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Tuesday,

June 26, 2001

Part IV

Department of
Education
National Institute on Disability and
Rehabilitation Research

Final Funding Priorities for Fiscal Years


2001–2003 for Four Disability and
Rehabilitation Research Projects;
Invitation for Applications for Fiscal Year
2001 New Awards and Announcement of
Pre-Application Meetings; Notices

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34026 Federal Register / Vol. 66, No. 123 / Tuesday, June 26, 2001 / Notices

DEPARTMENT OF EDUCATION National Education Goals ‘‘intervention’’ in the general purpose


The eight National Education Goals statement suggesting that it is a poor
National Institute on Disability and choice of words and may be
focus the Nation’s education reform
Rehabilitation Research; Notice of misinterpreted. The commenter
efforts and provide a framework for
Final Funding Priorities for Fiscal recommends dropping the word
improving teaching and learning.
Years 2001–2003 for Four Disability altogether so that the last sentence of the
This notice addresses the National
and Rehabilitation Research Projects general purpose statement reads ‘‘* * *
Education Goal that every adult
American will be literate and will determine the efficacy and utility of AT
AGENCY: Office of Special Education and
possess the knowledge and skills and the implications.’’
Rehabilitative Services, Department of Discussion: NIDRR agrees that the
Education. necessary to compete in a global
term ‘‘interventions’’ may be
ACTION: Notice of final funding priorities economy and exercise the rights and
misconstrued because of varying
for fiscal years 2001–2003 for four responsibilities of citizenship.
definitions and interpretations.
disability and rehabilitation research The authority for the program to Changes: The word ‘‘interventions’’
projects. establish research priorities by reserving has been dropped from the general
funds to support particular research purpose statement.
SUMMARY: We are announcing four final activities is contained in sections 202(g) Comment: The second bulleted
funding priorities under the Disability and 204 of the Rehabilitation Act of activity lists a number of relevant
and Rehabilitation Research Projects 1973, as amended (29 U.S.C. 762(g) and organizations that applicants must
and Centers Program (DRRP) of the 764(b)). Regulations governing this collaborate with. Given that AT users
National Institute on Disability and program are found in 34 CFR part 350. are the primary targets of this priority,
Rehabilitation Research (NIDRR) for FY Note: This notice does not solicit this bulleted activity should be
2001–2003: Assistive Technology applications. A notice inviting applications is expanded to include AT users.
Outcomes, Impacts and Assistive published in this issue of the Federal Discussion: The second bulleted
Technology Research Projects for Register.
activity enumerates relevant NIDRR
Individuals with Cognitive Disabilities, Analysis of Comments and Changes projects and not specific stakeholders.
Resource Center for Community-based The purpose of this priority is to
Research on Technology for On April 6, 2001, we published a investigate AT outcomes and 2 impacts
Independence, and Community-based notice of proposed priorities on the and cannot be carried out without the
Research Projects on Technology for Assistive Technology Outcomes and full participation and support of AT
Independence. We take this action to Impacts and the Assistive Technology users.
focus research attention on areas of Research Projects for Individuals with Changes: None.
national need. We intend these Cognitive Disabilities in the Federal Comment: The assessment and
priorities to improve the rehabilitation Register (66 FR 18366). The Department evaluation of AT should include
services and outcomes for individuals of Education received 12 letters questions related to both positive and
with disabilities. commenting on the notice of proposed negative impacts of AT use and the
DATES: These priorities take effect on
priorities by the deadline date. acquisition of AT through various
July 26, 2001. Technical and other minor changes— financial means.
and suggested changes we are not Discussion: Economic and cost
FOR FURTHER INFORMATION CONTACT: legally authorized to make under factors, as well as positive and negative
Donna Nangle. Telephone: (202) 205– statutory authority—are not addressed. outcomes, of AT use are discussed in
5880. Individuals who use a
Priority 1: Assistive Technology the background statement. An applicant
telecommunications device for the deaf
Outcomes and Impacts can propose methodological approaches
(TDD) may call the TDD number at (202)
to measure outcomes and impacts that
205–4475. Internet: Comment: The primary stakeholder take into account both positive and
Donna.Nangle@ed.gov regarding AT outcomes is the person negative impacts of AT use and the
Individuals with disabilities may who uses (or is expected to use) a acquisition of AT through various
obtain this document in an alternative particular AT device. Family members financial means and the peer review
format (e.g., Braille, large print, and caregivers are secondary process will evaluate the merits of the
audiotape, or computer diskette) on consumers, however, they may be proposal.
request to the contact person listed in considered primary stakeholders in the Changes: None.
the preceding paragraph. sense that two thirds of all AT is Comment: One commenter feels that
SUPPLEMENTARY INFORMATION: This procured through first party and family the application of AT to specific
notice contains final priorities under the funding. Therefore, it is crucial that this populations (such as frail elderly
Disability and Rehabilitation Research priority require applicants to focus on persons, infants and toddlers, and their
Projects and Centers Program (DRRP) for the individual with a disability rather care providers) should be examined in
Assistive Technology Outcomes, than other primary and secondary terms of financial benefits to individuals
Impacts and Assistive Technology stakeholders. and care systems as well as functional
Research Projects for Individuals with Discussion: NIDRR feels the priority is outcomes for individuals.
Cognitive Disabilities, Resource Center sufficiently flexible to allow the Discussion: NIDRR agrees with the
for Community-based Research on applicant to propose methodological commenter that an examination of the
Technology for Independence, and approaches that focus on the needs of application of AT to specific
Community-based Research Projects on primary stakeholders such as populations and its impact on care
Technology for Independence. individuals with disabilities. The peer systems as well as individuals is critical
The final priorities refer to NIDRR’s review process will evaluate the merits to the development of useful
Long-Range Plan (the Plan). The Plan of the proposal. measurement systems and this was
can be accessed on the World Wide Web Changes: None. mentioned in the background statement.
at: http://www.ed.gov/offices/OSERS/ Comment: One commenter is An applicant may propose to examine
NIDRR/#LRP. concerned about using the word the financial benefits to individuals and

