- RECREATION THERAPY AND HEALING OUR WOUNDED WARRIORS

[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]

RECREATION THERAPY AND
HEALING OUR WOUNDED WARRIORS

=======================================================================

FIELD HEARING

before the

SUBCOMMITTEE ON HEALTH

of the

COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS

SECOND SESSION

__________

JUNE 8, 2010

FIELD HEARING HELD IN NEW PORT RICHEY, FL

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Serial No. 111-82

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Printed for the use of the Committee on Veterans' Affairs

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U.S. GOVERNMENT PRINTING OFFICE
57-026 WASHINGTON : 2010
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COMMITTEE ON VETERANS' AFFAIRS

BOB FILNER, California, Chairman

CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, Jr., South
Dakota Carolina
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
DEBORAH L. HALVORSON, Illinois BRIAN P. BILBRAY, California
THOMAS S.P. PERRIELLO, Virginia DOUG LAMBORN, Colorado
HARRY TEAGUE, New Mexico GUS M. BILIRAKIS, Florida
CIRO D. RODRIGUEZ, Texas VERN BUCHANAN, Florida
JOE DONNELLY, Indiana DAVID P. ROE, Tennessee
JERRY McNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia

Malcom A. Shorter, Staff Director

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Subcommittee on Health

MICHAEL H. MICHAUD, Maine, Chairman

CORRINE BROWN, Florida HENRY E. BROWN, Jr., South
VIC SNYDER, Arkansas Carolina, Ranking
HARRY TEAGUE, New Mexico CLIFF STEARNS, Florida
CIRO D. RODRIGUEZ, Texas JERRY MORAN, Kansas
JOE DONNELLY, Indiana JOHN BOOZMAN, Arkansas
JERRY McNERNEY, California GUS M. BILIRAKIS, Florida
GLENN C. NYE, Virginia VERN BUCHANAN, Florida
DEBORAH L. HALVORSON, Illinois
THOMAS S.P. PERRIELLO, Virginia

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.

C O N T E N T S

__________

June 8, 2010

Page
Recreation Therapy and Healing our Wounded Warriors.............. 1

OPENING STATEMENTS

Hon. Corrine Brown............................................... 1
Prepared statement of Congresswoman Brown.................... 42
Hon. Gus M. Bilirakis............................................ 2
Prepared statement of Congressman Bilirakis.................. 42
Hon. Jeff Miller................................................. 4
Prepared statement of Congressman Miller..................... 43

WITNESSES

U.S. Department of Veterans Affairs:
Cathy Chiovitti Williams, CTRS, Supervisor, Recreation
Therapy Section, James A. Haley Veterans' Hospital, Tampa,
FL, Veterans Health Administration......................... 32
Prepared statement of Ms. Williams....................... 56
Steven G. Scott, D.O., Chief, Physical Medicine and
Rehabilitation Service, James A. Haley Veterans' Hospital,
Tampa, FL, Veterans Health Administration.................. 34
Prepared statement of Dr. Scott.......................... 57

______

Hillsborough County, FL, Parks, Recreation and Conservation
Department, and Paralympic Sport Tampa Bay, Tampa Bay, FL,
Melinda Wheatley, Senior Recreation Therapist.................. 20
Prepared statement of Ms. Wheatley........................... 48
Keckler, Mary Ann, Spring Hill, FL............................... 5
Prepared statement of Ms. Keckler............................ 43
Nelson, Lee, Land O'Lakes, FL.................................... 8
Prepared statement of Mr. Nelson............................. 45
Paralyzed Veterans of America, Florida Gulf Coast Chapter, Tampa,
FL, Davis Celestine, Vice President............................ 7
Prepared statement of Mr. Celestine.......................... 45
Professional Golfers' Association of America, Adaptive Golf
Academy, Inc., David B. Windsor, Principal Instructor.......... 24
Prepared statement of Mr. Windsor............................ 52
Quantum Leap Farm, Inc., Odessa, FL, Edie E. Dopking, Ph.D.,
President and Founder.......................................... 17
Prepared statement of Dr. Dopking............................ 46
Sailability Greater Tampa Bay, Inc., Clearwater, FL, Sandy
Ackley, Programming and Events Coordinator..................... 22
Prepared statement of Ms. Ackley............................. 51

SUBMISSION FOR THE RECORD

Verax Technologies, Inc., Pensacola, FL, statement............... 58

RECREATION THERAPY AND
HEALING OUR WOUNDED WARRIORS

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TUESDAY, JUNE 8, 2010

U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Health,
Washington, DC.

The Subcommittee met, pursuant to notice, at 8:30 a.m., in
the New Port Richey City Hall, 5919 Main Street, New Port
Richey, Florida, Hon. Corrine Brown presiding.

Present: Representatives Brown of Florida and Bilirakis.

Also Present: Representative Miller of Florida.

OPENING STATEMENT OF HON. CORRINE BROWN

Ms. Brown of Florida. Good morning. The House of
Representatives Committee on Veterans' Affairs scheduled this
hearing and will now officially come to order.
I'm going to change the outline slightly. Before we bring
up our first panel, I would like my ex-colleague, Mr.
Bilirakis, who represented this area for many years, to come
and bring us greetings.
Come up, Mr. Bilirakis. Yes, the Chair says come up.
Mr. Michael Bilirakis. Madam Chairwoman, you used to order
me around up there.
Ms. Brown of Florida. Come on up.
Mr. Michael Bilirakis. I'm here with my fellow veterans.
I'd rather be here with my fellow veterans. I appreciate that
very much.
It was wonderful working with you. You were on the
Veterans' Committee all through the years from the time you
came up there until the time I retired, which shows an awful
lot of dedication on your part.
And I very much appreciate, on behalf of us, all that
you've done, the Veterans' Committee, down here, and you're
taking care of my little boy up there.
Ms. Brown of Florida. Thank you.
Will the first panel come up, please? I would like to thank
everyone for attending this hearing.
I would also like to express my sincere gratitude to the
city of New Port Richey and Congressman Bilirakis for hosting
us today.
Thank you.
Mr. Gus M. Bilirakis. My pleasure.
Ms. Brown of Florida. And I certainly want to thank Mr.
Miller for joining us also.
Modern medical advances have increased the survival rate of
our soldiers who sustain injuries while serving this country,
but those soldiers are also left with serious and complex
wounds, which require continuous care once they return home.
One of the key challenges facing the U.S. Department of
Veterans Affairs (VA) today is the ability to meet the
rehabilitation needs of our veterans by providing a broad and
varied menu of therapy and treatment.
There is a clear need for high quality rehabilitative care
for all of our veterans, both the old generation and those now
returning from Operation Enduring Freedom (OEF) and Operation
Iraqi Freedom (OIF).
Today's hearing offers us the opportunity to examine a
particularly exciting rehabilitation method. Recreational
therapy is an ideal component of the rehabilitation regime
because it allows veterans to be active by engaging in their
favorite sports and recreational activities, while
simultaneously sustaining the healing of the mental and
physical wounds of war.
Recreational therapists can use a variety of techniques,
including sports, games, art, dance, crafts, animals, drama,
music, and community outings to help reduce depression, stress
and anxiety; enhance basic motor functioning; and build
confidence among the program participants.
In other words, servicemembers and veterans have
opportunities to engage in their communities and participate in
sports and other activities that they may have enjoyed prior to
sustaining their war injuries.
Today, I look forward to hearing from the veterans on our
first panel about their personal testimony on how recreational
therapy has benefited them.
I am also eager to learn from our second and third panels
about the different types of recreational therapies that are
available to our veterans, and how VA and private organizations
are working together to offer this valuable treatment option to
wounded warriors in the Tampa region and across the country.
I now want to recognize Mr. Bilirakis for any opening
remarks that he may have.
Thank you again, Mr. Bilirakis.
[The prepared statement of Congresswoman Brown appears on
p. 42.]

OPENING STATEMENT OF HON. GUS M. BILIRAKIS

Mr. Gus M. Bilirakis. Thank you, Madam Chairwoman. I really
appreciate it very much.
I'm so pleased to be here today in the heart of the 9th
Congressional District and want to thank my fellow Floridian
colleagues, Corrine Brown and Jeff Miller, for taking the time
out of their busy schedules to be here today.
As a matter of fact, ladies and gentlemen, we have votes
this afternoon. If it were not for these two, we would not be
having this hearing this morning. So they really made a special
effort.
As you know, Corrine is from the Jacksonville area, and
Jeff is from the Panama City/Pensacola area, and they really
went out of their way to be here; that's how much they care
about this issue. So we really appreciate them very much.
It's a pleasure to serve this great State with two
individuals so committed to championing the best interest of
our servicemembers, veterans, and all the residents of Florida.
I'm grateful to both of you again.
I also want to recognize the representative from Ginny
Brown-Waite's office, Shirley Anderson.
Is she here? I know she's on her way.
Oh, hey, Shirley.
Ms. Anderson. Hi.
Mr. Gus M. Bilirakis. Thanks for being here.
Most importantly, I'm happy this morning to see my
constituents from the 9th Congressional District.
Whether here as a witness or an interested participant,
seeing so many that have gathered so early and are willing to
spend their Tuesday morning exploring the role of recreation
therapy in healing our wounded warriors is a testament to the
depth of patriotism and caring in this community. I thank you.
It's an honor to represent you in Congress.
Throughout my career, honoring the service and sacrifices
of our veterans has been among my highest priorities--as a
matter of fact, it's been my top priority. Ensuring the men and
women who fought so bravely for our freedoms are given access
to the highest quality care and services is a commitment I take
seriously. That's why I specifically requested a seat on the
Veterans' Committee when I was elected to serve in Congress in
2006.
Since then, I've introduced numerous bills, many of which
were incorporated into law, aiming at improving veterans' care
and benefits. I was pleased to lead the effort to bring a VA
outpatient health clinic to Hillsborough County, and to work
with local and national VA officials to expand the Pasco County
Outpatient Clinic and bring additional services such as dental
care to the 9th Congressional District.
I'm very appreciative of the fact that we have a world-
class medical and polytrauma center, as well as the Michael
Bilirakis Spinal Cord Unit--I'm very proud of that--nearby at
the James A. Haley VA Medical Center.
The dedicated medical staff at Haley is second to none, in
my opinion. However, it's always important that we strive to
enhance the care and services provided to our brave veteran
patients. We have to keep working and keep fighting.
And, today, I anticipate learning from those of you
gathered here about the important topic of recreation therapy.
Recreation therapy is a therapeutic endeavor that improves
an injured veteran's physical, mental, emotional and spiritual
health through activities aimed at increasing independence and
quality of life. It doesn't surprise me that Florida is a
national leader in recreation therapy.
I look forward to taking the ideas we discuss today back to
Washington to improve the lives of veterans, not only in our
State, but in every VA facility throughout the Nation.
In closing, I would like us to take a moment to recognize
and honor those veterans in the room. As always, I'm humbled by
your bravery.
Please raise your hand or stand up, if you'd like, all of
our heroes. Thank you very much.
As always, I'm humbled by your bravery and your dedication
to a cause bigger than yourselves. Because of your efforts, we
are able to gather this morning freely, safely, and
democratically.
On behalf of our grateful Nation, I thank you for your
service.
I yield back my time. Thank you, Madam Chair.
[The prepared statement of Congressman Bilirakis appears on

p. 42.]
Ms. Brown of Florida. I'm going to yield to Mr. Miller for
his opening statement. And also I want to thank him in
particular for coming because he's from Pensacola, Florida, and
I know he's struggling with challenges there with oil problems.

OPENING STATEMENT OF HON. JEFF MILLER

Mr. Miller. Thank you very much, Madam Chairwoman. It is
indeed a pleasure for me to be here with each and every one of
you today.
I do have a written statement that I would like to enter
into the record, but it is a pleasure to join both the
Chairwoman, Ms. Brown, and Gus Bilirakis here in New Port
Richey.
I have the great honor of representing the 1st
Congressional District. We like to say that it is the western
gate to the Sunshine State where thousands live like millions
wish they could.
Interestingly enough, I was born in Pinellas County and I'm
a McMullen by birth, so our roots go pretty deep around here.
And I can remember very clearly driving up and down U.S. 19
when it was just two lanes. So that tells you how far back it
was.
And it's great to see both Mike and Evelyn here. Mike
thinks I used to listen to him. It was actually Evelyn that
would tell me what to do.
But I just--one thing that somebody had put in my opening
statement--and I think it's very important--an old sergeant
once said that morale is what makes your body do what your mind
knows ain't possible. And that is very, very true.
And all of us on the VA Committee do what we can to make
sure that the Administration has the tools that it needs to be
able to provide the services for our veterans.
Again, northwest Florida is home to many veterans and, of
course, quite a few military installations, as well.
So I ask that my full statement be entered into the record.
And I look forward to hearing from the panelists that are here.
Thank you for coming today.
[The prepared statement of Congressman Miller appears on p.
43.]
Ms. Brown of Florida. Thank you.
And Mr. Bilirakis will introduce the first panel.
Mr. Gus M. Bilirakis. Thank you, Madam Chair.
And, Mr. Miller, there is a little road connecting Pasco
and Pinellas named after you, McMullen-Booth Road.
All right. It's my pleasure and honor to introduce the
first panel.
Mary Ann Keckler, a veteran from Spring Hill, Florida.
Welcome.
Davis Celestine, Vice President of the Florida Gulf Coast
Chapter of the Paralyzed Veterans of America (PVA). Welcome,
sir. Thanks for being here.
And then Lee Nelson, a veteran from Land O'Lakes. Thank you
so much for being here.
I'm so excited about this hearing. We're going to learn so
much. And I'm really happy that there are members of the media
here, as well, because we really need to get the word out.
Thank you.
Ms. Brown of Florida. Thank you.
We're going to start with Mary Ann Keckler, who I've seen
in many of our hearings around the State.

STATEMENTS OF MARY ANN KECKLER, SPRING HILL, FL; DAVIS
CELESTINE, VICE PRESIDENT, PARALYZED VETERANS OF AMERICA,
FLORIDA GULF COAST CHAPTER, TAMPA, FL; AND LEE NELSON, LAND
O'LAKES, FL

STATEMENT OF MARY ANN KECKLER

Ms. Keckler. Thank you very much, Congresswoman Brown.
And good morning, Congressman Miller, Congressman
Bilirakis, and Congresswoman Brown. Thank you very much for
allowing me to testify today. It is my pleasure to be able to
help in any way I can where our veterans are concerned.
My testimony this morning will be to let you know that I'm
a veteran enrolled in the James A. Haley VA Medical Center
since 1992. I have been both an inpatient and an outpatient. I
am also the VAVS representative for the Disabled American
Veterans (DAV) at this facility, as well as I have a son that
is enrolled in this facility in the spinal cord unit, 100
percent service-connected, total permanent.
As an inpatient for 3 weeks in September of 1996, in the
pain management program, I have had the opportunity afforded to
me to deal with the many aspects of therapy to help with my
pain problem. The one that stood out the most, and the one that
worked on the mental release of my pain was recreation therapy.
All therapies, i.e., physical, mental, all just enhanced
the pain as your mind on these two is constantly on the issues
of the body. Not that they were not helpful--they were--but
recreational therapy kept my mind off the problems it was
dealing with.
When I went into the pain program, I was in a great deal of
depression. Getting up every day was a major chore for me. I
was encountering muscle spasms, and living off Flexeril to
counteract them. This put me into an extreme lethargic state.
While in the pain program, I was interacting with others
with similar problems. Recreation therapy kept my mind off my
problems. I was able to show my creative side and also had
socialization with others. We not only worked with our hands,
but we went out on outings as a group. I then forgot I was
suffering from chronic pain; mind over matter.
Suicide is a definite relation to depression. Pills that
mask the pain--Flexeril, Valium, Morphine, Halcion, Demerol--
can cause major depression leading to suicide, which from these
I am a survivor, until I could feel myself going down that path
again. I then took measures to correct this effort. I am pill-
free since 1996, and deal with my pain in other ways.
While in the hospital, I had the opportunity to clearly
take hold of my problems. Recreational therapy played a major
role in this. Not only did I have an hour a day with the
therapist, I also took projects back to my room to work on
later on. If I had a problem at any time working on a project,
a therapist was always available.
The present Chief of Recreation Therapy, Cathy Williams,
was one of my therapists. She always was willing to work with
me on projects. This eliminated any thoughts of my physical
aspects of pain. Again, mind over matter. It beats all pain
medication, helps with my thoughts of depression or suicide.
This is the best medicine yet.
Not only have I been successful with it, as a volunteer, I
have seen this work on many occasions. By the way, this is why
I became a volunteer, to make a difference and help other
veterans.
Here is the story of another veteran. This young man has
been in the hospital in the spinal cord injury center for
several years. He is now in the long-term care facility in
spinal cord. When I first met him he would not speak hardly to
anyone. As an amputee, he also was on pain meds. Depression had
set in on him and he was feeling sorry for himself. He was
pretty well bedridden.
The DAV had sponsored a pitcher from the Detroit Tigers
through recreation therapy. This veteran loved baseball. This
was the highlight of his stay.
I would then visit him on a regular basis and also spoke to
recreation therapy about programs to the bedside. This was
done. A smile appeared. He is now in a wheelchair and is all
over the hospital, and he looks forward to the outings that
recreation therapy sponsors. He is the first outside waiting to
be loaded into the van.
I am working with another spinal cord veteran that is
indeed--indeed tried to commit--tried to commit suicide. He and
I have had some discussions on this matter. He also is now in
recreation therapy daily and has a smile on his face, as he
also goes on the outings. And that makes his day. Happiness
goes a long way.
The present Chief of Recreation Therapy has worked very
hard on programs that make a difference for our veterans, both
in and out.
Winter sports clinic, wheelchair games, golden age games,
disability golf, horseback riding, sports venues--there is no
time to feel sorry for yourself.
This has all been put together in the last few years. Three
years ago I went to the past chief to put together the winter
sports clinic program, which is sponsored by the DAV. The
answer was: This is Florida. People do not ski or participate
in cold weather activities. My answer was that we were all
mostly transients from other areas of the country and have at
some time or another experienced winter sports.
Under the new chief this is a reality and many are
participating.
My son, a spinal cord patient, when he was in the hospital,
his forte was computers. Recreation therapy helped set up a
computer for them to use or hooked up the one they brought in.
Again, the outside world is available to them.
Bedside programs are available, football pools, and they
all look forward to the pizza parties sponsored by
organizations and run by recreation therapy, dinners sponsored
by organizations through recreation therapy. Someone from the
department needs to be on board when these are taking place.
And, believe me, we have many. Ice cream socials. The list goes
on and on. Without the recreation therapy department, this
would not be possible.
I, as a volunteer, have the opportunity to work with
recreation therapy in many aspects and areas of the hospital.
They do make a major difference.
My life has taken a turn because of their efforts. As a
volunteer, I also have the opportunity to go out on the outings
and help them. When on the outings, they also have to act as a
therapist and nurse's assistant. Their training goes beyond
just fun and games.
If I was not--if it was not for recreation therapy and the
staff that we have now, we veterans would not be able to
participate in as many functions as made possible for the
amount of veterans and active duty, both inpatients and
outpatients, that we presently serve.
In summary, with regard to the above, recreation therapy is
a must along with health care, to address the medical needs of
our patients on both a mental and physical aspect. They are
trained professionals in this respect and deserve to be noted
as such.
Respectfully submitted, Mary Ann Keckler.
[The prepared statement of Ms. Keckler appears on p. 43.]
Ms. Brown of Florida. Thank you. Thank you for your
testimony.
We are--the testimony should be 5 minutes and--to give us
time to ask questions at the end.
Mr. Celestine.
Mr. Celestine. Mine is going to be short.
Ms. Brown of Florida. No, no. Take your time. It's your
time.

