Rebuilding bodies and restoring lives a companion guide for a school wide discussion series

RebuildingBodiesandRestoringLives: ACompanionGuideforaSchool-WideDiscussionSeries

1. Foreword Harold P. Jones, Ph.D. 2. “Lecture Series Overview” Jon Nugent 3. “Adapted Physical Education: Alabama’s Benefits from Lakeshore Foundation” Kristi Menear, Ph.D. 4. “Disabilities, ADA and Reality” James. R. Kilgore, Ph.D., PA-C 5. “Michael E. Stephens Profile” Anita Smith 6. “Finding the Unlimited Potential in Rehabilitation by Asking Tough Questions” David A. Brown, Ph.D., PT 7. “Professional Advocacy: Lessons Learned and Rewards Received” David M. Morris, Ph.D., PT 1

8. “Out of the Darkness and into the LIGHT: Lakeshore Institute for Global Health Transformation” James H. Rimmer, Ph.D. 9. “Rebuilding Bodies, Restoring Lives” Carroll Papajohn 10. “The Human Spirit” Spencer Hall 11. “Capturing the Spirit of Lakeshore” Jason E. Vice 12. “Lakeshore Foundation Today” Jeff Underwood 13. Epilogue “Learning in Context: It’s Not Just for Students” Donna J. Slovensky, Ph.D.

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FOREWORD Written by Harold P. Jones, Ph.D. Dean, UAB School of Health Professions During the spring of 2013, I was introduced to a new book “Sports Rehabilitation and the Human Spirit: How the Landmark Program at the Lakeshore Foundation Rebuilds Bodies and Restores Lives.” I was very aware of the Lakeshore Foundation and its founder, and one of the coauthors, Michael Stephens. The School of Health Professions has a close relationship with both.

Lakeshore Foundation is an incredible place. It is the nation’s, if not the world’s, premiere site for using sports, recreation and activity as a platform to improve the quality of lives of those with physical disabilities or physically-disabling conditions. It has incredible facilities and programs that reach thousands of individuals with physical disabilities and their 3

families. It was the first facility in the United States, outside of the U.S. Olympic and Paralympic Headquarters in Colorado Springs, to fly the Paralympic and Olympic rings – and has served as the site for world Paralympic competitions in multiple sports.

In addition, it has developed signature programs as part of its Lima Foxtrot effort which addresses the needs of wounded military and veterans – ranging from sporting activities for the visually-impaired to those suffering from traumatic brain injuries, spinal cord injuries, and limb loss. Its on-site residential housing for wounded warriors and their families has allowed ground-breaking work that helps our veterans establish active lifestyles that can be translated back into the communities in which they live.

While the Paralympic and military-related programs are often those that catch the most external attention, the 4

Lakeshore Foundation’s greatest contributions come through its service to the community that surrounds its campus. The vast majority of the members of Lakeshore Foundation are those within the Birmingham community and surrounding region Patients who have suffered strokes, spinal cord injuries, limb loss or have physically disabling conditions such as Parkinson’s Disease are all represented and, with their families, comprise Lakeshore’s largest membership group.

Their stories of success are both inspiring and monumental.

For many years, the School of Health Professions had an off-and-on relationship with the Lakeshore Foundation.

Individual faculty and students found their way to Lakeshore to participate in research, educational and service activities.

However, a few years ago the relationship flourished with the establishment of the UAB-Lakeshore Research Collaborative.

Through the creation of this collaborative the School and University established a formal structure to link the research 5

resources of the School and the University to Lakeshore to better address critical research needs. Research problems examining how exercise and nutrition could best contribute to promoting the quality of life for those with physical disabilities or physically-disabling conditions have begun to flourish. This partnership has been a rousing success. Led by Dr. James Rimmer, the Collaborative has become home to several centers including the CDC-funded, National Center for Health, Physical Activity and Disability (NCHPAD).

Michael (Mike) Stephens, co-author and founder of the Lakeshore Foundation has a long relationship with the School of Health Professions. After his injury in an accident, Mike completed first his undergraduate degree at the University of Montevallo and then attended and completed our Master of Science in Health Administration program.

After graduation, he serendipitously, ended up as the CEO of a rehabilitation hospital and subsequently developed a major 6

enterprise in the area of rehabilitation. After leaving that role, he invested himself and his resources in the development of the Lakeshore Foundation, as he envisioned a better way to support those with physical disabilities.

When I arrived at UAB, some 13 years ago, I soon met Mike. Over the years, he has served as a wonderful advisor and mentor, but more importantly, as a great friend.

His compassion and generosity, and his strong entrepreneurial spirit are evident in all that he does. His passion for Lakeshore was obvious from our first encounter.

Prior to reading this book, I felt that over the years, I have learned much of Mike’s and Lakeshore’s story, but my reading of the book brought me knowledge and insights I had never contemplated before.

As I read the book, it became obvious to me that this book had much to offer our students. By examining Mike’s 7

journey from his accident, through his rehabilitation, his career as a leader of a rehabilitation-related healthcare delivery system, and the formation of the Lakeshore Foundation, one could gain an interesting perspective on the needs of those with physical disabilities from the role of both the patient and the provider community and could see the struggles that face both those with physical disabilities and those that seek to provide care and add value to the lives of those with physical disabilities.

While the book initially tracks Mike’s story to help us understand the philosophy underpinning and the events that led to the establishment and growth of the Lakeshore Foundation, the book does much more. Through the lives of those who have been touched by Lakeshore, we gain an understanding of the unique and remarkable spirit that is Lakeshore – a spirit you feel when you enter the doors of its facilities. Each story helps us better understand the 8

complexity and personal nature of individuals dealing with the challenges that are faced with disabilities. It also allows us to experience their struggles, challenges and triumphs. It pushes each of us to think how we can contribute to positively impacting the lives of others.

Because of this, I thought a school-wide discussion and series of activities related to this book, could serve as a powerful tool in promoting inter-professional interactions among students and faculty in our school. Since the book addressed a wide range of issues, it was appropriate to include students across a wide range of programs from healthcare management to clinical service delivery. Our team, led by Dr. Donna Slovensky, associate dean for Academic and Student Affairs, grew this idea into a year-long program that exceeded expectations. Special recognition to Jon Nugent, who along with our chairs and program directors, helped this monograph evolve into a companion piece to this book.

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In this monograph, you will find the overall program outlined and the process we used to deliver this IPE activity.

It includes a series of articles by faculty across our programs offering their perspective on related issues, three reflective pieces written by students who participated in the series, an update from co-author, Anita Smith on Mr. Stephens and an update on the Lakeshore Foundation written by their CEO Jeff Underwood.

It is my hope that you will find both the book and this monograph to be useful for you and your students and wish you the best as you continue to seek to address the task of empowering and adding quality to the lives of all members of your community and our world.

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“LECTURE SERIES OVERVIEW�

Written by Jon Nugent Director of Marketing, UAB School of Health Professions In the fall semester of the 2013-2014 academic year, the UAB School of Health Professions launched a multipart program designed to engage students in an ongoing discussion about physical rehabilitation, its components and growing importance as an integral part of twenty-first century health care. At its core, the program was inspired by Michael Stephens, a health care executive, philanthropist and alum of the School of Health Professions, and Dr. Harold Jones, Dean of the School. In addition to his other achievements, Mr. Stephens was instrumental in the growth of the Lakeshore Foundation, an internationally recognized center of excellence in rehabilitation therapy, and home of the U.S. 11

Paralympic Training Center. The Foundation was in fact so well regarded that it had been the subject of numerous articles, and in early 2013, served as the basis of the book, “Sports Rehabilitation and the Human Spirit,” by Anita Smith. Together Mr. Stephens and Dr. Jones decided to select that book as the framework around which they would build a multipart program to provide members of the School of Health Professions community with unique and valuable insights into the personal journeys and professional experiences of leaders in the fields of Occupational Therapy, Physical Therapy, Physician Assistant Studies, Rehabilitation Science, and Health Services Administration.

The program began with a gift, specifically a gift of books. To launch the program and facilitate the discussion, Mr. Stephens generously donated over 400 copies of Ms. Smith’s book and had them delivered to Dean Jones’ office on campus. Over the next several weeks, the Dean’s staff 12

coordinated distribution of the books to the School of Health Professions’ students and faculty with suggestions of how to best integrate individual chapters into the curriculum. In parallel with those activities, the School of Health Professions’ Office of Student Success began development of a speaker series that would bring some of the most pertinent concepts from the book, out of the classroom and into open forums. In order to augment the speaker-led discourse, facility tours of the nearby Lakeshore Foundation and Spain Rehabilitation Center were arranged, service learning activities were developed and an annual essay contest was established.

To set the appropriate tone for the program, Dr. Jones hosted a Town Hall style meeting with Mr. Stephens, and Ms. Smith. Attended by more than 200 students and dozens of faculty, the event was an enormous success, as the UAB community turned out to listen and participate in the discussion. During the event, Ms. Smith, a veteran journalist 13

with a background writing about health care, described how the techniques pioneered by personnel at the Lakeshore Foundation have added to the way therapists work with patients and how individuals think about themselves and their abilities. She discussed the integration of active, sometimes aggressive athletics into regimens undertaken by people who, through illness or injury, had experienced significantly decreased mobility, lost limbs or other abilities that they thought would have made such activities impossible. It was the mission of Lakeshore, Ms. Smith said, “to not isolate people with disabilities but rather to empower them so that they can get out and mix with the whole world.” For many in the audience though, the real excitement came from hearing Mr. Stephens talk about Lakeshore and how work performed at the facility has helped change perceptions about the disabled. “We are fortunate that seeing people with steel for an arm or leg is becoming more natural in society,” he said.

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“Right now they are on the rise, they’re at Lakeshore, rehabbing and having fun. These are great people who will rehab into something even greater.”

Over the next two semesters, a number of speakers including many of the School of Health Professions’ leading faculty members, delivered presentations as part of the program. Dr. James Kilgore, Assistant Professor, Director of the Physician Assistant Studies program, and an expert on public policy, delivered two presentations to standing-roomonly crowds of students and other faculty about the nuances of the Americans with Disabilities Act, its amendments and impact on care and treatment of those with disabilities.

During his second presentation, Dr. Kilgore addressed the intricacies involved in understanding the impact of reimbursement on acute and long-term rehabilitation care, a particularly complex concept given recent changes in Federal health care policy. Presentations by other speakers were also 15

delivered to capacity crowds including, Dr. David Morris’ talk regarding personal insights into professional advocacy and its importance in health care, and Dr. David Brown’s discussion of challenge-based physical training for stroke survivors. In total, more than 10 presentations were delivered, lending special insight into the learning experience of hundreds of students.

The culmination of these events was delivered by the students themselves. In the spring of 2014, Dean Jones announced an essay contest open to all of the students who had participated in the program. Again, Mr. Stephens’ generosity was on display as he graciously donated to the program, supporting scholarships to be awarded to the winning authors. Structured around a loose framework of lessons learned as a result of participation in the program, the contest elicited piles of essays detailing not just the personal journeys of the students who had written them, but also the 16

objective success of the program. Ms. Smith chaired the panel of judges that ultimately selected the essay written by Carrol Papajohn, a graduating senior in the Department of Health Services Administration’s MSHA/MBA program, as the winner. Entitled, “Rebuilding Bodies, Restoring Lives,” Mr. Papajohn’s essay focused on life-shaping personal experiences that he had accumulated outside of the classroom, married with lessons and insights gained from participation in the program developed by Mr. Stephens and Dean Jones.

Speaking about the essay, Ms. Smith commented, “I was drawn to Carrol’s essay because of the eloquent way he explained how he has been inspired to ‘focus on patients as a whole, rather than the sum of their illnesses.’” Other essay winners included Spence Hall, like Mr. Papajohn, also a graduating senior in the MSHA/MBA program, for his contribution, “The Human Spirit,” and Jason Vice, a first year Occupational Therapy student for his essay, “Capturing the 17

Spirit of Lakeshore.� Each of the winning essays is contained elsewhere in this book.

Finally, the program was completed with the coordination of this book. More than just a coda, this volume contains several new essays commissioned specially for inclusion here. Among the pieces written just for this book are essays by Drs. Kilgore, Brown and Morris as well as an article authored by Dr. James Rimmer holder of the Lakeshore Foundation Endowed Chair in Health Promotion and Rehabilitation Sciences, and Jeff Underwood, President of the Lakeshore Foundation. There is no question that the program was rousing success and hundreds of new alumni and current students have been enriched by a concept developed by Mr. Stephens and Dean Jones.

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“ADAPTED PHYSICAL EDUCATION: ALABAMA’S BENEFITS FROM LAKESHORE FOUNDATION” Written by Kristi Menear, Ph.D. Associate Professor, UAB Department of Human Studies The modern-day roots of adapted physical activities implemented through the Lakeshore Foundation, e.g., adaptive sport, recreation, and leisure time pursuits for individuals with disabilities or chronic conditions, are in physical education for students with disabilities. When the first special education law was passed by the United States Congress in 1975, physical education was included as a direct service. As a direct service in this federal law that is now called the Individuals with Disabilities Education Act, physical education must be provided to all students, regardless of ability, in their least restrictive environment, and according to their individual education plans. Students with 19

disabilities do not have to “qualify” to receive physical education. Per the law, physical education is taught to students with disabilities at least as often as it is taught to students without disabilities. Coupled with more current education laws related to “highly qualified” instructors, one can see that educators should be trained to implement high quality adapted physical education programs, administrators should hire educators with this training and continue to provide them with appropriate professional development, and parents should expect their children with disabilities to become physically educated through services that resemble the quality and quantity of those provided to children without disabilities.

