HTML> 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)]
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>From the Federal Register Online via GPO Access []
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Part III
Department of Education
National Institute on Disability and Rehabilitation Research; Notice
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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.


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:

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 


Invitation To Comment

    We invite you to submit comments regarding these proposed 
    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 

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 

    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: (

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


    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 

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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, 
    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, 
    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 

Proposed Priority 2: Assistive Technology Research Projects for 
Individuals With Cognitive Disabilities


    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 
    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 
    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, 
    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 
    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 

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 
[FR Doc. 01-8464 Filed 4-5-01; 8:45 am]