Staying connected

How do you treat brain injury patients during a pandemic? Alum found a way.

By California State University, Bakersfield

April 20^th, 2021

Russell Bryant paints a bleak picture of what life would probably look like today if he hadn’t received the physical and cognitive therapy he did – all via computer – during the height of the pandemic.

He’d be depressed. He’d be bored. He’d be stuck on the couch with his laptop all day.

“And it could have easily destroyed the marriage,” the 64-year-old retired policeman said on a Zoom call next to his wife, Alison, from their Tulare home. “It could have destroyed me.”

Bryant required brain injury treatment last year after suffering a fall caused by orthostatic tremors in his legs and drinking. He was suffering from hallucinations, memory problems, violent dreams and difficulty completing everyday tasks. Not being able to drive or go hunting really got him down.

Bryant was able to get the treatment he needed because Bakersfield-based Centre for Neuro Skills figured out how to treat its approximately 850 brain injury patients virtually thanks in large part to the foresight of Joe Castillo, its regional director of operations and a 2014 CSUB alum (pictured above).

The center adapted business conferencing technology Castillo had implemented a few years ago to telehealth use, a godsend for people like Bryant who could have suffered devastating setbacks without it.

Bryant still struggles physically due to his underlying neurological disorder. But after six months of treatment ending in February, he’s no longer hallucinating, can multi-task much better, passed a driving test and has even done a little recreational shooting.

“Of course, I can’t tell you how it would have been if it was one-on-one (in person),” Bryant said of his progress. “But I would rate telehealth very high. Five out of five stars.”

Going virtual

The Centre for Neuro Skills provides medical treatment, therapeutic rehabilitation and disease management services to traumatic brain injury patients from seven locations in California and Texas. It offers both outpatient and inpatient care.

When schools and businesses started shutting down in March 2020 because of COVID-19, an obvious question surfaced at the center: How do we treat patients without exposing them and staff to a deadly virus?

“It was a bit overwhelming, as you can imagine,” said company President David Harrington, who earned his MBA from CSUB in 2005.

David Harrington, president of the Centre for Neuro Skills, is also a CSUB alum. He earned his MBA from the university in 2005.

Castillo, the operations director, determined that the system CNS was using for a limited number of physician office-based telehealth sessions wouldn’t work for larger-scale therapy. But its business conferencing system, Ring Central, would, even though it wasn’t a telehealth platform.

“All we need to do is make sure people have access to the Internet,” Castillo recalled thinking.

Next came some hardware installation at the center’s in-patient facilities, getting some of its outpatient clients online, and figuring out the scheduling. Within one week, all its in-patient patients were on the new system and within two weeks all its outpatient patients were, too.

In all, the Centre for Neuro Skills treated 850-plus people between January and December 2020, most of them via telehealth.

“I’m proud to say we probably did this better than anyone else in our space,” Harrington said, noting many other programs either shut down for a time or disregarded safety and let COVID spread throughout their facility.

While the Centre’s two-week transition to telehealth was a companywide effort, the pivot would not have been made as quickly and effectively without Castillo’s earlier adoption of the technology and his helping staff understand how they could use it for telehealth, Harrington said.

'A bit clunky'

That’s not to say there weren’t hiccups, Castillo said. Some Centre clients didn’t have strong Internet access at the beginning, and some staff and patients were more tech savvy than others.

“I’ll be honest. At first it was a little bit clunky,” Castillo said. “But just to give you some comparisons, prior to COVID we were probably doing 30 to 50 meetings (online) per day. And now on average, we’re doing 370 meetings.”

The center found that patient outcomes before the pandemic and during widescale use of telehealth were comparable, depending on the severity of symptoms and type of care, Castillo said. Telehealth worked best for those needing speech and educational therapy, but also well for a lot of occupational and physical therapy, he said.

Predictably, Castillo said, it was most difficult to obtain OT and PT gains with lower-functioning patients via telehealth versus if they'd had in-person treatment. Limitations with some of the hands-on interventions and access to sophisticated therapy equipment accounted for the difficulties.

Alison and Russell Bryant of Tulare describe what they consider life-saving physical and cognitive therapy Russell received from the Centre for Neuro Skills via telehealth during the height of the pandemic.

Bryant was the perfect candidate for telehealth. He could do all his physical therapy – stretches and exercises – and cognitive therapy – brain teasers and memory games – in front of a computer so his therapists could watch, interact and assess.

“It was very good because I got back to almost where I want to be,” Bryant said. “The only thing that’s off is my balance. And that may never come back to me because of other problems.”

New business opportunities

Most of the Centre for Neuro Skills’ in-patient clients are receiving in-person care now. Most of its outpatient clients are still doing telehealth, though those who’ve been fully vaccinated against COVID-19 are gradually coming back in.

Interestingly, many patients’ families appreciated the telehealth option because it allowed them to get more involved with their loved one’s day-to-day treatment, and they plan to continue that involvement, Castillo said.

This unplanned foray into expanded telehealth could also speed up the Centre for Neuro Skills’ expansion plans, Castillo said. CNS operates in seven cities in California and Texas; it opened its seventh location, in Austin, Texas, this month.

“Now we’re looking into, ‘OK, how do we grow this business line?’” Castillo said. “’How do we penetrate other markets that maybe we didn’t have access to? Hey, you know what, why can’t we treat someone in Virginia from a current clinic?'"

One huge question mark, though, is whether insurance companies will continue covering telehealth services after the threat of COVID-19 passes. They didn’t cover much of it before, but now that the benefits are undeniable, he’s hoping they will continue to in the future.

Rising at CNS

Castillo is originally from Montana but was doing oilfield work in Texas before moving to Bakersfield. He left oilfield work in Bakersfield to become a residential aide at the Centre for Neuro Skills in 2001; the job paid less but he was attracted to the air conditioning and patient care.

The Centre for Neuro Skills is headquartered in Bakersfield (pictures) but has six other locations in California and Texas. — The Centre for Neuro Skills is headquartered in Bakersfield (pictured) but has six other locations in California and Texas.

Castillo moved up to residential supervisor, clinical supervisor, senior admissions coordinator, director of admissions and, in 2016, regional director of operations. Aiding his ascension within the company was the MBA he earned from CSUB in 2014.

“At that point school kind of intimidated me, but then I was like, ‘At some point, you just have to do it,’” he said.

Castillo later transitioned from CSUB graduate to instructor, teaching introduction to business for almost two years. He hopes to return to teaching on campus next spring.