FR Doc 04-6725
[Federal Register: March 25, 2004 (Volume 69, Number 58)]
[Page 15305-15308]
From the Federal Register Online via GPO Access []
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RIN 1820 ZA37

National Institute on Disability and Rehabilitation Research; 
Notice of Proposed Priorities

AGENCY: Office of Special Education and Rehabilitative Services, 
Department of Education.

ACTION: Notice of proposed priorities for health and function outcomes 
for individuals with disabilities.


SUMMARY: The Assistant Secretary for Special Education and 
Rehabilitative Services proposes priorities under the Rehabilitation 
Research and Training Centers (RRTC) Program for the National Institute 
on Disability and Rehabilitation Research (NIDRR). The Assistant 
Secretary may use one or more of these priorities for competitions in 
fiscal year (FY) 2004 and later years. We take this action to focus 
research attention on areas of national need. We intend these 
priorities to improve health and function outcomes for individuals with 

DATES: We must receive your comments on or before April 27, 2004.

ADDRESSES: Address all comments about these proposed priorities to 
Donna Nangle, U.S. Department of Education, 400 Maryland Avenue, SW., 
room 3412, Switzer Building, Washington, DC 20202-2645. If you prefer 
to send your comments through the Internet, use the following address:

FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 205-
    If you use a telecommunications device for the deaf (TDD), you may 
call the TDD number at (202) 205-4475 or via Internet:

    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 under FOR FURTHER 


Invitation To Comment

    We invite you to submit comments regarding these proposed 
priorities. To ensure that your comments have maximum effect in 
developing the notice of final priorities, we urge you to identify 
clearly the specific proposed priority that each comment addresses.
    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 proposed priorities in room 3412, Switzer 
Building, 330 C Street, SW., Washington, DC, between the hours of 8:30 
a.m. and 4 p.m., Eastern time, Monday through Friday of each week 
except Federal holidays.

Assistance to Individuals With Disabilities in Reviewing the Rulemaking 

    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, please contact the person 
    We will announce the final priorities in a notice in the Federal 
Register. We will determine the final priorities after

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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 effect of each type of 
priority follows:

    Absolute priority: Under an absolute priority, we consider only 
applications that meet the priority (34 CFR 75.105(c)(3)).
    Competitive preference priority: Under a competitive preference 
priority, we give competitive preference to an application by either 
(1) awarding additional points, depending on how well or the extent to 
which the application meets the priority (34 CFR 75.105(c)(2)(i)); or 
(2) selecting an application that meets the competitive priority over 
an application of comparable merit that does not meet the competitive 
priority (34 CFR 75.105(c)(2)(ii)).
    Invitational priority: Under an invitational priority, we are 
particularly interested in applications that meet the invitational 
priority. However, we do not give an application that meets the 
invitational priority a competitive or absolute preference over other 
applications (34 CFR 75.105(c)(1)).

    Note: NIDRR supports the goals of President Bush's New Freedom 
Initiative (NFI). The NFI can be accessed on the Internet at the 
following site:

    These proposed priorities are in concert with NIDRR's 1999-2003 
Long-Range Plan (Plan). The Plan is comprehensive and integrates many 
issues relating to disability and rehabilitation research topics. While 
applicants will find many sections throughout the Plan that support 
potential research to be conducted under these proposed priorities, a 
specific reference is included for each priority presented in this 
notice. The Plan can be accessed on the Internet at the following site:

    Through the implementation of the NFI and the Plan, NIDRR seeks 
to--(1) improve the quality and utility of disability and 
rehabilitation research; (2) foster an exchange of expertise, 
information, and training to facilitate the advancement of knowledge 
and understanding of the unique needs of traditionally underserved 
populations; (3) determine best strategies and programs to improve 
rehabilitation outcomes for underserved populations; (4) identify 
research gaps; (5) identify mechanisms of integrating research and 
practice; and (6) disseminate findings.

