So good to see everyone joining us. We'll give everybody just a little bit of time to come in from the waiting room and a couple, a little bit to log in, but we won't hold it for too long. We've got a lot of great stuff to cover this evening. Well, I think by the end of this, you might get tired of hearing me talk anyways. So with that, on behalf of the Pediatric Rehabilitation Community Leaders, Dr. David Burbrare, Mike Green, Mary Dubon, and myself, Jolene Brandenburg, welcome back to the 2020 AAPMNR Virtual Annual Assembly. This is our Pediatric Rehabilitation Community Session, Session Two, and thank you for joining us for the second part of our two-part community day. We had amazing lectures on Tuesday for the first Pediatric Rehab Community Session and yesterday at the Rady-Peds Rehab Pre-Day and are looking forward to more this afternoon. And for those of you who are not yet members of this Pediatric Rehab Community, please check out the AAPMNR website. We welcome everybody. Click on Join or Renew at the website. Scroll down to the orange Join a Community button on the left-hand side of the page, super easy. Click on the Peds Community and voila, you are now a member. So during this session, please be sure that your microphones are muted. I think everybody's muted coming in. And also we're asking for you guys to turn your cameras off too to help us be able to focus on our presenters. Please put any questions that you have for the speakers in the chat box in the Zoom control panel. And you can also send messages to the panelists and to all the attendees via the Zoom chat function. I think you all have done a wonderful job of using those already. To claim CME credit, you will need to complete an evaluation for each session you attend live or watch on demand during the assembly. All sessions will be recorded and made available on demand until July 31st, 2021. And for those of you who missed session one, it's already available and on demand for you to watch. Visit the Member Resource Center if you have questions and also note your feedback on the evaluation does help the Program Planning Committee outline content for future annual assemblies. So please ensure to give suggestive content for us. For today's session, we have two presentations. First, we have the past, present, and future of pediatric tele-rehabilitation, quite timely in this day and age. This will be presented by Josh Alexander, Louise Speery, Bob Rinaldi, and Lauren Davidson. Following this, we will have the Pediatric Community General Meeting, which will be run by our community leaders. We will adjourn around six o'clock central time tonight, and at seven will be the general session with Michelle Gitler running that. And with that, I will turn it over to our first set of speakers, and Bob, go ahead and share your screen. Cross your fingers, please. I am not technologically savvy. Hey, look at that. All right. That's great. I'm Josh Alexander. I get to go first. And what I want to first say is that when the four of us started talking about doing this presentation a year ago, we proposed this presentation because we thought that it would be a good idea to share what we know about pediatric tele-rehabilitation because most people weren't doing it, and most people didn't know about it. So we thought that it would be a great idea. And so we put a concept to introduce this to people and encourage them to be able to do this. So what a difference a year makes. I tell people around here that perhaps one of the few silver linings in the COVID cloud is the discovery of telehealth. And this is something that right now what we're going to do is talk to you a little bit about various aspects. Can I go to the next slide, please, Bob? Okay, as we go on, these are just some basic objectives for it. Know how to access resources that you need for telehealth. Create different models of telehealth delivery. Look at some of the research potential overall. These are overarching objectives, and we have a few more embedded within the presentations. You're going to have four presentations. I'll be the first. We'll have three others, and then we'll have hopefully some time where we can all talk together, because right now, we're all experts. Many of us have done acetyl health, so we'll try to learn from each other and share our expertise with each other at the end. Next, please. So, what I'm going to do first, whoops, actually, back for one second, I'm going to start with a brief history of pediatric telerehabilitation, and those of you who know me well know that I've been thinking about pediatric telerehabilitation pretty much every day for the past 22 years, so it's been something on my mind, and I'm just so happy to be here with my co-presenters and this is really not a culmination of anything. This is the start, I hope, of moving forward for all of us as a group, perhaps, towards providing increased access to services for the children and families that we serve. Next, please. So, I have nothing to disclose, so let's start. The first program, really, one of the first telemedicine programs for children with disabilities was started by a neuropsychologist and some others in Iowa. So, Dennis Harper and his colleagues started with a hub-and-spoke approach. The hub is where the expertise is, and the idea is to share that expertise out to lots of different places. It was the most common type of telerehabilitation perspective, initially, and has persisted until this day. Next, please. So, his project was actually just one of five clinical research projects embedded in the National Library of Medicine grant, and basically what they did was they did multidisciplinary team-to-team consultations. So, it was a team on one end providing the expertise to area teams around distal sites for children with special healthcare needs in rural Iowa communities, focusing on schools, and they evaluated the efficacy, and basically, they found that it was useful. Next, please. Oh, right, here we go. Next year, the next, they did something similar in the Medical College of Georgia. They did a hub-and-spoke as well, but this was basically not really, they said special needs, but really it wasn't the populations that we serve as much. Thirty-five percent of it was pediatric allergy immunology, 29% pulmonology, but the idea was to serve children with special needs in rural communities across the state, again, using a hub-and-spoke approach. Next, please. In 1996-97 at UT Galveston, so everyone down there in UT and Texas, they had, it was like a hub-and-spoke, but if you look at it, it was really just two sites, so I call it, it's like the hub and, it's the water molecule kind of hub-and-spoke, where they had two nursing schools where a primary team provides services to see if it was feasible. They said, can a tertiary interdisciplinary team provide that? Would patients and caregivers be satisfied? The answers were yes. Next, please. So this is what I've been doing most of my time for, gosh, the last 20 years or so. In 1998, we started TELLAbility, which was, as you can see, a community-oriented interdisciplinary program designed to enhance the lives of children with disabilities. Focusing initially on birth to three, we used the early intervention centers around our state to provide the services. So we did real-time video clinic visits. Sometimes it was team-to-team, sometimes it was person, expert-to-team. We also did interdisciplinary educational programs, and shout-out right now to everyone who's been doing all the great pediatric rehab medicine, you know, nighttime sharing with looking at article reviews, educating each other. That's what we need to keep doing for ourselves and for others. We had a searchable online directory so that the key was to find those experts across the state in the rural and urban sites who knew mostly about autism here or communication there, or feeding over here, and to be able to identify them and then use the same equipment to make kind of super teams across the state. We had also chat rooms, which we eventually threw out because they were too slow. Dread discussion lists had the same fate. We had listserv in communities, and the listservs were both professionals and families together. So there was no separate listservs for parents or professionals. Everyone was together as a community to offer support, ideas, where's the best person who can do this, where can I find this, I've got an extra piece of equipment to share, and the like. One of those listservs is still active, probably has about three to 350 people, and we still get posts every day. We had an equipment exchange post where people who had outgrown their equipment and no longer needed it could offer it up to other people, like a free cycle early on, and you can read the other things we had here, links, articles, medication information was made for parents that could understand the side effects, the articles that we would read. We also gave reviews, but they were parent-friendly. Next, please. So the difference, I think, in this case was it was an interconnected network of early intervention centers, developmental daycare centers, pediatric residential facilities, private therapy practices. So everyone worked together, so we built a community of practice using each other's expertise as opposed to using that central hub and spoke. So as you think about what you're doing today, we're all serving our families in the kind of classic, I'm going to take care and provide that service to you model, but I want you to think about maybe how can we use that model and use the new technologies to expand this further across our states and country and world. Next, please. So this was basically an example. This would be, this is our 18 sites that we had across the state of North Carolina that each served a different color-coordinated area. No one was more than 100 miles from any one of these sites in the rural areas. And what we did was you could use a searchable database to identify those people who had the expertise. So for example, where I live right in between area 10 and 11, that's where I live in Chapel Hill. But the expert who had, a feeding expert, the best one in the state, the one I want my child to see was in area 17 at the very bottom. And the person with communication expertise in all com AEC devices was in area two. And the like, and going so on and so on. So we identify