[Federal Register Volume 65, Number 52 (Thursday, March 16, 2000)]
[Notices]
[Pages 14346-14355]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-6140]



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Part II





Department of Education





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National Institute on Disability and Rehabilitation Research; Final 
Funding Priorities for Fiscal Years 2000-2001; Invitation for 
Applications for Model Spinal Cord Injury Centers and Research Centers; 
Notice

  Federal Register / Vol. 65, No. 52 / Thursday, March 16, 2000 / 
Notices  

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DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research

AGENCY: Department of Education.

ACTION: Notice of Final Funding Priorities for Fiscal Years 2000-2001 
for Certain Centers.

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SUMMARY: The Assistant Secretary for the Office of Special Education 
and Rehabilitative Services announces final funding priorities for 
fifteen Model Spinal Cord Injury Centers and two Rehabilitation 
Engineering Research Centers (RERCs) under the National Institute on 
Disability and Rehabilitation Research (NIDRR) for fiscal years 2000-
2001. The Assistant Secretary takes this action to focus research 
attention on areas of national need. These priorities are intended to 
improve rehabilitation services and outcomes for individuals with 
disabilities.

DATES: These priorities take effect on April 17, 2000.

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) 205-4475. Internet: Donna--
[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 Special Projects and Demonstrations for Spinal Cord Injuries (SCI) 
Program and two RERCs related to Low Vision and Blindness and Children 
with Orthopedic Disabilities. The final priorities refer to NIDRR's 
Long-Range Plan (the Plan). The Plan can be accessed on the World Wide 
Web at: http://www.ed.gov/legislation/FedRegister/other/1999-12/68576.html.
    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. 762(g) and 764).

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

Analysis of Comments and Changes

    On December 9, 1999 the Assistant Secretary published a notice of 
proposed priorities for the Model Spinal Cord Injury Centers in the 
Federal Register (64 FR 69154). The Department of Education received 25 
letters commenting on the notice of proposed priorities by the deadline 
date. On December 17, 1999 the Assistant Secretary published a notice 
of proposed priorities for two Rehabilitation Engineering Research 
Centers in the Federal Register (64 FR 70956). The Department of 
Education received 8 letters commenting on the notice of proposed 
priorities by the deadline date. Technical and other minor changes--and 
suggested changes the Assistant Secretary is not legally authorized to 
make under statutory authority--are not addressed.

Model Spinal Cord Injury Centers

Priority 1: Model Spinal Cord Injury Centers

    Comment: Several commenters discussed the issue of the national 
database, with a range of questions and recommendations. Some asked 
whether it was a given that the national database would be continued as 
is, or whether the requirement might be to contribute to a national 
database not yet configured. Many commenters asked whether the number 
or type of variables in the current database (MSCIS) would be 
maintained or altered for the next five-year period. One commenter 
suggested that only large Centers should be required to contribute to 
the database. Several commenters asked whether there would be changes 
in the selection criteria or funding levels related to database 
participation.
    Discussion: All Centers will be required to contribute to the 
national database as designated by the Secretary. The database has 
evolved over its entire existence, and will continue to evolve to meet 
current needs. NIDRR intends to evaluate the existing database within 
the next twelve months, and prescribe modifications as necessary. These 
modifications may include changes in the number and type of variables 
or limits on follow-up samples. However, for the purpose of responding 
to this notice, prospective applicants should base their proposals on 
the database as currently configured. If those modifications require 
changes to the proposed scope of work or budget of any funded Center, 
these changes can be negotiated with the funding agency.
    Changes: None.
    Comment: A number of commenters stated that the proposed research 
priority areas were either unclear or too limiting. Several questioned 
whether the Centers were to be limited to one area or topic. Some 
questioned why the Associated Research Areas section of the Plan, as 
well as other specific priorities in the Plan, were not referenced, and 
others proposed that each Center be encouraged to undertake one 
research project addressing Health and Function and one project 
addressing a second chapter of the Plan.
    Discussion: This priority encourages focused, cohesive, and 
integrated research programs that will make a substantial contribution 
to the knowledge base in SCI rehabilitation, while simultaneously 
discouraging fragmented programs with numerous discrete and disparate 
projects. The Plan presents an integrated approach to research. NIDRR 
recognizes that disability and rehabilitation are both holistic 
phenomena. Investigations of major issues in one area, for example 
Health and Function, may involve issues of technology or independent 
living. Applicants have the freedom to investigate any issues 
prioritized in the Plan, including those in the associated areas 
chapter and issues that cut across areas of the Plan. The priority 
encourages studies that will capitalize on each Center's population and 
programmatic characteristics to make significant contributions to SCI 
rehabilitation. Applicants should carefully justify the likelihood of 
achieving the proposed research objectives.
    Changes: The list of priorities for the research projects has been 
modified to include the associated areas chapter of the Plan, and to 
incorporate investigation of any long-range plan priority areas, 
including cross-cutting issues.
    Comment: Several commenters discussed the mechanism of running a 
separate competition for collaborative research projects. Most 
commenters supported this idea, although one contended that large 
Centers should be funded to do site-specific research, while Centers 
with smaller patient loads could collaborate on research projects.
    Discussion: A major advantage of supporting a Model Systems program 
is the ability to conduct studies with large samples on populations 
that are geographically, ethnically, culturally, and otherwise diverse. 
This is an important justification for the common data collection 
system. In the past, Centers have been required to propose both 
collaborative and site-specific research. This was an administrative 
problem, because applicants would have to propose collaborations with

