An Overview of Telehealth and Paediatrics

The healthcare provider can access a wide variety of paediatric communities using paediatric telehealth, including those with obstacles such as physical location or limited resources. Paediatric telehealth has grown in the last 10 years. Telehealth by allied health and nurses in rural and remote areas may be as successful as a face-to-face session, according to the authors of a systematic review and meta-analysis. However, there is poor uptake to telehealth amongst practitioners. Different devices are used in paediatric telehealth including desktops, laptops, tablets, and smartphones.

Barriers

Licensure issues, a lack of interest from insurers, and a lack of training tools to properly educate healthcare providers in the use of telehealth are all barriers for healthcare professionals. Provider challenges are seen as more of a concern than technical issues. Poor internet connectivity, insurance problems, liability uncertainty, and a negative attitude in healthcare professionals and the clients are also barriers to telehealth.

As shown by various study results that indicate either satisfaction and acceptability or a high drop-out rate, telehealth is not suitable for all clients. There is also a downside of using telehealth where a physical contact is required for an intervention. Therapists believe that if they can’t place their hands on a patient or take physical measurements, they can’t properly handle them. This has improved in recent years, with technology allowing the therapist to perform real-time measurements.

There are barriers that are unique to the paediatric community as opposed to adults. Children do not appreciate telehealth sessions or be able to focus during them, according to participants in a qualitative study from 2019. Participants often believed that telehealth communication would not be as efficient as in-person meetings, that the quality of relationships would suffer, and that telehealth was not appropriate for areas of health that need physical contact. Depending on the child’s age, the parent may be required for therapies that include physical interaction, supervision, or instruction on the therapist’s behalf to promote learning and work. This barrier can be broken down by teaching parents how to deliver interventions.

Benefits

● Telehealth connects a child to a variety of healthcare facilities that may not be accessible in their immediate region.

● Telehealth may be used in place of or in addition to traditional face-to-face sessions.

● It enables healthcare facilities to be delivered at times and locations that are not always convenient.

● Cost, resource and time effective.

● No weather conflicts or transportation costs.

● Reduces the amount of time it takes for families or healthcare staff to travel long distances, particularly when the patient lives in a remote location.

● There are no difficulties in finding childcare for the family’s other children.

● Immunocompromised children do not have a chance of contracting an infection.

● Improves therapy adherence, particularly when both parents are working.

● The child may be more at ease in his or her own home, playing with their own toys.

● Therapy can continue even if the child or parent is unwell.

● For telehealth, group therapy sessions with many children may be held without the possibility of cross-infection.

● To increase physical activity, telehealth may include gamification and social-based activities through activity trackers.

● Patients are followed up on by a multidisciplinary team.

● Telehealth allows the therapist to watch from the outside and take notes on the whole movement.

Uses of Telehealth in Paediatrics

● At home, children who use asthma inhalers are monitored for adherence and technique.

● The therapist will track and promote airway clearance as well as physical activity in children with cystic fibrosis.

● Hybrid models — provide both interactive and in-person telehealth visits. This is a complementary model in which the therapist will provide daily video calls with the child to ensure that he or she is receiving home counseling and that the interventions are being applied correctly. This raises the amount of sessions a patient can have while also improving patient monitoring.

● Pre-surgery, post-surgery follow-up, and pre-treatment examinations are all part of paediatric orthopaedics.

● Children with various illnesses, such as haemophilia, are monitored and encouraged to participate in physical activity.

● To offer patient management and treatment to families, paediatric palliative care is provided at home.

Practicalities

Before the session

● It is important to screen suitable patients for telehealth. Only use telehealth when it is a viable method for improving patient outcomes. You must be able to have the same level of treatment as you would in an in-person session.

● Share the intake questionnaire with the parents ahead of time so you have all the details you need about the child to prepare for the session and what you and the parents will need.

● If technology fails, make sure you have other ways to reach the parents/caregiver.

● It is important to consider when a parent/caregiver/advocate should be present during a telehealth consultation with a child.

● The therapist should have a variety of toys to illustrate what is needed, such as blocks, bubbles, and so on. Prepare music to attract the child’s attention or to engage the child in a musical activity.

● Organize for an orthotist and come to the patient’s home to measure the child for AFOs or adaptive equipment; you may also be on the video call as they measure the child.

