Ed Johnson, Clinical Innovation Advisor
A growing body of evidence shows that even for traditionally hands-on supports like handwriting therapy or swallowing assessments, online speech and occupational therapy can be as effective as in-person therapy. Just as importantly, this article tells us that families of kids with disabilities in particular want timely and high-quality support whether it’s online or in-person: Johnson et al., 2020.
Umbo uses approaches which are based on scientific evidence. This means that we read and interpret scientific studies, then use them in our work with clients. Because using a combination of video, telephone, and internet to support clients is still relatively new, there is new evidence from scientific studies emerging all the time.
In occupational therapy and speech pathology, there are lots of different kinds of supports for different goals, so there is research which focuses on different areas. Below are just a few examples of areas of therapy which are effective online according to scientific research:
- Handwriting: interactive handwriting therapy via videoconference worked for children with fine motor or visual motor difficulties (Criss, 2013)
- Sensory processing: using a telehealth app at home allowed families to remember to practice consistency, and see improvements in sensory processing goals in a variety of contexts (Gal & Steinberg, 2018)
- Coordination: teletherapy was used to facilitate and improve motor coordination and motor control in people with cerebral palsy (Reifenberg et al., 2017)
- Activities of daily living: older people or people recovering from neurological illness can maintain or improve their skills in activities of daily living through teletherapy (e.g. getting dressed, cooking, cleaning, showering) (Gokalp & Clarke, 2013)
- Speech sounds: Children who received speech therapy online made the same progress towards their goals as children who did speech therapy in-person (Coufal et al., 2018)
- Language: children with autism showed significant improvements in language skills when their parents were coached in techniques to develop language skills (Hao et al., 2021)
- Learning outcomes: school children who received speech therapy or occupational therapy online at school for communication or occupational goals showed better overall learning outcomes at school (Langbecker et al., 2019)
When it comes to the research, many of these areas have something in common – if we coach someone close to the client (a parent, therapy assistant, teacher, disability support worker) to deliver the support in-person with the client, then we get great outcomes, and we get sustained improvement. We don’t always see these benefits from more traditional 1:1 therapy sessions.
This research tells us that coaching by the therapist online helps to build skills in the people who support clients directly in their own community (whether that’s family, therapy assistants, or another supporter) (Snodgrass, 2017).
Is online therapy the same as in-person therapy? Does it need to be done in a certain way?
Online therapy is not the same as in-person therapy. Some people are put off by the idea of online therapy at first. When we ask them, it’s often because they think therapists will try to do the same in-person therapy sessions with people via a video conference. We hear people say: “my client is too complex for that” or “my toddler doesn’t sit still that long” But we don’t want them sitting still if that’s not what they do! Whilst therapy like this does fit well in some situations, we know this doesn’t work in a lot of cases. That’s why instead of trying to do therapy directly with a person all the time, we will coach people around the person to help them. That means that complexity or attention isn’t a barrier for us. It also means that people around that person get skills in supporting them which they can use every day, and be confident that they can help their person practice participating and communicating without the therapist there.
What does that actually look like? It means that we often have lots of people involved in therapy – parents, teachers, health workers, therapy assistants, disability support workers. We want to teach people around the person how to support them to achieve their goal.
Here’s an example – a 4-year-old child with an intellectual disability and a language delay is learning to use sign language (Key Word Sign) to be able to communicate when they need help and when they’re hungry. The therapist meets with the parents and an early childhood educator via videoconference. The therapist talks about why and how the signs might help the child, and demonstrates the signs. The parents and the educator practice the signs to get used to them. The parents then move the camera to focus on the room where the child is, and the therapist observes playtime with the child while the parents and educator practice the signs around the child. The therapist coaches the parents into helping the child use the signs by talking them through how they’re going with the signs. The parents and educator now know how to use the signs, the child is not disengaged by being forced to sit in front of a screen, and practice can happen in real life situations in order to get better results.
What kinds of goals can online therapy work with?
Depending on the issue, people can get the same results from online services as being with a clinician in-person, with a number of added benefits such as reduced risk of infection, convenience, and no travel time or costs.
Scientific evidence shows the effectiveness of online therapy across a variety of disciplines, including but not limited to occupational therapy, speech pathology, physiotherapy, and nursing. Therapies that may be more difficult to deliver online include positioning assessments and wheelchair prescriptions, although our knowledge of how to achieve all therapy goals online is improving rapidly.
With a coaching approach, the possibilities of the different goals which can be targeted is vastly increased, because we are coaching you and the focus person how to implement skills at home and in the community, in contexts which are meaningful to you.
References
Coufal, K., Parham, D., Jakubowitz, M., Howell, C., Reyes, J. (2018). Comparing traditional service delivery and telepractice for speech sound production using a functional outcome measure. American Journal of Speech-Language Pathology, 27, 82-90. https://dx.doi.org/10.1044/2017_AJSLP-16-0070
Criss, M. J. (2013). School-based Telerehabilitation In Occupational Therapy: Using Telerehabilitation Technologies to Promote Improvements in Student Performance. International Journal of Telerehabilitation, 5(1). https://doi.org/10.5195/ijt.2013.6115
Gal, E., Steinberg, O. (2018). Using home-program adherence app in pediatric therapy: case study of sensory processing disorder. Telemedicine Journal & E-Health, 24, 649-654. https://dx.doi.org/10.1089/tmj.2017.0118
Gokalp, H., & Clarke, M. (2013). Monitoring activities of daily living of the elderly and the potential for its use in telecare and telehealth: A review. Telemedicine Journal and e-Health, 19, 910–923. https://doi. org/10.1089/tmj.2013.0109
Hao, Y., Franco, J. H., Sundarrajan, M., Chen, Y. (2021). A pilot study comparing tele-therapy and in-person therapy: perspectives from parent-mediated intervention for children with autism spectrum disorders. Journal of Autism & Developmental Disorders, 51, 129-143. https://dx.doi.org/10.1007/s10803-020-04439-x
Johnson E, Lincoln M, Cumming S. (2020). Principles of disability support in the rural and remote Australia: Lessons from parents and carers. Health Soc Care Community. 1–10. https://doi.org/10.1111/ hsc.13033
Langbecker, D. H., Caffery, L., Taylor, M., Theodoros, D., Smith, A. C. (2019). Impact of school-based allied health therapy via telehealth on children’s speech and language, class participation and educational outcomes. Journal of Telemedicine & Telecare, 25, 559-565. https://dx.doi.org/10.1177/1357633X19875848
Reifenberg, G., Gabrosek, G., Tanner, K., Harpster, K., Proffitt, R., & Persch, A. (2017). Feasibility of pediatric game-based neurorehabilitation using telehealth technologies: A case report. American Journal of Occupational Therapy, 71, 7103190040. https://doi.org/10.5014/ajot.2017.024976
Snodgrass, M. R., Chung, M. Y., Biller, M. F., Appel, K. E., Meadan, H., & Halle, J. W. (2017). Telepractice in Speech–Language Therapy: The Use of Online Technologies for Parent Training and Coaching. Communication Disorders Quarterly, 38(4), 242–254. https://doi.org/10.1177/1525740116680424
Telehealth in occupational therapy. (2018). American Journal of Occupational Therapy, 72, 7212410059p1-7212410059p18. https://dx.doi.org/10.5014/ajot.2018.72S219