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other applicants who might not be chosen for funding. After the Centers 
were funded, many had to drop or alter proposed collaborative studies 
because some of the partners did not receive funding. Also, the peer 
review process in the past did not give adequate attention to the 
research proposals, as they were focused on evaluating the 
comprehensiveness and quality of the systems of care. A separate 
competition for collaborative research projects in Fiscal Year 1998 for 
the NIDRR Traumatic Brain Injury program led to awards of substantial 
and meaningful research projects. It should be noted that collaboration 
is not precluded in the current competition. Applicants can form 
collaborative relationships with any appropriate entity as required to 
address their particular research.
    NIDRR acknowledges the concerns of Centers that are tracking large 
patient populations. Projects will be funded at varying amounts up to 
the maximum allowed based on individual factors in proposals. Proposed 
budgets should reflect costs associated with data collection, proposed 
research, and administration. Funding will be determined individually 
for each successful applicant up to the maximum allowed based upon 
documented workload, the peer review process, and the overall budgetary 
limits of the program.
    Changes: None.
    Comment: Many practitioners and researchers in SCI rehabilitation 
point out that the individuals with SCI of non-traumatic origins now 
comprise a large portion of the individuals treated in rehabilitation 
units. There have been strong arguments for expanding the scope of the 
SCI Model Systems beyond traumatic SCI.
    Discussion: This is an important change to consider. However, there 
has not been sufficient examination of the ramifications of changing 
the inclusion criteria of the database. NIDRR requires more data 
concerning the populations to be considered, proposed inclusion 
criteria such as time of onset and extent of lesion, and comparison of 
characteristics of traumatic vs. the non-traumatic SCI populations, 
including natural course, coexisting conditions, and socio-demographic 
variables. Applicants remain free to treat non-traumatic SCI in 
clinical settings and to include these patients in research projects. 
However, the parameters of the MSCIS will not be expanded at this time 
to include these non-traumatic patients. The peer review process will 
evaluate the merits of each proposal.
    Changes: None.
    Comment: Some respondents were concerned that there were too few 
points being awarded to adequacy of facilities, as the new selection 
criteria award a large number of points for project design. Respondents 
were unclear as to whether project design refers only to the design of 
the research portion. Other commenters objected to the inclusion of 
additional points for employment of individuals with disabilities on 
the project, arguing that applicants would tend to give pro forma 
responses, that the requirement is antithetical to the direction of 
current affirmative action practices, or that institutions may be 
forced into a bidding war for the relatively few qualified disabled 
researchers.
    Discussion: The new thrust of the model systems program is to 
emphasize research. NIDRR believes there are sufficient points allowed 
for a comprehensive, integrated system of care to supplement the 
importance of high quality facilities. The Project Design criteria 
refer to the research project, and the Service Comprehensiveness 
criteria refer to the model demonstration.
    NIDRR encourages employment of persons with disabilities on 
research projects not only as a measure of equal opportunity, but 
because individuals with disabilities bring important perspectives and 
concerns to research. The disability research field is also encouraged 
to find innovative ways to build research capacity among persons with 
disabilities.
    Changes: The Project Design criteria section has been renamed 
Research Project Design.
    Comment: Several commenters discussed the need for a specified 
minimum number of new injuries to be considered for inclusion in this 
program.
    Discussion: NIDRR agrees that a ``critical mass'' of new injuries 
is important for an SCI Center of Excellence. This is important for 
maintaining a high level of clinical skill and for having enough 
subjects to perform meaningful research. However, NIDRR views this 
requirement as contextual. It is expected that applicants will document 
their history of new patients, and the likelihood of obtaining 
sufficient numbers to maintain a center of excellence for SCI care and 
to conduct research. It is the responsibility of the applicants to 
demonstrate that they have sufficient admissions to maintain a clinical 
Center of excellence and to conduct significant research.
    Changes: None.
    Comments: Two commenters were concerned that the priority did not 
discuss the geographic distribution of the Centers.
    Discussion: When making funding determination, both the legislation 
(Section 204(b)(4) of Rehabilitation Act of 1973, as amended (29 USC 
764(b)(4)) and the regulations (34 CFR Part 359) specify that the 
Director must take into account the location of any proposed SCI Center 
and the appropriate geographical and regional allocation of such 
Centers. This geographic distribution is considered in making the final 
determination of the awards.
    Changes: None.

Rehabilitation Engineering Research Centers--General

    Comment: What criteria does NIDRR use for selection of RERCs?
    Discussion: NIDRR publishes selection criteria in the Notice 
Inviting Applications. The selection criteria are used by peer 
reviewers to evaluate the proposals submitted to NIDRR under this 
competition.
    Changes: None.
    Comment: Do RERCs have the authority to establish linkages with 
other agencies in order to achieve the necessary outcomes?
    Discussion: RERCs are required to collaborate with specific RERCs 
and RRTCs as identified in each priority. In addition to these 
requirements, an applicant could propose to coordinate with other 
agencies or organizations. The peer review process will evaluate the 
merits of each applicant's proposed activities.
    Changes: None.
    Comment: Are the proposed RERCs required to establish partnerships 
between product manufacturers and practitioners to design and implement 
innovative technologies?
    Discussion: NIDRR encourages applicants to include manufacturers, 
practitioners and consumers, as appropriate, in the design process. 
Each RERC is required to develop and implement, in consultation with 
the NIDRR-funded RERC on Technology Transfer, a utilization plan to 
ensure that all new and improved technologies developed by the RERC are 
successfully transferred to the marketplace. The peer review process 
will evaluate the merits of each application.
    Changes: None.

Priority 2: Low Vision and Blindness

    Comment: Four commenters suggested that a new activity should be 
added that requires the RERC to research and develop technologies that 
address jobsite adaptation, employment and daily living problems among 
the target population.

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    Discussion: NIDRR agrees that unemployment for persons who are 
blind or visually impaired is a very serious problem, as referenced in 
the first paragraph of the background statement.
    Changes: A new activity has been added requiring the RERC to 
investigate, develop, and evaluate new vocational and daily living 
technologies and approaches.
    Comment: Two commenters expressed concern that the word 
``screening'' in the first required activity may be interpreted to 
imply merely the detection of a problem, whereas the real need is for 
more detailed assessment and analysis of the complex problems. 
Substituting ``assessment'', ``analysis'' or ``evaluation'' for 
``screening'' would clarify and focus this priority.
    Discussion: NIDRR agrees that ``assessment'' is a more appropriate 
term.
    Changes: The first required activity has been revised by 
substituting the word ``assessment'' for ``screening.''
    Comment: One individual commented that the main mandate of RERCs, 
as stated in the Rehabilitation Act, as amended, is to focus on 
research and development ``to produce new scientific knowledge, and new 
or improved methods, equipment, and devices.'' This theme is very well 
represented in the third required activity, which refers to 
``technologies and approaches,'' but the other activities may be 
somewhat limiting in their focus. This would easily be remedied by 
inserting ``technologies and approaches'' or ``technologies and 
methods'' in each activity where the word ``technologies'' appears.
    Discussion: NIDRR agrees that the priority would be strengthened by 
replacing ``technologies'' with ``technologies and approaches'' where 
applicable.
    Changes: Required activities 1, 2, and 4 have been revised by 
replacing ``technologies'' with ``technologies and approaches.''
    Comment: The third required activity does not accurately reflect 
the background statement and the broad language used might suggest that 
any and all studies of vision and aging apply.
    Discussion: NIDRR believes that the background statement adequately 
supports each activity. However, while NIDRR agrees with the commenter 
that the third required activity would be strengthened by limiting the 
number of potential vision screening and assessment technologies 
investigated, NIDRR does not agree that the commenter's specific 
language recommendations accomplish this purpose.
    Changes: The third required activity 3 has been revised by adding 
the words ``and practical'' after the word ``simple.''

