National Institute on Disability and Rehabilitation Research (NIDRR)-Disability and Rehabilitation Research Projects and Centers Program-Rehabilitation Research and Training Centers (RRTCs) and Rehabilitation Engineering Research Centers (RERCs), 21338-21349 [E9-10653]

Agencies

• DEPARTMENT OF EDUCATION

[Federal Register Volume 74, Number 87 (Thursday, May 7, 2009)]
[Notices]
[Pages 21338-21349]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-10653]


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DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research 
(NIDRR)--Disability and Rehabilitation Research Projects and Centers 
Program--Rehabilitation Research and Training Centers (RRTCs) and 
Rehabilitation Engineering Research Centers (RERCs)

    Catalog of Federal Domestic Assistance (CFDA) Numbers: 84.133B 
Rehabilitation Research and Training Centers and 84.133E Rehabilitation 
Engineering Research Centers.

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

ACTION: Notice of proposed priorities for RRTCs and RERCs.

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SUMMARY: The Assistant Secretary for Special Education and 
Rehabilitative Services proposes certain funding priorities for the 
Disability and Rehabilitation Research Projects and Centers Program 
administered by NIDRR. Specifically, this notice proposes four 
priorities for RRTCs and three priorities for RERCs. The Assistant 
Secretary may use these priorities for competitions in fiscal year (FY) 
2009 and later years. We take this action to focus research attention 
on areas of national need. We intend these priorities to improve 
rehabilitation services and outcomes for individuals with disabilities.

DATES: We must receive your comments on or before June 8, 2009.

ADDRESSES: Address all comments about this notice to Donna Nangle, U.S. 
Department of Education, 400 Maryland Avenue, SW., Room 6029, Potomac 
Center Plaza (PCP), Washington, DC 20202-2700.
    If you prefer to send your comments by e-mail, use the following 
address: donna.nangle@ed.gov.
    You must include the term ``Proposed Priorities for RRTCs and 
RERCs'' and the priority title in the subject line of your electronic 
message.

FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 245-
7462 or by e-mail: donna.nangle@ed.gov.
    If you use a telecommunications device for the deaf (TDD), call the 
Federal Relay Service (FRS), toll free, at 1-800-877-8339.

SUPPLEMENTARY INFORMATION: This notice of proposed priorities is in 
concert with NIDRR's Final Long-Range Plan for FY 2005-2009 (Plan). The 
Plan, which was published in the Federal Register on February 15, 2006 
(71 FR 8165), can be accessed on the Internet at the following site: 
https://www.ed.gov/about/offices/list/osers/nidrr/policy.html.
    Through the implementation of 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.
    One of the specific goals established in the Plan is for NIDRR to 
publish all of its proposed priorities, and following public comment, 
final priorities, annually, in a consolidated notice. Under this 
approach, NIDRR's constituents can submit comments at one time rather 
than at different times throughout the year, and NIDRR can move toward 
a fixed schedule for competitions and more efficient grant-making 
operations. This notice proposes priorities that NIDRR intends to use 
for RRTC and RERC competitions in FY 2009 and possibly later years. 
However, nothing precludes NIDRR from publishing additional priorities, 
if needed. Furthermore, NIDRR is under no obligation to make an award 
for each of these priorities. The decision to make an award will be 
based on the quality of applications received and available funding.
    Invitation to Comment: We invite you to submit comments regarding 
this notice. 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 ways we could reduce 
potential costs or increase potential benefits while preserving the 
effective and efficient administration of the program.

[[Page 21339]]

    During and after the comment period, you may inspect all public 
comments about this notice in room 6029, 550 12th Street, SW., PCP, 
Washington, DC, between the hours of 8:30 a.m. and 4:00 p.m., 
Washington, DC time, Monday through Friday of each week except Federal 
holidays.
    Assistance to Individuals with Disabilities in Reviewing the 
Rulemaking Record: On request we will provide an appropriate 
accommodation or auxiliary aid to an individual with a disability who 
needs assistance to review the comments or other documents in the 
public rulemaking record for this notice. If you want to schedule an 
appointment for this type of accommodation or auxiliary aid, please 
contact the person listed under FOR FURTHER INFORMATION CONTACT.
    Purpose of Program: The purpose of the Disability and 
Rehabilitation Research Projects and Centers Program is to plan and 
conduct research, demonstration projects, training, and related 
activities, including international activities, to develop methods, 
procedures, and rehabilitation technology, that maximize the full 
inclusion and integration into society, employment, independent living, 
family support, and economic and social self-sufficiency of individuals 
with disabilities, especially individuals with the most severe 
disabilities, and to improve the effectiveness of services authorized 
under the Rehabilitation Act of 1973, as amended.
    Program Authority: 29 U.S.C. 762(g), 764(a), 764(b)(2), and 
764(b)(3).
    Applicable Program Regulations: 34 CFR part 350.

Proposed Priorities

    In this notice, we are proposing four priorities for RRTCs and 
three priorities for RERCs.
    For RRTCs, the proposed priorities are:
     Priority 1--Improved Employment Outcomes for Individuals 
with Psychiatric Disabilities.
     Priority 2--Transition-Age Youth and Young Adults with 
Serious Mental Health Conditions.
     Priority 3--Improving Measurement of Medical 
Rehabilitation Outcomes.
     Priority 4--Developing Strategies to Foster Community 
Integration and Participation for Individuals with Traumatic Brain 
Injury.
    For RERCs, the proposed priorities are:
     Priority 5--Telerehabilitation.
     Priority 6--Telecommunication.
     Priority 7--Cognitive Rehabilitation.

Rehabilitation Research and Training Centers (RRTCs)

    The purpose of the RRTCs is to improve the effectiveness of 
services authorized under the Rehabilitation Act of 1973, as amended, 
through advanced research, training, technical assistance, and 
dissemination activities in general problem areas, as specified by 
NIDRR. Such activities are designed to benefit rehabilitation service 
providers, individuals with disabilities, and the family members or 
other authorized representatives of individuals with disabilities. In 
addition, NIDRR intends to require all RRTC applicants to meet the 
requirements of the General Rehabilitation Research and Training 
Centers (RRTC) Requirements priority that it published in a notice of 
final priorities in the Federal Register on February 1, 2008 (72 FR 
6132). Additional information on the RRTCs can be found at: https://www.ed.gov/rschstat/research/pubs/res-program.html#RRTC.
Statutory and Regulatory Requirements of RRTCs
    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 disabilities;
     Provide technical assistance to individuals with 
disabilities, their representatives, providers, and other interested 
parties;
     Disseminate informational materials to individuals with 
disabilities, their representatives, providers, and other interested 
parties; and
     Serve as centers of national excellence in rehabilitation 
research for individuals with disabilities, their representatives, 
providers, and other interested parties.
    Applicants for RRTC grants must also demonstrate in their 
applications how they will address, in whole or in part, the needs of 
individuals with disabilities from minority backgrounds.

