[Federal Register Volume 63, Number 41 (Tuesday, March 3, 1998)]
[Notices]
[Pages 10428-10437]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-5379]



[[Page 10427]]

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Part II





Department of Education





_______________________________________________________________________



National Institute on Disability and Rehabilitation Research; Notice

  Federal Register / Vol. 63, No. 41 / Tuesday, March 3, 1998 / 
Notices  

[[Page 10428]]



DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research

AGENCY: Department of Education.

ACTION: Notice of proposed funding priorities for fiscal years 1998-
1999 for certain centers.

-----------------------------------------------------------------------

SUMMARY: The Secretary proposes funding priorities for three 
Rehabilitation Research and Training Centers (RRTCs) and four 
Rehabilitation Engineering Research Centers (RERCs) under the National 
Institute on Disability and Rehabilitation Research (NIDRR) for fiscal 
years 1998-1999. The Secretary takes this action to focus research 
attention on areas of national need. These priorities are intended to 
improve rehabilitation services and outcomes for individuals with 
disabilities.

DATES: Comments must be received on or before April 2, 1998.

ADDRESSES: All comments concerning these proposed priorities should be 
addressed to Donna Nangle, U.S. Department of Education, 600 Maryland 
Avenue, S.W., room 3418, Switzer Building, Washington, DC 20202-2645. 
Comments may also be sent through the Internet: [email protected]
    You must include the term ``Disability and Rehabilitation Research 
Projects and Centers'' in the subject line of your electronic message.

FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 205-
5880. Individuals who use a telecommunications device for the deaf 
(TDD) may call the TDD number at (202) 205-2742. Internet: 
Donna______N[email protected]
    Individuals with disabilities may obtain this document in an 
alternate format (e.g., Braille, large print, audiotape, or computer 
diskette) on request to the contact person listed in the preceding 
paragraph.

SUPPLEMENTARY INFORMATION: This notice contains proposed priorities 
under the Disability and Rehabilitation Research Projects and Centers 
Program for three RRTCs related to: aging with a disability, arthritis 
rehabilitation, and stroke rehabilitation. The notice also contains 
proposed priorities for four RERCs related to: Prosthetics and 
orthotics, wheeled mobility, technology transfer, and 
telerehabilitation.
    These proposed priorities support the National Education Goal that 
calls for every adult American to possess the skills necessary to 
compete in a global economy.
    The authority for the Secretary to establish research priorities by 
reserving funds to support particular research activities is contained 
in sections 202(g) and 204 of the Rehabilitation Act of 1973, as 
amended (29 U.S.C. 761a(g) and 762).
    The Secretary will announce the final 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 a particular project depends on the final 
priority, 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 this competition 
will be published in the Federal Register concurrent with or 
following the publication of the notice of final priorities.

Rehabilitation Research and Training Centers

    The authority for RRTCs is contained in section 204(b)(2) of the 
Rehabilitation Act of 1973, as amended (29 U.S.C. 760-762). Under this 
program, the Secretary makes awards to public and private 
organizations, including institutions of higher education and Indian 
tribes or tribal organizations, for coordinated research and training 
activities. These entities must be of sufficient size, scope, and 
quality to effectively carry out the activities of the Center in an 
efficient manner consistent with appropriate State and Federal laws. 
They must demonstrate the ability to carry out the training activities 
either directly or through another entity that can provide that 
training.
    The Secretary may make awards for up to 60 months through grants or 
cooperative agreements. The purpose of the awards is for planning and 
conducting research, training, demonstrations, and related activities 
leading to the development of methods, procedures, and devices that 
will benefit individuals with disabilities, especially those with the 
most severe disabilities.

Description of Rehabilitation Research and Training Centers

    RRTCs are operated in collaboration with institutions of higher 
education or providers of rehabilitation services or other appropriate 
services. RRTCs serve as centers of national excellence and national or 
regional resources for providers and individuals with disabilities and 
the parents, family members, guardians, advocates or authorized 
representatives of the individuals.
    RRTCs conduct coordinated, integrated, and advanced programs of 
research in rehabilitation targeted toward the production of new 
knowledge to improve rehabilitation methodology and service delivery 
systems, to alleviate or stabilize disabling conditions, and to promote 
maximum social and economic independence of individuals with 
disabilities.
    RRTCs provide training, including graduate, pre-service, and in-
service training, to assist individuals to more effectively provide 
rehabilitation services. They also provide training including graduate, 
pre-service, and in-service training, for rehabilitation research 
personnel.
    RRTCs serve as informational and technical assistance resources to 
providers, individuals with disabilities, and the parents, family 
members, guardians, advocates, or authorized representatives of these 
individuals through conferences, workshops, public education programs, 
in-service training programs and similar activities.
    RRTCs disseminate materials in alternate formats to ensure that 
they are accessible to individuals with a range of disabling 
conditions.
    NIDRR encourages all Centers to involve individuals with 
disabilities and individuals from minority backgrounds as recipients of 
research training, as well as clinical training.
    The Department is particularly interested in ensuring that the 
expenditure of public funds is justified by the execution of intended 
activities and the advancement of knowledge and, thus, has built this 
accountability into the selection criteria. Not later than three years 
after the establishment of any RRTC, NIDRR will conduct one or more 
reviews of the activities and achievements of the Center. In accordance 
with the provisions of 34 CFR 75.253(a), continued funding depends at 
all times on satisfactory performance and accomplishment.

Proposed General RRTC Requirements

    The Secretary proposes that the following requirements apply to 
these RRTCs pursuant to these absolute priorities unless noted 
otherwise. An applicant's proposal to fulfill these proposed 
requirements will be assessed using applicable selection criteria in 
the peer review process. The Secretary is interested in receiving 
comments on these proposed requirements:

[[Page 10429]]

    The RRTC must provide: (1) Applied research experience; (2) 
training on research methodology; and (3) training to persons with 
disabilities and their families, service providers, and other 
appropriate parties in accessible formats on knowledge gained from the 
Center's research activities.
    The RRTC must develop and disseminate informational materials based 
on knowledge gained from the Center's research activities, and 
disseminate the materials to persons with disabilities, their 
representatives, service providers, and other interested parties.
    The RRTC must involve individuals with disabilities and, if 
appropriate, their representatives, in planning and implementing its 
research, training, and dissemination activities, and in evaluating the 
Center.
    The RRTC must conduct a state-of-the-science conference in the 
third year of the grant and publish a comprehensive report on the final 
outcomes of the conference in the fourth year of the grant.

