Episode 49: Teletherapy is REAL Therapy, NOT “survival” Therapy

Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I'm your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist, SLP and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Hi and welcome to episode 49 of the Untethered Podcast. Today it is Hallie here, your host, and we're going to chat about a little update on teletherapy. Move my keyboard out of the way here. All right, so let's talk about a little, I guess you could call it a pet peeve of mine because I've been seeing this a lot in the online space. I am seeing where therapists who have never done teletherapy before are completely overwhelmed. And so there are a lot of people who are coming in and who are saying, oh you guys right now, this teletherapy is not real therapy, it is survival therapy. And let me tell you that I wholeheartedly disagree with that. I was doing teletherapy, as were many other professionals prior to this pandemic. And if you're listening to this at a later date, we are referring to the big pandemic known as COVID 19. And what I want to share with you guys, I'm going to talk to you guys about how teletherapy is real therapy. It is not survival therapy. Sorry you guys who are saying that out there, but you are wrong. And I'm going to give you four tips and I'm going to discuss four of my own personal patient cases because I don't want to keep you here all day. So I wanted to share some big wins with some patient cases and I have a pretty small caseload at the moment simply because I've been focusing efforts on our online feeds, course and some other things that are in the work. So I only have about a small day of therapy on Tuesdays right now where I'm treating just a handful of clients, patients. And these patients are all having success in their own ways. So we're going to talk about that. Some of them have also been dismissed as I've dismissed kiddos. I have not been filling those spaces right now simply because I just don't have the time. But my team, those who are treating them, have been thriving and we've been sharing a lot of ideas and I want to take the general consensus of what is going on and that's what I want to share with you today. So let's talk about some teletherapy tips that you can literally put into place today or tomorrow whenever you have your next teletherapy patient. And we're going to jump into that in a second. But I do want to share that prior to the pandemic I was doing teletherapy with myo cases. I was not doing it with my traditional feeding cases. So that, you know, there is something to be said for. Well, you know, some people can say, well Hallie, you are already doing teletherapy, so you know, why should we listen to you? Okay, I was doing teletherapy, like I said, for myo. That's a very different therapy than traditional feeding therapy, very different than traditional articulation. I often do multiple types of therapies in a given session with patients. However, for all intents and purposes, it was primarily either just articulation or myofunctional therapy. And never had I done feeding therapy online. So I am brand new to feeding therapy, which I would arguably like to say is a bit more challenging than your traditional language therapy. Just from the standpoint of not being able to interact with the foods at the table and oral motor skills that we're working on, there is definitely some extra level of challenges beyond a traditional language therapy session. So kind of keep that in mind as I'm sharing this with you because I've had to navigate new waters as well. But my approach and my, let's just say how I jumped in feet first and just said, you know, we're doing this. That has a lot to do with my success and I also believe my patients success in this whole experience. So, you know, there is a lot of people online that we want to keep in mind have been doing teletherapy, as I mentioned before, for a long time. And I think that it is a major disservice and quite honestly just not kind to say that teletherapy is not real therapy to say it's survival therapy, because we're basically discounting what a lot of our colleagues have been doing for years on years. And there's research to support that teletherapy is effective, as effective as in person therapy. So let's keep, keep that in mind too, because remember, what you put out on the Internet is going to get picked up by some parents. And all we're doing is kicking ourselves, basically putting our foots in our mouths is what I should say. If we are telling our colleagues that teletherapy is just survival therapy right now to make them feel better, and then a parent catches, you know, catches that message and they're like, oh, I don't need this therapy. It's just survival therapy. It's not real therapy. No, it's not. Okay. It is not fake survival therapy because that is the message that's being sent right now. So I just want to make that super clear. You guys can't tell. This is like a major soapbox at the moment. So, anyways, yes, teletherapy really does exist. Yes, it's equally as effective, if not sometimes more effective, as you're going to hear in some of my shares today. So let's talk about this a bit more. The one thing you can do with a parent to that might pivot what your sessions look like right now, which I think is the message that is that people are attempting to deliver, but they're kind of falling short in delivering this message, is that teletherapy is real, but how we provide the therapy might shift temporarily or part of the session might shift and look different than when it was in person. For example, we might work with a child on several skills and then we might pivot and talk to the parent about, you know, how are things going at home? What's changed? Can we help you with routines? How can I support you? Right. This can look completely different than prior to this situation. However, this is real therapy. This is part of a parent coaching model. This is part of even a medical model. Because when a patient comes into any medical practitioner's office, they should be checking in with them to understand what's going on at home. Why are you here? How can I help you? That is what a holistic practitioner does regardless of the delivery method. So I just want to put that out there because while yes, we should be asking these questions and yes, we might be doing more parent coaching than normal, and yes, the child might be running away, especially in the beginning, that doesn't make this fake therapy or survival therapy, okay? Because telling a parent that doesn't make them want to put in the effort or focus on, you know, providing this for their child, especially if they're paying out of pocket. Right? They need to understand this is real therapy and we are actually helping your child not just maintain their skills, but we're helping them gain new ones during this time. So if you want the family to value you and the service that you're offering, you have to first value yourself. This means you need to check your issues that you're having right now at the door when you step into that teletherapy room, just like when you step into your therapy room or patient's home or school or whatever. That doesn't change here. I know we're all in this new normal, but your approach and how your energy is what's going to drive and direct that teletherapy session. And I know I'm getting a little woo woo on you guys, so bear with me for a minute, ok? Because we're getting to the tips in a few minutes. I will share that throughout all of this. I had some of my own anxiety in the very beginning of all of this and I'm not an anxious person. The