Podcast | Episode 2: Adaptive Sports & Recreation with Alice KraussClinical Expertise
Sep 5, 2019
Tracy Davis: Welcome to the Brooks Rehabilitation Podcast. My name is Tracy Davis.
Tracy Davis: Yeah, so Alice, a brief bio about her. In 1982 Alice graduated from the University of Florida with a bachelor’s degree in occupational therapy. She received her Master’s Degree in Education from the University of North Florida in 1992. She’s worked with Brooks Rehabilitation as both clinician and manager for the past 36 years. She developed the occupation-based adaptive sports and recreation program as a healthcare innovation. So tell us, what got you interested in becoming an occupational therapist? Why of all the fields that you could have gone into, why did you choose OT?
Alice Krauss: Well, I wish I had some amazing story to tell you that I myself either needed occupational therapy services or somebody that was close to me. But really and truly, I was walking across the University of Florida campus when I was a sophomore in college, looking for a major, thumbing through the catalog. So Michelle doesn’t know, well, neither of you may know what a college catalog is, course catalog that’s-
Tracy Davis: I think all the courses that are available.
Alice Krauss: Yes, yep. And I came across this thing called occupational therapy and I was like, “Oh, I’ve never heard of that, but I’ve heard of somebody who does it.” So I read about it. And as soon as I read about it being based on the philosophy of the interrelatedness of the mind, the body, and the spirit, I was like, “Oh my gosh, that sounds a lot like how I think about life.” And so I made an appointment with one of the advisors in the occupational therapy program, and what she went on to share with me more about the philosophy behind the profession, I was all in.
Tracy Davis: This was in college?
Alice Krauss: Yep.
Tracy Davis: Where did you go?
Alice Krauss: University of Florida.
Tracy Davis: That’s right I thought so. Yep.
Alice Krauss: So I got myself busy with prerequisites and applied to the program and thankfully got in.
Tracy Davis: And then what was your journey like from there after you graduated? And …
Alice Krauss: So interestingly, I came to Cathedral Rehabilitation, which was the precursor to Brooks Rehabilitation.
Tracy Davis: That’s right.
Alice Krauss: This was back in 1981, and my occupational therapy program took a field trip to Cathedral Rehabilitation. And I remember coming into the cafeteria and all these patients were sitting in there and I was just amazed at what was happening and the transformation and the devastating injuries and illnesses they had. And I was like, “I want to be a part of that.” So I applied to do my internship at Cathedral Rehabilitation, and I did, so I did a three months physical disabilities internship, and then went on and did my mental health internship. And then I did a specialty in pediatrics down in Sarasota. So I left Jacksonville, went to Denver for my mental health, and went to Sarasota for my pediatric. And came back to visit some of my patients over the Christmas break, following my college graduation, and the occupational therapy manager at the time, Jane Davis said, “Oh, are you here to apply for the position, Karen’s leaving?”
And I was like, “I didn’t even know that, but sure.” And so we chatted a little bit. They already knew me because I’d been there for three months and I took my first job, thinking that I would stay a year and then returned to my hometown of St. Petersburg. And here I am 36 years later.
Tracy Davis: It never happened.
Alice Krauss: But it’s a great journey, and I don’t regret a minute of it.
Tracy Davis: So what are some of the spots you’ve worked in within Brooks over those years?
Alice Krauss: So I started out back in the 80s. Of course we were all generalists. So I started out as a generalist treating individuals that had experienced strokes, and brain injuries, and spinal cord injuries. And back then we worked with a lot of amputees and burns. So really just about anybody and everybody. Hip fractures, knee replacements, but I got more and more interested in neuro-rehabilitation. And so there was an opportunity to be the stroke program coordinator. So I did that for a while, and then I truly fell in love with my clinical passion and where I devoted most of my continuing education. And that was rehabilitation for individuals with traumatic brain injury. And I took a huge interest in cognition, vision, perception, and became neurodevelopmental certified and was the brain injury coordinator all the way up through 1995 and brought me to our current building. So I went from cathedral downtown Jacksonville, across the river to Memorial Rehabilitation Rehab Hospital, and then moved over to our current building in May of 1994 and became Genesis and then Brooks.