Priorities

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

Proposed Priority 1: Aging With a Disability

Background
    Advances in medical care, rehabilitation technology, and 
rehabilitative treatment have made aging a routine event for persons 
with a disability. The rapid increase in the number of people with a 
physical disability who are growing older has been well documented 
(McNeil, J., ``Americans With Disabilities,'' U.S. Bureau of the 
Census, Statistical Brief, SB/94-1, 1994). Many persons aging with a 
disability face significant new challenges to their health, daily 
functioning, and independence. These challenges may come from onset of 
chronic conditions such as hypertension or from secondary conditions 
such as post-polio. For example, approximately 70 percent of people 
with polio experience some form of ``post-polio syndrome,'' a condition 
that impairs functioning (Halstead, L., ``Assessment Differential 
Diagnosis for Post-Polio Syndrome,'' Orthopedics, 14, pgs. 1209-1222, 
1991).
    The problems resulting from aging with a disability can be grouped 
into four areas: (1) Decline in health status due to onset of new 
chronic conditions or development of secondary conditions; (2) decline 
in functional abilities due to changed health status; (3) difficulty 
maintaining psychological well-being and life satisfaction; and (4) 
diminished capacity of family and community support networks to 
accommodate changes associated with aging with a disability.
    Aging with a disability is a complex phenomenon, influenced by both 
normal and injury-related biological processes, by medical and 
rehabilitative developments, and by changing social, cultural and 
physical environments (De Vivo, M., et al., ``Causes of Death During 
the First 12 Years After Spinal Cord Injury,'' Archives of Physical 
Medicine and Rehabilitation, 74, pgs. 248-254, 1991). Although some 
progress has been made in systematically assessing the ``natural 
course'' of aging with a physical disability, (Whiteneck, G., 
``Learning from Empirical Investigations,'' Perspectives on Aging with 
Spinal Cord Injury, pgs. 23-27, 1992), this work is not complete.
    Persons aging with a disability face significant health problems 
because of the onset of new conditions associated with the aging 
process itself and potentially complicated by the disability condition. 
Research suggests that chronic diseases such as cardiovascular 
illnesses and diabetes occur at earlier than expected ages and in 
substantially higher percentages among persons who acquired a 
disability in early life (Pope, A. and Flemming, C., Disability in 
America: Toward a National Agenda for Prevention, pg. 191, 1991). 
Significant bone loss (osteoporosis) is higher in people with complete 
spinal cord lesions than in age-matched controls (Garland, D., et al., 
``Osteoporosis After Spinal Cord Injury,'' Journal of Orthopedic 
Research, 10, pgs. 371-378, 1992). Other age-related health problems 
may be impairment-specific secondary conditions such as hip 
dislocations in people with cerebral palsy or respiratory problems for 
persons with post-polio syndrome. One study found that 50 percent of 
people with a 40-year history of cerebral palsy had severe joint, back 
or neck pain (Murphy, K., ``Medical and Social Issues in Adults with 
Cerebral Palsy, The California Study,'' Developmental Medicine and 
Child Neurology, Vol. 37, pgs. 1075-1084, 1995).
    Fatigue, loss of strength, increased pain, and other health-related 
changes associated with aging may affect function so that capacity to 
perform activities of daily living (ADL) (e.g., mobility, bathing, and 
transfers), is diminished. Fatigue and weakness may affect 60 to 70 
percent of people with spinal cord injury (SCI) or post-polio (Gerhart, 
K., et al., ``Long-term Spinal Cord Injury: Functional Changes Over 
Time,'' Archives of Physical Medicine and Rehabilitation, 74, pgs. 
1030-1035, 1993).
    In addition to facing new physical challenges, some people aging 
with a disability also develop psychological conditions. In the general 
aging population, depression is often an unrecognized corollary of the 
aging process (Lebowitz, B., et al., ``Diagnosis and Treatment of 
Depression in Late Life,'' Journal of the American Medical Association, 
278 (14), pgs. 1186-1190, 1997). At least one study has found that 
between 25 and 40 percent of persons aging with a disability show high 
distress, especially as expressed in symptoms of depression (Fuhrer, 
M., et al., ``The Relationship of Life Satisfaction to Impairment, 
Disability and Handicap Among Persons with Spinal Cord Injury Living in 
the Community,'' Archives of Physical Medicine and Rehabilitation, 73, 
pgs. 552-557, 1992). Treatment of depression for persons aging with a 
disability is difficult to obtain because of the failure of health 
professionals to recognize depression in persons aging with a 
disability (Krause, J. and Crewe, N., ``Chronological Age Time Since 
Injury and Time of Measurement: Effect on Adjustment After Spinal Cord 
Injury,'' Archives of Physical Medicine and Rehabilitation, 72, pgs. 
91-100, 1991).
    Families may experience new stresses because of age-related 
conditions acquired by their family members with disabilities. In 
addition, aging of family caregivers may affect their ability to 
continue caregiving roles, thus reducing the ability of a person aging 
with a disability to remain in the family setting. The importance of 
this issue is reinforced by the fact that family caregivers provide 
most of the personal assistance to persons with disabilities (Nosek, 
M., ``Life Satisfaction of People with Physical Disabilities: 
Relationship to Personal Assistance, Disability Status and Handicap,'' 
Rehabilitation Psychology, 40, pgs. 191-197, 1995). Helping families 
cope can include options like expanding respite care or training 
related to age-related changes.
    The increase in the numbers of persons aging with a disability has 
increased the need for rehabilitation personnel trained in providing 
services to this population. Serving an aging population may also 
require new treatment and other service delivery models. Research on 
effective

[[Page 10430]]

accommodations, including the use of assistive technology, for this 
aging population has been limited.
    The Secretary proposes to establish an RRTC on Aging with a 
Disability to promote the health, functional abilities, psychological 
well-being, and independence of persons aging with a disability. The 
RRTC shall:
    (1) Investigate the natural course of aging with a disability;
    (2) Identify, develop, and evaluate methods to reduce aging's 
impact on health status, including onset of new chronic conditions and 
secondary conditions associated with the primary disability;
    (3) Identify, develop, and evaluate rehabilitation techniques, 
including the effective use of assistive technology, to maintain 
functional independence;
    (4) Investigate and evaluate methods to improve psychosocial 
adjustment; and
    (5) Conduct studies to identify the extent to which aging affects 
the ability of families to support persons aging with a disability in 
family and community settings and evaluate strategies that will enhance 
the ability of families to cope.
    In carrying out these priorities, the RRTC must coordinate with 
aging with a disability research and demonstration activities sponsored 
by the National Center on Medical Rehabilitation Research, the 
Department of Veteran Affairs, the Social Security Administration, the 
Health Care Financing Administration, and the RRTCs on Health Care for 
Individuals with Disabilities--Issues in Managed Health Care, Aging 
with Spinal Cord Injury, and Aging with Mental Retardation, and the 
RERC on Assistive Technology for Older Persons with Disabilities.

