Hi, everyone. Welcome to our joint community session today. We're really excited to be joining together three great communities today. So this is Adaptive Athletes in Sports, Intellectual Disabilities, and Pediatric Sports Medicine joining together. And we're talking about adaptive inclusive sports programs for intellectual and physical disabilities across the lifespan. So how we're going to have our setup today is we're going to have each community have about 20 minutes where they go through kind of an overview of some thoughts about this topic that's specific to their community. And then we'll have a little Q&A at the end. And then there'll be some time for breakout rooms where you can break out into the three different communities. You can actually jump from one community to another if you choose as well. And you can just network and talk with the communities and help brainstorm some things to be working on in terms of projects. So we're really excited to be working all together. And we're excited for you guys to be joining us today. So a couple of housekeeping tasks at the beginning here. So I'm just reading off some things from AAPM&R. So to claim CME credit, you will need to complete an evaluation for the session. And all sessions will be recorded and made available. For our session, what is going to be recorded is going to be that beginning session. And the breakout rooms are not going to be recorded. And note that the feedback on the evaluation helps the program planning committee. So they do encourage people to go ahead and fill that out as well. So I'm going to go ahead and get us started with the first group. So we're kind of starting from the younger age group and going then to adulthood. So I'm going to be representing our pediatric sports medicine community. So I'm just going to go ahead and share my slides here. And in terms of disclosure, so again, my name is Mary Dubon. I'm a pediatric sports medicine and pediatric rehab medicine physician at Boston Children's Hospital and Spalding Rehabilitation Hospital. And I'm the chair of the pediatric sports medicine community. In terms of disclosures, I do work with Special Olympics and have a couple of grants that are unrelated to the topic today, but have no grant funding that's directly related to the topics I'm speaking about today. So in terms of physical activity guidelines for youth, so I always like to start with this because I think it's really important. We know that we kind of have an issue right now in America where there's some kids that are playing quite a lot of sports and are maybe doing a little too much and have a lot of overuse injuries that we worry about. And then there's a lot of kids that are just not participating in sports or physical activity at all enough. And so the NFL actually did a great job with their play 60. And so that's a really good thing to remember. It's 60 minutes of physical activity daily. And there's specific recommendations in terms of vigorous, moderate to vigorous activity, muscle strengthening, bone strengthening activity. So this is the general guidelines for physical activity for youth. And then I always like to go over what those guidelines are for youth with disabilities. So if you notice what changed on the slide really here is the icons, but also just the word with disabilities. So I always like to remind folks that it really is the same recommendations, obviously with an asterisk there, you know, within reason and as able because there may be some modifications that may need to be made for folks, but it's a good reminder that youth with disabilities should be participating in just as much exercise as other individuals. And unfortunately, that isn't always the case. And I'm a little concerned that it may not always be necessarily as counseled about as it should be as well. So we know that it's important. We know that lots of really important organizations, including the American Academy of Pediatrics speak to the importance of promotion of children with disabilities in physical activity. But yet, as I mentioned, I don't know that it's necessarily being done as often as it should be. And so that's one big piece of advocacy that I think our group as a whole can be working on is to make sure that people really are counseling and advocating for this as much as possible. So barriers to physical activity participation are quite common in individuals with disability. This is particularly for individuals with physical disability, but is the case for individuals with intellectual disability, as we'll hear about later as well. And so some of them are similar to the general population, right? Lack of motivation, lack of time, common concerns that arise. But poor access to transportation is something that many of us take for granted, but is actually something that's a huge barrier to physical activity participation among youth with disabilities. There's also financial stress and accessibility to adaptive resources. So I always like to mention, you know, dance was my background. I was terrible at basketball. And so if wheelchair basketball was the only thing that was available to me, like, I'm not sure that I would really have met the physical activity guidelines as a child. So, you know, if really there's only one adaptive sport that's available to you or none that are available to you, that's going to really significantly decrease your exposure and your ability to participate in physical activity. So what things actually facilitate it, right? So knowledge of the health benefits. So knowing that it's important, knowing that it's healthy for you, knowing that it has positive benefits, motivation. So that's common too. Belief that it's fun. So again, we're talking about kids and adolescents. And so, you know, we're not talking about, okay, let's go on a treadmill and do something that's boring, like find something that's fun, find something that, you know, makes them excited. And then again, as we mentioned, access to adaptive physical activity resources. And so, you know, taking care of patients from multiple states, it's very obvious when people are in an area that has a lot of those resources versus those that don't. And this is something that I think, you know, physiatrists really can help advocate for too, is how do we expand those resources? And certainly during the pandemic, we've actually seen a lot of virtual resources come available, which has been actually really great for people to get that exposure. So I'm going to now pass it along to Dr. Paulson, who's going to actually talk to us about how do you motivate somebody and how do you talk to them about participating in physical activity? All right. So I'm Andrea Paulson. I'm a pediatric hematologist currently at Gillette, and I'm going to talk about getting kids more involved. And so, basically, most important is just to ask about activity, start the conversation. So when I think about how do we encourage it, you know, we just want to really bring that up in clinic. We want to normalize, these kids want to be involved in. And I usually just start by kind of opening up the discussion clinic and saying, you know, what are you currently doing? What are you doing? And then and saying, you know, what are you currently doing? What types of sports clubs or activities are you in? What, you know, what are you interested in doing? A lot of times I actually learn more about what's available in the community and surrounding communities by asking kids and I can use that information for additional patients in the future. I also try to ask what other sports are interested in to see if maybe there's something that I know about that's in the area that they haven't found yet. And just try to get them excited about it and really opening that conversation so that they understand that this is really important. Just like Mary was mentioning that this is a recommendation that we want these kids to be involved and active and just a resource in clinic. So I oftentimes will be Googling options. I'll be talking to parents, you know, sometimes I'll connect one parent to another parent, you know, with their permission, of course. And so I think that's really just opening that conversation. I also find that it's really helpful to find other team members in your local area. So that might be social work, that might be physical therapists that's particularly interested in adaptive sports that you can kind of also tap as your resources. And then it's good to know about some of the major organizations that are out there that are involved in adaptive sports and that you can direct your patients and your families to be. So the examples are on the slide here, but I think some of the ones you may want to know about are the American Association of Adaptive Sports Programs. You may want to know about some of the Disabled Sports USA and Adaptive Sports USA. These actually merge together and are now considered called Move United. There's Paralympics, there's Special Olympics, there's Wheelchair Sports Federation. There's other ones, but I think these are some of the big ones that have lots of good opportunities that families can talk about. And then one of the things that that often I'll be discussing