Sensory Integration Education

We welcome back Mahek Uttamchandani, Neonatal and Paediatric Occupational Therapist, Director of therapy services in the Stepping Stones Paediatric Therapy Centre, in Mumbai India. Mahek kindly shared about her role within a neonatal unit in our previous edition and now we hear how she has adapted and changed her service delivery in light of COVID-19. 

On the 11th March 2020 - the World Health Organization announced the COVID-19 outbreak a pandemic. None of us were prepared to deal with the devastation and disruption of life that this pandemic has caused. Schools, shopping centers, public spaces and transport and eventually entire nations and economies were forced to lock down. People were expected to stay home to prevent the contagion from spreading. This also meant that children could no longer visit the therapy centers to seek intervention. Despite this, life still had to go on, and so would the therapeutic services and support we provide to the children and families. 

I have been providing pediatric therapy services in hospitals and clinical setups for over a decade and half now - but this was altogether a new project! At first, this seemed almost impossible and difficult to execute. I had already been providing occupational based coaching to parents of children with special needs to those in remote areas and to those who were unable to travel to me in Mumbai. But delivering Sensory integration intervention (ASI) via teletherapy is not something I was very adept with. Was it going to be possible to address all the structural and process elements of ASI via teletherapy? And so, started my quest for acquiring a skill set to provide ASI virtually.

Providing intervention via teletherapy requires us to reorganize and reframe our models and/or frameworks of service delivery. A lot of what we provide as intervention to our clients, is based on a continuum of structural and contextual factors.

All these factors were going to have to be reconsidered and reviewed. I sought out by looking out for previously documented studies and research related to teletherapy. Teletherapy in occupational therapy has been used for providing therapy to clients that had poor or no access to intervention in remote areas and districts. In 2014, The World Federation of Occupational Therapists published a position statement on telehealth in the International Journal of Tele-rehabilitation. In this paper, telehealth is defined as the use of information and communication technologies (ICT) to deliver health related services when the client and the provider are in different physical locations. Teletherapy can refer to synchronous (real time) interactions between the client and the therapist via video conferencing, remote monitoring, virtual interactions using applications; and asynchronous (i.e. stored and forward) transmission of data (e.g. videos, photos or electronic mail) by the provider or the client. The position paper also mentioned a very important consideration - 'Occupational therapy services via telehealth should meet the same standards of care as services delivered in person and comply with all the jurisdictional, institutional and professional regulations governing the practice of occupational therapy'.

In the meanwhile, I also took up several courses and online webinars based on the successful delivery of occupational therapy via telehealth. These inputs were enough to help me steer confidently in the direction of providing occupational therapy and ASI via telehealth. Preparing to conduct the ASI sessions virtually requires redefining the structural therapeutic environment and creatively utilizing available space in the client’s home or immediate community. A thorough assessment of the client’s environment can be made by interviewing the caregiver; the parent may choose to share pictures of their home, toys and set up. Therapists must use this information to set up the intervention plan, always keeping in mind the client's interests, needs and most importantly safety.

The plan must be made collaboratively with the key stakeholders that is the family (and/or the siblings) who will assist in facilitation of activities. One must remember that as a therapist you do not have full control of the environment. Thus, it is important to allow for flexibility. It is also imperative to be cognizant of the family’s choices, thoughts and priority concerns. Virtual considerations include the availability of Wi-Fi, internet speed, identifying a safe virtual platform, available devices and the client/ family's competence in managing interactions through a virtual platform.

It's always useful to send parents the list of things that would be required for the session along with a tentative therapy plan. The family should be educated about what the session is going to look like so that they can anticipate the level of their participation required during the session. In some situations parents need to act as a proxy and prompt, and to guide and support the intervention at the client's end. It is also valuable to coach and educate the family/ caregivers about the therapeutic effects of the activities planned. This helps them see the value of the activities and their relationship to the goals of therapy.

The goals of therapy should be derived through the Data Driven Decision Making Tool. Items from the SIPT and parent report measures such as the SPM can help derive sufficient and valuable assessment data that help with the treatment planning.

Measuring the effectiveness of intervention is essential since there are many unknowns and limited data on the outcome of effectiveness of intervention provided by telehealth. The therapist providing teletherapy must not only be creative and flexible but also be spontaneous and learn to think out of the box. Therapy via telehealth is not always defined as providing direct one on one intervention to the client in real time. Therapy sessions could also involve educating and coaching parents, providing support to families or giving feedback regarding videos of activities the family may share with you (intervention with consultation and video footage) and personalized home programs (K Smith by RA Cook). It is rightly said,' Necessity is the father of invention'. We must continue to innovate and provide therapy to our clients via this new mode of intervention. It is not conventional, but it can still be effective. In the end, what matters is that we tried to overcome all adversities and continued to provide services to children and families we so deeply care about. I like to think the following mantra is very apt as we move forward through this new normal ' Start where you are, use what you have and do what you can'.