Deaf Athletes speak a different language, they are not disabled. They maybe Hard of Hearing but not any less capable. We have to learn how to provide healthcare for them the same as the hearing athletes.
Jennifer Warren learned signed language as a kid to communicate with one of her teammates and has continued learning and using the skills through her career.
Josh Woodall and John Ciecko have first hand experience working with deaf and hard-of-hearing athletes and share some ways we can provide more equitable care.
Jennifer, what is the best tip you have for working with hard of hearing or deaf athletes?
I would suggest that the hearing community speak naturally to those who are deaf or hard of hearing. Many can read lips, but when we accentuate our words, it distorts our mouths, which can make it more difficult to read lips.
Second tip, most people who are deaf and hard of hearing appreciate any sign language you may know. Spelling out words or signing slowly is welcomed and appreciated.
John: Communicate eye to eye, never tell the interpreter “tell them this…”, people of various abilities should never be excluded from sports.
Only 30% of the English language can be read on lips, and that’s with perfect lighting and a couple of strong cups of coffee. Helmets, low hats, or any kind of obstruction to see someone's face and mouth hinders this ability to catch what’s being said on the lips. This is why it’s so important for Athletic trainers to learn the basics of ASL.
Josh, give us an example of how you have used this or other tips from Jennifer?
The first week in Bryan ISD I had an athlete with a broken radius/ulna so had to learn real quick how to communicate with an interpreter.
Jennifer, what should we know about working with deaf and hard of hearing athletes?
Not all disabilities are cognitive disabilities. In fact, the deaf community does not see hearing loss as a disability. The deaf and hard of hearing community prefer to be seen as a community that uses a different mode of communication, rather than a group with a disability.
American Sign Language is considered a foreign language, which is simply a different mode of communication. The need to use sign language is comparable to the need to use Spanish when a student’s primary language is Spanish. This means that deaf or hard of hearing students are very capable or able to participate in athletics and other extracurricular activities.
Also, the words ‘deaf or hard of hearing’ can seem like a harsh way to describe a people group, but it is actually what is accepted and preferred by the deaf community.
And, Deaf and hard of hearing students may not hear the starter’s gun or whistles blowing. Adjustments may need to be made to allow for access to the audible elements of the sport.
Discuss some of the hearing devices and how we can protect those for participation.
Most students self-care for their devices by the time they make it to the secondary sports level. But, AT’s (Athletic Trainer/Assistive Technology) may find it helpful to know how to support these athletes:
FM systems – wireless assistive hearing devices that enhance the use of hearing aids. The coach or AT may wear a mic that is bluetoothed to the student’s hearing aid or cochlear implant. This allows the student to hear direct voice from the coach or AT.
Hearing aids -small device that fits on or in the hear to amplify sound
Cochlear implants – small device that consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin. The device has several parts that help reproduce the effects of sound.
It may be helpful for the AT to offer a secure place to store the devices.
John: actual sound or noise that comes through the auditory devices can vary from what you and I hear as hearing individuals, which is why it’s not always enough for effective communication especially in a loud setting such as an athletic field – to keep in mind for ATs
What is something about this population that is probably misunderstood?
Language (foreign language)
Disability vs Mode of Communication-little to no modifications to be able to participate in sports
John: Actual athletic ability is affected or that someone who is deaf or hard of hearing “don’t understand”
Section 504 and the ADA require that “reasonable accommodations” must be provided for an individual who can establish that he has a “disability” and that he is “otherwise qualified” to participate in the sport or activity in question. An accommodation can be an interpreter, lights or whatever is dictated by the student’s 504 plan.
Talking slower or louder does not help! However, facing the athlete and speaking directly to them does.
Deaf individuals also rely on facial expressions (the picture of me proposing to Jenny with my eyebrows raised indicates a question!)
What are some “PC” or non-PC things to say or talk about regarding our hearing-impaired athletes?
Auditory Impairment or Hearing Impaired is now replaced with Deaf and Hard of Hearing.
Watching people have a conversation in sign language is the same as eavesdropping a verbal conversation.
Josh-example of working with interpreters (interpreters translate what is being said exactly the way it is said).
Signs we want you to know
Help Thanks Yes No Pain Water Name
Podcasts or Youtube channels you like for learning more?
