Virtual Care: From A Pediatric Physical Therapist’s Perspective

In this second installment of our virtual care blog series, Virtual Care: From A People’s Perspective, Voices of Real Life member and pediatric physical therapist Summer Moss, PT DPT shares her virtual care experiences (read part 1 here). 

As the evolving COVID-19 pandemic has expanded options for receiving health care outside of in-person visits, this blog series examines how people across the country are experiencing virtual care. Here, we highlight benefits, challenges, and future considerations for virtual care raised by members of our Voices of Real Life, a group guiding our work by sharing their expertise on their communities’ needs.

In January 2022, United States of Care met with Summer Moss, PT DPT for a discussion on how virtual care has affected the way she provides physical therapy for children in clinics and at school. 

A day at work for Summer Moss, PT DPT has looked drastically different ever since the COVID-19 pandemic began. Moss, a California-based pediatric physical therapist with 3 years of experience in both clinical and school-based settings, was accustomed to working exclusively in-person with children on gross motor skills when the pandemic hit in early 2020. Since then, she has had to pivot rapidly to provide physical therapy through a virtual coaching model – for example, by modeling or describing movements like step ups and weight shifts via Zoom to a child’s parent, who then acts as the therapist’s hands to guide the child.

The shift online hasn’t come without its challenges for Moss though, especially with many of the children she works with spending more and more time staring at screens for both school and physical therapy. “Screentime is definitely affecting our kiddos in terms of how long they’re able to attend to a particular task,” Moss said. “In a time where everything is screen-related, it becomes compounded in terms of the difficulty… There is more of a sense of hopelessness that I’ve noticed, especially in my teenagers and my young kiddos. It’s just manifesting as distractibility and decreased attention [span].”

And while Moss has been able to support many of the children she works with through the transition from in-person to virtual care, she asserted that given the unique challenges of a virtual environment, healthcare professionals need to pay more attention than ever to rapport building and communication strategies with children who are just starting physical therapy virtually.

“The first session may look very, very different [in a virtual setting]… in the sense that you’re working a lot on rapport, you’re thinking of things in terms of games… conversations with parents, lots and lots of education, lots and lots of coaching,” Moss said. “Rapport building has always been important for my profession. But I feel like with mental and physical health, it’s becoming more important, because it does feel very impersonal to not have somebody in that room.”

For her, Moss said the keys to building rapport quickly and effectively in a virtual setting have been planning ahead and establishing clear expectations with new families. 

“If you’ve never been to physical therapy before and your first experience is going to be virtual, [I] set the expectation of, “I am going to be having a conversation with you for the next 10 or so minutes. I want your child to feel involved, I may occasionally ask them questions. These are the type[s] of topics we’re going to cover today. These are the goals. Do you agree with these? Are these things you want to collaborate on?”” she said. “Virtual care forces you to do way more planning ahead than on the fly, like you can do in the clinic.”

Other creative methods Moss has used to plan ahead include utilizing simple DIY or take-home therapy kits to make virtual physical therapy more accessible and effective.

“One of the things that my former school district did for the OT department was, they sent home a kit of tools that everyone could use,” she said. “[We’re] able to figure out what are common supplies at home that can be utilized for care and [make] sure that knowledge is available to families so that when they are doing things like, “Oh, we’re going to have physical therapy at home today because so-and-so is sick, I need to make sure I have a box ready, I can either have a ball or rolled-up socks.” Very simple tools can make therapy more effective.”

In the long run, Moss anticipates that virtual care will remain a viable and important modality of physical therapy – especially once people can more freely choose between virtual and in-person options without the pandemic hanging overhead. 

“Because [virtual care is] almost mandated right now, in the sense that it’s not considered as optional, it feels very oppressive… you have to fit within a certain box,” she said. “For example, I can only offer physical therapy in a coaching model. I can only verbally and visually diagram… I don’t have the hands-on ability right now for some of my kiddos who are a little bit more medically sensitive.”

In a world where virtual care is not the only option, Moss said she can see it being a convenient option that increases accessibility, especially for people who may have trouble finding transportation, scheduling appointments, or attending in-person visits due to physical, cognitive, or mental disabilities.

“I think long-term, once we work out the bugs, it will allow for more accessibility on a level of physical and mental ability,” she said. “And it allows for a little bit more versatility.”

To build toward a more accessible virtual care system for everyone, however, Moss pointed out the importance of addressing inequities she has long seen among her families that have been further exacerbated by the pandemic – namely, the difficulty of obtaining consistent, effective interpreter services for individuals with English as a second language.

“Having somebody who’s able to explain things, not only in someone’s language, but in the context of the setting, is really, really important… It’s hard to explain [FAPE] acts and services and all that if you don’t know the terms for it, if you don’t understand it,” Moss said, referring to the legal rights of students with disabilities to access a free, appropriate public education. “So there’s a really niche need. I think the demand is higher than the supply, and I think it’s going to continue to increase as telehealth continues to be the – I’m going to call it the norm.”

Since July 2021, Moss has shifted back to providing therapy mostly in-person, but she said that may change again depending on the course of the pandemic. In the future, Moss said that in addition to more accessible interpreter services, she hopes to see improved coverage for both virtual and in-person preventative services, including physical therapy.

“An ounce of prevention is worth a pound of cure,” Moss said. “I don’t know if that means that instead of, you know, 12 visits per physical therapy evaluation, it’s 24 visits that are covered… [but] I think it is so important. And being in this particular role, I feel like we have such a capacity to really impact things.”

Overall, Moss is hopeful about what the future holds for virtual care and pediatric physical therapy – as long as the principles of choice and equity remain at the forefront of the conversation. Like her fellow Voices of Real Life members expressed in part 1 of this blog series, she believes virtual care, if done right, can make health care more accessible and convenient.

As Moss, the children she works with, and countless others across the country continue to grapple with what virtual care means for them now and in the future, United States of Care is listening to real people across demographics to understand their personal experiences with virtual care and the changes they want to see. To learn more about our work in this space as we build toward a virtual care system that works equitably for everyone, click here.