Telemedicine broadening access to care for those with cerebral palsy

Dr. Loren Davison at UC Davis is projected from a monitor, as he watches physical therapist Janet Freeman work with a patient during a telemedicine session at Hoover Elementary School. The Stockton school is the site of a pilot Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services program serving physically disabled children in rural and underserved communities. Calixtro Romias, The Record

by Nicholas Filipas, The Record/TNS April 2, 2019

Stockton, Calif. — Physical therapist Janet Freeman soothes and relaxes a 17-year-old girl with cerebral palsy. As the girl’s hips and forearms are stretched, the child doesn’t make a sound.

The girl’s mother, who declined to be identified for this article, mentions that her daughter’s muscles tend to tighten during the winter. She’s also outgrown her walker and will need to be fitted for a new one.

Nearly 60 miles north at the University of California, Davis, Dr. Loren Davidson observes the checkup with his face projecting from a computer monitor.

Next, Davidson watched 6-year-old Jade Brunswick demonstrate her ability to walk across the room with and without assistance from her orange walker. She, too, has cerebral palsy and Davidson agrees with her father, Roger Brunswick, that the child appears to be doing just fine.

Throughout a recent Friday, Davidson and a small group of physical therapists from the San Joaquin County Public Health Services California Children’s Services and Medical Therapy program saw an additional eight young patients as part of a pilot program to provide medical therapy conferences electronically.

The School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services program provides physical therapy, occupational therapy and medical equipment to children with physical disabilities from infants to 21 years of age in rural and underserved communities.

The program was funded by a $2 million, five-year grant from the Agency for Healthcare Research and Quality to have access to UC Davis officials.

Armando Valerio, a therapy services manager at Public Health Services, said during one of these “telehealth” visits, the UC Davis medical team can speak directly with parents and caretakers to make recommendations for specialized equipment such as orthotics and wheelchairs, prescribe therapy services and make necessary referrals for specialized medical treatment.

Children with cerebral palsy, spina bifida, spinal cord injuries and other physical disabilities can benefit from the program, Valerio said.

“We see a lot of different things, but cerebral palsy is the biggest that we see — about 75 percent,” said Valerio.

The Centers for Disease Control and Prevention classifies cerebral palsy as a group of disorders that affect a person’s ability to move and maintain balance and posture. It is the most common motor disability in childhood and is caused by unusual brain development or damage to the developing brain.

Hoover Elementary School on Kirk Avenue in west Stockton was chosen to be the first site of the program back in January. Patients like Jade can now receive care from a pediatric physiatrist without having to leave town and make the trek to Sacramento.

Public Health Services was invited to participate in the pilot project and while it serves children in three other locations throughout the county (Washington Elementary in Lodi, McFall School in Manteca and McKinley Elementary in Tracy), Hoover Elementary is the first in the state to utilize “telehealth.”

“Our goal is to provide the same level of service now by video so that the main therapist will be my proxy for me,” said Davidson, a clinical professor for pediatric physical medicine and rehabilitation and grant co-investigator.

“What I have on my end is talking through the main camera that I can pan, tilt and zoom and watch the kids walk back and forth. There’s a second handheld camera that I can switch and the therapist can zoom in on small detailed looks.”

As he is physically on campus, Davidson is equipped with three computer screens with electronic medical records from the campus hospital, Shriners Hospitals for Children — Northern California and Sutter Health to look at and make recommendations in real time.

Jade and her father were all smiles when her 10-minute appointment was over.

She worked on moving her wrists, flexing downward to touch her toes and triumphantly showcased for the adults her ability to walk on her own.

Roger Brunswick commented he would prefer services be done in Stockton, and plans for additional rehab sessions scheduled for later in the year.

Said Davidson: “It was nice to see her walk across the room.”

Contact reporter Nicholas Filipas at (209) 546-8257 or Follow him on Twitter @nicholasfilipas

Source Disability Scoop via The Record/TNS

  Further reading

Telehealth at UC Davis – a 20-year experience, Nesbitt TS, Dharmar M, Katz-Bell J, Hartvigsen G, Marcin JP. Telemed J E Health. 2013 May;19(5):357-62. doi: 10.1089/tmj.2012.0284. Epub 2013 Jan 23.

Using telemedicine to provide pediatric subspecialty care to children with special health care needs in an underserved rural community, Marcin JP, Ellis J, Mawis R, Nagrampa E, Nesbitt TS, Dimand RJ. Pediatrics. 2004 Jan;113(1 Pt 1):1-6.

Forging successful academic-community partnerships with community health centers: the California statewide Area Health Education Center (AHEC) experience, Fowkes V, Blossom HJ, Mitchell B, Herrera-Mata L. Acad Med. 2014 Jan;89(1):33-6. doi: 10.1097/ACM.0000000000000069.

Also see
New pediatric tele-physiatry program helps children in rural and underserved communities UC Davis Health
Clinical Telehealth Services UC Davis Health
Telehealth Models for Increasing Access to Care Among Children Rural Health Information Hub

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