those experts. We could build super teams that could then multi-point video conference into any other site to help that patient get the best service they could. We coordinate those things together. Next please. So then what we did after that, oops, yeah, what we did after that was we thought, okay, why don't we become a little more granular? So actually if you go back one, Bob, I'm going to test your ability to go backwards if you can. All right. So area 12 is Raleigh. It's Wake County. It's the largest. It's our capital city. And so what we ended up doing was we ended up taking that, if you look at the shape of that and then go to the next slide, this is Wake County. And what we did was we went more granular and we could find every therapist, every private provider, every smart start, more at four, early intervention, some of the preschool services, everyone in all those geographic areas. And we made them into a directory, the expertise directory that a parent or a professional can say, I've got a three-year-old in this area who needs PT, OT, speech, maybe any autism sources. They click a button and they automatically will get the five or 10 sources in their area with links to those places so they could find those resources. Next please. Oh, next. Yeah. So let's go. Where are we? We've got about three or four more minutes now. So I'm going to make it really short, but where are we in 2020? Much better place. When we started this way back when we weren't cutting edge, we were bleeding edge because it really hurt. A lot of times there's technology issues, a lot of other things, but now things are much easier. Startup costs, much lower, credentialing, in some cases, non-existent needs, licensure. There's now a licensure compact that more than half the states in our country, you can get your license in over 25 states potentially at the same time. So it cuts down that paperwork if you need it. Connectivity is still a problem. Although we're going for 5G in some places, the rural areas in our country still needs to improve the access. HIPAA security is much, much better and easier. Payment, right now we're doing great and that's why everyone's being able to do it. Is it going to persist after the pandemic? We'll have to wait and see. And then the seventh one, which I didn't, I forgot to put here is legal issues. Legal issues are the same today as they were before. So if you ever have an evaluation where you have a concern, you're not quite sure if you make the call, tell the family that. Do not try to make a call because you are just as legally responsible when you're doing a telehealth anywhere in this country as you would be if it was an in-person exam. You can't figure it out. Don't try to make a call. If you don't feel comfortable, trust your gut and bring them in. Next, please. So two more minutes, I just want to go briefly, where are we otherwise in 2020? I mean, where are we? Where are we as pediatric physiatrists? So just, I went to the ABPMNR page just to see where people were. If you look at this, there's a discrepancy, there's a maldistribution, typically concentrated around states where they have big training programs. People like it. They like it. They move there and they go and live in the area and they grow bigger. So if you look at that, there's probably, what, 12, I have to look at the count, but there's 12 people, I think, in general, or 11 states, I think, with double digit numbers of pediatric physiatrists. Meanwhile, there are 12 to 13 states with absolutely none. And so what can we do? Well, we can convince people to go and move to those states. We could also provide telehealth services to adjoining states and get licensure in adjoining states, which in many of these cases, they have the ability to use that compact. So my hope, if we look at the next slide, please. So again, and thank you for everybody for telling me about, the numbers may be slightly off, but I swear I got them from the ABPMNR, tell the ABPMNR cabin about those numbers. So I want to move from the difference of having people in their states. I want us all just to think about my vision in the last half minute of this presentation for me. My vision is for all of us to get together and kind of scale that model of expertise that we have, that we've done in North Carolina and make it, next slide, please, make it a national type of program. So this is something that, you know, for probably the next 10 years of my life, I want to try to work towards. And if any of you have interest in that, desire to share that vision, please contact me offline or we can talk about it briefly at the end of this presentation. So I have about five seconds left. So I'll say thank you for your time. Thank you for coming up. And next up, Louise is going to be giving her presentation. Thank you. Thank you. Appreciate it. That's great. So I'm Louise Speer from the University of Florida in Jacksonville. And we can just jump onto the first slide of the, where it says, what is a telehealth resource? So I'm going to talk a little bit about resources for telehealth. No disclosures. So, all right, so talking about resources, healthcare has been described as a limited resource with unlimited demands. So how do we utilize this new ability to reach patients for our patients? What do we need when we're looking for resources? Can you go into the next slide? Thank you. So a lot of times when we talk about what we need for telehealth, administration is kind of looking at you like, well, what do you need on your cart? So the telehealth cart, the physical resources tend to be where you start. And honestly, there isn't all that much that's specialized for physical medicine and rehab. And when we were really developing during early COVID, we had some before, but really developing, I called around and said, you know, what are you using? What equipment do you need? Because there was some interest in that. But really a camera, audio, you know, a good ability to connect both ways, a stationary cart, maybe if you're getting fancy, one that swivels for following the patient. But a lot of the other things we just don't use as much. And certainly if you have grants, improving the connectivity on the other side, lower devices and various other things, a high-speed router is helpful. It is interesting that there's some apps out there that I would love to see a better, some presentation on maybe for next year. So there's a goniometer app, there's developing in Australia, an infant movement app. So you can actually just kind of videotape infant movements and use that for measurements, kind of similar to the general movement skills for looking at early signs of CP, gait pathology. So our visual scanning of gait is not terribly reliable. So having something videotaping gets you an extra level, but maybe in addition to that, you can involve some apps. And in terms of looking at it, there's a few things in development. Next slide, please. But if you're really thinking about, well, what do we need in our card? And you're looking at, well, what do we need for the physical exam? What do we need for telehealth? If you're talking about Ashworth strength, range of motion, really the only way to do that is to have haptic technology, to have the ability to remotely sense movements and you sort of put on a device and there's maybe a computer goes to your, I mean, a robot goes to your patient's home and stretching. It's the stuff of science fiction. I don't think we're gonna be close to there. And even when the technology comes out, we're probably not gonna be able to outbid other places like the military, the entertainment industry, but do you really need to be at that place to have a good reliable exam? And one thing to think about is how reliable is your exam already? So there's been some studies looking about, kind of medical decision-making and examination and if you look at, there's not really a great article of final physiatry exam, but you use as a marker, the neurology exam, a lot of what's truly reliable on your exam is what you observe. So observing muscle bulk, observing movement, observing asymmetry, even spasticity, you can get an idea as the patient's being moved and stretched, is there spasticity? You can't grade it obviously, but you get a sense. And perhaps more than trying to have a robot the patient is really trying to do a very standardized exam and the correct exam for the patient's diagnosis. So the Asia exam and other types of exam, I think could be modified for telehealth and you get a lot of data with that. And then certainly examiner training and experience, which that's a resource too. And we're in a time when physicians need to be and advanced practice providers need to be so very productive, but really thinking about the training and the time that we take as being a resource that's necessary to build this. Next slide, please. So our very tragically limited resources, pediatric physiatrists and also time. So the last slide when I talked about the inter-rater reliability of an in-person versus a virtual neurologic exam, they found things were very similar, but they found the virtual neurologic exam actually required more time. So you need to be in a safe place. You need to be set up. The cameras have to be in place. I think we all have kind of horror stories of people that were in their cars or we had a child almost running the road and screaming, mom, stop, stop. So you really setting up and explaining what happens on the exam and getting things set up. So we've had to hire additional medical assistant when we switched to mostly, well, for a while there, we were almost all telehealth and now we're probably about 30%, maybe even a little bit higher than that. And it takes a lot of time. So that's another valuable asset you need to bring and then connecting to the community. So the community therapists, the community providers, and I think that this was a wonderful presentation before, but thinking about how to use those types of resources. Next slide, please. And then certainly you need adequate space and you need to help the family know how to be there and adequate setup. Next slide, please. And then certainly, so in addition to needing that type of a resource of your quality of exam, the app, the connectivity, this new availability of telehealth, I guess the technology itself is not so new, but the availability of it, it has a