Susan Pattison's 10-point plan for working remotely with patients with brain injury
Susan Pattison has a self-proclaimed ‘passion’ for working with people with brain injuries. Indeed, it was the glaring lack of community-based rehab options for people in north west England that inspired her to open her first clinic in 1998.
Since then, her reach has extended beyond the original base in Bury, Greater Manchester, and her business has expanded to include having community-based therapists in Warrington, Cheshire, and Barnsley, south Yorkshire.
The impact of Covid-19 and the first lockdown of 2020 forced Susan and her team – including her, there are eight physios and occupational therapists – to ask themselves how they could reach patients. They knew their patients and their carers relied on them but found themselves suddenly unable to conduct face-to-face treatments.
‘At that time, I would have argued that it’s impossible to provide care remotely to our patients. But we have learned really, really quickly and undertook a massive amount of work so that we could continue treating our patients – despite only being a relatively little group of practitioners.’
If someone has a balance problem, you can’t just reach through the screen and help to steady them [Susan Pattison]
Susan admits she felt somewhat at sea initially, as the bulk of the official guidance from the government and professional bodies focused on the treatment of musculoskeletal disorders.
‘Guidance on treating people with lower back pain remotely is not transferrable to people with acquired brain injury,’ she points out. ‘If someone has a balance problem, you can’t just reach through the screen and help to steady them.’
Some practitioners have 'walked away'
Susan says she even knows of colleagues who have struggled, ‘walked away’ from physiotherapy or whose businesses have ‘gone to the wall’, as a result.
Now, in what she refers to as ‘lockdown three’, the ‘Susan Pattison Team’ is ‘calm and coordinated’, says Susan with evident pride.
‘Our car boots are full of personal protective equipment and we have robust risk assessments in place to permit the seamless switch to remote therapy via video link. Fortunately, everyone in the team had a tablet but I know some smaller practices just weren’t geared up to respond as we did.’
Though the rules governing the current lockdown have been loosened, meaning some patients can be seen in person, a number as yet lack the confidence to do so, Susan adds.
Susan has drawn up a 10-point plan that she hopes will be useful to others in a similar position.
- accept this is different to face to face
There is no guidebook so be realistic in your expectations of yourself and your patient.
- separate the tech from therapy
Avoid losing the therapeutic relationship due to the strains of technology. Identify a member of your admin team to road test and ‘iron out’ patients’ technical issues to ensure they are comfortable and confident.
- sort out your space
This is not a desk task. What does your patient need to see, how will you ensure their view is clear and you can still see them while they move? What position do you/they need to be in? What equipment do you/they need?
- plan, prepare and practice
Know the abilities and limitations of your platform and work around them. For example, video yourself doing the task/exercise and watch it with the patient as a baseline for their practice so you can observe rather than demonstrate.
- safety first
Plan a virtual of your patient’s home, agree a safe treatment space. Enlist the help of household members support but don’t forget to ensure everyone is okay, check for back pain, give advice on posture or ensure change of position to avoid arm ache from holding the camera.
- observe, observe, observe
The focused angle of a camera can allow you to observe in detail, but don’t forget what you can’t see – repeat the task or exercise and change the camera angle or position you will be surprised what you learn. With their consent, video the patient’s performance and let them watch it back and analyse it for themselves.
- don’t feel the need to talk all the time
Working remotely is cognitively demanding for the therapist and the patient. The patient is working with fewer cues than if you were present, give them time to process and respond. Check in with them at the end of the session as to what did and didn’t work. Remember, this is tough for them too!
- record keeping
Identify in your clinical reasoning what worked and what didn’t and any compromises you made versus face to face. Just because remote is possible does not mean it is preferable to face to face.
- diary management
Schedule an hour per session, but plan on 15 minutes' preparation time, 30-minute session time and 15 minutes to write up your notes and plan the next session.
- share your success
The pandemic has provided professionals like us with a unique window to develop tools to assist our patients way beyond the restriction of lockdown. There are some fantastic blogs out there, and our professional bodies are keen to learn from our experiences in the field.
For more information about Susan Pattison Therapy Services, visit: https://www.sptherapyservices.co.ukAuthor: Ian A McMillan