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The Value of GRIT Adaptive Functional Fitness

Originally published on QLI Omaha.

QLI’s adaptive functional fitness program, GRIT, blends industry-leading rehabilitation expertise with the revolutionary fitness and health principles of CrossFit. In this informative and inspiring webinar, QLI discusses how GRIT works and how adaptive fitness workouts can be a specialized and easily modifiable form of delivering fitness interventions.

Speakers: Brad Dexter, Tim Benak, Stephanie Roob

Video Transcription


Tim Benak

Good morning, everyone. Brad Dexter and Stephanie Roob are here with me this morning. We’ve got a new presentation, the value of grit, adaptive functional fitness, we’re excited to broadcast this out to everyone this morning. We’ll jump right in Brad, you’ve been here what?

Brad Dexter

Since 2011, a long time, nine years.

Tim Benak

So the coordinator of physical therapy and occupational therapy services as well as part of the telerehab team. You’ve been doing a lot around here.

Brad Dexter

Telerehab has been 18 to 24 months now that we’ve been doing that, kind of ramped up my role on that team as well.

Tim Benak

That’s awesome. And then Stephanie, been here since 2005. And tell us a little bit about what you do.

Stephanie Roob

My official title is director of nutrition services, so I am a registered dietitian and a licensed medical nutrition therapist, really clinically involved at QLI. We just hit our two year mark for grit. So I’m the director of grit, adaptive functional fitness as well.

Tim Benak

Well, that’s very fitting, because that’s what we’re gonna be talking about today. All right, well, I’ll let you guys go ahead and launch right into it. And as always, ask questions throughout.

Brad Dexter

A few objectives for you guys today that we want to hit as we’re going through this. One, we want you to understand the secondary complications that can arise primarily due to sedentary lifestyles, falling neurological injury.

What is Adaptive Functional Fitness?

We’re talking about adaptive functional fitness. We’re really talking about individuals that have had some type of neurological or catastrophic type of injury. Those are the folks that we’re trying to serve with this type of program. We’ll describe why adaptive fitness workouts can be a specialized and easily modifiable form of delivering fitness interventions.

Once you guys understand and are able to identify the benefits of in person, as well as virtual delivery platforms for accessing adaptive functional fitness program.

About QLI

Most of you are familiar with QLI, we land in the post acute care world. We’re primarily serving individuals that have had some type of neurological catastrophic types of injury, spinal cord injury, stroke, brain injury, limb loss, chronic pain.

We also wanted to really try to impact the community in what we were doing too. We had a lot of great facilities and assets on campus. We have some amazing people that work within our company.

We’re trying to figure out how do we share that? How do we allow more people from the community to to access what we’re trying to do? Stephanie has had a huge role in making that happen with the the grit adaptive fitness program.

That’s where the community based care part of the spectrum really lands.

Why Is Adaptive Fitness Important?

We want to start off talking today about why is fitness important in the first place, something we know about fitness, adaptive fitness is that if it’s individualized, and it’s adapted appropriately for the folks that we’re trying to serve, it can help promote a healthy lifestyle can help impact recovery. It can help improve quality of life.

Sedentary Lifestyles

But what happens if people don’t have access to fitness? Again, after all, having the types of injuries that we’re discussing here, people are at higher risk for sedentary lifestyles, right? These types of injuries lead to inactivity.

A lot of the time, people have a hard time accessing equipment that you or I might be able to access at their local gym. It takes a lot more effort to complete activities, and it doesn’t really match the return on investment.

I can think over the years a number of folks that I’ve heard come back to me and say, yeah, I went to the gym, but it was just, it was so hard, I couldn’t do anything with my hands. I couldn’t hold on to the grips.

We have gotten better, internally over the years at trying to show adaptive ways to access local fitness equipment, but really it felt like it could really take the next step as well.

Lack of resources, so not only may the gym itself not be as accessible for the individual, but sometimes people run into the inability to actually transport themselves there, they may not be able to drive themselves, they may not have the finances to hire a ride service.

And then last thing that all of us probably have a hard time with but haven’t changed can be overwhelming, when you’re starting something new, you’re trying to learn something new change a habit, can be really hard. Especially doing that on your own.

Mental Health

Something else, mental health, it’s a big area without fitness that can be affected after these types of injuries. Depression, we know from the research, that individuals that have had traumatic brain injury, especially spinal cord injury, post injury are at a higher risk for depression, and anxiety.

Not only have they lost some of their physical ability, but it becomes an identity issue, who they were before, it’s challenged relationships break down social systems, support systems can break down.

Many of the folks that we serve, are highly independent, they had a lot of control over their lives prior, and that’s one of the biggest things that we try to focus on giving people back through empowering them and education in the inpatient setting, you know, give them control back over their lives.

We need to teach them what they need to do, teach them about their bodies, and how they can take care of themselves again, so they can get some of that control back. We just know transition is hard.

