portland

With the advancement of technology coupled with the limitations that physical therapy health care providers are encountering via insurance limitations telemedicine allows patients immediate access, near and far, to get specific health care advice, prescriptions of movement and consultations which could prevent unnecessary diagnostic tests and measures.

As our health care world continues to change I am excited to be part of the telemedicine movement.

In the past month we had a patient encounter that we felt we important to share for a couple reasons:

• This case specifically highlights the difficulties that normal people go through when dealing with our current medical model and all the practitioners one may encounter.
• It also highlights how when patient cases are dealt with properly someone can get more effective treatment regardless of whether someone is local or thousands of miles away.
• With proper resources and communication people can receive physical therapy via telemedicine and it can be very effective

To protect the patient’s confidentiality names have been omitted, substituted with initials.  DW has agreed for me to post this case and she hopes that it will provide some insight to our Telemedicine process and how it has helped her.

A few weeks ago I received a Facebook message from an old college friend asking if I knew anything about a “rare” diagnosis named “idiopathic lumbosacral radiculoplexus neuropathy”.  Turns out his mother, who lives on the other side of the country, had been diagnosed with this over a year ago and was frustrated with her progressive worsening.  I told him that I had seen thousands of patients with idiopathic back pain that also had some sort of radicular symptoms down the extremities.  In layman terms idiopathic means unknown cause, lumbosacral defines the lower back and pelvic tailbone region, radiculoplexus neuropathy basically is an irritation or inflammation of the nerve bundles that exit from the spine.  It is important to note my friend’s mother, until acquiring this diagnosis was a normal active nurse and after dealing with this diagnosis she had now lost the ability to walk independently or perform many of her prior activities of daily living. I received multiple emails from the son and daughter of the patient, which gave me some insight on the patient’s medical history and timeline of diagnostic tests.  Now through these emails I had found out that over the past year DW had been to multiple doctors, multiple specialists, undergone 7 MRIs, 2 X-rays, formal physical therapy and various prescription medications to help her symptoms without any definitive plan or answers to why she had acquired this “idiopathic diagnosis” or more importantly what to do from today moving forward.

After reviewing the medical notes I set up our first Telemedicine appointment, which was just like any normal evaluation we perform here in our clinic.  Per the patient’s request DW had her daughter present on the video conference as to be an assistant just in case DW would need help with any mobility testing and/or we had technologic difficulties. Normal subjective examination was performed, objective testing, and special tests in order to determine an action plan.  In the hour appointment we spoke of DW’s diagnosis, and I came up with a physical therapy assessment of her orthopedic limitations and her functional impairments.  In addition I gave her some mobility exercises to start on that day that she could perform independently and some exercises that her daughter would assist with.

It is important to note here that in just this first appointment DW and her daughter mentioned that they received more from me in the initial evaluation that they had in the past 6 months. How does this happen?! How can one person see that many doctors, specialists and participate in formal physical therapy without some sort of education, evaluation and proper action plan to address this patient’s needs and goals.

Our next appointment was 1 week later however I told DW and her daughter that we were always available via phone, email, or Facebook messenger if they needed to contact us prior to our next appointment.

The next appointment we learned and witnessed some pretty amazing things. She had gained more mobility in her leg than she had in previous months.  She also mentioned feeling more sensation in her leg something that had been absent for quite some time.  Her mobility was starting to return but her strength and endurance for maintaining these new positions was very poor.  At this appointment she was given a progression from her day one exercises and we planned on meeting in another week.  The next goal would be to stand and be able to shift her weight from one leg to the other.

Next appointment was two weeks later and once again more good news. DW was bearing more weight through her legs with less assistance with her arms on the assistive walker she had been using to stand.  Even better news was that DW felt her muscles in her legs working, something she hadn’t felt in months.  Her ability to transfer from chair to wheelchair, wheelchair to bed, bed to sitting and sitting to standing all improved.  Her strength and endurance were slowly improving but more importantly DW had new hope.  She was seeing progress herself.

Now DW and her daughter were given more exercises to perform daily and DW was instructed that returning to a local physical therapist was the next recommended intervention.  Going to a local physical therapist that understood DW’s needs, goals and progression was crucial to her continued recovery.  In order to assure DW’s transition our office called local physical therapists near to DW, explained to the therapists what we had accomplished in just a few visits & recommended our physical therapy assessment and plan of action and collaborated with DW what she would have to do moving forward from here on out.

I’m happy to say that DW had her first physical therapy appointment this week and I received some good feedback from her regarding her first visit.  I plan to follow up with a video conference in the beginning of next year to see how far she has come with her functional mobility and if she is closer to her goal of being able to walk again…