Kintinu'd Conversations
You’re listening to Kintinu’d Conversations. We’re healthcare providers working at Kintinu Telerehab out of Omaha, NE. We provide physical, occupational, speech, and psychological therapy to help individuals around our country get back to life. This podcast is designed to engage a variety of listeners on topics that matter to us-- whether at work, in life, or in our relationships.
Kintinu'd Conversations
S3E24 - The Playbook, Part 2
Backed by decades of experience producing exceptional clinical outcomes, Kintinu Telerehab connects recovery to everyday life. In this podcast, we explore hot topics in rehabilitation, the keys to personal growth and recovery, and how to apply it all to the real-world.
What if there was a way to seamlessly transition rehab patients back into their communities, saving both time and resources? In this episode of Kintinu’d Conversations, Brad Dexter, Steve Kerschke, and Claire Thelen sit down to discuss navigating catastrophic injury care and rehabilitation.
In part two of our Playbook discussion, we bring to light the various options available after an inpatient program, including outpatient therapy and tele-rehab. We delve into the power of contextual therapy and its ability to echo real-world challenges. We also discuss the critical difference between merely recovering from an injury and learning to live with it, highlighting the importance of integrating therapy into everyday situations and home environments.
Enjoy!
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Welcome to continued conversations where we explore hot topics and rehabilitation, the keys to personal growth and how to apply it all to the real world. All right, hey, welcome back to continued conversations. This is Brad Dexter, and I have Steve Kershke and Claire Thielen in the studio again with me. Today we started a conversation really centered around our starting of tele-rehab and we wanted to start looking at what we've learned over the last couple of years. We've been doing this for the last four to five years and where are we now? Over the course of a few conversations, the way that we left it in our last conversation, we finished up on the continuum of care and really looking at that community-based model of care that would happen after an inpatient type of program, which we were calling the post-acute or post-hospital rehab level. Let's just start at that community-based level and maybe define what are the different options that exist there before diving in and explaining where our place is. Claire, would you mind just picking up there for us?
Speaker 2:Yeah, I think the easiest place to start is probably to look at the past 10 to 20 years, historically, what has been done when it comes to community-based care. I'd probably say people often are familiar with outpatient therapy, receiving physical therapy, occupational therapy, speech therapy and a brick and mortar outpatient setting. That's kind of what their benefit, their insurance benefit, would allow them. When we go to our benefits and we see what are our resources, that kind of triggers us to say this is what I'm going to do next. This is the obvious next step From a community-based standpoint.
Speaker 2:We have outpatient therapy. There's the in-person option which I just talked about, the pretty traditional option, but there's becoming to be a lot more options as technology and just our understanding of recovery continues to evolve. As this all continues to evolve, we're going to look at what we're doing, which is tele-rehab Think outpatient therapy, think outpatient clinic but all done virtually. What's different between the outpatient clinic, traditional outpatient therapy and tele-rehab is the setting. The same individual might be a candidate for both programs. I think it just comes down to where are they at in the continuum and what setting is going to be the most valuable for that individual and their goals.
Speaker 1:Maybe just to put some practical thoughts or situations around that Someone that needs a lot of hands-on assistance to complete some physical tasks, you'd be really important to probably in some cases, look at that brick-and-mortar setting to make sure that the right equipment, the right people with the right expertise are really around to provide the right amount of support to get the right amount of repetitions to help them with their recovery.
Speaker 1:Would there be a place for that same person to maybe receive some of that care within the context of their own home, their own environment, with a family member or a caregiver? As a person with some of that experience, the answer to that would be well, maybe it depends. It really depends on the situation, because we get that question often Can you actually do that in their home? How are you going to do that? Again, it really depends on the situation and who it is. Claire, like you were mentioning, maybe it's equipment, it's having that hands-on experience or we're in touch with the person that is necessary to help them with their recovery. Steve, is there anything else that you would want to say to differentiate what that community-based care model looks like?
Speaker 3:I guess the biggest difference, other than the hands-on option, is we call it contextual. By that we mean the therapy is most closely related to the challenges they face outside of a clinic or in the real world, right, and so one of the values of tele rehab is that you can see the actual environment that the person is in and you can see the actual challenges they face or what their abilities are going to need to be in order to be successful. You can see them with your own eyes, and the only way to do that outside of video is to be on site in person, see them with your own eyes and then in the clinic I think historically, brad, you and I have been there as clinicians we depend on someone to articulate what that is to us, or we've seen it, and then we try to recreate it, and we often fall short because it's pretty hard to recreate every single aspect of that environment, and so I think that's a big difference that we see and we don't have to make things up.
