[Federal Register Volume 63, Number 113 (Friday, June 12, 1998)]
[Notices]
[Pages 32526-32539]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-15697]



[[Page 32525]]

_______________________________________________________________________

Part IV





Department of Education





_______________________________________________________________________



National Institute on Disability and Rehabilitation Research; Notice of 
Final Funding Priorities for Fiscal Years 1998-1999 for Certain Centers 
and Office of Special Education and Rehabilitative Services; Notice 
Inviting Applications for New Rehabilitation Research and Training 
Centers and New Rehabilitation Engineering Research Centers for Fiscal 
Year 1998

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

[[Page 32526]]



DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research; 
Notice of Final Funding Priorities for Fiscal Years 1998-1999 for 
Certain Centers

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

EFFECTIVE DATE: This priority takes effect on July 13, 1998.

FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 205-
5880. Individuals who use a telecommunications device for the deaf 
(TDD) may call the TDD number at (202) 205-5516. Internet: 
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 final priorities under 
the Disability and Rehabilitation Research Projects and Centers Program 
for three RRTCs related to: aging with a disability, arthritis 
rehabilitation, and stroke rehabilitation. The notice also contains 
final priorities for four RERCs related to: prosthetics and orthotics, 
wheeled mobility, technology transfer, and telerehabilitation.
    These final priorities support the National Education Goal that 
calls for every adult American to possess the skills necessary to 
compete in a global economy.
    The authority for the Secretary to establish research priorities by 
reserving funds to support particular research activities is contained 
in sections 202(g) and 204 of the Rehabilitation Act of 1973, as 
amended (29 U.S.C. 761a(g) and 762).

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

Analysis of Comments and Changes

    On March 3, 1998, the Secretary published a notice of proposed 
priorities in the Federal Register (62 FR 10428-10437). The Department 
of Education received forty-five letters commenting on the notice of 
proposed priority by the deadline date. Technical and other minor 
changes--and suggested changes the Secretary is not legally authorized 
to make under statutory authority--are not addressed.

Rehabilitation Research and Training Centers--General

    Comment: One commenter suggested that NIDRR should do more than 
encourage all Centers to involve individuals with disabilities as 
recipients of research training and clinical training. A second 
commenter suggested that RRTCs should be required to hire individuals 
with disabilities.
    Discussion: Involvement of individuals with disabilities is one of 
the general requirements that apply to all RRTCs. All RRTCs must 
``involve individuals with disabilities and, if appropriate, their 
representatives, in planning and implementing its research, training, 
and dissemination activities, and in evaluating the Center.'' 
Applications for RRTCs are evaluated, in part, on the extent to which 
the applicant encourages individuals with disabilities to apply for 
employment.
    Changes: None.
    Comment: NIDRR received a comment in response to the proposed 
priority on Arthritis Rehabilitation that suggested that NIDRR require 
the RRTC to collaborate with arthritis-related organizations as well as 
other RRTCs.
    Discussion: This comment prompted a general review of all of the 
collaboration and coordination requirements contained in the proposed 
RRTC and RERC priorities to determine their appropriateness and 
consistency. That review revealed some inconsistency in language 
requiring clarification.
    Changes: The RRTC priorities have been revised to clarify that 
having met the stated collaboration or coordination requirements, each 
RRTC has the authority to collaborate or coordinate with other entities 
carrying out related activities.
    Comment: NIDRR received comments in a preceding FY 98 RERC 
competition that suggested that the requirements for conducting a 
state-of-the-science conference and publishing a final report should be 
more flexible.
    Discussion: As a result of this comment, NIDRR revised the general 
state-of-the-science conference and final report requirement in the 
preceding priority. The following reason was provided for this change: 
``Information from the state-of-the-science conference will be used, in 
conjunction with NIDRR's programs reviews and other inputs in the 
determination of future research issues and as part of NIDRR's 
Government Performance Results Act database. The budget planning 
process requires this information to be available during the fourth 
year of a five year grant. As long as the report is available in the 
fourth year of the grant, grantees should have as much flexibility as 
possible in regard to the scheduling of the state-of-the-science 
conference.''
    Changes: To be consistent with the state-of-the-science conference 
requirement used in the previous priority, it has been revised in the 
RRTC and RERC priorities to allow grantees total discretion in 
scheduling the conference.
Priority 1: Aging With a Disability
    Comment: Research and training on aging with a disability should be 
interdisciplinary.
    Discussion: An applicant could propose to carry out the RRTC's 
research and training activities using an interdisciplinary model. The 
peer review process will evaluate the merits of the proposal. However, 
NIDRR has no basis to determine that all applicants should be 
prohibited from proposing other models.
    Changes: None.
    Comment: The priority should include health promotion and wellness 
programs in the second activity on reducing aging's impact on health 
status.
    Discussion: An applicant could propose to include health promotion 
and wellness programs in the second activity of the priority. The peer 
review process will evaluate the merits of the proposal. However, NIDRR 
has no basis to determine that all applicants should be required to 
include health promotion and wellness programs in their efforts to 
address reducing aging's impact on health status.
    Changes: None.
    Comment: The fourth activity on psychosocial adjustment should be 
expanded to include community integration in order to address broader 
community resource issues such as access to health care and employment.
    Discussion: NIDRR agrees that expanding the scope of the fourth 
activity to include community integration will enable the RRTC to 
address a wider range of important issues. It will also provide 
applicants with more discretion to propose activities that address a 
wider range of issues related to psychosocial adjustment.
    Changes: Community integration has been added to the fourth 
activity of the priority.

[[Page 32527]]

Priority 2: Arthritis Rehabilitation
    Comment: The RRTC should study managed care in order to enable 
persons with expertise in arthritis to contribute to this burgeoning 
field of interest.
    Discussion: The impact of managed care on the provision of services 
to persons with arthritis is an important area. However, it is not 
feasible, considering the complexity of the topic, for the RRTC to 
address managed care in addition to the current requirements in the 
priority.
    Changes: None.
Priority 3: Stroke Rehabilitation
    Comment: The RRTC should address reducing the incidence and impact 
of coexisting and secondary conditions on stroke survivors. These 
conditions are not only common in all age groups of stroke survivors, 
but also have a significant impact on the course, care, and outcome of 
stroke rehabilitation efforts.
    Discussion: NIDRR agrees that including coexisting and secondary 
conditions within the activities of the RRTC constitutes a more 
comprehensive approach to stroke rehabilitation.
    Changes: The first activity has been revised to include coexisting 
and secondary conditions.

