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Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Appendix A

Grant Summaries

This appendix contains individual summaries of the 30 grants that participated in the summative evaluation. Each grant summary includes (1) an abstract describing the overall work of the grant; (2) a table presenting each of the projects under the grant and listing the corresponding outputs for each project that were reviewed by the committee; and (3) a brief description of each reviewed output. Abstracts of the grants were adapted from the abstract in each grantee’s Annual Performance Report (APR) or from abstracts contained in National Institute on Disability and Rehabilitation Research’s (NIDRR’s) National Rehabilitation Information Center (NARIC) (see: http://www.naric.com/research/ [Janauary 9, 2012]). In addition to listing the projects and reviewed outputs, the tables present the NIDRR research domains addressed by each project (see Chapter 1 for a description of NIDRR’s five research domains). The output descriptions were developed by examining the outputs themselves and adapting information from the output abstracts, where available. The listing below shows each grant included in the evaluation and identifies the page in this appendix where the grant’s summary can be found.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Funding Mechanism/Grant

BURN MODEL SYSTEM (BMS)

Grant Title: Burn Model System/Data Coordinating Center

Grant Title: North Texas Burn Rehabilitation Model System

TRAUMATIC BRAIN INJURY MODEL SYSTEM (TBIMS)

Grant Title: Mayo Clinic TBI Model System

Grant Title: Spaulding/Partners Traumatic Brain Injury Model System at Harvard Medical School

SPINAL CORD INJURY MODEL SYSTEM (SCIMS)

Grant Title: Northern New Jersey Spinal Cord Injury System

Grant Title: The Missouri Model Spinal Cord Injury System

REHABILITATION RESEARCH AND TRAINING CENTER (RRTC)

Grant Title: Meeting the Nation’s Needs for Personal Assistance Services: Center for Personal Assistance Services

Grant Title: RRTC on Disability Demographics and Statistics

Grant Title: RRTC on SCI: Promoting Health and Preventing Complications Through Exercise

REHABILITATION ENGINEERING RESEARCH CENTER (RERC)

Grant Title: RERC on Telerehabilitation

Grant Title: RERC on Universal Interface and Information Technology Access

DISABILITY AND REHABILITATION RESEARCH PROJECTGENERAL (DRRP)

Grant Title: The Effect of Scheduled Telephone Intervention on Outcomes After TBI

Grant Title: Asset Accumulation and Tax Policy Project

Grant Title: Medicaid Quality Indicators for Individuals with Disabilities

Grant Title: Persons Aging with Hearing and Vision Loss

FIELD INITIATED PROJECT (FIP)

Grant Title: Efficacy of Pressure Garment Therapy After Burns

Grant Title: A Longitudinal Study for Hospitalization, Pressure Ulcers, and Subsequent Injuries After Spinal Cord Injuries

Grant Title: Black-White Disparities in Stroke Rehabilitation

Grant Title: Development of Intelligent Personal Activity Management and Prompting Applications for Individuals with Cognitive Disabilities

Grant Title: Driving After Stroke

Grant Title: Functional Effects of Bifocal Use: Implication for Falling Intervention

Grant Title: Inclusive Indoor Play

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Grant Title: Interference in Hearing Aids from Digital Wireless Telephones: Improved Predictive Methods

Grant Title: Motor Training and Assessment in Adults with Hemiplegic Cerebral Palsy—The ULTrA Program

Grant Title: Using the U.S. EEOC Employment Discrimination Charge Data System for Research and Dissemination

SMALL BUSINESS INNOVATION RESEARCH II (SBIR-II)

Grant Title: Universal Access to Passenger Rail Cars

Grant Title: Web-Enabled Creation and Distribution of Audio-Tactile Maps for Use in Orientation and Mobility Training

SWITZER FELLOWSHIPS

Grant Title: A Noninvasive Surface Electromyogram Decomposition Method and Its Application in Disability Rehabilitation

Grant Title: Demographic Soup: Disentangling the Conceptual, Political, and Methodological Dimensions of Disability Statistics

Grant Title: Physical and Social Environmental Factors That Influence Health and Participation Outcomes for Chronically Ill Adults

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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BURN MODEL SYSTEM (BMS)

Grant Title: Burn Model System/Data Coordinating Center

Grant Award Number: H133A020402

Grantee: University of Colorado Denver, Colorado School of Public Health

Grant Mechanism: Burn Model System

Grant Start and End Dates: October 1, 2002, to September 30, 2008

Total Direct Cost: $1,410,621

Abstract:1 The mission of the Burn Model System/Data Coordinating Center (BMS/DCC) was to support its respective four Burn Model System Clinical Centers by (1) serving the clinical, research, and public communities to which it is responsible; (2) serving the needs of good scientific procedure in multi-institutional outcomes research; and (3) supporting the needs for patient safety and data confidentiality as required by federal regulations when conducting collaborative clinical studies. To accomplish these objectives, researchers developed integrated systems to affect national data collection, project management, data coordination, technical support, collaborative clinical projects, scientific conduct, scientific publication, and effective dissemination. A central function of the BMS/DCC was also to accumulate and integrate a central repository of data from the four Burn Model System Clinical Centers, while being responsive to technical and analytical needs of the centers.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included six journal articles, one technical report, one fact sheet, one website, and one data dictionary. The following table shows the three projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

_______________

1 Abstracts are adapted from the abstract in each grantee’s Annual Performance Report, except for two, which are marked with separate footnotes.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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(Note that because this grant was for a coordinating center, it was not organized by projects in the same way as the research and development grants. Therefore, for one of its main “activity areas,” the grantee submitted more than two outputs for the committee’s review.)

Project/Research Domains* Outputs
A. Establish and Maintain BMS Database A1. Lezotte, D.C. (2008). Model system for burn injury rehabilitation national database data dictionary (16) [Data code listing]. Denver: Colorado School of Public Health, University of Colorado Denver.
Health and Function Employment Participation and Community Living Lezotte, D.C. (2004). Model system for burn injury rehabilitation national database data dictionary, Appendix A (12) [Data code listing]. Denver: Colorado School of Public Health, University of Colorado Denver.
B. Develop and Implement Support Systems

Health and Function
B1. Lezotte, D.C., and Sloan, R. (2004). Process review of level I data center activities for burn model system/clinical sites. Unpublished report, Department of Biostatistics and Informatics, University of Colorado, Denver.
  B2. Klein, M.B., Lezotte, D.C., Fauerbach, J.A., Herndon, D.N., Kowalske, K.J., Carrougher, G.J., deLateur, B.J., Holavanahalli, R., Esselman, P.C., San Augustin, T.B., and Engrav, L.H. (2007). The National Institute on Disability and Rehabilitation Research Burn Model System Database: A tool for the multi-center study of the outcome of burn injury. Journal of Burn Care & Research, 28(1), 84-96.
  B3. Lezotte, D.C., Hills, R.A., Heltshe, S.L., Holavanahalli, R.K., Fauerbach, J.A., Blakeney, P., Klein, M.B., and Engrav, L.H. (2007). Assets and liabilities of the Burn Model System Data Model: A comparison with the National Burn Registry. Archives of Physical Medicine and Rehabilitation, 88(12), S7-S17.
  B4. Fauerbach, J.A., Lezotte, D.C., Hills, R.A., Chromes, F.G., Kowalske, K., deLateur, B.J., Goodwin, C.W., Blakeney, P., Herndon, D.N., Wiechman, S.A., Engrav, L.H., and Patterson, D.R. (2005). Burden of burn: A norm-based inquiry into the influence of burn size and distress on recovery of physical and psychosocial function. Journal of Burn Care & Rehabilitation, 26(1), 21-32.
  B5. Serghiou, M.H., Rose, M.W., Pidcock, F.S., Esselman, P.C., Engrav, L.H., Kowalske, K.J., and Lezotte, D.C. (2008). The WeeFIM [R] instrument—A paediatric measure of functional independence to predict longitudinal recovery of paediatric burn patients. Developmental Neurorehabilitation, 11(1), 39-50.
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×
Project/Research Domains* Outputs
B. Develop and Implement Support Systems

Health and Function
B6. Lezotte, D.C. (2011). BMS publications with DCC PI support. Unpublished list of publications, Department of Biostatistics and Informatics, University of Colorado, Denver.
C. Implement a Dissemination Strategy for BMS C1. Lezotte, D.C. (No date). Public and secured BMS website for consumer information. Available: http://bms-dcc.ucdenver.edu/ [January 9, 2012].
Health and Function Employment Knowledge Translation C2. Kaufman, M.S., Graham, C.C., Lezotte, D.C., Fauerbach, J.A., Gabriel, V., Engrav, L.H., and Esselman, P. (2007). Burns as a result of assault: Associated risk factors, injury characteristics, and outcomes. Journal of Burn Care & Research, 28(1), 21-28.

*This column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: From the project to establish and maintain a BMS database, a data dictionary (A1) was reviewed. The data dictionary identifies what kind of data to collect and provides a coding scheme for the data. Data that should be collected include protected health information, patient status, preburn information, parts of body burned, parts of body grafted, skin-related problems, distress level, and scarring problems.

The next six outputs reviewed came from the project aimed at developing and implementing support systems. The first of these outputs was a technical report (B1), which describes site visit reviews of Burn Model System/Clinical Centers. Site visits were conducted to review data management operating procedures, review data security and privacy, seek feedback and recommendations for improving operations, and identify collaborative projects for which BMS/DCC could provide more support. Through the site visits, researchers assessed the quality of the data coming in from each site and documented effective site-specific management techniques and practices so they could be shared with other sites.

The next four outputs reviewed under this project were journal articles. Klein et al. (B2) conducted a descriptive study of both the data quality and structure of the Burn Model System database after 10 years of existence. They noted that a total of 4,600 patients had been entered into the database, with data being collected during hospitalization as well as at 6, 12, and 24 months after discharge. The structure of the database includes sections on demographics, injury complications, patient disposition, and functional and psychological surveys. It was concluded that the data and structure of the database were both of high quality and that the database is an important resource in supporting the work of Burn Model System projects. The next journal article (B3) compares the Burn Model System population with patients in the National Burn Registry. Patients from both populations were

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

compared in terms of demographics and burn characteristics at discharge and over the course of follow up. Populations were compared in total and also broken down into groups with similar burns. Only minor and insignificant demographic variations between the Burn Model System and the National Burn Registry populations were discovered, and Lezotte et al. therefore concluded that the Burn Model System population is a representative sample, and results using Burn Model System data should be generalizable. Fauerbach et al. (B4) conducted a longitudinal study on the influence of physical and psychological burden on burn recovery. Participants included 162 adults with major burns from three burn centers. Participants were compared by level of burden and against published normative data. It was found that physical recovery was significantly slower for participants with either large physical or psychological burden. Additionally, psychosocial recovery was significantly slower for participants with large psychological burden. It was concluded that, in additional to treating the burns, clinicians must address physical and psychological burden in order to promote recovery. The final journal article (B5) was a study on the effectiveness of the WeeFIM, a standardized measure of functional performance developed for use in children 6 months to 8 years of age, in measuring the impact of burn size on functional independence and time to recovery. A total of 249 patients, ages 6 months to 16 years, participated in the 2-year study. WeeFIM measurements were taken at discharge and at 6 months, 1 year, and 2 years after burn injury. Results indicated that the WeeFIM could accurately describe the relationship among burn size, functional capacity, and recovery up to 24 months after burn injury. Serghiou et al. believe the tool should be used more widely to track recovery of burn victims.

The final output reviewed under this project (Develop and Implement Support Systems) was a list of publications (B6) from Burn Model System Clinical Centers that were produced with support from the DCC. The list includes 16 published journal articles, 1 journal article that was submitted for publication, and 1 journal article that was to be submitted for publication.

Under the project on implementing a dissemination strategy, two outputs were produced. The first, a website (C1) for the BMS/DCC, includes information about the DCC participating institutions, study group criteria, program priorities and policies, consumer products, special topics, and related links. The website also has a search function. Through the website, researchers can access Burn Model System publications, systematic reviews, consumer information, newsletters, and facts and figures, and can also contact and collaborate with DCC staff. The second output, a journal article (C2), compares victims intentionally burned as the result of an assault with victims unintentionally burned as the result of an accident. Participants included 80 intentionally burned victims and 1,982 unintentionally burned victims. Kaufman et al. discovered that intentionally burned victims were more likely to be female, black, and unemployed, and had higher rates of

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

substance abuse, larger burns, greater mortality rates, and greater psychological distress. It is the authors’ hope that understanding the characteristics of intentionally burned victims will lead to better health and social services for this population.

Grant Title: North Texas Burn Rehabilitation Model System

Grant Award Number: H133A020104

Grantee: UT Southwestern Medical Center at Dallas

Grant Mechanism: Burn Model System

Grant Start and End Dates: October 1, 2002, to September 30, 2008

Total Direct Cost: $1,190,475

Abstract: The North Texas Burn Rehabilitation Model System (NTBRMS) grant included five major research projects: (1) Barriers to Return to Work after Major Burn Injury, (2) Long-Term Outcome of Major Burn Injuries, (3) Outcome Following Deep Full Thickness Hand Burns, (4) Burn-Associated Neuropathy: Evolution over Time, and (5) The Socioeconomic Determinants of Disability in Individuals with Major Burn Injury. Each of these projects linked directly with several areas of the NIDRR Long-Range Plan. The plan of operation included clearly defined objectives, responsibilities, and timelines for model system demonstration, research, and dissemination. Additionally, researchers sought to close the loop and reassessed the progress of each activity to create intervention plans as needed to ensure that they met the proposed priorities. The NTBRMS also contributed data to the national Burn Injury Rehabilitation Model System database.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included nine journal articles, one newsletter, one seminar, one clinic, and one intervention program. The following table shows the six projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×
Project/Research Domains* Outputs
A. Barriers to Return to Work After Major Burn Injury—Collaborative

Employment
A1. Esselman, P.C., Askay, S.W., Carrougher, G.J., Lezotte, D.C., Holavanahalli, R.K., Magyar-Russell, G., Fauerbach, J.A., and Engrav, L.H. (2007). Barriers to return to work after burn injuries. Archives of Physical Medicine and Rehabilitation, 88(12), S50-S56.
B. Long-Term Outcome of Major Burn Injuries

Health and Function
B1. Kowalske, K.J. (2003, September). The challenge of burn care: How to maximize outcomes—A seminar. Seminar conducted at University of Texas Southwestern Medical Center at Dallas.
  B2. Holavanahalli, R.K., Helm, P.A., and Kowalske, K.J. (2010). Long-term outcomes in patients surviving large burns: The skin. Journal of Burn Care & Research, 31(4), 631-639.
C. Outcome Following Deep Full-Thickness Hand Burns—Collaborative

Health and Function
C1. Schneider, J.C., Holavanahalli, R.K., Helm, P.A., O’Neil, C., Goldstein, R., and Kowalske, K. (2008). Contractures in burn injury part II: Investigating joints of the hand. Journal of Burn Care & Research, 29(4), 606-613.
  C2. Holavanahalli, R K., Helm, P.A., Gorman, A.R., and Kowalske, K.J. (2007). Outcomes after deep full-thickness hand burns. Archives of Physical Medicine and Rehabilitation, 88(12 Suppl. 2), S30-S35.
D. Burn-Associated Neuropathy: Evolution over Time

Health and Function
D1. Gabriel, V., Kowalske, K.J., and Holavanahalli, R.K. (2009). Assessment of recovery from burn-related neuropathy by electrodiagnostic testing. Journal of Burn Care & Research, 30(4), 668-674.
E. The Socioeconomic Determinants of Disability in Individuals with Major Burn Injury

Participation and Community Living
E1. East Texas Medical Center (ETMC) Outreach Satellite Clinic. Described to committee in grantee questionnaire.
  E2. Holavanahalli, R., Lara, C., Tollar, A., Stevens, C., Crump, D., Ellsworth, B., and Leal, D. (2006, 2008, 2009). SOAR Annual Report. Unpublished report, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas and Parkland Regional Burn Center, Parkland Health and Hospital System Dallas.
F. Contribution to a Longitudinal National Database

Demographics
F1. Holavanahalli, R.K., Lezotte, D.C., Hayes, M.P., Minhajuddin, A., Fauerbach, J.A., Engrav, L.H., Helm, P.A., and Kowalske, K.J. (2006). Profile of patients lost to follow up in the Burn Injury Rehabilitation Model Systems’ longitudinal database. Journal of Burn Care & Research, 27(5), 703-712.

*This column also shows the key NIDRR research domain(s) that were being addressed by each project.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

Brief Description of the Outputs: Under the first project, a journal article was produced addressing barriers to return to work after major burn injury. Esselman et al. (A1) followed 154 individuals who were hospitalized and met the American Burn Association criteria for major burn injury. Participants were asked to identify perceived barriers to their returning to work. Physical and wound issues, working conditions such as temperature and safety, and psychosocial factors such as flashbacks and appearance concerns all presented barriers to the return to work. The article concludes that returning to work involves treatment of both physical and psychosocial factors.

The next two outputs reviewed were associated with the long-term outcomes project. A 1-day seminar (B1) aimed to address critical issues in the treatment of individuals with burn injuries (including physical, psychological, and social outcomes) and included 14 presentations and one panel discussion on such topics as the pathophysiology of burns, wound and skin care products, neurological complications, psychological effects, community reintegration, and return to work. The seminar was intended to present relevant principles and techniques that physicians and other health care professionals could use to provide outpatient wound and skin care and rehabilitation following acute burn injuries. Holavanahalli, Helm, and Kowalske (B2) conducted a study of long-term residual skin problems in persons with severe burn injuries. They evaluated 98 individuals who had survived burns over 30 percent or more of their total body surface area. Study participants were asked to complete a patient information form and a medical problem checklist and underwent a comprehensive physical examination. The researchers identified problems that persist many years following the burn injury, such as sensory loss and itching; problems that tend to decrease over time, such as painful scars and skin rash; and problems that tend to increase over time, such as cuts and tears in fragile burns. They concluded there is a need for better long-term follow up with survivors of large burns.

Two journal articles were produced under the project assessing outcomes following deep full thickness hand burns. The first was a journal article (C1) based on a study of the incidence and severity of hand contractures after burn injury. Data were collected over 10 years from 985 adult burn survivors. Twenty-three percent of study patients developed at least one hand contracture. Schneider et al. were able to identify statistically significant predictors of both contracture development and number of contractures. Given the significant impairment hand contractures represent, the authors believe use of the identified predictors will significantly aid burn survivors. The second article (C2) was a descriptive study on measuring hand performance after deep hand burns. Thirty-two burn survivors participated. Fifty percent of participants had amputations, 40 percent had a functional range of less than 180 degrees, and 22 percent had injury to the tendons in

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

the hand. Participants took the Jebsen-Taylor Hand Function Test (JTHFT) and Michigan Hand Questionnaire (MHQ). Holavanahalli et al. concluded that, while deep full-thickness burns did compromise hand performance, the muscles were generally still intact enough to perform a modified grasp. Training programs on this grasp could be developed to aid burn survivors.

The next output reviewed was a journal article produced under the project on burn-associated neuropathy. Gabriel et al. (D1) investigated the natural recovery from burn-related peripheral neuropathies. Thirty-six participants with burn-related neuropathy, out of 370 screened burn survivors, were repeatedly tested for improvement. Mean time between the tests was 169 days. Significant improvement between the initial and follow-up tests was found, suggesting burn-related neuropathy will naturally heal. According to the authors, the prognosis for recovery from burn-related neuropathy had not been adequately described in the literature prior to this study.

From the project on socioeconomic determinants of disability in individuals with major burn injury, two outputs were reviewed. The first, a quarterly outreach satellite clinic (E1) at the East Texas Medical Center in Tyler, Texas, cared for an average of 25 patients each quarter between 2002 and 2007. Clinic personnel included NTBRMS burn surgeons, physical medicine and rehabilitation physicians, and research personnel. In addition to receiving medical care, patients participated in NTBRMS research studies and educational programs on various burn rehabilitation topics. The clinic enabled patients living in the area to receive medical care for their burn injuries closer to their homes. The second output, Survivors Offering Assistance in Recovery Program (SOAR) (E2), provides peer support during recovery to burn patients and their families. Volunteer burn survivors and family members are trained in peer support. Each burn unit patient receives a visit at least once a week from a trained volunteer. Many burn unit patients have reported that the opportunity to speak with a recovered peer made them more optimistic about their own recovery.

The final output reviewed was part of the project focused on contributions to a longitudinal national database. Holavanahalli et al. (F1) describe common characteristics among burn survivors lost to follow up at 6, 12, or 24 months after injury. Participants were tracked over 2 years through the Burn Injury Rehabilitation Model System database, and characteristics related to both increased and decreased likelihood of attending follow-up sessions with physicians were identified. This study was reported to be the first of its kind for burn survivors, and the authors hope these findings will lead to strategies for reducing attrition in burn survivors.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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TRAUMATIC BRAIN INJURY MODEL SYSTEM (TBIMS)

Grant Title: Mayo Clinic TBI Model System

Grant Award Number: H133A020507

Grantee: Rehabilitation Hospital of Indiana

Grant Mechanism: Traumatic Brain Injury Model System

Grant Start and End Dates: October 1, 2002, to March 31, 2009

Total Direct Cost: $1,402,265

Abstract: The Mayo Clinic Traumatic Brain Injury Model System (TBIMS) grant was focused on three local research projects: (1) decision making and outcomes of inpatient and outpatient rehabilitation pathways, (2) very longterm (5-15+ years postinjury) process and outcome for people with TBI identified through the Rochester Epidemiology Project, and (3) telehealthbased (Internet) cognitive rehabilitation. These projects were developed with careful attention to sample size; rigorous methodology; practical issues of data acquisition; and the needs of and feedback from people with TBI, their families, and significant others. The Mayo Clinic TBIMS also continued to contribute substantially to the TBIMS National Database and was involved in other collaborative projects using this database.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included 13 journal articles, one classification system, one inventory, one guide, one set of audiovisual materials, and one curriculum. The following table shows the four projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×
Project/Research Domains* Outputs
A. Factors and Effects on Outcome of Clinical Decision Making in Selecting Rehabilitation Pathways After Traumatic Brain Injury

Health and Function
A1. Malec, J.F., Mandrekar, J.N., Brown, A.W., and Moessner, A.M. (2009). Injury severity and disability in the selection of next-level care following acute medical treatment for traumatic brain injury. Brain Injury, 23(1), 22-29.
  A2. Malec, J.F., Brown, A.W., Leibson, C.L., Flaada, J.T., Mandrekar, J.N., Diehl, N.N., and Perkins, P.K. (2007). The Mayo classification system for traumatic brain injury severity. Journal of Neurotrauma, 24(9), 1,417-1,424.
B. Process and Outcome of TBI in the Very Long Term

Participation and Community Living
B1. Brown, A.W., Leibson, C.L., Malec, J.F., Perkins, P.K., Diehl, N.N., and Larson, D.R. (2004). Long-term survival after traumatic brain injury: A population-based analysis. NeuroRehabilitation, 19(1), 37-43.
  B2. Flaada, J.T., Leibson, C.L., Mandrekar, J.N., Diehl, N., Perkins, P.K., Brown, A.W., and Malec, J.F. (2007). Relative risk of mortality after traumatic brain injury: A population-based study of the role of age and injury severity. Journal of Neurotrauma, 24(3), 435-455.
C. The Feasibility and Efficacy of Telehealth-Based Cognitive Rehabilitation

Health and Function Technology
C1. Bergquist, T.F., Gehl, C., Lepore, S., Holzworth, N., and Beaulieu, W. (2008). Internet-based cognitive rehabilitation in individuals with acquired brain injury: A pilot feasibility study. Brain Injury, 22(11), 891-897.
D. Minnesota Advocacy Project

Participation and Community Living
D1. Malec, J.F. (2008). Minnesota advocacy project curriculum. Unpublished curriculum materials, Rehabilitation Hospital of Indiana, Indianapolis.
  D2. Malec, J.F., Brown, A.W., and Moessner, A.M. (2010). Two new measures for assessing advocacy activities and perceived control after acquired brain injury. Disability and Rehabilitation, 32(1), 33-40.