When people leave campus, and they go back out into the community, some of those habits that they formed, are a little harder to carry over into that real world setting. That’s where again, that learned helplessness can come in depression, anxiety can kind of creep back in as well.

We feel like GRIT, adaptive functional fitness is a great means for filling that gap for those individuals.

Secondary Conditions

Then lastly, on this list, secondary conditions. Many of these folks maybe can’t walk anymore, or if they can walk, it’s shorter distances. Oftentimes they may be using a chair as their primary means of mobility.

We know that sitting does terrible things for our bodies, you look at some of the more recent research just in general, for human beings, if we’re sitting we are at a higher risk for obesity, for diabetes, for cardiovascular disease, imagine, the folks that we’re talking about in this discussion, who maybe are using a wheelchair primarily, they have a hard time getting their heart rate up when they go to a gym, and they try to exercise in a cardiovascular type of manner.

There’s just going to be at a higher risk for obesity, for cardiovascular disease for diabetes, circulatory issues, deconditioning and then you see how this spirals down too, and can affect poor sleep quality hygiene, self image, all those categories.

Brad Dexter

Having worked with several individuals, some of them who are highly fit and highly active prior to their injuries, it’s a real struggle for them to be able to exercise at the intensity they want to be able to exercise at, and they know and they see how some of these secondary conditions are creeping into their lives.

They need to have a means to be able to access appropriately intense fitness for themselves.

Studies That Show The Importance of Fitness

Stephanie Roob

Here are a couple studies that support the mental health component and the secondary conditions component.

So in 2010, they did a study of 156 individuals with traumatic brain injury. They introduced them to the control study that did not do exercise, but was on medication for depression. Then they had another group that used exercise instead of medication.

What they found was significantly reduced levels of depression at the end of four months, and at the end of 10 months a lower level of severe depression relapse versus the medication control group.

In that study, they showed that being part of a fitness community was more beneficial than the medication control group.

There’s a study that showed that the peak V02 which is like the max consumption of oxygen for recovering traumatic brain injury patients are 75% of just your typical sedentary individual.

That shows you again, the impact of having a sedentary lifestyle on someone with a traumatic brain injury.

Stephanie Roob

The body isn’t going to function very efficiently. Not even as well as just a general population sedentary individual.

Then a another study showed that TBI survivors are three times more likely to die, one year post injury from circulatory conditions.

That is a cause for concern, and a reason why we really are pushing physical activity.

About GRIT – Guts. Resilience. Intensity. Tenacity.

Our Program is called GRIT, which stands for guts, resilience, intensity, and tenacity. And what adaptive functional fitness is, is really focusing on training your muscles to work together, and prepare them for daily tasks by simulating common movements.

It’s teaching your body how to best use what it has in the space that it’s given. That’s the whole purpose behind functional fitness.

What we do at QLI is we incorporate our rehab principles, and we relate them directly to the man’s of the real world. It made so much sense to start this program as part of QLI because we recognized that when individuals left our doors, that there was this need to stay connected.

Maybe their support systems weren’t the best, maybe they didn’t know where to go, where their resources were. People tend to stay pretty connected to QLI afterwards and for those that don’t, sometimes they reach back out saying hey, I’m really struggling, and I need some help.” What a perfect opportunity for us to get involved by starting a program that promotes health and wellness for individuals out in our community.

The Ideal Athlete

What is the ideal athlete? I will tell you the ideal athlete is anyone who needs adaptive fitness. Anyone who would struggle going into a community gym and figuring out how to adapt that equipment to work best for them, is the ideal athlete for GRIT.

That is our only qualifier when we have people apply to the program. We ask them, what is your injury? What are your deficits? What are your goals, what do you struggle with, and if they can meet the criteria they’re welcome in our gym.

Our ideal athlete is any adaptive athlete, we’ve had quite a variety in our gym. We’ve had spinal cord injury, we’ve had traumatic brain injury, we’ve had MS, we’ve had Parkinson’s, limb loss, West Nile, little bit of everything in there, some chronic pain.

We’ve really been able to show our community and ourselves that we’re able to serve quite a diverse population.

Scientific Guidelines

What scientists show is 20 minutes of aerobic exercise at a moderate to vigorous activity two times a week, and three sets of strength training at a moderate to vigorous intensity two times a week.

That’s where GRIT falls, GRIT falls in that category.

Our athletes come to our gym two times per week, if they’re participating in our in person classes. Which again, with adaptive functional fitness, that’s all worked into those workouts, so they’re getting strength training, and they’re getting aerobic exercise during those sessions.

The general population, they say 75 minutes, vigorous, weekly. For brain injury, what you find is two to three times a week weight training, and cardio three to five times a week, weight training.

What some of our folks do is they come and do these really intense workouts a couple times a week, and then they may go for walks, jump on a recumbent bike, get their cardio, their aerobic exercise and other ways outside of these classes.

