PARAPLEGIA NEWS FEBRUARY 2021 Accessible & Autonomous Emerging transportation options Virtual Reality Therapy program helps veterans

Smart Security Keep your tech gadgets safe

contents FEBRUARY 2021 VOL. 75 NO. 2

ON THE COVER Paralyzed Veterans of America Texas Chapter National Director Anne Robinson is diligent in protecting the smart device security inside her home. Photo by Harry Robinson/Illustration by Kerry Randolph/© Getty Images Stephen Brashear/Bill Oxford 2424 18 18 24

FEATURES

18 Where To? 30 Virtual Therapy Rory A. Cooper, PhD, & Brad Dicianno, MD Brittany Martin Autonomous vehicles are still in various stages of Virtual reality is helping veterans with SCI/D development, but they hold great promise to help in St. Louis to improve their mental and people with disabilities travel faster, safer and physical health. more easily.

24 Halt The Hackers Amanda Laverman Smart home technology and smart devices provide convenience and independence, but it’s important to manage security risks.

ALSO IN THIS ISSUE ...

6 Contributors 35 Newsbeat 46 Index of Advertisers 6 Editor’s Desk 42 Sports & Rec 47 And Finally ... 9 PVA Chapter Roster 43 PVA Service Office Roster 11 PVA Points 46 Classified Ads Visit us online at pnonline.com

If you like wheelchair sports and recreation, you’ll love our sister publication — SPORTS ’N SPOKES! Preview online at sportsnspokes.com

“People who initially begin a stretching routine may find their range is limited from longtime seated positions, but all wheelchair users would benefit from stretching on a daily basis.”

— Arthur Jason De Luigi, DO, MHSA 38 30 38

DEPARTMENTS Now in its 75th year and the official publication of Paralyzed Veterans of America, PN is a national, monthly magazine that covers news, health, research, lifestyle and issues of interest and concern 8 PVA From the Top to veterans and others with spinal-cord injury and disease. Anyone interested in submitting an article to PN should consult the Contributors Guidelines found on our website at pnonline.com. David Zurfluh PN neither endorses nor guarantees any of the products or services advertised in the magazine. Readers should thoroughly investigate any product or service before making a purchase.

10 Reasons & Remarks PN STAFF Tom Fjerstad TOM FJERSTAD STEVE MAX Editor Advertising Representative Ext. 100 / [email protected] 215-284-8787 [email protected] SHERRI SHEA 13 On The Hill Operations Manager ANN GARVEY Heather Ansley, Esq., MSW Ext. 102 / [email protected] Art & Production Director Ext. 103 / [email protected] ANDY NEMANN Assistant Editor KERRY RANDOLPH Ext. 112 / [email protected] Production and Graphics/Web Assistant 16 Innovations Ext. 104 / [email protected] Lisa Van Loo JOHN GROTH Editorial Coordinator SUZI HUBBARD Ext. 105 / [email protected] Circulation Coordinator Ext. 109 / [email protected] BRITTANY MARTIN 38 Health Smarts Editorial Coordinator EDITORIAL, BUSINESS, AND Jennifer Best Ext. 110 / [email protected] ADVERTISING OFFICE 7250 North 16th Street, Suite 100 CHRISTOPHER DI VIRGILIO Phoenix, AZ 85020-5214, USA Web Content Manager Tel: 602-224-0500 44 Veteran Advisor Ext. 106 / [email protected] pnonline.com / [email protected] Raymond Ty McWhorter, NSO PN (ISSN 0031-1766) is published monthly by Paralyzed Veterans of America, Inc., 7250 North 16th Street, Suite 100, Phoenix, AZ 85020-5214. Periodicals postage paid at Phoenix, Ariz., and additional mailing offices. POSTMASTER: Send address changes to PN, 7250 North 16th Street, Suite 100, Phoenix, AZ 85020-5214. Subscription rates: $26 annually. Foreign orders: $38 (U.S. funds drawn on a U.S. bank).

© 2021 Paralyzed Veterans of America, Inc. All rights reserved. Reproduction of the whole or any part of the contents without permission is prohibited. FEBRUARY PARALYZED VETERANS Editor’s OF AMERICA DESK NATIONAL OFFICE 801 Eighteenth Street, NW Washington, DC 20006, USA 202-872-1300 • www.pva.org

PVA OFFICERS PN. David Zurfluh If you love technology, you’re going to love this issue of President

We can once again count on our friend, Rory Cooper, PhD, and his Charles Brown h’s Human Engineering Research team at the University of Pittsburg Senior Vice President Where To? on page 18 is co-authored by Cooper and Brad Laboratories. Hack Albertson Dicianno, MD, and sheds light on the topic of self-driving cars and the Vice President work being done to ensure people with disabilities are included in the Robert Thomas planning stages of this potentially life-changing technology. Vice President logy, I recently expanded my per- Speaking of life-changing techno Tammy Jones sonal use of smart home tech, and numerous items in my home can Vice President now be controlled via the Amazon Echo Dot. However, one thing I didn’t Kenneth Ness think too much about was protecting those devices from hackers. Vice President ve thought about how these devices If you have a similar setup or ha Tom Wheaton Halt The Hackers on page 24. Get some could make your life easier, read Treasurer great tips from Paralyzed Veterans of America member Anne Robinson, Marcus Murray who uses a vast array of this technology. The article also contains some Secretary rds — something I struggle to do. easy ideas for creating strong passwo Al Kovach Jr. There’s plenty of other great content this month. Enjoy! Immediate Past President

PVA NATIONAL OFFICE Carl Blake Executive Director

Shaun Castle Deputy Executive Director

Len Selfon General Counsel

Cheryl Topping Chief Financial Officer

Peter Gaytan Associate Executive Director Veterans Benefits

Heather Ansley contributing to this issue… Associate Executive Director Government Relations

Mark Lichter Director: Architecture & Facilities

Cheryl Vines Director: Research & Education

Liz Deakin Director: Communications Amanda Lisa Van Loo Laverman (p. 16) Fabio Villarroel (p. 24) Director: Sports & Recreation

6 | PN February 2021

DAVID ZURFLUH NATIONAL PRESIDENT PVAfromtheTOP

Even trying to do something simple close Valentine’s Day to your home could be problematic this year. Depending on where you live, you may still I must confess before doing research on be facing severe dining restrictions or limited Valentine’s Day, I wouldn’t be able to answer a entertainment opportunities. question on its history. So, I did a little digging, However, don’t despair or let pessimism and here’s a brief, summarized version. enter your heart. Just reimagine and figure out There were three St. Valentines, who were a different way to make Valentine’s Day fun. each martyred for practicing their Christian Just be grateful you’re not living in the times of faith. The first two were killed during the time the Roman soldier. of the Roman Empire in Europe, and the third Below are ideas I’ve researched to help was killed in a Roman prov- make Valentine’s Day a joyous one for you and ince of Africa with others. The your loved one. If you have kids, you may have If you’re like me and exact details are unknown. the chance to include them, too. The first St. Valentine, who have someone special was martyred around 270 AD, Cooking performed clandestine mar- ■ Have a Parisian night (French food, wine, in your life, you try riages for Roman soldiers. Mar- desserts and coffee). to find something to riage for soldiers was forbidden ■ Create a waffle bar with your favorite top- because of the emperor’s belief pings and fruits. enjoy as a couple. it would distract a soldier from ■ Bake cookies or other goodies. his duties and loyalty to him. ■ Take an online cooking class for couples. Disobedience resulted in exe- cution for those caught. Drinking St. Valentine wore a very distinctive ■ Take a mixology class online. purple amethyst ring so soldiers wanting to ■ Do your own wine and chocolate tasting get married could distinguish him from others (try it while watching a movie). and approach him covertly to arrange their clandestine marriages. Legend says that after Non-Food Ideas performing the ceremony, St. Valentine would ■ Take a hike/roll. cut out a heart from parchment paper and give it to the couple to discreetly display and cel- ■ Play tourist in your hometown. ebrate their love each year. ■ Go for a drive. If you’re like me and have someone spe- ■ Make a scrapbook. cial in your life, you try to find something to ■ Write love letters and read them aloud to enjoy as a couple. One past Valentine’s Day, each other. we took an early morning flight from Seattle ■ Do a massage/spa day. to San Francisco (a one-and-a-half hour flight ■ Watch a sunset. with one carry-on), hopped on the train from ■ the airport to downtown, saw the sights, ate a Watch the stars at night through romantic dinner, took an Uber back to the air- a telescope. port and caught a late flight back home. ■ Make a game night (board games or cards, This year, however, the novel coronavirus no video games). (COVID-19) pandemic has put up a few obsta- ■ Try a do-it-yourself tarot reading. cles. Vaccines are on their way to all of us, but a ■ Build a bonfire. romantic trip like the one we took isn’t a prac- tical option for many people because of the Whatever you choose to do, just remember risk of flying, attractions being shuttered and to make it your day as a couple and fall in love restaurants and bars being closed. again together. ■

