assistive technology adaptive sports recreation · 2014. 10. 8. · adaptive sports &...

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Assistive Technology Series

ADAPTIVE SPORTS & RECREATIONKendra Betz, MSPT, ATP

Spinal Cord Injury & Disorders Services

Bill Wenninger MS PTRehabilitation & Prosthetic Services

January 10, 2014

VETERANS HEALTH ADMINISTRATION

Adaptive Sports & Recreation Technologies

Objectives

Upon completion of this session, participants will . . .

1) Understand various adaptive sports and recreation activities that are available to disabled Veterans.

2) Understand the requirements and recommendations for providing sports and recreation equipment to Veterans.

3) Identify documentation recommendations for adaptive sports and recreation equipment.

4) List resources to obtain information on the evaluation and on making recommendations for adaptive sports and recreation equipment.

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Background Information

• Specific products are referenced to reinforce educational material and does not represent endorsement or critique of any product or company.

• Photos are provided from a variety of sources:

– The athletes pictured

– Challenged Athletes Foundation

– US Paralympics

– Manufacturers

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VETERANS HEALTH ADMINISTRATION 3


Overview of Adaptive Equipment Options

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Alpine Skiing

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Cycling


Handcycle Positioning Options

7www.topendwheelchair.com

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Handcycle Trends

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2012

2002



Track and Field

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Options: AT for Hand Function

www.accesstr.com

www.bike-on.com


Hand Support for Paddling

www.Creatingability.com

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Goal Ball

Visual Impairment

Audio rifle designed and built for visually impaired biathlon. Used in international competition.www.eko-aims.com



What is Assistive Technology?

Assistive Technology is any item, piece of equipment or product system whether acquired commercially off the shelf, modified, or customized that is used to increase or improve functional capabilities of individuals with disabilities.

(Assistive Technology Act, 1998, PL 105‐394, S.2432)

• Supports function in a varied of environments – (home, work, school, community, )

• Engage in meaningful activities – (ADLs, play, learn, communicate, work, travel...)

• Achieve independence at maximum

level possible

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Assistive Technology Model

• HAAT Model• Human

• Activity

• Assistive technology

• Context

• Functional task analysis– i.e. the SPORT

• Hierarchy of AT

– No techlow techhigh tech

– Commercially available custom medical devices

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Diagram from Cook & Hussey,’sAssistive Technologies, 2009.



Hierarchy of AT Applied to Adaptive Sports

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SwimmingNo Tech

3-Track SkiingLow Tech

Off Road CyclingHigh Tech

www.radventures.com www.reactiveadaptations.com

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Understand the “human” participant In this case, the athlete.

Complete a comprehensive interdisciplinary evaluation, assessment & treatment plan.

EVALUATION– Interview– Medical background– Physical assessment– Social profile– Functional evaluation– Environmental profile– Client goals



Client Evaluation

GOT RANGE?

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AT and Clinical Care

The assessment & treatment plan . . .

• Based on interdisciplinary evaluation

• Client centered goals are identified

– Long term for end result

– Short term for interim progress measures

• Assessment requires awareness of technology options

• Plan is individualized to the person

• Outcome measures must be incorporated


Understand activity requirementsIn this case, the “sport” or recreation activity.

• Client considerations

• Diagnosis & prognosis

• Functional capabilities

• Interests & preferences – (theirs, not yours )

• Equipment specific considerations

• Options available

– For the individual

– For the specific sport

– For the level of participation19

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Participation Goals:Recreation vs. Competition

www.aspenseating.com



HAAT Model Applied to Adaptive Sports

Relative to identified impairments and options . . . – What is the typical “standard” (if any) equipment utilized for the activity?

– Within context of identified impairments, can the client use the standard equipment safely and effectively?

– If not, can the standard equipment be modified for safe and effective use?

– If not, what technology options are available to support participation in the activity?

– Which interventions or combination of interventions best support independence and participation?