In Alabama, universities that train future and current physical educators have a community-based resource that is beyond anything that can be similarly accessed by universities outside of the state. The Lakeshore Foundation has 20

collaborated for many years with Alabama’s universities and K-12 school systems to bring awareness to adapted physical activity and provide professional learning opportunities for future and current adapted physical educators and general physical educators. Future and current physical educators benefit from observing adapted physical activities in action, including fitness testing and fitness-based programming, sports team practices and national competitions, and small and large group recreational activities for school-age children via inclusive programs. They also benefit from tours of the fully accessible campus in Birmingham, viewing adaptive equipment and programming that can be emulated in their local contexts. And, many have benefitted from Lakeshore’s staff visiting their school or university with a demonstration team that not only exposed large numbers of students, teachers, and administrators to the competitive abilities of wheelchair athletes, but may also have given students, 21

teachers, or administrators opportunities to see for themselves the challenges and successes of participating in a physical activity while seated in a wheelchair.

Lakeshore Foundation is a turning point in the minds and professional abilities of many of Alabama’s current and future physical educators. Like the students they teach and may even encourage to become members of Lakeshore, physical educators see national sporting events that parallel the intensity, competition, and athleticism of sporting competitions they have viewed or participated in much of their lives. Through Lakeshore, they observe and possibly meet Paralympic athletes.

In a way, adapted physical education and Lakeshore Foundation have grown up together, expanding the parallel professional arenas across education and community-based settings. Following the special education legislation that was passed in 1975 and included physical education as a direct 22

service, many states now offer adapted physical education teacher certification. For those that do not, the national Certified Adapted Physical Education exam was based on the Adapted Physical Education National Standards developed by members of the National Consortium for Physical Education and Recreation for Individuals with Disabilities as a result of an “Action Seminar� with the National Association of State Directors of Special Education and Special Olympics International. Alongside this national development, Lakeshore was paving the way open the current facility and subsequently become an official U.S. Olympic & Paralympic Training Site as well as the official home of USA Wheelchair Rugby.

While the profession of adapted physical education was growing and Lakeshore Foundation was expanding its facilities and programs, disability sports experienced more attention by sporting associations, researchers, advocates for 23

individuals with disabilities, athletes, and various related professions. Perhaps most well-known are the notable changes to the Paralympics and Olympics through an agreement with both organizations. Since the summer games of 1988 and the winter games of 1992, the Paralympics and the Olympics have taken place in the same cities and venues as the Olympics, and Paralympic athletes participate in Olympic ceremonies, with the Paralympics being held immediately following the Olympics.

Simultaneously over the last 15 years, the National Center on Health, Physical Activity and Disability (NCHPAD) has served as one of the most well-known and fastest growing resources for both adapted physical educators (both in K-12 and in higher education), adapted physical activity community providers, and disability sport participants and coaches. Technology has enabled NCHPAD to reach all corners of the United States and across the globe. Alongside 24

NCHPAD’s growing reputation, faculty at the University of Alabama at Birmingham (UAB) have contributed increasingly important work from their research, teaching, and service relative to adapted physical education/activity. It is with foresight and commitment that the administrators of NCHPAD and UAB teamed up with Lakeshore Foundation to create a collaborative partnership that guarantees the future of adapted physical education/activity is in the state of Alabama.

The timing for the collaboration among NCHPAD, UAB, and Lakeshore Foundation is significant in many ways.

The relationship is built on the health and reputation of each entity along with the professional disciplines they represent. It is also built on the identified strength of collaborative efforts that impact teaching, research, service, and adapted physical education/activity programming for individuals with disabilities. And, it is understood that there is much to do.

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While there have been tremendous gains in physical education programs for students with disabilities, there is much room for improvement. Not all states even require general physical educators to take an adapted physical education course for their teacher certification much less offer a designated teaching certificate for a teacher who has had numerous courses on adapted physical education pedagogy and assessment. This means that children with disabilities who are capable of being included in general physical education, with or without an individual education plan, do not have teachers who are trained to know about diagnoses and how diagnoses are impacted by movement or how they impact an individual’s movement in individual, dual, and team sports and other physical and fitness activities. It means teachers are not trained to provide individual motor and fitness assessments that meet a student’s physical, cognitive, or sensory needs in order to develop goals and 26

activities that help students to improve their performance. It means teachers are not taught best practice pedagogy that fosters positive outcomes for all students in inclusive physical education classes. It means students without disabilities do not see students with disabilities being set up for success or set up to do their best.

While there have been tremendous gains in competitive sporting events for collegiate and professional athletes with disabilities, these gains do not extend to high school or community sports across the United States. It is the rare exception that an elementary, middle, or high school student with a disability has the opportunity to try out for and participate on a competitive sports team. In fact, the Paralympics are not even shown on national television like the Olympics are; therefore, these students have few opportunities to become aware of ways they can be

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participate in sports and, likewise, they have few role models who are athletes.

A collaboration such as the one established among NCHPAD, UAB, and Lakeshore Foundation has the opportunity to bring awareness to the abilities of individuals with disabilities, thereby fostering the potential for them to have more opportunities in school and throughout their lives and communities in which they live. It also has the opportunity to deepen the professional knowledge base about the physical education, physical activity, sports, and exercise needs and abilities of individuals with disabilities. By extending the collaboration to state organizations, such as what NCHPAD, UAB, and Lakeshore Foundation are doing with the Alabama Department of Public Health’s Scale Back Alabama Program and with the Alabama State Department of Education through representation on the Adapted Physical Education Task Force, knowledge dissemination creates 28

awareness, fosters acceptance, and builds expectations for programs and communities to appropriately include individuals with disabilities.

Appropriately including individuals with disabilities in programs and communities means providing these individuals high quality services based on current knowledge and best practices. The partnership among NCHPAD, UAB, and Lakeshore Foundation has the potential to impact UAB students in education, engineering, public health, health professions, medicine, and nursing programs. The ripple effect of this impact can mean that as these students become employees across a wide range of jobs and employment settings, they enter their professions with knowledge about the abilities of individuals with disabilities. Along with their civic service, future UAB alumni will have the opportunity to change culture. Collectively, they will have the opportunity to improve the physical education of students with disabilities, 29

increase the quality and quantity of community-based adapted physical activity and sporting events that individuals with disabilities can participate in appropriately, and impact the national focus on sports so athletes and fans expect to see individuals with disabilities competing in local, national, and international sporting events.

The partnership among NCHPAD, UAB, and Lakeshore Foundation comes with more than opportunity. It comes with responsibility. Responsibility to build on the independent success of each entity and collectively become something greater than the sum of its parts. Responsibility to unite many disciplines, many programs, many communities.

Responsibility to build on UAB’s tagline, “Knowledge that will change your world”, by fostering a more accepting and inclusive world in which Lakeshore Foundation’s mission to “break down barriers and enable people with physical disability and chronic health conditions to lead healthy, active 30

and independent lifestyles” is met to the extent that the word “barriers” can be removed.

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“DISABILITIES, ADA AND REALITY�

Written by James R. Kilgore, Ph.D., PA-C Director, UAB Physician Assistant Studies program Almost 1 in 5 Americans have a physical or mental disability. Yet, most of us have limited experience with the disabled. In fact, for many people, images on television, haphazard encounters at work, school or the supermarket may be their only interaction with the handicapped. As a result, it can be difficult to understand the issues they face.

We can read about the Americans with Disabilities Act, but many of us fail to appreciate its impact even though that legislation is about to celebrate the 25th anniversary of being signed into law.

The ADA law was written to provide the same opportunities for people with disabilities as those without.

But for many of us even recognizing disability can be 32

difficult. Conceived to prohibit discrimination based on ability, the Americans with Disabilities Act (ADA) was designed to afford protections for those citizens who are significantly limited in their activity by impairment.

Specifically, the law provides protections against unfair hiring practices,

and

ensures

accommodation

on

public

transportation, and at public facilities, including those that are privately owned, like restaurants and shops. Of particular importance is the inclusive nature of the Act which expands beyond protection for those with readily apparent, or “visible” physical disabilities, to provide equal rights to all persons with impairments, including mental and other “invisible” limitations. In fact, while the ubiquitous International Symbol of Access, colloquially, the “handicap symbol,” depicts a figure in a wheelchair, the vast majority of disabilities are invisible and are not related to mobility. The most prevalent of these include speech impairments, chronic 33

pain, and fatigue, cognitive impairments, and diabetes. The unseen nature of invisible disabilities inhibits awareness and fosters misunderstanding.

Currently almost one in ten Americans suffers from one or more disabilities. Nearly three-quarters of those people, about 15 million Americans, do not require assistive devices or exhibit otherwise obvious signs of illness. These are the persons with invisible disabilities, it is their lack of obvious symptoms that influences public expectations and leads to confusion, even among medical professionals. It is all-to-common for a person suffering from a chronic condition, who outwardly appears healthy, and doesn’t “look sick� to be judged differently from a person without sight or the use of a limb. If visible then we assume there is a limitation. If not visible we many times question the true impact on the person. But making that assumption does a

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disservice to those who have disabilities we cannot see but are severely limited in their ability to function.

My experience is more personal than most. I had an older sibling who was born with Spina Bifida and passed away at an early age. I have spent the past 40 years attending church with a lady whose mother was exposed to Thalidomide during pregnancy and has several obvious limb abnormalities, a cousin who was injured in a motorcycle accident as a teenager and suffered irreparable brain damage limiting him throughout his life, close colleagues who have children with Down Syndrome and an in-law who has developed seizures late in life that has severely limited his lifestyle.

As we look around we can see that society is moving from the concept of a sterile white handicapped bathroom for example to one more pleasing in color and functionality.

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This move is much more than atheistic and a change in attitude amongst society of those who do have a limiting disability. Society in general has moved away from the medical model of a disability where the disability only affects the individual and their issue is contained with them and not a problem for society. For example if you are in a wheelchair and come upon a flight of stairs that is the person in the wheelchairs issue not everyone else’s.

Our acceptance of different colors and more functionality in a handicapped bathroom is much more about the move to a social model of disability where we see the barriers as issues that need to be eliminated or an alternate route be provided so that a limiting disability requiring the use of a wheelchair still gives the individual the opportunity to participate.

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There are many opportunities to take steps to be inclusive of individuals with limitations. But the mindset to recognize and eliminate or decrease the barriers has taken time to become part of mainstream. And it is still evolving today.

As medical providers we have to adopt the social model concept in providing care to patients. We find it easy to adapt our usual procedures and office practices to accommodate the visible disability. However we are just as not accommodating as others when we cannot see or identify the disability. An important principle of the social model of treating disabilities is that the individual is the expert on their requirements in a particular situation and that this should be respected, regardless of whether the disability is obvious or not.

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So what is important for us as providers to recognize in our practices as we care for patients with disabilities? The first is that disabilities come in all shapes and forms. Some will be visible and some will not. Second, we must be receptive to an individual who has a perceived visible disability and have an open dialogue on how they expect to be treated. It is critical that we have this open dialogue with someone about any limitation, especially when not visible.

This can have a dramatic impact on the care they receive from a provider.

Our perception will impact the care that others receive. It is easy to judge an individual based on what we see as their limitation. But what we see as a limitation may actually be a motivation to the individual involved. Making snap decisions about what a person can and cannot do can dramatically impact their ability to participate in activities, get a job or be judged medially with a chance.

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What might we see in our daily care of patients?

Amputations of digits, arms or legs are very common today.

Visual acuity issues including blindness, glaucoma or significant impaired vision can significantly impact a patient.

Stoke victims who have limited mobility or upper or lower extremities or limited speech ability can struggle with daily activities. Traumatic brain injuries that impair the memory of a patient can impact their ability to maintain a medication regimen over time. And unseen injuries such as the Post Traumatic Stress Disorders that affects an individual to be able to function in crowds or sit or stand with the backs to open areas can impact their ability to hold a job or work in certain situations.

As providers we must be able to access the degree of impairment and be willing to suggest options for needed treatment. We have to be sensitive to the limiting disability and the patient’s desire for treatment. We cannot assume we 39

know best. We have to be knowledgeable of the resources available to us and the patient. We have to be willing to involve a “team� in providing care to individuals with a limiting disability.

Today treatments have improved and facilities to provide quality care to the patient with a limiting disability have greatly expanded. Medical problems such as stokes, paralysis, spinal cord injuries, brain injuries, hip fractures, amputations, multiple trauma and severe debilitating arthritis can be successfully treated in rehabilitation centers making a significant impact on the quality of life of the patient. Even diseases once thought not treatable such as multiple sclerosis, cerebral palsy, Spina Bifida and many more now have treatment regimens that can be implemented making in many cases improvements in the quality of life of the individual.

