Cognitive disabilities affect more than 15 million people in the United States today (Kraus & Lewis, 2017). The national percentage of people with cognitive disabilities increases with age, starting at 4.2% for those ages 5-17, rising to 4.5% for those 18-64, and almost doubling to 8.9% for those aged 65 and over (Kraus, Lauer, Coleman, and Houtenville, 2018). The term cognitive disabilities describes a range of symptoms and conditions that are associated with impaired intellectual functions and abilities such as learning, memorizing, information processing, problem solving, communication, and a reduced ability to adapt to environmental demands due to orientation deficits, and problems with recognizing and responding to social cues. The underlying individual level conditions leading to cognitive disabilities are manifold and include prenatal events, genetic anomalies, acquired brain injuries, stroke, Alzheimer's disease, and severe mental illness (Bodine, 2005). Overall, the number of Americans with cognitive disabilities is growing (Alzheimer’s Association, 2018; Centers for Disease Control and Prevention, 2015).
The increasing number of Americans with conditions that lead to cognitive disabilities presents a number of pressing challenges. Chief among these will be the need to promote and sustain independence and community living, and to find community-based approaches to delivering the services and supports people need to remain as independent and engaged in their communities as possible.
Given the projected growth in the number of Americans with cognitive disabilities (Alzheimer’s Association, 2018; Centers for Disease Control and Prevention, 2015), the U.S. has a substantial financial and social interest in developing technologies that enhance independence and community living and can reduce the reliance on traditional long term services and supports (LTSS) (Commission on LTC, 2013). Particularly, in the area of support for persons with cognitive disabilities, there is substantial potential for technologies to provide assistance that otherwise would need to be provided by human support providers (Lauraitis, Maskeliunas, Damasevicius, Polap, and Wozniak, 2019; Beckerle, Kõiva, Kirchner, Bekrater-Bodmann, Dosen, et. al, 2018; Wang, Mahajan, Toto, McCue, and Ding, 2018; Gillespie, Best, and O’ Neill, 2012).
Technology-based alternatives to direct services and supports to promote independence and community living for people with cognitive disabilities include assistive and smart technologies to provide cueing prompting, or coaching. Such technologies also include home and community monitoring systems, community wayfinding applications for hand-held devices, socially assistive robotics, smart environments, workplace supports, computer and Web-based teaching programs, tele-supports, technology-based care, service coordination systems, and many other applications of existing technologies (IOM, 2013; LeadingAge CAST, 2011; NCD, 2011; NASEM, 2017).
Advances in science and engineering and the increased availability of new and emerging technologies, applications of existing technologies to new circumstances, and ever-improving information technology infrastructures offer promise in responding to the challenges of assisting the increasing number of people with cognitive disabilities to enhance independence and community living (IOM, 2013). Technology-based alternatives represent substantial opportunities to support independence and quality of life for people with cognitive disabilities in ways that are both liberating and cost-effective and that advance the widely endorsed goal of improving or maintaining community living for people with disabilities and older adults (U.S. DHHS Community Living Initiative, 2010).
Alzheimer’s Association. (2018). Alzheimer’s disease facts and figures. Journal of Alzheimer's & Dementia; 14 (3): 367-429.
Beckerle, P., Kõiva, R., Kirchner, E.A., Bekrater-Bodmann, R., Dosen, S., Christ, O., Abbink, D.A., Castellini, C., and Lenggenhager, B. (2018). Feel-good robotics: Requirements on touch for embodiment in assistive robotics. Frontiers in Neurorobotics. Dec 11; 12-84.
Bodine, C. (2005). Cognitive disability, information technology systems and the workplace, Accessibility and Computing, 83, 25-29.
Centers for Disease Control and Prevention. (2015). Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA.
Commission on Long-Term Care: Report to Congress. (September 30, 2013). Final Report http://www.chhs.ca.gov/OLMDOC/Agenda%20Item%206-%20Commission%20on%20Lo….
Gillespie, A., Best, C., and O’ Neill, B. (2012). Cognitive function and assistive technology for cognition: A systematic review. Journal of the International Neuropsychological Society; 18 (1); 1-19.
IOM (Institute of Medicine). (2013). Fostering Independence, participation, and healthy aging through technology: workshop summary. Washington. DC. The National Academies (Free access available at: http://books.nap.edu/openbook.php?record_id=18332).
Kraus, Lewis. (2017). 2016 Disability Statistics Annual Report. Durham, NH: University of New Hampshire.
Kraus, L., Lauer, E., Coleman, R., and Houtenville, A. (2018). 2017 Disability Statistics Annual Report. Durham, NH: University of New Hampshire.
Lauraitis, A., Maskeliunas, R., Damasevicius, R., Polap, D., and Wozniak, M. (2019). A smartphone application for automated decision support in cognitive task based evaluation of central nervous system motor disorders. IEEE Journal of Biomedical and Health Informatics; Jan 9.