We also can be a good add in to a more moderate intensity activity.


So a little bit about intensity. Functional fitness is considered an intense activity, the workouts are intense.

It’s a really well rounded activity. We’re working at pretty much every part of that human’s body that we can work.

The sessions are an hour long. Within that hour, it’s anywhere from usually about 20 to 40 minutes is the actual activity. Some workouts are fast and hard, and they’re out in 20 minutes. Then sometimes we’re really focused not on speed, but on duration, and so they’re longer activities. That’s kind of how those workouts go.

We are looking to impact strength and endurance. We want people leaving, not just stronger, but also feeling like, wow, I can do so much more. I don’t tire out as quickly, I’ve got a lot more energy.

It facilitates motor learning too.

We also adjust them based off the individual. Even though we’re saying while these workouts are really intense, we also get to know our athletes well, so we adjust them based off of where they are at.

We like to push them, but we also have very open communication about what feels good, what doesn’t feel good. The athletes if they can be, are really involved in deciding what weight they feel like.

We take time before the workouts to do some run throughs to see what feels right for that individual. The intensity is based off what the athlete is able to do.

Class Sizes

Our class sizes are really small, and that is intentional. We like to think of the classes more like personal training sessions versus going to a gym class.

We have one head trainer. She’s a level three CrossFit instructor and a certified adaptive instructors. She’s incredibly knowledgeable and then we have assistants in the room who are generally either QLI staff, so their rehab trainers who are very knowledgeable about the background of the individuals we serve, or they are OT or PT students that are coming in and volunteering their time.

So typically, we’ll have two to three coach assistants in the room, as well as Addy the head coach. We have anywhere from two to three to five to six athletes.

Our goal, depending on the complexity of the athletes we’re working with, is never more than two athletes per coach. We like to keep it to one athlete per coach, if possible. We do have some groups, some of our SCI groups who are a lot more independent after setup, where we can increase that class size a little bit.


There are a couple studies to back up what we’re talking about.

There’s this protein called BDNF, it supports existing neurons and also helps with neurogenesis. They have actually shown that it is stimulated by exercise.

In a 2017 study in biological psychology, they showed that cardiovascular exercise leads to positive change in the areas of the brain that are responsible for motor control.

Then another study showed, with young stroke patients, that there is an increase in motor learning after an eight week high intensity training program versus a stretching program.

We would fall into that high intensity training program.

One was from the American College of Sports Medicine, and then also done with the American Heart Association, that showed that unsupervised fitness programs can result in inadequate duration and intensity to meet the desired benefits.

When Brad was talking about the return on investment, that kind of falls into that category of, I can go but I really don’t know what I’m doing and I don’t know how to adapt it, so now I’m not getting the benefit that I want from it.

We help people navigate that.

A survey of spinal cord injury clients, they surveyed them about exercise programs and why they don’t participate in exercise programs.

One of the biggest things they said was that they felt that health professionals did not provide sufficient support and recommendations for exercise, once they are home.

So they just didn’t feel like they had the guidance to do an exercise or program that they felt was beneficial to them.

Brad Dexter

I’m thinking about intensity, back along the lines of motor learning too, we’ve been talking about finding that sweet spot when it comes to teaching someone something new.

I’m speaking from PTs view right now, but if we let people be too comfortable in how we’re training them, whether that’s walking again, or learning how to stand up from the edge of a mat, or lifting weights in our gym, if we’re letting them be too comfortable, we’re doing them a disservice. If they live in that comfort zone, they’re not going to get better right there.

We also can’t push them too far either. We can’t push them over the edge of the cliff, because that could be a little bit detrimental. We may not help them learn that way.

So we really have to walk that line and find the sweet spot. I think GRIT does a really nice job of that.

I think speaking from my profession, sometimes I think we treat the neurological population and some of the folks that we’ve been discussing in this presentation, as if they’re breakable almost.

Certainly they have medical conditions that need to be taken into account, but it’s our job from a skill standpoint to look at them and to understand how far can I push them? How intense can I make this? It needs to be appropriate.

I love having those conversations with other people in my profession too and being able to discuss how do we challenge people that we’re serving, even more how do we recommend appropriate intensity.

And again, I love what is happening in GRIT because I think it really does encompass that vision.

Fitness Community

Stephanie Roob

A little bit about the fitness community and why I think we’re able to do what we do is, the first thing is the camaraderie and competition.

You’re entering this community that is encouraging, that is pushing you, you have people cheering you on.

I think the reason we are able to push people a little beyond their comfort zone is because we have that camaraderie, because you have your fellow athlete cheering you on, because you have a coach that’s knowledgeable, and is able to come up with an exercise that works well for you and feels good and makes you feel like you are truly getting something from it. That’s hard to find.

I talked some about the coaches, with coach Addy, our head coach.

Physical therapy, lucky for us is right here. If there is something that we are struggling at figuring out, I know, we’ve had an athlete who, when we were doing mat work, so like groundwork and then getting up on the boxes.