● Check in with the family a day or two before the appointment. Determine what they want to work on or what time of day will be most convenient for them. Sell the concept of parent coaching, emphasizing that the parent will be with the child for the remainder of the week and can attend the course.

● Plan the session’s timing based on the objectives. Do you want to stay away from naps, feedings, and medication hours, or do you want to be present at those times to assist with positioning and other tasks?

● Prepare a rough outline for your meeting.

● Prepare the family ahead of time for what would be required for the session, such as blocks, toys, a blanket, or the location of the session.

● Educate parents on developmental milestones, then break down tasks to achieve those milestones and explain why you’re doing it.

Evaluation

● Make use of past medical history and subjective history.

● Screen the patient for any red flags and refer on when necessary.

● In telehealth it is difficult to apply standardised tests and measurement, so make use of your clinical observation skills.

● Ask the parents to do spontaneous play with their child for a few minutes and use that as an assessment.

● Evaluate the child through different functional movements and different positions including the transitions.

During the session

● Be calm and confident.

● Don’t overthink it — keep it simple.

● Rely on your skills of observation as a physiotherapist/ physical therapist.

● Tell the parents what to expect and walk them through each process to be a good communicator. They would not feel stressed as a result of this. Explain the session’s aim and how exercise or movement will help you achieve it.

● Allow time for questions and concerns during the session.

● Educate the parents about the condition, work, and level of success of their children.

● Empower, teach, and prepare the parents so that they can handle the therapy the rest of the week on their own.

● Parents and caregivers should be trained on proper body mechanics to avoid personal injury.

● Spread out a blanket or yoga mat on the patient’s floor so the child has a video “protected” zone where they are within camera range and you can see them while they are on the blanket.

● Use props such as a chair to help the child stand or maintain their balance when standing.

● To demonstrate procedures or handling to the parents, use a baby doll.

● For sitting exercises, try corner sitting on a corner couch or against a wall.

● Where manual procedures are needed, an assistant will accompany the patient.

● Remember to coach the parent or caregiver. Effective communication is important. Encourage the family to incorporate the tasks into their everyday lives, such as weight bearing on the arms during other activities.

● Tell the parents that you will advise them on what to do next if the child is running around and wants a break, so they will be ready when the child is. Parents can also need a break when you discuss education or summarize the session.

● If the child continues to move out of the camera’s view, you may ask the parent to move the device, or if that’s too complicated, simply ask the parent to explain the movement. You may also invite other siblings to attend and participate in the session, which can help to keep the child involved.

● If you are nervous and starting with telehealth for the first time you can start by just observing their normal routine and play to see what it is like. This will help you and the family to get used to the telehealth idea. You can even turn your video and sound off for 10 minutes and just observe. Ask the parents opinion of what they experienced and where they need more coaching. Give positive feedback before giving constructive feedback.

● Provide the family with a few options for activities to focus on basic developmental goals. This will give both the parent and the child the ability to make decisions. Although simply asking what you want to focus on may be beneficial, it may be too large for some parents.

● Summarize what was accomplished at the end of the session and then assign 1–2 homework assignments. They would be more obedient if these exercises were part of their everyday routine.

● Create a moment of contemplation at the end of the session to learn what the child and the parents/ caregiver enjoyed or didn’t like, as well as what they want to focus on in the next session.

After the session

● You can add videos or handouts to your telehealth sessions to help parents who are doing it at home.

● Send a list of the topics discussed during the meeting.

● During the session, do some self-reflection.

Telehealth regulations are updated on a regular basis, which is particularly important given the coronavirus pandemic. “In terms of telepractice for paediatric care, there is no clear-cut determination or one-size-fits-all solution.” It is the practitioner’s duty to be aware of any local, state, or national laws governing telehealth physiotherapy/physical therapy. To determine whether telehealth is suitable for each particular patient, the health care provider should use clinical logic, review the context/situation, and consider ethical and individual preferences. It’s also a good idea to double-check any regulations concerning further training and the scope of practice for telehealth consultations.

Medical aids/ insurance companies have different payment structures or agreements pertaining to telehealth services, this should be taken into consideration and discussed with the family prior to the appointment. Have all your procedures in place for telehealth consultations and make sure you have a procedure for emergency situations.

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