Welcome everyone. Good evening. Thank you for joining us. If you guys are able to show your faces, we appreciate it. We really want to take this opportunity to get to know each other in this community. So I am the chair of the adaptive athletes and sport community and really excited to have an opportunity to assemble a panel for you tonight. I'm really excited about, you know, what we can bring together to the field to further the Paralympic movement. And as you can see from the panel and the variety that there's many many roles and aspects that we can all get involved in some way. And so I we really were listening to our membership we had a survey in the fall, and people were really seeking opportunities for networking and mentorship. Certainly, a lot of people come into this space very organically or coincidentally from exposure or meeting somebody, but really being able to be thoughtful and strategic of your involvement I think will actually help increase, you know, opportunities and interest for people to really be involved. And we want to make sure that those opportunities are known. So I'm going to do a quick introduction of our panel and then we'll take it from there. Let me just pull this up here. Okay. Can everyone see the slides. Yes. Okay, great. Okay. So, we have no disclosures. We are just here really representing our own experiences and opinions about how we've been involved in adaptive sports. So Dr. DeLuigi, Dr. DeLuigi are you on? I know he is trying to log in currently. So, he is the chair of PM&R at Mayo Clinic Arizona, and we are so happy that he can speak to being a head team physician at a very high level with Paralympic sports and alpine skiing and snowboarding, but certainly has worn many many hats in adaptive sports. Dr. Tao is assistant professor of PM&R and sports medicine and pediatric rehab at University of Colorado. She has again also a multitude of hats in this space, but certainly her expertise is, will be sharing with you classification as head classifier and head team physician at US Paralympics swimming. Dr. Melissa Tinney, I am clinical assistant professor of PM&R at the University of Michigan. I have a multitude of hats as well but certainly today I would like to talk and share with you about my experience, helping to run our grassroots community facing program through our medical center called the University of Michigan adaptive and inclusive sports experience. Dr. Kenneth Lee, he is a professor of PM&R and Medical College of Wisconsin and chief of the SCI Center at Zablocki VA Medical Center in Milwaukee. Also has many years of experience with multiple organizations, but certainly can speak to what it means to run a very large scale adaptive sporting event. And last but not least, Jonathan Napolitano. Jonathan comes to us from the Ohio State University College of Medicine, who is clinical assistant professor and a pediatric sports medicine specialist and the director of their adaptive sports medicine program, and can speak to really incorporating adaptive sports medicine into clinical practice. Okay, so certainly we can all speak to, you know, our areas of expertise that we're highlighting tonight, but we all have different. So if you have any questions, feel free to also jump in, in the discussion if there's other things that you want to speak to from various experiences that you've had. So I think maybe to start, unless somebody has like a hot burning question. I really just wanted to talk about the pathway in, and how people just got started in the space. I think that would be really helpful for somebody who hasn't been involved in adaptive sports. Welcome. All right. So, anyway, I don't know if I'll just kind of throw the baton out to Dr Napolitano if you want to go ahead and get started, and we'll just kind of go around on the panel. Yeah, I guess a couple of different ways to speak to that. None of you are trainees or maybe a few of you are. So you can speak about the way that we got here that way but also the way that we got involved. I think differently. And I think each of us have had our unique paths. My background as Melissa mentioned, PM&R residency but then a pediatric sports medicine fellowship. And in that space and completing my fellowship at Nationwide Children's Hospital in Columbus, I realized that there was a growing need for care of the athlete with disabilities. So that's how I kind of created the niche program that we developed which is our pediatric adaptive sports medicine clinical program. In order to do that, it was really close integration with what was already set up within the communities looking at the various programs that have been started by parents and community programmers, city organizers, and then just seeing how we could get involved. My role with them is not so much sideline coverage as I do in my traditional sports role but more of networking and connection. And then within our clinic, I kind of describe it to people as there's two separate paths, where I see people in clinic who are looking to get active and have no idea how to start. That referral can come to us from primary care physician, another PM&R doctor, or even they can just come in on their own. They can hear about our program and come in to learn more. And in those visits, I help get kids connected with community events or programs that may interest them and fit their needs and interests. But then the other goal, the long-term goal of this program is to have enough participants that just like my traditional sports med clinic, I'm seeing acute athlete injuries, evaluating their acute injury with knowledge of their underlying ability, disability, and talking about biomechanics and return to play progression. That's kind of my pathway and what I do day-to-day. And as we said, we'll be happy to take additional questions throughout here. But, I don't know, Kenneth, you're unmuted. Do you want to speak to your path and getting involved? Sure. Thank you, everyone, for coming. And thanks, Dr. Kinney, for inviting us here. My pathway is a rehab physician to SCI fellowship. But shortly after I got the job at the Milwaukee VA, I was deployed as part of the National Guard. I was deployed to Iraq. And that really helped me get through it. Then I decided then I just became the chief of SCI back then as well. So I decided that I'm going to convert our SCI Center therapy and recreation therapy as a adaptive sports themed. So when we built our new SCI Center, we had that in mind when we were given certain amount of money to start equipment. I know adaptive sports require it's a highly logistic intensive program. So we just started purchasing everything we can that was allowed like 20 sports chairs and quad rugby chairs. I think initially like 12 hand cycles of all different kinds, things like that. Then we became kind of a mecca for adaptive sports for veterans. Then we became a board member. I started and owned a wheelchair lacrosse team in Milwaukee. It was a money draining team, but it was okay. It was kind of fun. But we realized in Milwaukee area, we were competing each other like wheelchair basketball team was competing against me for funding and everything else. So eight teams, eight sports got together and we decided we're going to join as one group. And that's what our VA utilizes as a partner. And it has now grown to a huge program and just give you the size of the program. Between the chairs of different kinds, I think 20 something hand cycles. And that doesn't even count the lacrosse chairs and the rugby chairs, the bowling chairs and everything else that includes. So it does take a good partnership to make it happen. And that's how I ended up getting involved. And then the VA picked me up to do medical director for the National Veterans Wheelchair Game. That's about 550 wheelchair athletes with about 2000 volunteers occurring every year at different city. And I'm also the chief medical officer for all the six national programs of different kinds. So we're different head at different times. But that's how I got involved and I'm kind of stuck in it to anything else. All right, Stephanie, I'll pass it on to you. Thanks, Dr. Lee. I was just going to say, you know, it's so awesome when you became chief of the VA Rehab Center and the SEI unit and did that because it takes me back to like, I'm sure some of you guys know the history of how the, at least the Paralympic movement, when we talk about adaptive sports, there's a lot of different organizations, right? And I know that's not the scope of tonight's talk. But when you look at the founding of the Paralympic movement, it like, you know, it all started with Sir Ludwig Guttmann, who, you know, he started with what 16 wheelchair veterans in archery. And, you know, it's, that's where we bring it back, right? Like, adaptive sports is about rehab as well. So that's awesome. My pathway, I did PMNR residency, and then a pediatric rehab fellowship, and then a pediatric sports medicine fellowship. I always had a passion for adaptive sports. And I did a lot of volunteering when I was a medical student. One of the pediatric rehab docs in New Jersey, where I was for med school, had an adaptive climbing program. And so that's where I learned early on, like, I asked people, like, how do you be, you know, how do you get more involved in like Paralympic stuff and adaptive sports? I knew early on, I wanted