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Federal Register / Vol. 66, No. 123 / Tuesday, June 26, 2001 / Notices 34027

care systems as well as functional Changes: None. to explain some of the legislative and
outcomes for individuals with Comment: One commenter cites the regulatory constraints under which they
disabilities and the peer review process need to develop methods and standards were proposed. Technical and other
will evaluate the merits of the proposal. of practice to help organizations minor changes—and suggested changes
Changes: None. monitor the quality of services and we are not legally authorized to make
Comment: One commenter suggested outcomes. under statutory authority—are not
that long-term outcomes need to be Discussion: Developing methods and addressed.
addressed specifically. Preliminary standards of practice for organizational
research indicates that the use of AT General Comments
monitoring of quality assurance is
will delay institutionalization and, beyond the scope of this priority. Comment: Several commenters
along with personal attendant services, Changes: None. suggested that each project be required
will maintain a person in a relatively Comment: The same commenter feels to address a variety of different topics,
independent state for a given period of that three levels of information must be such as rural areas, effects of technology
time. For people with significant measured; the impact of AT on the on health outcomes, 5 specific disability
disabilities, including those with individual, the impact on the populations, such as deaf individuals,
Alzheimer’s and other dementia community and how and in what caregivers, or families.
diseases who use assistive devices, it context the service was delivered. Discussion: A major purpose of this
may be useful and instructive to Discussion: NIDRR agrees that these program is to address issues, within the
discover the long-term effects of reliance are important dimensions of AT use and general area of access to appropriate
on AT for independent living. addressed these factors in the technology, that are identified as
Discussion: NIDRR agrees that background statement. An applicant important by individuals with
maintaining an independent life style may propose ways to measure the disabilities. This priority is concerned
for as long as possible is critical for all different levels of impact of the generally with research on
people and that the use of AT plays an provision of AT on the consumer, on the understanding potential roles for
important role in independent living. community, and the context in which community-based disability
The background statement and the the AT was provided. The peer review organizations in research on increasing
priority support the commenter’s process will evaluate the merits of the access to Assistive Technology (AT) and
contention. An applicant may propose proposal. systems technology, and with
ways to measure the impact of AT on Changes: None. developing partnerships and research
maintaining independence in its strategies for use by community-based
Priority 2: Assistive Technology disability organizations. NIDRR elects
application and the peer review process
Research Projects for Individuals With not to further constrict the selection of
will evaluate the merits of the proposal.
Cognitive Disabilities problems for study. Applicants may
Changes: None.
Comment: The cost-benefit of AT on Comment: Four commenters suggest elect to study issues of single disability
healthcare is an essential impact that an activity should be added to the populations or cross-disability concerns,
question. Efforts to evaluate the priority requiring applicants to and may target any populations relevant
appropriate use of AT and its financial investigate ways of making the Internet to improving access to technology,
benefits to insurance providers (both accessible to people with cognitive including families, caregivers,
public and private) are essential. disabilities. professional service providers, product
Related to this issue is the impact of Discussion: NIDRR agrees that access distributors, or others. It is up to the
managed care systems on the to the Internet, and therefore, applicants to convince the peer
appropriate provision of AT to persons information is extremely important for reviewers of the importance of the
with disabilities. The positive or persons with cognitive disabilities. An problem they elect to address.
negative effects of this type of delivery applicant could propose to investigate Changes: None.
system should be investigated in terms ways to make the Internet more Comment: Several commenters
of long-term health outcome, including accessible for persons with cognitive discussed the definition of community-
the reduction of time spent in disabilities and the peer review process based disability organization and of
healthcare institutions, for individuals will evaluate the merits of the proposal. consumer control. The gist of these
with disabilities. Changes: None. comments related to either: declaring
Discussion: NIDRR agrees that there certain types of organizations (e.g.,
Priority 3: Resource Center for University Affiliated Programs, now
are a myriad of issues related to the cost, Community-Based Research for
economics, and financial benefits of AT. named University Centers of Excellence,
Independence; Priority 4: Community- or facility-based employment programs)
An applicant may propose to investigate Based Research Projects on Technology
issues related to the cost, economics, to be community-based organizations;
for Independence restricting the competition to consumer-
and financial benefits of AT and the
peer review process will evaluate the On April 6, 2001, we published a directed organizations; or declaring
merits of the proposal. notice of proposed priorities in the various types of organizations to be
Changes: None. Federal Register (66 FR 18360). The either eligible or ineligible for the
Comment: The same commenter Department of Education received 14 competition. One commenter argued
believes that the impact of expanding letters commenting on the notice of that the intent to ‘‘involve community
approved lists of durable medical proposed priorities by the deadline date. disability organizations’’ is
equipment through DMERCs on Many of the comments concerned both objectionable, and that grants should be
individual outcomes should also be priorities, raised multiple issues and made only to grassroots organizations,
assessed. suggestions, and overlapped with other and not universities.
Discussion: Developing lists of comments. NIDRR is responding to the Discussion: NIDRR does not have the
approved durable medical equipment comments on priority one and priority authority to restrict eligibility for the
through DMERCs and assessing their two jointly. As a group, the comments DRRP competition beyond that specified
impact on individual outcomes is indicated a need to clarify the purposes in the statute. The regulations specify
beyond the scope of this priority. and expectations for these priorities and that any public or private organization,

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34028 Federal Register / Vol. 66, No. 123 / Tuesday, June 26, 2001 / Notices

whether nonprofit or for-profit, prescription, funding, maintenance, often effective, it would be