LeadingAge CAST. (2011). Preparing for the future: Developing technology-enabled long-term services and supports for a new population of older adults. Washington, DC: LeadingAge (www.leadingage.org/uploadedFiles/Content/About/CAST/Resources/Preparing…).
National Academies of Sciences, Engineering, and Medicine. (2017). The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington,DC: The National Academies Press. https://doi.org/10.17226/24740.
NCD (National Council on Disability). (2011). The power of digital inclusion: Technology’s impact on employment and opportunities for people with disabilities (www.ncd.gov/publications/2011/Oct042011).
U.S. Department of Health and Human Services (DHHS). Community Living Initiative. (May 20, 2010). Centers for Medicare & Medicaid (http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD10…).
Wang, J., Mahajan, H.P., Toto, P.E., McCue, M.P., and Ding, D. (2018). The feasibility of an automatic prompting system in assisting people with traumatic brain injury in cooking tasks. Disability and Rehabilitation: Assistive Technology; Oct 14: 1-9.
The Administrator of the Administration for Community Living (ACL) establishes a priority for a Rehabilitation Engineering Research Center (RERC) on Technologies to Enhance Independence and Community Living for People with Cognitive Disabilities. This RERC must focus on innovative technological solutions, new knowledge, and implementation strategies that enhance the self-management, independence, community living, and quality of life of people with cognitive disabilities. Under this priority, the RERC must research, develop, and evaluate new technologies, or adapt and evaluate existing technologies, to enhance the ability of people with cognitive disabilities to perform daily activities of their choice in the home, community, or workplace. The RERC must be designed to improve outcomes of people with cognitive disabilities in the following outcome domain: community living and participation.
Research and development topics under this priority may include, but are not limited to: robotics and automation technologies; monitoring and prompting technologies or other information or communication aids; assistive technologies, including socially assistive robotics; mobile and wearable technologies; virtual reality; and care coordination or tele-health, tele-rehabilitation and other tele-support systems to facilitate improved independence and community living outcomes of people with cognitive disabilities. However, we do not give an application that addresses these topics a preference over other applications.
Applicants under the priority in this notice are required to specify in their proposal the following:
1) The target population or populations of people with cognitive disabilities.
2) The methods or approaches used to gather input from the target population to shape the proposed research and development activities.
3) The research to be conducted and the new knowledge that will be generated.
4) The development activities to be conducted and the means of testing and evaluating the products to be produced.
5) How the research and development activities will improve the independence, community living, and quality of life outcomes of people with disabilities.
Requirements applicable to RERC priorities:
As a national center, the RERC must conduct high quality research, development, technical assistance, capacity building, knowledge translation, and dissemination activities that address significant needs, promote independence, and improve the quality of life and community living outcomes of people with disabilities. In order to optimize benefits to people with disabilities, the RERC must ascertain efficacy and safety of proposed strategies, technologies, or interventions, and collaborate with appropriate entities to facilitate the transfer and adoption of development products. The RERC must follow and understand emerging technologies, and communicate to NIDILRR, ACL, and other appropriate stakeholders about the potential opportunities and drawbacks associated with these technologies.
A RERC established under the priority in this notice must be designed to contribute to the following outcomes:
Increased technical and scientific knowledge relevant to its designated priority research area. The RERC must contribute to this outcome by conducting high-quality, rigorous research projects. When applicable, the RERC must utilize engineering knowledge and techniques to collect, analyze and/or synthesize research data.
Increased innovation in technologies, products, environments, performance guidelines, or monitoring and assessment tools applicable to its designated priority research area. The RERC must contribute to this outcome through the development and testing of these innovations. When applicable, the RERC must apply engineering knowledge and techniques to achieve development objectives.
Improved research capacity in its designated priority research area. The RERC must contribute to this outcome by collaborating with the relevant industry, professional associations, and institutions of higher education, health care providers, or educators, as appropriate, to train research and development professionals in its designated priority research area.
Improved usability and accessibility of products and environments in the RERC’s designated priority research area. The RERC must contribute to this outcome by emphasizing the principles of universal design in its product research and development. For purposes of this section, the term “universal design” refers to the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.
Improved awareness and understanding of cutting edge developments in technologies within its designated priority research area. The RERC must contribute to this outcome by identifying and communicating with NIDILRR, people with disabilities and their representatives, disability organizations, service providers, professional journals, manufacturers, and other interested parties regarding trends and evolving product concepts related to its designated priority research area.
Increased impact of research and development in the designated priority research area. The RERC must contribute to this outcome by providing technical assistance to relevant public and private organizations, people with disabilities, employers, and schools on policies, guidelines, and standards related to its designated priority research area.
Increased transfer of RERC-developed technologies to the marketplace. The RERC must contribute to this outcome by developing and implementing a plan for ensuring that all technologies developed by the RERC are made available to the public. The technology transfer plan must be developed in the first year of the project period in consultation with the NIDILRR-funded Initiative to Mobilize Partnerships for Successful Assistive Technology Transfer (Impact Center).
