Physical therapy via Telehealth visits

Nicole Santoriello, clinical director of PHOENIX Rehab in Brookville, is ready to lead a client through a physical therapy session. While it may appear as if she is alone, she will actually be using Telehealth to work with a client remotely. Telehealth allows Santoriello to see the client and the client to see her as they go through a therapy session.

BROOKVILLE — Anyone who has had to have physical therapy knows that working with a physical therapist is usually a hands-on situation. The therapist at times may reach out to adjust a person’s stance or the alignment of their neck while the client is performing an exercise to make sure they are doing the exercise correctly, safely, and will get the most benefit from it.

Telehealth, using computers and Zoom, connects the therapist to the client while each is in a different location. It provides convenience for clients with busy schedules, and in the age of the coronavirus allow patients to remain safely at home and still be able to continue with their physical therapy.

Phoenix Rehab in Brookville is one of the very first physical therapy clinics to offer this innovative service. Nicole Santoriello, who holds physical therapist and doctor of physical therapy degrees and is the clinical director at Phoenix Rehab, says it did take some adjustments for the physical therapists.

“I’ve had to learn to be very good with verbal cues and explaining to them (the clients). I found the best thing – I just demonstrated so I ended up kind of exercising along with them. I can show them what I want or (tell them) ‘this is how I want you to change what you’re doing,’” she said.

As they were learning how to connect with their clients who opt to do a Telehealth appointment, Santoriello said one of the trainers asked them, “‘could you still take care of your patients if you had two broken hands?’ At first, I think all of us wanted to be like, ‘Well, no.’”

However, she said, when physical therapists look at the fact that “there’s still a lot of people who are having pain or recovering from surgeries” and as “experts in this area” they can benefit these patients while not being able to touch them, then the answer to the trainer’s question changes to yes.

“It’s challenging. It’s making us work outside the box and think about things a little bit differently for sure,” she said, adding that it is easier for her to reposition and guide patients with her own hands, verses, trying to do it on a video chat “but so far it actually has gone pretty well.

“A lot of our training is observation, watching how people move, trying to teach them functional movement patterns and things like that. I can do my evaluation, having them move around and kind of help me through the evaluation.”

Santoriello said the Telehealth option is easy and the patient doesn’t have to download any software. They just need a smartphone, a laptop or some kind of computer tablet. She sends them an email with a link – Telehealth connects via Zoom – and all the patient needs to do is click on the link. The program opens and both the patient and therapist are able to see each other in real time. She will teach patients the exercise program she wants them to follow at home by working out with them and then immediately emails them handouts that they can print out as reference for the various exercises. Within that follow-up email there is another link, she noted, that enables the patient to access videos of a person actually doing the exercises if they prefer that to the handouts.

The technology is not only great for now when people are trying to stay in as much as possible but also for when the stay-at-home order is lifted as well. Santoriello noted that the option of Telehealth appointments could be a boon to those patients who might have strayed from their exercise program or are too busy to come to an in-house therapy session. Through the video component they are able to check with a patient and set up and demonstrate a new exercise program for them without the patient having to leave their home.

She said their are patients who are dealing with chronic pain or recovering from surgery, “and we can still guide them through their rehabilitation process so it’s kind of exciting.

“I hope that it will be something that can continue after the coronavirus because there’s a lot of patients...that it’s just very difficult for them to come into our clinic,” she said and Telehealth provides them an option since those sessions are normally take less time. She noted that while “it’s always best if you could see your therapist in person,” the Telehealth program is better than not seeing a therapist at all.

Santoriello has had to think about more than just how she explains something to a patient when using Telehealth. She also has to be aware of what the patient is seeing and how to position her computer to show what she wants the patient to see, especially when she’s demonstrating an exercise or movement. She said she practiced with her husband to figure out how to create the meetings and to learn how she needed to do to position her computer to know that “if I angle my computer here or I position it here this is what body parts they’ll see on me if I need them to see my knees, this is what I’ve got to do.”

She also had to consider where in the office she was going to do the Telehealth sessions. Because of protecting everyone’s privacy, she said, “We’re not going to have other people around while we’re doing it (a session).” Beyond that she says, “We’ve got to kind of reteach ourselves out of our habits. We all have habits and we all have ways to treat in certain ways and this has kind of shaken things up a little bit for us,” which has caused them to go back to the basics in a lot of way.

“It has it’s been fun and we’ve been lucky and glad that that this (Telehealth) got pushed through and we were allowed to do it. We’ve been trying to do it in the profession for a while, and this accelerated it and gave us that final push to give it a try and so now hopefully it sticks around. Right now one of the cool things about Telehealth is the OIG (Office of the Inspector General) has waived – it’s temporary for now – but there is no co-pays, no coinsurances, no deductibles for the Telehealth visit. So it’s kind of this cool thing too for patients that have a lot of out of pocket costs. This is an opportunity for them to still receive the visit. It’s still covered by insurance” but no out of pocket costs. Santoriello says they don’t know how long that will last but adds, “for now it takes that stress away because unfortunately healthcare does have a financial aspect to patients.

While at first they didn’t think they would be able to do Medicare Telehealth visits, she said that at the last minute the OIG pushed that through as well. Now that they have the option of Telehealth that the physical therapy industry has been hoping for, she said, “Hopefully we can keep it around now. We’ll find that it’s something really worthwhile and then the government will let us continue to do it is my hope.”

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