Is Teletherapy Effective In Pediatric Physical Therapy?

In-person pediatric physical therapy, provided in-home or in a clinic setting, can offer huge benefits to children. What about physical therapy sessions conducted through teletherapy? Could a child benefit from a virtual physical therapy session? These questions were thrust into the forefront of my consciousness in March 2020. And I didn’t think the answer was a resounding yes.

Prior to March 2020, I had not given much thought to the question of teletherapy for the children I serve. What very little thought I had given it led me to believe it would not be a very useful tool in my practice. So much of what we do is hands-on. I thought it would be too much for the family to try to be my hands. The system seemed complicated at best. Virtual sessions seemed like they would be messy, difficult, and a poor use of time.

BUT THEN COVID 19 HAPPENED

Suddenly some of my most valued mentors and distinguished colleagues were discussing teletherapy. They reported it was not only working, but working quite well. I decided to jump in and try some teletherapy with my clients.

I could not have been more wrong about teletherapy. It has been an absolutely amazing journey. The first thing I had to do was figure out what this would look like. I am surrounded by tech-savvy people who were able to quickly set me up and train me on a platform to do the audio-visual connections. A few practice runs with family and friends and I was navigating the tech like a pro.

The sessions went amazing!!! I was absolutely blown away! The parents and children were eager and excited to continue services. They were ready to do whatever it took. That made my job that much easier. Therapists are natural teachers, especially in pediatrics, so some of this came naturally. I was pleasantly surprised how quickly I adapted to talking through and demonstrating on myself, a doll, or another prop. I was teaching not only HOW to do the task but WHY we did it that way. The parents and nurses that participated in the sessions were all rock stars. They soaked up the information and not only applied it in the sessions; but, also found ways to incorporate it into their daily routines. We always provide home programs and parental instruction during each in-person session. This active learning that was taking place had far better carryover between sessions. Traditional sessions in which I am treating the child place the parent in a more passive role. By being active, I saw approximately 100 percent MORE carryover of activities between sessions. That carryover resulted in quantifiable, objective progress towards goals.

I had the opportunity to work with a wide range of children with varying degrees of abilities, and it worked very well in almost all cases. I was even able to do some equipment orders via teletherapy while the ATP (Assistive Technologies Professional) went in person. We are typically both there in person to complete the assessment for adaptive technologies. The child, mom, the ATP, and I were all communicating and working through Zoom and it went extremely well.

SOME THINGS ARE HARDER

We had one kiddo that just was not a good fit for teletherapy. I think there were several factors involved here. One, she was an active and mobile 2-year-old. Mom also had an infant in the home. We were able to thoroughly review and re-iterate the home program with Mom. We also provided reference materials through screen share to educate her on the recommended activities.

Technology can fail. There were some glitches from time to time with the technology, although it was much rarer than I anticipated. We had the occasional screen freeze or internet issues. They were infrequent, and most were quickly resolved.

Sometimes there is no substitute for a therapist’s hands. We have trained hands that can quickly respond to dampen an abnormal reflex or abnormal tone response. But the upside was I did work to train the parents for manual cues and holds specific to their child. Most did so very successfully after a little practice. These new skills are now available to the parent as they interact with their child on a daily basis.

OTHER SETTINGS

During this time, I had the opportunity to see telehealth from the patient standpoint. My son had a telehealth visit with his neurologist. I was very pleasantly surprised at how well that session went! It was a smooth process and I can see it being useful even in the future. Not all face to face visits can or should be replaced. However, some routine follow-ups would be nice as his neurologist is 50 minutes from our home.

I can envision a future that utilizes some telehealth for not only pediatric but all areas of physical therapy in the future. I practice on the outskirts of a major city in Texas. Texas is a very large state with many rural areas. Many areas lack qualified and experienced therapists for pediatrics. Telehealth could be a way to reach this need. Telehealth could be a great avenue for following up on home programs and equipment needs. The opportunities are endless!

My experiment in telehealth has been not only enlightening but fun as well. The children have continued to progress towards their PT goals during a challenging situation. Parents and nurses have gained new skills and knowledge. And I have enjoyed stretching my brain and learning to function as a therapist in a whole new way. I look forward to exploring ways to utilize more telehealth to meet the needs of children now and beyond the pandemic.

Wendy McKinney Gibbs, MS, PT has practiced physical therapy since January of 1997. The majority of her practice (www.jumpstartpttx.com) has been dedicated to pediatrics. Wendy enjoys providing education to families and therapists on innovative and evidence-based ways to promote functional mobility for all children.