The peer review process will evaluate

the merits of this approach. However,

NIDRR declines to require all applicants

to implement these concepts because

the RERC’s purpose could be achieved

without adherence to these concepts.

Changes: None.

Comment: The RERC should not only

research strategies that employ remote

technologies to deliver services, but also

strategies to collect and analyze process

and outcome data over time.

Discussion: NIDRR agrees with the

commenter and points out that the

RERC is required to develop and

evaluate these strategies under the third

activity in the priority. No further

changes are necessary in the priority.

Changes: None.

Comment: Although some systems

may already be in place to facilitate the

delivery of telerehabilitation services,

new technologies are emerging every

day. The word ‘‘develop’’ should be

included in the first activity.

Discussion: NIDRR agrees that the

RERC should not only identify and

evaluate, but also develop

communications systems under the first

activity in the priority.

Changes: The priority has been

revised to require the RERC to develop

communications systems under the first

activity in the priority.

Comment: The priority does not

mention the potential that

telecommunication technology has in

promoting organizational and

multidisciplinary team collaboration.

NIDRR should place an emphasis on

evaluation of telecommunications

technology in fostering collaboration.

Discussion: An applicant could

propose to place an emphasis on

telecommunications technology that

fosters collaboration. The peer review

process will evaluate the merits of this

emphasis. However, NIDRR has no basis

to determine that all applicants should

be required to place an emphasis on

telecommunications technology that

promotes collaboration.

Changes: None.

Comment: Given that shorter lengthsof-stay are becoming common place

throughout the rehabilitation

community, the RERC should be

required to explore techniques for

extending rehabilitation programs in the

home and other settings (e.g., day care

centers, senior centers, independent

living centers).

Discussion: An applicant could

propose to explore techniques for

providing rehabilitation services

through telerehabilitation in a variety of

settings, including day care centers,

senior centers, and independent living

centers. The peer review process will

evaluate the merits of this proposal.

However, NIDRR has no basis to

determine that all applicants should be

required to propose extending

rehabilitation programs through

telerehabilitation in a variety of settings,

including day care centers, senior

centers, and independent living centers.

Changes: None.

Comment: Virtual reality is a costly

technology and activities related to

virtual reality development and testing

could engage a disproportionately high

portion of the resources available for

this RERC. A relatively modest project

involving applications of virtual reality

could easily account for all of the funds

proposed to support this RERC. It would

be disappointing to see a focus on such

a high profile application deter

development of lower cost technologies

that may have more immediate and

broader payoff.

Discussion: NIDRR recognizes that the

emerging field of virtual reality could
32530 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices

easily overwhelm the resources of the

RERC and has purposefully limited the

fourth activity to research related to

virtual reality rather than development.

Changes: None.

Comment: Care should be taken to

ensure that technologies developed

under this RERC can be used in settings

without state-of-the-art hardware and

software. Developing technology

applications that take advantage of the

existing communication infrastructure

has the potential to put state-of-the-art

rehabilitation services within reach of

all people, regardless of the wealth of

the community.

Discussion: NIDRR agrees that the

RERC should develop technologies with

the broadest application. The selection

criteria used in the peer review process

will address this issue by evaluating the

impact of the proposed activities on the

target population.

Changes: None.

Comment: The priority should be

broadened to require the RERC to study

policy issues (e.g., reimbursement issues

and selection criteria) that will affect the

implementation of telerehabilitation.

Discussion: NIDRR agrees that there

are policy issues that will affect the

implementation of telerehabilitation. An

applicant could propose to integrate

policy issues into the first, third, and

fourth activities of the priority. The peer

review process will evaluate the merits

of the proposal. However, there is

insufficient evidence to require that all

applicants address policy issues related

to the implementation of

telerehabilitation.

Changes: None.

Comment: The third activity appears

to focus on remote therapeutic

interventions while the second activity

focuses on evaluation tools. Is this

interpretation correct?

Discussion: The commenter’s

interpretation is correct.

Changes: None.

Rehabilitation Research and Training

Centers

The authority for RRTCs is contained

in section 204(b)(2) of the Rehabilitation

Act of 1973, as amended (29 U.S.C. 760–

762). Under this program, the Secretary

makes awards to public and private

organizations, including institutions of

higher education and Indian tribes or

tribal organizations, for coordinated

research and training activities. These

entities must be of sufficient size, scope,

and quality to effectively carry out the

activities of the Center in an efficient

manner consistent with appropriate

State and Federal laws. They must

demonstrate the ability to carry out the

training activities either directly or

through another entity that can provide

that training.

The Secretary may make awards for

up to 60 months through grants or

cooperative agreements. The purpose of

the awards is for planning and

conducting research, training,

demonstrations, and related activities

leading to the development of methods,

procedures, and devices that will

benefit individuals with disabilities,

especially those with the most severe

disabilities.

Description of Rehabilitation Research

and Training Centers

RRTCs are operated in collaboration

with institutions of higher education or

providers of rehabilitation services or

other appropriate services. RRTCs serve

as centers of national excellence and

national or regional resources for

providers and individuals with

disabilities and the parents, family

members, guardians, advocates or

authorized representatives of these

individuals.

RRTCs conduct coordinated,

integrated, and advanced programs of

research in rehabilitation targeted

toward the production of new

knowledge to improve rehabilitation

methodology and service delivery

systems, to alleviate or stabilize

disabling conditions, and to promote

maximum social and economic

independence of individuals with

disabilities.

RRTCs provide training, including

graduate, pre-service, and in-service

training, to assist individuals to more

effectively provide rehabilitation

services. They also provide training

including graduate, pre-service, and inservice training, for rehabilitation

research personnel.

RRTCs serve as informational and

technical assistance resources to

providers, individuals with disabilities,

and the parents, family members,

guardians, advocates, or authorized

representatives of these individuals

through conferences, workshops, public

education programs, in-service training

programs and similar activities.

RRTCs disseminate materials in

alternate formats to ensure that they are

accessible to individuals with a range of

disabling conditions.

NIDRR encourages all Centers to

involve individuals with disabilities

and individuals from minority

backgrounds as recipients of research

training, as well as clinical training.

The Department is particularly

interested in ensuring that the

expenditure of public funds is justified

by the execution of intended activities

and the advancement of knowledge and,

thus, has built this accountability into

the selection criteria. Not later than

three years after the establishment of

any RRTC, NIDRR will conduct one or

more reviews of the activities and

achievements of the Center. In

accordance with the provisions of 34

CFR 75.253(a), continued funding

depends at all times on satisfactory

performance and accomplishment.

General RRTC Requirements

The following requirements apply to

these RRTCs pursuant to these absolute

priorities unless noted otherwise. An

applicant’s proposal to fulfill these

requirements will be assessed using

applicable selection criteria in the peer

review process.

The RRTC must provide: (1) applied

research experience; (2) training on

research methodology; and (3) training

to persons with disabilities and their

families, service providers, and other

appropriate parties in accessible formats

on knowledge gained from the Center’s

research activities.

The RRTC must develop and

disseminate informational materials

based on knowledge gained from the

Center’s research activities, and

disseminate the materials to persons

with disabilities, their representatives,

service providers, and other interested

parties.

The RRTC must involve individuals

with disabilities and, if appropriate,

their representatives, in planning and

implementing its research, training, and

dissemination activities, and in

evaluating the Center.

The RRTC must conduct a state-ofthe-science conference and publish a

comprehensive report on the final

outcomes of the conference. The report

must be published in the fourth year of

the grant.

Priorities

Under 34 CFR 75.105(c)(3), the

Secretary gives an absolute preference to

applications that meet the following

priorities. The Secretary will fund under

this competition only applications that

meet one of these absolute priorities.

Priority 1: Aging with a Disability

Background

Advances in medical care,

rehabilitation technology, and

rehabilitative treatment have made

aging a routine event for persons with

a disability. The rapid increase in the

number of people with a physical

disability who are growing older has

been well documented (McNeil, J.,

‘‘Americans With Disabilities,’’ U.S.