*This column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: Two journal articles were produced under the first project, Factors and Effects on Outcome of Clinical Decision Making in Selecting Rehabilitation Pathways After Traumatic Brain Injury. Malec et al. (A1) analyzed the association of demographic factors, posttraumatic amnesia, and ability limitations with clinical decisions for next level of care following moderate to severe TBI. Participants included 159 individuals suffering from posttraumatic amnesia who were also rated for ability limitations. The authors discovered that posttraumatic amnesia and certain ability limitations were associated with the decision to admit versus discharge a patient in 93 percent of cases. Age was found to be the only

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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demographic factor associated with the decision. A more standardized measure of ability limitations was developed, which the authors believe should lead to more consistency in rehabilitation decision making for patients with TBI. The second journal article (A2) reviewed discusses a test of the Mayo Classification System for Traumatic Brain Injury Severity. The Mayo system can classify TBI from consideration of a number of factors and unlike other systems is not dependent on a single factor. Malec et al. classified a sample of 1,501 individuals with history of TBI, concluding that the Mayo classification system is accurate and superior to other, single-indicator systems and can be used both in retrospective research and for planning care.

Under the project analyzing the process and outcome of TBI in the very long term, another two journal articles were produced. The first article (B1) describes a population-based retrospective cohort study of 1,448 Olmsted County, Minnesota, residents who developed TBI from 1935 to 2000. Analysis of the case fatality rates showed (1) mild TBI to be associated with a small but significant reduction in long-term survival compared with the general population, (2) moderate to severe TBI to be associated with a very high fatality rate, but (3) 6-month survivors of moderate to severe TBI to be associated with long-term survival rates similar to those of patients with mild TBI. Brown et al. believe the similarity in long-term survival rates between patients with mild TBI and 6-month survivors of moderate to severe TBI is a new finding that could lead to new community services for TBI survivors. The second article (B2) describes a study on whether observed versus expected mortality of individuals with TBI differs by age. From residents of Olmsted County, Minnesota, with any diagnosis suggestive of TBI between 1985 and 1999, Flaada et al. randomly sampled 7,800 and reviewed records to confirm the event. Confirmed cases were divided into three age groups—pediatric (<16), adult (16-65), and elderly (>65)—and observed versus expected 6-month and 10-year mortality rates for each age group were compared. It was found that within 6 months, more individuals died from TBI than was expected for all age groups, with the elderly group showing the greatest difference and the pediatric group the smallest difference. After 10 years, observed mortality for the pediatric and elderly groups matched expected rates, but a larger percentage of the adult group had died than was expected. The authors believe these findings will help clinicians target and better care for the most vulnerable populations suffering from TBI based on age.

The next journal article (C1), from the project The Feasibility and Efficacy of Telehealth-Based Cognitive Rehabilitation, assessed whether individuals with brain injury including memory impairment could learn to use an Internet-based cognitive rehabilitation program. Ten participants were trained in using an instant messaging system and participated in weekly therapy sessions. Bergquist et al. report that only two participants missed

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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a few of the sessions, demonstrating that individuals with memory impairment can participate in telerehabilitation.

Two outputs were produced from the Minnesota Advocacy Project. The Minnesota Advocacy Project Curriculum (D1) serves to train individuals with TBI and their families/significant others in three contiguous Midwest states in effective self and system advocacy skills. The four sessions of the curriculum include presentations on advocacy, lessons in civics, presentations on community organizing, and a mock hearing during which participants can practice applying what they have learned. Creators hope the curriculum will lead to more independence for individuals with TBI. The second output, a journal article (D2), aimed to evaluate two questionnaires: the Advocacy Activities Scale (AAS) and the Perceived Control Scale for Brain Injury (PCS-BI). These questionnaires were mailed to individuals with acquired brain injury and the responses analyzed. Malec, Brown, and Moessner determined that both the AAS and the PSC-BI showed satisfactory internal consistency and concurrent validity with other measures and concluded that survey researchers should use both questionnaires where appropriate.

Grant Title: Spaulding/Partners Traumatic Brain Injury Model System at Harvard Medical School

Grant Award Number: H133A020513

Grantee: Spaulding Rehabilitation Hospital

Grant Mechanism: Traumatic Brain Injury Model System

Grant Start and End Dates: October 1, 2002, to September 30, 2008

Total Direct Cost: $1,410,621

Abstract: The Spaulding TBI Model System (TBIMS) provided a comprehensive spectrum of care for people with traumatic brain injury (TBI) through the collaborative efforts of three hospitals that are part of Partners Health Care System, Inc. and three organizations that operate a variety of postacute rehabilitation programs. Studies completed under the grant resulted in published articles on regional cerebral activation on functional magnetic resonance imaging (fMRI) as a predictor of outcome for a memory rehabilitation program following TBI, the ability of the size of cerebral structures associated with memory to predict the outcome among people with TBI who participate in a memory rehabilitation program, the effect of use of

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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strategies during memorization of words on brain activation on fMRI, the efficacy of a group memory rehabilitation program emphasizing semantic strategies, the test-retest reliability of the VIrtual Planning Test (VIP), families’/caregivers’ emotional status and support systems (lead center: Virginia), racial differences in employment outcomes after TBI (lead center: Virginia), and the risk of progressive cognitive deterioration in aged survivors of TBI (lead center: Texas). The Spaulding TBIMS enrolled an average of more than 50 subjects in the national database annually during the 5 years of the grant cycle from October 1, 2002, to September 30, 2007.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included 10 journal articles, one diagnostic instrument, one field-tested product, and one newsletter. The following table shows the six projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Regional Cerebral Activation on fMRI as a Predictor of Outcome Following TBI

Health and Function
A1. Strangman, G.E., O’Neil-Pirozzi, T.M., Goldstein, R., Kelkar, K., Katz, D.I., Burke, D., Rauch, S.L., Savage, C.R., and Glenn, M.B. (2008). Prediction of memory rehabilitation outcomes in traumatic brain injury by using functional magnetic resonance imaging. Archives of Physical Medicine and Rehabilitation, 89(5), 974-981.
  A2. Glenn, M.B. (2008). The TBI newscaster. In Spaulding Rehabilitation Hospital, TBI Newscaster: A publication of Spaulding/Partners Traumatic Brain Injury Model System at Harvard Medical School (winter edition). Boston, MA: Spaulding Rehabilitation Hospital TBI Model System.
B. Test-Retest Reliability of the VIrtual Planning Test (VIP): Subjects with Brain Injury

Health and Function
B1. O’Neil-Pirozzi, T.M., Goldstein, R., Strangman, G.E., Katz, D.I., and Glenn, M.B. (2010). Test-retest reliability of the virtual planning test in individuals with traumatic brain injury. Brain Injury, 24(3), 509-516.
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
C. Risk of Progressive Cognitive Deterioration in Aged Survivors of Moderate to Severe Brain Injury: A Collaborative National Database Project

Health and Function
C1. Marquez de la Plata, C.D., Hart, T., Hammond, F.M., Frol, A.B., Hudak, A., Harper, C.R., O’Neil-Pirozzi, T.M., Whyte, J., Carlile, M., and Diaz-Arrastia, R. (2008).
Impact of age on long-term recovery from traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89(5), 896-903.
D. Family Members’ and Survivors’ Emotional Well Being: A Collaborative Module Project

Health and Function
D1. Kreutzer, J.S., Rapport, L.J., Marwitz, J.H., Harrison-Felix, C., Hart, T., Glenn, M., and Hammond, F. (2009). Caregivers’ well-being after traumatic brain injury: A multicenter prospective investigation. Archives of Physical Medicine and Rehabilitation, 90(6), 939-946.
E. Efficacy of a Group Memory Intervention: A Pilot Study

Health and Function
E1. O’Neil-Pirozzi, T.M., Strangman, G.E., Goldstein, R., Katz, D.I., Savage, C.R., Kelkar, K., Supelana, C., Burke, D., Rauch, S.L., and Glenn, M.B. (2010). A controlled treatment study of internal memory strategies (I-MEMS) following traumatic brain injury. Journal of Head Trauma Rehabilitation, 25(1), 43-51.
F. TBI Model Systems National Database

Health and Function Employment Demographics
F1. Arango-Lasprilla, J.C., Ketchum, J.M., Williams, K., Kreutzer, J.S., Marquez de la Plata, C.D., O’Neil-Pirozzi, T.M., and Wehman, P. (2008). Racial differences in employment outcomes after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89(5), 988-995.

*This column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first two outputs reviewed were associated with the project on regional cerebral activation on fMRI as a predictor of outcome following TBI. Strangman et al. (A1) assessed whether fMRI can be used to predict rehabilitation outcomes for TBI patients. Participants included 54 individuals who had suffered from TBI for at least 1 year. While being scanned, participants performed a word memorization task. They then participated in a 6-week memory rehabilitation group program emphasizing semantic strategies. Imaging analysis connected fMRI results with gains in memory testing following the memory rehabilitation program. The authors believe further research will clarify the relationship and allow fMRI to be used as a predictor of outcomes. The second output reviewed was an annual newsletter of the Spaulding/Partners TBIMS (A2). This newsletter was developed in a format accessible to research scientists, clinicians, people with disabilities, and their families. Its intent was to provide a general audience with information about TBI and the center’s work. Study progress and findings to date were discussed.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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From the project aimed at assessing the test-retest reliability of the VIP for individuals with TBI, a journal article was produced. O’Neil-Pirozzi et al. (B1) administered the VIP to 75 individuals with TBI. Participants each took the VIP twice, with 6-8 weeks separating the tests. The study concluded that the VIP had moderate overall test-retest reliability for individuals with TBI, with some elements of the test showing high reliability but other elements low reliability. The authors state that the VIP is now the first such “ecologically valid” test with demonstrated test-retest reliability for persons with TBI.

Another journal article was produced under the project on progressive cognitive deterioration. The longitudinal cohort study (C1) addressed whether functional decline after TBI was more likely for older individuals. Participants included 428 individuals with TBI enrolled in the Traumatic Brain Injury Model Systems national data set. Participants were divided into three age groups—youngest (16-26 years), intermediate (27-39 years), and oldest (.40 years). Data from the first 5 years after the injury were examined for each age group. Marquez de la Plata et al. found that the greatest improvement over the first 5 years occurred in the youngest group and the greatest decline over the first 5 years in the oldest group. They believe these finding suggest changes in TBI treatment practice are warranted for older individuals with TBI.

From the project on emotional well being of survivors and family members, a journal article (D1) assessing the emotional distress and life satisfaction of caregivers was produced. Participants included 273 caregivers who took the Brief Symptom Inventory-18, an 18-item self-report instrument designed to quantify psychologic distress. Kreutzer et al. discovered that 1 in 5 caregivers showed significant depression, anxiety, and/or somatic symptoms. Higher distress was associated with caring for individuals with worse functional status, individuals needing more supervision, individuals who were less satisfied with life, and those who used alcohol in excess. The authors believe these findings reinforce the need to support caregivers as well as patients.

Within the project on the efficacy of a pilot study on group memory intervention, O’Neil-Pirozzi et al. (E1) described the effects of a memory group intervention on persons with TBI. Participants included 94 adults with TBI and resulting memory impairment at least 1 year postinjury at the time of study. The authors found that participation in the intervention did improve memory for those with mild, moderate, and severe TBI compared with controls (although there was less improvement in cases of severe TBI), and the improvement was maintained 1 month after the intervention. They believe further research can build on this finding to increase use of such a memory group intervention.

The final article relates to the project on contribution to the Traumatic

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Brain Injury Model Systems National Database. Arango-Lasprilla et al. (F1) performed a retrospective study examining racial differences in the employment and occupation of individuals with TBI 1 year after injury. Data for this study were taken from the Traumatic Brain Injury Model Systems National Database on 3,486 white and 1,791 minority individuals hospitalized with TBI between 1989 and 2005. It was concluded that whites were 2.17 times more likely to be employed 1 year after TBI than minority individuals, although race did not have an impact on occupation. The authors believe this finding suggests more assistance should be given to minorities seeking work after TBI.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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SPINAL CORD INJURY MODEL SYSTEM (SCIMS)

Grant Title: Northern New Jersey Spinal Cord Injury System

Grant Award Number: H133N000022

Grantee: KMRREC (now Kessler Foundation)

Grant Mechanism: Spinal Cord Injury Model System

Grant Start and End Date: September 1, 2000, to August 31, 2007

Total Direct Cost: $1,361,714

Abstract: The Northern New Jersey Spinal Cord Injury System (NNJSCIS) was established as a Spinal Cord Injury Model System in 1990 by NIDRR and serves the Northern New Jersey catchment area, a 13-county, ethnically diverse region of 10.2 million persons. It is a cooperative effort of the Kessler Medical Rehabilitation Research and Education Center (KMRREC), the University of Medicine and Dentistry of New Jersey University Hospital, and the Kessler Institute for Rehabilitation (KIR). For the original funding cycle, the NNJSCIS model system focused on six research projects and one demonstration project. The subsequent funding cycle focused on dissemination efforts, validation of the consumer index of accessibility demonstration project, and continued recruitment and data collection for the database.

The six research projects addressed one of the most common medical problems faced by persons with spinal cord injury (SCI) (urinary tract infections), common health issues among individuals with SCI (obesity and upper-limb overuse), and promotion of health and wellness in individuals with SCI (health literacy and the identification of health and psychosocial risk factors). The researchers developed an instrument for assessing outcomes and care specified by the Consortium for Spinal Cord Medicine’s clinical practice guidelines (which was used to collect data and determine the validity of these guidelines). The consumer accessibility demonstration project tested the feasibility of an innovative methodology for expanding community access for individuals with SCI.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included 14 journal articles, one book

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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chapter, two interventional protocols, and one newsletter. The following table shows the five projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Health Promotion and Disease Prevention among Individuals with SCI

Health and Function
A1. Diab, M.E., and Johnston, M.V. (2004). Relationships between level of disability and receipt of preventative health services. Archives of Physical Medicine and Rehabilitation, 85(5), 747-757.
  A2. Johnston, M.V., Diab, M.E., Chu, B.C., and Kirshblum, S. (2005). Preventative services and health behaviors among people with spinal cord injury. Journal of Spinal Cord Medicine, 28(1), 43-54.
B. Health Literacy: Its Relationship to Educational Materials and to Health-Related Outcomes among Individuals with SCI Living in the Community

Health and Function
B1. Johnston, M.V., Diab, M.E., Kim, S.-S., and Kirshblum, S. (2005). Health literacy, morbidity, and quality of life among individuals with spinal cord injury. Journal of Spinal Cord Medicine, 28(3), 230-240.
C. Empiric Antibiotic Treatment for Urinary Tract Infections in Persons with SCI

Health and Function
C1. Linsenmeyer, T.A., and Oakley, A. (2003). Accuracy of individuals with spinal cord injury at predicting urinary tract infections based on their symptoms. Journal of Spinal Cord Medicine, 26(4), 352-357.
  C2. Lisenmeyer, T.A., Bodner, D.R., Creasey, G.H., Green, B.G., Groah, S.L., Joseph, A., Lloyd, L.K., Perkash, I., and Wheeler, J.S. (2006). Bladder management for adults with spinal cord injury: A clinical practice guideline for health-care providers. Journal of Spinal Cord Medicine, 29(5), 527-573.
D. Changes in Shoulder Pain Intensity During Upper Extremity Exercise in Individuals with Spinal Cord Injury

Health and Function
D1. Dyson-Hudson, T.A., Sisto, S.A., Bond, Q., Emmons, R., and Kirshblum, S.C. (2007). Arm crank ergometry and shoulder pain in persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 88(12), 1,727-1,729.
  D2. Dyson-Hudson, T.A., and Kirshblum, S.C. (2004). Shoulder pain chronic spinal cord injury, Part I:
Epidemiology, etiology, and pathomechanics. Journal of Spinal Cord Medicine, 27(1), 4-17.
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
E. Studies Based on Data Submitted to National SCI Statistical Center Database

Health and Function
E1. Kirshblum, S., Millis, S., McKinley, W., and Tulsky, D. (2004). Late neurologic recovery after traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 85(11), 1,811-1,817.
  E2. Cardenas, D.D., Hoffman, J.M., Kirshblum, S., and McKinley, W. (2004). Etiology and incidence of rehospitalization after traumatic spinal cord injury: A multicenter analysis. Archives Physical Medicine and Rehabilitation, 85(11), 1,757-1,763.

*This column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: All outputs from this grant reviewed by the NRC committee were publications. The first two journal articles, produced under the health promotion and disease prevention project, analyze the receipt of preventative services among people with SCI. Both analyze survey items from the Behavioral Risk Factor Surveillance System (BRFSS) (1998 and 2000). Diab and Johnston (A1) examined the relationships between level of disability and receipt of certain preventative services. The severity of disabilities was found to be related to the receipt of certain preventative services but not necessarily in a simple or unidirectional way. Regardless of disability, receipt of a checkup was an important determinant of receipt of preventative health services. The Johnston et al. article (A2) documents receipt of understudied preventative services and health behaviors in SCI patients compared with the general population. Surprisingly, although deficiencies in the provision of preventative services were found, they were similar to those in the general population. However, these deficiencies could be particularly problematic in SCI patients given the narrower margin of health. It is therefore recommended that preventative care needs and safety factors be routinely assessed and provided for people with SCI.

The third output reviewed, under the health literacy project, was a journal article (B1) aimed at describing levels of health literacy in SCI patients and to investigate the possible associations with morbidity, health-related quality of life, functional independence, community participation, and life satisfaction. A total of 107 community-living people with SCI were recruited from a private New Jersey outpatient SCI center and surveyed using measures from the Test of Functional Health Literacy in Adults (TOFHLA), standard questions about morbidity from the BRFSS, the Craig Handicap Assessment and Reporting Technique (CHART), the Short Form-12, and the Diener’s Satisfaction with Life Scale. In this study, only 14 percent of people with SCI were found to have limited health literacy. Health literacy was found to be independently related to physical health morbidity, but as

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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sociations with other outcomes were limited, intertwined with education, and affected by severity of injury.

The outputs produced under the third project (Empiric Antibiotic Treatment for Urinary Tract Infections in Persons with SCI) address one of the most common medical problems faced by persons with SCI, urinary tract infection (UTI). Linsenmeyer and Oakley (C1) describe a study aimed at evaluating the accuracy of people with SCI in determining whether they had a UTI based on signs and symptoms. The authors undertook a 9-month prospective case review of 147 persons with SCI who presented to an outpatient urology clinic with symptoms they attributed to a UTI. They found that 39 percent of SCI patients were not accurate in predicting a UTI based on signs and symptoms. This finding supports the importance of performing a urinalysis before prescribing antibiotics for UTI treatment, in addition to having high suspicion of other medical conditions. The other output from this project was a set of published guidelines (C2) for health providers on bladder management for adults with SCI. These guidelines were developed by the Consortium of Spinal Cord Medicine, led by a steering committee made up of one representative with clinical practice guideline experience from each of the consortium’s 17 member organizations.

The next two outputs were journal articles from the project focused on analyzing shoulder pain in persons with SCI. Dyson-Hudson et al. (D1) examined whether a primary fitness program for people with SCI, which used arm cycle ergometry, resulted in increased shoulder pain. A comparison of 23 persons with chronic SCI participating in a weight loss program of diet alone versus diet plus arm crank ergometry found that shoulder pain did not increase in SCI subjects who used wheelchairs and performed moderate-intensity arm crank ergometry. Dyson-Hudson and Kirshblum (D2) reviewed the epidemiology, etiology, and pathomechanics of shoulder pain in persons with SCI in order to aid in the evaluation, treatment, and prevention of this disorder.

The final two outputs reviewed were journal articles produced as part of the project to conduct studies based on the National SCI Statistical Center Database. The first article (E1) presents and analyzes Spinal Cord Injury Model System (SCIMS) data on late neurologic recovery after 1 year post-SCI. Analysis of data on 987 patients with traumatic SCI admitted to an SCIMS center between 1988 and 1997 with 1- and 5-year follow up found a small degree of recovery after traumatic SCI. In addition, late conversion from complete to incomplete recovery occurred in 5.6 percent of cases. This knowledge may be useful for future surgical and pharmacological intervention studies aimed at enhancing recovery. Cardenas et al. (E2) performed an analysis of cross-sectional data to determine the frequency of and reasons for rehospitalization in person with acute SCI during follow-up years. They also examined the association between rehospitalization and demographics,

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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injury severity, payer sources, length of stay, functional status at discharge, and discharge residence. The authors believe this information is important for the development of preventive strategies and management for persons with SCI to reduce rehospitalizations.

