Adapting to a New World with Telehealth

Sheri Ireland-Berk, PT
The frantic, frenzied family scramble to scoop up the kids from school and race to soccer practice, dance class, scout meetings, and after school activities came to a screeching halt when the Coronovirus forced the world to stay at home and shelter in. For families of children with many kinds of disabilities this “stay home” order threatened to keep them from getting critical services like physical, occupation, and speech therapy.
These services help to build skills for independence and functional participation in the world. As a pediatric physical therapist who relied on face-to-face, hands-on, play-based interaction with children and their caregivers I had to shift gears, leave the clinic behind and find new ways to reach out to these kids so that weeks, months and even years of crazy-hard work and progress would not be lost or reversed.

...Enter Teletherapy!

Tele-What?..you say.

In a nutshell, telemedicine (a.k.a. telehealth) refers to the use of digital tools to provide some forms of medical treatment. It utilizes computer programs that create things like Home Exercise Programs (HEPs) for patients, shared portals for electronic medical records (EMRs), and secure messaging systems where patients can converse with their therapists or healthcare providers. Telemedicine isn’t exactly new, but our current world health crisis has kicked its development and use it into hyperdrive. In an instant, health care providers like me, deemed essential workers, have been called on to get creative and get their clients right back into the game. When technology is used within the therapy world, these services are called teletherapy.  

Teletherapy involves therapists providing care virtually over a computer platform in real-time. We are virtually in your homes, with your families, using the stuff you forgot you had in your basement or garage to try to recreate or simulate a therapeutic environment for your kiddo who has cerebral palsy, Down Syndrome, Autism, or developmental delays of any kind. These kids need to keep moving, keep learning, keep up with the family and they are often the very ones who could be left sitting idle when families are already stressed during this crisis. We, as therapists, have made this shift and come alongside these families and the results, although challenging to achieve, have actually been ...well, pretty great.  

I have been a Pediatric Physical Therapist for more than 30 years and I have treated my little ones in all sorts of places from stuffy stairwells in some of the dingiest old buildings in New York City, to sterile hospitals in New Jersey, to well-stocked high-tech private clinics in the Chicago suburbs. I am lucky to have developed an arsenal of ideas, tactics, games, modalities, and methods and I have used every single one to try to motivate and manipulate kids into working hard for Mom, Dad, Grandma, and… even for the family dog. I’ve seen miracles happen when we repurposed an old chair in the attic into an adaptive seating system so that a child could sit at the family table for the first time, dropped training wheels into Dad’s tennis shoes for a “make-shift” propped-up Peleton experience, and even filled a bathtub with shaving cream and beach toys (don’t ask...please don’t ask) to provide a unique sensory experience for a kid in total meltdown (it worked). My kids are doing better, they are getting stronger and they are surprisingly motivated while their parents (although weary) are becoming more invested because they are a much bigger part of their kid’s progress and development. IT’s working...it’s really working and it’s (mostly) wonderful!

Teletherapy is NOT for the faint of heart and it does not and can not replace face-to-face (sometimes in-your-face) therapy. I sometimes find it exhausting and tedious to sit and stare at a screen all day when I am used to spending hours squatting on the floor with a 2-year-old trying yoga, swimming next to a child in a pool during aquatic therapy, or chasing a new bike rider around the minivans in the parking lot. It’s challenging to encourage a tantruming toddler and his quarantined mother to find new ways to stretch his tension-filled hamstrings over the kitchen table. ...But it's also oddly rewarding. I get texts from the mom who’s son (the one who could barely walk 15 feet without crutches) is now walking free of assistance for A MILE around his neighborhood while his entire family walks behind him cheering. I get messages telling me that the 7-year-old young lady with Cerebral Palsy is sitting on her adaptive potty seat having a successful potty training session because the family is finally able to work through the time-consuming positioning, the diet regulation, the patience of waiting, and the reward involved with strengthening and programming her body to do something that most of us take for granted.
My inbox is filled with video after video of the first steps, the “she finally rolled over”, the “is this what you meant by spinal extension?”, and the photos of exhausted little ones who have worked hard in spite of all that has changed, all that is missing, and all that is stressful right now. These kids depended on a routine that has been significantly upended and shifted by something they can’t begin to understand AND THEY ARE ROCKING IT! It’s progress! It’s important to work!

Teletherapy has taken off, is flying high, and is showing no signs of landing any time soon. We can utilize digital growth and invention to reach more kiddos than we ever thought possible in remote areas of our country and of the world where they would otherwise have to do without. We can make available to the masses our research, valuable services, and resources providing guidance, wisdom, and expertise. We can guide caregivers to facilitate movement patterns, positioning strategies, and weight shifts that can take someone from sitting alone missing out to moving ahead and fitting in...literally “Zooming” them forward until we can find them the equipment, services, and therapy that they so desperately need and deserve.

Over these long weeks of social isolation and incessant news coverage, I have learned (again) that these children are my HEROs and their families are HERO MAKERS! I have watched struggle transform to triumph as caregivers learn to appreciate my job and I further respect and revere them in theirs. I have learned that a paper towel roll duct-taped to the refrigerator can replace the most expensive new toy and Daddy’s leg makes a darn good simulated horseback riding experience. I’ve learned that a virtual high-five can mean the world to a six-year-old who I watched stand up from the floor for the first time without help. I’ve learned that children who showed little signs of being able to adapt to change yesterday CAN and WILL when loving families and dedicated therapists come together with a common goal today! ...and I’ve learned after three decades as a physical therapist that I’ve still got a whole lot to learn about the resiliency of the Human Being.