STATEMENT OF DAVIS CELESTINE

Mr. Celestine. Good morning. My name is Davis Celestine. I
was injured in 2001 in a training accident going over to
Afghanistan for our yearly detachment. After my accident, I
woke up in a hospital bed with several doctors around me. At
first I thought it was a dream until I came to reality and it
was not a dream. One of the doctors turned and said to me that
you might never walk again, but miracles happen every day.
So with that said to me, I decided to do whatever it takes
to stay active in my daily life. However, I was shipped off to
the James A. Haley Hospital Rehab and that's when I was
introduced to Cathy Williams and Jennifer Day.
From there on they got me started with simple stuff such as
the game ``Trouble'' and playing cards. They paired me up with
a paraplegic named Max and he told me, ``If your fingers are
not working as well, use your mouth to make a pair of moccasins
for your wife.'' So with that type of motivation in their
clinic, it was an inspiration to be there.
Now their programs have grown so well they have pushed me
into the world of--the Paralympic world to compete in
handcycling and swimming.
Also, I have a good family support that really helps. My
wife, Deborah, and my twins keep me going to be the best that I
can be.
In my spare time, I volunteer at my local chapter where I
am the Vice President and fundraising chairman. I give back to
the local hospital by trying to get the newly injured involved
in the great sports program. And that concludes my testimony.
[The prepared statement of Mr. Celestine appears on p. 45.]
Ms. Brown of Florida. Thank you. And thank you so very much
for your service.
Mr. Celestine. You're welcome.
Ms. Brown of Florida. And we're going to have questions
when the last witness finishes. Mr. Nelson.

STATEMENT OF LEE NELSON

Mr. Nelson. Good morning, Madam Chairwoman, Mr. Bilirakis,
Mr. Miller, and council members. Thank you for having us here
today. And it's an honor to be here addressing each one of you.
My name is Lee Nelson and I am a Chaplain in the United
States Army on active duty.
Last summer when I was driving to work stationed in Italy,
I got tangled up with a semi-tractor trailer and received a
spinal cord injury from that. There was some other injuries
that they worked on as well--collapsed lung, different things
like that--but I received a surgery and treatment there in
Italy from the civilian hospital and was transferred to Walter
Reed in Washington, DC, and then here to the Tampa VA Center,
James A. Haley, because of the spinal cord injury work that the
VA hospital in Tampa has done.
When I realized where I was here in the VA, they had a
number of therapies that was set up for me: physical therapy,
occupational therapy, speech therapy, and, of course,
recreational therapy.
And when the recreation therapist talked with me about
doing different things and we went and did some track and field
events and some of the other things like swimming or things
like that, but she talked with me about horseback riding. And I
had been horseback riding before and been on trail rides and
doing different things while on vacation or whatever. And I was
familiar with the concept of riding a horse.
But because I was not an equestrian and didn't really know
a lot about it--I had some experience of sitting on a horse--I
knew that in order to stay on the horse I would wrap my legs
around the horse and hang on with my legs and I wouldn't fall
off. And if something were to happen, you had the saddle horn
there to hang on to; but, otherwise, my stability was my legs.
Well, because I'm a paraplegic now, that ability to hang onto
the horse with my legs is gone.
And so I told her, the recreation therapist, that that's
just a silly idea, get on a horse and fall off. And she said,
``Well, there'd always be someone there to help stabilize you
and everything.'' I said, ``Well, you know, I'll just be
falling around in people's arms all day.''
But after talking with her and some of the patients that
had been involved in the horseback riding, realizing that it
was an ongoing program and other people did it who were
paraplegics, so there must be another way to sit on a horse
besides wrapping your legs around it, I got involved on
Tuesdays. I go to the Quantum Leap stables, which actually is
in this part of the State, not too far from here, and ride the
horses.
And as I think about recreation therapy, recreation in a
sense--of course, you can break down the word and think about
recreation and how it works--but I always thought about it just
as off-time and time to relax, time to goof-off, and didn't
really think about it as being productive.
Now, I've ridden horses before. In order to help my
physical abilities, I did physical training in the military to
do that, and riding the horse was for fun.
But as I have ridden the horses here at the Quantum Leap
stables I've learned that there are certain core muscles that I
had that were weaker than what I was thinking. And that was
just simply because I had to balance myself on the horse--and
even though there were a couple of people walking along on
either side of me, somebody else guiding the horse--I thought
it would be best if I tried to stay on the horse instead of
just falling into their loving arms waiting for me there, but--
so as I managed to do that.
And for the past several weeks, going each Tuesday,
horseback riding has increased my core stability significantly.
And I didn't realize how that had gotten weaker over this past
year. It was last August I received my injury.
The core stability muscles had increased in such a way
where it's easier for me to sit up in a chair long-term and--or
throughout the day--instead of just a few hours and then lay
back down exhausted and not being able to do anything else. I'm
able to do more.
And so the horseback riding events has significantly
strengthened up my core muscles enabling me to do other things
and to be able to go and work with people.
And as I said before, being able to just simply maintain
the day of being able to do things instead of having to stop
and rest and lay down and everything in the middle of the day.
In fact, there was a moment one time, a few weeks ago, and,
apparently, there were some flies bothering the horse, and the
horse is trying to get rid of the flies. But their ability to
reach up with their hooves and flick a fly off is--they don't
have the dexterity that we do, so they just kick.
And as I was trying to get the horse to go around a barrel
to the left, he decided to kick and throw me in that direction
a little bit more than what I was planning on going. But
because of the strength of my core stability muscles, I didn't
fall off the horse. I just fell over to the side. And, of
course, the young lady that was walking alongside me was able
to straighten me back up.
But if I did not have that strength that I had received
from several weeks of horseback riding, I probably would have
just simply fallen on the ground very quickly and not been able
to stay up on the horse.
But the important thing is not that I'm striving to be an
equestrian or my ability to ride horses better, it is how it
affects me in other areas of life: Being able to sit up in the
wheelchair long-term, being able to go different places to sit
and talk with people as a Chaplain.
I'm a counselor. And doing that counseling and talking with
people is--in my mind it seems like, well, that's a very simple
thing, you just go and talk to people. But because of my injury
it's not so simple anymore or hadn't been.
But now, with the recreation therapy, I'm able to maintain
my daily routine in being able to sit down and talk with people
and have an extended conversation with them and help them
through counseling, and as was mentioned before, sometimes
suicidal thoughts and different things.
Just what I was doing when I was stationed in the military
base talking with our soldiers, oftentimes marriage counseling
is the topic. But suicidal thoughts, unfortunately, are common
enough with our young soldiers.
And dealing with those issues and talking with them has
been a requirement that I have the ability to stay alert and
talk with them and not be exhausted in the middle of the
conversation and distracting them and me from being able to
give them a well thought out conversation and counseling. And
the recreation therapy has enabled me to do that.
Thank you.
[The prepared statement of Mr. Nelson appears on p. 45.]
Ms. Brown of Florida. Thank you very much. Thank you for
your testimony. And for sharing that with us.
I've learned a lot just from listening to you, and I just
want you to know, I also have experience riding horses. And
it's wonderful.
The horses that I've been on in the past, they tried to
throw me, so I'm glad you've been able to stay on.
But this is very educational, so thank you. And thank you
all three of you, for your service.
I have a couple questions that I want to ask you. You all
evidently went to the same service center, the James A. Haley
Center. And, obviously, they're doing a very good job with
their recreational therapy program.
How do you think we can improve the program to ensure that
veterans nationwide enjoy the benefits of recreational therapy?
And we can start with you, Ms. Keckler.
Ms. Keckler. Well, yes, it is something that's needed. We
are number 1 in recreation therapy. We have a leader that has
really taken the bull by the horns and moved with it. And it's
something that probably should be experienced around the Nation
in our VA hospitals, because it does make a major difference.
And what can we do to make it better? That is appropriated
funding to be able to get out. Not every hospital can get the
donations that we have been successful in getting.
And, of course, you know, with the economical situation in
this country today, the donations are not as great as they were
in the past.
Appropriated funding is the most important thing we can do
for recreation therapy to be able to help our veterans get on
their feet.
Ms. Brown of Florida. Mr. Celestine, what kind of
activities do you participate in?
Mr. Celestine. I participate in handcycling, swimming. I do
archery. I do field events, that is put on also by recreation
therapy, which includes javelin, shot put, and a couple others.
But the program is so well put together. But it's just more
or less having like participation from the individuals to come
out and see exactly what people, like myself and others, can do
so they could get enjoyment and get more involved.
That's when you can become an athlete by going on to the
Paralympics and getting picked up by those guys and doing more
extensive training and--well, it's pushing you forward, pushing
yourself every day so you can know that there is a life out
there after you get injured and just don't feel sorry for
yourself.
Ms. Brown of Florida. I watched a group yesterday play
water basketball. Do you do that also? Not yet?
Mr. Celestine. No, not yet.
Ms. Brown of Florida. I mean, they were just doing it. And
I was like okay. All right.
Mr. Nelson, do you want to add anything to that?
Mr. Nelson. Well, I think that, as you mentioned, it would
be an excellent opportunity for our hospital patients across
the country to be able to have facilities like this, because
it's a dual role in that there's the physical aspect of just
working on your balance and core stability to be able to sit on
a horse. But as the side walkers would and the leader there
would take the horse out into the fields and around through the
woods, it's, of course, a different training when the horse is
moving a little bit differently than just simply walking around
in the stable area. And, of course, that requires a little bit
more balance and a little bit more focus to stay on the horse.
But more than just the physical aspect of it, it's just
simply being out in the outdoors and the connection with the
animal.
The horses are different than horses that I had ridden
before, which, in some cases, I had a hard time hanging on with
my legs and my arms and everything else in some cases because
the horse is--not to the extreme of trying to buck me off, but
at the same time were not careful.
But these horses are very much trained and used to having
people with some type of a handicap ability. And there seems to
be a connection that's there.
And being able to connect with that large animal, even
small horses are much larger than we are, and being able to
bond with that animal and have some kind of a therapy, there is
simply a connection between humans and animals that is
beneficial, as well.
And, of course, being able to get outdoors and not just
working out with weights in the gym and different things like
that, which is excellent, as well. But there's a place for
that. And then getting outside and feeling like you're alive--
Ms. Brown of Florida. Yes, sir.
Mr. Nelson [continuing]. Is very useful.
And the mental aspect of having some type of handicap
ability is extreme and it can be overwhelming.
And being able to do things like this brings the soldiers
back to the thought that they're still alive, they're still
here on planet Earth, and they can be--well, having a sense of
normalcy to them.
And realizing that whatever the case may be, whatever their
handicap is, they still have that particular loss, but they've
not lost their ability to be alive and experience things in the
world.
So this is an excellent program that I would recommend for
all the VA hospitals across the Nation.
Ms. Brown of Florida. Thank you.
Mr. Bilirakis.
Mr. Gus M. Bilirakis. Thank you, Madam Chair.
Lee, you've actually addressed this issue.
But, Davis, can you elaborate on how recreation therapy has
improved your quality of life?
Mr. Celestine. Recreation therapy has improved my life
whereas I can get up and go. They gave me--they instituted a
lot of stuff into me where you never--like, for instance, like
I started off playing a game ``Trouble.'' I could have never
picked up the little game piece to move it along, but with--
with the patience and the therapists, they allowed me to grow.
And then with that said, it's like--it gives you more or
less an introduction to doing stuff. It's like if you can't
figure it out, take a minute, understand your situation, and
then go forward. Because sometimes you have to step back and
look at the bigger picture before you start trying to apply
yourself.
And that's one of the things they really instituted into
me, that you look at the big picture first before you start
jumping into the water and knowing that you can't swim and it's
too late then.
So with that said, that's the feeling I got from this
program. And that's why I'm so adamant about trying to get
other people to understand the logic and the ability of these
therapists to instill stuff into us that's going to be
beneficial to us in the lifelong--in the life that we have.
Mr. Gus M. Bilirakis. Thank you very much.
Mr. Celestine. You're welcome, sir.
Mr. Gus M. Bilirakis. Thank you.
Next question for the entire panel: What other recreation
therapy would you like to see offered that's not being offered?
We'll just start with you, Mary, if you'd like.
Ms. Keckler. Well, you know, that's a good question. And
I'm trying to think in my mind, because we have a vast amount
of recreational programs going on in our hospital, probably
more than any other VA--I know more than any other VA in the
country--and I can't honestly think of anything right off the
top of my head because we have so many programs.
We're constantly--we're not just 24/7. We're 48/7 with
programs in our hospital.
We now have instituted a lot of the programs such as the
wheelchair basketball games--or wheelchair games we're doing
through the PVA, there's the winter sports clinic in the DAV,
we're doing the golden age games, which has been done for a
long time. We're really moving on. We do the swimming.
Oh, there's so much going on in recreation therapy. I can't
think of another thing, unless something new comes on the block
that we don't know about, except putting volleyball courts out
there, but with the spinal cords--unless we train the spinal
cords to be equipped to play volleyball.
Mr. Gus M. Bilirakis. Lee, would you like to add?
Mr. Nelson. Well, again, I would have to repeat what Ms.
Keckler was saying is that there's so much there that it is
difficult to think of something that's not happening right now.
And I am new to the paraplegic world and so I'm not real
familiar with what all is out there, what all can we do.
But I think that the only thing that I can say as far as
getting something that we don't have, I can't think of
anything.
Possibly improving or expanding on some of the things that
we do, such as the bicycling, the handcycling. I've gotten
involved with that some. But the areas where you can
handcycle--and for inpatients you have to be kind of careful
with them and what they can do and everything--but you might
expand the program some. But it's there and people are able
to--and they take patients out to go through the parks and
handcycle through that area in a safe environment and
everything. But that would be the only thing I can think of is
to expand some programs that are there.
And, of course, obviously, we talk about other hospitals,
they don't have some of these therapies, so to put them there
would certainly be an improvement for them and for those
veterans that are there.
But the only thing I can think of is to expand some of the
things that they have going on right now.
Mr. Gus M. Bilirakis. Very good.
Davis, do you have anything? What would you like to see
offered that's not being offered today?
I know we're very fortunate in this area, but this will be
very helpful to the other Members of Congress throughout the
United States.
Mr. Celestine. I was going to say we need to implement
football. But they already have that, and that's called quad
rugby.
Basically, like I said, there's nothing I could see unless
we look at certain programs that will be beneficial to certain
areas. Because depending on the terrain that you're at, it
might be beneficial to them. Like I think next week they're
putting on a ski clinic.
So they have different stuff going on, but at the same time
you need to know what's right for that area or the type of
crowd that you're more or less pertaining to.
So I'm going to have to say I don't know what else we can
add to the curriculum.
Mr. Gus M. Bilirakis. Thank you.
Mr. Celestine. You're welcome.
Mr. Gus M. Bilirakis. In the interest of time, I'll ask one
more question, even though I have a few more, because we have
two more panels.
I think this is very important. What would you say to those
who might question whether, in such economic times,
recreational therapy, even in a therapeutic setting, is a
necessary component of rehabilitation? What would you say to
those who question this type of therapy whether it's feasible
economically?
Ms. Keckler. My answer to that is it is the ultimate of
necessity in the VA hospital.
As I explained in my testimony, it takes the mind off of
the problems that you're experiencing while you're in there. It
gives you an outlook on life. It brings your life up. It lifts
you up. It makes a difference. You're not looking at four
walls. Recreation therapy doesn't allow you to do that. You
don't have the thoughts of depression.
And, yes, we need to go forth and we need to use the VA at
James A. Haley as an example nationwide to get this moving.
It is--I can't think of anything more important in our
hospital than our recreation therapy department.
And even what I experienced with our veterans, as well as
myself, and those who are in and out, that's all I hear is
recreation therapy, recreation therapy, recreation therapy.
It's a very important factor for them.
Mr. Gus M. Bilirakis. You would say it's essential,
correct?
Ms. Keckler. Essential. Above essential.
Mr. Gus M. Bilirakis. Okay. Very good.
Lee.
Mr. Nelson. I would have to agree with Ms. Keckler that it
is essential.
When I first arrived in the hospital and was involved in
therapies and I was told about recreation therapy I was
thinking, okay, well, that's our day off, that's the time to
goof off and not do anything productive.
But as the weeks and months have gone by, I realized how
essential it is. I do go to the gym. I work out with weights. I
do some different things like that there in the hospital with
therapists that are there.
And as necessary as that is, there's an obvious
practicality to that aspect. You work out with weights, you
increase your strength, and there's that direct correlation;
whereas, with the--and you might get with like the swimming--in
recreation therapy see a little bit more of the connection is
there rather than horseback riding or some of the other--
playing basketball. You're using muscles and balance that you
would not otherwise use.
And simply being involved in a game or a sports event
pushes you just to finish the game, just to keep up with the
person that's next to you. And it pushes you mentally to be
able to push yourself and do a little bit more than you would
normally do. Not more than you could do, because if you can't
do it, you can't do it, but you don't think you can do it, you
don't realize you can do it. And so you learn from that aspect
of--there's certain moves or certain balance or certain
strength that I do have that I didn't realize I had it; and by
doing that then it would increase that strength and that
balance and that coordination and all those things.
And so simply going to the gym, working out with weights--
as essential as that is--by itself, is incomplete.
And so the recreation therapy completes the therapeutic
work for the wounded veterans that are dealing with certain
handicaps that simply going to the gym, working out with
weights, or other aspects of calisthenics, different things
like that we do in the gym by itself, would be far short of
what they could achieve through recreation and sports and games
and pushing themselves to a higher level.
Mr. Gus M. Bilirakis. Davis, on a scale of 1 to 10, a 10
being the highest, what would you rate recreation therapy?
Mr. Celestine. I'd say 11.
Mr. Gus M. Bilirakis. It's good enough for me.
Mr. Celestine. As I said, the thing about recreation
therapy is just trying to get you to do some stuff.
And the other thing I asked was--you know, usually, when
you come through the door, the words that you can't really say
in recreation therapy is ``I can't,'' because that's not in
their vocabulary. So they actually excluded those words. So
they give you, more or less, a more positive outlook and like
to move forward.
And, like I said, with that said, recreation is definitely
needed within our hospitals and our way of life. That's it.
Mr. Gus M. Bilirakis. All right. Thank you. Thank you for
your service to our country.
Ms. Keckler. One of the things I would like to add to that,
one of the things that recreation therapy does in our
hospital--we have a lot of catastrophic injury, i.e., the
spinal cord, the polytrauma, and we have a lot of caregivers
because of this.
Recreation therapy--we have the outpatients that come in
that are catastrophically injured, the caregivers drop them
off, and they work with them to be able to get them to get
their motor skills back together. And it gives the caregiver a
break while they're there for an hour or two. That's a very
important aspect of recreation therapy.
Mr. Gus M. Bilirakis. Good point. Good point. Thank you
very much for your service. Thank you for your testimony.
I yield back to Madam Chair.
Ms. Brown of Florida. Congressman Miller.
Mr. Miller. I'm probably one of the most tight-fisted
fiscal conservatives in the House.
But, Davis, I will tell you, that if anybody asks in
regards to where we spend our money, you're the perfect shining
example of where money is being spent appropriately; to think
that you went from playing a simple board game ``Trouble'' to
hand bicycling and those types of things. There's no question.
Quickly--because I want to try to help the Chairwoman get
back on schedule--how did you guys find out that these services
existed? A lot of your fellow soldiers and veterans may not be
aware of it.
So how do we get the word out to them and encourage them
that it works?
Ms. Keckler. To me, like you have to introduce them to
something they actually like or something they actually had in
the past, then it kind of re-sparks their interest in getting
themselves involved.
And that's what recreation does. It sparks your interest
in--you know what, actually, I did it this way when I was an
able body. Well, let me try it their way. And that's when they
introduce a different way of doing stuff.
And, I mean, it's just--like I said, it goes back to basic
stuff, just getting a better understanding of how to take your
time, look at the big picture, and then apply yourself.
Mr. Nelson. Well, one of the things that has happened there
in the hospital is that they sign you up. They don't wait for
you to ask. They don't ask you if you want to do it. They just
tell you this is what you're doing to do.
Mr. Gus M. Bilirakis. I like that.
Mr. Nelson. Now, I'm a soldier in the Army and I know how
to follow orders. And so my nurses would come in and say,
``Okay, Major Nelson, you're going to go and do this.'' And I'd
just say, ``Yes, ma'am,'' and go do it, including the
recreation therapy.
Now, physical therapy, speech therapy, occupational
therapy, all of those fell in the same category of they wrote
out my schedule. And my schedule was at this time I'm going to
recreation therapy, at this time I'm doing physical therapy,
and that's what I did. I got up in the morning and I did the
schedule that they set up for me.
Now, when I got to recreational therapy, they did have a
wide variety of things where each week when I would go there
they would have something different.
And some of the things really wouldn't be of interest to
certain--to some people. But others, they find it was much more
interesting than they thought it would be just thinking about
what would you like to do, this event. And the answer would be,
well, I don't know if I want to do that.
But they don't ask would you like to do it. You just do it.
And you learn, oh, this is--this is something--when we went to
some track and field events, we were doing shot puts and discus
and different things, and they were asking, ``Well, how many
times have you thrown a discus?'' And that's an easy answer. I
can keep up with that. It was zero.
And they showed us how to throw the discus and the shot
put, which I'm thinking is a big, heavy softball. So I guess
you fling it over just like a softball. But, no, this is too
heavy to do that. You can injure yourself. Anybody can injure
themselves, their shoulders, whatever else, taking a shot put
and throwing it like a softball.
And so in doing that, I was using different muscles and
different coordination. And it's not something that I would
have signed up for if it was just on the wall saying, oh, sign
up for what you want to do. I mean, I may not have signed up
for half of what I've done over the last year that they said,
okay, this week, this is what we're going to do and go. And
doing that particular outing turned out to be very beneficial.
I wasn't much of a basketball player previously. When I'm
standing up, I'm really not all that tall. I played football,
not basketball. So when they said, well, we're going to play
basketball today, I'm thinking, well, I wasn't good at that
before, I'm certainly not going to be good at it now. But we
went out to play it anyway. And it was fun. I enjoyed it.
But more importantly, again, it's moving the wheelchair at
a faster rate of speed than you normally do. And not just
simply cones on an obstacle course, but you're having to get in
a certain position to throw the basketball up through the hoop
and different things like that that can cause people to find
out what they're interested in.
Because once I did that for about an hour then--for some
people that would really spark a deeper interest, then they
could continue on with it. And for other people it's like,
well, that was fun, but I'm not going to do that again.
But, again, depending on the particular recreation, the
particular game, then some people would be interested in it, it
would click for them, and be beneficial to their physical
disability in finding out that it's not so much of a disability
as they thought it was, and being able to do more than they
thought they could do.
So this hospital has the word out. You know, like I said,
not just a poster on the wall, signing up for it that everybody
can see, but it is: This is what you're going to do today. And
no questions. No options. Just as one guy said, ``No highway
options.'' Just this is what you're going to do today, and you
go and do it. And it's a good opportunity to find out that you
can do more than what you thought you could.
Mr. Gus M. Bilirakis. Thanks.
Ms. Brown of Florida. Thank you. I'm going to thank all
three of you. It's been very educational for all of us and we
learned a lot.
And you all, your experience is amazing. You have a program
that's a 10 and what we need to do is pass that on.
And on behalf of a very grateful Nation, we want to thank
you so very much for your service, and also for your testimony.
We're going to stand in informal recess for 5 minutes,
because I think the media wants to interview you all. And then
would the second panel get ready to come up? We'll come back at
9:35.
Thank you.
[Recess.]
Ms. Brown of Florida. Okay. We will officially come back to
order.
Now, the second panel consists of Dr. Edie Dopking, Melinda
Wheatley, Sandy Ackley, and David Windsor.
We will start with Dr. Edie E. Dopking.

