Advances in the design and delivery of trauma care and acute medical management have increased the number of survivors of traumatic brain injury (TBI), producing societal consequences and medical challenges. Although access to health care for rural patients remains a critical challenge, teletherapy may represent a viable means for the delivery of therapeutic services to such patients. A case study is presented in which teletherapy was successfully utilized to improve the functional outcomes, both physical and cognitive, of a patient with a severe TBI. A physical therapist from a metropolitan rehabilitation center employed teletherapy to provide Neuro Developmental Treatment for a patient and to mentor staff in a nursing home located over 100 miles from the metro area. The patient, who participated in 48 physical teletherapy sessions over a 24-week period, demonstrated improvements in physical functioning and neuropsychological status. During the course of therapy, goals were adjusted upward to match the patient's improvements. This case study provides confirmatory evidence that teletherapy represents an effective and efficient means for providing rehabilitation services for patients in rural communities, as well as for facilitating mentoring relationships between seasoned professionals and trainees located in rural settings.

Schools in the UnitedStates are required to supply specific specialty services such as speech, occupational and physical therapy under the Individuals with Disabilities Education Act (IDEA). Because of their geographic locations and sparse populations, many rural communities do not have these specialties. The alternative of traveling to metropolitan areas where these services are more readily available is hard on the children and their families. INTEGRIS Health and the Hugo Public Schools collaborated in a two-year speech teletherapy pilot study to test speech therapy services delivered over two-way, interactive videoconferencing. The effectiveness and satisfaction of this mode of delivery was measured. A comparison of lost therapy time due to technical difficulties was also made.Steps taken to develop and implement the school teletherapy program, outline of a typical session, perceptions of rural administration, clinical outcomes, lessons learned and future applications will be discussed.

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