Pediatric physical therapist Kate Von Schuch reaches out a hand during a telehealth session on Friday to interact with her 9-year-old patient Brianna Marston, pictured below reaching out her hand as well. Her grandmother, Sharon Marston, attended the session with her from home in Woodstock. Also pictured, at bottom left, is Shenandoah University physical therapy student Julianna Smith, who helped facilitate the therapy session.

On a recent snowy morning, 9-year-old Brianna Marston and her grandmother, Sharon Marston, of Woodstock, called into a virtual appointment with staff from Shenandoah Memorial Hospital.

Brianna, who has been in weekly physical therapy sessions since last June, transitioned to virtual sessions in November, said pediatric physical therapist Kate Von Schuch.

Brianna’s sessions went virtual because of safety protocols during the COVID-19 pandemic, she said, but they’re also helpful during times of inclement weather.

“I think telehealth is something that’s not going to go away anytime soon,” said Von Schuch. “I think there’s a lot of value of providing flexibility.”

Brianna likes it, too, saying she feels safer being at home and not having to worry about wearing a mask.

“It’s really nice to be able to stay at home,” she said. “I just feel safe at home.”

Brianna attends the sessions to learn how to flatten her feet more as she walks, instead of walking on her toes.

“I am really struggling with walking flatfooted,” she said.

Von Schuch and Shenandoah University physical therapy student, Julianna Smith, help by offering Brianna various exercises and activities to strengthen her muscles, balance and coordination.

At a recent session, she did yoga poses, stretches and other movements on a balance ball.

“We do a lot of things with the balance ball,” Brianna said.

One of her favorite activities during the sessions is to stand on one foot while using the toes of her other foot to pick up marbles and move them from one container to another.

It helps with Brianna’s balance, Von Schuch said.

Other exercises help with heel-to-toe walking, “so that it feels better for her, too,” Von Schuch said.

“She’s one of our hardest working kiddos.”

Besides offering safer options during the pandemic and bad weather, telehealth appointments have helped physical therapists better coordinate their recommendations with the home environments of their patients.

It’s one thing using a balance ball during an office visit, said Von Schuch, but if patients don’t have access to this equipment at home, that can make their recovery more difficult.

Being able to see her patients’ homes also helps her assess their space needs and the height of the furniture they’re using to help them balance and perform exercises.

Smith said the virtual sessions are useful for assessing other physical needs or concerns that might develop. When Brianna started having back pain a couple of weeks ago, she and Von Schuch were able to look at what was causing that and address her family’s concerns.

For younger children, Smith said the home environment can put them at ease during their sessions while offering them a familiar setting among their toys while physical therapists talk with their parents.

Planning to graduate from Shenandoah University in August, Smith said she’s working with Brianna as part of her 12-week clinical at Shenandoah Memorial Hospital.

As she works with Brianna, directing her from one exercise to the next, she asks for the girl’s input and comfort level.

“Let’s do some single-limb hopping,” she tells Brianna. “Does that sound good to you?”

She asks Brianna to start on the left foot and “see how many hops you can get.”

After a few seconds, Von Schuch chimes in: “Try the left side, we’ll give righty a break.”

Afterward, Smith assesses Brianna’s experience.

“Is that easy, medium, or hard for you?” she asks.

Acknowledging that the exercise requires several components of attention, strength, coordination and balance, she reassured Brianna that she’s doing well.

“You’re able to do that 10 times in a row, so that’s good,” she said.

Though telehealth has its advantages, Von Schuch said that technical difficulties can still get in the way depending on patients’ internet access, bandwidth and electricity during and after a storm.

“It depends on the day,” she said. “We have two different platforms that we can use with the telehealth.”

But the benefits are many, she said.

Besides the safety aspect during the pandemic, she’s noticed the ease of accommodating homebound family members, such as children taking virtual classes, parents working from home and others who are isolating.

“[There are] quite a few families that are still staying home with COVID,” Von Schuch said.

“It’s still a way for us to have sessions, [to] see each other,” she said.

Going forward, it’s likely that area health-care providers will continue to offer telehealth as an option for their patients, said Kyla Sine, director of rehabilitation and fitness at Shenandoah Memorial Hospital.

“The COVID pandemic has encouraged us to consider our care delivery model,” she said in a Friday email. “We now are able to provide care in an alternate way when travel to the clinic is not ideal, either for safety reasons or illness.”

It’s a great way to broaden their abilities to care for the community, she said.

Marston, who lives with her granddaughter and attended the recent virtual session, said she works in the school system but was off that day. When she can’t attend, she said Brianna’s grandfather does.

“She is improving yes, I do see improvement,” Marston said.

“I’m just glad that she can continue this way,” she said. “I’m glad it was an option for us to do. It’s been a good thing.”

Contact Josette Keelor at