[Federal Register Volume 62, Number 42 (Tuesday, March 4, 1997)]
[Notices]
[Pages 9886-9892]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-5241]



[[Page 9885]]

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Part IV





Department of Education





_______________________________________________________________________



National Institute on Disability and Rehabilitation Research; Notice

  Federal Register / Vol. 62, No. 42 / Tuesday, March 4, 1997 / 
Notices  

[[Page 9886]]



DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research

AGENCY: Department of Education.

ACTION: Notice of proposed priorities for fiscal years 1997-1998 for 
research and demonstration projects, rehabilitation research and 
training centers, and a knowledge dissemination and utilization 
project.

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SUMMARY: The Secretary proposes priorities for the Research and 
Demonstration Project (R&D) Program, the Rehabilitation Research and 
Training Center (RRTC) Program, and the Knowledge Dissemination and 
Utilization (D&U) Program under the National Institute on Disability 
and Rehabilitation Research (NIDRR) for fiscal years 1997-1998. The 
Secretary takes this action to focus research attention on areas of 
national need to improve rehabilitation services and outcomes for 
individuals with disabilities, and to assist in the solutions to 
problems encountered by individuals with disabilities in their daily 
activities.

DATES: Comments must be received on or before April 3, 1997.

ADDRESSES: All comments concerning these proposed priorities should be 
addressed to David Esquith, U.S. Department of Education, 600 
Independence Avenue, S.W., Switzer Building, Room 3424, Washington, 
D.C. 20202-2601. Internet: [email protected]

FOR FURTHER INFORMATION CONTACT: David Esquith. Telephone: (202) 205-
8801. Individuals who use a telecommunications device for the deaf 
(TDD) may call the TDD number at (202) 205-8133. Internet: David--
E[email protected]

SUPPLEMENTARY INFORMATION: This notice contains proposed priorities to 
establish R&D projects for model systems for burn injury and traumatic 
brain injury, RRTCs for research related to aging with a spinal cord 
injury and severe problem behaviors, and a D&U project to improve the 
utilization of existing and emerging rehabilitation technology in the 
State vocational rehabilitation program.
    These proposed priorities 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 Secretary will announce the final funding priorities in a 
notice in the Federal Register. The final priorities will be determined 
by responses to this notice, available funds, and other considerations 
of the Department. Funding of particular projects depends on the final 
priorities, the availability of funds, and the quality of the 
applications received. The publication of these proposed priorities 
does not preclude the Secretary from proposing additional priorities, 
nor does it limit the Secretary to funding only these priorities, 
subject to meeting applicable rulemaking requirements.

    Note: This notice of proposed priorities does not solicit 
applications. A notice inviting applications under these 
competitions will be published in the Federal Register concurrent 
with or following publication of the notice of the final priorities.

Research and Demonstration Projects

    Authority for the R&D program of NIDRR is contained in section 
204(a) of the Rehabilitation Act of 1973, as amended (29 U.S.C. 760-
762). Under this program the Secretary makes awards to public agencies 
and private agencies and organizations, including institutions of 
higher education, Indian tribes, and tribal organizations. This program 
is designed to assist in the development of solutions to the problems 
encountered by individuals with disabilities in their daily activities, 
especially problems related to employment (see 34 CFR 351.1). Under the 
regulations for this program (see 34 CFR 351.32), the Secretary may 
establish research priorities by reserving funds to support the 
research activities listed in 34 CFR 351.10.

Priorities

    Under 34 CFR 75.105(c)(3), the Secretary proposes to give an 
absolute preference to applications that meet one of the following 
priorities. The Secretary proposes to fund under this program only 
applications that meet one of these absolute priorities:

Proposed Priority 1: Burn Injury Rehabilitation Model System

Background
    Each year more than 2.0 million persons (about one percent of the 
population of the United States) receive a burn injury. Of these, 6,500 
to 12,000 do not survive; 500,000 require medical care and result in 
temporary disability with respect to home, school, or work activities; 
and 70,000 to 100,000 are severe enough to be admitted to a hospital 
(Rice, D.P. and MacKenzie, E.J., ``Cost of Injury in the United States: 
A Report to Congress,'' Atlanta, GA: Centers for Disease Control, 
1989).
    In 1994, NIDRR provided funding to establish Burn Injury 
Rehabilitation Model Systems of Care. These R&D projects focused 
primarily on developing and demonstrating a comprehensive, 
multidisciplinary model system of rehabilitative services for 
individuals with severe burns, and evaluating the efficacy of that 
system through the collection and analysis of uniform data on system 
benefits, costs, and outcomes. NIDRR's multi-center model systems 
program is designed to study the course of recovery and outcomes 
following the delivery of a coordinated system of care including 
emergency care, acute care management, comprehensive in-patient 
rehabilitation, and long-term interdisciplinary follow-up services.
    Burn rehabilitation requires interventions as soon as possible 
after admission to hospitals and has treatment implications for several 
years following hospital discharge. Burn trauma often causes injuries 
and impairments in addition to the burn, and many individuals with burn 
injuries have secondary complications related to the burn condition. 
These may include open wounds, contractures, neuropathies, cosmetic 
abnormalities, deconditioning, bony deformities, hypersensitivity to 
heat and cold, amputation, psychosocial distress, chronic pain, and 
scarring. The complicated nature of burn injuries, the difficulty of 
treatment, and the risk of infection with possible loss of function 
requires interventions quickly and frequently to attempt to maintain a 
functional lifestyle and return to living independently. Minimization 
of physical deterioration and prevention of further impairment and 
functional limitation is critical and research is needed to find the 
appropriate procedures for clinical applications. Research is needed to 
develop and refine methods to determine the effectiveness of 
interventions to prevent, manage, and reduce medical complications that 
contribute to short- and long-term disability in burn patients.
    Improved measures are needed of an individual's functional ability 
as a result of burn rehabilitation interventions. Functional assessment 
brings objectivity to rehabilitation by establishing appropriate, 
uniform descriptors of rehabilitation care and changes in individual 
capacity to perform activities of daily living or other measurable 
elements of an individual's major life activities (Granger, C. and 
Brownscheidle, C., ``Outcome Measurement in Medical Rehabilitation,'' 
International Journal of

[[Page 9887]]

Technology Assessment in Health Care, 11:2, 1995). Increasingly, health 
and rehabilitation services require effectiveness and impact measures 
to evaluate their services as a part of procedures for cost-
reimbursement and billing for services. With greater emphasis on 
individual choice in services delivery, consumers and advocates are 
likewise advocates for functional assessment measures as encoders of 
service effectiveness. Few existing functional assessment measures, 
however, address the specialized and complex combination of 
psychosocial and medical challenges encountered by an individual who 
has experienced severe burn injury (Rucker, K., et al., ``Analysis of 
Functional Assessment Instruments for Disability Rehabilitation 
Programs,'' SSA Contract No. 600-95-2194, Virginia Commonwealth 
University, 1996).
    Burn injuries can produce emotional problems, such as post-
traumatic stress disorders, anxiety, and depression. These problems may 
result from a variety of causes (e.g., reaction to cosmetic 
alterations, changes in functional abilities, changes in work status, 
restrictions on recreational activities) (Cromes, G.F. and Helm, P.A., 
``Burn Injuries,'' in Medical Aspects of Disability, pgs. 92-104, 
1993). The aesthetic disability of disfigurement is frequently more 
severe than the physical disability and may result in profound social 
consequences for those afflicted (Hurren, J.S., ``Rehabilitation of the 
Burned Patient: James Laing Memorial Essay for 1993,'' Burns, Vol. 21, 
No. 2, 1995). The more severe the burn, the greater the likelihood of 
long-term psychosocial adjustment issues related to both physical and 
psychosocial problems, that affect quality of life. Although 
psychosocial adjustment is a critical factor in the long-term recovery 
of burn injury patients, there continues to be limited emphasis on 
research in the area of psychosocial rehabilitation and its 
relationship to quality of life. Family and friends play an important 
role and provide major support in the psychological recovery of burn 
patients. Research in this area needs to address the role of the family 
and personal advocacy systems in providing support during the burn 
injury rehabilitation process.
    Difficulty with long-term follow-up of all patients after hospital 
discharge has always been a problem, but it is even more difficult when 
the individual lives far from the specialized rehabilitation unit. 
Problems are also encountered with those individuals living in rural 
areas, where access to burn injury rehabilitation, including mental 
health services, may be quite limited due to lack of proximity to 
specialized practitioners, limited access to technological advances, 
and hospital closures.
    Return-to-work and educational pursuits are important measures of 
rehabilitation success. Work is an important source of satisfaction, 
self-respect, and dignity, as well as an arena for socialization for 
individuals who have experienced burn injury (Salisbury, R., ``Burn 
Rehabilitation: Our Unanswered Challenge,'' 1992 Presidential Address 
to the American Burn Association, April, 1992). However, the efficacy 
of vocational rehabilitation interventions for this population has not 
been documented adequately. The physical, psychosocial, and emotional 
factors that lead to successful employment have not been clearly 
identified. Research is needed to examine relationships between 
vocational interventions and supports, employment, functional capacity, 
and degree of burn injury, including secondary complications.

