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National Institute on Disability and Rehabilitation Research: Notice of proposed funding priorities for fiscal years (FYs) 2001-2003 for two Disability and Rehabilitation Research Projects [OSERS]
[Federal Register: April 6, 2001 (Volume 66, Number 67)]
[Notices]
[Page 18365-18369]
>From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr06ap01-135]
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Part III
Department of Education
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National Institute on Disability and Rehabilitation Research; Notice
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DEPARTMENT OF EDUCATION
National Institute on Disability and Rehabilitation Research
AGENCY: Office of Special Education and Rehabilitative Services,
Department of Education.
ACTION: Notice of proposed funding priorities for fiscal years (FYs)
2001-2003 for two Disability and Rehabilitation Research Projects.
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SUMMARY: We propose funding priorities for two Disability and
Rehabilitation Research Projects and Centers Program (DRRP) one on
Assistive Technology Outcomes and Impacts and the other on Assistive
Technology Research Projects for Individuals with Cognitive
Disabilities under the National Institute on Disability and
Rehabilitation Research (NIDRR) for FY 2001-2003. We may use these
priorities for competitions in FY 2001 and later years. We take this
action to focus research attention on areas of national need. We intend
these priorities to improve the rehabilitation services and outcomes
for individuals with disabilities.
DATES: We must receive your comments on or before May 7, 2001.
ADDRESSES: All comments concerning these proposed priorities should be
addressed to Donna Nangle, U.S. Department of Education, 400 Maryland
Avenue, SW., room 3414, Switzer Building, Washington, DC 20202-2645.
Comments may also be sent through the Internet: donna_nangle@ed.gov
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.
Individuals with disabilities may obtain this document in an
alternative format (e.g., Braille, large print, audiotape, or computer
diskette) on request to the contact person listed in the preceding
paragraph.
SUPPLEMENTARY INFORMATION:
Invitation To Comment
We invite you to submit comments regarding these proposed
priorities.
We invite you to assist us in complying with the specific
requirements of Executive Order 12866 and its overall requirement of
reducing regulatory burden that might result from these proposed
priorities. Please let us know of any further opportunities we should
take to reduce potential costs or increase potential benefits while
preserving the effective and efficient administration of the program.
During and after the comment period, you may inspect all public
comments about these priorities in Room 3414, Switzer Building, 330 C
Street SW., Washington, DC, between the hours of 8:00 a.m. and 4:00
p.m., Eastern time, Monday through Friday of each week except Federal
holidays.
Assistance to Individuals With Disabilities in Reviewing the
Rulemaking Record
On request, we will supply an appropriate aid, such as a reader or
print magnifier, to an individual with a disability who needs
assistance to review the comments or other documents in the public
rulemaking record for these proposed priorities. If you want to
schedule an appointment for this type of aid, you may call (202) 205-
8113 or (202) 260-9895. If you use a TDD, you may call the Federal
Information Relay Service at 1-800-877-8339.
National Education Goals
These proposed priorities will address the National Education Goal
that every adult American will be literate and will possess the
knowledge and skills necessary to compete in a global economy and
exercise the rights and responsibilities of citizenship.
The authority for the program 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(b)(4)). Regulations governing this
program are found in 34 CFR part 350.
We will announce the final priorities in a notice in the Federal
Register. We will determine the final priorities after considering
responses to this notice and other information available to the
Department. This notice does not preclude us from proposing or funding
additional priorities, subject to meeting applicable rulemaking
requirements.
Note: This notice does not solicit applications. In any year in
which we choose to use these proposed priorities, we invite
applications through a notice published in the Federal Register.
When inviting applications we designate each priority as absolute,
competitive preference, or invitational.
The proposed priorities refer to NIDRR's Long-Range Plan that can
be accessed on the World Wide Web at: (http://www.ed.gov/offices/OSERS/
NIDRR/#LRP).
Disability and Rehabilitation Research Projects and Centers Program
The purpose of the program is to plan and conduct research,
demonstration projects, training, and related activities to:
(a) Develop methods, procedures, and rehabilitation technology that
maximizes the full inclusion and integration into society, employment,
independent living, family support, and economic and social self-
sufficiency of individuals with disabilities; and
(b) Improve the effectiveness of services authorized under the Act.
Proposed Priority 1: Assistive Technology Outcomes and Impacts
Background
One of the greatest challenges facing health care systems, social
services providers and policymakers is to ensure that scarce resources
are used efficiently. To a large extent, this challenge explains the
growing interest in outcomes research and evidence-based medicine.