STATEMENTS OF EDIE E. DOPKING, PH.D., PRESIDENT AND FOUNDER,
QUANTUM LEAP FARM, INC., ODESSA, FL; MELINDA WHEATLEY, SENIOR
RECREATION THERAPIST, HILLSBOROUGH COUNTY, FL, PARKS,
RECREATION AND CONSERVATION DEPARTMENT, AND PARALYMPIC SPORT
TAMPA BAY, TAMPA BAY, FL; SANDY ACKLEY, PROGRAMMING AND EVENTS
COORDINATOR, SAILABILITY GREATER TAMPA BAY, INC.,
CLEARWATER, FL; AND DAVID B. WINDSOR, PRINCIPAL INSTRUCTOR,
PROFESSIONAL GOLFERS' ASSOCIATION OF AMERICA, ADAPTIVE GOLF
ACADEMY, INC.

STATEMENT OF EDIE E. DOPKING, PH.D.

Dr. Dopking. I want to start out by thanking all of you for
having me and having the rest of us here to talk about this
today. It is a very important subject.
I'm the President and Founder of Quantum Leap Farm. We're a
10-year-old non-profit veterans' service organization located
here in Tampa, Florida.
Please accept my sincerest thanks, again, for the
opportunity to present my testimony today.
Quantum Leap Farm serves current and former military
servicemembers and their families from the current conflicts
all the way back to World War II.
We provide exercise therapy, cognitive/behavioral
counseling, family reintegration days, and personal and
professional growth workshops for military servicemembers,
families and groups. We use horses as a therapeutic tool and
catalyst for positive change.
We've worked closely with the therapists at James A. Haley
VA Hospital's recreation therapy department for just over 10
years. Through word-of-mouth referrals from our friends in
recreation therapy, we also receive referrals from a list of
other departments at James A. Haley VA: mental health intensive
case management, social rehab, polytrauma, and spinal cord
injury, as well as others.
In addition, we receive referrals from Bay Pines Medical
Center and from family services centers located on MacDill Air
Force Base: The Airmen and Families Services Center, CENTCOM
Family Services Center and SOCOM Family Services Center, and
from other veterans' service organizations.
This fiscal year alone, our organization will provide
services to over 850 unique military servicemembers and their
families at a cost of over $469,000 to our organization.
Up until 2 years ago, our friends in recreation therapy
were judicious with their referrals as they understood we
didn't have funding to do this work and were donating our
services entirely. In fact, we have never charged veterans of
any conflict for any of the services we offer here at the Farm.
During our 10 years of working together, only two small
recreation therapy grants became available through the general
post fund. Our friends in recreation therapy applied for and
received small amounts of funding for us--approximately $2,500
in 2005, and $2,900 in 2008--to help cover the costs of
services we were providing their patients.
On several occasions, recreation therapists have made
personal donations to the Farm to help cover the costs of their
referrals.
Recently, though, we were awarded a one-time-only privately
funded grant provided by the Florida BrAIve Fund and
administered by The Gulf Coast Community Foundation of Venice.
BrAIve Fund monies are earmarked per the original donor for
services supporting OEF and OIF servicemembers and their
families. This grant of $618,566 enabled us to expand the types
of services we offer, the amount of services we provide, and
the number of military servicemembers we provide services to by
1,200 percent in barely 2 years: from 32 unique servicemembers
in 2008 to 850 in 2010.
Unfortunately, our BrAIve grant funding expires September
30, 2010. We are currently seeking alternative sources of
funding, both private and governmental, and are exploring the
possibility of establishing a contractual fee-for-service
relationship with the VA and/or the U.S. Department of Defense
(DoD).
This increase in military referrals we've experienced
reflects a great and increasing need on the part of military
servicemembers and their families.
Likewise, it also reflects the great and increasing degree
to which VA hospitals are depending upon civilian
organizations, like ours, to assist in healing visible and
invisible wounds of war that our veterans and their families
are so bravely enduring. The current conflicts in Iraq and
Afghanistan are generating more catastrophically injured combat
survivors than any other conflict to date thanks to great
improvements in field medicine. The ramifications are good and
bad, big and small, focal and widespread.
VA health care workers are handling rapidly expanding
caseloads of seriously injured patients; both the number and
medical complexity exceed the caseloads VA medical
professionals have managed before.
In fact, our friends at James Haley Recreation Therapy tell
us that each of their therapists are serving over 130 beds,
many of their occupants with traumatic brain injuries (TBIs),
amputations, spinal cord injuries and burns. And those are
merely the physical injuries. Many of them also suffer
depression, post-traumatic stress disorder (PTSD) and have
emotional and family issues to manage, as well. Young families
are facing a lifetime of caregiving for seriously injured
family members as they struggle to raise children, work,
maintain households and marriages. Not surprisingly, divorce
and suicide rates are high in this population.
Recreation therapists are instrumental in assisting injured
servicemembers and families to successfully navigate the
numerous and significant challenges they face post-injury.
Recreation therapists help injured veterans and families
discover the new ``normal'': helping injured veterans
reintegrate into civilian life; reacquainting family members
with each other after extended separations and functional
changes; helping families learn to recreate together focusing
on strengths, abilities and resources; and promoting healthy
relationships and engaged, active lifestyles.
Likewise, civilian veterans' service organizations, like
Quantum Leap Farm, are instrumental in helping recreation
therapists do their jobs, helping a large and diverse
population of injured servicemembers and their families rebuild
and recover from war-related trauma.
Recently our attendance at the Conference on Iraq and
Afghanistan Veterans (CIAV) in Washington, DC, was sponsored by
our military grantor, The Gulf Coast Community Foundation of
Venice. Presenters included Brigadier General Loree Sutton,
M.D., Director of the Defense Centers of Excellence for
Psychological Health and Traumatic Brain Injury. There were
also panels of veterans, caregivers, and service providers.
Some of the Nation's most intelligent and well-informed
lecturers spoke with legislators, met various department heads
within the VA, and networked with other service providers
sharing our experiences working with injured veterans.
Most relevant among several over-arching conclusions of the
CIAV Conference: Although there is much great legislation
currently being passed to help our Nation's wounded warriors
recover physically, emotionally, socially and financially, it
seems very little funding is trickling down to the community
level where it would do the most good. If we're willing to
award multi-million dollar contracts to defense and other
governmental contractors, why are we not willing to award
similar contracts to organizations that help fulfill our
Nation's promise of caring for those willing to lay down their
very lives for our freedom?
As a Nation, we are in unchartered territory. The number of
profoundly disabled veterans needing long-term care and
services is rising rapidly and won't peak for years to come.
The effects on our health care system, our economy and our
American culture remain to be seen. However, one thing is
certain: We, all of us, owe these veterans and their families
our unfailing support and gratitude for their inestimable
sacrifices.
It is my pleasure to submit this testimony to you today.
Thank you again for your time and your consideration.
[The prepared statement of Dr. Dopking appears on p. 46.]
Ms. Brown of Florida. Thank you. And I will remind the
panel to please keep this testimony to 5 minutes so that we can
get to the questions.
Thank you for your testimony.

STATEMENT OF MELINDA WHEATLEY

Ms. Wheatley. I'll try to keep it short. My name is Melinda
Wheatley. I'm a Senior Recreation Therapist with Hillsborough
County Parks, Recreation and Conservation Department. And I do
work closely with Paralympic Sport Tampa Bay (PSTB).
And I'm here today to tell you about Paralympic Sport and
what we do in conjunction with James A. Haley VA Hospital.
The mission of Paralympic Sport Tampa Bay is to promote
health and independence and personal growth to people with
physical disabilities--mainly, physical disabilities.
For a long time--talking about getting the education,
Chairwoman Brown--for a long time people with physical
disabilities had to participate in things like Special
Olympics, which pretty much everybody is very familiar with
Special Olympics. But Special Olympics is mainly for people
with cognitive deficiencies.
But Paralympic Sports programs were developed nationally to
emphasize the importance of sports and recreational activities
for people whose primary diagnosis was a physical impairment.
The Paralympic Sport program works with people with
cerebral palsy, spinal cord injuries, amputation, visual
impairments, dwarfism, and then other problems like head
injuries, muscular dystrophy, muscular sclerosis, etc.
Paralympic Sport Tampa Bay offers year-round seasonal
programs like track and field, archery, wheelchair tennis,
swimming, wheelchair soccer, wheelchair basketball, among
others. And then we also offer 1-day clinics in close
conjunction with the VA staff.
Next weekend--as one of the panelists said--we're doing a
water ski clinic at Lake Wales, which will be the sit-ski
clinic where all people can participate regardless of their
abilities.
Hand cycling--we just had a strength and conditioning
physical clinic last week which exposes the participants to
different recreational activities, and then those skills can be
enjoyed throughout their life. And they're enjoyed by adults
and youth, as well. They provide--the clinic provides the
fundamentals of a sport, which can be pursued through team
activities or individual activities.
Now, our program has traditionally catered to youth. It was
originally called Blaze Sports, if anybody has ever heard of
that. But through the involvement with James A. Haley VA
Hospital, we've grown to serve more adults.
We now have a Division 3 wheelchair basketball team, which
is ranked 16th nationally, and an adult wheelchair softball
team that is co-sponsored by the Tampa Bay Rays baseball
organization.
Reviewed by many across the Nation as a program that should
be modeled by all communities that have VA hospitals, the
partnership between James A. Haley VA Hospital and Paralympic
Sport Tampa Bay is a wonderful marriage. And I like to call it
that because it's just that: We fit well together.
Not only, as many people have said, do sports and
activities promote self-esteem and positive image of the
participants, but they help release stress and depression as
well.
Reintegration into the community after an injury is one of
the most important aspects of rehabilitation. And the
relationship is developed when our adult veterans and the
children that we already serve participate in programs
together. They're just unique and just so refreshing.
The adults become mentors to the youth, young athletes. And
then they have similar disabilities so they share stories. And
the adults tend to give advice about life situations that
they've had to deal with and how they've dealt with them.
But at the same time, the adults are motivated by the youth
because kids--our kids especially--are fearless and they'll try
anything, which really inspires the adults to try new things,
too.
So now I'd like to tell you a little bit about our office
facilities in Hillsborough County, which have really, I think,
benefited us in Hillsborough County, and not only in
Hillsborough, but regionally, especially in this district,
Pinellas, Pasco, Hillsborough. People come from all over to
join in, veterans and youth alike.
Our facility is called the All People's Life Center. It is
a wonderfully accessible place for people to recreate and play.
It is a 44,000-square-foot facility. It's a community center
which everybody can use, able body and disabled, but people
with disabilities have priority usage on the facility.
We offer such amenities as a fitness center, which is fully
accessible, gymnasium, double gymnasium, a dance room,
beautiful outdoor trails, and an accessible playground for
people to enjoy.
And I have to add to that that sometimes, you know,
especially our veterans, they come back, they have families
that if they go to a playground and it's not accessible, then
the families can't play--the disabled can't play with their
able-bodied kids. So accessibility is important from both
aspects.
The place was designed for people with disabilities in
mind. So everything down to the showers, down to the sinks,
down to the way the floor was built, the signage, everything
about it is totally accessible. It was a pleasure being able to
help design it.
So as you can see, our viable relationship with James A.
Haley Hospital is mutually successful. The veterans have a
great place to come, and we have successful participants in our
program.
I can't say enough about the awesome recreation therapy
staff both organizations have. We have a team of 10 through
Hillsborough County Parks and Recreation that offer not only
sports but community outreach programs, after-school summer
camp programs for kids. We're offering specialty camps for
adults and kids this summer.
But the therapists at the VA hospital have always been so
wonderful with planning things that they know they will like.
And they plan that so kids might join and jump in, too.
And, you know, some things are just for adults and some
things are just for kids, but we work very well together.
And even if it's a VA-sponsored event, our staff will come
join in. If it's a PSTB event, then the VA staff joins in. So,
like I said, it's kind of a unique marriage. I hope that we can
continue to work real closely with the VA hospitals and develop
some new exciting things that everybody can enjoy.
And I thank you very much for your time in speaking about
something that's very, very close to my heart.
Thank you.
[The prepared statement of Ms. Wheatley appears on p. 48.]
Ms. Brown of Florida. Thank you.
Ms. Ackley.

STATEMENT OF SANDY ACKLEY

Ms. Ackley. Yes. Hi. My name is Sandy Ackley. I work for
Sailability Greater Tampa Bay, which is a non-profit operating
out of Pinellas County. The services are provided to the
Greater Tampa Bay area.
Our mission is to provide affordable, accessible sailing
activities and education to children and adults of all ages and
abilities, focusing on community integration to improve the
quality of life for all involved.
The concept of our program was born in March of 2001. It
was at that time a small group of people envisioned and
implemented an opportunity within their community.
The challenged individuals that we take out sailing quickly
realized that the only limitations they faced were those in
their mind, and that whatever one might set their mind to do
can be accomplished. This I know because my husband is also a
veteran who is disabled, and recreation therapy is what kept my
family strong.
Sailability is 9 years old now and has built a fleet of 13
access boats, 3 catamarans and a motor boat.
Grants, fundraising and local supporters made it possible
for us to purchase our first 303 servo assist boat that has
adaptive equipment which includes a ``sip and puff,'' chin
control, electronic joysticks and adaptive seating, which a
ventilator dependent quadriplegic would be able to sail
independently.
In fact, after training provided by Sailability Greater
Tampa Bay, Lynn, from James A. Haley, a ventilator dependent
quadriplegic, set a record here in Clearwater--well, there in
Clearwater--to be the first ventilator dependent quad to sail
independently in the United States on an access dinghy.
Lynn and other veterans come out to our community sails,
which are held four times a year, to lead the way demonstrating
the opportunities our waters can provide to veterans while he
navigates the Clearwater Intercoastal Waterway.
We have wheelchair-bound veterans from our community,
recreational rehab and spinal cord programs, various veteran
support groups, as well as Paralyzed Veterans, James A. Haley,
Bay Pines Hospital, returning Iraqi veterans accompanied by
their families and friends and therapists, watch in awe from
the top of The Miss Beverly, which is known--it's a 24-foot
pontoon boat that we borrow from the Bay. This is when I know
that what I do gives our vets a sense of worth, confidence,
assurance and belief while building on self-esteem reaching
their goals and drives, as they wave their arms--screaming
words of joy and triumph with happy tears running down their
faces. I know this because Sailability is what empowers people
and kept my family strong.
The Miss Beverly, again, is a 24-foot wheelchair accessible
pontoon that resides at MacDill. The Miss Beverly is borrowed
to take Bay Pines, James A. Haley and community veterans out
fishing or used as a spectator boat for the more ``I have to
challenge Sandy'' veteran while others sail the bay. I get them
all in a boat sooner or later. They learn to trust in, believe
in themselves again, this I know with certainty.
Since we are driven to get as many veterans out on the
water as possible, we also strive to support those who would
like to facilitate programs such as ours locally, regionally
and nationally.
Not only does this enhance awareness of all individuals, it
facilitates the need to keep our waterways and environment not
only eco-friendly and pristine but accessible to all.
We are proud of the fact that since our inception we have
been able to have a positive impact on many individuals.
Our program has graduated a multitude of sailors, many of
which were either mentally or physically challenged, as well as
able-bodied children, adults, and seniors. Some of those
physically challenged individuals include, but are not limited
to, paraplegics, quadriplegics, amputees, stroke survivors, and
those with neurological impairments such as cerebral palsy,
multiple sclerosis and head trauma injuries.
Moreover, we've been able to introduce the experience of
sailing and touch the lives of more than 500 individuals, along
with their family members and caregivers. This I know because
I'm the one who gets the tears of joy, the ``thank you'' cards
for giving me my life back, the gratitude from recreation
therapists, staff, and the appreciation from family and
friends. These sailboat rides are more rewarding to me than I
can describe. Men that have the wind taken out of their sails,
from them I get my strength to make others strong.
Sailability Greater Tampa Bay also has the ability to
travel to outside counties and support other groups. Our
presence at these travel events raise awareness in our
community for the need to maintain community inclusion and
accessibility for all, while giving our veterans what they need
and deserve.
We are obligated to do this for people who gave their souls
in belief that we will stand by them. We feel that our presence
and support within our community will fuel the acceleration of
programs like ours. And this I know because my son is a third
generation Marine, who volunteered since he was 10 years old
putting veterans out on the water. These proud veterans taught
my son loyalty, trust and gave him confidence and strength.
We pride ourselves on the fact that all these
accomplishments have been made through an extremely dedicated
volunteer staff.
And as we move into the next decade, we anticipate growing
our program and touching more lives as we live through war.
Thank you.
[The prepared statement of Ms. Ackley appears on p. 51.]
Ms. Brown of Florida. Mr. Windsor.

