Well, welcome everybody and thank you. Thank you, Dr. Rowe and Dr. Casey for joining us. I'm Kim Barker. I am at UT Southwestern. Dr. Inanoglu, do you want to introduce yourself or I can introduce you as well? I'm Dita Inanoglu. I'm at Franciscan Children's and Spaulding Rehab in Boston. Yeah. Thank you for joining us. This is our second mid-year symposium, that's the resident fellow track. Today is day one of it. I think some people may not be able to join all of it today because I've been a lot of bros since we were still doing clinical duties, but thank you for those who are joining and it'll be recorded and you can view later. Today's theme was moving in medicine. And the first talk is going to be elite sports coverage with Dr. Monica Rowe, who's at the Shirley Ryan Ability Lab and then Dr. Ellen Casey, who's at the Hospital for Special Surgery. So thank you for joining us and I'll let you guys take it away. All right. Well, Kevin Colton, thanks for joining us. We're very excited to have you here. Listen, since it's really just going to be kind of a small group of people, like if you guys have questions and you just want to talk about something totally different, we could talk about whatever it is you want. So you guys get your money's worth here. But Dr. Casey and I were asked to talk about elite sports coverage. Are either of you guys interested in sports medicine? No. Maybe, could be. It's okay, I don't want to put you on the spot. It's okay if you're not interested, but we're just going to talk to you about kind of our pathways and how we kind of got to where we are kind of in our careers. So I'm going to share my slides here. I told Dr. Casey I wasn't going to do slides and then I did slides. So hopefully she doesn't get mad at me here. So let's see here. Okay. Can you guys see that okay? Yeah, all right, thanks. So, you know, just to give you a little bit of history, you know, since both of you, it looks like Colton, you're a PGY-1, Kevin, you're probably, are you a PGY? I don't know what you are. It doesn't say. Are you a resident, Kevin, or a student? No. It should be all residents or fellow residents. Okay, well, in that case, you're a PGY-something. So probably you don't, it's hard to have an idea of kind of the history of all this, but, you know, sports medicine actually was not always a part of PM&R. And actually it took a lot of people a long time to actually fight to get sports medicine recognized within our specialty. And I think it's really important to recognize the people who kind of paved the way for us. And we are in one moment of time here. And I feel like Ellen and I really like took the ball from a couple of people who started paving the way. We've started to run with it. And then, you know, soon enough, we're going to be passing the ball on to the next generation of people. We need to keep that ball rolling. But it is kind of in the histories in the eye of the beholder. I'm a little biased because I trained in Chicago. So, you know, when you come out of Chicago, the person who really started sports medicine in Chicago was Joel Press. He's not in Chicago anymore, but, you know, there was Joel Press in Chicago that started sports medicine and musculoskeletal medicine within PM&R. In the West Coast, Stan Herring, that's the gentleman on the left here, who really started sports medicine within the UW and in the Seattle area. And then there's Jerry Malenga in the East Coast that really pushed sports medicine and the East Coast. So, but again, you know, you ask different people from different regions, they're going to give you a different story. They're going to give you a different origin story. But this is my, this is the origin story that I know. Dr. Press in the late 90s or, I'm sorry, early 90s actually just showed up one day to his chair, wrote a mission statement and said, did you know we are now doing sports medicine and we're also doing spine medicine and occupational rehabilitation? Just kind of had his Jerry Maguire moment, wrote this mission statement. And then the chair of the department at the time, Dr. Henry Betts, was just like, oh, we do have one of these? Okay, I guess we have one. He literally just drafted this letterhead himself and just kind of made up the program himself. And I am lucky, and so is Dr. Casey, we are both lucky that he did this because as a result of starting that training program back in the early 90s, he got it to a point that by the time Dr. Casey and I were residents in Chicago in the mid 2000s, there was a little bit of a program here, you know? There was probably more of a musculoskeletal spine program that was established. We were seeing athletes in the clinic, but, you know, there wasn't a lot of elite athlete care taking place at that time. There was one attending when Ellen and I were residents here that had just started working with the WTA. And that was a little bit of an exciting thing for everyone involved. But when you looked nationally, there wasn't a ton of physiatrists doing things at an elite level. Now, Stan Herring, for those of you who may or may not know, he was actually a team physician for the Seattle Seahawks for 20 plus years. He just stepped down, I think, last year. And so he was certainly doing it at an elite level, but it was not pervasive throughout the country. And just to give you a little bit more background, you know, the ACGME didn't recognize sports medicine fellowships within PM&R until 2009. And that was the year, not to date both Dr. Casey and I, but that was the year we both graduated residency. And so really we were the first group of sports medicine fellows that went through an accredited program. Actually, my program, my sports medicine fellowship at Washington University became accredited halfway through my fellowship year. So really when you think about the grand scheme of things, this has really only been 13 years of accredited sports medicine fellowships. In 2010, there were only eight ACGME-accredited PM&R-based sports medicine fellowships in the country. And now there are 22. So that has grown immensely. And then just so you know, there's only 917 board-certified sports medicine physiatrists. And I think it's kind of cool when I actually look at my certificate, I think I'm 112 or something like that. I literally, you must be like 111 or 110, Dr. Casey, because I think you might have, Casey comes before Rowe in the alphabet. So I'm guessing you got yours before I did. And so there's still less than 1,000 sports medicine accredited physiatrists in this country. So it's not a huge number of people. Here at the Shirley Ryan Ability Lab, sports medicine is a part of a bigger umbrella of musculoskeletal medicine, but it is really important to kind of identify these other aspects of musculoskeletal medicine within what we do, because I do, what I'm gonna touch upon when I talk a little bit about my story is how a lot of these other things and other interests that I had really helped kind of develop my pathway towards taking care of elite athletes. So when I look at Chicago, I graduated medical school in 2005. And when I kind of think about how far we've come, and obviously I didn't quite get to 2022 yet here on this, but in 2005, in terms of coverage opportunities at RIC back then, they were covering Ravinia, which was an outdoor music venue. We were starting to cover the Chicago Marathon in 2008, nine or seven, eight, nine, when I was a resident, we would do that. In 2013, when I was an attending here, we got asked to be the race director for CARA, which is the Chicago Area Running Association. And we were some of the first physiatrists to be medical race directors for the 10 miler race in Chicago, which was kind of a big deal for physiatrists, but Chicago was always a highly dominant primary care sports medicine run place. In 2014, I did get the opportunity to become the company physician for the Joffrey Ballet, which I did for a number of years. Around 2015, we had a fellow who graduated here and then became a team physician for the Washington Wizards, which I thought was a really nice thing for him to do. We graduated a fellow here who became the chairperson of the International Paralympic Committee. So that's Dr. Sherry Blowett. I always kind of joke, we always take credit for Sherry, but we probably didn't have much to do with her success, meaning she was gonna be successful wherever she went, but we still like taking credit for what she did because she was our fellow at one point in time. And then around 2016, we became the team, we became the physicians in charge of the Blue Man Group here in Chicago. Then in 2015, I started working with U.S. soccer with the men's Paralympic team, and that evolved to working with, going to the Rio Olympics in 2016. And then Sherry Blowett was announced to be on the board at the U.S. OPC. And I will tell you, she was actually, one of the very first things that she did, she was pivotal in getting the name change of the organization. So the name used to be USOC. So the United States Olympic Committee is what they used to call it. Soon after Sherry got on the board, she is very humble and she will not take credit for it, but Ellen and I both know she was a pivotal reason that they pushed forward the name change so that it would be called the USOPC. So they included Paralympic into the title of the organization, rightfully so. And then of course, in 2017, I started working with the women's national soccer team. And then I believe 2018, Dr. Casey started working with the women's USA gymnastics team. And we take credit for Dr. Casey too, because she was also a fellow in our program, also an attending and a resident in our program as well. And so that's kind of how things evolved in Chicago. Nationally, when we think about how the care of elite athletes has grown, we've also come a very long way. Now, this by no means is a comprehensive list of every sports team that is covered by a physiatrist in the country. There's probably someone I'm missing, and in a good way, this is changing constantly, right? This list is growing rapidly, but we have physiatrists that are working with US ski and snowboard at Stanford University. One of the first physiatrist who's a head team physician of a D1 collegiate team is Carly Day at Purdue, which is a huge deal. Ken Mountner and his group take care of the Atlanta Hawks and the Atlanta Braves. We've got Brian Murtaugh taking care of the Washington Wizards. We have the WashU group, Chi Ting and Heidi Prather were taking care of the St. Louis Blues. You've got Mike Kadavy taking care of Kansas City Sporting. You've got Ashwin Babu taking care of the New England Revolution. And then you've got Kelly McGinnis taking care of every Boston team there is known to man. I think she also was just named a team physician for Harvard as well. And then of course, you've got Dr. Casey taking care of USA Gymnastics and again, Seattle Seahawks, USA Curling, University of Utah. So physiatrists are really all over the place when it comes to elite athlete care. It has been, the last 10 years has been a huge boom in the presence of physiatrists in the sports medicine world at an elite level. And it's important to know that this was not always like this and that things have evolved over time and that we have to keep on pushing the envelope to stay relevant and to stay present in these roles because physiatrists, in my opinion, are natural sports medicine physicians. And it's really important to kind of see that. So I'm gonna talk a little bit about my pathway because a lot of people ask me, well, how did this happen for you? Like, how do I get to be the team physician for the Women's National Soccer Team? And so my story kind of goes back to when I was a resident, I started volunteering at the Bank of America, Chicago Marathon. And I did this year after year. And when I became an attending, I started doing this. And it was very clear when I became an attending, there was like only a handful of physiatrists that would volunteer at the Bank of America, Chicago Marathon. Most of the time it was ER physicians and primary care sports medicine docs. And it was very obvious. There was like a little bit of a club and they all kind of knew each other. And the physiatrists were kind of a little bit on the outskirts. And so I think my big thing that I started doing when I went to volunteer there is I was just there to help. I was not there to be a diva. I was not there to demand that I be at the finish line or demand that I see the most exciting part of the course or demand that I be placed in the most important, prominent place for a sports medicine physician to be in. I just showed up and I said, where do you need me? And then I did that for years. And over time they started just kind of plugging me in different places. If someone didn't show up, I would just get plugged in here. I'd get plugged in there. And over time I developed this relationship with George Champis, who was the chief medical officer of the Chicago Marathon. And there'd be some years they'd literally put me at the first aid station where I'd hand out Vaseline for two hours or five hours. And there was nothing medically going on there but there was a need for a physician to be there. So I said, listen, I have no ego about this. I'm going to just kind of be helpful. And so wherever they need me, I'll go. And the reason why I tell that story is wherever you end up practicing sports medicine you might find yourself in an environment where they don't understand physiatry yet. They don't understand the utility of a sports medicine physiatrist. And that means you're starting from the bottom up. And if that's the case, and if you find yourself in that situation, know where you are and know how to climb out of it. And Ellen and I both share a mentor who tells us all the time that we have to exceed expectations. And that's a direct quote from Dr. Joel Press. And so that's the key. You've got to exceed expectations in order to move up in the world. And so I think because I was low maintenance and I was someone who was just always agreeable and saw the bigger picture of what needed to get done, that I fell into favor with Dr. Champis. Now in 2015, Dr. Champis actually gets named to be the chief medical officer of U.S. Soccer. It's the first time U.S. Soccer ever names a chief medical officer. And he is now in charge of the men's women's, the men and women's national teams. He's also in charge of all these youth teams and the Paralympic men's team. And so it's probably like 20 different teams that he's in charge of. He goes into the organization, looks across the board of all the different healthcare providers that are being asked to provide help to these teams. And he realizes there's one team without a traveling physician with them. And that's the men's Paralympic team. And so he gets a call at one point from the athletic trainer on the road with the men's Paralympic team. And the athletic trainer said, oh, the kid went up for a head-to-head, for a header and had a collision head-to-head with another player. And he came down, he says he has a headache, but he keeps on talking about his VP shunt and he's concerned about his VP shunt. And I don't know what that is. And so certainly that threw up major alarms in Dr. Champis' mind and said, this is the one team that should not be traveling without a physician. And so at that point in time, I think maybe I might've been one of the only sports medicine physiatrist that George, maybe not the only, but I guess as a sports medicine physiatrist volunteering at the Chicago Marathon, I was at the forefront of his mind. And he's thinking here like, well, she's a physiatrist. She took care of brain injury. She took care of CP. She took care of stroke at some point in her career. And now she's a sports medicine physiatrist. Maybe she would be a good fit for the men's Paralympic team. So he actually gave me a call, told me that if I sign up for this, I have a chance to go to Rio and he had me sold. So I started traveling with the men's Paralympic soccer team for US soccer. It is a team that comprises of cerebral palsy, TBI, brain injury, stroke. It was really interesting. About a third of the team were ex-military special forces. They had TBI's or brain injuries as a result of their combat. About a third of the team were guys with CP and some of them were actually playing D1, D3 soccer. And then about a third of the team kind of had like either a stroke or like an aneurysm or cancer that was resected from the brain or something along those lines that created their neurologic impairment. And it really was a great fit for a physiatrist. I think it's a great fit for a physiatrist to take care of Paralympic athletes and adaptive athletes. And it was a wonderful opportunity. I did go with the US delegation to the 2016 Paralympics. It's really fascinating. This is the picture of Team USA medical staff at the Paralympics in Rio. And what's really fascinating about this is there are certain teams, and this is something that a lot of people may not be aware of. There's Team USA and there's the medical staff that the USOPC provides. But then each team, if they have the appropriate resources can bring their own medical staff. So USA Soccer is actually a fairly well-funded organization. And so because we're well-funded by US Soccer, they're able to have their own physician and their own trainer. But a lot of other, particularly Paralympic sports do not have the funding