Lifeprint.com for learning sign and about deaf culture and history
Signingonline.com – For full lessons (fully online) based on a two-year curriculum. Used by high schools, colleges, and universities for their 2-year world language credits. Also used to obtain CEs (WHICH I'M PUSHING THE BOC TO ADOPT)
If you take the patient out of the equation you are showing your ego… “I want the patient back playing in two weeks..”
A big failure is removing the patient from the equation
Having coaches dictate when an athlete or parent can return to play.
Daria: LongCOVID – I want to get back to running, walking, dancing. I am stubborn and would do them but then was just crashed out.
How I have asked:
“What is your goal for today?”
“What are you hoping to get out of coming in today”
“What are you wanting to hear after the evaluation?”
Thoughts on asking these goal-setting questions?
With kids, it may just be awkward because they are answering them for themselves the first time
There are therapy goals and then daily goals
They should still tie into what the overall goals are
John: Relationship building
A majority of people will not know what their goals for the day are.
What is the real question?
Realistically you are talking about the history
“How are you doing today?”
“What have you learned today?”
You use those things as clinicians to help them define their goals.
Remember the history and relationship with the kid and consider that as you are asking the “goal” question.
We do not use a lot of objective goals because we do not have to report it, but they can be useful in motivating.
“How can I help you today?”
Ray Olivo – on helping patients set goals for their healthcare
Continue to ask questions to figure out who they are as a person rather than an injury
“How can we work together to get you to your goal?
Daria – the psychosocial is such a huge piece as well.
Some goal-setting is defined by statements such as: “I want to get on the floor with my kids/ grandkids and play but the pain is preventing it.”
Trying to document for insurance forces Daria to put all of the pieces together.
Are there stairs in your apartment
It sounds like you are saying this, this, and this. How can we work together to get better?
Example of “Goals” for athletes
Return to play
Instead of “Here is what you are going to do today.”
“Here is what I feel like we need to work on how do think we can accomplish that?
John – I like to look at it as a department view
“What are our professional goals”
We write them out and put them on the wall and it leads everything we did
You still need to have a goal as an AT to guide the patient’s recovery.
Celebrate small goals
In the secondary setting where we potentially see them every day, what should this look like?
John – The target – “what is your bullseye?” Work backward from the outer rings to see how they get to the bullseye. We keep soap notes and rehab sheets out for all of our athletes. Rehab charts are on the back of the soap notes.
WRITE THINGS DOWN
Daria – know the target and work out from there 8 weeks walking pain-free So what steps can we use to get you there at 2 weeks, 4 weeks, and 6 weeks?
Ray– having them see their goal is important Let’s take a picture of your ankle daily and compare it Or lets video you walking and running Each athlete is by appointment currently and they have an agenda for the day. Ask them what their plan is
Other tips for implementing the patient goal setting in rehab?
Daria: Long-standing pain – the goal is not being pain-free, but finding distractions to keep his mind off his pain.
Certain hobbies and activities and helping him build those into their life and improving the ability to perform those tasks.
Ray: There are many ways to do goal setting.
IT’S ALL ABOUT THE PATIENT
John: Practice what we preach.
How are your goals going to help your patient population?
If you are good at setting your own goals it will show in your practice
John Ciecko has been hesitant, mostly about what it looks like to go fully digital, so we set up a meeting of the minds.
Have you been thinking about moving from paperwork to an EMR in your athletic training practice?
If you answered yes, you will want to listen to today’s show. Both Danny Barringer and Christopher Dean recently switched to EMR’s and today on pod they will highlight the benefits and help you navigate the roadblocks.
Why should AT’s move to this fully digital model?
Ease, portability, security, and accessibility. As AT’s we are often not seated at our desk during the day. Moving to an EMR allows us to access information as well as enter information whenever and wherever we need to.
How did you decide which EMR to utilize?
It’s important to research the available EMR’s but before you even get to that point identify what is important to you and your stakeholders in the EMR’s capabilities.
Danny researched and found that DragonFly Max offered everything he needed as an outreach director at a hospital with multiple schools and sports.
Chris was introduced to NextGen when the orthopedic practice merged with a hospital that already utilized an EMR. While NextGen didn’t have a lot of what he felt AT’s needed, the IT department was able to customize NextGen to make it more useful for the athletic trainer.