Proposed Priorities

Proposed Priority 1--Improved Employment Outcomes for Individuals With 
Psychiatric Disabilities

Background
    Individuals with psychiatric disabilities have one of the lowest 
rates of employment of any disability group--only one in three of these 
individuals is employed (Kaye, 2002). They also comprise the largest 
diagnostic category of working-age adults receiving Supplemental 
Security Income or Social Security Disability Insurance (Social 
Security Administration [SSA], August, 2008; SSA, September, 2008; 
McAlpine & Warner, 2001). For individuals with these disabilities who 
are employed, job retention is a major challenge (Murphy, Mullen & 
Spagnolo, 2005).
    For individuals with psychiatric disabilities, there are numerous 
barriers to obtaining, retaining, and advancing in meaningful 
employment. These barriers include: The stigma associated with these 
disabilities; discrimination; disincentives associated with the loss of 
Social Security and Medicaid benefits; limits on available and 
effective vocational rehabilitation (VR) services for this population; 
and ineffective collaboration between VR, SSA, mental health agencies, 
and consumer groups (Dew & Alan, 2005; United States Government 
Accountability Office, 2005; New Freedom Commission on Mental Health, 
2003). For some individuals with psychiatric disabilities, these 
barriers to employment are compounded by ineffective services for 
addressing the unique needs of individuals from racial, cultural, or 
linguistic minorities and individuals with both mental and physical 
health conditions (Substance Abuse and Mental Health Services 
Administration, 2005; United States Public Health Service Office of the 
Surgeon General, 2001). Research is needed to develop and advance 
innovative interventions that address these problems and barriers 
facing individuals with psychiatric disabilities.
    Mental health research funded by NIDRR and others has led to 
advances in theory development, measurement tools, community-based 
supports, and treatment options for individuals with psychiatric 
disabilities. One example of an area of research that has led to 
advances in community-based supports and treatment options is research 
related to supported employment, a VR intervention that places 
consumers in integrated job settings and provides on-the-job training 
and supports, and salaries at or above minimum wage. Research in this 
area contributed to the conclusion that supported employment is an 
effective and evidence-based VR intervention for individuals with 
psychiatric disabilities (Dew & Alan, 2005; Mueser et al., 2004; New 
Freedom Commission on Mental Health, 2003).
    Despite advances in theory development, measurement tools, 
community-based supports, and treatment options for individuals with 
psychiatric disabilities, literature in this

[[Page 21340]]

area indicates that evidence-based and promising approaches for 
improving employment outcomes for individuals with psychiatric 
disabilities are not being incorporated into existing practice in an 
effective and consistent manner (Casper & Carloni, 2007, Dew & Alan, 
2005). There is extensive documentation about the need to improve the 
incorporation of research findings in mental health service delivery to 
improve outcomes for individuals who receive mental health services 
(Institute of Medicine, 2001; New Freedom Commission on Mental Health, 
2003; Substance Abuse and Mental Health Services Administration, 2005).
    Further research is needed in order to address the low employment 
rate of individuals with psychiatric disabilities and to find solutions 
to the unique barriers these individuals face in obtaining, retaining 
and advancing in meaningful employment. This research should include a 
focus on improved models, programs, and interventions, and increased 
knowledge translation of research findings.

References

Casper, E.S. & Carloni, C. (2007). Assessing the underutilization of 
supported employment services. Psychiatric Rehabilitation Journal, 
30(3), 182-188.
Dew, D.W. & Alan, G.M. (Eds.). (2005). Innovative methods for 
providing VR services to individuals with psychiatric disabilities 
(Institute on Rehabilitation Issues Monograph No. 30). Washington, 
DC: The George Washington University, Center for Rehabilitation 
Counseling Research and Education.
Institute of Medicine. (2001). Crossing the quality chasm: A new 
health system for the 21st century. Washington, DC: National Academy 
Press.
Kaye, H.S. (2002). Employment and social participation among people 
with mental health disabilities. San Francisco, CA: National 
Disability Statistics & Policy Forum.
McAlpine, D.D. & Warner, L. (2001). Barriers to Employment Among 
Persons with Mental Illness: A Review of the Literature. New 
Brunswick, NJ: Institute for Health.
Mueser, K.T., Clark, R.E., Haines, M., Drake, R.E., McHugo, G.J., 
Bond, G., et al. (2004). The Hartford study of supported employment 
for persons with severe mental illness. Journal of Consulting and 
Clinical Psychology, 72(3), 479-490.
Murphy, A.A., Mullen, M.G., & Spagnolo, A.B. (2005). Enhancing 
individual placement and support: Promoting job tenure by 
integrating natural supports and supported education. American 
Journal of Psychiatric Rehabilitation, 8, 37-61.
New Freedom Commission on Mental Health, U.S. Department of Health 
and Human Services. (2003). Achieving the promise: Transforming 
mental health care in America. Final Report. (DHHS Publication No. 
SMA 03-3832). Rockville, MD: Author.
Office of the Surgeon General, U.S. Public Health Service, U.S. 
Department of Health and Human Services. (2001). Mental health: 
Culture, race, and ethnicity: A supplement to mental health: A 
report of the Surgeon General. Rockville, MD: Author.
Office of Research, Evaluation, and Statistics, Office of Retirement 
and Disability Policy, Social Security Administration (2008, 
September). Social Security Insurance annual statistical report, 
2007. (SSA Publication No. 13-11827). Washington, DC: Author.
Office of Research, Evaluation, and Statistics, Office of Retirement 
and Disability Policy, Social Security Administration (2008, 
August). Annual statistical report on the Social Security Disability 
Insurance program, 2007. (SSA Publication No. 13-11826). Washington, 
DC: Author.
Substance Abuse and Mental Health Services Administration, U.S. 
Department of Health and Human Services. (2005). Transforming mental 
health care in America. Federal action agenda: First steps. (DHHS 
Publication No. SMA 05-4060.) Rockville, MD: Author.
U.S. Government Accountability Office. (2005). Vocational 
rehabilitation: Better measures and monitoring could improve the 
performance of the VR program. (GAO Publication No. 05-865.) 
Washington, DC: Author.