of their national governing body. And as a result of that, they rely on the USOPC to provide physician staff and training staff when they go to big games like this. So what's interesting about this group is that I think for the Rio games, if I remember correctly, only USA Soccer and USA Track and Field brought their own medical providers. Everyone else was supplied by the USOPC. And there were three chiropractors there. There was one orthopedic surgeon. There was one ER physician. There was one other physiatrist besides me. And then there were two primary care physicians. And the other physiatrist besides me was Susie Kim, who's right here, if you can see my cursor. And Susie Kim is actually not sports medicine board certified, but she has spinal cord medicine certified and had worked for years with USA Track and Field and had worked in the Paralympic movement quite a bit. But as you can see, outside of me and Susie, there was really no other physician who had very extensive background in taking care of people with stroke, CP, spinal cord injury, amputations. It was eye-opening and surprising to me that there was really only two physiatrists in the entire delegation to the Paralympics, right? That being said, this group of people were phenomenal. They're a very motivated and dedicated group of people. But when it came to autonomic dysreflexia, when it came to spasticity, when it came to some of these topics that uniquely we are best suited to take care of, a lot of these other people were maybe a little bit in out of their depths. And so the reason why I bring this up is I believe we can do better. And I know that this talk is about elite sports coverage and everyone wants to hear my experiences with the Women's National Soccer Team, but I actually think these are elite athletes. Our Paralympic athletes are elite athletes and we should be at the forefront of taking care of these athletes. And so if you are listening to this talk and have any interest in sports medicine, this is where we need to grow. And again, it's great if some of our physiatrists start working in the NBA more and the NFL and the MLB, that's great, but really it's a shame if we can't put more people at the Paralympics representing Team USA. And of course, a big part of how that's gonna change is obviously we all know John Finoff is now the Chief Medical Officer of the USOPC and that's gonna change in a, I think, a very positive way given his influence there. So again, a lot of people might wonder, how did I start here and then get to the Women's National Team? Well, as a typical physiatrist, when we're given one thing to do, we can't just like look at one body part. We have to kind of look at the whole- I know, I do my best. These patients. And so that's essentially what started happening with the Paralympic athletes. I just started taking care of other things outside of soccer things. So I started kind of trying to address other aspects of their healthcare to really kind of optimize them holistically. So what ended up happening is after a couple of years of doing this, Dr. Champis called me up one day and said, do you realize you're giving better care to our Men's Paralympic Soccer Team than our Women's National Team is receiving? And I was pretty surprised by that. And the system for the Women's National Soccer Team prior to me arriving was that the physicians would just come in the day before a game and then cover the game. And he didn't want that to happen anymore. He wanted there to be more physician involvement. He wanted someone who was going to coordinate the extensive medical team involved with the care of these athletes. And he liked what I was doing with the Men's Paralympic Soccer Team and wanted me to continue to do that with the Women's National Team. So then I did become the head team physician for the Women's National Soccer Team in the end of 2017. There is a large high-performance team. It includes myself. We have three orthopedic surgeons that work with our team. We have two primary care sports medicine physicians that also work with the team. The physicians all don't travel at the same time. We need a large group of people because we spend a lot of time on the road. So I help coordinate which physicians go to which events. We have one head athletic trainer. We have three assistant athletic trainers. I'm sorry, I didn't update this slide, but we also have one physical therapist that always travels with us. We have three massage therapists. We have one sports scientist. We have one strength and conditioning coach. We have one nutritionist, and then we have a chef that travels with us for the big events. So as you may know, the team physician role, you're coordinating the medical team. And so this is really no different than coordinating the rehabilitation team. So you've got a lot of subspecialty experts in that area. You have to bring them all together and you have to work towards a common goal. And so it is very similar to what we do, what we see on the inpatient units as a physiatrist. So we obviously are involved in the injury diagnosis and management, any medical illness management. There's injury data collection that we have to do from either our own internal standpoint or data collection during big tournaments for FIFA. We oversee any player drug testing. We try to follow the rules of WADA. I mean, we don't try. We do follow the rules of WADA and we advise people on what supplements to avoid, what medications to avoid and whatnot. And then we coordinate all the medical providers involved in large tournaments and games, such as if we're at a World Cup or an Olympics. So I think a lot of people then view my job like this. I mean, they think this is what I get to do all day. I always get to celebrate goals with Pino and Alex and be on fields with 70,000 fans and jump up and down and cheering. The truth of what the reality looks like is this. We are a traveling roadshow, okay? And so the U.S. Women's National Soccer Team, we don't have a home base. So every time we go somewhere, we're on the road and we bring a whole training room with us. So a good chunk of the time, I just came back from a camp. I spent a lot of hours packing up boxes, moving boxes, moving coolers. And so to be a team physician for an elite sports team, you have to make sure you have a very low ego because you are gonna be asked to do a lot of things that it shouldn't seem like it's your job, but it is gonna be your job because that is part of being the team, that's part of being the staff. So I will say that's a huge part of it. And I will tell you, you get more respect from players and other staff members if you sit there and you pick up boxes and you pick up coolers and you fill water bottles. And that allows you to do your job as a physician better because you immediately have respect from people because they know that you're not above them, right? And so for me, that has been like a huge, I would say it's a little secret to the success of being able to manage a fairly large team like this, a high performance team like this. This is just some pictures of the training rooms that we kind of build in hotel room. They're usually not in hotel rooms, they're usually in hotel ballrooms. And we just kind of build training rooms within those areas. And obviously the training room is a place to have fun as well. So it's not just all kind of business, but we do create kind of a pretty extensive training rooms. Another aspect I think of being a physician for an elite team is the scrutiny and the media attention. And I think Dr. Case is gonna talk a little bit more about this, but certainly there's a lot more media here than there is in my regular job. I will tell you, I try to make a point to stay away from the media. If I am somewhere quoted anywhere in the media, something has gone wrong and that's not usually a good thing. It's important, I think, for elite team physicians to stay in the background. And in general, it's not about us. The coaches are the happiest when they talk to the physician the least, right? And so it's not that we don't have regular communication. We do, I talk to Vladco quite often and we have good communication, but a successful tournament for him is when he doesn't have to talk to me very often. And when the media guy doesn't have to ask me, how do I explain this injury to ESPN? So I think that's a big part of the job that I think is sometimes kind of overlooked, but it is a very important piece of this job to make sure that I personally value the fact that I try to stay out of the media and I don't want to bring attention to myself when I'm in these environments. Although sometimes things like this happen and there is media scrutiny around this. And so, I don't know if people were following in the Olympics, it was hard because the time change was pretty bad, but we certainly had an event in the Olympics where we had a goalkeeper go down. And I'll tell you in these moments, it has given me a lot of sympathy for when I see other moments that happen on field because you don't really know what's going on unless you're there. And when this particular injury happened on the field, I made a very conscious effort to stay away from Twitter afterwards. I did not need to hear what people were saying about how we managed certain injuries on Twitter. I didn't need to hear it from ESPN commentators or from NBC commentators. And I think it is really important if you're thinking about going into this particular line of work, you stand by what you do. You are the only one that might know the decision you made and why you made certain decisions. And it's really important that you are certain of, you stay self-assured in yourself and know that you're making good decisions and keep the noise out because there are a lot of people on the internet that wanna pick apart what it is you're doing and judge how you choose to make decisions. And it's not important because they don't have all the information. So I have some lessons learned that I just wanna share with you. Hopefully part of my own story of how I got to where I am today is I have been influenced by a lot of people who wanted to see change and such as Joel Press, he wanted to see change. So guess what? He went and changed it. Instead of sitting back and saying like, you should change this for me, he went and changed it for himself. And so, Ellen and I grew up in that type of environment where we saw people just grabbing the change for themselves and we've been heavily influenced by that. And so that made it easier for us to say, you know what, I can be the head team physician for the women's national soccer team. No physiatrist has done that before, but why not me? And so if you wanna see something change, if you haven't seen a physiatrist do something before, become a part of the change. Stop waiting for it. Stop waiting for someone else to do it. Stop waiting for the next guy to do it so that you can kind of slide into their position afterwards. Don't do that. Become a part of the change yourself. You do it. Take matters into your own hands because you gotta be bold and then you have to back it up, right? And so again, I think Ellen and I saw a lot of that in our careers. And so I think we've been heavily influenced by that. I personally think the core sense of what it means to be a physiatrist will take you to great heights. And so when people ask me how I became the women's national team doctor, the short answer is it's not because I'm the best sports medicine doctor in the world. I got chosen to do this job because of my values and what it means to be a physiatrist at its core. My ability to take care of inpatient TBI, stroke, you know, spasticity, that type of management, that actually got my attention. It got me attention within U.S. soccer, not because I was taking care of ACLs. They have thousands of people to take care of an ACL. It's hard to find people who can coordinate a team and use that physiatric principle of team work and team-based management and comprehensive care that a lot of elite athletic teams are thirsting for. They need someone who's gonna coordinate all that stuff for them. So that is really important. Another little pearl that I found is communication like common sense is not as common as you think. And so we actually excel as physiatrists at communication. So embrace that, you know, embrace that part of your training. And then don't just speak teamwork. You wanna live by it. It's not good to have egos in these environments. There's a lot of egos already running around. The last person they want to have an ego is the physician. I can assure you as the team physician coordinator, I always hear if a physician is brought into the environment and has too big of an ego and is not gonna fit in the environment, I always hear that feedback. And guess what? Physicians with high egos don't make it in these environments very often. So don't just speak teamwork, you wanna live by it. So that's my portion of the talk. I will turn it over to Ellen, but thank you. And I'm happy to entertain any questions at the end of all this. All right. Well, that is a tough act to follow as usual, Dr. Rowe. Can you guys see my slides? Okay, great. All right. So when Dr. Rowe and I talked about this a couple of months ago, we decided to try to keep it really streamlined. And we even said, maybe we'll just do five to 10 pictures and talk about those pictures. So some of us did that assignment. Others of us, as you saw, did more traditional slides. But I am taking the approach in this PowerPoint and have almost no words whatsoever, all pictures. So we will see if Albert Einstein is correct in that one picture is worth a thousand words. So like most of us who go into sports medicine, we've got an origin story. You just heard Dr. Rowe's. Mine with USA Women's Gymnastics certainly starts with my own journey within the sport. Although you can see me here on the balance beam really young, I actually didn't start gymnastics competitively until I was nine, which is quite late for gymnastics. But fortunately, had the honor of competing for our country both nationally and internationally, and then all the way through college. And not only did this get me interested in ultimately working with USA Gymnastics, but really brought me into the field of sports medicine. And I remember thinking kind of end of high school, early college, just looking around at my training partners and seeing some people were super flexible here and some people were really strong and powerful. And wouldn't it be interesting if somebody could understand what those attributes meant, not only to performance, but also to risk of injury. And then if you could identify that if somebody were not flexible enough in a certain area or needed to do some different types of exercises that that might actually prevent injury. And really that's how I ended up in sports medicine and certainly in physiatry. Kind of the next big milestone in my journey was my education after medical school that occurred at Northwestern and the formerly known as Rehab Institute of Chicago. As Monica mentioned, we were lucky to be mentored by many wonderful people, including Dr. Joel Press. What I, you know, I spent, let's see, residency, fellowship, and then four years as an attending there. And I really feel at that time, I kind of honed not only my clinical skills, but also teaching and interest and passion for that, and then research. And you can see me here holding a ton of pregnancy tests while I was very pregnant. It's not that I wasn't taking them myself, but my research primarily focuses on basically the intersection of reproductive endocrinology and sex differences in sports medicine. And so one of the things I was studying there is how the menstrual cycle and hormones affect risk of ACL injury. And so, you know, the ability to train in a place that not only was so inspiring, but, you know, provided tools for pushing boundaries, you know, clinically from a teaching perspective and research was really certainly something that I, you know, carry with me to this day. Not for professional reasons, but to be closer to family, moved back to the East Coast and worked in Philadelphia for a couple of years. And so if anybody has questions about, you know, how do you switch gears and build a practice in another location, happy to touch on that too. But I spent some time both at Drexel and Penn while I was in Philadelphia. And what I think I got a lot more of when I was there is a lot more sideline and kind of field sports medicine coverage. At the time when I was in Chicago, we didn't have as much of that as I wanted. And so I spent a lot of time on the sidelines of, you know, high school and college football, sometimes bringing my son and nephew, as you can see there, they're holding their like Fisher Price medical kit ready to help treat some athletes. But also there was a large gymnastics invitational competition that happened every February. And, you know, when I moved there, I decided to figure out, you know, what gymnastics was happening in the city. I called the meet director and said, hey, what do you have for sports medicine for this? I think there's like, you know, 6,000 kids that compete in a weekend. And they said, well, nothing. Sometimes we have EMS, which is obviously like very unacceptable from a sports medicine perspective. So I said, okay, hey, do you want a medical director? You know, I'll volunteer. And the first year it