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And then any reactions, feel free to raise your hand as well. And then just another way to access unmute, start video, and hide non-video participants. Okay, and from here, I'm going to go ahead and turn it over to Dr. Tao, who will introduce Dr. Tim. Thanks, Fannie. Hi, everyone. My name is Stephanie Tao. I am out of University of Colorado and Children's Hospital Colorado, and I have the pleasure of introducing my wonderful colleague, Dr. Melissa Tinney today. She's a clinical assistant professor in the Department of Physical Medicine and Rehabilitation at the University of Michigan Medical School. She has 18 years of clinical experience in amputation care, musculoskeletal medicine, spinal cord injury care, and adaptive sports medicine. She provides adaptive sports medicine care through the Ann Arbor VA Healthcare System and the University of Michigan Healthcare System. She helps lead the University of Michigan Adaptive and Inclusive Sports Experience, also known as UMASE, a Move United chapter, providing oversight for multiple adaptive sports and recreation activities. She volunteers as a team physician supporting the University of Michigan Adaptive Sports and Fitness Collegiate Competition Teams, and she also serves on the national medical team for the National Veterans Wheelchair Games since 2017. She also is our immediate prior chair of our adaptive sports member community for AAP Menard. And so she is going to be talking today about Exploring Adaptive Sports, Innovation, and Technology, Your Guide to Getting Involved. We will ask that everyone hold questions. Feel free to write questions in the chat, but we will be answering all questions at the end of her talk. All right. Dr. Tinney. Thank you, Dr. Tao. I'm really excited to be here with everyone tonight. This is really an exciting time to be presenting about adaptive sports. I actually changed my title a little bit when I started because it's really a reflection of how I've come to this space and practice of adaptive sports medicine. So I call it Exercise Prescription to Adaptive Sports Physician, and really thinking about all the different innovations in practice, technology, and education that I have had, you know, the fortunate experience of being exposed to in this space. So I have no disclosures, no financial. The topics discussed are my personal interpretations and do not necessarily reflect that of the Department of Veterans Affairs, University of Michigan, or AAP Menard. The products discussed do not imply specific endorsement of a particular item or company. So this picture was taken at our first adaptive sports skills lab in New Orleans this past year. A lot of my work, as Dr. Tao mentioned, is with the VA healthcare system here in Ann Arbor. But I've been with the VA since I finished residency in 2006. I've been with the Department of Veterans Affairs amputee system of care since its inception. In 2008, and I'm a proud member of the National Veterans Wheelchair Games National Medical Team. And I'm really excited this year, I am going to be supporting the National Medical Teams for the National Disabled Veterans Winter Sports Clinic and the National Veterans Golden Age Games. I have a lot of hats with you, Mays, a Move United chapter, our collegiate program at the University of Michigan, and also an advisor to our Human Performance and Sports Science Center and our School of Kinesiology. First I want to take time to thank all my collaborators. There's many faces here and probably many more that I haven't been able to squeeze onto the screen or onto the slide. But I am really fortunate to have many willing collaborators from multiple disciplines, multiple sectors. So from from fellow faculty to researchers to therapists, PTs, OTs, rec therapists, trainers, coaches, athletes, within the University of Michigan, within the VA system, outside of these institutions, and also in that bottom corner, my family are all definitely supportive and along for the ride. So the objectives today are to talk about adaptive sports as a continuum of rehabilitation, to review the roles of the physiatrist in adaptive sports, to identify innovations in clinical practice, technology, and education, and how to get involved in adaptive sports. So first, I'd like to frame it from my career, you know, my personal career timeline and key moments that really have shaped my practice. So I will start with 9-11. In 2001, I was in my fourth year of medical school, and that's when Operation Enduring Freedom began. I graduated from medical school in 2002 from the West Virginia School of Medicine. And then in 2003, Operation Iraqi Freedom begins. I finished my residency in 2006 and graduate from the University of Michigan, and I start my career with the VA. So as a new physician and very quickly a new chief of a rehab department, I found myself right at the moment when things were changing rapidly in how we were providing rehabilitation care for our nation's veterans. So in 2007, for the polytrauma system of care for the VA, the largest rehab network in the world was assembled. And I remember sitting there, you know, in this large room with, you know, thousands of professionals thinking about what we were going to do to shape rehabilitation for our newly injured. And so in short order, in 2008, the VA National Amputee System of Care was also formalized where I spent a lot of my clinical time. And in that time over the last decade and plus, you know, I have really been actually tasked by my own patients to really learn about facilitating ongoing physical activity. And in 2017 is when I had my first experience as a medical provider with the National Medical Team for the Wheelchair Games. So really thinking about for my own practice, you know, I was, you know, veterans would come through Landstuhl in Germany from, you know, the battlefield. Newly injured, they would stop often at Walter Reed Medical Army Medical Center. And then would end up on our doorstep at the local VA. Another key stop for many veterans was the Center for the Intrepid. So this was actually a state-of-the-art rehabilitation facility located at San Antonio, Texas at Brooke Army Medical Center. And really here, the work being done at the Center for the Intrepid really pushed the boundaries of, you know, what can we do