Tracy Davis: That’s right.
Alice Krauss: So I was a clinician until 1995, and then I became the manager of the Inpatient Occupational Therapy program. And then I absorbed the therapeutic recreation department for a short period of time. And then in 2007 launched Adaptive Sports and Recreation.
Tracy Davis: Have you seen drove by the old cathedral building? I don’t know that I’ve ever seen it in person. I might had and didn’t know it.
Alice Krauss: I drive by it several times. So I go to the monthly mayor’s disability advisory council in city hall. And so I drive by it at least one time a month when I go to that meeting at city hall. And it is amazing. And then in April of this year, we, several of the old time therapists from the early 80s, that would be occupational therapists, physical therapists, speech therapists, and actually some of the nurses and nurse’s aides, got together at my house just coincidentally as a reunion. So we had about 50 or 60 people that had worked back in the 80s together, and we reconnected and had a wonderful time. But as part of that I was going to put together a slideshow. So I went and took some pictures of the building. It has not changed very much.
Tracy Davis: What’s going on inside?
Alice Krauss: It’s a nursing home.
Tracy Davis: Okay.
Alice Krauss: Yeah, I forget who, oh, it’s still called Cathedral Terrace maybe. So it’s still called Cathedral and perhaps is associated with the Episcopal church as it was back then. But I don’t know that for a fact.
Tracy Davis: I just have a question before we get to Adaptive Sports. What was it like, the transition at Brooks at that time of us moving in and having our own hospital, our own kind of standing building that’s all ours?
Alice Krauss: Well, it was certainly very exciting, because we as clinicians were given some opportunity and responsibility to select the floor plan of our offices and our clinic area and the equipment that we would be using on a day-to-day basis with our patients. And we were, no surprise, we were looking at state-of-the-art things to be able to provide our patients. So we felt like it was a great opportunity to have an input into such an important project as the construction of a new rehabilitation hospital. So it was very exciting. And as soon as the contractor gave us permission, we were allowed to come in with hard hats and tour the building. And it was very exciting. So we were given the opportunity to be involved in a very limited way, but an exciting way from the very beginning. And we all were and are passionate about Brooks and about what we do. So it was very exciting.
Tracy Davis: Yeah, I bet it was. I have a question about, I’m always trying to learn more about occupational therapy and how does it fit in with the … Because this will help us lead into Adaptive Sports, is where does it fit in on the therapy team for a patient? The whole patient might need speech therapy, physical therapy, OT, where does that come in?
Alice Krauss: So occupational therapy is the profession that digs deep into what makes the patient tick. So we base our intervention on what the person tells us is important to them. So in rehabilitation, if somebody has had a stroke or a traumatic brain injury, spinal cord injury, and we find out what their life roles are, were, before they had an illness or injury, and what was important to them, what brought meaning and purpose to their life before. Then we try to incorporate that into our intervention, working on the skills that are deficient because of the stroke or the spinal cord injury or the traumatic brain injury. So if it was important to you, Tracy, let’s say you’d had a stroke and you were paralyzed and you couldn’t move one side of your body and maybe you couldn’t see so well and think so well, and you were my patient.
I would find out what’s important to you. So you’re newly married. You have a passion and a professional responsibility with technology and videography and the internet. And so I would be thinking, “Okay, you need to be able to use your vision skills. You’d need to be able to use your manual dexterity skills. You would need to be able to pay attention and use good judgment about what you post on the internet for Brooks Rehabilitation.” I’d look at all of your life roles and what you need to be able to do to fulfill those life roles, because you’ve selected those life roles. So that’s what has brought meaning and purpose to your life. And then during our occupational therapy treatment session, that’s exactly what we’d work on. So I’d bring in a computer. I would bring in a camera. I’d bring in a video camera and work on those things and say, “Okay, let’s figure out a way and adaptation where you can hold the camera and take a good picture.