was just me and I think some athletic trainers. And ultimately, you know, we had a pretty well-rounded team after I did it for a couple of years. And also, you know, continued my interest in kind of building programs for women's sports medicine. When I was at Penn, you can see this large billboard on the Schuylkill if any of you have been through Philly. So that was pretty cool. And we had that up there advertising that program. And then in 2018, I shifted over to the hospital for special surgery where I got to work once again with one of my wonderful mentors, Dr. Joel Press, who you'll recognize from Dr. Rowe's slides and also joined the original Interdisciplinary Women's Sports Medicine Program, which basically I had learned about years prior and Dr. Rowe and I tried to build something like that in Chicago and then also in Philadelphia. So it was pretty cool to be joining a group that had been doing this, what so many of us were trying to do historically sort of all over the country. And while at HSS, some of the things that allowed my career to change a little bit was I was given more time not only to direct research for our department, but also spend on research and also some flexibility in my schedule so that when more gymnastics coverage opportunities came up, I was in a place that not only supported them because I was interested in them, but the Hospital for Special Surgery has probably 10 to 15 physicians who are covering national governing bodies like USA Gymnastics or at the Olympics and Paralympics. And so that's not only an acceptable thing to do, but it's actually something that the hospital really rewards and wants you to do. And that was really, I think, validating and unique for me coming from different academic centers. Around that same time, there was a significant reckoning in the sport of gymnastics. So for those of you who may not be familiar, the former team physician was basically accused and found guilty of sexually abusing over 500 girls and women over several years time, including many of the national team members. So in addition to that, because that cannot happen in a vacuum, there was a lot of uncovering of cultural problems that had certainly been going on for a long time, but through social media and documentaries such as this one I have a picture of for Athlete A, really showed that there was a significant problem in the sport from a cultural perspective. And it wasn't just one person who needed to go to jail, but obviously there needed to be a change so that there was a significant shift in how athletes and coaches were acting, how athletes were being supported in an attempt to create a much healthier environment. So all of those things happening at the same time where I was in a position where I was in a hospital system who would allow me to take on a role in USA Gymnastics. And then obviously this cultural change led to me taking the role as the head team physician for women's gymnastics in 2018. And I share that role with Dr. Marcy Faustin, who's at UC Davis. She's actually a primary care sports medicine physician, but in the department of physiatry there. So we kind of like to claim her as our own. And basically I've been working with the team since that time. So what does that mean on sort of the day-to-day? Basically, Dr. Faustin and I each travel about 50 days a year. And during those times we're either at a monthly camp or we're at the three to four domestic competitions that we take care of per year. We might be at three to four different international competitions. And certainly the Olympic games, for example, were held almost recently. And all of those trips, of course, require a significant amount of preparation. So if it's a domestic competition that happens to be in St. Louis, I'm based in New York, Dr. Faustin's based in California, USA Gymnastics is based in Indianapolis. And so what we have to do, as Dr. Rowe was saying, is not only get all the supplies and create the training room wherever we are, but we have to develop an emergency action plan for whatever could possibly happen in a new city, kind of plugging into local sports medicine and emergency services resources in the time of COVID that became even much more complicated to do all of that. So there's this sort of constant reinvention of not only the physical space and the equipment, but the plans for dealing with the inevitable things that come up. And in sports medicine, you wanna be prepared for everything, but not have to do anything, right? That's the best scenario, because if you're doing something and you're busy, as Dr. Rowe said, that's not great for the athletes. So there's a lot of strategic, how can you pack all of this stuff in the best way possible? Where do you put stuff in your bag? That's my kit at the bottom, where the minute somebody needs X, you know exactly where that is in a quick competition scenario. And so it really utilizes, if you like, organization or the home edit or those sorts of things, like really those skillsets go far in the sports medicine world. But this little picture of this kind of like small massage table, you know, and a little bit of equipment, that was our training room in Tokyo, which was unfortunately in a hotel room. We try to avoid rooms, but we took the bed out, we put the massage table in there or the treatment table. And then even within that little space, because of what happened within the sport of gymnastics and safe sport, which basically means that any interaction that I would have as an adult with a minor athlete has to be with another adult present, it has to be observable, it has to be interruptible. There's no closed doors and treatment happening one-on-one. So even in these small, small situations, you have to make sure that you're still kind of sticking with the guiding principles of athlete safety. But it certainly can be a lot to manage and organize, but on the sort of big event days when you get to support athletes doing what they love and are passionate about, it's very rewarding. These are a couple of pictures from Tokyo, which is the only Olympics I've ever covered. And I don't know how different it was in the pandemic, but it was certainly a unique experience. But there are a couple other physicians that I've gotten to know really well. These are the doctors from Great Britain and the Netherlands. And so you see the same people, these competitions, we've actually written a white paper together. We have research projects in the works. And so some of this stuff I never would imagine would open doors from even a research perspective with this type of care, but that's been really fantastic. The three of us in red here, that's me with our physical therapist and our sports psychologist who we utilize through the USOPC. We do not come with a chef and three massage therapists and I don't know, nannies or whatever Dr. Rowe was talking about, a little bit different budget for USA Gymnastics, I believe. But anyway, these, you know, certainly there's differences sport to sport. I would say, you know, covering the Olympics besides the challenges of the pandemic, there were some certainly highs and lows for women's gymnastics. And I'm happy to talk more about any, either of these. The two most controversial, you know, were that we did have an athlete test positive and navigating that in a, we were outside of Tokyo in a pregame situation. And so we actually didn't get to utilize all of the support that we expected to have through the USOPC. So that was an interesting challenge. And then certainly the twisties or the, you know, the getting lost in space for Simone Biles was completely unexpected and certainly relied heavily on the coordination and communication of the medical team. So things you might never expect can also happen. And I think when people ask, you know, well, how can I get from point A to point B? I think in general, you know, luck is what happens when preparation meets opportunity. So there, even though I was a gymnast, I have a great passion for, you know, caring for gymnasts. I had no intention that this is exactly what I would do with my career. There are so many variables that have to happen and change in the timing of things. But what I would say, if you have an interest in something, absolutely prepare yourself, create opportunities, ask questions for doors to open, and then should they open at the right time, you're ready to go. And that certainly is something that has worked well for me and certainly others, I think, in this field. And when, you know, at the very end of the day, have fun, have fun with the people with whom you work, develop mutual respect with your, you know, with your athletes, with your medical team. And, you know, it's a lot of work to care for athletes at this level or really any athlete. And a lot of times in between events, I think, gosh, this is a lot to do on top of my other job and life and everything else. But if you can work with people whom you absolutely, you know, value and can collaborate with and know that it's not about you, it's about, you know, your small role in these athletes achieving things that they've dreamed of for their whole lives, then it's a really rewarding experience. So I think we have about eight minutes, right? We can happily take questions either for me or Dr. Rowe, if you guys have them. I do have a question about the twisties and how you guys, can't like, I'm sure that was not at all what you expected to be dealing with. Yes. And so to be clear, Dr. Faust and I split the Olympic games because we didn't think it was fair if one person covered it, you know, versus the other. So I was actually there for the COVID nightmare. I left the day of their prelim competition. And so I was actually at home watching, you know, in my kitchen, trying not to wake up the whole family and still on the text thread that we had with the coaches and, you know, and the, you know, admin staff. So I could sort of observe what was happening and see what was really happening behind the scenes. And it was completely unexpected, certainly. I mean, the twisties are a common phenomenon, terrible name, but, you know, a phenomenon that occurs in gymnastics and it can occur in anyone at any level. And, you know, it can be extraordinarily dangerous, especially if you're doing the types of skills that these elite athletes, including Simone, you know, we're doing. So it really became, obviously it was a mental health situation. One of the biggest, you know, besides somebody being suicidal, this is like the biggest mental health crisis, really, that could have occurred in the sport of gymnastics at the Olympic Games. But, you know, it could have had certainly physical manifestations that would have been devastating. And what was challenging for Dr. Faustin is that when you're at the Olympic Games, they're only the athletic trainers on the floor with the team. So the physician has to trade a card, like a physical card to get onto the floor. It's craziness. And so they had to make this decision within basically five minutes, fill out a form that was in Japanese, you know, they had a translator. But, and then if she hadn't been pulled at that time, then the United States would have essentially forfeited because she was supposed to compete, you know, on the next event. So it was completely unprecedented and there was absolutely no time. But I think the only way that that works is, one, if you have the trust of the athletes and the coaches, and they're willing to say to you, I can't do this, what do we do? And then also you have to kind of know the, who to communicate that, you know, with as far as the different people on the floor. So it's a lot of like rehearsing potential scenarios in your head and then figuring out like if X happens, you know, kind of like thinking about running a code or something like that, practicing and we do that mentally, we walk every exit, we see where the ambulances are gonna be, because again, in any situation you wanna be on, you know, doing this as efficiently and effectively as possible, but on international, you know, live television, it's a significantly amped up level of pressure for sure. Right, have you had, have actually gone through scenarios like that where there's more of, like you said, there's more mental health issue rather than a physical injury? Because I mean, as scientists, we do deal with a lot of psychological issues that go along with disability, but not necessarily in this, right? I mean, previous to that, we had not been like, hey, let's say Simone at the Olympics can't like lose, gets lost in the air. Cause I mean, that's her thing. Like her gift is knowing exactly where she is in the air. So we didn't do that exactly. We do now have a mental health EAP, meaning emergency action plan. And that is an initiative that's also supported by the USOPC. That's a little bit more like, hey, I'm at a camp and this kid is having a massive anxiety attack or, you know, sadly for us, we've had, you know, kids with abusive coaches and they're, you know, kind of really in a bad mental place. And so, you know, we now do train for some of those scenarios. We did practice like, for example, you know, where would the doctor stand when the athletic trainer's here so that they can like make eye contact? Cause you can't have your phone out on the floor either. And so the field of play is no phones. So then there's smartwatches and other things, but we did practice with like, I'm gonna stand here. So if something's happening, you look at me, I will get to you, we'll switch the card. I mean, it's just a lot of that rehearsing. It's crazy. Thank you. So there's one question on the chat coming from Zach. Yeah. Like to take that. So Ellen, the question is, how have you navigated your commitments with these teams and your clinical teaching responsibilities? I only take care of D2 University, but I find it challenging in my institution to get the support to do extracurricular activities as often as I'd like. I'm happy to start. Ellen and I have talked about this. I will tell you, neither of us are making tons of money based off of what we do. That being said, I think, I mean, I think one of the things that you have to realize is, and this may be a little bit more blunt than what most people wanna hear, but to do this comes at a cost and it does come at a sacrifice. And I think, so I think there is a movement in sports medicine to pay physicians to do these jobs. I will tell you a lot of places will still not pay. And there is a famous story around here that about 15 years ago, RIC was approached to take care of a D1 basketball team. And we were asked to pay a million dollars to be their physicians. And so I do, that still exists in the sports world somewhere, but I do think there is a push to come out of that mentality. That being, and I will say, I do, I have a contract. Well, I should say the Shirley Reinability Lab has a contract with US Soccer for my time. And that helps a tremendous amount because there's no one here within my organization that is constantly looking over my shoulder saying, hey, how many days have you been out? Because I do, in a World Cup year, I was traveling over a hundred days out of the year. I am contracted for about 60 days. And if I have to exceed the 60 days, then more money gets exchanged in whatever way that happens. I will say I have a very understanding employee, employer. They, the Shirley Reinability Lab from the top down has been a hundred percent supportive of what I do with US Soccer. And they've actually been very supportive of what people do with our Paralympic team too. And it's not just because I'm taking care of the elite athletes, I should say. It's not because I'm taking care of the women's national soccer team because both groups are elite athletes, but it is important to them to just kind of help support that. But I understand that other, some institutions don't necessarily, may not value that as to the same degree. And I find, and I may be in a very unique situation. That being said, we don't make more money by doing this. We probably lose a little bit of money from doing it depending on what kind of compensation structure you have at home. But there is always sacrifice to doing this to some degree. We should, as a group of sports medicine physicians should always advocate that people get compensated appropriately. That being said, if you really do want to make, if you want to participate at some of the top levels, you are going to have to make sacrifices at this point in time. I don't know anyone that is working at an elite level saying that they're making more money doing that than being at home seeing patients. Monica, could you also speak to being a trainee, being a resident or fellow, and being a trainee while you're doing, trying to do all those extracurricular activities? How does that fit into the schedules and the ACGME requirements? You being the residency program director too. Yeah. Well, number one, I mean, your work as a resident should always come first. Always come first. So if you have a coverage opportunity, that's great. But if you're a resident, you're probably going to need to do a sports medicine fellowship anyway, and there'll be plenty of time to do those coverage opportunities later on. And I don't know that I think it's wildly important for residents to have tons and tons and tons of coverage opportunities before they apply for fellowship. I think, so I do think you have to prioritize your