to facilitate return to potentially active duty or even return to a high level of physical activity that many soldiers were used to. And so you can see the applications of virtual reality began during this time, innovation in orthotics design, and certainly sports and adaptive sport was fundamental in rehabilitation. And so thinking back to the roots of the Paralympic movement in 1948, Sir Ludwig Guttman founded the Stoke Mandeville Games after World War II. And thinking about how, you know, I am now part of that legacy facilitating, you know, adaptive sports for veterans and many non-veterans as well. It's really a proud moment, you know, I'm really excited to be part of this heritage. And so I think thinking now forward, you know, I think back at my timeline, but there's a lot here currently happening and into the future that really is an exciting time for anyone who's interested in growing their skills in this space. So thinking about these key moments as catalysts for change, in 2019, the U.S. was the first Olympic committee to include the term Paralympic in its name, but it's not just in name, it's certainly in how resources and programs and support are being run. And it's really, you know, gives a chance for Paralympic sports to really thrive in our country. In 2021, the U.N. convention included sports participation as a human right in addressing articles on disability. In 2022, this is actually a very key moment, a pivotal moment for a state in Maine was the first state to pass a law for insurance to cover activity-specific prostheses. And I'll talk about that a little bit more later in this talk. Just last year, the NCAA included wheelchair tennis and wheelchair racing to competition events, and hopefully this is the beginning of, you know, growth in our relationship and collaboration for adaptive sports collegiately. And that's a picture of Spencer Heslop, one of our former wheelchair tennis players. In 2024, so just in January, the first NCAA Division I adaptive track and field athlete with an above-knee amputation was signed to USC. His name is Ezra Frech. That is a huge acknowledgment of, you know, adaptive sports and Paralympians. In 2028, obviously this is a big one for our country. The summer Paralympic Games will be in Los Angeles. And so we have a lot of work to do in short order between Paris this year and then very quickly in 2028, you know, we have a huge opportunity in our country. And then even further and beyond in 2034, the winter Paralympic Games will be in Salt Lake City. So there's a lot of opportunity. So thinking about the continuum of rehabilitation, you know, how do you get from, you know, I'm a general physiatrist trying to focus on, you know, basic mobility and how am I going to get somebody started if they weren't already doing, you know, a lot of activity to begin with. And so I would say that one moment in my practice, I probably was prescribing more motorized scooters than I was prescribing adaptive cycles. But I will say that my practice fortunately has transitioned to where I'm actually prescribing more adaptive cycles than power scooters. And so when we think about, you know, rehab medicine, I was a journalist for many, many years and still am. And, you know, outcomes, you know, we focus on safe mobility and ADLs. We think about, you know, our home programs, but we might not address, you know, sports participation explicitly, may not focus on a specific sport. And I think because we have a variety of disciplines, a variety of conditions that we're treating, that journey, you know, into physical activity, adaptive sport might not be, you know, it might be really highly varied on how we might arrive at that destination. When I think about sports medicine and my colleagues, I think very frequently it's an able-bodied model that's predominant, limited training that not all programs have exposure to adaptive sports. There's limited faculty, you know, faculty are providing education in adaptive sports and it's not a current core requirement of fellowship or PM&R residency. So what does that pathway look like? You know, I think that very frequently from groups of individuals that I've worked with, people come from all different places to this destination, you know, of adaptive sports medicine, many are in pediatric rehab, spinal cord injury. For me, it's limb loss, limb deficiency, sports medicine, et cetera. And really, so what I also noticed about it is that people would arrive very organically, you know, it wasn't necessarily something that was kind of a pathway that they could follow, everyone just kind of made their way, you know, there. But what I think is interesting is that, you know, in PM&R as our physiatrist roots, we have these fundamentals that we've been trained, you know, to have knowledge and skill in, you know, and these are just some, you know, a few of them, right, building blocks. And if you look, you know, for adaptive sports, it actually is, you know, identical, right? Very common, you know, crossover. So I think physiatrists are perfectly, you know, suited for the job of, you know, practicing adaptive sports medicine. And so that brings me to, this book actually was just hot off the presses. It was released in February of this year. And just disclosure, I am an author in one of the chapters in the book, and it's about adaptive sports in the military veteran, which I'm proud to have contributed to that. And so I want to talk about adaptive sports medicine as a discipline. Really, we have, you know, knowledge of baseline medical conditions, which can be severe, fluctuating or progressive. We're understanding, we have a good understanding of associated comorbidity factors related to disability and their significance. We have experience with complications, managing injuries that can affect function and experience with specialized equipment. So this brings me to the roles, you know, that a physiatrist plays in adaptive sports, you know, from, you know, really my start as a clinic provider, and then kind of expanding into thinking about how I can help as a general volunteer, to medical volunteer, to team physician, medical director, classifier, researcher, and advocate. And I can also add to those jobs, equipment hauler and snack supplier, for sure. So you're thinking about where I feel I have been able to contribute