Let’s talk about what is appropriate, not appropriate to post on the internet for Brooks Rehabilitation. And then we just keep breaking it down into smaller and smaller pieces based on your skill level. So if you had a devastating stroke, maybe the only thing that I’d be trying to get you to do is to use your weak extremity to hold the camera. So forget using the camera, because that may have flown out. Those skills may have flown out the window. But now we’re just trying to move out of a depressed state, move you into a motivated state to engage in rehabilitation, by bringing in things that are familiar and previously have brought meaning and purpose to your life. So we work on skill, not necessarily the same skills, but there’s some overlap obviously with all the teams. So nurses, therapeutic recreation, PT, OT, but what makes us distinctly different is that our intervention uses in therapy activities that were previously meaningful to the individual.
So it would be very different, but the science behind it is that when you engage the part of the brain that has to do with motivation and memory, that the nervous system is more responsive. So even down to the cellular level. So the science behind occupational therapy starts at the cellular level. What neurotransmitters are stimulated to be circulating in your system, how neurons talk to each other.
Michelle Orallo: So you mentioned back in 2007 that you started the Adaptive Sports and Recreation program. What is that?
Alice Krauss: So the Adaptive Sports and Recreation program is community-based and it is one of the many wonderful community health programs that Brooks sponsors. And we use the occupations of sports and recreation to help people recover from the illnesses and injuries that are challenging them, as well as sustain lifelong health, wellbeing, and quality of life.
Tracy Davis: While you were talking about all the aspects of an OT, I was seeing Adaptive Sports in my head of all the things that comes together through Adaptive Sports, all of the occupational therapy type stuff of getting the passion and the motivation. And even a lot of them are doing things that they weren’t even necessarily interested in before their accidents or injuries. But you can just see the passion that they have again for doing whatever it is that they do, whatever sport they’re doing that day, and just in interacting with each other. So, I had never thought about it in that direct way before with the OT part of it.
Alice Krauss: So yeah, you’re spot on, Tracy. So what we offer is a menu of occupations. So we can’t offer people every single occupation that’s out there, from brain surgery to welding, to golf, to crochet, to walking your dog. Like we can’t offer everything.
Tracy Davis: Right.
Alice Krauss: But we are very intentional about offering a variety of programs in hopes to have something in our menu that engages everybody in our community that we’re trying to serve. So we’ve got inside and outside, we’ve got very physical, like wheelchair rugby to not so physical, like mindfulness-based yoga. We’ve got team sport for people who are motivated by that. And then we’ve got individual sport. And for everything we do, we offer participation at both a recreational and a competitive level, because our community is very diverse. So we’ve got all ages and all abilities. So we have to have diverse programming to offer them, but really it’s a menu of occupation.
So every single activity that we offer, from rugby to yoga, to game day, and everything in between, those are all occupations in occupational therapy language, they’re just occupations. So sometimes there’ll be a perfect link between somebody’s previous life and something that has given meaning and purpose to their life before. And then it’s kind of easy. Okay, how can we build on your abilities to enable your participation in that thing that you loved before? And sometimes there’s no crossover at all, and there’s no way they’re going to go back to participating in the thing that turned them on, whatever that might be. But when I evaluate them, I assess what are the characteristics of that activity. So maybe we don’t have photography for you guys, Michelle and Tracy. But what is it about that that you liked? Well, I like to do outdoors photography. Okay, so you like outdoor, you like to be outdoors. You like to be creative, you like art. So I start to identify with the customer, with the person we’re serving. What do you like about that? We don’t have that, but let’s see if we can get something close.
Tracy Davis: So one of the things I’ve always loved about Brooks is just how they listen to employees for things that just make sense for filling a gap for our patients in some way, shape, or form. And now we talked to Jody on the last episode about the Aphasia Center and Crowdsourcing, but this Adaptive Sports came before Crowdsourcing. So tell us about that process of where you, obviously you were being an OT before, you had this idea, how to do all of that start? How did Adaptive Sports come to be?