8 | PN February 2021 pva chapter roster

ARIZONA GEORGIA MISSOURI SOUTH DAKOTA Arizona PVA Southeastern PVA Gateway PVA North Central PVA 5015 N. 7th Ave., Ste. 2 4010 Deans Bridge Rd. 1311 Lindbergh Plaza Center 209 N. Garfield Phoenix, AZ 85013 Hephzibah, GA 30815 St. Louis, MO 63132 Sioux Falls, SD 57104-5601 800-621-9217 706-796-6301 314-427-0393 800-505-4782 602-244-9168 706-796-6338 314-427-4183 (fax) 605-336-0494 www.azpva.org www.gatewaypva.org 605-332-8656 (fax) ILLINOIS CALIFORNIA Vaughan PVA NEBRASKA TENNESSEE Bay Area & Western PVA 2235 Enterprise Dr., Ste. 3501 Great Plains PVA Mid-South PVA 3801 Miranda Ave., Westchester, IL 60154 7612 Maple St. VAMC, Rm. 2D100 Bldg. 101, Rm. A1-219, 800-727-2234 Omaha, NE 68134-6502 1030 Jefferson Ave. Mail Code 816 708-947-9790 402-398-1422 Memphis, TN 38104 Palo Alto, CA 94304 708-947-9755 (fax) 901-527-3018 800-273-6789 www.vaughanpva.org NEVADA 650-858-3936 Nevada PVA TEXAS California PVA IOWA 704 S. Jones Blvd. Lone Star PVA 5901 E. Seventh St. Iowa PVA Las Vegas, NV 89107 3925 Forest Ln. Long Beach, CA 90822 7025 Hickman Rd. Ste. #1 702-646-0040 Garland, TX 75042 562-826-5713 Urbandale, IA 50322 702-646-3712 800-583-5252 pvacaliforniachapter.org 515-277-4782 www.nevadapva.org 972-276-5252 [email protected] Cal-Diego PVA www.iowapva.org OHIO VAMC, Rm. 1A-118 Texas PVA 3350 La Jolla Village Dr. KENTUCKY Buckeye PVA 6418 FM 2100 Rd. San Diego, CA 92161 Kentucky-Indiana PVA 26250 Euclid Ave., Ste. 115 Crosby, TX 77532 858-450-1443 2835 Holmans Lane Euclid, OH 44132 800-933-4261 www.caldiegopva.org Jeffersonville, IN 47130 216-731-1017 713-520-8782 502-635-6539 713-520-8217 (fax) COLORADO www.kipva.org OKLAHOMA VIRGINIA Mountain States PVA Mid-America PVA 12200 E. Iliff Ave. #107 MASSACHUSETTS 6108 NW 63rd St., Ste. A Mid-Atlantic PVA Aurora, CO 80014-5376 New England PVA Oklahoma City, OK 73132 11620 Busy St. 303-597-0038 1208 VFW Parkway, Ste. 301 405-721-7168 Richmond, VA 23236 303-597-0039 (fax) West Roxbury, MA 02132 800-852-7639 www.mscpva.org 800-660-1181 OREGON 804-378-0017 617-942-8678 Oregon PVA 804-378-0026 (fax) DELAWARE 857-203-9685 (fax) 3700 Silverton Rd., NE WASHINGTON Colonial PVA www.nepva.org Salem, OR 97305 700 Barksdale Rd. Suite 2 800-333-0782 Northwest PVA Newark, DE 19711 MICHIGAN 503-362-7998 616 SW 152nd St., Ste. B 888-963-6595 Michigan PVA 503-362-9837 (fax) Burien, WA 98166 302-861-6675 (fax) 46701 Commerce Center Dr. www.oregonpva.org 800-336-9782 www.colonialpva.org Plymouth, MI 48170-2475 206-241-1843 248-476-9000 PENNSYLVANIA 206-433-0749 (fax) FLORIDA 248-476-9545 (fax) Keystone PVA WEST VIRGINIA Central Florida PVA 1113 Main St. 2711 S. Design Ct. MINNESOTA Pittsburgh, PA 15215-2407 West Virginia PVA Sanford, FL 32773-8120 Minnesota PVA 800-775-9323 336 Campbells Creek Dr. 407-328-7041 1 Veterans Dr. 412-781-2474 Charleston, WV 25306 407-328-7139 SCI-Room 238 412-781-2659 (fax) 304-925-9352 [email protected] Florida PVA Minneapolis, MN 55417 WISCONSIN 3799 N. Andrews Ave. 612-467-2263 PUERTO RICO Fort Lauderdale, FL 33309 612-726-9472 (fax) Wisconsin PVA 954-565-8885 mnpva.org Puerto Rico PVA 750 N. Lincoln Memorial Dr., Ste. 306 954-565-8843 (fax) Urb. Country Club Milwaukee, WI 53202-4018 MISSISSIPPI 812 Moluca Street 800-875-9782 Florida Gulf Coast PVA Bayou Gulf States PVA San Juan, PR 00924-1723 414-328-8910 15435 N. Florida Ave. 15489 Dedeaux Rd. 787-757-6465 / 405-5551 414-328-8948 (fax) Tampa, FL 33613 Gulfport, MS 39503-2667 1-800-784-9502 (fax) 800-397-6540 228-832-6864 [email protected] 813-264-6285 (fax) 228-539-5494 (fax) www.floridagulfcoastpva.org [email protected]

February 2021 PN | 9 reasons remarks & TOM FJERSTAD, EDITOR

Years later during a 1985 interview for the No Bias In SCI PVA-published book An Oral History Of The Paralyzed Veterans of America, Robert Moss, who February is Black History Month. In recog- was PVA’s second national president, recalled nition, I’d like to share a story I came across in notifying the press, “I called in the wording to our archives that speaks to racial segregation the wire services, DPI and Associated Press. I during the World War II era. forget the exact wording now, but something to Segregation was still commonplace in the effect that spinal cord knows no bias. When I the years following World War II, but attitude called it in and the operator heard the language, changes were slowly occurring as many peo- she said in a very thick Southern drawl, ‘It’s ple dug in their heels in opposition. One about time people around here got some sense.’ ” example was the action taken by a new The day after its original story, the Rich- “... We do veterans service organization called mond Times-Dispatch ran a follow-up article the Paralyzed Veterans Association of titled Hotel Lifts Racial Ban For Banquet. know that a America, which was later shortened to Detailing the latest news of the situation, the Paralyzed Veterans of America (PVA). article read, “Hotel John Marshall, which had spinal-cord Leaders of this new group refused refused to permit paralyzed Negro Veterans to injury knows to accept a situation they found them- attend a banquet there tomorrow night, yes- selves facing under what were commonly terday rescinded its action. The annual ban- no bias.” referred to as Jim Crow Laws. On Sept. 26, quet is scheduled for 7:30 p.m. in the Virginia 1947, PVA had called to order its second Room of the Hotel.” – Gilford Moss formal meeting, a three-day confer- It was the first time that Blacks had been ence taking place at the Hunter Holmes served in the Hotel John Marshall since the Civil McGuire Veterans Administration Hos- War. This occurred just 10 months before then- pital in Richmond, Va., with a closing banquet U.S. President Harry Truman signed Executive planned at the Hotel John Marshall on Sept. 28. Order 9981, Desegregation of the Armed Forces, However, the hotel informed PVA that none which stated that “there shall be equality of of its Black members or delegates would be treatment and opportunity for all persons in the allowed to attend the banquet. PVA members armed forces without regard to race, color, reli- voted for a telegram of protest to be sent to the gion, or national origin.” hotel and to notify the press of the situation. This order also established the President’s The local Richmond Times-Dispatch Committee on Equality of Treatment and newspaper began its coverage on Sept. 27 Opportunity in the Armed Services, an advisory with an article on page 3, titled Racial Ban committee to examine the rules, practices and Lifting Asked For Meeting. The article detailed procedures of the armed services and recom- the circumstances and included the follow- mend ways to make desegregation a reality. ing excerpt from the telegram: I was glad to see that PVA took a position, “The telegram, signed by Gilford Moss, of however controversial at the time, that we Chicago, national chairman for the Paralyzed can now look back on and say, “We were on Veterans’ Association stated that, ‘We have been the right side of that one.” Gilford Moss and informed that the Negro members of the Para- that convention of delegates showed their lyzed Veterans Association will not be allowed recognition of bonds that occur between so to join us at our banquet that concludes our many PVA members because “a spinal-cord convention. The Paralyzed Veterans Associa- injury knows no bias.” tion of America urges the manager of the hotel The Hotel John Marshall was converted into to reconsider his stand for this occasion. As an an apartment complex in 2011, but the Virginia organization we are not concerned with the Room where PVA’s banquet took place lives on as problems of racial prejudice but we do know that part of the John Marshall Ballrooms and is now a spinal-cord injury knows no bias.’ ” a popular choice for wedding receptions. Q

10 | PN February 2021 pva points

Women’s Retreat

Registration is open for the Paralyzed Veterans of America (PVA) Women Vet- erans Empowerment Retreat (formerly WE Served). An all-expenses-paid event, the retreat focuses on the holistic well-being of women veterans with disabil- ities. Set for April 23–25 at the Tempe Mission Palms Hotel &

The Paralyzed Veterans of America Women Veterans Empowerment Retreat is set for April in Tempe, Ariz. COURTESY OF PARALYZED VETERANS OF AMERICA COURTESY OF PARALYZED VETERANS OF AMERICA

February 2021 PN | 11 COURTESY OF PARALYZED VETERANS OF AMERICA MINNESOTA CHAPTER

The Paralyzed Veterans of America Minnesota Chapter participated in a drive-by holiday parade Dec. 19. COURTESY OF PARALYZED VETERANS OF AMERICA MINNESOTA CHAPTER

Cars decked out in holiday decorations drove by the Minneapolis Department of Veterans Affairs Medical Center and Minnesota Veterans Home Dec. 19.

Conference Center in Tempe, For more information The PVA Minnesota Ariz., this immersive and or to register, visit pva.org/ Chapter joined with several outcome-driven experience is womenveterans. other veterans service orga- limited to just 40 attendees. nizations to conduct a drive- Participants will enjoy by holiday parade Dec. 19. four days of learning and Drive-By Parade The parade featured more community-building in an than 30 vehicles, with many inclusive and supportive The novel coronavirus decked out in all types of environment. (COVID-19) pandemic holiday decorations. PVA is working to assem- made this past winter holi- The holiday drive-by ble a lineup of experts and day season tough on many parade paid honor and gave thought leaders to present a people, but the Paralyzed holiday greetings to veter- multitude of topics on health, Veterans of America (PVA) ans and health care workers money, stress manage- Minnesota Chapter found at the Minneapolis Depart- ment, nutrition, education, a way to spread some sea- ment of Veterans Affairs employment, health care, sonal joy to those who Medical Center and Minne- volunteering and more. couldn’t get out. sota Veterans Home.