to get involved with the Paralympic movement. And so the advice I got early on was just just volunteer wherever you can locally find adaptive sports groups. I know when I matched into my residency program in Texas, my original program director at the time had told me, oh, there's no, we don't have any connections with adaptive sports groups. Like, I don't know if you're going to be able to do that. And I found out there were tons of adaptive sports groups in Dallas-Fort Worth. And we connected with them, we offered sports coverage, went out and just volunteered with them. And the athletes and their organizations love it because they want to teach people about their sport and, you know, connect people in ways, you know, it's all about inclusivity. When I was interviewing for Peds Rehab Fellowships, I met my mentor, Pam Wilson, who's a Paralympian and curling. She was my fellowship director in Colorado. And before I even matched at Colorado for Peds Rehab Fellowships, she already, when she had interviewed me, she had learned about my interest in adaptive sports and knew I was a past swimmer. And just the timing happened to be right because right before I matched, she emailed me and was like, hey, Paralympic swimming is looking for classifiers. You may be interested in this. And so I applied. And I got, I was fortunate. There's on the USOPC website, if you just Google like how to become a classifier, there's a website on the Team USA website that shows up. And at the bottom, you can fill out a survey. That's one way to sign up for classification. Although I will say sometimes it's just luck or, or like who's looking at the applications or the timing of when they're offering courses. I did just post, I think last night, USA Archery is looking for classifiers. So if you guys are interested in that pathway, you know, that's a good way to sign up, even if it's not necessarily the sport that you're interested in. I found out later on that a lot of Peds rehab docs around the country are involved in classification. And so that was really cool. And then over time, I built up my relationship with US Paralympic swimming, had shared my interest in becoming their team physician, given my sports med interest, and then ended up coincidentally dealing with a lot of medical emergencies while I was at events for classification, because otherwise they didn't have a medical team. They just had lifeguards available. And so they expedited the process, and I became their head team physician in 2020 and continue to do work with them. And so, yeah, that's my background. That's my pathway. I think just getting involved in any way you can, even if it's not necessarily the sport that you're interested in, so that you can develop experience. It's a very small community and you just get connected with one person and then another. I guess I'll hand it to, is Dr. DeLuigi on? I see him on there. I just don't see his face. Otherwise, back to Dr. Tinney. Okay, I'll go ahead and then I am here. Oh, there you are. Okay, great. I was trying to get the picture to come up so I can hold it, but it wasn't accepting it. So I apologize. So I'll try that again here. So see if it will let me take the picture so that you can see me, but I keep saying no background, but it's not taking it. Okay, it's reversed. So anyhow, it does not take it. I apologize. So I was having problems with the link. And then, so I guess Mayo doesn't have the same level of Zoom update that the APM&R has. So I kept saying an administrator had to update it. So I'm using my phone. So I apologize for any of the technical difficulties. So how I first got involved. So I did my residency at Walter Reed Army Medical Center. And so during my internship year was what occurred September 11th. So, you know, and, you know, the military, you know, inpatient and our, and our, you know, patient population rapidly changed, you know, when, you know, post 9-11, when we started sending troops into Iraq and Afghanistan. And we're getting, you know, instead of taking care of strokes and, you know, our old World War II and persons with amputations, right, we, we are now taking care of fresh injuries and lots of multi trauma every day. So, you know, during my first PGY-2 year, we were still, you know, my, my, my, one of my first patients was the first person who got fitted for the C-leg, you know, and from that standpoint. So, but we hadn't really gotten to the point to start adaptive sports. And over the next year or two, we are having a number of different, you know, groups that would come to Walter Reed and try to set that up. So, you know, when I became a chief resident, I then coordinated, you know, we would have fifth Friday activities where we would have, you know, where we can do a community service based group that was related to PM&R. So, I was setting these up with the National Amputee Golf Association to cover some of the tournaments there. We were doing, you know, opportunities for the weekend, you know, golf instruction that they're having at one of the local driving ranges and getting involved there. So, I then got stationed at Fort Campbell and, and, and was deployed myself. So, there wasn't much of an opportunity in that realm, but I got to do my fellowship with Stu Willick at the University of Utah. And so he was the most recent medical director of the Paralympic Winter Games at that time in Salt Lake City. So, I had the opportunity to work with him and the adaptive athletes there. I was getting restation back to Walter Reed, but got deployment orders again. So, I was supposed to cover adaptive sports, but I couldn't do so from Iraq. So, so I had to pause again. And when I came back, I was able to cover, you know, the US Paralympic Alpine Ski Team, which back then was still called the US Disabled Ski Team. So, you know, they've since changed the nomenclature multiple times, you know, but, you know, rapidly involved with them. They, they really enjoyed the care that I was providing and being part of the team. And, you know, with, with that opportunities, you know, they had asked me to become the medical director and the main person that's coordinating and, you know, for me to cover whatever events I could. And if I couldn't make it, then start setting up for other persons, you know, you know, within that thread, you know, now they started the US Para snowboarding, which didn't have it. So, it was the same head coach for both teams initially and then they started adding more coaches and then I was covering the US Para snowboarding events too, you know. Simultaneously, when I went back to Walter Reed, you know, the adaptive sports program had continued to grow, you know, while I was away at Fort Campbell, Allison Franklin, you know, became staff there and was very integral in getting that running and amplified and so then she was getting restation and I took over the as the medical director for our adaptive sports program at Walter Reed. And, you know, one of the things we had many different opportunities and it was basically a blanket sign up sheet for any of the wounded warriors who wanted to do things but there wasn't always necessarily the you know they were having horseback riding events, you know, and they were having people sign up who are an anti coagulation and had balance issues right so so one of the things that I had initiated into the program was setting up, you know, type of a pre participation physical right to at least review, you know your current medical conditions and and do an evaluation to see if it was appropriate for you to do that this time because these are, you know, either inpatient still or just had gotten you know just said recently exited the inpatient setting. And so, you know, I coordinated that and ran that over the next, you know, several years, you know, when I was being asked, because I was the, you know, the title was the amputee clinic director for Walter Reed, I was getting asked to do a lot of lectures on prosthetics and especially the advances and prosthetics that we were doing, you know, so we started coordinating efforts with Dr. Boninger from UPMC and, and, and the pit hurl human ergonomics research lab at Rory Cooper. We're doing research and national veterans wheelchair games and working with Dr. Lee. And, you know, I was incorporating adaptive technologies into my lectures when we're talking and so people then started asking me to give lectures specifically on adaptive sports, and not just, you know, the person that you know with with limb loss, and so eventually actually got to the point where I'd given several lectures and one of the publishers had asked me saying there's no textbook at all. And I'm the only person that was really routinely talking about this so so so they they invited me to write the textbook and subsequently the second edition, you know, many of you have contributed and thank you for doing so. And, you know, I think it's wonderful, you know, to be able to get that out for everybody to utilize my goal with that was, you know, we shouldn't be worried about taking care of persons with disabilities right you know from PM&R we're used to it, you know, but you know, many of the other persons in sports aren't necessarily used to it right from that standpoint, and even some of our rehab docs aren't used to seeing persons and disability complete competing, it's such a high level right you