Proposed Priority

    The Assistant Secretary for Special Education and Rehabilitative 
Services proposes a priority for a Rehabilitation Research and Training 
Center (RRTC) on Improved Employment Outcomes for Individuals with 
Psychiatric Disabilities. The RRTC must conduct rigorous research, 
training, technical assistance, and knowledge translation activities 
that contribute to improved employment outcomes for individuals with 
psychiatric disabilities. Under this priority, the RRTC must be 
designed to contribute to the following outcomes:
    (a) Improved models, programs, and interventions to enable 
individuals with psychiatric disabilities to obtain, retain, and 
advance in competitive employment of their choice. The RRTC must 
contribute to this outcome by--
    (1) Identifying or developing, and testing, innovative 
interventions and employment accommodations using scientifically based 
research (as this term is defined in section 9101(37) of the Elementary 
and Secondary Education Act of 1965, as amended). These interventions 
and employment accommodations must include an emphasis on consumer 
control, peer supports, and community living, and address the needs of 
individuals from traditionally underserved groups (e.g., individuals 
from diverse racial, ethnic, and linguistic backgrounds, and different 
geographic areas, and individuals with multiple disabilities).
    (2) Conducting research to identify barriers to, and facilitators 
of, effective partnerships between State vocational rehabilitation (VR) 
agencies, the Social Security Administration, State and local mental 
health programs, and consumer-directed programs, and collaborating with 
these entities to develop new models for effective partnerships.
    (3) Developing, testing, and validating adaptations of evidence-
based interventions to enhance the effectiveness of those interventions 
for individuals from traditionally underserved groups (e.g., 
individuals from diverse racial, ethnic, and linguistic backgrounds, 
and geographic areas, and individuals with multiple disabilities). 
Current evidence-based approaches include but are not limited to 
supported employment.
    (b) Increased incorporation of research findings related to 
employment and psychiatric disability into practice or policy. The RRTC 
must contribute to this outcome by coordinating with appropriate NIDRR-
funded knowledge translation grantees to advance their work in the 
following areas:
    (1) Developing, evaluating, or implementing strategies to increase 
utilization of research findings related to employment and psychiatric 
disability.
    (2) Conducting training, technical assistance, and dissemination 
activities to increase utilization of research findings related to 
employment and psychiatric disability.
    In addition to contributing to these outcomes, the RRTC must:
     Collaborate with state VR agencies and other stakeholder 
groups (e.g., consumers, families, advocates, clinicians, policymakers, 
training programs, employer groups, and researchers) in conducting the 
work of the RRTC. Research partners in this collaboration must include, 
but are not limited to, the NIDRR-funded RRTC for Vocational 
Rehabilitation Research, the Disability Rehabilitation Research Project 
on Innovative Knowledge Dissemination and Utilization for Disability 
and Professional Organizations and Stakeholders, and other relevant 
NIDRR grantees.

Proposed Priority 2--Transition-Age Youth and Young Adults With Serious 
Mental Health Conditions

Background

    The prevalence of serious mental health conditions in youth and 
young

[[Page 21341]]

adults transitioning from adolescence to adulthood is conservatively 
estimated to range from 1 to 3.2 million (Davis, 2003; Davis & Vander 
Stoep, 1997).\1\ This prevalence estimate is difficult to calculate 
largely because diagnostic categories applicable to individuals under 
the age of 18 differ from those applicable to adults. As defined by the 
Substance Abuse and Mental Health Services Administration (SAMHSA), the 
term ``serious emotional disturbance'' (SED) refers to diagnosable 
mental, behavioral, or emotional disorders resulting in functional 
impairment that substantially interferes with major life activities in 
individuals from birth to age 18 (SAMHSA, 1993). The term ``serious 
mental illness'' is used for comparable disorders in individuals aged 
18 and older (SAMHSA, 1993).
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    \1\ Because this estimate is based on a narrower age range (16-
25) than the one specified in this priority, we believe it is a 
conservative estimate.
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    For this priority, we define the target population as individuals 
between the ages of 14 and 30 who have been diagnosed with either SED 
or serious mental illness, as defined by SAMHSA. We refer to this 
target population as youth and young adults with serious mental health 
conditions (SMHC). The best estimate of the prevalence of SMHC is based 
on the prevalence rates of SED. Estimates of the prevalence of SED are 
5 to 9 percent of the population (Davis & Vander Stoep, 1997).
    Making the transition to adulthood is especially challenging for 
youth and young adults with SMHC. As youth and young adults with SMHC 
transition to adulthood, they are at increased risk for a variety of 
negative outcomes, including but not limited to arrest, substance 
abuse, unplanned pregnancy, dropping out of school, unemployment, 
difficulties in family and peer relationships, and difficulties with 
independent living (Armstrong et al., 2003; Jonikas et al., 2003). 
Individuals with disabilities transitioning from adolescence to 
adulthood, particularly youth and young adults with SMHC, who come from 
disadvantaged backgrounds (e.g., backgrounds involving foster care, 
poverty, histories of abuse, or histories of substance abuse), are at 
even greater risk for negative outcomes (Bobier & Warwick, 2005; Geenen 
et al., 2005; Lubman et al., 2007; National Council on Disability, 
2008).
    The New Freedom Commission on Mental Health (Commission) issued a 
series of recommendations regarding mental health care and its delivery 
in the U.S. (New Freedom Commission on Mental Health, 2003) that have 
applicability to programs serving youth and young adults with SMHC. 
Based on these recommendations, programs for youth and young adults 
with SMHC should be designed to achieve recovery-based outcomes, e.g., 
employment, education, and community integration. In addition, these 
programs should be family- and consumer-guided, i.e., consumers would 
choose the programs and providers to work with them, and partner with 
those providers to develop individualized plans of care and to make 
funding decisions (New Freedom Commission on Mental Health, 2003, pp. 
28-29).
    Previous research has also identified a number of interventions 
that show some promise of improving education and employment outcomes 
for youth and young adults with SMHC. There is some evidence, for 
example, that supported postsecondary education and supported 
employment can facilitate positive postsecondary and employment 
outcomes for this population (Cook et al., 2005; Weiss et al., 2004).
    Nevertheless, currently available services for this population have 
a number of problems. First, because interventions are often designed 
for either children or adults, the services provided to youth and young 
adults with SMHC frequently are not coordinated and are not geared 
toward successfully transitioning children into the adult mental health 
systems (Davis & Sondheimer, 2005). Second, because service providers 
are frequently trained to work either with children or adults, they are 
not adequately trained to work with youth and young adults with SMHC 
who are transitioning between childhood and adulthood (Davis & 
Koyanagi, 2005). Under these conditions, programs and interventions are 
often not well suited to helping this target population to acquire 
necessary skills for independent living, employment, and community 
integration, and to maintain those skills in adulthood. In addition, 
many programs fail to provide a developmentally appropriate balance 
between the need to involve family members in decision-making and the 
need for youth and young adults with SMHC to become independent.
    Previous NIDRR-funded work has documented the needs of this target 
population and has contributed to the current knowledge of best 
practices in transition programs for youth and young adults with SMHC 
(Deschenes & Clark, 2001; Jonikas et al., 2003). Other NIDRR-funded 
research has identified factors associated with better community 
adjustment for this target population, such as initial levels of social 
adaptive behavior (Armstrong et al., 2003). However, despite previous 
work concerning youth and young adults with SMHC, there is little 
scientifically based research demonstrating which interventions are 
most likely to overcome the barriers described in the prior paragraph, 
and improve transition outcomes for youth and young adults with SMHC. 
There is even less scientifically based research on the efficacy of 
interventions for individuals from this target population who come from 
disadvantaged backgrounds (e.g., backgrounds involving foster care, 
poverty, histories of abuse, or histories of substance abuse).