STATEMENT OF DAVID B. WINDSOR

Mr. Windsor. Good morning. Thank you very much. It is an
honor to be here. I really appreciate everyone on the same
wavelength here today.
For the record, my name is David Windsor. I'm a member of
the Professional Golfers' Association (PGA) of America. I've
been a PGA member for 10 years, I've been a teaching
professional for 20, and for the past 10 years I've been
teaching adaptive golf.
I represent the Adaptive Golf Academy, but most
importantly, as a community supporter of the James A. Haley VA
Adaptive Golf program every Friday morning at Terrace Hill Golf
Club.
As we heard from the first panel, we heard testimonies
stating about how they felt, the way that they were thinking
before they were involved with recreational therapy.
Specifically, with adaptive golf, our participants, the
therapists, the staff, the supporters, they're helping change
the way our veterans are thinking; a more positive track.
It's a noted fact that disability or injury can put
veterans in a lonely place, both mentally and physically. The
James A. Haley Adaptive Golf program introduces and involves
these patients into a fail-proof athletic activity within the
confines of a positive environment. And this method of
combining personal and physical interaction takes their mind
off of that therapy and allows their recovery process to be
self-initiated. And we heard that quite a bit from panel one.
In November of 2007, the program was just a couple months
going, and I had the opportunity to meet a Humvee gunner. His
name was Jim. He had survived an improvised explosive device
roadside blast. He was badly burned, 53 percent of his body,
both legs were broken; one, I remember, being shattered, which
explained the rods and pins that were extending from his left
leg.
His first time out we remember him saying he didn't even
feel like swinging a golf club. He was just happy to get out of
the hospital for a little while. That's what he was looking
forward to.
Then he was introduced to the SoloRider golf cart. This
golf cart is designed for wheelchair players to become more
upright so they can swing the golf club better and get really
complete access to the golf course.
He said--he was quoted as saying, ``You know, we have
classes with therapists and they're great, but we're inside.
For me, the best was being outdoors and having people like this
to help crack a few balls . . . this is my best day of therapy!
This is helping my body get going again, a great way to get
out, get some fresh air and be with a bunch of people who love
golf.'' So this is really expanding the therapy that goes on
outside of the hospital.
I just want to make a quick note that I actually sent him
an e-mail. We've been staying in touch a little bit. And, I
just want to confirm, he's still playing golf.
But just in a case like his, what started out to be a case
of cabin fever, being inside those four walls, doing that
traditional therapy, it just led Jim to experience that greater
feeling, that better--that good feeling that you get when you
enjoy it. He's around caring folks that empowered him for the
future.
And one thing I do remember, I remember how he had really
drawn an audience. He was in that SoloRider golf cart, he's in
an upright position, he had rods coming out of his left leg,
and he's cracking balls out there and he's drawing an audience.
And you could just see how his chest started to bow up and
he was feeling so proud of himself. And everybody started to
clap. And it was just a feeling that was contagious among
everyone.
Just the simple act of getting outside and leaving that
traditional therapy setting, it just encourages other patients
to interact in a nonstressful situation in whatever
organization.
And they're with their peers that are facing similar
issues. They're able to talk to other folks that had boots on
the grounds. So a therapist or a staff or whatever, with that
veteran, they're on the equation and they're doing their thing
together. It's a veterans-helping-veterans atmosphere.
They're there and they can trust a consistent form of
therapy that they can pursue for the rest of their life. They
focus on improved connection with their family, their friends
and co-workers.
I can't tell you how many times being there helping
instruct I had someone turn to me after hitting some shots
right down the middle of the driving range or out on the course
and they'd say, ``Hey, is this something I can do to bring my
kids out or bring my wife?'' You know, it's just a great way
for them to do something together in hometown U.S.A. and just
get reconnected.
They're there and they focus on what we say; ``fairways and
greens'' for you golfers in the room. And that's their escape
from their issues, just like any of us. Right? We all need an
escape.
I don't have to really list and bullet point what the
adaptive golf really serves, but to name just a few: brain
injury, spinal cord injury, limb loss, all those that we've
been aware of here today.
And, again, we've heard from panel one, you know, how easy
it is to become detached or disconnected from themselves, from
their family and their communities. And that's a challenge
right here that the James A. Haley Adaptive Golf program faces
and has taken head-on every Friday.
Did you know that the James A. Haley VA Adaptive Golf
program is now approaching its 3rd year? It began on September
28, 2007, a Friday morning, and has continued every Friday
right here in Tampa Bay.
The program consists of the James A. Haley inpatients,
brought by the therapists over to Terrace Hill Golf Club--it's
a nearby course off of Busch Boulevard--where they're greeted
by PGA professional Ken Juhn and members of AVAST, which is the
Amputee VA support team; and it is a solid group of area
outpatients and volunteers that are there every Friday morning.
The golf program has been more than just a weekly golf
outing, but rather a vital part of the rehabilitation process
and community reintegration process that's taking place.
And for the record, as I stated, I've been involved with
adaptive golf for 10 years, so this is not the very first
program of its kind; rather, it's an extension of a weekly
program that I helped develop in 1999 in Sarasota, Florida.
I was a PGA professional. As a club professional I had a
27-hole golf course, and I was approached to have therapists
bring out their clients as a golf outing at first. However, I
soon realized that there was much more to the program than just
helping them hit a few balls down the fairway.
And this is the reason why our veterans are coming out week
after week, playing additional rounds of golf with their
friends, with their peers at area courses right here in Tampa
Bay.
So they are affirming that they want this positive
environment. It's a therapeutic outlet and it's a
nontraditional therapy setting.
At the James A. Haley Veterans' Hospital our active-duty
soldiers and veterans who face physical challenges or
complicated barriers with their PTSD, depression, traumatic
brain injuries, are encouraged to reach functional independence
so they can get back to their lives. The theme here: The
quality of life.
Of all recreational activities we favor the adaptive golf
experience the most as it introduces the concept to help our
patients maximize their potential. With adaptive golf this
process of recovery is self-initiated.
And in the words of Dr. Scott--What is more American than a
game of golf? It's the band of brothers coming together on
Friday mornings. It is something that everyone can learn and do
no matter where they end up, in hometown U.S.A.
We have had our CTRS, Kathryn Bryant, not just bringing
over and maintaining the program on Fridays, but she has
accompanied a number--I think it's the 2nd year they're going
to be going to the National Tee Tournament out in Iowa. It is
an opportunity for veterans around the country to gather for
such an event, and that's going to continue.
What's next? We have golf now as part of the 2016 Olympics.
That means Paralympics are on a lot of folks' minds right now.
To sum it up, the James A. Haley Adaptive Golf program has
become a driving force for the rehabilitation process for which
veterans, active military personnel with disabilities can
relearn and develop skills which they thought were beyond their
capabilities.
Physically, adaptive golf improved their balance,
coordination, endurance, functional ability for those daily
activities, decreasing risk of falls and injuries and
increasing overall quality of life. Mentally, it helps train
individuals to focus on more positives and develop better,
everyday life and judgmental skills.
When you come out to the golf course there's not too many
people there saying, ``Gee, I think I'm going to play worse
today.'' They're there looking to improve their skills. And
they're around that positive environment, improving every time.
And that just really leads to self-esteem, confidence,
independence and a feeling of dignity, giving new hope to
expand their horizons as they transition back into civilian
life.
And, in closing, there is one way to know that it's
Veteran's Day at Terrace Hill. As for the golfers in the room,
traditionally you would hear out on a golf course, ``Fore!'' if
someone happens to hit their ball toward another group. But at
Terrace Hill you're going to hear, ``Incoming!'' And that's
when you know it's Friday.
Thank you very much.
[The prepared statement of Mr. Windsor appears on p. 52.]
Ms. Brown of Florida. Thank you.
Thank you for all of your testimony, too.
I have a couple of quick questions. This question is for
the entire panel.
Each of you uses a different recreational therapy: Sports,
sailing, golf. Is there any particular therapy that's better
for a veteran depending on their ability, disability or----
Dr. Dopking. I'll jump in here.
Ms. Brown of Florida. Do you understand?
Dr. Dopking. Yeah, yeah. I think it depends on a person's
personal preferences and their history with a certain sport,
their interest, their family's interest.
I think it's important to have a wide variety of sports
available because there's such a wide variety of military
servicemembers and their families, you know, there has to be
something to appeal to everybody, but it's so important to
offer those things.
Ms. Brown of Florida. Well, I heard what Mr. Nelson said,
and it was very interesting because when they first offered him
horseback riding, he said, ``Absolutely not. What's wrong with
you?'' But he found he enjoyed it.
Dr. Dopking. That's the thing about recreation therapy,
though, is it introduces people to things that they didn't
really know they were going to like, you know.
So it's so important for them to be able to explore all
those options in golf and sailing, you know, and all the
different sports that you offer, horseback riding, hang-gliding
and water-skiing. You know, it's so good for them to be able to
get out there and experience that new ``normal'' that I was
talking about.
Ms. Brown of Florida. Well, what I hear you saying is more
about getting them to do it. Because we can bring them to the
baseball games and football games, but this is something that
they're physically participating in, which is good.
Ms. Wheatley. Right. And it's not only just about the
physical aspect.
I mean, when you were asking the panel about what other
sports and things could be offered at the Veterans' Hospital--
you know, I have a lot of friends that have disabilities
because I've done therapy with them for so long, I guess, and a
lot of them are just not really into--they're not into sports,
they're not into any physical activities, they're more into
things like woodworking or shooting sports, things like that.
So you're asking how to expand those programs; you might
consider looking into things that are daily activities, but--
things that we all do on a daily basis but just need a little
modification in order to continue those activities when with a
disability.
Ms. Brown of Florida. I heard you all talking about the
cost of funding the program. And I know that we've increased
veteran funding. But for some reason we have not been able to
get the VA to collaborate with community partners.
I think none of the Members are happy with this. And that
is the area that we're continuing to work on because it is so
important that as we expand the number of veterans, that we
expand the community partners we work with as well.
And so can you talk about the unit cost for caring for the
veterans? I know that you all are working well together, but
we're talking about funding, which is a little different than
the program.
Dr. Dopking. I know for our organization our cost is $95
per ride or per half hour. But, you know, Quantum Leap, because
we have horses there to care for, it's a 24/7 sort of
operation.
So, you know, we have staff members that are directly
involved with the program because they're caring for the
animals and the horses. And we also have a large number of
volunteers that are very, very generous with their time that
help us maintain the program, too. And even with that, our cost
is $95 a half hour.
I'm sure that these other programs have some similar costs,
too. And, of course, you know, we--I'm sure we all get funding
from numerous places and none of us I think are looking to one
source to support our entire program.
I think--I don't want to put words in your mouths, but I
think we're looking to get paid for what we do, you know, like
a fee-per-person that we work with or, you know, in a
contractual relationship, rather than a grant or something like
that.
I don't know. What are your thoughts?
Mr. Windsor. Well, with the golf program, we established
that as pretty much more of an internal coming from the James
A. Haley program.
It was my intention right along to develop this program,
help them see that and adopt, in which--with the blessing of
Dr. Scott and Cathy Williams and now Kathryn Bryant helping on
every Friday--we've gotten to that. So now it's part of their
programs. There's a general posting fund that's set up to
specifically help this adaptive golf program.
And we're just working on a very minimal budget right now.
We're working together for another year. But right now it's a
little over $1,000 a month for the services we provide locally.
Ms. Brown of Florida. How many people participate in the
program?
Mr. Windsor. Inpatients could vary every Friday. Could be
anywhere from three up to six to eight inpatients that come.
And a large number of outpatients come, as well. And they pay
their own fee to access the golf course.
Ms. Brown of Florida. And sometimes you said they come with
their family members.
Mr. Windsor. Sure. You may have 20 to 30 outpatients from
the Tampa Bay area that come.
Ms. Brown of Florida. And sailing?
Ms. Ackley. We--it usually costs $60 per hour to put a boat
out, including staff. We try to put a little in the till for
wear and tear on the boat. Boat parts are very expensive.
But we only charge James A. Haley $10 per head. We do----
Ms. Brown of Florida. Do they just sail or fish or what do
they do?
Ms. Ackley. Well, for the first-timers that need to be
reassured that it's going to work for them, they want to see
someone else do it first.
Ms. Brown of Florida. Yes.
Ms. Ackley. So the returning sailors we put in the boats
pretty immediately. And then anyone else--spectator, family
members, the therapists, we even give them a day out on the
water--they'll be fishing off of the pontoon, The Miss Beverly.
And then they watch.
And by the second month they'll come out and they'll get in
a boat. And it just keeps on rotating out. They keep bringing
their parents and their grandparents and their kids. And so it
is a very large family. It's a big family day.
Mr. Windsor. And I'd like to add that, I mean, we do the
same thing, you know, minimal cost for the inpatients to come.
But to do any program properly, to train the staff, to have
the right equipment, that's where some of the cost can come in
for--such as the accessible golf carts, some other equipment
that needs to be welded and modified for that to happen.
Ms. Brown of Florida. Mrs. Wheatley.
Ms. Wheatley. Paralympic Sport Tampa Bay staff is funded
through Hillsborough County Board of County Commissioners which
consists of four full-time staff for that particular program.
Everything else we do, you know, we get private donations,
funding, we do fundraisers, grants, et cetera, et cetera. We
try to never charge the participants, if at all possible, just
because usually people with disabilities have a lot more
personal costs and are many times unable to pay.
I agree with everybody here that if you've never bought a
wheelchair or anything like that, adaptive equipment is
probably three to four times more expensive than anything that
you and I would have to buy.
Consider the cost of a vehicle, a van. You know, you can
buy a vehicle for $15,000. And theirs is going to cost $60,000.
So, I mean, it's really--life with a disability is very costly
for some things.
Ms. Brown of Florida. Congressman Bilirakis.
Mr. Gus M. Bilirakis. Thank you, Madam Chair.
You are all non-profits, correct?
Dr. Dopking. Yes.
Mr. Gus M. Bilirakis. And you all participate in contracts
with the local VA?
Dr. Dopking. Uh-huh.
Mr. Gus M. Bilirakis. Explain to us how older veterans can
benefit from these programs.
Dr. Dopking. My Ph.D. is in aging study. It's very similar
to gerontology, only we study the process of aging rather than
older folks themselves. And I would say the need for physical
activity in older persons is just as great, maybe greater than
for people who are younger, because really your body and your
mind is a ``use it'' or ``lose it'' proposition.
So inactivity, and especially if there's a disability, you
know, people tend to be more inactive with a disability.
So older veterans with disabilities need physical activity.
They just--they really, really need to stay engaged and active
and probably in a greater way than younger folks do.
Mr. Gus M. Bilirakis. How many older veterans participate
in your program? I'd like to ask you first.
Dr. Dopking. Oh, boy.
Mr. Gus M. Bilirakis. Approximately, percentage-wise.
Dr. Dopking. I'll bet you--I don't have those numbers right
in front of me, but because we always focus on adults, our
mission is to serve adults, I'll bet 30 percent of our
population is 50 or older. We've had several World War II
veterans that were 92.
Mr. Gus M. Bilirakis. How do you get the word out that the
services are available?
Dr. Dopking. We don't have a big budget for advertising--
I'm guessing you guys don't either--so most of it is word of
mouth.
Mr. Gus M. Bilirakis. Word of mouth.
Dr. Dopking. Yeah. And the recreation therapists have done
a great job of promoting, especially Quantum Leap, and,
apparently, your programs, as well, and making it available to
everybody that they touch.
Mr. Gus M. Bilirakis. Very good. Thank you.
Anyone else?
Mr. Windsor. Well, primarily, the Adaptive Golf program in
its initial launch in September of 2007 was made up of Vietnam
veteran era, and they continue to be there week in and week out
as sort of the big brothers for the younger generation that
appears on Fridays from the VA.
We've had still a number of World War II veterans, Korean
war, and they're there. And they get just as much out of it as
the younger generation. They actually have more of an
appreciation of a lot of it because they're there and they're
taking part in it, which gives them that good feeling, that,
hey, this is--they call it the game of a lifetime. We have the
tools, the resources, the staff training. They love that
environment. That's what keeps them coming.
Mr. Gus M. Bilirakis. Without the golf cart, it would be
very difficult for veterans to participate in your program; is
that correct?
Mr. Windsor. For many. For many. If someone has had a
recent limb loss and they're working on endurance and balance
and different issues there, the golf cart is very beneficial
because it gets them in an upright position. It takes that
weight-bearing off.
Mr. Gus M. Bilirakis. Maybe you can show a picture of the
golf cart. I wanted to bring it in, but I guess it wasn't
practical.
How much does that cost?
Mr. Windsor. Don't quote me. I believe they're right around
like $9,000, $10,000.
And for the record, every military golf course and every
military base should have two of these by now. Not specifically
the one manufacturer, but I know it was made--maybe Mr. Miller
would know more about that--but two accessible golf carts
should be at every military golf course to provide
accessibility.
Mr. Gus M. Bilirakis. In the interest of time for the
panel, how many vets do you have participating in the
individual programs?
Dr. Dopking. Our number is as of--our fiscal year ends in
June. And from July 1 through now, we're over 850.
Ms. Wheatley. We have, depending on the sport, up to 200.
Ms. Ackley. Yeah, I have probably up to about 200, 250.
Mr. Windsor. What was the question? I'm sorry.
Mr. Gus M. Bilirakis. How many veterans participate in your
program?
Mr. Windsor. Inpatients? Outpatients? Everyone?
Mr. Gus M. Bilirakis. Everyone.
Mr. Windsor. Well, if you imagine, I mean, at least 20
every Friday. And it's every Friday. So 1,000 or more. If we do
clinics, if we do some things for awareness in the community,
you may have up to 100 that day, 200.
Mr. Gus M. Bilirakis. Okay. Very good. Thank you very much,
Madam Chairwoman.
Ms. Brown of Florida. Mr. Miller.
Mr. Miller. Madam Chairwoman, I'll pass.
Ms. Brown of Florida. Okay. Well, I wanted again to thank
you all very much for your service. And I want to tell you all
a secret. They're going to be sorry they invited me here
because now I'm jealous and we have to have these programs in
my area.
So thank you very much. In Jacksonville, we have some
water. We have lots of golf courses. I'm going to get her to
come over to Jacksonville and get my organizations going.
Mr. Windsor. And, for the record, you had asked the
question if all of us are non-profit.
My entity, The Adaptive Golf Academy, is not. But the goal
of that is to help non-profits as a service to develop Adaptive
Golf programs to serve the needs of their clients.
Ms. Brown of Florida. Good.
Mr. Windsor. And, really, the main objective is to develop
a sustaining Adaptive Golf program with every possible VA
hospital and community to enhance the physical, mental, social
and emotional well-being of veterans and increase their
participation around the great game of golf.
[The following was subsequently received from Mr. Windsor:]

July 13, 2010

To: Diane Kirkland, Printing Clerk, Committee on Veteran's
Affairs
From: David B. Windsor, PGA

I would like to request that the below material be added to
my testimony on Recreational Therapy and Healing on June 8.
This briefly states our objective for VA hospitals to better
serve wounded warriors/veterans and also our contact
information.
The objective of the Adaptive Golf Academy is to educate,
train and inspire physical and recreational therapists and
directors at VA hospitals around the country to develop their
own adaptive golf program and ultimately ``make a difference''
in many veterans' lives.