really at any setting. I feel like there's a lot of opportunity for we as physiatrists to be able to get involved. You know, certainly it doesn't have to be every single one of those roles. It could be one of those roles that I mentioned, and it can be in one of these settings from, you know, the hospital, having conversations early on with your patients to the clinic where I'll get into more specifics about clinic practice, you know, supporting a local program, adaptive sports program, being involved with a team, or supporting an event. So being a clinic provider, you know, what does, what is unique about an adaptive sports medicine clinic or practice? Certainly I talk about injury and illness prevention and treatment. The items in yellow, I'm going to go into a little bit more specifically, you know, exercise prescription and training considerations, pre-participation evaluation, equipment prescription, resource education, so grants and programs that are out there, sport event and event registration forms, therapeutic use exemptions, and classification forms. There's a lot to be done in, you know, in a clinic visit. So exercise prescription, that's where I'm going to start because that's fundamental, you know, to our practice, it's what we do. The CDC has this information on their website. Adults with disabilities were 82% more likely to be physically active if their doctor recommended it than if they did not get a doctor recommendation. However, only 44% of adults with disabilities who visited a doctor in the past year received physical activity recommendation from their doctor. And so certainly we can be doing a lot more. And so exercise guidelines, you know, I actually did a performance improvement project in my, you know, early on in my practice with this. Am I giving, you know, consistent, you know, exercise prescription and recommendations? And so I set up the project. I could tell I wasn't doing a very good job. I, you know, modified my templates, made sure I included it, you know, and I was, looked back and I was like, oh, okay, you know, a sample I pulled, it looks like I'm consistently giving information. And certainly that can look different ways. We can, you know, reference guidelines or we can also say something is better than nothing and maybe you'll use, you know, a different strategy depending on the individual. But really that wasn't enough. And I think this article is a great review that actually highlighted a couple of studies. And so there was a nationwide Canadian study that they had reviewed that found that an educational intervention designed to strengthen healthcare providers' intentions to discuss leisure time physical activity with patients with physical disability really had no long-term effect. You know, I even was starting to feel like, am I doing enough just to tick the box, you know, of exercise prescription or have I really, you know, gone further with it or how can I go further with it? And so conversely, they also reviewed a Dutch national project which provided training to staff in 18 rehabilitation institutions on how to deliver physical activity counseling and build collaboration between hospital staff and community-based physical activity providers. And so over a three-year period, the program reached 5,000, over 5,000 patients with various disabilities and substantially influenced participation in physical activity. And that's really a key piece is that collaboration directly with programs and physical activity providers. So one technology innovation I want to highlight certainly 2020 and beyond kind of was full of innovation, but I wanted to highlight virtual adaptive exercise programs. You know Blowett and colleagues reviewed developing a virtual adaptive sports program in response to the pandemic and certainly what they found is that you know the virtual platforms would reduce social isolation. It was more cost effective and had a larger geographic reach and so Move United was really responsive to this time. They are a large non-profit that supports adaptive sports programs across the country and they have actually a full free on-demand catalog. Many of the chapters contribute video content to that. The VA responded with a Sports for Vets Throwdown virtual fitness competition. If you're not familiar with NCHPAD, NCHPAD is the National Center on Health Physical Activity and Disability and they have a current 14-week to a Healthier You program that is free. Also there are you know paid subscription services for working out like the Nike Training Club and Peloton that both have adaptive exercise content now and our collegiate program I think helped with some of the development of the wheelchair exercise modules on Peloton. So again with the clinical provider hat on you know pre-participation, you know physical evaluation is certainly part of sports medicine and not unique for adaptive sports medicine. It's foundational to sports participation at all levels. You know it's really intended for safety, health and wellness and injury prevention. This monograph has a supplemental form for athletes with disabilities and it's also included in the IPC medical code in 2019 and this version, this fifth edition was also published in 2019. So when I think about medical clearance you know is that a one-off form or you know can we do more than just a simple you know one-time screening. An adaptive sports medical evaluation is something that I thought about when I was developing my clinic and thinking about how I'm going to use that time you know it's not just filling out forms but really treating it like a periodic health exam and really getting the most out of that interaction with the patient. So similar to what's covered in the monograph for the supplemental form if you you know refer back to it, I incorporated elements of that PPE form from the monograph as well as forms that I would come across for medical clearance for some of our VA adaptive sports programs. And so I'll you know I'm just have some highlights here of adaptive sports activities, functional history including classification history and really differentiating between daily use medical equipment and adaptive sports equipment and really transportation. As far as medical and surgical histories certainly cover the gamut from hearing and vision, thermoregulation, autonomic