Virtual clinic appointments are changing how we support patients

Amy Rusby, Specialist Neurological Physiotherapist, discusses how adapting to COVID-19 has led to new and exciting ways of working

Having worked as a neurological physiotherapist in the community setting for over twenty years, when Covid-19 hit, it completely disrupted how I deliver rehabilitation to my patients. It wasn’t safe to be going from house to house, so my practice was put on hold.

But patients were missing out, and desperately in need. After a year or so, I needed to come up with another way to provide physiotherapy. I began to adapt my way of working, providing neurological physiotherapy remotely with patients – all by video call.

I am sure a lot of people reading this will be thinking, as I did initially, “how would that work?” In fact, this new way of working has expanded the possibilities of neurological physiotherapy. All that is needed is an internet connection and a place to position the device, and then the rehabilitation can take place within the comfort of the patient’s own home.

Why it works

The benefits of virtual appointments for patients are many. Of course, no travelling to clinics is needed. By being in their own homes, patients can be more relaxed and comfortable, and more confident in their normal environment. In fact, patients can be anywhere, in this country or abroad, and still be able to access the expertise they need.

We know that the families and carers of our patients are central to their wellbeing, and virtual appointments all them to be more involved in the physiotherapy. It can be a worrying time and by the families being more involved, they can feel more supported and have the opportunity to gain more information and advice. They often feel more empowered by having a better understanding and the patients often feel more in control of their own therapy with me as the facilitator. It is also very easy to add other people into the call, so if it is helpful for another parent to join, this can easily be done at their convenience wherever they are. Sometimes it is beneficial to include school or college staff in supporting the patient with physiotherapy and this can also be achieved. Having key people on the call also means that training can be given to people that support the patient.

What happens at a virtual clinic?

During these video calls, we work on many aspects of therapy, as in the more traditional clinic appointments. This includes activating the right muscles for improved movement and posture; maintaining range of movement; balance; co-ordination; strengthening; proprioception / spatial awareness; perception/ awareness of whole body as one and as individual parts and how they work together; walking and sometimes jumping and running; pain management; fatigue management and chest/respiratory care.

All of these elements work on improved function and making daily living easier, and we work to engage young people by using activities, tasks, games, dancing, anything that they enjoy - because therapy is meant to enhance life, so we incorporate life into therapy and therapy into life. That way, the effects and benefits last.

This approach works so well for so many people, including those that are high-functioning as well as those that need more support. Training can be done via the video calls to enable hands-on therapy as well, given by the physiotherapist via the hands of the parents or support staff with close guidance. However, there is a small number of patients that need specific handling that can only be done by a specialist and for this group of patients, face to face appointments are necessary.

I work with people of all ages and all neurological conditions, so including cerebral palsy, complex learning and physical disability, brain tumours, strokes, spinal injuries, acquired brain injury, Retts sydrome, and more.

Case studies of neurological physiotherapy by video call:

Who? A man of 22 who developed hydrocephalus when he was 17. He lives at home with his parents and brother and works in a supermarket on the checkout 2 short days a week.

What support is needed?: His main problems are balance, co-ordination and spatial awareness, all affecting his ability to walk. He has had several falls. Difficulties with short-term memory also affect his ability to remember sequences to help with tasks such as getting up from the chair in a good position, and how to keep better control of his balance and walking. He can walk around the house and short distances outside, but needs support and a wheelchair for longer distances.

What have been the results? He has weekly sessions of neurophysiotherapy and has made excellent progress with practising routines to help with standing up / sitting down, walking, balance, coordination. He is now more aware of where the true middle is when standing, is better able to clear the ground with his right foot and has had significantly fewer falls, including outside when walking from the supermarket to the car when he is picked up from work. He now uses a treadmill to enable him to build up his exercise tolerance and this enhances his walking ability as well. We also liaised with other services to get equipment provided for making him safer on the stairs and getting in and out of the bath.

Who? A lady of 20 who had a brain tumour as a child followed by an acquired brain injury. She lives at home, part of the time with her mother and part with her father.

What support is needed? She is planning to go to college in September to do art, dance and drama and has problems remembering to use her left arm and hand, which is also more difficult for her to use than the right one. She has some difficulties with balance and co-ordination and avoids things she finds difficult, so was not fulfilling her full potential.

What have been the results? She had an assessment and some neurological physiotherapy and after just two sessions she was dancing more, exercising, walking better, more confident to use her left arm to drink from a beaker and to involve in her art.

A report was provided for the college regarding special education needs and her mother was able to better understand and know how to help her to do the things she can do but didn’t think she could.

Who? A girl of 8 who has a brain tumour. She lives with both parents and her younger brother. She loves dancing and playing board games. What support is needed?: She has difficulties using her left hand and arm, as well as difficulties with walking, balance and tiredness.

What have been the results?: With weekly neuro-physiotherapy we have incorporated dancing to music to improve her balance, timing and co-ordination, played games such as draughts and jigsaws using only her left hand, provided a programme of exercises that her parents can work on with her. We have also worked on managing the tiredness, so she can do her school work, as well as enjoy more quality time watching her favourite tv programmes and playing with her brother.

A lot of information, advice and support is being given to the family as well as help accessing other services.

Who: A boy of 17 who has complex physical and learning difficulties. He lives in a specialist care home and has 2 to 1 care during the day and 1 to 1 care at night.

What support is needed? He has been having problems with pain resulting from poor range of movement and stiffness in his limbs, chest infections from aspirating due to poor swallowing ability, and the staff have been struggling with transfers so he was being hoisted from wheelchair to bed. He also has a standing frame that he was not using much due to poor tolerance.

What have been the results? He has been having two sessions of neurophysiotherapy a week and this has involved working really closely with his support staff, training them to be able to do passive movements to improve his flexibility and make him more comfortable. Training has also involved positioning and chest physio to enable him to keep his chest clearer, leading to fewer infections. We have also worked with adjustments to the standing frame so it is set up more specifically for his individual needs and he is using that every day, as well as advising on suitable equipment and training staff with safe transfers so he is no longer having to be hoisted all the time.

Amy Rusby BSc Hons – Specialist Neurological Physiotherapist amy.rusby@nruk.co.uk 07741 908830