know, a trans femoral amputee and, you know, in a sit ski, doing an Olympic downhill right now, or somebody who's a spinal cord injury doing that right so from that standpoint so it's very rewarding my goal was that to make everybody aware of what may or may not see what the sport is what a common injuries are there, and to make it, you know, more palatable and more comfortable. Should somebody have the opportunity to, you know, cover and volunteer for a Paralympic sporting events. Interestingly, when I was blown up in Iraq and was recovering and Walter he Jason was one of the resident taking care of me. So, we went back to history that way. For patient confidentiality I wasn't going to say that but since you volunteered it so I was actually the chief resident on the consult service and we had an automatic consult any free time. And so one of the patients I got to see on my consults was Dr. Lee. And so it was going through all of this history and you know doing a good physiatric history and asking them, you know, you know, because he was you know what he does and what he's doing and hand dominance and everything and so, you know, I shared with our leadership and, you know, I, I then I then, you know, said hey it's going to be great for his rehabilitation if he can teach us spinal cord injury because we don't have a spinal cord specialist either. So, so I parlayed that into a great relationship and opportunities for our residents to learn it was very valuable to have you as, as faculty, you know, when you're still a patient. Well thanks for sharing that story that's tremendous and, you know, obviously you know everyone here who's kind of come into the space I appreciate hearing your stories and, you know, want to open it up but I'll briefly share my experience, how I came into the system and really learning about adaptive sports came as my, you know, in figuring out how to take care of my patients. I started my career with the VA and was a chief of a PM&R department in Huntington West Virginia at right at the time where polytrauma and traumatic brain injury, and the amputee system of care within the VA system was being more formalized. So kind of really taking care of people who had been deployed and really hearing about Dr. DeLuigi's experience and Dr. Lee's experience. You know I was in a state where we had the largest number of activated National Guard in the state of West Virginia, with no military treatment facility. So I found myself in a role where I was really functioning as that person and provider for people who were having two, three and four deployments. And because of that, I really was starting my career out as, you know, newly injured vets were coming back and trying to figure out together, how are we going to keep you strong and healthy as you are through injury and change of function and adaptive sports with early exposure and having the fortunate exposure through Center for the Intrepid and Walter Reed, and certainly those programs really emphasize early exposure to adaptive sports, really early on in the rehabilitation process. And because of that I really had to learn clinical competency on how I was going to continue that from, you know, prescribing high level, you know, prosthetic limbs to sport wheelchairs, etc. And we're very fortunate in the VA system to be able to learn that because we have the opportunity for funding to prescribe equipment, but I don't think that that should stop providers from learning how to do it, because the more that we know how to do it, especially over time, we hope that we will all be able to do it and then there's going to be coverage or access. So I think that's really important to still have those skills and be familiar as a clinician, but certainly that's how I got my start in adaptive sports and then certainly I ended up joining Dr. medical team for the wheelchair games from my experience with the VA, and then when I joined faculty with the University of Michigan. I started volunteering with like adaptive kayaking and slowly got involved with you maze, University of Michigan adaptive and inclusive sports experience where we really are just a grassroots program, we are move United chapter, really just developing And so that's really been a wonderful aspect and really being able to see that I saw what how valuable it was on the VA side and wanted to really invest and make sure that you know on for for people who are not veterans to still have that same level of access to high quality programs. And so I started to, you know, help with not just program development, but also quality and medical oversight, really making sure that we had safe sport training proper volunteers with background checks and really having those key pre participation checks in in how we designed our programs. And so that's where I found you know with my administrative had my VA experience I was able to bring that to a community program. So I think if you kind of look at your own skill sets I think you can kind of see where you might be able to add. Even if you're not necessarily thinking that you know traditional sports coverage or you don't know anything about the particular sport. There's so many facets that your knowledge as a PM and our physician will be really valuable in many, many aspects. So I just want to open it up so that you've had a chance to hear a variety from the panel, where people would want to have a discussion or dialogue about this. Anyone want to want to chime in. Melissa I also, I should have mentioned to you. I didn't know if you wanted me to go into it when I introduced myself I didn't know if you want me to talk more about like what I don't know if everyone knows what classification is. I think that was probably one specific aspect that people are less familiar with. Yeah, and I know, I know some of some of some of us have talked about like some of our roles and I didn't really go into it but as a medical classifier we really get to use. I love it because I just feel like it uses my skills as a PM and our physician in a really unique way that I just are athletes like love well. Okay, I should correct, they don't love the classification process but they value our skills in evaluating them. So the classification system is at least for the Paralympic movement. I don't know, you know, I'm not as familiar with like other adaptive sports organizations, like I know Special Olympics might have some semblance of a classification system. I don't know if Deaflympics does. But, um, for Paralympics they, you know, if you think about it in what we call able, able body sports right or like mainstream sports. We compete based on age or gender. But for when we talk about para sports. You have to kind of level the playing field right and so the way the classification works is it's a sport specific process, and as a medical classifier we work with a technical classifier to evaluate how an athlete's medical diagnosis. We use our medical knowledge to figure out how their medical diagnosis impacts them functionally. And then we have that we do a physical exam that is a specific protocol for every sport to figure out what is their functional impairment in that sport and how does that affect them, and then they get put in different classes. Every sport has a significantly different classification system, back in the day when it first started. It used to be like there was one classification across all sports, but then over time they've realized that hey every sport uses different biomechanical skills and different functional skills. And so that's why now it's like a very sport specific process. Usually the processes, the protocol is supposed to be based off evidence and research, and it's driven by the International Federation so for in para swimming, the World Para Swimming Organization is the one that creates our protocol, and then we follow that protocol. And so for an example, if I have an athlete who had osteosarcoma and had an amputation from osteosarcoma. I'm going to measure their limb length from their side that's affected compared to the other side, but I wouldn't do like a muscle strength exam right because unless they had surgery that remove some of their muscles that amputation should not affect as opposed to someone who had like a, like a T six spinal cord injury, I would check their strength, but I wouldn't measure their leg lengths, I may check for range of motion because sometimes they can develop contractures and so it's it's really cool because you have to like take your medical knowledge and sometimes I see really rare diagnoses which I nerd out right because I'm a pizza rehab physician to, and we always see like all these rare diagnoses. And so I'm like googling Oh my gosh what is this medical condition okay and then figuring out okay what is their functional impairment that I would expect and piecing it all together. And really, there's as a medical classifier there's a lot of trust in you to make sure that you're protecting the integrity of the system to write. I think a lot of times I have this challenge where I see athletes come to us especially at the novice level and they're like, Oh yeah, my doctor said I'm eligible. And you're like, well, if I, you know, like you have to do your due diligence and making sure you're doing the correct evaluation. Like for instance, if you have an athlete with like a lumbar spinal cord