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.



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Appendix A Grant Summaries This appendix contains individual summaries of the 30 grants that par- ticipated 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 descrip- tion 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 in- cluded in the evaluation and identifies the page in this appendix where the grant’s summary can be found. 207

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208 REVIEW OF DISABILITY AND REHABILITATION RESEARCH Funding Mechanism/Grant Page Number BURN MODEL SYSTEM (BMS) 210 Grant Title: Burn Model System/Data Coordinating Center 210 Grant Title: North Texas Burn Rehabilitation Model System 214 TRAUMATIC BRAIN INJURY MODEL SYSTEM (TBIMS) 218 Grant Title: Mayo Clinic TBI Model System 218 Grant Title: Spaulding/Partners Traumatic Brain Injury Model System at Harvard Medical School 221 SPINAL CORD INJURY MODEL SYSTEM (SCIMS) 226 Grant Title: Northern New Jersey Spinal Cord Injury System 226 Grant Title: The Missouri Model Spinal Cord Injury System 230 REHABILITATION RESEARCH AND TRAINING CENTER (RRTC) 233 Grant Title: Meeting the Nation’s Needs for Personal Assistance Services: Center for Personal Assistance Services 233 Grant Title: RRTC on Disability Demographics and Statistics 237 Grant Title: RRTC on SCI: Promoting Health and Preventing Complications Through Exercise 242 REHABILITATION ENGINEERING RESEARCH CENTER (RERC) 248 Grant Title: RERC on Telerehabilitation 248 Grant Title: RERC on Universal Interface and Information Technology Access 253 DISABILITY AND REHABILITATION RESEARCH PROJECT- GENERAL (DRRP) 261 Grant Title: The Effect of Scheduled Telephone Intervention on Outcomes After TBI 261 Grant Title: Asset Accumulation and Tax Policy Project 263 Grant Title: Medicaid Quality Indicators for Individuals with Disabilities 268 Grant Title: Persons Aging with Hearing and Vision Loss 271 FIELD INITIATED PROJECT (FIP) 275 Grant Title: Efficacy of Pressure Garment Therapy After Burns 275 Grant Title: A Longitudinal Study for Hospitalization, Pressure Ulcers, and Subsequent Injuries After Spinal Cord Injuries 276 Grant Title: Black-White Disparities in Stroke Rehabilitation 278 Grant Title: Development of Intelligent Personal Activity Management and Prompting Applications for Individuals with Cognitive Disabilities 280 Grant Title: Driving After Stroke 282 Grant Title: Functional Effects of Bifocal Use: Implication for Falling Intervention 284 Grant Title: Inclusive Indoor Play 287

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209 APPENDIX A Grant Title: Interference in Hearing Aids from Digital Wireless Telephones: Improved Predictive Methods 289 Grant Title: Motor Training and Assessment in Adults with Hemiplegic Cerebral Palsy—The ULTrA Program 291 Grant Title: Using the U.S. EEOC Employment Discrimination Charge Data System for Research and Dissemination 293 SMALL BUSINESS INNOVATION RESEARCH II (SBIR-II) 296 Grant Title: Universal Access to Passenger Rail Cars 296 Grant Title: Web-Enabled Creation and Distribution of Audio-Tactile Maps for Use in Orientation and Mobility Training 297 SWITZER FELLOWSHIPS 300 Grant Title: A Noninvasive Surface Electromyogram Decomposition Method and Its Application in Disability Rehabilitation 300 Grant Title: Demographic Soup: Disentangling the Conceptual, Political, and Methodological Dimensions of Disability Statistics 301 Grant Title: Physical and Social Environmental Factors That Influence Health and Participation Outcomes for Chronically Ill Adults 303

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210 REVIEW OF DISABILITY AND REHABILITATION RESEARCH 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 Clini- cal 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 pa- tient 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 dis- semination. 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 correspond- ing 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.

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211 APPENDIX A (Note that because this grant was for a coordinating center, it was not orga- nized 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 A1. Lezotte, D.C. (2008). Model system for burn injury BMS Database rehabilitation national database data dictionary (16) [Data code listing]. Denver: Colorado School of Public Health, University of Colorado Denver. Health and Function Employment Lezotte, D.C. (2004). Model system for burn injury Participation and Community Living 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 B1. Lezotte, D.C., and Sloan, R. (2004). Process review of Support Systems level I data center activities for burn model system/clinical sites. Unpublished report, Department of Biostatistics and Informatics, University of Colorado, Denver. Health and Function 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.

