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