Proposed Priority 1

    The Secretary proposes to establish Burn Injury Rehabilitation 
Model Systems R&D projects for the purpose of demonstrating a 
comprehensive, multidisciplinary model system of rehabilitative 
services for individuals with severe burns. An R&D project must:
    (1) Identify and evaluate techniques to prevent secondary 
complications;
    (2) develop and evaluate outreach programs to improve follow-up 
services for rural populations;
    (3) develop and evaluate measures of functional outcome for burn 
rehabilitation; and
    (4) identify and evaluate interventions, including vocational 
rehabilitation interventions, to improve psychosocial adjustment, 
quality of life, community integration, and employment-related 
outcomes.
    In carrying out these purposes, the R&D project must:
     Participate in clinical and systems analysis studies of 
the burn injury rehabilitation model system by collecting and 
contributing data on patient characteristics, diagnoses, causes of 
injury, interventions, outcomes, and costs to a uniform, standardized 
national data base as prescribed by the Secretary; and
     Consider collaborative projects with other model systems.

Proposed Priority 2: Traumatic Brain Injury Model Systems

Background
    An estimated 1.9 million Americans experience traumatic brain 
injury (TBI) each year (Collins, J.F., ``Types of Injuries by Selected 
Characteristics: US 1985-87,'' National Center for Health Statistics, 
Vital Health Stat 10 (175), 1990). Incidence is highest among youth and 
younger adults. Young males have the highest incidence rates of any 
group (``Disability Statistics Abstract,'' No. 14, Disability 
Statistics Rehabilitation Research & Training Center, University of 
California, San Francisco, November, 1995). Each year approximately 
70,000 to 90,000 TBI survivors enter a life of continuing, debilitating 
loss of function; an estimated 5,000 survivors experience seizure 
disorders; and 2,000 enter into a persistent vegetative state. The 
number of people surviving head injuries has increased significantly 
over the last 25 years as a result of faster and better emergency 
treatment, more rapid and safer transport to specialized treatment 
facilities, and advances in medical treatment (National Foundation for 
Brain Research, Washington, DC, 1994).
    In 1987, NIDRR provided funding to establish TBI Model Systems of 
Care. These R&D projects focused primarily on developing and 
demonstrating a comprehensive, multidisciplinary model system of 
rehabilitative services for individuals with TBI, and evaluating the 
efficacy of that system through the collection and analysis of uniform 
data on system benefits, costs, and outcomes. NIDRR's multi-center 
model systems program is designed to study the course of recovery and 
outcomes following the delivery of a coordinated system of care 
including emergency care, acute neuro-trauma management, comprehensive 
in-patient rehabilitation, and long-term interdisciplinary follow-up 
services.
    The TBI Model Systems serve a substantial number of patients, 
allowing the projects to conduct clinical research and program 
evaluation, which maximize the potential for project replication. In 
addition, the TBI Model Systems have the advantage of a complex data 
collection and retrieval program with the capability to analyze the 
different system components and provide information on project cost 
effectiveness and benefits. Information is collected throughout the 
rehabilitation process, permitting long-term follow-up on the course of 
injury, outcomes, and changes in employment status, community 
integration, substance abuse and family needs. The TBI Model Systems 
projects serve as

[[Page 9888]]