residency first, because if you are not a good physiatrist first, you are not going to be a good sports medicine physiatrist. Thank you. Ellen, do you want to add anything? No, I agree with what Dr. Rose said. I'm paid really to see patients, but at least my institution is supportive of me being gone. And so I make less money, but they're not worried about it from their perspective. And they like to be able to say, we have a doctor who does this and covers this team. I also have two, not so young anymore, they're eight and 10 now, but kids. And the logistics of this are very challenging. I mean, you cannot imagine the amount of time I spend on the schedule and then, can, like my mom will come in or my dad or my sister, not that my husband can't do it, obviously, but it's very difficult to take on all of the parenting. And some of these trips are long, they're three weeks, they're four weeks. And so trying to make it work with a family too is challenging. You certainly can do it, but it takes a lot of planning and a lot of preparation. And then they go and change the dates on you and you kind of have to roll with that a little bit, but it's possible, but it's certainly for me, it has to be worth it from the sport that I'm caring for and the athletes, if they're enough of a passion then that's worthwhile. Okay, it is 4.15. So let's get started. Welcome, everyone, and welcome back to those of the five I was seeing on the call before. So now we have our second session on advocating through social media. And thank you, Dr. Monica Vergesco Gutierrez and Dr. Nicole Finger from UT Health at San Antonio for joining us and sharing your stories with us. I will be on and I will be monitoring the chat, but we're such a small group, and the session is being recorded. So we will let you decide how you want to do this, how interactive you would like to do it. And please take it away. Thanks. I will say we do want it to be interactive. And, you know, there'll be questions embedded. So we want to hear people or see, you know, hear what they have to answer in the chat. And so just again, to introduce myself, I'm Monica Vergesco Gutierrez, the chair of Rehab Medicine at UT Health San Antonio. And we're going to call this How to Become a Social Media Star. So then maybe it would have named that maybe a lot more people would have come on to listen, but hopefully they'll watch it later. And so I actually recruited a social media star to help me with this. And Dr. Nicolette Finger, who's one of our outstanding residents who is presenting with me today. So go ahead. Yeah. So thank you for having me as well. I'm Nicolette Finger, PGY3 at UT San Antonio. So I will get started here. So this is just kind of an overview of the three social, you know, that are our social media accounts. Dr. Gutierrez's Instagram and Twitter and my Instagram and Twitter. And then we have one for our program as well. I think, you know, overall, social media is becoming such an important part of really everyone's life. And we'll get into that a little bit more. But especially with recruiting, everything being virtual now with interviews and like even these events, you know, conferences being virtual, this is how people are finding their news and their and the programs they're interested in. So a little about our story. I will let Dr. Gutierrez tell her story first, and then I'll kind of tell mine too about how we got involved in social media. Yeah. So my, I put that first picture on the left is my first picture on social media from Facebook. And it was from May 2012. And it was actually two days after my birthday. And the funny story about it is, you know, on Facebook that if you're on Facebook, you put your birthday in there. And then if you're following someone, it tells you whose birthday it is that day. So then you know whose birthday it is. And you can, you know, send them little messages and tell people happy birthday. One of my co workers at that time, missed my birthday. And he said, it's because you're not on social media, I don't know when your birthday is. And so he actually created my Facebook account. So that way, he would remember my birthday and found that that was like a picture that happened to come out in our local newspaper of my husband and I. And so he made that my first like social media picture of myself. And so the joke is like he created a monster. Now, you know, the next thing is like I'd gotten Instagram, but I really had gotten Instagram just to like make my pictures look nice. Because they have all the different you know, they had frames and they had you can make it black and white or whatever else you wanted to do. And so that's the reason I got Instagram. And then it was like, Oh, but maybe beyond just making my pictures look pretty, then I use it for other things as well. Now, again, advocacy sharing what I want to mostly now my Instagram is probably running related to summer runner and, you know, put a lot of stuff on running, but it's a public profile. And then Twitter got very involved in Twitter. Again, haven't been on since August of 2018. So again, not like 16. What does that say there? Not on kind of Julie silver was like, okay, people are connecting on Twitter, you should get on Twitter. So I got on Twitter, I learned how to, you know, a little bit, like you'll talk about here, you know, how to do advocacy, how your name should be. And this week got 20,000 followers on Twitter. Just again, sharing stories about physiatry and now long COVID, which is also, you know, made kind of what I do a lot more popular. So from something that was started by someone else, because they forgot my birthday to, you know, community and advocacy and sharing what physiatry does for long COVID. That's kind of my social media story. I love that. I started. So the picture on the left is when I was in undergrad, and I was a nutrition major. So I was sharing all of these, like healthy recipes, and I really had no goal in mind, I definitely didn't think that I was going to end up sharing so much of my, you know, journey in medicine. But that was pretty much what I was doing is sharing just my life in undergrad, and mostly just recipes. And then in medical school, I wanted to share more about my life, I was getting a lot of, you know, just people who knew I was in medical school at the time were asking me questions. And I wanted to be able to share that. So that's actually when I changed my Instagram name to Nicolette dot life, because I didn't want it to restrict me, I wanted it to be a name that was just me, and I was my own brand, and I was able to share whatever I wanted. And so there's a picture there in the middle of my, my, the co founder, and I have the mental health organization at our medical school. And then now in the past two years, I've really started taking social media more seriously, I actually got a residency interview from social media, at a PM and our program, like an attending at a program reached out to me and said, Have you interviewed with us yet? So I mean, there's are so many like really cool ways to connect with people on social media. And now I've been able to even partner with some other doctors in other fields and bring light to what PM and R really is. So that's that picture on the right is me and Doc Schmidt, we collabed on on kind of a just a funny skit about PM and R. And we got a lot of really good questions, people who had never even heard of the field before. So when people ask, like, who I am, or what I do on social media, I have kind of a blurb that I will read you guys here. So I say I'm a Texas based digital creator who serves as a role model and mentor within the healthcare space. I share a window into the life of a resident physician, both inside and outside of my career. So that's kind of my like overarching statement, if you will, about who I am on social media. So we want to play this fun video for you. This is Dr. Gutierrez and I were on call. And we we learned and recorded this dance all all at the same time. Hopefully you can hear it. I hope you can. Let's see. I don't hear it. But was everyone able to hear that? No, no. Oh, no. All right. Well, you can always go on our social media and find it to listen to it. But it was it's fun. And I think these kind of trends really get other people engaged. So they seemed, you know, they're, they're fun. They're silly. But these are the kind of things that young people are are on social media doing. And so when we kind of jump in and participate, that's how you you get a lot of engagement on social media. So the benefits of social media altogether, we know that we can educate and empower patients and not just patients, but other people, you know, we can really kind of reach a public health approach with social media and reach people who may not have access to our field. You know, PM&R is I know here in San Antonio is very big, but there's a lot of small cities around the nation that don't have access to PM&R. And those those people don't even know that we exist, you know, people who are not in medicine, just living in a small town may not even know that this kind of care is available. And so we can reach those people. We can also mentor and inspire people following in our footsteps. So pre meds and medical students. I know myself, I've been able to mentor a ton of people just over social media. It's kind of a joke on my social media that I send a bunch of voice messages because you can do that in Instagram. So I just tell them, don't email me, just send me a message and I'll just voice message you back. And it makes it really like fun and easy to kind of mentor a bunch of different people from all over. And then you can also form connections and network with people across the world. We can get advocates, we can get clinicians, innovators, financers, all at the same table and talking. It doesn't matter where our geographic location is. So I think doctors do belong on social media. I think that public health is an extension of what we do as physicians. And we need to meet the patients where they are. We need to meet the patients where they are. I think this chart is a great representation that 86% of US adults get their news on digital devices. So here, 86%, they're on their smartphone, their computer and tablet. And then kind of the next slide here, we can see that 42% of people between the ages of 18 and 29 are using social media. So not just news apps or podcasts or anything like that, but particularly social media. So that's almost half of these people. And if we want to meet those people where they're at, then we have to be there too. Just to add to that is that definitely even big legitimate organizations have a push for social media, like the World Health Organization has 12 point million followers on Instagram and them and the CDC have both had forums and meetings about meeting people where they are. They feel like it helps them with digital equity. There's some people in other parts, a lot of people have phones and are able to get on social media. So they may not be able to see physicians, but can they get some at least credible information from sites, from the World Health Organization, from the CDC? And so that is one way that large medical organizations are getting on social media, including even our national societies are there as well. Yeah. And there's a lot of misinformation on social media. And so we can combat that by being there and providing actual information. So a couple just statistics from studies that have been done, and really there is still so much more research that can be done on the influence of social media in medicine particularly, but these are a few that we found. So this was a survey that was given to all of the applicants of the University of Kansas. It was a family medicine program. And they had 138 applicants, 75, so 62% of, sorry, 75, so 54% of the applicants responded. And they saw that 62% of them said that they used social media to research residency programs, which I think is pretty big. And this is of course done in 2022. So this is recent, which the COVID pandemic likely pushed a lot of this change with everything being virtual, including interviews. But I think that this kind of highlights a very important point that residency programs on social media are going to be able to connect with medical students more than those that are not. Yeah. I will be presenting a poster at the next AAP meeting, or hopefully we're submitting. And we're also writing a paper up where we actually went out to applicants from the last two years to say, okay, who used social media? What were you using it for? What were you looking at? And more than half, like two thirds of the people that we, so the same thing, almost like the exact same percentage. So the applicants, same thing, two thirds of applicants were looking at social media to look at residency programs. And then it was interesting. We also looked at like what specifically they wanted to see on social media. And we'll actually, that's what we'll be presenting at AAP. So if program directors want to go and see what applicants want to see, then that's where all that, or when the paper comes out, you'll see where all the secrets, I'm not going to let out all the secrets yet. We'll just put it on ours. Put it on your radar. Right. And so hashtags on social media, we'll talk a little about this later too, kind of towards the end of the presentation, we'll talk about how to use social media and even give some pointers and kind of jump-starting tips. But just kind of looking at this study that was done, this was done at Tulane University in New Orleans, and 212 people responded to the study. 212 people responded, or 212 Instagram posts, and then 237 Twitter posts were used for this study. And they found that more companies were on Twitter and more physicians, like orthopedic practices and personal accounts were on Instagram. So it kind of shows you, usually Instagram is going to be the more casual, funny, silly place to be on social media, and Twitter is used a lot for networking and connecting. And each kind of social media platform has their benefits and the things that you can really use them for. And I do have a slide later where we can talk about the different benefits of each social media platform. Program directors on social media. So this was a survey done in 2015, and they had 110 program directors in general surgery complete this. And they were looking, this is kind of the opposite, right? They were looking at residency applicants from medical school. And it goes to show you the importance of being professional on social media, because 11% of the program directors reported that they lowered the rank or they completely removed a residency applicant from the rank order list due to their online behavior. And 68% of the respondents did actually agree that it was important to look at. They may just weren't part of this 11% that actually found something to kind of take a resident applicant off of the list. I will say though, that, you know, as having been a program director and currently one right now, that I'm not looking at it. I'm not going to like find every single 500 plus applicants and look them up on their accounts because ain't nobody got time for that. I barely have time to read through all the applications. I'm not going to also go on your social site. So usually it's just like, are there people who are ready? Like Dr. Finger had said, you know, someone had, oh, did you interviewed our place yet? And, you know, she, it was for the positive, for the good. And usually it's more for the good that I'm, you know, interacting with people on social media and not like searching and looking for negative things. Cause I think that's one thing that, you know, students or residents going into fellowship or like, do I need to get rid of my accounts? And I think as long as you've been keeping it clean, you don't, and it's actually, you know, a positive to be interacting with people. Yeah, I, I totally agree. And I think, um, to add to that, I felt at least when I was going through the process, you know, I had my social media up and running and I was actively posting when I was, um, in medical school, applying to residency. And I got a lot of questions from people like, aren't you going to change your name or make your profile private? And my response was that, well, if you look at me on social media, you'll see just me being me. Sure. You may see me being not like in a suit perfectly, you know, picture perfect. Like I would walk into an interview, but when I write on my application that I like to hike and hang out with my husband and be outdoors and do yoga and all of this stuff, and they see that on my social media, that's only going to be an extension of, of what I said, I, who I said I was. Um, and so if that's the case, then I think social media is, is completely safe in the application process. So, um, here's a slide, just a screenshot. Um, we have, I took from the, uh, podiatry.org and they actually have all of the PMNR residency programs, Twitter, and Instagram handles. And so, you know, you can see not all of these programs have social media handles, but this is a wonderful resource for medical students, especially if they go to this website and then they can just kind of search through and kind of see the culture at different programs. I know a huge thing has been like social media takeovers. There are multiple accounts online, like the PMNR scholars and