Priority 3: Technologies for Children with Orthopedic Disabilities

    Comment: Two goals for this RERC are to enable children to 
negotiate their environment and to enhance interactive play and social 
skill development. To accomplish these goals, the RERC must include 
typically developing peers.
    Discussion: An applicant could propose research methodologies that 
include the use typically developing peers. NIDRR elects to leave the 
choice of research methodologies to be proposed to the applicants. The 
peer review process will evaluate the merits of each proposal.
    Changes: None.
    Comment: Parental involvement should be a requirement in the design 
and use of technologies developed by this RERC.
    Discussion: NIDRR agrees that parental involvement is necessary for 
an RERC such as this one. There is mention of parental expectations in 
the first paragraph of the background statement. Furthermore, there is 
a general requirement that all RERCs involve persons with disabilities 
and their family representatives in planning and implementing their 
research and development activities. The peer review process will 
evaluate the merits of each applicant's proposed activities.
    Changes: None.

Model Spinal Cord Injury Centers

    The authority for Model Spinal Cord Injury Centers is contained in 
section 204(b)(4) of the Rehabilitation Act of 1973, as amended (29 
U.S.C. 764(b)(4)). The Secretary may make awards for up to 60 months 
through grants or cooperative agreements. This program provides 
assistance to establish innovative projects for the delivery, 
demonstration, and evaluation of comprehensive medical, vocational, and 
other rehabilitation services to meet the wide range of needs of 
individuals with spinal cord injuries.

Description of Special Projects and Demonstrations for Spinal Cord 
Injuries

    This program provides assistance for projects that provide 
comprehensive rehabilitation services to individuals with Spinal Cord 
Injury (SCI) and conduct spinal cord research, including clinical 
research and the analysis of standardized data in collaboration with 
other related projects.
    Each SCI Center funded under this program establishes a 
multidisciplinary system of providing rehabilitation services, 
specifically designed to meet the special needs of individuals with 
spinal cord injuries. This includes acute care as well as periodic 
inpatient or outpatient follow up and vocational services. Centers 
demonstrate and evaluate the benefits and cost effectiveness of such a 
system for the care of individuals with SCI and demonstrate and 
evaluate existing, new, and improved methods and equipment essential to 
the care, management, and rehabilitation of individuals with SCI. 
Grantees demonstrate and evaluate methods of community outreach and 
education for individuals with SCI in connection with the problems of 
such individuals in areas such as housing, transportation, recreation, 
employment, and community activities.
    Projects funded under this program ensure widespread dissemination 
of research findings to all SCI Centers, and to rehabilitation 
practitioners, individuals with SCI, and the parents, family members, 
guardians, advocates, or authorized representatives of such 
individuals. They engage in initiatives and new approaches and maintain 
close working relationships with other governmental and voluntary 
institutions and organizations to unify and coordinate scientific 
efforts, encourage joint planning, and promote the interchange of data 
and reports among SCI researchers.
    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 Center, 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.

Priority

    Under 34 CFR 75.105(c)(3) the Assistant Secretary gives an absolute 
preference to applications that meet the following priority. The 
Assistant Secretary will fund under this competition only applications 
that meet this absolute priority.

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Priority 1: Model Spinal Cord Injury Centers

Background
    Estimates of the number of people living with traumatic spinal cord 
injury (SCI) range from 183,000 to 230,000, with an incidence of 
approximately 10,000 new cases each year (``Spinal Cord Injury Facts 
and Figures at a Glance,'' National Spinal Cord Injury Statistical 
Center (NSCISC), University of Alabama at Birmingham). Although SCI 
predominately affects young adults (56% of SCIs occur among people aged 
16-30 years), there is an increasing proportion of new SCI cases in the 
population over 60 years of age (NSCISC, ibid.). The true significance 
of traumatic SCI lies not primarily in the numbers affected, but in the 
substantial impact on individuals' lives and the associated substantial 
health care costs and living expenses. A traumatic SCI has far-reaching 
repercussions on the lives of the injured persons and their families 
that can be devastating if not addressed effectively. According to a 
report from the Agency for Health Care Policy and Research (Hospital 
Inpatient Statistics, 1996, AHCPR Publication No. 99-0034), SCI is the 
most expensive condition or diagnosis treated in U.S. hospitals. The 
estimated lifetime costs for an individual injured at the age of 25 
range from $365,000 for an incomplete injury to more than $1.7 million 
for an individual with a high cervical injury (NSCISC, op cit).
    The Model SCI program was developed in 1970 to demonstrate the 
value of a comprehensive integrated continuum of care for SCI. Twenty-
six sites have been designated, at various times, as Model SCI Centers 
through funding initially from the Rehabilitation Services 
Administration, and subsequently from the National Institute on 
Handicapped Research, and its successor, the National Institute on 
Disability and Rehabilitation Research (NIDRR). For the period 1995-
2000 there are 18 funded Model SCI Centers. (Additional information is 
available on the World Wide Web at http://www.ncddr.org/mscis/). The 
clinical components of the Model Centers are specified in the program 
regulations, and include ``* * * emergency medical services, acute 
care, vocational and other rehabilitation services, community and job 
placement, and long-term community follow up and health maintenance'' 
(34 CFR 359.11). In addition to demonstrating and evaluating the 
benefits of such a system the centers are required to contribute data 
on their patients to the National Spinal Cord Injury Database (NSCID), 
and engage in research both within the center, and in collaboration 
with other centers.
    During the past 30 years, there have been substantial improvements 
in outcomes following SCI (Stover, S.L., et al., Spinal Cord Injury: 
Clinical Outcomes From the Model Systems, and Special Issue, Spinal 
Cord Injury: Current Research Outcomes from the Model Spinal Cord 
Injury Care Systems, Archives of Physical Medicine and Rehabilitation, 
Vol. 80, No. 11, November, 1999). Enhanced emergency medical services 
have led to increased preservation of neurologic function. Mortality 
during the first year following injury has continuously declined. Life 
expectancy, while still below that for those without SCI, has 
significantly increased for all levels of injury. The ideal of a 
comprehensive multi-disciplinary system of care for SCI has gained 
widespread acceptance.
    However, significant challenges and opportunities remain for SCI 
rehabilitation. Recent statistics from the National Spinal Cord Injury 
Statistical Center (NSCISC) suggest that as the length of stay in 
rehabilitation settings has progressively decreased (1993-1998), there 
has been an increase in re-hospitalization during the first year after 
injury. In addition, mortality after the first anniversary of injury 
declined continuously from 1973-1992, but now has increased for the 
period 1993-1998. Secondary medical complications, including, but not 
limited to, respiratory complications, pressure ulcers and autonomic 
dysreflexia, continue to be significant problems. Injuries due to 
interpersonal violence have increased as a proportion of the total SCI 
incidence and are more likely to be neurologically complete injuries.
    There is a need to identify, evaluate, and eliminate barriers in 
the natural, built, cultural, and social environments to enable people 
with SCI to achieve the goal of fully reintegrating into their 
community. Particular focus is required to address the needs of 
minority and underserved populations. Although employment for the U.S. 
population is at historically high levels, employment for the SCI 
population remains low. Individuals with SCI due to inter-personal 
violence have an employment rate approximately half of the average for 
all individuals with SCI (NSCISC, op cit).
    NIDRR shares the concerns of the rehabilitation community about the 
impact of changes in health care delivery and financing upon the 
continuum of care for SCI. People with SCI often have more difficulty 
in obtaining adequate primary health care than non-disabled 
individuals. The unique needs of women with SCI in cardiac 
rehabilitation, reproductive health, and early cancer screening are 
special issues that need to be addressed.
    There are also new and developing opportunities for improving SCI 
care. Medical and pharmacological therapies show promise for preserving 
and enhancing function. There is a need to identify and evaluate 
therapeutic interventions, including prevention and wellness programs, 
and complementary and alternative therapies using evidence-based 
evaluation protocols.
    Advancing technology has the potential to enhance access and 
function for individuals with SCI. There is a need to develop and 
evaluate service delivery models incorporating telerehabilitation 
strategies and technologies to provide services for people with SCI. 
Assistive technologies may reduce the likelihood of secondary 
complications in SCI. For example, improved wheelchair and seating 
systems may reduce musculoskeletal trauma associated with long term 
wheelchair use. Technological advancement has the promise of providing 
greater accessibility to information, telecommunications, and 
employment. The adoption of universal design methodologies will enhance 
access to the built environment as well as rapidly developing 
electronic and information technologies.
    The development of strong collaborations by SCI centers with 
community and social support organizations has the potential to impact 
positively the independence and community integration for individuals 
with SCI. Peer support beginning early in the rehabilitation process 
may enhance return to participation in the community. The causes of 
unemployment in SCI include lack of education and skills, lack of prior 
work experience, and policy disincentives. Pending changes in 
legislation and policy to permit retention of some medical insurance 
during employment, together with the high demand for skilled 
individuals in the workforce, represents an opportunity to foster 
education and employment of individuals with SCI.
    NIDRR has published the Plan that is based upon a new paradigm for 
rehabilitation that identifies disability in terms of the relationship 
between the individual and the natural, built, cultural, and social 
environments (63 FR 57189-57219). The Plan focuses on both individual 
and systemic factors that have an impact on the ability of people to 
function. The elements of the Plan include employment outcomes,

