From Hands-On to Virtual: A Physical Therapist’s Journey

For years, my day revolved around the rhythm of inpatient rehab—moving around a post-acute rehab campus assisting clients with transfers, gait training, and hands-on interventions. I was constantly on my feet, adjusting positioning, responding in real-time, and using touch as a tool to guide movement. But life has a way of shifting our paths. After five years at QLI in Omaha, my husband was offered a job in another city, and with our second child on the way, I faced a tough decision. I wasn’t ready to leave the work I loved, but I needed more flexibility. That’s when I transitioned to Kintinu Telerehab. 

The switch wasn’t just a career move; it required a fundamental shift in how I approached therapy. Could I still be effective without physically assisting my clients? Would my ability to build strong therapeutic relationships suffer? And how would I adapt my skill set to a different mode of care delivery? It took time, trial and error, and plenty of adjustments, but ultimately, I found new strategies that allowed me to continue providing high-quality care—just in a different way. 

Breaking Old Habits: Physical Therapy Without Hands-On Assistance

As a physical therapist in a post-acute rehab setting, working with individuals who have sustained traumatic brain injuries and strokes, therapy was always centered on intensity, consistency, repetition, and task specificity. The focus was on getting clients up on their feet efficiently and ensuring their safety as they navigated their environment. Virtual therapy required a shift in this approach, placing greater emphasis on verbal instruction, guided problem-solving, and self-correction. 

Initially, transitioning from hands-on guidance to virtual therapy felt like a challenge. Without direct physical support, I had to rethink how I facilitated movement and ensured safety, but I quickly realized that virtual therapy introduced unique advantages that traditional inpatient settings couldn’t always provide. 

One of the biggest benefits? Clients were more comfortable in THEIR own homes and are truly experiencing therapy in THEIR real world. They weren’t adjusting to a new therapy gym or trying to recall home exercises in a different setting—they were practicing movements in the exact spaces where they lived their daily lives. This helped with both carryover and independence since exercises were already integrated into their home environments. In fact, one client recovering from a concussion shared, “The time we’ve spent going over X, Y, Z in our sessions has been more beneficial to me than therapy in the past because I am able to put it into practice throughout my entire day.” This reflects a key advantage of virtual therapy—clients actively apply what they learn in real-time, reinforcing progress beyond structured sessions. 

I also found that guiding clients remotely encouraged more active participation and problem-solving. Instead of passively relying on hands-on support, they became more aware of their own movement patterns. To make this transition smoother, I used several strategies: 

• Breaking movements into step-by-step instructions – Instead of saying, “Shift your weight to the right,” I’d guide the process in small increments: “Start by placing your right foot slightly forward. Now, push through your heel and engage your core.” 

• Using mirroring techniques – Demonstrating movements on camera while facing my client helped reinforce their understanding. 

• Leveraging household items as tools – I’d tell a client, “Use the back of your couch for support,” or “Place a water bottle next to your knee to keep it aligned.” 

• Encouraging self-feedback – Teaching clients to assess their own movement and make micro-adjustments improved their body awareness and independence. 

Telerehab helps patients adapt quickly by increasing their mindfulness of movement throughout daily activities. Instead of relying on hands-on guidance, they learn to self-correct and adjust their movements, reinforcing progress beyond structured therapy sessions. 

Building Relationships Through a Screen

Building connections in virtual therapy requires a more intentional approach than in-person settings, where casual conversations, body language cues, and natural interactions occur organically. To bridge this gap, starting sessions with personal check-ins helps establish rapport, while using a client’s home environment to personalize treatment fosters a sense of familiarity and relevance. Acknowledging frustrations and validating concerns can ease the adjustment to virtual care, while involving caregivers or family members when needed enhances support and adherence to exercises. Over time, these strategies strengthen communication and create meaningful therapeutic relationships despite physical distance. 

Here are some additional benefits I saw to providing virtual care:

• Comfort in their own space – Clients tend to be more relaxed and open when engaging in therapy from home, allowing for stronger rapport and more natural conversations. 

• Tailored exercises for real-life settings – Being able to see a client’s actual environment helps customize therapy to fit their daily routines, whether that means using a sturdy couch for seated squats or practicing balance at their kitchen counter. 

• Clearer communication and engagement – Without hands-on guidance, virtual therapy fosters active listening and clear verbal instructions, helping clients develop independence and confidence in their progress.  

I also realized that the relationships I built in this setting weren’t any less meaningful, they were just different. The bond formed through encouragement, shared problem-solving, and mutual trust was just as strong, if not stronger, in some cases. 

The Practical Side: Managing Licensure, Documentation, and Fatigue

Beyond client care, virtual PT came with logistical adjustments. 

• Staying on top of licensure requirements – Since I was now treating clients across multiple states, I had to keep records of my licensing, CEU deadlines, and ever-changing telehealth regulations. 

• Relearning billing and documentation – Telehealth came with different reimbursement structures, new coding requirements, and a shift toward real-time documentation. 

• Adjusting to screen fatigue – Unlike inpatient PT, where movement was built into my day, virtual therapy meant long hours in front of a screen. By my sixth session of the day, my eyes hurt, and I felt mentally drained. I quickly learned the importance of scheduling breaks, adjusting my workspace, and staying active between sessions. 

Why It Was Worth It

The transition from inpatient PT to virtual PT was a challenge, but it also came with unexpected benefits. Virtual therapy allows for increased efficiency and flexibility, benefiting both therapists and clients in significant ways. 

• Maximized session time – Without the need for travel, sessions can start and end on time, ensuring every minute is dedicated to therapy. 

• Personalized treatment – Seeing clients in their home environment allows for exercises tailored to their real-life setup, making therapy more relevant and effective. 

• Flexible scheduling – Virtual therapy offers both therapists and clients more options to align schedules, which can improve consistency in treatment. 

• Different work dynamics – While inpatient settings require real-time response to urgent needs, virtual therapy allows for a different pace, with structured sessions and fewer immediate interruptions. Both settings serve vital roles, and each comes with its own unique demands and rewards. 

• More autonomy in scheduling – Virtual therapy can offer increased control over scheduling, allowing for better time management and, in some cases, improved work-life integration. 

• Encouraging client independence – Without hands-on guidance, clients become more engaged in problem-solving and self-correction, reinforcing progress beyond structured therapy sessions. 

However, there were challenges as well. Without the physical demands of inpatient PT, staying active required more intention. Long virtual days could lead to screen fatigue, requiring adjustments to workspace setup and scheduled breaks. Learning new documentation and billing processes also took time. These are all aspects to be mindful of when considering a shift to telehealth. I had to be intentional about my own movement and well-being. And I had to rewire my brain to recognize that just because I wasn’t physically guiding someone didn’t mean I wasn’t making an impact. 

Final Thoughts: Is Virtual PT the Right Fit?

If you’re considering making the switch to virtual PT, here are a few things to ask yourself: 

Can I adapt my communication style to guide movement effectively without hands-on assistance?  Am I comfortable with telehealth documentation, billing, and licensing requirements? Do I have the patience and creativity to keep clients engaged through a screen? 

Virtual PT isn’t a one-size-fits-all model, but for the right therapist, it offers an incredible opportunity to connect with clients in a meaningful way while gaining flexibility in your own life. The transition may feel daunting at first, but with the right mindset and strategies, it can be just as effective—if not more so—than in-person therapy. 

Contact us today to take the first step toward recovery. 

Brain Injury Rehabilitation, Online Therapy