in clinic once we talk about what are these kids actually involved in is what are the barriers to participation. And one of the big barriers is really funding. So adaptive sports can require a lot of sports specific equipment. You need special wheelchairs, you may need certain prostheses. Often these are very expensive and it's pretty prohibitive for trying a new sport because it's pretty, sorry, because most of these items are very customized to that particular individual. There are some potentials to find used equipment, but as you can imagine, it's much harder to find appropriate fitting used equipment for these athletes. So one of the most common ways we have to help the families pay for the different types of adaptive sports and equipment that they need is three different types of grant funding. So all the organizations listed here offer grants. Ones to know about, again, are Challenge Athletes Foundation. They'll provide a lot of grants for adaptive sports equipment like sports wheelchairs, hand cycles, monoskis, different sports specific prostheses. Disabled Sports USA also provides it. High Fives Nonprofit Foundation is another one, mainly for people with spinal cord injuries, traumatic brain injuries, and amputation. I Am Able Foundation, and then the Kelly Rush Foundation and the Travis Roy Foundation offer grants specifically for patients with spinal cord injuries. And so just things to think about, things to kind of get other resources to hand over to the families to try to get these kids more involved can really make a difference. And so I'm actually going to turn it back to Dr. Ruben now to talk more about kind of the adaptive sports clinics. Thanks, Andrea. And so what I'm going to do, I'm just going to share slides again here. I'm going to talk about a couple different programs, one of which is the program that I'm starting here at Boston Children's Hospital. And then I'll talk about the Spalding Adaptive Sports Clinic. And I'll also speak about the developing pediatric and adult adaptive sports clinic that's developing at Mayo Clinic. So the clinic that I'm developing here at Boston Children's Hospital is the Youth Athletes with Disabilities, Deafness, Hard of Hearing, and Blindness Low Vision program. And so it's run with me as medical director from a pediatric sports medicine hat. And then I have two other sports medicine partners who have knowledge of disability and experience either with Special Olympics or with working with adaptive sports who are my partners with this. We're really the medical home for this clinic because it truly is a sports medicine clinic. You know, there are a lot of programs for different athletes in our department, and this seemed to be really a hole within the athlete population. And so a big part of this is really kind of marketing and letting people know that we have, you know, sports medicine docs who really understand this population. And when I wanted to make sure that I was expanding it beyond just physical disability, but also to individuals with deafness, hard of hearing, blindness, low vision as well. Recognizing also that it can't really be done without collaboration with so many folks. And so what I've done over the past couple of years here is develop relationships with folks in the physical therapy, occupational therapy departments, and then across other medical specialties as well. So I have folks in the deafness, hard of hearing program, the blindness, low vision program, who provide medical care there, as well as folks in the brain injury program and neurosurgery program. So that if there's clinical questions about clearance for sport or safety for sport, we have folks that we can work with. Additionally, physical therapy and occupational therapy can kind of help out between equipment and, you know, rehabbing. And then adjustments for things like bracing or prosthesis as well. So that's kind of our team, and we really kicked this off last year with our big sports medicine conference, being on this topic and had speakers from all different divisions. And now this is kind of a program in development. We decided with our clinic to not make it one specific day of the week in particular, because we didn't want to isolate people so that they would feel like, oh, okay, I have a disability and I have to come this particular day of the week. And I think that, you know, there's different ways of doing it, and we've kind of debated. But we wanted people to just know that they have access to folks within sports medicine. And so that was kind of our goal. And so still developing program, and definitely I've been certainly following these patients over the past two years, but now excited to make it something that's official. I want to talk also, Dr. Sherry Blauwet is tied up in another session right now, but also, Dr. Sherry Blauwet is tied up in another session right now, but she shared her slide, and I'm very aware of her adaptive sports medicine clinic, which is really adult focused, but I put it in here since we're talking about the other programs as well. And what's nice is that, you know, two programs in Boston that we can kind of connect and collaborate pretty easily. And, you know, as someone ages out of my program, they're able to go into her program pretty nicely. Now her program is on a specific day of a month, and it's really nice because it's interdisciplinary. And so there's a physiatrist that's present, as well as somebody that really understands the equipment very well, and the physical therapist too. So I've been able to be a part of this clinic before, and it's really, I mean, it's really great for the athletes. There's a full evaluation on technique, on injury, on injury prevention, and so it's been really valuable. And then Dr. Amy Rabotin is another pediatric rehabilitation medicine and pediatric sports medicine trained physician. There's now four of us, which we're excited about. And so she just started over at Mayo Clinic after finishing her second fellowship, and so she is working together with folks over at Mayo Clinic on the adaptive athlete pilot clinic. And so this is pediatric and adult adaptive athlete clinic, and they basically also have similarly have collaborations with folks in lots of different departments, including physical therapy, occupational therapy, and really talk about sports participation exams, acute injury, and injury prevention. So I think the real message with these programs, and you'll hear from our other programs too, is that interdisciplinary collaboration is pretty important. So I'm going to pass it along to Jonathan Napolitano to talk about his program. Thanks, Mary, and thanks for having me as part of the community session here tonight. I'm going to share my screen as well, and you should be seeing them. So like Mary, I am trained in PM&R and then sports medicine. I took the one fellowship shortcut, so I'm not peds rehab trained, but rather pediatric sports medicine trained. Behind me here is the Nationwide Children's Hospital in Columbus, Ohio. That's where I practice. Our program has been in existence for coming up on three years, and the way that our program is set up is similar to, you know, what Mary had spoken of is the true medical home within a sports medicine clinic. The sports medicine clinic is truly set up very different than most rehab departments and rehab clinics, where I need to have same-day availabilities for an injury that happened the night before. And so similar to the way that we don't have a specific day of the week of clinic, I want to have perpetual availability. Also, my adaptive sports medicine program at Nationwide Children's is not one specific clinic, but it's rather a program with a not one specific clinic, but it's rather a program with various access points to it. So within the clinic, the availability to be seen for an injury is in the middle of a traditional sports medicine clinic. So the athletes in my waiting room are the quarterback of the football team and the wheelchair racer on the brochure here in front of you. So everyone integrated, and that's going to be a theme of our presentation here this evening. We've some unique aspects of this program. Our rehab is actually founded through athletic trainers. We do use physical and occupational therapy, which we're all familiar with, but we have unique programs, which are called the Play Strong program, and we really use that as a mechanism to get children active. So it's somebody who is not currently involved in an activity or a sport and is looking for conditioning and general well-being, we'll get them started in that program. And then the Stay Active program, we call it our functional rehab. Traditionally in our sports med clinics, we look at running mechanics and throwing mechanics, and now in the adaptive program, we're returning someone to sport focused on the mechanics of their sport specific. When we look at the adaptive sports medicine in our clinic, I think of how do we intersect with this cycle of adaptive sports. Some of my patients are individuals with disabilities who are not active. They come to me as a referral or seeing information on our brochure on their own, and they come to me in the clinic for recommendations