Teletherapy Tips for Feeding and Swallowing Therapy

For most of my career, my therapy sessions were taking place in hospital rooms, in our clinic, in the client’s classroom/cafeteria, or in their homes. In March of this year, my life – like all of yours’ – changed dramatically. The COVID 19 virus closed our clinic for two months and when we resumed outpatient services, we did so exclusively via telehealth. Even when the clinic began to open to clients, many of my clients, particularly the more fragile and medically complex, chose to continue virtual visits to protect their health. It has been quite a learning experience for this old therapist! It occurred to me that it might be useful to share some of the things we’ve learned about feeding and swallowing therapy via telehealth.

• Slow down: Speaking at a slightly slower rate gives your client additional time to process the information you’re providing. A slower rate also helps in case of mis-synchrony between audio and video feeds.
• Articulate clearly: Precise articulation is always important to communication but it is particularly important when audio connections may not be as clear as we’d like.
• Maintain eye contact: It’s easy to get distracted when communicating via video or teleconference but when you’re on screen, be sure to look at the camera and not away at whatever else might be going on in your environment. When others are on screen, maintain eye contact with them as much as possible too.
• Use prosody and intonation: Voice is an important tool in communication and in therapy and can help to keep the child’s attention on you. Be sure to keep your voice animated. Remember, prosody communicates a great deal of meaning – think about the difference between a hot dog (which you might want for lunch) and a hot dog (which you definitely wouldn’t want to eat!). The difference is emphasis and we can use prosodic emphasis to convey meaning and call our listener’s attention to whatever aspect of our message we want to highlight.
• Minimize distractions: Easy to say but hard to do, right? To the extent that you can, reduce the potential distractors around you so that your communication partner (or partners) can focus on you and your message. Find a quiet place to do your teleconferencing so that background noise is at a minimum.
• Simplify your message: Resist the urge to use long explanations and descriptions. Be direct and provide as much redundancy in your message as you can. Use additional visual cues or materials whenever that is possible to enhance your message.

In some ways, feeding and swallowing therapy treatments are uniquely suited for telehealth since home is where our clients eat most of the time. We can get a good look at the child’s typical feeding environment, evaluate their seating and positioning in their own kitchen or dining room, and meet all of their mealtime partners (including dogs and cats!) – all via our computer screens. Some preparation before the session will make things go more smoothly:

• Location, location: Talk with parents ahead of time about where the session will take place. Do you want the child in a particular seat? At a table? Positioned in a particular way? Perhaps you want to be able to see where the child typically eats.
• Plan the menu: Spend a few minutes (via phone, videochat, or email) with the child’s parents (or caregivers) planning for the visit. They will need to have food and utensils ready to go, so decide together what you’ll be working on before the session begins. I typically ask them to have one or two “easy” foods and one or two “new” foods available.
• It’s Still OK to Play: Have other activities available in the same way you would during an in-person session. Online games and e-books can be screen-shared and incorporated into your feeding activities. Some of my clients and I draw pictures together on the Zoom white board. Others prefer reading stories via the e-reader app. Most of the activities you incorporate into your in-person sessions can be digitally adapted. Just be sure to have them open on your computer ahead of time so you can access them easily once your televisit gets going.

• Ready for your close-up? Position the camera so that the child can see your face and any mouth movements you make easily. Ask the grown-ups on the other end to position their camera so that you can see the child’s face and mouth clearly.
• We’re all still eating together: The same rule applies – everybody eats! If you’ve planned ahead of time which foods you’re working on, you can have something similar available to eat yourself. Model food exploration, biting, and chewing in the same way you would if you were all in the same room, sitting at the same table. Even if what you’re eating is different from what the child is eating, you’re eating together.
• Collaborate: It is often a logistical nightmare to get parents, dieticians, therapists, ABA clinicians, etc in a single room at the same time for collaboration. Virtual sessions give us the unique opportunity to include a variety of team members in a single session so take advantage and invite other team members to your visits.
• Frame your face: When demonstrating or modeling, keep the child’s attention on your face. Hold the food or utensil high, next to or in front of your face to be sure it is “in the frame” and that your client can see you and it clearly. Foods or utensils that are on a plate or on the table in front of you will not be visible to the child in the way they would be if you were sitting together at the same table.
• Be Flexible: Things won’t always go as planned – connections can be lost, children can wander away from the screen – but this really isn’t any different than in-person sessions. Have a backup plan, and be prepared to work with the parents to trouble-shoot together.
• Finishing details: As the session ends, provide parents with feedback about feeding and swallowing skills and about issues related to the virtual format. Decide together what worked and what didn’t and make a plan for subsequent sessions.

And finally, relax! You know how to conduct a therapy session and have been doing it successfully for a long time. You may be using new tools, but therapy is still therapy.



*Photo by Artem Podrez from Pexels

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