institution of higher education, or training, and other problems. Potential inappropriate to limit the dissemination
Indian tribe or tribal organization, is applicants are referred to both the of findings to electronic media and that
eligible to apply for a grant in this NIDRR Long-Range Plan (1999) and the accessible electronic media in
program. Since the purpose of this Blueprint for the Millennium: An combination with other accessible
priority is to build research capacity in Analysis of Regional Hearings on media should be used.
community-based disability Assistive Technology for People with Discussion: Selection criteria for
organizations to study problems of Disabilities (1998) for discussions of the dissemination activities address
access to technology, NIDRR requires in complex issues in technology access for appropriateness of dissemination
the priority that any application to be individuals with disabilities. It is up to approaches and that such methods are
funded must include a community- the applicants to convince the peer accessible to individuals with various
based disability organization, either as reviewers of the importance of the disabilities.
sole applicant or as a partner in the problem they elect to address. Changes: None.
endeavor. According to the priority, ‘‘A Changes: None.
community-based disability Comment: Several commenters asked Disability and Rehabilitation Research
organization is a consumer-directed that additional NIDRR centers or entities Projects and Centers Program
disability organization * * * consumer funded from other sources be specified The authority for Disability and
control is the key.’’ While NIDRR as resources for cooperation in the Rehabilitation Research Projects (DRRP)
regulations do not define these terms, priority. is contained in section 204 of the
regulations for the Independent Living Discussion: The priority states, Rehabilitation Act of 1973, as amended
Programs, also funded under the ‘‘Coordinate with appropriate federally- (29 U.S.C. 762(g) and 764(b)). The
Rehabilitation Act, as amended, define funded projects.’’ The priority then purpose of the DRRP program is to plan
‘‘consumer control’’ to mean that ‘‘a provides examples of what may be and conduct research, demonstration
center or eligible agency vests power included. It is not feasible or necessary projects, training, and related activities
and authority in individuals with to list all potential cooperators, and to—
disabilities * * *’’ [34 CFR 364.4 (b)]. astute applicants will survey the field to (a) Develop methods, procedures, and
Further, dictionary definitions and the identify the most appropriate rehabilitation technology that
sense of this priority indicate that organizations for coordination to maximizes the full inclusion and
community-based organizations are not advance the success of their proposed integration into society, employment,
institution-based, and that disability projects. independent living, family support, and
organizations are those of, by, and for Changes: None. economic and social self-sufficiency of
persons with disabilities. It will be up Comment: One commenter requested individuals with disabilities; and
to the peer reviewers in applying the a clarification of the meaning of (b) Improve the effectiveness of
selection criteria to judge how well an ‘‘environmental access’’ and whether it services authorized under the Act.
application responds to the purposes of applies only to AT, or could include
the priority of building research other environmental issues. Priority 1: Assistive Technology
capacity in community-based disability Discussion: The priority refers to AT Outcomes and Impacts
organizations and works through and environmental access. The Plan Background
community-based disability refers to technology to improve function
organizations to ‘‘* * * broaden the and technology to improve access to the One of the greatest challenges facing
inclusion of persons with disabilities in built environment. Modifications to the health care systems, social services
developing practical and affordable physical and telecommunications providers and policymakers is to ensure
solutions to AT and environmental environments, including applications of that scarce resources are used
access problems and needs’’. universal design, may include efficiently. To a large extent, this
Changes: None. architectural modifications, signage for challenge explains the growing interest
Comment: Several commenters persons with sensory or cognitive in outcomes research and evidence-
discussed standards and requirements limitations, and public transit based medicine.
for AT to be developed under these modifications that enable persons with Particular interest in outcomes of
grants. At the same time, other disabilities to access the broader assistive technology (AT) is related to
commenters pointed out that there were environment. the amount of dollars spent on
many barriers to access beyond the Changes: None. developing and manufacturing AT, AT
development of new technology. Comment: One commenter stated that service delivery and to the need to
Discussion: The priority does not there should be a requirement that every improve the functional independence
address development of technology, but applicant must indicate how they are and well-being of persons with
rather research on improved access to developing research capacity among disabilities of all ages. Yet, assessment
technology. Applicants could propose to individuals with disabilities. of the impact of technology on function
develop new technology or devices if Discussion: NIDRR agrees that this is and other productivity and quality of
the project met the basic purposes of an important aspect of the projects and life outcomes lags behind outcomes
building research capacity in has added language in the priority to measurement in other areas of
community-based disability this effect. rehabilitation.
organizations by addressing issues of Changes: The language ‘‘applicants There are several factors that promote
increasing access to technology, both must describe how they will develop concern about the paucity of outcomes
individual AT and systems research capacity among individuals research in AT including the: (a) Ability
(environmental access). However, with disabilities at the community to demonstrate efficacy of new devices;
NIDRR does not anticipate that level’’ has been inserted as paragraph (c) (b) need to examine effectiveness of
development of new technology will be in the final section of both priorities. devices over time; and (c) need to chart
the focus of all, or even any, of these Comment: One commenter noted that future research and development to
projects. Issues of improving access also although dissemination of project improve devices (Fuhrer, M. J.,
include distribution, diagnosis and findings through electronic media is ‘‘Assistive technology outcomes

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Federal Register / Vol. 66, No. 123 / Tuesday, June 26, 2001 / Notices 34029

