The Future is Already Here
COVID-19 is changing the country’s landscape, including health care, as more doctors and specialists offer teletherapy appointments for patients who are sheltering at home. “It’s going to be the way of the future for therapy.”
In the field of Physical Therapy, remote therapy is growing as well. While this may seem counterintuitive as Physical Therapy would seem to presume that the therapist needs to be in the client’s physical proximity, a better understanding of how physical therapy works will shed some light.
As Moshe Roth, a Baltimore-based Physical Therapist, put it, “While ideally, physical therapy is to be hands-on, at the core of the discipline is the client’s movement; more specifically fixing the client’s abnormal movement. So if we can find a way to properly observe the client’s movement and intercede with exercises online, remote Physical Therapy needs not to be inferior to face-to-face.”
Challenges and Solutions
“An initial diagnosis or evaluation is more challenging to do virtually,” says Sherri Betz, spokesperson for the American Physical Therapy Association (APTA) and a board-certified geriatric clinical specialist. Betz has offered telemedicine evaluations for the last ten years or so and is now making all her physical therapy appointments remotely.
2. Camera Placement
Since the physical therapist can’t feel tissue tension during a telemedicine session, the camera must be set up so the therapist can see the client when evaluating or instructing them. “You have to get a good view, with good quality images,” she says. This requires careful camera placement at the onset of the session, and cautious movement to another position if needed.
In the clinic, the physical therapist has a wide array of equipment from which to select. When delivering remote physical therapy, the therapist needs to be creative and resourceful to find effective alternatives. Clients can use other props like water bottles, soup cans, and brooms for exercises. “You can even put tennis balls into a pillowcase for self-massage of the back,” adds Betz.
4. Other Considerations
When the required movement is more sensitive, safety may become a factor that could be compromised if the therapist isn’t physically close to the client. In such cases, the physical therapist is challenged to be creative without being risky. This might require the physical therapist to give the client simpler exercises rather than more complex ones.
The Advantages of Remote Physical Therapy
“Telemedicine (teletherapy) was really brought up to give patients access to care where access was difficult, like in rural areas or to see a specialist,” says Michael Mayrsohn, owner of Metro Physical & Aquatic Therapy in Garden City, N.Y. Since COVID-19 took hold in New York City (at that time the hardest hit area of the country), that entire practice has transitioned to telemedicine appointments.
Telemedicine is both safe and more convenient for physical therapy patients, he says. “Most practices deal with competing with patient’s lives. Patients are busy, and in the past, we’d get a lot of cancellations due to snowstorms, for example. Being able to work with patients remotely means patients can do at their own speed and in their own homes,” Mayrsohn says.
2. The Home Court Advantage
Aside from improved consistency, Mr. Roth added, “the home environment is a more natural environment than the clinic which enhances the client’s comfort and ability to focus during the session. And often the home environment is preferable for the exercises themselves. For example, training how to go up and downstairs is much better at home on the stairs the client will need to navigate than in the clinic where it’s one size fits all (or none).”
Education is critical to effective physical therapy. Greater client understanding often means more successful results. This goes for pediatrics as well. When the parent understands why we are working on a specific movement pattern within the context of how it fits into a greater picture, it makes more sense and promotes far more consistent implementation by the parent.
The Bottom Line
The convenience and flexibility that remote physical therapy offers make it likely that more people will opt for virtual physical therapy appointments even after COVID-19 has eased.
As Mr. Roth put it, “There is a very smooth transition from onsite to on the screen because the critical issue in physical therapy is observation and the challenge is implementation, which can be accomplished quite effectively by a creative and resourceful approach.”
“It’s going to be the way of the future for therapy,” Mayrsohn says. “We’re finding that not every patient needs to come in … if they’re comfortable doing at it home and they like that experience, we’re going to do everything in our power to make it available.”