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VETERANS HEALTH ADMINISTRATION 22

VETERANATHLETE

PCP/SpecialtyProviders

PT/OT/KT

O & PPSAS

Rec Therapy

Vision and/or Hearing

IndustryExperts

SEATING/wcSME

Adaptive Coach /

Instructors

Veteran ServiceOrganizations

Adaptive Programs


The Interdisciplinary Team & Adaptive Sports

Education / Training / Support

• Self management

• Mobility skills training

• Equipment options

• Psychosocial adjustment

• Community reintegration

• COLLABORATION

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SEATING for Sports & Recreation

Provide clinical expertise for athlete support . . .

• Comfort

• Postural stability

• Skin Protection

• Injury Prevention

• Performance

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Coming Next Month . . .

Assistive Technology Series

Seating for Sports & Recreation

February 7, 2014

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Assessment Components & Documentation

• Background

• Existing devices

• Body systems & structures

• Activities

• Participation

• Goals

• Environment

• AT trials

• Recommendations

• Outcome measures

• Implementation

DOCUMENTATIONThis same outlines serves as the documentation template surrounding the client evaluation, recommendations and associated treatment plan with respect to adaptive sports equipment.


Documentation ~ Supplemental Form for Recreational & Sports Equipment

RECREATION and SPORTS EQUIPMENT REQUEST

Supplement to Form 10‐2641

The following information must be complete and included with the required 10‐2641 form for recreation or sports equipment.

SPECIFIC EQUIPMENT REQUESTED (provide manufacturer and model):

* Please attach a detailed price quote from the manufacturer for the specific device being requested

I. VETERAN BACKGROUND

Name:

Last 4 digits of SS number:

Diagnosis/Functional Impairment for which the device is being requested:

Date of Injury or Illness Onset:

Precautions/Limitations/Pain:

History of musculoskeletal injuries (please list):

Anticipated surgeries or potential change in medical status:

II. MEDICAL CLEARANCE

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Documentation ~ Supplemental Form for Recreational & Sports Equipment

RECREATION and SPORTS EQUIPMENT REQUEST

Supplement to Form 10‐2641

III. ACTIVITY SPECIFIC BACKGROUNDDescribe activities Veteran is involved in – frequency, expertise, participation

IV. LEISURE INTERESTS AND PARTICIPATIONPrevious adaptive equipment issued, Leisure evaluation

V. EDUCATIONInclude education on options, equipment management and skin protection, etc.

VI. DOCUMENTATIONAttach clinical evaluation, assessment, goals, treatment plan, evidence for activity participation, outcome of equipment trials, identification of appropriate equipment specifications, accessories and/or necessary modification, etc.

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Prosthetic & Sensory Aids Service (PSAS)www.Prosthetics.va.gov

PSAS National Policy: VHA Handbook 1173

• 17 Chapters address broad range of technologies & services

– http://www.prosthetics.va.gov/PSAS_Handbooks.asp

– PSAS provides comprehensive support as a component of active treatment or rehabilitation.

• Clinical Practice Recommendations

– Recreational & Sports Equipment

• www.prosthetics.va.gov

• Select tab from list

• Policy clarification/FAQ documents (SharePoint) http://vaww.infoshare.va.gov/sites/prosthetics/Policy%20Questions/Adaptive%20Sports%20and%20Recreation%20Equipment.aspx

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Key Points – CPR Recreation & Sports Equipment

• Must be enrolled for VHA healthcare

• Minimum Level of Disability Required– Loss of or loss of use of

– Not for exercise

– Not for convenience

– Must meet minimum disability criteria for the specific sport

• Equipment is prescribed by VA clinician(s)– Preferably the medical team treating the Veteran

– Individualized comprehensive evaluation

– Not done by Coach or Vendor or Veteran




• Equipment support for sports that Veteran is actively engaged & meets criteria– No specific limit on types

– Must be actively engaged

– This must be documented

– Many smart phone apps can track progress

• Equipment trials required; Trials need to be documented– Document pros and cons of trials

– Include transfers, transportation and storage

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• Equipment is ADAPTIVE based on identified impairment– Adaptive sports equipment NOT exercise equipment

– Adaptive sports equipment NOT indicated based on diagnoses of pain, DJD, obesity, diabetes, etc.

