Providing telehealth

OT Services clinicians deliver patient care virtually

by Michele Berhorst  •  September 25, 2020

Left to right: Jill Jonas, MOT, OTR/L, conducts a telehealth visit with Susan Dirsa, who has post-concussion syndrome following a car accident. During the COVID-19 stay-at-home orders, Jonas used telehealth visits to continue seeing Dirsa bi-weekly.

“I look the same, but I’m not the same. That’s been the challenge,” says Susan Dirsa, 25, who has post-concussion syndrome following a car accident in July 2019. At the time, Dirsa was a psychology major at Maryville University in her senior year, and she found herself experiencing cognitive dysfunction. “It was hard in the beginning. There was no outward physical injury – I didn’t have a gash on my head, but I was not okay. My brain was on autopilot, and I felt very disassociated from my thoughts and emotions. It’s like the shoe hit the floor, and it laid there for a while before I realized what happened. I knew it was there, but I couldn’t pick it up. And I would tell people, what was coming out of my mouth was news to you and me. I would remember things, but not feel the emotion attached to the memories. It was extremely overwhelming.”

In addition to the concussion, Dirsa developed postural orthostatic tachycardia syndrome (POTS), a condition that affects blood pressure regulation and impacts concussion recovery. Individuals with POTS can experience lightheadedness, fatigue, headaches, chronic pain and other symptoms. It made Dirsa’s return to school in the fall even more difficult. Her primary doctor referred her to a neurologist, who referred Dirsa to Jill Jonas, MSOT, OTR/L, an occupational therapist in Washington University’s Occupational Therapy Services. Her area of interest is functional cognition, and Jonas primarily works with people like Dirsa who have experienced a traumatic brain injury, concussion or cancer-related impairments.

“The mild-cognitive area is exciting because there is neuroplasticity in the brain. My clinical approach is to encourage people to think about their goals and help facilitate them developing their own strategies that work for them in their lives,” explains Jonas, who started seeing Dirsa five months post-accident. “Her primary goal was to finish her degree. Despite the accommodations Maryville University put in place for her, there were many barriers she faced in managing her full course load.”

“Reading my textbooks was a big problem. My brain at once couldn’t process the information in front of me, but it couldn’t ignore it either. Jill suggested covering up one of the pages so I could concentrate better. Also, taking breaks after 20 minutes of reading so my brain could rest helped,” Dirsa says. “We worked on strategies for everything by setting realistic, attainable goals. Jill taught me how to break down each task and ask myself: What order do I want to do this in? How can I do it better? How can I solve the problem?”

Just as Dirsa was making progress through their weekly in-person sessions, the COVID-19 pandemic hit. Jonas was able to switch Dirsa over to bi-weekly telehealth visits. Dirsa, whose coursework also went online, was familiar with the Zoom app and eager to resume her sessions virtually. The COVID-19 restrictions created new mental and physical challenges for Dirsa, and Jonas helped her develop coping strategies during the pandemic.

“With POTS, I need exercise to help my blood pressure regulate. Because of the stay-at-home orders, I wasn’t getting out and exercising. That resulted in brain fog, and I couldn’t focus on my classes at all. Jill suggested I try yoga before class to help stimulate my brain. It helped me so much,” Dirsa explains. “I ended up falling in love with yoga, and I continue to practice every day.”

The Zoom platform gave Jonas a window into Dirsa’s world during the pandemic that she otherwise would not have had. “In preparation for the lockdown, I suggested Susan create a ‘classroom’ at home. When we met on Zoom for the first time, she showed me the room she had set up. She even made ‘class in session’ signs to put on the doors so her family knew not to disturb her. It was great – and it worked!” Jonas says.

With the various strategies in place, Dirsa was able to meet her goal of graduating on time in May 2020. As local restrictions eased, Dirsa was also able to have her final four occupational therapy sessions at the clinic with Jonas so she could thank her in person.

“Telehealth allowed Jill to be there for me when I needed her the most. I was at my most vulnerable point during the COVID-19 lockdown with school, stress and learning how to live my life differently. I couldn’t imagine going through it all without Jill. She has been one of the biggest, if not the biggest part of my recovery 100 percent,” Dirsa says. “She connected me to a concussion support group, and it helps to talk to others who are going through the same challenges I am in resuming life. Jill also taught me to advocate for myself and educate others about concussions. Above all, she’s helped me accept I am not the same person I was before.”

That acceptance led Dirsa to make the decision to wait a year before starting a master’s degree program in social work to give her more time to recover. Not one to sit idle, Dirsa is using the time to help children struggling with online learning as the pandemic continues. “It’s a blessing in a way – I wouldn’t be able to help these children if I wasn’t at this point in my recovery. Social work is my passion, so I see this as an opportunity for me to make a difference in the community now.”