Particular interest in outcomes of assistive technology (AT) is related
to the amount of dollars spent on developing and manufacturing AT, AT
service delivery and to the need to improve the functional independence
and well-being of persons with disabilities of all ages. Yet,
assessment of the impact of technology on function and other
productivity and quality of life outcomes lags behind outcomes
measurement in other areas of rehabilitation.
There are several factors that promote concern about the paucity of
outcomes research in AT including the: (a) Ability to demonstrate
efficacy of new devices; (b) need to examine effectiveness of devices
over time; and (c) need to chart future research and development to
improve devices (Fuhrer, M. J., ``Assistive technology outcomes
research: challenges met and yet unmet,'' American Journal of Physical
Medicine and Rehabilitation, 2001, In press). Outcomes research and
analysis is also needed to guide decisionmaking across multiple levels
of policy and program development, including: (a) Decisions on a
societal level regarding types of public programs and services to fund;
(b) decisions on a programmatic level regarding what services to
continue, enhance, modify or eliminate; (c) decisions on an individual
level regarding AT recommendations and interventions; and (d) decisions
on a research level regarding the comparative effectiveness of
individual devices and the impact on future designs (Smith, R.,
``Measuring the outcomes of assistive technology: challenge and
innovation'', Assistive Technology, Vol. 8, No. 2, pgs. 71-81, 1996).
In the face of a growing interest in outcomes, the inconsistent use
of
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terminology contributes to the confusion that exists in the application
of a generally accepted outcomes approach. In the field of
rehabilitation, outcomes measurement has focused on creating outcomes
management systems and measuring and communicating outcomes.
Rehabilitation has led the health care field in its emphasis on changes
in function as an outcomes measure. Still, even in rehabilitation,
outcomes measurement systems have typically focused on process
variables, i.e., the outputs of products and services, and not on gains
to the individual or society in either the short or long term.
Wilkerson posits that this emphasis on process will change because of
three factors: (a) The pressure to cut costs; (b) growth of consumerism
leading to increased input from users and increased focus on the needs
of the end user; and (c) concerns about quality in relation to costs
(Wilkerson, D., ``Outcomes and accreditation--The paradigm is shifting
toward outcome,'' Rehab Management, August/September, pgs. 112-115,
1997).
Outcomes research is defined in different ways across
rehabilitation and health services research as well as in the social
services field. The Foundation for Health Services Research (Foundation
for Health Services Research, Health Outcomes Research: A Primer,
Washington, DC, 1994) characterized outcomes research as research
focused on the ``end results of medical care--the effect of the health
care process on the health and well-being of patients and
populations.'' The Institute of Medicine (IOM) (Feasley, J.C., ed.,
Health Outcomes for Older People: Questions for the Coming Decade,
Washington, DC: National Academy Press, 1996) expanded this definition
to include ``the clinical signs and symptoms, well-being or mental and
emotional functioning; physical, cognitive, and social functioning;
satisfaction with care; health-related quality of life, and costs and
appropriate use of resources.'' Outcomes research has also been defined
as research designed to discover the sustained impact of rehabilitative
strategies and treatments in the everyday lives of persons with
disabilities. ``Outcomes research attempts to build a bridge between
interventions and long-term improvements in the lives of persons served
as they reenter the community'' (Johnston, M., et al., ``Outcomes
research in medical rehabilitation-foundations from the past and
directions for the future,'' Assessing Medical Rehabilitation
Practices: The Promise of Outcomes Research, Marcus J. Fuhrer, ed.,
pgs. 1-42, 1997). Regardless of how it is defined, outcomes research is
part of the larger framework of program evaluation (Fuhrer, op cit.,
1997), and includes both outcomes analysis and outcomes measurement
also known as performance measurement (Jennings, B.M. and Staggers, N.,
The language of outcomes, Journal of Rehabilitation Outcomes
Measurement, Vol. 3, No.1, pgs. 59-64, 1999).
Rehabilitation outcomes are changes produced by rehabilitation
services in the lives of service recipients and their environments.
Outcome indicators are measures of the amount and frequency of those
occurrences, and include service quality. Within this perspective, some
analysts use the word ``impacts'' to distinguish between longterm
outcomes or end results that occur on a societal versus an individual
level. Still others use the term ``impact'' more strictly to refer to
estimates of the extent to which the program actually ``caused''
particular outcomes (Hatry, H. et al., Customer Surveys for Agency
Managers: What Managers Need to Know, Washington, DC: Urban Institute,
1998). Deconstructing these various definitions and types of outcomes
and impacts requires recognition of complexity on many levels.
