Assistive Technology ADAPTIVE SPORTS RECREATION

1/9/2014Assistive Technology SeriesADAPTIVE SPORTS & RECREATIONKendra Betz, MSPT, ATPSpinal Cord Injury & Disorders ServicesBill Wenninger MS PTRehabilitation & Prosthetic ServicesJanuary 10, 2014Adaptive Sports & Recreation TechnologiesObjectivesUpon completion of this session, participants will . . .1) Understand various adaptive sports and recreation activitiesthat are available to disabled Veterans.2) Understand the requirements and recommendations forproviding sports and recreation equipment to Veterans.3) Identify documentation recommendations for adaptivesports and recreation equipment.4) List resources to obtain information on the evaluation and onmaking recommendations for adaptive sports and recreationequipment.VETERANS HEALTH ADMINISTRATION11

1/9/2014Background Information Specific products are referenced to reinforce educationalmaterial and does not represent endorsement or critique of anyproduct or company. Photos are provided from a variety of sources:– The athletes pictured– Challenged Athletes Foundation– US Paralympics– Manufacturers2VETERANS HEALTH ADMINISTRATIONAdaptive Sports & Recreation TechnologiesOverview of Adaptive Equipment OptionsVETERANS HEALTH ADMINISTRATION32

1/9/2014Adaptive Sports & Recreation TechnologiesAlpine SkiingVETERANS HEALTH ADMINISTRATION53

1/9/2014Adaptive Sports & Recreation TechnologiesCyclingVETERANS HEALTH ADMINISTRATIONHandcycle Positioning OptionsVETERANS HEALTH ADMINISTRATIONwww.topendwheelchair.com74

1/9/2014Handcycle Trends20022012VETERANS HEALTH ADMINISTRATION8Adaptive Sports & Recreation TechnologiesTrack and FieldVETERANS HEALTH ADMINISTRATION5

1/9/2014Options: AT for Hand Functionwww.accesstr.comwww.bike-on.comVETERANS HEALTH ADMINISTRATIONHand Support for Paddlingwww.Creatingability.comVETERANS HEALTH ADMINISTRATION6

1/9/2014Visual ImpairmentGoal BallAudio rifle designed andbuilt for visually impairedbiathlon. Used ininternational competition.www.eko-aims.comVETERANS HEALTH ADMINISTRATIONAdaptive Sports & Recreation TechnologiesWhat is Assistive Technology?Assistive Technology is any item, piece of equipment or productsystem whether acquired commercially off the shelf, modified,or customized that is used to increase or improve functionalcapabilities 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 maximumlevel possibleVETERANS HEALTH ADMINISTRATION137

1/9/2014Adaptive Sports & Recreation TechnologiesAssistive Technology Model HAAT Model HumanActivityAssistive technologyContext Functional task analysis–i.e. the SPORT Hierarchy of ATDiagram from Cook & Hussey,’sAssistive Technologies, 2009.– No tech low tech high tech– Commercially available custom medical devicesVETERANS HEALTH ADMINISTRATION14Adaptive Sports & Recreation TechnologiesHierarchy of AT Applied to Adaptive SportsSwimmingNo Tech3-Track SkiingLow Techwww.radventures.comVETERANS HEALTH ADMINISTRATIONOff Road CyclingHigh Techwww.reactiveadaptations.com158

1/9/2014Understand the “human” participantIn 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 goalsVETERANS HEALTH ADMINISTRATIONAdaptive Sports & Recreation TechnologiesClient EvaluationGOT RANGE?VETERANS HEALTH ADMINISTRATION179

1/9/2014AT and Clinical CareThe 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 incorporatedVETERANS HEALTH ADMINISTRATIONUnderstand 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 participationVETERANS HEALTH ADMINISTRATION1910

1/9/2014Participation Goals:Recreation vs. Competitionwww.aspenseating.comVETERANS HEALTH ADMINISTRATIONAdaptive Sports & Recreation TechnologiesHAAT Model Applied to Adaptive SportsRelative to identified impairments and options . . .– What is the typical “standard” (if any) equipment utilizedfor the activity?– Within context of identified impairments, can the clientuse the standard equipment safely and effectively?– If not, can the standard equipment be modified for safeand effective use?– If not, what technology options are available to supportparticipation in the activity?– Which interventions or combination of interventions bestsupport independence and participation?VETERANS HEALTH ADMINISTRATION2111