How do you get buy-in or navigate roadblocks with implementing an EMR?
Communicate the why, talk about liability and the lack of protection paper offers and remind them that one HIPPA violation would cover the cost of an EMR.
What is one thing you both love about the EMR’s you are using?
One thing both Danny and Chris agreed upon is the dictation feature that is found in both DragonFly Max and NextGen. They both appreciate the ability to dictate a note or eval info no matter where they are.
Can EMR’s assist with the PPE collection?
Absolutely! In DragonFly Max you can take a photo of the PPE and upload it into each student-athletes profile. NextGen allows you to internally or externally upload a PDF of the PPE into a student athlete’s file.
What’s one recommendation for AT’s who are wanting to make the switch to EMR’s.
Research all the EMR’s available and find one that has everything you need. Remember that Standard Of Care is EMR now. EMR’s can help AT’s prove relevance and value.
Watch on Facebook
Considering an EMR?
DragonflyMax has so much to offer you at a price that you can not beat.
Danny Barringer – Danny.Barringer@surgerypartners.com
We have been testing the units and now Brandon Hearn – Product Guru for Compex – joins the Sports Medicine Broadcast to discuss Compex live. We have lots of questions and he has lots of answers.
“The Compex is not Complex” – Brandon Hearn
Do you have a Compex Unit?
We plan to have another discussion down the road but what tips, tricks, or uses have you found for helping athletes (yourself included) to recover and heal using NMES units like Compex?
What questions do you need answers to?
Want a sweet deal?
During our Compex live podcast, Brandon extends a pretty sweet deal towards the end of the show for podcast listeners. You can get one of the upper-level units for a base unit price.
Buying through an approved vendor?
MioTech has great prices and great customer service.
Current prices for the units discussed:
Fix Massage Gun – $165
Theragun G3Pro – $599
Marc Pro – $655
Compex Edge 2.0 – $140
Best use ideas to get started?
If you are brand new to (or taken an extended break from) exercise then START SLOW…
John, Sofia, myself and Coach Caballero all went way too heavy to start.
We were struggling to walk, tie shoes or do most things normally. SO BE WARNED!!!
Using squats as an example:
Hook the pads up as shown on the Compex website for the area you are trying to target.
Turn the device on
Select the muscle group
leave the radiator image on
The top 2 uses for the devices:
Clearing of lactic acid in 7 minutes or less on the blood flow or warmup setting.
Increase muscle recruitment to improve training sessions.
Another great use for the device is pre and post-surgery. hooking the device up quad and hamstring simultaneously. This way they are all firing at the same time without movement. Decreasing muscle atrophy and improving long term outcomes.
Compex pads are expensive…
DON'T buy cheap ones on amazon. Brandon says the pads are more expensive to provide a better product and provide more safety. The cheap pads can actually cause burns to the skin if the adhesive is missing.
I bought some and we are going to test it out on ourselves…not on patients.
Two other safety features we learned about during the Compex Live session:
Biphasic current means the electricity goes into and out of the body through the pads.
You can not charge the device while operating it.
John, Sofia, Coach Caballero and I really tested these things out.
See the demo on Facebook
These people LOVE Athletic Trainers and help support the podcast:
Ever been the only white person in the room? How about your college program?
Eva Martinez says as a brown woman in Athletic Training she longs to see more diversity and inclusion in leadership. She wants to see people like her in leadership.
What is your Diversity and Inclusion story?
Have you been excluded from conversations because you did not fit the mold for the current leadership style?
Are you like Sofia and never really felt excluded or like there was a ceiling to your ability?
Do you get fired up when someone makes an off-color comment, let it slide or find a way to educate?
Find the Similarities
Sometimes people make comments because they are intentionally hurtful, but sometimes they are just ignorant.
I said something about going to a polish festival and used the word “polak” while talking to my wife. I read a book where the main character was Polish and referred to himself as a “Polak” so I thought it was normal…until she told me the word is derogatory.
If I had said this to a polish person it may have ended very differently.
Continuing to use the term after learning the meaning would be intentional. I have only used the term to tell the story since that day.
In your quest for Diversity and Inclusion be quick to extend grace and offer a chance for education and change.
In another Go4Ellis update, founder Ellis Mair discusses some big news.