regional and national models for program development and as information 
centers for consumers, families, and professionals.
    The TBI Model Systems National Database reports that the average 
length of stay in acute care has decreased approximately 50 percent, 
from 30 days in 1989 to 15 days in 1996; and the average length of stay 
in in-patient rehabilitation has decreased 38 percent, from 52 days in 
1989 to 32 days in 1996. With the changing patterns of service 
delivery, there continues to be a need to establish and evaluate new 
rehabilitation interventions and strategies. Specialized measurement 
tools have been developed by the TBI Model Systems to assess progress 
and describe clinical and functional outcomes. Refinement of these 
measurement tools is necessary to demonstrate the effectiveness of 
rehabilitation interventions in in-patient and outpatient settings. 
After the individual is discharged from an in-patient setting, there is 
an ongoing need for outpatient and community reintegration services in 
order to continue therapeutic interventions and the educational and 
referral process. As the average length of stay in in-patient settings 
decreases, there is a greater need to evaluate outpatient and community 
reintegration programs.
    Findings from a multi-center investigation of employment and 
community integration following TBI highlight the need for post-acute 
rehabilitation programs with particular emphasis on vocational 
rehabilitation (Sander, A., et al., Journal of Head Trauma 
Rehabilitation, Vol. 11, No. 5, pgs. 70-84, 1996). Kreutzer states that 
employment and productivity, relating to others in the community, and 
independently caring for oneself at home are important quality-of-life 
components (``TBI: Models and Systems of Care,'' Conference Syllabus, 
Medical College of Virginia, April, 1996). As functional recovery 
progresses during the first year or more after the injury, the focus of 
rehabilitation shifts from medical intervention and physical 
restoration to psychosocial and vocational adaptation. The ultimate 
goal of psychosocial and vocational rehabilitation is community 
reintegration and employment. It is important to emphasize that 
services aimed at community reintegration must consider not only 
attributes and limitations of the injured individuals, but also the 
social, educational, and vocational systems in which the individual 
will function. In addition, rates of competitive employment decrease 
substantially from pre-injury levels. Head injury frequently results in 
unemployment, and there are significant relationships between risk 
factors (e.g., substance abuse) and this changed employment status. 
However, there is no reliable information regarding the magnitude of 
risk associated with different factors, or with different levels of 
these factors (Dikmen, S., et al., ``Employment following Traumatic 
Head Injuries,'' Archives of Neurology, Vol. 51, February, 1994).
    A major disability like TBI has a profoundly disorganizing impact 
on the lives of individuals with TBI and their families. Questions 
involving community, family, and vocational restoration, as well as 
generic concerns about future happiness and fulfillment, are common 
(Banja, J., & Johnston, M., ``Ethical Perspectives and Social Policy,'' 
Archives of Physical Medicine Rehabilitation, Vol. 75, SC-19, December, 
1994). Even individuals who have integrated well into society 
experience adverse psychosocial effects. Employment instability, 
isolation from friends, and increased need for support are a few of the 
problems encountered by individuals with TBI. Families often function 
as the primary support system for individuals with TBI after they are 
discharged. There is a clear need for research to develop family 
treatment strategies and explore their effect on outcomes for 
individuals with TBI.
    The health care costs associated with TBI are staggering. The 
direct medical costs of TBI treatment have been estimated at more than 
$4 billion annually (Max, W., et al., ``Head Injuries: Costs and 
Consequences,'' Journal of Head Trauma Rehabilitation, Vol. 6, pgs. 76-
91, 1991). In view of current scrutiny of all health care spending, 
which may result in pressures to constrict or deny rehabilitation care 
to individuals with traumatic brain injury, it is important to gather 
information on the efficacy and cost-effectiveness of various treatment 
interventions and service delivery models. Credible outcome monitoring 
systems are needed to establish guidelines by which fair compromises 
can be reached (Johnston, M. & Hall, K., ``Outcomes Evaluation in TBI 
Rehabilitation, Part I: Overview and System Principles,'' Archives of 
Physical Medicine and Rehabilitation, Vol. 75, December, 1994). A 
greater emphasis on outcomes measurements and management will foster 
the gathering of information on efficacy and cost-effectiveness.
    Violence-induced TBI is increasingly common, and has significant 
implications for rehabilitation and community reintegration. According 
to the 1991 National Health Interview Survey data, violence was 
responsible for nine percent of all non-fatal TBIs. In addition, 
violence was a cause of injury in 30 percent of the 684 external injury 
cases in the TBI Model Systems database (a higher frequency due, in 
part, to the urban setting of one of the TBI Model Systems). The 
frequency of violence as a cause of TBI, in part, can be attributed to 
the fact that the individuals most likely to sustain TBI (i.e., males 
under age 18) are also those most likely to be involved in crimes and 
violence. The increase in violence as a cause of brain injury may have 
consequences with regard to rehabilitation costs, treatment 
interventions and long-term outcomes. For example, individuals with 
violence-related injuries show more difficulties with community 
integration skills one year following injury, which evidences itself in 
areas of social integration and productivity. Further research is 
needed to examine whether individuals who sustain a TBI as a result of 
violence require specialized rehabilitation interventions.
Proposed Priority 2
    The Secretary proposes to establish Model Systems TBI R&D projects 
for the purpose of demonstrating a comprehensive, multidisciplinary 
model system of care for individuals with TBI. An R&D project must:
    (1) Investigate efficacy of alternative methods of service delivery 
interventions after in-patient rehabilitation discharge;
    (2) Identify and evaluate interventions that can improve vocational 
outcomes and community integration;
    (3) Develop key predictors of rehabilitation outcome at hospital 
discharge and at long-term follow-up;
    (4) Determine relationships between cost of care and functional 
outcomes; and
    (5) Examine the implications of violence as a cause of TBI on 
treatment interventions, rehabilitation costs, and long-term outcomes.
    In carrying out these purposes, the R&D Systems project must:
     Participate in clinical and systems analysis studies of 
the traumatic brain injury model system by collecting and contributing 
data on patient characteristics, diagnoses, causes of injury, 
interventions, outcomes, and costs to a uniform, standardized national 
data base as prescribed by the Secretary;
     Consider collaborative projects with other model systems; 
and

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     Coordinate research efforts with other NIDRR grantees that 
address TBI-related issues.

Rehabilitation Research and Training Centers (RRTCs)

    Authority for the RRTC program of NIDRR is contained in section 
204(b)(2) of the Rehabilitation Act of l973, 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 such 
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.
    Under the regulations for this program (see 34 CFR 352.32) the 
Secretary may establish research priorities by reserving funds to 
support particular research activities.