research: challenges met and yet expanded this definition to include ‘‘the and facilitate activities of daily living.
unmet,’’ American Journal of Physical clinical signs and symptoms, well-being Some devices, such as computers,
Medicine and Rehabilitation, 2001, In or mental and emotional functioning; increase access to information and
press). Outcomes research and analysis physical, cognitive, and social support life long learning. AT devices
is also needed to guide decisionmaking functioning; satisfaction with care; vary significantly from highly complex
across multiple levels of policy and health-related quality of life, and costs and sophisticated computer-operated
program development, including: (a) and appropriate use of resources.’’ systems to low tech approaches that can
Decisions on a societal level regarding Outcomes research has also been be easily purchased or built.
types of public programs and services to defined as research designed to discover Complicating the issue even further are
fund; (b) decisions on a programmatic the sustained impact of rehabilitative the individual characteristics of the AT
level regarding what services to strategies and treatments in the user and the varied environments in
continue, enhance, modify or eliminate; everyday lives of persons with which users live, work, and learn.
(c) decisions on an individual level disabilities. ‘‘Outcomes research Approximately one-third of AT
regarding AT recommendations and attempts to build a bridge between devices will be abandoned by the user
interventions; and (d) decisions on a interventions and long-term (Phillips, B. and Zhao, H. ‘‘Predictors of
research level regarding the comparative improvements in the lives of persons assistive technology abandonment’’,
effectiveness of individual devices and served as they reenter the community’’ Assistive Technology, Vol. 5, pgs. 36–45,
the impact on future designs (Smith, R., (Johnston, M., et al., ‘‘Outcomes 1995). There are many reasons why
‘‘Measuring the outcomes of assistive research in medical rehabilitation— individuals with disabilities choose to
technology: challenge and innovation’’, foundations from the past and accept or reject AT devices. Since
Assistive Technology, Vol. 8, No. 2, pgs. directions for the future,’’ Assessing public funds provide a major source for
71–81, 1996). Medical Rehabilitation Practices: The purchasing AT devices and services,
In the face of a growing interest in Promise of Outcomes Research, Marcus useful and accurate measures of
outcomes, the inconsistent use of J. Fuhrer, ed., pgs. 1–42, 1997). outcomes and impacts is critical for
terminology contributes to the Regardless of how it is defined, accountability and to avoid wasteful
confusion that exists in the application outcomes research is part of the larger outcomes. Is abandonment a negative or
of a generally accepted outcomes framework of program evaluation could it be a positive outcome?
approach. In the field of rehabilitation, (Fuhrer, op. cit., 1997), and includes Abandonment has been viewed as the
outcomes measurement has focused on both outcomes analysis and outcomes end result of fragmented service
creating outcomes management systems measurement also known as provision, poor assessment techniques,
and measuring and communicating performance measurement (Jennings, lack of consumer choice in device
outcomes. Rehabilitation has led the B.M. and Staggers, N., The language of selection, inattention to device use
health care field in its emphasis on outcomes, Journal of Rehabilitation across environments, inadequate
changes in function as an outcomes Outcomes Measurement, Vol. 3, No. 1, training, costly repairs, need to upgrade
measure. Still, even in rehabilitation, pgs. 59–64, 1999). and obsolete or inappropriate
outcomes measurement systems have Rehabilitation outcomes are changes technology. However, abandonment
typically focused on process variables, produced by rehabilitation services in may be a natural phenomenon related to
i.e., the outputs of products and the lives of service recipients and their improved physical or cognitive
services, and not on gains to the environments. Outcome indicators are function, the result of a technology
individual or society in either the short measures of the amount and frequency upgrade or because different technology
or long term. Wilkerson posits that this of those occurrences, and include is a better fit between the end-user and
emphasis on process will change service quality. Within this perspective, the environment.
because of three factors: (a) The pressure some analysts use the word ‘‘impacts’’ There are other reasons to account for
to cut costs; (b) growth of consumerism to distinguish between long-term the lack of momentum in measurement
leading to increased input from users outcomes or end results that occur on a development and outcomes and impact
and increased focus on the needs of the societal versus an individual level. Still research on AT. Most of the
end user; and (c) concerns about quality others use the term ‘‘impact’’ more endorsements of a particular device or
in relation to costs (Wilkerson, D., strictly to refer to estimates of the extent service are based on anecdotal
‘‘Outcomes and accreditation—The to which the program actually ‘‘caused’’ information (Fuhrer, 1999) rather than
paradigm is shifting toward outcome,’’ particular outcomes (Hatry, H., et al., data generated from research. Frank
Rehab Management, August/September, Customer Surveys for agency managers: DeRuyter (‘‘Evaluating outcomes in
pgs. 112–115, 1997). What Managers Need to Know, assistive technology: do we understand
Outcomes research is defined in Washington, DC: Urban Institute, 1998). the commitment,’’ Assistive Technology,
different ways across rehabilitation and Deconstructing these various definitions Vol. 7, No. 1, pgs. 3–16, 1995), observed
health services research as well as in the and types of outcomes and impacts that historically, AT was considered a
social services field. The Foundation for requires recognition of complexity on remedy to impairment or dysfunction,
Health Services Research (Foundation many levels. and the urgency of consumer need was
for Health Services Research, Health Although AT has grown as a of greater importance than relying upon
Outcomes Research: A Primer, discipline and as an industry over the data to document the efficacy of a
Washington, DC, 1994) characterized past two decades, there has not been a particular device. In addition, quality
outcomes research as research focused corresponding maturity in developing or was perceived as too abstract and
on the ‘‘end results of medical care—the assessing the outcomes or impacts of AT difficult to measure and define. Vendors
effect of the health care process on the upon individuals with disabilities. AT and practitioners may feel threatened by
health and well-being of patients and devices and services outcomes also may potential findings and accountability
populations.’’ The Institute of Medicine be difficult to define because of the demands, which may also have
(IOM) (Feasley, J.C., ed., Health ways AT is used. For example, AT is contributed to the lack of outcomes
Outcomes for Older People: Questions used to increase participation in the studies (DeRuyter, op. cit., 1995).
for the Coming Decade, Washington, environment, enhance normative social While the AT arena is complex and
DC: National Academy Press, 1996) roles, promote and sustain employment, broad, several outcomes studies have

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34030 Federal Register / Vol. 66, No. 123 / Tuesday, June 26, 2001 / Notices