Rehabilitation Engineering and Research Centers--General

    Comment: The priorities should be broadened to include a field-
initiated activity for grants smaller in scope.
    Discussion: NIDRR's field-initiated projects competition is held 
annually. Therefore, including a field-initiated activity within an 
RERC priority is unnecessary.
    Changes: None.
Priority 4: Prosthetics and Orthotics (P and O)
    Comment: The RERC should be required to address the human-
technology interface.
    Discussion: The second activity requires the RERC to address 
selecting and fitting prosthetic and orthotic devices. The human-
technology interface is a required step in this process. Therefore, an 
additional requirement addressing human-technology interface is 
unnecessary.
    Changes: None.
Priority 5: Wheeled Mobility
    Comment: Three commenters suggested broadening the priority to 
address new technologies in the area of wheeled mobility. One commenter 
specifically suggested requiring the RRTC to investigate advanced 
electric powered wheelchair controls and develop new wheelchair 
technology to increase performance and accessibility while reducing 
cost and preventing secondary disability.
    Discussion: NIDRR agrees that research on new technologies in the 
area of wheeled mobility is needed. NIDRR believes that applicants 
should have as much discretion as possible in this emerging area. Under 
the revised priority (see below) an applicant could propose to 
investigate advanced electric powered wheelchair controls or develop 
new wheelchair technology to increase performance and accessibility 
while reducing cost and preventing secondary disability. The peer 
review process will evaluate the merits of these proposals. NIDRR also 
has no basis to determine that all applicants should be required to 
investigate advanced electric powered wheelchair controls or develop 
new wheelchair technology to increase performance and accessibility 
while reducing cost and preventing secondary disability.
    Changes: The priority has been revised to require the RRTC to 
develop and evaluate new technologies in the area of wheeled mobility.
    Comment: Thirteen commenters expressed concern about the need for 
continued research activities related to wheelchair transportation 
safety issues.
    Discussion: NIDRR agrees with the commenters that issues remain to 
be addressed in regard to wheelchair transportation safety. An 
applicant could propose to include wheelchair transportation safety 
issues in the activity to develop and evaluate new technologies in the 
area of wheeled mobility. The peer review process will evaluate the 
merits of the proposal. However, NIDRR has no basis to determine that 
all applicants should be required to carry out research on wheelchair 
transportation safety issues.
    Changes: None.
    Comment: The fifth activity should be expanded to include voluntary 
performance standards for wheelchairs, and the sixth activity should be 
expanded to include outcome measurement tools or quantifying seating 
and mobility interventions.
    Discussion: Expanding the fifth and sixth activities as suggested 
by the commenter is not necessary because an applicant could propose 
the commenter's suggestions under the new requirement to develop and 
evaluate new technologies in the area of wheeled mobility.
    Changes: None.
    Comment: Researchers have recently demonstrated wheelchair control 
systems that augment human motion control. Given the relevance of this 
area of research and the success of state-of-the-art prototypes, it is 
recommended that the commercialization of augmented wheelchair control 
systems be a requirement of this priority.
    Discussion: The RERC can carry out research on augmented wheelchair 
control systems, however, commercialization of augmented wheelchair 
control systems is outside the scope and purpose of the RERC.
    Changes: None.
    Comment: It may be unclear to applicants why it is important to 
integrate external devices with wheelchairs. The priority could be 
improved by adding the word ``control'' to the second activity.
    Discussion: The background section elaborates on the importance of 
control systems for external devices. NIDRR agrees that including 
``control'' in the second activity will clarify the purpose of the 
second activity.
    Changes: The second activity has been revised to include control of 
external devices.
    Comment: A fundamental need before outcome measures can be 
developed for wheelchair seating is to develop the standardized 
measures and terminology that will define and allow communication about 
the quantification of the wheelchair seated posture. The sixth activity 
regarding the development and evaluation of outcome measurement tools 
should be revised to include standardized measures and terminology of 
seated posture.
    Discussion: An applicant could propose to develop and evaluate 
standardized measures and terminology of seated posture under the sixth 
activity of the priority. The peer review process will evaluate the 
merits of this proposal. However, NIDRR has no basis to determine that 
all applicants should be required to develop and evaluate standardized 
measures and terminology of seated posture.
    Changes: None.
    Comment: The RERC should be required to investigate injury risk and 
assess technologies and strategies that will enhance wheelchair safety.
    Discussion: An applicant could propose to investigate injury risk 
and assess technologies and strategies that will enhance wheelchair 
safety under the new requirement to develop and evaluate new 
technologies in the area of wheeled mobility. The peer review process 
will evaluate the merits of the proposal. However, NIDRR has no basis 
to determine that all applicants should be required to investigate 
injury risk and assess technologies and strategies that will enhance 
wheelchair safety.
    Changes: None.

[[Page 32528]]

Priority 6: Technology Transfer
    Comment: The background section should be expanded to discuss 
technology commercialization and technology utilization.
    Discussion: Commercialization and technology utilization are key 
components of technology transfer. Commercialization and technology 
utilization are referred to in a variety of ways throughout the 
background section.
    Changes: None.
    Comment: The words ``technology transfer'' should be added to the 
third and fourth activities in order to clarify that the RERC is 
expected to address the continuum of technology transfer activities.
    Discussion: The third and fourth activities address specific 
development, evaluation, design, and dissemination tasks. It is not 
necessary to include the words ``technology transfer'' in order to 
understand these requirements or ensure that the continuum of 
technology transfer activities will be pursued by applicants.
    Changes: None.
    Comment: The RERC should be required to carry out demonstration 
activities. Technology transfer needs to be demonstrated using 
assistive technology products that are consumer and market responsive.
    Discussion: As reflected in the priority and the selection criteria 
that will be used to evaluate applications, the RERC is required to 
carry out research, development, training, dissemination, utilization, 
and technical assistance activities. Having met the requirements to 
complete these activities, an applicant could propose to carry out 
related demonstration activities. However, NIDRR has no basis to 
determine that all applicants should be required to carry out 
demonstration activities.
    Changes: None.
Proposed Priority 7: Telerehabilitation
    Comment: Four commenters feel the priority should be broadened to 
include the development of strategies and techniques necessary to 
provide and monitor vocational rehabilitation services.
    Discussion: The priority purposefully refers to ``rehabilitation 
services'' in general in order to be applicable to all types of 
rehabilitation services. Therefore, the RERC is expected to address 
vocational rehabilitation services as well as other rehabilitation 
services.
    Changes: None.
    Comment: The four activities do not contain the words ``research,'' 
``engineering,'' or ``science'' and could be misinterpreted as simply 
calling for demonstrations of existing technologies without 
significantly advancing the state-of-the-art. The wording of the 
priority should be modified to strengthen the commitment to scientific 
and engineering investigation.
    Discussion: NIDRR agrees that the priority should be revised in 
order to reinforce the RERC's commitment to scientific and engineering 
investigation.
    Changes: An investigation requirement has been added to the second 
and third activities.
    Comment: A new activity should be added to require the RERC to 
serve as the national focal point for telerehabilitation and virtual 
reality related to individuals with disabilities and to maintain links 
with the much larger international and national telemedicine and 
virtual reality communities.
    Discussion: RERCs are national in scope and expected to take a 
leadership position within the field. The RERC is also expected to 
communicate and coordinate with other entities carrying out related 
research and development activities. Unless the RERC could not achieve 
its purposes without a requirement to coordinate or collaborate with 
specific entities, NIDRR provides applicants with the discretion to 
propose the partners for coordination and collaboration activities.
    Changes: None.
    Comment: Two commenters indicated that, too often, patients in 
rural areas who experience communication disorders are unable to obtain 
state-of-the-art speech and language therapy in geographically 
accessible centers. These commenters suggested that scope of this RERC 
should be expanded to include the rehabilitation of individuals with 
communication disorders in rural settings.
    Discussion: Unless noted otherwise in a priority, any NIDRR-funded 
project or center must address the needs of all persons with 
disabilities, including those with communication disorders.
    Changes: None.
    Comment: Two commenters indicated that the background statement 
mentions ``spinal cord injury, stroke, and traumatic brain injury'' as 
examples of disabling conditions to which telerehabilitation techniques 
might usefully be applied. To avoid ambiguity and an unnecessarily 
narrow mandate, the background statement should be broadened to include 
a broad range of disabilities.
    Discussion: The fact that background statement mentions ``spinal 
cord injury, stroke, and traumatic brain injury'' as examples of 
disabling conditions to which telerehabilitation techniques might 
usefully be applied, is not intended to suggest that the RERC limit its 
activities to these conditions. This RERC is expected to address the 
rehabilitation needs of all persons with disabilities.
    Changes: None.
    Comment: Five commenters indicated the priority focuses too 
narrowly on individuals who lack easy access to outpatient 
rehabilitation care due to geographic remoteness. The commenters 
pointed out that many people in metropolitan areas have geographical 
access problems due, in part, from a lack of accessible transportation. 
The commenters suggest that the first activity be broadened to include 
all consumers of rehabilitation services who encounter barriers to 
receiving continued care through conventional means.
    Discussion: The communication systems that the RERC will identify 
and evaluate to connect comprehensive rehabilitation facilities with 
therapists, individuals, and family members living in remote areas will 
be applicable to all consumers of rehabilitation and settings, 
including metropolitan areas.
    Changes: None.
    Comment: Two commenters feel the last sentence of the third 
paragraph in the background statement appears to limit monitoring 
capabilities to only video and audio technologies. The commenters 
suggested that the sentence should be broadened to include a variety of 
promising sensor technologies.
    Discussion: The RERC will include sensor technologies in its 
activities, and these technologies are referenced in the second 
paragraph of the background statement.
    Changes: None.
    Comment: The word ``diagnostic'' in the second activity is too 
limiting and should be replaced with either ``assessment'' or 
``evaluation.''
    Discussion: NIDRR agrees that ``assessment'' is a more appropriate 
term.
    Changes: The second activity has been revised by substituting the 
word ``assessment'' for ``diagnostic.''
    Comment: The second activity should be expanded beyond 
rehabilitation to include post-rehabilitation health services.
    Discussion: Having met all the requirements of the priority, an 
applicant could propose to include post-rehabilitation health services 
within the scope of its activities. The peer review process will 
evaluate the merits of the proposal. However, NIDRR has no basis