to get active. So in that aspect, what I do is I push someone along, and we talk about what are their interests, where do they need to go, and how do we meet those interests. Is that through our Play Strong community, or is that directly into a community program down below? Other people come into my clinic who are already active in one of the various sports in our adaptive communities, and they've suffered an injury, and they don't know where to go. They're not sure if the sports medicine clinic in the Yellow Pages has an accessible room or an exam table or what their assessment is going to be. So we view that an adaptive sports medicine physician should have the knowledge and background in the patient's physical disability and their underlying diagnosis, but the focus should be on their functional ability and their return to play, getting them back on the field. So when we look at this cycle and cycling through there, wherever they enter and exit this cycle, we want to plug them back in. In Columbus, Ohio, we have a number of community programs that we work with, and one of the things that I'm most proud about is the Ohio State High School Athletic Association. Over the past now seven years, they have had a seeded division in the state tournaments for track and field. So we have wheelchair racing available at all high schools in Ohio, and then this year was the first year that they have two para-adaptive swimming events as part of your high school sports. So really proud to be practicing adaptive sports medicine in Columbus, Ohio. Next, I'm going to transition. I'm going to hand it off to my colleague, Stephanie Tao. Stephanie is also double-boarded, and will share a little bit about her programs in Texas. Thanks, Jonathan. I'm going to pull up my slides here and share that with you guys. Okay, hopefully everyone can see that. So I'm Stephanie Tao and I just started at UT Southwestern back in September. Hopefully we'll be seeing patients soon it just takes a while with the hospital credentialing process and everything. But like Mary, I'm dual trained in pediatric rehab and pediatric sports medicine and have a passion, like everyone else on this presentation for athletes with disabilities. And so, fortunately, I got hired where I also had done my residency three years ago before I went and traveled across the country for my different fellowships. And during my last year of residency, we created this adaptive sports coalition in the Dallas Fort Worth region because we noticed that there were a lot of different adaptive sports organizations in the area but some of them didn't necessarily talk with each other or collaborate, and we also felt like as a hospital system where we're kind of like that medical home that Dr. DuPont talked about, we need to have a strong relationship with these organizations in the community. And so, with this model we created it so that we are in partnership with our other applicable hospital systems right for children, sports medicine and children's health which are the two primary hospital sites that at which I work clinically. We have a partnership with them and then we collaborate with the surrounding organizations in our area and so we have the Dallas Junior Mavericks wheelchair basketball team for which I serve as a team physician. We have a bunch of big organizations that create events during a non pandemic world that we sometimes will provide medical coverage for. There's the Texas Tennis Association and so a lot of this is, you know, integrating with the community and then every year we have a big adaptive sports expo, which unfortunately this year because of the pandemic it was virtual but normally it was in its fourth year this year but the past three years, it was held as an all day event at one of the universities UT Arlington in the area and so, you know, lots of different examples and displays of different adaptive sports activities that kids and adults could try out, and we even had some patients from our inpatient rehab unit get passes to go and, you know, check out the event. So the program that I'm working on developing here in Dallas will, you know, similar to what you've been hearing with the other speakers will have multiple tracks for access because when we talk about adaptive and para athletes you're, you know, you're really able to reach out to multiple different levels and so for those who are already active already involved with sports or physical activity for my sports medicine hat, you know, there, I'm there to help care for them for the acute or chronic injuries that they have talked with them and coach them through injury prevention and also just talk about sports performance and optimization of function. And then, you know, if they have any interest in new sports helping them get connected with those different resources. Similar to Jonathan's program where you know they had to get get active for those who the kids who are not yet involved but are interested in learning about getting involved or, you know, maybe they've heard oh you're not allowed to do that certain sport and then they actually find out like oh with their condition they actually can do certain activities just with modification. They also are seen in my program. And my goals are to be able to provide them with customized exercise prescriptions, and then also helping them with monitoring the barriers that they're facing when they're trying to access their early stages of participation in the activities, and then giving them you know connections with recommended resources in the area. For other services that my program provides so big component of sports medicine is pre participation physicals and as we know, you know, a lot of those are done in like the mass setting for typically developing youth athletes, and it's a little bit more difficult with athletes with disabilities and so I provide that service, whether it's, you know, a day that I do it just for the basketball to the wheelchair basketball team or I have appointment slots for them. You know, that's the plan for that right now. And then also providing sports coverage for a lot of the different events and so I serve as team physician for us Paralympic swimming. We also have been trying to do some coverage for a lot of the different organizations in the area, helping them, especially during coven with return to play protocols and practices and how to progress that if you know our wheelchair basketball teams thinking about hosting a tournament in January I'm helping them from the medical perspective of this is what we need to think about from a pandemic perspective and then also just having, you know, emergency action plans in place and all the other typical sports medicine stuff. And then the other aspects of our program. Thinking was we're in a big academic center, our academics and research and so my hopes are to host, you know, in addition to our expo in the future and academic symposium where we bring in different speakers and talk to the community as well as other physicians about their adaptive sports interests, and then also collaborating with others on this presentation in developing a multi site research program focused on adaptive and para athletes, similar to everyone else on this call. You know, I think we realized that in order to fully serve athletes with disabilities, you need to have access to appointment slots and flexibility in that and not just like once a week or once a month. And so I'm primarily do pediatric rehab at Children's and then primary pediatric sports medicine at Scottish Rite but my adaptive sports program is at both sites. And so and I'm always willing to see patients in either the traditional pediatric sports medicine clinic that I have, or the traditional pediatric rehab clinic. And I, you know, have a good, you know, strong relationships and partnerships with the other departments like orthopedics recreational therapy, PT OT sports neurology, and then our, you know, multiple peds rehab group and then I'm also involved with our limb deficiency program up in Frisco, which, as we all know, you know, limb deficiency and wheelchair athletes, those are like the two biggest categories, although you know certainly we're trying to advocate for more athletes to get involved. But hopefully by being in that clinic I can help, you know, support their needs as well. And then lastly, just wanted to talk real quick this is a pilot program that are I'm working on with our recreational therapists at Scottish Rite, and so we're piloting it for for kids with spina bifida and cerebral palsy first but as you know talked about in her presentation there's a lot of barriers that, you know, kids or adults face when they're trying to start participation in a program and so we created this kind of program to have multiple checkpoints and follow up and kind of like that hand holding model to see how we can help them with the different barriers along the way until they've, you know, caught on to to activity. So this is our program in Dallas and now I'm going to turn this over to Dr. Priya Chandan, who will start the next group of presentations on athletes with intellectual disability. All right. Hi everybody I'm just bringing