Grant Title: The Missouri Model Spinal Cord Injury System

Grant Award Number: H133N000012

Grantee: University of Missouri

Grant Mechanism: Spinal Cord Injury Model System

Grant Start and End Date: October 1, 2000, to September 30, 2007

Total Direct Cost: $1,504,487

Abstract: The primary Missouri Model Spinal Cord Injury System (MOMSCIS) research study focused on the effect of a consumer-directed personal assistance services training intervention on consumer satisfaction, independent living, and community integration. The MOMSCIS study involved developing, implementing, and evaluating the in-person Individualized Management of Personal Assistant/Consumer Teams (IMPACT) workshop. The IMPACT workshop participants received information on preventing and treating secondary medical conditions; topics included pressure sores, urinary tract infections, bowel and bladder management, autonomic dysreflexia, pain management, chronic fatigue, and thermoregulation. The participants also received information on relationship issues, such as hiring and managing of personal assistants, communication styles and strategies, assertiveness, and team building. The objectives of the study were (1) to determine the effect of the IMPACT workshop on consumer satisfaction, the incidence of secondary conditions, activity, and participation; (2) to determine the effect of the IMPACT workshop on personal assistants’ job satisfaction, job stress, and attrition; and (3) to provide online resources to the disability community, including an online personal assistant training manual for consumers and assistants and an online resources database. A total of 99 consumers and 98 assistants participated in this study. Activity and participation were measured by the Participation Survey for Persons with Mobility Limitations (PARTS/M). To leverage NIDRR’s previous investment in developing the PARTS/M, the study included collaboration with Washington University and the University of Pittsburgh to combine data with which to validate the PARTS/M among a large sample of persons

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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with spinal cord injury (SCI). These data will provide valuable information for future studies seeking to document changes in personal independence and community integration.

In a secondary research project, surveys were sent to 16 Spinal Cord Injury Model System centers to assess which centers screen for total testosterone level among men with SCI during rehabilitation admission. A study was also conducted to document the prevalence of low testosterone among men with SCI. The study, which included 100 men with SCI, found that the prevalence of low testosterone was high. Specifically, 75 percent of participants had low testosterone levels (under 300 ng/dl). In addition, testosterone level was significantly associated with age and years since injury and with medical variables, including AST, ALT, hemoglobin, hematocrit, and albumin level.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included nine journal articles. The following table shows the main project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Individualized Management of Personal Assistant/Consumer Teams (IMPACT)

Health and Function
A1. Schopp, L.H., Clark, M.J., Hagglund, K.J., Sherman, A.K., Stout, B.J., Gray, D.B., and Boninger, M.L. (2007). Life activities among individuals with spinal cord injury living in the community: Perceived choice and perceived barriers. Rehabilitation Psychology, 52, 82-88.
  A2. Clark, M.J., Hagglund, K.J., and Sherman, K.J. (2008). A longitudinal comparison of consumer-directed and agency-directed personal assistance service programmes among persons with physical disabilities. Disability and Rehabilitation, 30(9), 689-695.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first output reviewed was a journal article by Schopp et al. (A1) exploring perceived choice over life activities and perceived barriers to engaging in life activities by persons with SCI. The authors state that this is the first study to use the International Classification of Functioning, Disability and Health (ICF) model developed by the World Health Organization with a community-based, multisite sample of community-dwelling persons with SCI. A total of 255 participants from

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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two urban sites and one rural site were surveyed or interviewed using items from PARTS/M. In addition, an inferential approach was used to examine relationships among personal assistance services and perceived choice in, satisfaction with, and barriers to employment. Approximately half of the participants reported little or no perceived choice with employment, and the majority reported low satisfaction with choice with employment. High percentages of participants had experienced physical accessibility and transportation barriers to accessing employment. Physical impairment, pain, and fatigue were also barriers. The article therefore suggests improvements in workplace and transportation accessibility, increased vocational supports, and interventions to decrease pain and fatigue to engage persons with SCI in life activities such as employment.

The Clark et al. (A2) article describes a longitudinal comparison of outcomes for persons who were enrolled in agency-directed personal assistance services (PAS) programs and changed to consumer-directed PAS programs. In-home interviews of a convenience sample of 26 participants revealed more satisfaction and fewer unmet needs after receiving consumer-directed PAS rather than agency-directed PAS. This finding suggests that consumerdirected PAS enhances outcomes for many persons with disabilities.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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REHABILITATION RESEARCH AND TRAINING CENTER (RRTC)

Grant Title: Meeting the Nation’s Needs for Personal Assistance Services: Center for Personal Assistance Services

Grant Award Number: H133B031102

Grantee: University of California, San Francisco

Grant Mechanism: Rehabilitation Research and Training Center

Grant Start and End Dates: July 1, 2003, to June 30, 2009

Total Direct Cost: $3,913,045

Abstract: The University of California, San Francisco (UCSF) proposed establishing a Rehabilitation Research and Training Center (RRTC) for personal assistance services (PAS). UCSF conducted four large research projects. The first project addressed the relationship between formal and informal PAS and caregiving support and the role of assistive technology (AT) in complementing PAS. The second project dealt with home and community PAS, including state and federal policies and programs, impediments to and new models for eliminating barriers to formal and informal PAS, and best practice models in states and in the home and community. The third project studied the PAS workforce and workforce development that reflects geographic diversity and addresses PAS workforce recruitment, retention, compensation, and benefits; professional training, development, and networking for PAS providers; and crossover issues between disability and aging providers. The fourth project focused on workplace PAS and models for eliminating barriers to formal and informal PAS and AT in the workplace and best practice models in the workplace. In addition, UCSF provided training, dissemination, and technical assistance relative to PAS.

The UCSF faculty are among the nation’s leading researchers in disability and PAS, with more than 15 years of research and policy experience, numerous academic publications, a previous track record of NIDRR funding for a national center for disability statistics, and teaching experience in disabilities studies. The RRTC collaborated with faculty members at the University of Maryland, the University of Michigan, and West Virginia University, as well as with the Topeka Independent Living Resource Center, InfoUse, and the Institute for the Future of Aging Services. A Blue Ribbon Advisory Committee of PAS users, disability advocates, business leaders,

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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independent living center leaders, and academics provided guidance to the project.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included 28 journal articles, three websites, and one fact sheet. The following table shows the four projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Conduct Research on Formal and Informal PAS and Caregiving Support and the Role of Assistive Technology and Evaluate Models to Eliminate Barriers

Health and Function Demographics
A1. LaPlante, M.P., Kaye, H.S., and Harrington, C. (2007). Estimating the expense of a mandatory home and community-based personal assistance services benefit under Medicaid. Journal of Aging and Social Policy, 19(3), 47-64.
  A2. Harrington, C. (2004-2011). PAS Center for Personal Assistance Services. Available: http://www.pascenter.org [January 9, 2012].
B. Identify, Develop, Evaluate, and Disseminate PAS in Home- and Community-Based Settings

Health and Function Participation and Community Living
B1. Kitchener, M., Ng, T., Miller, N., and Harrington, C. (2005). Medicaid home- and community-based services: National program trends. Health Affairs, 24(1), 206-212.
  B2. Kaye, H.S., Laplante, M.P., and Harrington, C. (2009). Do noninstitutional long-term care services reduce Medicaid spending? Health Affairs, 28(1), 262-272.
C. Conduct Research on the PAS Workforce and Workforce Development

Employment Participation and Community Living
C1. Kaye, H.S., Chapman, S., Newcomer, R.J., and Harrington, C. (2006). The personal assistance workforce: Trends in supply and demand. Health Affairs, 25(4), 1,113-1,120.
  C2. Center for Personal Assistance Services and PHI. (2008, July). State chart book on wages for personal and home care aides, 1999-2006. Available: http://www.pascenter.org/publications/publication_home.php?id=857&focus=PAS%20Center%20Publications [January 9, 2012].
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
D. Identify, Develop, Evaluate, and Disseminate Best Practices for PAS in the Workplace to Facilitate Employment for Individuals with Disabilities

Employment
D1. Stoddard, S., and Kraus, L. (2006). Arranging for personal assistance services and assistive technology at work: A report of the rehabilitation research and training center on personal assistance services. Disability and Rehabilitation: Assistive Technology, 1(1-2), 89-95.
  D2. Orselene, L., Batiste, L.C., Fullmer, C., Gamble, M., and Stoddard, S. (2010). JAN personal assistance services in the workplace. Morgantown, WV: U.S. Department of Labor. Available: http://www.jan.wvu.edu/media/pas.html [January 9, 2012].

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first two outputs were produced under the project focused on PAS support and technological support. LaPlante et al. (A1) provide an estimate of the cost of a mandatory PAS benefit under Medicaid for persons with low incomes, low assets, and significant disability. According to the article, the resulting estimate is one-tenth that of the Congressional Budget Office (CBO) because CBO did not restrict its estimate to persons with the required institutional level of need. The authors conclude that creation of a mandatory PAS benefit is a fiscally achievable policy strategy. The other output reviewed for this project was the website for the PAS Center (A2), specifically the pages on disability statistics and Medicaid homeand community-based services (HCBS) waiver information. This website has hosted the only historical database on waiver programs (1992-2007) and personal care and home health services (1999-2007) that includes types and numbers of participants, service expenditures, and total expenditures. This waiver information has been used by the Centers for Medicare & Medicaid Services (CMS), MedStat, AARP, the National Council of State Legislators, the Government Accountability Office (GAO), and other national and federal organizations to help describe the breadth and depth of Medicaid HCBS programs more fully.

The next two outputs were journal articles from the project aimed at identifying, developing, evaluating, and disseminating PAS in home and community-based settings. Kitchener et al. (B1) conducted a descriptive analysis of the latest national program trends in Medicaid HCBS and reported on a national survey of cost control policies used in waiver programs in 2002. The analysis revealed new information on the growth of Medicaid HCBS over 1992-2001. Waivers represented the majority of total HCBS spending. Wide variations in HCBS spending and access to services were found across states, with most states using cost controls and having limited numbers of waiver slots. The study revealed trends across states showing

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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growth in access to services but still suggested that there was a large unmet need among those wait-listed for services. Published in Health Affairs, this article was intended to publicize this information beyond the long-term care audience to reach an audience of health policy makers and state officials. Kaye et al. (B2) analyzed whether noninstitutional long-term care services reduce Medicaid spending in the long term. Analysis of state spending from 1995 to 2005 showed that for two distinct population groups receiving long-term care services, growth in spending was greater for states offering limited noninstitutional services than for those with large, well-established noninstitutional programs. The authors therefore concluded that although expansion of HCBS causes a short-term increase in spending, that increase is followed by a reduction in institutional spending and long-term costs.

Under the PAS workforce and workforce development project, the two outputs reviewed were a journal article and a chart book. Kaye et al. (C1) used data from two federal U.S. population surveys to assess the size of the workforce providing paid PAS and the relative growth of that workforce compared with the population needing such services. They found that the workforce providing noninstitutional personal assistance and home health services tripled between 1989 and 2004, growing at a much faster rate than the population needing such services. Medicaid spending for such services increased dramatically, but both workforce size and spending for similar services in institutional settings remained relatively stable. The article also confirms earlier findings of low wage levels and contributes an additional comparison of wage growth compared with that for other occupations. These low wage levels, scarce health benefits, and high job turnover rates highlight the need for attention to policy to ensure a stable and well-trained PAS workforce to meet the growing demand. Also produced under this project, a State Chart Book on Wages for Personal and Home Care Aides (C2) provides information on the wages received by personal and home care aides in all 50 states and the nation over a 7-year period.

The final two outputs reviewed were a journal article and a resource document produced as part of the project to identify, develop, evaluate, and disseminate best practices for PAS in the workplace to facilitate employment for individuals with disabilities. Stoddard and Kraus (D1) conducted structured telephone interviews with 20 workplace PAS users, 21 employers familiar with workplace PAS, and 19 employment organizations to learn about how workplace PAS and AT were arranged for in the workplace and what issues arose. Organizations were found to construct approaches that fit their needs, abilities, and constraints. The interview respondents identified a number of practices that are succeeding, including establishing policies arranging for PAS, centralizing accommodation budgets to remove work unit disincentives, and providing a shared personal assistant for interpreting or for task-related and personal care activities. The final output reviewed

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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was a document on PAS in the workplace (D2) (available online), produced to provide resources and information for Job Accommodation Network (JAN) users. JAN is a service of the Office of Disability Employment Policy, U.S. Department of Labor, whose users include employers, employees with disabilities, people with disabilities attempting to secure PAS, and others.

Grant Title: RRTC on Disability Demographics and Statistics

Grant Award Number: H133B031111

Grantee: Cornell University

Grant Mechanism: Rehabilitation Research and Training Center

Grant Start and End Dates: December 1, 2003, to November 30, 2009

Total Direct Cost: $3,607,885

Abstract: The Cornell Rehabilitation Research and Training Center (RRTC) on Disability Demographics and Statistics sought to bridge the divide between the sources of disability data and the users of disability statistics. Research explored (1) the reliability of existing data sources and collection methods and (2) the potential to improve current and future data collection efforts. A set of related applied activities also was conducted, including (1) utilizing existing data sources to provide a comprehensive and reliable set of disability statistics, (2) increasing access to and understanding of the effective use of these statistics to support decision making, and (3) working with key organizations to determine their needs and help them maximize the use of disability statistics in their ongoing efforts to improve the lives of people with disabilities and their families. The deliverables, resources, and services developed under this grant provided (1) tests of key hypotheses regarding the demographics of disability; (2) a best practices guide for surveying people with disabilities; (3) a set of users’ guides to existing data sources; (4) options for improvement in the national disability data system, an extensive but highly fragmented effort of the federal government to collect disability data and produce disability statistics; (5) a comprehensive set of disability statistics; (6) annual Disability Report Cards (also called annual Disability Status Reports); (7) comprehensive disability and demographic statistics (see http://www.disabilitystatistics.org [January 9, 2012]); (8) online user-directed Disability Statistics Templates; (9) a Disability Statistics Syllabus, reflecting an extensive training curriculum; (10) an On-Call Technical Assistance Service and a targeted On-Call Disability Statistics Estimation Service; (11) a set of trainings targeting key audiences; and (12)

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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a state-of-the-science conference and an edited volume on the current status of the national disability data system, recent advances, and high-priority options for improvement.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included three journal articles, two reports, one book, four annual Disability Status Reports, one users’ guide series, and two websites. The following table shows the five projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Analysis of Existing Data

Demographics
A1. Cornell University. (2010). Users’ guide series. Available: http://www.ilr.cornell.edu/edi/disabilitystatistics/sources-userGuides.cfm [January 9, 2012].
  A2. Stapleton, D., Honeycutt, T., and Schechter, B. (2010). Closures are the tip of the iceberg: Exploring the variation in state vocational rehabilitation program exits after service receipt. Journal of Vocational Rehabilitation, 32(1), 61-76.
B. Data Collection Methods

Demographics
B1. Weathers, R.R. II (2009). Chapter 2: The disability data landscape. In A.J. Houtenville, D.C. Stapleton, R.R. Weathers II, and R.V. Burkhauser (Eds.), Counting working-age people with disabilities: What current data tell us and options for improvement (pp. 27-68). Kalamazoo, MI: W. E. Upjohn Institute for Employment Research.
  Stapleton, D.C., Wittenburg, D.C., and Thornton, C. (2009). Chapter 9: Program participants. In. A.J. Houtenville, D.C. Stapleton, R.R. Weathers II, and R.V. Burkhauser (Eds.), Counting working-age people with disabilities: What current data tell us and options for improvement (pp. 299-352). Kalamazoo, MI: W. E. Upjohn Institute for Employment Research.
  B2. Stapleton, D.C., Livermore, G.A., and She, P. (2009). Chapter 11: Options for improving disability data collection. In. A.J. Houtenville, D.C. Stapleton, R.R. Weathers II, and R.V. Burkhauser (Eds.), Counting working-age people with disabilities: What current data tell us and options for improvement (pp. 381-418). Kalamazoo, MI: W. E. Upjohn Institute for Employment Research.
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
C. ICF

Demographics
C1. Bruyère, S.M., Van Looy, S., and Peterson, D. (2005). The International Classification of Functioning, Disability, and Health (ICF): Contemporary literature overview. Rehabilitation Psychology, 50(2), 113-121.
  C2. Bruyère, S.M. (2005). Using the International Classification of Functioning, Disability, and Health (ICF) to promote employment and community integration in rehabilitation. Rehabilitation Education, 19(2-3), 105-117.
D. Resource Center

Demographics
D1. Erickson, W., Lee, C., and von Schrader, S. (2009). 2008 disability status reports: The United States. Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability and Demographics and Statistics.
  D2. Cornell University. (2010). Disability statistics: Online resource for U.S. disability statistics. Available: www.disabilitystatistics.org [January 9, 2012].
E. Technical Assistance and Training

Demographics
E1. Cornell University and InfoUse. (no date). Local disability data for planners: A planning resource for county and state data. Ithaca, NY: Cornell University Employment and Disability Institute Available: http://www.disabilityplanningdata.com [January 9, 2012].
  E2. Bruyère, S.M., Houtenville, A., Ruiz-Quintanilla, S., and Weathers, R.R. II (2006). National disability statistics for research practice and consultation (master training module on disability statistics). Curriculum presented at the Cornell Summer Institute on Disability and Employment Policy, Ithaca, NY.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first two outputs reviewed stemmed from the project on analysis of existing data. The disability statistics users’ guide series (A1), a set of nine documents focused on nationally representative survey or administrative data sources such as the American Community Survey (ACS), Current Population Survey, and Panel Study of Income Dynamics, allows researchers, analysts, and other users of disability statistics to access complex data in an effective and efficient manner. The content of each guide was developed by subject experts and includes background, methodology, and definitions, as well as strengths, limitations, and implications of the data. Each guide also provides extensive documentation of the original data sources. The creators believe that such a usable and thorough resource on disability statistics did not previously exist. The second output reviewed was a journal article (A2) resulting from a study on the receipt of vocational

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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rehabilitation services by individuals with disabilities by demographics, education, and disability type (mental, physical, or sensory) and across states. The study combined data on vocational rehabilitation services from the Rehabilitation Services Administration-911 public use file for fiscal year 2007 with data on people with disabilities by state and demographic group from the 2007 ACS Public Use Microdata Sample. Stapleton, Honeycutt, and Schechter discovered that a national average of 1.3 out of every 100 working-age adults with a disability receive vocational rehabilitation services, with significant variation by state, demographics, and disability type. They concluded that the differences suggest that vocational rehabilitation services benefit some groups in certain areas of the country more than others.

The outputs produced under the project focused on data collection methods were book chapters. The first output was Chapters 2 and 9 (B1) from the book Counting Working-Age People with Disabilities: What Current Data Tell Us and Options for Improvement. The book describes the kinds of valuable information current statistics and data on working-age people with disabilities can provide; these are areas in which current statistics and data are lacking, and ways in which statistics and data can be improved. Chapter 2 provides a foundation for the book, including definitions of disability, descriptions of major national surveys, and comparisons of prevalence estimates from these data sources. Chapter 9 describes the available data and statistics on working-age people with disabilities who participate in major federal programs. The authors summarize, compare, and integrate data on participation from major federal surveys, administrative data and statistics from federal agencies, and state-level participation statistics from employment service programs. The second output was Chapter 11 (B2) from Counting Working-Age People with Disabilities: What Current Data Tell Us and Options for Improvement. In Chapter 11, Stapleton, Livermore, and She present major limitations of the current national disability data and statistics system based on the information contained in the book and additional interviews with producers and consumers of disability statistics. The authors then present and discuss relatively inexpensive options for improving the system, as well as recommendations for expanding the system.

Two journal articles were reviewed from the project on the International Classification of Functioning, Disability and Health (ICF). The first article (C1) reviews the literature on the ICF produced in the 3 years following its endorsement by the World Health Organization. The review includes literature from the fields of rehabilitation, psychology, and health and human services. Bruyère, Van Looy, and Peterson conclude that the ICF is being applied in many governmental, health care, and rehabilitation clinical and research settings in the United States and abroad, although ongoing work is needed to further implement and support the ICF. The second article (C2)

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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reviews selected rehabilitation literature on applications of the ICF to medical rehabilitation, employment, and community participation for persons with disabilities. It first describes the ICF and the need for a common classification system to inform data gathering and policy. The article then seeks to demonstrate the ICF’s potential as a common system through a review of the literature describing its relevance and application to rehabilitation and health care delivery practice. The article goes on to state that the ICF could also potentially improve rehabilitation counseling practice in the areas of employment and environmental factors. Bruyère suggests next steps for implementing the ICF and integrating it into rehabilitation service delivery, counselor education, and research.

The next two outputs were developed as part of the grant’s Resource Center. The 2008 Disability Status Reports (D1) consist of 53 individual reports produced annually, including a national-level report and reports on each state, Washington, DC, and Puerto Rico. The reports are based on analysis of the U.S. Census Bureau’s ACS Public Use Microdata Sample. They provide a summary of the previous year’s statistics on noninstitutionalized people with disabilities and are written such that anyone can understand and use the statistics. They contain information on disability prevalence based on population size, employment, earnings, and household income across demographic subpopulations. The disabilitystatistics.org website (D2) is a single, user-friendly, accessible resource for disability statistics from the three major national representative surveys that include disability measures: the ACS Public Use Microdata Sample, the Census Bureau’s decennial Census 2000 detailed disability data tables, and the Current Population Survey. Data are available at the national, state, county, congressional district, or metropolitan area level, as well as for American Indian/Alaska Native/Hawaiian home areas. The site provides statistics on disability prevalence, employment, income, and poverty status by disability type and by demographic characteristics. It also includes an interactive search tool, and technical assistance is available to users experiencing problems.

The final two outputs were produced under the project aimed at technical assistance and training. The disabilityplanningdata.com website (E1) serves as a community planning tool, providing information on the disability population to aid urban, community, and service planners in making decisions that will affect or determine community access for people with disabilities. The website provides housing tables and population tables at the county level. The information in the tables consists of combined data from several years of the ACS. The website also includes a Data Guide that describes the ACS and other significant national surveys and provides links to further information on the surveys. Planners have generally used information such as age, gender, and race or ethnicity in planning, and this website allows them to also use information on disability. A master training

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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module (E2) is aimed at training researchers and students to (1) understand available, existing data on people with disabilities; (2) understand, access, and utilize existing descriptive statistics; (3) identify instances in which descriptive statistics on disability can and should be meaningfully used; and (4) discuss and apply disability statistics using a personally relevant case study. The first section of the module provides a definition of disability and a description of how surveys identify disability. The second section includes an overview of the four major national survey disability data sources. The final section provides cases studies and examples in which trainees can apply the information from the first two sections. The module was created to improve the use of data and statistics in research and practice.