Speaker 1:Yeah, maybe just one quick example. I'm working with a gentleman who had a surgery for one of his knees and it was his PCL, his ACL and his meniscus, and he was working on I'm kind of supplementing with him in the home along with what he's getting in a brick and mortar setting, and he was working on stepping down and stepping up in the clinic but that wasn't translating over into the home at all and every day he has to go up and down a flight of stairs to get to his room. But every day he would do kind of this step, two pattern right when both feet end up on one step. And it took me learning what he was doing in the clinic and then just saying, hey, let's practice that on your stairs and now let's make sure that you're doing that every day. So just to kind of highlight that contextual piece that you were talking about, that was really important. And now he's doing that every day and he's getting repetitions and he's getting better at it.
Speaker 2:Yeah, I feel like that's really helpful. That example in context. Do you feel like there's a difference between recovering from an injury and living with an injury? So if you think about going to the clinic and getting PT to recover from an injury, the things that you're gonna do in the clinic are probably really based around range of motion, strength, endurance and things like that. But the way you explain this is, the things that you're doing with this individual at home are really related to putting that into practice with their lifestyle, with their home, with the layout of their home. So I guess it's just kind of more. It's the application.
Speaker 1:Yeah, so I think there's a component of making that contextual right, not just putting them in a box and kind of going through maybe a protocol that you need to go through over time, but like making it relevant to what their life is gonna look like. I think that's one piece of it, like Steve was talking about. I think another piece and we can have another conversation about this too is just maybe this proactive versus reactive approach to it. So maybe the recovery that your recovery versus living the recovery aspect maybe in one way is looking at it as reactionary, whereas the proactive approach would be looking at it as, hey, what little habits do you need to build into your lifestyle that are going to influence you and shape you over a longer period of time? And so I kind of sense that both of those pieces are in your question there.
Speaker 1:And yeah, there is a difference to answer that directly, and hopefully we can talk a little bit more about that in the future conversation too.
Speaker 3:I'm also careful. Just to bring us back to some examples you and I are physical therapists, so we always tend to give physical examples.
Speaker 3:Honestly, I think that's the hardest thing for people to wrap their heads around is normally I go to a physical therapist in person in a clinic because they have to be hands-on. I don't think that's true and we've given some examples. So, before we move away from that, what do you feel like has been the main skill you've had to hone in on in order to not be hands-on with someone, or skills to make it effective? Let's talk about that real quick before we go to some other examples.
Speaker 1:Yeah, I think it's a communication skill in a lot of ways and I've had to rely on what I have felt in the past and what I have heard from people that I'm treating to make that connection with the person that I'm working with virtually as well. Again, physical example, but let's think about a shoulder. I can kind of contextually think about the number of people that I've worked with that have had fancy word adhesive capsulitis, frozen shoulder ligaments get tight around that joint and then what you see happening when they're maybe raising their arm above their head gives me context and helps me think back to people that I've worked with in the past that have had something similar right. So I might know hey, is that pinching on top of the shoulder or do you feel like it's tight underneath? So it really comes down to some of those communication skills to help me get the information that I need to get.
Speaker 3:Yeah, I think you've also touched on observational skills, and I was having this discussion with another physical therapist and, without me prompting him, he said the majority of his job is observational, and then there's a small percentage that's hands-on, and then there's obviously that big communication component which I think for people who are skeptical about being able to do physical therapy through as a virtual approach. Just keep that in mind.
Speaker 3:The majority of what we do is just observe movement quality of movement, amount of movement, speed of movement and we make adjustments and we provide feedback and we go from there.
Speaker 1:Yeah, real. Another example I just did an evaluation with an individual and keep in mind this was actually an in-person evaluation that I did earlier this week, but we actually went for a walk outside and I didn't tell him where we were going, necessarily, but we ended up walking through some grass, we stepped down, over curbs, we were walking for probably 15 minutes before I got to a destination, but I actually gathered probably 95% of the information that I needed just from walking alongside that individual and seeing how they moved. Now, some of that was built off of context that I have from working with previous people. And then I had to take that information and I had to understand how it fit into that individual's life, the rest of their day-to-day, what was meaningful to them, what was valuable to them, and then I could really kind of piece all that together and come up with a plan?
Speaker 3:Yeah, and just a reference back to why we started Tell-A-Rehab. The same thing happens in our clinic here in Omaha. We get to see these people in person, but it's out of context and we have to transition them back into the real world, which is either in Omaha, which is just maybe a few miles from our clinic, or several hundred miles away from our clinic, and either way we have that big jump. Ok, so let's just real quick. What are some maybe examples? How speech language pathology Kelsey would be happy with us we didn't forget any aspect of that or occupational therapy, or even psychology. How might those be applied? Or what's the difference between in clinic and virtual care for those? And maybe some examples.