Bureau of the Census, Statistical Brief,
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices 32531

SB/94–1, 1994). Many persons aging

with a disability face significant new

challenges to their health, daily

functioning, and independence. These

challenges may come from onset of

chronic conditions such as hypertension

or from secondary conditions such as

post-polio. For example, approximately

70 percent of people with polio

experience some form of ‘‘post-polio

syndrome,’’ a condition that impairs

functioning (Halstead, L., ‘‘Assessment

Differential Diagnosis for Post-Polio

Syndrome,’’ Orthopedics, 14, pgs. 1209–

1222, 1991).

The problems resulting from aging

with a disability can be grouped into

four areas: (1) Decline in health status

due to onset of new chronic conditions

or development of secondary

conditions; (2) decline in functional

abilities due to changed health status;

(3) difficulty maintaining psychological

well-being and life satisfaction; and (4)

diminished capacity of family and

community support networks to

accommodate changes associated with

aging with a disability.

Aging with a disability is a complex

phenomenon, influenced by both

normal and injury-related biological

processes, by medical and rehabilitative

developments, and by changing social,

cultural and physical environments (De

Vivo, M., et al., ‘‘Causes of Death During

the First 12 Years After Spinal Cord

Injury,’’ Archives of Physical Medicine

and Rehabilitation, 74, pgs. 248–254,

1991). Although some progress has been

made in systematically assessing the

‘‘natural course’’ of aging with a

physical disability (Whiteneck, G.,

‘‘Learning from Empirical

Investigations,’’ Perspectives on Aging

with Spinal Cord Injury, pgs. 23–27,

1992), this work is not complete.

Persons aging with a disability face

significant health problems because of

the onset of new conditions associated

with the aging process itself and

potentially complicated by the disability

condition. Research suggests that

chronic diseases such as cardiovascular

illnesses and diabetes occur at earlier

than expected ages and in substantially

higher percentages among persons who

acquired a disability in early life (Pope,

A. and Flemming, C., Disability in

America: Toward a National Agenda for

Prevention, pg. 191, 1991). Significant

bone loss (osteoporosis) is higher in

people with complete spinal cord

lesions than in age-matched controls

(Garland, D., et al., ‘‘Osteoporosis After

Spinal Cord Injury,’’ Journal of

Orthopedic Research, 10, pgs. 371–378,

1992). Other age-related health

problems may be impairment-specific

secondary conditions such as hip

dislocations in people with cerebral

palsy or respiratory problems for

persons with post-polio syndrome. One

study found that 50 percent of people

with a 40-year history of cerebral palsy

had severe joint, back or neck pain

(Murphy, K., ‘‘Medical and Social Issues

in Adults with Cerebral Palsy, The

California Study,’’ Developmental

Medicine and Child Neurology, Vol. 37,

pgs. 1075–1084, 1995).

Fatigue, loss of strength, increased

pain, and other health-related changes

associated with aging may affect

function so that capacity to perform

activities of daily living (ADL) (e.g.,

mobility, bathing, and transfers), is

diminished. Fatigue and weakness may

affect 60 to 70 percent of people with

spinal cord injury (SCI) or post-polio

(Gerhart, K., et al., ‘‘Long-term Spinal

Cord Injury: Functional Changes Over

Time,’’ Archives of Physical Medicine

and Rehabilitation, 74, pgs. 1030–1035,

1993).

In addition to facing new physical

challenges, some people aging with a

disability also develop psychological

conditions. In the general aging

population, depression is often an

unrecognized corollary of the aging

process (Lebowitz, B., et al., ‘‘Diagnosis

and Treatment of Depression in Late

Life,’’ Journal of the American Medical

Association, 278 (14), pgs. 1186–1190,

1997). At least one study has found that

between 25 and 40 percent of persons

aging with a disability show high

distress, especially as expressed in

symptoms of depression (Fuhrer, M., et

al., ‘‘The Relationship of Life

Satisfaction to Impairment, Disability

and Handicap Among Persons with

Spinal Cord Injury Living in the

Community,’’ Archives of Physical

Medicine and Rehabilitation, 73, pgs.

552–557, 1992). Treatment of

depression for persons aging with a

disability is difficult to obtain because

of the failure of health professionals to

recognize depression in persons aging

with a disability (Krause, J. and Crewe,

N., ‘‘Chronological Age Time Since

Injury and Time of Measurement: Effect

on Adjustment After Spinal Cord

Injury,’’ Archives of Physical Medicine

and Rehabilitation, 72, pgs. 91–100,

1991).

Families may experience new stresses

because of age-related conditions

acquired by their family members with

disabilities. In addition, aging of family

caregivers may affect their ability to

continue caregiving roles, thus reducing

the ability of a person aging with a

disability to remain in the family

setting. The importance of this issue is

reinforced by the fact that family

caregivers provide most of the personal

assistance to persons with disabilities

(Nosek, M., ‘‘Life Satisfaction of People

with Physical Disabilities: Relationship

to Personal Assistance, Disability Status

and Handicap,’’ Rehabilitation

Psychology, 40, pgs. 191–197, 1995).

Helping families cope can include

options like expanding respite care or

training related to age-related changes.

The increase in the numbers of

persons aging with a disability has

increased the need for rehabilitation

personnel trained in providing services

to this population. Serving an aging

population may also require new

treatment and other service delivery

models. Research on effective

accommodations, including the use of

assistive technology, for this aging

population has been limited.

Priority 1

The Secretary will establish an RRTC

on Aging with a Disability to promote

the health, functional abilities,

psychological well-being, and

independence of persons aging with a

disability. The RRTC shall:

(1) Investigate the natural course of

aging with a disability;

(2) Identify, develop, and evaluate

methods to reduce aging’s impact on

health status, including onset of new

chronic conditions and secondary

conditions associated with the primary

disability;

(3) Identify, develop, and evaluate

rehabilitation techniques, including the

effective use of assistive technology, to

maintain functional independence;

(4) Investigate and evaluate methods

to improve community integration and

psychosocial adjustment; and

(5) Conduct studies to identify the

extent to which aging affects the ability

of families to support persons aging

with a disability in family and

community settings and evaluate

strategies that will enhance the ability of

families to cope.

In carrying out these priorities, the

RRTC must coordinate with aging with

disability research and demonstration

activities sponsored by the National

Center on Medical Rehabilitation

Research, the Department of Veterans

Affairs, the Social Security

Administration, the Health Care

Financing Administration, and the

RRTCs on Health Care for Individuals

with Disabilities—Issues in Managed

Health Care, Aging with Spinal Cord

Injury, and Aging with Mental

Retardation, the RERC on Assistive

Technology for Older Persons with

Disabilities, and other entities carrying

out related research or training

activities.
32532 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices

Priority 2: Arthritis Rehabilitation

Background

‘‘Arthritis’’ means joint inflammation

and encompasses a large family of more

than 100 so-called rheumatic diseases

that can affect people of all ages. The

prevalence of many of these diseases

tends to increase with age and several

occur predominantly in women; others

are more common in men. These

diseases can affect joints, muscles,

tendons, ligaments, and the protective

coverings of some internal organs. Onset

is usually in middle age, and arthritis

and musculoskeletal conditions

typically present a cluster of chief

complaints including, but not limited

to, pain, muscle impairments, and joint

impairments. Arthritis and

musculoskeletal conditions typically

result in functional limitations in ADL.

While individuals with arthritis

experience most of their limitations in

physical functional activities, the

concept of function has psychological

and social dimensions as well

(Guccione, A. A., ‘‘Arthritis and the

Process of Disablement,’’ Physical

Therapy, Vol. 74, No. 5, May, 1994). For

the purpose of this priority, arthritis and

musculoskeletal diseases must include,

but are not limited to, rheumatoid

arthritis (RA), osteoarthritis (OA),

juvenile rheumatoid arthritis (JRA),

osteoporosis, and fibromyalgia

syndrome.

Physical activity may provide

significant physical and mental health

benefits for persons with arthritis and

musculoskeletal diseases. In recognizing

that regular physical activity can help

control joint swelling and pain, the U.S.

