Does Online Rehab Help Differently-abled Kids During COVID-19?
If you have ever seen a rehabilitation center for differently-abled kids, kids such as the ones who are suffering from autism, cerebral palsy and certain neuromuscular disorders, you would notice that it is a big hall filled with several kids and their guardians along with many physiotherapists and occupational therapists who are trying their best to rehabilitate these kids.
Social distancing is, in short, a complete antithesis and no less than an enemy to the concept of rehabilitation of the differently-abled kids.
Understandably then, the sudden COVID-19 lockdown disrupted the entire rehabilitation journey of these kids, who rely on a continuous, rigorous and intense multi-disciplinary hands-on rehabilitation regimen that is delivered over several years and sometimes until they are well over 20 years old.
No health facility around the world was prepared enough or equipped enough to face the sudden challenges brought on by the lockdown and the ensuing social distancing norms. Some of these kids are also very vulnerable to COVID-19 infection and its complication because of their poor immunity and some may have underlying liver, kidney or muscle problems which make them susceptible to the infection. Several reports indicated that few of these kids could be carriers of COVID-19 and hence social distancing and mitigating measures to block person-to-person touch and contact was desperately needed.
Hence, the rehabilitation centers resorted to the next most logical thing to do and utilized the best available resources during the times, which is to deliver rehabilitation over telemedium services also called as telerehabilitation.
Tele-rehabilitation - Does it Work?
Telerehabilitation came with distinct advantages: namely, the services could be imparted remotely while maintaining social distancing, the travel and time for the patients were saved, the whole arrangement would also be more economical to the family. But we should understand, these kids need a very hands-on and a slow graduated approach. The telerehabilitation, although a promising and attractive option, had its own unique set of challenges.
The involvement of the parent or the guardian was crucial, and, in many cases, they had to assume a dominant role in imparting the rehabilitation care.
Insurance payout to the parents, audiovisual quality over internet connectivity and web literacy were other barriers for an effective telerehabilitation delivery. Although the parents were initially apprehensive because of a lack of specialist presence, but as the telerehabilitation progressed, the parents assumed a significant and major role in the program. Several parents also felt empowered towards imparting the education to their kids.
In fact, the telemedium services also opened up many new opportunities for some remote centers in a distant location of the country who could now seek expert opinion from advanced centers in Mumbai.
It was highly beneficial to the kids because if they received an average of 3-4 hours of in-person therapy per week before the pandemic, it was now reduced to only few minutes of an in-person consultation, and that too only if needed on occasions.
Pre-COVID, telemedium services in Australia or Europe had utilized heavy audio-visual equipment with an on-spot health care personnel. But during the COVID times, the preferred mediums are the videoconferencing apps such as ZOOM, skype and other such apps because they have excellent stability and user interface.
Can Telerehabilitation Be a Long-Term Solution?
Ironically, it is the pandemic that provided an opportunity to innovate a novel form of health care delivery. As of November 2020, the pandemic is showing no signs of abatement, hence telemedium and telerehabilitation is here to stay as it provides distinct advantages to both: the patients and the healthcare personnel.
However, many rehabilitation centers also feel that telerehabilitation is an important medium only for continuum of care rather than as a replacement for the in-person rehabilitation because an accurate examination and assessment of the kid is very difficult through the telemedium.
In the end, the big lesson for the governments, the rehabilitation centers and the hospitals is that they should invest in the newer technologies, audiovisual equipment, effective internet connectivity and generic apps for virtual consultation in order to smoothly deliver services such as rehabilitation and consultation especially during emergencies such as the recent pandemic where no other alternative exists and any interruption of care threatens to disrupt the progress and health care of many individuals and patients in the vulnerable group.
(Dr Dipit Sahu is a Shoulder Surgeon with Sir H.N. Reliance Hospital, Mumbai and Dr Tushar Agrawal is a Pediatric Orthopaedic Surgeon, Aastha Hospital, Mumbai)
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