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JaySTART clinic for physical, occupational and speech therapy leaps to virtual rehabilitation

When the COVID-19 pandemic closed the face-to-face Jaystart Clinic, students of physical therapy, occupational therapy and speech pathology turned to telehealth.

Alondra Del Real, speech pathology student, helps patients with speech skills through an online version of the JaySTART clinic. Students, faculty and patients meet virtually on the Zoom platform since the face-to-face clinic was closed by COVID-19 concerns. Photo by Elissa Monroe, KU Medical Center Photo Services

For students of physical therapy, occupational therapy and speech pathology, the once-weekly JaySTART Clinic offered a chance to practice what they'd learned in the classroom and help community members who might otherwise not receive therapy.

But when the COVID-19 pandemic closed the face-to-face clinic, faculty within the University of Kansas School of Health Professions found a solution. Like many other health care providers, they turned to telehealth to keep the therapy — and the learning opportunity — going.

‘Exceeded our expectations'

Stacia Troshynski Brown, DPT, clinical assistant professor of physical therapy and rehabilitation science, said the transition from the in-person clinic to an online videoconference (often called telehealth or telemedicine) was a "pretty gradual-fast ramp-up."

"We started right after spring break, with four patients, and then ramped up the number of patients significantly," Brown said, all the way to the usual 30 a week seen face-to-face in JaySTART. "For all the moving pieces, I'd say it's gone about as well as it could have. Actually, it's exceeded our expectations."

Before COVID-19

The pre-pandemic JaySTART Clinic was open from 1 to 4:30 p.m. Wednesdays in the Kirmayer Fitness Center. The building, located on the southwest corner of the University of Kansas Medical Center campus in Kansas City, was a prime meeting spot for faculty, students and community members in need of physical, speech or occupational therapy.

Patients were — and still are — from underserved populations who might not have received professional therapy sessions otherwise. With JaySTART, they received free therapy from either individual students or small groups working together, all under the watchful eye of their professors in the KU School of Health Professions. The goals of both rehabilitation and education could be met in a professional, yet social, setting.

Maintaining community commitment

After restrictions related to the COVID-19 pandemic closed Kirmayer Fitness Center and prohibited the traditional way of running JaySTART, appointments were conducted using Zoom videoconferencing. KU Medical Center's Information Resources technicians scrambled to set up the HIPAA-compliant connections amid a flurry of requests from departments across campus.

Melanie Somogie, M.A., clinical instructor in the Department of Hearing and Speech, said speech therapy as a discipline had ventured further into telehealth than physical or occupational therapy, and she accessed resources from their professional organization to help further.

"Telemedicine was already a growing area, and I think the pandemic really did propel us into the future," Somogie said.

Identifying challenges, making it work

So how do you make JaySTART work in a pandemic? You've got to adapt, explained physical therapy student KasiDee Cox.

"One thing I learned that I will take into my career is ultimate adaptability," she said.

In fact, converting to telehealth visits presented numerous challenges, and some are listed below along with its remedy or work-around.

Challenge: Loss of manual therapy (being able to physically touch the patient

Remedy: Creativity, verbal cues

It turns out that the "physical" in physical therapy doesn't necessarily relate to proximity. "Although we were not able to utilize manual therapy, there was not one person we were not able to treat," Cox said. "In any situation, we were able to adapt our treatments to get the job done. Most of the time, this meant we would use verbal cues over tactile or visual cues."

Challenge: Loss of emotional connection to patient in sharing physical space

Remedy: Creating emotional connection by seeing patient's home

The healing power of touch can build trust and understanding between health professionals and patients. So, how do you build that emotional bridge using telehealth?

"We discovered during telemedicine we could see their home environment, where they spend most of their day," explained Luke Fischer, a physical therapy student administrator for JaySTART. "This made it easy to modify exercises to fit more functional goals within the home."

Laurie Steen, clinical instructor of occupational therapy, said telehealth can't replace the healing effects of face-to-face therapy. "Some portions of occupational therapy just can't be provided in the telehealth format. Those pieces, I can't wait to get back to," she said.

On the plus side, however, Steen appreciated what she called the students' "creativity" to provide quality care within telehealth's limitations.

"The creativity piece - it makes our students really, really think about what they're doing, why they're doing it, and what is making that treatment or that intervention stand out so they know that's what they want to do," Steen said.

Occupational therapy as a profession values using the patients' natural surroundings as tools for therapy, she said. What better place for these tools than the patients' own homes?

"We can simulate things in the clinic, but with telemedicine we are able to help our clients immediately improve their daily activities," Steen said.

Challenge: Video chaos

Remedy: Closer collaboration

Telehealth appointments sometimes have a dozen people plus the patient, explained Alondra Del Real, speech pathology student. In face-to-face sessions, students rotated in and out of interactions to let the next specialty take over.
On video, all students stay with the treatment until the appointment is over. "Through this medium, it takes a lot more internal collaboration," Del Real said. "It's an interdisciplinary clinic. Beforehand, I didn't know as much about OT as I do now, and that's been rewarding."

Faculty and students build in extra minutes before the appointment to collaborate and strategize, and they take a few minutes after each appointment to summarize and discuss.

Challenge: Technical difficulties

Remedy: Prioritization and assistance from others

Not every JaySTART patient was tech savvy, and there was a steep learning curve for a few individuals. But Troshynski Brown said most patients knew someone - a caregiver, a grandchild or friend - who could help set up the initial telerehabilitation visit.

These helpers also came in handy for other tasks, such as holding a cell phone's camera at just the right angle. Since exercises need to be done correctly to achieve results, and students and faculty couldn't gauge the correctness of the exercise without the proper angle, having someone "film" the patient made the process much easier, Troshynski Brown said.

"We always joke with our family members that they're becoming videographers," she said.

Cox said she learned how to prioritize her 30-minute sessions with a patient because connectivity issues would sometimes shorten a session.

"I also learned that virtual therapy is incredibly helpful, and I believe will change the way therapy is executed," Cox said. "When I have patients in the future who may not able to come into the clinic multiple times a week for any number of reasons, I will not hesitate to offer virtual therapy due to my experience over the last few months."

After COVID-19?

Dave Burnett, Ph.D., KU School of Health Professions interim associate dean for faculty practice and community partnership, said he believes some portion of telehealth may remain a part of JaySTART.

"We're looking at expanding telemedicine as part of our faculty practice in the School of Health Professions," he said. "Telemedicine can help increase access to specialty services that people in rural areas don't have" as well as urban residents with transportation problems.Patients with impaired mobility and those living in remote locations can benefit from telemedicine, too," Burnett said. "Reimbursement models are still being developed for many providers of telemedicine services. However, some patients are willing to pay out-of-pocket for the convenience of not traveling a distance to see a specialized provider."

One complication of running JaySTART remotely is the extra time it requires. Onscreen JaySTART appointments take 2-1/2 days, compared to only a half-day commitment when the face-to-face clinic is up and running. That's because many separate appointments could be conducted simultaneously in the face-to-face clinic. In telehealth, appointments are sequential and one at a time.

The time commitment, though, is a priority to the professors if telehealth is the future of professional therapies. Troshynski Brown said, "We want our students that have that exposure so they can transform therapy, practice and delivery, and make it better than what we can even imagine right now."

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