FOX Clinicians Go Above & Beyond During This Pandemic

By Donna Cifuni, PT, DPT

Physical Therapist

In this unexpected time of a pandemic, FOX and other clinicians with access to patients in their home have been challenged to think outside of the box during treatment sessions in order to allow patients to optimally benefit from Physical, Occupational, and Speech Therapy services. While advocating for the importance of these professions on the “front line”, clinicians have realized that, besides exercise, being able to assist with other tasks in the patients’ homes provides an even greater impact. Treatment sessions, while previously only focused on treatment interventions that fall into the “scope of practice” of these professions, have now broadened even further. Clinicians are able to observe other aspects of the patient’s quality of life.

Being there for patients during this time has not only allowed us to strengthen their bodies and minds but also to strengthen their spirits.

Why is therapy so “essential” during a pandemic?

When COVID-19 first started here in the United States, Physical, Occupational, and Speech Therapists throughout the country were hit hard with cancellations from patients who were fearful of contracting this terrible disease. Clinicians were immediately challenged to try and advocate for the importance of their interventions and to educate families and patients on the potential deficits that could occur by stopping services. Studies have shown that two weeks of inactivity in the geriatric population can lead to a fourth of loss of muscle mass. This is one of the many reasons that patients are starting to influx back into clinicians’ schedules after placing themselves on hold at this time; they’ve realized the importance in continuing with services to prevent decline.

In addition to maintaining and improving muscle mass, aerobic activities can strengthen the circulatory and respiratory systems of older adults. This can reduce the risk of complications caused by COVID-19. Daily movement and exercise for the elderly population have various other benefits including regulation of the digestive system, improved cognition, and improved mood. Studies have shown that the presence of moderate-intensity exercise, as well as aerobic training combined with strength training, for older adults significantly reduces the effects of depression. It has also been indicated that exercise when combined with anti-depressive drugs, compared with medication alone, improves cognition in depression patients.

House call clinicians serve as the only medical professional interactions for the homebound

At the time of this pandemic, a lot of patients have not been able to go to their regular doctor appointments due to limited in-office visits, office closures, or patient fears of leaving the home. House call clinicians, in many cases, are the only medical professionals these patients are seeing in their homes. This challenges clinicians to be even more diligent in their observations. Now, more than ever, it is important for clinicians to be attentive to all aspects of their patients.

Some patients also may be developing new conditions during this time where they may not be seeing their physicians in person. When performing daily vital checks, a clinician may note decreased oxygen saturation which will then require the clinician to perform lung auscultation to look for signs of fluid accumulation or difficulty breathing. Also, when taking blood pressure, a clinician may notice uncharacteristically low blood pressure which may be indicative of dehydration. In severe cases, it is up to the clinician to use their clinical judgment in contacting the patient’s primary doctor or even calling 911.

Throughout a treatment session, other conditions may become evident to a clinician. For example, when stretching a patient’s legs, a PT may note edema in the ankles that were not previously present. This may elicit the PT to call the patient’s primary doctor if medication such as a water pill may be indicated. Edema or swelling in the legs could also be a sign of the patient consuming salty foods, such as Chinese food, with the patient benefiting from education on diet modification.

Additionally, due to isolation, a patient may start showing signs of depression. PTs, OTs, and SLPs can give the patient a psychologist recommendation or can speak with the patient’s primary physician regarding observations.

The importance of socialization in reducing depression

Many patients seen by FOX clinicians are primarily homebound. They rely on their families coming to visit for their social interaction. Many patients and family members at this time are limiting visits, or eliminating them altogether, for the safety of their loved ones. This means that clinicians may be the only people patients get to interact with.

While taking rest breaks, patients love to have conversations about their families and their life. Many patients love to hear about their therapists’ families as well and see pictures of kids or pets, which will brighten their mood. Patients also love to hear funny stories about their clinician’s weekend or other positive stories to take their mind off of the current situation with the virus. Talking can be very therapeutic, especially since this may be one of the only conversations patients have on that particular day.

A multitude of patients have pre-existing depression, anxiety, or other mood disorders, which are now being amplified by the presence of COVID-19 and social isolation. Checking in with patients on how they are feeling and providing support can drastically reduce their worries and fears. In addition to improving mood, socialization can reduce the risk of developing dementia as shown by two studies outlined in this article. It also has been shown that the removal of socialization can lead to long-term negative effects, including increased risk for developing dementia.

Not only is it important for these patients to interact with their clinicians, but it is also important that they interact with their loved ones. Set up a video call with a family member or make a phone call with the patient so they can speak with their loved ones. This will certainly brighten their day and will also reduce the feelings of loneliness they may be feeling. This may not exactly fall into their “roles” as clinicians, but it is something that will be extremely important to the patient and to the family. A patient with an improved mood will also be a better participant during sessions and will gain more from their exercises and activities.

Going above and beyond within treatment sessions

There are various ways in which clinicians during this time have proven to be essential in a multitude of areas of the patients’ lives. For example, some clinicians have implemented household tasks into treatment sessions due to patients not being able to have their cleaning personnel in their homes. Many clinicians have been encouraging patients to get outside, even if it’s just in the driveway, to get some fresh air and to change the environment since a multitude of patients has been in their homes for months. Specifically, some FOX Rehab teams have handed out paint-by-numbers for clinicians to perform with patients to challenge patients’ cognitive function or standing tolerance. This also adds more fun to treatment sessions.

Many patients in the geriatric home care population require assistance with technology. Some clinicians have assisted patients in setting up home delivery for groceries, have set up Amazon Alexa or Google Home in the patient’s home so they can listen to music, and have initiated video chats so that patients can communicate with family members. I, personally, even assisted with fixing a patient’s WiFi connection because they couldn’t get on their tablet which they use to communicate with friends and family.

The everlasting impact on the future of home care treatment sessions

The presence of this pandemic has allowed house call clinicians to become even better clinicians. For patients who went on hold and are coming back, clinicians are seeing the drastic decline in the absence of PT, OT, and SLP services – showing the true benefit of utilized interventions. Clinicians are now looking at patients as an even bigger picture than before; not only looking at their strength and function but taking the time to assess their mood, thoughts, and concerns. Therapists are learning what patients enjoy doing in their free time and can implement this into treatment sessions. Taking the time to make sure patients are able to do everything they want to do in their home, even if it means taking an extra five minutes to reset their WiFi router so that they can listen to music, makes a great difference to patients. Most importantly, clinicians are aware of the value of showing up every day with a positive attitude and a smile on their faces because these may be the only smiles those patients get to see for that day.

Physical, Occupational, and Speech Therapists have been essential during this pandemic and will continue to always be essential to patients.