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212 REVIEW OF DISABILITY AND REHABILITATION RESEARCH Project/Research Domains* Outputs B. Develop and Implement B6. Lezotte, D.C. (2011). BMS publications with DCC Support Systems PI support. Unpublished list of publications, Department of Biostatistics and Informatics, University of Colorado, Denver. Health and Function C. Implement a C1. Lezotte, D.C. (No date). Public and secured BMS Dissemination Strategy for website for consumer information. Available: http://bms- BMS dcc.ucdenver.edu/ [January 9, 2012]. C2. Kaufman, M.S., Graham, C.C., Lezotte, D.C., Health and Function Fauerbach, J.A., Gabriel, V., Engrav, L.H., and Esselman, Employment P. (2007). Burns as a result of assault: Associated risk Knowledge Translation 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 devel- oping 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 manage- ment 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 impor- tant 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

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213 APPENDIX A 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 insig- nificant 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 representa- tive sample, and results using Burn Model System data should be generaliz- able. 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, clini- cians 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 ac- curately 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 in- cludes 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 out- puts 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 con- tact 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

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214 REVIEW OF DISABILITY AND REHABILITATION RESEARCH substance abuse, larger burns, greater mortality rates, and greater psycho- logical 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 Determi- nants 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 dissemina- tion. 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 fol- lowing 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 follow- ing the table.

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215 APPENDIX A Project/Research Domains* Outputs A. Barriers to Return to A1. Esselman, P.C., Askay, S.W., Carrougher, G.J., Work After Major Burn Lezotte, D.C., Holavanahalli, R.K., Magyar-Russell, G., Injury—Collaborative 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. Employment B. Long-Term Outcome of Major B1. Kowalske, K.J. (2003, September). The challenge Burn Injuries of burn care: How to maximize outcomes—A seminar. Seminar conducted at University of Texas Southwestern Medical Center at Dallas. Health and Function 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 C1. Schneider, J.C., Holavanahalli, R.K., Helm, P.A., Deep Full-Thickness Hand O’Neil, C., Goldstein, R., and Kowalske, K. (2008). Burns—Collaborative Contractures in burn injury part II: Investigating joints of the hand. Journal of Burn Care & Research, 29(4), 606-613. Health and Function 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: D1. Gabriel, V., Kowalske, K.J., and Holavanahalli, Evolution over Time R.K. (2009). Assessment of recovery from burn-related neuropathy by electrodiagnostic testing. Journal of Burn Care & Research, 30(4), 668-674. Health and Function E. The Socioeconomic E1. East Texas Medical Center (ETMC) Outreach Satellite Determinants of Disability in Clinic. Described to committee in grantee questionnaire. Individuals with Major Burn E2. Holavanahalli, R., Lara, C., Tollar, A., Stevens, C., Injury Crump, D., Ellsworth, B., and Leal, D. (2006, 2008, 2009). SOAR Annual Report. Unpublished report, Participation and Department of Physical Medicine and Rehabilitation, Community Living University of Texas Southwestern Medical Center at Dallas and Parkland Regional Burn Center, Parkland Health and Hospital System Dallas. F. Contribution to a Longitudinal F1. Holavanahalli, R.K., Lezotte, D.C., Hayes, M.P., National Database 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 Demographics 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.

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216 REVIEW OF DISABILITY AND REHABILITATION RESEARCH Brief Description of the Outputs: Under the first project, a journal article was produced addressing barriers to return to work after major burn in- jury. 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, psycho- logical, 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 reha- bilitation 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 prob- lem 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 out- comes following deep full thickness hand burns. The first was a journal article (C1) based on a study of the incidence and severity of hand contrac- tures 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 per- formance 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

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217 APPENDIX A 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 par- ticipants 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 in- dividuals 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 stud- ies 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 contribu- tions 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.

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294 REVIEW OF DISABILITY AND REHABILITATION RESEARCH Abstract: This project was designed to analyze trends in employment dis- crimination charges related to the Americans with Disabilities Act (ADA) and other laws, using data from the Equal Employment Opportunity Com- mission’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 exam- ined 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 se- lected 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 tech- nical report, one chartbook, and one website. The following table shows the project carried out under this grant and lists the corresponding outputs

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295 APPENDIX A 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 A1. Bjelland, M.J., Bruyère, S.M., von Schrader, S., Employment Discrimination Houtenville, A.J., Ruiz-Quantanilla, A., and Webber, D.A. Charge Data System for Research (2010). Age and disability employment discrimination: and Dissemination Occupational rehabilitation implications. Journal of Occupational Rehabilitation, 20(4), 456-471. Employment 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 na- ture 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 employ- ment 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.