Alice Krauss: Well, I have been alive and worked as an occupational therapist in rehabilitation long enough to have experienced up close and personal the drastic changes in healthcare that happened in the 90s. So as reimbursement there was a lot of Medicare fraud across the healthcare system, and the federal government basically clamped down on all that, and so drove down reimbursement. So, many people were not even eligible to come into rehabilitation or to receive outpatient services. And those who did make the cut received a lot less care because there just wasn’t reimbursement for a lot of care. So if a person had a stroke or spinal cord injury and they would come into our care, they might stay six months, eight months. That same patient, if they were able to make their way into Brooks or another rehab organization across the country, they might only stay, what’s our average length of stay? Like 17 days.
Tracy Davis: Something like that.
Alice Krauss: It’s very short. So obviously we couldn’t get as much done. So the idea in occupational therapy is to pick the right challenge, pick the right activity at the right level that challenges the individual and then give them opportunities to practice those skills within a personally meaningful activity in ever more complex environments over time. So lots of repetition, slowly increase the complexity of the task, slowly decrease the assistance you’re providing. So that takes a lot of time, but that’s the best way for the nervous system to learn. We couldn’t do that. So the outcomes were just not, well they were different. They were just not as good. We didn’t have as much time to help people recover and get fully integrated into their lives and their communities and optimally recover. So I was involved in a few support groups, saw people out in the community, they’d come back in to see their therapist or whatever.
And I would notice that the same people who had graduated from our services, traditionally inpatient and outpatient, and had made great gains, because we do really good work at Brooks. They had made great gains, but had really fallen off the map after they left here, because they were not getting the support they needed to sustain those gains. And I was just frustrated. And I’m one of those people that once I see a problem, it’s hard for me to let go of that problem. My mind just continues to work on it. And I thought we’re using all these resources in the industry of rehabilitation, not just at Brooks, but you know, across the country. But then when people leave our care, we’re kind of saying, “Hmm, hope the rest of your life works out.” But yet what we were seeing was that without adequate support in the community, people were not sustaining the gains that they had made.
And in fact, their lives were characterized by social isolation and physical inactivity. And I felt like that’s kind of the same thing that I know about people who are born with a disability who have a congenital challenge. So I’m like, “Well, no matter how you enter the world of disability, it seems like you’re ending up at the same spot, living a life characterized by social isolation and physical inactivity.” And that that caused a lot of secondary health complications that I felt were preventable. So I was like, “What occupation could we use that would engage the maximum number of people so we could really impact our community in a way that would help them sustain lifelong health, wellbeing, and quality of life?”
And in our occupational therapy philosophy, we believe that the work-life-balance is something. We put a lot of credibility into that. So I thought if everybody, if that’s part of our being human, is that we have a need for the occupations of leisure and rest. Maybe that’s my ticket, because it won’t matter what age you are and what matter if you’re retired, it won’t matter. It won’t matter anything. If we believe that’s part of being human, then that’s how we can serve the most number of people as a nonprofit organization dedicated to the health of our community.
So that’s what I went with, and I was going to do it on my own because Brooks wasn’t doing it. And as much as I loved Brooks, I was like, “Well, it seems like I’m going to, I guess I’ll go try to fix this problem as a private practitioner, occupational therapist in the community.” And then somebody said, “You love Brooks, you love working there. Why aren’t you seeing if they want to start this program?” And I was like, “I guess I thought if they wanted to do it, they would have done it.” And they said, “Well, if I were you I’d be giving them the right to first refusal.”
So I did, and Doug and Michael quickly responded to my email and said, “We saw your proposal and we like it. Can you give us six months to figure out how to fund you?” And I never wanted to leave Brooks. Obviously I love Brooke.
Tracy Davis: Sure. When I think of Brooks, it’s hard to think of Brooks without Adaptive Sports being in the puzzle of Brooks, all the pieces that makes up who we are. Because I’ve been here for since 2005 and it started in ’07. But I was kind of in my own little world doing part-time work for Brooks back then, so I wasn’t fully aware. But when I came back in 2012, Adaptive Sports has been, everyone talks about it all the time about how beneficial it is. Now I’ve been a bunch of the events that we have. We just had PAR-TEE not long ago. And we always have amazing events and we have surfing coming up in-
Alice Krauss: August 10.
