Telehealth @ Dynamics

Telehealth @ Dynamics
What is Telehealth?

What is Telehealth?

Telehealth refers to any healthcare service that is provided over a technology platform. Telehealth is now being used for a variety of populations, health disciplines and diagnoses. Disciplines such as Occupational Therapy, Speech Therapy, Educational Therapy and Psychology are all able to provide a variety of support and care virtually using a computer or tablet platform.

Online therapy is provided in a similar manner as therapy that is delivered in face-to-face sessions. However, live video conferencing is used to address the child's therapy goals and provide guidance to parents and caregivers.



How we do it?

How we do it?

The therapist will provide the parent with a link and instructions about how to connect to the online platform. This may involve creating a Zoom or Skype account that will be used for the sessions. Usually, the therapist will test the Telehealth platform with the parent and child before they begin their first session. The therapist will also discuss with the parent what resources are available at home for the child to use during the sessions. Many Telehealth sessions require the same objects that a child would use in the centre. For example, for Occupational Therapy, to help strengthen a child's fine motor skills and reach developmental milestones, methods such as cutting skills and drawing are often used. For Speech Therapy on the other hand, the therapist may suggest resources like age appropriate books to expand the child's language abilities. Often a parent-coaching approach is used to guide parents to do therapy-like activities with their child at home in order to accelerate their progress. This way the parent learns exactly what to do and builds confidence in helping their child.



How we do it?

What are the benefits?

Telehealth provides therapy options within the comfort of the child's home environment. It provides ample opportunity for parent education and support from the therapist. It is convenient and keeps up to date with the latest trends. If you live far away from the centre or if transport is difficult, this is a way to bring occupational therapy, speech therapy, educational therapy or psychology into your home.


Benefits of Telehealth:

  1. Child Friendly: Computer-based activities are engaging and energizing for children.
  2. Goal Directed: Live online therapy helps child to be successful and achieve their goals
  3. Successful: Research has shown that the quality of teletherapy is as effective as in centre therapy. (See reference below).
  4. Convenient: Simple, easy to use technology implemented at home.


How we do it?

Who can attend?

It is suitable for all children who have access to high-speed internet, and a tablet or laptop with a webcam. Children of all ages can be supported through Telehealth by the therapist and their parent or caregiver. For sessions with younger children or those who need hands on support, a parent or caregiver is required to be present for the session. Telehealth can cater to a wide variety of children including those with Developmental Delays, Autism Spectrum Disorder, ADHD, Sensory Processing Disorder, Developmental Language Disorders, Language Disorders, Speech Sound Disorders, stuttering, difficulties with emotional regulation, and those that require counselling, educational support and many more.


How much parent/caregiver participation is needed

This is a great opportunity for parents and caregivers to be supported to work with their child. The level of parent/caregiver participation will depend on the level of support the child requires. This can be explored with the therapist and a plan put in place in how best to support the child. Research has shown that parent coaching through telehealth has been effective in increasing parent efficacy and child participation (Little et al, 2018). Support can range from sensory needs, educational needs, emotional and counselling support or language skills.






Telehealth Activities

Telehealth @ Dynamics

Making Homemade Play Dough

Items required:

  • 2 cups of flour
  • 1 cup of water
  • 2 tbsp of oil (cooking oil or baby oil)
  • 1/2 cup of salt
  • few drops of food colouring (optional) -add at the end

  1. Place all the ingredients into a large mixing bowl and have your child assist to mix the ingredients together with their hands.
  2. Continue to mix until the dough has formed. Add more flour if the dough is too sticky in texture.
  3. Practice kneading, rolling, squeezing, pulling and flattening the dough with your child.
  4. Store in the fridge in an airtight container.

Making Sensory Bags or Bottles

Items required:

  • Large size freezer/ziplock bag (option to remove the writing from the bag using nail polish remover)
  • Baby oil/ cooking oil
  • Water
  • Liquid food coloring
  • Duct tape/Electrical Tape

  1. This sensory bag has a high risk of bursting therefore it is recommended to place tape about the three closed sides of the bag. Place the tape on half of the bag and fold it over to the other side; start by taping the bottom and then the sides of the bag.
  2. Start by adding some baby oil (approximately 50ml).
  3. Add some drops of food colouring.
  4. Then add some water (approximately 50ml).
  5. Seal the bag, pushing out most of the air. It is good to leave some pockets of air to avoid it bursting.
  6. Tape up the open edge of the bag and it’s ready to play!

Items required:

  • Large size freezer/ziplock bag
  • Shaving foam
  • Paint
  • Duct tape/Electrical Tape

  1. Pour yellow paint into one corner of the freezer bag and blue paint into the other corner (red/yellow or red/blue).
  2. Place some shaving foam into the bottom corner of the bags. It’s important not to overfill the bag as this increases the risk of the bag splitting. Start by adding some baby oil (approximately 50ml).
  3. Remove air bubbles from the bag and seal the bag.
  4. Tape up the open edge of the bag. Allow the child to play with the bag and mix the colours together.

