[Federal Register Volume 62, Number 90 (Friday, May 9, 1997)]
[Notices]
[Pages 25760-25770]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-12259]



[[Page 25759]]

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Part VII





Department of Education





_______________________________________________________________________



National Institute on Disability and Rehabilitation Research; Notice of 
Funding Priorities for FY 1997-1998; Office of Special Education and 
Rehabilitative Services, Notice Inviting Applications for New Awards 
Under Certain Programs for Fiscal Year 1997

  Federal Register / Vol. 62, No. 90 / Friday, May 9, 1997 / Notices  

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DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research; 
Notice of Final Funding Priorities for Fiscal Years 1997-1998 for 
Research and Demonstration Projects, Rehabilitation Research and 
Training Centers, and a Knowledge Dissemination and Utilization Project

AGENCY: Department of Education.

SUMMARY: The Secretary announces final funding 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.

EFFECTIVE DATE: These priorities take effect on June 9, 1997.

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) 205-2742. Internet: David__--
E[email protected].

SUPPLEMENTARY INFORMATION: This notice contains final 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 final 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.

    Note: This notice of final priorities does not solicit 
applications. A notice inviting applications under these 
competitions is published in a separate notice in this issue of the 
Federal Register.

Analysis of Comments and Changes

    On March 4, 1997, the Secretary published a notice of proposed 
priorities in the Federal Register (62 FR 9886-9892). The Department of 
Education received ninety-four letters commenting on the notice of 
proposed priorities by the deadline date. Seventy-eight additional 
comments were received after the deadline date and were not considered 
in this response. Technical and other minor changes--and suggested 
changes the Secretary is not legally authorized to make under statutory 
authority--are not addressed.

Research and Demonstration Projects Program

Priority 1: Burn Injury Rehabilitation Model System
    Comment: The Burn Injury Rehabilitation Model System projects 
should provide care from the point of injury to the completion of care.
    Discussion: The projects are intended to provide care from the 
point of injury to the completion of care. The priority is not as clear 
as it could be on this point.
    Changes: The initial purpose statement of the priority has been 
revised to require a project to provide care from the point of injury 
through community integration and long-term follow-up.
    Comment: The 1992 Burn Model system's final priority excluded 
children. The new projects should provide care to children and adults.
    Discussion: The 1992 final priority discussion of the exclusion of 
children from the Burn Model system's program stated, ``The burn injury 
model system will be developed initially to serve and collect data on 
adults since NIDRR's experience with the model systems for spinal cord 
injury and traumatic brain injury projects indicates that these systems 
can be successful with adults. The model systems can be adapted for 
children later.'' (57 FR 57284). The commenter is correct, and the Burn 
Model System program should be able to include children without 
jeopardizing the database or service delivery progress that has been 
made to date.
    Including children will require the Burn Model System projects to 
address new and unique issues, such as the effect of the burn injury on 
physical, cognitive, and social development. It will also demand that 
the projects coordinate with children's service providers, including 
special educators. The annual funding of the Burn Model System projects 
has been increased in order to provide adequate support for the 
additional tasks that will result from this change.
    Changes: The background statement and the priority have been 
revised to require the projects to include children in the model system 
and the projects' research and demonstration activities. The fourth 
purpose statement has been revised to include special education 
interventions and education outcomes.
    Comment: The model system projects should be required to use 
electronic communication.
    Discussion: The use of electronic communication is so common that 
it is unnecessary to require it.
    Changes: None.
    Comment: What guidelines have been established for defining the 
cost of care data from the data which are more commonly available, 
i.e., charges of care?
    Discussion: There are no guidelines for defining cost of care. 
Applicants have the discretion to propose how they will define cost, 
and the peer review process will evaluate the merits of the definition. 
An applicant could propose to define cost as charges of care.
    Changes: None.
    Comment: A comment in response to the TBI Model System proposed 
priority questioned the use of the term ``multidisciplinary'' to 
describe the model system. The commenter opined that the manner in 
which care is rendered in most, if not all, the model systems is in an 
``interdisciplinary'' or ``transdisciplinary'' fashion. 
``Interdisciplinary'' or ``transdisciplinary'' should be used instead 
of ``multidisciplinary.''
    Discussion: This comment, although not addressed to the proposed 
Burn Injury Rehabilitation Model System priority, applies equally to 
it. The term ``multidisciplinary'' was used to convey that the projects 
should involve all necessary and appropriate disciplines in the 
delivery of care. Since there are no universally accepted definitions 
of any of these terms, use of any one term could lead to a 
misunderstanding.
    Changes: The term ``multidisciplinary'' has been deleted from the 
Burn Injury Rehabilitation Model System priority, and the priority 
requires the projects to involve all necessary and appropriate 
disciplines in the delivery of care.
Priority 2: Traumatic Brain Injury Model Systems
    Comment: The priority limits inclusion in the model systems 
database to patients who are admitted to a participating trauma unit 
and then transferred to a participating acute rehabilitation hospital 
for inpatient services. This limitation excludes patients who, after 
participating in a trauma unit, receive services at alternative post-
acute treatment sites such as a skilled nursing facility, a subacute 
rehabilitation facility, or at home. Increasingly, managed care