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health and function, technology for access and function, and 
independent living and community integration. As part of the Plan to 
attain the goals in these areas, NIDRR is committed to capacity 
building for research and training, and to ensure knowledge 
dissemination and utilization. Each area of the Plan includes 
objectives at both the individual and system levels. For example, the 
health and function objectives include research to improve medical 
rehabilitation interventions, as well as research to ensure access to 
an integrated continuum of quality health care services that address 
the unique needs of persons with disabilities. It is clear that the 
challenges and opportunities for SCI care reflect all of the priority 
areas of the Plan.
    NIDRR has recently completed Program Reviews of all current Model 
SCI Centers. Based upon presentations by the Centers, and discussion 
with the external reviewers, NIDRR has concluded that the value of a 
comprehensive integrated system of care for SCI has been demonstrated. 
Because this conclusion is widely accepted, NIDRR is shifting the focus 
of the program from demonstration, to place a greater emphasis upon 
research. Participants in the Program Reviews observed that the 
comprehensive continuum of quality care should continue to be a 
requirement for participation in the Model SCI Centers Program. There 
is significant diversity among the Centers, however, in research 
interests and capacities. This diversity extends across the priority 
areas of the Plan, and represents a strength of the program.
    Reviewers noted that uniformly comprehensive, high quality care, 
together with a common data collection system and administrative 
infrastructure makes the Model SCI Centers Program a valuable platform 
for various collaborative studies, including multi-center trials of 
therapies and technologies. To further the enhancement of the research 
mission, participants recommended a separate competition for the 
collaborative research portion of the program. A separate competition 
will facilitate focused, considered proposals, a higher level of 
scientific review, and the development of significant research projects 
in the Model SCI Centers. The competition for collaborative research 
projects will be conducted subsequent to the identification of the 
Model SCI Centers, and funds will be reserved for that purpose.
    During the Program Reviews, there was considerable discussion of 
the NSCID. It is clear that the database is a valuable resource and 
that participation in the NSCID is an essential element for the Model 
SCI Centers. For the purpose of the present competition, the data 
collection activities will be maintained without change. NIDRR expects 
that applicants will include historical documentation of numbers of 
patients as well as expected new patients and expected annual follow-up 
submissions based on current eligibility criteria for the NSCID. 
However, it is anticipated that, through discussion among the newly 
identified Model SCI Centers, NIDRR staff, and external reviewers, 
details of data collection may be modified following the award. This 
process should not result in increased data collection workloads above 
current levels.

Priority 1

    The Assistant Secretary will establish Model Spinal Cord Injury 
Centers for the purpose of generating new knowledge through research, 
development, or demonstration to improve outcomes for SCI through 
improved interventions and service delivery models. A Model SCI Center 
must:
    (1) Establish a multidisciplinary system of providing 
rehabilitation services specifically designed to meet the special needs 
of individuals with SCI, including emergency medical services, acute 
care, vocational and other rehabilitation services, community and job 
placement, and long-term community follow up and health maintenance;
    (2) Participate as directed by the Assistant Secretary in national 
studies of SCI by contributing to a national database and by other 
means as required by the Assistant Secretary; and
    (3) Conduct a significant and substantial research program in SCI 
that will contribute to the advancement of knowledge in accordance with 
the Plan. Applicants may select from the following examples of research 
objectives related to specific areas of the Plan or other research 
objectives, including those that cut across areas of the Plan:
     (Chapter 3, Employment Outcomes): Either (1) Assess the 
impact of legislative and policy changes on employment outcomes; or (2) 
test direct intervention strategies for improving employment outcomes.
     (Chapter 4, Maintaining Health and Function): Either (1) 
Study interventions to improve outcomes in the preservation or 
restoration of function or the prevention and treatment of secondary 
conditions; or (2) Design and test service delivery models that provide 
quality care under constraints imposed by recent changes in the health 
care financing system.
     (Chapter 5, Technology for Access and Function): Either 
(1) Evaluate the impact of selected innovations in technology and 
rehabilitation engineering on service delivery; or (2) Evaluate the 
impact of selected innovations in technology and rehabilitation 
engineering on outcomes such as function, independence, and employment.
     (Chapter 6, Independent Living and Community Integration): 
Assess the value of peer support and early onset of services from 
community and social support organizations to improve outcomes such as 
independence and community integration, employment function, and health 
maintenance.
     (Chapter 7, Associated): Either (1) Refine measures of 
medical rehabilitation effectiveness in SCI to incorporate 
environmental factors in the assessment function; or (2) Investigation 
of the impact of national telecommunications and information policy on 
the access of persons with SCI to related education, work, and other 
opportunities.
    (4) Provide for the widespread dissemination of research and 
demonstration findings to other SCI centers, rehabilitation 
practitioners, researchers, individuals with SCI and their families and 
representatives, and other public and private organizations involved in 
SCI care and rehabilitation. In carrying out these purposes, the SCI 
center must:
     Incorporate culturally appropriate methods of community 
outreach and education in areas such as health and wellness, housing, 
transportation, recreation, employment, and other community activities 
for individuals with diverse backgrounds with SCI;
     Demonstrate the research and clinical capacity to 
participate in collaborative projects, clinical trials, or technology 
transfer with other model SCI centers, other NIDRR grantees, and 
similar programs of other public and private agencies and institutions; 
and
     Demonstrate the likelihood of having a sufficient number 
of individuals with SCI, including newly injured persons, to conduct 
statistically significant research.