injury but then they've got weakness in their upper extremities, and they don't have a known diagnosis to cause that you should not be scoring them lower, you should not be evaluating their upper extremities to protect the integrity of the classification system right because if you're going to score them lower points in their upper extremities but they don't have an eligible diagnosis, known to cause that weakness. Now you're giving them an unfair advantage compared to other athletes who are competing against them in that class and so I always, you know it's classification, it's really interesting system and really interesting use of your medical skills. I would also chime in that if you're getting involved with adaptive sports. It is 100% worth it to look at local areas because they're always recruiting for classifiers. So even when I was first getting involved, there was a chance to be a level one wheelchair rugby classifier so I took that opportunity learned it and did some regional events, but I'm also classifier for the National Veterans wheelchair game which is a complete set of separate type of thing it's for this these veterans for our swimming and if I'm following Stephanie's thing we use the Paralympic, the world classification system but we modify a little bit because of our population. So our classification system cannot be used outside of the veteran wheelchair game, but it is a great way to get to know the sport, the athletes, and also the organizers, and that I would strongly recommend look for your local areas and if there's anybody who's teaching or showing how do you become a classifier, do that every chance we get for our fellows and even our residents, if they're going to stay with us usually two years or more. We try to introduce them to a classification system or lead classifier of a sport. So far trainees have gone through wheelchair game obviously because I'm involved in it but basketball, rugby. So they get at least introduction to that and become a level one classifier before they graduate. So those are always the chances to do. Yeah, that's a great point can I forgot to mention that like so like for para swimming like if you go and become like an official national classifier, like we can't, I can't just like classify a patient or an athlete in my clinic. I sometimes give them like what we call provisional classifications, which is not official but like, like, especially during the pandemic there was a huge backlog of athletes who needed classification for their local meets, and they like sometimes they're in high school, and they just need to know like pay what standards should I be swimming by. So sometimes I would give them a provisional classification in clinic, but telling them hey, you are not officially classified until you go appear at a national classification which always has to be paired with an official competition because part of the classification processes is observing them in competition. But yes, like Ken said, even some of the sports, like I talked to you guys about the Team USA website on how to sign up. Just note that not all sports are listed on that too that's only the sports that are governed by USOPC and so there's like another complexity layer that I've learned over the years. Some sports are not run by USOPC for instance like wheelchair basketball is run under the NWBA, National Wheelchair Basketball Association, and so they run their own classification I believe USOPC does not run their classification so there's some complexity there but definitely agree with Dr. Lee trying to find other opportunities for classification. If you're finding that you're not getting anywhere with going through the USOPC route. Does anyone have any questions? Interest where we can make connections for you. Thanks for doing the panel today. My name is Charlie Kenyon and I am trying to finish up a sports fellowship at Emory but I'll be joining the faculty at University of Washington in August. Through, you know, knowing several of you in conversations like, you know, getting familiar with pathways and like team position roles and such but I'd love to hear more about, you know, integrating adaptive sports into the clinical environment and any tips or different strategies for looking into that as I start my own practice. I'd be happy to speak to that. I think that's how we have been listed on the group here so that's primarily my, my role and, and I believe you said you're doing fellowship and Emory is that a sports fellowship. Yeah, I've been doing sports medicine fellowship. So that's essentially the same path as me, the differences is, mine was pediatric sports but same thing. So, you know, I think the primary role within my clinic is still traditional sports medicine. The way that I have personally integrated adaptive sports into clinic. And first of all, it differs from everybody who I've talked to Stephanie's program is different than Melissa's obviously at the VA what Ken's doing. And so it's very different anywhere you go. What I valued was inclusion, not only in participation but also in clinical care. So my position within the hospital is actually through the sports medicine department, which is through the pediatrics department, and not through PM&R or ortho or otherwise like that so in my clinical care then I have a sports medicine clinic that has adaptive sports medicine evaluation appointments. The hospital initially wanted me to have a specialized clinic day, but, you know, in a given month I may see for adaptive sports patients and 400, you know, traditional sports patients and so having that clinic the way that sports medicine works is I need to have that availability. In the moment, you get injured this weekend, I need to be able to see you this week I can't say oh well we just had our clinic last week and I'll next see you in a month. So we have a defined adaptive sports medicine program, but we don't have an adaptive sports medicine clinic. The advantage of that is the athlete, the wheelchair basketball player is sitting next to the quarterback of the football team in the waiting room. They are included that way. The disadvantage of that is that my resources aren't specifically unique to that patient so I can only do that clinic in one area, I know I have a high low table. My appointment slots flex to give me basically double the time with someone with an adaptive spot to give me that extra time to understand the underlying disability and it's not a simple ankle sprain or something like that. I didn't see in my traditional clinics. But I don't have a multidisciplinary clinic outside of what I normally work with with an athletic trainer. So that's the disadvantage. Victoria who I see on the call here and a couple others, their clinic is a specialized resource where they're doing a biomechanical analysis and they're seeing everybody and so they get a very well rounded experience. But as a injury clinic. You know you have to find time in your schedule otherwise. So that's what that's what I've done. Does that answer your question, Charlie about my experience. Yeah, and I think that all makes a lot of sense, you know, and, you know, I've heard the similar story that we've got different setups but certainly, you know, it's, you have to be flexible. The volume. As you get started is not going to be there to support that you need the hospital's support and understanding that this is a valuable and growing field, and that you can be a leader in your region in the country, really become that that destination But, but it's not a, you know, you, you can't fill the clinic right away. So you have to build that building on that then like how do you get awareness of the clinic out there, like, is that just through direct outreach or, you know, how are you building those partnerships? It's an outreach, um, both internal and external. The challenges we have is it's a huge hospital system and everybody's fairly disjointed. So we do a ton of like internal marketing and conversations and communications, but then I go out and meet them, like we spent most of this introduction about talking about everyone's outreach opportunities. So we have a sled hockey team in town and I'll go to their tournaments and practices and we do their registration with them and help them do sled fitting to make sure we're alleviating pressure areas. Um, their Ohio high school athletic association has a seated track and field division in traditional high school sports. And so, uh, the Columbus parks and recreation department has some chairs that they loan out. And so we go out there at the beginning of their season to measure athletes, making sure they're fitting in their loaner chairs appropriately. It's not perfect. It's custom for them. Um, but then I learned about the mechanics from those other. Um, athletes and participants just being in the community as well as being with the other specialties. So you have tons of tons of marketing. And I mean, I've been in my position for six years and it's still a much a work in progress. Awesome. Thank you. Yeah. You know, Charlie and everyone else, Jonathan had mentioned that when he was introducing himself, getting referrals from all his colleagues and stuff, that's an area that's really lacking in adaptive sports. Um, One of the biggest fault that we have in our PM and our areas that are, we ourselves don't even refer our