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The year 2020 was a significant year for many reasons. It was also the year that Governor Polis passed a law stating that telehealth could be used to help families get occupational, physical, and speech therapy services from many different insurance companies. The idea of trying telehealth can be scary. It is hard to imagine how a child can sit at a computer for 30-60 minutes and still gain important skills from their session. However, telehealth can be a great substitute for in person services when travel, quarantine requirements, or other unexpected events prevent your child from being seen within the clinic environment.

How do telehealth sessions work?

Telehealth sessions are conducted using an online platform (most commonly Zoom via phone or computer). Sessions last anywhere from 30 minutes to 60 minutes depending on the usual length of your in-person session. The telehealth session takes place at the same time as your usual appointment time that you would come for in person services. However, a telehealth session does not necessarily have to be the entire length of your child’s in-clinic session, and can be designed to fit your child’s specific needs and attention span. Some children may need more frequent breaks during the session than others, and that is okay! During times when your child needs a break from the session, that can be a very important time for the therapist to provide 1:1 parent education on how you are able to work on your child’s skills within your own home. It is also a wonderful time for you to ask any questions you may have for your therapist.

Your therapist will let you know what materials are required for your teletherapy session ahead of the session. It is important that in order to gain the most benefit out of the teletherapy session that a parent or guardian is present for the session. It is helpful that parents work with the child on activities during the session in most instances. Children ages 10 and older may be able to participate without a parent based on therapist discretion.

Sample Telehealth Session Outline (OT):

• At the beginning of the session, the therapist typically greets the child and asks them how they are. Within the first 5 minutes of the session the therapist will ask the therapist or guardian if there are any updates they should know about since last seeing the child for a visit.
• Activity #1: Sensory Strategies
  • Using common household items to regulate the sensory system, improving transitions based on items that are in the home, or working on strategies for tolerating activities of daily living within the home such as teeth brushing, feeding, or hair brushing are some examples of sensory activities and education that may be able to be provided through telehealth.

• Activity #2: Gross Motor Coordination Activity
  • Balance, core strength, or bilateral coordination activity that usually lasts about 10 minutes

• Activity #3: Fine Motor Coordination Activity
  • Manipulating fasteners, handwriting, prewriting, and drawing games may be the types of activities provided in this section.

• Another activity or two are added based on the length of the session and client needs. Activities of daily living, visual scanning skills, visual perceptual skills, play skills, and social skills may be areas of focus for these activities.

• The last 5-10 minutes of the session are typically spent for answering last minute questions, reviewing the session, and to close out the session.

Benefits of Telehealth:

Some of the benefits of telehealth include:

• Your therapist being able to see what items your family has at home and provide you with suggestions on how to work on certain skills with those items.
• As a parent, you can directly see how the therapist interacts with your child and what skills they are working on in real time.
• The therapist is able to see the amount of space in your home environment you have for gross motor and fine motor movement
• Sessions can take place inside but also can take place outside weather permitting with a child’s playset, bike, trampoline, etc. as long as you have internet connection.
• Other members of the household that usually are not able to attend in-clinic sessions may be able to see what skills are being worked on in therapy.
• The therapist is able to see how the child behaves within their home environment while performing skills, where they are usually most comfortable.

Telehealth Session Topics:

• Activities of Daily Living – working on feeding, brushing teeth, hair brushing, and dressing (fasteners and tying shoes) within the home environment
• Gross Motor Skills – can be worked on using stairs within the home, a child’s bike or scooter, trampoline or playset, or through various interactive digital activities supplied by your therapist
• Fine Motor Coordination Skills – drawing skills, grasping skills, crafts, etc.
• Visual Scanning – digital word searches, ISpy games, spot the difference, and other online activities.
• Sensory Processing – clinicians can advise on how to use common household items to provide suggestions on how to support your child’s sensory system within the home environment outside of the clinic
• Social Skills – working on answering questions to community based real life social situations via digital game or video, learning to interpret facial expressions (no mask required with telehealth), and emotional skills.