podiatry mentors that host virtual takeovers. I know our program just did one last week and are two weeks ago, and that's a really great opportunity as well to get medical students involved and talking with the programs. So this is a really great resource. So if your program, if anyone watching this now, or later in the recorded session, doesn't have a social media, um, start one and get it added to this, this list, because this is a great resource for med students. So, um, this is where we want to do a couple interactive, uh, questions. I want to know when people first learned about PMNR. For me, it was during my third year of medical school. For me, it was my first or second, but I definitely did not know about it going into medical school. I did a preclinical elective in sports medicine and it was actually run by PMNR. So that's how I learned about PMNR. Awesome. Dr. Barker says in college. That's awesome. Dr. Gibbons in high school. That's awesome. I did not know about it that early. And I think there are definitely the people who know it going in into, um, or going into medical school, but there are a lot of people, you know, like me who didn't, I went into medical school to do something totally different and then fell in love with PMNR. So, um, this is another reason why I think social media is very important because a lot of times, especially like when I post on social media, I'll get people who comment, um, like, what is this? Right. Especially people who don't maybe follow me and my video or my picture ends up on their, their home screen somehow. And they've never heard of PMNR. And this is a great way to introduce our field to pre-meds and medical students so that they have the chance to learn about what we are and what we do. So how many PMNR opportunities were, um, or are available to you in medical school? For example, do you have a, did you have a mentor in the field? Um, if so, were they local? Other questions I would have would be, you know, are there PMNR residency programs nearby every medical school? Um, I know the answer to that is, is usually no. Uh, Dr. Barker says none at, at her medical school utilized outside mentors. I hear that a lot from people on my Instagram. Um, they'll message me and say, you know, how do I even get involved? I have no mentor. I don't know anybody in this field. Who do I even rotate with? I was lucky. I was in a place where there was a big PMNR department. So it was like, okay, then once I really, then once I figured out what PMNR was, it was easier to do rotations and have mentors. But then that was, you know, I realized it was very privileged in that experience. If you have to think there's about 99, I think we just got 100 residency programs in PMNR and there's a lot more medical schools and a lot more osteopathic medical schools now, much more than a hundred of where they do not have PMNR and they don't. Um, yeah, inclusive of a lot of the medical schools that are like the historically black college university medical schools. None of those have, um, PMNR programs. So we have to find, you know, this is a great way for them to find mentors and to connect with people in the field. Yeah. And even research, um, a lot of research studies, you know, case reports or case series, um, for, uh, survey based research can be done remotely. And I know Dr. Gutierrez and I both have seen many people collaborate on research studies through social media, uh, which is something that would not have been available. You know, at least even for me, I was lucky enough to be near a residency program, even though it was like 45 minutes away from my medical school, but I was at least close enough to be somewhat involved. But that's not the case for most people. So this is a great way to get them involved. So other things that we can do, so we can educate pre meds and medical students about physiatry, we can connect mentors to mentees, we can host virtual events, we see that on you know, APS, virtual intro to PM&R, they have virtual journal clubs, these are all really great resources. We can engage medical students with PM&R residency programs. We even have medical students right now doing research, remote research with some of our residents and faculty, and they connected with us through social media. And so providing those remote research opportunities are very good as well. One thing that is not on here that I, it's really important to bring up is, and I know, Facebook is for the boomers like me, but it's not really, when we looked at our, when we did our research about what applicants use for social media, just definitely, they're using Instagram the most these days. But on Facebook, there's the Women Physiatrists Facebook group, and you can't get on it as a medical student until you really match and you're in the field. But that's just been another way for Women Physiatrists to form a community, to be able to ask questions of each other to be able to advocate for things, you know, sometimes then we plan in person events at conferences. And we've done advocacy that way as well, at a kind of a few years ago, Medscape always has the survey for Physician Compensation Survey. And about four-ish years ago, PM&R wasn't on that list. So it's like, well, what do you know? We don't know anything about the compensation of what PM&R is based on the Medscape surveys that they had for all these other specialists. And so there was two physicians, two Women Physiatrists who brought this up. And then we created a whole very kind social media account reaching out to Medscape. And then by the next year, they added PM&R on the now it's in the compensation survey every year. So, you know, it's something that we did to help advocate for our specialty. And I think the Academy had been asking them for several years and hadn't gotten as far as what we got in two days. So that's incredible. Yeah. And I think, you know, just another extension of that, is that we also can educate other specialties about what we do. So, Dr. Gutierrez, she does a ton of education on spasticity and long COVID. And this is just a screenshot of one of the articles that I recently wrote about what I wish other doctors knew about PM&R. And these are really great ways to educate other physicians on what we do. We're lucky in, you know, here in San Antonio that they, a lot of our hospital knows our department and what we do, but that's not the case in a lot of places. So there's a picture on here. Oh, there we go. Creating your brand. So I think this is always a funny statement. Whenever we say brand people, it makes people feel a little bit weird. And they don't really know, you know, how they feel about saying that they have a brand. But really what your brand is, is how you're perceived by the public. So how does the public perceive you? This is a really cool picture that, that a lot of, you know, Dr. Gutierrez, I think started this, and they put this together during COVID. And I think it really was a positive kind of coming together point during the midst of all of COVID. So creating your brand, how, how do you even go about that? And what does that even mean? I think first, you have to set a goal. And the most important part of all of this is that it's not stagnant, you know, your goals can change, all of these things can change as you kind of go through social media. Dr. Gutierrez and I both as we shared our story in the beginning, had had big changes in what we thought what we wanted to share at that time in our life and in our journeys. And so you can kind of continually, continuously go through this exercise. But so you want to set a goal. So what is your purpose? Why do you want to post on social media? Do you want to educate pre meds and med students? Do you want to be involved with public health? Do you want to kind of collaborate and connect people with mentors, mentees and research opportunities? What's your goal for your social media account? And then with that comes who is your target audience? Who are you speaking to? Right? So if your goal is to is to mentor, are you mentoring pre meds and med students, and you'll want to keep those people in mind whenever you're posting, right? Imagine who you're posting for when you're posting that. What do they want to hear? What do they need to hear? And you'll want to create consistent content to keep your audience engaged. So people, you know, you want people to remember you're still there. There's a lot of times I'll follow someone I really like on social media, and then they don't post for, you know, maybe a year or two, and then they, they maybe come up on my feed at some point, and I totally have forgotten that I that I followed them, right? So you want to be consistent with your your content, and engage with others. So social media is a two way street. It's not, you know, if you're putting posts out there, but not engaging with other people, then they're not really going to feel like it's that social connection. So keep the keep the social and social media and analyze your past posts. So I like to kind of go through and see what I posted in the past and how it performed. And if people liked it, if people, you know, had a lot of really good input or comments on And I like to then post more of that stuff, right, that people really liked. So the kind of the last thing is staying up to date with new features, Instagram, Twitter, they all have new features all the time, and kind of keeping up to date with all of that. So you can be in the know and participate how the users are really using the platforms. And then kind of how I said at the beginning, you'll kind of keep going through this cycle, your goals may change, as you progress through your journey, or decide that you have a deep passion and something else. The other thing is, you don't have to have a really fancy, like, oh, my mission statement for life on social media is like maybe your brand and your goal is just to get out there and to interact and you know, post some pictures or, you know, just so that you can start something simple, or maybe your goal is get on so you can creep on all the med students and see who you're not going to give interviews to. No, I'm joking. That's not anyone's goal. And so yeah, building your brand. So this is kind of a continuation. You want to share across social media sites. And this doesn't have to be overwhelming. I would honestly suggest picking one to start with, pick your main platform and just stick with it even for a while if you don't even do that second point. But then once you get more comfortable, you don't have to do all of this extra work, you can repurpose the content that you made for one platform for other platforms. So this I really liked this little picture that I found online from social champ. And it kind of showed how one person you know, they write a blog post, and maybe they make an ebook off of that, or they make a YouTube video. And that same YouTube video, you know, if you shoot it vertically, because YouTube has all of these short, they're called shorts, and they're basically tick tock videos and reels. And you can post that same video to all three of those platforms. You can talk about that blog post on a podcast. So this same information can be reused. The other thing that you can do is say you write a really long blog post, you can break that up into little bullet points and make probably 1015 videos, short 15 second 20 second videos on social media, and repurpose that content make series out of them. So it doesn't have to take up all of your time. And it doesn't have to be like this super big, you know, beast that you have to accomplish. You can make it simple and people actually really like when you show up authentically. The other thing for platform is that you have to remember that the platforms are different. So if I'm going to put something on, usually I put similar stuff on Instagram and Facebook. And that I can write as much as I want. But if I'm on Twitter 280 characters in a tweet, and then but you know, I can add other tweets to it. But usually, you know, I have to remember that there's character limitations. And also people are following me for different things in different places. So I think this is a really great first step. Anyone can do this, you don't have to have a certain number of followers, at least I don't, as far as I know, you do not have to have a certain number of followers or anything. And then you can make your account and a professional account. So this is just I went through it on Instagram. But the same thing kind of exists on each platform. So you usually go to your settings and whatever platform it is and find your account. And usually somewhere there will say account type. So this is Instagram, and I say switch account type. And then you can choose, you can choose business, you can choose a creator. They're really not business or creator is not really different. It's just going to be that you're going to be able to see insights on your posts. So you'll actually be able to see how many people looked at it, not just the likes, but how many people looked at it, what, what percentage were like male or female, you're going to be able to see all of that. If you make this make your account a professional account. And a lot of questions that usually come up after I say this is, do I need to be verified? And the short answer is that you don't actually getting verified on social media is very difficult. All of these, like these four checkboxes, they look really simple, because most all of us, especially as physicians, you are authentic, you are unique about what you're sharing. completeness of your account really just means that you've got a professional account, that you've got like a bio, you have your full name, that's what that means. And that notability, I think that notability piece is usually the hardest, because it usually requires that someone is very well published, and easily like Googleable, so that it's, they're very well known. So this is very difficult to do. And it's not necessary. It's definitely very cool if you can get it. But it's not necessary. I will say on Twitter, it's very interesting how they verify there as well. It's different than an Instagram. And so I've tried twice to get verified and haven't it has to do with, you know, you have to fit into a category. So you know, are you someone that works in the government? Are you someone that media, if you're someone that works in media, you can easily be verified. Sometimes they look for experts. So and at the time at the beginning of the pandemic, they were letting a lot more doctors get verified. And then I didn't probably try and didn't get in at that time. And then it almost like they shut it off to that. So then even now that I'm an expert in long COVID, I've not been able to be verified. And you also you have to have it linked to your professional account, a professional email, so mine's linked to my work email, and all that didn't matter. And you have to have a certain number of followers as well. And you know, I can have a Google account I can have, I do have already lots of research on long COVID still like have been able to be verified. Yeah, it's very difficult. It's extremely difficult. And if you want to try, you can this is at least on Instagram, Twitter is very similar, you go into your settings, I believe, and there will be a similar button there to request verification. And at least on Instagram, you can submit a new request every 30 days to be verified, you'll have to submit kind of links to to maybe publications or things that pop up on Google about you to kind of verify that you deserve it. But, you know, it's very difficult to get. It is because I could link articles from like, Forbes, Wall Street Journal, like all these other ones that I've been quoted in. Yeah, they're like not good. So long story short is that you you don't need it. You don't need it. It's you can be up or have a professional account and do all of this without that. So don't make you exactly exactly. So now we're getting into kind of how how do you even do this? If you wanted to start posting on social media? Where do you even start? So we have a few slides here on the best times to post on each website. So Facebook, this is kind of shows you the best time. Usually earlier in the week, late morning seems to be the best time on Facebook. Instagram, we can see here, that is usually weekdays around 11 to noon, that seems to work the best on Instagram. On Twitter, it's like Tuesday to Thursday. So it looks like the middle of the week is usually the best from about 10 to 12. LinkedIn looks like Tuesday and Fridays 10 to 11. I don't know if this is because everyone's at their jobs. And maybe it's like, at the beginning of the week, and at the end of the week, you're kind of like wanting to scroll on social media. But good, good insights for that platform. But I will use that and think about like, okay, if I want to, yeah. Sometimes I just post up my, you know, my musings as they come. But sometimes it's like, do I want to, you know, put one of my articles out? Do I want to put out? And they have also best times for health content. And it's pretty similar to what you know, she just showed us here. So this is the time that you'd get the most engagement doing health, at least on Twitter, it's going to be like in the middle of the week in the middle of the morning. Mm hmm. And then a really cool feature is that if you have a professional account, you can