Grant Title: RRTC on SCI: Promoting Health and Preventing Complications Through Exercise

Grant Award Number: H133B031114

Grantee: National Rehabilitation Hospital/Medstar Research Institute

Grant Mechanism: Rehabilitation Research and Training Center

Grant Start and End Dates: December 1, 2003, to November 30, 2009

Total Direct Cost: $3,607,885

Abstract: Persons with spinal cord injury (SCI) have long been ranked at the lowest end of the physical activity spectrum. Studies published over the past decades have addressed the need for persons with SCI to adopt habitual exercise as part of a healthy lifestyle. Benefits of exercise for people with SCI mirror positive multisystem health benefits documented for those without paralysis. However, despite ample documentation of these benefits, no current exercise guidelines for people with SCI exist. NIDRR’s Long-Range Plan Priorities 1 and 2 and the National Institutes of Health’s (NIH’s) National Center for Medical Rehabilitation Research (NCMRR) Research Priorities focus specifically on the development of clinical guidelines for identifying individuals at risk for secondary conditions and involving consumers in exercise regimens to prevent secondary conditions.

In response to these priorities, this Rehabilitation Research and Training Center (RRTC) systematically and comprehensively addressed the role and impact of physical activity in the prevention of secondary conditions in people with SCI. The RRTC was a collaborative effort of clinical and disability researchers, SCI consumer organizations, and independent living

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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advocates. Consumers were involved in the planning, implementation, analysis, and dissemination of all research and training activities. Critical physiological responses to exercise in SCI were established, and risk for cardiovascular disease in individuals with SCI was examined comprehensively, applying accepted guidelines used in the able-bodied population. Exercise formats specifically designed according to severity and chronicity of SCI were developed to address the prevention of and knowledge regarding osteoporosis and other secondary conditions. It was determined whether regular exercise is related to fewer secondary conditions. These research findings fed into four training activities that included a peer mentoring program for newly injured people with SCI, a consumer-driven education curriculum for physical therapy and medical students, a state-of-science and training conference, and the development of a virtual resource network on exercise and prevention.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included 14 abstracts, 14 journal articles, one book chapter, one diagnostic instrument, two training manuals, one fact sheet, one educational aid, and one set of audiovisual materials. The following table shows the five projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Cardiovascular Disease Risk Stratification Across Injury Levels After Spinal Cord Injury: Assessment of Need for Intervention and Its Predictors

Health and Function
A1. Groah, S.L., Nash, M.S., Ward, E.A., Libin, A., Mendez, A.J., Burns, P., Elrod, M., and Hamm, L.F. (2010). Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury. Journal of Cardiopulmonary Rehabilitation and Prevention, 31(2), 73-80.
  A2. RRTC on Spinal Cord Injury. (2005). Coronary heart disease and SCI [Cardiometabolic education package]. Available: http://www.sci-health.org/RRTC/edupackage/CHD_Final.pdf [January 9, 2012].
   
  RRTC on Spinal Cord Injury. (2010). Research highlights obesity and heart disease after spinal cord injury [Cardiometabolic education package]. Available: http://sci-health.org/RRTC/edupackage/Obesity_Research_Highlights.pdf [January 9, 2012].
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
B. Effect of an Acute Intensive Exercise Intervention on the Prevention of Bone Mineral Density Loss in Individuals with Spinal Cord Injury

Health and Function
B1. Groah, S.L., Lichy, A., Libin, A., and Ljungberg, I. (2010). Intensive electrical stimulation attenuates femoral bone loss in acute spinal cord injury. Physical Medicine and Rehabilitation, 2(12), 1,080-1,087.
  B2. RRTC on Spinal Cord Injury. (2005). Osteoporosis and SCI [Bone health and osteoporosis education package]. Available: http://www.sci-health.org/RRTC/edupackage/CHD_Final.pdf [January 9, 2012].
   
  Lichy, A., Libin, A., Ljungberg, I., and Groah, S.L. (2007, November). Preserving bone health after acute spinal cord injury: Differential responses to a neuromuscular electrical stimulation intervention. Paper presented at the 12th Annual Conference of the International FES Society, Philadelphia, PA. Available: http://sci-health.org/RRTC/edupackage/IFESS2007_Lichy.pdf [January 9, 2012].
C. Effect of Robotic Body-Weight Supported Treadmill Training on Bone Mineral Density and Selected Secondary Conditions in Individuals with SCI

Health and Function
C1. Hidler, J., Hamm, L.F., Lichy, A., and Groah, S.L. (2008). Automating activity-based interventions: The role of robotics. Journal of Rehabilitation Research and Development, 45(2), 337-344.
  C2. Lichy, A., Groah, S.L., Hamm, L.F., and Field-Fote, E. (2007). Cardiac and metabolic benefits of robotic-assisted gait training after spinal cord injury. Poster presented at the Annual Meeting of the American Spinal Cord Injury Association and Rehabilitation. Available: http://sci-health.org/RRTC/edupackage/Lichy_ASIA%202008%20poster.pdf [January 9, 2012].
   
  Badday, H., Pineda, C., Lichy, A., and Groah, S. (2010). Asymmetric bone mineral density loss in an ambulatory individual with spinal cord injury: A case report. Poster presented at the Annual Meeting of the American Academy of Physical Medicine and Rehabilitation. Available: http://sci-health.org/RRTC/edupackage/BaddayAAPMR2010.pdf [January 9, 2012].
D. Comparison of Exercise Training Formats in Individuals with Spinal Cord Injury

Health and Function Participation and Community Living
D1. Kroll, T., Kehn, M., Ho, P.S., and Groah, S.L. (2007). The SCI Exercise Self-Efficacy Scale (ESES): Development and psychometric properties. The International Journal of Behavioral Nutrition and Physical Activity, 4(34).
  D2. RRTC on Spinal Cord Injury. (2005). Exercise and SCI [Exercise and self-efficacy package]. Available: http://sci-health.org/RRTC/edupackage/Exercise_Factsheet.pdf [January 9, 2012].
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
E. Exercise and Secondary Conditions: A National Survey of Individuals with Spinal Cord Injury

Health and Function Participation and Community Living
E1. Kroll, T., Neri, M.T., and Ho, P.-S. (2007). Secondary conditions in spinal cord injury: Results from a prospective study. Disability and Rehabilitation, 29(15), 1,229-1,237.
  E2. National Rehabilitation Hospital’s RRTC on SCI. (2006, November). State of science video package. Presented at the State-of-the-Science Conference, Bethesda, MD. Available: http://www.sci-health.org/sos/toc.html [January 9, 2012].

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: Each pair of outputs reviewed corresponds to a project and includes a journal article and a consumer education/informational package.

The first two outputs correspond to the project on cardiovascular disease risk assessment. The Groah et al. article (A1) describes cardiometabolic risk factors and risk clustering in people with SCI. It is based on a large-scale cross-sectional study that assessed 121 individuals with motor complete SCI, which according to the authors makes it one of the largest nonveteran studies of this type. The authors also report that the scope of the cardiopulmonary assessments was much broader than that of assessments previously performed and reported in the literature. The article indicates that cardiometabolic risk clustering in people with SCI differed by degree of injury. A preponderance of overweight/obesity was found in the entire population with SCI. Ten percent of the population with SCI had moderate to high 10-year risk of myocardial infarction or death. The consumer cardiometabolic education package (A2) included a coronary heart disease and SCI fact sheet, research highlights on obesity and heart disease after SCI, and an obesity trends animation piece.

The next two outputs correspond to the project focused on the effects of acute intensive exercise interventions on the prevention of bone mineral density loss in persons with SCI. Groah et al. (B1) investigated the effects of intensive electrical stimulation (ES) on femoral bone mineral density loss in acute SCI. They found that an intensive lower extremity ES program may attenuate bone mineral density loss after acute motor complete SCI, although it remained unknown whether these benefits would be maintained in the long run. The authors claim the study is one of the few randomized controlled trials investigating bone health in people with acute SCI. The consumer bone health and osteoporosis education package (B2) included an osteoporosis and SCI fact sheet resulting from an abstract on interim findings on osteoporosis in SCI presented at the 2007 American Spinal Cord Injury

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Annual Meeting (awarded third-best presentation), as well as at the 2007 International Functional Electronic Stimulation Society Annual Meeting.

In an article produced under the project focused on the effect of robotic body-weight supported treadmill training on bone mineral density and selected secondary conditions in individuals with SCI, Hidler et al. (C1) review the use of robotic devices in delivering intense, activity-based therapies, which could result in significant exercise benefits for people with SCI. In the manuscript, they also present preliminary data from studies investigating the metabolic and cardiac responses during and after 6 months of lower-limb robotic training. The early evidence suggested that interventions, such as robotic-assisted gait training, may improve gait as well as metabolic and cardiovascular performance. The findings from this project did not result in a consumer education package; rather, the informational outputs targeted physicians and physical therapists. The robotics package (C2) therefore consisted of two posters, “Cardiac and Metabolic Benefits of Robotic-Assisted Gait Training after Spinal Cord Injury” and “Asymmetric Bone Mineral Density Loss in an Ambulatory Individual with Spinal Cord Injury: A Case Report,” invited for presentation at the Annual Meeting of the American Spinal Cord Injury Association in 2007 and the Annual Meeting of the American Academy of Physical Medicine and Rehabilitation in 2010, respectively. Knowledge from this project, however, was able to be incorporated into consumer materials A2 and B2.

The journal article (D1) produced under the project comparing exercise training formats in individuals with SCI describes the development and psychometric properties of the Exercise Self-Efficacy Scale (ESES), a major outcome of the RRTC. Self-efficacy has wide application in studies on exercise and other health promotion activities. However, few efforts had been carried out to assess self-efficacy in people with SCI. The article’s preliminary findings indicate that the ESES is a reliable instrument with high internal consistency and scale integrity. Consumer materials (D2) dealing with the prevention of secondary conditions through exercise and promotion of healthy lifestyles incorporate knowledge resulting from the ESES scale development. The materials provided for the output included the ESES questionnaire itself and a fact sheet on exercise and SCI.

The final two outputs reviewed were produced as part of the project on exercise and secondary conditions. Kroll et al. (E1) present findings from a prospective mail survey study aimed at determining significant predictors of pressure ulcers and urinary tract infections (UTIs) in adults with SCI over 2 years. The findings suggest that experience of a pressure ulcer at time 1 as well as not being married or cohabitating with a partner and lack of access to primary care services are significantly associated with the occurrence of a pressure ulcer at time 2. Reporting previous UTI, having greater functional limitations in activities of daily living, and not engaging in exercise were

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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associated with UTI at time 2. The State-of-the-Science Conference and associated dissemination materials (E2) included multidisciplinary speakers and panel participants interested in the health and well-being of persons with SCI and in research focused on understanding the impact of exercise and physical activity on the prevention of secondary conditions in people with SCI.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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REHABILITATION ENGINEERING RESEARCH CENTER (RERC)

Grant Title: RERC on Telerehabilitation

Grant Award Number: H133E040012

Grantee: University of Pittsburgh

Grant Mechanism: Rehabilitation Engineering Research Center

Grant Start and End Date: June 1, 2005, to May 31, 2009

Total Direct Costs: $3,046,093

Abstract: The vision of this Rehabilitation Engineering Research Center (RERC) was to serve people with disabilities by researching and developing methods, systems, and technologies that support remote delivery of rehabilitation and home health care services for individuals who have limited local access to comprehensive medical rehabilitation outpatient and community-based services. Research and development activities included (1) Remote Wheeled Mobility Assessment: determining whether individuals with mobility impairments can obtain appropriate prescriptions for wheeled mobility devices through the use of a telerehabilitation system based on information and telecommunication technologies; (2) Remote Accessibility Assessment of the Built Environment: determining the effectiveness of a remote accessibility assessment system in evaluating the built environment of wheeled mobility device users; (3) Telerehabilitation Infrastructure and Architecture: developing an informatics infrastructure and architecture that build on existing programs and technologies of the University of Pittsburgh Medical Center’s e-Health System, supports the RERC’s research and development activities, meets Health Insurance Portability and Accountability Act (HIPAA) requirements, provides a test bed for third-party telerehabilitation applications, and can be used as a model for future telerehabilitation infrastructure; (4) Telerehabilitation Clinical Assessment Modeling: developing a conceptual model for matching consumers with telerehabilitation technology. The model is user-oriented and driven by consumer experiences regarding satisfaction, simplicity, and reimbursability of telerehabilitation; (5) Teleassessment for the Promotion of Communication Function in Children with Disabilities: developing a web-based teleassessment infrastructure that links therapists and child participants, allowing therapeutic content to be adapted to a child’s individual progress and abilities; and (6) Behavioral Monitoring and Job Coaching in Vocational Rehabilitation: researching technologies for conducting remote delivery of rehabilitation services to

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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individuals with limited access to rehabilitation services that are necessary to participate in and achieve education and employment outcomes in their community.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included six abstracts, two book chapters, five journal articles, 36 proceedings, one intervention protocol, two field-tested products, one piece of software, one fact sheet, one training manual, one set of audiovisual materials, one e-journal, and one website. The following table shows the six projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Evaluation of Remote Wheelchair Prescription

Health and Function
A1. Schein, R.M., Schmeler, M.R., Brienza, D., Saptono, A., and Parmanto, B. (2008). Development of a service delivery protocol used for remote wheelchair consultation via telerehabilitation. Telemedicine and e-Health, 14(9), 932-938.
  A2. Schein, R.M., Schmeler, M.R., Holm, M.B., Saptono, A., and Brienza, D. (2010). Telerehabilitation wheeled mobility and seating assessments compared with in person. Archives of Physical Medicine and Rehabilitation, 91(6), 874-878.
B. Remote Accessibility Assessment of the Built Environment for Individuals Who Use Wheeled Mobility Devices

Participation and Community Living
B1. Kim, J.B., and Brienza, D.M. (2006). Development of a remote accessibility assessment system through three-dimensional reconstruction technology. Journal of Rehabilitation Research and Development, 43(2), 257-272.
  B2. Kim, J., Brienza, D.M., Lynch, R.D., Cooper, R.A., and Boninger, M.L. (2008). Effectiveness evaluation of a remote accessibility assessment system for wheelchair users using virtualized reality. Archives of Physical Medicine and Rehabilitation, 89(3), 470-479.
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
C. Information Infrastructure and Architecture

Health and Function
C1. Parmanto, B., Saptono, A., Pramana, G., Pulantara, W., Schein, R.M., Schmeler, M.R., McCue, M.P., Brienza, D.M. (2010). VISYTER: Versatile and Integrated System for Telerehabilitation. Telemedicine and e-Health, 16(9), 939-944.
  C2. VISYTER (Version 2) [computer software]. Pittsburgh, PA: RERC on Telerehabilitation, Department of Rehabilitation Science and Technology. Available: http://him1.shrs.pitt.edu/LinkClick.aspx?fileticket=mwI2LqrS4HI%3d&tabid=39 [January 9, 2012].
D. Development of a Model for Clinical Assessment and Use of Telerehabilitation Services

Health and Function
D1. Pramuka, M., and van Roosmalen, L. (2009). Telerehabilitation technologies: Accessibility and usability. International Journal of Telerehabilitation, 1(1), 85-97. Available: http://telerehab.pitt.edu/ojs/index.php/Telerehab/issue/view/227 [January 9, 2012].
  D2. Rehabilitation Engineering Research Center on Telerehabilitation. (2010). World wide rehab (online telerehab resource tool). Available: http://www.rerctr.pitt.edu [January 9, 2012].
E. Development and Implementation of a Teleassessment Architecture for the Promotion of Communication Function in Children with Disabilities

Health and Function
E1. Speech-Language Telerehabilitation System based on Cosmobot—as described in:

Parmanto, B., Saptono, A., Murthi, R., Safos, C., and Lathan, C.E. (2008). Secure telemonitoring system for delivering telerehabilitation therapy to enhance children’s communication function to home. Telemedicine and e-Health, 14(9), 905-911.
  E2. Store and Forward Telemonitoring Protocol—as described in:

Parmanto, B., Saptono, A., Murthi, R., Safos, C., and Lathan, C.E. (2008). Secure telemonitoring system for delivering telerehabilitation therapy to enhance children’s communication function to home. Telemedicine and e-Health, 14(9), 905-911.
F. Behavioral Assessment and Job Coaching

Employment
F1. McCue, M., Fairman, A., and Pramuka, M. (2010). Enhancing quality of life through telerehabilitation. Physical Medicine Clinics of North America, 21(1), 195-205.
  F2. Schmeler, M., Schein, R.M., McCue, M., and Betz, K. (2009). Telerehabilitation clinical and vocational applications for assistive technology: Research opportunities and challenges. International Journal of Telerehabilitation, 1(1), 59-72.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Brief Description of the Outputs: The first four outputs reviewed were all journal articles. The first two were produced under the Evaluation of Remote Wheelchair Prescription project. The Schein et al. article (A1) describes the development of a service delivery protocol that connects rural wheelchair users with urban specialists via telerehabilitation technology. To evaluate the protocol, a repeated measure study design was used. Effectiveness was evaluated through pre and post scores of the Functioning Everyday with a Wheelchair (FEW) outcome measure tool. Since many rural areas lacked qualified specialists, the protocol and study were launched at one initial site and then subsequently replicated at several additional sites. In the second journal article, Schein et al. (A2) report on a comparative assessment of wheeled mobility and seating in person at a clinic versus remotely via telerehabilitation. They used a prospective, multicenter controlled nonrandomized design at five wheelchair clinics in Western Pennsylvania. Participants included 50 individuals assessed at a clinic and 48 individuals assessed remotely. The study used the FEW outcome tool to gauge whether both sets of participants were assessed equally well. Results showed no significant differences in the quality of the assessment, indicating that such assessments can be completed adequately via telerehabilitation.

The next two journal articles stemmed from the project on remote accessibility assessment of the built environment for individuals who use wheeled mobility devices. Kim and Brienza (B1) describe an accuracy assessment of the ability of their Remote Accessibility Assessment System (RAAS) to create a 3-D reconstruction of a wheelchair user’s environment for a clinician. Since the camera and 3-D reconstruction software chosen for the system can affect its overall reliability, they analyzed the accuracy of dimensional measurements in a virtual environment and compared the measurement accuracy of 3-D models created with four cameras/settings. The assessment led Kim and Brienza to identify which digital camera and software package available to consumers were capable of running the system. Using the camera and software, researchers conducted a successful field test of the system. In the next article, Kim et al. (B2) compare assessments of home environment based on the RAAS image reconstruction with assessments of home environment based on in-person inspection. The comparison was performed in three different homes of people who use wheeled mobility devices. For each home, assessments by each method were performed by a different specialist. Results indicated that assessments of the three homes by the two methods were in agreement 94 percent of the time. The authors believe these results demonstrate that the system could provide adequate service to wheelchair users in remote areas.

Under the Information Infrastructure and Architecture project, two outputs were produced. VISYTER (C1), a software platform for developing various telerehabilitation applications, includes high-quality videoconferencing,

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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stimuli presentation, remote multiple camera control, remote control of the display screen, an eye contact teleprompter, and access to electronic health records. Since its development, the VISYTER system has been used to evaluate remote wheelchair prescriptions, support adult autistic assessments, and facilitate international physical therapy teleconsultations. The Telerehabilitation Portal (C2) supports telerehabilitation services such as remote wheelchair assessment and remote assessment of built environments. It also assists the grantee research team in managing clinical workflow and increases their ability to collaborate.

The project aimed at development of a model for clinical assessment and use of telerehabilitation services produced two outputs. The Pramuka and van Roosmalen article (D1) discusses the strengths and weaknesses of various telerehabilitation technologies. It highlights a conceptual framework that can be used to match telerehabilitation technologies, clinical applications, and user capabilities. The authors also suggest some methods of using the technology to improve the effectiveness of telerehabilitation versus in-person rehabilitation. The online tool World Wide Rehab (D2) is a resource database for information related to telerehabilitation services, such as technologies, disability types, and population types. It contains more than 800 resources (case studies, journal publications, reports, etc.) in the area of telerehabilitation, as well as a compilation of state (Medicaid) policies and clinical licensure policies related to telerehabilitation. The tool is available for all to use, and users are able to add new resources or update the information in the database. Creators envision the World Wide Rehab site resulting in better-informed clinicians and better-informed patients.

The next two outputs were pieces of netware created as part of the project on development and implementation of a teleassessment architecture for the promotion of communication function in children with disabilities. The first was a speech-language telerehabilitation system (E1) adapted from an existing stand-alone speech therapy system called Cosmobot. Researchers were able to add a secure, usable two-way telemonitoring system to Cosmobot, creating a more dynamic and valuable telerehabilitation system. They believe these efforts provide both an example of and a methodology for converting existing stand-alone rehabilitation systems into telerehabilitation systems. Converting existing systems is potentially more cost-effective for both clinicians and patients than developing and distributing new systems. The second output was a secure store-and-forward telemonitoring protocol (E2) for use in telemonitoring systems such as output E1. The protocol was new technology developed by the grantee that has wide application as more telerehabilitation systems are developed.

The final two outputs were journal articles produced under the project focused on behavioral assessment and job coaching. McCue, Fairman, and Pramuka (F1) review the literature on the history of telerehabilitation,

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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which they describe as still a developing field. However, evidence from the literature suggests that the expressed advantages of telerehabilitation— lowering costs while increasing access and performing interventions in a patient’s comfortable, natural environment—are being seen in the results of rehabilitation and in the quality of life of patients. The authors conclude that telerehabilitation has been largely successful over the course of its existence, but improvements still can be made, and further research is needed. Schmeler et al. (F2) summarize the clinical and vocational applications of telerehabilitation. As presented by the authors, these applications include pressure ulcer prevention, virtual reality applications, speech-language pathology applications, seating and wheeled mobility applications, vocational rehabilitation applications, and cost-effectiveness. The authors also provide a discussion of clinical and policy issues related to telerehabilitation and of some of the external influences on telerehabilitation.

