Occupational therapy at home during COVID-19

by Kathy Kuhl — This spring, I’ve been speaking with pediatric occupational therapist Laurie Chuba of Learning Integrations.  A veteran homeschooler, she helps children who are homeschooled or in private school. We discussed how COVID-19 was affecting her students with learning challenges and their therapy.

But first,

Why might my child need an occupational therapist?

“An occupational therapist helps people across the lifespan to do what they need to do,” says Ms. Chuba—that is, with the skills they need for daily life. “Occupational therapists are trained in anatomy, neurology, and psychology to access why a person is struggling in a specific area. They use functional techniques to allow individuals of all ages to live happy, productive, meaningful lives,” she explained.

What’s a child’s occupation? To learn and to play. Play takes social skills as well as gross and fine motor skills. Kids also need to eat, sleep, dress, groom themselves, and do chores. So, a pediatric occupational therapist helps children with the skills they need for all these activities.

Ms. Chuba explained that pediatric occupational therapists look at the child’s development in all areas, physical, emotional, and academic. Therapists help parents and teachers see what’s missing, and correct or work around those glitches. An occupational therapist (OT) also considers accommodations that the parent or teacher could provide.

For instance, suppose that a parent or teacher has assigned a project making a Venn diagram, expecting it would take the student two hours. If it takes four hours instead, an OT wants to know why. Could it be a memory problem? A problem of distractibility? Does the child need the accommodation of dictating his or her work? If the child knows what should be written and can indicate where on the diagram it should be put, why not “outsource” the penmanship?

I asked Ms. Chuba how COVID-19 has affected occupational therapy for students?

The impact of the pandemic for occupational therapist sessions

It’s hard to learn when you are afraid or stressed. So Ms. Chuba has discovered that, more than ever, she has to begin each virtual therapy session by chatting with the student. It’s important to get a sense of the child’s readiness to learn. If the student is fearful about COVID-19, or worried about a sick relative or a parent who has lost a job, those fears limit learning. If the child is frustrated being homebound, that affects how well they can learn.

Expressing empathy and interest lays the groundwork for a good therapy session. It also gives the therapist opportunities to offer new strategies to help lessen stress and conflict. As Ms. Chuba said, “I may have six goals. But if this child is having a hard week, I need to choose an activity that won’t make it harder, one that may even make it easier.”

While some therapy sessions now take place via video on a computer, many parents lend their smartphones to their children for the session. This provided unexpected benefits. The therapist can ask children to show her their favorite toy or a beloved pet. On the phone, they can show her more of their daily routine, enabling her to customize their therapy to their surroundings. She can suggest simple changes at home that can help the child make progress.

Parents learn about their children

Because the therapy is now taking place in the child’s home, instead of at a school or in Ms. Chuba’s home office, the parents see more of the therapy. Since the pandemic, Ms. Chuba has seen parents better understand their children’s struggles. “I had no idea this was so hard for him!” several parents told her, even when simply helping their children to maintain skills. Helping parents understand the difficulties their children face is important, because parents can do so much to help.

What do parents need to know?

First, says Ms. Chuba, parents need to understand, “Learning needs not to be painful.” That sounds obvious, but with struggling learners, so much can be difficult that we parents can forget to begin at the beginning.

People have a harder time learning when they are hurting. Have you ever panicked in class over difficult material? Decades later, I can still remember my panic one day in a high school math class. I saw I was expected to know trigonometry, which I had never studied. How stressful!

One way to help our children reduce their stress is to play with them. Don’t let schoolwork and therapy eliminate your time for relaxation together. You’re the parent, not merely a boss. Don’t let your relationship become all about their tasks.

If therapy time and schoolwork are crowding out playtime, make changes. Enjoy educational activities that are really fun together. Explore nature, tell stories, draw together, and play games. Enjoy sports and outdoor time as you can. Play can rejuvenate parents, too.

Most importantly, Ms. Chuba wants parents to “ask, ask, ask” their children’s therapists and teachers. Some parents who are homeschooling because of the pandemic struggle with vague instructions from their teachers. “What should I do?” is a good first question. But we also should ask:

• How long should this exercise take?
• Why is this hard for my child?
• When and how should I scale back the assignments if they are too much for the student?
• What can we do to maintain skills?

Parents also need to tell therapists what’s hard. Tell them:

• In what circumstances the child is fidgety.
• What kinds of assignments take much longer than the teacher or therapist expected.
• If there is unusual stress at home—whether Grandpa’s in the hospital, this child worries about current events, vacation was just cancelled, or another reason.

Some parents who are homeschooling because of COVID-19 are worried about their children regressing because of not getting sufficient therapy. But Ms. Chuba says our priority must be guarding our child’s mental health by addressing anxiety, fear, and frustration. Then, by communicating with our children’s therapists, we can help them serve our children better. We can learn how our children struggle, and how to help them thrive.

In part 2, I explain more about occupational therapy at home, including how to find a good therapist.

If you have questions, please post them below.

Resources

Learning Integrations

American Occupational Therapy Association can help you find a therapist near you (more coming soon)

From my blog:

How de-schooling can help your child

Skipping ahead to jump rope success