lot of potential. I mean, healthcare availability, healthcare resources have always been distributed in ways that kind of reflect the inequities in our system. So rural patients don't get adequate access, patients that live long distances to centers, patients in communities where transportation is an issue is a big difficulty. But we have now the chance to build this and there has been attempts to support this in the past. So there are groups like the National Telehealth Resource Center, which was supported under the safety net amendments of 2002 and maybe will be again, grown and developed. There's certainly examples of states, states being able to build these types of resources. So that Georgia, your sweet Georgia, it's really kind of leading the way. Hopefully we're headed that way. Georgia has done a lot in terms of building with budgets and we're starting to see a sliver of that in Florida, but trying to emphasize and develop the importance of this. And I just kind of happened to see in the chat that Dr. Murphy jumped in as, it can do everything, of course not, but it's a chance to really build this resource. And most of our patients, we don't see them fully telehealth, but we have had patients that we haven't seen in years. I mean, it's been two, three years and they're coming back in and we can actually see them as a virtual visit. And it just was that whole restriction in terms of trying to get in to see us, trying to find a parking space, trying to find reliable transportation. And sometimes when we have a chance to really meet them and it's amazing how much you can bond over telehealth that you really, I was very skeptical to begin with, honestly, that we would do that, but it's a chance to really kind of let them know what can be offered and then it sort of opens up that relationship. So I'm hoping that we'll see this grow and develop further. Thank you so much. I don't wanna take too much more time. So I just move on to the next presenter. Okay, that would be me. I'm Bob Rinaldi. I'm down at UT Southwestern in Dallas, previously up in Kansas City Children's Mercy Hospital. I'm going to take a little bit of a different tack. In my previous life in Kansas City, I was the Medical Director for Telehealth Services at the hospital, and was charged with coming up with new strategies and helping divisions and sections strategize ways that they could uniquely apply telehealth services. Reaching back to Josh's presentation beginning this talk, there really is a lot of power in integration of telehealth services. As Josh so eloquently demonstrated, is they're doing the tele-ability in North Carolina. I think that's the real power of telehealth, is being able to integrate different specialties and different services, and hospital services through this method. I'm going to go through some basic information first, and then look at some different novel approaches to application. I have no disclosures at all. What is telemedicine? I think if we had taken a poll of everybody in this room 12 months ago, I would guess probably 20-30 percent of people have some experience with telemedicine. If we took a poll now, I would guess that 90-100 percent of you have experience with telemedicine simply because of COVID. It grew out of necessity that we had to reach out to our patients, so we developed telemedicine services fairly rapidly. Subsequently, we've been able to provide services, not ideal, certainly, but services are being provided until healthcare is being delivered to patients. Now, the COVID model, as I like to call it, is somewhat limited, obviously, because if you're interacting with your patient typically in their home setting, so there are limitations to that in terms of how you can actually do the examination. Telemedicine really expands way beyond that type of model that many of us in the room here have been utilizing and experiencing. What is it? Well, it's the use of medical information exchanged from one site to another via electronic communications to improve a patient's clinical health status. Josh and I had the same cartoon because I think it's a very good cartoon, 60 years old now. I'm not aging myself, but I remember watching Jetsons when I was a kid being fascinated by this doctor in the television thing. No, I am not 60, I'm closing in on it, but not quite. Some definitions that we utilize when we talk about telemedicine services are asynchronous service, which is basically store and forward transmission of medical images or data. Radiologists, dermatologists, pathologists typically are utilizing asynchronous telehealth models as they upload images and transfer images to other facilities for evaluation. Then there's remote monitoring, which is the use of mobile medical devices to perform routine tests and send that data to a healthcare professional in real time. Basically, home EKG monitoring, things like that where that data is acquired and sent to a professional who's monitoring that data in a distance. What I did in terms of intraoperative neurophysiologic monitoring Kansas City for 18 years, that was all remote monitoring capacity, where we were observing surgical cases in the operating room and looking at evoked potential data. Then there's synchronous telehealth, which is what most of us are used to where there's interactive video connection between you and your patient, where information is being transmitted in live time on video back and forth. What is the rationale for telemedicine? I think it's been covered pretty nicely in the first couple of presentations here. One, the big thing is it improves efficiency and delivery of care. I think that's been shown in the literature. It can reduce costs, which has also been shown in the literature, and it increases access to telehealth services. I'm in full agreement with Josh's model of one united country in terms of healthcare delivery through these means. As he noted, there are many, many states without pediatric physiatric healthcare, and this provides a mean to deliver that. It absolutely does. The goals in my mind is developing a telehealth program is really to align your clinical development with changing landscape of healthcare and with the hospital vision. It needs to be flexible. It has to be able to meet the changing needs of the different divisions in that hospital, and it needs to support and complement the hospital outreach programs. That's why I say it really needs to be an integrated program across the hospital and across your division. When I got to Dallas, I was fairly blown away by the complexity of the model that Dallas Children's had in place. They had a tele-emergency room and tele-NICU services where they're providing interactive consults at partner facilities throughout North Texas. Tele-consultations, which are non-emergent. These could be either synchronous or asynchronous consultations predominantly run through neonatology and our neuroimmunology programs. We had technology-enabled remote interpretations, again, asynchronous, as well as remote lifetime monitoring. We have a robust outreach program to schools. We're providing primary care services into the school as well as behavioral health services. Then obviously with COVID, we've developed a fairly robust provider to home program and delivering health care services appropriately. Some basic models, I think when you break this down, there's some basic models you can consider in looking at telehealth and applying it to your practice. There's the remote specialist, us, to the originating clinical site model. We are connecting to a patient or an originating site. Now, that can be us connecting to the patient's home. It can be us connecting to an outpatient clinic, so brick and mortar facility that your hospital may own. An ambulatory clinic, say for me in Tyler, Texas that I would link into from either my home or my office in Dallas, I can see patients that Tyler, Texas clinic. Then there's the physiatrist to hospital connection. That can be any hospital in your network. If you have referring facilities, you can, in theory, be a consultant in that referring facility. You can have credentialing and privileging in that facility and provide inpatient physiatric consults. For instance, one of the models we're working on is creating a model with the hospital in Amarillo, Texas, where we are basically consultants. We're on staff at that hospital and we are telemedicine staff and we're providing consultations to patients in real time. There are different ways that you can reach out and really build this model. Ideally, an optimal model is having personnel, the originating site that can facilitate your session for you. As Louise noted, the bulk of what we do can be observational, but you can also have somebody facilitate that exam for you, whether it's a therapist, an RN who's been trained in a physiatric type of assessments. That ideally gives you a little bit more objective data perhaps than just an observational examination. So ideally, if you want to optimize the visit, you have an originating site that has a facilitator for you to give you a little bit more objective information. There are different models that are built around how to facilitate an exam. There are proctoring models as well, where the remote specialist links into a clinical site with trainees and can provide proctoring as those trainees are trying to get proficiencies in either examination or procedures. And that can be a specialist into the operating room, for instance, or it can be a specialist into a clinical site, for instance. An example would be, say, a surgeon in Boston who's proctoring surgeons in Dallas who are trying to get proficiency in new surgical techniques. That model is actually fairly common across the United States. So proctoring is absolutely something that's out there and something we, I think, as physiatrists can consider. And then there's training types of models, where again, the remote trainees are linking into a clinical site that houses a specialist or a trainer. And that individual is providing training to multiple trainees at the same time. So international surgeons, for instance, observing surgical procedures in the United States at a single facility. You know, the interesting thing to me is can we translate these types of models, probably these training, proctoring and training models into PM&R fellowship programs and into PM&R training? So