Grant Title: RERC on Universal Interface and Information Technology Access

Grant Award Number: H133E030012

Grantee: University of Wisconsin–Madison, Trace Center

Grant Mechanism: Rehabilitation Engineering Research Center

Grant Start and End Date: October 1, 2003, to March 31, 2009

Total Direct Cost: $3,685,031

Abstract: The focus of this Rehabilitation Engineering Research Center (RERC) was on both access to information in its various forms and access to interfaces used by information technology and by electronic technologies in general. The research and development program was carefully designed to provide an interwoven set of projects that together advanced accessibility and usability in a fashion that took into account, and supported, the full range of access strategies used by manufacturers and people with disabilities. These strategies ranged from enhancing the design of mainstream products so they can be used by individuals with different ability sets to enhancing the ability of users to deal with information and interfaces as they encounter them. The program focused on advances that would have both short- and long-term outcomes related to assistive technologies (AT), interoperability, and universal design. It also included research with the potential to completely rewrite the basic precepts and approaches for accessibility and usability of

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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information and interface technologies by people with disabilities, and may even impact the definitions and concepts of AT and universal design. Key to these projects was the development of new models and approaches for characterization of the functional requirements of current and future interfaces and a better understanding of the type, diversity, and similarity of functional limitations across etiologies and disabilities.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included five journal articles, four proceedings, four technical reports, one book chapter, two diagnostic instruments, one checklist, two miscellaneous tools, two industry standards, one working prototype, one patent, one product transferred to industry, three educational aids, and one website. The following table shows the eight projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

(Note that the grantee submitted more than two outputs for the committee’s review for one of its projects, as reflected in the table below.)

Project/Research Domains* Outputs
A. Tools to Facilitate Built in Cross-Disability Access

Employment Participation and Community Living Technology Knowledge Translation including Technology Transfer
A1. Vanderheiden, G.C. (2009). Accessible and usable design of information and communication technologies. In C. Stephanidis (Ed.), The universal access handbook (pp. 31-56). Boca Raton: CRC Press.
  A2. Vanderheiden, G.C. (2006-2009). EZ access guidelines for implementers: Version 1.6. Unpublished User’s Guide, Trace Center, University of Wisconsin–Madison.
B. Tools for Incorporation of Interoperability Features in Mainstream Products

Employment Participation and Community Living Technology Knowledge Translation including Technology Transfer
B1. Zimmermann, G., and Vanderheiden, G. (2008). Accessible design and testing in the application development process: Considerations for an integrated approach. Universal Access in the Information Society, 7(1-2), 117-128.
  B2. ISO/IEC 24752-1:2008(E): Information technology—user interfaces—universal remote console—Part 1: Framework. Available: http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=42309 [January 10, 2012].
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
C. Server-Assisted and Virtual AT

Employment Participation and Community Living Technology
C1. Vanderheiden, G.C. (2008). Ubiquitous accessibility, common technology core, and micro assistive technology. ACM Transactions in Accessible Computing, 1(2), 10.1-7.
D. Support of National and International Standards and Guidelines Efforts

Employment Participation and Community Living Technology
D1. Cladwell, B., Cooper, C., Reid, L.G., and Vanderheiden, G. (2008). Web Content Accessibility Guidelines (WCAG) 2.0 W3C recommendation. Available: http://www.w3.org/TR/2008/REC-WCAG20-20081211/ [January 10, 2012].
  Supporting Materials: Cladwell, B., Cooper, C., Reid, L.G., and Vanderheiden, G. (2008). A guide to understanding and implementing Web Content Accessibility Guidelines 2.0. Available: http://www.w3.org/TR/2008/NOTE-UNDERSTANDING-WCAG20-20081211/ [January 10, 2012].
   
  Cladwell, B., Cooper, C., Reid, L.G., and Vanderheiden, G. (2008). Techniques and failures for Web Content Accessibility Guidelines 2.0. Available: http://www.w3.org/TR/2008/NOTE-WCAG20-TECHS-20081211/ [January 10, 2012].
  D2. Photosensitive epilepsy analysis tool (PEAT)—with live capture [computer software]. Madison: The Board of Regents of the University of Wisconsin System. Available: http://trace.wisc.edu/peat/ [January 10, 2012].
  D3. Vanderheiden, G. (2008). HFES 200 software accessibility guidelines/ISO 9241-171 software accessibility standard. Santa Monica, CA: Human Factors and Ergonomics Society.
  D4. ISO/IEC TC JTC1 N-888:2007: Information technology—accessibility considerations for people with disabilities—Part 1: User needs summary. Available: http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=45161 [January 10, 2012].
  D5. Trace Center. (2008). Report to the access board: Refreshed accessibility standards and guidelines in telecommunications and electronic and information technology. Unpublished report to the Access Board, University of Wisconsin–Madison.
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
E. Disability and Interface Characterization Study

Health and Function Technology
E1. Irwin, C.B., Meyer R.H., Yen, T.Y., Kelso, D.P., and Setso, M.E. (2008, September). Force and impulse production during the use of a touch screen by individuals with motor control disabilities. Paper presented at the Human Factors and Ergonomics Conference, New York, NY.
  E2. Irwin, C.B., Yen, T.Y., Meyer, R.H., Vanderheiden, G.C., Kelso, D.P., and Sesto, M.E. (2011). Use of force plate instrumentation to assess kinetic variables during touch screen use. Universal Access in the Information Society, 1-8.
F. Abstract User Interfaces and Interface Sockets

Participation and Community Living Technology
F1. Trewin, S., Zimmermann, G., and Vanderheiden, G. (2004). Abstract representations as a basis for usable user interfaces. Interacting with Computers, 16(3), 477-506.
  F2. Zimmermann, G., and Vanderheiden, G. (2007). The universal control hub: An open platform for remote user interfaces in the digital home. In J. Jacko (Ed.), Human-computer interaction: Interaction platforms and techniques (vol. 4,551; pp. 1,040-1,049; Book Series-Lecture Notes in Computer Science). Heidelberg, Germany: Springer. Available: http://www.springerlink.com/content/x60015150w13g116/?p=4e776fc25dbf416fb05aa70120ac8664&pi=1 [January 10, 2012].
G. Technology Watch and State-of-the-Science Conference

Participation and Community Living Technology
G1. National Council on Disability. (2006). Over the horizon: Potential impact of emerging trends in information and communication technology on disability policy and practice. Washington, DC: Author. (Written by Gregg Vanderheiden for NCD.)
  G2. Trace Center. (2007). Emerging technology overview. Available: http://trace.wisc.edu/tech-overview/ [January 10, 2012].
H. Direct Brain Interface Study

Health and Function Participation and Community Living Technology
H1. Felton, E.A., Radwin, R.G., Wilson, J.A., and Williams, J.C. (2009). Evaluation of a modified Fitts law brain–computer interface target acquisition task in able and motor disabled individuals. Journal of Neural Engineering, 6 056002. Available: http://iopscience.iop.org/1741-2552/6/5/056002/pdf/1741-2552_6_5_056002.pdf [January 10, 2012].

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first two outputs were produced by the project involving the development of tools to facilitate built in crossdisability access. The first, a book chapter (A1), describes the changing

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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nature of accessible interfaces to information and communication technologies (ICT). The chapter includes discussion of AT interfaces, pluggable user interfaces, universal design, how the meaning of these terms has changed and continues to change, demographic information, tables summarizing the known approaches to accessibility both within and across disabilities, and strategies for prioritizing. The chapter also includes a discussion of future challenges and opportunities related to ICT interfaces. The second output, the EZ Access Techniques Package and Checklist (A2), is a system of design techniques and hardware components to be used in conjunction with existing interactive electronic products to make the products more usable and accessible. According to the creators, EZ Access provides access for people with low vision; blindness; hearing impairment; deafness; physical disabilities of reach and motor control; and many cognitive, language, and learning disabilities. It also allows use of touchscreen kiosks via touchscreen or a keypad alone; has been shown to provide access for individuals with most single disabilities and most combinations of disabilities; and has been adopted by organizations, such as the U.S. Postal Service for its automated postal stations, the Phoenix Airport for its communication stations, Amtrak for its ticket kiosks, IBM for its airport checking kiosk designs, the Department of Homeland Security for its airport security kiosks, the Federal Deposit Insurance Corporation (FDIC) for its kiosk, and the World War II Memorial, among others.

Under the project focused on tools for incorporation of interoperability features in mainstream products, two outputs were produced. Zimmermann and Vanderheiden (B1) believe accessible design principles should be applied throughout any product development cycle and describe an integrated approach to accessible design. They suggest using “personas” to model the user base and derive design guidelines that would form the basis for the accessibility evaluation. From this point, iterative testing could be used to finalize the design. These principles are all in agreement with existing best practices of software engineering. The next output was a five-part International Standards Organization (ISO) standard for universal remote consoles (B2), encompassing a framework, user interface socket description, presentation template, target description, and resource description. The standard is intended for industry developers and manufacturers of electronic ICT products and systems. It directs network technology product design to expose an “interface socket” that allows users to control the new products with a previously existing interface. Creators believe the ability to use a known interface will allow users with disabilities to access more products. As reported by the grantees over 200 institutions are working directly or indirectly with these URC standards.

Associated with the project on server-assisted and virtual assistive technologies, the next output reviewed was an invited commentary article

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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(C1). Vanderheiden comments on changes in accessibility of computing since publication of a landmark article by Glinert and York in 1992. Changes include awareness of the need to design for accessibility and increased and improved accessibility features built into every operating system. Areas that have not changed include the prohibitive cost and limited availability of AT and the lag between new technology and necessary accessibility features. Vanderheiden introduces several new concepts that he believes researchers should be exploring to further improve AT, such as ubiquitous accessibility, a common technical core, and micro AT. As reported by the grantees, these concepts are now part of international efforts to build a Global Public Inclusive Infrastructure.

The next five outputs were all developed under the project Support of National and International Standards and Guidelines Efforts. The Web Content Accessibility Guidelines (WCAG 2.0) (D1), cover methods for making web content more accessible to people across disabilities, including blindness and low vision, deafness and hearing loss, learning disabilities, cognitive limitations, limited movement, speech disabilities, photosensitivity, and combinations of these. The Photosensitive Epilepsy Analysis Tool (PEAT) (D2) is a diagnostic instrument that captures video of a website in action and then analyzes the video for website content that may induce seizures in people with photosensitive seizure disorders. The analysis includes details of the severity of the risk associated with the content and suggestions for modifications that could eliminate the risk. PEAT is now a free, downloadable resource for web developers. According to the creators, the tool is cited in the support materials for both the World Wide Web Consortium (W3C) Web Accessibility Initiative (WAI) WCAG and Section 508 refresh materials. The next output involved bringing a set of software accessibility standards into alignment (D3). The Human Factors and Ergonomics Society (HFES) guidelines are the American standard, and the ISO standard is the European counterpart. The purpose of each standard is to provide guidance for designing accessibility into human-system software interfaces, but over time, the American and European standards had diverged. As reported by the developers, this effort created two new, harmonized standards that were used by the Access Board Advisory Committee in developing recommendations for revision of Section 508 of the Rehabilitation Act and Section 255 of the Communications Act. The last two outputs developed under this project were technical reports. The first was a technical report (D4) on the user needs of people with disabilities. The report was intended for standards developers, developers of information technology products, and accessibility advocates. The report describes the needs of users with a wide range of disabilities, identifies the common problems these users face when interfacing with technologies, and can be used to analyze whether accessibility measures will be effective. According to the grantee, the report was

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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adopted by the ISO/International Electrotechnical Commission (IEC) Joint Technical Committee 1 (JTC1) Special Working Group on Accessibility as its user needs summary and processed into an ISO technical report (ISO/IEC TR 29138-1). The second technical report (D5) contains recommended standards and guidelines for updating regulations that implement two laws regarding accessible ICT: Section 508 of the Rehabilitation Act and Section 255 of the Communications Act of 1996. These two laws represent the core of all U.S. accessibility policy regarding ICT. The recommended updates will create guidelines that will work better across all technologies and devices, will be agile enough to provide guidance for technology that will be created in the near future, and will also be more in line with international standards.

Produced under the Disability and Interface Characterization Study were two publications. Irwin et al. (E1) describe touch screen use by individuals with motor control disabilities, citing a lack of such research. The authors examined how well participants with cerebral palsy and multiple sclerosis were able to use a touch screen. Kinetic variables and dwell time were measured. The study confirmed that button size is a key variable in allowing users with motor control disabilities to use devices with touch screens more easily up to a point, but that increasing the size of buttons beyond a certain level may not increase accessibility for those with severe motor impairments as is often believed. A proceedings article (E2) describes the development of instrumentation to measure the force applied to a touch screen. Irwin and colleagues designed a touch screen force plate to measure force applied to a touch screen by different users. A pilot study of the force plate included both participants with motor control disabilities and nondisabled participants. Results of the pilot study indicated that the plate was successful in measuring force for all users. The authors believe the instrumentation is the first of its kind, and the force plate was used by the study described as output E1.

The next two outputs were associated with the project on abstract user interfaces and interface sockets. Trewin, Zimmermann, and Vanderheiden (F1) examined four standards for abstract description of user interfaces. They describe a universal remote console scenario in which a personal device could easily connect with and operate any other local relevant device or service. They conclude that the technologies XForms and URC have the greatest potential to support a universal remote console scenario. The authors also identify two research challenges related to tagging and authoring. The Universal Remote Console Hub (F2) is a technology output that accesses the user interface of multiple electronic devices and provides access to all of them through one interface. It is intended to greatly improve access for persons with disabilities through the creation of one easy-to-use interface that can operate many devices. It also allows multiple devices to be controlled simultaneously and reduces the number of controllers and controls needed to operate the devices.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Under the project Technology Watch and State-of-the-Science Conference, two outputs were produced. A technical report (G1) provides an overview and analysis of the trends in technology and their impact and potential impact on various dimensions of accessibility and disability policy. The report includes such topics as trends and technological advances that are changing the rules; new opportunities, barriers, and concerns; and seven general recommended actions to be taken on a research and development and policy basis. This report was adopted and distributed by the National Council on Disability as part of its report series. The Emerging Technology Overview website (G2) is an online review, compiled in 2007, of selected emerging ICT. The website presents the information as a series of slides with images and links to further information. Its intent was to provide a sense of how future ICT could impact access by users with disabilities. The technology selected was intended to illustrate significant changes. The purpose of the overview was not to be exhaustive but to promote awareness of advances in interface technologies over the last decades that many disability (and mainstream) researchers were unaware of, and that could impact access to technologies and provide new approaches to meeting the needs of users with disabilities.

The final output reviewed was produced under the Direct Brain Interface Study. Felton et al. (H1) explored whether Fitts’ law (a model of psychomotor behavior) applies when nondisabled and disabled individuals are moving a cursor on a computer screen through neural signals. Participants included eight nondisabled and five motor-disabled participants who moved a cursor on a computer screen through use of an electroencephalogram (EEG). Comparisons were made between nondisabled and disabled participants and between EEG and joystick cursor movement in nondisabled participants. Analysis of the results showed that Fitts’ law did apply to the cursor movement by neural signals by both the nondisabled and disabled participants. The researchers believe this work has implications for the future design of devices controlled by neural signals.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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DISABILITY AND REHABILITATION RESEARCH PROJECT-GENERAL (DRRP)

Grant Title: The Effect of Scheduled Telephone Intervention on Outcomes After TBI

Grantee: University of Washington

Grant Award Number: H133A040004

Grant Mechanism: Disability and Rehabilitation Research Project-General

Grant Start and End Dates: June 1, 2005, to May 31, 2010

Total Direct Cost: $3 million

Abstract: About 80,000 survivors of traumatic brain injury (TBI) are discharged from the hospital with long-term disabilities. Few interventions for persons with moderate to severe TBI have been shown to improve outcomes. This project examined the effect of a low-cost, easily implemented intervention on functional and health outcomes for these individuals. A randomized controlled trial was carried out in three widely disparate sites (Seattle, Washington; Philadelphia, Pennsylvania; and Jackson, Mississippi) to examine the effect of scheduled telephone intervention (STI) on function and quality of life for persons with TBI at 1 and 2 years after discharge from the hospital. The study randomized survivors of TBI into an experimental group and a control group upon discharge from inpatient rehabilitation. Both groups received the usual care, but the experimental group additionally received STI. Specific Aim 1 evaluated the effect of STI at weeks 1-2, 4, 8, and 12 and months 5, 7, and 9 on functional level, health and emotional status, community integration, and perceived quality of well-being over 1 year after TBI. Specific Aim 2 evaluated the effect of additional STI at months 15, 18, and 21 on the same variables and employment at 2 years after TBI. Specific Aim 3 evaluated whether the effects of such an intervention are similar in multiple sites over a wide geographic area and in demographic subgroups. Specific Aim 4 examined the differential impact of the intervention in demographic subgroups, with particular attention to minority versus nonminority racial and ethnic populations.

This study was based on a successful pilot single-site study carried out at the principal site, Seattle. This extension allowed cross-validation of the original results and determined whether the treatment and its results could be generalized to other disparate sites. Additionally, continuing STI through the second year allowed meaningful evaluation of its effect on return to

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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work. Timely intervention to identify problems after TBI, to teach patients and their families coping techniques within their own communities, and to support their independent decision making would effectively decrease the need for expensive and often inaccessible services and improve the quality of life for survivors of TBI. A successful multicenter demonstration of this technique would have convincing implications for health care policy and provision of services to persons with TBI.

In addition to the original purpose, a validation study of the Community Participation Indicators, a measure being developed by Heinemann under NIDRR auspices, was carried out. Responses from persons with TBI and those from participant-identified significant others were compared to determine the validation of proxy responses for this instrument.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among outputs they had produced under the grant. These included one journal article and one workshop. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. The Effect of Scheduled Telephone Counseling on Outcome After TBI

Health and Function
A1. Hart, T., Sherer, M., Temkin, N., Whyte, J., Dikmen, S., Heinemann, A.W., and Bell, K. (2010). Participant-proxy agreement on objective and subjective aspects of societal participation following traumatic brain injury. Journal of Head Trauma Rehabilitation, 25(5), 339-348.
  A2. Bell, K. (2010). An experience-based discussion of challenges to conducting multicenter clinical trials in rehabilitation. Presentation at the 2010 American Congress of Rehabilitation Medicine-American Society of Neurorehabilitation Joint Educational Conference, October 20-23, Montreal, Quebec, Canada.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: This DRRP did not find a significant difference between treatment groups receiving STI and control groups. Secondary analyses were planned to see whether any subgroups within the intervention group had a differential response and whether there were any effects of intervention dosage. The intervention did not achieve its goals as it was

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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applied in the study. Therefore, the outputs reviewed by the committee address some of the challenges and lessons learned in carrying out the study. The first output was a journal article (A1) examining agreement between participants and proxies (significant others) when reporting societal participation in three objective domains (economic, community, and social activities) and subjective satisfaction with participation at 1 year after TBI. The article concludes that proxy report may be an acceptable substitute for missing participant report on productivity and community activity outcomes, but should be used with caution for questions about social activities and degree of satisfaction with participation.

The second output was a workshop presentation, An Experience-Based Discussion of Challenges to Conducting Multicenter Clinical Trials in Rehabilitation (A2), held in Montreal, Canada. The objective of the workshop was to analyze the project to identify experimental factors that may have contributed to its unexpected outcome, including framing of the research question, use of pilot data, study design, recruitment and consenting of subjects, protocol management and treatment fidelity, data collection and quality monitoring, data analysis, effective dissemination, grant management, and institutional review board (IRB) concerns.

Grant Title: Asset Accumulation and Tax Policy Project

Grant Award Number: H133A031732

Grantee: University of Iowa

Grant Mechanism: Disability and Rehabilitation Research Project-General

Grant Start and End Date: June 1, 2007, to April 9, 2009

Total Direct Cost: $1,438,795

Abstract: The Asset Accumulation and Tax Policy Project (AATPP) adopted a team-based participatory approach to research, training, education, and technical assistance activities to bring to bear expertise in multiple disciplines—law, economics, community development, finance, disability studies, and public policy—and the real-world experience of persons with disabilities and their families, financial service providers, and community developers. Over a 5-year period, the Law, Health Policy, and Disability Center ( LHPDC) at the University of Iowa College of Law and its strategic partners systematically examined the relationship between tax policy and asset accumulation for persons with disabilities and resultant improvements

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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in economic and community integration. The AATPP investigated the impact of multiple intervention strategies—including financial education, matched savings accounts, expanded financial services, and increased use of state and federal tax incentives for asset and community economicdevelopment—on youth in transition and adults with disabilities in six states and 10 pilot demonstration sites nationwide. The AATPP used triangulated quantitative and qualitative techniques and a multimethod design (e.g., structured and open-ended interviews, archival analyses, policy and systems analysis, and survey techniques) to enhance the scientific rigor, policy relevance, and realworld usefulness of the research to key stakeholders, including persons with disabilities, policy makers, financial service providers, and community-based organizations.

The AATPP’s knowledge transfer activities included 12 complementary methods for reaching target audiences through such avenues as publications, electronic communication, training, open forums, leadership institutes, and technical assistance activities. The AATPP partners’ dissemination networks extended to the disability community and the asset accumulation and community development sectors in all 50 states. The collaborators brought a unique combination of expertise and experience as researchers, policy analysts, and practitioners in asset development (at the individual and systems levels) and economic development (at the local and state levels) to enhance knowledge transfer and impact nationwide.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included three journal articles, two technical reports, one book, one web journal, one intervention protocol, one tour, one online distance education series, one industry standard, one piece of software, two training manuals, and two newsletters. The following table shows the four projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
A. Survey of Community A1. Harrison, V., Ratigan, T., and Apfel, D. (2008).
Development Credit Unions Community development credit unions respond to the needs of the disability community. In Building a better

Participation and Community Living

economic future: A progress report for individuals with disabilities & their families in America (pp. 99-108). Manchester, NH: Community Economic Development Press. Available: http://realeconomicimpact.org/data/files/reports/building_better_future.pdf [January 10, 2012].
  A2. World Institute on Disability. (2006). National Federation of Community Development Credit Unions “each one, teach many.” Facilitator’s guide. Disability access concepts and practice: Building bridges and breaking barriers. Oakland, CA: World Institute on Disability. Available: http://www.natfed.org/files/public/NFCDCUDisabilityModule.pdf [January 10, 2012].
B. Tax Facts and Family Disability Survey B1. Hartnett, J. (2006). Educating and democracy: Tax and financial service needs of working Americans with disabilities. Washington, DC: National Disability Institute.
Employment Demographics Available: http://www.realeconomicimpact.org/data/files/reports/ford_report.pdf [January 10, 2012].
  B2. Hartnett, J.T., Morris, M., and Stengel, J. (2008). Real economic impact tour. In Building a better economic future: A progress report for individuals with disabilities & their families in America (pp. 85-98). Manchester, NH: Community Economic Development Press. Available: http://realeconomicimpact.org/data/files/reports/building_better_future.pdf [January 10, 2012].
   