the slides up. You should be able to see the slides now let me make this. All right. So I'm going to talk briefly about athletes with intellectual disability and first thank you to my colleagues in the pediatric rehabilitation medicine group, as well as the adaptive athlete and sport group, it's really nice to be able to do this kind of together So I'm also going to try to talk a little bit about areas where we overlap and sort of opportunity for collaboration there. I'm an assistant professor at UofL in Louisville, Kentucky. I also am a global clinical advisor for Special Olympics as well as one of the senior editors for the PM&R journal. I am now I'm full time research, the majority of my research is regarding health services research as well as medical education. So those are the lenses I tend to approach things with. So briefly, I usually don't I don't think it's really needed with this group but I always try to talk about a little bit about what do we mean when we say intellectual disability. So just understanding that that's referring to people that have limitations in intellectual functioning as well as adaptive behavior. Be aware of the definition of this population is by nature hard to pin down sometimes because there are clinical definitions or administrative definitions there are service definitions. So the ages the age range is can can vary and you guys know that especially those of you engaged in pediatric rehabilitation medicine I know you've seen that. And so I just bring this up to say that you know this is a population that's already a little bit hard to define, which makes research and evidence about them a little bit difficult to come by, which will. Again, just thinking about intellectual disability is essentially under that broader umbrella category of developmental disabilities. There are other developmental disabilities as well. And again, just thinking about this is not really something I have to go into with this group but remembering that you know intellectual disability does not mean that you necessarily also have a primary motor disorder or vice versa. Again, this sort of preaching to the choir in this. So in thinking about intellectual disability I listed some of the common causes, but important to also remember that for the majority of people. The cause is in fact often unknown. And I bring this slide up here just to emphasize that when it comes to intellectual disability. The majority of people with intellectual disability have mild intellectual disabilities. In terms of physical activity guidelines. This is probably my favorite side of the entire presentation because I can just refer back to my pediatric medicine colleagues as well as the adult physiatrist to come to say that for intellectual disability someone does not change sort of those physical activity guidelines. So again, to always remember that as Dr. Dubon mentioned, important to remember as physicians our ability to sort of facilitate sports participation or to be a barrier to it. And I think, you know, making sure that we counsel on that and remind patients that it is the same guidelines, I think is important advocacy work that we can do. So to talk briefly about health disparities and really my purpose in bringing this up was to kind of get us thinking about the lens of equity. The Pumanar Journal is going to be doing a supplement in the spring on health equity. So this is kind of a preview of that, but it's it's to really sort of change the way I think that we think about things sometimes. And when you talk about health disparities, you have to have a very good understanding of equity, because ultimately health equity is the principle that you are working towards if you do any work related to health disparities. And so that might be the measurable disparity we see it may be disparities that we know exist in those the determinants of those clinical outcomes so sometimes it's clinical sometimes it's more proximal than that. But essentially equity is when everyone would have the opportunity to attain their highest level of health. My colleagues have talked about this before, but really, it comes down to choice. I really like this, this picture to illustrate the difference between equity and equality. And you can see here I thought this was particularly relevant to our discussion today. But you can see how in a situation of equity, everyone has the, in this case a bicycle that is appropriate for them that meets their needs. And that's really the point is that in a situation of equality, it may not meet everyone's needs. People do not necessarily need the same thing and so if we blanketly apply one solution, it may not be what is needed by different people. And again, it comes down to choice. So my colleagues in Pediatric Rehabilitation Medicine mentioned, you know, when it with regards to participation, lack of access is a problem, and lack of access to multiple choices so you know you can you, we all know, as in sports as an athlete. You know, it's not going to be one sport maybe you're really into, others that you really don't want to have anything to do with. So the more choices we have available, the more we can encourage people to engage in sport and that goes for people with intellectual disability, physical disability, disabilities, not disabilities in general, it's about choice. So for that reason, I like to highlight the word measure so think of it as it's a measure of progress in the situation where we eliminated health disparities and we had a situation of health equity that wouldn't have a job anymore and that would be totally fine by me. But until then I will be sort of continuing to measure our progress towards. So this slide I bring up just to highlight here. So if we are thinking about equity, we have to recognize that healthcare is a is a fraction of the determinants that lead to inequities, it is part of the system but really to kind of address health disparities you have to go more approximately to some of those determinants to some of the social determinants of health so you see that reflected here. I also want to mention, you know, there's things we can do but if you're really committed to this work sometimes you have to kind of get out of the medicine silo and interface with other industries as well. So I bring up insufficient training for healthcare providers, because for people with intellectual disabilities, athletes with intellectual disability. It's one of the main determinants that we see. So I'm going to say it was about 10 years ago but sadly I don't know how much these statistics have changed but 81% of medical students, not having any training on people with intellectual disability, same in around 90 with primary care residents. And so some consequences to this I find this very interesting but in pretty much any marginalized population you will see a variant of this concept, intellectual disability we refer to it as diagnostic overshadowing. But when it comes to experts in LGBTQ health, they refer to it as trans broken arm syndrome and it's referring to the same thing it's where a particular diagnosis a particular health condition sort of overshadows our clinical decision making. And then we then attribute everything to that diagnosis so as an example, somebody with intellectual disability. There's a complaint about certain behaviors, we medicate the behaviors, the behaviors then decrease. But the problem gets worse. And so then we, the, we end up increasing the behaviors inadvertently by over medicating. I give a few examples here on the slide but I really want to focus on polypharmacy because in this population. That's really kind of the focus. I know today is sort of a brief snapshot but I encourage everybody to think about polypharmacy, if you are sort of interfacing with athletes with intellectual disability. We've seen that it's our athletes with autism, as well as cerebral palsy that have the highest rates of polypharmacy particularly when they have co occurring intellectual disability. And that can affect sports participation as well as performance and as you can imagine if you are on multiple psychotropic agents, it may be difficult for you to really participate, not just in sports but in life, and has implications certainly. So briefly about Special Olympics International and the reason I focus on Special Olympics International is my colleagues presented some great slides about different organizations that tend to focus on different populations. Within, within the intellectual disability community I would say that when you're talking about sport. I think that Special Olympics is what pops into mind first for everybody. Just so you're kind of aware of the organization of that Special Olympics International is the international body that is headquartered in Washington DC, and sort of sets the standards but local programs are really the heart of the movement and that is when we're looking for resources for our patients it's the local program that you're going to want to look for so just because something is available on the SOI website, it really sort of varies by location, I'm going to speak to it in overview just you have a sense of what possibilities may exist. But I encourage you