12 | PN February 2021 on the

HEATHERhill ANSLEY, ESQ., MSW © GETTY IMAGES/MSTAHLPHOTO © GETTY Advocacy Priorities bers’ needs to receive timely health care services and the financial benefits The start of the 117th Congress and employment assistance that will and a new administration means Para- help them and their families. lyzed Veterans of America (PVA) will With the opportunity to move past have many opportunities to educate the pandemic on the horizon, PVA will leaders in Washington, D.C., about PVA also advocate for priorities that ensure members’ needs. its members have improved access to Department of Veterans Affairs (VA) health care and benefits, as well as dis- ability civil rights protections and other programs that provide needed supports Expanding PCAFC for people with disabilities. Another critical priority is proper implementation of the VA’s Program of Specialized Services Comprehensive Assistance for Family One of PVA’s most important priorities Caregivers (PCAFC) expansion. remains preserving access to the VA’s The VA Mission Act directed specialized services. the PCAFC be expanded to severely PVA firmly believes the VA is the injured veterans of all eras through best health care provider for veterans a phased approach beginning Oct. with spinal-cord injuries and disorders 1, 2019. The VA missed this deadline (SCI/D). The VA’s specialized systems and didn’t begin expansion until of care follow higher clinical standards Oct. 1, 2020, for veterans who were than those required in the private sector. severely injured in the line of duty on PVA remains concerned that if the or before May 7, 1975, and on or after VA continues to shift care to the private Sept. 11, 2001. sector and woefully understaff its facili- Phase 2, which will include veter- ties, the department’s capacity to treat ans who served between May 8, 1975, veterans will be diminished and could and Sept. 10, 2001, is expected to begin lead to facility closures and reductions Oct. 1, 2022. PVA believes, however, in services offered to catastrophically that prolonged delays in expansion are disabled veterans. further straining caregivers who des- This year, PVA will advocate for perately need relief now, particularly in preservation of the VA’s specialized light of the global pandemic’s impact. services, including the funding needed PVA will advocate for Phase 2 of the to maintain them. PVA will also advo- caregiver program to begin on Oct. 1, cate for the VA to address pandemic- 2021, as Congress originally intended. related delays in the delivery of “nonessential” health care to SCI/D Long-Term Care © GETTY IMAGES/GSHELDON veterans, including colonoscopies and PVA also plans to focus on the need for in-person annual exams. adequate long-term care (LTC) options In 2020, the novel coronavirus Telehealth isn’t a long-term for veterans with SCI/D. (COVID-19) pandemic required PVA replacement for in-person annual There are few LTC facilities that are to shift its focus to ensure Congress exams for SCI/D veterans. In addition, capable of appropriately serving SCI/D and the administration addressed PVA will advocate for the VA to develop veterans. The VA operates six such facil- those needs. and implement a new staffing model ities, and only one of them is located This year, PVA will continue to that identifies and prioritizes staffing west of the Mississippi River. advocate for pandemic-related legisla- needs at the national level while sup- Since VA SCI/D LTC facilities tion and policies that focus on its mem- porting flexibility at the facility level. are exceptionally limited, veterans

February 2021 PN | 13 with SCI/D who have chronic medi- cal issues are being treated in com- munity institutions by providers not trained in SCI/D. This often results in compromised quality of care and poor outcomes. In some areas, it’s nearly impos- sible to find placements for veterans who are ventilator-dependent or who have bowel and bladder care needs. As a result, PVA will advocate for the VA to direct and design a SCI/D LTC strategic plan that addresses the need for increased LTC beds in VA SCI/D centers. Furthermore, PVA will advocate for increased funding in future fiscal years directed at the completion of remain- ing SCI/D-related construction proj- ects, including those focused on LTC. Auto Grants Improved transportation assistance through the VA for the most severely disabled veterans is another one of PVA’s key priorities. Access to an adapted vehicle is essential to the mobility and health of catastrophically disabled veter- ans who need a reliable means of transportation. The current one-time VA Automobile Allowance grant of approximately $21,500 covers any- where from one-half to one-third of the cost to procure a vehicle. PVA believes veterans need ongoing access to this grant and will support legislation to increase the frequency with which eligible veterans would be able to receive it. PVA will also advocate for the VA to properly reimburse veterans for the cost of items on the VA’s current Automobile Adaptive Equipment list, as well as modern driver assistance technologies to broaden opportuni- ties for veterans with catastrophic disabilities to drive more comfort- ably and safely.

14 | PN February 2021 © GETTY IMAGES/GREJAK

Furthermore, PVA months of limited travel will support legislation because of the pan- to allow veterans who demic. Finally, PVA will have non-service-con- continue to advocate nected catastrophic for legislation that will disabilities to receive ensure the long-term the same type of solvency of important adaptive automobile Social Security benefits. equipment as veterans To learn more about whose disabilities are these PVA priorities for service-connected. 2021, including how to PVA will also advocate with your Con- advocate on a variety Improved transportation assistance through the Department of Veterans gress members, visit pva. of issues impacting its Affairs is a key priority for Paralyzed Veterans of America. org/research-resources/ members as people legislative-priorities. with disabilities. PVA’s Heather Ansley, priorities include improved enforce- and access to air travel under the Air Esq., MSW, is PVA’s associate executive ment of access requirements under Carrier Access Act, particularly as its director of government relations in the Americans with Disabilities Act members return to the skies following Washington, D.C. ■

February 2021 PN | 15 LISA VAN LOO innovations

Sensing Pressure The Sensoria Mat’s app shows a user’s pressure relief history and can Pressure sores were the least of make that information available to Garrison Redd’s worries as a teen- authorized telehealth providers. ager growing up in Brooklyn, N.Y. But a catastrophic spinal-cord injury (SCI), sustained after Mat system serves as a wheelchair Redd was struck by wellness coach, reminding users to a stray bullet at move every 30 minutes and alert- age 17, changed ing them to their success. everything for “There are about 36 conclusive him. research studies that agree if a per- son in a wheelchair can effectively offload consistently during the day, multiple times a day, in a specific pattern by using a certain process, the risk of ulceration is reduced,” says Davide Vigano, Sensoria co- founder and CEO. “It’s very hard to treat a pressure ulcer. Once you develop one, it’s hard to heal them.” The Sensoria Mat, developed with researchers at Rancho Los

ALL PHOTOS COURTESY OF SENSORIA OF COURTESY PHOTOS ALL Amigos National Rehabilitation Center in California, is a holistic system that uses data from a set of sensors to relay information to a mobile app and a cloud-based dashboard of metrics that’s acces- sible, with a patient’s permission, to telehealth providers. While the system was in devel- opment before the novel coronavirus

Quality (AHRQ) estimates costs the health care system almost $27 billion a year to treat. That’s why Redd says he was The bullet thrilled to try the Sensoria Mat, a new burned nerves in his system the Team USA para powerlifter spine, leaving the active, describes as “cool and innovative.” athletic teen unable to The technology aims to help reduce walk. And as someone who was now the number of pressure sores those using a wheelchair, it also elevated his with SCI endure each year. The Sensoria Mat is a holistic system concern about developing ulcerations, a that uses data from a set of sensors, dangerous condition for those with SCI. A Perfect Match shown here, to relay information It’s a serious problem that the Since pressure sores develop as a result to a mobile app and a cloud-based Agency for Healthcare Research and of sustained immobility, the Sensoria dashboard of metrics.

16 | PN February 2021 (COVID-19) pandemic took hold, its timing could not have been better, as the need for telehealth resources and remote care increased. Jeff Rankin, co-director of rehab engineering at Rancho Los Amigos, says his team was encouraged by others to approach Sensoria and The Sensoria Mat contains a paper-thin collaborate on the product’s develop- insert that sits inside a custom wheelchair ment after previous partnerships with cushion. The insert is positioned below other tech companies didn’t pan out. a gel layer to keep the cushion cool. “We were going to use Sensoria for a completely different project,” Rankin says, making note of the referrals they had received. “It’s been a perfect match enough or doesn’t perform it physi- to further develop the product, Rankin in so many ways ever since.” cally correctly, the app encourages the says the team hopes to get the product user to try again. to as many users as possible. Positive Feedback “In general, the feedback has been “The goal is to make it so it’s attrac- The AHRQ estimates about 2.5 mil- positive,” Rankin says. tive and mass-adopted,” Rankin says. lion people a year incur pressure Vigano and Rankin describe the sores, and about 60,000 Americans die status of the Sensoria Mat as a pro- Changing Lives each year from complications of the totype, although Vigano is confident Redd sees the benefits. As a powerlifter, ulcerations. Put simply, moving helps. Sensoria will be able to ship units to it’s not unusual for him to complete sev- “Relieving the pressure between users who have purchased them by the eral pull-ups while still strapped into the chair and your body is the single end of March. his chair. But Redd says Sensoria makes biggest factor someone can do,” Rankin In addition to conducting an vital movements possible for anyone. says of the best prescription for avoid- economic impact study with Johns “You don’t need to be able to lift two ing ulcerations. And that’s the sole Hopkins University in Baltimore, the times your body weight to use the Sen- focus of the Sensoria Mat. team at Rancho Los Amigos launched a soria Mat,” Redd says. “However, you do A paper-thin insert sits inside a research study in January that required need to lift a small portion of your body custom wheelchair cushion and sends 80 participants. The study is expected weight to prevent ulcerations.” data to a small device, which transmits to last a couple of years and gather addi- Rankin is just pleased at how well the information to the Sensoria app tional data about the Sensoria Mat and the Sensoria partnership turned out and its accompanying dashboard. The its impact on pressure sores. and says he’s looking forward to the day insert is so thin, the user can’t even “We need more data to refine the this technology is widely available. For feel it. It is positioned below a gel layer algorithms. The challenge is really him, this type of progress has been a to keep the cushion cool. patient recruitment,” Vigano says, long time coming. “It’s super soft and super comfy,” referring to the pandemic’s limitations. “To have a company like Sensoria Vigano says of the cushion, noting that “So, we decided to launch a crowdfund- Health that has the technology and is the app employs positive reinforcement ing campaign so we can send out the willing to work with us, and to see the and constructive coaching. “The coach devices at the lowest possible cost.” vision turn into a device that’s useful inside the application will tell them if The campaign, which will raise and something people are really excited they didn’t do the exercise correctly funds through Kickstarter, is set to about ... it has been amazing,” Rankin and to do it again.” begin early this year. Vigano estimates says. “I have no doubt whatsoever that For example, one of the exercises the system will cost about $500 but this device will in many ways change a may be a left lean for 30 seconds. If the says during the Kickstarter campaign, number of lives in positive ways.” user completes the assigned exercise it will cost less. For more information, visit correctly, the app rewards the user. If Between the campaign and a fed- sensoriahealth.com/sensoria-mat. ■ the user doesn’t hold the exercise long eral grant Rancho Los Amigos received

February 2021 PN | 17 Autonomous vehicles are still in various stages of development, but they hold great promise to help people with disabilities travel faster, safer and more easily.

by Rory A. Cooper, PhD, & Brad Dicianno, MD

Throughout much of the Since 2009, the vast United States, the capacity to drive opens the majority of the $14 bil- door to greater participation in life, job oppor- lion invested in AV tech- tunities, access to health care, education and nology has been spent a general sense of freedom. in pursuit of mass However, those same opportunities can market driverless cars. be really restricted for people with disabili- These efforts have ties such as spinal-cord injury and disease produced signifi- (SCI/D). There are some who don’t drive, cant advances, but don’t have easy access to a ride or live in a the technological, metropolitan area with limited public trans- psychological and portation options. regulatory con- Additionally, with the ever-growing straints that remain retirement of the baby boomer generation, will likely make who largely want to “age in place,” there’s an widespread AV market increasing need for accessible and enabling adoption a decade or personal transportation. more away. The transportation industry is in the Despite the billions middle of one of its largest transforma- invested and rapid technolog- tions, with unprecedented investment and ical advances, the transportation advancements in electric and autonomous options for older adults and persons vehicle (AV) technologies. with disabilities remains largely the same.