Surgeon General’s 1996 Report on

Physical Activity and Health, urges

people with arthritis to exercise. The

Center for Disease Control and

Prevention has indicated that most

persons with arthritis and other

rheumatic conditions should engage in

physical activity because exercise helps

people with arthritis maintain normal

muscle strength and joint function and

reduces the risk of premature death,

heart disease, diabetes, high blood

pressure, colon cancer, depression, and

anxiety (Krucoff, C., ‘‘Taking Action

Against Arthritis,’’ The Washington Post

Health Section, October 21, 1997).

Maintenance of health and wellness is

important when dealing with the

problems of arthritis and

musculoskeletal diseases. A number of

factors, such as understanding and

managing fatigue and conserving

energy, developing relaxation

techniques, participating in exercise

programs, and learning about weight

control and proper nutrition, aid in the

goal of achieving a quality of life for

individuals who cope with the various

problems encountered.

Pain is a major concern for

individuals with arthritis and

musculoskeletal diseases. Pain can

affect the ability to work or function

independently in the home or

community. The increased dependency

encountered, the thoughts of progressive

deformities, and feelings of frustration

through loss of control often lead to

psychosocial difficulties. Rehabilitation

interventions can reduce pain,

depression and improve functional

abilities.

Musculoskeletal conditions are among

the top-ranked conditions causing

limitations in the ability to perform

work and reported as causes of actual

work loss. Estimates for prevalence of

work disability, defined as ceasing to

work, ranges from 51 percent to 59

percent. Clinical studies have indicated

that when RA is in a severe form, this

rate could be as high as 60 percent a

decade after diagnosis (Felts, W. and

Yelin, E., ‘‘The Economic Impact of the

Rheumatic Diseases in the United

States,’’ Journal of Rheumatology, 16,

pgs. 867–884, 1989). Decreased work

satisfaction has been reported by

persons with RA; 59 percent are unable

to maintain gainful employment. In

addition, patients with RA are

significantly more likely to have lost

their job or to have retired early due to

their illness, and are the most likely to

have reduced their work hours or

stopped working entirely due to their

illness (Gabriel S. E., et al., ‘‘Indirect

and Nonmedical Costs Among People

with RA and OA Compared with

Nonarthritic Controls,’’ Journal of

Rheumatology, 24(1), pgs. 43–48,

January, 1997). Reasonable job

accommodations for people with

arthritis and musculoskeletal diseases to

manage fatigue, stress, job performance

issues, allowances for medical

treatments and individual-related

modifications are areas for employers to

consider.

More than 200,000 children in the

U.S. are affected with some form of

arthritis (Cassidy, J. T., et al., ‘‘Juvenile

Rheumatoid Arthritis,’’ Textbook of

Pediatric Rheumatology, pgs. 133–233,

1995). JRA is the most common

childhood connective tissue disease

(Chaney, J. and Peterson, L., Journal of

Pediatric Psychology, Vol. 14, No. 3,

1989). JRA affects the physical,

psychological and social development

of children and adolescents. Assessing

needs and developing strategies to aid

in the promotion of improved medical,

educational, psychosocial, and

vocational services is essential with this

population.

Priority 2

The Secretary will establish an RRTC

on Arthritis Rehabilitation to improve

the functional abilities and promote the

independence of individuals with

arthritis and musculoskeletal diseases.

The RRTC shall:

(1) Identify, develop, and evaluate

exercise and fitness programs;

(2) Identify, develop, and evaluate

rehabilitation interventions to increase

psychological well-being and reduce

pain;

(3) Identify, develop, and evaluate job

accommodations to maintain

employment; and

(4) Identify, develop, and evaluate

programs to maintain health and

wellness.

In carrying out the purposes of the

priority, the RRTC must:

• Address the needs of children and

youth; and

• Coordinate with arthritis activities

sponsored by the National Institute on

Arthritis and Musculoskeletal and Skin

Diseases, the National Center for

Medical Rehabilitation Research, and

other entities carrying out related

research or training activities.

Priority 3: Stroke Rehabilitation

Background

In the U.S., there are approximately

three million stroke survivors and

400,000 to 500,000 new or recurrent

stroke cases annually (Gorelicj, P.,

‘‘Stroke Prevention,’’ Archives of

Neurology, 52(4), pgs. 347–355, 1995).

Stroke survivors are the largest

population in rehabilitation hospitals,

and an estimated $30 billion is spent on

stroke treatment each year (Alberts, M.,

et al., ‘‘Hospital Charges for Stroke

Patients,’’ Stroke, 27 (10) pgs. 1825–

1828, 1996). Previous NIDRR-funded

stroke rehabilitation research has

focused on prevention and treatment of

secondary conditions of stroke;

enhancing functional capacity following

stroke; improving social and community

functioning; and studying the natural

history of impairment, disability, and

quality of life after stroke.

Rehabilitation goals for stroke patients

focus on maximizing physical and

psychological function, teaching

patients about prevention of recurrent

stroke, and working with family

members to facilitate integration of the

person recovering from stroke back into

family and community settings. Stroke

patients potentially face a number of

functional problems resulting from the

paralysis, dysphagia, neurological, and

other health-related sequelae of stroke.
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices 32533

Higher order cognitive deficits, such

as incomprehension and short-term

memory loss, have been shown to have

a primary role in predicting

rehabilitation length of stay, functional

outcome and long-term care needs of

stroke survivors. Early, comprehensive

assessment of cognitive deficits has

been shown to play a significant role in

effecting better rehabilitation outcomes

(Galski, T., et al., ‘‘Predicting Length of

Stay, Functional Outcome, and

Aftercare in the Rehabilitation of Stroke

Patients. The Dominant Role of HigherOrder Cognition,’’ Stroke, 24 (12), pgs.

1794–1800, December, 1993).

Endurance exercise is recognized as

an important component of

rehabilitation for stroke patient recovery

of sensorimotor function. The ability of

stroke patients to participate in exercise

is compromised because they have

lowered motor functional ability as a

result of both reduced oxidative

capacity and reduced availability of

motor units. Traditional methods of

measuring aerobic capacity are not

appropriate for this population, nor are

exercise training protocols that do not

reflect stroke patient capacity for

exercise (Potempa, K., et al., ‘‘Benefits of

Aerobic Exercise After Stroke,’’ Sports

Medicine, 21(5), pgs. 337–346, 1996).

Changes in personality, mood, and

temperament can be confusing and

distressing for stroke survivors and their

caregivers. Depression can be a

significant problem for both survivors

and caregivers (Kumar, A., et al.,

‘‘Quantitative Anatomic Measures and

Comorbid Medical Illness in Late-life

Major Depression,’’ American Journal of

Geriatrics Psychiatry, 5(1), pgs. 15–25,

1997). Effective treatment of

psychological and behavioral problems

may require more standardized

approaches that incorporate

psychopharmacological, behavioral, and

psychological interventions.

Although stroke is predominantly a

phenomenon that strikes persons aged

65 and over, five percent occur in

persons under age 45. Individuals in

this age cohort are generally employed,

have a longer life expectancy than older

stroke patients, and generally have

better underlying health status and

incur less brain injury related to the

stroke (Ferro, J. and Crespo, M.,

‘‘Prognosis After Transient Ischemic

Attack and Ischemic Stroke in Young

Adults,’’ Stroke, (8), pgs. 1611–1616,

August, 1994). Rehabilitation for

younger patients may emphasize

vocational options, sexuality, and social

functioning (Roth, E., ‘‘From the

Editor,’’ Topics in Stroke

Rehabilitation—The Young Stroke

Survivor, Vol. 1, pg. vi, Spring, 1994). In

addition, complications such as drug

use or pregnancy may complicate

rehabilitation strategies (Meyer, J., et al.,

‘‘Etiology and Diagnosis of Stroke in the

Young Adult,’’ Topics in Stroke

Rehabilitation—The Young Stroke

Survivor, Vol. 1, pgs. 1–14, Spring,

1994).