dysreflexia, cardiopulmonary, hematologic, you know bladder bowel, any skin you know breakdown or pressure ulcers, spasticity, seizure disorder, fractures, latex allergy. And on physical exam just wanted to highlight having a nice detailed neuromuscular exam, trunk strength and certainly balance especially seated balance and if you're able to to see somebody's position and their sports equipment can really enhance the physical exam. And then I want to highlight things that I carry forward you know if this is a periodic health exam and I'm going to see somebody in follow-up I want to really emphasize that this is you know I might be giving medical clearance for adaptive sports as part of their continued rehab goals but also you know addressing contraindications or concerns for specific activities, equipment prescription and I'm going to get into that in greater detail and to follow up to re-evaluate equipment needs and continued participation in adaptive sports. So one clinical practice innovation you know learning health system obviously that's not my innovation but it's certainly something that we're seeing more and more throughout health systems and through programs and clinics across the country. And I really saw this as an opportunity practicing across two different health systems with the VA and the University of Michigan and now more recently providing care for collegiate adaptive athletes. Thinking about how I can take that about periodic health evaluation and really create a learning health system to have consistent elements of evaluation, demographics you know barriers, facilitators of activity, outcome measures and injury data. And so certainly this is something I'm continuing to build to be able to collect information probably the VA is my longest running clinic where I have more more data but still this is growing and hope to be you know one day multi-center. And some great examples within our discipline really is the Cancer Rehabilitation Medicine Metrics Consortium and the Cerebral Palsy Research Network. These two groups have really had built a robust learning health system that are multi-center and I hope that that's something that we can build and certainly want to talk about that more if anyone's listening to this. Another innovation when we're talking about collecting information on our patients, one technology innovation that will really enhance this are wearables in adaptive sports that can really provide you know health data. I'd say that the two identified sensors that were most commonly used in research for adaptive sports were inertial measure units and electromyography. And so you could do a whole probably symposium on biometrics and sport but certainly wanted to talk about this as you know there's a lot of opportunity for us to get information. Another technology innovation is synchronization or automation for logging activity. I actually put this up here because I had a patient bring in his information because he information because he likes to ride on Zwift and is doing his adaptive cycling on there. So having a smart trainer is something that as I'm seeing more of and people really like to be able to have that synchronization. So applications for wearable sensors, this article that I reference that talks about wearable sensors in sports for persons with disability. This review is a really good article. It really talks about the future applications for wearable sensors. So athlete classification, if you're thinking about you know measuring trunk strength, injury prevention, they talk about using electromyography in the shoulder, performance characterization, you know similar electromyography might be able to help you know identify you know modification or training you know activities. And then equipment customization and I put this picture up here because this is the one I'm probably that that a lot of us are very familiar with now for you know non-sport application right pressure seat mapping. Thinking about how we do that for daily you know or day use equipment but certainly can translate that over into adaptive sports equipment. So when I think about equipment considerations as a provider you know certainly fundamental there's like these checks and actually the this practice really was ingrained in me when I was having these large committees you know would review adaptive sports equipment prescription within the VA. And so it still is reviewed by a local medical committee when I when I write for something. And medical clearance you know so you have to make sure you check that box. Have they had you know the opportunity to have experience or exposure to the activity? Have they received adequate instruction in the use of that equipment? And do they have a way to store and transport the equipment? So I'm going to kind of broad strokes go across this innovation timeline but I'm going to go into a little bit more detail about the pieces I mentioned. And and the reason that I picked these items is I've had experience prescribing them or that my patients have used them so I wanted to have a direct frame of reference. There's probably there's so many more that could be included but just wanted to highlight a few. And I also so I mentioned you know the year that it's invented the price so you can see kind of the the cost of things. And so the in 2007 the Grip Freedom Chair an all-terrain wheelchair came it was invented in 2009 the Intrepid Dynamic Exoskeletal Orthosis. Same year the Moto Knee by BioDapt came out in 2010. Adjustable sockets well one in particular the RevoFit came to market in 2010. The VersaFoot again by BioDapt became available in 2012. The Strike Force Power Soccer Chair this is the first power wheelchair to be designed specifically for sport. And just last year a new overlay a product called an overlay was released by a company called Ethnocare. So the Grip Freedom Chair is a really neat you know all-terrain wheelchair. It's actually used in if you're familiar with spartan you know races or competition that are really rigorous races with physical obstacles this Grip Freedom Chair is used for para-spartan competition. And so you can change gears easily with just based on the hand position on the cranks. And if you put your hand at the top of the handlebar it actually increases the torque enough that you can get over rocks and you know