Telehealth helped physical therapists to provide essential care for pediatric patients during pandemic

As a pediatric physical therapist in Clinton, Missouri, Jessica Luechtefeld was used to a hands-on coaching approach whenever meeting with her patients at their preschools, in their homes or at the Child's Play Therapy clinic. But the COVID-19 pandemic forced physical therapists like Luechtefeld to cancel in-person sessions and quickly transition to telehealth appointments to continue providing essential care.

While the switch to telehealth showcased new opportunities for how critical therapy services can still be delivered virtually, a new study at the University of Missouri found it also exposed some technical issues for patients in rural areas.

When meeting with patients virtually, I would demonstrate to the parents or caregivers what I wanted them to do to coach their child through the exercises, and we would try to come up with fun games to keep the child engaged. For example, I might tell them to roll up some towels and line them up end to end to make a balance beam, placing a toy car on one end and a racetrack on the other end so the child had an incentive for practicing his balance while walking."

Jessica Luechtefeld, pediatric physical therapist

Curious how other pediatric physical therapists were adjusting to providing virtual services during the pandemic, Luechtefeld collaborated with Jamie Hall, an assistant teaching professor in the MU School of Health Professions, to create and distribute a survey to pediatric physical therapists to better understand their successes and challenges using telehealth. While caregiver engagement was reported as the biggest facilitator to successful telehealth therapy sessions, access to reliable Wi-Fi was a common challenge, particularly for rural families.

"The switch happened so suddenly that many pediatric physical therapists had no training, experience or support with telehealth, but we all desperately wanted to continue providing these much-need services to our patients as they are developing so early on in their lives," Hall said. "We see a wide variety of patients. While some kids might be recovering from a sports injury, other children might be born with early onset conditions, such as cerebral palsy, down syndrome or muscular dystrophy."

Luechtefeld saw firsthand the challenges that arise when physical therapists are so heavily reliant on technology, as broadband internet can be limited in rural areas and Wi-Fi can be spotty at times.

"Sometimes a parent or caregiver would ask me what step they should do next to help their child through an exercise, and the video would start buffering, so it was harder to track the child's progress," Luechtefeld said. "Another thing we noticed was using a laptop or tablet would work better since the screen is larger and you can set it down without holding it, but not every family can afford those devices, so access remains a big issue, particularly in rural areas."

Hall found a silver lining that was discovered during the pandemic is the convenience and flexibility telehealth may provide for families who often drive long distances to and from physical therapy clinics for their children to receive hands-on, in-person appointments.

"Going forward, we can consider a hybrid model where patients come into the clinic once a month and then they can do a telehealth visit from home twice a month as well," Hall said. "Telehealth can help cut down on travel time and improve efficiency while still delivering the essential services kids need to support their mobility, balance, posture and overall development."

As a pediatric physical therapist, Hall is passionate about the role telehealth will play for younger physical therapists like Luechtefeld moving forward.

"I have been able to impact families one at a time as a clinician," Hall said. "Now as a researcher and assistant teaching professor, I can help the next generation of physical therapists, so it feels great to help out as many families as possible."

"Pediatric physical therapy telehealth and COVID-19: Factors, facilitators, and barriers influencing effectiveness – a survey study" was recently published in Pediatric Physical Therapy.