to really look for your state program to really drill down to those concrete resources for patients. Again, Special Olympics, it's year round. I often get asked you know when is the Special Olympics and the answer is it's all the time. And in terms of who does it serve its children and adults as well. So here's briefly the different sports that are offered again, this is at the SOI level but so there's 32 as well as three what they call locally popular sports. And so dance were also added in 2019. We faced a little bit of a stall there just because of COVID but you'll be seeing more of that into the future. So, just briefly again, I think the perception of Special Olympics is that it is a sports organization and primarily it is, but it's important to realize that they do a really good job as a public health sort of orientation, interfacing with other industries so there's sport programming there's also education so programs within the schools, as well as the health side of things, as well as community, and so I primarily engage on the health side as well as community, but certainly deal with the education programming as well which is really exciting and really innovative and I think that's really kind of what's what's changing the game, sort of crossing over into health as well. I will briefly just mention a couple of areas. Someone mentioned sort of the pre participation screening so thanks to collaboration with Special Olympics International as well as myself and Dr. Jubon we were able to get the Special Olympics forms integrated into the AAP website and you can imagine how for athletes with intellectual disability, because that is a form that is required for them to participate and so now it appears alongside the forms for children with disabilities as well as children in the general population and so I think having all of those resources housed in the same place sends an incredibly powerful message. We're also working on some activities related to sports injury tracking and prevention, and I won't get into, you know, much more related to Special Olympics but if you're interested in more details there is a publication out that's kind of your Special Olympics 101 also goes through comparing contrast with para sports as well so sort of breaks down where it fits in sort of into the conversation. I bring this slide up just to remember to mention sports injury and tracking so I don't think it will come as a huge surprise that in the intellectual disability world, and we are far behind the first time that this was even brought up was in 2018 So that is the first time data was collected on this, moving forward, hoping to integrate some systems, Dr. Jubon assisting with that as well. So again, the collaboration across our groups is, I think, really incredible, but this is something that other areas of sports are far ahead. We're hoping to catch up, but as other presenters mentioned, funding is always an issue. If you see me mentioning Special Olympics over and over, it's because that is the primary source of funding, and so that's where a lot of efforts tend to be housed. Again, just thinking about the musculoskeletal encounters, I put this slide in just to say, oh, well, you know, turns out the most common encounters for athletes within Special Olympics at the USA Summer Games was, I think, conditions that will seem familiar to our sports medicine physicians out there. So that skill set really sort of cross-applies. So now I want to transition a bit to talking about how physiatrists can become more involved regarding athletes with intellectual disability and just the intellectual disability community more broadly. So the first set of action items I'll cover relate to education. So as I mentioned, the lack of provider education, the lack of physician education is specifically one of the main determinants of the poor health outcomes that we see for people with intellectual disability. So the answer there is to engage in education, and at all levels, really, of the education continuum. So I'll speak about a couple initiatives at different levels. On the medical student education side, the National Curriculum Initiative in Developmental Medicine, it's a five-year partnership between the American Academy of Developmental Medicine and Dentistry and Special Olympics International. And the resources come from a cooperative agreement funded by the CDC. And the goal there is to provide training to medical students in the field of developmental medicine. But as is always the case, we try really hard to integrate other topics by using the lens of equity. So what I mean by that is any time we have the opportunity to talk about intellectual disability, we use that opportunity to also talk about physical disability, to also talk about LGBTQ health. So in that way, we're able, under the lens of equity, to cover many topics that affect many of the populations that we serve. I'm excited that within NCIDM, and I'm the project director, so I'm sort of on the team that manages all of the, we're up to 20 medical schools now. And within those 20, multiple of our site PIs and internal champions are from PM&R. And even beyond that, many of our fiercest advocates have been some of our residents. So I think there's a lot of energy and excitement in physiatry when it comes to developmental medicine or care of people with intellectual disability across the lifespan. Regarding at a resident level, so at our program locally, we do the standardized patient exercise for our residents, for them as sort of part of their clinical training as practice. And so we've always worked with patients with stroke, with spinal cord injury, and used our actors to portray musculoskeletal patients. So this time, we partnered with a acting program locally through Down Syndrome Louisville. So they are actors who have Down Syndrome, and we trained them to portray a knee pain and a shoulder pain case. And so our residents went into the clinical scenario, were just given the door chart that said patient presents for knee pain, gave them the information they needed. They walk in, and the person has Down Syndrome. We did not frame it as this is a case of Down Syndrome. This was a case of knee pain, because people with intellectual disabilities also get musculoskeletal pain. But sort of that framing was intentional, and I think really helpful in helping our residents. We had a fabulous debriefing session. We debriefed with the self-advocates with Down Syndrome, as well as with the residents. And I think it was really sort of positive all around, and really great for the actors with Down Syndrome, because now they have a line on their CV when it comes to their acting careers, and it has sort of helped them gain other roles in the community. So it was a win-win, but that's just one example of really partnering with the community. Another example is on the fellowship side. There are conversations to start developmental medicine adult-focused. So while there's developmental behavioral pediatrics on the adult side, pediatric medicine and pediatric rehabilitation medicine colleagues can certainly, I'm sure, tell wonderful stories about transition, and how sometimes the issue with transition is, where do I transition my patients to? And so this is sort of efforts that are in their very beginning phases, but I'm sort of involved in those discussions and welcome others that might want to be, because I really think it's important for physiatry to have a seat at the table. So I've sort of been advocating for our field in that capacity. I want to then talk a little bit about a sort of a case study, or a story, if you will, for one of my colleagues, Dr. Matt Adamkin, who's also at UofL, and I am going to slide over and let him speak his piece. Hey, hello. I'm Matt Adamkin. We have two presenters at the same place here, which is exciting. I'll go very briefly, because I know we are going to kind of butt up against the time of our next presenters, but I'm not a sports-trained physician. I'm not a pediatric-trained physician either. I run our inpatient medically complex rehab service at University of Louisville and Fraser Rehab. My interest in the intellectual disability population is twofold. I, in my outpatient life, work at the Lee Specialty Clinic, which is a multidisciplinary clinic for adults with intellectual disabilities, and then I have also spent the last several years becoming involved in Special Olympics volunteering. Dr. Chanin was detailing all the Special Olympics initiatives, specifically MedFest, and trying to involve PM&R residents in the pre-participation physicals that get performed at MedFest. In addition to that, I also run an amputee clinic, so all these things kind of combined into this story about Deontay Foster. And because we're a little short on time, I'll skip some of the details. We can talk about him later if they want to come up, or you guys can Google Deontay Foster, and you'll see a bunch of articles about this gentleman. But in short, Deontay is a very high-level tennis player from St. Kitts and Nevis. Back in 2015, he went to the Special Olympics World Games, where he won gold. During that time, he started developing pain in his leg, and he was actually