rocky uneven terrain. The front wheel serves as a shock absorber. It has a two times like the stronger axle than a standard wheelchair and it has built-in suspension in frames in the frame and wheels. And what I like about this product is that it's made of off-the-shelf bike parts so somebody can take this to their local bike shop and be able to have repairs done. So the Intrepid Dynamic Exoskeletal Orthosis or the IDEO race was a collaboration and research at the Center for the Intrepid with the Department of Defense and the VA. And then what's really interesting about this and you can see it doesn't look like any other you know AFO is that the patellar tendon bearing cough is like a clamshell that is really designed to offload the foot and the ankle. There is a modular posterior energy storing strut. This thing is really heavy duty metal if you think about the forces that it needs to withstand for someone who's running. There are sidebars that limit inversion eversion if you're thinking about the design of this was intended for soldiers who had limb salvage. And so really having that control and protection is really important. And it had a slightly plantar flex foot plate to accommodate heel cushion. So the article I reference here actually was published in 2021 talking about their experience in the development of the IDEO race. Really the key points of what they found in using this it's really a select population. They found better response for people who had the diagnosis of foot drop. It did delay time to amputation for those who were seeking elective amputation. And so in the right candidate it can be really something that's useful that you know to be able to to run or hike or jog. And you know I have been able to continue to utilize this in patients with severe ankle trauma. I want to talk about a little bit about the Modo Knee. So this was actually invented by Adapt is a company that was founded by Mike Schultz a Paralympian who really saw that there were some shortcomings and what he needed to be able to you know do you know high impact winter sports in particular. What I want to highlight there's a lot of specs on this diagram and if you're not in you know in OMP practice it might be a lot. So really want to just highlight that there's 120 degrees of flexion with a more natural progressive feel because it's hydraulic but it has more than what you might see in a standard hydraulic knee. And then it also has an optional flexion lock feature if you're thinking about you know somebody who's snowboarding and it has an air shock that allows for resistance and hydraulic dampening to really mimic what you would get as far as control from the quads. And so I thought those were really really specific and you can tell that a lot of thought went into the design so how it functions to be able to you know support people who are skiing and snowboarding. The Revofit. Now the adjustable socket there's a lot of adjustable sockets on the market. The reason that I mentioned the Revofit specifically is because it seems to be the most popular design amongst people who are highly active. And so you see that there's window cutouts within the socket. Those are customized based on the shape of the person's residual limb, what they can tolerate. It's been really useful for people who have trauma and it has a dial that you see on the back. So the dial is a BOA system. So there's threaded cables throughout the window cutouts and so you can tighten it down or you can release it based on you know what activity they're doing or you know their comfort. And obviously with sports you want to control as much motion as possible when you're in that interface with your socket. So the Versafoot 2 also invented by Bioadapt. I just want to highlight here that it has like the 30 degrees of dorsiflexion. Really adjustable and it has a high performance shock. This is great again for skiing, snowboarding but is also great for like biking or mountain biking. Really having that motion and adjustability really lends itself. So because very oftentimes you know a standard prosthesis is not going to accommodate very well on a pedal. The Strike Force Power wheelchair and soccer guard just want to highlight about it. It has a wide wheelbase which is great and a low center of gravity. If you think about a standard power chair it sits much higher and it also has a soccer guard for more accuracy and power. So the first time if you've never seen one of these it can whip around pretty quick. But I will say my first time covering a power soccer match there were two injuries in that game. And one was where the person was using their standard power wheelchair. They had a sled that is just bolted you know mounted on. It's plastic sled with screws. And the way the screws were positioned when there was a collision the person you know sustained like a laceration from the screw position. And thinking about this soccer guard being built in it's like much safer. And also I saw somebody tip and if you think about like you know wanting to cover your eyes seeing a power wheelchair tip over you know certainly can have you know really serious injuries. And the person ended up having you know an arm fracture no surprise because of the hundreds of pounds those things weigh. So the low center of gravity and this design really you know makes it very very stable. So the overlay made by Ethnocare it has an integrated air pump. And there's a very thin fabric that fits over most liners that are on the market. It has air cells that you position on the back side of the residual limb. And these can expand to two ply or greater. And it also works with a variety of suspension methods. So that's really it's like an adjunct right. So your person already has their prescription for their liner their socket. But this is really to enhance that in replacement of socks. And so again with high level of activity where you're getting extra rotation, pistoning, motion you really want to control for that. And so I had a patient who's a snowboarder. He really wanted to have better control and so he tried this and is really you know happy happy with it. So another technology innovation and more recently wanted to talk about this kind of exciting opportunity in 3D printing. And of course we all know that 3D printing has many many applications in health care. But