Items required:

  • Large size freezer/ziplock bag
  • Glitter
  • Liquid Food Colouring
  • Hair Gel
  • Scissors
  • Duct tape/Electrical Tape

  1. Open the large freezer bag on a flat surface and add the hair gel into the bag.
  2. Apply a couple drops of food colouring to the gel inside the large freezer bag.
  3. Sprinkle glitter into the bag -as much as the child would like.
  4. Seal the bag and tape it up.
  5. Use on a white surface and allow the child to draw shapes and write letters on the bag.
  6. Option: To add in small plastic toy items to the bag for further play opportunities.

During telehealth sessions with your child’s therapist and while at home with your child there are lots of opportunities throughout the day for practicing following and giving instructions. Instructions can be given verbally, written, with pictures, modelled or even with a short video. There are a variety that you already use throughout the day. Some might be simple routine instructions such as “get your bag”, ‘take your plate to the table and sit down”, or “put on your shoes”. There are also longer and more complex instructions such as “first colour the tree green, then clap your hands, and last draw 3 clouds in the sky”. These skills can be expanded out for older children using their literacy skills to read and follow written instructions to complete a task.

For both younger and older children, it is important that they get the opportunity to give instructions to you or to their siblings. This helps with developing their expressive language skills including use of correct grammatical structures, expanding their vocabulary and concept knowledge, their ability to order and sequence events (if giving multiple part instructions) and it can be used to practice and develop their turn taking skills. Your child’s therapist will be able to guide you for the type of prompts or supports needed to help your child successfully give and follow instructions.

Some ideas for following and giving instructions could include:

  • Playing “Simon says” – for example “Simon says clap your hands and turn around”, or “Simon says pick up all the red blocks”.
  • Going on a “treasure hunt” inside the house or on a socially distanced walk in the park– for example, “find something green”, or “find something that you can throw”, or “find something that starts with the sound ‘t’”.
  • Doing a shared colouring or drawing activity – for example “draw a blue circle on the swing”, or “colour the girl’s hair purple after you draw a big snowman”. Doing something unexpected or a bit silly will help keep your child engaged in the activity for longer as will finding worksheets with their favourite characters. Take turns with giving and following instructions with your child. Your child’s therapist will be able to guide you for the type of instructions your child is currently working on.
  • Playing games with rules and getting your child to explain the rules to you or playing games without the rules and make up your own instead.
  • Choosing a recipe to cook with adult supervision. Your child can choose a recipe they want to make and write a list of the ingredients they need, then check what you have at home and what needs to be bought at the store. They can then work either independently or with as much support as is required to follow the recipe. This could be with them reading the recipe, you saying the instructions or a combination of both. Encourage your child to sound out any familiar words or letters or identify numbers that they need for measuring.
  • Learning or making up a dance routine (or even learning a TikTok dance using an online video)
  • Getting your child to give you instructions for what to do with their favourite online game – such as Minecraft or Roblox – if your child is interested in it then they will be more likely to stay engaged in the activity with you for longer.

Shared book reading is a great activity that can be introduced during telehealth. Your speech-language therapist can read a book to your child through telehealth and use different approaches to engage your child with the book. This is a wonderful way to support parent-child interaction and promote positive engagement rich in language. You can also encourage your child to show their favourite book to the therapist and talk about their favourite book. The therapist can ask open-ended questions during shared reading, for example, “What is this picture on the cover?” “What happens on this page?” “Tell me about your favourite part of the book?” and support your child with their responses by modelling the appropriate language. This activity is also a great way to develop vocabulary, expand on your child’s answers and develop their ability to answer -WH questions (who, what, where, what doing, why, when). With an older child, shared book reading is also a great way to develop their inferencing and prediction skills, by asking them what do they think will happen next or why do they think the character is doing a certain action. It is also a wonderful way to introduce and develop their understanding of more nuanced emotions and body language. It is a great way to connect with your child and enjoy some parent-child time in a positive environment!

1. RAN Tasks

Rapid Automatized Naming (also known as Rapid Automatic Naming or RAN) is the ability to name items and symbols in a quick and automatic manner. The ability to easily retrieve information, rapidly and automatically without effort represent additional skills that are involved with successful reading. These other skills include attentional, perceptual, conceptual, memory, lexical, and visual sequential processing. Difficulty in this skill can hamper speaking, reading, and writing.

Taken from https://bonnieterrylearning.com/blog/rapid-automatized-naming-reading-dyslexia/

There are many different kinds of automatized naming games that require rapid naming and recall, like charades, taboo, pictionary, etc.