Relevant Research:

• A recent study conducted in 2020 published in the International Journal of Telerehabilitation found via an online survey that 176 families who participated in telehealth occupational therapy services at a point in time in 2020 out of 230 respondents to the survey (77%) supported telehealth services as a substitute for in person services when needed (Dahl-Popolizio, Carpenter, Coronado, et al., 2020).
• In a study that examined 270 individuals who received mental health support via an occupational therapist through telehealth, it was found that patients who received occupational therapy services via telehealth relapsed less in the following 6 months than those who did not receive telehealth intervention, or stopped services due to COVID-19 (Sanchez-Guarnido, A.J, Dominguez-Macias, E., Garrido-Cervera, J.A.,  et al., 2021). This study is significant because it demonstrates that more progress is made by choosing telehealth as an alternative way to receive services as opposed to stopping services
• Within a review study examining 22 research articles on effectiveness of occupational therapy services delivered through telehealth within pediatric settings found that most studies indicated positive outcomes as a result of telehealth service delivery (Onal, G., Gun, F., & Huri, M, 2021).
• One study administered a survey to 205 individuals to measure satisfaction with virtual visits during COVID-19 for physical, occupational, and speech therapy sessions (Tenforde, A., Borgstrom, H., Polich, G., et al., 2020). Patients and patient care advocates reported high quality healthcare delivery (94% of responses), as indicated by a response of “excellent” or “very good” on the survey. Additionally, 87% of responders stated that they would find high value in future telehealth visits.

The idea of telehealth can be hard to picture. Sometimes it only takes one time to try telehealth with your child to see how successful it can be for your child’s progress when they are unable to come into the clinic. We hope now that you have a clearer picture of what telehealth may look like for your child. If you have any further questions about teletherapy services specifically at Amaryllis Therapy Network, please consult your therapist, and we are happy to help!

Written by Erin Bachler, OTR/L, MSOT

Meet Our Physical Therapists!

Our very own physical therapists, Lily and Emily would like to tell you more about their work here at Amaryllis Therapy Network. Check it out by clicking on the video above!

It’s spring in Denver and finally safe to put all of those starters and veggie and flower seeds in the soil. This is a wonderful opportunity for a fun, stress-free, joyful time with your kids. No matter their age, they can get involved.

“Messy play” provides much needed touch sensory input. As your child plays in the dirt, they can improve their ability to tolerate other textures, from the food they eat to the textures of their clothing. A picky eater can become more interested in the food they see in the refrigerator when they get to watch it grow from the ground and pick it fresh from the garden. If they are wary of getting their hands in the soil, you can provide them with some “heavy work” prior to working in the soil. Heavy work can be anything from carrying pots or bags of soil, to pushing a wheelbarrow, to even doing animal walks.

Watching a plant grow from a seed is very magical for children. In addition, if you plant some flowers that birds love you can entice more birds to your yard, which is such a benefit for you, your kids, and the birds!

You don’t need a lot of space, but you do need sun. If you have space outside, think of setting aside a small area just for your child. Containers are a great option if your space or sunlight are limited. If you use containers, you can increase the fun and your child’s ownership by letting them decorate their pots. Most of all, let them get dirty and don’t get worried about cleaning them up right afterward. Their immune system will thank you — the benefits of getting dirty are immense!

You might want to plant some vegetables or flowers that respond quickly, including sugar snap peas, lettuce, kale, and sunflowers. If you have room, pumpkins can be very rewarding to watch grow. There are some great ideas for gardening with children on Planet Natural.

Written By: Robin Hoffman OTR/L

IBCLC Ran Baby Feeding Support Groups or One-on-One Consultations

Breastfeeding can be a beautiful and bonding experience for both you and your baby. Unfortunately, it doesn’t always reach a level of ease for the mother-baby dyad immediately. From slow weight gain and low milk supply, to sore nipples and mastitis, we are here to support you.  If you need help with any step along the way, need a weight/feeding transfer weight or just need to know that there are other mothers out there experiencing the same things you are, please join Katie, our in-house International Board Certified Lactation Consultant (IBCLC), for our breastfeeding support groups or a one-on-one consultation.

Click here for more information!