focused on a discrete segment of the the population including severity of (c) Investigate and analyze the
entire system. Smith says that there are impairment, duration of disability, complexity of factors contributing to the
essentially two domains of outcome presence of co-morbidities, aging and abandonment of AT, including age-
measurement: the performance of an other sociodemographic factors related changes, and identify how these
individual using assistive technology influence technology utilization and factors are incorporated into outcomes
and the cost of achieving the level of bias outcomes study? What is the role of and impacts measurement instruments.
performance (Smith, R. O., environmental, economic, awareness In addition to activities proposed by
‘‘Accountability in assistive technology and training barriers in AT use and the applicants to carry out these
interventions: measuring outcomes,’’ outcomes? These different levels of purposes, each project must:
Volume I—RESNA Resource Guide of outcomes can look at impacts and • Develop and disseminate to AT
Assistive Technology Outcomes: effects of technology at one point in stakeholders and other interested and
Measurement Tools, pgs. 15–43, 1998). time, more typically a clinical or relevant audiences, as determined by
Minkel proposed that the primary functional outcome, or can be examined NIDRR, materials on AT outcomes
measure to determine the value of the in terms of long-term impacts on studies and impacts analyses and,
assistive technology is the basic formula individual quality of life, productivity periodic updates on the project’s
of outcomes divided by cost (Minkel, J., and social participation. As one milestones, products and results; and
‘‘Assistive technology and outcomes researcher expressed it, in addition to • Collaborate with relevant NIDRR-
measurement: Where do we begin?’’ longitudinal studies, ‘‘the research sponsored projects, such as the AT/IT
Technology and Disability, July, pgs. agenda must consider lifelong use of Consumer Survey (University of
285–288, 1996). There are others within assistive technology, documenting Michigan), the RESNA Technical
the AT community who operate under effectiveness of that technology as an Assistance projects, and the RRTC on
the assumption that improvements and intervention, identifying stages for Medical Rehabilitation Outcomes, as
innovation in technology will reconsideration of its use, and defining identified through consultation with the
‘‘naturally’’ lead to successful use and environmental and social NIDRR Project Officer.
implementation, and therefore do not considerations’’ (Turk, M. A., ‘‘Early
need to be evaluated. From this Priority 2: Assistive Technology
development-related condition,’’ Research Projects for Individuals With
perspective, technological solutions Assessing Medical Rehabilitation
have been viewed as a panacea without Cognitive Disabilities
Practices—The Promise of Outcomes
the benefit of data to support prevailing Research, Marcus J. Fuhrer, ed., pgs. Background
assumptions (DeRuyter, F., ‘‘Concepts 367–392, 1997). Technology and assistive devices
and rationale for accountability in Innovations in AT will continue to have commonly been used to assist
assistive technology,’’ Volume I— evolve and many AT users, as they have
RESNA Resource Guide of Assistive persons with mobility, communication
in the recent past, will experience and sensory difficulties. Because of the
Technology Outcomes: Measurement increases in independence, function,
Tools, pgs. 2–15, 1998). positive impact that technology has
and general well being. Concurrently, played in the lives of these individuals,
At a minimum, the process of
the gap between the promise of there is now a strong push toward the
evaluating AT outcomes must measure
technology and the ability of development of such devices for people
and establish a baseline of what works,
individuals and funding sources to with cognitive disabilities. The
identify how well and for whom it
afford them will continue to widen. Assistive Technology Act of 1998
works, and at what level of economy
This will result in a greater need for defines an AT device to be any item,
and efficiency. This process will
necessitate taking information from knowledge about the cost-effectiveness piece of equipment or product system
several performance monitoring and efficiency of particular devices and whether acquired commercially off the
dimensions (De Ruyter, op. cit., 1998). services (Fuhrer, M.J., ‘‘Assistive shelf, modified or customized that is
In approaching the challenges of AT technology outcomes research: used to increase, maintain or improve
outcomes measurement, it is important challenges met and yet unmet,’’ functional capabilities of individuals
to identify if the outcomes relate to the American Journal of Physical Medicine with disabilities. Rapid advances in
AT product or service, the user, or to the and Rehabilitation, 2001, In press). technology provide great potential for
environment in which the technology is Priority 1 development of new devices or
being used. While not standardized or adaptation of available devices to assist
widely endorsed, a variety of We will establish multiple research individuals with cognitive disabilities to
measurement techniques and projects on AT outcomes and impacts to develop and maintain skills.
instruments are currently utilized. determine the efficacy and utility of AT Technology professionals, such as
These measurement tools tend to be and the implications for abandonment computer scientists and rehabilitation
specific to a given practice area or of AT devices. In carrying out these engineers, have limited experience
limited to a functional domain, (Volume purposes, the projects must: applying AT solutions to users with
I: RESNA—Resource Guide for Assistive (a) Assess the current status of AT cognitive disabilities. Nor do they yet
Technology Outcomes: Measurement outcomes and impacts measurement understand the mapping between
Tools, 1998). systems and approaches, identifying specific needs and equally specific
To proceed with assessing AT measurement methodologies, design solutions. Most people with
outcomes and impacts, the following characteristics of key instruments cognitive disabilities have a range of
questions need to be addressed. First, including utility to AT field, and critical learning and processing capabilities.
what are the key gaps and weaknesses gaps in measurement; Wide variations in cognitive functioning
in our knowledge of AT use and its (b) Based upon the findings of make it difficult to develop generic
impacts? Are the key research questions paragraph (a), evaluate efficacy of solutions appropriate for all individuals.
related to a particular intervention at a existing measurement instruments or Functional capabilities associated with
particular point in time? How do device develop and evaluate new outcomes and these disabilities may include wide
modifications and upgrades change the impacts measurement methodologies to ranges of ability in memory, reasoning,
intervention? How do characteristics of meet the needs of AT stakeholders; and and language comprehension. Cognitive

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Federal Register / Vol. 66, No. 123 / Tuesday, June 26, 2001 / Notices 34031