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Mike Stephens talks about “Sincere happiness through peace with self is possible through inner strength in the book Sports Rehabilitation and the Human Spirit. When you have a limitation, a disability, that joy must come from the person looking in the mirror. That joy must radiate from within”. That insight should drive how we approach our patients who present with a limiting disability. Until we can help nurture a positive environment by listening, offering support when solicited and providing access to information about needed resources, on the patient’s own terms, we cannot help the patient reach that point where they are at “peace with themselves” or be able to dig deep to find that strength to make the next level of recovery or growth. That open dialogue becomes so important so we help provide care to meet their expectations. Support networks are great and make a difference. Compassion for the patient is critical but

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sympathy is not motivating. We need empathy but we do not need to be judgmental.

My experience has taught me over my many years of practice that a person with a limiting disability does not want to stand out or be singled out – they just want to be treated with respect. When we listen, we empathize and we act as compassionate practitioners we can and will help that patient heal themselves from the inside out. “Peace with self is possible through inner strength” is a profound statement but at the center of the care we should provide our individual patients.

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“MICHAEL E. STEPHENS PROFILE” Written by Anita Smith Author Sports Rehabilitation and the Human Spirit When Michael E. “Mike” Stephens was 26 years old, his life was changed forever by a devastating injury resulting from a diving accident in his hometown of Birmingham, Alabama. On the Sunday afternoon of that accident in the early summer of 1970, he was visiting a friend – a young man he knew well. He and the friend went for a swim in the pool at the apartment complex where the friend lived. When Mike dived in, something went terribly wrong. His head hit the bottom of the pool. Mike couldn’t move – from his arms down.

The end result was a severe spinal injury that initially left Mike fighting for his life. Then, after it appeared he would survive, his neurosurgeon stood by his bedside and 43

told him that he didn’t believe he would ever walk again.

Although Mike regained use of his arms, considerable paralysis in his legs persisted. As he went through a rehabilitation program, strong-willed and volatile Mike lashed out at the program. Frustrated that he still could not walk on his own, he felt that the rehab program was not pushing him hard enough or fast enough. He became a rehab program “dropout,� leaving rehab earlier than scheduled. Then, using to the maximum the limited strength and sensation that had returned to his legs, Mike supplemented that with his own sheer will and determination. At first he crawled when need be. Then, forcing himself to walk, he stumbled and fell again and again, but each time picked himself up and, however painful and treacherous, walked some more. Deciding that maneuvering on flat surfaces was not sufficient to get him anywhere close to his goals for walking, Mike forced his frail, ravaged body to walk on uneven sidewalks and to climb flight 44

after flight of steep stairs in a tall Birmingham office building.

Mike later would be told that as a result of pushing himself so hard, he further damaged his already traumatized back. But he got what he wanted at the time. For years he would be able to walk, albeit with great difficulty and with a severe limp. Then, later in life, more health problems would put him back in a wheelchair.

Unlikely as it might seem, in the years immediately after his injury Mike Stephens began achieving beyond anything he would have imagined, and, in fact, in arenas he previously would never have considered entering. He would look back in years to come and tell people that he mastered those post-injury achievements not in spite of his injury, but because of it. He said his injury altered him as a person, remolding many of the perspectives and priorities he had held since childhood.

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As Mike was growing up, he became known as what some might call a hell-raiser. He was fun-loving, cocky, a practical jokester. He obviously had an exceptionally bright mind, the intellectual capability to earn whatever grades he chose with little effort. However, Mike often opted to give his studies only enough effort to get by – with the fun side of life winning out in claiming his attention. As a high school student, Mike heard some teachers say he wasn’t using a fraction of his potential, that he could be a real star student if he decided to focus a bit more on serious studies than so much on the lighter side of life. After he went to the University of Montevallo as a college student, that mischievous, practical-jokester side of him got him into so many problems with a dean that Mike voluntarily dropped out of college.

After leaving college without a degree, Mike used his bright, quick mind to forge a career as a successful salesman 46

for Prentice-Hall publishers, selling reference materials tailored for attorneys, accountants, physicians, hospital administrators, and other professionals. Mike’s appearance matched his success – tall, handsome, impeccably dressed. By the time Mike was injured, he was deeply involved in his Prentice-Hall sales career. On the Sunday he was injured, he was making plans to embark the next day on yet another week of making sales calls.

After his accident, hospitalization, and abbreviated stint in rehabilitation, a gradual transformation began for Mike. He felt drawn to leave behind his sales career and to pursue a career in the health field. He was fascinated with hospital administration. Mike left Prentice-Hall and returned to the University of Montevallo and completed his baccalaureate degree. Then he earned a master’s degree in healthcare administration at what is now known as the UAB School of Health Professions. As he was finishing the 47

master’s program, his first choice job-wise was to become an administrator in a general acute-care hospital. Instead, the job offer he received was to become Executive Director of Lakeshore Hospital, a relatively new and already struggling rehabilitation hospital located in older former tuberculosissanatorium facilities in the Birmingham area, on a campus recently redesigned to provide multi-services to those with physical disabilities. Being associated with a rehab hospital was not on Mike’s radar screen. He wanted to shove his own injury-and-rehab memories as far back in his head as possible; he did not want to be reminded again and again in his work life. Nevertheless, in 1975 Mike reluctantly accepted the Lakeshore offer, planning to stay two years and then get a general acute-care hospital position. (Mike now has been associated with Lakeshore in one capacity or another for 39 years.) He would look back and say that it was a stroke of

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luck that the Lakeshore offer came his way. He would be glad that, however reluctantly, he accepted the Lakeshore offer.

The paths that Mike traveled after his injury became dual paths of a visionary champion/advocate for the physically disabled, and also that of a highly successful businessman.

On the campus of the Lakeshore Rehabilitation Complex, Mike joined forces with Alabama vocational rehabilitation leaders to make the Lakeshore campus a beacon for taking care of the health and rehabilitation needs of those with physical disabilities, and also for retraining them to handle different types of jobs so they could again become productive citizens.

As director of Lakeshore Hospital, Mike was in charge of a hospital where health professionals such as physicians, nurses, physical therapists, and occupational 49

therapists ministered to physical and rehabilitation needs of those with spinal injuries, amputations, and other major physical disabilities. As Mike became increasingly committed to helping these individuals, he called them “my people.�

Driven to make changes by his own insider understanding of rehabilitation, and armed with his natural tendency to speak candidly and to move forward with determination, he successfully tackled one Lakeshore problem after another.

Those problems were numerous and serious: Old, inadequate roach-infested Lakeshore buildings, dire cash-flow crises, complex employee dilemmas, and forceful opposition from competitors who viewed the emerging Lakeshore, and soon its satellites, as a threat. Mike also would become a voice calling for community acceptance of and opportunities for those with physical disabilities. Along the way, he would feel that he had a special spirit cheering him on. The spirit was that of Millie Ragland. She was a young African-American 50

woman, a paralyzed single mother who had been rehabilitated at Lakeshore only to run head-on into seemingly insurmountable obstacles in the community. One day she picked up a shotgun and pulled the trigger that ended her life.

Believing that the rehabilitation system and the community had failed Millie, Mike was inspired by her haunting story to advocate for more change – which he did.

In the late 1970s and early 1980s, Mike Stephens began focusing some attention on opening up additional Lakeshore avenues of opportunity for those with physical disabilities through the use of sports, recreation, and fitness.

Mike himself was athletic. He had spent some time coaching a wheelchair basketball team. He strongly believed that sports, recreation and fitness could give a physically disabled person a much-needed physical outlet, help him have fun and re-engage with life after he finished conventional rehab, and show him goals he was capable of achieving not only in 51

sports but also in mainstream life. Mike knew that Lakeshore needed a new facility to house and showcase these sportsrelated programs. Toward that end, he set out to enlist the help of Alabama Governor George C. Wallace in securing funds to make possible that new facility. Mike Stephens could talk to George Wallace about this need as one man with a physical disability speaking to another who also had a physical disability – the governor confined to a wheelchair because of damage from a bullet fired by a would-be assassin, and Mike with his body forever weakened by a dive into a swimming pool that had gone wrong. George Wallace agreed to help; the Wallace Recreation Center opened on the Lakeshore campus in 1981. That was a first big step. Then, as Mike Stephens led the way in reorganizing and creating divisions of the growing Lakeshore Hospital, in 1984 he convinced the hospital’s board of directors that one of those divisions should be a separate Lakeshore Foundation devoted to 52

sports, recreation, and fitness. The Lakeshore Foundation that Mike founded was destined to develop into one of the most effective and influential entities in the world for providing progressive sports, recreation, and fitness programs to those with physical disabilities.

With Mike as the visionary force, other groundbreaking developments also were in the wind in the 1980s. Seeing the positive difference that Lakeshore Hospital had made in so many lives, in 1986 Mike became the founder, president, and CEO of a rehabilitation company called ReLife. The flagship hospital for ReLife was Lakeshore. In 1991, Mike led ReLife through a successful public offering, and the company gained national attention for the individualized approach it took to rehabilitation. By the time ReLife merged with HealthSouth Corporation in 1994, Mike Stephens had led ReLife to become a company with a reach that spanned 12 states and included 46 rehabilitation facilities 53

specializing in treating individuals with brain and spinal cord injuries and an array of work-related injuries.

After the ReLife/HealthSouth merger of 1994, Mike had the opportunity to take a prominent leadership position in the large rehabilitation corporation resulting from the merger. Instead, Mike decided (1) to retire from being in the operations end of the rehabilitation industry, but (2) to remain connected to rehabilitation through sports, recreation, and fitness by accepting an opportunity to serve on the Lakeshore Foundation board of directors, where he still serves today. Mike was a Lakeshore Foundation board member as a new $22 million building for the Foundation was planned and ultimately opened on the Lakeshore campus in 2001. Then, as a board member, Mike was among Lakeshore Foundation leaders who led the discussions that would result, in 2003, with the Foundation being designated by the U.S. Olympic Committee as an official training site for 54

athletes training to participate in both the Olympics and Paralympics. As a board member, Mike has watched as Lakeshore Foundation has established prototype sports, recreation, and fitness programs for wounded U.S. military personnel, including some injured in combat in Iraq and Afghanistan. And, as a board member, Mike was involved in 2009 when Lakeshore Foundation and the University of Alabama at Birmingham (UAB) entered into a first-of-its kind collaborative to develop a world-class research program in rehabilitative science; this collaborative links Lakeshore’s programs for individuals with physically disabling conditions with research expertise coordinated through UAB’s School of Health Professions.

As the decades have gone by, achievements of Michael E. Stephens have been recognized in many ways. In 1995, the University of Montevallo awarded him an Honorary Doctorate of Laws. In 1997, that University rededicated its 55

College of Business as the Michael E. Stephens College of Business. In 2002, he received an Honorary Doctorate of Humanities from UAB. He had been recognized as Outstanding Alumnus by the UAB National Alumni Society.

He received the John S. Jemison Jr. Venture Award, presented by the Birmingham Venture Club to Birmingham’s Entrepreneur of the Year. He became the recipient of the Lakeshore Foundation’s Sington Soaring Spirit Trophy, for outstanding service to the disabled community. In 2006, he was inducted into the Alabama Sports Hall of Fame as a Distinguished American Sportsman. In 2009, he was honored by the UAB School of Health Professions as one of the School’s “Fab 40” alumni. And, on August 23, 2014, he was inducted into the Alabama Healthcare Hall of Fame.

The fun-loving, free-spirited traits of Mike Stephens are still there. In addition, for more than 40 years now, his traits of vision, leadership, and caring also have found and 56

spread their wings as the focus of his life has been dramatically different. The lasting results – to the benefit of countless individuals with physical disabilities – speak for themselves.

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“FINDING THE UNLIMITED POTENTIAL IN REHABILITATION BY ASKING TOUGH QUESTIONS” Written by David A. Brown, PT, Ph.D. Professor and Program Director of UAB PhD in Rehabilitation Science I am privileged to be the Director of a PhD Program that trains individuals to engage in research that attempts to answer big questions about “How can people with disease, injury, or other conditions that impact livelihood, reach their fullest potential for lifelong physical activity?” This essay will explain my personal point of view about the research process and how, I believe, it holds the key to finding the most important answers to the above question. My bias as a rehabilitation clinician and a scientist compels me to ask tough questions about the current state-of-the-art in 58

rehabilitation practice. I ask current and future rehabilitation scientists to be critical of clinical practice, and to question whether we challenge clients at a sufficient level in order to produce satisfactory clinical outcomes.

What is rehabilitation science research and why is the process so important?

Research is a basic process that involves a scientist asking a delimited and focused question, examining the current theories about the question, identifying specific expected predictions based upon the theory, and then planning and implementing a method to gather evidence that either supports or refutes the expected prediction. After a research study is performed, the researcher is obligated to examine the entirety of the evidence from their study as well as other studies, and then put the results in a broader context about how well the evidence answers the question. There is a 59

long history of research and researchers beginning from the times of the Scientific Revolution, beginning in the mid-1500s with the publications of Copernicus’ treatise on the heliocentric model of the universe and Vesalius’ groundbreaking work on human anatomy. These works signaled a new era where direct observation of phenomena became the proof for certain theories, rather than religious or philosophical thought experiments.

