Family Centered Occupational Therapy and Telerehabilitation for Children with Autism Spectrum Disorders

Background:  The growing incidence of Autism Spectrum Disorders (ASD) has created an increased demand for outpatient therapy services (Shimabukuro, Gross, & Rice, 2008), including clinic-based occupational therapy (OT).  Since parental involvement is crucial to the success of intervention for children with ASD (Cohn, Miller, & Tickle-Degnen, 2000), it is imperative to create more efficient and effective methods to ensure carryover of therapeutic techniques  Technology now exists that may allow more convenient ways to partner with parents (Klein, 2002). Parent collaboration sessions can occur in the clinic, but other options exist, such as virtual involvement using webcams. The use of virtual collaboration allows another opportunity for therapists to develop ways to partner with and support families. Most importantly, virtual collaboration may provide families with choices as to how they want to collaborate. Virtual collaboration may also improve participation in therapy while reducing the costs incurred by families.

Objectives:  This pilot project explored the use of telerehabilitation for collaborative OT sessions with parents of children with ASD. The aim was to improve carryover of therapeutic strategies by parents to address children’s sensory modulation in their natural environments.

Methods:  Four families participated in the project.  Families initially participated in clinic-based collaboration sessions with the therapist.  These sessions were followed by on-line sessions that used a website and webcams.  Methods of data collection consisted of family needs assessment surveys, family schedules completed by the parents, sensory diets collaboratively developed by the therapist and the parent, observation and recording of web sessions, and  the Sensory Processing Measure (SPM) Home Form before and after initiation of the telerehabilitation sessions.

Results:  The family needs assessment revealed one parent strongly supporting family centered care.  All other scores fell within the range of fair.  Eight web sessions were reviewed.  All web sessions included review of specific techniques in the home program and discussion of the child’s response to the home program. Specific techniques were reviewed by the therapist observing the parent or child performing the technique and providing feedback, the therapist showing a web video of correct performance, and by the therapist demonstrating the proper technique.  In the majority (5/8) sessions, parents asked the therapist for specific guidance about correct performance of the home program. Education of the parent about the reasoning behind specific components of the home program occurred in 5/8 sessions. With the exception of one child, total SPM scores remained stable or improved after contact phase. As anticipated, sub scores on initial and follow up assessment varied among subjects.

Conclusions:  Telerehabilitation provided a supplemental service for families of children with ASD.  Preliminary results indicated telerehabilitation enabled improved carry-over of home therapy programs by providing opportunities for parents to ask questions and for therapists to review sensory techniques and the reasoning behind these techniques to facilitate parents’ understanding of the child’s home program.   Although improvement, as reflected by the SPM, was minimal, parents reported that they valued the collaboration with the therapist that was provided through the telerehabilitation program.