References

Armstrong, K.J., Dedrick, R.F., & Greenbaum, P.E. (2003). Factors 
associated with community adjustment of young adults with serious 
emotional disturbance: A longitudinal analysis. Journal of Emotional 
and Behavioral Disorders, 11, 66-91.
Bobier, C. & Warwick, M. (2005). Factors associated with readmission 
to adolescent psychiatric care. Australian and New Zealand Journal 
of Psychiatry, 39, 600-606.
Cook, J.A., Lehman, A.F., Drake, R., McFarlane, W.R., Gold, P.B., 
Leff, H.S., et al. (2005). Integration of psychiatric and vocational 
services: A multisite randomized, controlled trial of supported 
employment. American Journal of Psychiatry, 162, 1948-1956.
Davis, M. (2003). Addressing the needs of youth in transition to 
adulthood. Administration and Policy in Mental Health, 30, 495-509.
Davis, M. & Koyanagi, C. (2005). Summary of Center for Mental Health 
Services (CMHS) youth transition policy meeting: National Experts 
Panel. Technical paper produced by University of Massachusetts 
Medical School and the Judge David L. Bazelon Center for Mental 
Health Law under contract 280-03-8082 with American 
Institutes of Research which was supported by a contract with CMHS 
of the Substance Abuse and Mental Health Services Administration.
Davis, M. & Sondheimer, D.L. (2005). State child mental health 
efforts to support youth in transition to adulthood. Journal of 
Behavioral Health Services & Research, 32, 27-36.
Davis, M., & Vander Stoep, A. (1997). The transition to adulthood 
for youth who have serious emotional disturbance: Developmental 
transition and young adult outcomes. The Journal of Mental Health 
Administration, 24, 400-427.
Deschenes, N. & Clark, H.B. (2001). Best practices in transition 
programs for youth with emotional and behavioral difficulties. Focal 
Point, 15, 14-17.
Geenen, S., Powers, L.E., & Lopez-Vasquez, A. (2005). Barriers 
against and strategies for promoting the involvement of culturally 
diverse parents in school-

[[Page 21342]]

based transition planning. Journal for Vocational Special Needs 
Education, 27, 4-14.
Jonikas, J.A., Laris, A., & Cook, J.A. (2003). The passage to 
adulthood: Psychiatric rehabilitation service and transition-related 
needs of young adult women with emotional and psychiatric disorders. 
Psychiatric Rehabilitation Journal, 27, 114-121.
Lubman, D.I., Allen, N.B., Rogers, N., Cementon, E., & Bonomor, Y. 
(2007). The impact of co-occurring mood and anxiety disorders among 
substance-abusing youth. Journal of Affective Disorders, 103, 105-
112.
National Council on Disability (2008). Youth with Disabilities in 
the Foster Care System: Barriers to Success and Proposed Policy 
Solutions. https://www.ncd.gov/newsroom/publications/2008/FosterCareSystem_Report.html).
New Freedom Commission on Mental Health, U.S. Department of Health 
and Human Services. (2003). Achieving the promise: Transforming 
mental health care in America. Final Report. Page 29425. DHHS Pub. 
No. SMA-03-3832. Rockville, MD: Author.
Substance Abuse and Mental Health Services Administration, U.S. 
Department of Health and Human Services. (1993). Final notice. 
Federal Register, 58 (96), 29425.
Weiss, J., Maddox, D., Vanderwaeerden, M., & Szilvagyi, S. (2004). 
The Tri-County Scholars Program: Bridging the clubhouse and 
community college. American Journal of Psychiatric Rehabilitation, 
7, 281-300.

Proposed Priority

    The Assistant Secretary for Special Education and Rehabilitative 
Services proposes a priority for a Rehabilitation Research and Training 
Center (RRTC) on Transition-Age Youth and Young Adults with Serious 
Mental Health Conditions (SMHC). This RRTC must conduct research that 
contributes to improved transition outcomes for youth and young adults 
with SMHC, including youth and young adults with SMHC from high-risk, 
disadvantaged backgrounds. The research conducted by this RRTC must 
focus on family and consumer-guided care. For purposes of this 
priority, the term ``youth and young adults with SMHC'' refers to 
individuals between the ages of 14 and 30, inclusive, who have been 
diagnosed with either serious emotional disturbance (for individuals 
under the age of 18 years) or serious mental illness (for those 18 
years of age or older). Under this priority, the RRTC must contribute 
to the following outcomes:
    (a) Improved and developmentally appropriate interventions for 
youth and young adults with SMHC. The RRTC must contribute to this 
outcome by identifying or developing, and evaluating, innovative 
interventions that meet the needs of youth and young adults with SMHC 
using scientifically based research (as this term is defined in section 
9101(37) of the Elementary and Secondary Education Act of 1965, as 
amended). In carrying out this research, the RRTC must utilize 
recovery-based outcome measures, including improved employment, 
education, and community integration, among youth and young adults with 
SMHC. The RRTC must involve youth and young adults with SMHC, and their 
families or family surrogates, in the processes of identifying or 
developing, and evaluating, interventions.
    (b) New knowledge about interventions for youth and young adults 
with SMHC who are from disadvantaged backgrounds (e.g., backgrounds 
involving foster care, poverty, abuse, or substance abuse). The RRTC 
must contribute to this outcome by conducting scientifically based 
research to identify or develop, and evaluate effective interventions, 
for these at-risk youth and young adults with SMHC.
    (c) Improved coordination between child and adult mental health 
services. The RRTC must contribute to this outcome by conducting 
research to identify and evaluate innovative approaches that address 
financial, policy, and other barriers to smooth system integration 
between the child and adult mental health service systems.
    (d) Improved capacity building for service providers. The RRTC must 
provide training and technical assistance with a particular emphasis on 
graduate, pre-service, and in-service training and curriculum 
development designed to prepare direct service providers for work with 
youth and young adults with SMHC.
    (e) Increased translation of findings into practice or policy. The 
RRTC must contribute to this outcome by coordinating with the RRTC on 
Vocational Rehabilitation and with appropriate NIDRR-funded knowledge 
translation grantees to--
    (1) Collaborate with State VR agencies and other stakeholder groups 
(e.g., State educational agencies, youth and young adults with SMHC, 
families, family surrogates, and clinicians) to develop, evaluate, or 
implement strategies to increase utilization of findings in programs 
targeted to youth and young adults with SMHC; and
    (2) Conduct dissemination activities to increase utilization of the 
RRTC's findings.