Ellis and her team were able to double not only the number of states using her online platform which connects Athletic Trainers to per diem work but also double the number of Athletic Trainers using the platform.
Always ready for a fun conversation, John Ciecko sits down with Ellis on the podcast live from NATA Las Vegas and discusses this accomplishment and many more.
Ellis states that attending 8 of the 10 NATA district conference meetings and reaching out to every state head explaining the background, goals, and mission of Go4Ellis has certainly helped grow the platform.
She also explains working from the top to bottom approaching leadership first is critical to communicating the vision and educating. However, working from the bottom up and reaching out to AT’s in certain communities to build growth in each state was important too.
What exciting new partnerships are happening with Go4Ellis?
A new partnership with US Lacrosse began this year requiring a mandatory AT per every 3 fields at every US lacrosse event.
A partnership with Players Health EMR allows AT working these lacrosse events to create injury reports. These injury reports are then able to collect data for epidemiology reports being researched by MedStar.
What makes Go4Ellis beneficial to the athletic trainer and the profession of Athletic Training as a whole?
Athletic Trainers are able to work per diem to earn extra money when they are available or when they may be facing additional upcoming expenses.
But by increasing the presence of Athletic Trainers’ at a variety of athletic events, including most recently a rise in Quidditch events, Go4Ellis helps increase exposure athletes have to Athletic Trainers’.
We also ontinue to educate National Governing Boards of a variety of youth sports on the importance and necessity of an AT at all of their events and give us as Athletic Trainers’ an opportunity at each per diem event to educate and advocate for our profession.
Can you only make money by working an event?
No, through their 4werks.com referral system, AT’s can refer an organization or event to Go4Ellis for coverage and if the event runs that AT will receive a check for 125.00.
What are Ellis’ future goals for this next year?
Increase the number of operators of events, AT’s involved as both operator’s and per diem and partner with more NGB’s.
Be actively working in all 50 states.
Renew partnerships with the NATA and become more involved in data collection on the field.
Work the Players Health EMR into their app.
Need more Go4Ellis info?
If you would like to contact Ellis Mair feel free to email her at Ellis@go4ellis.com As you’ll hear during the podcast, she is really good about returning emails quickly.
One way the NATA is working to improve the practice of secondary school athletic trainers is through a new online tool launched in 2019 called PASS (Some features require NATA login credentials).
Today on the podcast John talks with Bart and Larry about the online tool they helped create through an entire year of data collection, research and collaboration.
What is PASS?
PASS is an online tool available to secondary school athletic trainers that are NATA members. The tool takes the AT through 12 standards with narratives and annotations that can help ensure that can help elevate the care at a secondary school and ensure that you are practicing at the highest level.
Who should use PASS and how should it be used?
Bart and Larry encourage all secondary school AT’s to login and process through the PASS system. Their goal is for at least 20% of all HS AT’s participating in PASS so that they can then pull of data of each state and assess where each state is meeting the standard and what needs improvement.
They recommend that an AT take approx 1 month to go through each standard and at the end of the year (12 standards) each secondary school will have a comprehensive collection of their policies, procedures, EAP’s and other administrative information.
How can an AT use PASS to move towards appropriate medical care?
The standards provided in PASS will ensure the AT is practicing at the highest level of care. Each standard includes evidence and case law for compliance.
The standards are also a great tool to present to stakeholders within your school to encourage change. For example, there is a standard of clean and safe facilities. If you as an AT are struggling to get your AT room and equipment cleaned properly, this standard can be taken to a stakeholder in the district and will help them understand the need for and importance of clean facilities.
The PASS system is also a great way to transition between AT’s in your school. All EAP’s, policies, etc are stored on the PASS sight for the next AT at that high school.
We are already a NATA Safe School. Should I still do PASS?
Bart and Larry encourage even Safe School Award winners to process through PASS. “If they have already been awarded the Safe School Award, they have probably already completed 70-80% of PASS.
Bart’s dream is to have Safe Schools and PASS connect so that AT’s are not only participating in PASS but also apply for the Safe Schools Award.
What is the end product of PASS?
Elevated care within the secondary setting and moving from a model where a non-medical professional evaluates the AT to a medical model where the health care team works together to not only evaluate the AT but also to evaluate all the policies and procedures with the high school.