Proposed Priority 2: Arthritis Rehabilitation

Background
    ``Arthritis'' means joint inflammation and encompasses a large 
family of more than 100 so-called rheumatic diseases that can affect 
people of all ages. The prevalence of many of these diseases tends to 
increase with age and several occur predominantly in women; others are 
more common in men. These diseases can affect joints, muscles, tendons, 
ligaments, and the protective coverings of some internal organs. Onset 
is usually in middle age, and arthritis and musculoskeletal conditions 
typically present a cluster of chief complaints including, but not 
limited to, pain, muscle impairments, and joint impairments. Arthritis 
and musculoskeletal conditions typically result in functional 
limitations in ADL. While individuals with arthritis experience most of 
their limitations in physical functional activities, the concept of 
function has psychological and social dimensions as well (Guccione, A. 
A., ``Arthritis and the Process of Disablement,'' Physical Therapy, 
Vol. 74, No. 5, May, 1994). For the purpose of this proposed priority, 
arthritis and musculoskeletal diseases must include, but are not 
limited, to rheumatoid arthritis (RA), osteoarthritis (OA), juvenile 
rheumatoid arthritis (JRA), osteoporosis, and fibromyalgia syndrome.
    Physical activity may provide significant physical and mental 
health benefits for persons with arthritis and musculoskeletal 
diseases. In recognizing that regular physical activity can help 
control joint swelling and pain, the U.S. Surgeon General's 1996 Report 
on Physical Activity and Health, urges people with arthritis to 
exercise. The Center for Disease Control and Prevention has indicated 
that most persons with arthritis and other rheumatic conditions should 
engage in physical activity because exercise helps people with 
arthritis maintain normal muscle strength and joint function and 
reduces the risk of premature death, heart disease, diabetes, high 
blood pressure, colon cancer, depression, and anxiety (Krucoff, C., 
``Taking Action Against Arthritis,'' The Washington Post Health 
Section, October 21, 1997). Maintenance of health and wellness is 
important when dealing with the problems of arthritis and 
musculoskeletal diseases. A number of factors, such as understanding 
and managing fatigue and conserving energy, developing relaxation 
techniques, participating in exercise programs, learning about weight 
control and proper nutrition, aid in the goal of achieving a quality of 
life for individuals who cope with the various problems encountered.
    Pain is a major concern for individuals with arthritis and 
musculoskeletal diseases. Pain can affect the ability to work or 
function independently in the home or community. The increased 
dependency encountered, the thoughts of progressive deformities, and 
feelings of frustration through loss of control often lead to 
psychosocial difficulties. Rehabilitation interventions can reduce 
pain, depression and improve functional abilities.
    Musculoskeletal conditions are among the top-ranked conditions 
causing limitations in the ability to perform work and reported as 
causes of actual work loss. Estimates for prevalence of work 
disability, defined as ceasing to work, ranges from 51 percent to 59 
percent. Clinical studies have indicated that when RA is in a severe 
form, this rate could be as high as 60 percent a decade after diagnosis 
(Felts, W. and Yelin, E., ``The Economic Impact of the Rheumatic 
Diseases in the United States,'' Journal of Rheumatology, 16, pgs. 867-
884, 1989). Decreased work satisfaction has been reported by persons 
with RA; 59 percent are unable to maintain gainful employment. In 
addition, patients with RA are significantly more likely to have lost 
their job or to have retired early due to their illness, and are the 
most likely to have reduced their work hours or stopped working 
entirely due to their illness (Gabriel, S.E., et al., ``Indirect and 
Nonmedical Costs Among People With RA and OA Compared With Nonarthritic 
Controls,'' Journal of Rheumatology, 24(1), pgs. 43-48, January 1997). 
Reasonable job accommodations for people with arthritis and 
musculoskeletal diseases to manage fatigue, stress, job performance 
issues, allowances for medical treatments and individual-related 
modifications are areas for employers to consider.
    More than 200,000 children in the U.S. are affected with some form 
of arthritis (Cassidy, J.T., et al., ``Juvenile Rheumatoid Arthritis,'' 
Textbook of Pediatric Rheumatology, pgs. 133-233, 1995). JRA is the 
most common childhood connective tissue disease (Chaney, J. and 
Peterson, L., Journal of Pediatric Psychology, Vol. 14, No. 3, 1989). 
JRA affects the physical, psychological and social development of 
children and adolescents. Assessing needs and developing strategies to 
aid in the promotion of improved medical, educational, psychosocial, 
and vocational services are essential with this population.

Proposed Priority 2

    The Secretary proposes to establish an RRTC on Arthritis 
Rehabilitation to improve the functional abilities and promote the 
independence for individuals with arthritis and musculoskeletal 
diseases. The RRTC shall:
    (1) Identify, develop, and evaluate exercise and fitness programs;
    (2) Identify, develop, and evaluate rehabilitation interventions to 
increase psychological well-being and reduce pain;
    (3) Identify, develop, and evaluate job accommodations to maintain 
employment; and

[[Page 10431]]

    (4) Identify, develop, and evaluate programs to maintain health and 
wellness.
    In carrying out the purposes of the priority, the RRTC must:
     Address the needs of children and youth; and
     Coordinate with arthritis activities sponsored by the 
National Institute on Arthritis and Musculoskeletal and Skin Diseases, 
and the National Center for Medical Rehabilitation Research.