Proposed Priority 3--Improving Measurement of Medical Rehabilitation 
Outcomes

Background

    One of the central objectives of NIDRR-funded rehabilitation 
research is to ``increase the number of validated new or improved 
methods for assessing function and health status'' (NIDRR Long-Range 
Plan, 2005-2009, Executive Summary, 2007). To achieve this objective, 
state-of-the-art methods of measuring medical rehabilitation outcomes 
and the personal, clinical, and environmental factors that shape those 
outcomes are needed.
    Data collection techniques, such as item-response theory and 
computerized dynamic assessment technologies, have demonstrated great 
potential for increasing the efficiency of data collection and the 
precision of measuring rehabilitation outcomes (Ware, 2003). Continued 
improvements in data collection and measurement methods will improve 
the capacity of practitioners to measure medical rehabilitation 
outcomes in a wide variety of settings and across disability groups.
    In the past, NIDRR has funded several centers on rehabilitation 
outcomes measurement and sponsored numerous conferences and symposiums 
on this topic. A recent NIDRR-funded Post-Acute Rehabilitation 
Symposium (Symposium) identified a number of emerging outcomes 
measurement topics that require a special focus (Heinemann, 2007).
    One topic the Symposium identified was the measurement of cognitive 
functioning. The ability to learn, as well as to attend to and 
participate in self-care, are critical cognitive skills associated with 
other successful medical rehabilitation outcomes (Johnston et al., 
2007). Cognition is both a rehabilitation outcome in itself (Sayer et 
al., 2008) and a factor that is related to broader functional and 
community outcomes for individuals with a wide variety of disabling 
conditions (Van Baalen, Odding, & Stam, 2008; Hershkovitz et al., 
2007). Improved capacity to measure cognition is needed (Clohan et al., 
2007). Specifically, improved measures of cognition that can be applied 
across rehabilitation populations and settings are needed to improve 
clinical practice and to assess the effectiveness of rehabilitation 
interventions and programs. Current measures of cognition do not 
adequately capture the range of cognitive functions among individuals 
in medical rehabilitation settings (Hall et al., 1999; Schepers et al., 
2006), and do not

[[Page 21343]]

always reflect abilities that are relevant to performing activities in 
the community (Donovan et al., 2007).
    The Symposium also identified the measurement of environmental 
factors associated with outcomes as a topic in need of further 
investigation. Environmental factors, such as staffing and care 
practices, differ across settings, and can influence rehabilitation 
treatments and outcomes. Examples of such settings are post-acute care 
settings, including rehabilitation facilities, skilled nursing 
facilities, long-term care hospitals, home health agencies, and 
outpatient settings.
    As with the measurement of cognitive functioning, there has been an 
increase in the amount of research being conducted on the influence of 
environmental factors on medical rehabilitation outcomes in recent 
years. For example, research indicates that the environment in which 
people live is a prominent predictor of community integration 
(Reistetter & Abreu, 2005), and that environmental factors such as the 
reduction of physical barriers are associated with community 
participation outcomes for children and youth with acquired brain 
injuries discharged from inpatient rehabilitation (Bedell, 2004). This 
increasing evidence that environmental factors are associated with 
rehabilitation outcomes has led to calls for developing health-related 
quality of life measures for individuals with disabilities that 
consider environmental factors (Schwartz et al., 2007).
    There have been some international efforts pertaining to the 
measurement of the effects of the environment on rehabilitation 
outcomes. The Quebec Model for the Handicap Creation Process 
(Fougeyrollas, 1993) was the first disability-related taxonomy to offer 
a classification of environmental factors that influence rehabilitation 
outcomes. This taxonomy influenced the subsequent inclusion of 
environmental factors in the International Classification of 
Functioning, Disability and Health (ICF) (World Health Organization, 
2001). The Craig Hospital Inventory of Environmental Factors (Craig 
Hospital Research Department, 2001) is a measurement tool designed to 
implement the ICF's environmental factors taxonomy, but is not 
specifically designed to assess differences across rehabilitation 
settings. Despite the current research and need in the field, state-of-
the-art measures of cognition and of environmental factors for use 
across medical rehabilitation settings and subpopulations have not been 
developed.

References

Bedell, G.M. (2004). Developing a follow-up survey focused on 
participation of children and youth with acquired brain injuries 
after discharge from inpatient rehabilitation. NeuroRehabilitation, 
19, 191-205.
Clohan, D.B., Durkin, E.M., Hammel, J., Murray, P., Whyte, J., 
Dijkers, M., et al. (2007). Postacute rehabilitation research and 
policy recommendations. Archives of Physical Medicine and 
Rehabilitation, 88, 1535-1541.
Craig Hospital Research Department (2001). Craig Hospital Inventory 
of Environmental Factors (CHIEF) Manual, Version 3.0. Englewood, CO: 
Craig Hospital.
Donovan, N.J., Kendall, D.L., Heaton, S.C., Kwon, S., Velozo, C., & 
Duncan, P.W. (2008). Conceptualizing functional cognition in stroke. 
Neurorehabilitation and Neural Repair, 22(2), 122-135.
Fougeyrollas, P. (1993). Explanatory models of the consequences of 
disease and trauma: The handicap creation process. ICIDH 
International Network 6.
Hall, K.M., Cohen, M.E., Wright, J., Call, M., & Werner, P. (1999). 
Characteristics of the Functional Independence Measure in traumatic 
spinal cord injury. Archives of Physical Medicine and 
Rehabilitation, 80(11), 1471-1476.
Heinemann, A.W. (2007). State-of-the-science on postacute 
rehabilitation: Setting a research agenda and developing an evidence 
base for practice and public policy, an introduction. Archives of 
Physical Medicine and Rehabilitation, 88, 1478-1481.
Hershkovitz, A., Kalandariov, Z., Hermush, V., Weiss, R., & Brill, 
S. (2007). Factors affecting short-term rehabilitation outcomes of 
disabled elderly patients with proximal hip fracture. Archives of 
Physical Medicine and Rehabilitation, 88(7), 916-921.
Johnston, M.V., Graves, D, & Greene, M. (2007). The uniform 
postacute assessment tool: Systematically evaluating the quality of 
measurement evidence. Archives of Physical Medicine and 
Rehabilitation, 88, 1505-1512.
National Institute on Disability and Rehabilitation Research. 
(2007). Long Range Plan for Fiscal Years 2005-2009: Executive 
Summary. https://www.ed.gov/rschstat/research/pubs/nidrr-lrp-05-09-exec-summ.pdf.
Reistetter, T.A. & Abreu, B.C. (2005). Appraising evidence on 
community integration following brain injury: A systematic review. 
Occupational Therapy International, 12, 196-217.
Sayer, N.A., Chiros, C.E., Sigford, B., Scott, S., Clothier, B., 
Pickett, T., et al. (2008). Characteristics and rehabilitation 
outcomes among patients with blast and other injuries sustained 
during the Global War on Terror. Archives of Physical Medicine and 
Rehabilitation, 89(1), 163-170.
Schepers, V.P., Ketelaar, M., Visser-Meily, J.M., Dekker, J., & 
Lindeman, E. (2006). Responsiveness of functional health status 
measures frequently used in stroke research. Disability and 
Rehabilitation, 28(17), 1035-1040.
Schwartz, C.E., Andresen, E.M., Nosek, M.A., & Krahn, G.L. (2007). 
Response shift theory: Important implications for measuring quality 
of life in people with disability. Archives of Physical Medicine and 
Rehabilitation, 88, 529-536.
Van Baalen, B., Odding, E., & Stam, H. (2008). Cognitive status at 
discharge from the hospital determines discharge destination in 
traumatic brain injury patients. Brain Injury, 22(1), 25-32.
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.
World Health Organization (2001). ICF: International Classification 
of Functioning, Disability and Health. Geneva, Switzerland: Author.