[[Page 32529]]

to determine that all applicants should be required to include post-
rehabilitation health services within the scope of the RERC's 
activities.
    Changes: None.
    Comment: Managed care will have a major impact on the extent to 
which telerehabilitation will be used once these technologies are 
developed. Therefore, this RERC should be required to coordinate its 
activities with the NIDRR funded RRTC on Managed Health Care for 
Individuals with Disabilities.
    Discussion: An applicant could propose to coordinate with the RRTC 
on Managed Health Care. The peer review process will evaluate the 
merits of this proposal. However, it is not necessary for the RERC to 
coordinate with the RRTC on Managed Health Care in order to carry out 
its purposes.
    Changes: None.
    Comment: Three commenters suggested that the priority should 
identify relevant rehabilitation disciplines such as occupational 
therapy, physical therapy, speech pathology and nursing. A fourth 
commenter indicated that nurses are the most common caregivers in the 
home setting and suggested that nurses should be included in the first 
activity.
    Discussion: NIDRR agrees that the use of the term ``therapists'' in 
the first activity may be interpreted narrowly. ``Providers of 
rehabilitation services'' is a broader category would clearly include 
nurses.
    Changes: The first activity has been revised by substituting 
``providers of rehabilitation services'' for ``therapists.''
    Comment: In regard to the second and fourth activities, the RERC 
should provide a testbed environment to demonstrate concepts prior to 
investment, including simulating telecommunication links to test 
bandwidth performance and simulating new rehabilitation strategies and 
devices in virtual reality software. Specifically the RERC should: 
demonstrate the application of tools via pilot tests with regional 
rehabilitation service partners; demonstrate the application of 
technology to establish on-line rehabilitation services communities; 
and provide collaborative virtual reality capabilities establishing on-
line communities via the Internet to provide job postings, 
rehabilitation news, tips and best practices, virtual reality 3D chat 
rooms, push technology features to reach remote users, and education 
and training simulations.
    Discussion: All of the proposals contained in this comment are 
within the scope of the priority and could be proposed by an applicant 
to achieve the purposes of the second and fourth activity. The peer 
review process will evaluate the merits of the proposals. There is 
insufficient evidence to warrant requiring all applicants to carry out 
the activities suggested in the comment.
    Changes: None.
    Comment: Although telerehabilitation and virtual reality are new 
technologies, they have little in common. Virtual reality is a therapy, 
while telerehabilitation is a health care delivery and educational 
system. The fourth activity requiring the RERC to investigate the use 
of virtual reality should be deleted from this priority. Virtual 
reality deserves a separate priority.
    Discussion: NIDRR disagrees that virtual reality is a therapy. 
NIDRR believes that it is an emerging technology with significant 
therapeutic potential. In light of substantial work that is being 
supported elsewhere in the public and private sector on virtual reality 
applications, NIDRR believes that authorizing this RERC to undertake 
one activity investigating the use of virtual reality in rehabilitation 
is a proper course of action.
    Changes: None.
    Comment: The RERC should be required to implement the concepts of 
universal design and universal access in all facets of their research.
    Discussion: NIDRR supports the promotion of universal design and 
universal access through a variety of research, training, technical 
assistance, and information dissemination activities. An applicant 
could propose to carry out its activities consistent with concepts of 
universal design and access. The peer review process will evaluate the 
merits of this approach. However, NIDRR declines to require all 
applicants to implement these concepts because the RERC's purpose could 
be achieved without adherence to these concepts.
    Changes: None.
    Comment: The RERC should not only research strategies that employ 
remote technologies to deliver services, but also strategies to collect 
and analyze process and outcome data over time.
    Discussion: NIDRR agrees with the commenter and points out that the 
RERC is required to develop and evaluate these strategies under the 
third activity in the priority. No further changes are necessary in the 
priority.
    Changes: None.
    Comment: Although some systems may already be in place to 
facilitate the delivery of telerehabilitation services, new 
technologies are emerging every day. The word ``develop'' should be 
included in the first activity.
    Discussion: NIDRR agrees that the RERC should not only identify and 
evaluate, but also develop communications systems under the first 
activity in the priority.
    Changes: The priority has been revised to require the RERC to 
develop communications systems under the first activity in the 
priority.
    Comment: The priority does not mention the potential that 
telecommunication technology has in promoting organizational and 
multidisciplinary team collaboration. NIDRR should place an emphasis on 
evaluation of telecommunications technology in fostering collaboration.
    Discussion: An applicant could propose to place an emphasis on 
telecommunications technology that fosters collaboration. The peer 
review process will evaluate the merits of this emphasis. However, 
NIDRR has no basis to determine that all applicants should be required 
to place an emphasis on telecommunications technology that promotes 
collaboration.
    Changes: None.
    Comment: Given that shorter lengths-of-stay are becoming common 
place throughout the rehabilitation community, the RERC should be 
required to explore techniques for extending rehabilitation programs in 
the home and other settings (e.g., day care centers, senior centers, 
independent living centers).
    Discussion: An applicant could propose to explore techniques for 
providing rehabilitation services through telerehabilitation in a 
variety of settings, including day care centers, senior centers, and 
independent living centers. The peer review process will evaluate the 
merits of this proposal. However, NIDRR has no basis to determine that 
all applicants should be required to propose extending rehabilitation 
programs through telerehabilitation in a variety of settings, including 
day care centers, senior centers, and independent living centers.
    Changes: None.
    Comment: Virtual reality is a costly technology and activities 
related to virtual reality development and testing could engage a 
disproportionately high portion of the resources available for this 
RERC. A relatively modest project involving applications of virtual 
reality could easily account for all of the funds proposed to support 
this RERC. It would be disappointing to see a focus on such a high 
profile application deter development of lower cost technologies that 
may have more immediate and broader payoff.
    Discussion: NIDRR recognizes that the emerging field of virtual 
reality could