Persons at the other end of the age

spectrum, those over age 75 who

comprise 41.8 percent of stroke

rehabilitation patients (Personal

communication with Samuel J.

Markello, Ph.D. and Carl V. Granger,

M.D., Director, National Rehabilitation

Outcomes Database, maintained by the

Uniform Data System for Medical

Rehabilitation, University of Buffalo,

January, 1998), are at risk for poor

rehabilitation outcomes possibly

because of the effects of frailty and comorbid disease (Falconer, J., et al.,

‘‘Stroke Inpatient Rehabilitation: A

Comparison Across Age Groups,’’

Journal of the American Geriatric

Society, 42(1), pgs. 39–44, January,

1994). In this population, presence of a

healthy and caring spouse, bladder and

bowel continence, and ability to feed

oneself have predicted better outcomes

(Reddy, M. and Reddy, V., ‘‘After a

Stroke: Strategies to Restore Function

and Prevent Complications,’’ Geriatrics,

52(9), pgs. 59–62, September, 1997).

Prevention of stroke recurrence is

increasingly a goal of medical

rehabilitation stroke treatment programs

(Gorelick, P., ‘‘Stroke Prevention,’’

Archives of Neurology, 52(4), pgs. 347–

355, April, 1995). Prevention methods

include teaching individuals to monitor

their blood pressure, raising awareness

of the importance of nutrition and

exercise, and educating family members

about stroke.

Medical research shows promise for

dramatically improving the diagnosis

and treatment of stroke in acute care

settings. New drug therapies may

significantly limit the impact of the

initial stroke. Better diagnostic tools,

such as using magnetic resonance

imaging (MRI) to determine stroke type,

size, and location, will result in earlier

diagnosis and treatment (Centofanti, M.,

‘‘Fighting Back Against Brain Attack,’’

Johns Hopkins Magazine, pgs. 18–24,

November, 1997). The consequences of

improved initial stroke treatment for

rehabilitation treatment and service

delivery mechanisms are unknown.

Changes in financing and service

delivery models of stroke rehabilitation

have created different rehabilitation

treatment setting options for stroke

patients. Increasingly, stroke patients

are receiving rehabilitation in post-acute

service settings (e.g., nursing-home

based rehabilitation programs). As a

consequence of these changes, there are

questions about the impact on outcomes

of stroke patients. For instance, how

does treatment intensity vary across

settings; does treatment intensity affect

outcomes across settings; do population

characteristics differ across settings?

Initial research indicates that outcomes

may not differ dramatically when

comparing acute to post-acute

rehabilitation settings (Cramer A., et al.,

‘‘Outcomes and Costs After Hip Fracture

and Stroke—A Comparison of

Rehabilitation Settings,’’ JAMA, Vol.

277, pgs. 396–404, 1997); however,

knowledge about long-term outcomes of

treatment in these different settings is

still inconclusive.

Another development affecting stroke

rehabilitation is implementation of

practice guidelines. In 1996, the Agency

for Health Care Policy and Research

published stroke treatment guidelines

(Post-Stroke Rehabilitation: A Quick

Reference Guide for Clinicians, Pub. 95–

0663, 1996). These guidelines aim to

minimize variation in treatment across

acute care and rehabilitation settings

(Ringel, S. and Hughes, R., ‘‘Evidencebased Medicine, Critical Pathways,

Practice Guidelines, and Managed Care.

Reflections on the Prevention and Care

of Stroke,’’ Archives of Neurology, 53(9),

pgs. 867–871, 1996). The rate of

adoption of these guidelines and their

impact on rehabilitation service and

outcomes is not yet known.

Priority 3

The Secretary will establish an RRTC

for Stroke Rehabilitation to develop and

evaluate rehabilitation approaches to

improve stroke rehabilitation treatment

for all patients. The RRTC shall:

(1) Identify, develop, and evaluate

rehabilitation techniques to address

coexisting and secondary conditions

and improve outcomes for all stroke

patients, giving specific emphasis to

rehabilitation needs of older and

younger patient groups and to methods

that incorporate cognition in the

treatment protocols;

(2) Develop and evaluate standard

aerobic exercise protocols; and

(3) Identify and evaluate methods to

identify and treat depression and other

psychological problems associated with

stroke;

(4) Determine the effectiveness of

stroke prevention education provided in

medical rehabilitation settings;

(5) Evaluate the impact of changes in

diagnosis and medical treatment of

stroke on rehabilitation needs;

(6) Evaluate long-range outcomes for

stroke rehabilitation across different

treatment settings;
32534 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices

(7) Evaluate the impact of stroke

practice guidelines on delivery and

outcomes of rehabilitation services.

In carrying out the purposes of the

priority, the RRTC must:

• Collaborate with RRTCs on Health

Care for Individuals with Disabilities—

Issues in Managed Health Care, and

Aging with a Disability; and

• Coordinate with stroke activities

sponsored by the National Center for

Medical Rehabilitation Research, the

National Institute on Neurological

Disorders and Stroke, and other entities

carrying out related research or training

activities.

Rehabilitation Engineering Research

Centers

The authority for RERCs is contained

in section 204(b)(3) of the Rehabilitation

Act of 1973, as amended (29 U.S.C.

762(b)(3)). The Secretary may make

awards for up to 60 months through

grants or cooperative agreements to

public and private agencies and

organizations, including institutions of

higher education, Indian tribes, and

tribal organizations, to conduct

research, demonstration, and training

activities regarding rehabilitation

technology in order to enhance

opportunities for meeting the needs of,

and addressing the barriers confronted

by, individuals with disabilities in all

aspects of their lives. An RERC must be

operated by or in collaboration with an

institution of higher education or a

nonprofit organization.

Description of Rehabilitation

Engineering Research Centers

RERCs carry out research or

demonstration activities by:

(a) Developing and disseminating

innovative methods of applying

advanced technology, scientific

achievement, and psychological and

social knowledge to (1) solve

rehabilitation problems and remove

environmental barriers, and (2) study

new or emerging technologies, products,

or environments;

(b) Demonstrating and disseminating

(1) innovative models for the delivery of

cost-effective rehabilitation technology

services to rural and urban areas, and (2)

other scientific research to assist in

meeting the employment and

independent living needs of individuals

with severe disabilities; or

(c) Facilitating service delivery

systems change through (1) the

development, evaluation, and

dissemination of consumer-responsive

and individual and family-centered

innovative models for the delivery to

both rural and urban areas of innovative

cost-effective rehabilitation technology

services, and (2) other scientific

research to assist in meeting the

employment and independent needs of

individuals with severe disabilities.

Each RERC must provide training

opportunities to individuals, including

individuals with disabilities, to become

researchers of rehabilitation technology

and practitioners of rehabilitation

technology in conjunction with

institutions of higher education and

nonprofit organizations.

The Department is particularly

interested in ensuring that the

expenditure of public funds is justified

by the execution of intended activities

and the advancement of knowledge and,

thus, has built this accountability into

the selection criteria. Not later than

three years after the establishment of

any RERC, NIDRR will conduct one or

more reviews of the activities and

achievements of the Center. In

accordance with the provisions of 34

CFR 75.253(a), continued funding

depends at all times on satisfactory

performance and accomplishment.

General RERC Requirements

The following requirements apply to

the RERCs pursuant to these absolute

priorities unless noted otherwise. An

applicant’s proposal to fulfill these

requirements will be assessed using

applicable selection criteria in the peer

review process.

The RERC must have the capability to

design, build, and test prototype devices

and assist in the transfer of successful

solutions to relevant production and

service delivery settings. The RERC

must evaluate the efficacy and safety of

its new products, instrumentation, or

assistive devices.

The RERC must disseminate research

results and other knowledge gained

from the Center’s research and

development activities to persons with

disabilities, their representatives,

disability organizations, businesses,

manufacturers, professional journals,

service providers, and other interested

parties.

The RERC must develop and carry out

utilization activities to successfully

transfer all new and improved

technologies developed by the RERC to

the marketplace.