  National Disability Institute. (2010). Real Economic Impact Tour, 2009-2010 annual progress report. Washington, DC: National Disability Institute. Available: http://www.realeconomicimpact.org/UploadedDocs/Documents/2010REITourReport.pdf [January 10, 2012].
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
C. Volunteer Income Tax Assistance and Financial Education Project C1. Volunteer Income Tax Assistance and Financial Education Study Intervention Protocol—as described in:
  Partch-Davies, T., and Rivera, J. (2008). Everyday heroes:
Employment How taxpayers with significant disabilities are building assets. In Building a better economic future: A progress report for individuals with disabilities & their families in America (pp. 45-62). Manchester, NH: Community Economic Development Press. Available: http://realeconomicimpact.org/data/files/reports/building_better_future.pdf [January 10, 2012].
  C2. Hartnett, J., and Davies, T. (2010). Disabilityinclusive asset building: New strategies for achieving real economic impact for Americans with disabilities. In Opportunities for community development finance in the disability market (pp. 39-53). Boston, MA: Federal Reserve Bank of Boston. Available: http://www.realeconomicimpact.org/data/files/reports/outside%20reports/draft%201-21-10.pdf [January 10, 2012].
D. IDA Project Demonstration for Self-Employment D1. Individual Development Account Protocol—as described in:
   
Employment Partch-Davies, T., and Rivera, J. (2008). Everyday heroes: How taxpayers with significant disabilities are building assets. In Building a better economic future: A progress report for individuals with disabilities & their families in America (pp. 45-62). Manchester, NH: Community Economic Development Press. Available: http://realeconomicimpact.org/data/files/reports/building_better_future.pdf [January 10, 2012].
   
  D2. Hartnett, J. (2008). Making financial connections training brochures. Unpublished brochures, Center for Community Economic Development and Disability, Southern New Hampshire University School of Community Economic Development.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first two outputs reviewed under the Survey of Community Development Credit Unions project were a book chapter and a facilitator’s guide for an education training module. The book chapter (A1) summarizes and identifies how the members of the National Federation of Community Development Credit Unions are serving people with disabilities and improving services and products for this community. The facilitator’s guide (A2) provides an overview and training

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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on disability access concepts and practice. The distribution of this publication to organizations nationwide provided background on the need for and importance of serving the financial needs of disabled people. As reported by the grantee, the efforts resulted in 1,400 credit union accounts being opened by members with disabilities.

Under the Tax Facts and Family Disability Survey project, two publications of a technical nature were produced. The first, a report on the tax and financial service needs of working Americans with disabilities (B1), provides a profile of the utilization and demographics of use of tax filing and financial services for eligible workers with disabilities. This work provided a foundation for further research and led to 2007 and 2010 Internal Revenue Service (IRS) benchmark reports on the characteristics and profiles of taxpayers with disabilities. The project’s second output, the Real Economic Impact (REI) Tour (B2), is described in two documents. The REI Tour is a public and private partnership of federal, state, and local organizations that promotes self-determination and full inclusion of Americans with disabilities in building a healthy economic future for themselves. The grantee reported that since 2004, the REI Tour has increased the number of taxpayers with disabilities accessing free tax services from 6 percent to 14 percent, representing more than 1 million taxpayers with disabilities and more than $1 billion in returns.

The next two outputs, produced under the Volunteer Income Tax Assistance and Financial Education Project, were a study intervention protocol and a paper. The Volunteer Income Tax Assistance and Financial Education Study Intervention Protocol (C1) is a comprehensive protocol for financial coaching designed to improve financial management behaviors of persons with disabilities consistent with financial security and asset holdings. The paper (C2) was published by the Federal Reserve Bank of Boston to raise awareness of the existing market of people with disabilities among community development, nonprofit, and private financial institutions. The paper uses the REI Tour and Volunteer Income Tax Assistance and Financial Education Project as examples of partnerships between community development and disability service organizations and implementation strategies that enhance the economic and social well-being of low-income taxpayers with disabilities. These efforts are providing the private sector with a snapshot of persons with disabilities as an emerging market segment and have engaged the Federal Reserve Banks in hosting annual meetings on economic empowerment and disability.

The final two outputs reviewed were another study intervention protocol and training brochures produced as part of the IDA Project Demonstration for Self-Employment. The Individual Development Account Protocol (D1) was intended to aid persons with disabilities in saving money from earnings for home ownership, postsecondary education, and business development,

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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and to be used by community development entities in making their programs more universally accessible and adapting some of their program parameters for persons with disabilities. The Making Financial Connections training brochures (D2) targeted community development and rehabilitation specialists in an effort to build a more comprehensive, disability-inclusive infrastructure linking the two sectors. The brochures provide introductory, interdisciplinary training and information on assistance programs and resources (Making Financial Connections), returning to work (Back to Work), available tax credits and services (Taking Your Credit), effects of financial decisions (Your Money, Your Choices), and asset-building programs and ways of reaching financial goals (Building a Strong Future).

Grant Title: Medicaid Quality Indicators for Individuals with Disabilities

Grant Award Number: H133A040016

Grantee: George Mason University

Grant Mechanism: Disability and Rehabilitation Research Project-General

Grant Start and End Dates: January 1, 2005, to June 30, 2009

Total Direct Cost: $1.2 Million

Abstract: Nearly every state (43) operates at least one managed care plan for people with disabilities, and many Medicaid beneficiaries with disabilities have a choice of health plans. However, existing Medicaid report cards are not specifically geared to the interests of people with disabilities. The purpose of this 5-year study was to develop and test the use of comparative measures of quality, access, and satisfaction for people with disabilities and the general population. The study was designed as a joint project of George Mason University (Virginia), the Delmarva Foundation for Medical Care (Maryland), Kaiser-Permanente Center for Health Research (Oregon), and Baylor University (Texas).

The first component of the study was intended to refine a computer program that mines state Medicaid claims data to identify people who are very likely to face challenges in receiving the care they need as the result of a disability. The researchers planned to verify the accuracy of the computer program by surveying Medicaid beneficiaries in California about their ability to participate in community activities, live independently, and visit the doctor. The objective of the second study component was to review the two most widely used health plan quality indicators—the Consumer Assessment of

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Healthcare Providers and Systems (CAHPS ®) survey on consumer-reported quality of care and the Healthcare Effectiveness Data and Information Set (HEDIS ®) Medicaid measures—to identify questions and measures (such as rates of preventive care) that are especially appropriate for people with disabilities and are statistically valid even when a relatively small number of people are being considered. The intent of the third component of the study was to interview working-age adults with disabilities in Oregon, California, and Baltimore-Washington, DC, to learn what types of information they would like to have when selecting a health plan and how they would like to obtain that information.

The overall aim of the study was to improve the field’s ability to help people make informed choices among health plans, help health plans compare their performance against benchmarks and measure the progress of their quality improvement programs, and help states monitor health plan performance.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included seven publications, four measures, a software program, and a patent application for the software program. The following table shows the three projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Case Identification A1. Palsbo, S.E., Sutton, C.D., Mastal, M.F., Johnson, S., and Cohen, A. (2008). Identifying and classifying people
Health and Function with disabilities using claims data: Further development of the Access Risk Classification System (ARCS) algorithm. Disability and Health Journal, 1(4), 215-223.
  A2. Palsbo, S.E., and Mastal, M.F. (2006). U.S. Patent application no. GMU-06-017U. Washington, DC: U.S. Patent and Trademark Office.
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×
Project/Research Domains* Outputs
B. Assessment of Health Plans and Providers by People with Activity Limitations (AHPPPAL) and Administrative Measures B1. Palsbo, S.E., Hurtado, M.P., Levine, R.E., Barrett, K.A., and Mastal, M.F. (2011). Enabling a survey of primary care to measure the health care experiences of adults with disabilities. Disability and Rehabilitation, 33(1), 73-85.
Health and Function B2. Palsbo, S.E., and Mastal, M.F. (2008). Quality indicators for individuals with disabilities in managed care. Unpublished administrative measures, grey paper, Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA.
C. Comparative Reporting Tool (Plan-Reported Indicators, Comparative Reporting Tools and Consumer-Reported Indicators) C1. Palsbo, S.E., Diao, G., Palsbo, G.A., Tang, L., Rosenberger, W.F., and Mastal, M.F. (2010). Casemix adjustment and enabled reporting of the health care experiences of adults with disabilities. Archives of Physical Medicine and Rehabilitation, 91(9), 1,339-1,346.
Health and Function  

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: In an article produced under the first project, Palsbo et al. (A1) describe the results of an initiative to “refine and revalidate a software algorithm, the Access Risk Classification System (ARCS), using automated claims data to classify people into one of four categories based on the probable need for care coordination or health system accommodations.” Using and combining existing sources of data, the ARCS identifies individuals needing extra medical assistance, such as those with disabilities. The authors evaluated the algorithm’s sensitivity and specificity by comparing the predicted classification against self-report. Results showed the overall classification range to be from good to fair. The second output, a patent application for the algorithm (A2), was under review by the U.S. Patent and Trade Office as of this writing.

The next two outputs were produced under the project Assessment of Health Plans and Providers by People with Activity Limitations (AHPPPAL). Palsbo and colleagues (B1) field-tested adapted items from the CAHPS to assess whether this adapted instrument could capture the health care experiences of adults living with disabilities. Cognitive testing revealed problems with several items in the existing survey when answered by or about people with disabilities. Thirty-eight percent of respondents reported learning disabilities, which can interfere with access to health care services. Eight content areas in primary care were identified that are particularly important to maximize the functioning and well-being of people with disabilities. Palsbo

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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et al. concluded that the study demonstrated the feasibility of adapting an existing instrument for use with persons with mixed functional limitations and severity of limitations. Data gathered with such an instrument could be used to identify and improve specific practices so as to provide better quality medical care for people with disabilities. The second output reviewed, Quality Indicators for Individuals with Disabilities in Managed Care (B2), resulted from an initiative to develop and field test quality measures derived from administrative and survey data sources, building on the CAHPS and HEDIS. Collection of these measures created a foundation for further exploration and testing of their relevance for individuals with disabilities. Palsbo and colleagues themselves were able to develop five peer-reviewed articles from this foundation.

The final output, reviewed under the project focused on comparative reporting tools, was a journal article (C1). It reports results of a study aimed at developing activity limitation clusters for case-mix-adjustment measures of health care processes and acting as a population profiler. Using the same respondent database as in output B1, a principal components analysis created four clusters of activity limitations. An analysis of scores of the adapted version of the CAHPS with the case-mix adjustment showed that disability caused a greater bias on health plan ratings than did demographic factors. According to Palsbo and colleagues, the new AHPPPAL is superior to the CAHPS for assessing individuals with disabilities.

Grant Title: Persons Aging with Hearing and Vision Loss

Grant Award Number: H133A020701

Grantee: Mississippi State University

Grant Mechanism: Disability and Rehabilitation Research Project-General

Grant Start and End Dates: November 1, 2002, to October 31, 2009

Total Direct Cost: $2,505,000

Abstract: The Rehabilitation Research and Training Center (RRTC) on Blindness and Low Vision at Mississippi State University (MSU), in collaboration with San Diego State University and the Helen Keller National Center for Deaf-Blind Youths and Adults in Sands Point, established a consortium Disability and Rehabilitation Research Project-General (DRRP) on Persons Aging with Hearing and Vision Loss. The collaborative effort focused on exploring strategies to improve outcomes for persons who are blind or visually

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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impaired or deaf or hard of hearing and are now additionally experiencing a secondary onset of hearing loss or vision impairment as a result of the aging process. The 5-year project had the following priorities: (1) investigating the prevalence of age-related onset of deafness among older American blind individuals and age-related onset of blindness among older American deaf individuals and the impact on employment and community integration options, including more viable communication systems for each population; (2) identifying and evaluating technology and service delivery options, such as transportation, housing, and community integration activities, for individuals with early-onset deafness or blindness and late-onset hearing or vision loss and their effectiveness with persons experiencing secondary sensory loss resulting from aging; (3) identifying and evaluating access to use of technologies, including assistive devices and telecommunication or other existing communication systems, such as tactile interpreter support, needed to assist persons with early-onset deafness or blindness and lateonset hearing or vision loss and their effectiveness with persons experiencing secondary sensory loss resulting from aging; and (4) using available dissemination mechanisms, with appropriate assistive technical modification, and disseminating findings, and developing strategies to educate both consumers and providers, especially vocational rehabilitation workers, in the use of these techniques.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included 11 journal articles, one newsletter, and one website. The following table shows the four projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Prevalence of Hearing and Vision Loss in Seniors and the Impact on Employment and Community Integration

Employment Participation and Community Living Demographics
A1. Capella-McDonnall, M., and LeJeune, B.J. (2008). Employment among older adults with combined hearing and vision loss. Journal of Applied Rehabilitation Counseling, 39(3), 3-9.
  A2. Sansing, W.K. (2010). An overview of hearing, vision and dual sensory impairment prevalence in the U.S. Unpublished paper, RRTC on Blindness and Low Vision, Mississippi State University.
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
B. Technology and Service Delivery Options

Participation and Community Living
B1. LeJeune, B.J. (2005). Persons Aging with Hearing and Vision Loss (PAHVL) newsletter. Issue 3.Available: http://www.blind.msstate.edu/pahvl/project/summary/PAVHL_Newsletter_3.pdf [January 10, 2012].
  B2. LeJeune, B.J. (Fall 2010). Aging with dual sensory loss: Thoughts from consumer focus groups. AER Journal of Research and Practice in Visual Impairment, 3(4), 146-152.
C. Identification and Evaluation of Access to Technology

Technology
C1. LeJeune, B.J., Steinman, B., and Mascia, J. (2003). Enhancing socialization of older people experiencing loss of both vision and hearing. Generations, 27(1), 95-97.
  C2. Capella-McDonnall, M.E. (2005). The effects of single and dual sensory loss on symptoms of depression in the elderly. International Journal of Geriatric Psychiatry, 20(9), 855–861.
D. Dissemination

Participation and Community Living
D1. LeJeune, B.J. (2010). Persons Aging with Hearing and Vision Loss (PAHVL) newsletter series. Available: http://www.blind.msstate.edu/pahvl/project/summary/ [January 10, 2012].
  D2. Rehabilitation Research and Training Center on Blindness and Low Vision and Helen Keller National Center for Deaf-Blind Youths and Adults. (2006). Creating roads to independence for persons aging with hearing and vision loss. Conference held in Atlanta, GA, February 8-10.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first two journal articles produced under the Prevalence of Hearing and Vision Loss in Seniors and the Impact on Employment and Community Integration project analyze employment and prevalence of hearing and vision impairment among older adults. Capella-McDonnall and LeJeune (A1) performed an exploratory study in which they compiled data on the employment status and experiences of a group of older adults with combined hearing and vision loss. Data were obtained from two sources: primary data were collected through a survey and secondary data from a nationally representative sample. The study’s results indicate that many of these adults do work or want to work and that accommodations, assistive technology, higher education levels, and changes in job or type of work are associated with continued employment. The second article (A2) is a literature review on the prevalence of hearing, visual, and dual sensory impairment among seniors in the United States. It reports that nationally representative survey estimates produce varied prevalence totals, but all

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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demonstrate increased numbers of people aged 55 and over with all types of sensory loss.

Under the Technologies and Service Delivery Options project, the NRC committee reviewed two outputs. The first was a newsletter (B1) updating research participants, service providers, and stakeholders on the project, including survey status and results. The second was a journal article (B2) on the issues concerning services and access to technology that consumer focus groups (nine groups of 68 older adults self-identified with both hearing and visual impairments) reported having experienced. There appeared to be a perceived lack of accommodation related to hearing loss in programs for older blind adults and a lack of knowledge about visual impairment among the deaf or hard of hearing who acquired vision loss later in life.

The next two outputs were journal articles produced under the third project, Identification and Evaluation of Access to Technology. The LeJeune et al. (C1) article focuses on enhancing socialization of older people experiencing both vision and hearing loss, particularly through suggestions for improved communication, including assistive technologies. Capella-McDonnall (C2) analyzed the effects of single and dual sensory loss on symptoms of depression in the elderly. She performed secondary analyses of 2001 National Health Interview Survey data from 9,832 people age 55 and older living in community settings. Results showed that elderly individuals with dual sensory loss were not significantly more likely than those with vision loss, but were significantly more likely than those with hearing loss, to experience symptoms of depression.

The final two outputs reviewed, produced under the Dissemination project, were a newsletter series and a national conference. The Persons Aging with Hearing and Vision Loss (PAHVL) newsletter series (D1) was distributed to research participants, service providers, and stakeholders. The newsletters contained updates, preliminary research results, and helpful information. The national conference, entitled Creating Roads to Independence for Persons Aging with Hearing and Vision Loss (D2), attracted 117 participants. A variety of new information was presented on such topics as the basics of sensory loss, use of support service providers, communication strategies, assistive technology, and psychosocial adjustment. Evaluations were positive and led organizers to hold a second conference.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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FIELD INITIATED PROJECT (FIP)

Grant Title: Efficacy of Pressure Garment Therapy After Burns

Grant Award Number: H133G050022

Grantee: University of Washington

Grant Mechanism: Field Initiated Project

Grant Start and End Dates: October 1, 2005, to September 30, 2009

Total Direct Cost: $450,000

Abstract: The objective of this project was to determine the efficacy of custom-fit pressure garment therapy in the prevention of hypertrophic scarring in healed burns through a randomized controlled trial. Pressure garments are the common therapy used today to minimize hypertrophic scarring, one of the most devastating outcomes following burn injury. However, these garments are unattractive, expensive, and uncomfortable, and their use needs to be validated by rigorous research.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. Under this grant, an instrument and a journal article were produced. The following table shows the project carried out under this grant and the corresponding output that was nominated by the grantees and reviewed by the NRC committee (the grantee chose to nominate only one output for review). The reviewed output is briefly described following the table.

Project/Research Domains* Outputs
A. Efficacy of Pressure Garment Therapy After Burns

Health and Function
A1. Engrav, L.H., Heimbach, D.M., Rivara, F.P., Moore, M.L., Wang, J., Carrougher, G.J., Costa, B., Numhom, S., Calderon, J., and Gibran, N.S. (2010). 12-year within- wound study of the effectiveness of custom pressure garment therapy. Burns, 36(7), 975-983.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Brief Description of the Output: Engrav and colleagues (A1) describe the effectiveness of custom pressure garment therapy using a randomized within-wound comparison over a 12-year period. Data were obtained on 54 consecutively enrolled patients from 1995 to 2007. The study found that custom pressure garment therapy is effective, but clinical benefit is restricted to those with moderate or severe scarring. In addition, the article underlines the limitations that may have affected the paucity of prior randomized controlled trials confirming the effectiveness of custom pressure garment therapy. The authors state that theirs is the first study to utilize a within-wound protocol.

Grant Title: A Longitudinal Study for Hospitalization, Pressure Ulcers, and Subsequent Injuries After Spinal Cord Injuries

Grant Award Number: H133G050165

Grantee: Medical University of South Carolina

Grant Mechanism: Field Initiated Project

Grant Start and End Dates: June 1, 2007, to May 31, 2010

Total Direct Cost: $449,984

Abstract: The purpose of this project was to perform a longitudinal study to identify protective and risk factors associated with the onset of multiple types of adverse health events among a large sample of individuals with spinal cord injury (SCI). The onset of SCI increases the risk for development of a number of secondary conditions that may adversely impact an individual’s life and even result in early mortality.

Predictor variables were first measured over a 10-month period in 1997-1998, including biographical status, injury status, psychological status, environmental factors, and health behaviors. Several health outcome measures were also used. During follow up, multiple outcome measures were administered, with a focus on adverse events (pressure ulcers, subsequent injuries, and hospitalizations) and treatments. Structural equation modeling was performed to develop risk models for each outcome. A consumer advisory committee met to review instrumentation and made recommendations regarding all components of the project.

This project addressed important NIDRR priorities related to health and function. The ultimate goal of the study was to enhance the lives of people with SCI by identifying the risk and protective factors associated

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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with adverse health events to serve as a foundation for prevention efforts by rehabilitation and public health professionals. Consumers will be directly empowered to improve their own health through the provision of concrete information and recommendations for promoting better health and avoiding preventable secondary health complications.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included 12 journal articles, one newsletter, and one website. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. A Longitudinal Study for Hospitalizations, Pressure Ulcers, and Subsequent Injuries After Spinal Cord Injuries

Health and Function
A1. Krause, J.S., and Saunders, L.L. (2009). Risk of hospitalizations after SCI: Relationship with biographic, injury, educational, and behavioral factors. Spinal Cord, 47, 692-697.
  A2. Krause, J.S., Reed, K.S., and McArdle, J.J. (2010). A structural analysis of health outcomes after spinal cord injury. The Journal of Spinal Cord Injury, 33(1), 22-32.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The two outputs reviewed by the NRC committee were journal articles. The first (A1) was intended to identify variables and individual health behaviors associated with hospitalization after SCI. Through a cross-sectional mail survey of 1,386 persons with SCI, two biographical and injury characteristics were found to be associated with hospitalization: race and SCI severity. After controlling for these characteristics, three behavioral factors were found to be significantly associated with hospitalization: use of prescription medications, greater engagement in smoking behaviors, and more SCI-specific health behaviors. The authors hope these findings will establish target behaviors for prevention and intervention strategies and will encourage more conservative practices regarding prescribing of medications.

In the second journal article (A2), Krause et al. describe a measurement model developed through both exploratory and confirmatory factor analysis of health domains and a latent model linking basic biographical,

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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injury, and educational characteristics with health outcomes for persons with SCI. Survey data were obtained from 1,388 adult patients with traumatic SCI of at least 1 year’s duration. The study used structural equation modeling in identifying common factors for health outcomes, distinct factors relating to secondary conditions, and factors relating to health impact. Six health outcome domains (the best overall solution) were identified in the study and were found to have a significant relationship with biographical, injury, and educational status. The authors conclude that the composite scores generated from multiple indicators provide more informative and stable outcome scores than the use of single indicators.