The process of research is important because it allows debate, dialogue, and possible resolution on important questions that form the basis for practical applications that can improve life for people all over the world. The answers to basic questions about biology, physics, chemistry, astronomy, etc. can lead to real-life solutions and devices that help people live longer and more-fulfilling lives. In some cases, the answers to research questions will contradict the current

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understanding of nature and cause a “revolution� in how we all see the world and the way it works.

How do rehabilitation scientists approach the research process?

Despite the long history of science, Rehabilitation Science, as a discipline, is relatively new, with rehabilitation scientists starting to ask questions about recovery and change after a physical or mental disability within the last 20 years or so. Rehabilitation scientists are interested in making connections between a disease process or injury and its impact on body structures and function that will alter performance of activities, and that can lead to improvement in occupational involvement and participation in society.

These connections are intricately involved with environmental conditions and personal/cultural issues.

Whereas traditional medical science targets basic questions 61

about how physiological processes and structures work, the intricate connectivity of Rehabilitation Science requires a new approach to science that investigates interactions rather than isolated elements.

For example, the traditional medical scientist might ask questions about recovery from illness by studying cellular structures or processes in isolation at the petri-dish or microscopic level. These levels of inquiry might result in discoveries about fundamental processes, but will possibly miss connections to functional performance and eventual lifestyle changes to a person who experiences a disabling condition. The rehabilitation scientist takes advantage of new methods in Translational Science that can connect animal models of research with human models of research. The human models of research are then conducted in environments that are closer to real-life conditions and can shine light on important factors that will speed up recovery 62

and will move people with a disabling condition closer to a lifestyle that is satisfying and enriching.

Challenging exercise as an active change agent for people recovering from disabling conditions When I was trained as a physical therapist, way back in 1983, conventional wisdom was that neurological injury or disease resulted in permanent damage that prevented people from ever regaining skillful and purposeful movement. We, as clinicians, were taught to squeeze as much function out of a person during the recovery process, but then to be satisfied with the endpoint that was achieved, which was very often unsatisfactory to the individual. Forty years later, we now know that the nervous system is quite plastic and is able to adapt to injury or disease so that individuals can reach much higher levels of functional recovery. We have also learned that high intensity exercise can produce some of the greatest 63

levels of outcomes. However, clinicians were often reluctant to make exercise too challenging or uncomfortable for fear that an individual would feel tired or frustrated.

Recent work with colleagues in my lab (UAB Locomotor Control and Rehabilitation Robotics Lab) has revealed that, after a stroke, the human brain is very capable of learning complex and high level locomotor and balance skills. The key to the high level of skill acquisition is that individuals must be challenged to practice tasks at very difficult levels. This process is similar to an athlete who is exposed to very difficult skill practice sessions and who works at the skill over and over again until the skill is mastered. Rather than feel frustrated, participants in my research studies often feel empowered by their new-found abilities, and gain confidence to go out into the world and learn new ways to enhance their quality of life. The lesson that I have learned from these studies is that a person will 64

strive to achieve goals if they are meaningful and purposeful for the person’s daily life and that rehabilitation provides the environment and structure to challenge people to achieve their personal goals.

What is the hope for the future?

Rehabilitation scientists are on the cutting edge of translational research that can discover new theories underlying the optimal conditions for recovering from a disabling illness or injury. As described above, rehabilitation scientists take a unique approach to research that forges connections between physical processes and psychosocial processes in order to understand the physical recovery process. The future holds many challenges for rehabilitation scientists, but perhaps the greatest challenge is to foster the growth and support for rehabilitation science during a time when research dollars are dwindling. As the US population 65

ages, and as the number of people with disabling conditions are on the rise, the hope is that we develop a strong cadre of rehabilitation scientists (here at UAB, and elsewhere) who can ask the tough questions, make the complex connections, be willing to propose bold new approaches and innovative technologies, and remain focused on the goal of helping individuals to reach their highest levels of human potential.

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“PROFESSIONAL ADVOCACY: LESSONS LEARNED AND REWARDS RECEIVED�

Written by David M. Morris, PT, Ph.D. Professor, UAB Department of Physical Therapy As a faculty member in the UAB School of Health Professions, I am routinely required to describe my professional activities in teaching, scholarship and service.

Throughout my 23 years on faculty, the easiest category for me to justify, by far, has been my productivity in professional service. This is because I am somewhat of a professional advocacy fanatic. I have served on numerous boards, committee or task forces and actually enjoyed it! When this book series began and I read Sports Rehabilitation and the Human Spirit it suddenly dawned on me when and why I became so enthusiastic for professional advocacy - it came from volunteering at the Lakeshore Foundation. Flipping 67

through the pages brought back so many wonderful memories of amazing and inspirational people as well as many life-changing experiences. In 1983 I moved to Birmingham right after graduating from physical therapy school at UNC- Chapel Hill. I took my first job at Spain Rehabilitation Center with a goal of starting a therapeutic aquatics program there. I first had to learn about therapeutic aquatics and Lakeshore was the place in Birmingham to gain those skills. So, after work in the evenings, I volunteered in the aquatics program at Lakeshore. Two remarkable Recreation Therapists, Beth Allred and Sis Theuerkauf, shared their vast knowledge about adapted swimming (i.e., teaching individuals with movement challenges how to swim) with me. From there I became involved in wheelchair athletics and eventually became Chair of the Board of Directors of the Dixie Wheelchair Athletic Association – my first experience with organizational leadership. Since then I 68

have been bitten by the advocacy bug. When asked to participate in this book series, I decided that I would share my love of professional service and encourage new health care providers to embrace professional advocacy as an essential part of being a health professional. In this essay, I hope to share: 1) my definition of professional advocacy and what I believe is fundamental about such activities; 2) selected experiences I have had and incredible advocacy mentors I have known; 3) the lessons I have learned; and 3) the rewards I have received.

Advocacy can be defined in many ways. The definition that particularly appeals to me is: Advocacy represents the series of actions take and issues highlighted to change the “what is” into a “what should be”, considering that this “what should be” is a more decent and just society. Individuals who engage in advocacy go beyond the traditional 8 am to 5 pm job and work to make their vocational duties really matter. They are the true “agents 69

of change” and their dedication to their work and those they serve distinguishes them as professionals.

I tend to describe professional advocacy activities as taking one of three forms: 1) patient/client advocacy – representing and promoting the individuals who seek your services; 2) legislative/policy advocacy – working to change laws and policies to advance your patients/clients and your profession ; and 3) professional innovation advocacy – moving your profession forward through creative thinking and courageous actions. Below I will explore each type in more detail.

Patient/Client Advocacy Since we chose our profession to serve others, most health professions advocates start with this type of advocacy.

This type of work is characterized by going beyond “the expected” to enrich the lives of those you serve. My first 70

patient/client advocacy experience happened when I volunteered at Lakeshore. Early along in this experience Beth and Sis had paired me up with Birmingham Native Leslie Walker. Leslie had experienced a spinal cord injury several decades ago and is quadriplegic. She already knew how to swim quite well. In fact, she swam competitively. She simply wanted to improve her swim strokes. Looking back on the pairing, I think that Beth and Sis were more interested in Leslie teaching me instead of the other way around – and she really did. During our weekly swimming sessions, Leslie shared so much about her day to day life. She talked about her challenges and victories as well as her hope and dreams.

Leslie improved her skills, not so much because of me, and participated in the 1988 Seoul Paralympics. She profoundly influenced my view of rehabilitation and the ultimate goals behind the therapeutic partnerships I was forging daily in the physical therapy clinic. From there I began volunteering at 71

the Dixie Wheelchair Athletic Association (DWAA) Games, became a swimming official for the National Wheelchair Sports Officiating Association, became a Certified National Wheelchair Sports Classifier, was appointed to the Board of Directors for the DWAA and later became DWAA Chair, and finally represented Alabama and Georgia in the House of Delegates for the National Wheelchair Sports Association. By this time I was officially hooked on professional advocacy.

These experiences taught me so many lessons that enhanced my skills as a PT. Here are a few of them: 

My job as a health professional goes far beyond treating my patients’/clients’ injuries.



My job is to develop a partnership (i.e., therapeutic alliance) with the individuals who seek my services.

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I must empathize with their situation by continuously working to understand their feelings and needs - but

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never pity them. Pity is condescending and rarely useful in a therapeutic situation. 

I must strive to continuously listen to their concerns, hopes and dreams; therein lies the truly important goals for therapy.

Legislative/Policy Advocacy I first engaged in advocacy in the American Physical Therapy Association when I was working towards a Master of Science in PT Education at UAB. Two of my professors, Gail Jensen, PT, Ph.D., FAPTA and Jane Walter, PT, Ph.D., FAPTA asked me to serve on the Alabama Chapter of the APTA’s Research Committee. I had never thought that I had much to offer this group; especially the research committee.

Still Drs. Jensen and Walter saw some potential and fostered my advocacy skills. Before I knew it, I was Chair of the Committee. Since then, I have held multiple appoints and 73

offices in APTA components including two terms as President of the APTA Aquatic Physical Therapy Section and two terms as President of the Alabama Chapter of the APTA. By far, my most meaningful activity in the APTA was as CoChair of the Patient Interest and Access Act (PIAA) Task Force. This group was charged with introducing and promoting a bill in the Alabama Legislature to allow access to physical therapy services without a referral; a fight that the PTs and PTAs of Alabama had been engaged in for 25 years.

My Co-Chair, Emmett Parker, PT, MS, ATC had been one of my former students and owns several PT clinics in Birmingham and surrounding communities. Emmett is a master at the political process. He understands how Alabama politics works and how to exert influence over the process.

He and I have very different advocacy skill sets. Emmett knows how to navigate Montgomery and was the one to work with the Chapter’s lobbyists, develop relationships with 74

the senators and representatives, and negotiate deals with opponents to our bills. My energies were focused on the PT professionals. I traveled across the state multiple times holding town hall meetings with PTs and PTAs encouraging to get involved in political rallies in Montgomery, to develop relationships with their legislators and seek their support for the bill. Supporting our efforts were a phenomenal group of Task Force members who dutifully took on responsibilities to support a wide range of coordinated efforts. PIAA was first introduced in 2011 and was soundly defeated early in the process. We were not deterred however and came back with another bill in 2012, having learned from our defeated and engaged in a whole new set of strategies. Direct access legislation was passed and enacted in July of 2012. While arduous and time consuming, this professional advocacy experience was by far the most meaningful and rewarding experience of my professional career. Along the way, I 75

developed life-long friendships with my fellow advocates that truly enriched my life. Emmett, my former student, taught me more than I could have ever taught him. Here are a few things I learned: 

The political process (state or national) is less about right or wrong – it is more about influence and having your voice be heard.



It is critical to get to know your legislators and develop a relationship with them. In that way, they will be more likely to support your cause when you need them.



Efforts to change laws and policies are rarely successful the first time. Success comes from learning from your mistakes and perseverance.



Successful teams are made from individuals with different yet complementary skill sets.

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

Success is rarely achieved by a few individuals working in isolation. Engaged teams of individuals are needed and lots of delegation to willing participants is the key to major legislative efforts.



Regardless of your profession, it is critically important to support your professional organization. Even if this simply means being a dues paying member. They are there to protect your career and their strength lies in numbers…the more the better.

Professional Innovation Advocacy This type of advocacy comes from those courageous visionaries within our professions. They are rarely satisfied with the status quo and constantly ask “what could be a better way of doing our jobs?” This type of advocacy is closely related to another positive professional characteristic; Entrepreneurship. The link to professional innovation 77

advocacy is when these entrepreneurs use their creativity to advance their profession. The individual that I think of as being most influential in my desire to engage in this type of advocacy is Marilyn Gossman, PT, Ph.D., FAPTA. Marilyn was Chair of the UAB Department of PT from 1967 until she died of breast cancer in 1998. She hired me as a UAB faculty member in 1991. Marilyn was the quintessential Innovator; always thinking of the taking that next step toward greatness.

She loved a challenge and taking on one after another, she turned our Department into one of the best in the country.

She readily shared her love of this type of thinking and deliberately fostered it in those she mentored‌including me.

My most recent experience with this type of advocacy was in 2013 when I participated in an APTA Task Force to elevate the role of the physical therapist in prevention, health and wellness. While always known for their role in rehabilitation, fewer think of PTs (including PTs) as having a role in 78

preventing injury. Having a strong interest in this issue, when I learned that such a Task Force was being formed I actually lobbied to be put on it. Luckily the other task force members were also passionate. We spent an entire year on phone conferences and in-person meetings sharing and growing our vision for the future of PT. I’m very proud of the Task Force’s final report and believe that our recommendations can really advance the profession. Such gratification is characteristic of a successful innovation experience. I know that will not be my last. My experiences of that type have taught me a few things about Entrepreneurs: 

They screen for and seize opportunities exert their innovation skills. In other words, they are “opportunity obsessed.”



They have great tolerance for risk, ambiguity and uncertainty. However, the risks they take are smart ones…with just the right amount of uncertainty.

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

They have great flexibility in their way of thinking – listening to and carefully considering all possibilities (even the crazy ones) before taking action.



They know how to handle failure. They simply step back, examine the situation, learn from the failed attempt, and do it differently in their next attempt.



They are unwavering in their pursuits. All professions need these individuals!