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296 REVIEW OF DISABILITY AND REHABILITATION RESEARCH 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 pas- senger 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 pro- posed 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 nomi- nate 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

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297 APPENDIX A reviewed by the NRC committee. The reviewed outputs are briefly de- scribed following the table. Project/Research Domains* Outputs A. Development of a Powered A1. The RailRamp: Installation and user’s guide Ramp Device for Use in RailRamp II version 1.0 [apparatus]. (2009). Verona, PA: Commuter Rail LINC Design for Human Use. A2. van Roosmalen, L., Glogowski, F.S., Heiner, D.A., Technology Jamison, R.S., Horvath, P.D., and Walker, S. (2010). U.S. Knowledge Translation 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 provid- ed 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.

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298 REVIEW OF DISABILITY AND REHABILITATION RESEARCH 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 meth- ods. 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 unsophisti- cated 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 follow- ing the table.

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299 APPENDIX A Project/Research Domains* Outputs A. Usability Testing of the TMAP A1. Miele, J.A., Landau, S., and Gilden, D. (2006). Reader System with up to 100 Talking TMAP: Automated generation of audio tactile Current Users of the Talking maps using Smith-Kettlewell’s TMAP software. The Tactile Tablet in Geographically British Journal of Visual Impairment, 24(2), 93-100. Diverse Settings A2. Landau, S. (Producer). Touchgraphicresources [video for TMAP software]. New York: Touch Technology 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 audio- tactile 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.

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300 REVIEW OF DISABILITY AND REHABILITATION RESEARCH 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) decomposi- tion methods suitable for relatively low muscle contraction levels to replace and/or supplement traditionally used indwelling needle electrode-based de- composition 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 correspond- ing 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 A1. Zhou, P., Suresh, N.L., Lowery, M.M., and Rymer, Surface Electromyogram W.Z. (2009). Nonlinear spatial filtering of multichannel Decomposition Method and surface electromyogram signals during low-force Its Application in Disability contractions. IEEE Transactions on Bio-medical Rehabilitation Engineering, 56(7), 1,871-1,879. A2. Zhou, P. (2009). Selective surface electrode Health and Function 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 T his abstract was adapted from the project abstract found on http://ww.naric.com [January 10, 2012].

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301 APPENDIX A 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, in- vasive 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 tis- sue 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 record- ing. 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 dis- ability 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 meth- odologies—including historical review; analysis of political processes and decision making; and comprehensive examination of the source, place- ment, 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

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302 REVIEW OF DISABILITY AND REHABILITATION RESEARCH context, which includes chapters on the history of disability measurement; (2) examination of the conceptualization and definition of disability, in- cluding 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 tech- nical report, one book chapter, and one set of presentations. The following table shows the project carried out under this grant and lists the correspond- ing 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: A1. Altman, B., and Bernstein, A. (2008). Disability and Disentangling the Conceptual, health in the United States, 2001-2005. Hyattsville, MD: Political, and Methodological National Center for Health Statistics. Available: http:// Dimensions of Disability www.cdc.gov/nchs/data/misc/disability2001-2005.pdf Statistics [January 24, 2012]. A2. Altman, B. (2009). Population survey measures Demographics of functioning: Strengths and weaknesses. In National Knowledge Translation 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

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303 APPENDIX A 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 out- comes 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 objec- tives: (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 neighbor- hood; 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

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304 REVIEW OF DISABILITY AND REHABILITATION RESEARCH 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 A1. Prvu Bettger, J A. (2009, November). System Environmental Factors of support and services and the relationship with That Influence Health and hospital utilization. Paper presented orally at the 137th Participation Outcomes for American Public Health Association Annual Meeting, Chronically Ill Older Adults Gerontological Health Section, Philadelphia, PA. A2. Prvu Bettger, J.A. (2010, February). What aspects Participation and of the social environment are associated with physical Community Living 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 relation- ship between hospital utilization and each level of social support and envi- ronment. 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 envi- ronment 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 depres- sion, 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 influ- ences on health behavior in health promotion research and practice.