Rehabilitation Research and Training Centers

    RRTCs conduct coordinated and integrated advanced programs of 
research targeted toward the production of new knowledge to improve 
rehabilitation methodology and service delivery systems, alleviate or 
stabilize disability conditions, or promote maximum social and economic 
independence for persons with disabilities. Additional information on 
the RRTC program can be found at:

General Requirements of Rehabilitation Research and Training Centers

    RRTCs must:
     Carry out coordinated advanced programs of 
rehabilitation research;
     Provide training, including graduate, pre-
service, and in-service training, to help rehabilitation personnel more 
effectively provide rehabilitation services to individuals with 
     Provide technical assistance to individuals with 
disabilities, their representatives, providers, and other interested 
     Disseminate informational materials to 
individuals with disabilities, their representatives, providers, and 
other interested parties; and
     Serve as centers for national excellence in 
rehabilitation research for individuals with disabilities, their 
representatives, providers, and other interested parties.
    The Department is particularly interested in ensuring that the 
expenditure of public funds is justified by the execution of intended 
activities and the advancement of knowledge and, thus, has built this 
accountability into the selection criteria. Not later than three years 
after the establishment of any RRTC, NIDRR will conduct one or more 
reviews of the activities and achievements of the RRTC. In accordance 
with the provisions of 34 CFR 75.253(a), continued funding depends at 
all times on satisfactory performance and accomplishment of approved 
grant objectives.

Proposed Priorities

    The Assistant Secretary proposes to fund three RRTCs that will 
focus on improved outcomes measures, health status, and rehabilitation 
of persons with traumatic brain injury to facilitate the ability of 
individuals with disabilities to live in the community. Under each of 
these priorities, the RRTC must:
    (1) Contribute substantially to the scientific knowledge-base 
relevant to its respective subject area;
    (2) Research, develop, and evaluate interventions or tools to 
assist with outcomes for its focus area;
    (3) Develop, implement, and evaluate a comprehensive plan for 
training critical stakeholders (e.g., consumers/family members, 
practitioners, service providers, researchers, and policymakers);
     (4) Provide technical assistance, as appropriate, to critical 
stakeholders, (e.g., consumers/family members, practitioners, and 
service providers) to facilitate utilization of research findings in 
its respective area of research; and
    (5) Develop a systematic plan for focused dissemination of 
informational materials based on knowledge gained from the RRTC's 
research activities, and disseminate the materials to persons with 
disabilities, their representatives, service providers, and other 
interested parties.
    In addition to these activities, we propose that under each of the 
priorities, the RRTC must:
     Conduct a state-of-the-science conference on its 
respective area of research in the third year of the grant cycle and 
publish a comprehensive report on the final outcomes of the conference 
in the fourth year of the grant cycle. This conference must include 
materials from experts internal and external to the RRTC;
     Coordinate on research projects of mutual 
interest with relevant NIDRR-funded projects as identified through 
consultation with the NIDRR project officer;
     Involve individuals with disabilities, including 
those from diverse racial and ethnic backgrounds, in planning and 
implementing its research, training, and dissemination activities, and 
in evaluating the RRTC;
     Demonstrate in its application how it will 
address, in whole or in part, the needs of individuals with 
disabilities from minority backgrounds; and
     Articulate goals, objectives, and expected 
outcomes for the proposed research activities. It is critical that 
proposals describe expected public benefits, especially benefits for 
individuals with disabilities, and propose projects that are designed 
to demonstrate outcomes that are consistent with the proposed goals. 
Applicants must include information

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describing how they will measure outcomes, including the indicators 
that will represent the end-result, the mechanisms that will be used to 
evaluate outcomes associated with specific problems or issues, and how 
the proposed activities will support new intervention approaches and 
strategies, including a discussion of measures of effectiveness.


    Each RRTC must focus research on one of the following priorities:

Proposed Priority 1--Measuring Rehabilitation Outcomes and 

    In a research environment increasingly driven by the demand for 
evidence-based practice, it is becoming even more necessary to develop 
and use measures to evaluate the effectiveness and efficacy of 
interventions and their value to individuals with disabilities. Despite 
significant investment in development of measures, there is general 
agreement that much remains to be done. This changing environment 
necessitates the development, evaluation, and application of the next 
generation of rehabilitation outcomes measures. These measures must be 
valid, reliable, efficiently collected, relevant to the lives of people 
with disabilities, and easily utilized to drive decisions made by key 
rehabilitation stakeholders. Changing rehabilitation payment structures 
and clinical pathways are necessitating the development of outcome 
measures that can be applied across the spectrum of acute and post-
acute care settings. Through their report entitled ``Crossing the 
Quality Chasm: A New Health System for the 21st Century,'' the 
Institute of Medicine (IOM) emphasizes the importance of transparency 
and accountability in the health care delivery system (Institute of 
Medicine, 2001. Crossing the Quality Chasm: A New Health System for the 
21st Century. Washington, DC: National Academy Press).
    Collecting rehabilitation outcomes is labor intensive in any 
setting. Applications of item-response theory and computerized dynamic 
assessment technologies, which have been successfully applied in the 
fields of education and psychology, have great potential to increase 
efficiency and precision of rehabilitation outcomes data collection and 
measurement (Ware, J. 2003. Conceptualization and Measurement of 
Health-Related Quality of Life: Comments on an Evolving Field. Archives 
of Physical Medicine and Rehabilitation, 84(4 Suppl 2): S43-S51). 
Further application of these state-of-the-art computer-based 
measurement and analysis methods in medical rehabilitation will 
complement the Institute of Medicine's recommendations for the 
development of a national health care information-technology 
infrastructure (Institute of Medicine (2003a). Patient Safety: 
Achieving a New Standard for Care. Washington, DC: National Academies 
    Evolving disability classification frameworks such as the 
International Classification of Functioning, Disability, and Health 
(ICF) (World Health Organization. International Classification of 
Functioning, Disability, and Health; ICF. Geneva: World Health 
Organization) emphasize the importance of participation in a wide 
variety of life situations. In order to apply such frameworks to 
medical rehabilitation services and research, it is necessary to 
develop measurement tools that can assess participation and link this 
outcome to interventions in the rehabilitation setting.
    Priority: This center must conduct research to advance the field of 
medical rehabilitation by increasing the utility, efficiency, and 
relevance of its outcomes measurement tools and processes. The research 
funded under this priority must be designed to contribute to the 
following outcomes:
     Improved measurement tools that can be used to 
track the outcomes of individuals across a wide variety of 
rehabilitation settings.
     Improved measurement tools that incorporate 
consumer perspectives to assess long-term community integration 
outcomes within a comprehensive model for evaluating rehabilitation 
effectiveness, such as the ICF.
     Increased efficiency of rehabilitation outcomes 
data collection, through the application of strategies such as item 
response theory and computer adaptive testing techniques.
     Identification of effective methods for 
translating outcomes data into information that can be utilized to 
inform decisions made by key rehabilitation stakeholders, including 
consumers, payers, provider organizations, and clinicians.
    The reference for this topic can be found in the Plan, chapter 4, 
Health and Function: Research on Rehabilitation Outcomes, pp. 49-50.

Proposed Priority 2--Health and Wellness in Long-Term Disability

    Healthy People 2010 reports on the health status disparity between 
people with disabilities and people without disabilities (U.S. 
Department of Health and Human Services. Healthy People 2010 
Washington, DC: Office of Disease Prevention and Health Promotion, 
2001). On average, health status decreases as the severity of one's 
disability increases. For older people with disabilities, this 
relationship is even stronger. (U.S. Census Bureau. Americans with 
Disabilities: Household Economic Status Washington DC: U.S. Census 
Bureau, 2001).
    Despite this established empirical correlation, health and 
disability are separate and distinct concepts that must be measured on 
separate scales. Research has demonstrated that concepts of health 
status are commonly merged with concepts of disability. New measures of 
health status are needed that are relevant to the experiences of 
persons with long-term disability to facilitate assessment of health 
promotion and wellness activities among this population.
    NIDRR-funded research on aging, disability and secondary conditions 
has identified factors associated with health and wellness outcomes for 
individuals with disabilities. Access to primary (routine) health care 
is one factor that may affect health status of individuals with 
disabilities. Pain management, exercise, and nutrition counseling are 
critical interventions to counteract the results of increasingly 
sedentary lifestyles of persons with long-term disability (Campbell, 
ML, Sheets, D, Strong, PS. Secondary Health Conditions Among Middle-
Aged Individuals with Chronic Physical Disabilities: Implications for 
unmet needs for services. Assistive Technology; 11: 105-122, 1999; 
Motszko M, Preventing osteoporosis. Lifelong nutrition and exercise 
habits are the most powerful weapons. Advanced Nurse Practitioner; Jul: 
10 (7): 41-3, 76, 2002). Rehabilitation researchers have also 
identified complementary and alternative therapies that may promote or 
contribute to improved health and wellness for persons with 
disabilities (Shiffett, SC. Acupuncture and Stroke Rehabilitation. 
Stroke; 32(8); 1934-6-9, 2001).
    Priority: This center must conduct research that will help to 
overcome the health disparities of individuals with disabilities 
compared to individuals without disabilities. The research