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E M A R F IA V S/ K R O W R O M A T E M / S E G A M I Y T T E G © H LP O D N A R Y R ER K Y B N O TI RA ST LU IL

Incorporating Accessibility

A 2015 report from Q Research and development of AVs and the National Council their components should include a on Disability titled requirement that demonstrates that any Self-Driving Cars: resulting products incorporate accessibil- Mapping Access to a ity of people with diverse disabilities, Technology Revolu- and these technologies should be tion explored the required to comply with Section 508 “emerging revolution of the Rehabilitation Act of 1973. in automobile technology and the promise it holds for Q Guidelines are needed for how people people with disabilities, as with disabilities can safely interact with well as the obstacles the dis- and use AVs. ability community faces to real- ize that promise.” It makes several Q All types of common and public use AVs key recommendations: must be fully accessible.

February 2021 PN | 19 COURTESY OF HUMAN ENGINEERING RESEARCH LABORATORIES

The Human Engi- neering Research Laboratories (HERL) at the University of Pittsburgh and the U.S. Department of Veterans Affairs was recently funded by the Department of Trans- portation to create the Automated vehicle Service for People with disabilities – Involved Toyota is among the vehicle manufacturers trying to develop and test Responsive Engineer- autonomous vehicles. ing (ASPIRE) Center. The ASPIRE Center is investigating the implications of accessible taxonomy and definitions for automated driving automated vehicles and mobility services for to simplify communication and facilitate col- people with disabilities and their caregivers. laboration within technical and policy domains. A 2017 survey from the Bureau of Trans- The SAE defines more than a dozen key portation Statistics found that 6 million terms and provides full descriptions and people with a disability have difficulty get- examples for each level of autonomy. Unfortu- ting the transportation they need. There have nately, it doesn’t address usability and acces- been no overarching federal laws specifically sibility for people with disabilities. governing AVs, but the National Highway Ford, Toyota, Hyundai, Mercedes-Benz, Traffic Safety Administration released fed- Tesla, Google and Uber, among others, are eral guidance on the issue in 2019. developing AVs that are either currently The Society of Automotive Engineers (SAE) being tested on American roadways or will be international standard J3016 provides a common within the next five years. COURTESY OF HUMAN ENGINEERING RESEARCH LABORATORIES

Hyundai plans to produce and deploy air vehicles in collaboration with Uber through a ground and aerial rideshare network.

20 | PN February 2021 Self-driving personal vehicles could potentially provide a hands-free autopilot driving mode. © GETTY IMAGES/ METAMORWORKS

Of course, not all AVs are intended for planning from day one is critical to a success- roads. Hyundai is working with the city of fully accessible product, regardless of how many Los Angeles to introduce accessible flying years in the future it lies.” AVs as an urban air mobility solution. Hyun- The report found that mitigating trans- dai has adopted a NASA strategy by publicly portation-related barriers for people with This self-driving vehicle releasing its design concepts to inspire peo- disabilities would enable new employment is used for test drives ple to use them to innovate emerging engi- opportunities for approximately 2 million conducted by Uber neering technologies. Technologies Inc. Hyundai plans to produce and deploy air vehicles in collaboration with Uber through a ground and aerial rideshare network. A collaborative infrastructure is being developed to support this on- demand AV transportation system. Eliminating Barriers Different levels of automation pose distinct possibilities and challenges for people with disabilities. Therefore, accessibility research needs to be driven by and for people with disabilities to assure that their needs and preferences are incorporated. As noted by the National Council on Disability’s 2017 report, Self-Driving Cars: The Impact on People with Disabilities, “The disability community knows better than any other how being involved in the © GETTY IMAGES/ JASONDOIY

February 2021 PN | 21 people with disabilities and save $19 billion importance of developing futuristic tech- annually in health care expenditures from nologies related to transportation. missed medical appointments alone. This work indicates that advancements in Most people with disabilities have only technologies related to transportation are very three viable transportation options: important to individuals with disabilities and represent a significant unmet need. More than Q Operate a personal vehicle 60% of respondents rated the importance of Q Rely on the services of others technology in meeting their personal mobility Q Use accessible public transportation needs as “critical,” and over 40% thought that traveling freely was also “critical.” For people with disabilities who don’t live Some survey participants provided addi- in urban areas, owning and operating a per- tional comments, with approximately 12% sonal vehicle or relying on friends and fam- mentioning transportation as being critical ily are the only realistic options. In multiple and “self-driving” vehicles being included in studies to identify unmet needs of individuals nearly 50% of those comments. with disabilities receiving community-based services, transportation has been consistently Making An Impact highlighted as an issue. There are risks and challenges associated with HERL investigators surveyed the opinions both AVs and accessible vehicles. of more than 1,000 users of mobility devices The experiences gathered through the and assistive technology to identify a research University of Pittsburgh Medical Center’s Cen- and development road map. The survey ter for Assistive Technology show that current focused on advancements in mobility-related levels of autonomy available in commercially assistive technologies and asked about the available vehicles can have an impact. For example, older drivers or “insecure © GETTY IMAGES/ SCHARFSINN86 drivers” can (re)gain the safety and confi- dence to drive, and driving instructions can improve through quantitative data. Such features as rear collision/obstacle avoidance, corrective steering and blind-spot warnings can make all drivers safer and make driving possible for others. The Merlin Co-pilot is an AV technology that is intended to mitigate the risks and challenges by providing capabilities com- patible with newer accessible vehicles to make them more autonomous. The system is integrated into the vehicle to access vehicle functions and features, including braking, signaling and others that are essential for safe vehicle control. It adds autonomous features to peo- ple’s existing accessible vehicles. This is particularly important because accessible vehicle modifi- cations can be expensive, ranging from as low as $1,500 to as high To be successful, automated vehicle technology needs extreme reliability, as $100,000, excluding the cost of especially if it’s the only means a person has to drive safely. the vehicle. People tend to keep

22 | PN February 2021 Toyota Motor Corp. President Akio Toyoda speaks in front of the e-Palette Concept Vehicle, a fully autonomous, battery- electric vehicle, during a press event for the consumer electronics trade show known as CES in Las Vegas in 2018. © GETTY IMAGES/ ALEX WONG

their modified accessible vehicles as long as it is many people with disabilities. Moreover, the feasible. For people who use adaptive vehicles need to buy a new vehicle is a significant hurdle to eventually adopt AVs, the technology has to for many people with disabilities. be available, affordable and compatible with Currently, accessible personal electric vehicle access needs. vehicles, the likely future for autonomous It’s likely to be over a decade before this is vehicles, are in various stages of research and possible, and even people with disabilities who development. Toyota Motor Corp. plans to buy an accessible vehicle today will probably be deploy an accessible autonomous transporta- using that same vehicle even as other customers tion system for this summer’s Olympic and start to transition to AVs. Paralympic Games in Tokyo. The system will include a wide range of Moving Forward vehicles to travel within and between venues. Most AVs are based on electric vehicle chassis. This should prove an important milestone in Some electric vehicles that could be accessible accessible AV progress and provide important to people present challenges because they don’t information for moving forward. include, for example, traditional handholds used Autonomous vehicle technologies have to help transfer in/out of the vehicle. the potential to drastically improve access For people who use their wheelchairs for people with SCI/D, as well as for people as seats in motor vehicles, the ability to who have vision, hearing, intellectual and use wheelchair tie-downs and occupant developmental disabilities. People with restraints needs to be considered. By upgrad- disabilities need to be engaged in and help ing existing modified vans, this barrier could guide the development of AV technologies. be lowered at least until manufacturers start For more information on HERL, visit producing purpose-built vehicles. herl.pitt.edu. To be successful, AV technology needs Rory A. Cooper, PhD, is the founder and extreme reliability, especially if it’s the only director of HERL, while Brad Dicianno, MD, means a person has to drive safely. Cost is also serves as the organization’s medical director a notable issue. Devices and systems that are and chief operating officer. Q too costly will essentially be inaccessible to

February 2021 PN | 23 Smart home technology and smart devices provide convenience and independence, but it’s important to manage security risks.

Alexa, a smart device by Amanda Laverman name commonly spoken multiple times a day inside many households across the country, has become synonymous with completing tasks by voice command. Everything from kitchen appliances to thermostats, doors and fans can now be controlled by smart home devices. These Internet of Things (IoT) devices — devices that use sen- sors, software and other technolo- gies to exchange data with other internet- enabled devices — increase con- venience and inde- pendence. However, these devices also increase your home’s security risk.

24 | PN February 2021 ILLUSTRATION BY KERRY RANDOLPH © GETTY IMAGES/ THITICHAYA YAJAMPA/ NE2PI/ YUICHIRO CHINO/ CONGORILLA/ STEPHEN BRASHEAR/ BILL OXFORD COURTESY OF LUCI OF COURTESY The media shares horror stories of hacked baby monitors, compromised security cameras and identity theft. But you can protect yourself by knowing what data your device is collecting, what that data is being used for and how it is being transferred and stored. “A big part of security is knowing what is being collected and commu- nicated,” says Jered Dean, co-founder and chief technical officer for LUCI, a hardware/software product that attaches to power wheelchairs to prevent tips, collisions and drop-off falls and provides security, stabil- ity and connectivity through cloud and sensor- fusion technologies. “Smart products connect to the internet and collect data, but why? What data is being collected and transmitted and what does that do for you? Make sure that you LUCI is a product that attaches to power wheelchairs and provides security, are benefiting from the data collection and stability and connectivity through cloud and sensor-fusion technologies.

February 2021 PN | 25 connectivity before committing to a new smart your use of the app, you can change it to only technology. Then, focus on data storage and access your location when that particular app transmission for the technology.” is in use. “Take your data security seriously. Focus Keeping Devices Secure on how your identity is used or combined with The default data permissions on most smart data,” Dean says. “As a general best practice, home devices are often very generous. look for devices that don’t store your data in Carefully evaluate all privacy settings and connection with your name or ID. Or look for requested permissions on each device and its devices that store your information encrypted associated apps. Only share what is neces- at rest [on the device] and in transit [when sary or what you are comfortable with shar- being transmitted over the internet]. Take the ing, and edit the default settings accordingly. time to find out how the smart device handles For example, a device may ask for per- data and look under the privacy, security or mission to know your phone’s location all the data-sharing options for the device to config- time. If you believe this is unnecessary for ure things how you want them.” PHOTOS THIS PAGE BY HARRY ROBINSON PAGE BY HARRY THIS PHOTOS

Anne Robinson’s newest device, the Echo Loop, is a ring with a button on it that Robinson can push to activate and talk to Alexa while she’s outside or in her vehicle. She can open the front door from outside or call her emergency contact with just two clicks of the button.

26 | PN February 2021 HARRY ROBINSON

Anne Robinson demonstrates how she uses Amazon Echo Show and Eufy, a robotic vacuum, to clean her floors. She says she has 18 smart devices in her home.