[[Page 32530]]

easily overwhelm the resources of the RERC and has purposefully limited 
the fourth activity to research related to virtual reality rather than 
development.
    Changes: None.
    Comment: Care should be taken to ensure that technologies developed 
under this RERC can be used in settings without state-of-the-art 
hardware and software. Developing technology applications that take 
advantage of the existing communication infrastructure has the 
potential to put state-of-the-art rehabilitation services within reach 
of all people, regardless of the wealth of the community.
    Discussion: NIDRR agrees that the RERC should develop technologies 
with the broadest application. The selection criteria used in the peer 
review process will address this issue by evaluating the impact of the 
proposed activities on the target population.
    Changes: None.
    Comment: The priority should be broadened to require the RERC to 
study policy issues (e.g., reimbursement issues and selection criteria) 
that will affect the implementation of telerehabilitation.
    Discussion: NIDRR agrees that there are policy issues that will 
affect the implementation of telerehabilitation. An applicant could 
propose to integrate policy issues into the first, third, and fourth 
activities of the priority. The peer review process will evaluate the 
merits of the proposal. However, there is insufficient evidence to 
require that all applicants address policy issues related to the 
implementation of telerehabilitation.
    Changes: None.
    Comment: The third activity appears to focus on remote therapeutic 
interventions while the second activity focuses on evaluation tools. Is 
this interpretation correct?
    Discussion: The commenter's interpretation is correct.
    Changes: None.

Rehabilitation Research and Training Centers

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

Description of Rehabilitation Research and Training Centers

    RRTCs are operated in collaboration with institutions of higher 
education or providers of rehabilitation services or other appropriate 
services. RRTCs serve as centers of national excellence and national or 
regional resources for providers and individuals with disabilities and 
the parents, family members, guardians, advocates or authorized 
representatives of these individuals.
    RRTCs conduct coordinated, integrated, and advanced programs of 
research in rehabilitation targeted toward the production of new 
knowledge to improve rehabilitation methodology and service delivery 
systems, to alleviate or stabilize disabling conditions, and to promote 
maximum social and economic independence of individuals with 
disabilities.
    RRTCs provide training, including graduate, pre-service, and in-
service training, to assist individuals to more effectively provide 
rehabilitation services. They also provide training including graduate, 
pre-service, and 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.

General RRTC Requirements

    The following requirements apply to these RRTCs pursuant to these 
absolute priorities unless noted otherwise. An applicant's proposal to 
fulfill these requirements will be assessed using applicable selection 
criteria in the peer review process.
    The RRTC must provide: (1) applied research experience; (2) 
training on research methodology; and (3) training to persons with 
disabilities and their families, service providers, and other 
appropriate parties in accessible formats on knowledge gained from the 
Center's research activities.
    The RRTC must develop and disseminate informational materials based 
on knowledge gained from the Center's research activities, and 
disseminate the materials to persons with disabilities, their 
representatives, service providers, and other interested parties.
    The RRTC must involve individuals with disabilities and, if 
appropriate, their representatives, in planning and implementing its 
research, training, and dissemination activities, and in evaluating the 
Center.
    The RRTC must conduct a state-of-the-science conference and publish 
a comprehensive report on the final outcomes of the conference. The 
report must be published in the fourth year of the grant.

Priorities

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

Priority 1: Aging with a Disability

Background
    Advances in medical care, rehabilitation technology, and 
rehabilitative treatment have made aging a routine event for persons 
with a disability. The rapid increase in the number of people with a 
physical disability who are growing older has been well documented 
(McNeil, J., ``Americans With Disabilities,'' U.S. Bureau of the 
Census, Statistical Brief,

[[Page 32531]]

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

[[Page 32532]]

Priority 2: Arthritis Rehabilitation

Background
    ``Arthritis'' means joint inflammation and encompasses a large 
family of more than 100 so-called rheumatic diseases that can affect 
people of all ages. The prevalence of many of these diseases tends to 
increase with age and several occur predominantly in women; others are 
more common in men. These diseases can affect joints, muscles, tendons, 
ligaments, and the protective coverings of some internal organs. Onset 
is usually in middle age, and arthritis and musculoskeletal conditions 
typically present a cluster of chief complaints including, but not 
limited to, pain, muscle impairments, and joint impairments. Arthritis 
and musculoskeletal conditions typically result in functional 
limitations in ADL. While individuals with arthritis experience most of 
their limitations in physical functional activities, the concept of 
function has psychological and social dimensions as well (Guccione, A. 
A., ``Arthritis and the Process of Disablement,'' Physical Therapy, 
Vol. 74, No. 5, May, 1994). For the purpose of this priority, arthritis 
and musculoskeletal diseases must include, but are not limited to, 
rheumatoid arthritis (RA), osteoarthritis (OA), juvenile rheumatoid 
arthritis (JRA), osteoporosis, and fibromyalgia syndrome.
    Physical activity may provide significant physical and mental 
health benefits for persons with arthritis and musculoskeletal 
diseases. In recognizing that regular physical activity can help 
control joint swelling and pain, the U.S. Surgeon General's 1996 Report 
on Physical Activity and Health, urges people with arthritis to 
exercise. The Center for Disease Control and Prevention has indicated 
that most persons with arthritis and other rheumatic conditions should 
engage in physical activity because exercise helps people with 
arthritis maintain normal muscle strength and joint function and 
reduces the risk of premature death, heart disease, diabetes, high 
blood pressure, colon cancer, depression, and anxiety (Krucoff, C., 
``Taking Action Against Arthritis,'' The Washington Post Health 
Section, October 21, 1997). Maintenance of health and wellness is 
important when dealing with the problems of arthritis and 
musculoskeletal diseases. A number of factors, such as understanding 
and managing fatigue and conserving energy, developing relaxation 
techniques, participating in exercise programs, and learning about 
weight control and proper nutrition, aid in the goal of achieving a 
quality of life for individuals who cope with the various problems 
encountered.
    Pain is a major concern for individuals with arthritis and 
musculoskeletal diseases. Pain can affect the ability to work or 
function independently in the home or community. The increased 
dependency encountered, the thoughts of progressive deformities, and 
feelings of frustration through loss of control often lead to 
psychosocial difficulties. Rehabilitation interventions can reduce 
pain, depression and improve functional abilities.
    Musculoskeletal conditions are among the top-ranked conditions 
causing limitations in the ability to perform work and reported as 
causes of actual work loss. Estimates for prevalence of work 
disability, defined as ceasing to work, ranges from 51 percent to 59 
percent. Clinical studies have indicated that when RA is in a severe 
form, this rate could be as high as 60 percent a decade after diagnosis 
(Felts, W. and Yelin, E., ``The Economic Impact of the Rheumatic 
Diseases in the United States,'' Journal of Rheumatology, 16, pgs. 867-
884, 1989). Decreased work satisfaction has been reported by persons 
with RA; 59 percent are unable to maintain gainful employment. In 
addition, patients with RA are significantly more likely to have lost 
their job or to have retired early due to their illness, and are the 
most likely to have reduced their work hours or stopped working 
entirely due to their illness (Gabriel S. E., et al., ``Indirect and 
Nonmedical Costs Among People with RA and OA Compared with Nonarthritic 
Controls,'' Journal of Rheumatology, 24(1), pgs. 43-48, January, 1997). 
Reasonable job accommodations for people with arthritis and 
musculoskeletal diseases to manage fatigue, stress, job performance 
issues, allowances for medical treatments and individual-related 
modifications are areas for employers to consider.
    More than 200,000 children in the U.S. are affected with some form 
of arthritis (Cassidy, J. T., et al., ``Juvenile Rheumatoid 
Arthritis,'' Textbook of Pediatric Rheumatology, pgs. 133-233, 1995). 
JRA is the most common childhood connective tissue disease (Chaney, J. 
and Peterson, L., Journal of Pediatric Psychology, Vol. 14, No. 3, 
1989). JRA affects the physical, psychological and social development 
of children and adolescents. Assessing needs and developing strategies 
to aid in the promotion of improved medical, educational, psychosocial, 
and vocational services is essential with this population.
Priority 2
    The Secretary will establish an RRTC on Arthritis Rehabilitation to 
improve the functional abilities and promote the independence of 
individuals with arthritis and musculoskeletal diseases. The RRTC 
shall:
    (1) Identify, develop, and evaluate exercise and fitness programs;
    (2) Identify, develop, and evaluate rehabilitation interventions to 
increase psychological well-being and reduce pain;
    (3) Identify, develop, and evaluate job accommodations to maintain 
employment; and
    (4) Identify, develop, and evaluate programs to maintain health and 
wellness.
    In carrying out the purposes of the priority, the RRTC must:
     Address the needs of children and youth; and
     Coordinate with arthritis activities sponsored by the 
National Institute on Arthritis and Musculoskeletal and Skin Diseases, 
the National Center for Medical Rehabilitation Research, and other 
entities carrying out related research or training activities.