evaluated by the medical team at the World Games, and he was referred back to see a doctor at home, where he was ultimately diagnosed with osteosarcoma in his left leg with meds to his lung. Ultimately, he ended up going up to New York and getting chemotherapy, underwent an above-knee amputation, went through months and months of treatment, and then returned to St. Kitts as an amputee, and really without any follow-up. He continued playing tennis on one leg. He did this for about two years. They started trying to raise funds for him to try to get a prosthesis, to try to get medical care, and they were just running into resistance, not really getting any momentum towards giving him the care he really needed. Ultimately, they engaged with the Special Olympics St. Kitts group. That group reached out to Special Olympics International. Special Olympics International kicked that to their global health advisor, who just so happens to be the president of that league clinic that I work at, and also a very good friend of Dr. Chandon's. He reached out to Dr. Chandon, who was more involved with local physicians. She said, did you know Dr. Adamkin has an amputee clinic and also works with Special Olympians? Ultimately, we ended up getting Deontay to come up to Louisville, Kentucky to get his prosthetic care. We involved some local prosthetics groups, got all these things donated, and ended up getting him a very high-level prosthesis that he could play tennis on. The sad part about this, it sounds like a happy, fun story, but the sad part of this is this guy went two years with no care, and really had such poor access to care that didn't change until he got a physical disability. I think there's a lot of lessons to be learned from his experience, and how we could apply it to so many others, that he ended up having to travel 2,000 miles to get something that he should have been able to receive in a much more timely and convenient fashion for him. With him in mind, I will actually pass this back to Dr. Chandon to tell how this story ends. I'm going to be brief, because I know we're approaching time. But essentially, the important part here is along the way, we got involved with Jeff Burns, who is an adaptive athlete. He had an amputation secondary to a tibial deficiency when he was a child. He has been working very closely with USTA on adaptive standing tennis. He reached out and mentored Deontay. Ultimately, the second chapter was Deontay trained really hard, was ready to compete at an elite level, went to USTA, and was not allowed to compete because he has intellectual disability. And so it was really Jeff, who is an adaptive athlete himself, who advocated for him and argued his case, put it on Facebook, generated some well-deserved anger, and eventually USTA changed their minds. And then they also changed the rules for the rest of the tournament, as well as for all athletes moving forward. So it's just an example to say of sort of how we can collaborate together. This is somebody who is an athlete and didn't have to do that, but really opened doors for Deontay, as well as for other athletes with intellectual disability. And I put this here just so you can see Deontay and understand that I think this resonates with everyone who engages with sports medicine, that sports means the world to athletes. And that's what you see here is it means the world to Deontay. He wouldn't have been able to compete in the USTA tournaments otherwise. And he came back and he won. So that was kind of chapter two of that story. I will stop here because I want to make sure to introduce our next group. So I will pass it over to Dr. Melissa Tinney. Thanks, Priya. Let me go ahead and get my screen shared. Okay, and hold on. Okay, all right. So where our group is going to be talking, myself, Dr. Kasten and Dr. Lee, we all have a shared experience in working with the National Veterans Wheelchair Games, which is the largest wheelchair sporting event in the world, 600 plus participants. And so this is where we're coming from on our experience, really from my adaptive sports management talk from the sidelines. We have no financial disclosures as a group. And so I'll start with the physical activity guidelines and disparities. As Mary had talked about earlier, as far as physical activity guidelines, she talked about these are similar as far as the source on cardiovascular exercise and strength training, as far as the guidelines that have been published in 2018. I think most are familiar. This is in the adult population, very similar, almost the same, as far as the guidelines that are put out by the American Heart Association. And that's just adults in general. Now, as far as defining intensity, just as a quick review, moderate intensity is really by METS, an absolute scale of 3 to 5.9. Vigorous intensity is 6 or more METS. When we're talking about sports participation, you can easily range between that moderate to vigorous intensity. So it's really important to keep that in mind when we're making recommendations, not only for physical, just general physical activity, but then also making recommendations as far as sports and sports training. Other guidelines that have been published in populations with disability, there are published guidelines for MS, and they're slightly modified as far as the amount of aerobic activity with considerations for training in high-temperature locations. Other physical activity guidelines that have been published as far as for cerebral palsy, I think Mary had already kind of highlighted this. There is one group at the University of Michigan that has published kind of a reiteration of what was already said earlier in this talk. But the one thing that I wanted to highlight is they did define sedentary activity, less than two hours per day, seven days a week. So that included sitting at a desk or playing video games. So I thought that was interesting to include because that definition was defined. And then in regards to spinal cord injury, there are guidelines that have been published specifically for spinal cord with 20 minutes of aerobic exercise two times a week, and then three sets of strength exercises for each major functioning muscle group two times per week. And so in regards to talking about health disparities, to piggyback on what Priya and Mary have already talked about, you know, obviously the populations that we work with, whether they're pediatric or adult, are dealing with increased risk for multiple comorbidities, including diabetes, cardiovascular disease, stroke, cancer, and obesity. Of course, conditions can be severe, fluctuating, and progressive. And also common musculoskeletal injuries can have major impact in regards to functional consequences. So I think that this slide also highlights very similar, I think this is a running theme that it's really important to highlight. And I think it's why we all serve as patient advocates and our really important job that we do. And I always think about this is that we're not just team physicians, but we're also advocates to building the programs. So very oftentimes you could be a team physician for a track team, but you're not trying to build the track team simultaneously. And I feel like we, as even healthcare providers, are, as you can see, a lot of the members of this panel have a lot of investment in programming and programming sustainment and building, and a lot of community outreach, which is to be applauded because it takes considerable efforts. So again, similar themes and barriers that have already been highlighted in earlier talks. So there's a few references that I thought were, just wanted to mention because there are some key articles that really highlight some of these, particularly for adult populations. I'm including one article from Dr. Blowett that had, she would have been on this talk, had she not had a conflict. Okay. And so I'll go ahead and pass this over to Dr. Kasten. All right. Hey guys, I'm Kimby Kasten. I'm a sports medicine fellow at University of Michigan. I did my PNR residency also at University of Michigan with Dr. Tinney and had a lot of fun with Ken Lee at the National Veterans Wheelchair Games. So just continuing the encouraging activity. Something that Dr. Tinney and I have found to be really successful is an arm cycle or even a portable leg cycle. You can Google these, you can Amazon these. They're as cheap as 20 bucks, depending on which one you want to get. And for upper extremity aerobic exercise, it's if you do it for endurance or intervals, you can get an appropriate aerobic workout. Same with the portable leg cycle. It's a good place to start when you're trying to encourage activity. This is on the opposite side of the spectrum of our adaptive athletes where sports is their world. This is trying to get someone with a physical disability to start exercising. And there's a lot of ways we can try to get our adaptive patients or physical disability patients to do resistance training. And so you can see a couple examples here of chair resistance exercises to encourage the resistance and strength portion of exercise recommendations. We wanted to include a bunch of links that you guys can use and reference this later. For guidelines, here's