Teletherapy during COVID-19

Telehealth goals for Speech and Occupational Therapists during COVID-19

A lot of kids on your caseload benefit from consistency and schedules.  The next couple of weeks (maybe more but we’re trying to stay positive) will mean a disruption of school, a lot of down time and lack of schedules.  

At A2 Therapy Works, we are implementing telehealth for most of our caseload and we’re having fun brainstorming some functional goals.  We figured we share! Have ideas? Please comment on our social media or in the blog comments. We’re all in this together!

• Tell me your schedule for the day? For OTs, let’s add a written language component with having the kids write a list.  
  

 Skills: fine motor, pencil grip, language expansion, expressive language, organization, executive processing skills.

• Kids struggling coming up with what they will do for the day?  Give them a list of items that they will then have to put in order. Ex. Brush teeth, brush hair, go to bed, help mom unload dishwasher, make your bed… 
  

Skills: expressive language, language expansion, executive function skills.

• How can you help mom/dad/sister today?  This helps children not only think about “me” but others. 
  

Skills: social emotional skills, language expansion.

• Bring the ipad into your room and describe everything I see there.  Tell me things you like and things you might like to change. Tell me about your most prized possession. 
  

Skills: expressive language, language expansion, social flexibility.

• Let’s talk meal planning!  What’s your favorite meal? Let’s brainstorm how you think we make that.  What ingredients do you think you might need? What are the steps in preparing it? Let’s write it down. 
  

Skills: executive functioning skills, language expansion, fine motor, handwriting.

• Having trouble connecting or teletherapy isn’t working?  Practice functional goals like a phone call. Work on greetings, asking questions, listening to answers and then asking follow up questions. For young adults work on mock telephone interviews, calling in a prescription, contesting a charge on a credit card or scheduling a doctor’s appointment.
  

 Skills: executive functioning, social/pragmatics, expressive language.

• Work on interviewing a family member. You and your client can come up with a list of questions to ask (mom, sister, grandma), they can interview them and then report back what you learned at the next telehealth session.  
  

Skills: asking wh- questions, language expression, social/pragmatic skills.

• Draw a picture of your family, write as many details as you can about that family member. 
  

Skills: language expansion, social/pragmatics, fine motor skills.

• Work on gross motor skills by using gross motor cards. You can make these or find them online.  Show your client the card and have them follow the picture- jumping jacks, frog leaps, skipping, toe touches. 
  

Skills: following directions, following visual direction, gross motor skills.

• Drawing project: You get to redo your bedroom.  Draw your new room with as many details as you can.  
  

Skills: pencil grip, language expansion, fine motor skills, visual detailing

• Calendar print out, work on writing events into a paper calendar, collect important dates like birthdays.  
  

Skills: organization, social pragmatics (learning about other people’s important events), visual memory.

• Following 3 step directions. Ask your client to follow 3 step directions and then come back to you, ex. “(1)Go downstairs and (2) get a banana, (3) go make your bed and then come back and tell me what you did”.
  

 Skills: auditory processing, receptive language, auditory memory.

• “How to” steps for adaptive skills for the alien that’s never been here before. Pretend you’re an alien (feel free to pull out some cool alien antennas) and have your client walk you through the steps of daily living.  Ex. What is this thing called “tooth brushing” let’s head to the bathroom (mom will hold the ipad) and you can teach me all the steps as to how to brush teeth. This will be great for Alien dental hygiene! Other adaptive skills to learn the steps: making cereal for breakfast, taking out the trash, making your bed, taking the dog for a walk, feeding the dog.  
  

Skills: adaptive skills, verbal sequencing, executive functioning, organizational skills, language development.

• Packing for a trip. Have your client get a suitcase and we will work on imaginative play to pack for a trip.  Where should you go? Is it warm or cold? How does that change what you pack? Let’s make a list of what you should pack.  Once done packing be sure to unpack and put away. Did you remember toiletries? 
  

Skills: fine motor skills, executive functioning, problem solving skills, expressive language.

FAQ telehealth questions:

Q: “I don’t think telehealth would work for my kid. His sessions are usually playbased or he’s too young”

A: You don’t know if you don’t give it a try.  We recommend families do 2 trial 15 minute sessions. You’d be surprised how kids will like the screen time and the added bonus of having mom or dad there to act as a facilitator. 

Q: “How are you going to keep if fun without all the games in therapy?”

A: An important aspect of telehealth is to have a parent or older sibling help facilitate and be the “man on the ground” especially with younger kids.  We will often ask them to have a game set up that will act as a reward system between each therapeutic trial. We also have ways to do it independently with older kids.  For example, we might have a game of hangman going while working on articulation “r” sounds.

Q: “Is it hard to set up”

A: Nope.  We will send you a link and any other documents you may need for your session.  The interface is very user friendly. If for some reason it doesn’t work, no worries, we have other options like Facetime or Google meetup.  

Q: “I don’t know, maybe we should just take a break?”

A: While in the end it is the family’s choice, especially during times like these, we think some consistency to their normal routine is key.  This is a way that families can still participate but in a safe environment. It’s also a nice way to break up the monotony of the day/weeks to come.

Q: “How will pediatric OT work with telehealth, it’s so hands-on?”
A: We will be giving home programs and the telehealth session will be used as a check in to see how you are doing with the home programs.  This is also a great opportunity to work on adaptive skills around the house like making a bed or brushing teeth properly.

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