Teletherapy, a form of telehealth, is the process of providing occupational, physical, or speech therapy sessions virtually. Teletherapy is used when an in-person session is not possible. This requires both parties to have appropriate equipment and software, which can differ based on the setting or patient population.
Therapy is predominantly an in-person treatment which often requires therapists to physically guide body mechanics, modify a situation, or provide tactile cues to complete an intervention. Even before COVID-19, teletherapy had become slightly more prevalent in recent years. This virtual form of therapy originally emerged in settings such as school-based occupational therapy where there was better access to technology, and where school schedules did not always accommodate an in-person visit. The small amount of therapy-based telehealth being provided before COVID-19 was limited to situations that did not easily allow for in-person visits, such as patients in rural areas or individuals with an immune deficiency. And these teletherapy visits could only happen if approved by insurance.
How Teletherapy is Being Used Now
The coronavirus pandemic has affected so many aspects of daily life, including therapy. Therapists who solely provided in-person sessions previously have found themselves adapting to virtual therapy sessions almost overnight. This sudden change has resulted in telehealth being used much more frequently and in a variety of different outpatient settings, including hand therapy, early intervention, and more.
Embracing teletherapy took engenuity and flexibility by professionals throughout therapy fields, but it also took changes in legislation. For providers to be reimbursed by insurance for services, new legislation had to be passed quickly to allow therapists to provide virtual therapy sessions. The American Occupational Therapy Association (AOTA) has published state-by-state updates on State Statutes, Regulations and Regulatory Board Statements in regards to occupational therapy and telehealth. Similarly, the American Physical Therapy Association (APTA) has resources related to Legislation and Regulations.
Now, teletherapy is being provided in settings which were not even widely considered before the COVID-19 pandemic began. A great example of this is early intervention (EI) which provides services for children from birth to age 3. EI therapists have to be hands-on and active due to physical dependency at those very young ages. Some states have approved telehealth for EI and now therapists are exploring what it will look like to provide these types of sessions virtually.
Future of Teletherapy: Potential Barriers, Regulatory Concerns, and Training Required
The forced and quick adaptations during the coronavirus pandemic have shed light on the virtual care possibilities of teletherapy. Some therapy settings, like home health, that did not previously practice telehealth, have started providing services virtually, presenting benefits, barriers, and challenges for patients and therapists.
Potential barriers vary depending on the setting, but can include the reliance on caregivers or parents, technology requirements, available tools/ equipment, and the ability to conduct assessments.
- When caring for dependent, highly involved, or pediatric patients, conducting virtual therapy sessions requires the assistance of a caregiver, parent, or loved one. Physical therapy and occupational therapy can require physical movement, and, especially for young patients, requires active participation from the caregiver.
- Teletherapy is only possible with internet access and the right equipment. Virtual therapy requires the patient to have the necessary means to be able to join the session. This is a huge barrier if the patient does not have the proper equipment and insurance cannot provide it for them.
- In-person therapy relies on the use of various tools like fine motor activities, parallel bars, and sensory stations. Providing telehealth impacts the diversity of therapy sessions and relies heavily on tools the patient already has within the home. You may start to think of everyday objects, like a clothes basket, as unique new therapy tools!
- The ability to gather ROM degrees, standardized assessments, or a 6-minute walk test may be difficult or sometimes impossible with teletherapy. During assessments, therapists are trying to gauge their patient’s current level of function which typically involves many physical tasks. Completing these physical tasks is much safer with a skilled therapist by their side. Thus, safety concerns can limit the extent therapists are able to assess patients as well as lead them to safely achieve their goals.
Training for Teletherapy and Telehealth: What Students Need to Know
Throughout graduate school, therapy students are encouraged to be flexible and adaptable in order to provide care in a variety of expected and occasionally unexpected situations. As therapists, we need to focus on our diverse skill sets to be able to adapt to any environment.
With teletherapy, there is an increased demand for the ability to verbalize, describe, and accurately communicate our therapy minds and plans into motion. With in-person intervention, therapists can physically guide the patient through motions or activity. However, with teletherapy, therapists are relying on verbal communication and their ability to accurately describe what the patient needs to do.
This shift to teletherapy requires strong verbal communication skills that students in professional healthcare programs need to be aware of. Can therapists adapt and verbally describe, and guide a patient through a session? Is your eye keen on proper PROM techniques and body mechanics? Can you spot a compensation tactic during a transfer? With pediatrics, this can be especially tough while trying to maintain a young patient’s attention at the same time. Students should take every opportunity to hone in on, practice, and increase verbal communication skills necessary for teletherapy.
As students, your fieldwork may have been impacted by COVID-19. It may be hard to focus and you are probably mentally drained. But now is the time to focus and study to crush the NBCOT or NPTE. Set a goal to review the neuromuscular disorders, signs of a left versus right stroke, developmental milestones, muscles involved in a rotator cuff tear, or facts for a total knee replacement. By studying these topics now – in this time of studying from home – you will gain a deeper understanding, and you will be able to ace the NBCOT and NPTE exams.
At this time, many patients may be missing the more social aspects of therapy. Students can help by writing notes and cards to send to residents at local hospitals, assisted living facilities, or group homes. It’s a great opportunity to express empathy and develop interpersonal skills. Here are some organizations providing unique services at this time:
- Operation Get Well
- Bee a Blessing Card Drive
- Send a Greeting Card to a Patient | Blank Children’s Hospital
A final thought for students — during the coronavirus pandemic when so many of you are isolated and studying at home, students should embrace their therapy minds for themselves too. It is important to incorporate routines, self-care strategies, and leisure occupations similar to what therapists might suggest to their patients. Practice breathing techniques, take breaks when needed, get the amount of sleep your body needs, and remember to take care of your mental, social, and physical health.