• Equipment that is not adaptive will not be provided– Helmets

– Water bottles

– Training clothing

– Eye/face protection

– Etcetera – Etcetera – Etcetera – Etcetera




• Veteran OWNS adaptive equipment provided– It is not on loan

– It generally is not returned to VA Prosthetics

– If Vet or family wants to donate work through voluntary services

• Replacement equipment provided when current device worn out or there is a significant change in medical condition– Not “to be more competitive” or “new model released”

– Lighter material does not equate to “adaptive”

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• Power devices not provided for recreation alone– Must be a power chair user without other options

– See FAQ for all terrain power

• Many resources exist for equipment that is not adaptive and therefore not provided by VA.– Examples include but are not limited to bicycles, archery equipment,

throwing implements, air rifles, snowboards, skis/boots/poles, surfboards, canoes, kayaks.




Adaptive interventions can be provided for standard (non-adaptive) equipment when indicated and prescribed

www.Creatingability.com

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• Spare devices NOT indicated for sports equipment

• One device provided per activity meeting criteria– Multiple devices not supported (i.e. training/competition)

• Responsibility does not end when the device is issued



VA Sponsored Events

• Creative Arts Festival

• Golden Age Games

• Summer Sports Clinic

• Training‐Exposure‐Experience (TEE) Tournament

• National Veterans Wheelchair Games

• Winter Sports Clinic

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Additional Select Resources

• Challenged Athletes Foundation– Operation Rebound for non‐adaptive equipment & athlete support

• Military Support Organizations– Such as Team Semper Fi Fund for injured Marines

• Veterans Service Organizations– i.e. PVA, Wounded Warriors, BVA, DAV, VFW, etc.

• Disability Specific Support Programs– i.e. Christopher Reeves Foundation, MS Society, ALS Foundation

• Other regional/national Non‐Profit Support Programs – Such as Operation Comfort, Disabled Sports USA




• VA 2013 Community‐Based Adaptive Sports Programs Directory– http://www.va.gov/adaptivesports/docs/CBASP_web_spreads.pdf

• VA Adaptive Sports Program– http://www.va.gov/adaptivesports/

• Paralympics– http://www.paralympic.org/

• USOC Paralympics– http://usoc.org/US‐Paralympics

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• Air Rifle – International Paralympic Committee

• Archery – Disabled Archery USA

• Basketball – National Wheelchair Basketball Association

• Bowling – American Wheelchair Bowling Association

• Handcycling – United States Handcycling Federation

• Nine Ball – National Wheelchair Poolplayer Association

• Power Soccer – US Power Soccer Association

• Quad Rugby – United States Quad Rugby Association

• Softball – National Wheelchair Softball Association

• Swimming – Wheelchair & Ambulatory Sports, USA

• Track and Field – Wheelchair & Ambulatory Sports, USA

• Weight Lifting – Wheelchair & Ambulatory Sports, USA

• Trap Shooting – PVA Sports and Recreation – Andy McDonald


Related Education Sessions

“Assistive Technology for Sports & Recreation”– Polytrauma AT Program Grand Rounds with University of Pittsburgh Rehab

Science and Technology Continuing Education (RSTCE).– Expanded 2‐hour session not specific to VA; available open source.– http://www.rstce.pitt.edu/RSTCE_Webinar/2013/RSTCEwebinarP249_13.html

“Wheeled Mobility Provision Process”‐ VALU Talent Management System (TMS) course # 12643‐ Many concepts for wheeled mobility and seating directly applicable to adaptive

sports technology considerations.‐ Adaptive sports equipment is addressed toward the end of the course.‐ www.tms.va.gov

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Key “Take –Aways” . . .

• Work as a team & share interdisciplinary expertise

• Evaluate the athlete

• Analyze the sport specific activity

• Identify participation challenges

• Consider/trial available solutions

• Provide athlete education & training

• Document your work and treatment plan

• GET OUT THERE!

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GET OUT THERE!

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To love what you do and feel that it matters, how could anything be more fun?

~ Catherine Graham

Thank You!Kendra Betz, MSPT, ATP

[email protected]

(303) 639‐7020 Denver

Bill Wenninger MS PT

[email protected]

414‐384‐2000 ext. 41104 Milwaukee

assistive technology adaptive sports recreation · 2014. 10. 8. · adaptive sports &...

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