in adaptive sports actually just last month the VA they have been doing 3D printing for a variety of items for years. But what is interesting is that the VA's Office of Advanced Manufacturing released a public library of files so that instead of waiting for a particular item to have tech transfer and then make it to market. They're able to just share the files because 3D printing is so widely available. Their library right now doesn't have a lot specifically for adaptive sport. But what's really interesting is that over time you know this database will grow and you might see more that can be shared. And this is just one example. They do have a BACHA ball mount assembly that works with a standard like ADA like lap holder so that somebody who's a wheelchair user can have their BACHA you know balls on their lap when they're competing. But I think that's really a neat thing that this library has a lot of potential to have a lot of items that aren't necessarily you know have a huge market share but enough that it can be really useful for you know some select patients. So thinking about equipment you know pay to play right. So there's a lot of cost to participation in adaptive sports. I just wanted to give some you know idea of cost for a variety of things that you know I have had some experience of trying to obtain or prescribe for different patients over the years. And it's really costly. So what do we rely on if you're not in the VA system, right? Grant resources. So this list was from Move United. And this is a list of some examples of, you know, grants that people can apply for. But really what I wanna talk about is that there is, you know, a change happening state by state. And I mentioned that starting in May of 2022 with Maine. And so I wanted to highlight the Maine's law that actually it was, you know, stated that, you know, enrolling in insurance would have, you know, something that will allow the person to ambulate, run, bike, and swim. I think that's really into maximize upper limb function. This is a huge thing, as we know that a lot of activities, specific prostheses, people, you know, wait on that grant to get that. So the leading the charge of this campaign is called So Everybody Can Move. And really the American Orthotic and Prosthetic Association and their key partners are really pushing this campaign. So the legislation has been enacted in Arkansas, Colorado, New Mexico, and Maine. And legislation is introduced in several other states. They actually have a hope that by 2028, when the Paralympics are here, that they'll have 28 states, you know, will have passed laws. So they're calling it the 28 by 28 campaign. And if you're a provider in the four states that already have laws passed and don't have experience with, you know, activity specific prostheses, you know, I think that's time to have, you know, discussion and collaboration, you know, use our community to really get that information to you, because you have an opportunity to facilitate getting these types of prostheses to your patients. So one innovation I want to talk about is, you know, how do we document so that we can justify equipment access? This is just a snippet of a template that I had, you know, borrowed from our physical therapist at our children's hospital. She is really crafty with her words, you know, in making sure that it has the exact statements that you want to have for either somebody who is going to provide a grant or somebody, you know, or if there's potential for insurance coverage. And for me, the documentation is key so that I can have that major medical committee approve my prescription. So I like how she highlights, you know, they're unable to ride a conventional bicycle. They are able to sit, you know, safely sit and maintain balance while riding an adaptive tricycle. And she really goes into equip with the specific components and why each accessory or component might be needed. And also talking about, you know, functional level, they have decreased functional mobility. They're unable to exercise without significant assistance. They're unable to participate in age-appropriate sport activity with peers and are unable to perform regular aerobic exercise without adaptive equipment. That is really a nice practice that she has. So I'm going to jump to the role of general volunteer. Certainly I have my kids in tow with me. This is when my son was real little. But thinking about if you really only had time to, you know, not really necessarily have the desire to shift your practice, but you're thinking, I want to have a better understanding of, you know, what I might recommend, you know, going and being a general volunteer, seeing, you know, the equipment, knowing the, you know, who functionally would be a good candidate, you know, understanding mechanisms of injury are all really helpful just attending. I think this is a really funny photo of me in my first, you know, role with the National Veteran Wheelchair Games. I don't know, it could have been a practical joke by my medical director. I was stationed at the far end of the hand cycling course and there was nothing out there except for like a mound of coal. And I thought, oh, well, okay, it's just me and my coffee and my partner. And it was an out and back course. And so sure enough, you know, after everyone kind of turned around, like the last participant, you know, by the time he got to the end and we were there by the big coal mound. And team physician. So being involved with a team is another opportunity. You know, there's the opportunity for pre-participation evaluation, concussion screening and management, sideline coverage, you know, again, injury treatment management and risk management, thinking about safety protocols. These are all things that are, you know, fundamental to sports medicine. And certainly we need, you know, more providers, you know, contributing and helping to provide, you know, enough medical support for our adaptive athletes. Safety is a key, you know, part of that role. So I highlight here where we're, they're measuring prior to competition, you know, the height of the casters. It's just one example. So certainly, you know, making sure that the equipment is, you know, as safe as it possibly can be for competition is important. You know, had maybe somebody identified those screws on that power