Priority 3: Stroke Rehabilitation

Background
    In the U.S., there are approximately three million stroke survivors 
and 400,000 to 500,000 new or recurrent stroke cases annually 
(Gorelicj, P., ``Stroke Prevention,'' Archives of Neurology, 52(4), 
pgs. 347-355, 1995). Stroke survivors are the largest population in 
rehabilitation hospitals, and an estimated $30 billion is spent on 
stroke treatment each year (Alberts, M., et al., ``Hospital Charges for 
Stroke Patients,'' Stroke, 27 (10) pgs. 1825-1828, 1996). Previous 
NIDRR-funded stroke rehabilitation research has focused on prevention 
and treatment of secondary conditions of stroke; enhancing functional 
capacity following stroke; improving social and community functioning; 
and studying the natural history of impairment, disability, and quality 
of life after stroke.
    Rehabilitation goals for stroke patients focus on maximizing 
physical and psychological function, teaching patients about prevention 
of recurrent stroke, and working with family members to facilitate 
integration of the person recovering from stroke back into family and 
community settings. Stroke patients potentially face a number of 
functional problems resulting from the paralysis, dysphagia, 
neurological, and other health-related sequelae of stroke.

[[Page 32533]]

    Higher order cognitive deficits, such as incomprehension and short-
term memory loss, have been shown to have a primary role in predicting 
rehabilitation length of stay, functional outcome and long-term care 
needs of stroke survivors. Early, comprehensive assessment of cognitive 
deficits has been shown to play a significant role in effecting better 
rehabilitation outcomes (Galski, T., et al., ``Predicting Length of 
Stay, Functional Outcome, and Aftercare in the Rehabilitation of Stroke 
Patients. The Dominant Role of 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. 337-346, 1996).
    Changes in personality, mood, and temperament can be confusing and 
distressing for stroke survivors and their caregivers. Depression can 
be a significant problem for both survivors and caregivers (Kumar, A., 
et al., ``Quantitative Anatomic Measures and Comorbid Medical Illness 
in Late-life Major Depression,'' American Journal of Geriatrics 
Psychiatry, 5(1), pgs. 15-25, 1997). Effective treatment of 
psychological and behavioral problems may require more standardized 
approaches that incorporate psychopharmacological, behavioral, and 
psychological interventions.
    Although stroke is predominantly a phenomenon that strikes persons 
aged 65 and over, five percent occur in persons under age 45. 
Individuals in this age cohort are generally employed, have a longer 
life expectancy than older stroke patients, and generally have better 
underlying health status and incur less brain injury related to the 
stroke (Ferro, J. and Crespo, M., ``Prognosis After Transient Ischemic 
Attack and Ischemic Stroke in Young Adults,'' Stroke, (8), pgs. 1611-
1616, August, 1994). Rehabilitation for younger patients may emphasize 
vocational options, sexuality, and social functioning (Roth, E., ``From 
the Editor,'' Topics in Stroke Rehabilitation--The Young Stroke 
Survivor, Vol. 1, pg. vi, Spring, 1994). In addition, complications 
such as drug use or pregnancy may complicate rehabilitation strategies 
(Meyer, J., et al., ``Etiology and Diagnosis of Stroke in the Young 
Adult,'' Topics in Stroke Rehabilitation--The Young Stroke Survivor, 
Vol. 1, pgs. 1-14, Spring, 1994).
    Persons at the other end of the age spectrum, those over age 75 who 
comprise 41.8 percent of stroke rehabilitation patients (Personal 
communication with Samuel J. Markello, Ph.D. and Carl V. Granger, M.D., 
Director, National Rehabilitation Outcomes Database, maintained by the 
Uniform Data System for Medical Rehabilitation, University of Buffalo, 
January, 1998), are at risk for poor rehabilitation outcomes possibly 
because of the effects of frailty and 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.
    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.
Priority 3
    The Secretary will establish an RRTC for Stroke Rehabilitation to 
develop and evaluate rehabilitation approaches to improve stroke 
rehabilitation treatment for all patients. The RRTC shall:
    (1) Identify, develop, and evaluate rehabilitation techniques to 
address coexisting and secondary conditions and improve outcomes for 
all stroke patients, giving specific emphasis to rehabilitation needs 
of older and younger patient groups and to methods that incorporate 
cognition in the treatment protocols;
    (2) Develop and evaluate standard aerobic exercise protocols; and
    (3) Identify and evaluate methods to identify and treat depression 
and other psychological problems associated with stroke;
    (4) Determine the effectiveness of stroke prevention education 
provided in medical rehabilitation settings;
    (5) Evaluate the impact of changes in diagnosis and medical 
treatment of stroke on rehabilitation needs;
    (6) Evaluate long-range outcomes for stroke rehabilitation across 
different treatment settings;

[[Page 32534]]

    (7) Evaluate the impact of stroke practice guidelines on delivery 
and outcomes of rehabilitation services.
    In carrying out the purposes of the priority, the RRTC must:
     Collaborate with RRTCs on Health Care for Individuals with 
Disabilities--Issues in Managed Health Care, and Aging with a 
Disability; and
     Coordinate with stroke activities sponsored by the 
National Center for Medical Rehabilitation Research, the National 
Institute on Neurological Disorders and Stroke, and other entities 
carrying out related research or training activities.