Description of the Rehabilitation Research and Training Center 
Program

    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 the individuals.
    RRTCs conduct coordinated 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 in-service training, for rehabilitation research 
personnel and other rehabilitation 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.
    NIDRR encourages all Centers to involve individuals with 
disabilities and minorities as recipients in research training, as well 
as clinical training.
    Applicants have considerable latitude in proposing the specific 
research and related projects they will undertake to achieve the 
designated outcomes; however, the regulatory selection criteria for the 
program (34 CFR 352.31) state that the Secretary reviews the extent to 
which applicants justify their choice of research projects in terms of 
the relevance to the priority and to the needs of individuals with 
disabilities. The Secretary also reviews the extent to which applicants 
present a scientific methodology that includes reasonable hypotheses, 
methods of data collection and analysis, and a means to evaluate the 
extent to which project objectives have been achieved.
    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

    The Secretary proposes that the following requirements will apply 
to these RRTCs pursuant to the priorities unless noted otherwise:
    Each RRTC must conduct an integrated program of research to develop 
solutions to problems confronted by individuals with disabilities.
    Each RRTC must conduct a coordinated and advanced program of 
training in rehabilitation research, including training in research 
methodology and applied research experience, that will contribute to 
the number of qualified researchers working in the area of 
rehabilitation research.
    Each Center must disseminate and encourage the use of new 
rehabilitation knowledge. They must publish all materials for 
dissemination or training in alternate formats to make them accessible 
to individuals with a range of disabling conditions.
    Each RRTC must involve individuals with disabilities and, if 
appropriate, their family members, as well as rehabilitation service 
providers, in planning and implementing the research and training 
programs, in interpreting and disseminating the research findings, and 
in evaluating the Center.

Priorities

    Under 34 CFR 75.105(c)(3), the Secretary proposes to give an 
absolute preference to applications that meet one of the following 
priorities. The Secretary proposes to fund under these competitions 
only applications that meet one of these absolute priorities:

Proposed Priority 3: Effective Interventions for Children and Youth 
With Disabilities Who Exhibit Severe Problem Behaviors

Background
    In recent years researchers have focused on the application of non-
aversive approaches to reduce and eliminate severe problem behaviors 
(SPBs) exhibited by children and youth with disabilities. This has been 
the case because of ethical concerns about aversive interventions 
expressed by disability professionals, parents, and advocates, as well 
as research findings which indicate that aversive interventions are 
largely ineffective in eliminating or reducing SPBs over an extended 
period of time. Because of their disruptive nature, SPBs such as 
physical aggression, self-injury, violence, and property destruction 
are among the primary obstacles to full inclusion of children and youth 
with disabilities in age-appropriate community-based activities and 
regular education settings. School and community-based program 
personnel need effective methods to reduce and eliminate SPBs in order 
to provide these children and youth with disabilities with 
opportunities to learn, play, and work with their non-disabled peers.
    Previous research in this area has improved our understanding of 
the early indicators of SPBs. For example, children with disabilities 
who display minor self-injurious behavior during the preschool years 
are strong candidates to exhibit more SPBs within two years (Hall, S., 
``Early Intervention of Self-

[[Page 9890]]

 injurious Behavior in Young Children with Intellectual Disabilities: 
Naturalistic Observation,'' Presented at the Annual Meeting of the 
American Association of Mental Retardation, San Francisco, June, 1995). 
Further research is needed on how severe problem behavior patterns 
develop and whether early intervention efforts can reduce, and perhaps 
prevent, SPBs.
    Preliminary research has also indicated that problem behaviors can 
be reduced by understanding the antecedents to and function of the 
behavior. Accordingly, children and youth with disabilities who exhibit 
SPBs may be able to learn to self-manage their problem behaviors.
    While there are encouraging indications that non-aversive 
approaches can be effective in reducing and eliminating SPBs, there is 
a need to develop effective interventions that can be maintained over 
extended periods of time. Treatments of self-injurious behaviors are 
particularly problematic in regard to long-term effectiveness. Research 
has shown that children who exhibit self-injurious behaviors, even 
after intensive non-aversive treatment programs, may revert to self-
injury at high rates within a few months of intervention (Durand, V.M., 
et al., ``The Course of Self-injurious Behavior Among People with 
Autism,'' Paper presented at the Annual Meeting of the Berkshire 
Association for Behavior Analysis and Therapy, Amherst, MA. 1995).
    Information from functional assessments can be used to develop 
educational plans and address inappropriate behavior. Functional 
assessment is the general label assigned to describe a set of processes 
(e.g., interviews, rating, rating scales, direct observations, and 
systematic experimental analyses of specific situations) for defining 
the events in an environment that reliably predict and maintain 
behaviors. More research needs to be been done in order to expand the 
application of functional assessments with children and youth with 
disabilities who exhibit severe behavior problems.
    Under normal circumstances, children and youth with disabilities 
who exhibit SPBs in school and the community are also exhibiting these 
behaviors at home. In order for non-aversive approaches to be 
implemented consistently across environments, parents and other 
caregivers must not only consent to the approach, but also be capable 
of implementing the approach effectively in the home environment. The 
non-aversive strategies that are developed must be compatible with the 
home environment, and take into account providing parents and guardians 
with the skills they need to implement the program effectively.
Proposed Priority 3
    The Secretary proposes to establish an RRTC for the purpose of 
providing school and community-based program personnel with effective 
methods to reduce and eliminate SPBs in children and youth with 
disabilities. The RRTC shall:
    (1) Develop and evaluate non-aversive interventions that reduce and 
eliminate severe behavior problems exhibited by children and youth with 
disabilities;
    (2) Investigate the etiology of SPBs for the purpose of developing 
prevention and early intervention strategies;
    (3) Investigate the durability and maintenance of effective non-
aversive interventions;
    (4) Investigate the effectiveness of self-management strategies;
    (5) Develop and evaluate functional assessments to address SPBs in 
educational and community-based settings;
    (6) Develop materials and provide training to educators, community-
based program personnel, parents, and caregivers who address SPBs; and
    (7) Develop and disseminate informational materials and provide 
technical assistance to local and State educational agencies to address 
SPBs.
    In carrying out the purposes of the priority, the RRTC shall 
disseminate materials and coordinate training activities with related 
projects supported by the Office of Special Education Programs, 
including the Regional Resource Centers and Parent Information Centers.

