You might think that transitioning between adult and pediatric telehealth physical therapy is a piece of cake, but I’m here to tell you that you should definitely do some homework before embarking on a virtual journey with littles. If you don’t want your session to end with both you and your patient in tears, then a little preparation is vital. I’ve worked with many children via telehealth, and here are some of the key tips that I have discovered along the way. Hopefully this advice will save you from unnecessary roadblocks—and keep you from pulling out your hair!
1. Be flexible.
First and foremost, flexibility—the ability to go with the flow—is essential to practicing with the pediatric population via any delivery method. Telehealth magnifies this requirement. There will be technological glitches, non-compliance, and other surprises that pop up. You have to adjust and pivot your ideas to ultimately achieve what is important to the child and family.
Take cues from the child’s home environment.
Rely on your observational skills as the basis of assessment and treatment. Scheduling video visits during a particularly challenging time for a family can be invaluable; you can observe issues in real-time and problem-solve with the family to come up with solutions. Read the child and the parents through non-verbal cues to assess the need for breaks or transition time between activities.
Empathize with families and caregivers.
Remember how tiring some sessions can be with a severely-involved kiddo? Empathize with the families, because they are the ones experiencing the exhaustion now! Use the time during rest breaks to give gentle feedback, summarize what you just did, talk about what is coming up next, or address questions and concerns. You are the coach; the parents/caregivers are your hands.
2. Be creative.
Telehealth has been an amazing outlet for my creativity as a therapist. I feel less constrained to “traditional” plans of care, and I love to brainstorm new and fun ideas that will target each patient’s functional goals. Thinking outside of the box is very helpful when it comes to tailoring treatment sessions to the telehealth delivery method. Collaboration via telehealth with other professionals (e.g., occupational therapists, speech therapists, equipment providers, and orthotists) who are involved in the child’s care is a great way to brainstorm and provide a holistic healthcare approach.
3. Prepare a rough outline of each session before you get online.
To develop fun, effective pediatric physical therapy sessions, it’s crucial that therapists plan ahead of time. With telehealth, preparation is one aspect that can make or break your virtual visit. Having a game plan will help you streamline your session and avoid awkward pauses.
Now, I’m not recommending you develop a minute-by-minute itinerary, because that will surely lead you down a path you do not want to navigate with children. What I do recommend, though, is:
- a skeleton outline of what you are going to focus on,
- an explanation of how those focal points apply to the child’s goals,
- a list of materials you and the parents need for the session, and
- a few ideas of things they can work on for the next session.
Use this framework to communicate clear, concise instructions and expectations. This outline will give you confidence and a sense of calm—both of which will translate through your interactions with the child and the family.
4. Use motivators.
Every pediatric therapist knows that motivators are key when it comes to children. This is no different in the virtual world. Whether it be food rewards given by the parents at home, or fun games to play via screen-share, a good bribe will be your best friend. You just need to figure out what motivates each specific child. One simple way to do this is to ask the parents. They are a wealth of information that you absolutely should tap!
5. Incorporate child-driven activities into goals.
Many times, children have their own ideas about what they are and aren’t going to do, no matter how many awesome motivators and words of encouragement you provide. This can either throw you off completely and put your visit up in smoke, or you can use that child’s intrinsic motivation and imagination to target his/her functional goals. It may not be exactly what you had in mind, but it will be rewarding. The child will feel a sense of accomplishment and independence by being able to “lead” the activities, and you will be able to integrate goals into those activities.
6. Cover logistics with parents/caregivers prior to each appointment.
Collaborating with the parents/caregivers before a telehealth session can give you invaluable insight into:
- their priorities for goals,
- materials/equipment available within the home, and
- the general structure of the home routine.
This information can help you optimize treatment outcomes.
Collect necessary information upfront.
Furthermore, make sure you have all forms and consents ready and that you’ve listed telehealth in the plan of care. I recommend allowing patients and caregivers to submit forms electronically, so that everything is stored securely and in one place.
Another tip would be to create a customized, thorough intake form incorporating pertinent information you seek when evaluating a new patient. This helps me create a picture in my mind of the patient’s functional level. That way, I can be better prepared with appropriate assessments, questions, and materials before ever seeing the child.