For me, reading Sports Rehabilitation and the Human Spirit brought back many positive memories and helped me to understand when and where my passion for professional advocacy began. I believe that my professional advocacy experiences have taken my career to one of great fulfillment.

My hope for all health professions students is that they can find their own “Lakeshore experience” and launch in the exciting and fulfilling world of professional advocacy.

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“OUT OF THE DARKNESS AND INTO THE LIGHT: LAKESHORE INSTITUTE FOR GLOBAL HEALTH TRANSFORMATION” Written by James H. Rimmer, Ph.D. Lakeshore Foundation Endowed Chair in Health Promotion and Rehabilitation Sciences

The poorer health status observed in people with disabilities and chronic health conditions including multiple sclerosis (MS) and Parkinson’s creates an unnecessary burden on the individual, caregiver and/or other family members.1 Society is impacted by the increased economic costs of supportive healthcare and community services required, and poor health is known to predict higher rates of unemployment and reduced social participation.2 Efforts to contain healthcare costs have led to shorter inpatient stays and reduced rehabilitation services. Many people are 81

discharged poorly prepared to return to their community and may begin a downward spiral leading to rehospitalization, placement in an institutional setting, and decreased functional status.3 This has created a critical need for an organization in the U.S. to bridge the existing gap between medicine and health/wellness in order to begin to address this issue on a national scale.

In 1979, Dr. Joel Feigenson, at the time a medical rehabilitation physician at Burke Rehabilitation Center in New York, wrote an editorial for the journal, Stroke, encouraging rehabilitation professionals to seek a better way to treat their patients after they were discharged from the hospital. Dr. Feigenson wrote: “After surviving a major physical, psychological and socioeconomic catastrophe, the rehabilitated stroke survivor is often shunned by society, is unable to return to work and reeducation. His savings may be depleted 82

and he may be forced to seek public assistance. It is not unusual for the stroke survivor to become depressed, withdrawn, apathetic, and bitter that modern medicine has saved his life only to have ‘The System’ make it difficult for him to resume a reasonably normal existence.”

This comment is as true today as it was 35 years ago.

A generation of rehabilitation has come and gone and people with newly acquired disability or newly diagnosed conditions such as multiple sclerosis (MS) and Parkinson’s are still in need of some type of transformative health approach that supports their transition from hospital-clinic-doctor to communityneighborhood-home. The window between a new diagnosis or disability and the return home is a critical time in which health and fitness professionals are most needed; a time when people with disabilities and those with newly diagnosed health conditions are searching for ways to optimize their health.

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Today, many people who acquire a new disability or are newly diagnosed never make the switch from ‘patient’ to ‘participant.’ They are tethered to a healthcare system that does an excellent job of diagnosing the condition and providing medications to treat and manage it but falls short in meeting the individual’s associated health and wellness needs.

Health system administrators and insurance providers, faced with rapidly increasing health care costs, too often see reducing the amount of contact time physicians and rehabilitation professionals have with patients as an important step in cost containment. It is disgraceful for a society as wealthy as the U.S. not to have a targeted, evidence-driven health/wellness program post-diagnosis or post-disability.

Life after Disability and Diagnosis Employment. One of the major challenges an individual faces after an injury or diagnosis is going back to work. Many people with newly acquired disability or a recent diagnosis of 84

a neurological condition such as MS or Parkinson’s, return to work and discover that they can no longer perform some, perhaps most of their duties in the manner or at the level they had previously performed. Unless needed supports or accommodations are provided, they continue to perform poorly and may experience reduced employment hours or even job loss. They often lose connectivity with fellow coworkers and friends, become despondent, and find they have a substantial amount of ‘free’ time that is not filled with productive, health-enhancing activity.

How big is the problem? Employment data on people with disabilities paints a bleak picture. Data from the National Health Interview Survey reported an employment rate of 80.5% for the nondisabled population versus only 46.6% for people with disabilities.4 In the Institute of Medicine (IOM) report, The Future of Disability in America, Moss and Burris5 noted that many studies have reported a decline in 85

employment rates among people with disabilities since passage of the ADA, and Mitchell et al.6 reported that people with long-term disabilities begin to experience a sharp decline in employment after age 40. This raises a very serious question: What are people to do with their time if they are not working and have limited opportunities to re-engage in community events?

Health Disparities. It’s not entirely clear if high rates of unemployment lead to health complications but one thing is clear: people with disabilities have a greater risk of chronic and secondary health conditions compared to the general population.7,8 In 2010, people with disabilities had double to triple the rates of hospital stays compared to people without disability.9 This percentage increases with the severity of disability. As a result, people with newly acquired disability and new diagnoses are often readjusting to community life after being discharged from a rehabilitation or hospital setting 86

with reduced health and functional capacity10,11 and not having the awareness, knowledge or financial resources to prevent or reduce significant, but avoidable, declines in health and function.

Secondary Conditions. While the health trajectories of people in the general population are typically impacted by lifestyle behaviors and genetics, people with disabilities or chronic conditions often have a third, less understood dimension: the onset and course of secondary conditions and their ‘weighted’ or ‘additive’ effect on changes in health and function.12-23 On average, people with disabilities and conditions such as MS and Parkinson’s report having 4 to 13 secondary health conditions.16,20,24-26 The most frequently reported secondary conditions include pain, fatigue, deconditioning, anxiety, depression, cardiometabolic disease, and obesity.16,20,24-33 These health conditions have a profoundly negative impact on health and function and in the 87

aggregate, impose substantial limitations to participation in general life activities including employment, social and community engagement and performing instrumental activities of daily living.29,33-38 Obesity. Of particular concern is the reportedly higher incidence of obesity observed in people with disabilities.1,39 As disturbing as the obesity prevalence data are for the general U.S. population, data on people with disabilities and chronic health conditions are even more alarming. Two reports on the prevalence of obesity among adults with disabilities show a disproportionately higher prevalence compared to the general population. Among adults with physical disabilities, there was a 66 percent higher rate of obesity compared to people without disabilities. In a CDC analysis of obesity prevalence data on people with disabilities,40 regardless of age, sex, or race/ethnicity, people with disabilities were reported

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to have higher rates of obesity than people without disabilities.

While obesity results in significant societal and personal costs for all individuals, among people with disabilities it further reduces or limits opportunities for various types of community participation including employment and leisure activities. Walking, climbing stairs, wheelchair transfers, rolling up ramps and other essential activities become substantially more difficult in individuals with a disability or chronic condition who are also obese.

Physical inactivity. National data sets report that people with disabilities have one of the highest rates of physical inactivity in our society.41-46 In particular, rates of physical inactivity among people with spinal cord injury (SCI) and multiple sclerosis (MS) are strikingly low. Latimer and coworkers47 reported that people with SCI spent less than 2% of their waking hours engaged in any type of structured 89

exercise or leisure time physical activity, and concluded that physical inactivity is a serious public health issue in this population. People with MS also have lower rates of physical activity, often related to wanting to conserve energy to reduce fatigue.48 Our own research has found that people with disabilities typically have much lower rates of physical activity compared to the general population,49 are likely to perform a lower amount of unstructured physical activity across the day related to work and household activity,50 and were more likely to spend much of their day in sedentary behavior (i.e., sitting).44 The recent growing awareness of the significant health consequences associated with long bouts of sitting behavior51 is a major concern for people with physical disabilities who use wheelchairs or do not stand during the day. Emerging research is substantiating the negative health effects associated with long bouts of sitting,52-56 which include 90

cardiometabolic and inflammatory risk biomarkers such as increased waist circumference, glucose, insulin, triglycerides and the inflammatory marker, C-reactive protein.52,53,56-58 A downward spiral of poor health and function can also occur when individuals transition from use of a manual wheelchair, cane or braces for community and household ambulation to a power wheelchair, maintaining or gaining personal mobility but further reducing their overall levels of physical activity.24,59 This may be particularly problematic among younger disabled populations who acquire new secondary health conditions (e.g., pain, fatigue, injury, weight gain)28,59-61and elect to use power wheelchairs or scooters in place of manual wheelchairs or other assistive devices to maintain community ambulation, thus reducing daily levels of physical activity.

Built environment. Characteristics of the built environment can have a subtle but substantial influence on the physical activity patterns of a community. Too often 91

characteristics of the built environment have a negative effect on the health status of people with disabilities. Inaccessibility of the built environment predisposes people with mobility disabilities to remain in their homes for longer periods of the day and subsequently lead to a higher incidence of sedentary behavior and reduced energy expenditure.

The built environment also creates substantial limitations in accessing outdoor and indoor physical activity programs and venues.62-66 Outdoor exercise may be unavailable because neighborhoods either lack sidewalks or have surfaces that are badly damaged; high traffic volume makes it problematic and possibly dangerous to get across streets; hilly terrain may be too difficult to traverse.67 People with disabilities who join fitness facilities often find that exercise professionals have very little knowledge about how to adapt programs or make reasonable accommodations to facilitate access to group exercise classes, exercise equipment 92

or other areas of the facility.62,65,66,68-70 Some of the more enjoyable forms of exercise that have higher rates of adherence because of their socially constructive elements – Yoga, Pilates, dance – are often not accessible or available to people with physical disabilities.

Bringing People with Disability and Diagnoses out of the Darkness and into the LIGHT:

Lakeshore Institute for Global Health Transformation There is a small window of opportunity when an individual with a disability or chronic health condition recognizes that the elements of health promotion and in particular, exercise, may become a portal to wellness. In many respects, the most effective way to do this is to immerse them in a culture of health, wellness and optimism, surrounded by a highly qualified staff and other individuals who are experiencing a similar set of circumstances in their life.

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It is widely recognized that the healthcare system in the United States is in crisis. Despite having the highest percapita health care expenditures of major industrialized nations, it has repeatedly been shown to underperform on key health outcomes relative to other countries in surveys conducted by the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD). Further, demands on the U.S. healthcare system are expected to increase substantially over the next 20 years as the post WWII baby boom generation reaches old age with the attendant increased need for medical services. As noted earlier, cost-containment strategies in health care are already emphasizing reduced contact time between patients and health care professionals.

Many people who currently are living with a disability or chronic health condition are likely to see this trend continue as the healthcare system struggles to accommodate 94

an influx of patients with chronic conditions associated with aging such as arthritis, osteoporosis, back pain, hip and knee injuries, diabetes and obesity. People with disabilities and diagnoses of MS and Parkinson’s need to move away from complete reliance on the healthcare system and embrace a wellness and health promotion focus based on the most effective evidence-based strategies to self-manage their health.

The Lakeshore Institute for Global Health Transformation, or LIGHT, has, as its core mission, to improve the lives of people with disabilities and chronic health conditions and reduce major health disparities in this population by developing health and wellness management skills derived from the highest quality research and taught through state of the science training methods. The ultimate goal of LIGHT is to demonstrate how the scientificallysound knowledge of the health benefits attainable through 95

exercise and other forms of health promotion can be incorporated into working, scalable programs that improve the health and quality of life for people with disabilities or chronic health conditions while also reducing overall healthcare costs.

LIGHT is designed to be a transformative health campus where people with acquired disability such as SCI, or people with a diagnosis of MS and Parkinson’s, or veterans and others labeled failing-to-thrive under current medical care, can experience mind-body-spirit connectivity and leave with a set of skills that will assist them in optimizing their health and function. There are many successful in-residence programs for alcohol treatment, drugs, depression and weight loss, but there are currently no evidence-based, in-residence programs that focus on teaching people with disabilities and diagnoses of MS and Parkinson’s how to take a proactive approach toward optimizing their health status. LIGHT has the 96

capacity to introduce individuals to the critical health/wellness life skills that will assist them in taking an aggressive step towards better managing their health and wellness, and in the process, find their purpose in life and transmute apathy and disillusionment into optimism and inner peace.

Three Points of LIGHT. The LIGHT model emphasizes knowledge and skill development in three essential content areas: exercise, nutrition and mindfulness. As shown in the figure, each of these has a core set of knowledge and skill elements to be mastered by LIGHT participants with the program goal being to have each participant leave with demonstrated competence in applying these skills to improve quality of life and reduce their risk of acquiring secondary health conditions (e.g., depression, loneliness, isolation, deconditioning, fatigue, obesity) or at the minimum, better manage them.

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First Point of LIGHT: Exercise as the Portal to Health Our approach begins with an emphasis on the many physical, social and psychological benefits that can be derived from developing and maintaining a physically active lifestyle.

Just as increasing rates of sedentary behavior are associated 98

with negative health outcomes, increasing rates of exercise and physical activity are associated with positive health outcomes. Further, participation in various types of exercise and physical activity provide a familiar context for engagement with the community.

In the book, Sports Rehabilitation and the Human Spirit, Mike Stephens, founder and architect of Lakeshore Foundation, describes how important it was for him to have a place to play wheelchair basketball during his recovery.

Participating in a team sport kept him engaged with friends in the community, promoted his health, and filled a void with something enjoyable and health-enhancing, both physiologically and emotionally.

Exercise can play a particularly important role for individuals who are unemployed or retired. It provides a sense of purpose by giving the individual a regular routine that they can accomplish on a daily basis; it breaks the cycle 99

of inactivity and sedentariness; and it can replace part of the void that was left after they stopped working. Joining a fitness facility is also an excellent alternative to sitting at home as there are potential social opportunities to meet other people and reconnect with community members. It also reduces the amount of time that the person is in the home surrounded by food and screens (TV, computer), both of which can have deleterious consequences on health.