We were having a little trouble with figuring out that transfer of getting them off the floor. We needed just a couple extra eyes to help us figure out what would be the best thing. We pulled Brad in to look at that. Just to come on over quick and kind of guide us through it to make sure that it’s looking good for what we’re doing.

So in the occasion that we do run into something like that we have additional experts here, which is fantastic.

Then we talked about the small group format. The reason why we keep those classes so small, why we consider more of a personal training session.

One thing I didn’t mention, I mentioned that the classes are an hour, and that typically the workouts are anywhere from 20 to 40 minutes.

In that additional time, of course, they’re doing some stretching and some warming up and going through those exercises.

Addy actually takes them through the workout. So what what is the workout of the day? What are those movements? And what does each athlete need to get through those movements?

It’s not like there’s just the equipment out there, and she goes through it and somebody grabs something, and we figure it out.

Every athlete is laid out with the equipment that they’re going to need for that workout before the timer starts, so that they are ready to go and they feel comfortable with what they’re doing once that timer starts.

We do time our workouts, there’s a scoring way of doing things. We also keep track of everybody’s scores after workouts because we like to show them, hey, we did this workout six weeks ago, we’re doing it again. Let’s compare your scores.

One thing Bob, one of our athletes that he said he really likes is he loves the scorekeeping. He wants to know everything about what he did.

What’s beautiful about it is they’re not competing against each other. They’re competing against themselves.

They are just interested in what their score was, and how they can make that better. Then they cheer on their fellow athletes to do the same. It’s not, where it can be in some other gyms of, hey, how’d you do, I did 10 seconds better than that.

These athletes don’t have that. It’s just more of let me do my best, and I’m going to cheer you on to do your best, which is a super cool thing.

A quick story of one of our athletes who was really struggling with being home. He did not have a vehicle yet to get back and forth, and was struggling was having some medical complications from being at home, was having some mental health issues from being stuck at home and was able to find GRIT.

The amount of support that he received there, whether it be just opening up to his fellow athletes, letting them know what he was going through, some of them had been through similar things.

Doing that story sharing how deconditioned he was by being home for three to four months. Just getting himself conditioned again.

He’s told us that he truly believes that QLI and GRIT saved his life. When you are secluded, like an injury where you’re not able to just freely move about as you would wish, depression is a very real thing. Seclusion is a real thing.

When you get connected to a community, it can be a real blessing in someone’s life.

Brad Dexter

Yeah, I’m thinking about the same individual and I think he had a couple good months after he went home from rehab and was transitioning well, and then things just kind of went awry.

It was hard for him to be connected with his situation there, and getting connected with people around something that he loved was truly impactful for him.

The GRIT Approach

Stephanie Roob

Practical Application

About our approach, we are practical application related to the demands of the real world. So again, how to best use your body in the space that is provided in our well rounded, functional workout.

Well-rounded, functional workouts

The whole point of functional fitness is you’re not kind of separating individual muscle groups to work them out. You’re trying to work as much of your body into a movement as you can.

We like to work on flexibility, we like to work on strength, we like to work on balance. All those types of things are worked into the workout of the day.

Endless Variety

There’s a lot of variety, we do similar movements, but they’re different, they’re working the same muscle groups, or they’re working the same body parts.

It’s not like sometimes you go to the gym, and you’re like, oh, what am I going to do today, I’m gonna jump on this piece of equipment, or it’s back day, so I’m going to do this.

We’re just constantly bringing new stuff in.

Metrics to Track Progress

We keep track of what everyone’s progress is in the workouts. Addy writes it all down and keeps track of it so they can check in and see if they’ve seen improvements.

Compliment Formal Therapies v. Stand Alone

Then we can compliment formal therapies versus standalone. Some people just do GRIT twice a week. Some people do GRIT with their own kind of physical activity on the side, and we have some folks that do formal physical therapy sessions, and then also come and join us for GRIT.

How People Use GRIT

Brad Dexter

Can you talk a little bit maybe about some specific examples that you’ve seen from people that are using GRIT? How does it change what they’re doing on a day to day basis?

Stephanie Roob

I think that what I hear from a lot of our SCI folks, is their comfort and knowing that if they were to fall out of their chair, that they know, now they have the strength and they understand their body better, and how to maneuver out of that situation.

We had a gentleman who has an elevator, in his home. He was loading his chair into the elevator, and it started to move without him pushing the button, and it tipped his chair forward.

That was right when he started GRIT.

He was a little banged up, and he talked about how he was laying on the floor for a while, because he couldn’t get himself to where he needed to go, and nobody could hear him.

Then we were about four months into our workouts. He had another situation where he had kind of gotten out of his chair, not because the elevator, but had talked about, oh my god, like what I was able to do in that circumstance. I wish I would have had that back when I had that really scary ordeal because it would have really helped me and I wouldn’t have been as scared.