Proposed Priority 4: Aging With Spinal Cord Injury

Background
    Persons who experience a spinal cord injury (SCI) and related 
conditions are surviving in significant numbers to late middle age and 
beyond. Less than fifty years ago the average life expectancy for a 
spinal cord injured individual in the United States was approximately 
three years post-injury; today life expectancy approaches that of the 
general population (Enders, A., ``Issues and Options in Technology for 
Disability and Aging,'' National Conference on Disability and Aging, 
Institute for Health and Aging, San Francisco, 1986). Estimates of 
spinal cord injury prevalence in America range from 180,000 to 250,000 
with between 7,000 and 10,000 new spinal cord injuries each year 
(National Spinal Cord Injury Statistical Center, The University of 
Alabama at Birmingham, 1995). One of four individuals who previously 
sustained a spinal cord injury is now at least 20 years post-onset. The 
average age of a SCI survivor is now about 48 years and about 20 
percent of SCI survivors are over age 60.
    Many SCI survivors develop new medical, functional, and 
psychological problems that threaten their independence. In addition, 
many experience job loss, barriers to accessing proper health 
maintenance and caregiver/personal assistance services, loss of 
financial assistance, and economic hardship. Persons aging with SCI are 
susceptible to multiple health maintenance problems including 
cardiovascular, urinary tract infections, pressure sores, hypertension, 
fractures, blood in the urine or bowel problems, diabetes, respiratory 
and neurological problems (Whiteneck, G. (Ed.), Aging with a Spinal 
Cord Injury, 1992). The leading medical cause of death and further 
disability that affects people with SCI is now premature cardiovascular 
disease of the atherosclerotic kind. Whiteneck, using data from 
England, found that cardiovascular disease is now tied with genito-
urinary problems as the leading cause of death in people aging with 
SCI.
    Individuals aging with a SCI also experience complications as a 
result of osteoporosis and lower extremity fractures (Garland, D.E., 
``Bone Mineral Density about the Knee in SCI Patients with Pathological 
Fractures,'' Contemporary Orthopaedics, 1992 and Garland, D.E., 
``Osteoporosis Following SCI,'' Journal of Orthopaedic Research, 1992). 
Garland discovered a high prevalence of carpal tunnel syndrome, which 
increased with the length of time after injury. In addition, Sie found 
an increased prevalence of general upper extremity pain and shoulder 
pain with time since injury in both paraplegic and tetraplegia 
individuals (Sie, I., ``Upper Extremity Pain in the Post-Rehabilitation 
SCI Injured Patient,'' Archives of Physical Medicine and 
Rehabilitation, 1992). Shoulder pain occurs in about 50 percent of 
people with paraplegia secondary to prolonged wheelchair use. Pain, 
fatigue and weakness are also commonly reported but accommodations for 
them are poorly understood.
    Further research is needed to determine the changes in functional 
ability to perform activities of daily living (ADL) and work. Research 
related to work performance and employment status indicates that ten 
years after the SCI, the employment rate peaks at about 40 percent for 
persons with paraplegia