[[Page 25761]]

organizations and rehabilitation providers are utilizing these excluded 
treatment sites. These exclusions should be eliminated from the 
priority in order to allow the projects to study the impact of these 
alternative treatment pathways.
    Discussion: This recommendation raises fundamental questions about 
the purpose and future directions of the TBI Model Systems program. As 
indicated in the background statement, ``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 
inpatient rehabilitation, and long-term interdisciplinary follow-up 
services.'' Including other pathways of post-acute treatment such as 
skilled nursing facilities, subacute rehabilitation facilities, and 
home care would significantly change the nature of the model system 
that has been in place for since 1987. This change would require 
projects to engage in data collection activities from a wider range of 
treatment sites, and possibly a wider range of severity of brain 
injury. The nature and quality of services provided at these 
alternative treatment sites, as well as the population served, may vary 
significantly, and this variation would need to be addressed in the 
compilation of the national database.
    Post-acute treatment of TBI is going through a period of 
transition, and it is necessary for the TBI Model system program to be 
equally dynamic in order to maintain the program's relevance. In order 
to facilitate a smooth transition, the priority is being changed to 
provide applicants with the option of expanding their scope of 
activities to include alternative post-acute treatment sites while 
maintaining the requirement that all projects include the current 
pathway of inpatient rehabilitation treatment. This change is made with 
the acknowledgment that complications may occur. For example, if some 
projects expand to include alternative post-acute treatment sites, 
while others maintain the current treatment pathway, the uniformity of 
the database will be affected. These complications should be outweighed 
by the new information that will be generated about the post-acute 
alternative treatment sites. In addition, if at some future date, the 
inclusion of alternative post-acute treatment sites becomes a 
requirement rather than an option, the experience of the next round of 
projects that include those sites in their systems will serve as a 
useful source of information about the transition.
    Changes: The background statement and the priority have been 
revised to provide projects with the option of including alternative 
post-acute treatment sites in their system while maintaining the 
requirement that all projects include post-acute inpatient 
rehabilitation sites. In addition, the final priority includes an 
invitational priority in order to encourage applicants to pursue this 
option.
    Comment: The phrase ``specific treatment interventions'' should be 
added to the fourth purpose of the priority.
    Discussion: The fourth purpose of the priority requires a project 
to determine the relationship between cost of care and functional 
outcomes. In order to make this determination, the project should link 
the cost of care to a specific intervention. The commenter's 
recommendation clarifies this point.
    Changes: The fourth purpose statement has been revised to require a 
project to determine the relationship between cost of care, specific 
treatment interventions, and functional outcomes.
    Comment: The projects should examine the issues of aging with TBI.
    Discussion: Applicants have the discretion to propose areas of 
investigation as long as those areas are within the purpose of the 
priority. However, examining issues of aging with TBI is outside of the 
scope of activities that an applicant could propose to fulfill the 
purpose of a project in the TBI Model Systems program. There is 
insufficient evidence to support establishing an absolute priority on 
this topic under other NIDRR research programs.
    Changes: None.
    Comment: The projects should examine the impact of pre-injury 
psychosocial factors on rehabilitation outcomes.
    Discussion: Applicants have the discretion to propose areas of 
investigation as long as those areas are within the purpose of the 
priority. Thus, in response to the revised third purpose statement, an 
applicant could propose to delineate the role of premorbid factors in 
outcome in TBI. The peer review process will evaluate the merits of the 
proposal.
    Changes: None.
    Comment: The priority refers to a ``multidisciplinary'' model 
system of care. The manner in which care is rendered in most, if not 
all, the model systems is in an ``interdisciplinary'' or 
``transdisciplinary'' fashion. ``Interdisciplinary'' or 
``transdisciplinary'' should be used instead of ``multidisciplinary.''
    Discussion: The term ``multidisciplinary'' was used to convey that 
the projects should involve all necessary and appropriate disciplines 
in the delivery of care. Since there are no universally accepted 
definitions of any of these terms, use of any one term could lead to a 
misunderstanding.
    Changes: The term ``multidisciplinary'' has been deleted, and the 
priority requires the projects to involve all necessary and appropriate 
disciplines in the delivery of care.
    Comment: In order to provide the priority with a consumer 
perspective, ``subjective well-being'' should be added to the third 
purpose statement.
    Discussion: The third purpose statement requires the project to 
develop key predictors of rehabilitation outcomes at hospital discharge 
and at long-term follow-up. Including subjective well-being in the 
priority will promote the inclusion of consumers' perspectives among 
the rehabilitation outcomes.
    Changes: The third purpose statement has been revised to require a 
project to address subjective well-being when it develops key 
predictors of rehabilitation outcomes.
    Comment: The efficacy of interventions should not be weighed 
against the cost of interventions alone. Purposes statements four and 
five should be revised to refer to ``costs to society.''
    Discussion: Determining ``costs to society'' is an imprecise 
endeavor. While ``cost of interventions'' admittedly constitutes a more 
limited perspective, it is a measure that can be used consistently 
across projects with a much higher degree of confidence.
    Changes: None.
    Comment: The projects should investigate potential systematic 
biases in longitudinal studies of persons with TBI.
    Discussion: Applicants have the discretion to propose areas of 
investigation as long as those areas are within the purpose of the 
priority. However, investigating potential systematic biases in 
longitudinal studies of persons with TBI is outside of the scope of 
activities that an applicant could propose to fulfill the purpose of a 
project in the TBI Model Systems program. There is insufficient 
evidence to support establishing an absolute priority on this topic 
under other NIDRR research programs.
    Changes: None.
    Comment: The TBI Model Systems program should promote variation in 
care, along with systematic data collection, so that the impact of 
variations can be studied. To the extent