if we have a residency program that doesn't necessarily have a strong pediatric, physiatric presence or presence at all, can we provide a clinical presence through telemedicine for that program? And this goes back to that whole idea, again, of integrating services so that everybody benefits from this technology, right? So there's really a lot of power if you think about integrating this across or in multiple ways. And finally, there's an e-consult model where you're providing consultation services through telehealth. That can be either asynchronous stored forward processing of information and data, or there are some models where the specialist actually goes into the primary care physician's office to see a patient with the primary care physician. So there are different models to this. The advantage of e-consult modeling is that it gives fast access to subspecialist input, can potentially lead to a decrease in unnecessary testing that has been shown through some studies out there, and a decrease in unnecessary referrals. You know, we did a quick evaluation of the community in Kansas City when I was up there previously, looking at what parents wanted in sort of that communication between primary care physician and subspecialist, because our wait times were fairly extensive for patients to get into subspecialists for care. And the parents really, their primary thing was they just wanted to know if the primary care physician had spoken to a subspecialist about their child. That was goal number one. And if they had done that and the primary care physician had a plan in place, then the family was happier with that wait time to get in to see that subspecialist, if in fact they had to. So that initial communication can be addressed through e-consult modeling. So there is power in a fairly simple thing. What, kind of looking at sort of building a system and building a model of what we're doing in Dallas is building, again, sort of this hub and spoke type model within my division. What we've got in place right now in the green and what we want in the other color, I'm colorblind for you guys who know me, so I'm not even gonna try to guess what that color is, is we have the central physiatrist and we can function out of our home, our office or our clinic. And ideally we can reach out to the inpatient rehab facility if needed to evaluate a patient or to see one of our patients for a reason. We can reach into the patient home and provide services, which we're doing right now in the COVID model. We can reach out into the PM&R clinic. So if you're home sick, or many of us have young children, if we've got a child who's home that's sick and we wanna be home with that child, we can still hold clinic. You can still do it through telemedicine. So those are the three sort of spokes we have in place right now and hoping to put e-consult in place as well as referral hospital consultation services, as I mentioned, and then getting into our own hospital floors to provide quick e-follow-ups or telehealth follow-ups on patients who may be following in consultation because our clinic is offsite. So a lot of different ways to look at integrating this technology into your practice to make you more efficient, to expand your outreach and to help patients out, such as we're doing right now in the pandemic. Two unique clinics that we had in place in Kansas City, I'm gonna briefly mention these because I think they have somewhat of a unique twist to them that sort of lent a little bit more power to the model. Our regular eclectic clinic, we had the originating site for our patients that we were seeing was a regional hospital in Wichita. We ran our remote service through our clinics in Kansas City. So once a month, we would reach out to that hospital in Wichita. The patient would be with their occupational therapist who would facilitate the examination for us as a brachial plexus team. And then I had my occupational therapist with me who could help with the evaluation from my end. The power to this model was that that OT in Wichita now had direct face-to-face communication with an OT hand specialist whose background is brachial plexus injury management. So there was this transfer of knowledge, right? So there's an educational component element associated with it as well. And we ran a seating clinic that essentially did the same thing. The seating clinic is down in Joplin. And we ran the physician service through Kansas City, and it was the same element. We could provide physician oversight of a seating clinic in an outpatient therapy facility and provide that level of expertise for the therapist doing the seating evaluations with their local vendors, something they had not had previously. So really, again, it's a powerful tool. You can look at very creative ways to apply it and different strategies to apply it to help your division. Couple of quick practical caveats. One, not all populations or patients are fit for this model, obviously. The face-to-face, hands-on visit cannot be replaced nor should it be replaced completely. I think a hybrid model is the best approach. Skilled, trained facilitators are necessary for complex, comprehensive evaluations, much easier than you think. It can increase your clinical reach as well as productivity. And state and federal regulations can be a limiter, but those barriers are beginning to break down and hopefully will continue to break down moving forward once we get out of the pandemic. So that is all I have. I'm gonna move into the next presenter. Thanks, Bob. This is Loren Davidson, and my presentation will be talking about some of the evidence that we've obtained supporting telephysiatry. As you guys all know, every good research project starts with an acronym. So ours was STARS, School-Based Telephysiatry Assistance for Rehabilitative and Therapeutic Services. And we were looking at children with special healthcare needs in California in rural and underserved communities. Next slide, please, Bob. So our work was supported by a grant from the Agency for Healthcare Quality and Research. Next slide, please. So the objectives of this talk, I'll kind of review our parent and therapist as well as physician satisfaction with telemedicine. We'll look at the economic impact of telemedicine from a payer perspective, and we'll discuss our program design and implications for sustainability and efficiency. Next slide. So in the state of California, our state Medicaid system is known as Medi-Cal. Under the Medi-Cal umbrella, children with special healthcare needs are served by California Children's Services, and that's CCS. So it's a large state. There are currently 130 MTUs in the state of California. So every county in the state is responsible for having a means to meet these children's needs. And so they're served through medical therapy units. The state currently employs approximately 600 full-time PT and OTs. It serves approximately 23,000 patients. And physicians, either physiatrists or pediatricians serve as medical consultants, providing medical direction, therapy orders, orthotics, and durable medical equipment. The map to your right, the colors indicate, the purple is actually the primary practice location for Peds Rehab. The green is where the Peds Rehab docs are traveling to to see these kids either via driving in car or potentially telemedicine. And yellow really are underserved areas where there either aren't physiatrists and families would have to drive there or potential great targets for telemedicine. The physicians, by way of relevance, they're only paid an hourly rate while they're seeing the kids in clinic, and they get a small amount of reimbursement for traveling mileage-wise in their car one way only. Next slide, please. So this slide just further illustrates the provider gap. It may take half a day for a physician to drive to a rural clinic. The outreach clinics are often difficult to sustain. They have low patient population, so you may drive three hours to only have to see four kids. Very hard to justify that with your employer due to the lost productivity. Children and family, if you don't, children and family, if you don't, or unable or unwilling to drive out there would otherwise have to drive to the tertiary care center to see the specialists. And I think telemedicine is a great model to bridge that provider gap. In our state, many of the academic centers, because the reimbursement for these state-funded programs is not great, they've actually threatened and in some instances actually pulled their physiatrists out of these clinics. So when I started this project, it was actually more to find a sustainable model to keep providing care for these kids. Next slide, please. So this was our study design. Our hypothesis was that physiatrists, PEDS rehab specifically, medical direction for the CCS medical therapy program when given by telemedicine would result in at least equal patient experience, equal perceived quality of care for parents, therapists, and physicians, and measurable economic benefit. We used quality measures and our proxy was adherence to the HIP surveillance guidelines as dictated by the AACPDM care pathway. It was a non-inferiority cluster randomized crossover study. We randomized clinics that we were otherwise providing care for to either telephysiatry or a referral group that received in-person physiatry care. And a key to our pre-COVID plan was that the therapists at these remote clinics would perform the physical exam. And I'll circle back to that, but I think that is really a key component to get quality information and make good clinical decisions. Next slide, please. So because this was pre-COVID, actually there was a lot of resistance to telemedicine. All the things that I'm seeing in the chat were echoed by the therapists. It doesn't replace in-person exams. We're doing fine. We'd rather have someone drive out there. And while the centers that were close to the, you know, the children's hospital had the option of a physician driving there, those that were rural couldn't really just maintain status quo because they weren't getting served. So we had to really do a sell to the therapists and the CCS program as to what the benefits would be. And there were some intended benefits and some unintended benefits. A lot of these rural communities don't have an electronic medical record. So we had to figure out a plan on how to do that. It