the CP guidelines, exercises medicine, just another thing to help. And then switching to sideline management. This is our group of U of M sports physicians at the National Veterans Wheelchair Games, sports spinal cord. Something to know if you are not involved in adaptive sports and you want to be involved in adaptive sports is that athletes when they're about to compete or when they're getting into a sport get a disability classification. So here is the list of the disability classifications. I think this is pretty consistent among the wheelchair games, IOC, Special Olympics, Paralympics. So when you're starting before competition, there are things to know about specific to adaptive athletes. There are so many equipment adaptations, obviously, to just get to be an adaptive athlete. Then there are some simple things like U of M has a wheelchair tennis team and we have an army of volunteers and docs that tape the rackets to the athlete's wrists for anyone that has hand weakness or contractures. Other than a normal wheelchair, there might be an athletic wheelchair that is needed, different bracing that is needed, and it's good to note that 18% of the injuries at the 2002 Winter Paralympics were due to equipment issues. Then the two big things in addition are baller bladder programs and skin protection. Baller bladder programs need to be handled and organized around competition and practice. Skin protection becomes extra sensitive with all the sweating impact of different sports. As has been said throughout this evening, it's still a lot of MSK. It's worth noting that non-ambulatory adaptive athletes tend to have more upper extremity injuries and wheelchair athletes have rotator cuff, general shoulder injuries, bicep tendon overuse, premature OA. Amputees, they'll have prosthesis associated skin injury. Upper extremity amputees have cervical thoracic pain. Lower extremity amputees have lumbar pain and there is, of course, not to be forgotten, overuse of the intact more functional limbs. As for visually impaired athletes, it's common to have a lower extremity injury because they have a loss of proprioception. Sideline emergencies is something that is probably one of the first things that people think about when it comes to adaptive sideline management. Autonomic dysreflexia is the big scary issue. Just a quick review, always want to check all the possible offending factors causing autonomic dysreflexia. You have nitro paste and antihypertensives as options. Those should be in your med kit. In general, disabled athletes tend to have disordered autonomics, autonomic regulation, whether it's a spinal cord athlete, amputee, other form of disability. They tend to be more prone to hypotension, fluid loss, heat stress, and then again pressure ulcers. UTI and neurosepsis is another big one in spinal cord. Saw that a lot at the wheelchair games. And then, of course, c-spine injuries and concussions are not to be forgotten, which cannot talk about. I included a slide on what you might want in your medical tent for disabled athletes. We had a few different bags for the sideline doctors. This is a quick list of things to think about. Now, on to Dr. Lee's presentation. Thank you. I'm the caboose at the end of this train here. I was supposed to be done by four minutes ago. I'm only going to present four slides, just some impact slides here. Go ahead, next slide. Basically, I would like to just talk about briefly about sports medicine versus adaptive sports medicine, the differences, and also talk about concussion. That's my new thing at this time. Go ahead, next. If you look at able-bodied athletes, in general, they're a healthy bunch of people, aren't they? I mean, they're best of the best. They're the best crop of the human beings in a way. They have the best physical condition. And if they get injured, maybe six to eight weeks broken bones, and they'll heal well, and then their life doesn't really affect their life that much. Go ahead, next. Go ahead, next. But from when we talk about adaptive sports athletes, they all have a baseline medical condition that we need to be aware of. That is the requirement to participate in many other sports, especially at the competitive level. And so many of them may not be in their top medical condition. By default, some of them just may have a baseline medical at-risk condition, such as T6 and above. They're going to be prone for autonomic dysreflexia. That's just going to be their baseline condition they come with. We need to be aware of that. And more importantly, if they get injured, this becomes a huge factor for their everyday life. It affects their ADL, potentially their work, and their livelihood. So we need to be aware that a simple ankle sprain is not a simple ankle sprain for an amputee who's got a sound leg, but that ankle gets a sprain. This may have them go into a wheelchair. We do have injuries in winter sports clinic where a para becomes a tetraplegic because of the fall. That's a significant life-altering changes. Also, the equipment. Pretty much every one of these guys come with an equipment, whether it's a sports chair, or specialized amputee prosthesis, or even their own equipment. For instance, Kim talked about taping the hands with a tennis racket. You can't just tape it all around. What if their skins are very different according to the individual sensitivities on it? Or you tape it too tight, not too tight. Would the athlete know that it's too tight for them? All these come with an increased risk assessment that you all have to do. That's a huge difference between regular sports medicine or athletes versus our adaptive sports athletes. Next. I want everybody to know that as you start going into adaptive sports. Know the disability, know the people that you're going to be working with. PM&R docs are in a great position to do that as you get into it. Concussion in adaptive sports is something new that I'm getting involved in. Mainly, I am the team physician for Milwaukee Eagles wheelchair lacrosse team. I also qualify with my impairments to play in the sport as well. One of the national championship in Denver, Colorado two years ago, I had a significant concussion and dislocated jaw. When I came to, I was telling my resident who I took with how to relocate it back just with hand movements since I couldn't talk. We were able to relocate my jaw back. Smartest resident is, he wouldn't let me go back and play because I had a concussion. I was really mad at him. I was about to flunk him. He did the right thing. Concussion happens. Then we realized, let's look at all our athletes during some power impact games during the wheelchair game. What we realize is that we're watching all these games and we're like, that guy had a concussion or that guy just hit his head. They're going back in and playing because they're in a wheelchair. They're not wobbling around. They just go out for a second. They come back right in, but we've seen them get hit. We've seen them unsteady a little bit. They're in a chair. That's made me realize that we're missing concussion in wheelchair athletes. Two years ago, we started looking at this and how to test them. There's no studies out there. There's nothing hardly anything out there that can do. We started our own program of concussion management program in Medical College of Wisconsin. With all the athletes that I'm involved in, we're starting to put together a baseline testing. One other thing we did was, as we looked at some of the things that were out there, we had to modify some of these tests. When we're finding out during a concussion, whether it's pediatrics or adults, once we did an exam after a concussion, it didn't mean anything. We couldn't compare it with the baseline because some of their baseline is just like what a concussion would look like. It was important to get a baseline testing done, baseline history done as well. That third bullet down in the middle there was this concussion management program. That's something I can share with everyone. It's on our 21st revision. It's been shared internationally as well with the other federations such as wheelchair rugby programs and a couple other ones as well. We have been doing a lot of the education and teaching. Important thing, again, I want to say is baseline, baseline, baseline. Currently, one of the most important work that's going on is Sherry Blowett is involved with this thing. Dr. Ahmed is a PhD. We are actually putting together the first position statement of the concussion parasport. This group of experts, it's amazing the knowledge that they have. It is actually ready and submitted for print. We'll see how that goes. My group actually have a sideline concussion exam for wheelchair athletes, a consortium of experts. Basically, since there's nothing scientific out there, we put together about 14 experts in parasports. We are actually in the first phase of putting all that sideline exam booklet done. It's actually a consortium, so not a scientific base. We're hoping that everyone else will participate in that. Go ahead and go to where the examples are right there. Just give you some of the idea of what the wheelchair game demographics looks like. It's a majority of them are spinal