patients to adaptive sports when we fully know they can benefit from it. Let alone you think about pediatrics, primary care, those who take care of these people with all different types of disability. Right. And so try not to do this by yourself. You need partners, you need community organizations. Um, you know, I'm a founder and a board member for Wisconsin adaptive sports association. That's nine different sports, adaptive sports we do, but we struggled, um, for what, eight years of trying to get more members in more athletes. And we stayed at 80 to 100 for our longest time until we raised enough funds to hire an outreach coordinator. And what did this outreach coordinator do? We said, first get veterans involved. That's where the grant money's come from veterans. Second, reach out to the medical community. Let them know that we exist. VA has a program. Community has a program. Let them know that they need to refer their patients to us, right. To your clinic, the adaptive sports clinic you're making our adaptive sports program, for instance, for us. So in one year, she actually went to visit every medical clinic. She can find, uh, even a single private person's, um, pediatric clinic and did a little show and tell. Now it's an automatic referral. She refers her, every one of our patients automatically to the community, um, uh, adaptive sports program. From there, automatically we send our patient, those same people to, uh, PM and our, um, uh, our adaptive sports or our regular sports clinic to get clear. They can't come to the VA obviously for me, but so that's how this all starts. So like Jonathan's saying, it's a constant work of letting the important people in this case, I'm going to say it's, it's the referring providers. They're just not doing it. You need to make partners with them. Let them know Charlie is here. I'm trained in memory. I'm here, I'm here in Seattle. Uh, and I'm waiting for you guys to refer all these types of patients and I can introduce them to adaptive sports in order to do that, Charlie, then you need to be involved with adaptive sports. So get to know who's who your community partners will be, because you may see them in your clinic and do your clinic stuff, but last thing you want to do is, well, that's it, right? You want to say, you know what, for your age type of sport you want, there is a Seattle Seahawk, uh, wheelchair basketball for juniors. Let me get you connected to that. Cause that's what you want as well. And that's what we found out is if you don't have community partners, you're swimming alone. Uh, everyone that's doing, um, here, Jonathan, me, uh, Jason, Melissa, and Stephanie, we have community partners. That that's a key and you just need to get involved. My first start was being a team physician for a wheelchair rugby team in Milwaukee. I follow them everywhere. And I started as a resident and I went to all the tournaments locally that they did. And that's how my name got known in Milwaukee. Then all the other sports said, well, can you do it for my team as well? And after a while, your wife starts getting mad at you. So you have to kind of stop. Right. I mean, or put a limit to it. Yeah. Too late for that. Right. Yeah. To echo what, you know, to take what Dr. Lee was just saying and kind of Trent, you know, and expanding upon it, you know, it really all stems from advocacy, right? So there, there's multiple different ways to advocate, right? So, you know, there's advocacy for your patients and finding them the opportunities in the community, right. Advocating, you know, to the different community partners that you have, you know, advocating with the medical community, you know, and then also the sports, right, you know, from that standpoint, right. As we get to continue to grow and develop and, you know, you know, asking them, you know, what they need, right. And then trying to figure out ways to make that work in your community. Right. You know, in addition to all of that, you know, you know, we have, we have a lot of growing, you know, and other new, you know, Paralympic sports, right. From that standpoint from that standpoint, but not all of them are getting, you know, equal inclusion, you know, into some of the things, right. Some of them are just either local. They may have started having national championships, you know, and, and incorporating different, you know, disability types, you know, you know, for example, like golf, right. Golf was just added back into the Olympic games recently. Right. But it's still not, but it's still not included into the Paralympic games, despite them, you know the USAGA having a national championship, right. Most of the other, you know, golf organizations having national championship and opportunities of that. It would be great to try to, you know, work and advocate to try to get, you know, others growing sports, you know, I know when I was talking about chapters from my textbook, you know, Dr. Dr. Lee was educating me with, with, you know, the wheelchair football leagues that are starting and, you know, the different teams that were sponsoring with the NFL, you know, and I'm, I'm in the community and, you know, you know, and pretty active as much as I can be. Right. And, you know, I, I wasn't even aware that, you know you know, of some of the developments and that they're starting a wheelchair football league, you know, from that standpoint. Right. So, you know, I, I started looking into it and, you know, learning more about it and seeing where the teams were. And then, you know, obviously if you're having professional, you know, teams that are sponsoring, you know, wheelchair football teams, then there's opportunities for us to try to get wheelchair football teams in the local communities. Right. So that's, you know, advocating back, you know, from the top down. Right. And, you know, obviously there's the grassroots going up. So, but, you know, you know, as we work together as a community, I think this is a great opportunity within our FIS forum community, you know, to continue to find areas where we may need each other's support, you know, working together for unified advocacy, you know, elevating sports and international competition, you know, creating greater opportunities in our local areas, you know, you know, across the full spectrum. And I don't know if you guys all listened to Dr. Finoff's lecture. This was, I think about a year ago. He gave a great lecture about how he got involved. And when his chairman and department asked, you know, why should we have, have you be part of the CMO for us Paralympic? And then you're gone like half the time. You're not even generating the revenue for us and all that. He gave a perfect answer to his boss. And it was that I am not, I may not be bringing in that kind of income, but I'm going to be bringing a lot of people referral because what you have is going to be Dr. Finoff, who's a CMO for Paralympics. So this could be Dr. Kenyon in Seattle, who's a team physician for a major say adapted sport. It shows that you have a qualified, highly educated, involved in adaptive sports that people are really getting into. I am going to, my name's going to bring people in and this program is going to be recognized because of me or something or the program. He gave a perfect answer to the question of when the boss is asked, you know, why should I give you time off to do this? Because your affiliation with adaptive sports, everybody loves adaptive sports. As soon as they find out what it is, then it becomes just, you know, I'll help you do whatever you can. Even my own chair in person was similar kind of picture until it started becoming popular, then using the adaptive sports program that we're doing. She's able to actually get better residents involved and also get more, more clients, if that's the right word to bring in. So if that's recorded, you guys should listen to his lecture. One thing I wanted to mention to echo Dr. DeLuigi's comment about advocacy is that one thing that I have been able to be involved with, which is, you know, not specifically adaptive sports, but have noticed that other programs that are wanting to be more inclusive, just traditional able-bodied sports programs are coming to us, coming to me for consultation on how they can make their programs more inclusive. So having the lens of having designed adaptive sports programs and understanding how we can, you know, help, you know, create pathways within a traditional sports organization, I think is tremendous because I feel like that is going to be a huge I think there are expertise will be really valuable there where a lot of programs that are going to need that information and that knowledge of how to implement these things. So we just noticed we're starting to get busier and busier on consultation of how can we do this, even if they're not standalone adaptive sports programs, which I think is, you know, hopefully that's going to be the trend, you know, nationwide. So I wanted to make sure that we had a couple of questions in the chat that I wanted to make sure they got addressed. So Svetlana had asked, could someone clarify classification? So I know you mentioned it a little bit, Stephanie, in your definition, but I wasn't sure I wanted to make sure she felt like she got that answered. Yeah, so classification, Svetlana, did you have a specific question as to what I said before