Proposed Priority 3: Stroke Rehabilitation

Background
    In the U.S., there are approximately three million stroke survivors 
and 400,000 to 500,000 new or recurrent stroke cases annually 
(Gorelicj, P., ``Stroke Prevention,'' Archives of Neurology, 52(4), 
pgs. 347-355, 1995). Stroke survivors are the largest population in 
rehabilitation hospitals, and an estimated $30 billion is spent on 
stroke treatment each year (Alberts, M., et al., ``Hospital Charges for 
Stroke Patients,'' Stroke, 27(10), pgs. 1825-1828, 1996). Previous 
NIDRR-funded stroke rehabilitation research has focused on prevention 
and treatment of secondary conditions of stroke; enhancing functional 
capacity following stroke; improving social and community functioning; 
and studying the natural history of impairment, disability, and quality 
of life after stroke.
    Rehabilitation goals for stroke patients focus on maximizing 
physical and psychological function, teaching patients about prevention 
of recurrent stroke, and working with family members to facilitate 
integration of the person recovering from stroke back into family and 
community settings. Stroke patients potentially face a number of 
functional problems resulting from the paralysis, dysphagia, 
neurological, and other health-related sequelae of stroke.
    Higher order cognitive deficits, such as incomprehension and short-
term memory loss, have been shown to have a primary role in predicting 
rehabilitation length of stay, functional outcome and long-term care 
needs of stroke survivors. Early, comprehensive assessment of cognitive 
deficits has been shown to play a significant role in effecting better 
rehabilitation outcomes (Galski, T., et al., ``Predicting Length of 
Stay, Functional Outcome, and Aftercare in the Rehabilitation of Stroke 
Patients. The Dominant Role of Higher-Order Cognition,'' Stroke, 24 
(12), pgs. 1794-1800, December 1993).
    Endurance exercise is recognized as an important component of 
rehabilitation for stroke patient recovery of sensorimotor function. 
The ability of stroke patients to participate in exercise is 
compromised because they have lowered motor functional ability as a 
result of both reduced oxidative capacity and reduced availability of 
motor units. Traditional methods of measuring aerobic capacity are not 
appropriate for this population, nor are exercise training protocols 
that do not reflect stroke patient capacity for exercise (Potempa, K., 
et al., ``Benefits of Aerobic Exercise After Stroke,'' Sports Medicine, 
21(5), pgs. 337-46, 1996).
    Changes in personality, mood, and temperament can be confusing and 
distressing for stroke survivors and their caregivers. Depression can 
be a significant problem for both survivors and caregivers (Kumar, A., 
et al., ``Quantitative Anatomic Measures and Comorbid Medical Illness 
in Late-life Major Depression,'' American Journal of Geriatrics 
Psychiatry, 5(1), pgs. 15-25, 1997). Effective treatment of 
psychological and behavioral problems may require more standardized 
approaches that incorporate psychopharmalogical, behavioral, and 
psychological interventions.
    Although stroke is predominantly a phenomenon that strikes persons 
aged 65 and over, five percent occurs in persons under age 45. 
Individuals in this age cohort are generally employed, have a longer 
life expectancy than older stroke patients, and generally have better 
underlying health status and incur less brain injury related to the 
stroke (Ferro, J. and Crespo, M., ``Prognosis After Transient Ischemic 
Attack and Ischemic Stroke in Young Adults,'' Stroke,(8), pgs. 1611-
1616, August 1994). Rehabilitation for younger patients may emphasize 
vocational options, sexuality, and social functioning (Roth, E., ``From 
the Editor,'' Topics in Stroke Rehabilitation--The Young Stroke 
Survivor, Vol. 1, pg. vi, Spring, 1994). In addition, complications 
such as drug use or pregnancy may complicate rehabilitation strategies 
(Meyer, J., et al., ``Etiology and Diagnosis of Stroke in the Young 
Adult,'' Topics in Stroke Rehabilitation--The Young Stroke Survivor, 
Vol. 1, pgs. 1-14, Spring, 1994).
    Persons at the other end of the age spectrum, those over age 75 who 
comprise 41.8 percent of stroke rehabilitation patients (Personal 
communication with Samuel J. Markello, Ph.D. and Carl V. Granger, M.D., 
Director, National Rehabilitation Outcomes Database, maintained by the 
Uniform Data System for Medical Rehabilitation, University of Buffalo, 
January 1998), are at risk for poor rehabilitation outcomes possibly 
because of the effects of frailty and co-morbid disease (Falconer, J., 
et al., ``Stroke Inpatient Rehabilitation: A Comparison Across Age 
Groups,'' Journal of the American Geriatric Society, 42(1), pgs. 39-44, 
January 1994). In this population, presence of a healthy and caring 
spouse, bladder and bowel continence, and ability to feed oneself have 
predicted better outcomes (Reddy, M. and Reddy, V., ``After a Stroke: 
Strategies to Restore Function and Prevent Complications,'' Geriatrics, 
52(9), pgs. 59-62, September 1997.
    Prevention of stroke recurrence is increasingly a goal of medical 
rehabilitation stroke treatment programs (Gorelick, P., ``Stroke 
Prevention,'' Archives of Neurology, 52(4), pgs. 347-355, April 1995). 
Prevention methods include teaching individuals to monitor their blood 
pressure, raising awareness of the importance of nutrition and 
exercise, and educating family members about stroke.
    Medical research shows promise for dramatically improving the 
diagnosis and treatment of stroke in acute care settings. New drug 
therapies may significantly limit the impact of the initial stroke. 
Better diagnostic tools, such as using magnetic resonance imaging (MRI) 
to determine stroke type, size, and location, will result in earlier 
diagnosis and treatment (Centofanti, M., ``Fighting Back Against Brain 
Attack,'' Johns Hopkins Magazine, pgs. 18-24, November 1997). The 
consequences of improved initial stroke treatment for rehabilitation 
treatment and service delivery mechanisms are unknown.
    Changes in financing and service delivery models of stroke 
rehabilitation have created different rehabilitation treatment setting 
options for stroke patients. Increasingly stroke patients are receiving 
rehabilitation in post-acute service settings (e.g., nursing-home based 
rehabilitation programs). As a consequence of these changes, there are 
questions about the impact on outcomes of stroke patients. For 
instance, how does treatment intensity vary across settings; does 
treatment intensity affect outcomes across settings; do population 
characteristics differ across settings? Initial research indicates that 
outcomes may not differ dramatically when comparing acute to post-acute 
rehabilitation settings (Cramer A., et al., ``Outcomes and Costs After 
Hip Fracture and Stroke--A Comparison of Rehabilitation Settings,'' 
JAMA, Vol. 277, pgs. 396-404, 1997); however, knowledge about long-term 
outcomes of treatment in these different settings is still 
inconclusive.

[[Page 10432]]

    Another development affecting stroke rehabilitation is 
implementation of practice guidelines. In 1996, the Agency for Health 
Care Policy and Research published stroke treatment guidelines (Post-
Stroke Rehabilitation: A Quick Reference Guide for Clinicians, Pub. 95-
0663, 1996). These guidelines aim to minimize variation in treatment 
across acute care and rehabilitation settings (Ringel, S. and Hughes, 
R., ``Evidence-based Medicine, Critical Pathways, Practice Guidelines, 
and Managed Care. Reflections on the Prevention and Care of Stroke,'' 
Archives of Neurology, 53(9), pgs. 867-871, 1996). The rate of adoption 
of these guidelines and their impact on rehabilitation service and 
outcomes is not yet known.
    The Secretary proposes to establish an RRTC for Stroke 
Rehabilitation to develop and evaluate rehabilitation approaches to 
improve stroke rehabilitation treatment for all patients. The RRTC 
shall:
    (1) Identify, develop, and evaluate rehabilitation techniques to 
improve outcomes for all stroke patients, giving specific emphases to 
rehabilitation needs of older and younger patient groups and to methods 
that incorporate cognition in the treatment protocols;
    (2) Develop and evaluate standard aerobic exercise protocols; and
    (3) Identify and evaluate methods to identify and treat depression 
and other psychological problems associated with stroke;
    (4) Determine the effectiveness of stroke prevention education 
provided in medical rehabilitation settings;
    (5) Evaluate the impact of changes in diagnosis and medical 
treatment of stroke on rehabilitation needs;
    (6) Evaluate long-range outcomes for stroke rehabilitation across 
different treatment settings;
    (7) Evaluate the impact of stroke practice guidelines on delivery 
and outcomes of rehabilitation services.
    In carrying out the purposes of the priority, the RRTC must:
     Collaborate with RRTCs on Health Care for Individuals with 
Disabilities--Issues in Managed Health Care, and Aging with a 
Disability; and
     Coordinate with stroke activities sponsored by the 
National Center for Medical Rehabilitation Research and the National 
Institute on Neurological Disorders and Stroke.

Rehabilitation Engineering Research Centers

    The authority for RERCs is contained in section 204(b)(3) of the 
Rehabilitation Act of 1973, as amended (29 U.S.C. 762(b)(3)). The 
Secretary may make awards for up to 60 months through grants or 
cooperative agreements to public and private agencies and 
organizations, including institutions of higher education, Indian 
tribes, and tribal organizations, to conduct research, demonstration, 
and training activities regarding rehabilitation technology in order to 
enhance opportunities for meeting the needs of, and addressing the 
barriers confronted by, individuals with disabilities in all aspects of 
their lives. An RERC must be operated by or in collaboration with an 
institution of higher education or a nonprofit organization.