Proposed Priority

    The Assistant Secretary for Special Education and Rehabilitative 
Services proposes a priority for a Rehabilitation Research and Training 
Center (RRTC) on Measurement of Medical Rehabilitation Outcomes. This 
RRTC must create and implement state-of-the-art measures for medical 
rehabilitation outcomes and identify the cognitive and environmental 
factors that shape those outcomes. Under this priority, the RRTC must 
be designed to contribute to the following outcomes:
    (a) New tools and measures that facilitate research to promote 
improved clinical practice in the field of medical rehabilitation. The 
RRTC must contribute to this outcome by developing valid and reliable 
measures of cognitive function for individuals who receive post-acute 
medical rehabilitation, as well as measures to assess environmental 
factors that affect outcomes among individuals with disabilities living 
in the community. The RRTC may also develop medical rehabilitation 
outcome measures in other areas where a demonstrated need has been 
identified in the literature. In order to promote efficient collection 
of outcomes data, this RRTC must develop and apply strategies including 
item response theory and computer-adaptive-testing techniques. Measures 
developed by the RRTC must be designed to improve the capacity of 
researchers and practitioners to measure medical rehabilitation 
outcomes in a wide variety of settings and across disability groups.
    (b) Improved capacity to conduct rigorous medical rehabilitation 
outcomes research. The RRTC must contribute to this capacity by 
providing a coordinated and advanced program of training in medical 
rehabilitation research that is aimed at increasing the

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number of qualified researchers working in the area of medical 
rehabilitation outcomes research. This program must focus on research 
methodology and outcomes measurement development, and provide for 
experience in conducting applied research.
    (c) Collaboration with relevant projects, including NIDRR-sponsored 
projects, such as the Disability Rehabilitation Research Project on 
Classification and Measurement of Medical Rehabilitation Interventions, 
and other projects identified through consultation with the NIDRR 
project officer.

Proposed Priority 4--Developing Strategies to Foster Community 
Integration and Participation for Individuals with Traumatic Brain 
Injury

Background

    The Centers for Disease Control and Prevention (CDC) report that at 
least 1.4 million individuals sustain a traumatic brain injury (TBI) in 
the United States each year (Langlois, Rutland-Brown, & Thomas, 2006). 
A substantial number of these individuals subsequently have low levels 
of community integration and participation (CIP) (Gordon et al., 2006). 
CIP includes: assimilation (the ability to fit in with and be accepted 
by other individuals in the community); social support (being part of a 
network of family, friends, and acquaintances); occupation (having 
meaningful and productive activity during the main part of the day); 
and independent living (independence in daily tasks and in making 
everyday decisions and life choices) (Winkler, Unsworth, & Sloan, 
2006).
    Although the findings for CIP for individuals with TBI vary, 
research indicates that the unemployment rate among these individuals 
is 40 to 50 percent and the rate of social isolation for this group is 
50 to 60 percent (Franulic, Carbonell, Pinto, & Sepulveda, 2004). Other 
long-term CIP consequences for individuals with TBI include financial 
dependence (Dikman, Machamer, & Temkin, 1993); divorce (Lezak, 1995); 
various forms of incarceration in places such as lockup care 
facilities, State hospitals, and prisons; and inability to perform 
instrumental activities of daily living such as driving a car, riding a 
bus, balancing a checkbook, and preparing meals.
    Over the years, NIDRR has sponsored research to promote a 
methodological infrastructure that assists rehabilitation researchers 
in generating knowledge about the extent of CIP among individuals with 
TBI and the effectiveness of interventions to promote CIP for these 
individuals. For example, NIDRR recently funded an initiative to 
generate a classification system of medical rehabilitation 
interventions that will promote effective CIP research through 
improving the field's ability to determine the active ingredients of 
rehabilitative care and carry out effective intervention studies.
    A TBI-specific classification system that categorizes individuals 
according to the physical characteristics of their injury was promoted 
by a 2007 workshop sponsored by the National Institute of Neurological 
Disorders and Stroke. This classification system will link physical 
characteristics of injuries to the brain, with appropriate medical and 
rehabilitation interventions (Saatman et al., 2008). Still needed is a 
classification system based on symptoms experienced by individuals with 
TBI who are living in the community. This classification system can be 
used to link the post-rehabilitation consequences of TBI with CIP-
oriented interventions. Such a classification will allow practitioners 
and researchers to better match individuals with TBI with specific 
interventions, and to better characterize their study samples. This 
classification will also advance CIP research by increasing 
comparability of findings across studies, and promoting the 
replicability and generalizability of findings.

References

Dikmen, S.S., Machamer, J.E., & Temkin, N.R. (1993). Psychosocial 
outcomes in patients with moderate to severe head injury: 2-year 
follow-up. Brain Injury, 7, 113-124.
Franulic, A., Carbonell, C.G., Pinto, P., & Sepulveda, I. (2004). 
Psychosocial adjustment and employment outcome 2, 5 and 10 years 
after TBI. Brain Injury, 18, 119-129.
Gordon, W.A., Zafonte, R., Cicerone, K., Cantor, J., Brown, M., 
Lombard, L., et al. (2006). Traumatic brain injury rehabilitation: 
State of the science. Archives of Physical Medicine and 
Rehabilitation, 84, 343-382.
Langlois, J.A., Rutland-Brown, W., & Thomas, K.E. (2006). Traumatic 
brain injury in the United States: Emergency department visits, 
hospitalizations, and deaths. Atlanta, GA: Centers for Disease 
Control and Prevention, National Center for Injury Prevention and 
Control.
Lezak, M.D. (1995). Neuropsychological assessment. New York: Oxford 
University Press.
Saatman, K.E., Duhaime, A-C., Bullock, R., Maas, A.I.R., Valadka, 
A., Manley, G.T., Workshop Scientific Team, et al. (2008). 
Classification of traumatic brain injury for targeted therapies. 
Journal of Neurotrauma, 25, 719-738.
Winkler, D., Unsworth, C., & Sloan, S. (2006). Factors that lead to 
successful community integration following severe traumatic brain 
injury. Journal of Head Trauma Rehabilitation, 21, 8-21.

