By Ed Roth

Technology has a way of changing the way we see things, sometimes overnight. Since COVID-19 has become an unwelcome part of our lives, doctors and patients are creating a new normal for effective treatment. In several short months, the playing field has changed, thanks to telemedicine. In fact, many health care leaders claim the pandemic has accelerated the adoption of telemedicine by at least a decade.

It’s not a new concept; doctors have been utilizing this form of digital health since the late 1950s, when a closed-circuit setup connected the Nebraska Psychiatric Institute and Norfolk State Hospital.

Fast forward to 2020. With the coronavirus pandemic in full swing, traveling to the doctor’s office has become more difficult, and sometimes, impossible. For people recovering from brain injuries, being able to be treated without leaving home has become just what the doctor ordered.

For Christina Kwasnica, M.D., director of neuro-rehabilitation and the Center of Transitional Neuro-Rehabilitation at Barrow Neurological Institute at Dignity Health St. Joseph’s Hospital and Medical Center, telemedicine has become an integral part of her arsenal for treating people with brain injuries. “In the past, we used telemedicine to reach remote parts of the state where specialist providers weren’t always available,” she says. “Patients would have to go to a nearby clinic to participate and someone there, like a nurse, would help with the examination. Now, we can see patients virtually in their homes.”

Although her patients and staff miss seeing each other in person, and tech issues may emerge, the advantages outweigh the disadvantages. “I love seeing the family interactions, their pets, toys, etc.,” says Dr. Kwasnica. “It also helps me to see some of the challenges we face with our patients, such as how much space they live in, and how rural their home may be.”
Laura Johnson suffered a brain injury in 2007. Currently a patient of Dr. Kwasnica’s, she still has difficulty going to appointments. “Because of my brain injury, just driving to the doctor produces a ton of anxiety. From the traffic to the parking, navigating the hospital campus can be overwhelming. Telemedicine has taken away all that stress.”

Another enthusiastic adopter of telemedicine is Brain Injury Alliance of Arizona (BIAAZ) Board Member Katie Pierce, PT, DPT, a physical therapist at CoreBalance Therapy. Herself a brain injury survivor, she combines her personal and professional experiences to develop and deliver unique treatment plans for her patients.

“Some people had fear of technology, didn’t have Zoom on their phone, or were concerned about privacy. However, after the first time, they loved it…and I was delighted.”

Pierce cites several advantages, including treating people in their own environment. “One brain injury survivor patient was falling often at home. In our first telemedicine appointment, I helped him identify fall risks at home, like the throw rugs, and the protruding lip leading to the kitchen. Once we removed the barriers we could, and practiced safely navigating the others, he hasn’t fallen once in the past 10 weeks since we started telemedicine.”

Like Dr. Kwasnica, she favors a hybrid approach. “Sometimes there’s no substitute for touch. For instance, if they’re a high-fall risk, they need staff to guard them with upright exercises.” She adds, “I think once people can come back in the clinic, it could be ideal to have one session weekly in the office, and one over telemedicine at home.”

Perhaps the most surprising feature of telemedicine is how insurance companies support it. It is covered by most insurance plans, including Medicare and Medicaid.

Ed Roth is the communications director for the Brain Injury Alliance of Arizona.