The RERC must involve individuals

with disabilities and, if appropriate,

their representatives, in planning and

implementing its research,

development, training, and

dissemination activities, and in

evaluating the Center.

The RERC must conduct a state-ofthe-science conference and publish a

comprehensive report on the final

outcomes of the conference. The report

must be published in the fourth year of

the grant.

Priorities

Under 34 CFR 75.105(c)(3), the

Secretary gives an absolute preference to

applications that meet the following

priorities. The Secretary will fund under

this competition only applications that

meet one of these absolute priorities.

Priority 4: Prosthetics and Orthotics

Background

Prosthetic limbs (also called artificial

or replacement limbs) perform functions

previously performed by lost or absent

limbs or portions of limbs. Orthoses

(also called braces or anatomical

technology devices) are devices applied

to limbs or other parts of the body that

have either lost or impaired function to

compensate for certain differences in

anatomical shape or size, muscle

weakness, or paralysis. Appropriately

fitted prosthetic and orthotic (P and O)

devices improve functional abilities for

work and ADL.

The National Health Interview Survey

of 1992 reported a prevalence in the

United States of 102,000 individuals

with upper extremity loss or absence,

and 256,000 individuals with lower

extremity loss or absence (LaPlante, M.

and Carlson, D., ‘‘Disability in the

United States: Prevalence and Causes,

1992’’ Disability Statistics Report No. 7,

NIDRR, pg. 29, 1996). The majority of

these individuals use or need prosthetic

limbs. It is more difficult to estimate the

prevalence of individuals who use or

need orthotic devices because orthoses

are used in a wide variety of disabilities,

and unlike loss or absence of a limb,

have not historically been a specific

category in national surveys. However,

the National Health Interview Survey on

Assistive Devices (NHIS–AD) of 1990

reported that 3,514,000 individuals in

the United States used anatomical

technology devices, categorized as

braces for either the leg, foot, arm, hand,

neck, back or other (LaPlante, M. P., et

al., ‘‘Assistive Technology Devices and

Home Accessibility Features:

Prevalence, Payment, Need, and

Trends,’’ Advance Data from Vital and

Health Statistics, National Center for

Health Statistics, No. 217, pg. 6, 1992).

According to the Institute of

Medicine, there is a lack of a complete

and widely accepted base of scientific

and engineering data to support the

process of individuals obtaining the

optimum device for their particular

need. The lack of an effective scientific

and theoretical foundation for human

gait inhibits the engineering design of

technology to aid ambulation. More
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices 32535

work is also needed in research and

development directed to the problems of

arm and hand replacement (Enabling

America: Assessing the Role of

Rehabilitation Science and Engineering,

Institute of Medicine Report, pgs. 111–

117, 1997).

The enormous diversity of P and O

devices to address many different

muscular, neuromuscular, and skeletal

issues, adds to the complexity of this

field and supports the need for

quantitative documentation to improve

the process by which individuals obtain

the most appropriate P and O device for

their need (Esquenazi, A. and Meier, R.

H., ‘‘Rehabilitation in Limb Deficiency.

4. Limb Amputation,’’ Archives of

Physical Medicine and Rehabilitation,

Vol. 77, pgs. s18–s28, 1996). For

example, there are approximately 100

commercially available prosthetic knees

capable of being used in transfemoral

prostheses (Michael, J. W., ‘‘Prosthetic

Knee Mechanisms,’’ Physical Medicine

and Rehabilitation: State of the Art

Reviews, Vol. 8, pgs. 147–164, 1994),

making it difficult to evaluate all

possible options. The trend in health

care toward evidence-based decision

making will require the collection and

analysis of data that may not have

occurred in the past (Guyatt, G., et al.,

‘‘Evidence-Based Medicine: A New

Approach to Teaching the Practice of

Medicine,’’ JAMA, Vol. 268, pgs. 2420–

2425, 1992).

Evaluations will play a key role in

shaping the services available in the

future (Hailey, D. M., ‘‘Orthoses and

Prostheses,’’ International Journal of

Technology Assessment in Health Care,

Vol. 11, pgs. 214–234, 1995). As more

quantitative measurements are being

made at the individual level with

respect to device selection, there is a

need to collect data on use of devices by

individuals in a uniform format for

archival reference and research

purposes. A database that could be used

to evaluate the outcomes of individuals

using P and O devices does not exist.

Such a database might include, but

would not be limited to: technical

specifications and details of the device;

appropriate performance and outcome

measures; relevant anthropometric

measurements of the wearer;

appropriate medical and demographic

data, and payment information.

The increased attention to prosthetic

technology in developing nations (Day,

H. J. B., ‘‘A Review of the Consensus

Conference on Appropriate Prosthetic

Technology in Developing Countries,’’

Prosthetics and Orthotics International,

Vol. 20, pgs. 15–23, 1996) along with

the advanced state of science in many

European nations, provides opportunity

and impetus for the development of

international standards in P and O. In

addition, increased international

exchanges of both information and

technology, as a result of comparative

work, are highly likely to be beneficial

to both the United States and other

countries.

Priority 4

The Secretary will establish an RERC

on Prosthetics and Orthotics to

strengthen and expand the scientific

and engineering basis for the field, and

develop new ways to use information

technology that will ultimately result in

delivery of improved service to

individuals who can benefit from

prosthetic and orthotic devices. The

RERC shall:

(1) Increase the understanding of the

scientific and engineering principles for

human locomotion, reaching,

prehension, and manipulation, and

incorporate these principles into the

design of P and O devices;

(2) Develop and evaluate a prototype

computer-based system to select the

most appropriate P and O device (or

combination of devices), and fit the

device to an individual;

(3) Develop a prototype database of

individuals using P&O devices in

collaboration with industry including,

but not limited to, technical details of

the device, appropriate performance and

outcome measures, relevant

anthropometric measurements of the

wearer, appropriate medical and

demographic data, and cost and

payment information; and

(4) Maintain an international

exchange of scientific information and

participate in the development of

international standards.

In carrying out these purposes, the

RERC must coordinate on activities of

mutual interest with the RERC on Land

Mines and other entities carrying out

related research or development

activities.

Priority 5: Wheeled Mobility

Background

Approximately 1.4 million Americans

use a wheelchair as their primary source

of mobility (Kraus, L., et al., Chartbook

on Disability in the United States,

InfoUse, Berkeley, CA, 1996), including

approximately 600,000 Americans who

live in skilled nursing facilities and are

over the age of 65 (Shaw, G. and Taylor,

S. J., ‘‘A Survey of Wheelchair Seating

Problems of the Institutionalized

Elderly,’’ Assistive Technology, Vol. 3,

RESNA Press, pgs. 5–10, 1991). The

number of Americans who use

wheelchairs nearly doubled between

1980 and 1990 while the general

population increased by 13 percent

during that same period (LaPlante, M.

P., et al., ‘‘Assistive Technology Devices

and Home Accessibility Features:

Prevalence, Payment, Need, and

Trends,’’ Advance Data from Vital and

Health Statistics, No. 217, U.S.

Department of Health and Human

Services, September, 1992). The number

of wheelchair users increases as a

population ages (Ohlin, P., et al.,

‘‘Technology Assisting Disabled and the

Older People in Europe,’’ The Swedish

Handicap Institute, Stockholm, 1995).

As the American population continues

to grow older, the number of individuals

who will require the use of a wheelchair

for mobility is expected to increase.

Wheelchairs and wheelchair seating

systems have dramatically improved

over the past decade due in part to

advances in lightweight, high-strength

materials, improved mechanical

designs, and improved microprocessor

control technologies, and more efficient

drive train systems for powered chairs.

There are virtually hundreds of options

available to wheelchair users (e.g., frame

sizes and designs, castors, hand rims,

seat sizes, and seat backs). Selecting the

appropriate options when either

prescribing or purchasing a wheelchair

or wheelchair seating system can be

complicated and difficult for therapists

and consumers.