In addition, a RERC established under the priority must--
Have the capability to design, build, and test prototype devices and assist in the technology transfer and knowledge translation of successful solutions to relevant production and service delivery settings;
Evaluate the efficacy and safety of its new products, instrumentation, or assistive devices;
Provide as part of its proposal, and then implement, a plan that describes how it will include, as appropriate, people with disabilities or their representatives in all phases of its activities, including research, development, training, dissemination, and evaluation;
Provide as part of its proposal a plan to disseminate its research results to people with disabilities and their representatives, disability organizations, service providers, professional journals, manufacturers, and other interested parties. If funded, the RERC must consult with the Center on Knowledge Translation for Disability and Rehabilitation Research and other relevant NIDILRR-sponsored KT Centers to implement this dissemination plan;
Conduct a state-of-the-science conference on its designated priority research area in the fourth year of the project period, and publish a comprehensive report on the final outcomes of the conference in the fifth year of the project period; and
Coordinate research projects of mutual interest with relevant NIDILRR-funded projects, as identified through consultation with the NIDILRR project officer.
Specify the stage or stages of proposed research projects. If the applicant proposes to conduct research that can be categorized under more than one stage, including research that progresses from one stage to another, those stages must be clearly specified. These stages, exploration and discovery, intervention development, intervention efficacy, and scale-up evaluation, are defined in this section of the funding opportunity announcement.
Specify the stage or stages of development of the development projects that they are proposing. If the applicant proposes to conduct development that can be categorized under more than one stage, those stages must be clearly specified. These stages, proof of concept, proof of product, and proof of adoption are defined in this section of the funding opportunity announcement.
Definitions - Stages of Research:
Exploration and discovery means the stage of research that generates hypotheses or theories through new and refined analyses of data, producing observational findings and creating other sources of research-based information. This research stage may include identifying or describing the barriers to and facilitators of improved outcomes of people with disabilities, as well as identifying or describing existing practices, programs, or policies that are associated with important aspects of the lives of people with disabilities. Results achieved under this stage of research may inform the development of interventions or lead to evaluations of interventions or policies. The results of the exploration and discovery stage of research may also be used to inform decisions or priorities.
Intervention development means the stage of research that focuses on generating and testing interventions that have the potential to improve outcomes for people with disabilities. Intervention development involves determining the active components of possible interventions, developing measures that would be required to illustrate outcomes, specifying target populations, conducting field tests, and assessing the feasibility of conducting a well-designed intervention study. Results from this stage of research may be used to inform the design of a study to test the efficacy of an intervention.
Intervention efficacy means the stage of research during which a project evaluates and tests whether an intervention is feasible, practical, and has the potential to yield positive outcomes for people with disabilities. Efficacy research may assess the strength of the relationships between an intervention and outcomes, and may identify factors or people characteristics that affect the relationship between the intervention and outcomes. Efficacy research can inform decisions about whether there is sufficient evidence to support “scaling-up” an intervention to other sites and contexts. This stage of research may include assessing the training needed for wide-scale implementation of the intervention, and approaches to evaluation of the intervention in real-world applications.
Scale-up evaluation means the stage of research during which a project analyzes whether an intervention is effective in producing improved outcomes for people with disabilities when implemented in a real-world setting. During this stage of research, a project tests the outcomes of an evidence-based intervention in different settings. The project examines the challenges to successful replication of the intervention, and the circumstances and activities that contribute to successful adoption of the intervention in real-world settings. This stage of research may also include well-designed studies of an intervention that has been widely adopted in practice, but lacks a sufficient evidence base to demonstrate its effectiveness.
Definitions - Stages of Development:
Proof of concept means the stage of development where key technical challenges are resolved. Stage activities may include recruiting study participants, verifying product requirements; implementing and testing (typically in controlled contexts) key concepts, components, or systems, and resolving technical challenges. A technology transfer plan is typically developed and transfer partner(s) identified; and plan implementation may have started. Stage results establish that a product concept is feasible.
Proof of product means the stage of development where a fully-integrated and working prototype, meeting critical technical requirements is created. Stage activities may include recruiting study participants, implementing and iteratively refining the prototype, testing the prototype in natural or less-controlled contexts, and verifying that all technical requirements are met. A technology transfer plan is typically ongoing in collaboration with the transfer partner(s). Stage results establish that a product embodiment is realizable.
Proof of adoption means the stage of development where a product is substantially adopted by its target population and used for its intended purpose. Stage activities typically include completing product refinements; and continued implementation of the technology transfer plan in collaboration with the transfer partner(s). Other activities include measuring users' awareness of the product, opinion of the product, decisions to adopt, use, and retain products; and identifying barriers and facilitators impacting product adoption. Stage results establish that a product is beneficial.