Description of Rehabilitation Engineering Research Centers

    RERCs carry out research or demonstration activities by
    (a) Developing and disseminating innovative methods of applying 
advanced technology, scientific achievement, and psychological and 
social knowledge to (1) solve rehabilitation problems and remove 
environmental barriers, and (2) study new or emerging technologies, 
products, or environments;
    (b) Demonstrating and disseminating (1) innovative models for the 
delivery of cost-effective rehabilitation technology services to rural 
and urban areas, and (2) other scientific research to assist in meeting 
the employment and independent living needs of individuals with severe 
disabilities; or
    (c) Facilitating service delivery systems change through (1) the 
development, evaluation, and dissemination of consumer-responsive and 
individual and family-centered innovative models for the delivery to 
both rural and urban areas of innovative cost-effective rehabilitation 
technology services, and (2) other scientific research to assist in 
meeting the employment and independent needs of individuals with severe 
disabilities.
    Each RERC must provide training opportunities to individuals, 
including individuals with disabilities, to become researchers of 
rehabilitation technology and practitioners of rehabilitation 
technology in conjunction with institutions of higher education and 
nonprofit organizations.
    The Department is particularly interested in ensuring that the 
expenditure of public funds is justified by the execution of intended 
activities and the advancement of knowledge and, thus, has built this 
accountability into the selection criteria. Not later than three years 
after the establishment of any RERC, NIDRR will conduct one or more 
reviews of the activities and achievements of the Center. In accordance 
with the provisions of 34 CFR 75.253(a), continued funding depends at 
all times on satisfactory performance and accomplishment.

Proposed General RERC Requirements

    The Secretary proposes that the following requirements apply to 
these RERCs pursuant to these absolute priorities unless noted 
otherwise. An applicant's proposal to fulfill these proposed 
requirements will be assessed using applicable selection criteria in 
the peer review process. The Secretary is interested in receiving 
comments on these proposed requirements:
    The RERC must have the capability to design, build, and test 
prototype devices and assist in the transfer of successful solutions to 
relevant production and service delivery settings. The RERC must 
evaluate the efficacy and safety of its new products, instrumentation, 
or assistive devices.
    The RERC must disseminate research results and other knowledge 
gained from the Center's research and development activities to persons 
with disabilities, their representatives, disability organizations, 
businesses, manufacturers, professional journals, service providers, 
and other interested parties.
    The RERC must develop and carry out utilization activities to 
successfully transfer all new and improved technologies developed by 
the RERC to the marketplace.
    The RERC must involve individuals with disabilities and, if 
appropriate, their representatives, in planning and implementing its 
research, development, training, and dissemination activities, and in 
evaluating the Center.
    The RERC must conduct a state-of-the-science conference in the 
third year of the grant and publish a comprehensive report on the final 
outcomes of the conference in the fourth year of the grant.

Priorities

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

Proposed Priority 4: Prosthetics and Orthotics

Background
    Prosthetic limbs (also called artificial or replacement limbs) 
perform functions previously performed by lost, absent, or portions of 
limbs. Orthoses (also called braces or anatomical technology

[[Page 10433]]

devices) are devices applied to limbs or other parts of the body that 
have either lost or impaired function to compensate for certain 
differences in anatomical shape or size, muscle weakness or paralysis. 
Appropriately fitted prosthetic and orthotic (P&O) devices improve 
functional abilities for work and ADL.
    The National Health Interview Survey of 1992 reported a prevalence 
in the United States of 102,000 individuals with upper extremity loss 
or absence, and 256,000 individuals with lower extremity loss or 
absence (LaPlante, M. and Carlson, D., ``Disability in the United 
States: Prevalence and Causes, 1992'' Disability Statistics Report No. 
7, NIDRR, pg. 29, 1996). The majority of these individuals use or need 
prosthetic limbs. It is more difficult to estimate the prevalence of 
individuals who use or need orthotic devices because orthoses are used 
in a wide variety of disabilities, and unlike loss or absence of a 
limb, have not historically been a specific category in national 
surveys. However, the National Health Interview Survey on Assistive 
Devices (NHIS-AD) of 1990 reported that 3,514,000 individuals in the 
United States used anatomical technology devices, categorized as braces 
for either the leg, foot, arm, hand, neck, back or other (LaPlante, M. 
P., et al., ``Assistive Technology Devices and Home Accessibility 
Features: Prevalence, Payment, Need, and Trends,'' Advance Data from 
Vital and Health Statistics, National Center for Health Statistics, No. 
217, pg. 6, 1992).
    According to the Institute of Medicine, there is a lack of a 
complete and widely accepted base of scientific and engineering data to 
support the process of individuals obtaining the optimum device for 
their particular need. The lack of an effective scientific and 
theoretical foundation for human gait inhibits the engineering design 
of technology to aid ambulation. More work is also needed in research 
and development directed to the problems of arm and hand replacement 
(Enabling America: Assessing the Role of Rehabilitation Science and 
Engineering, Institute of Medicine Report, pgs. 111-117, 1997).
    The enormous diversity of P&O devices to address many different 
muscular, neuromuscular, and skeletal issues, adds to the complexity of 
this field and supports the need for quantitative documentation to 
improve the process by which individuals obtain the most appropriate 
P&O device for their need (Esquenazi, A. and Meier, R. H., 
``Rehabilitation in Limb Deficiency. 4. Limb Amputation,'' Archives of 
Physical Medicine and Rehabilitation, Vol. 77, pgs. s18-s28, 1996). For 
example, there are approximately 100 commercially available prosthetic 
knees capable of being used in transfemoral prostheses (Michael, J. W., 
``Prosthetic Knee Mechanisms,'' Physical Medicine and Rehabilitation: 
State of the Art Reviews, Vol. 8, pgs. 147-164, 1994), making it 
difficult to evaluate all possible options. The trend in health care 
toward evidence-based decision making will require the collection and 
analysis of data that may not have occurred in the past (Guyatt, G., et 
al., ``Evidence-Based Medicine: A New Approach to Teaching the Practice 
of Medicine,'' JAMA, Vol. 268, pgs. 2420-2425, 1992).
    Evaluations will play a key role in shaping the services available 
in the future (Hailey, D. M., ``Orthoses and Prostheses,'' 
International Journal of Technology Assessment in Health Care, Vol. 11, 
pgs. 214-234, 1995). As more quantitative measurements are being made 
at the individual level with respect to device selection, there is a 
need to collect data on use of devices by individuals in a uniform 
format for archival reference and research purposes. A database that 
could be used to evaluate the outcomes of individuals using P&O devices 
does not exist. Such a database might include, but would not be limited 
to: technical specifications and details of the device; appropriate 
performance and outcome measures; relevant anthropometric measurements 
of the wearer; appropriate medical and demographic data, and payment 
information.
    The increased attention to prosthetic technology in developing 
nations (Day, H. J. B., ``A Review of the Consensus Conference on 
Appropriate Prosthetic Technology in Developing Countries,'' 
Prosthetics and Orthotics International, Vol. 20, pgs. 15-23, 1996) 
along with the advanced state of science in many European nations, 
provides opportunity and impetus for the development of international 
standards in P&O. In addition, increased international exchanges of 
both information and technology, as a result of comparative work, are 
highly likely to be beneficial to both the United States and other 
countries.

