By: ROBYN MERKEL-WALSH, MA, CCC-SLP/COM®
The biggest challenge for many therapists was “How in the world do I do oral motor , feeding or orofacial myofunctional therapy via telepractice?” I myself said the same. It was unchartered waters for sure. Teletherapy is not new for many clinicians but COVID-19 made it obligatory for therapists who have never tried it before.
Tactile therapies pose different issues than general speech disorders such as delayed language or even traditional articulation therapy. School-based and medically based therapists alike have students/clients who receive specialized therapy techniques such as Beckman Protocol, SMILE Program , TalkTools® Bite Block program, and PROMPT. These are very hands on approaches requiring the SLPs to touch the student/client. The same is most likely true for lactation consultants, RDHs, chiropractors , OTs and PTs who also use hands on treatment modalities.
Here are some things I learned from converting from live to online sessions:
The first realization of telepractice was that we need to train our parents, caregivers and clients and have them practicing in front of us more often to ensure they are using the methods correctly. I was somewhat shocked as to how many of my caregivers did not know what the oral placement tools were called or how to use them even though they were practicing at home. Our caregivers need our support more than we know.
Technology can be social ! As an adult I learned how to socialize via FaceTime and House Party during the pandemic and lo and behold many of the clients and students could do the same in a teletherapy model. They responded to my voice, my directions and were very engaged with me, sometimes even more so than in live sessions. I am apparently more animated and engaging on a screen.
Young children for the most part found their parents to be very reinforcing during sessions. They enjoyed the fact that the parents were using touch and helping them with their goals with undivided attention away from work, spouses and siblings. Very few children responded negatively to this model of therapy.
Guess what? We all need movement. The hardest part about teletherapy is the confinement in a chair most hours of the day.
We are clearly magicians who can make something that seems impossible become motivating and successful . We as therapists have worked in hallways , closets (true story) and in people’s homes. We can invent new modalities of treatment when we are called upon and when the motivation is there to help our students /clients.
Here are my tips to successful tactile therapies online:
Be sure that your attendee understands the tech part/platform of the sessions. Example, ethernet is better than WIFI, laptops have better stability than phones and tablets. I did free 15-minute trial/test runs with everyone before the first session.
Send out safety precautions before such as: “before the session be sure to wash your hands, wear gloves and have a receptacle ready to place used items”. Just because it is their child, or they are working directly with you (teens and adults) does not mean they should not follow proper protocols to reduce the spread of germs especially in these uncertain times.
Have the parent /caregiver and patient facing one another. You will get a side view , but there will be better placement of the tools and alignment of the head and neck if the parent faces the child as you do . Older children and adults who are doing more volitional tasks can face the screen.
Have a flashlight or Throat Scope present so the caregiver can see inside your mouth when needed as a guide.
Have a full set of tools available to demonstrate all tasks in session and follow proper disinfection procedures for your own supplies.
Discuss a reinforcement system for children with challenging behaviors before the first session. Restricted access items, such as a highly desirable snack should be used just in therapy to maximize the sessions.
Be kind to your back and body .
Build in movement breaks for both clinician and student/client even if this means a 1-2-minute stretch. Invest in a supportive chair if possible.
Schedule sessions with a cushion of time so that you may eat, drink or use the rest room. I have been doing 45-minute sessions in 60-minute slots for this reason as well as accounting for possible disconnections. (NOTE: This may not be allowed in a school system but is best practice to ensure children receive full frequency and duration of services.)
Gentle reminders regarding seating, location of the home and noise level are helpful from time to time to avoid interruptions (BIG TIP: no chairs on wheels unless you want vertigo!)
So, what I thought would be a short lived trial of teletherapy will now be an important part of my practice. It can be done during inclement weather, if you need to be home with a sick child or if a patient travels from afar. It is not just for emergencies. Just be sure to check state licensing laws regarding seeing patients outside your state. Generally speaking, you must be licensed in the state the patient is located in to conduct services. Wishing you all the best of luck!