Contact info:
David Windsor, PGA (941) 650-5750
Email: [email protected]
Website: www.AdaptiveGolfAcademy.com

Thank you,
David

Ms. Brown of Florida. That sounds good. These are in all my
areas, but we don't have these programs, so thank you very
much.
Mr. Windsor. Thank you.
Ms. Wheatley. We'd love to come up and help train folks. We
can all share in that and go up and help people, you know,
train people in recreation therapy and how to implement
programs.
Ms. Brown of Florida. That's good. Thank you all very much.
Mr. Windsor. And I'll bring the golf clubs.
Ms. Brown of Florida. Yes. I have a set myself and I sent
them away Sunday because they're rusting from not being used.
Thank you all very much.
Dr. Dopking. Thank you.
Ms. Brown of Florida. All right. The last panel, please.
So this is the great center that everybody has been talking
about all day.
Ms. Cathy Williams, the James A. Haley VA Veterans' Medical
Center, VA Health Administration, U.S. Department of Veterans
Affairs. You all are doing a tremendous job.
And Dr. Steven G. Scott, D.O., Chief, Physical Medicine and
Rehabilitation Center, James A. Haley VA Medical Center,
Veterans Health Administration, U.S. Department of Veterans
Affairs.
Well, I'll take the word back to Washington that you all
are doing a good job. You all are getting 11s, not even 10s, on
the scale.
We're going to start with you, Ms. Williams. Thank you very
much.

STATEMENTS OF CATHY CHIOVITTI WILLIAMS, CTRS, SUPERVISOR,
RECREATION THERAPY SECTION, JAMES A. HALEY VETERANS' HOSPITAL,
TAMPA, FL, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF
VETERANS AFFAIRS; AND STEVEN G. SCOTT, D.O., CHIEF, PHYSICAL
MEDICINE AND REHABILITATION SERVICE, JAMES A. HALEY VETERANS'
HOSPITAL, TAMPA, FL, VETERANS HEALTH ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS

STATEMENT OF CATHY CHIOVITTI WILLIAMS, CTRS

Ms. Williams. Good morning, Congresswoman Brown,
Congressman Bilirakis, and Congressman Miller. Thank you for
inviting us here today to discuss recreation therapy at James
A. Haley Veterans' Hospital. It is truly an honor for me to be
here.
The James A. Haley Veterans' Hospital provides recreation
therapy to veterans and servicemembers within Veterans
Integrated Service Network 8. The Physical Medicine and
Rehabilitation Service's Recreational Therapy Section currently
has 21 full-time employees, 17 of which are recreation
therapists who possess specialized training, which is a
bachelor's degree or master's degree in therapeutic recreation.
Most of my staff are--currently hold certifications in--from
the National Council for Therapeutic Recreation, and all of my
recreational therapists are certified brain injury specialists.
Our goal is to maximize each patient's rehabilitation
potential through active recreation, leisure and sport
pursuits, which are designed to improve or maintain the
physical, emotional, social and cognitive functioning for a
better quality of life and increased independence.
Recreation activities enhance physical health, psychosocial
and cognitive status, and improve functional independence in
the community.
Recreation therapy provides resources and opportunities to
improve overall health and well-being. It improves physical
health by increasing mobility, range of motion, strength, motor
skills coordination, vestibular balance, agility and athletic
skills.
Recreational therapy also improves psychosocial
communication, trust and cooperation while enhancing morale,
life satisfaction, self-esteem, socialization and, of course,
camaraderie.
In addition, the program addresses cognitive deficiencies--
because most of our active servicemembers have had brain
injuries--through attention, memory and perception; increased
alertness and awareness of surroundings; and reduced confusion
and disorientation.
VA clinical staff conducts a thorough assessment to ensure
that we develop a treatment plan that best meets the needs of
the individual patient. We work with the patient and his or her
family to help develop this plan. Activities and programs are
developed to be appropriate for each individual patient to
facilitate the best possible outcome.
In sum, we adopt the ``whole person'' view that considers
the individual's activity interests and patterns before injury,
illness and disability, and we focus on returning the patient
as much as possible to his or her previous functionality,
ability and activity level to promote active community
participation.
The therapeutic recreation staff conducts leisure education
counseling to provide a baseline of information for patients.
This counseling enables patients to broaden their perspective
of what activities are available to them. Patients are offered
as many opportunities as possible to participate in community
recreation resources and to improve their overall well-being
through leisure.
In Tampa, our recreation therapy programs include
activities such as archery, animal-assisted activities--which
is pet therapy--bowling, fishing, horseback riding, air gun and
trap shooting, basketball, cycling, golf, power soccer, rowing,
sled hockey, tennis, water skiing, sailing, track and field,
and most of all, arts and crafts.
The James A. Haley Veterans' Hospital Recreation Therapy
program benefits considerably from our multiple community,
government and university partnerships. We collaborate closely
with external parties to provide recreational special events
for inpatients such as trips to Kennedy Space Center shuttle
launches, cultural and community events, and local sporting
events such as basketball games, NASCAR events, and, of course,
the Super Bowl.
Veterans receiving treatment at our facility also
participate in VA nationally sponsored events such as the
National Veterans Summer Sports Clinic, the National Veterans
Winter Sports Clinic, the National Veterans Wheelchair Games,
the National Veterans Golden Age Games and the National
Veterans TEE Tournament.
The national training exposure and experience that these
patients receive also--I'm sorry. We have patients that also
participate in other national events that are often not
necessarily sponsored by VA, which include Challenge Aspen,
Lima Foxtrot, the Endeavor Games, and the Paralympics Military
Sports Camps.
Our program in Tampa continuously provides patient-centered
recreation therapy services. This enhances current abilities
and helps veterans develop new skills through recreation
activities for daily living, community functioning and, of
course, quality of life.
Thank you again for the opportunity to appear before you
today. My colleague and I are prepared to answer any questions
that you may have.
[The prepared statement of Ms. Williams appears on p. 56.]
Ms. Brown of Florida. Mr. Scott.

STATEMENT OF STEVEN G. SCOTT, D.O.

Dr. Scott. Congresswoman Brown, Congressman Bilirakis, and
Congressman Miller, thank you for the opportunity to discuss
the James A. Haley Veterans' Hospital Therapeutic Recreation
Therapy program and its role in rehabilitation of those who
serve our country.
In my role--and I've always done rehabilitation medicine
for over 30 years--I've always emphasized the importance of
recreation and sport activities in personal development and
rehabilitation.
My colleague, Cathy Williams, has presented an overview of
our current program and its benefits as a patient-centered
service. I'd like to focus today and discuss the importance of
recreation therapy to the veterans from Operation Enduring
Freedom and Operation Iraqi Freedom.
We are in a new era of rehabilitation and recreation
therapy. Our society values sports, recreation and leisure.
Sports and recreation activities have been an important part of
the lives of our newest veterans, and their identities are
frequently linked to these activities, so that injuries that
limit their ability to participate may have a significant
impact on their sense of self.
Changes in warfare and battlefield medicine have led to new
injuries and new challenges in rehabilitation. Some of our
newest veterans come to the Department of Veterans Affairs with
brain injuries, ranging from minimal to the most profound that
we have ever seen in the history of medicine; severe post-
traumatic stress disorders; other mental health problems; and
multiple injuries that often need prolonged rehabilitation that
we've never seen in mankind.
In this era of rehabilitation, recreation therapy success
is possible through specific inclusion in a multidisciplinary
rehabilitation team that includes physical, occupational and
speech therapies.
Recreation therapy provides an environment of adventure and
discovery within which each veteran can practice and integrate
the skills that they learn from other therapy team members.
For our newest veterans, recreational therapy provides new
hope, new opportunity to discover new goals and new dreams for
the future. It is an integral part of our rehabilitation that
our veterans are provided the opportunity to relearn the skills
that they once had, to develop relationships, and find new
meaning and purpose in life.
In addition to this approach to care, new technology and
new advances have opened up new opportunity for our veterans to
participate in recreation activities and sports. New prosthetic
devices and other assistive technology have allowed people like
amputees to participate in competitions or sport events or in
community events where previously they were not able.
Wheelchair technology has allowed family members to transport
the most severely injured veterans to community activities,
allowing them to participate in a wide range of public affairs.
The Internet and video games have opened new possibilities
for connecting through social networking. And recreational
activities such as hunting and sailing, as you heard, that were
once not possible, are now available.
The newest veterans have greater interest in extreme sports
and recreational activities. These include a wide range of
activities that we've never seen before. We just talked about
horseback riding, adaptive golf. But we've also seen hot air
ballooning, we've seen blimps, we've seen flying, we've seen
kayaking, we've seen water skiing, we've seen hockey, we've
seen scuba diving. You name the sport and they have
participated in all of those.
We have observed severely injured veterans run marathons,
compete in 20-mile bike races, catch a 100-pound fish. We have
observed a very severely injured, blind individual who's an
amputee record a song, composing it in his room on a tape-
recorder at night. The joy to see these experiences is really
beyond words and beyond what makes us great as a country to
observe these things.
Recreational therapy does give a freedom to those who
fought for our freedom: freedom to run when they couldn't
stand, freedom to think when they could not remember their
name, freedom to be successful when they felt lost, and a
feeling of hope for a new meaningful life at home.
Thank you for this opportunity to appear before you. And my
colleague and I are prepared to answer any questions you might
have.
[The prepared statement of Dr. Scott appears on p. 57.]
Ms. Brown of Florida. Thank you. Thank you both for your
testimony.
Dr. Scott, let me ask you this question. Well, let me just
make a statement first.
There are 30,000 suicides in the U.S. every year, 20
percent of which are veterans. That's about 6,000 a year.
Suicide rates are up 26 percent from 2005 to 2007 for young
veterans age 18 to 29. Veterans who used to be in a health care
system were less likely to commit suicide than those who were
not.
What role do you think what we're doing with recreation
therapy at your center can play in helping to combat the number
of young veterans committing suicide?
Dr. Scott. There's actually documented studies that show
that recreational therapy and adaptive sports do reduce suicide
rates.
And this should be emphasized and done more frequently, to
help maybe to reach out to those who we haven't reached.
And this is an opportunity that we can do that and do it in
a positive way. And as you mentioned, reduce that terrible
statistic so that we can give at least an opportunity that we
can--in some type of healthy environment.
Ms. Brown of Florida. Yes.
Dr. Scott. And we can tell them what's right and not what's
wrong, and what's good and not what's bad, and what's well and
not what's sick. And I think with that approach we'll have a
better outcome.
Ms. Brown of Florida. Thank you very much.
Ms. Williams, as you heard in the earlier testimony, one of
the questions had to do with funding. And I think it was a
comment about fee-for-service or how we can get additional
resources to some of your stakeholders. The VA has been very
slow to collaborate with community groups that help us with our
veterans.
Ms. Williams. Well, basically, where we're at is we
function off what's called a general post fund, which is donate
a dollar. So at our VA we have to connect the dots with the
community. So when we saw the service and we saw the need we
were able to reach out to the community and kind of connect the
dots.
Ms. Brown of Florida. So these are not taxpayer dollars.
Ms. Williams. These are all donated funds.
Ms. Brown of Florida. Okay. And what kind of budget do you
have for the donated funds? I know it varies, and it's probably
down this year.
Ms. Williams. Yes, ma'am. With those in kind donations,
which are non, you know, cash donations for equipment and other
things, I brought in almost $500,000 last year.
But, again, it takes a lot of money to run as many patients
as we are running through our program. So it takes a large
amount of money to have that outcome.
Ms. Brown of Florida. I see.
Mr. Bilirakis.
Mr. Gus M. Bilirakis. Thank you. Question for both
witnesses: Has it been proven that a veteran may take less
medication due to these recreational programs?
Dr. Scott. Absolutely. One of the things is as you get more
active and as you start to develop a healthy lifestyle you
become less in need of dependency on medication, less in need
of dependency on being sedentary, less dependent on really
health care in general, which is good, you know, because you're
out there and being productive. And so it has those positive
benefits. It's a hidden cost value that we need to probably
emphasize more.
Mr. Gus M. Bilirakis. Thank you.
Ms. Williams. As you can tell from the first panel, when
you actually talk to the patients, as they become more
involved, they're--if they were taking medicine for depression,
they'll tell you that they're still taking it, but they now
have better quality.
So I can't necessarily say that it's decreased. I just know
what our successes are, that we see patients that have severe
PTSD and they're wandering around and they don't really know
what to do. You know, we can guide them, we can kind of contain
them back into their life.
And, you know, I can't answer the question: Does it
actually decrease medicine? I don't know. Can I tell you that
it helps with quality? Absolutely. And we have testimony on
that.
Mr. Gus M. Bilirakis. Appreciate it. Doctor.
Dr. Scott. I just want to add your first witness today
stated she was in a chronic pain program and was able to reduce
medications. And what we see is they come home with a whole
smorgasbord of medications, tons of them, and too many of them,
they can't even remember what they're taking.
And one of the first things we do is get them active and
get them in recreation, get some fun back into their life, fill
them with self-esteem, and reduce their medications.
And in our pain program, recreational therapy is an
integral part of that. And almost everyone gets off narcotics,
reduces their medications dramatically, improves their
function, improves their quality of life and has all the
positive outcomes.
Mr. Gus M. Bilirakis. That's vitally important as far as
I'm concerned.
And how much Federal funding do you receive? How much does
Haley receive for the recreation program?
Dr. Scott. I will have to actually get back to you on that,
because they don't really fence in the money specifically for
it. So we can do our best to put that together and get back to
you on that answer.
Mr. Gus M. Bilirakis. Thank you.
[The VA subsequently provided the following information:]

In fiscal year 2010, the James A. Haley Veterans Hospital in
Tampa, FL, received $29,719 to support the various National
Games (such as the Wheelchair Games, the Golden Age Games,
etc.), and received $1,566,076 for staffing expenditures. The
total recreational therapy budget allocation for this facility
is $1,595,795.