There’s all kinds of stories like that of people just talking about how confident they are in themselves. They understand their bodies better, how their bodies move better, and they’re stronger. That’s exactly what we’re going for.

Workouts Require Minimal Equipment And Are Easily Modified

Stephanie Roob

Another thing that’s great about adaptive functional fitness is in functional fitness, you require minimal equipment so we don’t have a lot of machinery.

There’s not a lot of fancy stuff in our gym. We have free weights, bars, squat racks, we do have a couple pieces of cardio equipment like a row machine and skiers but it’s just really simple gym equipment.

Those kind of things can be really easily modified for athletes if you have the knowledge on how to do it. We want to promote proper technique and high energy output.

The last thing we ever want is to put one of our athletes in a situation where they feel uncomfortable or unsafe. We work really hard to ensure that whatever piece of equipment we are using, that the athlete knows how to use the proper technique with it, so they remain safe.

What’s been great about going into the tele world is that because functional fitness requires minimal equipment, we were able to transfer that over to tele pretty easily.

We were able to look what we’re using in our gym sessions, and some things you could find at home that could easily be put in place, if you don’t have free weights, or if you don’t have a slamball.

There’s all kinds of things that you could use at home. Again, that just means getting creative thinking outside the box, be knowledgeable of your craft.

Virtual Training

Brad Dexter

When pandemic hit, mid March, all of a sudden, we had to close down our campus.

Some of these folks that were coming on to campus to come to GRIT, they couldn’t come do that anymore. And so, thankfully, like you said, it was really easy to transition a lot of this into a virtual environment.

Steph already hit on one, you still have access to Addy as a coach. She’s there, the workouts can still be very challenging, even with equipment that they have around their home for themselves.

I am actually working with a couple of those individuals, doing telerehab with them from their homes as well. It’s worked really well over a virtual platform.

The other thing, I’m thinking about working on the the telerehab side of things. QLI here too has started serving people from all over the country with our telerehab program, and we’ve had a few individuals that they need some supplemental fitness, they need fitness in their lives, because we see how it’s going to help with what we’re doing for PT or OT with them in that telerehab environment.

We’ve had a few folks that have started using GRIT from other areas of the country, connections through the telerehab program, and it’s been a great melding to serve those individuals.

Stephanie Roob

Yeah, it’s been fun to watch it.

When we started doing the virtual classes, there’s always been this unknown of, how exactly is this going to go to get the quality that we want.

So a lot of gyms are doing virtual classes right now. They’re usually pretty big class sizes and there’s not a personal touch, right? So you just jump into the class and you just start doing the workout.

Whereas with ours, we’ve really been mindful to ensure that Addy can still view each athlete and give in the moment feedback coaching to every single athlete that’s on that call that’s really important to her too, that she is making sure they’re all getting individualized attention.

Part of it is because she’s so knowledgeable. We’ve been able to successfully have quite a few athletes on a call. Addy has been able to maneuver and watch them all and give guidance and direction.

It’s also fun to watch the banter between all the athletes on there, they’re still cheering each other on, so the community is still there.

Stephanie Roob

We’ve had athletes who could possibly access a community gym, where they are living now. They have chosen to stay on with the virtual classes through GRIT because of the expertise and because of the community, which that’s a big deal to me that they do have options, some of them and they have chosen to stay with us.

I think has been a good complement to the program and to Addy.

Adaptive Functional Fitness in Practice

Brad Dexter

It’s great. Well, we want to show you guys a little bit of this in practice, and so give us a short moment here. We’ll get our video shared with you.

Stephanie Roob

We’re gonna take you through some movements.

Burpee Variations

So the first thing I want to show you is a burpee. These are pretty usual movements within the functional fitness community.

Addy was showing you a burpee, it’s a full body movement, it’s great for bodyweight conditioning. Instead of using equipment, you are using your own bodyweight, for strengthening.

It’s also good for flexibility and coordination. So that’s a really good functional fitness exercise.

Now, what we’re going to show you is Jeremy doing a couple adaptations.

Jeremy has a traumatic brain injury. He’s showing you a similar movement with the walk out of the arms and the legs.

That is where Jeremy started, that was very, very difficult for him to do because of his balance and coordination.

He shows you that one, and now he’s going to show you what he progressed to, which is still an adaptation because it’s not completely lowering himself to the ground, like Addy would and then getting up off the ground. It was still a good variation of a burpee for someone who has better coordination strength.

Now we’re looking at spinal cord injury, obviously, the burpee is going to be a little bit more challenging and that type of environment.

So if you have someone who we can’t get on the mat, to do some form of exercise, these are called U turns.

So again, you’re having to practice coordination, you’re having to work on some balance. Another variation is what we call mat hops, curve hops, plate hops, whatever you might want to call them, which is again, a similar thing.

It’s about coordination. It’s about pacing, and it’s about upper body strength.