cord injury and some amputee. We do have 550 athletes. This is the largest annually occurring wheelchair sports in the world. Paralympic happens every four years. Go ahead and next. Because we're out of time, we'll put away this case presentation. There are some cool case presentations. Some other time, perhaps, I can share with you guys the case presentation. I think we're supposed to throw back at Mary, right? No, we're going to ask Priya to segue. Thank you, Ken, to our Q&A section. If the folks on the panel could turn on your cameras so we can have our attendees. Either can put questions in the chat if you would like. Then Priya, if you want to go ahead. Yeah, sure. If you all want to put questions in the chat, I'm also going to share one slide just with some things to think about. You don't have to respond. If we want to have discussion on it, we can since this is a community session and it gives us the chance to have discussion with each other. Let me get that up real quick. I think some of the general trends that we've seen in the different presentations that we've heard from today, I think really raise a couple of points that I want to bring up just to get everybody's thoughts and have everybody do some reflection on. Really, a lot of the things that we've heard is obviously as physiatrists, we think about disability from the ICF or from a functional model, knowing that there's medical models as well as social models and we tend to utilize that functional approach. Even though that is how we're trained, are we unintentionally perpetuating ableism? I'm going to give a couple of examples here. I sought input from our athletes with disabilities as well as trainees. What are things they wanted to bring up to have us all think about? One was Jeff said, he mentioned some of the politics that he sees within the sports world within athletes and wanted to bring that up because he said, to me as an adaptive athlete, when I say that, I mean the breadth of things, but wanting to think more about that. Some of the trainees brought up the question within sports medicine, how are we unintentionally perpetuating ableism? Which sports coverage things are considered sexier than others? I say that as an example within Special Olympics, we only have coverage at World Games. That story with Deontay, it's only at World Games, cannot for the life of us get coverage most of the time otherwise. Also thinking about sexism. Dancers are athletes, gymnasts are athletes. I went to a very big football program, so I recognize that football is king, but why is that? From a sports perspective, I think we would agree that all elite athletes are elite athletes. Then thinking about some of the self-advocates said, essentially understand the term adaptive, how it's used in your community. If the community you're in thinks that it includes them, but it doesn't, you want to be very, very clear about what the opportunity, who they're open to, who they're designed for. Just being clear in communication. Then one other tip with communication, the self-advocate said to mention, is avoiding inspiration porn. The way to do that is to elevate the voices of people with disabilities. If you're curious how to do that, simply what we did here, where we just put quotations, so in their own words. As physicians, we will get asked by the media to comment on certain activities, to comment on the wonderful clinic examples that everybody shared earlier. Just to be mindful to always ask to be able to proofread those pieces, because if you're thinking from a lens of equity, if you're thinking from that framework, you can make sure that there's not that language in there that all of our groups have talked about when it comes to suffers from or things like that. Those are just some last minute tips that I think the wider community wanted to share. I'm going to stop sharing the screen and look at some of the questions that we have here. Let me take that first question while you scroll through them. Any of the high school sports associations count the adaptive sports participants in points towards the championship? That's a really good question and was hotly debated because there's really two sides of the argument from multiple sides of stakeholders there. The answer to your question is no, those points are not counted towards the team. That's because most teams do not have an adaptive athlete. Therefore, they would be almost rewarded for finding someone to fill a need on their team. That was chosen not to be part of that. However, that being said, you are by definition a member of your school's track team. You have to have a school-issued track uniform that you're able to don and off and that meets your abilities. That's how that's handled in Ohio. I'm not sure if it's different as far as wheelchair basketball and classifier. Maybe Stephanie, do you want to take those? Yeah, because I feel like that question about wheelchair basketball phases into classification as well. I'm a national medical classifier for US Paralympics swimming for the past three years as well as their team physician. I guess the easier question of how to get involved in being in classification, if you go to the Team USA US Paralympics website, there is a sign-up form where you just fill out a quick little form. I will say the person who's in charge of the classifiers has changed already three times since I started as a classifier. There's a lot of turnover, but the person in charge of it is pretty on top of it right now. I will say a lot of it is limited by the classification process is constantly evolving. I got trained in 2016 or 17 and that was right after they had just updated the process. Since then, for swimming, we haven't had any classification courses. They wanted me to go train for international a year or two ago and I'm still waiting until 2022 when they have the next course available, but that's tentative. Then, who knows with the pandemic now with funding and everything how things are going to work, but I will say it just depends on your sport. Just always ask. Definitely sign up on the US Paralympics website and email them and find out like, hey, I'm interested in classifying for wheelchair basketball. How do I get involved? Just let them know about your skill set because I know for me, I used to be a swimmer and I think my PM&R background helped with getting me connected. The question about basketball. Classification is not a perfect process. There's constantly great, cool research going on in that area. Unfortunately, right now, there's only certain eligible diagnoses. Who posted that slide with all the different eligible impairments? Kim related, so Kimmy did. On the Paralympic website, there is a table that shows if you have this impairment, these are the sports that you're eligible for. Swimming and track and field are one of the few sports that all the eligible diagnoses are eligible, but it still excludes certain diagnoses. If you have a chronic pain syndrome that's not related to an underlying disability like cerebral palsy or neuropathic pain from amputation, unfortunately, you're not eligible. Same thing with the functional disorders like conversion disorder. The problem is it's really hard to quantify those diagnoses when you do the classification exam. Until we have a better way to say, hey, you lose this many points when you have this pain disorder, it's still ongoing research for the classification process and eligibility for those sports. Thanks, Stephanie. I think we're at time right now to go to our breakout rooms. We have three different breakout rooms. Our friends from AAPMNR, Marcia and Margaret, are going to prompt you guys to those breakout rooms. You can pick. You can jump between different rooms. Andrew, if you want to join my session, I can answer your question in there because I have lots of thoughts for you on that and would love to hear from folks. See you guys soon. Margaret if you're talking, you're muted. No, maybe not. You know, I'm just following on Stephanie toes towels. The comments about classification. So I'm a classifier for the wheelchair games and I did the one for the IWRF, the wheelchair rugby federation, but I didn't keep up with it. There are many whenever there's an event near you, there's, there seems to be usually a call out for anyone interested in learning how to be a classifier. So parasailing came to Milwaukee area and then there was a call out for that. I did go but I didn't participate it was just too complicated for me. But just keep an eye on and your ears open for all those kind of activities and then you usually if it's a organized sport, the Federation usually wants to get as many classifiers trained. So, so do that. Yeah, I will second that that you know I think sometimes you might not be able to get your first choice sport. But if you're really interested in getting involved find those opportunities.

adaptive inclusive sports programs

individuals with disabilities

healthcare providers

exercise benefits

intellectual disabilities

physical disabilities

barriers to participation

interdisciplinary collaboration

customized equipment

athletes with intellectual disabilities

health equity

inclusive sports opportunities