Speaker 1:Yeah, let me. Let me think about, maybe from, like, an occupational therapy perspective first, and I might give an example of ADLs, and I might give an example around vision here. So if you were to see that person in the clinic setting and you wanted to maybe understand what ADLs look like, I think you're going to take a subjective assessment, you're going to try to understand from what they say or from what family members may help them communicate to you, and then you work on, maybe, some of the physical skills necessary, and even cognitive skills necessary to complete that task there. Now, what happens, though? When they get back home, maybe they can do that skill, but it's completely out of context, right?
Speaker 1:There's a lot of times that our occupational therapists are working with individuals that have, say, had a brain injury or spinal cord injury, some kind of other catastrophic injury, where structuring those skills and putting them together in a routine that's meaningful and important and that can happen on a consistent basis, to even start their day or end their day, is what's really important.
Speaker 1:Working on those skills in the clinic and then asking them to just go do them with those maybe injuries in particular, is actually a big jump to make, as opposed to doing that alongside of them within that home setting. Okay, so that's one example. Another example might be around vision for the occupational therapist, and vision could come into play for work tasks. It could come into play for driving, it could come into play with, maybe, dizziness or helping to care for kids or doing tasks around the home on a regular basis. You can give them exercises to do, but then how do you tie that into what they're doing functionally throughout the day? So, instead of maybe doing Brock, string exercises out in the front where you're working on accommodation skills for their vision. What if they did that when they were in the work setting in the workplace and they had something in front of them and something across the room? How can they work on applying those skills throughout?
Speaker 2:their day.
Speaker 1:So that's occupational therapy, speech therapy.
Speaker 1:Maybe we're looking at communication and cognition skills. One example that comes into my mind is our speech therapist was working with an individual who had a history of a traumatic brain injury but they were looking to get back into the workplace again. There are a number of skills that they were working on to help with memory, cognition, communication within that individual's own environment. But then what was actually the next crucial step was for the speech therapist to bridge the gap between the injured worker and the work environment as well. So she started communicating with the individual's employer direct supervisor. That led into taking the skills he was working on into the work environment and they could kind of communicate then on. How are those skills being applied there? Where do we need to work within our individual sessions and how do we give communication to the supervisor to help that individual be successful in that environment and then ultimately getting into that environment with the injured worker himself to make recommendations on the job there too Virtually though right Virtually first, and then we also did that in person for them too.
Speaker 1:So clarifying then. No, I think that was well rounded very well.
Speaker 1:Thanks. Anything you would add? See, I don't think so. Okay, so we've kind of talked about how that community-based care can can happen in a variety of different environments.
Speaker 1:What we do tends to be virtual first right. So we may lead with a virtual assessment, we may then lead with virtual care and the entirety of that program can be virtual right. Again, I think we have a lot of folks that may ask From a place of skepticism how do you, how do you do all of that virtually? We're coming at it from a place of creativity, of how, how can we do that? How can we make it happen in the context of their own environment? How do we do that? In a collaborative manner with multiple disciplines and, as we pointed out earlier, there are Situations where that doesn't make sense, and that's okay. We need to identify that and point the person in the right direction. But For the most part, those individuals getting referred to us have made a ton of sense and we've been able to provide that level of care in that way, right, well, I mean a key concept.
Speaker 3:He said virtual first. So that's a actually Claire turned turned us on to that Saying, I suppose and that just means that we take a virtual approach first. Virtual only, I would say, is not us, we are primarily virtual, but not virtual only. We just happen to be virtual first and if we need to go in person we can. So that's a key differentiator, to write so in person first and then perhaps they take a virtual if they need to or if they can. So it's just a small, small difference, but big, big difference in the approach, absolutely I.
Speaker 2:Think it's important to highlight, when we're talking about virtual first Kind of this, this distinction between virtual first and kind of what came about during COVID. A lot of people were doing virtual therapy, virtual Doctors, appointments, virtual everything Because they had to, but we started doing tele rehab because of how much it made sense, because what we know about Learning in a contextual environment. So I think, just when it comes to helping our patients and our families and our clients understand virtual first, it's a lot more easily adopted when they understand that this isn't the last resort. This is really the first option for us.
Speaker 1:Yeah, and that. That all kind of comes back to part one of this conversation, why we started this in the first place. Right, what the heartbeat of it is.
Speaker 1:That's great, I think this is a nice conversation to have, just in terms of differentiating, you know, why are we doing what we're doing and how are we starting to do that or how have we been doing that. And Clearly this came up in conversation earlier, but I think I'd love to go there in the next episode that we do, focusing on kind of being proactive versus reactive when it comes to approach to health care and how maybe we fit into that. So I think that'll be a great place to go next. Thank you, guys for your time and the listeners. Hope you enjoy the conversation.
Speaker 2:Thanks for joining the conversation with us today. If you found it helpful, please share with your family and friends. You can learn more about us on our website at continue tell the rehab comm or check us out on YouTube, instagram and Facebook.