soccer, you know, in that power soccer game that, you know, the person might not have been injured. So these are really important things to have an understanding of in the sports that you might be covering. And I want to mention that there is an injury and illness surveillance system within the IPC, really looking at these things. Another innovation that's come. So this book was released in 2021 by my colleagues, many of them within the VA regarding concussion management for wheelchair athletes. So this is just an example of these. One of our collegiate athletes was gracious to volunteer to have her photo taken to show examples of what we do for the West test. So how you would modify balance testing for a wheelchair user. Other advanced training. So the U.S. Center for Safe Sport offers training. The U.S. Anti-Doping Agency has a health pro advantage training that's free and mental health first aid is also available. Another role, medical director. So thinking about, you know, what is your skillset? Do I want to do something like this? Thinking about quality and safety oversight, safety protocols, medical policies, criteria for participation in events, staffing requirements and emergency preparedness. And so I serve in these roles or serve in this role for our collegiate competitions. But this photo was taken in our first wheelchair games after the pandemic. Although we were very much in the pandemic, certainly where we were doing, I don't know, hundreds and hundreds of nasal swabs. So classifier role, this, you know, this is something, again, a provider or physiatrist with the skillset, you know, certainly has an appropriate skillset to serve as an official. You know, the classifier ensures a fair playing field. They differ from sport to sport, differ between different types of conditions. And the knowledge of the sport and knowledge of function is really critical to the role. There's this video, this Paralympics GB classification explainer on YouTube that really is actually a really nice summary of what a classifier does. And IPC Classification Fundamentals is an online course that's free with like four self-paced modules. And what is, it's going to be updated because there's going to be changes for the IPC for their codes in 2025. And so those changes will be reflected in the course and learning more about that role. I've been fortunate to be part of an international work group looking at adaptive sports classification for adaptive figure skating with Skate Canada, the Icelandic Skating Association and US Figure Skating. So I'm going to talk about, kind of lastly about education innovation. So, you know, when I opened the talk, I mentioned that there isn't, you know, a requirement for adaptive sports medicine education, you know, in residency or in a sports medicine fellowship, but many medical centers like ours around the country are providing, you know, some form of education in adaptive sports, whether it be, you know, early exposure from in medical school to volunteering, to having sports coverage, to having, you know, some clinic education. And so these are just some of the institutions that I know have these activities going on as part of their education, but certainly there's probably many more on the list. And we definitely want to get that discussion going, knowing who's doing what at their institution within our community. And so the ACGME did publish guidelines in July of 2022 that does specifically mention adaptive sports education in sports medicine fellowship, but it's not a core requirement. So one thing that we have done with our wheelchair games, this is a collaboration between University of Michigan, Medical College of Wisconsin and University of Minnesota. When we have the wheelchair games, or if you think about a large sports event, it really is an opportunity for learning. And so we've created a clinical rotation to really get the most out of that educational opportunity that really can be replicated in other facets of the practice. So we have designed pre-rotation modules for preparation that cover the scope of the event, common medical issues that are encountered, and then the medical delivery logistics related to that event. We provide onsite education with clear education objectives that include equipment review, baseline concussion testing, classification observation. This year, new this year, we're going to be providing a pre and post rotation survey and quiz, and also the residents and fellows provide a post rotation narrative. And it's always nice to hear the feedback from their experiences. So I'm going to bring it home back to AAPMNR while we're all gathered today. I want to highlight that we have adaptive athletes in sports community. We are 643 members strong. We have some past sessions that we've recorded in our library. We have member May presentations and more to come on that in the future. And certainly want to encourage those listening or watching the recording to get involved. This is a picture from our inaugural meeting in 2019 when it was the first time the community was founded. And then new this year, the AAPMNR and the USOPC had a collaboration to really encourage physiatrists to get involved and attend the annual NGB medical conference that's held in Colorado Springs. And it was really nice to see a lot of physiatrists present at the training and also the incorporation of parasport education, really adaptive sports medicine was embedded throughout the lecture content and also in the hands-on clinical modules that they provide. I want to mention if people are interested also offered by AAPMNR is the concussion and mild TBI step course. And just knew this past year at annual assembly, we, Dr. Tao and I co-directed a practical applications in adaptive sports medicine skills lab. It was a jam packed, you know, three hours of education and we're hoping to expand that for, you know, the next annual assembly and beyond. It was a great opportunity for people to learn, you know, hands-on clinical scenarios, understanding of the sport, mechanism of injury, et cetera. And I want to thank the team. So I couldn't finish the lecture without a one University of Michigan football reference. So to quote Bo Schembachler, the team, the team, the team. But this is a photo of all of our faculty and instructors that helped us teach that course in