Proposed Priority 4

    The Secretary proposes to establish an RERC on Prosthetics and 
Orthotics to strengthen and expand the scientific and engineering basis 
for the field, and develop new ways to use information technology that 
will ultimately result in delivery of improved service to individuals 
who can benefit from prosthetic and orthotic devices. The RERC shall:
    (1) Increase the understanding of the scientific and engineering 
principles for human locomotion, reaching, prehension, and 
manipulation, and incorporate these principles into the design of P&O 
devices;
    (2) Develop and evaluate a prototype computer-based system to 
select the most appropriate P&O device (or combination of devices), and 
fit the device to an individual;
    (3) Develop a prototype database of individuals using P&O devices 
in collaboration with industry including, but not limited to, technical 
details of the device, appropriate performance and outcome measures, 
relevant anthropometric measurements of the wearer, appropriate medical 
and demographic data, and cost and payment information; and
    (4) Maintain an international exchange of scientific information 
and participate in the development of international standards.
    In carrying out these purposes, the RERC must coordinate on 
activities of mutual interest with the RERC on Land Mines.

Proposed Priority 5: Wheeled Mobility

Background
    Approximately 1.4 million Americans use a wheelchair as their 
primary source of mobility (Kraus, L., et al., Chartbook on Disability 
in the United States, InfoUse, Berkeley, CA, 1996), including 
approximately 600,000 Americans who live in skilled nursing facilities 
and are over the age of 65 (Shaw, G. and Taylor, S. J., ``A Survey of 
Wheelchair Seating Problems of the Institutionalized Elderly,'' 
Assistive Technology, Vol. 3, RESNA Press, pgs. 5-10, 1991). The number 
of Americans who use wheelchairs nearly doubled between 1980 and 1990 
while the general population increased by 13 percent during that same 
period (LaPlante, M. P., et al., ``Assistive Technology Devices and 
Home Accessibility Features: Prevalence, Payment, Need, and Trends,'' 
Advance Data from Vital and Health Statistics, No. 217, U.S. Department 
of Health and Human Services, September, 1992). The number of 
wheelchair users increases as a population ages (Ohlin, P., et al., 
``Technology Assisting Disabled and the Older People in Europe,'' The 
Swedish Handicap Institute, Stockholm, 1995). As the American 
population continues to grow older, the number of individuals who will 
require the use of a wheelchair for mobility is expected to increase.

[[Page 10434]]

    Wheelchairs and wheelchair seating systems have dramatically 
improved over the past decade due in part to advances in lightweight, 
high-strength materials, improved mechanical designs, and improved 
microprocessor control technologies, and more efficient drive train 
systems for powered chairs. There are virtually hundreds of options 
available to wheelchair users (e.g., frame sizes and designs, castors, 
hand rims, seat sizes, and seat backs). Selecting the appropriate 
options when either prescribing or purchasing a wheelchair or 
wheelchair seating system can be complicated and difficult for 
therapists and consumers.
    Individuals who use powered wheelchairs often rely on external 
devices (e.g., ventilators, augmentative communication devices, and 
environmental control systems) for respiratory support or to help them 
function during the day. Improvements in electronic technologies have 
led to the development of sophisticated wheelchair controllers with 
built-in flexibility and adjustability. Typical controllers are based 
on microcomputers and allow for the adjustment of parameters (e.g., 
acceleration and deceleration control, speed control, and tremor 
dampening) to improve the user's ability to control the wheelchair 
safely (Cook, A. M. and Hussey, S. M., Assistive Technologies: 
Principles and Practice, pg. 549, 1995). These controllers are also 
capable of directly controlling external devices. Most external devices 
are made by companies other than wheelchair manufacturers. As a result, 
compatibility between external devices and powered wheelchairs is often 
problematic.
    Wheelchairs and wheelchair seating systems combine to provide 
mobility, pressure relief, postural support, deformity management, and 
increased comfort, function and tolerance (Hobson, D. A., ``Seating and 
Mobility for the Severely Disabled,'' Rehabilitation Engineering, pgs. 
193-252, 1990). Most wheelchair users are candidates for seating and 
positioning interventions. Typical seating systems statically control 
an individual's posture by constraining the individual to a fixed 
position using modular or custom fit devices and systems such as foam 
wedges, hand-shaped foams, ``foam-in-place,'' vacuum consolidation, and 
CAD-CAM (Cook, A. M. and Hussey, S. M., op. cit., pgs. 237-239). For 
individuals who have a high degree of muscle tone or spasticity, 
staying in a fixed position can be uncomfortable and cause pressure 
sores. An alternative to static seating is dynamic seating. A recent 
case study in this area of research looked at the benefits of a dynamic 
seating system for an adolescent with cerebral palsy with a high degree 
of extensor tone. This system allowed the individual to extend during 
spasms, then returned the individual to a functional seating posture 
upon relaxation resulting in a reduction of generalized tone and 
improved posture (Ault, H. K., et al., ``Design of a Dynamic Seating 
System for Clients with Extensor Spasms,'' Proceedings of the RESNA 
1997 Annual Conference, pgs. 187-189, 1997).
    Pressure relief is critical for individuals who have little or no 
sensation in weight bearing areas, such as persons with spinal cord 
injury and some elderly, or those who are unable to shift their weight 
to relieve pressure (Bergen, A., et al., Positioning for Function: 
Wheelchairs and Other Assistive Technologies, pg. 4, 1990). Without 
proper pressure relief, individuals are prone to develop pressure sores 
(decubitus ulcers) that can result in tremendous costs for treatment 
and in time lost from work (Ditunno, J. F., Jr. and Formal, C. S., 
``Chronic Spinal Cord Injury,'' New England Journal of Medicine, Vol. 
330, pgs. 550-556, 1994). The incidence for pressure sores has remained 
fairly static (Stover, S. L., et al., Spinal Cord Injury: Clinical 
Outcomes from the Model Systems, pgs. 109-113, 1995). There are many 
factors that contribute to the development of pressure sores. External 
forces (i.e., tension, compression, and shear) applied to localized 
areas are the primary causes of pressure sores. Other factors affecting 
pressure sore development include, but are not limited to, stress, 
friction, body size, posture, nutrition, age, blood circulation, and 
the microclimate between one's body and the seating surface (Cook, A. 
M. and Hussey, S. M., op. cit., pgs. 282-285). Understanding the 
interactions between these factors is paramount to improving seating 
and positioning systems.
    Decisions made during seating evaluations are often subjective in 
nature and are based upon observational analyses and past experience of 
the therapists involved. There are over 300 commercially available 
cushions on the market (HyperABLEDATA, 1997), as well as a myriad of 
wheelchair options. Understanding these options and knowing when to use 
them is difficult for therapists and consumers. Voluntary performance 
standards for seating and clinical measurement devices would allow for 
objective comparison of products based upon standardized test results 
from each manufacturer.
    A number of outcome measurement tools may be used to measure 
functional outcomes of individuals during the rehabilitation process. 
However, many of these tools do not consider assistive technology 
interventions, including seating and mobility, when rating an 
individual's overall performance.
    For example, in order to get a maximum score using the Functional 
Independence Measure, the individual cannot rely on assistive 
technology; thereby implying that a person cannot be totally 
functionally independent if he or she uses assistive technology devices 
(Scherer, M. J. and Galvin, J. C., ``An Outcomes Perspective of Quality 
Pathways to the Most Appropriate Technology,'' Evaluating, Selecting, 
and Using Appropriate Assistive Technology, pg. 21, 1996). A number of 
clinical measurement devices (e.g., pressure monitoring devices, and 
seating simulators) may be used in seating and mobility clinic 
environments, however, they do not systematically measure and record 
outcomes of wheelchair and seating interventions.