Individuals who use powered

wheelchairs often rely on external

devices (e.g., ventilators, augmentative

communication devices, and

environmental control systems) for

respiratory support or to help them

function during the day. Improvements

in electronic technologies have led to

the development of sophisticated

wheelchair controllers with built-in

flexibility and adjustability. Typical

controllers are based on

microcomputers and allow for the

adjustment of parameters (e.g.,

acceleration and deceleration control,

speed control, and tremor dampening)

to improve the user’s ability to control

the wheelchair safely (Cook, A. M. and

Hussey, S. M., Assistive Technologies:

Principles and Practice, pg. 549, 1995).

These controllers are also capable of

directly controlling external devices.

Most external devices are made by

companies other than wheelchair

manufacturers. As a result,

compatibility between external devices

and powered wheelchairs is often

problematic.

Wheelchairs and wheelchair seating

systems combine to provide mobility,

pressure relief, postural support,

deformity management, and increased

comfort, function and tolerance
32536 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices

(Hobson, D. A., ‘‘Seating and Mobility

for the Severely Disabled,’’

Rehabilitation Engineering, pgs. 193–

252, 1990). Most wheelchair users are

candidates for seating and positioning

interventions. Typical seating systems

statically control an individual’s posture

by constraining the individual to a fixed

position using modular or custom fit

devices and systems such as foam

wedges, hand shaped foams, ‘‘foam-inplace,’’ vacuum consolidation, and

CAD–CAM (Cook, A. M. and Hussey, S.

M., op. cit., pgs. 237–239). For

individuals who have a high degree of

muscle tone or spasticity, staying in a

fixed position can be uncomfortable and

cause pressure sores. An alternative to

static seating is dynamic seating. A

recent case study in this area of research

looked at the benefits of a dynamic

seating system for an adolescent with

cerebral palsy with a high degree of

extensor tone. This system allowed the

individual to extend during spasms,

then returned the individual to a

functional seating posture upon

relaxation resulting in a reduction of

generalized tone and improved posture

(Ault, H. K., et al., ‘‘Design of a Dynamic

Seating System for Clients with

Extensor Spasms,’’ Proceedings of the

RESNA 1997 Annual Conference, pgs.

187–189, 1997).

Pressure relief is critical for

individuals who have little or no

sensation in weight bearing areas, such

as persons with spinal cord injury and

some elderly, or those who are unable

to shift their weight to relieve pressure

(Bergen, A., et al., Positioning for

Function: Wheelchairs and Other

Assistive Technologies, p. 4, 1990).

Without proper pressure relief,

individuals are prone to develop

pressure sores (decubitus ulcers) that

can result in tremendous costs for

treatment and in time lost from work

(Ditunno, J. F., Jr. and Formal, C. S.,

‘‘Chronic Spinal Cord Injury,’’ New

England Journal of Medicine, Vol. 330,

pgs. 550–556, 1994). The incidence for

pressure sores has remained fairly static

(Stover, S. L., et al., Spinal Cord Injury:

Clinical Outcomes from the Model

Systems, pgs. 109–113, 1995). There are

many factors that contribute to the

development of pressure sores. External

forces (i.e., tension, compression, and

shear) applied to localized areas are the

primary causes of pressure sores. Other

factors affecting pressure sore

development include, but are not

limited to, stress, friction, body size,

posture, nutrition, age, blood

circulation, and the microclimate

between one’s body and the seating

surface (Cook, A. M. and Hussey, S. M.,

op. cit., pgs. 282–285). Understanding

the interactions between these factors is

paramount to improving seating and

positioning systems.

Decisions made during seating

evaluations are often subjective in

nature and are based upon observational

analyses and past experience of the

therapists involved. There are over 300

commercially available cushions on the

market (HyperABLEDATA, 1997), as

well as a myriad of wheelchair options.

Understanding these options and

knowing when to use them is difficult

for therapists and consumers. Voluntary

performance standards for seating and

clinical measurement devices would

allow for objective comparison of

products based upon standardized test

results from each manufacturer.

A number of outcome measurement

tools may be used to measure functional

outcomes of individuals during the

rehabilitation process. However, many

of these tools do not consider assistive

technology interventions, including

seating and mobility, when rating an

individual’s overall performance. For

example, in order to get a maximum

score using the Functional

Independence Measure, the individual

cannot rely on assistive technology;

thereby implying that a person cannot

be totally functionally independent if he

or she uses assistive technology devices

(Scherer, M. J. and Galvin, J. C., ‘‘An

Outcomes Perspective of Quality

Pathways to the Most Appropriate

Technology,’’ Evaluating, Selecting, and

Using Appropriate Assistive

Technology, pg. 21, 1996). A number of

clinical measurement devices (e.g.,

pressure monitoring devices, and

seating simulators) may be used in

seating and mobility clinic

environments, however, they do not

systematically measure and record

outcomes of wheelchair and seating

interventions.

Priority 5

The Secretary will establish an RERC

on Wheeled Mobility to improve the

efficiency and selection of wheelchairs

and wheelchair seating systems and

investigate new seating system strategies

including dynamic seating systems and

pressure sore prevention. The RERC

shall:

(1) Develop and evaluate strategies

that can be used to aid therapists and

consumers in making informed

decisions when prescribing or

purchasing new wheelchairs and

wheelchair seating systems;

(2) Develop and evaluate strategies in

collaboration with industry to promote

the integration of external devices with

powered wheelchairs and the control of

these external devices, ensuring their

compatibility and usability;

(3) Develop and evaluate new

technologies in the area of wheeled

mobility;

(4) Investigate the viability of

dynamic seating systems;

(5) Investigate the factors that

contribute to the development of

pressure sores and develop and evaluate

tools, devices and strategies to prevent

them from occurring;

(6) Investigate the use of voluntary

performance standards for wheelchair

seating devices and clinical

measurement devices and, if

appropriate, develop in collaboration

with industry strategies to facilitate the

implementation of those standards; and

(7) Develop and evaluate outcome

measurement tools for quantifying

seating clinic intervention results.

In carrying out the purposes of the

priority, the RERC must coordinate on

activities of mutual interest with all the

RRTCs addressing Spinal Cord Injury,

the RRTC on Aging with a Disability,

and other entities carrying out related

research or development activities.

Priority 6: Technology Transfer

Background

Technology transfer is a means of

capitalizing on and increasing the value

of an initial investment in research of a

particular technology through new

applications. Technology transfer also

involves moving conceptualizations and

new inventions from a potential

application into a working prototype

and, ultimately, into a commercial

product. There has been an increased

interest in developing assistive

technology in recent years. Basic

research has yielded innovations

developed with the disability

population in mind and more generic

applied research has resulted in new

ways to transfer existing technologies

initially developed for different

purposes into assistive technology

products. In addition, there are an

increasing number of entrepreneurs and

inventors developing devices

specifically for persons with disabilities.

Approximately 13 million people

with disabilities use assistive

technology devices to assist them with

major life activities (Kraus, L., et al.,

Chartbook on Disability in the United

States, InfoUse, Berkeley, CA, 1996).

Understanding the functional needs of

persons with disabilities, translating

those needs into technical solutions,

identifying the markets and determining

which technologies may be successfully

transferred into usable assistive

technology products is critical to the
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices 32537

technology transfer process (Spaepen,

A. J., ‘‘Technology Transfer and Service

Delivery in Rehabilitation Technology,’’

Journal of Rehabilitation Sciences, Vol.

4, pgs. 84–87, 1991). The assistive

technology market is expected to grow

dramatically over the next two decades

as the American population ages and as

the survival rate of accident victims

continues to climb (Federal Laboratory

Consortium, ‘‘Federal Laboratory

Technologies Enable the Disabled,’’

Technology Transfer Business, Vol. 4, p.

11, 1997).

There are models of technology

transfer that are routinely utilized by

government, small businesses, nonprofit

organizations, universities and industry

(Rouse, D., ‘‘Technology Identification

and Partnership Development,’’

Research Triangle Institute, 1997).