actually see when your followers are online best. So this is a screenshot from my Instagram. So I can see, you know, personally, if I look on the picture on the right, which is when I'm sorting by day, it doesn't matter what day I post there, all of my followers seem pretty active on all days equally. But if I like say pick a day like Friday, then it's usually around noon when my followers are more active. And then I can even see, you know, most of my followers are women, I can see the different age groups, if I were to have scrolled, scrolled up on this platform, you'd see that my audience is mostly very young. So you can see all of this on your insights if you have a professional profile, which is is really useful. So ultimately check your own analytics and see if sometimes this is trial and error. You know, you post on a late on a Sunday night and realize, I don't think anyone was really up to see that. But yeah, and you just kind of learn and go from there. So hashtags on social media, these are used on pretty much every social media platform now, even Facebook, YouTube, they all now use hashtags. And this enables cross referencing of content. So if I was a medical student, and I just learned about PM and R, and I could search for the hashtag psychiatry, or physical medicine and rehabilitation, then I'm going to get a bunch of posts that have that hashtag. So this is a great way to reach that audience. You know, at the beginning, when you say like, Who are you? Who do you want to reach? Who are you trying to reach? This is a really good way to reach those people. And PM and R you can't have as a hashtag because the end cuts off. So it only be Yeah, hashtag PM. And then that's, you know, not what we are. Yeah, and I have tried to look at hashtag PMR. But I don't know what that acronym also stands for you end up seeing some weird posts. So I usually stick with the ones that I have here in bold. I don't know what, what else people are posting under PMR, but typically not physiatry. So all that's great and good. But how how do you even start? So you don't need a fancy camera, you don't need the perfect setup. I use my iPhone, and I use a window with really good light. That's pretty much my setup. And if you're going to make videos, you know, things like that, really just having a good quality camera, which most of our phones have nowadays is is what's important. And actually, people prefer more authentic content. So people don't really want all of this super highly produced content anymore. So you really you need good lighting and a good camera. And I there have been actually a lot of studies on, you know, in the new age of Tick Tock, because Tick Tock videos first started in the pandemic, and people were like, in bad lighting in their house on their couch, no makeup on in their pajamas, right. And that kind of whole culture of just showing up on social media authentically, is really what is popular now. And so you don't need all of that good stuff. In fact, if you have some really highly produced content, it may come off as not as authentic. So I thought this would be a good kind of place to put some ideas. And we were kind of talking about like, how could you jumpstart your posts, if you wanted to jump in, and you had no idea what to post first, this could be kind of 10 ideas that you could take advantage of, and maybe take it as a challenge or something like that. So you wouldn't have to post every day, you know, definitely on social media, you don't have to post every day, but maybe posting these 10 things over the course of two to three weeks, and just kind of finding something that fits in each of these niches. So like, for example, a photo, photo or video of your team, you could post a photo and introduce everyone on your team, right of who who you work with, and maybe a fun fact about each of them. Some of the most like common things are the trends that are currently going on on social media. So a lot of these audios, you'll see people do voiceovers of trending audios. And those are really great ways to get your content out. A lot of the times to let's say you post one of these things, let's say number seven, you post five quick facts about your job, you could actually link a trending audio, like maybe just as trending song in the background and turn the volume a lot down just so that it's kind of in the background. And that'll kind of push your video out as well. So you can take advantage of those current trends. Popular social media sites. So this is where we can kind of talk about the benefits of each one. I think there's a couple more. There we go. So LinkedIn, this is, you know, a great place to network with other professionals, share your resume, find job listings, Doximity is is very similar. I know a lot of us are familiar with Doximity because they have the features where we can call and text patients. Twitter, like Dr. Gutierrez mentioned, is going to be more short form posts. Instagram will be more photos and videos, similar to TikTok, which is also going to be videos. YouTube traditionally is very long videos, but has more recently, they came out with kind of a shorts feature. And that is pretty much the same as the Instagram and TikTok videos. Facebook, you can create groups and events and pages like Dr. Gutierrez was mentioning about women in physiatry. Of course, you can start your own blog, and have that be maybe even your main source if you prefer writing and have your other social stem off of that. And then of course, podcasts, you could start up and share them on Spotify or Apple podcasts and kind of talk about anything that that you're interested in. Which one's the most popular? Does anyone have any guesses? Or which one? How many people are on it? Dr. Barker says Instagram. Yeah. So just traditionally, Facebook does has like 2.8 billion people on Facebook. But they also, yes, that's how many people are signed on. But you know, some people might have two accounts, some people, you know, there might be robots, there might, you know, you know, someone that passed away, and they're not on Facebook anymore. But they also look at how many daily engagements that each of these platforms have. So Facebook just is also yes, the one that older people are on that, like my child, children are like, Oh, no, Facebook's for old people. And that's like myself, my sister, my parents, you know, are still on that. And we're at actually quite a big meeting for the NIH recovered trial. And there were patient advocates at that meeting too, talking about research. And they said, well, we're getting to a lot of patients who are dealing with long COVID through Facebook. And one of the guys was like, well, who's on Facebook? And I'm like, 2.8 billion people. There's a lot of people who are suffering, who are getting on these patient support groups on social media. So I think we're getting a fairly decent voice than just the few people that you may have seen in clinic, Mr. Researcher, you know. All right, so I'll be touching on professionalism. And we've talked about some of it throughout. And safety is another thing. And I think that I see, you know, I have two teenagers. And I always get worried about like, oh my gosh, my teenagers and social media and they're on their phones and their computers all the time. But I feel also they learned about it from a really early age and about what safety is. And yes, maybe they don't have, maybe they have privacy from me because they try to block me from following their accounts, but they also, you know, a couple, well, before even I go into the patient part, but they kind of understand the rules. I hadn't even, sometimes I post stuff and don't even think about it. Like when we were moving from Houston to San Antonio, I had posted our house and was like, house for sale, you know, tell your friends. And my daughter's like, you're putting our address on social media, that's a public account. So people can just like come, they know where you live now. They know where I live now. She was, you know, really concerned about that. And then there was another picture I had posted in San Antonio where it's like running in front of the house and she's like, our address is in the back of that picture. And it's something that I didn't even look at. So I feel like at least my children are very kind of in tuned on, you know, what you put out there and, you know, keeping yourself safe. So there's that level of like not sharing your personal information, not sharing where you are and trying to be safe in what you put out there. But also, I mean, it's just good for, you know, you don't want some creeper showing up at your house, but then also for privacy in general. And I don't want any creeper looking at my children or trying to find my children or anything like that. So my daughter also, another just general example was saying, she was saying my sister and niece, my sister's on TikTok and my niece who's younger likes to get on TikTok and put dances and such. And my daughter was looking at it and she goes, if you look at the dances that have a lot of watches, it's when she's wearing like shorter shorts. And so that means that it was like public and probably, you know, that creeper men were looking at it. And so my sister then like, whoa, she didn't even realize. And she quickly, you know, made it private. So it wasn't, you know, accessible for that kind of thing. So there is like, yes, I think about it big picture and about, you know, family and children, but also for yourself, you have to be careful about what you put on there. Also HIPAA goes for you on social media as well. So please don't break any kind of patient privacy or confidentiality. Yes, some of my patients follow me. Yes, some of my patients are my friends or we're linked together. And that's why I use it to, you know, put out information, put out information about long COVID, put it out, you know, truthful information. But I also, if patients try to message me, I will say, no, this, you can't use Epic, use whatever else this, I cannot communicate with you this way. I cannot give you information. And again, I'm not gonna usually, you know, I might post generalizations about a case, but not usually, you know, do something where they'd be able to say, oh, that's me. And that would be a HIPAA violation. You also have to say, you know, what is the rules at your institution? A lot of physicians get in trouble for, you know, what they're putting on social media. And that's part of HIPAA. Some have even lost their licenses. So, you know, monitor what you're putting out there, monitor and know that, you know, you might've put something and then you want to dirty delete it, like get rid of it. Cause it may have been an inappropriate, but someone probably have already, you know, found that screenshot or you'd already had seen it. Someone's probably already screenshot it. That does last forever, even if you delete it. So that's something that's out there as well and avoid conflicts of interest just means, you know, I'm just remembering what my brand is. And, you know, I've run races and sometimes some play, some are like, hey, we're Michelob Light. Do you want to be on our running team to run, you know, this marathon? It was like, no, I don't want to be on a running team for an alcohol because a lot of my patients have alcohol related traumatic brain injuries. And that's something that I don't want to promote. And so those are kind of also, you know, conflicts of interest as well. And then also when you have a job, you want to look and see if there's something, a lot of, you know, we have a very general, this is the University of Texas contract and we won't have anything about social media and some, but every institution will have guidelines. So it may not be on your contract, but it will, they will have institutional guidelines on what can be out there. And a lot of it has to do with, you know, you know, I have to have something like my tweets, my own, my tweets, my own opinion. So that way it's not saying that, oh, I stand for all of the University of Texas when I say that X, Y, Z, you know. So you have to make sure that you put something like there, out there like that and make sure to follow our institution, even like we said, we have a UT Health San Antonio PM&R department, Instagram account and Twitter account. And we also have to follow rules for that, that they want us to follow, which is fine once we do it. And then some places may actually want you to promote their content and know that you're on there for positive good and, you know, they want you to be out there and promoting stuff. Yeah. And one thing I thought was interesting, which is not in medicine, but my mom was a high school teacher and recently transitioned to college. And she had posted all these YouTube videos, teaching calculus and all this stuff. And when she left, she tried to take those videos and use them for her college classes. And she couldn't because the high school said they owned those videos, right? So not saying that it has to, you know, if you're aligned with your institution, owning whatever you are creating, then that's okay. But just knowing that that is something to be aware of. So if you are making a bunch of educational content and you want to own those property rights, just being aware of that as maybe something to bring up in a job contract. Your institution wants to own all that, you're right. Yeah. So these are some review sites. I know that we have all seen these. You can Google pretty much any physician and they pop up on all these websites, but I think it's important to Google yourself and know what is written about you. A lot of times you can't change it if it was just a patient that was upset and posted a bad review, but kind of knowing that and getting ahead of it, you can even take over some of these pages. So like for example, health grades, you can say, you know, if you've ever seen and you're on a physician's health grades website, it'll sometimes say, are you this person, right? And you can usually take over that page so that maybe you can manage it, post up-to-date information and that can be a good resource as well. And lastly, to have fun. This is the videos on Facebook. Yeah, exactly, they're on Facebook. Well, thank you both. This was a wonderful, wonderful presentation. And I was getting ready to ask you about the landmines, the potential risks, but you covered all that too. I personally am still struggling with social media use. And it is part of the culture I grew up in maybe. And I also struggle with my own institutions because I do remember, especially my old institution being very specifically told to refrain from using social media because it's full of landmines. You never know, you'll get in trouble. You never know, media can be, you know, accessing all that information. So any final tips on how to negotiate it in your contracts with your institutions? I think it's just asking about it. I don't think that, you know, I guess it just depends on where you are, but I think, you know, you have to, when you're going through this stuff, just ask about it if you want to be in it, if you want to be involved, you know, what they allow you to do, what they'll allow you to say. Again, if you say, you know, I'm keeping it separate or I'm going to have a private account or whatever it might be. And a lot of places might just say, okay, this is what our rules for it are. And you can look at the rules and follow those rules. And then the other thing about just engagement and social media, you have to stay engaged. Like it's hard if you don't, you know, now it's just kind of a habit, like, okay, I'm looking at Twitter, I'm looking at Instagram, I'm commenting, I'm talking, I'm ha-ha-ing, whatever, you know, putting a heart. And so maybe that's the addictive part of it. So Dan, let me ask you this, as a role model and a mentor and a change agent, do you take the time, and as a program director and a chair, do you take the time to educate your trainees on this particular topic? Do you have, for example, lectures where you talk about this stuff to them, trying to endorse this? So we have before, I have probably not given one in the last year, but I have given, you know, talks about social media and, you know, responsible use of it and how to advocate. And so, yeah, we do. Do they like it, your trainees? What is the feedback they give you? We like it, yeah. Are you guys like, we already know, we don't need to hear it from you. No, I actually think that as a trainee, having acknowledgement of social media is important, because if it's just never said, never talked about, you've never get a lecture on it, then it feels like you're doing something wrong. And it feels like maybe I'm, you know, maybe I shouldn't be on social media at all. And so I think if it's addressed, that's a lot safer than not being addressed. And we don't mind it at all. I remember Dr. Gutierrez's lecture to us, and we do not mind that at all. We enjoy it a lot, having that open discussion. Yeah, I agree. So transparency. Yes. Because people are on it. And so it's just, you know, reminding people how to use it responsibly and how to use it to advocate for our field and to make it educational and make it fun. People are doing this anyway, so how can we do it the right way? All right. So thank you for joining us today. I think I'll start off by introducing myself. So my name is Mark Fisher. I am a pediatric physiatrist in Kansas City at