Virtual Physical Therapy with Kintinu: A Student’s Perspective
April 24, 2022 by Steve Kerschke, PT
Recently, we had the pleasure of having Jake Massey, a physical therapy student from Creighton University, join Kintinu/QLI for an eight-week rotation. Over the years, we’ve had many talented students come through our doors. Jake is no different. From the day he set foot on campus, he absolutely made our team and our clients better. It was easy to view him as one of our teammates, not just a student. Just as important, our clients genuinely valued their time with Jake and saw him as a competent and compassionate clinician.
Our team looks forward to working with up-and-coming clinicians during their clinical rotations. While they may be eager to learn from us, we certainly appreciate the opportunity to grow right along with them. Jake, you made a lasting impact on our team and the lives of countless clients from all over the country. We hope you’ll take just a few things you learned during your time with us, and make them better, make them your own, and ultimately use them to shape the lives of others like you’ve shaped ours.
Best of luck! Upon graduation, we know you’ll be a valuable addition to any team.
What follows are some of Jake’s takeaways from his experience with Kintinu’s virtual physical therapy team, and we thought they were worth sharing…in his words.
Kintinu Telerehab: Motivating Language
“Over the past year I’ve felt like a human pin cushion.”
“I never felt like anybody actually listened to what I was telling them.”
“I have so many different exercises I’m supposed to do at home, but none of them help me get through my day.”
“I just want to get back to my life.”
Having the unique opportunity to work with the Kintinu Telerehabilitation team for 8 weeks as a physical therapy student was exactly that – unique. While in school at Creighton, we always discuss cura personalis, which is the importance of treating the whole person. As a future healthcare professional preparing to enter the field in the next few months, this is a standard I desire to uphold. But what does treating the whole person really mean? Creighton does an excellent job teaching students the importance of building relationships, and my clinical instructors have been great examples in this regard. Yet, it’s widely known that healthcare providers, like most humans, hesitate to engage in difficult conversations. Given all of this, if you were to tell me 8 weeks ago that I would learn more about building relationships, treating the whole person, and changing lives while in a 100% virtual environment, I wouldn’t have believed you.
Too often in rehabilitation, and in life, we all focus on what we can’t do. When I started with the Kintinu team I was guilty of this too. How will I measure strength and range of motion? How can I use special tests to help rule-in or rule-out conditions? What if someone would benefit from manual therapy? Is it possible to build relationships virtually? Can I really give this person everything they need through a computer from hundreds or even thousands of miles away?
Instead of viewing these as limitations, the Kintinu team sees them as challenges and focuses on what we can do in a virtual environment. At Kintinu, therapists literally meet patients where they are to build real-world skills and identify interferences that are limiting people in doing what they love all with the goal of bringing purpose and passion back into their life. In my experience, “entering into” someone’s home and meeting their friends and family creates a deep connection and allows for a trusting relationship to be established.
Language breeds culture. Kintinu also breaks down learning into easy to remember mantras that are woven in throughout their entire continuum. Here’s my take…
Tie it to the Task
From a physical therapy lens, meeting someone in their world provides key insights into their motivators and their barriers that aren’t as accessible in a clinical environment. This environment gives a whole new meaning to the physical therapy buzzword functional. During my time with Kintinu, I heard countless stories about how people did countless exercises for weeks and months with the time required for completion outweighing the perceived benefits. Another common theme was how people described the effectiveness of treatments they were given after their injury. Commonly, most of these treatments reached the proverbial ceiling. After reflecting on this, I learned effectiveness is based on education and delivery. This is where the term functional can be misconstrued. If therapy activities are not adapted and do not to transfer to daily life, then even the best treatments are limited.
Because therapy happens in the context of someone’s home or in their actual community, this not only helps visualize someone’s daily life more clearly, but it also helps individuals identify their specific challenges giving a whole new definition to the term functional. The treatment is directly tied to the task – because we’re literally doing the task. This was eye opening! I quickly began to ask myself ‘if someone gets dizzy when changing eye levels, like when doing laundry, why not actually practice that while doing the laundry?’ This sounds so simple, but I learned that this is where many clinics and therapists fall short.
On top of that, I saw how effective this was despite being created in a virtual environment – an idea that is counterintuitive to traditional beliefs about physical therapy. The clinicians at Kintinu maximize the benefits of treatments and raise the ceiling by allowing people to make connections between similar tasks that are challenging the same body systems. I was able to see firsthand how this leads to better outcomes and brings out a whole new level of intrinsic motivation because clients directly see how this can help improve their daily lives. This is what matters most to them!
Identify the Interferences
There’s much more to achieving outcomes than intrinsic motivation and tying treatment to daily activity. This is where Kintinu excels. With far less experience than a seasoned clinician, I’ve had my fair share of conversations with people who aren’t fond of exercise. I never knew exactly how to approach these conversations (and I believe many healthcare providers, and people in general, share the same feelings as I do). Despite this, I would give education on the benefits of exercise and how it can help with “insert problem here.” There’s nothing wrong with this because knowledge is powerful, but I learned how to ask the simplest, but important question when engaging in these conversations, “Why do you feel this way?”