[[Page 9891]]

and at 28 percent for persons with quadriplegia, and sharply declines 
about 18 years after the post-injury (SCI Model Systems Annual Report, 
1992). Interventions are needed to maintain the employment status of 
people aging with SCI and prevent job loss due to premature aging 
effects.
    As people age and their functioning changes, the need for 
assistance from others (i.e., family, friends, and paid caregivers) 
increases. Strategies to best assist the caregiver, in turn, to help 
the person who is aging with SCI need to be developed. Moreover, there 
is no ``typical'' caregiver, some are spouses, some are parents, and 
some are children. Fifty percent of people with SCI receive help 
exclusively from their families, and an additional 19 percent receive 
substantial help from their families. Living with family is the most 
frequently reported living situation, occurring in over 90 percent of 
cases (Nosek, M.A., ``Personal Assistance: Key to Maintaining Ability 
of Persons with Physical Disabilities,'' Applied Rehabilitation 
Counselor, Vol. 21, 1990).
    Declining or unstable support systems for people aging with SCI are 
also a major concern. Since parents of aging SCI individuals are often 
elderly, they are also at risk of poor health or death. Spousal support 
providers may experience ``burn-out'' and stress, or develop health 
problems. There are few alternatives to the informal support system. As 
individuals with SCI age, access to proper health care, especially with 
the growing trend toward managed care, is becoming a bigger problem. 
There is need for research on maintaining independence in the community 
for people aging with SCI through both the informal and formal systems 
of care.
    Psychological well-being for individuals aging with SCI is also of 
major concern. Depression is a very important issue requiring 
additional study because of its bearing on quality of life, its 
importance for overall health, and its relationship to suicide (Schulz, 
R., ``Long Term Adjustment to Physical Disability: The Role of Social 
Support Service of Control and Self Blame,'' Journal of Personality and 
Social Psychology, 5, pgs. 1162-1172, 1985). The research indicates 
that over 40 percent of people who have sustained functional changes as 
a consequence of aging with SCI show high levels of distress and 
depression. Pilot data on treatment are available from the NIDRR-funded 
centers, but a full treatment procedure for stress and depression needs 
to be developed.
Proposed Priority 4
    The Secretary proposes to establish an RRTC for the purpose of 
conducting research on rehabilitation techniques that assist 
individuals aging with SCI to maintain employment and independence in 
the community. The RRTC shall:
    (1) Identify, develop, and evaluate interventions that maintain 
employment for individuals aging with SCI;
    (2) Identify, develop, and evaluate rehabilitation techniques that 
will assist individuals aging with SCI to cope with changes in 
functional abilities, changes in ADL, and the impact of these 
techniques on quality of life;
    (3) Investigate how formal and informal systems of care could be 
improved to address the impact of problems associated with long-term 
care givers and personal service assistants;
    (4) Develop a program of information dissemination and training for 
individuals aging with SCI and those who provide services to them;
    (5) Develop regimens to minimize or take account of the impacts of 
aging with SCI and develop materials that support these regimens for 
individuals with SCI, their families, service providers and educators; 
and
    (6) Develop materials for individuals with SCI, their families, 
service providers and educators that will provide a better 
understanding of the natural course of SCI as persons age.
    In carrying out the purposes of the priority, the RRTC shall 
coordinate with all other relevant SCI research and demonstration 
activities, including those sponsored by the National Center on Medical 
Rehabilitation Research, RSA, Paralyzed Veterans of America, National 
Spinal Cord Injury Association and NIDRR-funded SCI projects.

Knowledge Dissemination and Utilization Projects

    Authority for the D&U program of NIDRR is contained in sections 202 
and 204(a) 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. Under the regulations for this 
program (see 34 CFR 355.32), the Secretary may establish research 
priorities by reserving funds to support particular research 
activities.

Priority

    Under 34 CFR 75.105(c)(3), the Secretary proposes to give an 
absolute preference to applications that meet the following priority. 
The Secretary proposes to fund under this competition only applications 
that meet this absolute priority:

Proposed Priority 5: Improving the Utilization of Existing and Emerging 
Rehabilitation Technology in the State Vocational Rehabilitation 
Program

Background
    One of the more persistent issues in the rehabilitation of 
individuals with disabilities has been maximizing the use of existing 
and emerging rehabilitation technology in the service settings of the 
State Vocational Rehabilitation (VR) programs.
    As defined in Section 7(13) of the Rehabilitation Act, as amended 
(Act), rehabilitation technology means ``the systematic application of 
technologies, engineering methodologies, or scientific principles to 
meet the needs of and address the barriers confronted by individuals 
with disabilities in areas which include education, rehabilitation, 
employment, transportation, independent living and recreation'' and 
includes ``rehabilitation engineering, assistive technology devices, 
and assistive technology services.'' Under Section 101(a)(5)(C) of the 
Act, designated VR agencies must describe in their State plan how the 
State will provide a broad range of rehabilitation technology services 
at each stage of the rehabilitation process. As appropriate, 
rehabilitation technology services are provided to individuals with 
disabilities served by State VR programs under an Individualized 
Written Rehabilitation Program.
    Rehabilitation technology, and information about rehabilitation 
technology, is generated by a variety of sources including, but not 
limited to, NIDRR-funded Rehabilitation Engineering and Research 
Centers, the Assistive Technology program funded under the Technology-
Related Assistance for Individuals with Disabilities Act of 1988, 
ABLEDATA, the Department of Veterans Affairs Research and Development 
projects, and manufacturers in the private sector. While many of these 
sources may undertake dissemination activities, too often 
rehabilitation counselors and related vocational rehabilitation service 
providers are unaware of existing or emerging rehabilitation 
technologies, resulting in a number of problems for clients of the 
State vocational rehabilitation system.
    The provision of inappropriate rehabilitation technology can result 
in nonuse. The nonuse of a device may lead to decreases in functional 
abilities, freedom, and independence. On a