Children's Mercy Hospital here. I'm just a few years out of my fellowship. So not too far removed from fellowship or residency and fellowship. And what I am gonna talk about today are really the basic, what are adaptive sports? What is the Paralympic movement? As well as some basics in terms of how you can start to look at sports medicine in the context of disability and some of the primary considerations as well as ways that you can get involved if you're interested on this topic. All right. So I don't have any significant financial disclosures related to this topic. I volunteer for a number of adaptive sports organizations and for some international involvement at the kind of a national governing body level and international level for para rock climbing as well. So what is the adaptive sports movement? Well, it really kind of started out in the late 1800s and really has evolved over the years and really kind of began to develop in kind of the 1950s with the institution of the Stoke Mandeville Games in England. And this was essentially a rehab hospital that developed some athletic competitions for the patients there. And that continued to grow and expand out of that rehab hospital into a regional competition into a national competition. And just the idea of using sports to motivate and challenge individuals with a disability continued to evolve and get more support over time such that in 1989, the International Paralympic Committee was formed to govern the Paralympic Games. And in 2001, there was a big step forward where there was essentially a decision to unite the Olympic and Paralympic Games processes so that one city and one set of facilities would host both the Olympic and Paralympic Games. So kind of put them on a similar footing. Then in 2019, just in the US, there was another step in the evolution where they renamed the United States Olympic Committee to the Olympic and Paralympic Committee. So brought it into the same organizational structure. And if there's one thing that I can bestow upon anyone and like any trainee that works with me, it's that disability doesn't mean you have an inability to participate. So there's a wide variety of opportunities that are available. And many people with impairment really don't know what or how they can participate. So there's a variety of different running events, cycling, golf, all kinds of wheelchair sports. I'm not gonna read through that entire list, but I'm happy to talk through anything individually if you have specific questions. But we also, there's sitting volleyball, water sports, hockey, all sorts of skiing, snowboarding, like winter sports, throwing sports, shooting, combat sports, and then some of the more extreme sports as well. But what, so that's kind of what adaptive sports are in a super high level sort of offering, but what's adaptive sports medicine? What does that mean for a practicing physiatrist? So sports medicine as a discipline, it's kind of a new, it's definitely a novel idea, relatively new and gaining traction, but it's the idea of preventing diagnosing issues and managing disability specific health complications that relate to sports and physical activity. So it's clinical service delivery, it's scholarly discipline, AKA research and advocacy. And we'll kind of circle back to those a little bit, or towards the end of the presentation of how you can get involved. So this is a population that has great need for physical activity support. There is, there's been studies that have looked at physical activity in children and adults with disability. And in general, they are much lower than their typically developed kids or individuals without an impairment. So eight to 9% of children with a disability are meeting, or 8.9% meet guidelines for physical activity. And there's a much higher prevalence of sadness being socially isolated or mental health issues in individuals with disability. We know that kids are largely excluded from interscholastic sports. Due to their disability, and then they're much less likely to participate in leisure time physical activity. There's also elevated rates of chronic diseases in those populations. We know that that has an impact on employment rates as well. So those with a physical disability are less likely to be employed. And we'll kind of talk about how that changes with sports and physical activity participation. So what are the primary barriers to participation? There, so this is a meta-analysis published in 2019 that looked at a lot of different articles looking at barriers to physical activity. And there are, I like to kind of group them into like the three highest. So you'll see that accessibility, cost and degree of impairments are some of the biggest barriers. If you go to kind of this next tier, it's transportation which I would essentially equate that to cost as well in a sense, because it is having a physical access or physical ability to engage at the site that the activity is participating. And then there's also a barrier of having decreased variety of activities available. And so if we look at those top things, there are difficulty getting to and affording participation. And then there's really difficulty in understanding what you can do and knowing what's out there. So kind of a cost and knowledge barrier. The same study looked at what the reasons people participate in exercise in adaptive sports. And the biggest drivers for it were a desire to improve your fitness and health. And then just equally though, is the desire to create social contacts. And for kids, that means fun and being able to participate and be confident in yourself. So that's what's most important to the participants. And what are the benefits? So we know that participation in exercise in adaptive sports improve your metabolic profile. So these are the markers of chronic disease. So I mentioned that this population has increased risk of chronic disease, but you can reduce body fat, increase lean muscle, decrease blood pressure, heart rate, lipid profile, and increase bone density by participating in adaptive sports. We also went through the fact that these individuals have increased risk of mental health issues and kind of decreased quality of life factors. And there's one study that was looking at high schoolers and they found that by participating in adaptive sports. It eliminated the increased risk of mental health. So it basically returned them to their peers in terms of rates of mental health issues. It seems like the quality of life improvements happen in a feed forward loop. So this kind of makes sense to you if you think through it, but research has also shown it, that if you participate in a challenging activity like adaptive sports, and you push yourself outside of your comfort zone, then you become more confident in your ability to push yourself outside of your comfort zone in the future. So that's called self-efficacy or a component of self-efficacy. And it's your confidence and your ability to overcome a challenge or overcome something that's difficult. So from a practical standpoint, this may look like a wheelchair athlete who has been working out and training and become stronger and more maneuverable in their wheelchair, being able to pop a wheelie to get over a curb in their community. So that's that practical benefit. We know that there are just physical exercise parameters that change with participation in adaptive sports. Muscles are trainable, whether they are, there are many muscles that are trainable despite a physical impairment. So you can increase strength, endurance, flexibility, and those that ambulate, we know that you can improve gait efficiency and gait mechanics and wheelchair propulsion in those that use a wheelchair. Things, specific exercise parameters like VO2 max increase, and this is across a wide variety of specific diagnoses. I would be happy to go through individual diagnoses, but the research is trickling in on the biggest populations of the benefits of exercise, and we can extrapolate to a wide variety of medical issues. And we know that participation improves the likelihood of employment once, like if you're already in the working age or once you reach working age. So a lot of that has to do with that self-efficacy and empowerment of being able to reenter or enter the workforce. There are studies showing that for every year that you participate in adaptive sports, you can increase your likelihood of employment. So what are the special considerations in an adaptive athlete? Well, so first off, you start with a kind of pre-participation exam. So unlike individuals, or if you have experience with it, or as a clinician having a school physical or a sports physical, it's kind of the same idea, but much more involved for an individual with a disability. So doing a pre-participation physical in para or special Olympians detects a abnormality or detects an issue about 40% of the time. That's compared to one to 3% in able-bodied athletes. So you have to approach it with a comprehensive mindset and look at their history. So if they're injured, then what was their pre-disability function? Did they participate in sports earlier in life? Do they have other injuries that are going to impact their participation? How long have they lived with their impairment matters? And then taking a careful kind of nutritional history can be helpful. Looking at what they can do now. So their current function, that's, are they training? Are they conditioned or deconditioned? Do they require assistance for their ADLs? What equipment are they using? And are they using any medications or supplements? And we'll kind of talk through on the next slide, what medications, what are some of the common issues associated with medications in this population? And then you want to think about what the impact of their impairment has on their participation. So collectively, all of these things put a physiatrist at the center of the pre-participation physical. And I would argue having a rehab physician or complete this evaluation is more useful than a primary care provider would be because the impact, the functional impact is more significant for these athletes. And so some of the common medications that we run into are antiepileptic drugs. And so those can predispose you to low bone mass and increased tissue laxity. So not a hard contraindication, but something to be aware of. Anticholinergics will worsen heat-related illness. So certainly something that I counsel my patients on if they're participating in a hand cycle marathon in the summer and they're on a anticholinergic, we want them to be aware of body temperature and how to manage that. Many of these athletes are on neurostimulants. So that increases theoretically the risk of arrhythmia or heat exhaustion. Those are also typically banned substances. So if they're at a competitive level, needing to understand the idea of a therapeutic use exemption that applies to those on medications to manage orthostatic hypotension as well. And spasticity management medications are important to consider for those highly competitive athletes that are participating in like a regulated event because the athletes are put into classes based off of their impairment. So they complete an evaluation and there may be some time in between that evaluation where they're put into a class and when they compete. So there's a scenario where you could do a procedure or change a medication and that impacts their level of impairment potentially in a positive way so that it makes them less impaired. That would impact their competition, not implying that you wouldn't want to lessen their impairment. You still would, but that athlete would then need to initiate like a reclassification. Classification, they need to be reevaluated so that they're not penalized. And I could spend a whole hour on just the medical considerations on a detailed basis for these athletes, but just wanna run through some of the common issues. So for our spinal cord injured athletes, being aware of autonomic dysreflexia is very important as potentially one of the most function and or life-threatening sort of problems on this list. So as a reminder to you, this is unregulated sympathetic outflow when the injury is above T6 and related to some nociceptive stimuli below that level of injury. And so you get significant elevations in blood pressure that can be severe and a risk. And if you're participating in adaptive sports more consistently or kind of getting involved into it, you need to be aware of people's intentional use of autonomic dysreflexia, commonly called to or referred to as boosting because you get a noradrenergic outflow of endogenous capillaries where you are stimulating your performance. So it's seen as a performance enhancing technique and these individuals may be just not self-capping before their participation and or something small to try and give them a competitive boost. That is, it's against the rules. It's a banned practice, but it does happen. Many of these individuals have impaired thermoregulation from a shivering to sweating standpoints. We know that individuals with impaired sensation are going to be at greater risk for skin pressure breakdown from shearing forces and pressure forces on their skin. So understanding the pressure mapping in their specific equipment, like the picture of the sit ski on the bottom right is showing these equipment have the, sometimes these athletes are in their equipment for hours on end. So understanding what that looks like for every individual athlete, make sure that they have appropriate fit. There's a much higher incidence of cardiovascular issues in this population. There's individuals with congenital heart defects, there's orthostatic hypotension that need to be accounted for in their sports participation. There are the issues with motor control or joint laxity. So hypertonia, hypotonia, those can predispose you to injury or overuse syndromes in a different pattern than is standard for a able-bodied athlete. And muscle strains and kind of overuse inflammatory processes are a bit higher in adaptive athletes, actually, if they have hemiplegia, because they will compensate with their typically functioning side to a greater degree. So they'll tend to overstress that side. In entrapment neuropathy, such as median mononeuropathy at the wrist is a very common issue. Over 50% of wheelchair athletes will encounter some carpal tunnel syndrome symptoms. And so it's teaching these individuals not to ignore those symptoms. And the reason is, you can also get an ulnar neuropathy at Guillain's Canal. The reason is that by gripping the push rims of a wheelchair you're increasing carpal pressure. So you're at high risk. There's not a lot that can be done to prevent it aside from good propulsion mechanics, but being aware of its high prevalence. With a limb deficiency, they're at risk of skin issues because of the intimate fit with their prosthetic. You're at risk of neuromas or MSK pain, just nociceptive pain in the residual limb. And in kids that have a traumatic injury, you're at risk of terminal overgrowth, which is where the bone continues to grow and at the amputation site, and that can cause significant problems. With, we know that individuals with a disability are at higher likelihood of having different nutritional requirements. So some individuals and some diagnoses have low energy expenditure compared to a able-bodied peer. Other individuals have greater caloric expenditure compared to their able-bodied peers. And so being aware of that and how that impacts an athlete is valuable. We know that energy availability, formerly known as kind of the female athlete triad, is very common and prevalent in Paralympic level athletes. And much of this is because there's little education about the issues of energy availability in these populations. It's increasing, and there's a lot of people that are doing great work of getting the word out and educating these athletes on the dangers of having low muscle mass and weight, but there's still work to be done. I talked before about that some of these medications can decrease bone density and certainly decreased weight-bearing results and decrease bone density. So you wanna be aware of that in anyone that's participating in a contact sport or a high-velocity sport so that they can be prepared. And then lastly, one of the kind of trademark issues seen in Special Olympic athletes, particularly those with Down syndrome, is the increased risk of atlantoaxial instability. And so that is a medical issue that was identified and really advocated for safety by the organization. And from a medical standpoint, they did a great job of screening these individuals, and it really fell on, or now it falls on the medical providers to understand atlantoaxial instability and if that person is actually at risk. And if that person is actually at increased risk or if they're still safe to participate. One of the reasons that I joined or got into PM&R in general was the technology, just how inspiring and innovative all this technology is as it gets developed and gets implemented for these patients and athletes. And from a sports perspective, there are very clearly and well-established trans-tibial, trans-femoral running prosthetics. There are cycling prostheses, golfing prostheses. There's essentially a prosthetic to do whatever activity you're looking for there are jump rope terminal devices for a prosthetic. There's just a great variety out there. There's