[[Page 25762]]

that all funded model systems are encouraged to develop similar systems 
of care, the opportunity to understand the impact of differences in 
care is lost. Specifically, the study of the impact of differences in 
the design and organization of rehabilitation interventions can be 
advanced by changing the enrollment constraints of model system 
patients, including those who are in a vegetative state, encouraging 
program innovations, developing innovative financing approaches to TBI 
rehabilitation, and supporting rigorous research on the treatment of 
both motor and cognitive impairments, including training regimens, 
pharmacologic treatments, and the use of orthotic and prosthetic 
devices.
    Discussion: The TBI Model System program is intended to demonstrate 
the effectiveness of a prescribed system of care implemented in a 
similar fashion by a number of projects. Some degree of variation 
occurs across projects, and this variation will increase markedly if 
grantees exercise the option of including alternative post-acute 
treatments pathways in their model system of care. The commenter is 
correct that to the extent all funded model systems are encouraged to 
develop similar systems of care, the opportunity to understand the 
impact of differences in care is lost. However, there are substantial 
benefits in regard to the quality of the knowledge that can be 
generated by demonstrating and evaluating a prescribed system across 
projects. In light of the resources available to the program, those 
benefits outweigh benefits that would result from a model system that 
would systematically promote variation in care.
    Changes: None.
    Comment: The projects should study the impact of managed care on 
healthcare delivery to persons with TBI.
    Discussion: Applicants have the discretion to propose areas of 
investigation so long as those areas are within the purpose of the 
priority. Thus, in response to the revised fourth purpose statement, an 
applicant could propose to study the impact of managed care on 
healthcare delivery to persons with TBI. The peer review process will 
evaluate the merits of the proposal. It should be noted that NIDRR has 
recently awarded an RRTC in fiscal year 1997 to study issues in Managed 
Health Care for individuals with disabilities.
    Changes: None.
    Comment: The impact of computers and technology should be 
emphasized in the priority.
    Discussion: Emerging technology is having a significant impact on 
the rehabilitation outcomes of persons with TBI. In order to keep pace 
with these developments, all of the TBI Model Systems projects should 
identify and evaluate the effectiveness of interventions that use 
emerging technology.
    Changes: The second purpose of the priority has been revised to 
require a project to examine the role of emerging technology in 
improving vocational outcomes and community integration.
    Comment: Rather than determine the relationships between cost of 
care and functional outcomes, the fourth purpose of the priority should 
require a project to understand factors that determine costs, i.e., 
``Quantify factors that affect the cost and benefits of care, such as 
functional outcomes.''
    Discussion: In response to the fourth purpose of the priority, an 
applicant could propose to quantify factors that affect the cost and 
benefits of care. Determining the relationships between cost of care, 
specific treatment interventions, and functional outcomes, and 
understanding factors that determine costs are not necessarily 
exclusive activities.
    Changes: None.
    Comment: Control groups or stable baselines are needed to study the 
outcomes and value of TBI rehabilitation. Databases that allow 
comparisons of similar patients who may experience different treatment 
strategies are invaluable in research designed to infer the 
effectiveness of rehabilitative interventions. All projects should be 
required to participate in controlled research.
    Discussion: Applicants have the discretion to propose the research 
design that a project will use, and the peer review process will 
evaluate the merits of the design. Thus, an applicant could propose to 
use controlled research, and the peer review process will evaluate the 
merits of the research design. However, requiring all projects to carry 
out controlled research could exclude equally effective research 
methodologies.
    Changes: None.
    Comment: The priority does not attend sufficiently to issues 
related to acute care of TBI. Attention should be focused on the 
prevention of secondary conditions through early rehabilitation 
interventions in the acute care setting. Incorporation of this 
component permits the investigation of novel pharmacologic strategies 
and early cognitive interventions to enhance long-term functional and 
vocational outcomes.
    Discussion: In response to the revised second purpose statement, an 
applicant could propose to emphasize the prevention of secondary 
conditions through early rehabilitation interventions in the acute care 
setting, and the peer review process will evaluate the merits of the 
emphasis. However, there is insufficient evidence to warrant requiring 
all applicants to emphasize the prevention of secondary conditions 
through early rehabilitation interventions in the acute care setting.
    Changes: None.
    Comment: Projects should study the effectiveness of behavioral 
management strategies and the role of family dynamics in TBI patients.
    Discussion: An applicant could propose to study the effectiveness 
of behavioral management strategies or the role of family dynamics 
under the second and third purpose statements, respectively. The peer 
review process will evaluate the merits of the proposals. However, 
there is insufficient evidence to warrant requiring all applicants to 
study the effectiveness of behavioral management strategies or the role 
of family dynamics.
    Changes: None.

Rehabilitation Research and Training Centers (RRTCs)

Priority 4: Aging With Spinal Cord Injury
    Comment: The background statement acknowledges an array of health 
maintenance problems including, but not limited to cardiovascular 
problems, urinary tract infections, pressure sores, hypertension, 
fractures, blood in the urine or bowel problems, and diabetes. However, 
the priority does not include a commensurate purpose statement 
requiring the RRTC to address these problems. The employment problems 
experienced by persons aging with SCI are usually problems of 
maintaining employment, and not gaining employment. Their difficulties 
maintaining employment are most often a function of a health 
maintenance problem. The priority places too much emphasis on 
employment-related issues and fails to address critical health issues.
    Discussion: This concern was expressed by thirty-seven of the 
thirty-eight comments that the Department received on this proposed 
priority by the deadline date. The commenters are persuasive that the 
priority places too much emphasis on employment-related issues and 
fails to address critical health issues.
    Changes: The priority has been revised to include a new purpose 
statement addressing health maintenance problems and to de-

[[Page 25763]]