Rehabilitation Engineering Research Centers

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

Description of Rehabilitation Engineering Research Centers

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

General RERC Requirements

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

Priorities

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

Priority 4: Prosthetics and Orthotics

Background
    Prosthetic limbs (also called artificial or replacement limbs) 
perform functions previously performed by lost or absent limbs or 
portions of limbs. Orthoses (also called braces or anatomical 
technology devices) are devices applied to limbs or other parts of the 
body that have either lost or impaired function to compensate for 
certain differences in anatomical shape or size, muscle weakness, or 
paralysis. Appropriately fitted prosthetic and orthotic (P and O) 
devices improve functional abilities for work and ADL.
    The National Health Interview Survey of 1992 reported a prevalence 
in the United States of 102,000 individuals with upper extremity loss 
or absence, and 256,000 individuals with lower extremity loss or 
absence (LaPlante, M. and Carlson, D., ``Disability in the United 
States: Prevalence and Causes, 1992'' Disability Statistics Report No. 
7, NIDRR, pg. 29, 1996). The majority of these individuals use or need 
prosthetic limbs. It is more difficult to estimate the prevalence of 
individuals who use or need orthotic devices because orthoses are used 
in a wide variety of disabilities, and unlike loss or absence of a 
limb, have not historically been a specific category in national 
surveys. However, the National Health Interview Survey on Assistive 
Devices (NHIS-AD) of 1990 reported that 3,514,000 individuals in the 
United States used anatomical technology devices, categorized as braces 
for either the leg, foot, arm, hand, neck, back or other (LaPlante, M. 
P., et al., ``Assistive Technology Devices and Home Accessibility 
Features: Prevalence, Payment, Need, and Trends,'' Advance Data from 
Vital and Health Statistics, National Center for Health Statistics, No. 
217, pg. 6, 1992).
    According to the Institute of Medicine, there is a lack of a 
complete and widely accepted base of scientific and engineering data to 
support the process of individuals obtaining the optimum device for 
their particular need. The lack of an effective scientific and 
theoretical foundation for human gait inhibits the engineering design 
of technology to aid ambulation. More

[[Page 32535]]

work is also needed in research and development directed to the 
problems of arm and hand replacement (Enabling America: Assessing the 
Role of Rehabilitation Science and Engineering, Institute of Medicine 
Report, pgs. 111-117, 1997).
    The enormous diversity of P and O devices to address many different 
muscular, neuromuscular, and skeletal issues, adds to the complexity of 
this field and supports the need for quantitative documentation to 
improve the process by which individuals obtain the most appropriate P 
and O device for their need (Esquenazi, A. and Meier, R. H., 
``Rehabilitation in Limb Deficiency. 4. Limb Amputation,'' Archives of 
Physical Medicine and Rehabilitation, Vol. 77, pgs. s18-s28, 1996). For 
example, there are approximately 100 commercially available prosthetic 
knees capable of being used in transfemoral prostheses (Michael, J. W., 
``Prosthetic Knee Mechanisms,'' Physical Medicine and Rehabilitation: 
State of the Art Reviews, Vol. 8, pgs. 147-164, 1994), making it 
difficult to evaluate all possible options. The trend in health care 
toward evidence-based decision making will require the collection and 
analysis of data that may not have occurred in the past (Guyatt, G., et 
al., ``Evidence-Based Medicine: A New Approach to Teaching the Practice 
of Medicine,'' JAMA, Vol. 268, pgs. 2420-2425, 1992).
    Evaluations will play a key role in shaping the services available 
in the future (Hailey, D. M., ``Orthoses and Prostheses,'' 
International Journal of Technology Assessment in Health Care, Vol. 11, 
pgs. 214-234, 1995). As more quantitative measurements are being made 
at the individual level with respect to device selection, there is a 
need to collect data on use of devices by individuals in a uniform 
format for archival reference and research purposes. A database that 
could be used to evaluate the outcomes of individuals using P and O 
devices does not exist. Such a database might include, but would not be 
limited to: technical specifications and details of the device; 
appropriate performance and outcome measures; relevant anthropometric 
measurements of the wearer; appropriate medical and demographic data, 
and payment information.
    The increased attention to prosthetic technology in developing 
nations (Day, H. J. B., ``A Review of the Consensus Conference on 
Appropriate Prosthetic Technology in Developing Countries,'' 
Prosthetics and Orthotics International, Vol. 20, pgs. 15-23, 1996) 
along with the advanced state of science in many European nations, 
provides opportunity and impetus for the development of international 
standards in P and O. In addition, increased international exchanges of 
both information and technology, as a result of comparative work, are 
highly likely to be beneficial to both the United States and other 
countries.
Priority 4
    The Secretary will establish an RERC on Prosthetics and Orthotics 
to strengthen and expand the scientific and engineering basis for the 
field, and develop new ways to use information technology that will 
ultimately result in delivery of improved service to individuals who 
can benefit from prosthetic and orthotic devices. The RERC shall:
    (1) Increase the understanding of the scientific and engineering 
principles for human locomotion, reaching, prehension, and 
manipulation, and incorporate these principles into the design of P and 
O devices;
    (2) Develop and evaluate a prototype computer-based system to 
select the most appropriate P and O device (or combination of devices), 
and fit the device to an individual;
    (3) Develop a prototype database of individuals using P&O devices 
in collaboration with industry including, but not limited to, technical 
details of the device, appropriate performance and outcome measures, 
relevant anthropometric measurements of the wearer, appropriate medical 
and demographic data, and cost and payment information; and
    (4) Maintain an international exchange of scientific information 
and participate in the development of international standards.
    In carrying out these purposes, the RERC must coordinate on 
activities of mutual interest with the RERC on Land Mines and other 
entities carrying out related research or development activities.

Priority 5: Wheeled Mobility

Background
    Approximately 1.4 million Americans use a wheelchair as their 
primary source of mobility (Kraus, L., et al., Chartbook on Disability 
in the United States, InfoUse, Berkeley, CA, 1996), including 
approximately 600,000 Americans who live in skilled nursing facilities 
and are over the age of 65 (Shaw, G. and Taylor, S. J., ``A Survey of 
Wheelchair Seating Problems of the Institutionalized Elderly,'' 
Assistive Technology, Vol. 3, RESNA Press, pgs. 5-10, 1991). The number 
of Americans who use wheelchairs nearly doubled between 1980 and 1990 
while the general population increased by 13 percent during that same 
period (LaPlante, M. P., et al., ``Assistive Technology Devices and 
Home Accessibility Features: Prevalence, Payment, Need, and Trends,'' 
Advance Data from Vital and Health Statistics, No. 217, U.S. Department 
of Health and Human Services, September, 1992). The number of 
wheelchair users increases as a population ages (Ohlin, P., et al., 
``Technology Assisting Disabled and the Older People in Europe,'' The 
Swedish Handicap Institute, Stockholm, 1995). As the American 
population continues to grow older, the number of individuals who will 
require the use of a wheelchair for mobility is expected to increase.
    Wheelchairs and wheelchair seating systems have dramatically 
improved over the past decade due in part to advances in lightweight, 
high-strength materials, improved mechanical designs, and improved 
microprocessor control technologies, and more efficient drive train 
systems for powered chairs. There are virtually hundreds of options 
available to wheelchair users (e.g., frame sizes and designs, castors, 
hand rims, seat sizes, and seat backs). Selecting the appropriate 
options when either prescribing or purchasing a wheelchair or 
wheelchair seating system can be complicated and difficult for 
therapists and consumers.
    Individuals who use powered wheelchairs often rely on external 
devices (e.g., ventilators, augmentative communication devices, and 
environmental control systems) for respiratory support or to help them 
function during the day. Improvements in electronic technologies have 
led to the development of sophisticated wheelchair controllers with 
built-in flexibility and adjustability. Typical controllers are based 
on microcomputers and allow for the adjustment of parameters (e.g., 
acceleration and deceleration control, speed control, and tremor 
dampening) to improve the user's ability to control the wheelchair 
safely (Cook, A. M. and Hussey, S. M., Assistive Technologies: 
Principles and Practice, pg. 549, 1995). These controllers are also 
capable of directly controlling external devices. Most external devices 
are made by companies other than wheelchair manufacturers. As a result, 
compatibility between external devices and powered wheelchairs is often 
problematic.
    Wheelchairs and wheelchair seating systems combine to provide 
mobility, pressure relief, postural support, deformity management, and 
increased comfort, function and tolerance