That is another variation for someone with an SCI for doing the burpee.

Now, we’re going to show you Chad. Chad is one of our athletes is at home and he’s doing a variation of a burpee from his chair.

Now he’s going to show you another variation than SCI can do from home as he just has a heavy pillow that he uses.

He is going to perform what would be equivalent to like a ball slam. So like in the gym, we have four pounds, six pound eight pound balls. He just uses that to do the ball slams.

Pull Up Variations

Next is the pull up. So Addy is going to show you a traditional pull up that is common in functional fitness along with a kipping pull up.

So again, you’re looking at wanting to strengthen the upper body really work on grip strength. It really focuses on shoulder health.

Stephanie Roob

Now, Jeremy is showing you a variation of just the leg swings, which again, he’s having to work on shoulder health and grip strength, Addy showing you a version of a seated one. So a lot of our SCI guys can pull themselves up through that seated variation.

Then we have Cole, Cole has some shoulder pain, back pain, and so we aren’t quite at where he can hold on to the bars and pull himself up to a pull up. So instead, we use the bands to mimic that motion of a pull up.

Brad Dexter

He was dealing with a lot of pain issues, for chronic pain, we know that aerobic exercise is really, really beneficial for chronic pain. If you can get people to be active, you improve oxygenation, and some of those tissues that aren’t really being oxygenated all that well, and it’s causing some chronic pain issues, right.

In this gentleman’s case, I think this was incredibly beneficial for some of the pain issues that he had going on, as well.

It’s supplemented, as he was impatient as supplemented what he was doing on the inpatient side of things really, really well.

So realize that’s an aside, but I wanted to point that out, since we didn’t really hit on something like that.

You know, and that’s just again, with Addy working with him to figure out. This is the movement ideal movement we’re looking at. Here are some different variations. We practice them, we see what feels good.

It’s not just that he’s gaining strength from that it’s one that it feels good, two he feels supported really well. They start to feel good about himself too right, what he is doing.

Stephanie Roob

I mean, for this individual, it’s been really fun to watch. Because, he’d come into the gym, pretty quiet, confidence was pretty low.

It’s been really fun to watch him blossom from now on. I’m not really comfortable to anybody watching me too. Yeah, go ahead, record me. Let’s do this. I want to show what I can do.

So you know, again, it’s been fun to watch him on that perspective as well.

So here’s Chad doing a variation of a pull up from home. So he has some light dumbbells that he can use. So that was an easy variation.

This is what we call a power snatch. It’s a full body movement, flexibility, balance, strength, coordination, all of that. It’s a very fast lift. It’s really focusing on dynamic movement, big range of motion.

So those are the goals of the snatch.

So then you have Jeremy doing a variation of it. So not going all the way to the ground, and not as quick of a moment because of his balance and coordination, but he is still able to get the core exercise, so he’s still able to get out of it, what we’re looking for.

Here’s another variation seated. So again, maybe not quite the speed, but still getting the core movement.

Then here you have, doing with dumbbells at home, a lot of people don’t have a bar at home. So we’re able to come up with different kinds that we can do.

Here’s another variation of the movement with the swing with both weights overhead.

This one is a clean and jerk, this one’s considered a power lift. So we’re really looking at a greater load lots of strength, a lot of power through.

Here is the movement with dumbbells in the gym. Again, not as much full body movement because of the strength and balance.

Here’s the seated variation. Again, with the hand weights, seated, it’s usually easier to do with the hand weights than a bar.

Then here’s another one at home. He happened to have a piece of wood that worked really well for him instead of a bar to do that, again, that exact same movement with an adaptation from something at home.

So hopefully, that gives you guys a good idea of, here’s the traditional movement in a functional fitness gym. Here’s how we would modify for someone with TBI possibly has like balance and coordination issues. Here’s how we would adapt in the gym for someone with an SCI.

And here’s how we adapt that home. So hopefully you guys got a good picture of the different layers of those workouts.

Tim Benak

We did have somebody just ask, you know, how much weight do you typically start with? Is that something that’s customizable?

Stephanie Roob

Yeah, it’s very customizable. So, you know, I would say that when we started our gym, we primarily bought three pound weights, five pound weights, I think the heaviest we got was about a 10 pound weight, and a 15 pound bar.

Some of our athletes have been with us for about a year and a half. And so we’ve had to invest in 30 pound hand weights 30 pound bars with more plates.

So yeah, we have we have quite a diverse selection. And a big part of that is we’ve been driven to because our athletes have made gains, and so we’ve had to invest in bigger equipment.

Brad Dexter

That’s awesome. Absolutely.

Well, just winding things down here for you guys.

GRIT Testimonials

The next few slides that we have are really just testimonials from individuals that have done this and Steph and I wanted to just share some quick stories on each of them, kind of looking at that, that flow from inpatient rehab into community based.