Proposed Priority

    The Assistant Secretary for Special Education and Rehabilitative 
Services proposes a priority for a Rehabilitation Research and Training 
Center (RRTC) for Developing Strategies to Foster Community Integration 
and Participation for Individuals with Traumatic Brain Injury (TBI). 
This RRTC must conduct rigorous research to examine barriers to and 
facilitators of community integration and participation (CIP) for 
individuals with TBI; provide training and technical assistance to 
promote and maximize the benefits of this research; develop and 
validate a symptom-based, clinically and scientifically useful system 
for classifying individuals with TBI after discharge from inpatient 
medical or rehabilitative care; and develop, implement, and evaluate 
interventions to improve long-term outcomes--including return to work--
for individuals with TBI. Under this priority, the RRTC must be 
designed to contribute to the following outcomes:
    (a) New knowledge about the full range of symptoms of TBI that are 
experienced by individuals with TBI at any time after they exit 
inpatient care and re-enter the community. The RRTC must contribute to 
this outcome by developing and empirically validating a comprehensive 
list of the symptoms of TBI that can exist after inpatient care and 
that have the potential to affect CIP, and provide or develop effective 
and practical methods for their identification. These symptoms include, 
but are not limited to, the following categories: neurological (e.g., 
motor, sensory, autonomic functions, movement disorders, appearance, 
seizures, headaches, visual deficits, sleep disorders); medical (e.g., 
pulmonary, metabolic, nutritional, gastrointestinal, musculoskeletal, 
dermatologic, degenerative disorders such as Parkinson's disease and 
Alzheimer's disease); cognitive (e.g., memory, attention and 
concentration, language, perception, executive/front lobe functions, 
problem solving, abstract reasoning, poor insight, judgment, planning, 
information processing organizational skills); and behavioral (e.g., 
aggression, agitation, impaired initiation, learning difficulties, 
impulsivity, social disinhibition, shallow self awareness, altered 
sexual

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functioning, mood disorders such as depression).
    (b) An improved research infrastructure for developing 
interventions that facilitate CIP for individuals with TBI. The RRTC 
must contribute to this outcome by--
    (1) Developing a classification system for use with individuals 
with TBI based on the symptoms identified in paragraph (a) of this 
priority;
    (2) Maximizing the likelihood that the classification system 
developed in (b)(1) of this priority will be adopted in TBI 
rehabilitation research and practice by: obtaining expert input in 
developing the classification system; conducting a comprehensive 
literature review to identify the barriers to CIP that are associated 
with the list of symptoms developed under paragraph (a) of this 
priority and the factors that tend to be effective in reducing these 
barriers; providing a practical validated ``short'' version of the 
classification system that can be used when there are time constraints; 
developing, field testing, and disseminating a comprehensive manual for 
using the classification system; and providing technical assistance to 
the public in the use of the manual.
    (c) New interventions to improve the level of CIP for individuals 
with TBI. The RRTC must contribute to this outcome by identifying or 
developing, and then evaluating, specific interventions tied to the 
classification system developed under paragraph (b)(1) of this priority 
and the barriers identified in the literature review conducted under 
paragraph (b)(2) of this priority, to improve the CIP of individuals 
with TBI using scientifically-based research methods. These 
interventions must target individuals in specific categories of TBI as 
established by the classification system developed under paragraph 
(b)(1) of this priority, as well as the barriers to CIP identified 
pursuant to the literature review conducted under paragraph (b)(2) of 
this priority; and
    (d) Improved levels of CIP for individuals with TBI. The RRTC must 
contribute to this outcome by--
    (1) Developing a systematic plan for widespread dissemination of 
informational materials related to the Center's TBI classification 
system and associated interventions to researchers, individuals with 
TBI and their family members, clinical practitioners, service 
providers, and members of the community. The RRTC must work with its 
NIDRR project officer to coordinate outreach and dissemination of 
research findings through appropriate venues such as NIDRR's Model 
Systems Knowledge Translation Center, State agencies and programs that 
administer a range of disability services and resources, the U.S. 
Department of Veterans Affairs Veterans Health Administration, the U.S. 
Department of Defense, and related veterans' service organizations; and
    (2) Establishing and maintaining mechanisms for providing technical 
assistance to critical stakeholders, such as researchers, consumers and 
their family members, clinical practitioners, service providers, and 
members of the community to facilitate the use of knowledge generated 
by the RRTC.

Rehabilitation Engineering Research Centers (RERCs)

General Requirements of RERCs
    RERCs carry out research or demonstration activities in support of 
the Rehabilitation Act of 1973, as amended, by--
     Developing and disseminating innovative methods of 
applying advanced technology, scientific achievement, and psychological 
and social knowledge to: (a) Solve rehabilitation problems and remove 
environmental barriers; and (b) study and evaluate new or emerging 
technologies, products, or environments and their effectiveness and 
benefits; or
     Demonstrating and disseminating: (a) Innovative models for 
the delivery of cost-effective rehabilitation technology services to 
rural and urban areas; and (b) other scientific research to assist in 
meeting the employment and independent living needs of individuals with 
severe disabilities; and
     Facilitating service delivery systems change through: (a) 
The development, evaluation, and dissemination of innovative consumer-
responsive and individual- and family-centered models for the delivery 
to both rural and urban areas of innovative, cost-effective 
rehabilitation technology services; and (b) other scientific research 
to assist in meeting the employment and independence needs of 
individuals with severe disabilities.
    Each RERC must be operated by, or in collaboration with, one or 
more institutions of higher education or one or more nonprofit 
organizations.
    Each RERC must provide training opportunities, in conjunction with 
institutions of higher education or nonprofit organizations, to assist 
individuals, including individuals with disabilities, to become 
rehabilitation technology researchers and practitioners.
    Each RERC must emphasize the principles of universal design in its 
product research and development. Universal design is ``the design of 
products and environments to be usable by all people, to the greatest 
extent possible, without the need for adaptation or specialized 
design'' (North Carolina State University, 1997. https://www.design.ncsu.edu/cud/about_ud/udprinciplestext.htm).
    Additional information on the RERCs can be found at: https://www.ed.gov/rschstat/research/pubs/.

Proposed Priorities 5, 6, and 7--Rehabilitation Engineering Research 
Centers (RERCs) on Telerehabilitation (Priority 5), Telecommunication 
(Priority 6), and Cognitive Rehabilitation (Priority 7)

Proposed Priority 5--Telerehabilitation

Background
    Telerehabilitation is the clinical application of consultative, 
preventative, diagnostic, and therapeutic interventions via two-way 
interactive audiovisual linkage performed in real time (Scheideman-
Miller et al., 2002). Telerehabilitation was primarily developed to 
provide equitable access to rehabilitative therapy for individuals who 
are geographically remote, and physically or economically disadvantaged 
(Theodoros & Russell, 2008). Telerehabilitation has the potential to 
improve rehabilitation care in a cost efficient manner. Results from 
Dhurjaty (2004) demonstrate that telerehabilitation is cost effective 
and benefits many stakeholders, such as rehabilitation providers, 
patients, and payers. Rehabilitation providers benefit from 
telerehabilitation because it gives them the ability to see and 
evaluate patients remotely. Remote access to patients allows providers 
to serve more people, thereby increasing their clinical productivity 
and efficiency. Patients benefit from telerehabilitation because they 
do not have to travel to remote clinics or rehabilitation facilities.
    The use of image-based telerehabilitation (e.g., 
videoconferencing); sensor-based telerehabilitation (e.g., wearable 
sensors for monitoring health and activity); and virtual environments 
and virtual reality telerehabilitation (e.g., immersive systems with 
haptic feedback), has resulted in advances in the fields of physical 
therapy, speech-language pathology, occupational therapy, and 
biomedical engineering (Russell, 2007; Theodoros & Russell, 2008). For 
10 years, NIDRR has contributed to these advances by funding research 
and development in telerehabilitation. Recent outcomes from this NIDRR-