Make sure the patient has the proper tech setup.
As far as technological and home setup, I recommend arranging an alternate form of communication you can use to contact the patient/family if either of you experience technical issues. To help avoid such issues, you can recommend the proper tech setup, which doesn’t need to be complicated. The main necessity is a device with a camera that connects to the Internet. There are other things that are nice to have, but don’t overthink it!
Let families know what materials they need to have on hand.
Letting the family know what materials they’ll need in advance of each session helps them feel prepared. It will also save time, as they won’t be searching for the right toy or equipment during the visit. I also like to send a reminder email or text the day of the session that contains the visit link and log-on instructions, along with quick bullet points of any materials they’ll need to bring.
7. Recommend an open treatment space within full view of the camera.
I always recommend that parents place a blanket or mat in an area that has a large open space in which the child and family can move around. The blanket or mat serves as a marker of what is visible on-screen. It is a great visual reminder of how far patients can stray before you need to call them back in! I also like to mark out an area on my side to ensure I am fully visible when demonstrating exercises by myself or with a doll.
8. Allow for extra time in line with children’s processing times and possible technological lag.
We all know that children need extra time to process instructions and information before responding, and telehealth can increase the amount of processing time needed. Allowing ample time for children to respond or perform an activity reduces frustration and stress levels for everyone. Plus, it helps mitigate the effects of technological lag.
9. Use a platform that allows you to interact with the child.
Do ample research on all of the different platforms available for telehealth. Assuming most telehealth platforms fulfill basic requirements (e.g., they are HIPAA-compliant, willing to enter into a business associate agreement, able to record sessions, and compatible with most devices), you’ll also want to look for one that caters to your population and treatment methods. For instance, if you like to create visuals to convey important information to the family, the telehealth platform should have screen-sharing capabilities. Some platforms even allow you to draw on the screen or play games interactively. Whatever system you choose, you need to be comfortable with all the features you plan to use. A quick test-drive—complete with a mock session— is a good way to troubleshoot any potential issues before you are on the clock with the family.
10. Send a quick summary of each session—along with one or two major things to focus on for the next session.
After each treatment session, write up a summary of the appointment (a few short sentences will suffice) and add one or two key activities or homework items for the patient to focus on before the next session. Because pediatric telehealth is so hands-on and requires the parents/caregivers to take an active role in treatment, sometimes families get overwhelmed and forget what you told them. A quick written reminder or clear visual can be a great way to ensure understanding and take some of the pressure off of the family to remember everything. It can be as simple as following this template:
Pediatric telehealth does require unique preparation to ensure successful treatment, but there’s no need to overthink it. Trust me! To recap my advice from above:
- Rely on your observational and educational skills as a therapist, as telehealth in pediatrics is more of a coaching model.
- Offer continuous feedback and gentle coaching to the parents/caregivers.
- Provide motivators and use the child’s intrinsic motivation to adapt activities in a way that targets functional goals.
- Over-communicate, and allow ample time for processing.
- Demonstrate activities in addition to providing verbal instructions.
- Think outside of the box, and don’t feel limited in your ability to use creativity.
- Perform frequent self-reflection as a therapist and contemplate what went well in sessions, where you felt unsure, what you could improve upon for next time.
Telehealth requires a shift in mindset for both the provider and the patient. You may find hidden strengths that you can leverage to provide great care for your patients. Practicing pediatric physical therapy via telehealth opens up opportunities to convey the wealth of knowledge we have that can be so beneficial to our children and families! We are definitely more than just our hands, and it is time that we embrace that.
Dr. Sierra Christensen, PT, DPT is a wife, mother of two boys, pediatric physical therapist, and telehealth entrepreneur. She is passionate about raising awareness of the importance of early childhood and empowering parents and healthcare professionals with knowledge about early child development. Dr. Christensen is always looking for others to help her in changing the current healthcare approach to more proactive prevention and early intervention, so visit develoPTpeds.com or reach out to Sierra via email at sierra@develoPTpeds.com if you share the same vision.