Although AT has grown as a discipline and as an industry over the
past two decades, there has not been a corresponding maturity in
developing or assessing the outcomes or impacts of AT upon individuals
with disabilities. AT devices and services outcomes also may be
difficult to define because of the ways AT is used. For example, AT is
used to increase participation in the environment, enhance normative
social roles, promote and sustain employment, and facilitate activities
of daily living. Some devices, such as computers, increase access to
information and support life long learning. AT devices vary
significantly from highly complex and sophisticated computer-operated
systems to low tech approaches that can be easily purchased or built.
Complicating the issue even further are the individual characteristics
of the AT user and the varied environments in which users live, work,
and learn.
Approximately one-third of AT devices will be abandoned by the user
(Phillips, B. and Zhao, H. ``Predictors of assistive technology
abandonment'', Assistive Technology, Vol. 5, pgs. 36-45, 1995). There
are many reasons why individuals with disabilities choose to accept or
reject AT devices. Since public funds provide a major source for
purchasing AT devices and services, useful and accurate measures of
outcomes and impacts is critical for accountability and to avoid
wasteful outcomes. Is abandonment a negative or could it be a positive
outcome? Abandonment has been viewed as the end result of fragmented
service provision, poor assessment techniques, lack of consumer choice
in device selection, inattention to device use across environments,
inadequate training, costly repairs, need to upgrade and obsolete or
inappropriate technology. However, abandonment may be a natural
phenomenon related to improved physical or cognitive function, the
result of a technology upgrade or because different technology is a
better fit between the end-user and the environment.
There are other reasons to account for the lack of momentum in
measurement development and outcomes and impact research on AT. Most of
the endorsements of a particular device or service are based on
anecdotal information (Fuhrer, 1999) rather than data generated from
research. Frank DeRuyter (``Evaluating outcomes in assistive
technology: do we understand the commitment,'' Assistive Technology,
Vol. 7, No. 1, pgs. 3-16, 1995), observed that historically, AT was
considered a remedy to impairment or dysfunction, and the urgency of
consumer need was of greater importance than relying upon data to
document the efficacy of a particular device. In addition, quality was
perceived as too abstract and difficult to measure and define. Vendors
and practitioners may feel threatened by potential findings and
accountability demands, which may also have contributed to the lack of
outcomes studies (DeRuyter, op. cit, 1995).
While the AT arena is complex and broad, several outcomes studies
have focused on a discrete segment of the entire system. Smith says
that there are essentially two domains of outcome measurement: the
performance of an individual using assistive technology and the cost of
achieving the level of performance (Smith, R.O., ``Accountability in
assistive technology interventions: measuring outcomes,'' Volume I--
RESNA Resource Guide of Assistive Technology Outcomes: Measurement
Tools, pgs. 15-43, 1998). Minkel proposed that the primary measure to
determine the value of the assistive technology is the basic formula of
outcomes divided by cost (Minkel, J., ``Assistive technology and
outcomes measurement: Where do we begin?'' Technology and Disability,
July, pgs. 285-288, 1996). There are others within the AT community who
operate under the assumption that improvements and innovation in
technology will
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``naturally'' lead to successful use and implementation, and therefore
do not need to be evaluated. From this perspective, technological
solutions have been viewed as a panacea without the benefit of data to
support prevailing assumptions (De Ruyter, F., ``Concepts and rationale
for accountability in assistive technology,'' Volume I--RESNA Resource
Guide of Assistive Technology Outcomes: Measurement Tools, pgs. 2-15,
1998).
At a minimum, the process of evaluating AT outcomes must measure
and establish a baseline of what works, identify how well and for whom
it works, and at what level of economy and efficiency. This process
will necessitate taking information from several performance monitoring
dimensions (De Ruyter, op. cit., 1998). In approaching the challenges
of AT outcomes measurement, it is important to identify if the outcomes
relate to the AT product or service, the user, or to the environment in
which the technology is being used. While not standardized or widely
endorsed, a variety of measurement techniques and instruments are
currently utilized. These measurement tools tend to be specific to a
given practice area or limited to a functional domain, (Volume I:
RESNA--Resource Guide for Assistive Technology Outcomes: Measurement
Tools, 1998).
To proceed with assessing AT outcomes and impacts, the following
questions need to be addressed. First, what are the key gaps and
weaknesses in our knowledge of AT use and its impacts? Are the key
research questions related to a particular intervention at a particular
point in time? How do device modifications and upgrades change the
intervention? How do characteristics of the population including
severity of impairment, duration of disability, presence of co-
morbidities, aging and other sociodemographic factors influence
technology utilization and bias outcomes study? What is the role of
environmental, economic, awareness and training barriers in AT use and
outcomes? These different levels of outcomes can look at impacts and
effects of technology at one point in time, more typically a clinical
or functional outcome, or can be examined in terms of long-term impacts
on individual quality of life, productivity and social participation.