Second Point of LIGHT: Nutrition as a Complement to Exercise Proper nutrition and developing healthy eating habits are vital elements in preventing chronic health conditions, and in particular, excess weight gain or obesity. Finding an appropriate nutritional pattern that is ideal for the person’s height, weight and disability or health condition requires special attention to what foods are consumed in relation to medications, associated conditions and overall health status.

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Exercise and proper nutrition each make important contributions to health, but when properly combined, they provide a synergy for achieving optimal health and wellness and reducing the risk of all-cause morbidity and mortality.

There are many issues associated with diet, food quality and behavior that need to be customized to people with various disabilities and health conditions. For example, physiologic changes that accompany a spinal cord injury may greatly diminish caloric requirements,71 although it is common for many individuals to retain pre-injury eating habits and calorie intake, leading to excessive weight gain.72 Use of certain medications to manage a chronic condition like MS or Parkinson’s may influence diet and nutritional intake, predisposing them to a higher prevalence of obesity or nutritional imbalances. Some medications reduce absorption of vitamins and minerals that are important for maintaining and improving cognition, bone and muscle quality, weight 101

management and cardiovascular health. And new research is starting to identify that the causes of chronic diseases may be more strongly associated with sugar and refined carbohydrates than fat consumption.73 In short, weight management and health protection require both exercise and good nutrition and teaching LIGHT participants how to manage them synergistically could have a substantial impact on optimizing their health and function.

Third Point of LIGHT: Mindfulness to Strengthen the Core The third element in our model involves helping participants learn to recognize repetitive negative, nonproductive thought patterns in their lives and acquire lifealtering techniques to reduce or eliminate them through increased focus and awareness on the present moment. Many scientists believe that the core elements of health begin in the mind, and that part of the risk associated with acquiring a 102

disability or health condition like MS or Parkinson’s is that the individual begins to dwell on thoughts of negativity, depression, and feelings of loss and anxiety, which substantially diminish recovery and reduce the potential effects of exercise and good nutrition.

Today, many clinicians and spiritual leaders recognize mindfulness as a valuable skill for attaining peace and contentment in life. The practice of mindfulness focuses attention on the present moment and helps people to recognize how persistent concern with perceived injustices or unfair burdens prevents us from truly experiencing life.

Eckhart Tolle, one of the foremost proponents of mindfulness and author of the book, The Power of Now, says that the key to being satisfied in life is being totally accepting of the current moment. Tolle explains that the thoughts and feelings that people have about their own life can become deeply negative and self-destructive. Reducing worry, tension, 103

frustration, fear, and negativity begins with recognizing that these are nothing more than mental constructs and that they have no power over our lives beyond that which we give them.

One of the most common techniques for developing mindfulness begins with focusing awareness on the most basic somatic activity – breathing. This offers an apt metaphor for mind-body integration. Purposeful attention, devoid of judgment, evaluation, or affect is surely one of the most primitive elements of mind. Joining purposeful attention to the most basic somatic activity helps the individual strip away the layers of emotional baggage that comprise much of our waking cognition. As the individual learns to attend purposefully and without affect, it becomes clear that much of our experience of life’s daily strife and conflict exist only as creations of the mind and, with

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continuing practice, we can greatly reduce or even eliminate their effect.

The practice of mindfulness is the natural complement to the benefits of physical activity and nutrition for the body. Developing these three elements in an integrated, in-residence program on the Lakeshore campus provides a unique opportunity for the participant to learn how to retake control of his/her life and discover joy and satisfaction in the simplest of activities. This third element of LIGHT focuses on using nature, relationship building, and spirituality as a framework for keeping the participant’s 16 to 17-hour period of wakefulness out of destructive mind patterns (i.e., negativity, self-defeat, apathy) and transforming them into acceptance of the Now. A LIGHT at the End of the Tunnel Lakeshore Foundation currently has all the resources required to initiate such a program. It has skilled, dedicated 105

staff and the capacity to provide a variety of in-residence programs. The natural beauty of Lakeshore’s campus provides an almost idyllic context for a program to enhance emotional, spiritual, and subjective wellbeing. There are many opportunities for participation in various forms of sport, recreation and fitness activities to allow individuals to experience the ‘flow’ and vitality between body and mind.

Teaching individuals appropriate cooking skills and eating patterns can reduce health complications including fatigue and obesity. Providing participants with the skills to overcome loneliness, isolation and depression can help them recapture the natural joy and inner harmony of life.

People with a newly acquired disability, diagnosis of MS or Parkinson’s, or those who simply feel they are failing to thrive in their current treatment regimen, can be taught how to reduce the imbalance between negative and positive thought patterns and develop self-management skills for 106

optimizing their health. Mike Stephens has a powerful quote in the book, Sports Rehabilitation and the Human Spirit, which relates to the importance of reestablishing control over negative mind patterns: “Trust that in the mystery of the brain resides our destiny and spirit, and, if we can escape its clutter of impressions, we may find our places in society.”

Today, both doctors and rehabilitation professionals struggle with discharging patients from hospitals and rehabilitation clinics with a lack of health/wellness skills that they can use to transform their lives from ‘patient’ to ‘participant.’ There are many people with and without disability and diagnoses, health professionals and federal agencies that are waiting for someone to turn on the LIGHT. Mr. Mike Stephens, master architect of Lakeshore Foundation, and Jeff Underwood, President of Lakeshore Foundation, have prepared this world-renowned campus for its next genesis: a science-based transformative health 107

institute -- LIGHT -- that can model a truly holistic approach to health and wellness for people with disabilities and diagnoses of MS and Parkinson’s. Winston Churchill famously said, “This is not the end; this is not even the beginning of the end; but it may be the end of the beginning.” Let this be the end of the beginning.

DR. RIMMER’s REFERENCES CAN BE FURNISHED UPON REQUEST

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“REBUILDING BODIES, RESTORING LIVES” Written by Carroll Papajohn 1st place, student essay contest Sports Rehabilitation and the Human Spirit is the original story of the Lakeshore Foundation, an internationallyrecognized rehabilitation, education and athletic complex for physically disabled individuals located in Homewood, Alabama. The formation and maturation of this cutting-edge facility is told primarily through the eyes of its pioneering founder, Michael “Mike” E. Stephens, who was himself the patient of a rehabilitation facility following a devastating diving accident in his mid-twenties. A number of themes permeate the book, most notably society’s misconceptions about the mental and physical state of disabled individuals, the power and role of the human spirit in healthcare, and the good that can result from changing the status quo.

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Through reading the book, these themes unified to give me a new perspective on life and business that I believe will make me a better hospital administrator. Sports Rehabilitation and the Human Spirit taught me the necessity of accounting for the spiritual and emotional health of patients, the efficacy of a goal-oriented approach to leadership and motivation, and the importance of evaluating a professional opportunity from an unbiased perspective. By applying these lessons on a daily basis, I know that the story of Mike Stephens and the Lakeshore Foundation will resonate throughout my career for years to come.

Early on in his tenure at Lakeshore, Mike realized that the organization was adequately addressing one dimension of patients’ needs, but completely neglecting other aspects of their care. While the hospital’s physical and vocational rehabilitation services were building patient’s strength and bolstering their employment prospects, nothing Lakeshore 110

did was explicitly aimed at addressing the emotional and spiritual well-being of patients. The standard operating procedure for a rehabilitation hospital at the time was to quickly address the physical needs of a patient and then abruptly reintroduce them into society. Mike understood firsthand how this jeopardized a patient’s ability to reintegrate with the able-bodied world and, in essence, set them up for failure. Therefore, he relentlessly dismantled this approach to rehabilitation and, in the process of doing so, created the new standard of care for these patients. He focused Lakeshore’s efforts on empowering patients to achieve the highest level of independence that was realistic in their individual circumstances, offered patients outlets for physical exertion that strengthened their bodies as well as their minds, and expanded services to include patients of all ages and socioeconomic backgrounds. By refocusing Lakeshore’s priorities on patients as a whole, rather than an 111

isolated physical disability, Mike successfully created programs that built up patients mentally, physically and spiritually. It would be difficult to overstate the magnitude of this change and its effect on patients; for the first time, patients at Lakeshore and the facilities it would later inspire had at their disposal facilities and services meant to care for their complete selves, not just their disabilities. Witnessing this impact through the personal stories of patients and staff at Lakeshore has inspired me to ensure that I always focus on patients as a whole, rather than the sum of their illnesses, as I move into my career as a hospital administrator. Too often the individuals tasked with managing healthcare facilities lose sight of their ultimate calling, which is to improve the quality of life in all possible respects for their patients. Mike’s actions and accomplishments at Lakeshore stand as an ideal example of the way in which hospital executives should approach their work.

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Sports Rehabilitation and the Human Spirit also taught me the effectiveness of goal- oriented motivation, which will serve me well as I lead my future staff towards the common goal of caring for our patients’ minds, bodies and spirits. The book is filled with anecdotes about Lakeshore patients throughout the years, and a common theme of them all is the centrality of goal-orientation to their rehabilitation. Time and time again, patients stated that having a competitive and physical outlet—whether they were competing against themselves or other disabled individuals—allowed them to set goals and blow past them for the first time in their lives. In turn, accomplishing goals engendered a sense of accomplishment in these patients, which motivated them to further prove to themselves and others that their disability was not going to hold them back from living a full, productive life. This motivation proved to be contagious, as other patients at Lakeshore observed 113

these individual victories and began to crave their own.

Those patients then set and accomplished their own goals, improving their lives while motivating still more patients to do the same; over time, this cycle created a snowball effect that completely changed the lives of every patient who walked through the doors at Lakeshore. This book vividly showcases the power of goal-orientated motivation, and I plan to carry these lessons into my future role as a healthcare leader. If focusing on a goal can motivate an individual who has, in many cases, given up on leading a full, productive life due to their circumstances, I am certain that it can motivate my future staff to achieve at their highest level, both professionally and personally.

Furthermore, observing the successes of co-workers will inspire others in my department to seek out and achieve their own goals, replicating the snowball effect seen at Lakeshore. By applying the concept of goal-orientation to 114

my day-to-day management of hospital staff, I know that I will be able to better serve them as a leader and help inspire them to achieve their goals.

While Sports Rehabilitation and the Human Spirit has highlighted a number of specific attributes I want to carry into my future as a hospital administrator, it has taught me even more about the decisions that will inform the projection of my career. When Mike Stephens entered graduate school, he did so with a singular goal in mind: becoming a senior administrator at an acute care hospital. He took all of the necessary steps towards accomplishing that goal; he worked hard in his graduate studies and was selected for a residency at a multihospital health system, Baptist Medical Centers (BMC), which was the traditional stepping stone into the type of position he desired. He even served as Co-Administrator of Baptist Medical Center Montclair, an acute care 115

hospital, following the mass exodus of senior leadership in the wake of the departure of BMC’s President and CEO, L. R. “Rush” Jordan. However, when BMC’s new President and CEO, Emmett R. Johnson, called a meeting towards the end of Mike’s residency to discuss his future with the organization, the position Mike had worked so hard for was not on the table. Rather, Mr. Johnson asked Mike to assume the Executive Director role at Lakeshore Hospital, a rehabilitation hospital in the nascent stages of development. Mike had serious reservations about Lakeshore Hospital and the implications for his career of taking such a position, and he couldn’t shake the feeling that he had been typecast for the position because of his history with paralysis and physical rehabilitation. Despite his concerns, Mike accepted the position and started down the path that would ultimately lead to the Lakeshore Foundation.

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Along the way, Mike found immense personal and professional success; developed a deep, motivating passion for the work that he was doing; and revolutionized the world of physical rehabilitation. His story stands as a testament to the value of pursuing an opportunity regardless of the preconceived notions or expectations one might have. This idea is particularly prescient in my life, as I was recently forced to make a similar decision; Mike’s story has given me the confidence to know that my decision was the right one, and has inspired a genuine excitement in me as I move into my own residency. In the future, Mike’s story will serve me well as I evaluate potential professional opportunities, and I will never again allow biased opinions to cloud my judgment or make me question my decisions.

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The story of Mike Stephens and the Lakeshore Foundation is one of passion, commitment to the service of others, and achievement in the face of formidable obstacles. Mike took Lakeshore, a nascent project stricken with money woes and societal disregard, and, by force of will, grew the organization and its influence to its current state. His work has changed the lives of countless individuals across the country and helped to shift society’s view towards individuals with disabilities. While there are numerous lessons to be learned from Mike’s story, I was most moved by his commitment to the treatment of patients as a whole, his use of goal-oriented leadership and motivation in the rehabilitation process, and the way in which he approached his personal career decisions. His story has also inspired me to seek out ways to volunteer with organizations like Lakeshore; while running a half marathon last week with the lessons of this book fresh in 118

my mind, I hit upon an idea to connect runners and individuals with disabilities who want to participate in road races. By committing to the principles laid out in this book and allowing the story of Lakeshore to inspire my own actions, I know that I will a better hospital administrator and—more importantly—person than I otherwise would have become.