1/9/2014PT/OT/KTPCP/SpecialtyProvidersRec TherapySEATING/wcSMEAdaptiveProgramsAdaptiveCoach /InstructorsO&PPSASVETERANATHLETEVision and/orHearingVeteran ServiceOrganizationsIndustryExpertsVETERANS HEALTH ADMINISTRATION22The Interdisciplinary Team & Adaptive SportsEducation / Training / Support Self management Mobility skills training Equipment options Psychosocial adjustment Community reintegration COLLABORATIONVETERANS HEALTH ADMINISTRATION2312

1/9/2014Adaptive Sports & Recreation TechnologiesSEATING for Sports & RecreationProvide clinical expertisefor athlete support . . . ComfortPostural stabilitySkin ProtectionInjury PreventionPerformanceVETERANS HEALTH ADMINISTRATION24Coming Next Month . . .Assistive Technology SeriesSeating for Sports & RecreationFebruary 7, 2014VETERANS HEALTH ADMINISTRATION2513

1/9/2014Assessment Components & Documentation Background RecommendationsExisting devices Outcome measuresBody systems & structures This same outlines serves as theGoalsdocumentation template surroundingEnvironment the client evaluation, recommendationsand associated treatment plan withAT trialsrespect to adaptive sports equipment.VETERANS HEALTH ADMINISTRATIONDocumentation Supplemental Form for Recreational & Sports EquipmentRECREATION and SPORTS EQUIPMENT REQUESTSupplement to Form 10‐2641The 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 requestedI.VETERAN BACKGROUNDName: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 CLEARANCEVETERANS HEALTH ADMINISTRATION2714

1/9/2014Documentation Supplemental Form for Recreational & Sports EquipmentRECREATION and SPORTS EQUIPMENT REQUESTSupplement to Form 10‐2641III.ACTIVITY SPECIFIC BACKGROUNDDescribe activities Veteran is involved in – frequency, expertise, participationIV.LEISURE INTERESTS AND PARTICIPATIONPrevious adaptive equipment issued, Leisure evaluationV.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 ofappropriate equipment specifications, accessories and/or necessary modification, etc.VETERANS HEALTH ADMINISTRATION28Prosthetic & Sensory Aids Service (PSAS)www.Prosthetics.va.govPSAS 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 activetreatment or rehabilitation. Clinical Practice Recommendations– Recreational & Sports Equipment www.prosthetics.va.gov Select tab from list Policy clarification/FAQ documents d%20Recreation%20Equipment.aspxVETERANS HEALTH ADMINISTRATION2915

1/9/2014Adaptive Sports & Recreation TechnologiesKey Points – CPR Recreation & Sports Equipment Must be enrolled for VHA healthcare Minimum Level of Disability Required––––Loss of or loss of use ofNot for exerciseNot for convenienceMust 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 VeteranVETERANS HEALTH ADMINISTRATIONAdaptive Sports & Recreation TechnologiesKey Points – CPR Recreation & Sports Equipment Equipment support for sports that Veteran is activelyengaged & meets criteria––––No specific limit on typesMust be actively engagedThis must be documentedMany smart phone apps can track progress Equipment trials required; Trials need to be documented– Document pros and cons of trials– Include transfers, transportation and storageVETERANS HEALTH ADMINISTRATION16

1/9/2014Adaptive Sports & Recreation TechnologiesKey Points – CPR Recreation & Sports Equipment 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–––––HelmetsWater bottlesTraining clothingEye/face protectionEtcetera – Etcetera – Etcetera – EtceteraVETERANS HEALTH ADMINISTRATIONAdaptive Sports & Recreation TechnologiesKey Points – CPR Recreation & Sports Equipment 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 currentdevice worn out or there is a significant change inmedical condition– Not “to be more competitive” or “new model released”– Lighter material does not equate to “adaptive”VETERANS HEALTH ADMINISTRATION17

1/9/2014Adaptive Sports & Recreation TechnologiesKey Points – CPR Recreation & Sports Equipment 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 notadaptive 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.VETERANS HEALTH ADMINISTRATIONAdaptive Sports & Recreation TechnologiesKey Points – CPR Recreation & Sports EquipmentAdaptive interventions can be provided for standard(non-adaptive) equipment when indicated and prescribedwww.Creatingability.comVETERANS HEALTH ADMINISTRATION18

1/9/2014Adaptive Sports & Recreation TechnologiesKey Points – CPR Recreation & Sports Equipment 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 issuedVETERANS HEALTH ADMINISTRATIONAdaptive Sports & Recreation TechnologiesVA Sponsored Events Creative Arts Festival Golden Age Games Summer Sports Clinic Training‐Exposure‐Experience (TEE) Tournament National Veterans Wheelchair Games Winter Sports ClinicVETERANS HEALTH ADMINISTRATION3719