emphasize employment-related issues. In addition, in recognition of the 
additional work that will be required to address health maintenance 
problems, the number of purpose statements has been reduced and the 
dissemination and training requirements have been consolidated and 
modified.
    Comment: Forty-four percent of the people who get a SCI are members 
of a minority group. The RRTC should place special emphasis on people 
aging with a SCI from minority backgrounds.
    Discussion: The commenter is correct. There are an increasing 
number of persons from minority backgrounds who are experiencing SCI, 
and their unique and varying needs merit special attention from the 
RRTC.
    Changes: The background statement and priority have been revised to 
evidence the unique needs of persons aging with SCI from minority 
backgrounds and require the RRTC to address those needs.
    Comment: Proper research designs need to be used to identify the 
potential causes of late life changes. Complex cross-sequential designs 
are needed to test these questions. Otherwise the results, even from 
longitudinal designs (which do not control from the effect of era), are 
flawed.
    Discussion: An applicant could propose to use complex cross-
sequential designs, and the peer review process will evaluate the 
merits of the design. However, requiring all projects to use complex 
cross-sequential designs could exclude equally effective research 
designs.
    Changes: None.
    Comment: The part of the second purpose of the priority that 
requires the RRTC to evaluate rehabilitation techniques that will 
assist individuals aging with SCI to cope with changes should be 
revised to develop better assessment and treatment methods for 
depression as people attempt to cope.
    Discussion: In response to the second purpose statement, an 
applicants could propose to develop better assessment and treatment 
methods for depression as people attempt to cope, and the peer review 
process will evaluate the merits of the proposal. However, there is 
insufficient evidence to warrant requiring all applicants to develop 
better assessment and treatment methods for depression as people 
attempt to cope.
    Changes: None.
    Comment: The RRTC should address the significant ethnic differences 
that exist among caregivers as well as the great diversity in who 
serves as caregiver (spouse, parent, sibling, friend, paid attendant).
    Discussion: An applicant could propose to address the significant 
ethnic differences that exist among caregivers as well as the diversity 
in who serves as caregiver under the third purpose of the priority. 
There is insufficient evidence to warrant requiring all applicants to 
propose to study these two topics.
    Changes: None.
    Comment: The data from the 1992 SCI Model Systems Annual Report 
that is included in the background statement is partially contradicted 
by the 1996 SCI Model Systems Annual Report. The background statement 
indicates that employment rate peaks at about 40 percent for persons 
with paraplegia and at 28 percent for persons with quadriplegia, and 
sharply declines about 18 years after the post-injury. However, the 
1996 Report shows employment peaking at 39 percent at fifteen years 
after injury and at 38.4 percent at 20 years after injury.
    Discussion: The 1992 and the 1996 report findings are different, 
but not contradictory. However, since the 1996 findings are more 
recent, they should be included in the background statement in place of 
the 1992 data.
    Changes: The background statement uses the information from the 
1996 SCI Model Systems Annual Report instead of the 1992 Report data.

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 gives an absolute 
preference to applications that meet one of the following priorities. 
The Secretary will fund under this program only applications that meet 
one of these absolute priorities:
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 inpatient 