One super-user of smart devices is Anne Robinson, current national direc- tor of the Paralyzed Veterans of Amer- ica Texas Chapter, an Army veteran and level C4 quadriplegic. Robinson’s home is set up with numerous smart devices that enable her to complete tasks independently, such as turning fans on and off, adjust- ing the lights and temperature and answering the front door. Robinson is diligent in protecting the smart device security inside her home. “I have 18 devices in the house that allow me to control everything,” says Robinson. “Keeping them safe is definitely a task that we have to con- tinually work on, as the threat is always there. The mesh Wi-Fi system that we use, [Amazon] Eero, is protected with encryption and several other things so that it is able to block any threats or intrusions on that

system, as well as HARRY ROBINSON everything it’s connected to.” Throughout Robinson’s house are numerous Amazon Echo Dots, which she uses to listen to audiobooks and music, adjust the lights and get other people’s attention. By pairing the Ring Doorbell with other devices, Rob- inson can easily view who’s at the front door and talk to the person with- out having to open the door. Anne Robinson uses Amazon Echo Show to see who is at the front door.

February 2021 PN | 27 HARRY ROBINSON

Anne Robinson uses the Amazon Fire TV Cube to control her bedroom television.

Open Sesame door open- ers allow her to open and close doors herself, which comes in handy for letting the cat in and out. The Amazon Fire TV Cube is connected to her TV, cable box, Blu-ray player and security cameras. Through voice control, she can switch between devices, search for movies, shop online and complete any other tasks that are normally done by using a remote. She also has control of her home’s alarm system, which comes with additional security measures. “I have an alarm system for the house, provided by a local company. The Total Connect system is con- “If security is built into the devices, nected via my iPhone to Alexa, the smart lock on the default security settings are usually not the door and the garage door. I can set the alarm enough,” says Petros Efstathopoulos, global system, turn off the alarm, unlock/lock the door, head of NortonLifeLock Research Group. open/close the garage door, all with particular “Similarly, consumers are often unaware that security measures to prevent unwanted people they can customize these default security from using it. The Honeywell digital panel for settings to maximize security and privacy. In the alarm system has a built-in speaker and your router settings, it’s a good idea to use a microphone that allows emergency services to strong encryption method like WPA2 [Wi-Fi talk directly through it instead of depending on a Protected Access 2] when you set up Wi-Fi net- landline or cellphone, which is good in an emer- work access. This will help keep your network gency,” Robinson says. and communications secure.” Security experts also list passwords as one Password Protection of the top areas that users are too lax with when it Attacks on the data the devices collect and comes to security measures. Always change the store online pose a significant risk. default password to something complex, unique One way to help mitigate it is by enabling to that account or device, and avoid including additional security protocols for your home any personally identifying information. Wi-Fi. Set up a guest Wi-Fi for your visitors to “The most common issue leading to a secu- use that will remain separate from the one con- rity incident is by far the fact that many users do nected to your devices. Also enable two-factor not change the default password of devices, or authentication for your accounts whenever pos- even if they do, they choose something short and sible, such as requiring a one-time code to be simple,” says Efstathopoulos. “Most IoT devices sent to your cellphone or email address to com- are as secure as the password you use for them. plete the login process. Use strong and unique passwords when set-

28 | PN February 2021 © GETTY IMAGES/TRAITOV ting up accounts associated with connected How To Create A devices, along with Wi-Fi networks.” In addition to creating a strong, unique Secure Password password, you should also change the default name of your router. Some of the best practices Check out these tips from the Global Head of NortonLifeLock for passwords apply to naming routers, as well. Research Group Petros Efstathopoulos on how to create a strong, Choose a name that is unique and doesn’t con- secure password. tain any personal information. “Give your router a name. Don’t stick Q Be unconventional. Avoid common words anyone can find in with the name the manufacturer gave it — it the dictionary. Simply adding numbers to common terms, like might identify the make or model,” Efstatho- mainstreet12, isn’t any better. Hackers write programs to crack poulos says. “Give it an unusual name not these types of passwords first. associated with you or your street address. You don’t want your router name to give Q Be complex. The longer and more complicated your password away any personal identifiers.” is, the harder it is to guess. Include numbers, symbols and mixed- Another important factor to consider case letters. Efstathopoulos says Google suggests this technique: with smart home devices is what will be your backup plan if, and when, something goes Uses a special Mixes uppercase and Uses a wrong. Prepare for how you’ll face such issues character lowercase letters number as a power outage, spotty Wi-Fi or a device malfunction. Not only do you need a plan for what you would do without the functionality the device provides, but make sure these issues M f T& J smafe1ad won’t put your device in an unsecure state. Acronym instead of conventional words “For wheelchair users especially, it’s important to ask what happens if the prod- uct malfunctions?” Dean says. “Does the product still work even if my Wi-Fi doesn’t? Create a phrase known only to you and associate it with a Is there a backup plan? Smart technology particular website. A phrase for your email could be, “My used for accessibility, particularly when it is friends Tom and Jasmine send me a funny email once a day.” combined with the wheelchair itself, needs Use numbers and letters to recreate it. “‘MfT&Jsmafe1ad’ is a to have robust plans for failing safely and password with lots of variations,” notes Google. keeping the wheelchair user independent Q Stay impersonal. Many people use birthdays, addresses or and mobile no matter what.” other personal information to make passwords memorable. But Unlike many household appliances, it is “alarmingly easy” for hackers to obtain personal information smart devices can’t be part of a “set it and about prospective targets, according to Symantec. Avoid any- forget” mindset. To maintain the security thing that refers to your name, nickname, the name of a family of devices, regularly update all software. member or pet and any personal numbers like phone numbers, These updates often contain security fixes. addresses or other information. A common method hackers use is to target Change them up. Passwords should be changed regularly to known software vulnerabilities in devices Q remain effective. How often? Online financial accounts should that have not been updated. be changed every month or two; corporate network passwords, “Keep your devices up to date,” Efstatho- every three to four months. For everything else, simply use good poulos says. “Check the device manufactur- judgment and don’t be lazy. er’s website regularly for firmware updates. Updates often include critical patches for Q Put it to the test. Online password checkers can evaluate a pass- bugs or security vulnerabilities.” Q word’s strength.

February 2021 PN | 29 Virtual reality is helping veterans with SCI/D in St. Louis to improve their mental and physical health.

Virtual reality (VR) is a 10-plus hours from their families, and stuck in quickly evolving technology that’s allowing bed trying to heal a pressure sore,” Luitjohan veterans with spinal-cord injury and disease says. “Looking at those same four walls can be (SCI/D) to experience a newfound sense of pretty difficult as far as your mental health, by Brittany Martin independence and freedom. so by going in and being able to put an Oculus With the help of recreational therapists headset on and give them the opportunity to in the Department of Veterans Affairs (VA) go fly with the Blue Angels or go scuba diving St. Louis Health Care System, veterans have in Australia or socialize with other veterans flown with the U.S. Navy’s Blue Angels, visited through the meeting spaces on those programs museums and battled with swords, all from kind of gives them an outlet to get out of that their wheelchair. room in their head, while their body is still, Recreational therapists Matt Luitjohan unfortunately, stuck in that room.” and Charley Wright started the program in November 2019 and were just beginning Starting The Program to ramp it up when the novel coronavirus Wright watched a VR demonstration several (COVID-19) pandemic shut it down. During years ago at the National Veterans Wheel- that time, however, they acquired five Oculus chair Games and saw its potential for use in Quest and seven Oculus Go VR headsets, and his clinic, but most of the technology was still more than 20 veterans have benefited from experimental and the price was unattainable. their use. As the technology evolved and prices came “Several of our inpatient veterans are often down, the program at the St. Louis VA took shape. on bedrest. They might be far away from home, While there are several types of VR systems on as far away as Wichita [Kan.]-plus, so possibly the market, Wright says the Oculus headsets

30 | PN February 2021 ILLUSTRATION BY KERRY RANDOLPH © GETTY IMAGES/ PETERSNOW/ 3DSCULPTOR

COURTESY OF CHARLEY WRIGHT

offered versatility, ease of use, a broader range of apps and software, a compact package and better price point. Both the Oculus Go and Quest are stand- alone headsets that use Wi-Fi and don’t require the units to be hardwired into a com- puter or laptop. However, Wright says the Go is more of a stationary device that’s better suited to watching 360-degree videos on YouTube, movies or other immersive live events. The Quest, he says, is better for gaming and has two motion controllers that allow the user to control gameplay, similar to Nintendo’s Wii, and interact with the virtual world. Wright and Luitjohan typically start vet- erans out with a five-minute tutorial that orients them, lets them practice using the various gestures and buttons and tells them what to do if they start to feel any motion sickness. “We have to be very familiar with the ves- tibular piece to what we do,” Wright says. “When Some of the equipment for the XRHealth virtual reality system is pictured at you introduce a 360 [-degree] environment or the Department of Veterans Affairs St. Louis Health Care System.

February 2021 PN | 31 COURTESY OF CHARLEY WRIGHT

a VR environment, it’s very flying, so we can put you on the Blue Angels, in important to introduce it the cockpit with one of the Blue Angels, and it in small segments first in a seems like you are actually there, flying. If you non-moving environment, tilt your head up, you’re looking outside, above where, ‘Hey, would you just you out of the cockpit. You turn around, and like to go sit on the beach for you’re seeing what’s behind you in the cockpit. 10 minutes?’ You can look You look this way, you kind of see in the window around, but that environ- and then down on the ground. So, it’s a video, ment, you’re not going to go but you’re fully immersed in that video.” forward, left, back, up and down. You’re literally just Extra Benefits Anthony Wilson, above going to be immersed in that Besides the entertainment factor and men- and inset, tries out environment, but you don’t tal health benefits for veterans, VR can also virtual reality at the necessarily move. You’ve got to let your brain help the recreational therapists by tracking Department of Veterans catch up. Otherwise, they’ll get sick and then patients’ physical changes through a health Affairs St. Louis Health they won’t want to do it again.” software program called XRHealth. Care System. Those who’ve used VR more often and are “Through that program, Charley and I are accustomed to it can use it for longer periods, able to track your range of motion, your reac- but typically the sessions are 10-45 minutes. tion time,” Luitjohan says. “It gives us some Veterans can choose from over 20 pro- data to look at to see how you’re improving. grams. Some have multiple exercises or envi- So when you’re doing XRHealth, for instance, ronments that are constantly expanding and there’s a wall of balloons, and you’ve got to use improving. Others provide free demos, which a sword and you’ve got to cut through these allow users to go through a couple of stages balloons, and you’ve got to go this way, so we before purchasing more. can see how much you’re turning, how quickly “Several of our other veterans really enjoy you’re cutting down those balloons.” doing YouTube videos, but in 360 [degrees],” Luit- Luitjohan and Wright can control what johan says. “Several of our veterans really enjoy the veteran is doing, seeing and experiencing

32 | PN February 2021 COURTESY OF CHARLEY WRIGHT CHARLEY OF COURTESY

“You put them on, and you’re in a different world. Games, you can do anything with it. And you’re kind of free. It’s hard to explain. You can see everything. It’s neat.”