standing or seated skiing equipment. There are relatively new addition in the last five or 10 years is snowboarding prosthetics. So as those prosthetics evolved, it was included in the Paralympic games, which has been a really cool to see that sport take off as a pure reflection of the technology, making it possible and competitive. There are swimming prostheses, although I will say majority of adaptive swimming is without a prosthetic. But if you're doing it recreationally or for a fitness standpoint, there are certainly swimming prosthetics. There's prosthetics for kayaking or rock climbing, outdoor sports, there's off-road wheelchairs, there's off-road canes, like rough terrain canes, things like that. And so wheelchair mechanics are an important part of understanding the forces that wheelchair users use on a daily basis. And then those forces that are amplified when they participate in sports. For example, 16 out of 20 of the summer Paralympic sports use a wheelchair at least some of the time. So wheelchair sports are well-represented on the national and international scale. So it's important to be aware of the forces. So when you are pushing, you are using your anterior deltoid, pec major, infraspinatus, serratus anterior and biceps. And so just generally, this is the anterior chain of your shoulder. And that is where the majority of the work generates when you're propelling a wheelchair. And you want to, so in the middle of the screen, kind of these different designs, I'm not sure if you can see my mouse or not, but these are different stroke patterns. And so this first one is described as an arc. So the reason this is not great is because a relatively short contact angle. So you have to have a greater frequency of stroke to get the same amount of output. And it's kind of quick little pushes. Then you have a single loop where blue is your contact angle and then orange, you kind of lift your hands up above the wheelchair rim to swing them back towards the contact point. Then there's double loop where you actually have the longest contact angle. It actually is the most powerful of the stroke patterns. The double loop is, but you are at increased risk of injury because you're using this increased momentum and to loop your hands back around and then you're swinging them up. And it's really this upward phase of this loop that causes a problem because that is pushing your humeral head into your subacromial space. You're literally activating the musculature that is pulling the humerus superiorly. And so that puts you at greater risk of impingement. And then you have the ideal, which is the semicircle contact angle and then dropping the hands below the axis of the wheel because that keeps your subacromial space more open. And then you're bringing it back to the rear of the wheel for the contact angle between like 11 and two is the goal. I routinely have conversations about the wheelchair mechanics with my athletes, particularly those that are running into shoulder pain and running into overuse issues. With injuries are a part of sports. They're part of mainstream sports. It's a part of adaptive sports. So we know that spinal cord injured athletes have a significantly higher prevalence of fractures compared to other athletes that primarily has to do with decreased bone density in the lower extremities, uh, but with, uh, if you look at adaptive sports on a broader scale, the injury rates, uh, at the elite level are fairly similar to those in mainstream sports. So the injury rate is like 9.3 per 1000 athlete exposures. This is basically practice or games as times that you're exposed to the sport. Football is 10.1 soccer is 9.8 basketball is 7.0. So though, and those are mainstream sports. So it's, it's right in that mix, uh, with the, um, comparing summer Paralympic games in 2012 compared to Olympic games, there is a slightly higher increased risk of injury, but it tends to be training and overuse injuries. From an acute standpoint, uh, you still run into sprains, cuts, fractures, um, from collisions. For those overuse injuries though, uh, the primary reason is because of not having a fully functioning full kinetic chain. So if an individual is swinging a bat or throwing a ball, uh, overhand, and they don't have the ability to engage their trunk and rotate at their hips and drive through their legs, you're missing these key mechanics that are taught in mainstream sports, uh, of using your legs, using your trunk to, to propel your upper body, uh, participation. So someone who uses a wheelchair, uh, will have a increased eccentric load on their upper extremity. So, uh, you're striking a ball and all of that force is going through the shoulder. Um, and kind of, we, we talked about if there's this predominance of. Anterior chain muscles in a wheelchair athlete, your shoulders tend to be protracted, um, resulting in scapular dyskinesia. You also tend to be internally rotated at the shoulder. You're in a kind of forward, uh, slouched or hunched posture. And, uh, kind of like what, what this child is showing, like when he's propelling, uh, and that increases the vertical force through the shoulder. So that's what puts you at increased risk. We also know that the same, uh, same little kiddo is showing a pretty significant, uh, neck sort of positioning challenge to his body. Uh, so you, they very often protract their neck and have a kyphotic posture in their back. So you can absolutely run into cervical pathology and particularly in adults. Um, and such that over 50% of shoulder pain is actually cervical in nature. So you want to, uh, pay attention to the C-spine when, uh, you're looking at these individuals, so I wanted to take a little bit of time and work through a case discussion as well. And, and this is, uh, a example kind of patient encounter that I have in adaptive sports. Um, and this doesn't have to be a kind of dedicated clinic. It can be a patient that you see, um, throughout your practice. Um, but this is a 20 year olds, uh, former elite level athlete who was experienced a T seven agent, a spinal cord injury, and they want to start playing wheelchair tennis. Uh, hadn't played tennis before, but wants to start pre morbidly or like not pre morbid, but before she even started tennis, she did have mild right shoulder pain after activity and she's right handed. So, uh, she participated in resistance training three times a week. She was active. Um, but what she did mainly consisted of biceps, deltoid, triceps, and chest exercises. So chest strengthening exercises. Um, she does reasonable sets and reps. She does, uh, some aerobic work, which is great. Um, and she uses a hand cycle, but she's propelling in a forward direction. And these are obviously leading you to, uh, think about everything that she does almost except for the tricep is your interior chain or part of that interior chain, it's in this forward direction. Um, and so she has good range of motion tender in the upper traps and rhomboids, but no major trigger points does have scapular dyskinesis. So her, uh, right scapula sits more protracted and, uh, well compared and has decreased medial, uh, retraction when she activates compared to the left scapular slide is positive, which is a exam basically looking at how much the scapula moves, uh, compared to midline, uh, with those motions. So it's just another marker of scapular dyskinesis. Yeah. Has she demonstrated a mildly positive Hawkins on the right, which, um, as you recall, as a sign of impingement and, uh, but nears was negative. Um, also another sign of, uh, impingement O'Brien's was negative. Um, a sign of labral pathology and, uh, pectoralis muscles were intact, not intact, flexible. Um, they were also intact, but, um, she had good movement there. And so diagnosis was scapular dyskinesis, um, mild rotator cuff impingement. So I looked at shoulder preservation and gave her shoulder preservation strategies. Uh, so this was an individual who did it need dedicated physical therapy. And so part of adaptive sports is figuring out where these, uh, athletes on the spectrum of, do they need guided, uh, physical therapy to recover from their, their issue? Um, or can we transition them into a fitness realm? Um, she already was in the fitness realm. She was already active. I just needed to give her a new set of exercises to incorporate into her routine. And she rehabbed herself. She was successful with this. Obviously I would bring someone back, um, if they're still having ongoing pain, and then we would pursue a physical therapy prescription, but this was successful. What I, um, and I'm not going to go through the details of these exercises, but I asked her to do, um, two exercises for her coffin to strengthen her external rotators, um, do a rowing exercise to strengthen her, um, posterior chain, um, along with. Um, some different, uh, different options that I gave her focusing on the posterior musculature. So how can you get involved there with adaptive sports? So from the, um, very beginning, I started getting involved through event volunteerism. Um, that's the most common way to become involved, um, at a trainee level. Uh, and it's a good opportunity to, um, see what's out there, um, begin to engage with, uh, these individuals and the programs that are putting on, uh, supporting these sports. So you get, you don't even have to do medical, uh, be a medical volunteer. You can just go help set up tables or run a scorecard scoreboard, um, at an events and that that's all it takes. Um, you can pursue sideline medical coverage. Um, I would encourage you to talk with your attendings or, um, representatives from your institution and learn what that means from a. Medical liability standpoint to make sure that you or your program and the system knows you're participating. Um, and you are covered for those, any, any work that you do on a sideline. And, um, after, after training, you can absolutely decide to pursue, um, team and, uh, or like a program position position where you are that standing contracted individual for, um, a certain team where you may travel with them on certain occasions or just certain events where you're responsible for the medical care for a group of individuals. You, uh, can participate from a administrative standpoint, and this is part of that advocacy piece of adaptive sports medicine that I talked about. You can participate in program and event development, um, that can be participating as, uh, creating your own nonprofit that that's a lot of work. Um, or you can jump in and be a resource and an advocate for a nonprofit that already exists in your region. So that can be as easy as being a medical consultant for them. Um, help them design their programs with a thoughtful, um, approach and taking into account different, uh, aspects of inclusion, uh, and then you, that can evolve or expand into being on a board of directors, um, for that, that nonprofit. You can, uh, pursue kind of the clinical delivery of care, uh, for these athletes, similar to what part of my practice is in the adaptive sports medicine program. Um, or you can just integrate it into your, uh, counseling and education of your athletes that come in to see you for different reasons. There is a huge lack of, uh, research in this area, um, of adaptive sports. Uh, so that is a, uh, area that we sorely need justification for many of these programs. Uh, and that's how you really begin to expand the support for these programs is being able to look at the research outcomes of those programs for these individuals. And then there's also engaging with the Paralympic movement. Uh, so that also, uh, can be administrative, educational advocacy or the classification process. And I mentioned I'm involved, um, on that classification process for para climbing. And, uh, what classification is I kind of talked about it's that, uh, those set of rules that are created for each individual, uh, sport where it ensures equitable competition, uh, between individuals so that you are able to compete on a level playing field. And the goal of classification is to ensure that you are able to compete is not to punish someone for training and being more trained or being more skilled. It's the intent is to really pick out the components of their impairment that is related to their diagnosis. So, um, I've been involved from a actually classification system design, uh, because para rock climbing is a relatively new sport. So we had to look at it from a practical standpoint of what groups of competitors do we want? How do we, uh, design these systems to be inclusive, inclusive, but fair, uh, and, uh, elevate the sport to an elite level, but there are well established sports, um, say take track and field, for example, um, where you can apply as a interested classifier, go through a training and do these classification evaluations as part of the system and as part of the, um, support for the sport as a whole, because these Paralympic level and elite level sports can't exist without. Fair and effective classification systems. So, uh, I couldn't have a talk like this without showing you a video of, uh, Paralympians who serve as role models for, um, our, our patients and helping them to reframe the psychology of identity that they have. So we know that, uh, individuals will, once they become more and more active, they identify as being active and they look at themselves and say, yes, I am an athlete and having a role model, uh, for them will show them that they can be an athlete, they make better decisions related to their health and nutrition and throughout their life, um, based off of that identity. Yeah. So sport doesn't care who you are. Competition doesn't care who you are. Everyone can participate in some form. I have a list of resources. All we'll talk about the best way to make this available, um, to, to the group. Um, but these are, it's just an example of, uh, national, uh, resources that are national programs that are, um, at the forefront of adaptive sports. Um, but it can be as simple as engaging with, uh, your community, uh, um, looking up adaptive sports in X city, uh, and finding the organizations that are, um, putting on this programming, I have references for some of those, uh, studies and part of the, uh, procedure or presentation. Uh, but I'm also happy to field any questions, um, or have anyone reach out to me if they have questions in the future. Well, thank you, Dr. Fisher. This is a very inspiring presentation. Yeah. Adaptive sports have the power to excite and inspire people. And I have seen that over, I know there was a, um, session on social media, uh, uh, and harnessing the power of social media and, um, as part of this, this program, and that's something that adaptive sports absolutely has done. Over the last 10 years or so, um, to really increase the awareness we're at the, uh, this kind of inflection point where, um, people are watching the Paralympic games, people are seeing ads, they're seeing stories of adaptive athletes, and there's more support and more acceptance of these individuals as, as athletes, just like in all of rehab medicine, it's important to look at a, or use the person first language. It's important to look at the, uh, these patients as individuals first that have a diagnosis. Uh, for those in, you heard me throughout the presentation say that these are athletes first and the, the, they're affected by some impairment. Um, but that doesn't, doesn't make them disabled or unable to participate. Definitely not. I have a quick question in terms of the practical, um, you know, perspective. Do you engage with schools when you create these adaptive sports programs? Um, do you, you know, how do you win them over as stakeholders too? Yeah. So there are a few examples throughout the country where this has been done, where it's been done successfully. Um, so in, uh, and I wouldn't, maybe I should qualify. I don't know that I can say in Kansas and Missouri that it's been done highly successfully, but there is a wheelchair track and field division at the high school level. Um, reason it's not been highly successful is it's not publicized. Uh, so there aren't very many participants. Um, there are some other examples of having wheelchair basketball, um, like having a wheelchair division as part of interscholastic basketball, um, programs, the way that those programs have started is by a nonprofit. Going into the school and basically offering to run the program to do the training, provide equipment, potentially provide coaching, um, or at least training for the coaches, uh, and providing a, uh, athlete interest and participation and really removing all of the barriers to the school where they just have to transport their athletes to different events, you know, like they would anyone else like for their other teams, um, that's where it's been the most successful is where you can take the schools by the hand and, and guide them through the process because there's, there's no experience or understanding or real resources to implement this from the school out. Um, but I it's encouraging to see the success stories. Yes, definitely. We just need more, more champions and experts like you, but thank you. This was very, again, very enlightening and inspiring. All right. Thank you all for the opportunity.

Simone Biles

competition

mental health

twisties

athlete safety

unexpected

social media platforms

healthcare

professional brand

target audiences

education

mentoring

advocacy

adaptive sports

role models