Ms. Brown of Florida. Because I'm just wondering--you're
telling me that not any of the Federal funds that come to the
medical facility are used for recreational therapy.
Dr. Scott. Well, funding generally comes from the Veterans
Equitable Resource Allocation model system, which is based on
average cost.
Ms. Brown of Florida. Right, right.
Dr. Scott. From the DoD appropriations if they're active
duty. Or sometimes you get third-party.
But, specifically, recreation therapy, it's not fenced in.
Ms. Brown of Florida. Well, I think we really need to take
a look at this area, because I think the therapy you all are
providing shows benefits in quality of life, suicide prevention
and incorporating the family in what we're doing. I think it's
really important.
And, of course, I want all of these partners that you all
have gone out and gathered, but I think these are programs that
should be instituted in all of the programs, really.
Mr. Gus M. Bilirakis. I'm with you, Madam Chair. I don't
think there is a line item----
Ms. Brown of Florida. Yes.
Mr. Gus M. Bilirakis [continuing]. Specifically in the
budget for recreation therapy, so I want to work with you on
that.
Ms. Brown of Florida. I think we should look at it. And
we'll look at it because we have a conservative Member on the
panel also.
Mr. Gus M. Bilirakis. I'm pretty conservative, too, but I
consider this a priority.
Ms. Brown of Florida. That's right. I am quoting the first
President of the United States, George Washington: ``The
willingness with which our young people are likely to serve in
any war, no matter how justified, shall be directly
proportional as to how they perceive the veterans of earlier
wars were treated and appreciated by their country.''
Mr. Gus M. Bilirakis. One more question. Dr. Scott, I
understand that last July the VA Central Office approved your
proposal to hold an East Coast National Veterans Sports Clinic
in 2010. Congratulations. This will complement the West Coast
program in San Diego.
What is the status of the funding for that particular
program?
Dr. Scott. Well, we were planning to move it ahead 1 year
and the funding stopped so we weren't able to hold it this
year.
We're supportive 100 percent behind the idea. We had some
great concepts of having the flag come down from Washington and
have all the service organizations along the East Coast join
them all the way down and participate in that. And I think it
would have been a great event.
And more importantly, I think Florida and the East Coast
having a yearly type of summer event would be important because
of reaching the media, and also all the veterans that we have
here.
And then also, as you mentioned, all the benefits you heard
this morning, which would be important.
And we can do it here in Tampa with minimal cost. We
thought it would not be that costly either.
Mr. Gus M. Bilirakis. Approximately how much would you say
it would cost?
Dr. Scott. About $100,000.
I said I'd do it for nothing because it's part of our
rehabilitation program.
I feel it's so essential that they have an opportunity--
that they get an opportunity to compete, that they have an
opportunity that their families could come together,
communities come together, and that they can be recognized with
achievement that I thought that we could probably do it for
nothing. It would be worth it as part of rehabilitation care.
Mr. Gus M. Bilirakis. If you did it for nothing, it would
take away from other programs; is that correct?
Dr. Scott. That's correct. Without the support that we
would need from the Central Office, we couldn't host the
national event. We had to have some support higher up.
Is that right?
Ms. Williams. Yes.
Mr. Gus M. Bilirakis. Chairwoman Brown, will you join me in
writing a letter to the Secretary?
Ms. Brown of Florida. Yes. I have a couple of questions for
him.
Mr. Gus M. Bilirakis. Okay. Yeah. You go ahead.
Ms. Brown of Florida. You said that it would cost $100,000.
When was the program planned? When would they have the East
Coast----
Dr. Scott. We were thinking April.
Ms. Brown of Florida. It would have been April.
Ms. Williams. Because of the heat.
Ms. Brown of Florida. It is Florida.
Mr. Gus M. Bilirakis. Apparently, there's only one in the
U.S. on the West Coast and it's extremely successful, is that
correct, in San Diego?
Dr. Scott. I don't know. Well, we didn't feel it would be
as successful as we could do.
Ms. Brown of Florida. Now he's messing with the Chairwoman.
But my question to you is: How long does it take to plan
such an event? Because I'm sure----
Ms. Williams. I can answer. I think if we were actually
going to do it correctly that we would need at least 6 months'
preparation, because you have to find venues, you have to be
able to move these patients, these outpatients, from place to
place; and they're all disabled, so, therefore, you have
transportation cost and----
Ms. Brown of Florida. But do you think you could do it for
$100,000?
Ms. Williams. Oh, absolutely.
Ms. Brown of Florida. All right.
Ms. Williams. I think we can--actually, you know, I think
we can do it not only better than California--it's just so
expensive to fly people across the country to participate in
something--we can do it better.
Ms. Brown of Florida. We're talking about the East Coast.
Ms. Williams. Well, they're currently doing it in
California now. And this year they set the limit at 100. And
our goal was when we're planning it, we could actually do 100
people just in our region, just people in our own region that
we've actually treated.
Ms. Brown of Florida. Well, let me see, how far is your
region? Does it go to Jacksonville?
Dr. Scott. Yes, it does. It covers the Panhandle.
Ms. Brown of Florida. Well, I think we could plan one for 6
months. I'll get with the Secretary and we'll get the funds,
we'll raise it.
Mr. Gus M. Bilirakis. Congressman Miller, are you going to
help us with that?
Mr. Miller. Yes, sir.
Ms. Brown of Florida. All right. Sounds like a plan.
Mr. Gus M. Bilirakis. Thank you very much.
Ms. Brown of Florida. Mr. Miller.
Mr. Miller. Doctor, if you would, the significant injury in
ongoing wars is TBI. How does recreational therapy assist with
TBI?
Dr. Scott. First, it's raised the awareness of this
impairment to the sports world and the recreational leisure
world.
We didn't even know how to classify TBI at the beginning of
the war. We had no classification.
We did not even know how to classify the severity of the
head injury so they could be in sports to compete.
So we had to start from scratch just like we've learned to
treat and medically rehabilitate them differently. We've had to
start from scratch to start to learn new ways and new
activities that they could participate in.
And what we find is that many times the head injury
population, especially the mild head injuries, they have
behavioral, cognitive memory type disorders, and have
interpersonal skills defects. And what we find with the
activities of sports and recreation, all those things are
treated nonmedically, without drugs and in a non-
institutionalized type setting.
And, if I may add back to the Subcommittee, a lot of times
you talk about costs, but this could be a cost avoidance if we
could have them take less meds, if they don't get
institutionalized, if we can reduce the number of hospital
visits for these mild head injuries and severe head injuries.
So, in terms of head injuries, we don't limit them based on
a head injury. Maybe deep scuba diving because of the
intracranial pressure.
I remember when we did our balloon flying, the biggest
scare we had was we took a couple of guys with seizure
disorders. And when you are a couple hundred feet above the
ground, you don't want anybody to have a seizure from a head
injury. And so we took some risks and that's what it's about
many times.
And by doing that, they learn they're able to go out and be
involved in the community without fear and without fear that
something is going to happen to them.
Mr. Miller. Ms. Williams, have you had any problematic
issues with any of the organizations that you've been involved
with? If you have, how did you resolve them?
Ms. Williams. You mean, for the community partners? Yes, VA
we--what we do is we consider a memorandum of understanding.
And it's, basically, the agreement is like a handshake that
says what the community can provide for us and what we can
provide for the community. And I've just recently had a little
bump in the road with one of our organizations.
And, you know, the VA's large and we have the support of
legal counsel. And we went to legal and said, ``What do we do?
We need to terminate this partnership.'' And they said okay.
And so we mailed a letter and said, ``Thank you for doing what
you do; however, we don't want to partner with you anymore.''
I haven't heard anything yet, so we'll see what happens.
But, yeah, we--it happens.
I mean, if your focus--our focus might be different than
the community. And we have to stay focused on what's important
for the veterans.
Mr. Miller. Thank you.
Ms. Brown of Florida. Thank you. Thank you all again for
your service to our veterans. And thank you for doing such a
great job. Mr. Bilirakis and Mr. Miller, do either of you have
any further questions?
Mr. Gus M. Bilirakis. Well, I just wanted to thank everyone
for attending. I want to thank the City Council for offering
City Hall chambers this morning.
And thank you, again, Madam Chair, for coming down from
Jacksonville.
And thank you, my good friend, Congressman Miller, for
coming, as well. I appreciate your service to our country and
God bless everyone.
Ms. Brown of Florida. Members have 5 legislative days to
make any revisions to the record.
And this hearing is officially over. But if you all don't
mind, I want to do something very different.
Will all participants come down front so we can take a
picture? We'll get ready for the letter we're planning to send.
Mr. Gus M. Bilirakis. You're always thinking ahead.
Ms. Brown of Florida. Yes. So will all of the participants
come down front?
Thank you.
[Whereupon, at 10:54 a.m., the Subcommittee was adjourned.]

A P P E N D I X

----------

Prepared Statement of Hon. Corrine Brown
The Subcommittee on Health will now come to order. I would like to
thank everyone for attending this hearing. I would also like to express
my sincere gratitude to the city of New Port Richey and Congressman
Bilirakis for hosting us today.
Modern medical advances have increased the survival rate of our
soldiers who sustain injuries while serving this country, but these
soldiers are often left with serious and complex wounds which require
continued care once they return home. One of the key challenges facing
VA today is the ability to meet the rehabilitative needs of our
veterans by providing a broad and varied menu of therapies and
treatments. There is a clear need for high quality rehabilitative care
for all of our veterans, both of older generations and those now
returning from Operation Enduring Freedom and Operation Iraqi Freedom.
Today's hearing offers us the opportunity to examine a particularly
exciting rehabilitative method.
Recreational therapy is an ideal component of the rehabilitative
regimen because it allows veterans to be active by engaging in their
favorite sports and recreational activities, while simultaneously
healing the mental and physical wounds of war. Recreational therapists
can use a variety of techniques, including sports, games, dance, arts
and crafts, animals, drama, music, and community outings to help reduce
depression, stress and anxiety; enhance basic motor functioning; and
build confidence among the program participants. In other words,
servicemembers and veterans have an opportunity to engage with their
communities and participate in sports and other activities that they
may have enjoyed prior to sustaining their war injuries.
Today, I look forward to hearing from the veterans on our first
panel about their personal testimonies on how recreational therapy has
benefited them. I am also eager to learn from our second and third
panels about the different types of recreational therapies that are
available to our veterans, and how VA and private organizations are
working together to offer this valuable treatment option to wounded
warriors in the Tampa region and across the country.
I now recognize Mr. Bilirakis for any opening statement that he may
have.

Prepared Statement of Hon. Gus Bilirakis
Good morning. I am so pleased to be here today in the heart of the
9th Congressional District and want to thank my fellow Floridian
colleagues, Corrine Brown and Jeff Miller, for taking time out of their
busy schedules to be here today.
It is a pleasure to serve this great State with two individuals so
committed to championing the best interests of our servicemembers,
veterans, and all of the residents of Florida. I am grateful to both of
you for being here. I am proud to call you colleagues and even prouder
to call you friends.
Most importantly, I am happy this morning to see my constituents
from the Ninth District. Whether here as a witness or as an interested
participant--seeing so many that have gathered so early and are willing
to spend their Tuesday morning exploring the role of recreation therapy
in healing our wounded warriors is a testament to the depth of
patriotism and caring in this community. I thank you for being here--
representing you is a true honor.
Throughout my career, honoring the service and sacrifices of our
veterans has been among my very highest priorities. Ensuring the men
and women who fought so bravely for our freedoms are given access to
the highest quality care and services is a commitment I take seriously.
That is why I specifically requested a seat on the Veterans' Affairs
Committee when I was elected to serve in Congress in 2006.
Since then, I have introduced numerous bills, many of which were
incorporated into law, aimed at improving veterans' care and benefits.
I was pleased to lead the effort to bring a VA outpatient health clinic
to Hillsborough County, to work with local and national VA officials to
expand the Pasco County Outpatient Clinic and bring additional services
such as dental care to Ninth District veterans.
I am very appreciative of the fact that we have a world-class
medical and polytrauma center in the nearby James A. Haley VA Medical
Center. The dedicated medical staff at Haley is second to none.
However, it is always important that we strive to enhance the care and
services provided to our brave veteran patients. And, today, I
anticipate learning from those of us gathered here about the important
topic of recreation therapy.
Recreation therapy is a therapeutic endeavor that improves an
injured veteran's physical, mental, emotional, and spiritual health
through activities aimed at increasing independence and quality of
life.
It doesn't surprise me that Florida is a national leader in
recreation therapy. And, I look forward to taking the ideas we discuss
today back to Washington to improve the lives of veterans not only in
our State, but in every VA facility throughout the Nation.
In closing, I would like us to take a moment to recognize and honor
those veterans in the room. As always, I am humbled by your bravery and
your dedication to a cause bigger than yourselves. Because of your
efforts, we are able to gather this morning freely, safely, and
democratically. On behalf of a grateful Nation, I thank you for your
service. I yield back my time.

Prepared Statement of Hon. Jeff Miller
Thank you and good morning.
It is a pleasure for me to join my colleagues, Corrine Brown and
Gus Bilirakis, in this historic city of New Port Richey to participate
in this important hearing. Having worked together for several years on
the Veterans' Affairs Committee, we have made great strides toward
better serving those who served our country.
I am honored to represent the Western Panhandle of our great State
and to stand for our servicemembers, veterans and all Floridians with
my two distinguished colleagues and friends.
I want to welcome our witnesses and thank all of you for taking the
time to be here today and to share your story, wisdom and expertise
with all of us.
For those veterans on our witness panels and in the audience, I
salute you for your service to this great Nation. You exemplify the
bravery and goodness inherent in our beloved State and all of Florida
should be proud to call you their own. Your sacrifices will not be
forgotten.
A sergeant once said that ``morale is what makes your feet do what
your head knows just ain't possible.'' I am sure this sentiment
resonates with all servicemembers and veterans who are accustomed to
performing seemingly impossible tasks with courage, integrity, and
ease.
That is also the attitude that lays the groundwork to understanding
the significance of our discussion today about the role of recreation
therapy in the healing process. Maintaining a sense of self sufficiency
and a high quality of life is vital as our wounded warriors move
through the process of rehabilitation and reintegration. It is
important for VA to provide guidance and support the allocation of
funds for recreation therapy because recreation therapy supports
wellness and provides the first opportunity to engage veterans in
sports as a part of their rehabilitation.
I very much look forward to our discussion about recreation therapy
services in the VA and exploring how we can better design, expand, and
maximize these programs to meet the individual needs and support the
recovery and enrich the lives of every veteran patient.
Again, I thank you all for being here and yield back.

Prepared Statement of Mary Ann Keckler,

Spring Hill, FL (Veteran)

I am a veteran enrolled in the James A. Haley Medical
Center since 1992. I have been both an inpatient and
outpatient.
I am also the VAVS representative for the DAV at this
facility, as well as I have a son who is also enrolled in this
facility as a spinal cord patient, 100 percent total permanent
injured on active duty.
As an inpatient for 3 weeks in September 1996, in the pain
management program, I have had the opportunity afforded me to
deal with many aspects of therapy to help with my pain problem.
The one that stood out the most, and the one that worked on the
mental release of my pain was recreation therapy. All other
therapies, i.e., physical, mental, all just enhanced the pain,
as your mind on these two is constantly on the issues of the
body. Not that they were not helpful, they were. But,
recreational therapy kept my mind off the problems I was
dealing with.
When I went into the pain program, I was in a great deal of
depression. Getting up every day was a major chore for me. I
was encountering muscle spasms and living on Flexeril to
counteract them. This put me in an extreme lethargic state.
While in the pain program, I was interacting with others
with similar problems. Recreation therapy kept my mind off my
problems. I was able to show my creative side and also had
socialization with others. We not only worked with our hands,
but we went out on outings as a group. I then forgot I was
suffering from chronic pain (mind over matter).
Suicide is a definite relation to depression. Pills that
mask the pain (Flexeril, Valium, Morphine, Halcion, Demerol)
can cause major depression leading to suicide, which from these
I am a survivor and I could feel myself going down that path
again. I then took measures to correct this effort. I am pill-
free since 1996, and deal with my pain in other ways.
While in the hospital I had the opportunity to clearly take
hold of my problems. Recreational therapy played a major role
in this. Not only did I have an hour a day with the therapist,
I also took projects back to my room to work on later on. If I
had a problem at any time working on a project, a therapist was
always available.
The present Chief of Recreation Therapy, Cathy Williams,
was one of my therapists. She always was willing to work with
me on projects. This eliminated any thoughts of my physical
aspects of pain. Again, mind over matter. It beats all pain
medications and helps with any thoughts of depression or
suicide. This is the best medicine yet.
Not only have I been successful with it, as a volunteer I
have seen this work on many occasions. By the way, this is why
I became a volunteer, to make a difference and help other
veterans.
Here is the story of another veteran. This young man has
been in the hospital in the spinal cord injury center for
several years. He is now in the long-term care facility in
spinal cord. When I first met him, he would not speak hardly to
anyone. As an amputee, he also was on pain meds. Depression had
set in on him, and he was feeling sorry for himself. He was
pretty well bedridden. The DAV had sponsored a pitcher from the
Detroit Tigers through recreation therapy. This veteran loved
baseball, this was the highlight of his stay. I would then
visit him on a regular basis and also spoke to recreation
therapy about programs to the bedside. This was done, a smile
appeared. He is now in his wheelchair all over the hospital,
and he looks forward to the outings that recreation therapy
sponsors. He is the first one outside waiting to be loaded into
the bus.
I am again working with another spinal cord veteran that
indeed tried to commit suicide lately. He and I have had some
discussions on this matter. He also is now in recreation
therapy daily and has a smile on his face, as he also goes on
the outings. And this makes his day. Happiness goes a long way.
The present Chief of Recreation Therapy has worked very
hard on programs that make a difference for our veterans, both
in and out. Winter sports clinic, wheelchair games, golden age
games, disability golf, horseback riding, sports venues. There
is no time to feel sorry for yourself.
This has all been put together in the last few years. Three
years ago I went to the past chief to put together the winter
sports clinic program, which is sponsored by the DAV. The
answer was this is Florida, people do not ski or participate in
cold weather activities. My answer was that we are all mostly
transients from other areas of the country and have at some
time or another experienced winter sports. Under the new chief,
this is a reality and many are participating.
My son, a spinal cord patient, when he is hospitalized, his
forte is computers. Recreation therapy helps set up a computer
for them to use or hooks up the one they bring in. Again, the
outside world is available to them.
Bedside programs are available, football pools, and they
all look forward to pizza parties sponsored by organizations
and run by recreation therapy, dinners sponsored by
organizations through recreation therapy. Someone from that
department needs to be on board when these are taking place
and, believe me, we have many. Ice cream socials. The list goes
on and on. Without the recreation therapy department, this
would not be possible. I, as a volunteer, have the opportunity
to work with recreation therapy in many aspects and areas of
the hospital.
They do make a major difference.
My life has taken a turn because of their efforts. As a
volunteer, I also have the opportunity to go on the outings and
help them. When on outings, they also have to act as a
therapist and nurse's assistant. Their training goes beyond
just fun and games.
If it was not for recreation therapy and the staff that we
have now, we (veterans) would not be able to participate in as
many functions as made possible for the amount of veterans and
active duty, both inpatients and outpatients, that we presently
serve.
In summary, with regard to the above, recreation therapy is
a must along with health care, to address the medical needs of
our patients on both a mental and physical aspect.
They are trained professionals in this respect and deserve
to be noted as such.
Respectfully submitted.

Prepared Statement of Davis Celestine, Vice President,
Paralyzed Veterans of America, Florida Gulf Coast Chapter, Tampa, FL
My name is Davis Celestine and I was injured in 2001 in a training
accident going over to Afghanistan for our yearly detachment. After my
accident, I woke up in a hospital bed with several doctors around me.
At first I thought it was a dream until I came to the reality that I
was not in a dream.
One of the doctors turned and said to me, ``You might never walk
again, but miracles happen every day.'' So with that said to me, I
decided to do whatever it takes to stay active in my daily life.
However, I was shipped off to the James A. Haley Hospital for Rehab and
that was when I was introduced to Cathy Williams and Jennifer Day. From
there they got me started with simple stuff such as playing the game
``TROUBLE'' and card games. They paired me up with a paraplegic named
``Max'' and he told me if your fingers are not working as well, use
your mouth to make a pair of moccasins for your wife. So with that type
of motivation in their clinic, it was an inspiration to be in there.
Now, their program has grown so well, they have pushed me into the
Paralympic world to compete in handcycling and swimming.
Also, having good family support really helps. My wife, Deborah,
and my twins keep me going and to be the best that I can be. In my
spare time, I volunteer at the local chapter, where I'm the Vice
President and fundraising chairman. I give back to my local hospital by
trying to get the newly injured involved in the great sports program.

Prepared Statement of Lee Nelson,
Land O'Lakes, FL (Veteran)
My name is Lee Nelson. I am a Chaplain in the U.S. Army. I received
a spinal cord injury in a traffic accident in Italy while traveling to
work on the morning of 11 August 1990. I got in a traffic accident with
a Semi-tractor trailer. After receiving back surgery in Italy, I was
transferred to the Tampa VA hospital in September 1990 from the Walter
Reed Hospital in Washington, DC. While in the hospital in Tampa, I
participated in different therapies such as physical therapy,
occupational therapy, speech therapy, and recreational therapy. In
recreational therapy, I participated in field events, basketball, and
horseback riding. These different activities were designed to increase
my strength, stability and coordination. The horseback riding took
place at the Quantum Leap Stables in Odessa, FL. We would go to the
stables on Tuesday morning and ride for about an hour each day.
When the recreation therapist asked me about horseback riding, I
thought that I would not be able to ride because when I rode in years
past I would stay on the horse by wrapping my legs around the horse and
holding on with my legs. Now that I am a paraplegic, that is
impossible. But she encouraged me to try and there would be a person
walking on either side of me and one leading the horse by the reins. I
understood that this was an ongoing program that the hospital had and
other paraplegics had participated so it must not be as impossible as
it sounded to me.
Upon arriving at the stables I took my wheelchair up a ramp, which
the horse stood beside, and they had an apparatus that hung from the
ceiling and went under my arms and held my legs up and carried me from
my wheelchair to the saddle on the horse. I held on tightly to the
saddle horn and relied on my ``side-walkers'' to catch me. As the horse
began to walk, I held on to the saddle horn with a death grip and
managed to balance myself on the horse, despite the movement. After
about 15 minutes of walking around, my arms were exhausted from holding
on with such a tight grip. So I loosened my grip and relaxed and relied
on my balance to keep from falling off the horse. I have kept going to
the stables each Tuesday for the past 5 months. We have ridden around
the fields in the area and I have guided the horse around obstacles.
After several weeks of riding, one day the horse tried to kick a fly
off his backside while I was trying to guide her to the left. I was
already leaning to the left so when she kicked the momentum threw me in
the direction that I was leaning and I fell over to the left side of
the horse. Because of the increased stability in my trunk muscles from
all the weeks of riding, I was able to stay on the horse and hang onto
her neck and my ``side-walker'' managed to straighten me back up in the
saddle and I could continue the ride.
While my physical therapist works on my core muscles as part of my
therapy, riding on the back of a horse has improved my core stability
more than all my physical therapy combined. I am now able to sit
straighter in my wheelchair and I am able to transfer from my
wheelchair to other devices easier, such as my bed, my car, a couch or
a La-Z-Boy chair as well as my stand-up machine that allows me to stand
up and put my full weight on my legs, which strengthens the density of
the bone mass in my legs. Because my core muscles are stronger I am
able to stay in my wheelchair for longer periods of time. Now I can
stay up in my chair all day rather than just a few hours at a time that
I was doing last fall.