— Lou Monken Scott Richards puts on a virtual reality through a tablet computer and can manipu- says. “While you have the headset on, you headset to test out late the controls for veterans who don’t have don’t see the room that you’re in, but if you XRHealth, a health full hand function. get outside that safe playing area, the virtual software program. “We can keep the duration really short, world disappears.” or we can extend the duration to see where Although the Quest requires the use of both they fatigue, if they fatigue, or over time if they hands for most operations, the recreational ther- build strength and endurance,” Wright says. apists have found ways to modify the controllers There are other games that require players for people with higher level quadriplegic injuries. to move their wheelchairs around more, so Luit- “They know where in spacial time you’re johan must designate the safe playing area in at, so with our quads, there are lot of situational the headset setup to keep veterans from bump- games and moving in space where they don’t ing into objects. He says it takes some practice necessarily have the dexterity of their fingers,” to learn to maneuver the wheelchair and the Wright says. “We can modify and wrap them controller at the same time. in their hands and orient those wands in a way “You’re getting some exercise in without that when they move their right hand or they realizing you’re getting exercise in,” Luitjohan move their left hand or their shoulders — obvi- ously, our quads are going to do it with their bicep — they can actually do a lot of the games that don’t require any dexterity or small move- ments with their digits.” Army veteran Lou

COURTESY OF CHARLEY WRIGHT CHARLEY OF COURTESY Monken, a Paralyzed Vet- erans of America Gateway Chapter board member who has multiple sclerosis, has tried VR a few times as an outpatient at the VA and enjoyed playing the games. “You put them on, and you’re in a different world,” Monken says. “Games, you can do anything with it. And you’re kind of free. It’s hard to explain. You can see Richard Banton plays a virtual reality game at the Department of everything. It’s neat. And Veterans Affairs St. Louis Health Care System. there’s so many different

February 2021 PN | 33 gait training with the headset on to feel like

COURTESY OF CHARLEY WRIGHT CHARLEY OF COURTESY she was walking in a forest. “That was really emotional for her,” Luit- johan says. “That was not something she felt like she was going to be able to do, but she was able to go take a walk in the woods, which was pretty great.” There are also cases like a study published by the Walk Again Project in 2016, where eight SCI patients recovered partial sensation and muscle control after about a year of training with VR and brain-controlled robotics. “I think there’s a huge benefit from a PT/ OT standpoint, and we’re hoping to expand that Michael Erbe takes program to include that, as well,” Wright says. a test run with Wright says VR is just another tool in his virtual reality. things you can do with it. I’ve only done a cou- and Luitjohan’s toolbox, but the toughest ple of games. I’ve done some scenery stuff.” part will be keeping up with the technology He says he even saw some improvements and the latest hardware. in his hand function. While there are endless possible uses “It’s good for the inpatients,” Monken for VR in the clinical setting, Wright is most says. “It gets them in a different atmosphere. excited about its potential to get veterans It’s good therapy for them, and I recommend involved in adaptive sports. all the inpatients do it while they’re there.” He’d eventually like to create original Luitjohan says the technology also opens 360-degree video content of events like the up possibilities for other clinicians, including National Disabled Veterans Winter Sports those in long-term care, pain management, Clinic to show patients who’ve never experi- physical therapy (PT) and occupational ther- enced a national program or newly injured Ruth Kult explores a apy (OT). One of the veterans wanted to do veterans what skiing down a mountain virtual reality scene. sounds, looks and feels like without the use of all four limbs. “They hear us from rec therapy saying, ‘You’re going to be able to do all of this,’ and they don’t believe us,” Wright says. “And then we say, ‘Would you like to try something?’ And we’ll put the headset on their head and

COURTESY OF CHARLEY WRIGHT CHARLEY OF COURTESY let them experience this three- or four-min- ute video of going downhill, climbing walls and scuba diving and snowmobiling and all those things. And when they’re done, you go, ‘When are you going to sign up?’ We want to see them experience it virtually, but then actually sign up for that clinic and go when the applications come out. That’s the success of the program, is they actually go and physi- cally do it for real.” Q

34 | PN February 2021 newsbeat

Free Park For purposes of this Brooklyn, N.Y., and the Uni- the board’s yearly caseload. Entry For Vets program, a veteran is identi- versity of Tennessee College There are over 30,000 post fied as an individual who has of Social Work, released a brief offices in the U.S., many of The U.S. Department of served in the United States that summarizes research on which occupy older build- the Interior announced it armed forces, including the out-of-pocket expenses faced ings. The U.S. Postal Service will grant free entrance National Guard and Reserves, by individuals with disabili- completed action to correct to national parks, wildlife and can present one of the ties compared to individuals accessibility issues at 37 facil- refuges and other federally forms of identification listed: without disabilities. ities under the ABA over the Research indicates that course of the fiscal year. Most © GETTY IMAGES/KEVINJEON00 a household with an adult cases concerned entrance who has a work-related dis- doors and customer parking. ability will need an aver-

age of 28% more income to IMAGES/KEVINJEON00 © GETTY obtain the same standard of living as a comparable household without a mem- ber who has a disability. The brief recommends “resetting the policy table” for greater equity by address- ing the tax code and eligibil- ity criteria for public benefits. To review the brief, visit nationaldisabilityinstitute. Veterans can get free access org/reports/extra-costs- Other cases concerned

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© Identification Card The U.S. Access Board is At the Kilauea Mili- tary Camp in Hawaii, the ■ Veteran Health charged with enforcing the Architectural Barriers Department of the Army Identification Card Act (ABA) of 1968, which installed compliant toilet managed public lands to all ■ Veteran ID card requires that buildings or and shower rooms in four U.S. military veterans and ■ Veteran designation facilities that were designed, accessible cottages and Gold Star families. on a state-issued U.S. built or altered with federal two guest buildings at the Unlike previous years driver’s license or dollars or leased by federal Morale, Welfare and Recre- where fees were waived for identification card agencies after Aug. 12, 1968, ation facility. a set period, this change be accessible. The ABA is not limited is permanent — meaning In fiscal year 2020, the to federal facilities and entrance fees and standard Disability Access Board resolved 55 applies to other sites that amenity fees charged by the Costs cases through corrective received federal funding. Bureau of Land Manage- action taken by the respon- One case concerned ment and Bureau of Recla- National Disability Insti- sible federal party. New York City’s Rockaway mation will be waived for tute, in partnership with The majority of cases Boardwalk, which was veterans and Gold Star fami- the Stony Brook University concerned access to U.S. post severely damaged by Hurri- lies from this point forward. School of Social Welfare in offices, which is typical of cane Sandy in 2012. The city’s

February 2021 PN | 35 © GETTY IMAGES/TANG MING TUNG

Department of Parks and — such as brain-controlled would allow for the patient to Recreation, which received prosthetic limbs or muscle communicate with external federal grants to rebuild stimulation devices — makes devices to power a robotic portions of the boardwalk, a world of difference. If the arm or to communicate with restored ramp access at two process of implanting tiny some sort of server to help locations in response to the electrodes in the brain were the veteran live a better life.” board’s investigation. to be improved, allowing for Gilbert will work with Department of Trans- stronger and longer-lasting Edmund Palermo, an assis- portation funding recipi- communication between tant professor of materials ents, including Wilson, neurons and external science and engineering at N.C., and the Puget Sound The Pfizer-BioNTech novel devices, it could significantly Rensselaer, to develop a poly- Regional Transit Authority coronavirus (COVID-19) enhance quality of life. mer coating out of curcumin, in Seattle, undertook cor- vaccine was 95% effective With the support of a a chemical compound found rective action to address in clinical trials. four-year, $1.2 million grant in turmeric, which has both access to public sidewalks from the Department of anti-inflammatory and and parking. Veterans Affairs

implementation phase, once (VA), an interdis- COURTESY OF GILBERT AND PALERMO LABS large supplies of the vaccine ciplinary team of VA COVID-19 become available. engineers from Vaccines The VA will report Rensselaer Poly- data on all vaccine doses technic Institute In December, the New administered by the VA in Troy, N.Y., aims Orleans and Bedford, Mass., to the Centers for Disease to create a polymer Department of Veterans Control and Prevention. coating that could Affairs (VA) medical centers The VA will also potentially be became the first two VA provide general, public capable of reduc- facilities to begin adminis- updates on the number ing the body’s Researchers are developing polymer- tration of novel coronavirus of people who receive the inflammatory coated electrodes implanted for (COVID-19) vaccinations to vaccination at these sites, response following brain-controlled prothetics or stimulators. frontline health care employ- similar to how the VA posts the implantation of ees and veterans residing in COVID-19 testing figures. these electrodes. long-term care community Veterans seeking addi- The inflammatory antioxidant properties. But living and spinal-cord injury tional information may sign response that often occurs first, the researchers need to and disorder centers. up to get updated at va.gov/ when microelectrodes are tackle the challenge of how Both facilities are part health-care/covid-19- implanted in the brain to turn curcumin, a fairly of the initial group of 37 VA vaccine/stay-informed, visit causes central nervous unstable molecule, into a medical centers across the va.gov/coronavirus-veteran- system scarring near the polymer material. country that began receiving frequently-asked-questions, implant and a loss of neu- From there, the team and administering the Pfizer- contact their care team or rons. Over time, the scarring has to design a technology BioNTech COVID-19 vaccine. visit their facility’s website. and neuron loss will dimin- for coating the electrode The sites were chosen for ish the current of informa- in such a way that it would their ability to vaccinate large tion being fed from the brain ultimately withstand imple- numbers of people and store Coating For to an exterior prosthetic mentation. The team also the vaccines at extremely Tiny Electrodes device or technology. wants the final polymer cold temperatures. “This is for veterans who to slowly release the cur- COVID-19 vaccine For individuals with cen- have some sort of paralysis,” cumin, so it could neutralize implementation will include tral nervous system paraly- says Ryan Gilbert, a professor inflammation at the imple- an initial limited-supply sis, the effectiveness of of biomedical engineering at mentation site and then phase followed by a general neuroprosthetic technology Rensselaer. “The electrode degrade away, so as to not

