Shining a light on BRILLIANT

Ivy Gumboc, the Coordinator for the Congé Précoce Assisté (CPA) program was interviewed by Lina Petrella, BRILLIANT’s Project Officer. We find out how the CPA program integrated telerehab services amidst the COVID-19 pandemic. Ivy and Lina also discuss BRILLIANT’s contributions to that transition and future plans for developing telerehab within the CPA program.

Ivy Gumboc, MScA, erg.

Coordinator Congé Précoce Assisté (CPA) / Early Supported Discharge (ESD) program, CIUSSS du Centre Ouest De l’Île-de-Montréal.

More than anything else, BRILLIANT has given us a light, to be able to continue with the rehab services that we are offering. It is provided light for the clients and caregivers.

Question: How has COVID impacted the way clinicians provide rehabilitation to patients? And how has it impacted the way clinicians work together?

Answer: I will try to summarize the changes, in three broad categories: adaptability, learning curve, and teamwork. There is a silver lining within this COVID pandemic, we were able to modify the way we practice, and modify interventions and rehabilitation provided to stroke clients and adapt our services within a virtual platform. Most of us have been practicing in the area of stroke for quite some time. You get used to the activities that you do with clients, being with them hands on, and seeing them face-to-face. Now, doing that virtually, and learning how to use the technology to be able to facilitate that and integrating your professional expertise with rehabilitation is a challenge the team went through. We faced that challenge by working really tightly as a team and this is something, I would like to highlight in the success of being able to continue providing CPA services to stroke clients. The teamwork has been great! In terms of interventions, we have had limitations, by adapting, we have been able to follow rehabilitation best-practices.

Question: What kind of feedback have your received from clients in the CPA program during this time?

Answer: Having a stroke, to begin with, is not something that is easy to manage. Having a stroke, changes your life, in an instant. Imagine that, in a COVID situation. There are many limitations. We are not able to get out of our houses. Even within your family, and the support that you can receive is very limited. Having a stroke, in that context, is difficult for the clientele. Surprisingly, and this is something very nice to see, you see a side of human nature. You are still seeing them adapt and push through their recovery and rehabilitation with the support of technology. As clinicians, we asked, are we going to be able to do this with our clients? We were worried that we were not going to be able to give them the best services, because it was being done virtually. Surprisingly, the feedback we have got from our clients, is that they are very thankful. They are thankful that they have access to rehabilitation virtually. They have access to a team, with expertise stroke recovery. They do enjoy the sessions. When there is a will, there is way. There is a will from the part of the clinicians, but most importantly, from the clients. For them, they have to learn how to use the technology, which is harder for our older clients. But they are on board. That’s amazing to see. To see a client, who is 90-years-old, who had a great interaction during a session – it is really good to see that! The issues with isolation post-stroke are being addressed with daily virtual sessions. They know, they will see someone every day. That component, is something that is great. I asked them, ‘What would be the difference?”. Some of them expressed, “You are not physically beside me. But I feel that virtually, the interventions are as effective as if we were face-to-face.”

Question: It seems like your clients are receptive to using technology.

Answer: Yes! I would like to highlight that we rely a lot on caregivers and their family. This is something that was always a key, even before COVID-19. Even before adapting to a virtual platform in CPA. With at-home rehabilitation, we have always encouraged caregivers to participate, but even more so now. They become our “camera” people. They carry-over the exercises with the clients because we are not there face-to-face. Then suddenly they become our extended rehab people-at-home. It’s almost like putting your hand through the screen, and they are the ones at the other end doing it with the clients.

Question: Have there been any limitations?

Answer: Yes, I have been asking them that. I ask them “Is there anything you think you are not getting from this kind of service?” I have asked at least three clients. The feedback, is more that they are grateful. They keep saying, because of the isolation due to COVID-19, we cannot be together, face-to-face. With that sense, the rehabilitation interventions they are receiving is fine for them.

Question: How has the BRILLIANT project been involved during this transition with COVID-19?

Answer: With the definition of ‘brilliant’, what the word brilliant is, is putting a light or glow on something. More than anything else, BRILLIANT has given us a light, to be able to continue with the rehab services that we are offering. It is provided light for the clients and caregivers. Because, with this type of intervention they are having the expertise of a stroke team dealing through the stroke recovery. With BRILLIANT, the technology, and the advice we have received, allowed us to implement our virtual interventions quickly. I know that the BRILLIANT team is going to continue with us to develop our tele-rehab practice and I am really, really excited about that.

Question: It seems that your team has been quite successful during this challenging period.

Answer: It is! It’s that teamwork. When everyone becomes onboard, the word ‘impossible’ becomes meaningless. People are able to focus on what we need to do.

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