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funded research and development include but are not limited to the 
following: new technologies to enhance a virtual reality 
telerehabilitation system that enables clients to assess the wheelchair 
accessibility of building environments (Yue, Kim, Wang, & Hamza, 2007); 
allowing occupational or physical therapy practitioners to provide 
wheeled mobility and seating interventions to clients in a remote 
location via interactive secure videoconferencing (Schein & Schmeler 
2007); an evaluation and comparison of seven instant messenger (IM) 
systems and remote communication techniques for telerehabilitation use 
(Kim & Fuhrman, 2007); and an information technology infrastructure 
(i.e., common applications and components that are generalizable across 
telerehabilitation applications such as web-conferencing, document 
sharing, and data sharing) to support telerehabilitation (Parmanto, 
Saptono, Sugiantara, Brienza & Nnaji, 2006).
    Much of this work has been done on a small scale, and further work 
in this area is needed in order to realize the potential benefits of 
telerehabilitation on a larger scale. The viability of 
telerehabilitation services in real world environments with large 
patient cohorts and the broader issues of costs, benefits, and cost-
effectiveness of telerehabilitation require investigation (Russell, 
2007). In addition, there are issues relating to implementation costs, 
standards, ethics, and reimbursement that may affect the establishment 
and advancement of telerehabilitation within large health care systems 
and require further investigation (Feist-Price, 2002; Theodoros & 
Russell, 2008). Accordingly, NIDRR seeks to fund an RERC on 
Telerehabilitation to develop methods, systems, and technologies that 
support consultative, preventative, diagnostic, and therapeutic 
interventions in real time and to address barriers to successful 
telerehabilitation for individuals who have limited local access to 
comprehensive medical and rehabilitation outpatient services.

References

Dhurjaty, S. (2004). The economics of telerehabilitation. 
Telemedicine Journal and e-Health, 10(2), 196-199.
Feist-Price, S. (2002, September 22). The use of telerehabilitation 
in assistive technology. The Free Library. See https://www.thefreelibrary.com/The use of telerehabilitation in assistive 
technology.-a094078142.
Kim, J. & Fuhrman, Y. (2007). Comparison of web-based 
videoconferencing systems for telerehabilitation applications. 30th 
Annual RESNA Conference Proceedings. Arlington, VA: Rehabilitation 
Engineering Society of North America Press.
Marshall, C.A., Sanderson, P.R., Johnson, S.R., Du Bois, B., & 
Kvedar, J.C. (2006). Considering Class, Culture, and Access in 
Rehabilitation Intervention Research. In K.J. Hagglund & A.E. 
Heinemann (Eds.), Handbook of Applied Disability and Rehabilitation 
Research (pp. 26-40). New York: Springer.
Parmanto, B., Saptono, A., Sugiantara, W., Brienza, D., & Nnaji, B. 
(2006). Information technology infrastructure for supporting 
telerehabilitation. 29th Annual RESNA Conference Proceedings. 
Arlington VA: Rehabilitation Engineering Society of North America 
Press.
Russell, T.G. (2007). Physical rehabilitation using telemedicine. 
Journal of Telemedicine and Telecare, 13 (5), 217-20.
Scheideman-Miller, C., Clark, P.G., Moorad, A., Post, M.L., Hodge, 
B.G. & Smeltzer, S. (2003). Efficacy and sustainability of a 
telerehabilitation program. Proceedings of the 36th Hawaii 
International Conference on System Sciences. New Brunswick, NJ: 
Institute for Electrical and Electronic Engineers (IEEE).
Schein, R.M. & Schmeler, M. (2007). Telerehabilitation: A proposed 
innovative approach for rural wheelchair service delivery. 30th 
Annual RESNA Conference Proceedings. Arlington, VA: Rehabilitation 
Engineering Society of North America Press.
Theodoros, D. & Russell, T. (2008). Telerehabilitation: Current 
perspectives. In Current Principles and Practices of Telemedicine 
and E-Health, 191-209. Washington, DC: IOS press.
Yue, J., Kim, J., Wang, Y., & Hamza, H. (2007). The virtual reality 
telerehabilitation system for accessibility of the built 
environment: feasibility test of multimedia decision supporting 
system, IP camera, and coded targets. Proceeding of RESNA 30th 
International Conference, June 2007.

Proposed Priority 6--Telecommunication

Background

    Telecommunication is the extension of communication over a distance 
through the electronic transmission of signals. Internet Protocol (IP) 
technologies and emerging telecommunications technologies offer several 
modes of conversation, allow for multiple features in one device, and 
have the potential to enable phones to meet the distinct needs of 
individuals with disabilities (National Council on Disability, 2006). 
However, new telecommunications technologies must be designed to be 
accessible and usable by individuals with disabilities in order for 
these individuals to fully benefit from their use.
    Access to telecommunications technologies by individuals with 
disabilities still remains a problem in 2009. To draw more world-wide 
attention to this issue, the International Telecommunication Union 
adopted the theme, ``Connecting Persons with Disabilities: Information 
and Communication Technologies (ICT) Opportunities for All,'' for last 
year's World Telecommunication and Information Society Day, May 17, 
2008. In addition, the World Summit on the Information Society urged 
member States to address the special requirements of persons with 
disabilities in their national e-strategies and encouraged the design 
and production of ICT equipment and services suited to their needs.
    For over 10 years, NIDRR has contributed to advances in 
telecommunications access, telecommunications standards development, 
and emergency notification and communications for individuals with 
disabilities. However, individuals with disabilities continue to face 
several barriers to telecommunications access, including the lack of 
interoperable communications--electronics systems or items, 
teletypewriter (TTY) compatibility issues, inaccessible interfaces, and 
inaccessible equipment (National Council on Disability, 2006). Better 
product engineering, increased industry and community partnerships, 
access to technology and IP, and implementation of standards may help 
to alleviate some of the access barriers to telecommunications systems 
and products. The use of universal design, i.e., products, services, 
and facilities that are designed from their inception to be accessible 
to and usable by the greatest range of individuals, regardless of their 
ability, and without the need for specialized adaptation, may help to 
ensure that access features are incorporated into telecommunications 
technologies from the outset (National Council on Disability, 2004). 
Integrating accessibility features into standards and maintaining them 
as the standards evolve over time may further ensure telecommunications 
access for individuals with disabilities (Jaeger, 2006). Accordingly, 
NIDRR seeks to fund an RERC on Telecommunication to research and 
develop technological solutions to promote universal access to 
telecommunications systems and products including strategies for 
integrating current accessibility features into newer generations of 
telecommunications systems and products.

References

International Telecommunication Union.

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(2008). Theme 2008: Connecting Persons with Disabilities: 
Information and Communication Technologies (ICT) Opportunities for 
All.