New Orleans. And so I just want to thank you for the opportunity to share all this information that's been really a joy to be able to develop this over the years when I'm looking back at, you know, what I have had the opportunity to be a part of, it's really exciting and what is going to be in the future. And so I've included my information there. So if you want to contact me, please feel free to do so and or follow me on Instagram. I've got a lot of interaction with a lot of different collaborators on there as well. So that's all I have for you tonight. Thank you, Dr. Tinney. That was an amazing talk and I can't believe you fit all of that information. So useful in such a short amount of time is quite a feat. We have a few minutes for questions. So far, what I've seen in the meeting chat, Carol Crooks just commented, we were helped by Ainsley's Angels for my sister in her final days of cancer to get an adaptive chair for her to be in a 5K pushed by us. But they had tons of chairs available for all different body types. They are in many states. Ainsley's angels.org is linked in her comment and they take volunteers regularly to run with those who need assistance. All right, and then Michelle- Thank you for sharing that. Thank you for sharing that, Carol. Carol is my fellow, we were in residency together. So thank you for tuning in and for sharing that resource. Yeah, that's awesome. Michelle Cintron just commented, amazing lecture, how can I connect? Please, you know, use, there's multiple ways. You know, I am on phys forum with our adaptive sports and athletes community. You can email me. I put both of my emails for the university and the VA. If there are any VA providers on, certainly you can use that email as well. And I'm happy to collaborate or discuss if you have questions. And I think really getting involved in the community. So that's led by Johan Latore. He was one of our former residents at University of Michigan. He's a faculty at UAB. He's really engaged and committed to growing the community. And so I would encourage you to join the conversation. And Deb Vennessy just wrote, thank you for your presentation. Anyone have any questions for the last couple of minutes? Do you have, so Alexandra wrote, do you have any suggestions for how med students can get involved? Well, one, you can still get involved, certainly in the community. There actually are a lot of student members in our adaptive sports community through AAPMNR. At a medical student level, I would say general volunteering. Being a general volunteer for your local adaptive sports programs is really the first step. A lot of our students do with our UMaze program and our collegiate program, get involved as a general volunteer because they're really just learning. What's the best way to transfer somebody? What are the criteria to be able to do this sport? You start to get exposed to these things and have an understanding. And I think just building your knowledge base, that's a really great way to start. All right, Joan wrote, do you know which insurances will authorize the IDEO, Modo Need to, Revo Fit Socket and et cetera? So I would say, IDEO, Modo Need to, Revo Fit Socket and et cetera. So those are not sports specific. So the Revo, so an adjustable socket is not, that's just your standard prescription. It's just knowing that that's an option, right? And figuring out who is the right candidate for that type of item. And that's where the discussion about what goes into an activity specific prosthesis or what makes a, what you think of a daily use prosthesis really good for lots of different activities. And so, and the IDEO brace, which I think it was branded by Hanger called, it has a different name, not the IDEO, but you can still look it up and order it like that as an IDEO, that it is covered with, if you were ordering an AFO, right? You just have the same justification as far as the muscle weakness, imbalance, things that would really just justify an orthotic prescription. John Hermanson said, so thank you for your passion and leadership. And then we're going to take one more question. So this will be the last question for tonight. Stacy, as you drew out, what is the process to become a classifier, i.e. contact the governing body directly? Question mark. Well, actually I would throw that to you, Dr. Tao, because you are head of classification for Team USA Swimming, Paraswimming. But I would say, yes, the governing body, correct? Yeah, to clarify, I'm not head classifier, but I'm just head team physician. So it depends. If you are working with a sport that is governed by the US OPC, the best way to find out or to show interest is to just Google Team USA, how to become a classifier. And if you go to that page, there's a huge page that talks about how to become a classifier. Information about what classification is. Go all the way to the bottom. There's a survey that you fill out and then you email it to a classification manager. That being said, that's only the sports that are governed by the US OPC. And also it is very variable on how often each sport does their classification courses. So for instance, in swimming, we have not done a course since 2017. If the sport is not governed by the US OPC, then you would email, like find their information on their website and email them directly to find out how you can become a classifier. And I think many sports are looking for classifiers. There's shortages that I hear about that there's not enough support in those roles. So anyone who's willing to do training has interest in the sport. I encourage you to pursue that. I actually had a colleague who is an avid golfer and he actually just took the EDGA training to be a classifier and is now doing it for virtually for golfers. And so it's been really a neat way for him to get involved in a sport that he loves. Thanks Dr. Roberts for putting the link in the chat and also Dr. Latore for putting in the link for the adaptive sports community. All right, well, thank you so much for joining us tonight. I hope you guys enjoyed Dr. Tinney's talk and we'll see you around. Thank you. Thank you so much. Have a great evening, everyone.

adaptive sports

inclusivity

equipment and training

healthcare providers

exercise prescription

3D printing

education opportunities

AAPM&R

USOPC

activity-specific prostheses coverage