Proposed Priority 5

    The Secretary proposes to establish an RERC on Wheeled Mobility to 
improve the efficiency and selection of wheelchairs and wheelchair 
seating systems and investigate new seating system strategies including 
dynamic seating systems and pressure sore prevention. The RERC shall:
    (1) Develop and evaluate strategies that can be used to aid 
therapists and consumers in making informed decisions when prescribing 
or purchasing new wheelchairs and wheelchair seating systems;
    (2) Develop and evaluate strategies in collaboration with industry 
to promote the integration of external devices with powered wheelchairs 
and ensuring their compatibility and usability;
    (3) Investigate the viability of dynamic seating systems;
    (4) Investigate the factors that contribute to the development of 
pressure sores and develop and evaluate tools, devices and strategies 
to prevent them from occurring;
    (5) Investigate the use of voluntary performance standards for 
wheelchair seating devices and clinical measurement devices and, if 
appropriate, develop in collaboration with industry strategies to 
facilitate the implementation of those standards; and
    (6) Develop and evaluate outcome measurement tools for quantifying 
seating clinic intervention results.
    In carrying out the purposes of the priority, the RERC must 
coordinate on

[[Page 10435]]

activities of mutual interest with all the RRTCs addressing Spinal Cord 
Injury and the RRTC on Aging with a Disability.

Proposed Priority 6: Technology Transfer

Background
    Technology transfer is a means of capitalizing on and increasing 
the value of an initial investment in research of a particular 
technology through new applications. Technology transfer also involves 
moving conceptualizations and new inventions from a potential 
application into a working prototype and, ultimately, into a commercial 
product. There has been an increased interest in developing assistive 
technology in recent years. Basic research has yielded innovations 
developed with the disability population in mind and more generic 
applied research has resulted in new ways to transfer existing 
technologies initially developed for different purposes into assistive 
technology products. In addition, there are an increasing number of 
entrepreneurs and inventors developing devices specifically for persons 
with disabilities.
    Approximately 13 million people with disabilities use assistive 
technology devices to assist them with major life activities (Kraus, 
L., et al., Chartbook on Disability in the United States, InfoUse, 
Berkeley, CA, 1996). Understanding the functional needs of persons with 
disabilities, translating those needs into technical solutions, 
identifying the markets and determining which technologies may be 
successfully transferred into usable assistive technology products is 
critical to the technology transfer process (Spaepen, A.J., 
``Technology Transfer and Service Delivery in Rehabilitation 
Technology,'' Journal of Rehabilitation Sciences, Vol. 4, pgs. 84-87, 
1991). The assistive technology market is expected to grow dramatically 
over the next two decades as the American population ages and as the 
survival rate of accident victims continues to climb (Federal 
Laboratory Consortium, ``Federal Laboratory Technologies Enable the 
Disabled,'' Technology Transfer Business, Vol. 4, pg. 11, 1997).
    There are models of technology transfer that are routinely utilized 
by government, small businesses, nonprofit organizations, universities 
and industry (Rouse, D., ``Technology Identification and Partnership 
Development,'' Research Triangle Institute, 1997). These models assume 
a market that is identifiable and definable, somewhat homogeneous, 
visible, and well-financed. Transferring promising technologies and new 
inventions to the assistive technology arena presents unique 
challenges. Devices that either have the potential for use by persons 
with disabilities, or were invented for consumers with disabilities 
often are not successfully commercialized because of the limited number 
of potential users or the developer's inexperience and limited 
understanding of disabilities and the assistive technology marketplace 
(Gilden, D., ``Moving from Naive to Knowledgeable on the Road to 
Technology Transfer,'' Technology and Disability, Vol. 7, pgs. 115-125, 
1997).
    Frequently, inventions and prototypes of devices require 
considerable engineering, modification and redesign. The vast majority 
of assistive technology companies are very small and have limited 
access to knowledge, resources, markets, funds, skills and finance 
(Swanson, D., ``Determining the Government's Responsibilities in 
Technology,'' Journal of Technology Transfer, Vol. 20 (2), pgs. 3-4, 
1995). Companies and entrepreneurs interested in transferring 
inventions and existing technologies into new products for persons with 
disabilities require technical assistance to make sound and profitable 
decisions and to do a better job of analyzing the viability of 
potential products.
    Proper screening of devices is critical to the assistive technology 
transfer process and requires a feasibility study to be performed for 
each device prior to any significant investment of time and financial 
resources. Typical questions to ask include: Does the device already 
exist in some other form? Do consumers have alternate and satisfactory 
ways to perform the same function that would negate the need for 
another device? Would the required investment justify the development 
of the new device? Is the market too small? Are consumers interested in 
using the device? (Newroe, B.N. and Oskardottir, A.Y., ``Identification 
and Networking of Assistive Technology-Related Transfer Resources 
Through the Consumer Assistive Technology Network (CATN),'' Technology 
and Disability, Vol. 7, pgs. 31-45, 1997).
    Assistive technology evaluation involves activities beyond the 
initial screening of new products and innovations. It is important to 
identify and include all other stakeholders in the evaluation process 
including, but not limited to, technology experts, engineers, 
developers, manufacturers, corporations, community organizations, 
providers and potential purchasers. In addition to evaluation studies, 
it is necessary to provide an estimate of the resources required and of 
the product's readiness for commercialization in order to attract a 
developer or manufacturer. Safety, reliability, cost, customer 
satisfaction and durability must also be measured (Sheredos, S., et 
al., ``The Department of Veterans Affairs Rehabilitation Research and 
Development Service's Technology Process,'' Technology and Disability, 
Vol. 7, pgs. 25-30, 1997).
    Most assistive technology devices are considered orphan products 
(devices used by very small populations and having limited market 
appeal). In anticipation of a products' low volume and unproven market 
demand, potential manufacturers and suppliers must be offered a well 
researched device prospectus that will act as an incentive for 
production. Products incorporating the principles of universal design 
are developed with built-in flexibility so they are usable by all 
people, regardless of age and ability, at no additional cost (Mace, R., 
et al., ``Accessible Environments: Toward Universal Design,'' Design 
Interventions: Toward Universal Design, pg. 156, 1991). The evaluation 
phase should include an assessment of whether a product may have 
universal application, thereby increasing its marketability.

Proposed Priority 6

    The Secretary proposes to establish an RERC on technology transfer 
to facilitate and improve the process of moving new, useful and better 
assistive technology inventions and applications of existing 
technologies from the prototype phase to the marketplace to benefit 
persons with disabilities. The RERC shall:
    (1) Identify and evaluate models of technology transfer that are 
applicable to assistive technology;
    (2) Identify the needs and provide technical assistance, including 
engineering design and support, to inventors, entrepreneurs, small 
companies, research laboratories, and industry and university labs to 
facilitate the transfer of assistive technology with particular 
emphasis on orphan products;
    (3) Develop and implement methodologies to screen promising 
assistive technology and to evaluate the potential for 
commercialization, including an assessment of principles of universal 
design of prototypes developed by individual inventors, small 
businesses and public or private research laboratories for use by 
persons with disabilities; and
    (4) Design and disseminate protocols for technical, user and market

[[Page 10436]]

evaluations of promising inventions and new uses for existing 
technologies.
    In carrying out the purposes of the priority, the RERC must:
     Conduct activities in consultation with industry, public 
and private research facilities, small businesses, entrepreneurs, 
university-based research laboratories and consumers; and
     Provide technical assistance and support to all RERC's on 
issues pertaining to technology evaluation and transfer.