Final Selection Criteria

    The Assistant Secretary will use these selection criteria to 
evaluate applications under this program. The maximum score for all the 
criteria is 100 points. The new emphasis on research and NIDRR's Plan, 
plus the importance of the NSCID, require some

[[Page 14351]]

modifications to the selection criteria for this program. The Secretary 
will redistribute points to reflect the increased emphasis on research, 
and to add references to the Plan and NSCID.
    (a) Research Project design (30 points). The Secretary reviews each 
application to determine to what degree--
    (1) There is a clear description of how the objectives of the 
project relate to the purpose of the program and the Plan;
    (2) The research is likely to produce new and useful information;
    (3) The need and target population are adequately defined and are 
sufficient for meaningful research and demonstration;
    (4) The outcomes are likely to benefit the defined target 
population;
    (5) The research hypotheses are sound; and
    (6) The research methodology is sound in the sample design and 
selection, the data collection plan, the measurement instruments, and 
the data analysis plan.
    (b) Service comprehensiveness (20 points). The Secretary reviews 
each application to determine to what degree--
    (1) The services to be provided within the project are 
comprehensive in scope, and include emergency medical services, 
intensive and acute medical care, rehabilitation management, 
psychosocial and community reintegration, and follow up;
    (2) A broad range of vocational and other rehabilitation services 
will be available to individuals with severe disabilities within the 
project; and
    (3) Services will be coordinated with those services provided by 
other appropriate community resources.
    (c) Plan of operation (10 points). The Secretary reviews each 
application to determine to what degree--
    (1) There is an effective plan of operation that ensures proper and 
efficient administration of the project;
    (2) The applicant's planned use of its resources and personnel is 
likely to achieve each objective;
    (3) Collaboration between institutions, if proposed, is likely to 
be effective;
    (4) Participation in the National Spinal Cord Injury Database is 
clearly and adequately described; and
    (5) There is a clear description of how the applicant will include 
eligible project participants who have been traditionally 
underrepresented, such as--
    (i) Members of racial or ethnic minority groups;
    (ii) Women;
    (iii) Individuals with disabilities; and
    (iv) The elderly.
    (d) Quality of key personnel (10 points). The Secretary reviews 
each application to determine to what degree--
    (1) The principal investigator and other key staff have adequate 
training or experience, or both, in spinal cord injury care and 
rehabilitation and demonstrate appropriate potential to conduct the 
proposed research, demonstration, training, development, or 
dissemination activity;
    (2) The principal investigator and other key staff are familiar 
with pertinent literature or methods, or both;
    (3) All the disciplines necessary to establish the 
multidisciplinary system described in Sec. 359.11(a) are effectively 
represented;
    (4) Commitments of staff time are adequate for the project; and
    (5) The applicant is likely, as part of its non-discriminatory 
employment practices, to encourage applications for employment from 
persons who are members of groups that traditionally have been 
underrepresented, such as--
    (i) Members of racial or ethnic minority groups;
    (ii) Women;
    (iii) Individuals with disabilities; and
    (iv) The elderly.
    (e) Adequacy of resources (5 points). The Secretary reviews each 
application to determine to what degree--
    (1) The facilities planned for use are adequate;
    (2) The equipment and supplies planned for use are adequate; and
    (3) The commitment of the applicant to provide administrative and 
other necessary support is evident.
    (f) Budget/cost effectiveness (5 points). The Secretary reviews 
each application to determine to what degree--
    (1) The budget for the project is adequate to support the 
activities;
    (2) The costs are reasonable in relation to the objectives of the 
project; and
    (3) The budget for subcontracts (if required) is detailed and 
appropriate.
    (g) Dissemination/utilization (10 points). The Secretary reviews 
each application to determine to what degree--
    (1) There is a clearly defined plan for dissemination and 
utilization of project findings;
    (2) The research results are likely to become available to others 
working in the field;
    (3) The means to disseminate and promote utilization by others are 
defined; and
    (4) The utilization approach is likely to address the defined need.
    (h) Evaluation plan (10 points). The Secretary reviews each 
application to determine to what degree--
    (1) There is a mechanism to evaluate plans, progress, and results;
    (2) The evaluation methods and objectives are likely to produce 
data that are quantifiable; and
    (3) The evaluation results, where relevant, are likely to be 
assessed in a service setting.

Final Additional Selection Criterion

    The Assistant Secretary also will use the following criterion so 
that up to an additional ten points may be earned by an applicant for a 
total possible score of 110 points:
    Within this absolute priority, we will give the following 
competitive preference to applications that are otherwise eligible for 
funding under this priority:
    Up to ten (10) points based on the extent to which an application 
includes effective strategies for employing and advancing in employment 
qualified individuals with disabilities in projects awarded under these 
absolute priorities. In determining the effectiveness of those 
strategies, we will consider the applicant's success, as described in 
the application, in employing and advancing in employment qualified 
individuals with disabilities in the project.
    For purposes of this competitive preference, applicants can be 
awarded up to a total of 10 points in addition to those awarded under 
the published selection criteria for this priority. That is, an 
applicant meeting this competitive preference could earn a maximum 
total of 110 points.

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:

[[Page 14352]]

    (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 these 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 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.

Priorities

    Under an absolute priority we consider only applications that meet 
one of these absolute priorities (34 CFR 75.105(c)(3)).