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

[[Page 25764]]

complications that contribute to short and long-term disability in burn 
patients.
    Children who are severely burned may present unique challenges to 
health care providers, educators, and family members due to the 
physical, cognitive and emotional development stages that they 
experience. For example, returning to school and neighborhood may pose 
a serious threat to the development of a child's self-esteem if 
disfigurement is evident. In order to minimize the impact of a severe 
burn on a child's development, an efficient, well-coordinated system of 
care must be in place that involves medical, rehabilitation, and 
educational service providers, including special educators.
    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 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,'' SEW 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.
Priority 1
    The Secretary will establish Burn Injury Rehabilitation Model 
Systems R&D projects for the purpose of demonstrating a comprehensive, 
model system of rehabilitative services, involving all necessary and 
appropriate disciplines, for children and adults with severe burns from 
point of injury to community integration and long-term follow-up. 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 and special education interventions, to improve 
psychosocial adjustment, quality of life, community integration, and 
education 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.
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

[[Page 25765]]

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 inpatient rehabilitation, and long-term interdisciplinary 
follow-up services. Projects are being given an option at this time of 
including, in addition to comprehensive inpatient rehabilitation, 
alternative pathways of post-acute treatment such as skilled nursing 
facilities, subacute rehabilitation facilities, and home care.
    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 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 inpatient 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 inpatient and outpatient settings. 
After the individual is discharged from an inpatient 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 inpatient 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

[[Page 25766]]

require specialized rehabilitation interventions.
Priority 2
    The Secretary will establish Model Systems TBI R&D projects for the 
purpose of demonstrating a comprehensive, model system of care for 
individuals with TBI, involving all necessary and appropriate 
disciplines. An R&D project must:
    (1) Investigate the efficacy of alternative methods of service 
delivery interventions after inpatient rehabilitation discharge and 
after other post-acute treatment pathways when applicable;
    (2) Identify and evaluate interventions, including those utilizing 
emerging technology, that can improve vocational outcomes and community 
integration;
    (3) Develop key predictors of rehabilitation outcome, including 
subjective well-being, at hospital discharge and at long-term follow-
up;
    (4) Determine the relationship between cost of care, specific 
treatment interventions, 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
     Coordinate research efforts with other NIDRR grantees that 
address TBI-related issues.
    Invitational Priority: The Secretary is particularly interested in 
applications that address the following invitational priority within 
this absolute priority. However, under 34 CFR 75.105(c)(1) an 
application that meets an invitational priority does not receive 
competitive or absolute preference over other applications. The 
invitational priority is for projects that include, in addition to 
comprehensive inpatient rehabilitation, alternative pathways of post-
acute treatment such as skilled nursing facilities, subacute 
rehabilitation facilities, and home care.