Grant Title: Black-White Disparities in Stroke Rehabilitation

Grant Award Number: H133G050153

Grantee: National Rehabilitation Hospital/Medstar Research Institute

Grant Mechanism: Field Initiated Project

Grant Start and End Date: October 1, 2005, to September 30, 2009

Total Direct Cost: $396,165

Abstract: The purpose of this 3-year study was to examine (1) how black and white stroke rehabilitation patients differ in terms of their clinical profiles, the care they receive, and their outcomes; and (2) how rehabilitation care and outcomes can be optimized for both groups. The goal was to translate these findings into an actionable quality improvement plan that would enhance care and outcomes for all black and white stroke rehabilitation patients.

The study capitalized on a unique comprehensive stroke rehabilitation database (N = 1,161) containing detailed patient, intervention, and outcome data assembled from 2001 to 2003 under the auspices of the NIDRRsponsored Post-Stroke Rehabilitation Outcomes project. This database contains extraordinarily detailed data on rehabilitation care processes and treatments that allowed investigators to examine the practice of stroke rehabilitation care and to dissect the processes of care that might be different for whites and blacks. This practice-based evidence method ensured clinical buy-in and ownership of the study’s findings. The project team also proposed an evaluation protocol for confirming the effectiveness and predictive validity of any suggested practice changes.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included five journal articles and one statistical technique. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Black-White Disparities in Stroke Rehabilitation

Health and Function
A1. Horn, S.D., Deutscher, D., Smout, R.J., DeJong, G., and Putnam, K. (2010). Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 91, 1,712-1,721.
   
  Deutscher, D., Horn, S.D., Smout, R.J., DeJong, G., and Putnam, K. (2010). Black-white disparities in motor function outcomes taking into account patient characteristics, nontherapy ancillaries, therapy activities, and therapy interventions. Archives of Physical Medicine and Rehabilitation, 91, 1,722-1,730.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Output: The two journal articles reviewed by the NRC committee were considered as a pair (one output) since all the information provided for the first article applied to the second article. The articles apply a practice-based evidence approach in analyzing disparities in rehabilitation services and outcomes. They capitalize on the unique comprehensive stroke rehabilitation database assembled from 2001 to 2003 under the NIDRR-sponsored Post-Stroke Rehabilitation Outcomes project. The first article focuses on black-white differences in characteristics and factors in patient stroke rehabilitation, and the second regresses these variables on motor function outcomes. Racial differences were found in certain aspects of service receipt and outcomes, with both blacks and whites benefiting in different ways. However, it was not race itself that made a difference in outcomes, but the interventions. This project thus shows the importance of using a practice-based evidence approach in studying the processes of care and dealing with issues related to bias in observational studies.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Grant Title: Development of Intelligent Personal Activity Management and Prompting Applications for Individuals with Cognitive Disabilities

Grant Award Number: H133G050313

Grantee: Eugene Research Institute

Grant Mechanism: Field Initiated Project

Grant Start and End Dates: October 1, 2005, to September 30, 2009

Total Direct Cost: $499,852

Abstract: This project built on the successful development of the Picture Planner icon-driven personal activity management application, supported in part by previous NIDRR funding. One of the conclusions derived from the field testing that led to the development and testing of that application was the need for intelligent activity planning and prompting applications that combine cognitively accessible software design with innovative artificial intelligence approaches to provide smart applications for life management and decision making. The goal of this project was to use a consumer-driven, participatory design process to build on that foundation and develop a prototype smart planning and prompting software package for implementation on desktop and handheld platforms. Major objectives included the following:

1.  Year 1—Needs assessment focus groups comprising 20 individuals with disabilities and 10 care providers, with the goal of surveying priorities from the consumer and assistant perspectives for features of a smart management system;

2.  Years 1-2—Development of a proof-of-concept design and validation process to guide the subsequent development of smart features;

3.  Years 2-3—Prototype application development, emphasizing integration of intelligent prompting elements into the desktop Picture Planner application and subsequent implementation on handheld systems;

4.  Year 3—Comparison study of smart versus standard methods of activity planning using random assignment of 20 Consumer Development Group members; and

5.  Year 3—Preparation of a final strategic white paper addressing technical challenges and directions for further development of smart life skills applications incorporating artificial intelligence methods.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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The primary outcome of this project was a field-tested and experimentally evaluated intelligent life skills management system enabling people with cognitive disabilities to improve their competence in daily activity management and enhance their community integration. In addition to a commercially viable desktop and handheld application, the white paper produced under Objective 5 provided source material for submission of at least three papers to refereed journals and conference presentations and for written and electronic products targeting a variety of audiences, including consumers, families, researchers, educators, and developers.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included one journal article, one proceedings, three audiovisual materials, one prototype, one netware product, one product in the marketplace, and one website. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Development of Intelligent Personal Activity Management and Prompting Applications for Individuals with Cognitive Disabilities

Technology
A1. Keating, T. (2009). Picture Planner: Icon-based personal organizer [software]. Eugene, OR: Cognitopia Software, LLC. Available: http://www.cognitopia.com/ [January 10, 2012].
  A2. Keating, T. (2006). Picture Planner: A cognitively accessible personal activity scheduling application. In S. Keates and S. Harper (Eds.), Proceedings of the 8th International Association for Computing Machinery, Special Interest Group on Accessible Computing (ACM SIGACCESS) Conference on Computers and Accessibility (pp. 239-240). Available: http://www.nationaltechcenter.org/conference2010/content/Tom_Keating/tom_keating_2.pdf [January 10, 2012].

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first output, Picture Planner (A1), is a personal organizer application designed for individuals who either have limited or no reading ability or need a simplified and graphically driven user interface. It functions as an icon-based scheduling system that assists in planning and viewing activities by individual activity, day, week, or

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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month. Icons can come from the stock library of images in Picture Planner, or the user can import pictures from any source. Picture Planner also uses synthesized speech to provide feedback and aid in accessibility. The target population for this application is individuals with significant cognitive disabilities, such as mental retardation or autism. The heterogeneity of this population, the challenge of representing complex concepts in graphical form, and the lack of standards or a universally understood icon system make the development of this sort of cognitively accessible application difficult. Despite the preponderance of visual scheduling applications, the developers believe there previously existed no similarly capable and cognitively accessible application.

In the second output, Keating (A2) describes the design elements and field test results that advanced the cognitive accessibility of the icon-driven Picture Planner. Field tests included more than 25 individuals with significant cognitive disabilities, ranging in age from 16 to 20 and with IQ and adaptive behavior scores that would place them in the moderate to mildly disabled range. Tested individuals were shown to be able to learn to use and benefit from an accessible computer-based self-management application such as Picture Planner.

Grant Title: Driving After Stroke

Grant Award Number: H133G050134

Grantee: Wayne State University

Grant Mechanism: Field Initiated Project

Grant Start and End Date: October 1, 2005, to May 31, 2009

Total Direct Cost: $330,474

Abstract: A variety of factors influence resumption of driving after stroke, only some of which accurately reflect the ability to drive safely. Although current methods can enhance accuracy in predicting fitness to drive, decisions about driving often are made independently of this information. Moreover, little research has focused on unwarranted barriers to driving or the consequences of having stopped. No study has examined the bases on which survivors make decisions about resumption of driving as it relates to objective driving fitness and community integration.

This study sampled pairs of survivors and their significant others recruited at inpatient discharge from the outpatient clinic of an urban

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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rehabilitation hospital and from the metropolitan community. Barriers to driving, driving status, and community integration were assessed 6 months poststroke. A subsample also underwent a comprehensive driving evaluation. The objectives were to identify the barriers to driving after stroke and the extent to which these barriers influence driving status (i.e., decision to drive), actual driving risk, and community integration. The long-term goal was the development of interventions that maximize independence and community integration while protecting public and survivor safety. The study of barriers to driving facilitates valid evaluation of fitness to drive and the psychoeducation of survivors and their significant others regarding decisions to resume or cease driving after stroke.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included five journal articles. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Driving After Stroke

Participation and Community Living
A1. Griffen, J.A., Rapport, L.J., Bryer, R.C., and Scott, C.A. (2009). Driving status and community integration after stroke. Topics in Stroke Rehabilitation, 16(3), 212-221.
  A2. McKay, C., Rapport, L.J., Bryer, R.C., and Casey, J. (in press). Self-evaluation of driving simulator performance after stroke. Topics in Stroke Rehabilitation 18(5), 549-561.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: Griffen et al. (A1) investigated the effects of driving cessation on community integration after stroke and assessed gender and social support as potential moderators of these effects. The authors state that most prior research had examined a single subjective outcome rather than assessing community integration as a multidimensional outcome including subjective and objective domains. The study found that driving status had a substantial influence on community integration after stroke and that social support facilitated this integration but did not buffer the effects of driving cessation. Men and women were found to resume

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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driving at equal rates, but driving cessation showed differential effects for men and women with regard to community integration, with women experiencing adverse effects that were less strong. The authors believe that these findings identify and emphasize the need for specific follow up regarding cessation of driving, especially as it relates to the risk of detrimental outcomes for quality of life, participation, and occupation.

McKay et al. (A2) examined self-awareness of driving simulator and neuropsychological performance among stroke patients compared with healthy controls. Despite the potential dangers associated with premature return to driving after stroke, very little prior research had examined the relationship between impaired self-awareness and driving. The driving simulators enabled evaluation of driving fitness in challenging situations without the risk of accident, the novel application of metacognitive self-evaluations in prediction and postdiction of performance, and insight into the impact of experience on accurate self-awareness of deficits. The study findings support the potential use of driving simulators as a useful and safe method for assessing and improving stroke survivors’ impaired self-awareness.

Grant Title: Functional Effects of Bifocal Use:
Implication for Falling Intervention

Grant Award Number: H133G050340

Grantee: University of Wisconsin–Milwaukee

Grant Mechanism: Field Initiated Project

Grant Start and End Dates: October 1, 2005, to September 30, 2009

Total Direct Cost: $320,631

Abstract: This project directed an integrated set of research activities to address a seriously underconsidered factor in falls research, the use of bifocal lenses. It focused on new users of bifocal glasses, typically individuals in their fourth or fifth decade of life, and targeted a better understanding of falls intervention strategies related to eyeglass wear. The five primary goals of the study were to (1) measure outcomes of bifocal use; (2) understand the process of adaptation to new bifocals; (3) explore brain function as a potential explanatory variable; (4) draft recommendations for clinical practice and design; and (5) disseminate scientific papers and presentations to inform research, device development, and practice. In Phase 1 of the study, researchers studied longitudinally how adaption to multifocal lenses

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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affected depth perception, edge contrast, and functional mobility. In Phase 2, researchers took functional magnetic resonance imaging (fMRI) scans of new users during adaptation. Study recommendations were articulated not only for multifocal lens wearers, but also for the producers of lenses and biomedical engineers.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included a diagnostic instrument, two technical reports, one manuscript in preparation, and four national/international presentations. The following table shows the three projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Functional Adaptation in New Wearers of Multifocal Lenses

Health and Function
A1. Smith, R.O. (no date). The DGI-M, Dynamic Gait Index-Modified [overview and protocol]. Unpublished document, Rehabilitation Research Design and Disability Center, University of Wisconsin–Milwaukee.
  A2. Smith, R.O., Tomashek, D., and Stalberger, K.J. (2010). The effects of new multifocal lens eyeglasses on contrast edge sensitivity, depth perception and functional gait for middle aged users. Unpublished manuscript, Rehabilitation Research Design and Disability Center, University of Wisconsin–Milwaukee.
B. Brain Response to Upper and Lower Lens Conditions, fMRI Analysis of Bifocal Wearers

Health and Function
B1. Smith, R.O. (no date). The upper and lower visual field depth perception performance measure [overview and protocol]. Unpublished document, Rehabilitation Research Design and Disability Center, University of Wisconsin–Milwaukee.
  B2. Vandenbush, K.J. (2009). The effect of multifocal lenses on visual attention and its interaction on motor performance. Unpublished paper, Rehabilitation Research Design and Disability Center, University of Wisconsin–Milwaukee.
Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Project/Research Domains* Outputs
C. fMRI Analysis of Bifocal Wearers

Health and Function
C1. Smith, R.O., and Tomashek, D. (2010). Failure of adaptation to multifocal lenses: Longitudinal evidence and implications on falling. Poster presented at the American Congress for Rehabilitation Medicine (ACRM) Conference, Montreal, QC Canada.
  C2. Smith, R.O. (no date). Preliminary output data from functional magnetic resonance imaging (fMRI) brain scans. Unpublished data, Rehabilitation Research Design and Disability Center, University of Wisconsin–Milwaukee.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first two outputs were produced under the project focused on functional adaptation in new wearers of multifocal lenses. The Dynamic Gait Index-Modified (DGI-M) tool (A1) is a modification of the original DGI, a well-regarded tool for measuring functional gait in older adults, used to discriminate between performance with and without wearing multifocal lens glasses. The modifications included increasing the scoring scale, adding tasks targeted to wearers of multifocal lenses, redesigning the walkway and obstacles involved in the tasks, and adding a subjective response questionnaire to gauge discomfort. According to its creators, the DGI-M improves on the original by also effectively measuring functional gait in younger (ages 40-59) participants. A technical report (A2) explores how visual and functional gait performance was affected when middle-aged users of single lens glasses transitioned to multifocal lenses. Participants used single lens glasses and had been prescribed multifocal lenses but had not worn them prior to the study. Participants were tested using the Howard-Dohlman Depth Perception apparatus, the Melbourne Edge Test, and the DGI-M. The authors found significant differences between users of single lenses and multifocal lenses in depth perception, contrast edge sensitivity, and functional gait. They concluded that the transition to multifocal lenses significantly degraded visual and functional gait performance in middle-aged adults, but did not appear to increase the risk of falling.

Under the project Brain Response to Upper and Lower Lens Conditions, fMRI Analysis of Bifocal Wearers, two technical reports were produced. The first (B1) describes how researchers developed a new three-dimensional (3-D) depth perception paradigm. The paradigm involves a set of four twocolor 3-D circles, one of which appears either closer to or farther away from the participant. Researchers also developed an apparatus to control participants’ heads in order to divide images between upper and lower lenses. Testing of the final paradigm showed significant differences for lens type

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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(single versus multifocal) and wearer group (multifocal versus nonmultifocal wearers). This measure allowed for the creation of a software-based data collection scheme that could be transferred to an fMRI. The creators believe this measure may lead to better understanding of depth perception and better intervention designs to prevent falls. The second technical report (B2) resulted from a study of differences in single lens versus multifocal lens use while users were (1) responding to targets in the upper versus lower visual field and (2) responding to targets with the presence of a visual distracter. Using both single and multifocal lenses, participants identified a circle, in either their upper or lower visual field, that was closer or farther away than other circles. At times participants made judgments while discriminating against a visual distracter. Statistical analysis of the data demonstrated significant performance differences between single and multifocal lenses. Results of this study suggest a difference in the attentional capability of single lens and multifocal lens users, which may be exacerbated by distraction.

The final two outputs were produced under the project focused on fMRI analysis of bifocal wearers. A presentation (C1) of a summary of output A1 at the 2010 annual meeting of the American Congress of Rehabilitation Medicine included background, goals, methods, results, conclusions, and implied future research directions. During the presentation, researchers highlighted the potential implications of their work for improving understanding of the relationship between use of multifocal lenses and falling for people with disabilities. The last output reviewed was a technical report (C2) resulting from an exploratory study of different attentional patterns for upper and lower visual fields in long-time users of multifocal versus nonmultifocal lenses. Using fMRI, maps of participants’ brains were created; participants then completed a nonattentional task and an attentional task. The areas of the brain activated by each task were recorded. Results indicated that the long-time multifocal lens users had different attentional patterns for upper and lower visual areas, while nonmultifocal lens users did not have different patterns.

Grant Title: Inclusive Indoor Play

Grant Award Number: H133G040324

Grantee: Tech Research Corp, Georgia Tech

Grant Mechanism: Field Initiated Project

Grant Start and End Date: August 1, 2005, to December 31, 2009

Total Direct Cost: $293,324

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Abstract:2 This study’s intent was to learn about the needs for indoor play among children with and without disabilities so universal playthings that can benefit all children can be designed. The project encompassed researching indoor play environments, developing universal design play guidelines, and designing models of play environments that are safe and accessible to all children. It included researching play and the play environment through a literature review; examining existing products, play environments, and children’s play designs; conducting focus group interviews with participants; consulting with experts; and testing full-scale simulated play environments. The second year of the project focused on the development of design concepts, construction of refined design in full scale, and testing with users. The final year of the project was dedicated to prototype construction and testing.

Research Projects and Outputs Reviewed: The pool of outputs that were developed under this grant included 13 conference proceedings articles, one journal article, three assessment tools (each consisting of rating scales for measuring different aspects of play), six technology products called “playthings,” and one play space known as a “Playscape.” The following table lists the two outputs that were reviewed by the NRC committee. These are briefly described following the table.

Project/Research Domains* Outputs
A. Inclusive Indoor Play

Participation and Community Living
A1. Endicott, S., Kar, G., and Mullick, A. (2009). Inclusive indoor play: Children at play. Human Factors and Ergonomics Society Annual Meeting Proceedings, 53(19), 1,527-1,531.
  A2. Mullick, A., and Grubbs, R. L. (2009). Inclusive indoor play: Play and playthings. Human Factors and Ergonomics Society Annual Meeting Proceedings, 53(19), 1,537-1,540.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The two outputs reviewed were both included in the 2009 Human Factors and Ergonomics Society conference proceedings. Because of their focus on able-bodied children, indoor playthings are underutilized as tools for social education of children with disabilities. The first proceedings publication (A1) identifies and analyzes five aspects of play that took place while children with and without disabilities interacted with a variety of playthings in a full-scale indoor play environment. The study was intended to provide information about the

_______________

2 This abstract was adapted from the project abstract found on http://www.naric.com [January 10, 2012].

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

needs for indoor play among children with and without disabilities. A total of 18 children participated, 15 of whom had disabilities. Results suggested that a correlation exists among independence in play, level of assistance needed, and effort required to play. Observations regarding the level of difficulty and fun experienced in playing with different things were used to determine plaything components that contribute to inclusive indoor play for children with disabilities.

The second proceedings publication (A2) summarizes the results of the focus-group interview aspect of the project. The researchers convened two focus groups to investigate inclusive indoor play and playthings. The first focus group served an exploratory role and probed inclusion in indoor play, while the second had two purposes—to learn more about inclusion in indoor play and to validate information offered by the first group. A total of 15 people participated in the two focus groups, including parents of children with and without disabilities, teachers, therapists, daycare providers, and toy designers. The results of the focus group interviews produced a comprehensive list of design and evaluation criteria for inclusive playthings.

Grant Title: Interference in Hearing Aids from Digital Wireless Telephones: Improved Predictive Methods

Grantee: Advanced Hearing Concepts

Grant Award Number: H133G050228

Grant Mechanism: Field Initiated Project

Grant Start and End Dates: November 1, 2005, to October 31, 2009

Total Direct Cost: $447,600

Abstract: Digital wireless telephones (commonly referred to as cellular phones) have opened up vast new opportunities for electronic communication that could be of substantial benefit to people with hearing loss. Unfortunately, digital cellular telephones generate electromagnetic (EM) interference in hearing aids, and many hearing aid wearers cannot use these telephones. In this study, experiments were performed to develop a basic understanding of this new form of interference and to develop ways of predicting its effects on speech perception and the usability of cellular telephones by hearing aid wearers. The results of this study not only benefit consumers in helping them select a hearing aid and/or cellular telephone but also provide industry with the basic theoretical underpinnings needed to allow for the

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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development of improved wireless telephones (and other digital wireless devices) that produce substantially less interference in hearing aids, thereby increasing the accessibility of modern digital communication systems for people with hearing loss.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included five journal articles, two industry standards, and one tutorial. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Interference in Hearing Aids from Digital Wireless Telephones: Improved Predictive Methods A1. Levitt, H. (2007). Historically, the paths of hearing aids and telephones have often intertwined. Hearing Journal, 60(11), 20-24.
   
Health and Function Supporting Materials: Levitt, H. (2007). A historical perspective on digital hearing aids: How digital technology has changed modern hearing aids. Trends in Amplification, 11(1), 7-24.
  A2. Levitt, H. (2007). American national standard methods of measurement of compatibility between wireless communications devices and hearing aids, ANSI c63.19-2007. New York: Institute of Electrical and Electronics Engineers, Inc.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first output reviewed by the NRC committee was an invited paper (A1) stemming from the Clinical Research Summit on Hearing Aids and Wireless Technology. The purpose of the summit was to identify needs for the future development of hearing aids and wireless technology. In the paper, Levitt traces the historical development and interconnectedness of hearing aids and telephones. The paper was published in a journal widely read by hearing aid engineers, telephone engineers, and audiologists, reaching its intended audience and encouraging cooperation among the three groups.

The second output is a standard method (A2) for measuring interference in a hearing aid produced by wireless communication devices such as cellular telephones. Data, methods of data analysis, and theoretical predictions

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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developed under the project were incorporated in the standard. Standard procedures are needed for these measurements to allow researchers, telephone companies, hearing aid manufacturers, and other interested groups to have a common basis for comparing experimental results and for complying with regulations of the Federal Communications Commission.

Grant Title: Motor Training and Assessment in Adults with Hemiplegic Cerebral Palsy—The ULTrA Program

Grantee: University of Michigan

Grant Award Number: H133G050151

Grant Mechanism: Field Initiated Project

Grant Start and End Dates: December 1, 2005, to November 30, 2009

Total Direct Cost: $446,964

Abstract: Although cerebral palsy (CP) is considered a nonprogressive condition, many adults with the disease experience declines in functional performance beginning as early as late adolescence. Since current understanding and treatment of motor deficits in CP have been derived almost exclusively from pediatric populations, very little is known regarding the nature of motor declines that may occur across the life span.

This project was designed to implement an 8-week Upper-Limb Training and Assessment Program (ULTrA Program) for adults with hemiplegic CP. The Motor Control Laboratory at the University of Michigan found that motor training leads to improved upper-limb coordination during functional tasks in children with hemiplegic CP. These observations, based on the notion of brain plasticity, supported the view that movement training can lead to functional improvement despite years of limited limb use. This project targeted a growing yet neglected segment of the CP community—adults. The project was home based but linked to the research laboratory through the Internet.