functioning also includes perception, integration is limited. There are only a Priority 2
problem-solving, conceptualizing, few large assessments of the technology We will establish multiple research
reading, thinking and sequencing needs of persons with cognitive projects on technology access for
(Electronic and Information Technology disabilities and results are ambiguous persons with cognitive disabilities
Access Advisory Committee, ‘‘EITAAC because of difficulties in identifying leading to practical and affordable
Report, May 13, 1999,’’ A Report to the persons with low incidence conditions solutions to identified community and
Architectural and Transportation and specific technology needs within workplace needs of this population. The
Barriers Compliance Board). Common the study population (Lakin, C. et al., projects must:
strategies to improve functioning in NIDRR Long-Range Plan Commissioned (a) Conduct an assessment of state-of-
activities of daily living across various Paper on Community Integration, 1996). the-art technology applications for
cognitive disabilities need to be persons with cognitive disabilities;
In order to take advantage of any
identified, as do, issues regarding (b) Based on the assessment results of
potential that technological advances
information processing that may be paragraph (a), identify technology gaps
unique to each of these groups. may have, it is important to define what
makes a device easier or more difficult and needs for persons with cognitive
Persons with cognitive disabilities disabilities and make recommendations
often have difficulty in carrying out for a person with a cognitive disability
to use. Products that are simpler and for new technology and modifications to
Instrumental Activities of Daily Living existing technology;
(IADLs) because of problems with time require fewer cognitive skills are easier
to operate for everyone (Vanderheiden, (c) Identify features that may be
management and information retrieval. incorporated into existing,
Researchers are experimenting with the G., 1992, ‘‘A brief look at technology
and mental retardation in the 21st commercially available technology that
use of electronic personal computers to could benefit persons with cognitive
compensate for memory problems. century,’’ in Mental Retardation in the
Year 2000, Louis Rowitz, ed., New York: disabilities; and
Other researchers are examining (d) Develop and explore strategies for
methods of matching individual Springer-Verlag). ‘‘Design guidelines’’
must then be communicated to the strengthening partnerships with
cognitive problems with compensatory developers and manufacturers of
strategies provided by a variety of manufacturers of consumer products
devices in order to facilitate the
commercially available portable and business information systems.
development of new technologies and
electronic devices. In traumatic brain Instructions for training on the use and
applications to incorporate cognitive
injury treatment, researchers are maintenance of the device also need to
access.
investigating the use of virtual reality be part of this design process. It is
In addition to the activities proposed
technology to test visual acuity and important for designers to be aware of
by the applicants to carry out these
reaction times to stimulus. Research is the real world tasks with which the user
purposes, the projects must:
also being conducted on the use of text- has difficulty; hence, research needs to • Coordinate with the appropriate
based messages to enhance include persons with cognitive Federal agencies and privately-funded
communication. disabilities at the front end of all projects, such as the University of
Technology is often viewed as technology development. End product Colorado’s Coleman Institute for
facilitating employment of persons with affordability is important not only in Cognitive Disabilities, that are relevant
disabilities. However, inaccessible meeting consumer needs, but also in to the applicants proposed activities as
technology can be a barrier to all creating the market demand that will identified through consultation with the
persons with disabilities. This is encourage manufacturers to enter NIDRR project officer; and
particularly true for persons with production. • Involve individuals with cognitive
cognitive impairments who may have The NIDRR Long-Range Plan disabilities in all aspects of the project.
difficulty using telephones, computers, discusses three objectives in developing
and other equipment that are staples of Priorities for Community-Based
technology to meet the needs of people
most work environments. Developers Rehabilitation Projects on Technology
with limitations in cognitive
and manufacturers of AT often do not for Independence
functioning: to assure that new
consider issues of cognitive access and
technologies are accessible and do not Background on Issues in Involvement of
flexibility when designing their
exacerbate exclusion from mainstream Community-Based Organizations of
products.
While the congruence between the activities; to assist people with cognitive People With Disabilities in Promoting
promise of AT and the needs of many limitations in the performance of daily Technology for Independence
people attempting to achieve activities; and to develop technologies As stated in the Plan, ‘‘It is the
community integration is obvious, little that can enhance or restore some mission of NIDRR to generate,
has been written about the manner in cognitive functions (NIDRR, Long-Range disseminate, and promote the full use of
which technology affects community Plan: 1999–2003, pg. 57). new knowledge that will improve
adaptation or the service needs of The University of Colorado recently substantially the options for disabled
individuals with cognitive disabilities accepted a gift of $250 million. The individuals to perform regular activities
in community settings. While specific endowment will fund advanced in the community, and the capacity of
manifestations of AT have identifiable research and development of innovative society to provide full opportunities and
benefits, the central question needs to technologies to enhance the lives of appropriate supports for its disabled
be empirically addressed—how can people with cognitive disabilities. The citizens.’’ Assistive Technology (AT)
assistive technologies contribute to endowment, to be paid over five years, and environmental access play key roles
community integration and in what will be used to establish the Coleman in this mission. The Plan provides
manner can the linkage be facilitated? Institute for Cognitive Disabilities detailed definitions, examples, and
The state of knowledge about the use of located at the University of Colorado. research objectives for AT and
AT for persons with cognitive Applicants for this project should environmental access, including
disabilities, as well as the outcomes of provide information on proposed universal design.
that use or lack of use and the cost- coordination with the Coleman According to a National Center for
effectiveness in achieving community Institute. Health Statistics report titled ‘‘Trends

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34032 Federal Register / Vol. 66, No. 123 / Tuesday, June 26, 2001 / Notices

and Differential Use of Assistive and environmental access problems and based disability organization’’ is a
Technology Devices: United States, needs. consumer-directed community
1994,’’ approximately 17 million people In recent years, a number of NIDRR organization such as a CIL. Consumer
used at least one AT device. AT and grant competitions have led to research control is the key. Some community
related environmental access projects and activities that aim at rehabilitation service organizations, for
approaches (environmental access improving access to AT and reducing example psychosocial rehabilitation
approaches include the concept of environmental barriers. For many years, programs, also value consumer
universal design) help people with NIDRR funded grants to States under the direction. Other disability-related
disabilities function on a more equal Technology-Related Assistance for organizations are located in community
basis in society. For more information Individuals with Disabilities Act of 1988 settings, but do not have significant
on the contributions of AT and access (Tech Act). In addition to research consumer direction. Section 7 of the
solutions, see the examples and links to programs under title II of the Rehabilitation Act, for example,
relevant web sites provided by the Rehabilitation Act of 1973, as amended identifies community rehabilitation
United States Architectural and (29 U.S.C. 796) (the Rehabilitation Act), programs as providers of AT devices
Transportation Barriers Compliance NIDRR now has responsibility for AT and services for persons with
Board, also known as the Access Board programs under the Assistive disabilities, but such organizations may
(http://www.access-board.gov/), and the Technology Act of 1998 (AT Act), which or may not be consumer directed.
Doorway to Research on Technology for replaced the Tech Act. A June 5, 2000 Organizations with consumer direction,
Access and Function at the National notice (65 FR 35768–35774) for a new including CILs and other organizations
Center for the Dissemination of Alternative Financing Program under such as protection and advocacy (P&A)
Disability Research (NCDDR) (http:// title III of the AT Act identified agencies, are in a unique position to
www.ncddr.org/rpp/techaf/index.html). numerous issues affecting access of help identify and study the specific
The new paradigm of disability people with disabilities to AT. An April needs for AT and environmental access
embodied in the Plan requires analysis 5, 1999 notice (64 FR 16531) under of individuals from diverse populations
of the extent to which AT and NIDRR’s Rehabilitation Engineering and therefore are the focus of this
environmental access helps individuals Research Center (RERC) program research effort.
with disabilities in attaining full discussed the importance of improving A number of private foundations and
participation in society. Much of access to the environment through international agencies have identified
NIDRR’s work reflects the components universal design. For information on the value of investing in ‘‘grassroots’’,
of the Independent Living (IL) ongoing and completed NIDRR- consumer-directed organizations,
philosophy: consumer control, self-help, supported activities in these areas, particularly in public health and
advocacy, peer relationships and peer contact the National Rehabilitation economic development. These
role models, and equal access to society, Information Center at or telephone 1– organizations aim at reducing poverty or
programs, and activities. IL and 800–346–2742. specific diseases such as HIV/AIDS, or
achieving community integration to the This year, NIDRR anticipates they provide assistance to special needs
maximum extent possible are issues at awarding a number of projects related to groups such as people in troubled urban
the crux of NIDRR’s mission. AT and environmental access. For and rural areas (see the World Wide
Furthermore, NIDRR is committed to the updates on the status of announcements Web sites or publications of the Pew
creation of a theoretical framework with please see the Education Department Fund for Health and Human Services
measurable outcomes that is based upon Forecast of Funding Opportunities http://www.pewtrusts.com/, the World
the experiences of individuals with under Department of Education Health Organization http://
disabilities. Discretionary Grant Programs for FY www.who.int/, and the Robert Wood
To improve ‘‘end-user’’ participation 2001 at: http://ocfo.ed.gov/grntinfo/ Johnson Foundation http://www.rwjf/
in addressing AT problems, and related forecast/forecast.htm org/index.jsp for examples).
environmental access solutions, NIDRR According to the Rehabilitation Act, Community-based research
will support projects that involve the purpose of IL programs is ‘‘to encompasses a broad set of research
community-based organizations in promote a philosophy of consumer activities with differing, and sometimes
researching AT related problems and control, peer support, self-help, self- competing, concepts and methods.
needs. Two types of projects will be determination, equal access, and Sociology, anthropology, community
supported. The first type includes individual empowerment, equal access, psychology and public health, for
research projects that will investigate and system advocacy, in order to example, use applied community
the use of, and need for, AT devices and maximize the leadership, research methods. For the purpose of
services at the community level. The empowerment, independence, and these two proposed priorities,
second type of project is a community- productivity of individuals with community-based research is intensive,
based research ‘‘Resource Center’’ that disabilities, and the integration and full systematic study directed toward new or
will develop, evaluate, and disseminate inclusion of individuals with full scientific knowledge or
improved research and training methods disabilities into the mainstream of understanding of AT or environmental
appropriate to AT and environmental American society.’’ The concepts in this access problems. In addition, the
access involvement of community-based philosophy of consumer control, peer research must be completed in the
disability organizations. The Resource support, and self-help place these title community under the direction of
Center will also provide AT and VII independent living centers (CILs) community-based disability
environmental access technical within a broader world-wide grouping organizations (Sclove, R.E, Scammell,
assistance to community-based known as ‘‘community-based’’ M.L. & Holland, B. (1998). Community-
organizations and will foster organizations. based Research in the U.S. Amherst,
cooperation among the funded projects. The term ‘‘community-based’’ MA: The Loka Institute (http://
These community-based research organization has varying meanings in www.loka.org/)).
projects will broaden the inclusion of disability and rehabilitation programs Community-based disability and
persons with disabilities in developing and in social research. For the purpose rehabilitation research puts primary
practical and affordable solutions to AT of these two priorities, a ‘‘community- emphasis on assisting persons with