was all paper charting prior to the telemedicine. We had the opportunity to make more frequent visits. So you can imagine a child who just had orthopedic surgery, a seminal type surgery, and they lived four hours away. The family couldn't drive frequently back and forth for check-ins to see how they're progressing with therapy. And it was strained communication with the therapist. Well, with telemedicine, we could check in as frequently as we wanted to or needed to, and could actually hop around the state very, very easily. Additionally, the durable medical equipment needs, let's say a child was appropriate for a new manual or power wheelchair, there's a face-to-face requirement. And what that required is the physician had to see the patient in person in order to document the medical appropriateness and that they were gonna be a safe user of the power wheelchair. It wasn't sufficient to say that the physician reviewed a therapist report. So that was a hardship. The families would have to drive in many hours to our hospital to see us in order for us to make that documentation. But with telemedicine, that met the criteria and we're able to do this face-to-face virtually. And it gave us a mechanism for improving documentation for our visits. Next slide, please. So this is an example of what we did. We either use Dropbox or OneDrive. These are both HIPAA compliant platforms that we use. We loaded previous clinical notes. And in fact, the clinic staff would load notes from all the specialists. So we'd essentially have an impromptu medical record. The nice part was, as you guys know, there's a lot of prescriptions, a lot of paper that gets generated in these clinics, durable medical equipment, orthotics, the therapy plan. And there was a lot of faxing back and forth, a lot of printing, signing, and all those things. Well, this allowed us to scan it all in digitally. And we're working through the process of getting a DocuSign or electronic signature so that we won't have to print and scan and all that extra legwork. But more importantly, often these prescriptions would go back to the hospital and get lost in medical records for some period of time before they surface. So ultimately we're able to provide more timely care for the patients. Next slide, please. So this was how we prepared the therapist for the exam. We had been working with these therapists for some time, but often they were not performing an orthopedic exam. They were very comfortable with range of motion, spasticity management assessment, but we needed them to be our eyes and hands for an orthopedic exam. And this, because they're so familiar with the patients and hands-on care, this was very easy. We taught them our orthopedic exam. This is our example of common things that we would check in our cerebral palsy population. But the therapist could give us real-time physical exams, show us what we needed to see, and we could tell them, please, can you show us a hip exam including Galeazzi and Thomas tests? And they knew exactly what we were talking about. Next slide, please. So these were our satisfaction results. The columns include our telemedicine visit and in-person. In-person is the physiatrist who's actually doing the hands-on exam. The telemedicine, there was a hands-on exam, but again, it was the therapist. So the parent survey included questions, five questions that were extracted from the CAHPS or the Consumer Assessment of Health Providers and Systems. It's a hospital survey. This range of scores was one to four, four being the most positive. The questions were the following. During this visit, how often did your child's doctor listen carefully to you? During this visit, how often did your child's doctor explain things to you in a way that was easy to understand? During this visit, how often did your child's doctor treat you with courtesy and respect? And lastly, during this visit, how often did this provider seem to know the important information about your medical history? The gist of the data is that there's no difference. Satisfaction was quite high for both the in-person physiatrist, as well as the therapist doing the hands-on exam and the physiatrist via telemedicine. So no statistical difference and high satisfaction for both models. The therapist surveys, the questions were the following. I felt confident in the quality of care that I provided. And I felt confident that the patient was educated about the continuing care plan. This was a seven point Likert scale. We wanted to have a little bit more detail, but again, the satisfaction was quite high and no statistical difference between the two groups of telemedicine versus in-person care. We initially got some feedback from the therapist or pushback from the therapist with regard to telemedicine. They were uncomfortable being on camera. They preferred the physician to do this portion, but as time went on, they felt very comfortable doing this. And I think they felt a more significant part of the team. So it was a very positive thing. Next slide, please. So this slide looks at the economic impact and unfortunately it only looks from one perspective and that's the perspective of CCS or the insurance payer. We were trying to make a business case for this. And so we chose to use that as the model. So the in-person versus telemedicine, the cost difference on average was about a hundred dollars. And the reason for that is that the mileage reimbursement was really the cost difference. What the physician would get is about $2 per mile one way, less 10 miles. So they take 10 miles off the top. So clearly that mileage reimbursement does not reimburse the physician for the time spent in the car. The clinical revenue, once you're actually seeing the kids, the physician gets an hourly rate and it was the same telemedicine versus in-person. I think more importantly, there's other economic factors to consider which are meaningful. We did not explore the potential impact on families of traveling to a specialist physician. These include lost wages for the parents, the need to find childcare for the other children, car and travel costs if they're using public transportation. And then also the intolerance of long car rides for our children with special healthcare needs. We also did not actually quantify the loss of productivity for the physicians, but it is significant. Next slide, please. So in summary, what our studies showed is that there's high parent satisfaction and therapist confidence for telephysiatry. It's similar to most all studies for telemedicine for children with special healthcare needs. A lot of the concerns often raised by stakeholders that telemedicine may be perceived as impersonal or a lesser option to traditional in-person care is not supported by our study, nor is it supported in the literature. Future research should examine the ability of telephysiatry to improve patient outcomes and access to care. I think if given enough time, it would certainly show that. I think we chose hip surveillance because these proactive x-rays in order to identify early hip subluxation and prevent frank dislocation and palliative surgeries, this wasn't being done when pediatricians were out in the community. And it's not a knock, it's just that they weren't integrated into an orthopedic team in a special care hospital that followed the literature and went to the AAC PDM meetings and all of these things. And then the last point is the term telemedicine is broadly used and loosely defined. We designed this study prior to COVID. And so we were able to use therapists to provide the physical exam. And I think the high satisfaction rate for all parties, meaning not only family, because they didn't have to drive, but also the therapist and physician was because we did have good quality data and a hands-on physical exam. Once COVID is waning and you have the opportunity to choose to keep telemedicine going or not, I urge you to consider how you structure this. And although you can get exams of kids without hands-on, it's much better data if you can have a therapist or a proxy do your exam. And I looked at the chat and everyone has horror stories of mother driving in the car, kid in the backseat and they're trying to do a telemedicine visit. That is not safe. That's not the quality of care that we strive to serve. And I wouldn't feel comfortable if that was my standard of care. So when I think of telemedicine, what we designed was what we would hope could be sustainable in the longterm. So thank you. Next slide, please. So these are the references in our study. And one more slide, please. These are my collaborators in the research study that we hopefully will have in the literature very soon. We're submitting it as we speak. Thank you. So Bhabha and Louise and Lauren, if you can, let's bring our video back up. I think, why don't we bring all our videos up but if you can still mute yourselves except for the presenters and put any questions or thoughts in the chat box. My job was to look at the chat as we went through the presentation. So just a few things for those of you who may or may not have been able to look and follow the chat too. It appears there's two articles regarding telehealth that are coming out in the General Pediatric Rehabilitation of Medicine shortly. One by, is it Dr. Nully or Nell and Nelson and Dr. Sukhav, Asante and Elizorov. So that's coming to you soon, if not already there. There's a question about telemedicine parity laws and payment laws. And there is efforts in every state that are trying to help for equal payment. And so that means payment parity for telehealth just the same as in-person, it varies by state. Just you need to work on your own state representatives. There was a question about the challenges providing phone-based virtual care. And I guess one of the questions related to that was what unique places. So I wanna ask our panelists or presenters what's the most unique place that you examined a child so far via telehealth? And then for others who are not presenters, if you wanna put it in the chat box, please go ahead and share that. Anybody wanna take this on? Grocery store. Farm with a petting zoo. Those are some of my favorites. Thank you. Actually, I've got to say our office has gotten pretty tough that you have to be in a certain spot within they'll reschedule, which is one benefit of telehealth. It's pretty easy to reschedule. I