As one researcher expressed it, in addition to longitudinal studies,
``the research agenda must consider lifelong use of assistive
technology, documenting effectiveness of that technology as an
intervention, identifying stages for reconsideration of its use, and
defining environmental and social considerations'' (Turk, M. A.,
``Early development-related condition,'' Assessing Medical
Rehabilitation Practices--The Promise of Outcomes Research, Marcus J.
Fuhrer, ed., pgs. 367-392, 1997).
Innovations in AT will continue to evolve and many AT users, as
they have in the recent past, will experience increases in
independence, function, and general well being. Concurrently, the gap
between the promise of technology and the ability of individuals and
funding sources to afford them will continue to widen. This will result
in a greater need for knowledge about the cost-effectiveness and
efficiency of particular devices and services (Fuhrer, M.J.,
``Assistive technology outcomes research: challenges met and yet
unmet,'' American Journal of Physical Medicine and Rehabilitation,
2001, In press).
Proposed Priority 1: Assistive Technology Outcomes and Impacts
We propose to establish multiple research projects on assistive
technology (AT) outcomes and impacts to determine the efficacy and
utility of AT interventions and the implications for abandonment of AT
devices. In carrying out these purposes, the projects must:
(a) Assess the current status of AT outcomes and impacts
measurement systems and approaches, identifying measurement
methodologies, characteristics of key instruments including utility to
AT field, and critical gaps in measurement;
(b) Based upon the findings of paragraph (a), evaluate efficacy of
existing measurement instruments or develop and evaluate new outcomes
and impacts measurement methodologies to meet the needs of AT
stakeholders; and
(c) Investigate and analyze the complexity of factors contributing
to the abandonment of AT, including age-related changes, and identify
how these factors are incorporated into outcomes and impacts
measurement instruments.
In addition to activities proposed by the applicants to carry out
these purposes, each project must:
Develop and disseminate to AT stakeholders and other
interested and relevant audiences, as determined by NIDRR, materials on
AT outcomes studies and impacts analyses and, periodic updates on the
project's milestones, products and results; and
Collaborate with relevant NIDRR-sponsored projects, such
as the AT/IT Consumer Survey (University of Michigan), the RESNA
Technical Assistance projects, and the RRTC on Medical Rehabilitation
Outcomes, as identified through consultation with the NIDRR Project
Officer.
Proposed Priority 2: Assistive Technology Research Projects for
Individuals With Cognitive Disabilities
Background
Technology and assistive devices have commonly been used to assist
persons with mobility, communication and sensory difficulties. Because
of the positive impact that technology has played in the lives of these
individuals, there is now a strong push toward the development of such
devices for people with cognitive disabilities. The Assistive
Technology Act of 1998 defines an assistive technology device to be any
item, piece of equipment or product system whether acquired
commercially off the shelf, modified or customized that is used to
increase, maintain or improve functional capabilities of individuals
with disabilities. Rapid advances in technology provide great potential
for development of new devices or adaptation of available devices to
assist individuals with cognitive disabilities to develop and maintain
skills.
Technology professionals, such as computer scientists and
rehabilitation engineers, have limited experience applying assistive
technology solutions to users with cognitive disabilities. Nor do they
yet understand the mapping between specific needs and equally specific
design solutions. Most people with cognitive disabilities have a range
of learning and processing capabilities. Wide variations in cognitive
functioning make it difficult to develop generic solutions appropriate
for all individuals. Functional capabilities associated with these
disabilities may include wide ranges of ability in memory, reasoning,
and language comprehension. Cognitive functioning also includes
perception, problem-solving, conceptualizing, reading, thinking and
sequencing (Electronic and Information Technology Access Advisory
Committee, ``EITAAC Report, May 13, 1999,'' A Report to the
Architectural and Transportation Barriers Compliance Board). Common
strategies to improve functioning in activities of daily living across
various cognitive disabilities need to be identified, as do, issues
regarding information processing that may be unique to each of these
groups.
Persons with cognitive disabilities often have difficulty in
carrying out Instrumental Activities of Daily Living (IADLs) because of
problems with time management and information retrieval. Researchers
are experimenting with the use of electronic personal computers to
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compensate for memory problems. Other researchers are examining methods
of matching individual cognitive problems with compensatory strategies
provided by a variety of commercially available portable electronic
devices. In traumatic brain injury treatment, researchers are
investigating the use of virtual reality technology to test visual
acuity and reaction times to stimulus. Research is also being conducted
on the use of text-based messages to enhance communication.