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Federal Register / Vol. 66, No. 123 / Tuesday, June 26, 2001 / Notices 34033

disabilities by producing and imply censorship of data or of contribute to the advancement of


disseminating knowledge and publication, but rather the opportunity knowledge in accordance with the Plan.
technology and promoting and to make clear the community’s views (b) Disseminate findings from the
advancing the rehabilitation and about the interpretation prior to final Resource Center’s program on
integration process at the community publication. community-based research to DRRPs on
level. Community-based disability and • Productive partnerships between Technology for Independence and other
rehabilitation research, according to researchers and community members related NIDRR-funded activities under
these two priorities, applies to the use should be encouraged to last beyond the the Plan; and
of, or need for, AT devices and services life of the project. This will make it (c) Describe how the resource center
by persons with disabilities in the more likely that research findings will will develop research capacity among
community, and related issues of be incorporated into ongoing individuals with disabilities at the
environmental access. Such research community programs and therefore community level.
should be performed by qualified provide the greatest possible benefit to In addition to the activities proposed
researchers in cooperation with the community from research. by the applicant to carry out these
community-based disability • Community members should be purposes, the Resource Center must:
organizations. NIDRR supports the • Involve individuals with
empowered to initiate their own
notion that persons with disabilities disabilities and, if appropriate, their
research projects that address needs
provide unique perspectives about representatives, in planning and
they identify themselves.
living with disability and must be implementing the research, training,
included in community-based research Priority 3: Resource Center for and dissemination activities, and in
projects to the greatest possible extent. Community-Based Disability and evaluating the Center;
Their experience with, and interest in, Rehabilitation Research Projects on • Coordinate with appropriate
finding practical solutions to problems Technology for Independence federally funded projects. Coordination
encountered in home, school, place of responsibilities will be identified
There is a need for capacity-building through consultation with the NIDRR
work, and community make them on conceptual and methodological
informed participants, if not particularly project officer and may include outreach
approaches to research on the to specific NIDRR DRRPs, RERCs,
qualified researchers. To ensure that involvement of community-based
technology-related problems relevant to RRTCs, DBTACs and AT Projects; Office
organizations of people with disabilities of Special Education technology
persons with disabilities are studied, in promoting technology for
contributions from such persons are projects and Parent Training and
independence. There is need for Information Centers; and Rehabilitation
encouraged. In addition, university- training, technical assistance, and
based research on disability needs to be Services Administration training,
dissemination efforts to guide ongoing special demonstration, and IL projects;
complemented by community-based efforts. Advice and strategies are needed
research to provide the community with • Convene a formative review session
in specific areas including, but not within six months of project award with
useful and immediate tools, limited to, research designs and
technologies, and knowledge for the DRRPs on Technology for
methodologies, case studies, focus Independence to assist these
overcoming barriers to access and
group research, AT and environmental community-based rehabilitation
participation in economy and society.
Community-based rehabilitation assessment, small sample surveys, researchers in the finalization of their
research is particularly suited for participant observation, ethnography, research plans, and to help them with
persons with disabilities. According to and participatory action research. There the commencement of their research
the University of Washington School of is a need to develop ‘‘how-to-do’’ projects; and
Public Health and Community materials on disability-related AT and • Conduct a state-of-the-science
Medicine’s Principles of Community- environmental access community-based conference, including the DRRPs on
Based Research, a research partnership research, reference resources, web-based Technology for Independence, in the
between a university and community- access to materials, and other means of third year of the grant and publish a
based organizations should accomplish communicating knowledge about comprehensive report on the final
the following: community-based rehabilitation outcomes of the conference in the fourth
• Community partners should be research in the U.S. year of the grant.
involved at the earliest stages of the Priority 3 Priority 4: Community-Based Disability
project, helping to define research and Rehabilitation Research Projects on
objectives and having input into how We will establish a resource center to
assist Disability and Rehabilitation Technology for Independence
the project will be organized.
• Community partners should have Research Projects on Technology for The Plan identifies disability in terms
real influence on project direction—that Independence and other related NIDRR of the relationship between the
is, enough leverage to ensure that the activities under the Plan with capacity- individual and the natural, built,
original goals, mission, and methods of building for improving the involvement cultural, and social environments (63
the project are observed. of community-based organizations of FR 57189–57219). The Plan focuses on
• Research processes and outcomes people with disabilities in promoting both individual and systemic factors
should benefit the community. technology for independence. that have an impact on the ability of
Community members should be hired In carrying out these purposes, the people to function. The elements of the
and trained whenever possible and project must: Plan include employment outcomes,
appropriate, and the research should (a) Establish and conduct a significant health and function, technology for
help build and enhance community and substantial resource program on access and function, and IL and
assets. capacity-building in research, training, community integration. To attain the
• Community members should be and TA on the involvement of goals in these areas, the Plan also
part of the analysis and interpretation of community-based disability includes capacity building for research
data and should have input into how organizations in promoting technology and training, and to ensure knowledge
the results are distributed. This does not for access and function that will dissemination and utilization. Each area