36 | PN February 2021 NATIONALCENTERDPH.ORG/OUR-FOCUS-AREAS/EMERGENCY-PREPAREDNESS COURTESY OF THE UNIVERSITY OF PITTSBURGH interfere with the electrode’s versity of Pittsburgh electrical conductivity. School of Health If the team’s polymer and Rehabilitation could reduce scarring tissue Sciences (SHRS) that is formed, electrodes have announced an would continue to work for a agreement for the longer period of time, there- school’s Department fore reducing the number of Rehabilitation Sci- of surgeries needed for elec- ence and Technol- trodes to be replaced. ogy (RST) to oversee In addition to its eventual Prepared4All links disability groups and administer Amy Lane, OTR/L, CDRS use for neuroprosthetics, with emergency management and the education and this new biomaterial coating public health organizations. training programs could also potentially be used offered by NMEDA. and operates SHRS’ Adap- on catheters, sutures or any- NMEDA is a non- tive Driving Program, to thing else that is introduced To learn more about profit trade association that serve as NMEDA’s director into the body to reduce the the Prepared4All initiative, administers the nationally of education and training, inflammatory response. visit nationalcenterdph.org/ recognized Quality Assur- with at least 50% of her our-focus-areas/emergency- ance Program accreditation time devoted exclusively to preparedness, or email for auto mobility dealerships, the association. Resources Emergency [email protected]. as well as the NMEDA Certi- from Pitt RST’s Continuing Preparedness fied Technician certification Education team will also be for individuals who install made available to NMEDA The Association of Univer- NMEDA, Pitt auto adaptive equipment. to assist with its Learning sity Centers on Disabilities Join Forces The agreement calls for Management System imple- and National Center on Dis- Pitt’s Amy Lane, occupa- mentation and ongoing ability and Public Health are The National Mobility tional therapist and certi- online education offerings. undertaking Prepared4All, Equipment Dealers Associa- fied driver rehabilitation The agreement marks an initiative that aims to tion (NMEDA) and the Uni- specialist, who manages the latest step in the cooper- increase the number of indi- ation between the viduals with disabilities and COURTESY OF THE UNIVERSITY OF PITTSBURGH two entities, which disability organizations that also included are actively engaged in local a special guest emergency planning efforts. appearance by Prepared4All links dis- Rory Cooper, PhD, ability organizations and distinguished individuals with emergency professor of RST management agencies, pub- and founder and lic health professionals and director of the health provider organiza- Human Engineer- tions on a local level. ing Resources Inclusion coaches from Laboratories, at the disability community will the 2020 NMEDA form action teams that will Annual Confer- collaborate with local emer- ence & Expo last gency management, public March in Daytona health and health providers Beach, Fla. ■ to offer a menu of services to support disability inclusion. University of Pittsburgh students take an adaptive driving class.

February 2021 PN | 37 healthsmarts JENNIFER BEST

Time To Stretch

Whether you work out on a regu- lar basis, play sports or simply go about your daily routine, stretching has many benefits for any wheelchair user. The common practice of stretch- ing has long been debated in its details: its effectiveness before versus after warmup, its impact on athletic performance and its contribution to sports longevity. For wheelchair athletes and those with spinal-cord injuries or disease (SCI/D), however, there is no debate — stretching is essential, for peak perfor- mance and daily health. Stretching can help with auto- nomic dysreflexia, an emergency con- dition that causes a sudden onset of excessively high blood pressure. “One of the biggest concerns we have in SCI patients is autonomic PHOTOS © GETTY IMAGES/GOODLIFESTUDIO dysreflexia development, which can be triggered by problems with lower extremity tightness or sensitivities Georgetown University School of Medi- all of that, eventually we get tight of the wheelchair,” says Arthur Jason cine in Washington, D.C. and lose range of motion.” De Luigi, DO, MHSA, of Mayo Clinic Stretching, he says, is among the Sports Medicine Center in Tempe, Get Started most important methods for loosening Ariz. “You may be insensate, but it can Wheelchair athletes whose every up that tightness. Additional treat- still cause your body to go haywire.” action involves propelling their chair ments such as applying heat or sitting Maintaining a regular exercise, should focus on rotator cuff, periscap- in a warm pool increase elasticity. movement and stretching routine can ular and pectoral warmups with Transcutaneous electrical nerve stimu- help maintain overall body condition- stretches above the head, to each side lation units cause vibrations that help ing, discourage circulatory and nervous and across the body. relax muscle fibers so they can stretch. complications and reduce injury risk. Often overlooked by athletes and Most wheelchair users will have “It’s certainly beneficial to stretch non-athletes alike are stretches for the tight hip flexors and hamstrings. before and after activities. You have lower body, De Luigi says. Recommended stretches for releas- people who say, ‘I don’t ever stretch, “One of the most important ing hip flexors include simply lying and I do great,’ but perhaps they’d do things about stretching is main- perfectly prone. better if they’d stretch,” says De Luigi, taining as much range as possible. For a more advanced stretch, who also serves as the clinic’s chair of When we’re born and as we move move from the prone position to cobra the Department of Physical Medicine & through life, we are more extension- pose. To perform the pose, spread your Rehabilitation, medical director of the based. When you’re in a chair, you’re hands on the floor under your shoul- Sports Medicine Independent Multidis- flexion-based. That’s where you’re ders, straightening your arms to lift ciplinary Program, associate professor likely to get contractures [permanent your chest off the floor and going only of physical medicine and rehabilitation shortening of muscles],” De Luigi to the point where your hips remain at Mayo Clinic School of Medicine and says. “As we age, after years of sitting, on the floor. Rather than pushing your professor of rehabilitation medicine at being on computers, slumping and ribs forward, which hardens the back,

38 | PN February 2021 Rotator cuff, periscapular and pectoral warmups with stretches above the head, to each side and across the body are good exercises for those with spinal-cord injury or disease.

squeeze your shoulder blades closer above the elbow and pull it across the to your spine while lifting through the body while relaxing the shoulder. top of the sternum. Active stretching, proprioceptive Hurdler stretches and modified neuromuscular facilitation (PNF) or hurdler stretches focus on hamstrings post-isometric relaxation each focus and quadriceps muscles. on making the tight muscles do the “People who initially begin a work and may best be performed stretching routine may find their with a trained partner. That same range is limited from longtime seated tight shoulder is first stretched across positions, but all wheelchair users the body by a partner. Then, the would benefit from stretching on a stretching arm pushes gently against daily basis,” De Luigi says. that partner’s hands before relaxing for another, deeper, gentle stretch by Types & Techniques that partner. Most stretching can be performed A multitude of studies have individually, but partner stretches shown that active stretching is ben- have their place when performed cor- eficial immediately prior to activ- rectly. Two options include passive ity, while PNF stretching should be stretching and active stretching. reserved following activity or with a Passive stretching involves sim- rest session or general warmup before ply relaxing the muscle that is to be taking part in the intended activity. stretched by gently pressing against it. “We have therapists work with For a passive stretch, use one hand to patients all the time. But if athletes cross the body, grab the opposite arm are working with random partners,

February 2021 PN | 39 Partner stretches, including those with stretch bands, offer wheelchair users one way to warm up their muscles. they may find themselves Baseball or softball pitchers, for paired with someone who example, can focus on warming up and doesn’t know what is a soft stretching their rotator cuffs and shoul- endpoint versus a firm end- ders. Wheelchair athletes should also point. There’s a chance you consider warming up and stretching can stretch and think you can muscles that will be used for propulsion. get a few more degrees, where De Luigi says athletes preparing other times you might just tear for an event should plan to spend 15 something,” De Luigi says. to 20 minutes stretching, but the jury He says it’s best to learn is still out on whether to warm up or how to perform partner © GETTY IMAGES/DANN TARDIF stretch first. stretches with trained individ- “If you stretch first before you uals, listen to the body’s response to “Some people do yoga for an hour warm up, you avoid potential strains those stretches, only work with trusted three to five days a week. I wouldn’t while warming up, but the benefit of partners and never push too hard. say that’s over-stretching but more warming up first is that you may get Stretching may be general or full-body, global stretching, which a better stretch because circulation activity-specific, and there’s no hard serves a different purpose from a of blood and increased heat in the and fast rule about how much is too wheelchair athlete who’s pitching a muscles and tendons allow for a bet- little or too much. softball game,” De Luigi says. ter stretch,” De Luigi says. ■

40 | PN February 2021

sports & rec

additional information to Preparation. Arbino is an National Veterans Wheel- PVA Hosting registered attendees. accomplished rifle marks- chair Games At Home and Author Q&A To register, visit pva. man and has attended over the summer, too. zoom.us/webinar/register/ the Advanced Rifle Coach The Postal Match sea- Paralyzed Veterans of WN_xbiMRoSkTDWIeYF9z school at the Olympic son runs through May 2021. America’s Sports & Recre- b6BsA. Training Center in Colo- November’s air rifle ation Department will host There are enough spots rado Springs, Colo. Postal Match results were: a virtual question-and- for about 500 people to attend. SH1-Division answer session with Wheels KERRY RANDOLPH 1. Steve Holbert of Courage author David (PVA Texas Chapter) – Davis this month. Air Gun Classes 626.4 points Davis’ book focuses 2. Toai Nolan Paralyzed Veterans of on how paralyzed veterans Air (PVA Northwest Chapter) – from World War II invented America (PVA) will have its Gun 623.1 points wheelchair sports, fought for final virtual Air Gun Session Formats 3. Jay Martin (PVA Mid- disability rights and inspired 105 class early this month. Atlantic Chapter) – Paralyzed Veterans of a nation. PVA Sports Program 617.2 points The question-and- Manager John Arbino will America (PVA) is expand- answer session will start at 1 provide instruction from ing its air rifle program SH-2 Division p.m. ET Feb. 4 on the Zoom his home on Zoom video using a Postal Match format 1. David Cromwell video conferencing platform. conferencing in a 3 p.m. ET because of the novel corona- (PVA Texas Chapter) – Davis will show photos, Feb. 4 session called Dry virus (COVID-19) pandemic. 620.4 points ■ answer questions and give Fire Training And Match It did this during last July’s COURTESY OF PARALYZED VETERANS OF AMERICA CAL-DIEGO CHAPTER

What A Catch Paralyzed Veterans of America (PVA) Cal-Diego Chapter members took a coastal deep sea fish- ing trip in September, catching more than 50 fish during their time at sea on the boat named Daily Double. PVA mem- bers Brian Delaney, right, and John Pou, left, each caught these big fish during the trip. COURTESY OF PARALYZED VETERANS OF AMERICA CAL-DIEGO CHAPTER CAL-DIEGO AMERICA OF VETERANS PARALYZED OF COURTESY