A key part of every BODY’s regulation is breath. While it may seem inherent to remember to breathe, stress to the body can easily stifle the natural breath pattern, causing us to hold our breath or shorten our breath as a reaction to feeling anxious. This can happen to our kids when entering an unfamiliar environment, when a change in schedule occurs, or during times of sensory overload. Here’s the kicker…when this happens telling our kids to “just take a breath” is about as helpful as feeding a thirsty puppy peanut butter.

So, what can we do? Let’s make breathing fun and exciting! Here are a few ideas to reload the steam in your kid’s engine through the power of good ol’ O2.

• Have a cotton ball race: blow cotton balls or other small items across a table through a straw and across a finish line
• Blow up balloons and play keep it up
• Blow bubbles and use your breath to keep them up in the air
• Make some music! Play harmonicas, whistles or small flutes
• Breathe like your favorite animals
o Lion’s breath – inhale deeply and on your exhale stick out your tongue and let out a roar!
o Snake breath – inhale deeply and on your exhale push the air through closed teeth to make a hissing noise.
o Bumble bee breath – inhale deeply and on your exhale cover your ears and hum with your lips closed, feeling a buzz with your breath.
• Check out the free Breathe, Think, Do phone app from Sesame Street. Help the monster calm down by taking deep belly breaths!

https://itunes.apple.com/us/app/breathe-think-do-with-sesame/id721853597?mt=8

May is better speech and hearing month! Here are some ideas to help your child practice his/her articulation and language skills over the summer.

1. Read books aloud together

• Listen for your child’s target sound and have him/her repeat words
• Ask who, what, where, how, and why questions about the story
• Ask your child to re-tell the story chapter focusing on event sequencing, main idea, and important details
• Pick an object/idea from the story to describe (category, function, additional attributes, parts, location, materials, etc.

2. Drawing pictures together

• Have your child follow verbal directions using concepts like: first, before, big, small, purple, beside, around, middle, above, several, many, etc. (e.g. first draw a big blue house in the middle of the page, then draw a little yellow flower next to the house)
• Look for objects within the picture with targeted speech sounds and repeat his/her words

3. Field trip

• Draw a map of your neighborhood/town and go on a “field trip”
• Have your child sequence directions to get from one place to another
• Follow his/her directions (even if they are incorrect) and see if your child can get to the correct place (this targets problem solving, directional skills, grammar, and descriptive skills)
• Also have your child practice his/her targeted speech sounds when giving directions (if applicable)

4. Cooking together

• Choose a fun recipe to make with your child
• Decide what supplies are needed, what steps need to be completed, and the order of steps
• Have your child re-tell the cooking sequence focusing on proper sequence of events, grammar, and targeted speech sounds

5. Vacation postcard

• If you go on vacation this summer have your child fill out a postcard (highlighting some of the most important things they did/activities they liked the most)
• You can do this if you stay home too (have them make your own postcard and write their favorite parts of the summer)
• You can mail them off to a friend or family member for a fun surprise!
• Focus on targeted speech sounds, sequencing, grammar, descriptive words, etc.

Nikki Kirchoff, MA, CCC-SLP

Families want the holidays to be a happy time for everyone, especially their children.  It is important to take a few moments and recognize that what adults view as the “hustle and bustle” of the season can be overwhelming and over-stimulating sensory input for children, especially those with Sensory Processing Disorder or other neurological challenges.  Here are a few suggestions to help children and adults stay healthy and happy over the holiday season.

Laugh!
Laughter is the best medicine! It’s the quickest way to change everyone’s mood from bad to good. Tell silly “knock-knock” jokes with your kids or watch funny movies together.

Breathe
That’s right, take a deep breath in and let your belly gently expand out. This sends a signal to your brain that it’s okay to relax and unclench those tight shoulders and jaw. Just like a yawn, belly breathing is contagious and your kids will start to copy your deep breath.

Remember Routines
Many routines are disrupted during the holidays and this can be very upsetting for children, causing them to be cranky and complaining. Try to keep naps and meals at the same time every day. It’s okay to say “no” to invitations when your kids (and you!) are on sensory overload. Offer to get together in the New Year, instead. Try using calendars or picture schedules to help your child know what to expect. Predictability helps everyone stay calm.

Enjoy your holiday traditions with your families!

Cindy Clark, MS, OTR/L, BCP, CIMI/L