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 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 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 following requirements 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 RRTC must disseminate and encourage the use of new 
rehabilitation knowledge. They must publish all

[[Page 25767]]

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 gives an absolute 
preference to applications that meet one of the following priorities. 
The Secretary will fund under these competitions only applications that 
meet one of these absolute priorities:
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-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 done in order to expand the 
application of functional assessments with children and youth with 
disabilities who exhibit severe problem behaviors.
    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.
Priority 3
    The Secretary will 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.
Priority 4: Aging With Spinal Cord Injury
Background
    While the mortality rate of persons who experience a spinal cord 
injury (SCI) and related conditions has improved markedly, life 
expectancy estimates are still well below normal (DeVivo, M. and 
Stover, S., ``Long-term Survival and Causes of Death,'' in Spinal Cord 
Injury: Clinical Outcomes from the Model Systems, Aspen Publications, 
Gaithersburg, Maryland, 1995). 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

[[Page 25768]]

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, but not limited to, 
cardiovascular problems, urinary tract infections, pressure sores, 
hypertension, fractures, blood in the urine or bowel problems, and 
diabetes (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.
    The 1996 SCI Model Systems Annual report shows employment peaking 
at 39 percent at fifteen years after injury and at 38.4 percent at 20 
years after injury. Interventions are needed to maintain the employment 
status of people aging with SCI and prevent job loss due to premature 
aging effects. In addition, further research is needed to determine the 
changes in functional ability to perform activities of daily living 
(ADL) and work.
    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.
    A significant trend over time has been observed in the racial 
distribution of persons in the SCI Model Systems database. Among 
persons injured between 1973 and 1978, 77.5 percent of persons in the 
database were Caucasian, 13.6 percent were African-American, and 6 
percent were Hispanic. Among those injured since 1990, 55.2 percent 
were Caucasian, 29 percent were African-American, and 12.8 percent were 
Hispanic (``Spinal Cord Injury, Facts and Figures at a Glance,'' 
National Spinal Cord Injury Statistical Center, University of Alabama 
at Birmingham, July, 1996). This increase in incidence of SCI among 
persons from minority backgrounds is accompanied by research at the 
current RRTC on Aging with SCI indicating that people from minority 
backgrounds experience different long-term consequences from SCI.
Priority 4
    The Secretary will 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 to address health 
maintenance issues, and prevent and treat secondary conditions for 
individuals aging with SCI;
    (2) Identify, develop, and evaluate rehabilitation techniques that 
will assist individuals aging with SCI to maintain employment and to 
cope with changes in functional abilities and ADL;
    (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 better understanding of the natural course of SCI as 
persons age and develop regimens to minimize or take account of the 
impacts of aging with SCI; and
    (5) Develop materials and a program of information dissemination 
and training for individuals aging with SCI, their families, service 
providers and educators that will assist them to understand the natural 
course of SCI as persons age.
    In carrying out the purposes of the priority, the RRTC shall:
     Emphasize the needs of persons from minority backgrounds; 
and
     Coordinate with all other relevant SCI research and 
demonstration activities, including those sponsored by the National 
Center on Medical Rehabilitation Research, the Rehabilitation Services 
Administration, 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

[[Page 25769]]

research priorities by reserving funds to support particular research 
activities.

Priority

    Under 34 CFR 75.105(c)(3), the Secretary gives an absolute 
preference to applications that meet the following priority. The 
Secretary will fund under this competition only applications that meet 
this absolute priority:
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 Veteran's 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 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.
Priority 5
    The Secretary will 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 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 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.

APPLICABLE PROGRAM REGULATIONS: 34 CFR Parts 350, 351, and 352. Program 
Authority: 29 U.S.C. 760-762.

(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)


[[Page 25770]]


    Dated: May 6, 1997.
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 97-12259 Filed 5-8-97; 8:45 am]
BILLING CODE 4000-01-P