TELEHEALTH

Telehealth refers to the delivery of health care services and information through the use of telecommunications technologies.  With the continuous advances in technology, the use of telecommunications technologies as a medium for intervention is becoming more widely used in various allied health professions, including occupational therapy.  

Community Therapy Services currently provides occupational therapy telehealth services in the school-based environment.  Services may include telehealth services for children on Individualized Education Plans (IEPs), but Response to Intervention services are also available to support student needs in the form of consultation and education for staff and/or caregivers.  Services are available, at this time, in more than 20 different states, including Arizona, California, Colorado, Florida, Georgia, Indiana, Massachusetts, Michigan, Minnesota, Nevada, Ohio, Oklahoma, Oregon, South Carolina, Tennessee, Virginia, and Washington.  

Twenty percent of individuals residing in the United States reside in rural areas and it can be very difficult to access health care providers in these areas, particularly in school-based settings.  The American Association for Employment in Education (2021) revealed that there was a shortage of occupational therapists in the school systems in 2021 for most reporting regions in the United States,.  Telehealth is a potential solution to the existing national concern of allied health personnel shortages, particularly in rural areas.

There is a trend in education in which families are increasingly choosing educational programming for their students that provide learning opportunities using Internet-based methods.  Despite the ability to access teacher support on-line, all students with special needs must still have access to appropriate special education services, including related services  of speech therapy, occupational therapy, and/or physical therapy.  Muller & Ahearn (2004) confirmed that it can be a difficult task to provide related services to students scattered over a large geographic area.  Various factors may hinder a student from receiving the services required on the IEP, including examples such as transportation issues associated with living in rural areas, mobility restrictions that may make travelling difficult, or compromised immune systems in which direct client contact may not be the desire of the caregivers.

Providing occupational therapy direct and consultation services, via Internet-based methods, is a potential solution to satisfy a need for occupational therapy services for students identified with special needs on an Individualized Education Program (IEP).  Direct occupational therapy services in a brick and mortar school environment, typically consisting of 20-30 minutes per week, do not always result in the most ideal or effective outcomes if there is limited follow-through in the classroom or home environments during other times of the week.  The most successful outcomes are often seen given occupational therapy consultation services, in which the therapist provides strategies and solutions to teachers, staff, parents, and/or caregivers to use at school and/or at home with the student.  The consultation model has become an increasingly used model of intervention for occupational therapists in the schools and is supported with evidence-based research (Dreiling & Bundy, 2003).  The virtual occupational therapy service model can be effective for many students using a combination direct service and consultative approach.  This intervention medium will not be appropriate, however, for all students on an IEP.  

To date, telehealth services have been successfully implemented with various impairments and pathologies.  A systematic review of 146 articles in the area of telerehabilitation from 1998 through 2008 by Rogante, Grigioni, Cordella, and Giacomozzi (2010) identified various impairments that have been treated through the use of telerehabilitation including hip and knee replacements, daily-living impairments, cognitive impairments, mobility impairments, upper and lower extremity impairments, speech impairment, and ulcer-related impairments.  Various pathologies have been addressed through telehealth intervention including, but not limited to, joint replacement, stroke, spinal cord injury, traumatic brain injury, walking inability, ulcers and wounds, multiple sclerosis, Parkinson's disease, carpal tunnel, cerebral palsy, congenital neurological disorders, and paraplegia.  Kairy, Lehoux, Vincent, and Visintin (2009) completed a systematic review of 28 experimental or observational studies on telerehabilitation.  They found that clinical outcomes for telerehabilitation using various methods were similar to or better than traditional intervention. 

During the 2011-2012 school year, research evidence revealed positive student outcomes and high levels of client satisfaction for participants attending a virtual charter school that took part in an occupational therapy telerehabilitation program through Community Therapy Services (Criss, 2013).

Click here to view a more detailed summary of the existing evidence for the use of telehealth services.

Click here to view a document that can be shared with parents or educators to give an overview of what telehealth services might look like and list of resources that are essential for effective telehealth implementation.

American Association for Employment in Education (2008). Educator supply and demand in the United States: 2008 executive summary. Retrieved from http://www.aaee.org/cwt/external/wcpages/resource/

Criss, M. (2013). School-Based Telerehabilitation In Occupational Therapy: Using Telerehabilitation   Technologies To Promote Improvements In Student Performance. International Journal of Telerehabilitation, 5(1).

Dreiling, D. S., & Bundy, A. C. (2003). Brief report—A comparison of consultative model and direct– indirect intervention with preschoolers. American Journal of Occupational Therapy, 57, 566–569.

Kairy, D., Lehoux, P., Vincent, C., & Visintin, M. (2009). A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disability and Rehabilitation, 31(6), 427-447.Muller, E. & Ahearn, E. M. (2004). Virtual schools and students with disabilities. Retrieved

from http://www.projectforum.org/docs/virtual_schools.pdf

Muller, E. & Ahearn, E. M. (2004). Virtual schools and students with disabilities.  Retrieved

 October 9, 2011 from http://www.projectforum.org/docs/virtual_schools.pdf

Rogante, M., Grigioni, M., Cordella, D., & Giacomozzi, C. (2010). Ten years of telerehabilitation: A literature overview of technologies and clinical applications. Neurorehabilitation, 27(4), 287-304.