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“THE HUMAN SPIRIT�

Written by Spencer Hall 2nd place, student essay contest The afternoon sun warmed Steve and me as we paddled in a canoe across Porcupine Reservoir in northern Utah. Although I had been in a canoe many times before, I felt apprehensive about this trip. I had never been guided by someone who was blind. Despite the apprehension, I was amazed at how well my friend could guide us across the reservoir safely. As a volunteer at Common Ground Outdoor Adventures, I helped people with disabilities participate in outdoor activities. It was amazing to see how people came alive when they had the opportunity to do something that they never thought was possible. The story of the Lakeshore Foundation and of Michael Stephens reminds me of the inspiring people I worked with at Common Ground. The most important things I learned 120

from the book, Sports Rehabilitation and the Human Spirit, are: focusing on the patient, determination, learning how to change the things I can, and how to help others by sharing my own experience.

In my Masters of Science in Healthcare Administration, the same program that Michael Stephens went through, I have learned to put the patient first. Providing the best quality care for each patient is the primary goal for all health services. Although, my program focuses on the business side of healthcare, it is crucial that I have the patient in mind when I make business decisions. Currently, the insurance market is in turmoil trying to provide access to healthcare to as many people as possible. This is a difficult task when hospitals, doctors, and insurance companies all want a piece of the pie. I have heard the phrase “no margin, no mission� many times in my program. This seems to be the story with the insurance companies that were paying for 121

the ReLife program in the Human Spirit. The ReLife program provided personalized and comprehensive treatment for each patient. The goal that Michael Stephens set for ReLife was to provide exceptional service to patients.

Insurers paid for the comprehensive services for a while, but as Michael put it - “they got greedy.� Soon, the insurers wanted to cut back on the services provided and only follow a set program for each patient regardless of whether it was the best possible care for the patient. From Michael’s point of view, this move by the insurance companies did not focus on the patient. In my career as a hospital administrator, I hope to not make the same mistake as the insurers and instead help provide the best possible care for each patient. Michael Stephens was a great example to me of determination. He made the decision to walk even when his neurosurgeon told him that he would probably never walk again. A fire and determination was kindled in Michael 122

when he felt the first sensations return after his surgery.

This fire was tested many times in the Spain Rehabilitation Center at UAB. Michael was so determined to walk that he annoyed the nurses and ultimately got kicked out of the rehab center. Michael’s determination is what helped him overcome so many obstacles in his journey at the Lakeshore Foundation. This kind of determination is what I hope to have as I begin my career at Genesis Health System in Davenport, Iowa. I am sure there will be challenges and mistakes that will test my will to succeed. I will remember Michael, who did amazing things at Lakeshore because of his determination.

As I was reading the stories from the people at the Lakeshore Foundation, I was reminded of the serenity prayer. “God, grant me the serenity, to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.� I say this prayer many 123

times each day. It reminds me to let go and let God worry about the things that I cannot control. I find a great deal of peace in my life because of this prayer. Bob Lujano was one person that reminded me of the serenity prayer. He had both arms and both legs amputated. I think it would be easy to get bitter, depressed, and give up on life if I faced the challenge the Bob had. Bob, however, did not give up. He accepted that he could not get his arms and legs back. The courage that he had to keep going was a gift that allowed him to eventually play basketball or as they call it at the Lakeshore Foundation, “murder ball.� Now Bob is able to share his experience, strength and hope with the kids that come to the Lakeshore Foundation after having the same procedure done as he had as a boy.

One of the most important things I learned from Michael Stephens is to help others by sharing my experience. I think Michael has been such a great CEO of the Lakeshore 124

Foundation because of his experience. The Spirit of Lakeshore is really driven by people sharing their experiences to give others hope. Humans are built for connection. The human spirit comes to life though connecting with others, especially when they have similar experiences. The 12th step of the Alcoholics Anonymous program for recovery is all about working with others. This step is key to an alcoholic’s sobriety. This same principle of working with others also helps those who are disabled. The Lakeshore Foundation allows those with disabilities to help others with the same challenges. It allows them to connect with the struggles of life. It provides physical and emotional healing. They have a support group, which helps them know that they are not alone in their struggles.

As Steve and I rode the bus back to town from our canoe trip, I couldn’t believe that I was just guided in a canoe by a blind man! I was amazed at how he had 125

overcome so many challenges in his life. The Lakeshore Foundation provides these types of experiences every day for people with disabilities. I hope to be able to use the lessons I learned from the Lakeshore Foundation as I start my career. Michael is a great example of truly pursuing a mission, a mission to let the human spirit free. I hope to have the same focus on patients, the determination to succeed, the courage to change what I can, and to help others by sharing my experience. The human spirit truly is remarkable.

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“CAPTURING THE SPIRIT OF LAKESHORE” Written by Jason E. Vice 3rd place, student essay contest When my father was admitted to Lakeshore Rehabilitation Hospital almost five years ago, little did either of us know the impact it would have on our lives. The fateful events that had brought us to the facility would reverberate into all aspects of our being. A stroke, quick and painless, had left my father a semblance of the strong and determined individual he was before. The situation seemed desperate, but then a social worker told us about Lakeshore Hospital. At Lakeshore, patients were asked to participate in daily, intensive therapy sessions that were integrated into a plan based on the individual’s specific needs. Once again, we had hope.

Hope is the cornerstone of the human spirit and at Lakeshore it was not in short supply. Although each day 127

brought new challenges, they also brought along a glimmer of possibility. For my father, this meant the possibility of recovering many of the skills and abilities he had lost following the stroke. Daily sessions with speech, physical, and occupational therapy practitioners meant that he was receiving the kind of treatment necessary to facilitate living the most independent and successful life possible. For me, it meant the possibility of something radically new.

My experience with the rehabilitation process had a most unintended consequence. As I witnessed my father’s progression and attempts to implement the adaptive techniques we had learned, it became apparent just how vital having the ability to participate in occupations of meaning and importance are to everyday life. What might seem to some a simple success, such as feeding oneself or putting on shoes, seemed to inspire my father the most to engage and participate in the activities set before him at Lakeshore.

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As a result of my experience at Lakeshore Rehabilitation Hospital, a new desire was born within me.

I realized the significant impact I could have on an individual’s life, if I were able to guide them toward successful participation in activities that held personal value. It was at this time that I embarked on a journey that would hopefully culminate in my entry into the field of occupational therapy, a profession that strives to help individuals live life to the fullest.

A successful first step on this endeavor was being accepted into the entry--�level occupational therapy program at the University of Alabama at Birmingham.

During my first few days on campus, my classmates and I were given a book by our department chair. The book, entitled Sports Rehabilitation and the Human Spirit, told the story of the Lakeshore campus and how an entity known as Lakeshore Foundation came to weave its way into the 129

hearts of individuals in the Birmingham community and beyond. Knowing what Lakeshore Hospital had done for my father, I was intrigued to discover how Lakeshore Foundation was going beyond to improve the quality of life for those with physical disabilities.

As I began to read, I discovered many lessons that enhanced and bolstered the skills we were learning in our graduate school coursework. The first lesson I recognized is that meaning is of utmost importance in ensuring long--‐term, successful outcomes. Anita Smith (2013) related how, prior to 1981, “graduates” of Lakeshore’s programs were failing to maintain successful work occupations and turning instead to social support programs. What they discovered was that people needed something “meaningful and stimulating” (p.

104) to increase their sense of independence. For graduates of Lakeshore, that place was the George C. Wallace Recreation Center.

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This sentiment is mirrored in the Occupational Therapy Practice Framework (2008), which explains how occupations are fundamental to a person’s identity, reflect their individual values, and have a “particular meaning” (p. 628) for the individual. When individuals experience circumstances or limitations that prevent them from participating in occupations that are important, they are said to be experiencing occupational deprivation. Occupational deprivation can lead to health problems and depression, a characteristic of Lakeshore graduates before the opening of the Wallace Center.

The second lesson I discovered is there is no one--‐size fits all approach to healthcare. Mike Stephens and ReLife achieved their greatest success when using a “tailor--‐made” approach to meeting the needs of their patients. This approach included making rapid modifications and adaptations to the types of support that patients were 131

receiving. The effect was that for each patient, the chance of recovery was maximized to the greatest extent possible (Smith, 2013, p. 169).

This also reflects a fundamental belief in occupational therapy that the design and implementation of interventions should be client--�centered. By using a client--�centered approach to treatment, an occupational therapy practitioner is able to ascertain what is important and meaningful to the client. In this manner, interventions are more likely to increase the client’s volition to participate in treatment and in turn, increase their rate of success.

Consequently, I determined from the story of Lakeshore that achieving success requires active participation.

Looking back on those served, Mike Stephens noted that the most successful graduates achieved independence by using Lakeshore as a support system, not a nursing system 132

(Smith, 2013, p. 327). Individuals, such as Bob Lujano, took this principle to heart when working with patients at Lakeshore Foundation. Years of experience in dealing with his own disability taught him how active engagement in meaningful occupations builds confidence in the ability to function independently in everyday life. Evidence of this principle in practice can be seen from Bob’s interaction with then 11--‐year old Mark Zucker, whose growing confidence in his wheelchair abilities spread into his other activities of daily living (Smith, 2013, p. 257).

Occupational therapy interventions are based on both theory and evidence. The Model of Human Occupation, an application of general systems theory, supports the idea that an individual’s successful participation in occupation can provide positive feedback that reinforces volition, habituation, or performance capacity. The confidence gained from success, no matter 133

how small, can positively influence the person’s sense of competence and identity in other areas of their life (Kielhofner, 2008) Another valuable lesson I learned is that an individual’s success is everyone’s success. Smith (2013) tells us that a crucial element to ReLife’s tailored approach was patient education (p. 167). The education of patients served a dual purpose: not only setting individuals up for reentry into society, but also ensuring they be productive members once they return. Mike Stephens and his team realized that ensuring a patient’s success benefited both the individual and society as a whole.

The decrease in patient readmission rates corresponded with a reduction in the need to rely on social welfare for support.

Occupational therapy practitioners use a variety of therapeutic modes when working with their clients. One of 134

these, the instructing mode, emphasizes the education of clients in therapy and provides training and rationale for the performance of occupational activities (Taylor, 2008, p. 80). Such techniques are often used to teach strategies and educate clients on incorporating healthy habits and routines into their daily activities. For the client, a healthy lifestyle means a diminished likelihood of illness and hospitalization, which in turn means a decrease in loss of productivity for society.

The final point I took from the book is that physical wholeness does not equal spiritual realization. Society seems to place many demands on individuals and it is often hard to keep up. Our hectic schedules leave little time for soul searching or spirituality. It is unfortunate that many must face some physical or emotional crisis before they are motivated to look within themselves for something greater. It was not until his accident that Mike Stephens 135

began to reflect upon the choices he had made in his life.

His brush with death revealed to him great insights into the human spirit: its ability to inspire, persevere, and most of all to hope.

Occupational therapy takes a holistic approach when considering a client, looking at factors such as body structures, body functions, values, beliefs, and spirituality.

No one component is greater than the next, nor does any ensure a client’s independence in everyday life. Beyond anatomy and physiology, a person is motivated to engage in occupations through their values, beliefs, and spirituality. According to the Occupational Therapy Practice Framework (2008), spirituality is “the personal quest for understanding answers to ultimate questions about life, about meaning and about relationship with the sacred or transcendent… (p. 633). Factors such as spirituality can

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influence performance in physical areas, even when functions or structures are absent.

In Sports Rehabilitation and the Human Spirit, Mike Stephens posed a question. If not for his life--�changing accident, would he have found his true calling (Smith, 2013, p. 326)? While we have no way of knowing the many paths we could have taken, we can only hope that there is some force guiding us toward our true direction.

In the same fashion, I have often questioned where I would be today, if not for my father’s stroke in 2009. I choose to believe that many of us are called to serve others and it often takes a fateful event, such as these, to open our eyes to the paths set before us. Whether we call this force fate or destiny, I believe this is the same spirit that has inspired so many at Lakeshore to overcome adversity and to set out on a journey of true meaning and success.

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“LAKESHORE FOUNDATION TODAY” Written by Jeff Underwood President, Lakeshore Foundation Forty years ago, a group of patients at a community based rehabilitation hospital, first took to the courts in an effort to use sport to improve their lives. They weren’t even a team yet but at that moment, the Lakeshore spirit was ignited.

A spirit that today is stronger than ever. Initially, this activity and those that followed were designed to serve a hospital, then a community, next a state, and today the spirit of Lakeshore Foundation touches the nation and the world. The understanding that people with disability can benefit greatly from exercise, physical activity, recreation and sport remains at the very center of everything at Lakeshore Foundation.

Evidence abounds of Lakeshore’s growing reputation, reach and impact. Dozens of cities from around the U.S., many far larger than Birmingham, have visited to see how 138

they too might have a Lakeshore-type program in their community. Our staff is clearly our greatest asset. Lakeshore professionals are sought out nationally and internationally to share expertise and serve as a resource to related organizations. The top national physical activity and disability researchers and funders are visiting and supporting our work.

People with disability from around the globe are connecting to Lakeshore to participate in programs and seeing the positive results they produce first hand.