[[Page 32536]]

(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, p. 4, 1990). Without 
proper pressure relief, individuals are prone to develop pressure sores 
(decubitus ulcers) that can result in tremendous costs for treatment 
and in time lost from work (Ditunno, J. F., Jr. and Formal, C. S., 
``Chronic Spinal Cord Injury,'' New England Journal of Medicine, Vol. 
330, pgs. 550-556, 1994). The incidence for pressure sores has remained 
fairly static (Stover, S. L., et al., Spinal Cord Injury: Clinical 
Outcomes from the Model Systems, pgs. 109-113, 1995). There are many 
factors that contribute to the development of pressure sores. External 
forces (i.e., tension, compression, and shear) applied to localized 
areas are the primary causes of pressure sores. Other factors affecting 
pressure sore development include, but are not limited to, stress, 
friction, body size, posture, nutrition, age, blood circulation, and 
the microclimate between one's body and the seating surface (Cook, A. 
M. and Hussey, S. M., op. cit., pgs. 282-285). Understanding the 
interactions between these factors is paramount to improving seating 
and positioning systems.
    Decisions made during seating evaluations are often subjective in 
nature and are based upon observational analyses and past experience of 
the therapists involved. There are over 300 commercially available 
cushions on the market (HyperABLEDATA, 1997), as well as a myriad of 
wheelchair options. Understanding these options and knowing when to use 
them is difficult for therapists and consumers. Voluntary performance 
standards for seating and clinical measurement devices would allow for 
objective comparison of products based upon standardized test results 
from each manufacturer.
    A number of outcome measurement tools may be used to measure 
functional outcomes of individuals during the rehabilitation process. 
However, many of these tools do not consider assistive technology 
interventions, including seating and mobility, when rating an 
individual's overall performance. For example, in order to get a 
maximum score using the Functional Independence Measure, the individual 
cannot rely on assistive technology; thereby implying that a person 
cannot be totally functionally independent if he or she uses assistive 
technology devices (Scherer, M. J. and Galvin, J. C., ``An Outcomes 
Perspective of Quality Pathways to the Most Appropriate Technology,'' 
Evaluating, Selecting, and Using Appropriate Assistive Technology, pg. 
21, 1996). A number of clinical measurement devices (e.g., pressure 
monitoring devices, and seating simulators) may be used in seating and 
mobility clinic environments, however, they do not systematically 
measure and record outcomes of wheelchair and seating interventions.
Priority 5
    The Secretary will establish an RERC on Wheeled Mobility to improve 
the efficiency and selection of wheelchairs and wheelchair seating 
systems and investigate new seating system strategies including dynamic 
seating systems and pressure sore prevention. The RERC shall:
    (1) Develop and evaluate strategies that can be used to aid 
therapists and consumers in making informed decisions when prescribing 
or purchasing new wheelchairs and wheelchair seating systems;
    (2) Develop and evaluate strategies in collaboration with industry 
to promote the integration of external devices with powered wheelchairs 
and the control of these external devices, ensuring their compatibility 
and usability;
    (3) Develop and evaluate new technologies in the area of wheeled 
mobility;
    (4) Investigate the viability of dynamic seating systems;
    (5) Investigate the factors that contribute to the development of 
pressure sores and develop and evaluate tools, devices and strategies 
to prevent them from occurring;
    (6) Investigate the use of voluntary performance standards for 
wheelchair seating devices and clinical measurement devices and, if 
appropriate, develop in collaboration with industry strategies to 
facilitate the implementation of those standards; and
    (7) Develop and evaluate outcome measurement tools for quantifying 
seating clinic intervention results.
    In carrying out the purposes of the priority, the RERC must 
coordinate on activities of mutual interest with all the RRTCs 
addressing Spinal Cord Injury, the RRTC on Aging with a Disability, and 
other entities carrying out related research or development activities.

Priority 6: Technology Transfer

Background
    Technology transfer is a means of capitalizing on and increasing 
the value of an initial investment in research of a particular 
technology through new applications. Technology transfer also involves 
moving conceptualizations and new inventions from a potential 
application into a working prototype and, ultimately, into a commercial 
product. There has been an increased interest in developing assistive 
technology in recent years. Basic research has yielded innovations 
developed with the disability population in mind and more generic 
applied research has resulted in new ways to transfer existing 
technologies initially developed for different purposes into assistive 
technology products. In addition, there are an increasing number of 
entrepreneurs and inventors developing devices specifically for persons 
with disabilities.
    Approximately 13 million people with disabilities use assistive 
technology devices to assist them with major life activities (Kraus, 
L., et al., Chartbook on Disability in the United States, InfoUse, 
Berkeley, CA, 1996). Understanding the functional needs of persons with 
disabilities, translating those needs into technical solutions, 
identifying the markets and determining which technologies may be 
successfully transferred into usable assistive technology products is 
critical to the

[[Page 32537]]

technology transfer process (Spaepen, A. J., ``Technology Transfer and 
Service Delivery in Rehabilitation Technology,'' Journal of 
Rehabilitation Sciences, Vol. 4, pgs. 84-87, 1991). The assistive 
technology market is expected to grow dramatically over the next two 
decades as the American population ages and as the survival rate of 
accident victims continues to climb (Federal Laboratory Consortium, 
``Federal Laboratory Technologies Enable the Disabled,'' Technology 
Transfer Business, Vol. 4, p. 11, 1997).
    There are models of technology transfer that are routinely utilized 
by government, small businesses, nonprofit organizations, universities 
and industry (Rouse, D., ``Technology Identification and Partnership 
Development,'' Research Triangle Institute, 1997). These models assume 
a market that is identifiable and definable, somewhat homogeneous, 
visible, and 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, p. 156, 1991). The evaluation 
phase should include an assessment of whether a product may have 
universal application, thereby increasing its marketability.
Priority 6
    The Secretary will establish an RERC on technology transfer to 
facilitate and improve the process of moving new, useful and better 
assistive technology inventions and applications of existing 
technologies from the prototype phase to the marketplace to benefit 
persons with disabilities. The RERC shall:
    (1) Identify and evaluate models of technology transfer that are 
applicable to assistive technology;
    (2) Identify the needs and provide technical assistance, including 
engineering design and support, to inventors, entrepreneurs, small 
companies, research laboratories, and industry and university labs to 
facilitate the transfer of assistive technology with particular 
emphasis on orphan products;
    (3) Develop and implement methodologies to screen promising 
assistive technology and to evaluate the potential for 
commercialization, including an assessment of principles of universal 
design of prototypes developed by individual inventors, small 
businesses and public or private research laboratories for use by 
persons with disabilities; and
    (4) Design and disseminate protocols for technical, user and market 
evaluations of promising inventions and new uses for existing 
technologies.
    In carrying out the purposes of the priority, the RERC must:
    Conduct activities in consultation with industry, public and 
private research facilities, small businesses, entrepreneurs, 
university-based research laboratories and consumers; and
    Provide technical assistance and support to all RERC's on issues 
pertaining to technology evaluation and transfer.