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funded under this priority must be designed to contribute to the 
following outcomes:
     Identification of strategies to overcome 
barriers that impede access to routine healthcare for individuals with 
     Identification of interventions in areas such as 
exercise, nutrition, pain management, or complementary and alternative 
therapies, that promote health and wellness and minimize the occurrence 
of secondary conditions for persons with disabilities.
     Improved health status measurement tool(s) to 
assess health and well-being of individuals with disability regardless 
of functional ability.
    The reference for this topic can be found in the Plan, chapter 4, 
Health and Function: Health Care at the Individual Level; Health Care 
at the Systems Level, pp. 42-43.

Proposed Priority 3--Traumatic Brain Injury (TBI) Interventions

    An estimated 5.3 million Americans currently live with disabilities 
resulting from traumatic brain injury (TBI). As stated in the 1998 
National Institutes of Health (NIH) Consensus Conference Proceedings, 
``TBI may result in lifelong impairment of an individual's physical, 
cognitive, and psychosocial functioning.'' Among children up to age 14, 
TBI results annually in an estimated 3,000 deaths, 29,000 
hospitalizations, and 400,000 emergency department visits. A working 
group convened by the National Center for Injury Prevention and Control 
at the CDC in October, 2000 called for more research on patterns of 
recovery, secondary conditions, effectiveness of treatment, and issues 
of measurement for this population. At the September 2003, NIDRR-funded 
State of the Science Conference on TBI Interventions, levels of 
evidence for many interventions in TBI rehabilitation were 
characterized as inconclusive.
    Priority: This center must conduct research to improve long-term 
outcomes for persons with TBI. The research funded under this priority 
must be designed to contribute to one of the following outcomes:
     Identification of interventions that demonstrate 
efficacy, or effectiveness, or both, in promoting improved 
rehabilitation outcomes for adults with TBI; or
     Identification of interventions that demonstrate 
either efficacy, or effectiveness, or both, in promoting improved 
rehabilitation outcomes for children (under age 16) with TBI.
    In addition, for either adults or children, the research funded 
under this priority must be designed to develop and evaluate improved 
techniques for assessing outcomes associated with TBI.
    The reference for this topic can be found in the Plan, chapter 4, 
Health and Function: Research on Trauma Rehabilitation, p. 47.

Executive Order 12866

    This notice of proposed priorities has been reviewed in accordance 
with Executive Order 12866. Under the terms of the order, we have 
assessed the potential costs and benefits of this regulatory action.
    The potential costs associated with the notice of proposed 
priorities are those resulting from statutory requirements and those we 
have determined as necessary for administering this program effectively 
and efficiently.
    In assessing the potential costs and benefits--both quantitative 
and qualitative--of this notice of proposed priorities, we have 
determined that the benefits of the proposed priorities justify the 
    Summary of potential costs and benefits: The potential costs 
associated with these proposed priorities are minimal while the 
benefits are significant. Grantees may anticipate costs associated with 
completing the application process in terms of staff time, copying, and 
mailing or delivery. The use of e-Application technology reduces 
mailing and copying costs significantly.
    The benefits of the RRTC Program have been well established over 
the years. Similar projects have generated new knowledge and 
    The benefit of these proposed priorities will be the establishment 
of new RRTCs, which can be expected to generate new knowledge through 
research, dissemination, utilization, training, and technical 
assistance projects that will improve the lives of persons with 
disabilities and thus improve their ability to live in the community. 
Applicable Program Regulations: 34 CFR part 350.

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 Adobe 
Portable Document Format (PDF) on the Internet at the following site:

    To use PDF you must have Adobe Acrobat Reader, which is available 
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    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:

(Catalog of Federal Domestic Assistance Number: 84.133B, 
Rehabilitation Research and Training Centers Program)

    Program Authority: 29 U.S.C. 762(g) and 764(b)(2).

    Dated: March 22, 2004.
Troy R. Justesen,
Acting Deputy Assistant Secretary for Special Education and 
Rehabilitative Services.
[FR Doc. 04-6725 Filed 3-24-04; 8:45 am]