How to make your own RAN sheet

  1. Think of 4-6 items and find pictures or icons for them. You can also use numbers, letters, or symbols.
  2. Put a total of 20-40 of these items in random order in a grid.

How to use it?

You will need a timer (and something to cover the sheet partially *optional*)

  1. Agree on how many items would your child have to name, and cover the sheet so that only the agreed number of items is shown.
  2. Ask your child to name each of the different items at random, your child should only use the same names for the items every time.
  3. Decide on the direction in which items are named.
  4. Prompt your child to start naming the items in the direction agreed upon as fast as they can, starting the timer once they start naming the first item.
  5. Keep a record of the number of items, time taken, and number of errors made to track progress over time.
    *To make it a little more challenging, you can also switch the names of items, or give it a different name.

2. Lumosity (www.lumosity.com)

Lumosity is a great website for training core cognitive abilities like memory, speed, attention, and information processing to name a few. Lumosity takes scientifically-validated tasks and turns them into fun games, actionable feedback, and rich insights into your cognition. (Information taken from lumosity's website). It tracks progress, is catered to all ages, and is also available on mobile devices for easy accessibility.

Mindfulness Strategies

During telehealth sessions there are many opportunities to practice mindfulness. Mindfulness practice can also be used throughout the day when your child is emotionally dysregulated, in a low mood or in general need of some relaxation strategies.


Some ideas for mindful breathing include:

• Roller Coaster Breathing

  1. Slowly trace your left hand with your right index finger, starting where your hand and wrist meet.
  2. As you trace each finger, breathe in as your finger climbs up, and breathe out as your finger slides down.
  3. Pretend that your finger is a SLOW roller coaster car, going very, very slow up and down the tracks.
  4. After you have traced your entire hand, switch hands and try it again.

• Ocean Wave Breathing

  1. Cover your ears with your hands.
  2. Close your eyes.
  3. Take long and slow in-breaths and out-breaths.
  4. Zoom your attention to the sounds that your breathing makes.
  5. Visualize peaceful ocean waves rolling slowly back and forth towards the shore.


Some ideas for mindful exercise and muscle relaxation:

• 5-4-3-2-1 Grounding

  1. Take a slow, focused breath and zoom your attention to the present moment.
  2. Taking your time, notice and list:
    • 5 things you SEE
    • 4 things you FEEL
    • 3 things you HEAR
    • 2 things you SMELL
    • 1 thing you TASTE
  3. Take 3 more slow, focused breaths and just be still for a moment or two longer.

• Wall Push-Ups:

  1. Stand next to a wall.
  2. Place your feet forward and palms flat against the wall.
  3. For the next 5-10 seconds, push against the wall with all your strength.
  4. Then relax your body.
  5. Do this exercise 3-5 times.

• Rocks and Socks

  1. Take a deep strong breath and make fists with your hands.
  2. Squeeze your hands with so much force; it is as if your strength can transform your fists into solid, indestructible rocks.
  3. When you can’t squeeze any harder, exhale and release your fists.
  4. Let go of all that tension and relax, as if your hands and arms have turned into dangling socks.
  5. Try turning other parts of your body, such as your shoulders, legs, and feet into rocks and socks too!




Telehealth Set Up: Zoom

Telehealth @ Dynamics

Zoom is a free video conferencing platform which allows people to connect online and share resources and their screen easily.

A computer or tablet is required which has a camera, microphone and speaker. For telehealth sessions, a camera is required to allow the therapist to be able to see and interact with the child.

While a Zoom account is not required to join a meeting, it is useful to have an account. The free zoom app can be downloaded from the Zoom website (under Resources > Download Client), or from the Apple App Store or Google Play Store.

When you open up the app, there will be an option to sign up for your free Zoom account using your email. It is a good idea to test the software prior to the meeting. This can be done by going to the link zoom.us/test which will allow you to test the technology for the microphone, speaker and camera. You can also check how to turn on and off the microphone and camera.

The therapist will send an invitation to join a meeting via email. In order to join the meeting, you can click on the weblink or enter the Meeting ID and Password which will be provided by the therapist. You will be placed in a waiting room and the therapist will allow you into the meeting room once the meeting starts. You will be able to see the therapist and have options to turn your video and microphone on or off.


Here is a useful YouTube video explaining the process of setting up a Zomo account and its functions: https://www.youtube.com/watch?v=d7xXZxRDFUU

Whilst Dynamics prefers using Zoom due to its ease in setup and usability, we can also use other platforms that may be preferred by clients such as Google Meetups, Skype etc.


[Above points adapted from: https://globalteletherapy.com/advantages/]

References:
Little, L. M., Pope, E., Wallisch, A., & Dunn, W. (2018). Occupation-Based Coaching by Means of Telehealth for Families of Young Children With Autism Spectrum Disorder. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 72(2), 7202205020p1–7202205020p7. https://doi.org/10.5014/ajot.2018.024786