Technology is often viewed as facilitating employment of persons
with disabilities. However, inaccessible technology can be a barrier to
all persons with disabilities. This is particularly true for persons
with cognitive impairments who may have difficulty using telephones,
computers, and other equipment that are staples of most work
environments. Developers and manufacturers of assistive technology
often do not consider issues of cognitive access and flexibility when
designing their products.
While the congruence between the promise of assistive technology
and the needs of many people attempting to achieve community
integration is obvious, little has been written about the manner in
which technology affects community adaptation or the service needs of
individuals with cognitive disabilities in community settings. While
specific manifestations of assistive technology have identifiable
benefits, the central question needs to be empirically addressed--how
can assistive technologies contribute to community integration and in
what manner can the linkage be facilitated? The state of knowledge
about the use of assistive technology for persons with cognitive
disabilities, as well as the outcomes of that use or lack of use and
the cost-effectiveness in achieving community integration is limited.
There are only a few large assessments of the technology needs of
persons with cognitive disabilities and results are ambiguous because
of difficulties in identifying persons with low incidence conditions
and specific technology needs within the study population (Lakin, C. et
al., NIDRR Long-Range Plan Commissioned Paper on Community Integration,
1996).
In order to take advantage of any potential that technological
advances may have, it is important to define what makes a device easier
or more difficult for a person with a cognitive disability to use.
Products that are simpler and require fewer cognitive skills are easier
to operate for everyone (Vanderheiden, G., 1992, ``A brief look at
technology and mental retardation in the 21st century,'' in Mental
Retardation in the Year 2000, Louis Rowitz, ed., New York: Springer-
Verlag). ``Design guidelines'' must then be communicated to the
manufacturers of consumer products and business information systems.
Instructions for training on the use and maintenance of the device also
need to be part of this design process. It is important for designers
to be aware of the real world tasks with which the user has difficulty;
hence, research needs to include persons with cognitive disabilities at
the front end of all technology development. End product affordability
is important not only in meeting consumer needs, but also in creating
the market demand that will encourage manufacturers to enter
production.
The NIDRR Long-Range Plan discusses three objectives in developing
technology to meet the needs of people with limitations in cognitive
functioning: To assure that new technologies are accessible and do not
exacerbate exclusion from mainstream activities; to assist people with
cognitive limitations in the performance of daily activities; and to
develop technologies that can enhance or restore some cognitive
functions (NIDRR, Long-Range Plan: 1999-2003, pg. 57).
The University of Colorado recently accepted a gift of $250
million. The endowment will fund advanced research and development of
innovative technologies to enhance the lives of people with cognitive
disabilities. The endowment, to be paid over five years, will be used
to establish the Coleman Institute for Cognitive Disabilities located
at the University of Colorado. Applicants for this project should
provide information on proposed coordination with the Coleman
Institute.
Proposed Priority 2: Assistive Technology Research Projects for
Individuals With Cognitive Disabilities
We propose to establish multiple research projects on technology
access for persons with cognitive disabilities leading to practical and
affordable solutions to identified community and workplace needs of
this population. The projects must:
(a) Conduct an assessment of state-of-the-art technology
applications for persons with cognitive disabilities;
(b) Based on the assessment results of paragraph (a), identify
technology gaps and needs for persons with cognitive disabilities and
make recommendations for new technology and modifications to existing
technology; (c) Identify features that may be incorporated into
existing, commercially available technology that could benefit persons
with cognitive disabilities; and
(d) Develop and explore strategies for strengthening partnerships
with developers and manufacturers of devices in order to facilitate the
development of new technologies and applications to incorporate
cognitive access.
In addition to the activities proposed by the applicants to carry
out these purposes, the projects must:
Coordinate with the appropriate Federal agencies and
privately-funded projects, such as the University of Colorado's Coleman
Institute for Cognitive Disabilities, that are relevant to the
applicants proposed activities as identified through consultation with
the NIDRR project officer; and
Involve individuals with cognitive disabilities in all
aspects of the project.
Applicable program regulations: 34 CFR part 350.
Program Authority: 29 U.S.C. 762(g) and 764(b)(4).
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(Catalog of Federal Domestic Assistance Number: 84.133A, Disability
and Rehabilitation Research Project and Centers Program)
Dated: April 2, 2001.
Andrew J. Pepin,
Executive Administrator for Special Education and Rehabilitative
Services.
[FR Doc. 01-8464 Filed 4-5-01; 8:45 am]
BILLING CODE 4000-01-P