about it? So that I know what I'm answering. Oh, she did, OK, so she felt like you answered it, OK, I just wanted to make sure. OK, and then the other question. So for those who also have sports training, what or anyone, she says, what is the time commitment like to be a team physician in the adaptive setting versus normal sports coverage? John and I were just chatting about this at AMSSM last week because he was asking me how much of a time commitment my head team physician role is for paraswimming. And I was like, it depends on the year. But like lately, it's been like super busy because I think like. Are you know, as so traditionally, a lot of adaptive sports groups are not used to having medical support, right, because a lot of it, like Jason was saying, is like a grassroots effort there. Like, I feel like personally, a lot of the athletes I've worked with, they've just been like, we need to find like options for inclusivity in sports and just getting involved. And then they're like, we'll figure out the rest of it later on. Right. So like sports medicine support is like an afterthought for them. And so as we've provided, I found that as I've provided like more sports medicine coverage of events, like more people are contacting me being like, oh, my gosh, do you have recommendations for this specialist or, you know, can you get me help for seeing this doctor or hey, I'm having, you know, they're coming with me with more appropriate issues now and I'm getting busier and busier. Hence, for anyone who's like board certified in sports medicine and has experience with working with para athletes, I'm recruiting and growing our volunteer medical pool for paraswimming for our national team. But I would say it just you can make it what you want it to be. You know, like Dr. Lee was saying, like it is very easy for your significant other just start like yelling at you because you're like, oh, my gosh, this is your passion. Right. But now all of a sudden you're gone every weekend because there is like when I was in Dallas, Fort Worth, there was something almost every weekend. And I was so grateful. I see Dr. Cassadin on here on the call. You know, he joined the practice shortly after I did. And I was like, oh, good. Like someone else I can like help volunteer so that I'm not the only one doing all the adaptive sports coverage. But it's you know, it's up to you. And I think some of the things we're talking about tonight, having an employer, your boss, very supportive of your efforts. My boss, when I when I negotiated my contract, they gave me at least one month of protected time to do any USOPC activities that includes my head team physician role or my classification stuff. And that's I don't have to take PTO. The other thing I negotiated as a sports medicine provider was not taking call for peds rehab. And so instead, my sports coverage counts as my call and that my adaptive sports coverage counts as that, too. And so when you're thinking about like work life balance and time commitment, seeing some of these things make a difference, too, in terms of figuring out how much you want to dedicate for sports coverage. But I would say, you know, it's up to you. I know like for for our mainstream sports at Children's Hospital Colorado, we don't cover every single tournament. Our athletic trainers do a lot. And then the physicians will cover like some of the bigger ones. But we're like on call as backup for our athletic trainers. So it just depends on your system and also what you're looking for in terms of how much you want to get involved. I will say the more you're involved early on when we're talking about referrals, right, like the faster you're going to get your name out there and people are going to send you patients faster. And I think I'd just add to that, too, I think it's all about that balance and what you want. As I look at Nova, I think that's the question that the example you gave, you know, wheelchair basketball versus high school basketball, that's that's the equivalent of, you know, comparing Stephanie's, you know, U.S. Paralympic swimming to the high school, like not the high school swimming team, but I don't know, Michael Phelps in the USA team. So I think at a very high level, it's certainly demanding in my community roles that I've done. They've been so excited to have medical connection that they weren't even looking to ask for coverage. So for me, when I go and, quote unquote, cover an event, it's. Hanging out, saying hi to patients and shaking hands and yeah, something happens and I have to evaluate a concussion or something, I'll talk to somebody, but it can be completely flexible. But at the same time, I do have that schedule where I'm looking at every single weekend and I want to go to the sled hockey tournament. I want to check out the wheelchair rugby team is hosting an event, but it can be what you make it to be and what you establish as the expectations, because right now in most of these programs, there isn't an expectation to have that affiliation, which is both an opportunity to increase it, but also ability to respect your your boundaries and your own limitations, too. I think remember your PM&R, I'm sorry, Melissa. No, no, you can go ahead. Remember, we're all PM&R docs. I'm assuming we're all PM&R docs. We're ahead of the game when it comes to adaptive sports. You know, a lot more knowledge than other specialty at this point. And if you have sports medicine background, that's great to answer. You know, what's the difference between adaptive wheelchair basketball versus high school basketball coverage? Dr. Uline, who is the sled hockey team physician, he and I always joke around that he says five percent medicine. I say two percent medicine and everything else is all just being a crony for the whole team because it's not about medical coverage. Actual medical coverage is like small. You know, occasionally you might have somebody heart stop or a broken leg or, you know, finger snapped and things like that. But you what you're doing is you're part of the team physician. If you are the team physician, half the time you're running their equipment back and forth, you're fixing their tires, you're fixing their broken chair. There's also so when I take residents over to any medical or any of the sports coverage or adaptive sports, I usually end up teaching them how to fix wheelchairs, how to fix some equipment, how to use tools, because that becomes part of our life with them. Because if you're a physician covering, you just sit there when a veteran or I'm sorry, when an athlete's wheelchair is broken and you don't know what to do at all for him, you kind of become useless for that athlete. So we try to learn as much of their sport, including their equipment, because we can be a huge support in that area. So get to know the sport, get to know the athletes. They'll teach you how to fix a certain equipment, too. These these are all part of our life. Even if I knew nothing about wheelchair lacrosse, I was able to string whatever the sticks. Right. I didn't know how to even string it, but somebody taught me and I start stringing when string broke. They go out coaches busy, so I'm the one who's stringing because no one's getting hurt yet. And this is how you become part of the team. You become known as someone who's dedicated to the team and then you start getting referred out to other people. They want you. That's how you want to be as part of the adaptive sports medicine back. Yeah, I was going to say that, you know, also some of the roles, you know, aren't necessarily coverage of a specific event. You know, I found that my my role as an administrator, understanding quality, improvement and safety, right, helping to write protocols, helping to give guidance to the rec therapist about designing, you know, what are our ratios for our staffing? You know, what is the minimum criteria for participation when we're doing our adaptive paddling? You know, we need a higher ratio when we're dealing with water. Those kinds of things and your knowledge of function can be really valuable in that setting. So community programs would really value having a voice like that or some partnership if you're if you're wanting to volunteer time in that way, not necessarily showing up at every single kayaking event or every single race or whatever it is. So there's a balance. You could decide, you know, what are the roles for you? Having had like kind of the hats from all the way from, you know, the direct clinical evaluation and prescription, understanding, you know, you know, the, you know, small, you know, local programs and then having exposed myself to like large scale events, I kind of seen the whole pathway kind of helps me understand where each role is valuable, to be honest, having seen the entire pathway. So I think that that is really important. The exposure, I know we keep saying it, but really just showing up and understanding is really where you can start if you don't have knowledge about a specific facet of this space. Okay. Stacey, you got a question? I have a question. Hello everyone, I'm Stacey. I'm a current PGY3 at Baylor College of Medicine in Houston, Texas. I'm also interested very much in adaptive sports and I'm currently involved with the Kiwis International in the New York chapter and also in Houston. And I just recently went to the Abilities Expo in New