Cycling, the adaptive, and the military

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1 Cycling, the adaptive, and the military an update Joseph Scholz, D.O. Ph.D. Captain US Army Walter Reed National Military Medical Center

Adaptive cycling define: Adaptive Cycling (AC) defined - is a cycling paradigm that reflects the uniqueness of a bicycle and the multitude of environments that it can operate in.

2 Adaptive cycling define: Adaptive Cycling (AC) defined - is a cycling paradigm that reflects the uniqueness of a bicycle and the multitude of environments that it can operate in. Its premise is that there is no one methodology or technique of cycling that can or must be applied to every situation or environment, rather existing methodologies are just tools that are part of a larger toolbox that the cyclist can use to adapt to his/her unique cycling needs and environment. Adaptive cycling seeks to use a combination of existing techniques and methodologies to provide solutions for specific situations that a cyclist faces in the environment they choose to ride in, as well as to create new, innovative solutions that not only apply to today's cycling world, but hopefully into the future. Reference: Bike forums.com

3 My definition: Adapting Cycling: Fitting the person s wants, needs and personality to the cycle. Taking the rider, to the next level. Fitting a bike, is the same as fitting your bike.

Context: Related concept IEP, individual educational plan, is adaptation of standard education delivery systems to children/learners with special needs.

4 Context: Related concept IEP, individual educational plan, is adaptation of standard education delivery systems to children/learners with special needs. Example: Kid with super skills in math: IEP: moving forward in curriculum to next level of math until toped out, then allowing learner to take advanced math in local college. #2: Kid with limited sight: IEP: move child to front of classroom, use assistive technologies to zoom text, large type text books, etc. #3: child wheelchair bound,: IEP access to elevators, ramps, desks, with space underneath, computers with extended reach, etc.

5 So, adaptive cycling: is the IEP for cyclist. Adaptation of standard cycling to people with special/unique needs.

6 Basic History: Bikes Wheelchairs Rehabiltation/ace ssability Medical

7 Bikes: about 200 years possible 1493 reference to Caprotti). Walking machines, 1817 Velocipede 1860 s Penny farthing 1870 s Safey bicycle, 1880 s Modern Bicycle, 1970 s to present. Recumbant bikes (~ s, big surge in 1970 s) Hand/alternative cycles

8 History of Wheelchairs. 6 th Century China and Greece wheelbarrows for people 525 AD, specialized wheeled Chairs china Bath chairs, 1700 s Modern chairs (two wheels), 1890 s- present Collapsible/portable chair, 1933 Harry Jennings Herbert Everest. Electric wheel chairs Joystick, 1980 Battery technology, 1950 s 1990 s Mecanum wheels, 1980 s Vertical wheel chairs Ibot, late, 1990 s Racing wheel chairs late 1990 s Segway, 2001

Other improvements: Stoke Mandeville games, 1950 --Rehab hospital, UK Special Olympics (1950-60 s)

International Special Olympics, 91968) Section 504 of Rehabilitation act, 1973 American with

9 Other improvements: Stoke Mandeville games, Rehab hospital, UK Special Olympics ( s) Eunice Kenneday-Shirver Paralympics Games 1960 International War Veterans association (1964) First International Special Olympics, 91968) Section 504 of Rehabilitation act, 1973 American with disabilities act, Title II and III Cerebral Palsy international sports and recreation association (1983)

10 Increase quality of medical care Saving people Medical technology Medically dependant patients

11 The combination of the four; Today, is here and now. Who needs a adaptive bike? Those with limb loss Those with balance issues

3 million/year Of note: Vascular 50% die with in 5 years, -Lower Ext

12 Limb loss ~2million US 45% Vascular, 45% trauma, cancer <2%, others 185,000 Amputations Hospital cost ~$8.3 million/year Of note: Vascular 50% die with in 5 years, -Lower Ext amputation: 55% will require 2 nd leg amputation with in 5 years) --5/5/5 rule, Dr. Craig Camasta, DPM, Atlanta

13 Military amputees: Recent Wars/Conflicts: Bush, Clinton, Bush, and Obama ~30 years of modern war ~30 years advancement in medical care People survive what who would have been died just years ago. Use of IED Legs gone, torso intact, person alive.

14 All Equals: increased ablebodied-multilimb amputees

15 Basic statistics recent conflicts: 16,000 disabling wounds ~1600 amputates * 83 % one or both legs Reference: (Fischer 2014)

16 Back to Cycling: Why do we cycle? Recreational vs. Competitive Military: the same, but different Regular reasons, plus Rehabilitation Therapy

17 General Categories: Modified upright cycles

18 General Categories: Handcycles Competitive Recreational MTB/extreme

19 Wheelchairs Racing Extreme sports/hunting Tennis Basketball Rugby

The Cycling program at WR-B Short history 1950-1990 s wheel chair therapy (Pt/OT/PM &R) 2000 s Gill Ramirez Palo Alto VA Tx PTSD Controlled reintegration Cycling: 2008 154 riders 2007-8 Formation of

20 The Cycling program at WR-B Short history s wheel chair therapy (Pt/OT/PM &R) 2000 s Gill Ramirez Palo Alto VA Tx PTSD Controlled reintegration Cycling: riders Formation of Ride-2-Recovery R2R Gil Ramirez John Wordin, Cyclist Now a multimillion Dollar foundation R2R East Coast challenge rides; WR Virginia Beach 2010 Project HERO: (healing exercise rehabilitation opportunity), Bethesda Naval Hospital Disabled and able together Hospital based therapy single site

21 Now ~40 Project HERO programs at Hospitals, VA s and Military sites 3 Cycling R2R major centers Balboa Naval Base Brooke Army Medical Center Water Reed, Bethesda Ray Clark, Bike guru

22 Adaptive Cycling: Recreational/Competitive Goals? similar goals.

23 Recreation Exercise Fitness and weight control (weight gain) Family reintegration

24 Competition Bringing back the athlete in the wounded warrior As part of therapy As Part of confidence training As part of life

25 Equipment: the cool stuff. Start with the reality: What is their history? What are the goals? What are their limitations?

26 Upright if possible Captain Reynolds

27 Upright if possible Captain Reynolds

28 Recumbent: Examples

29 Hand cycle Stephan Every rider is different So every cycle is different

30 Hand cycle

31 Modifications

32 Modifications

33 Modifications

34 Examples

35 How can you get involved Donate Spread the word Come ride

36 Questions: My contact information: Ray Clark Hero Project/R2R Walter Reed Bethesda (301)

References: All Images: Personal, Wikipedia or R2R with permission. Stats: Flscher, H. (2014) A guide to US Military Casualty Statistics. CrC report for Congress.

37 References: All Images: Personal, Wikipedia or R2R with permission. Stats: Flscher, H. (2014) A guide to US Military Casualty Statistics. CrC report for Congress. RS22452 Images of Capt Reynolds, with permission-- Personal communications, Jan-March, 2014 Images stephan, with permission, Personal Communications, Jan-March, 2014 Ride-2-recovery, Clark, R. (2013, 2014) personal Communications. WRNMC, Bethesda, MD.

Wheelchair Basketball all about 'picking and rolling'

FOR IMMEDIATE RELEASE June 16, 2014 By Gloria Montgomery Fort Hood Warrior Transition Unit Public Affairs 913-219-3663 (cell) gloria.l.montgomery.civ@mail.mil Wheelchair Basketball all about 'picking and