Prepared Statement of Edie E. Dopking, Ph.D.,
President and Founder, Quantum Leap Farm, Inc., Odessa, FL
Good morning. I'm Dr. Edie Dopking, President and Founder of
Quantum Leap Farm, a 10-year-old non-profit veterans' service
organization located here in Tampa, Florida. Please accept my sincerest
thanks for the opportunity to present my testimony today. Quantum Leap
Farm serves current and former military servicemembers and their
families from the current conflicts all the way back to WWII. We
provide exercise therapy, cognitive/behavioral counseling, family
reintegration days, and personal and professional growth workshops for
military servicemembers, families and groups. We use horses as a
therapeutic tool and catalyst for positive change.
We've worked closely with the therapists at James A. Haley VA
Hospital's recreation therapy department for just over 10 years now.
Through word-of-mouth referrals from our friends in rec. therapy, we
also receive referrals from a list of other departments at James A.
Haley VA: mental health intensive case management, social
rehabilitation, polytrauma, and spinal cord injury as well as others.
In addition, we receive referrals from Bay Pines Medical Center and
from family services centers located on MacDill Air Force Base: Airmen
and Families Services Center, CENTCOM Family Services Center, SOCOM
Family Services Center, and from various other local veterans' service
organizations. This fiscal year alone (July 1, 2009--June 30, 2010) we
will provide services to over 850 military servicemembers and their
families, at a cost of over $469,000.00 to our organization (please see
Attachment A).
Up until 2 years ago, our friends in recreation therapy were
judicious with their referrals as they understood we did not have
funding to do this work and were donating our services entirely. In
fact, we have never charged veterans of any conflict for any of the
services we offer here at the Farm. During our 10 years of working
together, only two small recreation therapy grants became available
through the general post fund. Our friends in rec. therapy applied for
and received small amounts of funding for us (approximately $2,500 in
2005, and $2,900 in 2008) to help cover the costs of services we were
providing their patients. On several occasions rec. therapists have
made personal donations to the Farm to help cover the costs of their
referrals. Recently, though, we were awarded a one-time-only privately
funded grant provided by the Florida BrAIve Fund and administrated by
The Gulf Coast Community Foundation of Venice. BrAIve Fund monies are
earmarked per the original donor for services supporting OEF/OIF
servicemembers and their families. This grant of $618,566.80 enabled us
to expand the types of services we offer, the amount of services we
provide, and the number of military servicemembers we provide services
to by 1,200 percent in barely 2 years: from 32 unique servicemembers in
2008, to 850 in 2010. Unfortunately, our BrAIve grant funding expires
September 30, 2010. We are currently seeking alternative sources of
funding, both private and governmental, and are exploring the
possibility of establishing a contractual fee-for-service relationship
with the VA and/or the DoD.
This increase in military referrals we've experienced reflects a
great and increasing need on the part of military servicemembers and
their families. Likewise, it also reflects the great and increasing
degree to which VA hospitals are depending upon civilian organizations
like ours to assist in healing visible and invisible wounds of war that
our veterans and their families are so bravely enduring. The current
conflicts in Iraq and Afghanistan are generating more catastrophically
injured combat survivors than any other conflict to date thanks to
great improvements in field medicine. The ramifications are good and
bad, big and small, focal and widespread. VA health care workers are
handling rapidly expanding caseloads of seriously injured patients--
both the number and medical complexity of these cases exceed caseloads
VA medical professionals have managed before. In fact, our friends at
James Haley Recreation Therapy tell us that each of their therapists
are serving over 130 beds, many of their occupants with traumatic brain
injuries (TBI), amputations, spinal cord injuries and burns. And those
are merely the physical injuries. Many of them also suffer depression,
post-traumatic stress disorder (PTSD) and have emotional and family
issues to manage as well. Young families are facing a lifetime of
caregiving for seriously injured family members as they struggle to
raise children, work, maintain households and marriages. Not
surprisingly, divorce and suicide rates are high in this population.
Recreation therapists are instrumental in assisting injured
servicemembers and families to successfully navigate the numerous and
significant challenges they face post-injury. Rec. therapists help
injured veterans and families discover the new ``normal'': helping
injured veterans reintegrate into civilian life; reacquainting family
members with each other after extended separations and functional
changes; helping families learn to recreate together focusing on
strengths, abilities and resources; and promoting healthy relationships
and engaged, active lifestyles. Likewise, civilian veterans' service
organizations, like Quantum Leap Farm, are instrumental in helping
recreation therapists do their jobs: helping a large and diverse
population of injured servicemembers and their families rebuild and
recover from war-related trauma.
Recently our attendance at the Conference on Iraq and Afghanistan
Veterans (CIAV) in Washington, DC, was sponsored by our military
grantor, The Gulf Coast Community Foundation of Venice. Presenters
included Brigadier General Loree Sutton, MD, Director of the Defense
Centers of Excellence for Psychological Health and Traumatic Brain
Injury (DCoE), and panels of veterans, caregivers, and service
providers--some of the Nation's most intelligent and well-informed
experts on veterans' issues. We participated in numerous workshops,
attended informative lectures, spoke with legislators, met with various
department heads within the VA, and networked with other service
providers sharing our experiences working with injured veterans. Most
relevant among several over-arching conclusions of the CIAV Conference:
Although there is much great legislation currently being passed to help
our Nation's wounded warriors recover physically, emotionally, socially
and financially, it seems very little funding is trickling down to the
community level where it will do the most good. If we are willing to
award multi-million dollar contracts to defense and other government
contractors, why are we not willing to award similar contracts to
organizations that help fulfill our Nation's promise of caring for
those willing to lay down their very lives for our freedom?
As a Nation, we are in uncharted territory. The number of
profoundly disabled veterans needing long-term care and services is
rising rapidly and won't peak for years to come. The effects on our
health care system, our economy and our American culture remain to be
seen. However, one thing is certain--we, all of us, owe these veterans
and their families our unfailing support and gratitude for their
inestimable sacrifices.
It is my pleasure and an honor to submit this testimony to you
today. Thank you again for your time and consideration.

Military Statistics--May 2009 Through May 2010
----------------------------------------------------------------------------------------------------------------
Total of
Bay Pines James A. James A. Military
VA Hospital Haley VA Haley VA Individuals
Recreational Hospital Hospital who came for TOTALS
Therapy Recreational MICHAM service NOT
Department Therapy Department Referred by a
Department VA Hospital
----------------------------------------------------------------------------------------------------------------
Number of Individuals Served 51 297 24 477 849
----------------------------------------------------------------------------------------------------------------
Number of Sessions Provided 224 1,725 516 2,474 4,939
----------------------------------------------------------------------------------------------------------------
Dollar Amount of Sessions Provided $21,284.48 $163,909.50 $49,030.32 $235,079.48 $469,303.78
----------------------------------------------------------------------------------------------------------------

Prepared Statement of Melinda Wheatley, Senior Recreation Therapist,
Hillsborough County, FL, Parks, Recreation and Conservation Department,
and Paralympic Sport Tampa Bay, Tampa Bay, FL

Overview of Paralympic Sport Tampa Bay and
Hillsborough County Parks, Recreation and Conservation Department's
Therapeutic Recreation Services

The mission of Paralympic Sport Tampa Bay is to promote health,
independence, and personal growth for people with physical disabilities
through sports.

Paralympic Sport Tampa Bay (PSTB) is one of over 100 community
based programs established by the Paralympic Division of the United
States Olympic Committee.
As a signature program of the Hillsborough County Parks,
Recreation, and Conservation Department, PSTB provides year-round
sports and recreation programs that promote physical activity, healthy
lifestyles, and recreational and competitive sports opportunities for
area children and adults with physical disabilities.

Program Highlights:

Over 200 athletes participate in at least one PSTB
program or event each year;
PSTB offers ongoing programs for athletes at all levels
from recreational to competitive elite in multiple sports such as
wheelchair basketball, track and field, adaptive tennis, swimming,
archery, and wheelchair team handball;
PSTB offers periodic clinics in additional sports such as
archery, adaptive golf, handcycling and water skiing;
PSTB has strong relationships with other community
agencies such as Shriner's Hospital for Children, James A. Haley VA
Hospital, and the Tampa Bay Sports Commission.

For additional information:

Contact Andy Chasanoff, Sports Coordinator
Paralympic Sport Tampa Bay, 6105 E. Sligh Ave., Tampa, FL 33617,
(813) 744-5307, Fax (813) 744-5309, or [email protected].

All People's Life Center

The showcase facility and home base for the therapeutics program is
the All People's Life Center (APLC), which opened in 2007. The 45,000
sq. ft. center has won awards for its design and accessibility. APLC
was recognized in 2008 by the National Association of County Parks and
Recreation Officials (NACPRO) winning the Barrier Free Initiative
Award. The facility was also recognized by the Hillsborough County
Alliance for Citizens with Disabilities winning the Karen Jacobs
Accessibility for All Award. The APLC not only serves as the home for
the department's therapeutic programs for people with special needs, it
is also open to all persons with typical abilities. Every detail of the
building exceeds ADA standards for accessibility, eliminating all
barriers to participation for people with disabilities. The facility
features a two-court full gymnasium, which can be divided by means of a
curtain, two multi-purpose rooms, two classrooms, fully accessible
playground, a dance room, a fitness center, a food-service grade
kitchen, a paved walking trail, an outside basketball court and a
multi-use field. The facility offers dance classes, martial arts,
basketball leagues for residents at all levels of ability, plus
community events and tournaments such as townhall meetings, wheelchair
rugby and team handball.

Prepared Statement of Sandy Ackley, Programming and Events Coordinator,
Sailability Greater Tampa Bay, Inc., Clearwater, FL
Sailability Greater Tampa Bay, Inc., is a 501(c)3 operating out of
Pinellas County, whose services are provided to the Greater Tampa Bay
area. We pride ourselves on our mission, which is to provide
affordable, accessible sailing activities and education to children and
adults of all ages and abilities, focusing on community integration to
improve the quality of life for all involved.
The concept of our program was born in March of 2001. It was at
that time that a small group of people envisioned and implemented an
opportunity within their community. The challenged individuals, that we
take sailing, quickly realized that the only limitations they faced
were those of the mind, and that whatever one might set their mind to
do can be accomplished; this I know because my husband is a veteran who
is disabled and recreational therapy is what kept my family strong.
Sailability is 9 years old now and has built a fleet of 13 Access
Dinghy boats, 3 catamarans and a motor boat. A grant, fundraising and
local supporters made it possible for us to purchase our first 303
servo assist boat which has adaptive equipment which includes a ``sip
and puff,'' chin control, electronic joysticks and adaptive seating,
which a ventilator dependent quadriplegic would be able to sail
independently. In fact, after training provided by Sailability Greater
Tampa Bay, Inc., Lynn Moers, a ventilator dependent quadriplegic from
James A. Haley Hospital, set a record here in Clearwater to be the
first ventilator dependent quad to sail independently in the United
States on an Access Dinghy. Lynn and other veterans come to our
community sails, which are held four times a year, and lead the way
demonstrating the opportunities our waters could provide to veterans
while he navigates the Clearwater Intercoastal Waterway. Wheelchair-
bound vets from our community, recreational rehab and spinal cord
programs, various veteran support groups, as well as the Paralyzed
Veterans, James A. Haley, Bay Pines Hospital and returning Iraqi
veterans accompanied by their families, friends and therapists, watch
in awe from atop ``The Miss Beverly.'' This is when I know that what I
do gives our vets a sense of worth, confidence, assurance and belief,
while building on self-esteem reaching their goals and drives as I
watch their arms in the air screaming out words of joy and triumph, and
happy tears running down their faces. I know this because Sailability
is what empowers people and kept my family strong.
The Miss Beverly is a 24-foot wheelchair accessible pontoon boat
that resides at MacDill. The Miss Beverly is borrowed to take Bay
Pines, James A. Haley veterans and community veterans out fishing or
used as a spectator boat for the more ``I have to challenge Sandy''
veteran while others sail the bay. I get them all in a boat sooner or
later. They learn to trust and believe in themselves again, this I know
with certainty.
We serve over 500 people per year on an all volunteer staff. Since
we are driven to get as many veterans out on the water as possible, we
also strive to support those who would like to facilitate programs such
as ours locally, regionally, and nationally. Not only does this enhance
awareness of all individuals, it facilitates the need to keep our
waterways and environment, not only eco-friendly and pristine, but
accessible to all.
We are proud of the fact that since our inception, we have been
able to have a positive impact on many individuals. Our program has
graduated a multitude of sailors; many of which were either mentally or
physically challenged, as well as able-bodied children, adults, and
seniors. Some of those physically challenged individuals include, but
are not limited to, paraplegics, quadriplegics, amputees, stroke
survivors, and those with neurological impairments such as cerebral
palsy, multiple sclerosis and head trauma injuries. Moreover, we have
been able to introduce the experience of sailing and touch the lives of
more than 500 individuals, along with their family members and
caregivers. This I know because I get the tears of joy, the ``thank you
for giving me my life back'' cards, the gratitude from recreation
therapists, the appreciation from family and friends. These sailboat
rides are more rewarding to me than I can describe. Men that have the
wind taken out of their sails, from them I get my strength to make
others strong.
Sailability GTB also has the ability to travel to outside counties
and support other groups. Our presence at these travel events raise the
awareness in our community for the need to maintain community inclusion
and accessibility for all, while giving our veterans what they need and
deserve. We are obligated to do this for people who gave their souls in
belief that we will stand by them. We feel that our presence and
support within our community will fuel the acceleration of programs
like ours, and this I know because my son is a 3rd generation Marine
who volunteered since he was 10 years old putting veterans out on the
water. These proud veterans taught my son loyalty, trust, and gave him
confidence and strength.
We pride ourselves on the fact that all these accomplishments have
been made through an EXTREMELY dedicated volunteer staff. And, as we
move into this next decade, we anticipate growing our program and
touching many more lives as we live through war.

Prepared Statement of David B. Windsor, Principal Instructor,
Professional Golfers' Association of America, Adaptive Golf Academy,
Inc.
Experience has shown that early intervention with active sports
results in successful rehabilitation. Individuals in the recovery
process, whether it's brain or spine injury, speech or limb loss, poor
awareness, impulsive behaviors, judgment or balance issues, are
frequently detached or disconnected from their communities, and worse,
their own families. This isolation only tallies up more problems
resulting from their injuries. It's a fact that a disability injury
puts you in a lonely place mentally, socially. Introducing and
involving patients into a ``fail-proof'' activity within a positive
environment takes their minds off ``therapy'' and allows their recovery
process to be self-initiated. The fact of getting outside, on the golf
course, to network with their peers facing similar issues, provides our
veterans and service men and women the consistent platform essential
for their level of connection, hence, improved family and community
relationships.
The James A. Haley VA Adaptive Golf program was introduced on
Friday, September 28, 2007 and has continued every Friday since
(approaching 3 years). The program consists of JAH inpatients brought
by therapists to Terrace Hill GC, a nearby course, where they are
greeted by a PGA professional, Ken Juhn, and members of AVAST, Amputee
VA Support Team (a group of area outpatients and volunteers). The
Friday JAH Adaptive Golf program has been more than just a weekly
``golf outing'' but rather a vital part of their rehabilitation process
and community reintegration practice.
For the record, this is not the first program of it's kind. This is
an extension of a weekly program that developed in 1998 in Sarasota, FL
with the involvement of myself as the PGA professional and therapists
and clients from the community. As a club professional at the time, I
first saw the program as just helping folks get better at hitting the
golf ball. I soon realized there was more to it, much more to why folks
were coming out week after week with their therapists and caregivers.
Everyone participating experienced first-hand how the restorative
properties of the game of golf positively enhanced their lives. Just on
the practice tee, inherently positive essential life skills are applied
and evaluated such as range of motion, balance, hand-eye coordination,
depth perception and an array of fine motor skills. During the ``on-
course'' portion of each weekly session, students learn about USGA
rules, proper etiquette, team-oriented playing formats, making proper
club selection and mapping their course strategies. These lessons
require participants to use life skills such as judgment for
decisionmaking, courtesy for others, honesty for scorekeeping, building
a more confident individual through perseverance. These physical and
cognitive skills are more often taken to new heights where experiences
can go far beyond words for these veterans and staff.
While many recreational therapy programs offer themselves as
rehabilitation or performance enhancements, adaptive golf sets itself
apart, offering many unique potentials for both clients and therapists.
First, the golf swing is one of the most complicated movements in all
sports. It requires stability in some joints and flexibility in others,
creating multiple avenues for a therapist's assessment of the client. A
common testimony from therapists observing patients on the course:
Apparent improvement in clients range of motion in trunk and/or
shoulder rotations once they were handed a golf club and a ball was
placed on a tee! Why? A thought re-direction, the mind shifts from,
say, an injured hip (their primary concern) to another focal point,
triggering an integration of other able functions/flexors such as feet,
knees and opposite hip for overall increased rotation.
Program participants who never thought golf was a viable
recreational opportunity now have discovered its inherent values, both
spiritual and physical. Even those suffering from severe Post-Traumatic
Stress Disorder (PTSD) depart a Friday session with an entirely
different outlook. ``They come back to the hospital talking golf,''
said Jim Switzer, the amputee case manager for James Haley Hospital.
``Many can't wait to get back out again.''

``At the James A. Haley Veterans Hospital in Tampa, FL, our
active duty soldiers and veterans who face physical challenges
or complicated barriers with their PTSD, depression, and/or
traumatic brain injuries, are encouraged to reach functional
independence so they can get back to their lives . . . of all
recreational activities, we favor the adaptive golf experience
the most as it introduces the concept to help our patients
maximize their new potentials . . . with adaptive golf, this
process of recovery is self initiated.''
Kathryn Bryant, CTRS

Real Stories:
Capt. Mark--survived Blackhawk helicopter crash in N. Italy during
training exercise in November 2007. One of five survivors of a crew of
eleven. Grew up playing ice hockey near Cleveland and during his first
visit to the golf course he stated to me from his wheelchair, ``I can't
wait to ice skate again someday!'' Comparison of the video clips of his
swing on his first visit to those 3 months later was remarkable, would
astound you. After just a little time around Mark, it was apparent that
helping him hit better drives down the fairways was motivating his
drive life!
Gunner Jim--survived Humvee roadside blast. His first time out, he
didn't even think about swinging a club. ``I was happy to just get out
of the hospital for a little while,'' he said. Then he was introduced
to the SoloRider golf car, a golf car designed for wheelchair players
to become more upright to swing the club better and complete access to
the golf course. ``You know, we have classes with therapists and
they're great, but we're inside. For me, being outdoors and having
people like this to help crack a few balls . . . this is my best day of
therapy!''
To sum it up, the JA Haley Adaptive Golf program has become a
driving force in the rehabilitation process for which veterans, active
military personnel with disabilities can relearn and develop skills
which they thought were beyond their capabilities. Physically, adaptive
golf improves individuals' balance, coordination, endurance and
functional ability to perform daily activities, decreasing risks of
falls and injuries and increasing overall quality of life. Mentally, it
helps train individuals to focus on more positives and develop better
everyday life and judgmental skills, self-esteem, confidence,
independence and feeling of dignity, giving new hope to expand their
horizons as they transition back into civilian life.
The next opportunity you have on a Friday morning to come visit the
JA Haley Adaptive Golf program, I encourage you to do so and see for
yourself why every Friday is Veterans Day at Terrace Hill Golf Club.