Priority 2: Low Vision and Blindness

Background
    According to recent estimates there are more than 3 million 
Americans with low vision, and almost one million who are legally blind 
(National Eye Institute, ``Vision research: A national plan 1999-
2003,'' A report of the National Advisory Eye Council, National 
Institutes of Health, 1999). Approximately 7.8% of persons over 65 
cannot see well enough to read newspaper print (Nelson, K.A., 
``Statistical brief #35: Visual impairment among elderly Americans: 
statistics in transition,'' Journal of Visual Impairment and Blindness, 
vol. 81, pgs. 331-334, 1987), and the number of persons in this age 
group is projected to increase twice as fast as the population as a 
whole (Schmeidler, E. and Halfman, D., ``Statistics on visual 
impairment on older persons, disability in children, life expectancy,'' 
Journal of Visual Impairment and Blindness, vol. 91, pgs. 602-606, 
1997). Blind and visually impaired individuals face major barriers in 
information access and handling, orientation and mobility, and access 
to jobsites and public facilities, resulting in very high rates of 
unemployment (Kirchner, C. and Schmeidler, E., ``Prevalence and 
employment of people in the United States who are blind or visually 
impaired,'' Journal of Visual Impairment and Blindness, vol. 91, pgs. 
508-511, 1997; Hagemoser, S.D., ``The relationship of personality 
traits to the employment status of persons who are blind,'' Journal of 
Visual Impairment and Blindness, vol. 90, pgs. 134-144, 1996). There is 
also a growing and underserved group of individuals with a combination 
of multiple sensory, physical, and cognitive impairments (Malakpa, S., 
``Job placement of blind and visually impaired people with additional 
disabilities'' RE:View, vol. 26, pgs. 69-77, 1994).
    The leading causes of vision impairment in children in the U.S. are 
cortical visual impairment (35%), retinopathy of prematurity (ROP), 
optic nerve hypoplasia, and other retinal conditions (Murphy, D. and 
Good, W.V., ``The epidemiology of blindness in children in 
California,'' American Academy of Opthalmology, pg. 157, 1997; Oxford 
Register of Early Childhood Impairments Annual Report, The National 
Perinatal Epidemiology Unit, Ratcliffe Infirmary, pgs. 32-36, 1998). As 
a result of improvements in medical diagnosis, treatment and 
technologies, more premature infants are surviving birth. However, a 
significant number of newborn infants experience traumatic conditions 
that include blindness and cognitive and motor deficits. New approaches 
and technologies are needed to identify and separate the sensory and 
cognitive deficits so that habilitation can be planned and monitored 
more effectively (Good, W.V., Jan, J.E., deSa, L., Barkovich, A.J., 
Groenveld, M. and Hoyt, C.S., ``Cortical visual impairment in children: 
A major review,'' Survey of Opthalmology, vol. 38, pgs. 351-364, 1994). 
Intervention in the very young age groups offers maximum promise of 
cost effectiveness and independent functioning throughout life.
    Wayfinding refers to the techniques used by persons who are blind 
or visually impaired as they move from place to place independently. 
Wayfinding is commonly divided into orientation and mobility skills. 
Orientation refers to the ability to monitor one's position in relation 
to the environment. Mobility refers to one's ability to move safely, 
from one location to the next with a limited amount of veering. 
Orientation and mobility are prerequisites to success at school, on the 
job, and in daily living. Various electronic devices and environmental 
modifications have been used in attempts to improve wayfinding and to 
reduce veering. Current technologies, including clear-path and drop-off 
detectors, do little to prevent veering.
    Low vision or blindness frequently coexists with other disabilities 
including hearing loss, cognitive impairments and mobility limitations. 
Individuals with multiple disabilities present technological challenges 
and require complex adjustments to achieve functionality in and across 
environments (Greenbaum, M.G., Fernandes, S. and Wainapel, S.F., ``Use 
of a motorized wheelchair in conjunction with a guide dog for the 
legally blind and physically disabled,'' Archives of Physical Medicine 
and Rehabilitation, vol. 79(2), pgs. 216-217, 1998).
    The most common cause of visual impairment among the aging 
population is Age Related Maculopathy (ARM) (Fletcher, D.C. and 
Schucard, R.A.,

[[Page 14353]]

``Preferred retinal loci relationship to macular scotomas in a low-
vision population,'' Opthalmology, vol. 104, pgs. 632-638, 1997). 
Visual impairments among this population impact a wide variety of 
activities of daily living. Further, visual impairment is often 
accompanied by hearing loss, cognitive deficits, and motor dysfunction. 
Many older individuals reside in congregate care settings (i.e., 
nursing homes) where the prevalence of eye disorders can be as high as 
90% (Marx, M.S., Werner, P., Feldman, R. and Cohen-Mansfield, J., ``The 
eye disorders of residents of a nursing home,'' Journal of Visual 
Impairment and Blindness, vol. 88(5), pgs. 462-468, 1994; Whitmore, 
W.G., ``Eye disease in a geriatric nursing home population,'' 
Opthalmology, vol. 96, pgs. 393-398, 1989; Horowitz, A., ``Vision 
impairment and functional disability among nursing home residents,'' 
The Gerontologist, vol. 34, pgs. 316-323, 1994). These facilities could 
be a platform for reaching many consumers with simple vision screening 
technologies that would permit non-clinical personnel to rapidly screen 
residents for visual impairments and make appropriate referrals. 
Currently, methods for assessing ARM include, but are not limited to, 
residual visual function and identifying optimal locations on the 
retina for reading and other tasks (Fletcher, D.C. and Schucard, R.A., 
op. cit., 1997). These methods address one eye at a time, and the 
advantages of binocular vision are often lost (Paul, W., ``The role of 
computer assistive technology in rehabilitation of the visually 
impaired: A personal perspective,'' American Journal of Opthalmology, 
vol. 127(1), pgs. 75-76, 1999; Schuchard, R.A. and Kuo, K., ``Retinal 
correspondence and binocular perception characteristics in low vision 
people with binocular eccentric PRLs,'' Investigative Opthalmology and 
Vision Science, vol. 91, pgs. 602-606, 1999).
    Chapter 5 of the Plan (64 FR 68575) discusses the importance of 
directing research and development activities toward the problems faced 
by individuals who have significant visual, hearing, and communication 
impairments. The number of individuals with both severe hearing and 
visual impairments (deaf-blind) is small but increasing. The greatest 
challenges persons with multiple sensory impairments face are 
communication and access to information technology (Engelman, M.D., 
Griffin, H.C. and Wheeler, L., ``Deaf-blindness and communication: 
Practical knowledge and strategies,'' Journal of Visual Impairments and 
Blindness, vol. 92(11), pgs. 783-798, 1999). Individuals who are deaf-
blind rarely use Braille for communication purposes. To date, 
technologies for individuals who are deaf-blind have focused primarily 
on tactile interpreting for face-to-face communication.
    In today's complex and multifaceted electronic world, access to 
graphical and spatial information is critical for persons who are blind 
or visually impaired to be successful in school and work (Kent, D., 
``Book review: Let's learn shapes with Shapely-Cal,'' Journal of Visual 
Impairment and Blindness, vol. 92(4), pgs. 245-247, 1998). Tactile 
graphical information and spatial and geometric concepts are difficult 
to represent for persons who are blind. Converting pictures or signs 
into raised tactile form has proven to be costly and time-consuming 
(Horsfall, B., ``Photopolymers, computer-aided design, and tactile 
signs,'' Journal of Visual Impairment and Blindness, vol. 92(11), pgs. 
823-826, 1998). Audio and audio-tactile methods of graphics 
presentation and spatial and geometric concepts may promote parity 
between individuals who are blind or visually impaired and others in a 
variety of environments including school, work, and recreation.