Tim is going to act as each individual, so you’ll get to hear his voice. But he’ll read these quotes for us. And then Steph, and I will just share a little bit of information about each one of these folks, too.

Tim Benak

So it’s gonna read a few quotes here.

GRIT Testimonial 1

“One year after my spinal cord injury, I was able to do my first setup. I’ve also tripled my overhead press and added an extra 20 pounds to my chair dips. Virtual services are great to stay fit.”

Brad Dexter

So this is a young gentleman, he actually came to us from the west coast, where he was living and got hurt.

He didn’t have a lot of community, not a lot of support systems and had a rough childhood and had a spinal cord injury from he was a painter and he had a fall while he was painting on the job.

And when he came he was like a C five level injury. He was able to do some of his own transfers, highly, highly competitive, young man. And so he was always competing against himself during rehab.

He was trying to figure out how fast can I make my car transfer? How fast can I break down my wheelchair? How quickly can I get in and out of bed? How long is it going to take me to do my morning routine or my evening routine? I want to get back to normal life.

And so I think when he had the opportunity to transition to grit, he probably took that same attitude over and I’ll tell you he’s continued his rehab journey beyond what he did and impatient, really through participating in grit.

Stephanie Roob

He’s been a really fun one to watch for me.

What’s also really rewarding is he recognizes the gains. Sometimes it’s hard when they’re in smaller increments, but he really recognizes it.

He started out, you see right now he has, I believe, a 25 pound bar with just some weights on it. But he started out with a PVC pipe. So literally you’re looking at a couple pounds, and we used to have to get gloves on, so he can grip the bar, so that’s where we started.

Now he’s waited bars with weights on it. He loves sled poles, I think his max sled pole was almost 400 pounds. He was pretty happy with that we just had to do some modifications to the rope to pull the sled.

His sit up, I have that on on video. That was pretty amazing to watch. It’s not like he got a bunch of core strength back or anything like that. It’s just that he was able to understand how he needed to move his body to get himself to do a sit up. He’s pretty impressive.

Tim Benak

He’s also a komplot award winner.

Yeah, he got to go out to San Diego a couple years back and accept his award. Yeah, he’s an incredible person.

GRIT Testimonial 2

“I joined GRIT three months ago, and already have more energy feel stronger and sleep better. I feel accomplished. The online classes provide a sense of community and accountability that works for me.”

Brad Dexter

So the thing that sticks out to me about this woman here is she’s around, I think, 25 years post injury, she had her spinal cord injury when she was in high school in the mid 90s. She’s been living with a spinal cord injury for a long time.

In fact, she’s influencing our community, and advocating on behalf of individuals that have had a spinal cord injury, she looks at accessibility in a number of environments around our community and calls for change.

We had the opportunity to have her come onto campus and to learn a little bit more, not just about QLI but about our GRIT program. She jumped on board with it. It’s been a phenomenal addition for her.

Stephanie Roob

Yeah, it’s been great to see her in the classes. She joined shortly before we went into this month off from COVID. Now, she shows up easily three to five days a week for the virtual classes.

She’s been fun because she had tried other gyms in the community. She had tried another adaptive gym in the community. And, always felt okay about it, but was never super excited.

It’s been rewarding for me because she’s posted twice on her on her advocacy website, about GRIT gym. She feels like it is such an excellent program for SCI folks in our community that she wants to spread the word.

GRIT Testimonial 3

Tim Benak

“The workout push recovery recovery beyond what I experienced exercising on my own, and virtual services offer the convenience of joining classes from home nine months ago, I parked my wheelchair in the garage and haven’t used it since.”

Brad Dexter

I think all of these stories have this theme to me, but it’s the theme of the story isn’t over yet.

I think what many of the individuals that we serve here is that, you know, 18 months to 24 months that’s about the amount of recovery that you’re going to have and I t kind of stops at that point.

We’re all about creating hope, not false hope, but creating hope.

I think if you look at a graph with an X axis and a Y axis where the X axis is time and the Y axis is the amount of recovery that you have, yeah, you’re gonna see a lot of recovery in the first you know, 18 months, right.

What we fail to look at a lot of the time is what happens after two years, what happens beyond that.

If you’re challenging yourself, and you have the right amount of intensity, your body can continue to change, it doesn’t mean it’s going to fully recover, but you can keep changing.

GRIT Testimonial 4

Here’s a gentleman that when he left rehab, he could walk a little bit around his home. He’s just continued to push himself a ton and GRIT has been instrumental in continuing to improve his recovery and and his access into life.

Stephanie Roob

Yeah, he’s worked really hard for this. I would say he would say that he needs the community.

I think there was even a ways pass injury, just this, true heavy sense of loss. And sometimes we’re in the gym and he still just wants to give up because it’s hard. It’s hard work.

But he shows up every day because he knows that he has a group of folks in there that are down on the ground with him cheering him on every movement that he makes. So the physicals been great but for him I think the the emotional connectivity has been has been impressive.

