1. ENDURANCE REDEFINED: ADAPTIVE SPORTS FOR VETERANS WITH DISABILITIES VA FACILITY NAME [MODIFY ON SLIDE MASTER] VA EASTERN COLORADO HEALTH CARE SYSTEM ADAPTIVE CYCLING PROGRAM 04/25/13 Crystal Black, MS, CTRS

2. 2 VA FACILITY NAME [MODIFY ON SLIDE MASTER] WHAT IT IS Recreational Therapy Referral (Consult) – Initial Assessment – Treatment Plan – Primary Care Clearance – Program Enrollment ENDURANCE REDEFINED

3. 3 VA FACILITY NAME [MODIFY ON SLIDE MASTER] WHAT IT IS Program Design – Mission: Adaptive cycling program allows individuals interested in beginning or resuming cycling after an injury or disability to develop and/or practice the necessary physical, psychosocial and cognitive skills in a safe environment. – Vision: Adaptive cycling program is directed toward achieving and maintaining optimal levels of independence, productivity, and well being, as well as enter/re-enter the mainstream of community life. ENDURANCE REDEFINED

4. 4 VA FACILITY NAME [MODIFY ON SLIDE MASTER] WHAT IT IS Program Design Continued – Inclusion: physical, social, emotional and/or cognitive barriers that prevent independent participation in community cycling. Must have PCP clearance. – Exclusion: weight bearing, range of motion, physical activity and/or behavioral limitations that may exclude him/her from participating in the activity safely. ENDURANCE REDEFINED

5. 5 VA FACILITY NAME [MODIFY ON SLIDE MASTER] WHAT IT IS Program Design (Continued) Interdisciplinary Approach –VA PM&RS staff RT, PT, OT, SW, BRS, ATP, Psychology, MD –Paralympic Sport Club staff ENDURANCE REDEFINED

6. 6 VA FACILITY NAME [MODIFY ON SLIDE MASTER] WHAT IT IS 12-week Duration – Goal Setting – Cycle Safety Assessment – Trail/Road Rating – Nutrition/Hydration – Equipment – Trail, Road & Race Skills – Progressive Independence – Community Discharge ENDURANCE REDEFINED

7. 7 VA FACILITY NAME [MODIFY ON SLIDE MASTER] WHAT IT IS Reassessments –Weekly –Quantitative –Qualitative Program Evaluation Risk Management ENDURANCE REDEFINED

8. 8 VA FACILITY NAME [MODIFY ON SLIDE MASTER] WHAT IT IS –Graduation Ride –Veterans, family, Paralympic Sport Clubs, VA staff, community members and organizations –Community Transition –Independence –Celebration ENDURANCE REDEFINED

9. 9 VA FACILITY NAME [MODIFY ON SLIDE MASTER] HOW WE GOT HERE ENDURANCE REDEFINED

10. 10 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 1 ECHCS Leadership Buy In: RT Supervisor PM&RS Department Supervisors Service Chief Chief of Staff Director ENDURANCE REDEFINED

11. 11 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 2 US Paralympic Outreach: Susan Rossi, MNpS, CTRS Paralympic Sport Club Contacts ENDURANCE REDEFINED

12. 12 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 3 Develop Partnerships: Adaptive Adventures – Handcycles, recumbent trikes, bicycles – Safety Equipment (flags, helmets) – Expertise Boulder EXPAND – Handcycles – Expertise – Graduation Items USA Handcycling – Jerseys ENDURANCE REDEFINED

13. 13 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 3 CONTINUED Primal – Water bottles – Discounted jerseys Paralyzed Veterans of America – Stationary trainers – Water Bottles – Training Opportunities Performance Bicycle Shop – Maintenance Gift Certificates ENDURANCE REDEFINED

14. 14 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 4 Design Program Outline Weekly Schedule Goals & Objectives Graduated Skill Development Progressive Independence ENDURANCE REDEFINED

15. 15 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 5 Enroll Veterans Maximum 6 Varied diagnosis Varied ability levels Equipment needs Ratios ENDURANCE REDEFINED

16. 16 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 6 Begin Clinic: Week 1 Nutrition education Hydration education Equipment education Goal setting ENDURANCE REDEFINED

17. 17 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 7 Begin Safety Assessment: Weeks 2-4 & 8-9* (Adapted from Andy Duprey, RT - VAPAHCS) Everyone must successfully complete to progress Includes: – Pre-trip inspection – Safety in a flat un-crowded area – On trail/road maintenance – Safety on the trail – Safety on the street – Emergency response* – Pre-arrangements* ENDURANCE REDEFINED

18. 18 VA FACILITY NAME [MODIFY ON SLIDE MASTER] ENDURANCE REDEFINED

19. 19 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 8 Progressive Independence Leisure Ability Model 4 weeks at Jewell Outpatient Clinic 7 weeks on community trails – Destination based on Trail/Road Ratings – 2 weeks planned by Veterans 1 week independently in the community ENDURANCE REDEFINED

20. 20 VA FACILITY NAME [MODIFY ON SLIDE MASTER] ENDURANCE REDEFINED

21. 21 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 9 Promotion, Marketing & Advancement Public Affairs Officer Medical Media Ride for Freedom US Paralympics Research ENDURANCE REDEFINED

22. 22 VA FACILITY NAME [MODIFY ON SLIDE MASTER] STEP 10 Discharge Community Referrals & Resources Referrals to Paralympic Sport Clubs ECHCS Sports & Recreation Equipment Committee Independent Rides Peer Networking Alumni Rides Peer Support/Mentor ENDURANCE REDEFINED

23. 23 VA FACILITY NAME [MODIFY ON SLIDE MASTER] ENDURANCE REDEFINED

24. 24 VA FACILITY NAME [MODIFY ON SLIDE MASTER] IN THE WORKS Research with Indiana University Investigate Outcomes for this model ENDURANCE REDEFINED

25. 25 VA FACILITY NAME [MODIFY ON SLIDE MASTER] QUESTIONS ENDURANCE REDEFINED