Proposed Priority 7: Telerehabilitation

Background
    One of the most notable changes in the nation's health care system 
is a dramatic downward shift in the average length of stay for patients 
admitted to rehabilitation hospitals. According to the National Spinal 
Cord Injury Statistical Center, the average length of stay for patients 
admitted into the Model SCI Care System dropped from 115 days in 1974 
to 49 days in 1995 (``Spinal Cord Injury: Facts and Figures at a 
Glance,'' National Spinal Cord Injury Statistical Center, University of 
Alabama at Birmingham, August, 1997). Individuals living in rural areas 
may have less of an opportunity to continue their rehabilitation than 
do individuals living in urban settings due to a lack of rehabilitation 
outpatient centers in rural regions. Given that individuals are being 
discharged earlier in the rehabilitation process, there is tremendous 
need for new and innovative therapeutic devices and strategies that can 
be used to continue therapy for individuals living in remote settings 
who may not have access to outpatient therapy.
    For more than 30 years, clinicians, researchers, and others have 
been investigating the use of advanced telecommunications and 
information technologies to improve health care, resulting in the 
advent of telemedicine. Telemedicine has a variety of applications 
including patient care, education, research, administration and public 
health (Telemedicine: A Guide to Assessing Telecommunications in Health 
Care, Institute of Medicine Report, National Academy Press, pg. 16, 
1996). At least 10 States have established Medicaid payment mechanisms 
for medical services provided through telemedicine (U.S. Department of 
Commerce, ``Telemedicine Report to Congress,'' January 31, 1997). 
Technological advances in medicine, sensor technologies, 
telecommunications and information technologies provide unique 
opportunities for expanding upon the field of telemedicine to further 
develop the field of telerehabilitation. By using technology, 
telerehabilitation enables rehabilitation professionals to provide 
rehabilitation services to individuals when distance separates the 
participants (Temkin, A.J., et al., ``Telerehab: A Perspective of the 
Way Technology is Going to Change the Future of Patient Treatment,'' 
REHAB Management, pg. 28, February/March, 1996). Telecommunication and 
information technologies used in telemedicine are modernizing medical 
rehabilitation services and are beginning to be used in other aspects 
of the rehabilitation process. For example, ongoing experiments to 
provide effective delivery of therapeutic counseling from the offices 
of professional psychologists to clients physically located elsewhere, 
using modified video-conferencing techniques, are under study by the 
American Psychological Association (Sleek, S., ``Providing Therapy from 
a Distance,'' APA Monitor, American Psychological Association, Vol. 28, 
No. 8, August, 1997).
    Two very important aspects of comprehensive rehabilitation are 
education and training. Rehabilitation practitioners work closely with 
individuals and family members to enhance their functional abilities, 
assist them in adjusting to their disability (Haas, J., ``Ethical 
Issues in Rehabilitation Medicine,'' Rehabilitation Medicine: 
Principles and Practice, Second Edition, pg. 34, 1993), and lessen the 
likelihood of secondary complications (Stover, S., et al., Spinal Cord 
Injury: Clinical Outcomes from the Model Systems, pg. 322, 1995). 
Secondary complications from acute trauma, such as spinal cord injury, 
stroke, and traumatic brain injury, are a leading cause for re-
hospitalization. One way of reducing the likelihood of contracting 
secondary complications is through education, training, and monitoring. 
This can be achieved using portable, low-cost communication devices 
capable of providing video and audio connection between comprehensive 
rehabilitation facilities and individuals living in rural communities. 
Those devices can enable individuals to communicate with rehabilitation 
professionals while at home or in remote clinical settings, and to 
continue with the educational and training components of the 
rehabilitation process. These devices also allow physicians and other 
clinicians to monitor the progress of these individuals and offer 
clinical diagnoses and interventions when appropriate.
    Traditional therapeutic interventions include the use of heat, 
cold, light, friction, and pressure to facilitate healing and relieve 
pain in affected areas. Many of these therapy techniques require costly 
equipment and can be used only by trained therapists. Given that 
individuals are being discharged earlier in the rehabilitation process, 
there is tremendous need for new, innovative and cost-effective 
therapeutic devices and strategies that can be used to safely continue 
therapy for individuals living in remote settings who may not have 
access to comprehensive outpatient rehabilitation therapy.
    Virtual reality is an interactive computer-based technology capable 
of simulating complex three-dimensional (3-D) environments. The number 
of virtual reality applications has risen dramatically over this past 
decade and includes flight simulators, 3-D medical imaging 
technologies, and entertainment systems (Hayward, T., Adventures in 
Virtual Reality, pgs. 41-48, 1993). The benefits of combining virtual 
reality with rehabilitation interventions are potentially extensive. 
Virtual reality technologies are being used to convert sign language 
into speech and to develop barrier-free designs for people with 
physical disabilities. Biosensors that provide qualitative and 
quantitative data about muscle activity, pressure and movements are 
also capable of being integrated into virtual reality systems for use 
in rehabilitation.

Proposed Priority 7

    The Secretary proposes to establish an RERC on telerehabilitation 
to identify and develop technologies capable of supporting 
rehabilitation services for individuals who do not have access to 
comprehensive outpatient rehabilitation services. The RERC shall:
    (1) Identify and evaluate communication systems capable of 
connecting comprehensive rehabilitation facilities with therapists, 
individuals and family members living in remote settings to provide 
ongoing rehabilitation education and training services;
    (2) Develop and evaluate monitoring and diagnostic tools that can 
be used in the provision of rehabilitation services through 
telerehabilitation;
    (3) Develop and evaluate strategies and devices to provide and 
monitor therapeutic interventions in remote settings; and
    (4) Investigate the use of virtual reality in rehabilitation 
including, but not limited to, education, monitoring, diagnosing, and 
therapy.

[[Page 10437]]

    In carrying out the purposes of the priority, the RERC must 
coordinate on activities of mutual interest with the RERCs on 
Telecommunications and Information Technologies Access and the RRTC on 
Rural Rehabilitation Services.
Electronic Access to This Document
    Anyone may view this document, as well as all other Department of 
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    Note: The official version of this document is the document 
published in the Federal Register.

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 3424, Switzer 
Building, 330 C Street SW, Washington, D.C., between the hours of 9 
a.m. and 4:30 p.m., Monday through Friday of each week except Federal 
holidays. Applicable Program Regulations: 34 CFR Parts 350 and 353. 
Program Authority: 29 U.S.C. 760-762.

    Dated: February 25, 1998.

(Catalog of Federal Domestic Assistance Numbers 84.133B, 
Rehabilitation Research and Training Centers, and 84.133E 
Rehabilitation Engineering Research Centers)

Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 98-5379 Filed 3-2-98; 8:45 am]
BILLING CODE 4000-01-P