Therapia Ex Machina

The SMHS Departments of Physical and Occupational Therapy explore how telehealth is changing the teaching and practice of rehabilitation

Sitting in a classroom on the fourth floor of the UND School of Medicine & Health Sciences, third-year occupational therapy (OT) student Erika Moderow found herself suddenly thinking very differently about the future of her profession. 

“I think telerehab has great potential to reach clients who would otherwise not follow-up with services or would receive less care than they need for any number of reasons,” said Moderow after listening to guest lecturer and occupational therapist Marsha Waind describe recent developments in “telerehab” in a class typically facilitated by UND associate professor of occupational therapy Anne Haskins.

“My mind started thinking about different services that OTs could offer this way. It would allow OTs to touch base with their clients more regularly and potentially even hold group sessions with multiple people.”

The discussion was like turning on a lightbulb, Moderow said.


Occupational telehealth

To hear both Haskins and Waind tell it, now that many private insurers have started covering not only medicine at a distance, but other telehealth services such as occupational or physical therapy, the only obstacle stopping providers from offering more distance therapy to patients is coordination within the health system.

“For therapists, this is a great opportunity,” added Waind, who cites many instances where an OT or her assistant could converse with a patient on a camera and provide the same therapeutic advice and evaluation as if the patient were in the clinic.

“If I can connect with mom over a tablet to see what’s going on at home during mealtime for a child with feeding issues, that’s a far better session than to have them come into my office,” Waind reasoned. “If I was a parent in Rolette, it’d be hard to take my child who has autism—plus two other kids—to appointments in Grand Forks to see the pediatric therapist. Because even if they get here, that appointment is just not as good or ‘natural’ as it could have been at home.”

This is why, added Haskins, the SMHS Department of Occupational Therapy is working to embed telehealth discussions and even practice into its curriculum now.

“We’re trying to prep students to do this and help them understand how easy this could be—providing that one-to-one intervention with clients virtually,” Haskins explained, noting that her team already helps students cultivate their “webside” manner. “The unique thing about our program is our distance campus in Casper, Wyoming, which means that by the time they graduate all our students have had three years of videoconferencing. They get a feel for what it’s like to be on the other end of the camera. So we get them thinking about rate of speech, how you move for a camera, how to dial back your body language, and so on.”


The P.T. Compact

From his office down the hall from Haskins, Dave Relling couldn’t agree more. As chair of the SMHS Department of Physical Therapy, Relling has considered how telehealth will affect the professional world his students will soon enter—and how his team should be teaching them as a result.

“There is a need for more physical therapists, especially in rural areas,” said Relling, noting that current regulatory practices limit P.T.s from practicing across borders. This reduced portability of licensure can result in limited access for persons needing care who live in low population regions close to state lines. “We’ve had interest in the topic of ‘compacts’ from our third-year students who will be graduating this year. They want to know more about the physical therapy compact and they want to know how to move forward on where to get their license.”

Saving these fresh physical therapists from having to acquire licenses from multiple states, said Relling, is something called the Physical Therapy Licensure Compact (PTLC), which allows therapists in member states more freedom to offer physical therapy services across borders by increasing the mobility of providers to work in multiple states. The compact was developed by the Federation of State Boards of Physical Therapy (FSBPT) in collaboration with the American Physical Therapy Association (APTA).

Working with state legislators across the country on implementing the compact, the FSBPT, APTA, and local physical therapy providers have convinced state lawmakers in nearly half of the American states so far, including North Dakota and Montana, to introduce—if not pass—legislation allowing for such inter-state practice.

“In the past, a North Dakota therapist doing outreach to rural Montana would need a separate Montana license,” Relling explained. “With the compact, however, a professional living here will get a state P.T. license as their home state. The P.T. will then obtain a ‘privilege to practice’ approval via the compact to begin seeing patients in Montana, increasing access to care while reducing regulatory steps to practice across state lines.”


A little of that human touch

Although the compact is in its early stages it is likely to increase therapists’ ability to provide telehealth services such as home-based cardiac rehab, exercises for certain types of joint replacement, or consults with physical therapy assistants (PTAs) at a distance.

The benefits of telerehab notwithstanding, Relling admitted that helping both therapists and patients acclimate to the idea of a physical therapy that lacks a physical presence could be a challenge.

“Interacting with patients in another location will be very different from a physical encounter, where you have a hands-on interaction,” he said. “But things are moving forward and the technology is changing. We need to prepare our graduates to effectively utilize telehealth when appropriate.”

Haskins agreed, noting that telerehab cannot simply replace human contact for many patients. “But it can accentuate what we do,” she concluded. “For our clients with mental health issues, for example, to be able to just call and videoconference with someone as a checkpoint, and to be able to reach out to rural communities, this could be fantastic.”