Challenging aspects of therapy – collaboration, co-treatments and international therapy – are now becoming more common through the Internet, which enables a free flow of ideas and information undreamed of only a decade ago.

Virtual therapy, remote medical monitoring and therapy forums are bringing together professionals and patients who would otherwise remain isolated. Researchers hope the current cyber-sharing trend will move from informal therapy blogs to encompass international collaboration for peer-reviewed clinical trials.

According to a collaborative Journal of Physical Therapy Education study, “The Feasibility of International Collaborative Assignments Using E-mail,” combining collaborative classroom projects with advances in Web-based learning environments “allows [for] virtually limitless international collaborative learning opportunities.”

The Problem
Despite the widespread use of the Internet, specifically e-mail, in both formal educational contexts and informal student contexts, study authors Marie Williams, PhD, associate professor at the Adeliade-based University of South Australia (UniSA) and Robert Feldman, MPT, associate professor at the University of the Sciences in Philadelphia (USP), say there are only a handful of published studies examining its application for collaborative learning and teaching.

The Project
Williams and Feldman filled the gap by creating an international, collaborative project for U.S. and Australian physical therapy students. The study investigated practice methods for international collaboration between 84 students from UniSA and USP. Students were divided into groups, given one of five patient-based scenarios and asked to develop goals and interventions for each scenario.

According to Williams, participants say the project enhanced their knowledge about developing treatment plans and working within international healthcare systems. Williams says, “Collaborative educational projects via the Internet between two geographically distant universities are both feasible and beneficial. This will hopefully lead to additional international educational collaborative uses of the computer, perhaps in areas such as peer review and research.”

The study used e-mail as the main form of communication because it is readily available to both individual therapists and large universities or teaching hospitals. Researchers postulate that using a simple medium to begin the collaboration process will help to create an international dialogue between therapists.

Feldman also says several studies illustrate “the cost effectiveness and efficiency of e-mail as a teaching medium in fields such as computer engineering, contextual language practice, medicine and developing international or cultural awareness.”

The Process
UniSA requires students to present a patient case to an international colleague, reporting similarities or differences in patient management between their experience within the Australian healthcare system and the response given by the colleague.

Williams and Feldman built on that by developing five client scenarios covering practice areas including multitrauma, lung volume reduction surgery, pediatric cystic fibrosis and spinal cord injury to compare and contrast U.S. and Australian treatment protocols.

They asked participants to solve scenarios including management, creating a therapy program including adjunctive equipment, cost and insurance issues and determining which insurance system best addressed needs.

According to the study, students say the project broadened their horizons as future therapists, that it was “quite rewarding,” and worth repeating. One student commented, “The project was very interesting in that we were able to learn differences in treatment styles and access different insurance information.”

Cyber-Space Challenges
Williams says student feedback indicated the project “highlighted and facilitated an understanding of international management.” However, she adds that students faced a challenge in “locating, accessing and receiving timely responses from international colleagues.”

One possible solution is to build networks between international universities and hospitals to create a seamless flow of information between students and international therapy professionals. Through these programs, Williams and Feldman hope to create larger networks that could facilitate collaboration with therapy research and possibly, set international treatment protocols.

Future International Collaboration
Collaborative assignments between international university programs are proven to expand student’s horizons, says Williams. She cited a Future Child study, “Changing how and what children learn in school with computer-based technologies,” suggesting that computer-assisted learning “needs to encompass four fundamental characteristics of learning: active engagement, participation in groups, frequent interaction and feedback and connections to real-world contexts.”

She encourages the further development of dedicated, shared Web sites between international universities, including student self-publishing, to eventually “permit greater educational opportunities, such as peer review.”

Active learning, as opposed to simply sitting in a classroom and listening to a lecture, boosts students’ retention and, according to Williams, “with careful and considered educational and resource planning, collaborative assignments between geographically distant, but similar, professional training programs has the potential to expand professional curricula.”

International Therapy and Resource Disparity
Kelly Nastasi, MS, OTR/L, knew she wanted to work in the medical field since she was 13 years old. In 2005, she spent two weeks on a medical mission to Beius, Romania, where she saw children not only in need of treatment, but also in desperate need of food.  
 
Now an occupational therapist at the Charleston-based Medical University of South Carolina, Nastasi says she will never forget when orphanage workers explained that Cheerios, brought to help the children work on fine motor dexterity, were also desperately need for the children’s breakfast.

Nastasi says, ”One of the workers, very humbly and in broken English, asked if it would be okay to use the Cheerios for breakfast for the children as well as a therapy tool … we never think about how precious a simple box of Cheerios can be.”

Nastasi now appreciates U.S. therapy resources and protocols, particularly after working with a woman in the orphanage who “wrote down literally everything” therapists suggested to help the children reach developmental milestones.

Working with patients who would travel for miles by horse or train to see a physician, Nastasi says they did not understand that therapists were providing free treatment. “The concept of doing something out of the goodness of your heart was really hard for these individuals to grasp because they have such a hard government to live in,” she says.

Sharing Collaboration Lessons
As U.S. therapists work to increase collaboration between disciplines, Nastasi hopes they will share the knowledge they gain with healthcare workers who are struggling to feed, let alone treat, pediatric patients. For healthcare professionals struggling to prevent developmental delays, using the Internet to send diagrams or photos of treatment positions “would be invaluable,” Nastasi says.

Nastasi provided an example of a child in the Romanian orphanage who, at 14 months old, could not crawl. She says the healthcare providers there had never heard of simple modalities, such as tummy-time, to prevent future fine motor deficits. “It would give the workers a point of reference and specific activities to help children reach milestones, especially for rescued babies that were [previously] chained to cribs all day.”

For therapists working to implement collaboration within their organization, she suggests developing working relationships with colleagues, using each other’s expertise as a resource. Nastasi says, “So many of our children are in a medically fragile state and do not [tolerate] lots of stimulation throughout the day. If therapists can coordinate certain days to see the patient, or plan to ‘cluster‘ care, our patients will have a much better outcome.”

Kate DeBevois is the staff writer for Therapy Times. Questions or comments can be directed to kdebevois@valleyforgepress.com.