York, New Jersey area and there was a lot of adaptive sports and I was super excited about all of that. So I was wondering what other organizations are available especially since I'm currently a resident and I learned about Achilles through my twin sister, Tracy from who she's in New York. So what other organizations other than Achilles and I know I saw Move United was one of them but for some of my other colleagues who are also interested in adaptive sports how can we get involved as residents or learn more about the different local organizations especially if I may be the first contact point or the first one making contact with other local organizations. I know we do have a VA in Houston at the DeBakey Center at the DeBakey VA, but it seems I have talked to the rec therapist there but just wondering what other places I can reach out to get more involved for myself and then for also my co-residents. And thank you so much to the panelists and for having this talk. This is really awesome. So Stacey, you are actually going for the big guns right away. You know, all these are large national programs but they also have chapters within different States as well. Maybe not right away, but most of them do have chapters. So you want to approach the chapters first. And as a resident, I think it's probably worthwhile to hit local areas first and know a specific sport and be recognizable. For instance, Houston Apollo is a brand new wheelchair lacrosse team. They just formed last year. First time competed at national. They want to compete more. They're not thinking of any doctors like Dr. Teruizzi say it's not in their part of the mental process, right? But showing up to them. And, you know, you can say, I heard this from Dr. Lee, right? And that you guys formed a team. You guys are going to be traveling. When do you guys practice? I mean, that's a highly aggressive thing. There's potential injuries that you can treat easily. It's a lot of bruises and things, concussions and things like that. So you can be really helpful in that arena approaching these guys. And that's the local program. And Houston has, besides the VA program, there's Houston has a, I believe a basketball, wheelchair basketball team and other sports as well. Those are easy to find. When you just Google, it'll pop up. And when you go to NWVA site, for instance, where the teams are in Texas, there'll be Dallas team coming up and a bunch of other teams coming up as well. So I would start there. Now you need to be very careful. You're a resident. What's your malpractice coverage? You can't just go and say, I want to be your team doctor. You're under the trainee program. So your program director and thing has to support you doing this, or you need to go get your own malpractice insurance. So a lot of the resident wants to do these things, but you have to protect yourself too. So make sure, see if you can get the program director and the chairman involved saying, can our program sponsor? When I approach something like this, they don't want to give money. Okay, nobody wants to give money. We're all cheap. The PM&R docs are all cheap. So they don't want to give money, but they would say, how about if us PM&R residents with an attending support, we sponsor this team as a medical coverage. That's how I approach my chairman and chairman loved it. So we have MCW logo everywhere for the team because we're sponsoring them as a medical support and then malpractice is covered. So always think about that for everyone too. I'll add to Ken too is that, so Move United, if you guys aren't familiar, they used to be Adaptive Sports USA and Disabled Sports USA and they merged in 2020. And they're trying to be like the premier adaptive sports organization for the US and all inclusive, right? Like Paralympic movement, Special Olympics, like all the different types of adaptive sports. So they've been building their website. It's not perfect yet, but they do have a lot of resources and they've been trying to connect with all of the different organizations because the patients or the athletes have the same issue. Like when someone moves from Maryland to Colorado and they're trying to get connected, they're like, what exists out here? How do I get connected? It's the same issue. So Move United has recognized that issue. So they're a great resource. Other great resources are like Challenge Athlete Foundation, other like big organizations. My advice, so Houston for sure has a big adaptive sports scene. Because I know they were like big competition for us in Dallas. The wheelchair tennis and wheelchair basketball groups for sure are big there. If you connect to the Houston recreation fair, recreation, Parks and Recreation Center there, they house a bunch of adaptive sports groups there. My recommendation for anyone, if you find one group, go out to that group, ask them, because those groups will know what other groups exist out there. And they'll be like, oh, if you're interested in adaptive rowing, I'll connect you to that person. And before you know it, you're like texting all these different people. And so that's the best way I think to just go out there, meet people and ask them what else is out there. One thing I would say with that though, if you're going in cold, having moved from like one area to another region, I really wanted to look at what I could feel safe recommending for a patient to go to. So I really started out with groups that are vetted. So of course, Move United chapters have insurance, they have safe sport training, there is a criteria to be a chapter. So I knew at least there's some quality oversight, which is helpful for that affiliation. Certainly looking at the listing of the VA grant recipients in the community, they put out the list for the last two years, every time they publish who has received a VA grant, they had to pass muster and have some level of competency of what they're providing. Because I have had organizations approach me that are just really bleeding hearts and want to be able to do something for a veteran, but they may be very ill-equipped to really provide a quality, safe experience. So I want to make sure that what I can recommend, I know at least in some way, if I have not been involved with them firsthand, that there's a way for me to be able to recommend it with confidence. If we do go to those as sideline coverage, but just as a volunteer, just to shadow, do we still need to get PD approval? Because in the past, even if it's for able-bodied, if we have, I mean, usually there's an attending onsite, but if we just volunteer just to get experience, but not actually doing hands-on because of the whole malpractice issue, is that located? It could be a non-medical volunteer. Oh, sorry. Go ahead, Jason. I was going to say as a former PD, it's best to do so, because they also have to worry about your duty hour reporting, right? Because if you're near duty hours and you're volunteering for a whole day on the weekend, and then you're on call the next day, we don't want you to inadvertently violate duty hours from that standpoint. So I'd say notification for if nothing else, for awareness is a minimum from that standpoint. Then if they have questions, you've given them an opportunity to ask you about it and for them to find out more about it from that standpoint. So like when I have opportunities and I'm looking for people to volunteer, I usually will email the program director. If the residents had emailed me before and said they wanted to do it, I at least want to email back the program director so they're aware. And then they can also share with additional residents, not just the one or two that asked me. Put in the chat two links, one to move United's location search. You can put in your zip code or whatever and find it. Same thing with Team USA. These are relatively updated. There's always smaller groups that are in your town. I'd say the one thing that just along those lines, find the groups in your town, follow them on social media and look to see when there's a tournament and just go learn about the sport. Like the first time I went out to sled hockey, I just went, paid an admission fee and sat in the stands and watched. And then after that, started introducing myself and figuring out what my role could be. But if these are all new to you, just start checking it out. And for a training program, consider making it an actual program for your program, Stacy, and all the other residents too. So when more and more residents were interested in doing adaptive sports, and when the chairman and PD decided, yeah, this is worth it for our residents. So all the programs that WASA does, for instance, it became, we're gonna be the premier medical coverage. So now the chief residents are responsible for coming up with a schedule for three-day weekend coverage and things like that. So it became part of the training program and it's chief resident's job to make sure there's an attending assigned and also resident assigned. And on a medical students assigned gets us, they join up as well. So if you kind of make it a little program, it's easier to participate in your local programs. Victoria, you have a question? Thanks. Hey everyone, I'm Victoria. I am PM&R in sports medicine in Cincinnati. I'm just curious. So I do a lot of, I have like local, I'm basically the main person for a lot of the local adaptive sports and doing