Priority 2

    The Assistant Secretary will establish an RERC that will identify 
and develop technologies that will improve assessment of vision 
impairments and promote independence for individuals with low vision 
and blindness. The RERC must:
    (1) Investigate, develop, and evaluate new assessment technologies 
and approaches that will identify and differentiate between vision and 
cognitive impairments in infants;
    (2) Develop and evaluate new wayfinding technologies and approaches 
that can be used by persons with coexisting disabilities;
    (3) Investigate, develop, and evaluate simple and practical vision 
screening and assessment technologies and approaches for identifying 
visual impairments associated with aging;
    (4) Investigate, develop, and evaluate new technologies and 
approaches to facilitate face-to-face communication for individuals who 
are deaf-blind and methods that will enable individuals who are blind 
or deaf-blind to navigate and interpret graphical, spatial and 
geometric information;
    (5) Investigate, develop, and evaluate new technologies and 
approaches that will assist individuals who are blind or visually 
impaired in vocational and daily living environments; and
    (6) Develop and implement, in consultation with the NIDRR-funded 
RERC on Technology Transfer, a utilization plan for ensuring that all 
new and improved technologies developed by this RERC are successfully 
transferred to the marketplace.
    In carrying out the above required activities, the RERC must:
     Develop and implement, during the first year of the grant 
and in consultation with the NIDRR-funded National Center for the 
Dissemination of Disability Research (NCDDR), a plan to effectively 
disseminate the RERC's research outcomes to all appropriate target 
audiences including: clinicians, engineers, manufacturers, individuals 
with disabilities, families, disability organizations, technology 
service providers, businesses, journals, organizations representing 
minorities and other underrepresented groups;
     In the third year of the grant, conduct a state-of-the-
science conference on technologies for individuals with low vision and 
blindness and publish a comprehensive report in the fourth year of the 
grant;
     Collaborate on research projects of mutual interest with 
NIDRR-funded RERCs on Information Technology Access and 
Telecommunications Access, RRTCs on visual disabilities and appropriate 
professional organizations; and
     Address the needs of children with vision disabilities 
from minority backgrounds and cultures.

Priority 3: Technologies for Children with Orthopedic Disabilities

Background
    It is estimated that 6 million children, age 18 and younger, in the 
United States have some type of disability. The prevalence of children 
with orthopedic impairments in the U.S., including paralysis and 
congenital anomalies, is roughly 420,000 (8.4 percent) (LaPlante, M. 
and Carlson, D., ``Disability in the United States: Prevalence and 
Causes,'' 1992 Report of the Disability Statistics Rehabilitation 
Research and Training Center, NIDRR, U.S. Department of Education, 
1995). The majority of these children are unable to perform a major 
activity or are limited in the amount or types of major activities, 
including education and play, they can perform (Wenger, B.L., Kaye, 
H.S. and LaPlante, M.P., ``Disabilities among children,'' Disability 
Statistics Abstract (No. 15), NIDRR, U.S. Department of Education, 
1996). Children with disabilities present unique challenges for health 
care

[[Page 14354]]

