Thoughts about web-based physiotherapy sessions: what is lost and what is gained?

Slowly but surely it is becoming clear that our options for delivering therapy in early intervention will continue to be shaped by the Covid-19 pandemic for a long time to come.

Face-to-face therapy sessions are being replaced by web-based interactions with the children and families we serve and we need to acknowledge that this changes everything. If we are to continue to help children and families in the best way possible it is perhaps helpful to think about what it is that we, and families we serve, most value about our therapy session in early intervention. . 

I thought it would be useful to start a conversation about what is lost and what is gained using this new medium, which will without a doubt differ between therapists and with different approaches.

To get the conversation going, in this blog post I describe, mostly off the top of my head, what I feel are for me the the losses and gains of using the web as a way of delivering physiotherapy sessions in EI. 

My approach to intervention is my starting point 

I use a solution focused task oriented approach to assessment and intervention (SF-TO-MT), which emphasizes infant initiated actions and exploration of possibilities for solving the movement problem.

SF-TO-MT is a hands-off approach – apart from some manual mobilization – and this lends itself web-based intervention strategies.

A list of the things that I value in a face-to-face intervention session 

My relationship with the child.

In therapy sessions I work hard to gain the child's trust and make the sessions challenging and fun. This means getting down on the floor and level with the child and playing games that encourage interaction and engagement. 

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A co-operative relationship with the family

My relationship with the family/caregivers and the opportunity to work as a team around setting goals, designing activities, adapting activities to allow the child to succeed and then thinking about how training can be incorporated into the daily routine.

This co-operative approach increases the care-givers' confidence in creating and adapting learning environments for the child.

Observation and adaptation of tasks and environment on the fly

An opportunity to observe the child performing tasks that caregiver's want to work on, along with the opportunity to adapt the task and the environment on the fly to allow the child to succeed.

Mobilisation

The opportunity to use my hands to assess flexibility and use active mobilisation to increase range of motions in the here and now. 

What is lost, changed and gained in a web-based session?

Completely lost 
Establishing and maintaining a relationship with a baby or toddler is a nearly insurmountable challenge. 

Change
Hands on mobilisation is not possible. I can demonstrate and provide written and video instructions. I can coach the parent to do the movements. This mostly works well enough. 

The upside is that I am, as it were, forced to coach the parent and in this way increase their confidence and understanding of the role of flexibility and ways to increase it on the fly.

Changed and enhanced 
As we all become more skilled at interacting at distance, our ability to communicate using web resources is improving.

The conversations about goals, progress, and planning for the week at hand are still possible.

In face-to-face situations I would often interact with a child, select toys and games to get them to engage with a task, and try out different adaptations, and then would invite the parent to take over.

Now I am forced to take a back seat and allow the caregiver to make choices, figure out how to adapt the tasks and so on. I can only make suggestions, and provide feedback and encouragement.

I am have to  relinquish some of my power as the expert. And since I take great pleasure in my ability to persuade even the most reluctant toddlers to do my bidding, I feel this loss keenly.

But this means that I am learning to trust caregiver's knowledge and ability to make decisions and create new and innovative learning opportunities for their children.


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Comments

Kelly Mallon PT (not verified)

I agree with every thing above. Every situations has positives and negatives. The true challenge for me will be as I get new families. Those face to face sessions made transitioning to online smother.

Sun, 04/26/2020 - 20:14
Shannon Rosenman (not verified)

Very well said .. I am an OT in Infant-Toddler EI in Pa. I share your experiences almost exactly. After 25 years in EI I don’t accept change as easily as I used to .. but I am enjoying watching parents feel empowered.

Mon, 04/27/2020 - 17:53
Sue Liebross (not verified)

In EI in New Jersey USA. I am finding that it is both a positive and a negative that I have to virtually step back and watch rather than make immediate adjustments in real time. I am having to accept that the interaction is truly about parent and child and not me and my ability to “ have a great session” !

Mon, 05/18/2020 - 15:57
Julie Kerem PT (not verified)

I find it a great challange to explain handling tecniques and biomechanics. The quality of the video/zoom can also be problematic. Often i demonstrate on the parent how to use their hands to help therlir child move and that is lacking. It is a challange and emerging skill to use the everyday objects i see in the background of the video for therapy

Mon, 05/18/2020 - 17:44
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