In pursuit of our mission, our work falls into three general areas, with strong integration among the three; Programs, Research, and Policy and Advocacy.

PROGRAMS At the center of Lakeshore’s mission are our programs. Removal of barriers to allow people with physical disability and chronic health conditions to have equal access 139

to exercise, sport, or recreation is one of Lakeshore’s highest priorities. Physical activity and health promotion are important for everyone but even more so for people with disability as they are more susceptible to secondary health conditions such as pressure ulcers, obesity, reduced muscle strength, falls, and cardiovascular issues. Furthermore, many people with disability struggle with low self-esteem, poor socialization, and isolation. Involvement in an exercise program can mitigate these conditions.

Our programs cover the life span and include a wide range of activities, all adapted where needed to be as inclusive as possible. Daily fitness and aquatics are the most popular programs. We also offer a variety of recreational and competitive athletic opportunities as well as outdoor pursuits such as water sports, biking, and hunting.

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Our programs are divided into three areas: community-based, elite athletic training, and injured military.

Collectively, these programs serve approximately 4,000 individuals annually. Additionally, we offer programs for many of their families because we understand the importance of helping those we serve to create a network of support to maintain a healthy lifestyle.

We often refer to our community program as the “heart and soul� of Lakeshore. The men, women, children and youth who frequent our facilities on a regular basis are not the high profile athletes or the heroes of military service, and they rarely get the attention from the media that those other groups deservedly do. But these community members work just as hard and fight the good fight to overcome the challenges of living well with a disability or chronic health condition so they may pursue the most active, independent and healthy lifestyle possible. They know, as we do, that in 141

being physically active and healthy they can lower their health care costs, minimize their dependence on others, and lead a socially engaging and healthy life.

Our facilities include a fieldhouse for club sports, walking and cycling, a fitness center, aquatics center with two pools, shooting range, and tennis courts. Most of the individuals who fall within our mission participate in our community or membership programs. Note that those we serve at Lakeshore Foundation are not “patients;� on the contrary, we consider them members, athletes or clients.

The membership program is fee-based and generally in line with similar types of community-based fitness facilities.

However, we turn no one away who falls within our mission and over one-fourth of our clients have a subsidized membership.

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As mentioned, the first activity forty years ago was wheelchair basketball. Sport has been a mainstay of Lakeshore programs ever since, and from that humble beginning a world class athletic program has emerged.

The development of Lakeshore’s athletic program and role as a U.S. Olympic and Paralympic Training Site is well chronicled in the book, “Sport Rehabilitation and the Human Spirit,” written by Anita Smith. Today, it is clear that Lakeshore has established itself as a leader among training sites. On a recent visit, USOC CEO Scott Blackmun told the Birmingham media that what the U.S. needs to maintain its Paralympic competitiveness internationally is “ten more Lakeshores.” In 2013 the USOC presented Lakeshore with the prestigious Rings of Gold Award for our youth sports programs. At Lakeshore we are training today’s elite athletes and developing tomorrow’s future stars

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Our Paralympic training activities focus on three sports: wheelchair rugby, men’s and women’s wheelchair basketball, and goalball. We currently serve as the home and quasi-national governing body for Team USA Wheelchair Rugby. Not surprisingly, Team USA is number one in the world.

While we are proud of our work in sports and the relationship with the USOC, for us it is not about the medals and championships. The value is in the boost to our community and state’s image and reputation, our contribution to the overall movement of adapted sport, and most of all, the opportunity that being a training site presents to a young child with a disability who can observe and interact with elite athletes to see the possibilities that they too can achieve. The power of sport is tremendous.

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In 2006 our servicemen and women were in conflicts around the world, serious ones; first Iraq, eventually Afghanistan. Military training and deployments intensified and as a nation, we witnessed the growing incidence and complexity of disabling injuries. At Lakeshore we knew that adapted sport and recreation could and should be a part of the rehabilitation and community reintegration of these men and women, and we felt an obligation to do our part. Two early decisions proved to be important to our success; include the family and pay for the entire experience, from their home town or base and back, on our nickel.

The military and the community responded. Once we had the opportunity to educate the military and VA establishment about the Lakeshore spirit and once the community learned that funding was needed, our program took off. From what started as one annual long weekend of adapted sport and recreation primarily serving a state or 145

regional population, has now grown into a national initiative with seven long weekend programs and a community program that combined, served close to 2,000 people from over 45 states and territories over the last eight years. This program, branded as “Lima Foxtrot� (think Lakeshore Foundation, Live Fit, or better yet, Liberty and Freedom), has become part of our identity and even though wars and conflicts leading to injuries are fortunately on the decline, the needs of those now injured never goes away.

While physical activity is the core of what we do programmatically, we understand the importance of other factors in the overall health of those we serve. Proper nutrition, stress reduction and other health promotion initiatives are now included in all our program areas.

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RESEARCH While we know from our everyday experiences that our programs result in improved lives, others also need to know and be provided with data and evidence that these programs are effective. It is not enough that we at Lakeshore understand the benefit of physical activity for people with disability; health care professionals need to know, elected officials and regulatory administrators need to know, business people concerned about wellness and health care costs need to know, and family members and caregivers need to know. It is only through research-driven data that these leaders will be convinced that the proper exercise program may work just as well as a drug, a surgery, or some other intervention.

Further, through technology-related research we can literally and virtually bring physical activity into the homes of people worldwide. We can find new ways to adapt existing 147

equipment and even gaming devices to promote and increase physical activity to more isolated areas and to people whose disability makes it very difficult to even leave the home.

After several years of operating research as a department of Lakeshore Foundation, it was realized that greater needs, opportunities and accomplishments could be achieved through a different organizational model. This process led to the creation of the University of Alabama at Birmingham (UAB)/Lakeshore Research Collaborative, established in 2009 and then coming to full fruition in January 2012 when Jim Rimmer, Ph.D. assumed the position of the inaugural holder of the Lakeshore Foundation Endowed Chair in Health Promotion and Rehabilitation Sciences in the School of Health Professions at UAB. Dr. Rimmer has been the leading voice and most successful researched in the U.S. in the area of physical activity and disability; the “founding father� so to speak of this body of 148

research. His move to Birmingham signaled to the world that the longstanding programmatic work of Lakeshore, now combined with the considerable research expertise of UAB, would create a new epicenter for expertise on physical activity and disability.

Two of the cornerstones of Dr. Rimmer’s work that he both brought to the UAB/Lakeshore Research Collaborative, and also subsequently was awarded competitive renewals, are the National Center on Health, Physical Activity and Disability or NCHPAD (funded by the Centers for Disease Control and Prevention) and the Rehabilitation Engineering Research Center on Interactive Exercise Technologies and Exercise Physiology for People with Disabilities (funded by the National Institute on Disability and Rehabilitation Research). Both programs are housed at Lakeshore Foundation. Rimmer has also successfully competed for several other grants all focused on 149

improving the health of people with disability through better access to physical activity. In the two and a half years since the Research Collaborative has been operational under his leadership, over $18 million in grant support has been secured, over 30 jobs created, and the work is just beginning.

POLICY AND ADVOCACY Research-based evidence and proven, replicable models on the beneficial impact of physical activity for people with disability is crucial, but the process cannot end with the publication of research results. Thus, the third leg of the Lakeshore stool is advocacy and policy. Simply put advocacy and pursuit of policy change is what puts research into action and ensures that research results indeed benefit people with disability.

Despite our forty years of work, barriers remain not only in our community but across the globe that effectively 150

block people with disability from fully engaging in appropriate and essential physical activity. Often only policy change will eliminate these barriers, which include reducing financial considerations; increasing affordable and accessible transportation; providing better access to facilities and equipment; improving the level of trained staff; and perhaps most importantly, increasing the inclusion of people with disability into all areas of community health and wellness.

The main thought behind Lakeshore Foundation’s commitment to advocacy and policy work is that we must talk not only about what we do and where we do it, but why it is important. We must also encourage, if not push a bit, health care providers, caregivers, family members, and people with disability, to be active. Today you will find Lakeshore “at the table� representing people with disability in local, state, national, and international conversations, supporting the rights of people with disability. We believe in the idea of 151

“nothing about us without us,� meaning that those with disability need to be in the conversation about matters that affect them.

NO LIMITS The seeds planted when that first group of rehabilitation patients began their wheelchair basketball team forty years ago have clearly grown into something no one would have comprehended. The opportunities continue to present themselves for Lakeshore Foundation to be an international leader in physical activity and disability, and to be a resource to the entire movement. There is now serious discussion underway about a transformational redevelopment of the campus itself using some visionary thinking from a recent Loeb Fellows Planning Charrette as well as thoughts and ideas from our staff, Board, and clients that will create a strong sense of place campus wide. Among the guiding 152

principles for this redevelopment are sustainability, accessibility, connectedness to our environment, and creation of special places indoors and outdoors that are conducive to a healthy and independent life.

Sports Rehabilitation and the Human Spirit chronicles not only the story of Lakeshore but the stories of the people who make up this extraordinary organization. As we move forward, those stories will continue to evolve and new ones remain to be told. With that, our vision “To improve the lives of people with disability around the world.� gains more focus each day. The spirit of Lakeshore has never been stronger.

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EPILOGUE “LEARNING IN CONTEXT: IT’S NOT JUST FOR STUDENTS” Written by Donna J. Slovensky, Ph.D. Associate Dean for Academic and Student Affairs, UAB School of Health Professions After Mike Stephens approached him about using Sports Rehabilitation and the Human Spirit as a teaching tool in the School of Health Professions, Dean Harold Jones brought the idea to his administrative team. The immediate response was enthusiastic support for the idea, quickly followed by discussion about the most effective approaches for student engagement in the endeavor. This discussion was the first of many, resulting in a dynamic planning experience that continued for many months, with the team proposing 154

and selecting activities and events that eventually culminated in this manuscript.

Some of the early decisions were fairly straightforward, such as which administrative unit would manage the activities (the Office of Student Success) and how soon we needed to get started (next week!). Other decisions, however, were more challenging, none more so than those connected to issues we did not anticipate in our plans. As our goals for disseminating the benefits of this experience evolved, we became determined to share the lessons we learned about designing and implementing such an activity along with the descriptions of our scheduled activities and the student and faculty essays.

The School of Health Professions’ 28 academic programs delivered 900 courses to a combined enrollment of 1200 students in academic year 2013-14, the time frame for 155

these events and activities. Thus, scheduling quickly became one of our first and most enduring challenges. Although participation in the book events was by invitation to students in five graduate programs (described elsewhere), we still were planning for more than 425 students, plus faculty and invited guests for some events. In addition to finding common time across the five programs to schedule events, we needed a venue to accommodate approximately 500 people. Although we were able to identify several potential locations on the campus, availability during our preferred time had to be balanced with the cost of renting the space. The location selected for our inaugural event, a moderated discussion between Dean Jones and Michaels Stephens and Anita Smith, was satisfactory, but we were unable to secure a similar venue for a large event to “close out� the series. Our lesson learned was that subsets of the larger group were more manageable with regard to student schedules and meeting locations. Thus, 156

some events were open only to one or two programs, or were scheduled more than one time. If space for a very large group is needed for an event, early negotiation of date and location is essential.

A second challenge was integrating the book effectively into program curriculums. We were committed to our “learning in context” approach, and wanted to use examples from the book in multiple classroom discussions and student work products. Often, the “best” program course to incorporate discussion of this book was scheduled for a term other than the one in which we sponsored the series. Although we expect faculty will continue to use examples from the book as those courses are taught, we did not achieve the degree of saturation of book concepts we had anticipated in some courses. Our lesson learned from this challenge was to encourage incorporating components of the book anywhere they are appropriate in a curriculum and not focus on the 157

“book discussion series” timeframe. In short, we believe the value of this book to the learning experiences of our students is not limited to the formal programming that occurred during one academic term.

Student engagement in cross-disciplinary events proved to be a third challenge, attributable in part to scheduling difficulties. Book discussion activities not incorporated in regular program classes faced competition with other demands on students’ time – studying, volunteer activities and fieldwork, and other personal and professional responsibilities. With multiple demands on their limited free time, students prioritized according to their personal criteria.

For example, we learned that prize money is an insufficient incentive for writing a non-credit essay when it pulls time away from preparing for comprehensive exams! Students responded well to the content of the book and to the discussion activities in which they participated. However, not 158

all students participated with the larger group to the extent we desired. Our lesson learned was that this teaching approach, just as any other approach, does not meet the needs of all learners. While we were deliberate in our attempts to provide a variety of activities and to offer events at different times of the day, with more faculty involvement in planning we can tailor events to coordinate better with concurrent program demands and student learning preferences.

Despite these and other challenges, we are very pleased with our foray into incorporating a book of this type into our academic programs’ portfolio of teaching approaches.

This book was special to our school for many reasons, including the long-standing friendships many of our faculty and administrators have enjoyed with Michael Stephens and Anita Smith. More importantly, however, the book is an effective medium through which health professions

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students can learn about the unique context of healthcare for individuals with disabilities.

Located in Birmingham, Alabama, our vision is to be recognized as the leading school of health professions – shaping the future of healthcare.

Our mission is to improve the quality of health through teaching, research and translation of discoveries into practice.

For more visit www.uab.edu/shp.

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