These models assume a market that is

identifiable and definable, somewhat

homogeneous, visible, and wellfinanced. Transferring promising

technologies and new inventions to the

assistive technology arena presents

unique challenges. Devices that either

have the potential for use by persons

with disabilities, or were invented for

consumers with disabilities often are

not successfully commercialized

because of the limited number of

potential users or the developer’s

inexperience and limited understanding

of disabilities and the assistive

technology marketplace (Gilden, D.,

‘‘Moving from Naive to Knowledgeable

on the Road to Technology Transfer,’’

Technology and Disability, Vol. 7, pgs.

115–125, 1997).

Frequently, inventions and prototypes

of devices require considerable

engineering, modification and redesign.

The vast majority of assistive technology

companies are very small and have

limited access to knowledge, resources,

markets, funds, skills and finance

(Swanson, D., ‘‘Determining the

Government’s Responsibilities in

Technology,’’ Journal of Technology

Transfer, Vol. 20 (2), pgs. 3–4, 1995).

Companies and entrepreneurs interested

in transferring inventions and existing

technologies into new products for

persons with disabilities require

technical assistance to make sound and

profitable decisions and to do a better

job of analyzing the viability of potential

products.

Proper screening of devices is critical

to the assistive technology transfer

process and requires a feasibility study

to be performed for each device prior to

any significant investment of time and

financial resources. Typical questions to

ask include: Does the device already

exist in some other form? Do consumers

have alternate and satisfactory ways to

perform the same function that would

negate the need for another device?

Would the required investment justify

the development of the new device? Is

the market too small? Are consumers

interested in using the device? (Newroe,

B. N. and Oskardottir, A. Y.,

‘‘Identification and Networking of

Assistive Technology-Related Transfer

Resources Through the Consumer

Assistive Technology Network

(CATN),’’ Technology and Disability,

Vol. 7, pgs. 31–45, 1997).

Assistive technology evaluation

involves activities beyond the initial

screening of new products and

innovations. It is important to identify

and include all other stakeholders in the

evaluation process including, but not

limited to, technology experts,

engineers, developers, manufacturers,

corporations, community organizations,

providers and potential purchasers. In

addition to evaluation studies, it is

necessary to provide an estimate of the

resources required and of the product’s

readiness for commercialization in order

to attract a developer or manufacturer.

Safety, reliability, cost, customer

satisfaction and durability must also be

measured (Sheredos, S., et al., ‘‘The

Department of Veterans Affairs

Rehabilitation Research and

Development Service’s Technology

Process,’’ Technology and Disability,

Vol. 7, pgs. 25–30, 1997).

Most assistive technology devices are

considered orphan products (devices

used by very small populations and

having limited market appeal). In

anticipation of a products’ low volume

and unproven market demand, potential

manufacturers and suppliers must be

offered a well researched device

prospectus that will act as an incentive

for production. Products incorporating

the principles of universal design are

developed with built-in flexibility so

they are usable by all people, regardless

of age and ability, at no additional cost

(Mace, R., et al., ‘‘Accessible

Environments: Toward Universal

Design,’’ Design Interventions: Toward

Universal Design, p. 156, 1991). The

evaluation phase should include an

assessment of whether a product may

have universal application, thereby

increasing its marketability.

Priority 6

The Secretary will establish an RERC

on technology transfer to facilitate and

improve the process of moving new,

useful and better assistive technology

inventions and applications of existing

technologies from the prototype phase

to the marketplace to benefit persons

with disabilities. The RERC shall:

(1) Identify and evaluate models of

technology transfer that are applicable

to assistive technology;

(2) Identify the needs and provide

technical assistance, including

engineering design and support, to

inventors, entrepreneurs, small

companies, research laboratories, and

industry and university labs to facilitate

the transfer of assistive technology with

particular emphasis on orphan

products;

(3) Develop and implement

methodologies to screen promising

assistive technology and to evaluate the

potential for commercialization,

including an assessment of principles of

universal design of prototypes

developed by individual inventors,

small businesses and public or private

research laboratories for use by persons

with disabilities; and

(4) Design and disseminate protocols

for technical, user and market

evaluations of promising inventions and

new uses for existing technologies.

In carrying out the purposes of the

priority, the RERC must:

Conduct activities in consultation

with industry, public and private

research facilities, small businesses,

entrepreneurs, university-based research

laboratories and consumers; and

Provide technical assistance and

support to all RERC’s on issues

pertaining to technology evaluation and

transfer.

Priority 7: Telerehabilitation

Background

One of the most notable changes in

the nation’s health care system is a

dramatic downward shift in the average

length of stay for patients admitted to

rehabilitation hospitals. According to

the National Spinal Cord Injury

Statistical Center, the average length of

stay for patients admitted into the

Model SCI Care System dropped from

115 days in 1974 to 49 days in 1995

(‘‘Spinal Cord Injury: Facts and Figures

at a Glance,’’ National Spinal Cord

Injury Statistical Center, University of

Alabama at Birmingham, August, 1997).

Individuals living in rural areas may

have less of an opportunity to continue

their rehabilitation than do individuals

living in urban settings due to a lack of

rehabilitation outpatient centers in rural

regions. Given that individuals are being

discharged earlier in the rehabilitation

process, there is tremendous need for

new and innovative therapeutic devices

and strategies that can be used to

continue therapy for individuals living

in remote settings who may not have

access to outpatient therapy.

For more than 30 years, clinicians,

researchers, and others have been
32538 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices

investigating the use of advanced

telecommunications and information

technologies to improve health care,

resulting in the advent of telemedicine.

Telemedicine has a variety of

applications including patient care,

education, research, administration and

public health (Telemedicine: A Guide to

Assessing Telecommunications in

Health Care, Institute of Medicine

Report, National Academy Press, p. 16,

1996). At least 10 States have

established Medicaid payment

mechanisms for medical services

provided through telemedicine (U.S.

Department of Commerce,

‘‘Telemedicine Report to Congress,’’

January 31, 1997). Technological

advances in medicine, sensor

technologies, telecommunications and

information technologies provide

unique opportunities for expanding

upon the field of telemedicine to further

develop the field of telerehabilitation.

By using technology, telerehabilitation

enables rehabilitation professionals to

provide rehabilitation services to

individuals when distance separates the

participants (Temkin, A. J., et al.,

‘‘Telerehab: A Perspective of the Way

Technology is Going to Change the

Future of Patient Treatment,’’ REHAB

Management, p. 28, February/March,

1996). Telecommunication and

information technologies used in

telemedicine are modernizing medical

rehabilitation services and are beginning

to be used in other aspects of the

rehabilitation process. For example,

ongoing experiments to provide

effective delivery of therapeutic

counseling from the offices of

professional psychologists to clients

physically located elsewhere, using

modified video-conferencing

techniques, are under study by the

American Psychological Association

(Sleek, S., ‘‘Providing Therapy from a

Distance,’’ APA Monitor, American

Psychological Association, Vol. 28, No.

8, August, 1997).

Two very important aspects of

comprehensive rehabilitation are

education and training. Rehabilitation

practitioners work closely with

individuals and family members to

enhance their functional abilities, assist

them in adjusting to their disability

(Haas, J., ‘‘Ethical Issues in

Rehabilitation Medicine,’’

Rehabilitation Medicine: Principles and

Practice, Second Edition, p. 34, 1993),

and lessen the likelihood of secondary

complications (Stover, S., et al., Spinal

Cord Injury: Clinical Outcomes from the

Model Systems, p. 322, 1995).

Secondary complications from acute

trauma, such as spinal cord injury,

stroke, and traumatic brain injury, are a

leading cause for re-hospitalization. One

way of reducing the likelihood of

contracting secondary complications is

through education, training, and

monitoring. This can be achieved using

portable, low-cost communication

devices capable of providing video and

audio connection between

comprehensive rehabilitation facilities

and individuals living in rural

communities. Those devices can enable

individuals to communicate with

rehabilitation professionals while at

home or in remote clinical settings, and

to continue with the educational and

training components of the

rehabilitation process. These devices

also allow physicians and other

clinicians to monitor the progress of

these individuals and offer clinical

diagnoses and interventions when

appropriate.