mean, just we'll catch you in an hour. So we didn't, I will say that I have, sounds like a lot of the other presenters the same, done a lot of versions of telehealth, the direct cell phone to cell phone, the interdisciplinary clinic, but the I'm virtual and the therapist is in person and also virtual telehealth to hospitals. And one thing I do say is if there's a mix of in-person and telehealth, it gets tricky. So I've tried to participate in conferences where some of the providers are there, some people are in telehealth and it's really hard to interact like that. So I would say that it was unique, but the sort of thinking about, and also I'd say having the ability to try different ways and see what works for your group. So I can share that the strangest place I did it was, I guess, in a tobacco field. So similar to Michelle, but it was more about, I told the family that they were in a car in order to look at the brace, I had to watch the child walk. And so they went and they stopped by the side of the road and the child walked in between rows of tobacco plants and walked over each row. So that helped me look and see what their gait was wearing that AFO. I can't say that I have as interesting interactions like that, but the weirdest thing I ever did is when I first started doing this, I actually had the patient enter the exam room before their scheduled clinic time. And what I saw, their phone must've been laying on a coffee table because I was looking at a ceiling fan spinning and I heard, I was basically eavesdropping on a family argument for about five minutes. And here I was saying, I'm here, let's start the appointment. I could hear people arguing in the background. And I was like, okay. So I learned to enter the room as soon as it was time for the clinical. Often our parents also put the phone down in the middle of an interview. And so you're looking straight up. And so I've come to just use the pet phrase, oh, you have a beautiful ceiling. And then they know, okay, let's pick it up and go ahead. One, I guess we have two more minutes. I want to just check. One issue was the difference between providing therapy and the problems our patients are having getting therapy services at home, like school-based services. It's not the same. We have, I think, a little bit easier than therapists because the ones who have to learn from a kinesthetic learners can't get that kinesthetic learning when they don't have a hands-on approach. There's also been a few other issues about what's the advantages of seeing it. And people have talked already about being able to watch the child run around on a playground outside their house. You can see all the equipment. The children are more comfortable. It's natural environments as well. And one last thing that's brought up as a language barrier, just like Bob said, as long as you have the technology to do so, there's no reason you can't bring in a virtual interpreter these days. The question is going to be the rate limiting step of earning access in rural areas. But as time goes by, I can tell you from my perspective, the technology will continue to improve. That's not going to be your barrier. It's going to be payment, licensure, and administrative time or being able to arrange and get things together. Anyone else with last thoughts about this before we come to the meeting? Okay. On behalf of my fellow presenters, thank you, everybody. We look forward to, and let us know afterwards what you thought, and if there's a future presentations in a similar fashion you'd like to have. And take it away, Julene. Thank you. That was awesome. I took a few notes on things that I can do to help with my tele-rehab visits too. I have not had any in a cornfield yet, which is surprising since I'm in Minnesota. So at this point, we are going to actually move on to our Pediatric Community General Session. And I really miss seeing you all. So please feel free to unmute your screens. Unless you're one of Mary Dubon's patients and you're maybe missing a piece of clothing. But the part that I miss about the meeting is being able to see you all, that granularity of catching up a little bit, of going out for beverages, even skipping part of the meeting to catch up. So please feel free to come back on and let us see the human beings who are here. With that being said, I am going to share my screen and pull up some slides. This session is usually a little bit more interactive than it's going to be, mostly because of some time constraints. So I apologize for that. And let me pull up. There we go. And let me do this. There we go. And I'm assuming everybody can see the slides. Some head nods, sweet, great, okay. So to get things started, for our PEDS community, we have four leaders of our community. Myself as the chair, David Burbrayer, who's our chair elect position, Mary Dubon, who is our education vice chair, and Mike Green, who's in the mix there somewhere, who is our communication vice chair. Now we've kept these titles from when we had the council, but frankly, we don't function like that. We more or less function like a group of four who get together and talk about things and get things organized. So it's really great that we can work together with that. It's been super helpful, especially this year. We've met approximately monthly, and leading up to this, about two and a half months ahead of time, we're meeting every other week, and then a month ahead of time, meeting weekly to go through things for the session and trying to anticipate challenges that may arise. So with that, I wanna thank Andrew Skolaski and his team for the virtual peds rehab day that we had yesterday. Super intense, great information, really engaging for that length of time. And so Rady Children's Hospital and San Diego University of California, San Diego were kind enough to host that for all of us with a lot of great topics that were covered. With regards to our community, we have some very specific goals that we set for things that we wanted to accomplish as a community. And those include things like advancing and sharing clinical knowledge to promote health and functioning and wellbeing of children with disabilities, advocating for better payment structures, inclusion of pediatric physiatrists in all areas of AAPMNR, serving as experts and advocates in pediatric rehab issues and topics for AAPMNR and growing our field. And we'll go through this based on what we have been able to hit this year in those goals that we have for our community. So with regards to advancing and disseminating knowledge, I would love for Mary Dubon to talk a bit about the Pediatric Rehab Virtual Lecture Series and the Journal Club. Yeah, thanks so much. So thank you to everyone who's been involved with the Virtual Lecture Series. It really was just amazing that so many people were so willing to give really wonderful lectures. So essentially what we did was starting in March, we had weekly that then turned into twice weekly during the beginning of the pandemic virtual lectures. And then it basically starting this academic year, it's been about twice a month. We skipped over the month of November because of the academy meeting. So please, my email address is there. So take a screenshot or save that. We are definitely looking for more people to lecture. So, you do get CME credit for watching the lectures and certainly for lecturing. And obviously it's geared towards trainees, but anyone can watch those lectures and they've been really helpful. And just in the interest of time, even though I am not one of the organizers of the Pediatric Rehab National Journal Club, I will speak on behalf of that crew who I know very well. So Lauren, Kelly and Simra have done an excellent job as trainees kind of getting together to host a National Virtual Journal Club that again, at the beginning of the pandemic was twice monthly, two articles at a time, one attending kind of mentoring for each article. Now it's about once monthly. So they have compiled a list of folks that are interested in joining for the lectures for the journal clubs rather. And so look on Facebook and Fizz Forum for more information on that. And then you can always email me if you're having a hard time figuring out how to get involved with that. I can connect you to them as well. And just also in the Journal of Pediatric Rehabilitation Medicine in press right now is an article that all of us wrote together a little bit about a survey study that we did for education during the pandemic for PEDS rehab trainees. Wonderful. And Mary remind me, where can they access the Pediatric Rehab Virtual Lecture Series? Yeah, so if you go to the ME site, so the My Education site on AAPMNR, if you just search for Pediatric Rehabilitation, you'll see them come up. And what happens is if you listen, if you like register and you listen to it, you still will have to go into the ME site to get your CME credits. You don't have to listen to it again. You just have to go there to claim the credits, but that's also where you can find the recordings as well. Thank you, Mary and Lauren and Kelly and Simra for all that work that you guys are doing to help keep us educated during COVID. We've also, I wanna thank all of our presenters for our Pediatric Rehabilitation Virtual Community Day, your flexibility in altering the time and dates that we were doing this and putting together these wonderful virtual presentations that we had. Elizabeth Moberg-Wolf had a team that did a update, an update of the Pediatric Focused Review Course for Board Review. So this is available on AAPMNR's online learning portal and included if you do the online education subscription. And this was a fairly monumental task. It's actually 23 modules that are ranged from eight to 41 minutes. You can get 8.75 CME through these modules and they're a great way to review if you've got your pediatric boards, pediatric rehab boards coming up or your pediatric boards updates or a licensure renewal coming up with that. So thank you to all of you who participated in that. With regards to inclusion in AAPMNR, and we'll get to Mike Green to talk about this in just a second, but I don't know if you know, but there's a whole bunch of committees that are involved in actually steering how AAPMNR runs and targeting different areas for AAPMNR. Over top of all of these committees is the PMNR BOLD Steering Committee. It's sort of the driver of