Coronavirus and Therapy Sessions – The Impact of Lockdown
As most of us are either living with COVID-19 restrictions or facing the prospect of further restrictions being imposed, I decided to write a blog highlighting the impact of lockdown on children with brain injuries, as well as the support and guidance that can still be accessed.
We represent a 5 year old child in a clinical negligence claim who, for the purposes of this blog, I will call Tom.
Tom’s brain was deprived of oxygen at birth; and as a result he has four-limb cerebral palsy, a speech impediment, poor concentration with some behavioural problems and dyspraxia (a condition which affects his physical coordination).
Tom started in Reception class in September 2020.
The Defendant Hospital has admitted fault in Tom’s case and he has received some of his compensation to meet his current needs; this includes the following:
- Therapy input to help improve Tom’s movement and boost his confidence and independence
- Educational psychology input to aid his learning and develop his social skills to support inclusion at nursery and school
- Specialist aids and equipment to assist him with everyday tasks and join in with activities
As a result of the claim, Tom has the benefit of private therapy input from a physiotherapist, speech and language therapist, occupational therapist and educational psychologist. Tom’s parents and therapists have seen improvements with the one-to-one therapy sessions and his progress has been encouraging.
The support he received from his rehabilitation team was essential in readying him for this big transition to full time school.
What was the impact of the COVID-19 lockdown on Tom’s daily routine and therapy sessions, and how did this affect him?
Young children are among some of the most affected by the lockdown. For a child, being unable to see friends or family or go to school can be a lonely and confusing feeling. Likewise, for Tom, his nursery was closed and his therapy sessions could no longer take place in person. Like all young children, he was unable to understand why he could not play with his friends or visit his grandparents.
Tom’s case manager and therapy team were aware of the need to act quickly to protect Tom from the impact of lockdown. They took swift action to avoid any significant gaps in his treatment.
Therapists continued their weekly sessions remotely via video call, with assistance from Tom’s parents. The team created a therapy timetable to ensure Tom was not missing out on any of the support he was receiving before the lockdown, and compiled a list of specialist toys and equipment to engage Tom in therapeutic physical activities throughout the day. Such toys and equipment can be purchased via Fledglings for example.
- Occupational Therapy & Physiotherapy
Tom’s remote sessions with the occupational therapist and physiotherapist were on the whole successful. Tom enjoys dancing so his therapists were able to incorporate dance, physical activity and exercise into their sessions so it felt more like ‘play’ for him. It was possible to see when Tom was becoming distracted and therapists could respond with different activities to keep him engaged.
Whilst it was on the whole positive that Tom was able to access the therapy sessions remotely, it has to be said that it was not all plain sailing.
- Speech and Language Therapy
Children with cerebral palsy can face significant difficulties with their speech. This can lead to a child being unable to find the right words or communicate their thoughts clearly, leaving them feeling frustrated.
The speech and language therapy sessions were especially demanding for Tom. It was difficult for him to clearly hear and understand the sometimes subtle differences in the sounds being made by the therapist via video call.
Also, Tom can find it difficult to concentrate and he was easily distracted, particularly when he found the task difficult or uninteresting. It was much harder for his parents and therapist to reengage him when he became unwilling to participate.
What was the effect of Tom’s nursery closing during the lockdown?
Children with a brain injury often benefit from the structure and familiarity of a routine and it usually has a positive impact on behaviour.
Tom’s therapy sessions used to take place at nursery where he attended several days per week. The end of that familiar routine was difficult for him and, as expected, his parents noticed an increase in behavioural issues during lockdown.
Without input from the treating team, and remote therapy sessions his parents would have found it difficult to recreate the structure he had in nursery.
Tom’s nursery re-opened in June and some of his therapy sessions were able to take place outdoors when appropriate.
Children with cerebral palsy often struggle with fatigue as they have to work a lot harder than uninjured children.
Tom was working hard to build his resilience and to be ‘school ready’. Nursery played a big part of this so when lockdown happened there was a worry this would regress.
Thanks to the remote therapy sessions Tom’s level of activity and movement during lockdown were closely monitored and remained active and challenged. Without this input there was a chance he would have to re-build his tolerance which risked making the already big transition from nursery to reception, even more of a challenge for Tom.
Support and guidance available during lockdown
Many organisations published helpful advice and guidance for parents and the NHS programme ‘Change4Life’ posted great 10 minute videos and other ‘accessible activities’ to keep disabled children active. These publications will be useful for parents in the event of further lockdowns.
My colleague, Caroline Klage, wrote a great blog on ‘Surviving lockdown as a parent of a child with complex needs’. This offers useful tips for setting a routine, meeting your child’s sensory needs as well keeping them entertained during lockdown. The blog highlights the importance of parents taking time to look after their own well-being during such an overwhelming time.
The charity, Contact, also launched their ‘Listening Ear’ service to support families during the lockdown. This is a free telephone service, where parents can speak with a family support advisor on 1-1 basis. As well as offering emotional support to families, the advisors provide practical guidance and strategies to help develop a daily structure and manage any behavioural challenges or anxiety issues that have arisen during the lockdown.
Appointments for the ‘Listening Ear Service’ as well as Contact’s ‘Virtual family workshops’ can be accessed on the Contact website here.
The benefits of private rehabilitation
The current pandemic has highlighted how pursuing a claim is particularly important for children like Tom. As a result of the claim, Tom has had immediate access to tailored support which is crucial in helping him become more active and independent. The therapists were liaising with Tom’s parents to implement techniques for home-based learning and therapy. They were able to trial different activities to determine what worked best for him. The input that he received from his private rehabilitation team sadly may not have been available for other children during the lockdown, at a time when the demands on the NHS have increased significantly.
NHS Trusts implemented video consultations and remote sessions to minimise the number of therapy sessions that were cancelled. However, there were some inevitable delays as systems were put into place. Luckily for Tom, his rehabilitation team were able to quickly implement a timetable to ensure continuity of the therapy and therapeutic intervention.
The remote sessions diverted the real risk of Tom’s progress being halted or, in the worst case, a regression in his condition. We are so pleased that through bringing a claim and having access to funds at this early age Tom has received significant benefit from remote sessions during lockdown and his parents have been reassured during an extremely uncertain and worrying time that everything possible was being done to support them and Tom during this key time in his life and education.