[[Page 9892]]

service delivery level, device abandonment represents ineffective use 
of limited funds by Federal, State, and local government agencies, 
insurers, and other provider organizations (Phillips, B. and Hongxin, 
Z., ``Predictors of Assistive Technology Abandonment,'' Assistive 
Technology, Vol. 5, No. 1, pg. 36, 1993).
    If vocational rehabilitation personnel are unfamiliar with an 
emerging technology, their clients are disadvantaged by not having 
access to recent developments in the field. These developments may be 
more effective and economical than existing rehabilitation technology. 
Because of the costs that can be involved, the decision to utilize a 
particular rehabilitation technology, even if the technology is 
outdated, can be difficult to reverse or modify.
    Information barriers related to rehabilitation technology also 
apply to secondary students with disabilities who increasingly complete 
their education with the help of assistive devices (Everson, J., 
``Using Person-centered Planning Concepts to Enhance School-to-Adult 
Life Transition Planning,'' Journal of Vocational Rehabilitation, Vol. 
6, 1996). In order to ensure their continued access to technical 
accommodation as part of their transition to employment and independent 
living, special education and vocational rehabilitation personnel 
involved in their transition must have proper training and access to 
current information.
    Assigning inappropriate or outdated rehabilitation technology to 
consumers can be avoided if vocational rehabilitation personnel are 
provided with comprehensive and current information on existing and 
emerging rehabilitation technology. Rehabilitation counselors and 
related vocational rehabilitation service providers gain access to 
information about rehabilitation technology from various sources 
including, but not limited to, their pre-service and in-service 
training, memberships in professional organizations, conferences, and 
more recently through the information superhighway. Because the field 
of rehabilitation technology is developing rapidly, and because it is a 
technically diverse and complex field, it has been a challenge for 
rehabilitation personnel development programs to keep pace with 
rehabilitation technology. There is a growing need for dissemination of 
information about rehabilitation technology, including the development 
of pre-service and in-service resources, in order to promote improved 
rehabilitation professional training on rehabilitation technology.
Proposed Priority 5
    The Secretary proposes to establish a knowledge dissemination and 
utilization project for the purpose of improving the ability of 
rehabilitation professionals to more effectively use rehabilitation 
technology in providing services to individuals through the State VR 
Services program. The proposed D&U project must:
    (1) evaluate the pre-service and in-service rehabilitation 
professional training materials that address rehabilitation technology 
and identify strengths and deficiencies in those materials;
    (2) Based on this evaluation, develop training materials that will 
improve the ability of rehabilitation counselors and related 
professionals to utilize existing and emerging rehabilitation 
technology;
    (3) Disseminate these materials to pre-service and in-service 
rehabilitation professional training programs;
    (4) As needed, provide technical assistance to these pre-service 
and in-service training programs to maximize the use of the materials; 
and
    (5) Using a variety of strategies, disseminate information about 
existing and emerging rehabilitation technology to rehabilitation 
counselors, special educators involved with the transition of secondary 
students, and related rehabilitation professionals.
    In carrying out the purposes of the priority, the proposed D&U 
project must:
     Coordinate with the Assistive Technology projects to avoid 
duplication of effort;
     Develop information about existing and emerging 
rehabilitation technology from a wide variety of sources; and
     On a regular basis, update the information and materials 
that are developed.

Invitation To Comment

    Interested persons are invited to submit comments and 
recommendations regarding these proposed priorities.
    All comments submitted in response to this notice will be available 
for public inspection, during and after the comment period, in Room 
3423, Mary Switzer Building, 330 C Street S.W., Washington, D.C., 
between the hours of 8:00 a.m. and 3:30 p.m., Monday through Friday of 
each week except Federal holidays. APPLICABLE PROGRAM REGULATIONS: 34 
CFR Parts 350, 351, and 352.

    Program Authority: 29 U.S.C. 760-762.

    Dated: February 27, 1997.

(Catalog of Federal Domestic Assistance Numbers: 84.133A, Research 
and Demonstration Projects, 84.133B, Rehabilitation Research and 
Training Center Program, 84.133D, Knowledge Dissemination and 
Utilization Program)
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 97-5241 Filed 3-3-97; 8:45 am]
BILLING CODE 4000-01-P