Today Jeane Kolbe shares her telehealth experience with us, how she started planning and processing, and some practical ideas to use over a screen.
Not unlike most other OT’s, I was completely thrown by the idea of doing tele-therapy. I am very hands on in my treatment and love the physical handling aspect of my job. To be honest, my employee seemed more eager and willing to tackle this new world of online therapy than me. It took me a full week of hard thinking, and enough hours spent on webinars to amount to a week’s worth of actual work, before I became more comfortable with the idea.
When I decided to start this journey, I had never before used a virtual platform. Not even for social calls. The idea of therapy using Zoom scared me immensely. Thanks to another colleague, who was at the forefront of kick starting tele-therapy in response to the national lockdown, I was talked into doing a session. His advice was simple: “Just do it.”
I decided to set up a trial session with my best friend’s daughter, and explained that it is primarily for my own benefit. I wanted to see whether I would be able to make tele-therapy work. This did not mean that it could not be beneficial for her daughter as well, so I asked her what she was concerned about. I prepared the consent form, and conducted an interview to establish what she had available and the aims she wanted to work on with her daughter. I wrote up the treatment plan and we scheduled a time for my first daunting session of tele-therapy.
My heart was beating out of my chest as I connected the Zoom call. How silly! This was my best friend and her daughter after all. Nonetheless,it felt like a 4th year final exam! It was the first time I had used Zoom as well. I started the session and pressed record. As the time passed, I felt more and more at ease, and after watching the recording I was proud of my first effort. The session did not come without hiccups. We ended up with massive kitchen scissors because the child-sized ones were for a left-hander and this child was right-handed. I wanted her to move between stations using different animal walks, but mommy ended up setting up the stations next to each other. Despite all of this, it was a great learning experience and most of my aims in the session were reached. Most importantly, the child had a lot of fun! From this, I developed more specific treatment plans and decided to do a walk-through with the mom before future sessions.
I sent a template to my employees, which they should use when doing tele-therapy, and we set some rules in place. The plan had to be sent the day before, and a quick call to the mom/dad to make sure they understood what was expected. Nothing was to be done without the consent form having been signed and sent back. The first treatment plan had to be signed off, and I was available to watch their sessions to give feedback. I am happy to say that they have been doing great jobs and are not in need of a lot of guidance. This is easier than it looks.
We soon sent out the consent forms to the children we felt could benefit and started tele-therapy for my practice. The response was definitely not overwhelming (about 10% of my case load), but I saw it as an opportunity to spend time developing activities which could be used for tele-health. I soon discovered the whiteboard feature on Zoom (see link at the bottom of this article), and that I could share my screen! Very exciting times for me!
Initially I used the whiteboard for very basic things, like getting the child to finish a symmetrical drawing, then later became braver and braver, to the point where I now use games I develop on Microsoft Publisher for the child to play with me. One of these games which was a great success, is to get the child to copy a shape/picture in a sensory medium and then reveal what is under the block. I have combined this with motor activities or pieces for a puzzle. The children love the surprise element and, depending on how quickly you reveal the picture, it could also work on visual closure.
To work on bilateral coordination and midline crossing, I made this printout (below) and asked parents to have 2 coins ready. The children are then asked to follow a path from a specific colour to another one, moving the coins with their fingers. You can swap fingers around, cross hands over, do one hand from the top and one from the bottom etc. It can address the aims of following of instructions, and discrimination between the left and right sides. You can upgrade it by starting with big coins and progressing to smaller ones.
Another activity which all kids seem to enjoy, big and small, is winding up a box to bring it closer to them. To work on the vestibular system, they spin and wind the rope (2m) around their waist to pull the box closer. Mom has to pull the box back in order to unwind again, allowing the child to spin in both directions. When I want to work on fine-motor skills, I get them to wind the rope around a toilet roll or pencil, for bilateral coordination. Each time the box gets to them, a new piece of a puzzle is presented. Just for clarity – the rope is tied to the box and the free end gets given to the child.
Playing any kind of lava monster game, where children need to use pillows or other equipment to move across the floor without touching the floor, has been a source of great fun for the little ones. I get completely out of my comfort zone and become very theatrical in the process, pretending to be asleep and then awake with big eyes to observe. They become very excited and everyone has a good giggle.
As part of my treatment plan, I send the worksheets or printouts I need the mommy to have available and ask her to print or copy them.The treatment plan also provides a list of things she has to have ready, and then the outline of the actual activities during the session. I also make provision for an extra activity should there be time left over and type the homework for the week.
When the session actually happens, I check the setup with the mommy, in order for me to have an understanding of where things are in the room/house. I then have a quick ‘check in’ with the child and explain the expectations of the session. After this, we follow the activity plan, and then end with saying goodbye. I often then spend an extra 5 minutes debriefing the parent and telling them what a great job they did.
What I have found to be amazing, is how empowered the parents feel after each session and how excited they are for the next one. All of the parents we have dealt with so far have been very supportive and positive about this new way of treating. It also seems as though the kids love the one-on-one time with the parent and flourish during the quality time spent together during tele-therapy.
Activities for tele-therapy are as broad as your imagination, and only limited by the resources at the parents’ disposal. In saying that, I find that most parents have a variety of items that you can use. Therapy balls, big blankets, pillows, swings or jungle gyms in the yard, trampolines/beds, soft toys and all sorts of other puzzles and toys etc.I found the supply list from Built to Bloom extremely helpful to gauge exactly what the parents have available. I also ask the parents for a video of the toys/puzzles they have, and sometimes a photo of the child next to a piece of equipment we might be able to use.
While I undoubtedly miss my practice and physical contact with my beautiful children; I am so glad that I decided to brave this new world to ensure continuation of therapy during a time where many of these children are feeling uncertain/insecure about the world around them. I hope this serves as inspiration to start or continue your tele-therapy journey. It is not as scary as it seems.
Thank you Jeane for sharing your experience with us. For those of you looking for telehealth resources, maybe some of the items below will help:
- How to use the whiteboard on zoom
- A social story for children to understand telehealth before you start, created by Child’s Play in Alabama
- An escape room activity where the child must decipher the code to get out of the toy room
- The teleshare.com site has wonderful lists of websites which are helpful for telehealth sessions, as well as samples of forms, lists and presentations. Some items are free, some for sale and you can even share your own designs and ideas with other therapists!
- The telehealth share Youtube channel has loads of videos advertising resources, but also demonstrating sessions and ideas.
It will take some time to work through these pages, but if this pandemic has taught us one thing, it’s that we are stronger and provide a better service when we share our ideas and help others along. If you have something you would like to contribute to our blog, please send an email to firstname.lastname@example.org. And why not join one of the SAISI support Whatsapp groups for even more ideas and support?