Prepared Statement of Cathy Chiovitti Williams, CTRS Supervisor,
Recreation Therapy Section, James A. Haley Veterans' Hospital, Tampa,
FL,
Veterans Health Administration, U.S. Department of Veterans Affairs
Good morning, Congresswoman Brown, Congressman Bilirakis, and
Congressman Miller. Thank you for inviting us here to discuss the James
A. Haley Veterans' Hospital Recreational Therapy program.
The James A. Haley Veterans' Hospital provides recreation therapy
to veterans and servicemembers within Veterans Integrated Service
Network (VISN) 8. The Physical Medicine and Rehabilitation Service's
Recreational Therapy Section currently has 21 full-time employees.
Seventeen (17) of the employees are recreational therapists who possess
specialized training and a Bachelor of Science or a Master of Science
degree in therapeutic recreation. Most of our staff is certified by the
National Council for Therapeutic Recreation. All Tampa recreational
therapists are certified brain injury specialists.
Our goal is to maximize each patient's rehabilitation potential
through active recreation, leisure and sport pursuits, which are
designed to improve or maintain physical, emotional, social, and
cognitive functioning for a better quality of life and increased
independence. Recreation activities enhance physical health,
psychosocial and cognitive status, and improve functional independence
in the community. Recreation therapy provides resources and
opportunities to improve overall health and well-being. It improves
physical health by increasing mobility, range of motion, strength,
motor skills coordination, vestibular balance, agility, and athletic
skills. Recreational therapy also improves psychosocial communication,
trust, and cooperation skills while enhancing morale, life
satisfaction, self-esteem, socialization and camaraderie. In addition,
the program addresses cognitive deficiencies through enhanced
attention, memory and perception; increased alertness and awareness of
surroundings; and reduced confusion and disorientation.
VA clinical staff conducts a thorough assessment to ensure we
develop a treatment plan that best meets the needs of the individual
patient. We work with the patient and his or her family to develop this
plan. Activities and programs are tailored to be appropriate for the
individual patient to facilitate the best possible outcome. In sum, we
adopt a ``whole person'' view that considers the individual's activity
interests and patterns before their injury, illness or disability and
we focus on returning the patient as much as possible to his or her
previous functionality, ability and activity levels to promote active
community participation.
The therapeutic recreation staff conducts leisure education
counseling to provide a baseline of information for patients. This
counseling enables patients to broaden their perspective of what
activities are available to them. Patients are offered as many
opportunities as possible to participate in community recreation
resources and to improve their overall well-being through leisure
participation. In Tampa, our recreation therapy programs include
activities such as archery, animal-assisted activities, bowling,
fishing, horseback riding, air gun and trap shooting, basketball,
cycling, golf, power soccer, rowing, sled hockey, tennis, water skiing,
sailing, track and field, arts and crafts, among others.
The James A. Haley Veterans' Hospital Therapeutic Recreation
program benefits considerably from its multiple community, governmental
and university partnerships. We collaborate closely with external
parties to provide recreational special events for inpatients such as
trips to Kennedy Space Center shuttle launches, cultural and community
events, and local sporting events, such as baseball games, NASCAR
events, and the Super Bowl. Veterans receiving treatment at our
facility also participate in VA sponsored events like the National
Veterans Summer Sports Clinic, the National Veterans Winter Sports
Clinic, the National Veterans Wheelchair Games, the National Veterans
Golden Age Games, the National Veterans Training, Exposure and
Experience (TEE) Tournament, and the National Creative Arts Festival.
We have had patients also participate in other national events not
sponsored by VA, including Challenge Aspen, Lima Foxtrot, Endeavor
Games, and the Paralympics Military Sports Camps.
Our program in Tampa continuously provides patient-centered
recreation therapy services. This enhances current abilities and helps
veterans develop new skills through recreation therapy activities for
daily living, community functioning, and quality of life. Thank you
again for the opportunity to appear before you today. My colleagues and
I are prepared to answer any questions you may have.

Prepared Statement of Steven G. Scott, D.O.,
Chief, Physical Medicine and Rehabilitation Service,
James A. Haley Veterans' Hospital, Tampa, FL,
Veterans Health Administration, U.S. Department of Veterans Affairs
Congresswoman Brown, Congressman Bilirakis, and Congressman Miller,
thank you for the opportunity to discuss the James A. Haley Veterans'
Hospital Therapeutic Recreation Therapy program and its role in the
rehabilitation of those who serve our country.
In my role, I have always emphasized the importance of recreation
and sport activities in personal development and rehabilitation. My
colleague, Cathy Williams, has presented an overview of the James A.
Haley Recreation Therapy program and its benefits as a patient-centered
service. I would like to focus and discuss the importance of recreation
therapy to veterans from Operation Enduring Freedom and Operation Iraqi
Freedom (OEF/OIF).
We are in a new era of rehabilitation and recreation therapy. Our
society values sports, recreation and leisure. Sports and recreation
activities have been an important part of the lives of our newest
veterans, and their identities have frequently been linked to these
activities, so injuries that limit their ability to participate may
have significant impacts on their sense of self. Changes in warfare and
battlefield medicine have led to new injuries and new challenges in
rehabilitation. Some of our newest veterans come to the Department of
Veterans Affairs (VA) with brain injuries, ranging from minimal to
profound; post-traumatic stress disorder (PTSD) and other mental health
problems; and multiple injuries that often need prolonged
rehabilitation.
In this new era of rehabilitation, recreation therapy success is
possible through specific inclusion in a multidisciplinary
rehabilitation team that includes physical, occupational and speech
therapies. Recreation therapy provides an environment of adventure and
discovery within which veterans can practice and integrate the skills
learned from the other therapy team members. For our newest veterans,
recreation therapy provides new hope and opportunity to discover new
goals and dreams for the future; it is integral to the rehabilitation
of our new veterans providing opportunities to relearn skills, develop
relationships and find meaning and purpose.
In addition to this new approach to care, technological advances
have opened up new opportunities for veterans to participate in
recreation activities and sports. New prosthetics for amputees allow
veterans the opportunity to participate in competitive sport activities
or in community events. Wheelchair technology has allowed family
members to transport severely injured veterans, allowing them to
participate in a range of public activities. The Internet and video
games have opened new possibilities for connecting through social
networking. And recreational activities such as hunting and sailing,
that were once not possible, are now available.
The newest veterans have greater interest in extreme sport and
recreation activities, adventure and competition. A wider variety of
activities are available now than ever before. Horseback riding,
adaptive golf, hot air balloon flying, kayaking, waterskiing, sled
hockey and scuba diving are just a few of the possibilities. We have
observed seriously injured veterans run a marathon, compete in a 20-
mile bike ride, and catch a 100-pound fish. We also had a seriously
injured, burned, and blinded servicemember record a song that he
composed in his room on his tape-recorder. The joy and achievement of
these experiences is beyond words.
Recreation therapy gives new freedom to those who fought for our
freedom: freedom to run when they could not stand, freedom to think
when they could not remember their name, freedom to be successful when
they felt lost, and a feeling of hope for a new meaningful life at
home.
Thank you again for the opportunity to appear before you today. My
colleagues and I are prepared to answer any questions you may have.

Statement of Verax Technologies, Inc., Pensacola, FL
MUSIC THERAPY PILOT PROGRAM
1. INTRODUCTION
Today's audio technology derives from the early days of the
industry when two channels were all that sound engineers had to work
with. However, advances in digital signal processing (including low-
cost, high-capacity computing power, distributed network architectures,
and component miniaturization), mean that technology no longer has to
be a limiting factor in sound reproduction, and in the last decade the
number of audio innovations has exploded. Because Verax got there
first, the company has been able to develop a rich portfolio of patents
relating to audio capture, modeling and reproduction techniques,
including sound source separation, 3D sound modeling and reproduction,
all of which may be rapidly deployed using off-the-shelf components. By
combining these technologies with others such as advanced EEG
diagnostics, we can open up a world of new treatment possibilities for
music therapists, patients and their families, who will be able to
optimize the location, spatial direction, volume, tone and other
characteristics of individual sound stimuli for maximum therapeutic
effect.
What makes this unprecedented level of control possible? The answer
is ``Sound Source Separation.'' This means that individual sounds from
an unlimited number of sources can each have their own loudspeaker,
which other systems (e.g., surround sound) cannot replicate. Because
each sound can be controlled separately without any special technical
training, patients and/or family members can make the most
imperceptible, yet highly meaningful adjustments to what is heard. This
is a fundamentally new approach to sound reproduction, not the typical
minor modification to existing sound reproduction techniques that add
marginal improvement at significant cost.
The following section provides an overview of how Verax solutions
can add measurable value to standard music therapy interventions for
PTSD and other disorders.
2. DEFINITION
Music Therapy is the use of music and/or its musical elements
(sound, rhythm, melody and harmony) by a qualified music therapist,
with a client or group, in a process designed to facilitate and promote
communication, relationships, learning, mobilization, expression,
organization and other relevant therapeutic objectives in order to meet
physical, emotional, mental, social and cognitive needs. Music therapy
aims to develop potentials and/or restore functions of the individual
so that he or she can achieve better interpersonal and/or interpersonal
integration and, consequently, a better quality of life, through
prevention, rehabilitation or treatment. (Source: World Federation of
Music Therapy, 1996).
3. THERAPEUTIC INTERVENTIONS
Music therapists use various active and receptive intervention
techniques according to the needs and preferences of the individuals
with whom they work. Using Verax's audio technologies in combination
with medical and other technologies, therapists will be able to
administer a range of therapeutic interventions, including but not
limited to the following:
Listening. Listening to music has many therapeutic applications.
Music reduces stress (Stratton, 1992) and anxiety levels (Mornhinweg,
1992). Music has improved mood according to self-report (Kenealy,
1988), and heart rate and systolic blood pressure have also been shown
to improve (Pignatello, Camp, Elder, Thomas, & Rasar, 1989). Music
helps to develop cognitive skills such as attention and memory. For
example, for those facing surgical procedures, it allows the individual
an opportunity to exert a sense of control over their unpredictable
environment. In situations where cognitive perceptions are compromised,
such as by PTSD, listening can provide a sense of the familiar, and
increase orientation to reality. Music listening can facilitate
increased openness to discussion by helping patients feel safe and
provide motivation for engaging in social activity. Verax's ``object
oriented'' technology (enabling one or more sounds to have its own
dedicated speaker) creates unprecedented opportunities to ``break the
sound barrier''--to go beyond what is ordinarily possible with music.
This is because of the unique ability to control not only the placement
of individual sounds in 360 degree space (i.e., around the patient),
but also their directionality--effects that may be accentuated through
the use of speakers designed specifically for a given frequency band.
In addition, music (and all sorts of special effects) can be played
much louder because amplification is possible without distortion.
Rhythmic based activities. These can be used to facilitate and
improve an individual's range of motion, joint mobility/agility/
strength, balance, coordination, gait consistency and relaxation.
Rhythm and beat are important in ``priming'' the motor areas of the
brain, in regulating autonomic processes such as breathing and heart
rate, and maintaining motivation or activity level following the
removal of a musical stimulus. The use of rhythmic patterns can
likewise assist those with receptive and expressive processing
difficulties (i.e., aphasia, tinnitus) to improve their ability to
tolerate and successfully process sensory information. Verax's object
oriented technology also creates unprecedented therapeutic
opportunities using rhythmic based activities. For example, with a
bedside user interface, patients and/or therapists can change the
location and distribution of sound sources, ranging from a purely
binaural (stereo) presentation to a more immersive distribution
comprising multiple speakers arranged in 360-degree space.
Singing. Singing is a therapeutic tool that assists in the
development of articulation, rhythm, and breath control. Singing in a
group setting can improve social skills and foster a greater awareness
of others. Singing can encourage reminiscence and discussions of the
past, while reducing anxiety and fear. For individuals with compromised
breathing, singing can improve oxygen saturation rates. Music may
stimulate the language centers in the brain promoting the ability to
sing. One advantage of Verax's technology is the ability to reproduce
live events that are virtually indistinguishable from the original,
allowing the patient to re-experience the event repeatedly on demand.
Playing instruments. This can improve gross and fine motor
coordination in individuals with motor impairments, neurological trauma
and other conditions. Instrumental ensembles can enhance cooperation,
attention, and provide opportunities for practicing various leadership-
participant roles. Playing instruments may assist those with prior
musical experience to revisit previously learned skills, thereby
allowing the individual to experience a renewed sense of pleasure and
enjoyment. It can also develop increased wellbeing and self-esteem in
those who are learning to play an instrument for the first time. Again,
the ability to reproduce live events that are virtually
indistinguishable from the original will enable patients to learn at a
faster pace.
Improvising. Improvising offers a creative, nonverbal means of
expressing thoughts and feelings. Improvisation is non-judgmental,
easily approached, and requires no previous musical training. As such,
it helps the therapist to establish a three-way relationship between
the patient/family, themselves and the music. Where words fail or
emotions are too hard to express, music can fill the void. Where trust
and interaction with others has been compromised due to trauma,
disorder or other causes, improvisation provides a safe opportunity for
restoration of meaningful interpersonal contact. Where learning ability
is limited, the opportunity to try different instruments, musical
sounds, timbres and mediums may provide an opportunity for mastery of a
new skill and increase life satisfaction. The flexibility of the Verax
solution will make it possible to create customized solutions for each
patient, enhancing the therapeutic effect of improvisation.
Composing/Songwriting. This is utilized to facilitate the sharing
of feelings, ideas and experiences. For example, with hospitalized
veterans, writing songs is a means of expressing and understanding
fears. It may also provide an opportunity for creating a legacy or a
shared experience with a comrade. Lyric discussion and songwriting can
help patients deal with painful memories, trauma, and express feelings
and thoughts that are normally socially unacceptable, while fostering a
sense of identification with a particular group. Verax's technology
provides unprecedented opportunities for musical expression, since the
system is customizable to patient needs. (Source: adapted from Canadian
Music Therapy Association, 2008).

4. PERSONALIZED TREATMENT PROTOCOLS

From the data harvested from multiple patients, evidence-based
standards may be developed, along with highly calibrated treatment
protocols to address disorders like PTSD with much greater efficacy.
For example, by combining Verax technology with EEG and other medical
imaging technologies, we will be able to analyze brain activity in real
time, and through advanced diagnostics determine the optimal
therapeutic intervention for each patient. We may then develop a
spectrum of optimization templates, each suited for a given patient
profile.
The following chart compares the expanded diagnostic and treatment
possibilities of the Verax approach to music therapy (outer circle
corresponding to upper diagram) with the limited possibilities of the
conventional stereophonic approach (inner circle corresponding to lower
diagram). Verax's approach may include stereophonic protocols, but then
can do so much more since the number of points of intervention is
limited only by the imagination of the therapist.

ADVANCED MUSIC THERAPY SYSTEM

APPENDIX A
Music Therapy: The New Frontier

According to a 2008 study of 1.65 million servicemembers by the
Rand Corp, 20 percent of Iraq and Afghanistan veterans (over 300,000
individuals) suffer from depression or post-traumatic stress disorder
(PTSD). Experts predict that the percentage could grow in coming years,
because stress disorders often take months or years to appear, and also
because of the upsurge in guerrilla tactics such as roadside bombings.
Victims need help dealing with issues (including flashbacks, withdrawal
symptoms, and heightened arousal) and resetting their pattern to
`default.' Left untreated, serious conditions such as PTSD can become
chronic disabling disorders, so effective diagnosis and treatment must
be given at the earliest opportunity. Music therapy first emerged to
help victims develop compensatory mechanisms. But new field of
Neurologic Music Therapy (NMT) has demonstrated that music can achieve
much more by actually restoring neurological function. Verax offers the
prospect of raising the bar still further, by enabling music to be
calibrated and optimized in ways that are not possible with existing
technology.

Neurologic Music Therapy (NMT)

With the rise of psychological ailments among Iraq and Afghanistan
war vets, military and VA hospitals have begun to rethink how they deal
with this age-old scourge of war. Music therapy in particular has shown
great promise as a powerful non-invasive therapeutic tool. Furthermore,
new research findings indicate that music therapy can not only help the
patient develop compensatory behaviors, but also restore neurological
function.\1\ The scientific, evidence-based field of Neurologic Music
Therapy has emerged with the goal of treating patients with various
neurologic issues (cognitive, speech/language, sensorimotor). NMT is
based on the principle of leveraging the physiological mechanisms
inherent in music perception and production.
---------------------------------------------------------------------------
\1\ Baker F., Roth EA. (2004). Neuroplasticity and functional
recovery: training models and compensatory strategies in music therapy.
Nordic Journal of Music Therapy. 13(1): 20-32.
---------------------------------------------------------------------------
A common task of music therapists is to induce a meditative
condition so as to influence brain neurophysiology. In order to
accomplish this, it is necessary to discover the most effective
rhythmic and tonal parameters for each patient. Individualized music
has superior healing properties to regular ``relaxation music,''
because everybody's EEG (the pattern of electrical impulses produced by
chemical reactions in brain cells) is as unique as their fingerprint.
To demonstrate this, one study sponsored by the University of Toronto
used computers to transform EEG traces into `brain music.' Sixteen EEG
channels were employed, each channel providing a selection from 120
musical instruments. Researchers were able to create changes in tempo,
vary the volume of each channel, transpose the music of each channel to
different octaves, change musical parameters (e.g., legato or
staccato), add major and minor chords, and analyze the note patterns of
each channel. Through a process of optimization they were able to
entrain and re-balance patients' brains. However, this level of
individualization is beyond the reach of practicing therapists, who
have relatively few audio channels to work with, and limited
opportunities for output control (master volume, left-right balance,
control of frequencies across all channels).

Verax Value Proposition

Today's audio technology derives from the early days of the
industry when two channels were all that sound engineers had to work
with. However, advances in digital signal processing (including low-
cost, high-capacity computing power, distributed network architectures,
and component miniaturization), mean that technology no longer has to
be a limiting factor in sound reproduction. Using Verax's patented
audio technologies in conjunction with advanced EEG diagnostics, music
therapists will be able to optimize the location, spatial direction,
volume, tone and other characteristics of individual sound stimuli for
maximum therapeutic effect. From the data harvested, evidence-based
standards may be developed, along with highly calibrated treatment
protocols to address disorders like PTSD with much greater efficacy.

APPENDIX B

Problem, Hypothesis and Military Relevance

Psychological health & traumatic brain injury
Advanced music therapy systems can build upon the proven
success of traditional music therapy treatments and protocols
Next-generation music therapy systems can be deployed
throughout the Military Health System (MHS) as a cost effective, non-
invasive method to assist in the tasks of:
Chronic pain management
Diagnosis and treatment of PTSD
Diagnosis and treatment of deployment-related
psychological health problems
Psychological resilience
Suicide prevention

Proposed Solution

Music therapy has shown great promise as a powerful, non-
invasive therapeutic tool
New research findings indicate that music therapy can
help patients develop compensatory behaviors and restore neurological
function
Individualized music has superior healing properties to
regular relaxation music because EEG patterns are as unique as
fingerprints
Today's audio technology derives from the early days of
the industry when two channels were all that sound engineers had to
work with
Verax's patented audio technologies, in conjunction with
advanced brain diagnostics, will enable music therapists to optimize
sound stimuli for maximum therapeutic effect
From the data harvested, evidence-based standards may be
developed along with highly calibrated treatment protocols to address
an array of psychological disorders with much greater efficacy