everything. And we actually have two PEDS rehab members that are on that BOLD Steering Committee, Bob Rinaldi and Mike Green. So a shout out to them for being so important in driving what's going on and having a PEDS voice for that. The QPPR, the Quality Practice Policy and Research Committee is super hardworking. Joe Horniak is one of the members of that and we have a PEDS voice on that really important committee. It's a quarter of the Strategic Coordinating Committees. We also have nine other committees that have PEDS members, as you can see on there, including our Program Planning Committee with Justin Burton. And I just wanna encourage you all, take a look at the committees that AAPMNR has. There's a way to volunteer to join or reach out to people who are on the committees to let them know you're interested to help get that PEDS voice on these AAPMNR committees. There's a lot more that don't have PEDS voices. And so there's a lot of room for us to be able to influence the direction of this organization. And with that, we also have the opportunity to serve as experts and advocates. And I wanna thank Elizabeth Martin for stepping up to serve as the AAPMNR representative to the American Academy of Neurology and Child Neurology Workgroup. And this is also another fairly heavy lift. It is a group of about 10 to 15 healthcare professionals and their first task is actually going to be to review the existing child neurology quality measures and update them as needed. So there's a bit of work in that and looking forward to hearing perhaps some updates from Elizabeth down the road as this gets moving forward. We've also had a couple of meetings looking at evidence quality and performance. That's the EQPC committee. C is the committee. Looking at recommendations for pediatrics. We've had some discussion work in progress on that. And Mike will talk about that. And also pediatric rehab data collection. Again, talking about things for QI measures and also for the registry. And with that, oops, sorry, Mike. Let me go back to your slide. We're gonna have Mike Green talk a bit about that and the BOLD. Thank you. Can everybody hear me? Can hear you, Mike. Perfect, okay. So can you go to the next slide? The AAPMNR BOLD, it's been an initiative that the AAPMNR has been doing for a few years now. Our section is kind of highlighted here. And in the next slide, it pretty much is, it's the path that AAPMNR with guidance from every subspecialty in AAPMNR has decided to move forward to create the physiatrist as a leader in many different aspects. In the PEDS section, we wanna be the, recognize an essential physician expert for children and youth with acquired and congenital disabilities with the main purpose to optimize function and life transitions across a care continuum and into the community. That was the, our set goal when we met with the AAPMNR a few years back. And I function mostly as a scribe for Bob Rinaldi because he's the most important person. And we meet with them yearly to kind of move this forward. So next slide. And this is kind of a continuation of the full thing. So everybody can read it at their own convenience. Next slide. And so another committee that I'm a part of, but I'm most likely going to be passing it on to somebody else soon is the Graduate Medical Education Committee. So this group meets yearly as well, and they have multiple in-between meetings where we kind of work on education for the next generation. We're working to improve, to take the bare minimum requirements for the education and challenge those requirements, to push the education for the next generation higher than it was in the past. So that's what it's set out to do. And so it works with many different groups to work on those goals. Next slide. And then the Evidence, Quality, and Performance Committee. This is a pretty new thing. We've only had one meeting about it, but it's kind of directly down from the bold is to identify where we could demonstrate our worth and demonstrate our value at a large national, international way. So identifying strengths, weaknesses, gaps, opportunities, and the pediatric rehabilitation to guide the academy's evolving quality strategy and potential tactics to address quality gaps. So next slide. So we had met once and we discussed a CP registry, a different type of CP registry than what exists now in different groups. But, and also we discussed how we can merge with them and kind of work together. We discussed better understanding the pediatric spinal cord injury population. We looked at better understanding neuromuscular patients, chronic pain. We looked at different populations to better understand and create registries as well as create potential interventions on a national way to improve our quality of care. So that's all I have. Thank you very much. Jolene, I'll pass it back to you. Thank you for all of that, Mike. It's been some fun work in moving some of these areas forward. I also wanna talk about how we're growing our field. And with that, Amy and Teddy did the Pediatric Rehabilitation Virtual Fellowship Fair hosting and recording. And I think Teddy is here to talk a bit more about that. Yeah, good afternoon, good evening, everybody. I'm Teddy. I'm a PGY-6 Peds Rehab Fellow in Colorado. And I'm happy to talk to you guys about our Virtual Fellowship Fair that we held over several months this year. So back in March and April when COVID hit, Amy and I were sort of brainstorming about how we could effectively recruit for the match this year. We wanted to make use of the virtual platform and really expand it to all interested and future fellow candidates as well as programs. So I reached out to all PM&R residencies to collect names and contact information names and contact info of all the current residents and fellow candidates who were interested. So PGY-2s through PGY-4s, well, the threes at the time really, built on our existing LISTSERV that Steph Tao has curated throughout the years. Then coordinated with current fellows and with the help of Amy with the fellow program directors to set up several online Zoom sessions for the candidates. So in mid June, we sort of had a couple of just fellow panelists hosting a Q&A session just to answer any questions about sort of the application process as well as just what was important, like in the application. And then in July, we did have four sessions where we had all the recruiting Peds Rehab Fellowships present. The program directors had sort of 10 to 15 minutes to present what their program strengths were. And at the end of that sort of two hour session, we held question and answer sessions as well. So we have four of those that are recorded and now posted on AAPM&R. And actually just last night, we finished up with again, a fellow run ranking Q&A session for the candidates. So overall, this was really well received and well attended. So we plan to have another virtual fellowship fair in the spring. And actually, if we can go to the next slide. So AAPM&R is posting these videos. If you go to the online learning portal, you just search 2020 Pediatric Fellowship Fair Recordings, it'll pop up or you can follow that link. So I just wanna thank Amy Kanellekin, our program director here at Colorado for helping coordinate with all the other PDs. Thank you to the other PDs as well as the AAPM&R for posting the videos. And of course the fellow candidates who are really the future of the field. Thank you, Teddy. That was great. And you guys did really nice work with that and helping to get the fellows together and keep the fellowship piece moving forward during this year. I wanna bring up some exciting news for next year before we move into a couple more things. So next year, hopefully we will be in Nashville at the Omni Hotel and Music City Center. I have my fingers crossed. But fortunately, Elizabeth Martin has agreed to host the Peds Rehab Pre-Day, which based on the calendar I looked at, looks like it will be November 10th. That's the Wednesday that's prior to when we usually have our meeting at Vanderbilt University. So looking forward to that and offering our support in whatever way we can to help Elizabeth with getting that piece moving forward whatever way that's gonna look like for next year. So please mark your calendars, plan your travel time to be able to attend the Peds Pre-Day next year. And with that being said, I would like to open things up for Kevin Murphy to talk a bit about the Molnar Award, the Peds Rehab Textbook and foundation support. Kevin, I know you're out there. Well, great guys. Can you hear me okay? I can hear you, Kevin. Yeah, thanks a lot. A wonderful presentation. The past couple of days, telemedicine is a wonderful thing. I appreciate the talk, Josh, everybody. Great job. A couple of things, the Dr. Molnar Fund is doing well. We have about $416,000 in there now and we're always looking for donations. It's our one big fund where we try to fund research education for the fellows and the field of pediatric rehabilitation medicine. And if there's any way you can donate a bit of money every year, it's greatly appreciated. It allows our fellows, whoever wins the Dr. Molnar Grant Award every year to present two years later. Maybe a lot of the fellows, it's their first time to be on a national podium to present. It also helps fund our Lifetime Achievement Award that we have given out every year also. So please keep it in mind. It's a great thing and we certainly appreciate the donations that have been received thus far. We do have the Dr. Molnar presentations coming up tomorrow, I think around 2 p.m., 2 p.m. Central Time. I hope you all can join us for that. We've put a lot of time into it. We're hoping for a good technology participation. I'm not the technology guru of my generation for sure, but it looks pretty good so far. We've passed the rehearsals and we're looking for a nice one hour presentation from 2 to 3 p.m. tomorrow. That would be great. We have our 2018 reward or grant winner, Dr. Gloria Vergara Diaz. She's gonna talk about robotics and gait training. Thanks, Gloria, for that. In addition, Dr. Turk is our 2019 Lifetime Achievement Award winner. She'll be presenting her talk tomorrow, the electorship, Dr. Molnar electorship on advocacy, advocacy in the time of COVID, particularly for children with physical disability. Very nice topic. There'll be a lot of times for questions and answers. We