Tracy Davis: August, that’s right. And I always go to that. I think I’ve been to every one of them the past few years, and it’s always such a good event. I actually invited our whole team to come and marketing. And just, even if they can’t participate, like volunteering, but just to see it. Different people do that. They’ll bring their family just to come out and watch, because we kind of take up that whole space in front of Jax Beach there. It’s a good chunk in front of Joe’s Crab Shack.
Alice Krauss: We’re going to take up even more space this year, because we have two more teams. So we’re going to be able to get 72 surfers out into the water this year.
Tracy Davis: Oh my gosh, that’s a lot, that’s great.
Alice Krauss: 300 volunteers, 72 surfers.
Tracy Davis: That’s amazing. That’s awesome. I’ll be out there taking photos and everything again.
Alice Krauss: Looking forward to it.
Tracy Davis: Yeah, that’s huge.
Alice Krauss: Yeah, you made it. You’ve made some incredible videos of our time out there.
Tracy Davis: I love it being out there and doing that event and just to show people the smiles on people’s faces of when they’re riding that surf board. It’s just amazing. And for those who don’t know, you get groups of volunteers to kind of create a funnel of people to just make sure that as the person surfing down that they’re staying safe. And if they get flipped over, there’s someone right there to pick them up. And so what’s maybe one of the biggest or a couple of the biggest sports that the Adaptive Sports participants love each week, because you guys are doing stuff every day, each week?
Alice Krauss: We have about 13 to 15 activities each week and we usually don’t have anything on a Sunday unless there’s a special event. So this week we have a special event with a military group and we’re doing a rugby scrimmage on Sunday afternoon. But unless it’s a tournament that runs over the weekend, we typically try to stay away from Sunday.
Tracy Davis: Right.
Alice Krauss: But we have regular programming six days a week, several activities during the day, and every single evening we have at least one and sometimes we have three. So it’s a robust, it’s a busy program. It still is the largest and most comprehensive in the country. And that’s because of the resources that Brooks Rehabilitation dedicates to it. That’s the only reason that we are able to serve the numbers that we do and engage a diverse community like we have. It’s because Brooks’ executives and board of directors make that commitment each and every year to our community.
Tracy Davis: Absolutely. What are some things coming up with the Adaptive Sports program that you can tell us about? Maybe some new fun things or changes?
Alice Krauss: Well, this coming Monday we are doing for the second time indoor skydiving, which is kind of exciting. That is in partnership with iFLY Jacksonville. And in 13 years we have never had a wait list as long as we did for our event in the spring. So that’s why we’ve brought it back. So we had a wait list, within a few hours we had a wait list of 41 people for the iFLY-
Tracy Davis: How many people can do it?
Alice Krauss: … they did previously. 36.
Tracy Davis: Oh, okay. Wow. So hopefully when this episode comes out, it’ll probably be out, it’ll be after.
Alice Krauss: Oh, okay.
Tracy Davis: But I mean, so I’m sure you’ll have it again down the road-
Alice Krauss: Yes, yeah.
Tracy Davis: … if it’s this in demand?
Michelle Orallo: If anyone listening is interested in volunteering or participating, when is the best way to contact you?
Alice Krauss: So if you are interested in getting involved with our program and you are somebody that is living with a disability, or you just want to find out more about our programming, you can call our office. And that is area code (904) 345-7314, and we’ll be glad to help you. If you are interested in finding out how to volunteer in our program or would just like to see our weekly schedule of events and the upcoming special events, you can go to brooksadaptivesportsandrecreation.com, or you can follow us on Instagram and check us out on Facebook as well.
Tracy Davis: Thank you for coming. We really appreciate your time.
Michelle Orallo: Thank you so much.
Alice Krauss: Thank you both so much for the opportunity. I love to talk about occupational therapy and Adaptive Sports and Recreation.
Tracy Davis: Thanks again to Alice for being on the episode this week. We really appreciate her time. Just a reminder for you. You can follow us on social media, Facebook and Instagram, just search for @brooksrehab. And if you have any comments or questions for the podcast, please email us Podcast@BrooksRehab.org.