GRIT Testimonial 5

Tim Benak

All right. “GRITs unique format, and expert trainers make a once unreachable exercise accessible and fun. It has been instrumental in pushing me to achieve my goals and set new ones.”

Brad Dexter

So this is an individual that has Guillain-Barre And it was one of the worst types of Guillain-Barre and his recovery has been very slow.

But if you know anything about Guillain-Barre, there is a quite a bit of recovery that happens within the peripheral nervous system just takes a long time, and it has to have the appropriate amount of intensity and appropriate timing to help it improve.

I’ve had the opportunity of working with this gentleman for quite a while now. And the thing that’s sticking out to me is the person on the last slide actually lives a couple blocks down the street from him.

I just learned recently that they’ve made a pact with one another that as soon as the previous individual, as soon as he’s able to walk a little bit longer distance, they’re going to walk down to Bob’s house together, they’ve set that goal and I want to get a video of that it would be monumental for them.

Both of them have just set targets and goals down the line, and they they keep achieving them.They keep fighting for them.

Stephanie Roob

Two stories from Bob real quick that I really appreciated, that brought a little tear to my eye anyway.

One of them was when he was recovering and going to his doctor, and they would measure his recovery in millimeters and his nerves and even though it’s a really slow recovery, his doctor said, what are you doing, because I’m really impressed with your progress.

The physician said, I really think it’s because of how you’re pushing yourself physically, that you are getting the return like this. Which made me happy because it’s like, oh, there’s the science behind it. Right? Yeah.

Another great story for Bob is when he started, we say, you know, what are your goals? What are your desires? What do you want to do.

And, he said, you know, I have a lake place. And I, I really would love to get back on my boat. But I think I think at this point, we’re gonna have to sell the boat because I don’t see myself being able to drive it. I don’t see myself being able to get on it successfully.

Then you get to the, I don’t even remember how many months and we were, and he came in just grinning ear to ear he got on the boat. He could drive the boat.

That was like goal check, right? And so then you move on to the next, because he did it. He really, really honestly thought in his heart that you’d have to sell it. Again, it’s these gems aren’t just about strength training, there’s so much more, and that’s why we’re here.

Wrapping Up

Tim Benak

All right, I’m going to go ahead and launch the poll question here.

So that is now on the screen. Again, just a quick reminder, that is for anyone wanting to receive your certificate for this, I do want to just throw that out there.

So typically, we send you an evaluation really shortly after this. We have applied for CCMC’s for this, as always, we do expect that it is going to be approved by the end of this week. There is going to be a delay in getting the follow up email sent out to you guys after this.

Please give us a little bit of a grace period there. I know, we love getting everything sent out to you guys right after, but we just want to make sure that you know, we’ll let you guys know.

But our expectation is that it will be approved by the end of this week, and early next week, you should receive at the latest, your follow up emails from us.

Questions About GRIT

Okay, we actually had a few questions, guys.


There’s a few people asking about cost, please feel free to reach out to either Brad or Stephanie, on that their emails are up on the screen right now.

So if you are concerned about the cost, reach out to Brad and Stephanie and they can either get you directed to the correct person and so that or themselves can answer it.

What is the typical length of time an individual participates?

We did have someone ask what is the typical length of time an individual participates? And are you saying work comp patients or who’s all paying for this?

Stephanie Roob

Sure, I can take that.

The duration of participation is variable. If someone is coming to us from the community, we don’t make them commit, but we ask for a three month commitment. Just because we feel like that’s what’s needed, to truly understand the gains that they’re making, you’re not going to see much in three to four weeks, they really need to commit to the process to understand what it’s doing for them.

We also serve folks who are at QLI, so they attend GRIT gym, in addition to their rehab, and those people might be shorter just depends on their their length of stay, but most community folks are in it for at least three months.

I would tell you that most of our athletes, once they start, they don’t stop. So the biggest percentage of our athletes have been with us for a year or longer.

Who Pays For It?

Tim Benak

Is it a private pay? Is it work comp? Are you seeing kind of a mixed payer source across the board?

Stephanie Roob

It’s a mixed power source. So we have individuals I’d say the majority are either private pain or workers comp as our two biggest funding sources right now.

Are you currently open?

Tim Benak

We had someone asked, are we currently open with COVID going on? Are we currently accepting outpatient, new GRIT athletes?

Stephanie Roob

Yep. And that’s where reaching out later will be helpful.

We are not doing in person classes right now except for people who are in our facility already. So if we have somebody who’s already a QLI client on campus, they can continue to do the live classes.

For everybody else, we are doing virtual classes. It’s a unique situation right now, because of COVID. We just wanted to provide a service of value.

So we’re kind of in a unique spot right now. We do intend on broadening our offering of the virtual classes. That will be something to come.

If you want to specifically reach out and give me your name and your contact information, and then I can make sure that gets to the people who need it who are more involved with the tele services part of this.