Regardless of which member of the Kintinu team you’re working with, they all recognize the different domains of health and wellness and how an injury can affect multiple domains. They recognize these changes and work together as a team to identify the interferences someone is experiencing.
In other words, they take the time to identify the barriers to learning, growth, and recovery. This allows the Kintinu team to treat the person, not the problem, and develop comprehensive programs tailored to each individual client. The clinicians understand that simply providing treatments and education will only go so far, and they actively listen during all interactions to learn how to help someone best. The most powerful lesson I learned was to slow down and identify the interferences in the road to long-term success. In doing so, it will allow me to help remove those barriers effectively boosting the chances of recovery.
Motivate with Meaning
Interestingly, the most impactful observations I made have much more to do with behavior, communication, and other psychosocial variables than what many would consider ‘physical therapy.’ Just as important, I recognized that building relationships is a skill that can be learned and is crucial for success in any profession or walk of life. I would argue that building relationships makes any ‘physical therapy’ intervention much more effective.
Deep relationships lead to a deeper understanding of what is meaningful and motivating to others. The Kintinu team takes the time to learn about the client and everything associated with his/her life, including family/friends, support, hobbies/work, and challenges. I was always taken back when a client would describe how he/she not only got their life back, but also “made true friends.”
Everybody in healthcare is fueled by heart, meaning that they got into their job to help people and impact lives. Being able to hear comments like this from clients reinvigorates the underlying passion we all have, and I saw this in action everyday due to the effort Kintinu puts into relationship building. Kintinu recognizes that we’re all human. They understand we have good days and bad days, and they effectively adjust their plan to either push a little harder or pull back. They engage in difficult conversations to break down barriers to allow people to take an active role in their rehabilitation. Kintinu strives for much more than clients who comply with their plan of care and do their homework. They figure out how to maximize engagement and bring out passion to truly motivate with meaning. On top of these difficult conversations, the clinicians also understand the power of laughter that brings light and joy to a long, challenging rehabilitation.
Support for Success, Just Outside Comfort Zone
In school, we are told our hands are one of our greatest tools. We use our hands to facilitate movement, feel how something is moving, deliver manual therapy, and keep people safe. While it’s easy to assume physical therapy can’t be done without your hands, the Kintinu proved otherwise. Despite being anxious about having to adjust to clinical practice without my hands, I quickly saw how this would only be a constraint if I chose to let it become one.
Not being able to use my hands became an intangible opportunity rather than a barrier. It was an opportunity for me to build my observational and verbal skills. I quickly realized that an assessment of one’s ability can often been seen before it can be felt, and by asking the right question(s), I can gain an accurate assessment despite not being hands-on. Verbally, I honed my ability to give clear directions and feedback. Both of these skills will serve me well in the future.
The Kintinu team builds strong relationships with genuine care and compassion for each person, which creates a supportive atmosphere. At various points along the recovery journey, the amount and type of support varies to promote more safety and comfort or greater challenges to support the learning process. Paired with a keen eye on whether we are pushing people too far beyond their comfort zone or becoming complacent, we vary the complexity and intensity of our treatment activities. Ultimately, it is our job to educate and prepare our patients to take full accountability and ownership for their own health and wellness. Not being physically present during telerehab sessions places an increased responsibility on the client (and family members) to be an active participant in treatment. I found this to be another terrific benefit that was naturally addressed simply because of the virtual nature of telerehab.
This comes to fruition in a few different ways. First, when completing activities like transfers and walking that may be more challenging and provoke increased fear and anxiety, the clinicians use visual and verbal skills to set up the environment and explain the task, but ultimately, it’s on the client and family/support to execute. This increased responsibility allows the client to become more of an active participant because they must take education and apply it themselves to successfully accomplish a task.
This is also prevalent outside of actual sessions. The Kintinu team is adept at changing perspectives, and they understand their role is to paint a picture of hope by helping their client’s gain clarity on ‘what’ they have to look forward to and ‘why’ they want to achieve it. The focus on this as it relates to traditional rehab is not common and is especially difficult to achieve. This approach of identifying meaning, providing the right amount of support for success , and offering experiences just outside of one’s comfort zone are essential for long-term success.
Repeat, repeat, repeat.
There’s also an attitude of efficiency. Rather than telling someone to carve out an additional 30 minutes of walking into their day, they help clients blend therapy activities into their day. This change in perspective improves engagement and is an effective strategy to maximize repetition – another key aspect of recovery.
If you spend 10 minutes searching “physical therapy” on Instagram, you’ll see thousands of different pages with tens of thousands of different exercises. There’s nothing wrong with creativity, but a fallacy exists where many assume something needs to be fancy to be effective. I used to train athletes, and my mentor in this field would always say “do simple things savagely well.” I’ve carried this sentiment with me and encountered this same philosophy with Kintinu. They understand that at least 80% of our life is spent doing basic tasks, so practicing these tasks repeatedly is crucial to improving function and confidence. Repetition results in measurable progress. Another benefit of repetition with simple, but important, tasks is people are empowered because they learn that they have all the tools to be more independent in helping themselves. While working with Kintinu, I saw how this small detail breeds resiliency, which is a critical aspect of changing lives.