42 | PN February 2021 pva service office roster

ALABAMA Vocational Rehabilitation Office MISSOURI PUERTO RICO VARO, Montgomery Augusta VAMC, Kansas City VACHS, San Juan 800-795-3581 706-733-0188, ext. 2875 800-795-3612 / 816-922-2882 787-641-7582 ext. 11566 334-213-3433 ILLINOIS VAMC, St. Louis VARO, San Juan ARIZONA VARO, Chicago 866-328-2670 / 314-894-6467 888-795-6550 / 787-772-7384 VARO, Phoenix 800-795-3598 / 312-980-4278 VARO, St. Louis SOUTH CAROLINA 800-795-3582 / 602-627-3311 VAMC, Hines 800-795-3614 / 314-253-4480 VA RO, Co lumbia ARKANSAS 800-795-3599 / 708-202-5623 NEBRASKA 800-795-3631 / 803-647-2432 VARO, North Little Rock Vocational Rehabilitation Office VARO, Lincoln SOUTH DAKOTA (North Dakota) 800-795-9236 / 501-370-3757 Hines 800-795-3615 / 402-420-4017 VAMROC, Sioux Falls 708-202-5832 800-795-3632 / 605-333-6801 CALIFORNIA (Hawaii, Manila) NEVADA (Utah) VAMC, Long Beach INDIANA VARO, Las Vegas TENNESSEE 800-795-3584 VARO, Indianapolis 800-795-3583 VAMC, Memphis 562-826-8000, ext. 23774 800-795-3601 / 317-916-3626 702-791-9000, ext. 14458 800-795-3568 VARO, Los Angeles IOWA VAMC, Reno 901-523-8990, ext. 7795 310-235-7796 VARO, Des Moines 775-321-4789 VARO, Nashville VAMC, Mather 800-795-3602 / 515-323-7544 NEW JERSEY 800-795-3569 / 615-695-6383 916-843-2602 KANSAS VARO, Newark TEXAS VAMC, Palo Alto VAMROC, Wichita 800-795-3617 / 973-297-3228 VAMC, Dallas 650-493-5000, ext. 65046 800-795-3603 / 316-688-6875 NEW MEXICO 800-795-3570 / 214-857-0105 VARO, Rancho Cordova KENTUCKY VAMC, Albuquerque VAMC, Houston 800-795-3587 / 916-364-6791 VARO, Louisville 505-265-1711, ext. 5046 713-794-7993 VAMC, San Diego 800-795-3604 VARO, Albuquerque VARO, Houston 858-552-7519 502-566-4430 / 4431 800-795-3618 / 505-346-4896 800-795-3571 / 713-383-2727 VARO, San Diego LOUISIANA NEW YORK VAMC, San Antonio 800-795-3586 / 619-400-5320 VARO, New Orleans VAMC, Bronx 800-795-3572 Vocational Rehabilitation Office 800-795-3605 / 504-619-4380 866-297-1319 210-617-5300, ext. 16819 Long Beach 718-584-9000, ext. 6272 VARO, Waco 888-771-8387, ext. 24607, MAINE (Vermont, New Hampshire) VARO, Buffalo 800-795-3573 / 254-299-9944 562-826-8000, ext. 24607 VAMROC, Augusta 866-795-1911 / 207-621-7394 800-795-3619 / 716-857-3353 Vocational Rehabilitation Office COLORADO (Wyoming) San Antonio MARYLAND VARO, New York VARO, Denver 800-795-3620 / 212-807-3114 877-469-5300, ext. 10148 800-795-3588 / 303-914-5590 VARO, Baltimore 210-617-5300, ext. 10148 800-795-3606 VAMC, Syracuse DELAWARE 410-230-4470, ext. 1020 315-425-4400, ext. 53317 VIRGINIA VARO, Wilmington VAMC, Hampton MASSACHUSETTS (Connecticut, RDAA, Syracuse 800-795-3589 / 302-993-7252 315-423-5013 800-795-1350 Rhode Island) 757-722-9961, ext. 2943 DISTRICT OF COLUMBIA VARO, Boston NORTH CAROLINA PVA National Office 800-795-3607 / 617-303-1395 VAMC, Richmond VARO, Winston-Salem 800-795-3574 / 804-675-5316 800-424-8200 / 202-872-1300 VAMC, Brockton 800-795-3622 VARO, Roanoke FLORIDA 774-826-2219 336-251-0836 800-795-3575 / 540-597-1707 VAMC, Lake City Vocational Rehabilitation Office OHIO Vocational Rehabilitation Office 386-755-3016, ext. 2236 West Roxbury VAMC, Cleveland Richmond VAMC, Miami 857-203-6091 216-791-3800, ext. 4159 866-752-8105 / 804-675-5155 800-795-3587 / 305-575-7180 MICHIGAN VARO, Cleveland VAMC, Orlando VARO, Detroit 800-795-3623 / 216-522-3214 WASHINGTON (Alaska, Montana) 800-795-3593 800-795-3608 / 313-471-3996 VAMC, Seattle 407-631-1000, ext. 11835 OKLAHOMA (Arkansas) 206-768-5415 MINNESOTA VARO, Muskogee VARO, Seattle VARO, St. Petersburg VAMC, Minneapolis 800-795-3624 / 918-781-7768 800-795-3594 / 727-319-7470 800-795-3576 / 206-220-6149 612-629-7022 VAMC, Oklahoma City VAMC, Tampa VARO, St. Paul 800-795-3625 / 405-456-5483 WEST VIRGINIA 800-795-3595 / 813-978-5841 800-795-3609 / 612-970-5668 VARO, Huntington OREGON (Idaho) Vocational Rehabilitation Office 800-795-3577 / 304-399-9393 Vocational Rehabilitation Office VARO, Portland Tampa Minneapolis 800-795-3627 / 503-412-4762 WISCONSIN 813-972-2000 , ext. 5681 612-629-7021 VARO, Milwaukee PENNSYLVANIA GEORGIA 800-795-3580 / 414-902-5655 MISSISSIPPI (Louisiana) VARO, Philadelphia VARO, Atlanta VARO, Jackson 800-795-3628 / 215-381-3057 800-795-3596 / 404-929-5333 800-795-3610 / 601-364-7188 VARO, Pittsburgh VAMC, Augusta 800-795-3629 / 412-395-6255 800-795-3597 / 706-823-2219

February 2021 PN | 43 veteranadvisor RAYMOND TY MCWHORTER, NSO

VA Telehealth from home, the clinic or the hospital. considerable distance or across state That ability should allow veterans, lines to receive care. During these unusual times, many wherever they may be and whatever the The rule also expands veterans’ of us are very conscious about our circumstance, to obtain care at a time it access to critical care that can be daily actions and encounters. could really be needed. provided virtually — such as mental We carefully plan what we do The utilization of telehealth, or health care and suicide prevention — and where we choose to go each day. virtual technology, allows VA doc- which should translate to quicker and This includes trips to easier access to the VA a store, the gas station mental health provid- and even to the doc- ers through telehealth. tor’s office to seek care or to attend a follow- House Call up appointment. Telemedicine is a If you find your- modern-day version of self on the edge about the old-fashioned doc- attending a doctor’s tor’s house call, where appointment with your you see your physician Department of Veterans via your video or smart- Affairs (VA) primary phone conferencing. care physician, you Although telemedi- should inquire about cine isn’t an end-all, be- the option of complet- ing your appointment via telehealth. Telemedicine offers The VA amended its veterans the chance medical regulations by to have access to care © GETTY IMAGES/GEBER86 standardizing the deliv- anytime, anywhere. ery of care by VA health care providers through telehealth. tors, nurses and other health care providers to administer care to veter- Expanding Services

ans regardless of where in the United PRODUCTIONS IMAGES/SDI © GETTY This final rule, which went into effect States the provider and veteran are June 11, 2018, came with the inten- located, including when care will tion of increasing the availability of occur across state lines or outside a mental health, specialty and general VA facility. clinical care for all beneficiaries. In Previously, it was unclear addition, the VA aims for telehealth whether VA providers could fur- to offer the same level of care to all nish care to veterans in other states beneficiaries, irrespective of the state through telehealth because of licens- or location in a state of the VA health ing restrictions or state-specific tele- care provider or the veteran. health laws. The 2018 rule exercises all approach to complete medical care, The VA looks to lead the way in federal preemption to override those and probably not a good idea when you telehealth innovation to make sure vet- state restrictions, paving the way for have complicated needs, it often works erans can access care when and where the VA to expand telehealth care to well when you have a straightforward they need it. The VA aspires for tele- veterans across the country. complaint, such as a cold, allergies, health services to transform how veter- Telehealth enables veterans rashes, sprains, strains or joint pains. ans access VA health care. VA telehealth nationwide to receive care at home, One of telemedicine’s upsides is technologies look to make it easier for especially those living in rural areas the convenience of basically having you to connect with your VA care team who would otherwise need to travel a access to care anywhere, anytime.

44 | PN February 2021 Another benefit is that your doctor can Drawbacks Also, as with any electronic quickly assess you from the comfort of While it has many positives, telemed- communication, there’s always the your home and answer questions about icine does have some drawbacks. possibility of experiencing glitches. medications. If you need additional One is that it’s not suitable for all When using telemedicine, you’re care, your physician can schedule you cases. Yes, you can get a fast evalu- dependent on technology, and thus, for an in-office visit or send you to an ation using telemedicine, but you you’re at the mercy of anything that urgent care center or specialist. can’t get a full physical exam. In those can interrupt your connection, such In addition to saving time trav- cases where physical tests or labs are as bad weather, loss of power or even eling to an appointment, you don’t required, a remote consultation will outdated software. have to spend additional time sitting not be sufficient. To learn more about the VA’s tele- in a waiting room. Your primary care physician will health program, visit telehealth.va.gov. For those concerned about pri- need to arrange for you to physically For questions or help with a bene- vacy issues, VA policy stipulates that visit a facility in those cases or when fits issue, contact a Paralyzed Veterans telemedicine systems must abide by you require care for more serious and of America (PVA) national service offi- all Health Insurance Portability and involved medical issues. This is likely cer (NSO) from the roster on page 43. Accountability Act of 1996 (HIPAA) no more true than with the complex A 23-year Army veteran, Raymond guidelines and offer the same level of issues for those with spinal-cord inju- Ty McWhorter has been a PVA NSO privacy you receive when you see a ries and diseases such as multiple scle- since 2016. ■ doctor in the clinic. rosis and amyotrophic lateral sclerosis.

February 2021 PN | 45 classifieds

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46 | PN February 2021 FLORIDA AUTHOR NAME andfinally...

During Black History Month, PN recalls this 2009 Veterans Day photo of Paralyzed Veterans of America’s first Black National President Gene Crayton, seated, attending ceremonies at Arlington National Cemetery in Virginia with then-U.S. President Barack Obama, standing right, and then- Department of Veterans Affairs Assistant Secretary Tammy Duckworth, standing left. Photo by Keith Mellnick.

February 2021 PN | 47