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34034 Federal Register / Vol. 66, No. 123 / Tuesday, June 26, 2001 / Notices

of the Plan includes objectives at both project officer and may include outreach DEPARTMENT OF EDUCATION
the individual and system levels. For to specific NIDRR DRRPs, RERCs,
[CFDA No.: 84.133A]
example, the technology for access and Rehabilitation Research and Training
function area of the Plan includes Centers (RRTCs), Disability Business Office of Special Education and
research objectives to develop AT that Technical Assistance Centers (DBTACs) Rehabilitative Services; National
supports people with disabilities to and AT Projects; Office of Special Institute on Disability and
function and live independently and Education technology projects and Rehabilitation Research
obtain better employment outcomes, Parent Training and Information
and research objectives to promote Centers; and Rehabilitation Services ACTION: Notice inviting applications for
improved access to the built Administration training, special fiscal year (FY) 2001 new awards and
environment and concepts of universal demonstration, and IL projects. announcement of pre-application
design. It is clear that the challenges and meetings.
opportunities for AT and improved • Involve individuals with
environmental access reflect all of the disabilities in key decision-making. SUMMARY: We invite applications for
priority areas of the Plan. • Participate in a formative review new FY 2001 grant awards for four
session to be convened by the Resource Disability and Rehabilitation Research
Priority 4 Projects and Centers Program (DRRP)
Center within six months of award, and
We will establish research projects to cooperate with the Resource Center’s on: (1) Assistive Technology Outcomes
involve community-based disability and Impacts, (2) Assistive Technology
capacity-building and evaluation
organizations in AT and environmental Research Projects for Individuals with
activities.
access research leading to practical and Cognitive Disabilities, (3) Resource
affordable solutions to identified • Participate in a state-of-the-science Center for Community-based Research
problems and needs, and building conference in the third year of the grant. on Technology for Independence, and
research capacity at the community Selection Criteria (4) Community-based Research Projects
level and in community-based on Technology for Independence.
organizations serving persons with The selection criteria to be used for Purpose of the Program
disabilities. these competitions will be provided in
In carrying out these purposes, a the application package for each The purpose of the Disability and
project must: competition. Rehabilitation Research Projects and
(a) From the examples of research Centers Program is to improve the
objectives below, conduct a significant Applicable Program Regulations: 34 effectiveness of services authorized
and substantial research program on the CFR part 350. under the Rehabilitation Act of 1973.
involvement of community-based Electronic Access to This Document We take this action to focus research
disability organizations in promoting attention on an area of national need.
technology for access and function that You may view this document, as well The priorities are intended to improve
will contribute to the advancement of as all other Department of Education rehabilitation services and outcomes for
knowledge in accordance with the Plan documents published in the Federal individuals with disabilities.
by: Register, in text or Adobe Portable
• Investigating and developing National Education Goals
Document Format (PDF) on the Internet
research questions, methodologies, and at the following site: www.ed.gov/ The eight National Education Goals
recommendations for use by other focus the Nation’s education reform
legislation/FedRegister
research entities in solving technology- efforts and provide a framework for
related, engineering, psychosocial, To use PDF you must have Adobe improving teaching and learning.
economic and other problems at the Acrobat Reader, which is available free This notice addresses the National
individual and systems levels, in the at this site. If you have questions about Education Goal that every adult
United States (U.S.); and using PDF, call the U.S. Government American will be literate and will
• Designing and testing models for Printing Office (GPO), toll free, at 1– possess the knowledge and skills
partnership of community-based 888–293–6498; or in the Washington, necessary to compete in a global
disability organizations in research, DC, area at (202) 512–1530. economy and exercise the rights and
participant observation studies and Note: The official version of the document responsibilities of citizenship.
other qualitative and quantitative is published in the Federal Register. Free Applicable Regulations
research approaches to using technology Internet access to the official edition of the
in community-based settings; Federal Register and the Code of Federal The Education Department General
(b) Disseminate findings from Regulations is available on GPO Access at: Administrative Regulations (EDGAR),
community-based research to persons http://www.access.gpo.gov/nara/index.html 34 CFR Part 74, 75, 77, 80, 81, 82, 85,
with disabilities, their representatives, 86 and 97; and the following program
disability and rehabilitation service (Catalog of Federal Domestic Assistance regulations: Disability Rehabilitation
providers, researchers, planners, and Numbers 84.133A, Disability Research Projects and Centers—34 CFR
policy makers; and Rehabilitation Research Project) part 350, and the Notice of Final Priority
(c) Describe how the applicant will Program Authority: 29 U.S.C. 762(g) and published elsewhere in this issue of the
develop research capacity among 764(b). Federal Register.
individuals with disabilities at the
Dated: June 20, 2001. Pre-Application Meeting
community level.
In carrying out these purposes, the Francis V. Corrigan, Interested parties are invited to
project must: Deputy Director, National Institute on participate in pre-application meetings
• Coordinate with appropriate Disability and Rehabilitation Research. to discuss the funding priorities. In each
federally funded projects. Coordination [FR Doc. 01–15959 Filed 6–25–01; 8:45 am] meeting you will receive technical
responsibilities will be identified assistance and information about the
BILLING CODE 4000–01–P
through consultation with the NIDRR funding priority. You may attend the

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