Coronavirus: Families see roles shift as occupational therapy goes virtual

Much of Louisiana and the country have been shut down for six weeks, but there are things that simply don't stop happening, even during a pandemic.

"Despite restrictions and stay-at-home orders, babies are going to continue to be born and to have feeding struggles," Jeanne Pichoff said.

Pichoff is an occupational therapist and certified lactation counselor who opened her own practice in Lafayette last year. Her primary focus is on infants and toddlers with feeding issues, whether that's breastfeeding, bottlefeeding or transitioning to solids.

She provides feeding and therapy services to children with motor or developmental differences.

She only saw patients in her office in the city's Oil Center, and she still could, as therapists are considered essential and not mandated to close. But she moved everything online for her patients.

Read more:Coronavirus: As Louisiana considers reopening, more testing is needed

"I decided telehealth was necessary to do now to keep everybody healthy," Pichoff said. "After coronavirus things have changed a lot for sure. I always envisioned doing a little telehealth, but this kind of forced our hand."

Now she's connecting with regular clients like 4-month-old Capri with the help of a laptop, iPhone and a lot of parental involvement.

Capri's parents, Heather and Heathe Courville of Lafayette, set up their iPhone in a tripod, so they can hold the baby and speak virtually with Pichoff.

More:Teletherapy brings services into home while schools, businesses are closed

It's similar to an in-person visit in some ways, with Heather Courville able to feed Capri during the session and to get advice from the therapist. Pichoff uses a mannequin baby to explain what she's saying since she can't touch Capri.

"She'll demonstrate with a mannequin and show us what to do," Courville said. "We mimic, and she watches us and guides us."

Courville also puts on rubber gloves to feel inside Capri's mouth, the oral exam Pichoff would normally conduct. Now mom has to describe how her baby sucks because Pichoff can't feel what's happening, and Courville worries she'll miss something.

"It makes me anxious I'm not doing it right," Courville said.

Her husband admits feeding therapy can be tricky over the computer. But they're both happy it's a possibility and that they didn't lose Pichoff "with all this."

"It's challenging but at the same time I'm thankful it's still available," Heathe Courville said.

Capri began seeing Pichoff after a procedure to correct a tongue and lip tie. The therapist discovered Capri also had Laryngomalacia, a congenital softening of the tissues of the larynx above the vocal cords.

Keep reading:Coronavirus: As Louisiana considers reopening, more testing is needed

The condition causes tissues to partially block her airway opening. Capri had surgery to address it in February.

They see Pichoff less frequently during quarantine — every other week instead of weekly. But they continue to weigh Capri every week to report and track her weight gain.

While Pichoff has closed her office, she made a baby scale available right outside the door. Families like the Courvilles can use it without coming into contact with anyone else, maintaining social distancing and what's best for their baby.

"Weights are the biggest thing," Pichoff said. "Weighing a baby helps drive decisions about feeding a baby."

Practicing this way makes her think creatively about he best way to coach the parents. She has to be very observant, from the oral exam to the feeding to equipment parents have available.

"It forced me to enhance my skills as a clinician," Pichoff said. "I think 'strange' is going to be the reality for a while. It's up to us as providers to find creative ways to do this."

'I know they want to jump through the phones'

Cassie Semmes and her family are learning right along with Pichoff and her other clients.

Her youngest son, Callum, spent the first three anda-half months of his life in the Neonatal Intensive Care Unit. He has Down Syndrome and had open heart surgery — one of four surgeries he underwent in his first year.

"It's his airway that's been giving us the most issues," Semmes said.

For the past four weeks, 14-month-old Callum met Pichoff through his mom's iPhone while his older siblings use the family computer to complete their distance learning homework. 

More:Majority of Louisiana school districts report low percentages of students with internet

Semmes said she and Pichoff have switched roles in some ways as they transitioned online. She mostly just watched Pitchoff during her son's therapy, making videos of what she said and did to ensure she'd remember them correctly at home.

"As parents we kind of tend to sit back and watch," Semmes said. "But it's always better when we do more. And this is forcing the parent to do more. It's so much different to have the child in your hands."

But it has to be frustrating for therapists who would love to be able to show them something in person.

"I know they want to jump through the phones," Semmes said laughing. 

She wasn't nervous about moving to teletherapy, but she wasn't expecting much to come from it either. She thought, "How much can you learn through the phone?"

She's been pleasantly surprised by both her son's progress and how much she's learned during their weekly sessions.

"He has made so many strides throughout these weeks," Semmes said. "As Jeanne watches me she'll say, 'Watch for this' or 'remember this.'

"There are so many things, with Down Syndrome in particular, like you have to wake up his muscles by rubbing his face."

Callum has three virtual telehealth appointments a week — occupational, physical and speech therapy.

"It's totally important (to continue therapy now)," Semmes said. "It's made me more intentional about it. He could just fall through the cracks. This is so crucial in the first year to three years of life. It will determine how independent he will be later in life. We want him to be as self-sufficient as possible."

The village is virtual

Teletherapy likely will remain an option for Callum, Capri and all of Pichoff's clients. But she is excited to see them in person again once she can.

"I miss babies and interacting with people," Pichoff said.

But mostly she wants families to know that teletherapy is an option now during this time of isolation and business closures.

"I cannot imagine the first-time mom who has no idea what she's supposed to do or what things are supposed to look like and who might not have access to family she normally would, I cannot imagine how stressful that would be," Pichoff said.

"I want families to know support is still out there. It just looks a little different. The village is still out there. It's just virtual."