only have an hour this year, only an hour, but we're thankful to have an hour. And there'll be a little time at the end for questions and answers, in addition to just a little discussion on Dr. Molnar herself, the person, the professional that people have questions about who she was, what she was like. I spent about 24 years with her and other people can comment too. Sometimes the newer colleagues into the field of pediatric medicine haven't had a taste of Dr. Molnar and some of her generation. So we'll give a little time for that also. So we certainly wish you joining us tomorrow and participating, have a good time. In addition, the new textbooks out are sixth edition. Hope you all enjoy it. We're really looking for a good review input. We tried to make it completely different as much as possible. Almost 30 chapters this year. First time we have an electronic version online. First time there's videos. First time we have so many new chapters, eight new chapters, I think on genetics and robotics and a lot of things, advocacy chapter. But it can be a lot better and we wanna make it a lot better going to the seventh edition. So I'll put my email on the chat. If you just email me or one of the co-editors on there also about your comments, concerns, recommendations for the seventh edition, we'll file that away, look at it carefully. We just wanna make it bigger and better. It's your textbook and we want everybody to have a serious input into it. So thanks very much for the time. Jolene, everybody has a great day so far and event and just get better as we move on into tomorrow and the end of the conference. Thanks a lot. Thanks, Kevin. Flattery will get you everywhere. I just wanna do a plug for the Pediatric Rehab site on Facebook. If you're not members, look for that. Glenda Lees posted a really nice link to the foundation and instructions for how to donate specifically for the journal, which also would apply for how to specifically donate and direct it to the Molnar Award. It made it super easy and I was able to do both today. So I checked those off my list of things to do. So thank you for doing that and take a look out for that. And now I am going to pass the torch over to Elaine Pico to talk about the journal that we've all been talking about over the course of the past few days. Hi, Jolene. Can everyone hear me? Can hear you great, Elaine. Great, thank you. And thank you for your donations to both the journal and the Molnar Award. If we can go to the next slide, please. These are a list of editors and editorial board and you too could become an editorial board member if you'd like to just contact me with your interest. If you're an editorial board member, you automatically get a free subscription to the journal. Can I have the next slide, please? As you can see, the top of the list, Janet Newfield, Dr. Jacob Newfield's mother is an associate editor of manuscript mechanics and grammar. And she has read probably every manuscript that's been published in the journal since 2018 after Dr. Newfield passed away. Next slide, please. This year and every year we have four issues. And every year we have four issues. This year we have had three special issues. The cerebral palsy has become an annual topic. And in 2021, we will go into the third year of the cerebral palsy special issue. And Deborah Gabler-Spera and Michael Green are our guest editors. In April, it was decided that we needed to have a COVID issue and Matt McLaughlin and Christian Verclair were our guest issues. We have over 20 manuscripts in that issue. Lots of manuscripts on ethics and telemedicine and other things. And it's a wonderful issue that's in pre-press and will be out very, very soon. And then the spina bifida issue, it's become an annual issue as well with Tim Bray and Heidi and Jonathan Castillo as our guest editors. We have 20 of the spina bifida guidelines, 20 out of 22, and all would be open access. They've all been sponsored by the Spina Bifida Association to be open access forever. Next slide, please. Just to remind you that all manuscripts are blinded without author institution identification. Every research case study or systematic or scoping review is blinded peer reviewed by two authors of their stats. It's also reviewed by a statistician. The distribution is worldwide in 200 countries, 2000 institutions. And we found out this year that we're in the top 5% of all out metrics for views. It's a leading data tracking firm that reports that JPRM is ranked in the top 5% of journals represented in over 14 million articles viewed since they began tracking in 2011. And we're indexed in all of these sources. Next slide, please. From 2018 to 2020, we have increased production by 150% each year. We're going to have a new JPRM website and we need bloggers for the new JPRM website. We have a global track now. We have met the last two years of AAPMNR and we'll be meeting again this Saturday with Dave Pruitt's group. We've had 100% program director interest of the residents and fellows. And we also surveyed the residents and fellows and they're interested too. And we had a trial program in 2019 regarding this and to really launch this program fully, we need funding to do so. Next slide, please. This is what the pre-press publication looks like and it's fully citable. Here's a manuscript by Jolene and Lonnie and Susan and Amy and Robert and Maurice. Next slide, please. And this is a letter that was such a surprise and wonderful and delightful that I received from Dr. Bruce Becker on the 11th yesterday. And he asked for this letter to be shared with all of the pediatric colleagues. And I'm not sure if you can read this right now. I can read it to you, but it talks about his strong support of the Journal of Pediatric Rehabilitation Medicine and its mission from its birth under Jay Neufeld to the present. And that Jay was a dear friend with him. He had many conversations about the journal and that Dr. Becker was a consistent supporter and that Jay was a consistent supporter of the foundation and that Jay was a truly visionary, physiatrist, energetic and creative and bringing that journal into reality. And it was just beginning to realize that potential when his untimely death occurred. And please accept our sincere apologies for the time it has taken to move forward on a relationship to assist the Journal of Pediatric Rehabilitation Medicine and its evolution. And he talks about the logistics, how those have been sorted out. And I think you can read the rest of it faster than I can read this to you, but we can certainly make this letter available to everyone per Dr. Becker's wishes. Next slide, please. So we'd like to ask you to support the Journal of Pediatric Rehabilitation Medicine through the Foundation for PM&R. You can support JPRM with a restricted or designated donation to the Foundation of PM&R. Donations will help be used to support the distribution of the journal throughout the pediatric rehabilitation community nationally and internationally. It will help build our resident and fellows program and help the journal really reach its full potential. You need to go to foundationforpmandr.org, push the donate now button, put in the dollar amount and add special instructions to the seller. And those special instructions to the seller are either please put JPRM for our journal and also I'm a big supporter of the Molnar Fund as well. Next slide, please. Thank you so much and we look forward to a great 2021 for JPRM. And I'm happy to put my email in the chat for those of you who do not have it, but it's also available on the website and in the cover of the journal. Oh, and lastly, but not least, you can use matching donations from your employer. And in some cases they'll double or triple or quadruple the donation that you've made. Thank you. Thank you, Elaine. I don't know how you do this and keep all the balls in the air that you do and keep the journal moving forward. You've really helped, I think, Jace's vision with this journal and continuing to build with that. So thank you. Thank you very much, Jolene, for all that you do. I don't know how you do all that you do either. I guess we just work 23-7, right? I think we all do. We're very passionate about what we do. Yes. And with that, I wanna also say, please think about with all that extra time that we have on our hands, right? Volunteering for AAPMNR, again, trying to get as much PEDS voice into the academy to help guide and not make sure that our most vulnerable kids are missed in the activities that are being done in AAPMNR. So please go online, look for where there's openings, apply, and look for that on FYS forum. Please, if you're not a member of the community, feel free to join. We love having new members. You can join as many communities as you want. And also look on FYS forum in the future. We aren't exactly sure how things are gonna look next year for PEDS community day. So we usually do a call for proposal for our session, but aren't going to do that just yet till we have at least a little bit more direction and guidance as to how this is gonna look. It sounds like we are gonna have some sort of session. We just don't know exactly what that's gonna be. So appreciate your patience and waiting for us to find that out before we get that information out to you all. And with that being said, I thank you all for, let me stop sharing so I can see everybody. There we go. Thank you all for joining us tonight. Thank you for letting us see your faces. Like I said, I miss seeing you guys in person. I love seeing the new names and the new faces that are part of our group too. It's so lovely to see us growing and building. We had over 90 people that were on this session and I think over 70 that were on the one on Tuesday plus over 200 that were on the one on Wednesday. So thank you for your participation and don't forget about the sessions that are coming up through the rest of AAPMNR including Michelle Gitler's opening session that will be tonight in about an hour. So around seven, I'm hoping that I can get home to have a beverage of my choice while watching that session. So with that, thank you all and appreciate all your support. Thank you.

telephysiatry

in-person physiatry care

children with special healthcare needs

satisfaction

cost savings

access to care

pediatric rehabilitation

telemedicine

COVID-19

research

advocacy

collaboration

disabilities