professionals when compared to adults with similar disabilities. For 
example: children experience periods of accelerated growth affecting 
shape, strength and body alignment; their body sizes are 
disproportionate to adults, they are not scaled-down adults; they 
experience developmental stages that affect their fine and gross motor 
skills; their capabilities change as they mature and as they learn to 
control their bodies and their environment; and parental expectations 
about their child's disability can influence medical treatment and 
therapeutic interventions.
    Chapter 5 of the Plan (64 FR 45766) discusses the importance of 
research and development activities that will enhance mobility and 
improve manipulation for individuals with orthopedic impairments. 
Children with orthopedic impairments present unique challenges for 
rehabilitation specialists. The technology to `replace' a child's 
missing limb does not exist today. It is possible, however, to restore 
considerable function with a prosthesis. The usefulness of such a 
device depends largely upon its weight, how well it fits, how easy it 
is to control and its durability, reliability and aesthetics. Continual 
developmental changes, including physical, emotional, and social 
growth, make it difficult to fit a child with a prosthesis and to 
determine the most appropriate time for introducing a prosthesis to a 
child. For example, the importance of fitting a child early with a 
prosthesis is well cited. However, there continues to be discussion 
about which developmental milestones to consider when determining the 
most suitable prosthesis for a child (Patton, J.G., ``Development 
approach to pediatric upper-limb prosthetic training,'' Atlas of Limb 
Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles, 
Mosby, St. Louis, pgs. 778-793, 1992).
    In addition to congenital and acquired amputations there are other 
conditions that can cause orthopedic impairments in children. Cerebral 
palsy (CP) is a motor disorder originating from a central nervous 
system injury that occurs before, during or shortly after birth. 
Children under the age of five who sustain brain injuries are also 
classified as having CP. The disability ranks third among childhood 
disabilities (LaPlante, M.P., Disability risks of chronic illness and 
impairments, Disability Statistics Program, San Francisco, CA., 1989) 
and is the most common cause of paralysis in children (Wenger, B.L., 
Kaye, H.S. and LaPlante, M.P., op. cit., 1996). The reported prevalence 
of CP in the U.S. is two per thousand and the incidence is 
approximately one per thousand live births (Turk, M.A., ``Early 
development-related conditions,'' Assessing Medical Rehabilitation 
Practices: The Promise of Outcomes Research, Marcus J. Fuhrer, ed., 
pgs. 371-372, 1997). Individuals with CP typically have abnormal muscle 
tone, muscle weakness, primitive reflexes, or uncoordinated movements 
requiring seating and orthotic interventions for postural control and 
alignment (Cook, A.M. and Hussy, S.M., Assistive Technologies: 
Principles and Practice, Mosby, St. Louis, pg. 237, 1995). Spina bifida 
is a congenital anomaly in which the neural tube that forms the spinal 
cord does not fully develop, leading to a number of lower extremity 
problems, including muscle paralysis, hip dislocations, knee 
hypertension, and club feet. The reported incidence of spina bifida is 
between 0.5 and 1 per thousand (Turk, M.A., op. cit., pgs. 378-379, 
1997).
    The most common management strategy for motor impairments caused by 
cerebral palsy and spina bifida is developmental therapy (i.e., 
physical, occupational, speech and language therapies). However, 
orthotics, specific spasticity-reducing regimens (Baclofen pumps, 
botulinum toxin injections), orthopedic surgery, and adaptive equipment 
also are used in intervention. Orthotics are used on both upper and 
lower extremities to improve function, to prevent or compensate for 
anomalies, and to control muscle weakness, spasticity and structural 
instability. Most orthotic devices (e.g., ankle-foot orthoses) are 
designed to be rigid. Dynamic orthoses and splints for gait, spasticity 
and contracture management may have significant application.
    Adaptive equipment is used to improve functional independence in 
mobility, self-care, communication, environmental control, and school 
activities. There is no definitive study on how to make the best choice 
among all the options or which improves function the most (Turk, M.A., 
op. cit., pg. 376, 1997).
    Composite materials have much to offer in prosthetic and orthotic 
design. They are strong, lightweight, and durable. However, these 
materials require different and more costly manufacturing techniques 
than those used with traditional materials such as metal and 
thermoplastics. A problem associated with composite materials is that 
they are difficult to postform, a process whereby prosthetic or 
orthotic devices are adjusted slightly during final fittings (White, 
M., ``Development of an advanced lightweight composite orthosis,'' 
Presented at ASM International--Aeromat 1992, New Trends in Advanced 
Composites, Anaheim, CA., May 20, 1992).
    Leisure time is critical to a child's well-being and development. 
Play is one means for children to master developmental tasks and learn 
important behavioral and social skills. The ability to interact 
effectively with the environment through play can affect a child's 
self-esteem, behavior, self-awareness, confidence, and competency 
(Masten, A.S., ``The development of competence in favorable and 
unfavorable environments: Lessons from research on successful 
children,'' American Psychologist, vol. 53, pgs. 205-220, 1998). 
Children with disabilities, including those with amputations, cerebral 
palsy and spina bifida, encounter many challenges in their attempts to 
engage in learning and play activities. Often sensory and motor 
impairments severely limit the degree to which they are able to 
negotiate their environment and interact with others. Facilitating play 
for these children involves adapting the environment and providing 
appropriate technologies that will enhance interactive play and social 
skill development. The product market is challenged to meet the demands 
of millions of children with disabilities and their families who need 
alternative strategies in order to engage in recreation and social 
activities.

Priority 3

    The Assistant Secretary will establish a RERC on technologies for 
children with orthopedic disabilities to identify and develop 
technologies that will help children with orthopedic disabilities to 
overcome functional deficits and to support their ability to learn, 
play and interact socially. The RERC must:
    (1) Develop and evaluate new, lightweight upper and lower limb 
prosthetic and orthotic devices for children;
    (2) Investigate the use of dynamic orthoses for controlling 
spasticity and contractures for children with orthopedic impairments 
including those with cerebral palsy and spina bifida;
    (3) Identify, develop, and evaluate models for determining when 
during children's development to introduce assistive technologies and 
prosthetic and orthotic devices;
    (4) Investigate, develop, and evaluate technologies, and strategies 
for their use, that will enable young children, including children with 
cerebral palsy and spina bifida, to participate in interactive play and 
socialization activities; and
    (5) Develop and implement, in consultation with the NIDRR-funded 
RERC on Technology Transfer, a

[[Page 14355]]

utilization plan for ensuring that all new and improved technologies 
developed by this RERC are successfully transferred to the marketplace.
    In carrying out the above required activities, the RERC must:
     Develop and implement, during the first year of the grant 
and in consultation with the NIDRR-funded National Center for the 
Dissemination of Disability Research (NCDDR), a plan to effectively 
disseminate the RERC's research outcomes to all appropriate target 
audiences including: clinicians, engineers, manufacturers, individuals 
with disabilities, families, disability organizations, technology 
service providers, businesses, and journals;
     In the third year of the grant, conduct a state-of-the-
science conference on technologies for children with orthopedic 
disabilities and publish a comprehensive report in the fourth year of 
the grant;
     Collaborate on research projects of mutual interest with 
the RERC on Prosthetics and Orthotics, the RERC on Wheeled Mobility, 
and the RRTC on Children with Special Health Care Needs; and
     Address the needs of children with orthopedic disabilities 
from minority backgrounds and cultures.

Final Additional Selection Criterion

    The Assistant Secretary will use the selection criteria in 34 CFR 
350.54 to evaluate applications under this program. The maximum score 
for all the criteria is 100 points; however, the Assistant Secretary 
also will use the following criterion so that up to an additional ten 
points may be earned by an applicant for a total possible score of 110 
points:
    Within these absolute priorities, we will give the following 
competitive preference to applications that are otherwise eligible for 
funding under these priorities:
    Up to ten (10) points based on the extent to which an application 
includes effective strategies for employing and advancing in employment 
qualified individuals with disabilities in projects awarded under these 
absolute priorities. In determining the effectiveness of those 
strategies, we will consider the applicant's success, as described in 
the application, in employing and advancing in employment qualified 
individuals with disabilities in the project.
    For purposes of this competitive preference, applicants can be 
awarded up to a total of 10 points in addition to those awarded under 
the published selection criteria for these priorities. That is, an 
applicant meeting this competitive preference could earn a maximum 
total of 110 points.

Electronic Access to This Document

    You 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 Internet at either of the 
following sites:
http://ocfo.ed.gov/fedreg.
htm http://www.ed.gov/news.html

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 (GPO), toll free, at 1-888-293-6498; or in the 
Washington, D.C., area at (202) 512-1530.

    Note: The official version of this document is the document 
published in the Federal Register. Free Internet access to the 
official edition of the Federal Register and the Code of Federal 
Regulations is available on GPO Access at: http://www.access.gpo.gov/nara/index.html.

    Applicable Program Regulations: 34 CFR Part 350.

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

(Catalog of Federal Domestic Assistance Number 84.133N, Model Spinal 
Cord Injury Centers and 84.133E, Rehabilitation Engineering Research 
Centers)

    Dated: March 8, 2000.
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 00-6140 Filed 3-15-00; 8:45 am]
BILLING CODE 4000-01-U