like coverage and things, but are there other ways then to get involved in, not necessarily being like a head team doctor for one of the like Paralympic teams, but just like, I know Stephanie, you're insane, like being on the lift for medical coverage for swimming. Like, are there other options like that if you're just trying to volunteer your time that way? Yeah, there's a lot of, so Victoria, you're asking to be like a, like still doing sports coverage, but just not having the full responsibilities of like that leadership role. Yeah, there's like, for instance, you know, it's not as common as like the mainstream sports, right? And like, at least at the, like if you're talking about like elite sports, like Olympic versus Paralympic, Olympic is usually way more developed in terms of their sports coverage, right? Like if you look at USC and snowboard or USA swimming, they have a huge pool of volunteer medical providers. They also have way more resources to support that. Para, a lot of the Para sport NGB, national governing bodies are a bit limited in resources and traditionally have not, they've been a little hesitant, I think, to be able to support the needs for sports medicine, but it is growing now that Dr. Finoff has become CMO. He's been encouraging a lot of the Para sports national governing bodies to grow their medical support for their athletes. If you check out, if you Google USOPC volunteer or sports medicine volunteer opportunities, that lists all of the different sports that are currently looking for volunteer sports medicine providers. And it either lists like an application link or an email address where you can inquire like whether they're still looking for volunteer medical providers to add to their pool. But yeah, and then otherwise, you know, at the local level, usually isn't as much of a time commitment. Awesome, thanks. And sometimes you'll find a local event that's being hosted by a national organization, right? They may have, you know, a track and field or, you know, the Para archery championships in your area, right? So then you could always, you know, and sometimes it's, you know, a cold email, right? And sometimes saying, I'm not sure who the right person is, but if you can put me in touch with them, you know, I'd be looking to, you know, seeing if they need any volunteer help. So, you know, like looking at, for example, the US Adaptive Open Championship for USGA, right? That's, you know, so, and under their FAQs, it said due to overwhelming, you know, response, you know, they've closed the volunteer pool, but that doesn't mean it's volunteers for medical, right? They may have a paucity, right? You know, and, you know, you may not be able to travel to North Carolina and you may not have a North Carolina license, which would be one of the other things about going to different events about what you're allowed to do as far as licensing, you know, but one of those standpoints was that, if you, that's why I was saying, if you find something local, you could reach out to them, right? You know, from that standpoint and find what your opportunities are, you know, to, you know, volunteer as an extra set of hands there. Somebody had mentioned Mike Cottingham on here, who's a tremendous contact. He's leading an initiative to look at a North American Society for Research in Adaptive Sports. Just for the residents or anyone who's interested, certainly you can tie your research interests to adaptive sports. We need more literature out there. Certainly that's another way to be involved and to, you know, contribute to the movement. It's really a valuable thing. And I think that if there, if you can then even piggyback some of that exposure or collaboration with someone or organization, certainly that's another way that you could really build it into your official time, you know, as a trainee. Certainly we're always trying to advance the ball with as many, you know, facets of research in this area. Yeah, that's true. For those who are in academic medicine, adaptive sports research is like pretty low. If you pick a topic and spit at it, it will land on something that could be on a research program, right? And if you look at our research pool, I mean, you have a perfect setting of all these athletes in an event that you can collect data in one week or even three days, right? It's a perfect setting if you choose to do research in that group, as long as it doesn't interfere with the athlete's performance. So think about it. It's a great area for research. There is also, you have to make a determination as well. And I made a stupid determination to go the other way. So there's sports medicine coverage for adaptive sports, but there's also program management. So I chose both of them and program management is a complete different animal. You're not being a physician, you're actually managing a team, managing a sport. It becomes life consuming. You know, when a season happens, your life belongs to that season and you have to manage that team. I'm writing grants constantly so I can get our athletes travel to different competitions, right? And just recently, somebody asked me to put together a wheelchair pickleball. Okay, did it. Now I got 11 wheelchair athletes, one of them compete and no one else wants to take over the program that I started. So now I'm stuck with these guys, right? So I'm putting together tournaments locally so they can actually compete. So be careful what you step into. And if you do, for me, yeah, it's a pain, but I love it. And, you know, there's another program for residents to come and do medical coverage. Not that pickleball is gonna have a major trauma or anything like that, but it's another sport that residents are interested. For one weekend, there's five residents that came and did round robin coverage and they just enjoyed it. So don't be afraid to step in. That's also one way to get your name out there as well as you help the program or you make your own program and develop it into something. And don't be afraid to get in the chair or anything else and participate with them. They may be short during practice, right? You have wheelchair basketball guys and only four showed up, but there's an extra chair. Well, get in the freaking chair and play with them. They'll laugh at you. Your hand will be all messed up and cracked because theirs is all calloused and yours is a baby soft and now it's ruined. But the athletes will love you and will accept you because you're doing all that with them. Don't be afraid to get in the chair and play with them. Yeah, I had a dislocated jaw playing wheelchair lacrosse. Somebody checked me pretty hard. And yeah, and that's okay. I mean, it's part of the game, right? Yeah, I'm really inclusive now because I was injured with them, yeah. Okay, well, I know that we are a little bit over our allotted time. I wanna make sure that everyone was able to ask their questions. This has been a great discussion. It's really interesting to hear the different perspectives and different ways that we can all get involved. So if there's anything else that anyone would like to share, we certainly- I have one. Yes. Jason, can you put together a wheelchair pickle team in your Phoenix there so we can travel over there and compete and kick your ass? Oh, you're muted, Jason, you're muted. Sorry about that. I thought I hit the button it didn't take. So yeah, I'm sure I can. I mean, pickleball is really growing here. It's amazing how many tennis courts they've repurposed into pickleball courts. They even repurposed our gym that we're at locally and they took one of the basketball court and they made it into two pickleball courts indoor. So it's amazing how much they're doing. Everybody, that's an easy sport to put together and be part of. Especially you can put a hybrid games together. That's one wheelchair, one upright, one normal. So everyone can get involved. And I'm actually reaching out to the local tournament places saying that put a wheelchair division in. No one has it at least in Wisconsin. So we're now asking them to put a wheelchair division and put a hybrid tournament as part of it as well. So then you have the entire community part of the wheelchair sport that can actually compete next together. So put it together, Jason, so I can travel over there. As long as we can come up there in the summers and you can come down here in the winters. For sure. So hopefully you guys have your own team and we can all get together and compete and show off our own athletes. Well, thank you everyone for joining tonight. I hope we can keep this dialogue going, sharing information on this forum. I really wanna make sure that we continue to share these opportunities in our community because I really think that PM&R physicians are really well positioned to advance the ball and really contribute to the Paralympic movement because of our knowledge, our scope, and really we are used to being part of a team. So certainly I think that it's really tied to kind of what's inherent to our discipline. So appreciate everyone joining. Thank you so much and more to come. We will be having a half day course in the fall in New Orleans. The conference, we're really pleased to announce that that was accepted. And so more to come on that as well. All right. Thank you so much everyone for joining. Thanks everyone.

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