Traditional therapeutic interventions

include the use of heat, cold, light,

friction, and pressure to facilitate

healing and relieve pain in affected

areas. Many of these therapy techniques

require costly equipment and can be

used only by trained therapists. Given

that individuals are being discharged

earlier in the rehabilitation process,

there is tremendous need for new,

innovative and cost-effective

therapeutic devices and strategies that

can be used to safely continue therapy

for individuals living in remote settings

who may not have access to

comprehensive outpatient rehabilitation

therapy.

Virtual reality is an interactive

computer-based technology capable of

simulating complex three-dimensional

(3–D) environments. The number of

virtual reality applications has risen

dramatically over this past decade and

includes flight simulators, 3–D medical

imaging technologies, and

entertainment systems (Hayward, T.,

Adventures in Virtual Reality, pgs. 41–

48, 1993). The benefits of combining

virtual reality with rehabilitation

interventions are potentially extensive.

Virtual reality technologies are being

used to convert sign language into

speech and to develop barrier-free

designs for people with physical

disabilities. Biosensors that provide

qualitative and quantitative data about

muscle activity, pressure and

movements are also capable of being

integrated into virtual reality systems

for use in rehabilitation.

Priority 7

The Secretary will establish an RERC

on telerehabilitation to identify and

develop technologies capable of

supporting rehabilitation services for

individuals who do not have access to

comprehensive outpatient rehabilitation

services. The RERC shall:

(1) Identify, develop, and evaluate

communication systems capable of

connecting comprehensive

rehabilitation facilities with providers of

rehabilitation services, individuals and

family members living in remote

settings to provide ongoing

rehabilitation education and training

services;

(2) Develop, investigate, and evaluate

monitoring and assessment tools that

can be used in the provision of

rehabilitation services through

telerehabilitation;

(3) Develop, investigate, and evaluate

strategies and devices to provide and

monitor therapeutic interventions in

remote settings; and

(4) Investigate the use of virtual

reality in rehabilitation including, but

not limited to, education, monitoring,

diagnosing, and therapy.

In carrying out the purposes of the

priority, the RERC must coordinate on

activities of mutual interest with the

RERCs on Telecommunications and

Information Technologies Access, the

RRTC on Rural Rehabilitation Services,

and other entities carrying out related

research or development activities.

Electronic Access to This Document

Anyone may view this document, as

well as all other Department of

Education documents published in the

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Anyone may also view these

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or, toll free, 1–800–222–4922. The

documents are located under Option

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Press Releases.

Note: The official version of this document

is the document published in the Federal

Register.

Applicable Program Regulations: 34 CFR

Part 350.

Program Authority: 29 U.S.C. 760–762.

(Catalog of Federal Domestic Assistance

Numbers 84.133B, Rehabilitation Research
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Notices 32539

and Training Centers, and 84.133E

Rehabilitation Engineering Research Centers)

Dated: June 8, 1998.

Curtis L. Richards,

Acting Assistant Secretary for Special

Education and Rehabilitative Services.

[FR Doc. 98–15697 Filed 6–11–98; 8:45 am]

BILLING CODE 4000–01–P

DEPARTMENT OF EDUCATION

[CFDA Nos.: 84.133B and 84.133E]

Office of Special Education and

Rehabilitative Services, National

Institute on Disability and

Rehabilitation Research; Notice

Inviting Applications for New

Rehabilitation Research and Training

Centers and New Rehabilitation

Engineering Research Centers for

Fiscal Year 1998

Note to Applicants: This notice is a

complete application package. Together

with the statute authorizing the

programs and applicable regulations

governing the programs, including the

Education Department General

Administrative Regulations (EDGAR),

this notice contains information,

application forms, and instructions

needed to apply for a grant under these

competitions.

These programs support the National

Education Goal that calls for all

Americans to possess the knowledge

and skills necessary to compete in a

global economy and exercise the rights

and responsibilities of citizenship.

The estimated funding levels in this

notice do not bind the Department of

Education to make awards in any of

these categories, or to any specific

number of awards or funding levels,

unless otherwise specified in statute.

Applicable Regulations: The

Education Department General

Administrative Regulations (EDGAR),

34 CFR Parts 74, 75, 77, 80, 81, 82, 85,

and 86; and Disability and

Rehabilitation Research Projects and

Centers—34 CFR Part 350, particularly

Rehabilitation Research and Training

Centers in Subpart C and Rehabilitation

Engineering Research Centers in

Subpart D.

Program Title: Rehabilitation

Research and Training Centers (RRTCs)

CFDA Number: 84.133B.

Purpose of Program: RRTCs conduct

coordinated and advanced programs or

research on disability and rehabilitation

that will produce new knowledge that

will improve rehabilitation methods and

service delivery systems, alleviate or

stabilize disabling conditions, and

promote maximum social and economic

independence for individuals with

disabilities. RRTCs provide training to

service providers at the pre-service, inservice training, undergraduate, and

graduate levels, to improve the quality

and effectiveness of rehabilitation

services. They also provide advanced

research training to individuals with

disabilities and those from minority

backgrounds engaged in research on

disability and rehabilitation. RRTCs

serve as national and regional technical

assistance resources and provide

training for service providers,

individuals with disabilities and

families and representatives, and

rehabilitation researchers.

Eligible Applicants: Parties eligible to

apply for grants under this program are

States, public or private agencies,

including for-profit agencies, public or

private organizations, including forprofit organizations, institutions of

higher education, and Indian tribes and

tribal organizations.

APPLICATION NOTICE FOR FISCAL YEAR 1998 REHABILITATION RESEARCH AND TRAINING CENTERS, CFDA NO.84–133B

Funding priority

Deadline for

transmittal

of applications

Estimated

number of

awards

Maximum

award

amount

(per year)*

Project period

(months)

Aging with a Disability ...................................................................................................... 8/12/98 1 $700,000 60

Arthritis Rehabilitation ....................................................................................................... 8/12/98 1 800,000 60

Stroke Rehabilitation ........................................................................................................ 8/12/98 1 800,000 60

* Note: The Secretary will reject without consideration or evaluation any application that proposes a project funding level that exceeds the stated maximum award amount per year (See 34 CFR 75.104(b)).

RRTC Selection Criteria: The

Secretary uses the following selection

criteria to evaluate applications under

the RRTC program. (See § 350.54)

(a) Importance of the problem (9

points total).

(1) The Secretary considers the

importance of the problem.

(2) In determining the importance of

the problem, the Secretary considers the

following factors:

(i) The extent to which the applicant

clearly describes the need and target

population (3 points).

(ii) The extent to which the proposed

activities address a significant need of

those who provide services to

individuals with disabilities (3 points).

(iii) The extent to which the proposed

project will have beneficial impact on

the target population (3 points).

(b) Responsiveness to an absolute or

competitive priority (4 points total).

(1) The Secretary considers the

responsiveness of the application to the

absolute or competitive priority

published in the Federal Register.

(2) In determining the responsiveness

of the application to the absolute or

competitive priority, the Secretary

considers the following factors:

(i) The extent to which the applicant

addresses all requirements of the

absolute or competitive priority (2

points).

(ii) The extent to which the

applicant’s proposed activities are likely

to achieve the purposes of the absolute

or competitive priority (2 points).

(c) Design of research activities (35

points total).

(1) The Secretary considers the extent

to which the design of research

activities is likely to be effective in

accomplishing the objectives of the

project.

(2) In determining the extent to which

the design is likely to be effective in

accomplishing the objectives of the

project, the Secretary considers the

following factors:

(i) The extent to which the research

activities constitute a coherent,

sustained approach to research in the

field, including a substantial addition to

the state-of-the-art (5 points).

(ii) The extent to which the

methodology of each proposed research

activity is meritorious, including

consideration of the extent to which—

(A) The proposed design includes a

comprehensive and informed review of

the current literature, demonstrating

knowledge of the state-of-the-art (5

points);

(B) Each research hypothesis is

theoretically sound and based on

current knowledge (5 points);