Prior to and following the intervention, upper-limb sensorimotor function was assessed quantitatively using established motor control techniques. Each participant received a computer-based upper-limb training unit including high-speed connectivity. A 40-minute intervention program was performed 5 days a week. During three of these training sessions, participants were assisted by a student coach via webcam Internet connection. Data were recorded and uploaded to a central website that serves as a resource for consumers and researchers in the area of mobility in CP across

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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the life span. Recruitment took place locally and from two other areas in Michigan, thereby demonstrating increased access to Internet-based motor training programs. This project addressed several future research priorities of NIDRR. By targeting older individuals with CP, it directly addressed the issue of aging with a disability. By developing an intervention program that is accessible through Internet technology, it addressed the issue of improved, cost-effective delivery of rehabilitation services and expansion of evaluation approaches. Lastly, this project combined a community-based, theory-driven model of upper-limb rehabilitation with a strong education component for consumers and pre-health professional students.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included five journal articles, two working prototypes, two newsletters, one website, one intervention protocol, and a field-tested product. The following table shows the two projects carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Assessment of Sensorimotor Function in Adults with Hemiplegic Cerebral Palsy

Health and Function
A1. Langan, J., Doyle, S.T., Hurvitz, E.A., and Brown, S.H. (2010). Influence of task on interlimb coordination in adults with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 91(10), 1,571-1,576.
  A2. Brown, S.H., Langan, J., Kern, K.L., and Hurvitz, E.A. (2010). Remote monitoring and quantification of upper limb and hand function in chronic disability conditions. In P.M. Sharkey and J. Sanchez (Eds.), Proceedings of the 8th International Conference on Disability, Virtual Reality and Associated Technologies (pp. 147-155). Available: http://www.icdvrat.org/2010/papers/ICDVRAT2010_S05_N05_Brown_etal.pdf [January 10, 2012].
B. Sensorimotor Training in Adults with Hemiplegic Cerebral Palsy

Health and Function
B1. Brown, S.H., Lewis, C.A., McCarthy, J.M., Doyle, S.T., and Hurvitz, E.A. (2010). The effects of Internet-based home training on upper limb function in adults with cerebral palsy. Neurorehabilitation Neural Repair, 24(6), 575-583.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Brief Description of the Outputs: All outputs reviewed by the NRC committee for this grant were journal articles. The first two were produced under the project aimed at assessment of sensorimotor function in adults with hemiplegic CP. Langan et al. (A1) describe changes in upper-limb reaching performance in adults with CP. They performed a quantitative study using between-group (four men with hemiplegic CP and four age-matched controls) repeated-measure analyses. The study concluded that bilateral sequential movements were more conducive to faster movement time compared with unilateral and bilateral simultaneous movement. According to the authors, this finding has implications for the development of more effective movement-based therapies and suggests training that includes bilateral sequential movements may be beneficial to adults with hemiplegic CP. Brown et al. (A2) describe the ULTrA Program, a home-based telerehablitation system designed to improve upper-limb and hand function in adults with CP. The program delivers exercise modules to the patient’s home and is able to transmit performance-related data back to the laboratory.

The third journal article (B1), produced under the Sensorimotor Training in Adults with Hemiplegic Cerebral Palsy project, describes the improvement, detected through increased movement speed and enhanced hand manipulation, achieved and monitored through the ULTrA Program. Homebased telerehabilitation programs such as ULTrA make task-based movement training more accessible to individuals with disabilities while providing clinicians with quantitative feedback via remote monitoring, which in turn facilitates adaptation of the training program throughout the intervention period. The creators believe the ability to generate and transmit quantitative measures throughout the intervention period provides an advantage over other rehabilitation approaches that rely on pre- and postintervention assessments to conduct evaluations and make changes.

Grant Title: Using the U.S. EEOC Employment Discrimination Charge Data System for Research and Dissemination

Grant Award Number: H133G040265

Grantee: Cornell University

Grant Mechanism: Field Initiated Project

Grant Start and End Dates: October 1, 2004, to September 30, 2009

Total Direct Cost: $450,000

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

Abstract: This project was designed to analyze trends in employment discrimination charges related to the Americans with Disabilities Act (ADA) and other laws, using data from the Equal Employment Opportunity Commission’s (EEOC’s) Charge Data System (CDS). The CDS collects data on employment discrimination charges covered under Title I of the ADA, as well as data on such charges related to other laws. It contains information on (1) the demographic characteristics of charging parties, such as gender, racial and ethnic status, age, location, and type of disability (e.g., back impairment, depression); (2) the type of discriminatory behavior, such as refusal to hire, failure to provide reasonable accommodation, unfair discharge, and harassment; and (3) charge outcomes, such as withdrawal with benefits and settlements. These data were used to explore trends over time and across the states and to investigate whether these trends were related to changes in the composition of the population with disabilities and in labor market conditions. Using regression analysis, the researchers explored the relationship of the ADA-related charge rates to state-level economic conditions, statistics on participation in government programs by people with disabilities, and other state-level characteristics. Also examined were changes in the composition of charges over time with respect to the characteristics of charging parties, the size and industry of employers, and the types of alleged discriminatory treatment; differences in claims between the EEOC and the Fair Employment Protection Agency (FEPA); differences in trends and types of charges between the ADA and other statutes (specifically the Age Discrimination in Employment Act [ADEA]); and, where relevant, the potential impact of Supreme Court decisions on trends in these compositional changes. To achieve a better understanding of patterns in ADA-related charges, collaboration and input were sought from the EEOC and selected disability advocacy organizations, such as selected state FEPAs; state protection and advocacy agencies; and as needed, AARP, the American Association of Persons with Disabilities, the National Disability Rights Network (formerly called the National Association of Protection and Advocacy Systems), and the law firm of Powers, Pyles, Sutter, and Verville.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included one journal article, one technical report, one chartbook, and one website. The following table shows the project carried out under this grant and lists the corresponding outputs

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Using the U.S. EEOC Employment Discrimination Charge Data System for Research and Dissemination

Employment
A1. Bjelland, M.J., Bruyère, S.M., von Schrader, S., Houtenville, A.J., Ruiz-Quantanilla, A., and Webber, D.A. (2010). Age and disability employment discrimination: Occupational rehabilitation implications. Journal of Occupational Rehabilitation, 20(4), 456-471.
  A2. von Shrader, S., Bruyère, S., and Bjelland, M. (2010). Americans with Disabilities Act (ADA) charge data chartbook. Unpublished data chartbook, Employment and Disability Institute, ILR School, Cornell University, Ithaca, NY.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: Bjelland et al. (A1) investigated the nature of employment discrimination charges that cite the ADA or ADEA individually or jointly. The authors found that employment discrimination charges originating from older or disabled workers are concentrated within a subset of issues that include reasonable accommodation, retaliation, and termination. Based on analyses of the discrimination charges filed under the ADA and ADEA, the authors discuss issues relevant to rehabilitation and human resource practitioners, including strategies for improving employment outcomes among older workers and those with disabilities and chronic health conditions as the labor force evolves to include more members of these communities.

The second output, a chartbook (A2), was the result of a request by the EEOC Office of Research, Information, and Planning for a product based on ADA charges to post on the EEOC website. The chartbook is intended to provide basic statistics on ADA charges for a wide variety of audiences that access the EEOC website.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

SMALL BUSINESS INNOVATION RESEARCH II (SBIR-II)

Grant Title: Universal Access to Passenger Rail Cars

Grant Award Number: H133S050136

Grantee: Marshall Elevator Company/LINC Design LLC

Grant Mechanism: Small Business Innovation Research II

Grant Start and End Dates: October 1, 2005, to September 30, 2009

Total Direct Cost: $499,750

Abstract: Since freight rail cars often share train tracks with passenger rail cars, differences in car width result in horizontal gaps between passenger rail cars and boarding platforms. The grantee proposed a compact device—the RailRamp—that can be retrofitted to existing rail cars or integrated into new rail car designs. The device extends out from the rail car boarding area onto the station platform to provide quick, safe, easy, and independent boarding access for all possible rail passengers. The proposed boarding device is expected to eliminate the need for rail personnel assistance for individuals with disabilities and others with extra boarding needs when boarding and exiting trains. A motorized version of this device would increase passenger independence for all train riders and personnel; the manual version would reduce personnel involvement and train delays. The design was evaluated by members of the rail transit industry. Support for this research and development effort came from industry. The project built on Phase I activities during which the feasibility of the device was demonstrated.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included two descriptive publications about the RailRamp, an Installation and User’s Guide, a powered RailRamp, the prototype and two subsequent prototype versions of the RailRamp, a patent disclosure, a manual boarding ramp device, a pamphlet, an instructional brochure, and two websites on the RailRamp. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Development of a Powered Ramp Device for Use in Commuter Rail

Technology Knowledge Translation
A1. The RailRamp: Installation and user’s guide RailRamp II version 1.0 [apparatus]. (2009). Verona, PA: LINC Design for Human Use.
  A2. van Roosmalen, L., Glogowski, F.S., Heiner, D.A., Jamison, R.S., Horvath, P.D., and Walker, S. (2010). U.S. Patent no. 7,802,337 B2. Washington, DC: U.S. Patent and Trademark Office.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The RailRamp Installation and User’s Guide (A1) describes the need for the device, explains how it works, and provides the system components and requirements. Instructions are provided for transporting the ramp, installing it, and integrating it with automated doors and exiting controls. The Guide also details operation of the ramp, including deploying and stowing it both mechanically and manually, and provides general troubleshooting instructions. Finally, the Guide describes how to maintain the ramp and provides information on the testing and certification of ramp components. The Guide was intended to be used by rail car manufacturers and railroad operators.

The second output reviewed was the RailRamp patent disclosure (A2). The inventors submitted a patent application on December 22, 2007. The patent provides an abstract, as well as 13 figures illustrating and describing the ramp from multiple perspectives, including not installed and installed and not extended and extended. Figures also show the ramp broken down into components and how the components are assembled. The text of the patent contains background information on the invention, including the need for a more effective ramp that is also compliant with the ADA and the UK Code of Practice. The patent, approved on September 28, 2010, will allow the designer to market the device and potentially improve rail car access.

Grant Title: Web-Enabled Creation and Distribution of Audio-Tactile Maps for Use in Orientation and Mobility Training

Grant Award Number: H133S060105

Grantee: Touch Graphics, Inc.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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Grant Mechanism: Small Business Innovation Research II

Grant Start and End Dates: October 1, 2006, to March 30, 2009

Total Direct Cost: $499,852

Abstract: This Small Business Innovation Research II (SBIR-II) project called for the development of a system for providing talking tactile neighborhood maps on demand for use by individuals who are blind, have low vision, or are otherwise print disabled. Files downloaded from a website are used to create raised-line maps from standard Braille embossers or by other methods. The finished maps are placed on a Talking Tactile Tablet, a computer peripheral device. The user interacts with a map by exploring it through touch sense and pressing down on streets and other features to hear names and descriptions of map entities of interest. The system, known as TMAP Reader, includes a web service for requesting maps of any location in the United States, a software application for outputting downloaded map files to a standard Braille embosser, an application that facilitates user interaction with the maps, and a map production and delivery service for unsophisticated users or users without access to equipment for outputting maps. Two stages of user testing were carried out to evaluate the efficacy of the planned system in orientation and mobility training.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included three technical reports, one survey, one piece of software, one website, and two automated systems. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×
Project/Research Domains* Outputs
A. Usability Testing of the TMAP Reader System with up to 100 Current Users of the Talking Tactile Tablet in Geographically Diverse Settings

Technology
A1. Miele, J.A., Landau, S., and Gilden, D. (2006). Talking TMAP: Automated generation of audio tactile maps using Smith-Kettlewell’s TMAP software. The British Journal of Visual Impairment, 24(2), 93-100.
  A2. Landau, S. (Producer). Touchgraphicresources [video for TMAP software]. New York: Touch Graphics Inc. Available: https://sites.google.com/site/touchgraphicsresources/ [January 10, 2012].

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The TMAP software (A1) creates dynamic, interactive maps that are accessible to users with disabilities. The software works on the Talking Tactile Tablet, also developed by Touch Graphics, Inc. The tactile maps used through TMAP are intended to be explored by either touch or vision. When a user presses down on a map element, the name of the element is spoken aloud. According to the designer, the audiotactile display used by TMAP is a significant improvement over previous attempts at tactile cartography and allows for much greater exploration and customization of the maps.

The TMAP production service (A2) is an automated system available through the Touch Graphics website that can generate multisensory maps of any neighborhood in the United States and Canada for use with the TMAP software. The service is very easy to use and delivers maps in only a few days. According to the designer, the production service represents one of the most sophisticated examples of tactile graphics production currently on the market.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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SWITZER FELLOWSHIPS

Grant Title: A Noninvasive Surface Electromyogram Decomposition Method and Its Application in Disability Rehabilitation

Grant Award Number: H133F070022

Grant Mechanism: Switzer Fellowship

Grant Start and End Dates: October 1, 2007, to January 15, 2009

Total Direct Cost: $75,000

Abstract3: This study developed surface electromyogram (EMG) decomposition methods suitable for relatively low muscle contraction levels to replace and/or supplement traditionally used indwelling needle electrode-based decomposition approaches. Results benefit the rehabilitation community and a large population of patients by reducing pain, emotional tension, and risk of infection during EMG examination.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from the pool of outputs they had produced under the grant. These outputs included one journal article and one intervention. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. A Noninvasive Surface Electromyogram Decomposition Method and Its Application in Disability Rehabilitation

Health and Function
A1. Zhou, P., Suresh, N.L., Lowery, M.M., and Rymer, W.Z. (2009). Nonlinear spatial filtering of multichannel surface electromyogram signals during low-force contractions. IEEE Transactions on Bio-medical Engineering, 56(7), 1,871-1,879.
  A2. Zhou, P. (2009). Selective surface electrode arrays [design of surface electrode array]. Chicago, IL: Rehabilitation Institute of Chicago, Northwestern University.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

_______________

3 This abstract was adapted from the project abstract found on http://ww.naric.com [January 10, 2012].

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
×

Brief Description of the Outputs: Zhou et al. (A1) introduce the use of nonlinear spatial filters to identify single motor unit discharge from multiple channel surface EMG signals during low force contractions. Previously, invasive percutaneous intramuscular EMG recordings were used routinely to selectively record single motor unit activity. Such invasive recordings can be inconvenient, can induce pain, and carry the risk of damage to muscle tissue and nerves. This article investigates the advantages of a novel nonlinear spatial filtering method for enhancing surface motor unit action potentials using noninvasive surface EMG recordings. Previous methods relied on linear methods for filtering. The authors demonstrate that nonlinear spatial filtering achieves better results for single-motor unit detection during low force contractions.

The second output reviewed was a one- and two-dimensional surface electrode array (A2) developed for noninvasive motor unit activity recording. The design allows for the extraction of single motor unit information using surface EMG and the appropriate signal processing methods described in output A1. A study using these arrays won the “Best Clinical Research” award at the XVIIIth Congress of the International Society of Kinesiology and Electrophysiology in 2010.

Grant Title: Demographic Soup: Disentangling the Conceptual, Political, and Methodological Dimensions of Disability Statistics

Grant Award Number: H133F060011

Grant Mechanism: Switzer Fellowship

Grant Start and End Dates: December 1, 2006, to November 30, 2009

Total Direct Cost: $75,000

Abstract: Wide variations exist in disability research, including how disability is defined and how information on the various definitions is obtained and converted into usable data. This project compiled in one document (a book manuscript) the accumulated knowledge on defining and measuring disability in survey and census contexts. By incorporating several methodologies— including historical review; analysis of political processes and decision making; and comprehensive examination of the source, placement, and evaluation of disability measures currently in use—this book manuscript contributes to the improvement of disability statistics and serves as a reference for understanding the data that exist. The manuscript is divided into five sections: (1) examination of the political and historical

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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context, which includes chapters on the history of disability measurement; (2) examination of the conceptualization and definition of disability, including chapters on the political definitions for programmatic purposes and theoretical definitions and models; (3) examination of the science and purpose of and relationships among the components of measurement and the special problems of measurement in specific populations (children, the elderly); (4) reviews of samples of research analyses focused on the use of data, including data sources and research questions, with special focus on measures used in specific areas of research (i.e., aging and employment); and (5) exploration of international measurement of disability and the role of the United States in its development. Recommendations for improving and standardizing the measurement and data collection process are offered.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among the larger pool of outputs they had produced under the grant. This larger pool of outputs included one journal article, one technical report, one book chapter, and one set of presentations. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Demographic Soup: Disentangling the Conceptual, Political, and Methodological Dimensions of Disability Statistics

Demographics Knowledge Translation
A1. Altman, B., and Bernstein, A. (2008). Disability and health in the United States, 2001-2005. Hyattsville, MD: National Center for Health Statistics. Available: http://www.cdc.gov/nchs/data/misc/disability2001-2005.pdf [January 24, 2012].
  A2. Altman, B. (2009). Population survey measures of functioning: Strengths and weaknesses. In National Research Council, Improving the measurement of late-life disability in population surveys: Beyond ADLs and IADLs: Summary of a workshop. Washington, DC: The National Academies Press. Available: http://www.nap.edu/openbook.php?record_id=12740&page=99 [January 24, 2012].

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: The first output reviewed by the NRC committee was a chartbook (A1) compiled using data from the National Health Interview Survey (NHIS) in an attempt to begin to uncover what the data represent and what they reveal about health care for persons with

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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disabilities. To this end, the first part of the chartbook interprets current disability definitional approaches and translates them into measures that are available in the NHIS. The rest of the chartbook uses those measures to examine the health care experience of persons with disabilities.

The second output reviewed was a paper entitled “Population Survey Measures of Functioning: Strengths and Weaknesses” (A2). The paper was presented as the Invited Plenary Presentation at an NRC workshop and was then published as an appendix to the NRC workshop summary, Improving the Measurement of Late-Life Disability in Population Surveys: Beyond ADLs and IADLs. The paper addresses the measurement process and the components of measurements and breaks the process down into steps one should consider when measuring or choosing measurements that are already constructed.

Grant Title: Physical and Social Environmental Factors That Influence Health and Participation Outcomes for Chronically Ill Adults

Grant Award Number: H133F080014

Grant Mechanism: Switzer Fellowship

Grant Start and End Dates: July 1, 2008, to June 30, 2009

Total Direct Cost: $65,000

Abstract: This project explored the factors in health and participation outcomes among older adults with chronic conditions who are living in the community with or without disabilities, considering individual factors such as informal, formal, and societal supports. The research had three objectives: (1) determining the direct and indirect effects of a community’s social capital on health and participation outcomes; (2) identifying the relationship between health and participation outcomes and measures of the neighborhood; and (3) assessing the relationship between the subjective measure of perceived social capital and the objective measures of the neighborhood for their collective influence on the health and community participation of older adults with and without disabilities. The project included research aimed at improving community practice, policy, and the health system in order to assist adults in achieving independence, greater participation, and social involvement.

Research Projects and Outputs Reviewed: Grantees were asked to nominate two outputs from each of their projects for review by the committee. These

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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outputs were identified by the study’s key personnel as those that would best reflect their grant’s achievements. Grantees selected the outputs to be reviewed from among outputs they had produced under the grant. These outputs included one manuscript and one abstract. The following table shows the project carried out under this grant and lists the corresponding outputs that were nominated by the grantees and reviewed by the NRC committee. The reviewed outputs are briefly described following the table.

Project/Research Domains* Outputs
A. Physical and Social Environmental Factors That Influence Health and Participation Outcomes for Chronically Ill Older Adults

Participation and Community Living
A1. Prvu Bettger, J A. (2009, November). System of support and services and the relationship with hospital utilization. Paper presented orally at the 137th American Public Health Association Annual Meeting, Gerontological Health Section, Philadelphia, PA.
  A2. Prvu Bettger, J.A. (2010, February). What aspects of the social environment are associated with physical activity post-stroke? Paper presented at International Stroke Conference, San Antonio, TX.

*The column also shows the key NIDRR research domain(s) that were being addressed by each project.

Brief Description of the Outputs: Prvu Bettger (A1) explored the relationship between hospital utilization and each level of social support and environment. The study assessed hospital utilization among 2,286 nonworking adults aged 60 or older reporting at least one chronic condition or condition requiring regular medical treatment in the 2006 Southeastern Pennsylvania Household Health Survey. Several person-level factors were found to be strongly associated with hospital utilization, such as older age, low income, poor-to-fair perception of health, and use of an assistive device. Social environment factors found to be significantly associated with hospital utilization were receipt of formal care, receipt of meal services, and absence of a regular source of care. Findings highlight the relationship between specific social supports and services and hospital utilization, but further investigation into the interaction between social factors and hospital utilization is needed.

The second output was an abstract (A2) presented at the International Stroke Conference 2010. It describes a study of stroke survivors’ activity and factors that prevent them from being physically active. Prvu Bettger analyzed the responses of 214 stroke survivors who participated in the 2004 Southeastern Pennsylvania Household Health Survey. Absence of depression, good-to-excellent health status, community participation, and use of transportation services were positively correlated with physical activity. Findings highlight the need for social environmental supports to facilitate physical activity poststroke and for greater attention to environmental influences on health behavior in health promotion research and practice.

Suggested Citation:"Appendix A: Grant Summaries." National Research Council. 2012. Review of Disability and Rehabilitation Research: NIDRR Grantmaking Processes and Products. Washington, DC: The National Academies Press. doi: 10.17226/13285.
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The National Institute on Disability and Rehabilitation Research (NIDRR) is the principal federal agency supporting applied research, training, and development to improve the lives of individuals with disabilities. NIDRR's mission is to generate new knowledge and promote its effective use in improving the ability of persons with disabilities to perform activities of their choice in the community, as well as to expand society's capacity to provide full opportunities and accommodations for its citizens with disabilities.

NIDRR prides itself on being proactive in establishing program performance measures and developing accountability data systems to track the progress of its grantees. An electronic annual reporting system is used to collect data from grantees on many aspects of grant operation and outputs. Various formative and summative evaluation approaches have been used to assess the quality of the performance and results of the agency's research portfolio and its grantees. Prompted by the need to provide more data on its program results, in 2009 NIDRR requested that the National Research Council (NRC) conduct an external evaluation of some of the agency's key processes and assess the quality of outputs produced by NIDRR grantees (National Institute on Disability and Rehabilitation Research, 2009a). Review of Disability and Rehabilitation Research presents the results of that evaluation.

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