Priority 7: Telerehabilitation

Background
    One of the most notable changes in the nation's health care system 
is a dramatic downward shift in the average length of stay for patients 
admitted to rehabilitation hospitals. According to the National Spinal 
Cord Injury Statistical Center, the average length of stay for patients 
admitted into the Model SCI Care System dropped from 115 days in 1974 
to 49 days in 1995 (``Spinal Cord Injury: Facts and Figures at a 
Glance,'' National Spinal Cord Injury Statistical Center, University of 
Alabama at Birmingham, August, 1997). Individuals living in rural areas 
may have less of an opportunity to continue their rehabilitation than 
do individuals living in urban settings due to a lack of rehabilitation 
outpatient centers in rural regions. Given that individuals are being 
discharged earlier in the rehabilitation process, there is tremendous 
need for new and innovative therapeutic devices and strategies that can 
be used to continue therapy for individuals living in remote settings 
who may not have access to outpatient therapy.
    For more than 30 years, clinicians, researchers, and others have 
been

[[Page 32538]]

investigating the use of advanced telecommunications and information 
technologies to improve health care, resulting in the advent of 
telemedicine. Telemedicine has a variety of applications including 
patient care, education, research, administration and public health 
(Telemedicine: A Guide to Assessing Telecommunications in Health Care, 
Institute of Medicine Report, National Academy Press, p. 16, 1996). At 
least 10 States have established Medicaid payment mechanisms for 
medical services provided through telemedicine (U.S. Department of 
Commerce, ``Telemedicine Report to Congress,'' January 31, 1997). 
Technological advances in medicine, sensor technologies, 
telecommunications and information technologies provide unique 
opportunities for expanding upon the field of telemedicine to further 
develop the field of telerehabilitation. By using technology, 
telerehabilitation enables rehabilitation professionals to provide 
rehabilitation services to individuals when distance separates the 
participants (Temkin, A. J., et al., ``Telerehab: A Perspective of the 
Way Technology is Going to Change the Future of Patient Treatment,'' 
REHAB Management, p. 28, February/March, 1996). Telecommunication and 
information technologies used in telemedicine are modernizing medical 
rehabilitation services and are beginning to be used in other aspects 
of the rehabilitation process. For example, ongoing experiments to 
provide effective delivery of therapeutic counseling from the offices 
of professional psychologists to clients physically located elsewhere, 
using modified video-conferencing techniques, are under study by the 
American Psychological Association (Sleek, S., ``Providing Therapy from 
a Distance,'' APA Monitor, American Psychological Association, Vol. 28, 
No. 8, August, 1997).
    Two very important aspects of comprehensive rehabilitation are 
education and training. Rehabilitation practitioners work closely with 
individuals and family members to enhance their functional abilities, 
assist them in adjusting to their disability (Haas, J., ``Ethical 
Issues in Rehabilitation Medicine,'' Rehabilitation Medicine: 
Principles and Practice, Second Edition, p. 34, 1993), and lessen the 
likelihood of secondary complications (Stover, S., et al., Spinal Cord 
Injury: Clinical Outcomes from the Model Systems, p. 322, 1995). 
Secondary complications from acute trauma, such as spinal cord injury, 
stroke, and traumatic brain injury, are a leading cause for re-
hospitalization. One way of reducing the likelihood of contracting 
secondary complications is through education, training, and monitoring. 
This can be achieved using portable, low-cost communication devices 
capable of providing video and audio connection between comprehensive 
rehabilitation facilities and individuals living in rural communities. 
Those devices can enable individuals to communicate with rehabilitation 
professionals while at home or in remote clinical settings, and to 
continue with the educational and training components of the 
rehabilitation process. These devices also allow physicians and other 
clinicians to monitor the progress of these individuals and offer 
clinical diagnoses and interventions when appropriate.
    Traditional therapeutic interventions include the use of heat, 
cold, light, friction, and pressure to facilitate healing and relieve 
pain in affected areas. Many of these therapy techniques require costly 
equipment and can be used only by trained therapists. Given that 
individuals are being discharged earlier in the rehabilitation process, 
there is tremendous need for new, innovative and cost-effective 
therapeutic devices and strategies that can be used to safely continue 
therapy for individuals living in remote settings who may not have 
access to comprehensive outpatient rehabilitation therapy.
    Virtual reality is an interactive computer-based technology capable 
of simulating complex three-dimensional (3-D) environments. The number 
of virtual reality applications has risen dramatically over this past 
decade and includes flight simulators, 3-D medical imaging 
technologies, and entertainment systems (Hayward, T., Adventures in 
Virtual Reality, pgs. 41-48, 1993). The benefits of combining virtual 
reality with rehabilitation interventions are potentially extensive. 
Virtual reality technologies are being used to convert sign language 
into speech and to develop barrier-free designs for people with 
physical disabilities. Biosensors that provide qualitative and 
quantitative data about muscle activity, pressure and movements are 
also capable of being integrated into virtual reality systems for use 
in rehabilitation.
Priority 7
    The Secretary will establish an RERC on telerehabilitation to 
identify and develop technologies capable of supporting rehabilitation 
services for individuals who do not have access to comprehensive 
outpatient rehabilitation services. The RERC shall:
    (1) Identify, develop, and evaluate communication systems capable 
of connecting comprehensive rehabilitation facilities with providers of 
rehabilitation services, individuals and family members living in 
remote settings to provide ongoing rehabilitation education and 
training services;
    (2) Develop, investigate, and evaluate monitoring and assessment 
tools that can be used in the provision of rehabilitation services 
through telerehabilitation;
    (3) Develop, investigate, and evaluate strategies and devices to 
provide and monitor therapeutic interventions in remote settings; and
    (4) Investigate the use of virtual reality in rehabilitation 
including, but not limited to, education, monitoring, diagnosing, and 
therapy.
    In carrying out the purposes of the priority, the RERC must 
coordinate on activities of mutual interest with the RERCs on 
Telecommunications and Information Technologies Access, the RRTC on 
Rural Rehabilitation Services, and other entities carrying out related 
research or development activities.

Electronic Access to This Document

    Anyone may view this document, as well as all other Department of 
Education documents published in the Federal Register, in text or 
portable document format (pdf) on the World Wide Web at either of the 
following sites:

http://ocfo.ed.gov/fedreg.htm
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To use the pdf you must have the Adobe Acrobat Reader Program with 
Search, which is available free at either of the preceding sites. If 
you have questions about using the pdf, call the U.S. Government 
Printing Office at (202) 512-1530 or, toll free at 1-888-293-6498.
    Anyone may also view these documents in text copy only on an 
electronic bulletin board of the Department. Telephone: (202) 219-1511 
or, toll free, 1-800-222-4922. The documents are located under Option 
G--Files/Announcements, Bulletins and Press Releases.

    Note: The official version of this document is the document 
published in the Federal Register.

    Applicable Program Regulations: 34 CFR Part 350.

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

(Catalog of Federal Domestic Assistance Numbers 84.133B, 
Rehabilitation Research

[[Page 32539]]

and Training Centers, and 84.133E Rehabilitation Engineering 
Research Centers)

    Dated: June 8, 1998.
Curtis L. Richards,
Acting Assistant Secretary for Special Education and Rehabilitative 
Services.
[FR Doc. 98-15697 Filed 6-11-98; 8:45 am]
BILLING CODE 4000-01-P