anxiety that I felt was more related to the energy around me and taking on the responsibilities of my team and our families that we serve and, you know, creating an online business that we launched on March 16 and closed doors on March 23, quite literally in the middle of everybody getting their stay at home orders. And so, you know, people are losing jobs, people are being furloughed. People who own businesses didn't know how many clients they would have that next week and if they'd be able to pay their bills. So my, you know what I was feeling, and maybe it wasn't truly anxiety, but I felt heaviness on my heart. I could literally feel that. And I do feel energy. And I've had to learn tools to like release that back into the universe. And again, I know I'm getting kind of woo for some of you guys, but bear with me here. I have this platform, I'm going to use it. So things just felt heavy, right? So I sat with myself and I was able to use my tools that I have, which we're not going to go into because that's not the point of this episode. But I was able to find and regain my inner peace. I was able to sit in peace. And this is one of the most powerful tools that one of my mentors has taught me, Jim Fortin, he has taught me to quite literally shut off the world and just sit in peace. And this is the most powerful place that anybody can work from. And I say this because, well, I have a two year old and a four year old and then local private practice that is now online and an online business we just launched with a second phase of the business rolling out this summer that we're now working on in addition to the content I'm creating for the modules that I'm teaching in a few weeks. You know, there's a lot going on right now, so I have not had that downtime that a lot of business owners or other therapists have had. I've been just. I've been probably more busy than I was prior to all this, and I. I would welcome some downtime right now. And I'm having to force myself to have some downtime and just turn off work. But in all of that, I am maintaining a level of calm, happiness and peace. And so while we're all going a little stir crazy over here because we're quarantined in a house with little kids and that's enough to drive anybody up a wall sometimes, I still work from that place of peace. And another thing that Jim has taught me is that everything has been, is, and will be okay. And no, I'm not downplay what's going on in the world by any means, but we're going, the world is going to come out of this no matter what, in time. And what that looks like, we won't know until we're there. Right? Everyone keeps saying we are now living a new normal and we are going to come out of this with a new normal. I can guarantee you some people are going to probably want to stay providing teletherapy, whereas others can't wait to get back into the office. And there are going to be a lot of things that change, both in your home life and your work life, in your daily lives. Most people will not go back to exactly the same routine and setup that they had prior to this. Some might, but a lot of people will not. So just let that sink in for a minute. Because control is an illusion. I used to be a control freak until I learned control is an illusion. I felt like I had to have my hands and everything. And if I didn't have control and I felt like I was out of control, it was just not a good. It was not good. It wasn't fun to be around me. I don't work from that anymore. I work from a place of peace. And so that's why I say the most successful place any person can work from is a place of peace. And in order to achieve that, we just have to take a deep breath, learn to just let things go. Like seriously, let all that ish go. Everything that's weighing you down right now. Take a deep breath and release it into the universe, the world. If you believe in religion, whatever, whatever it is that you go to is your go to. Like, use that right now. And again, I know I. I've gone totally woo woo on you guys, but I really felt called to share that because those who are able to show up and help others are the ones who are able to take messy action, keep their stuff together so they can show up and support others. And people need you right now, right? Your clients need you, your colleagues need you, and everyone has a choice. So I choose to be at peace and a sounding board for others. But I don't internalize what those others say say to me or what they share. Right? It would quite literally make me sick if I literally internalized all of their energy and all of their thoughts and feelings. But anyways, let's shift gears and talk about teletherapy tips, because that's definitely enough woo for one day. I know most of you are probably not so woo woo on this podcast, but that's my piece, now that I've said it. So let's jump into the tips and you'll be surprised that some of these tips can kind of go hand in hand with what I've already shared. And we could arguably say that finding your inner peace is that first tip. But tip number one beyond that is kiss K I S S. You guys have heard this before. Let's bring it back. Keep it simple. We'll say silly to keep it nice. I am watching therapists online talk about how they're spending hours upon hours prepping for each session. Unlike they ever did in person. They did a lot of prep before, but like, wow, every waking hour outside of their teletherapy sessions, they're just prepping different materials for every session. Oh my gosh. Like, would you be mad if I told you I sit down at my computer, log on to zoom literally one minute before my first session starts for the day. Like, I do my sessions back to back with like little to no breaks. And if a client is a few minutes late, I might go and grab some more water or I might catch up on a session note from the prior client, but I am done at the end of the day when my sessions are done, I am done. Unless I fell behind on a few notes and I take five minutes to do those. Or I need to grab a resource to email to the family with the note that we email out each session. Keep it simple. Okay, I know some kids need like Interactive things to keep their attention. There are so many tools online find like this is number, this is tip number two. Figure out what works for your most challenging clients and then use that for all of your clients. Because if it works for them, it's gonna work for the others who don't even really require as much. Or you can take a break from that and do some more straightforward, less, you know, less fun type of therapy. I am like a super boring therapist and I am proud of it. I am simple. I, you know, sometimes we might open zoom and we might scream screen, share something. And like for example, ilovelessonpix.com this is not an ad for them. We do not have any partnerships. But I'm going to share that because it's cheap. A parent can access it, a therapist can access it, a teacher can access it and it's great. You can pull up all kinds of words, phrases, pre created tools that others have made, they've shared on there. You can take any set of like vocabulary or speech sound word, you know, speech sounds or words and turn it into a variety of like shoots and ladder, game of snakes and ladders or shoots and ladders, whatever you want to call it. Bingo coloring activity of word search activity, a picture, picture search. You can do cutting activity, cutting activities for ot. There's just, there's a whole variety of educational tools that you can take your specific targeted list of words or vocabulary, for example, and after you have it on the board, you can create like 100 different activities to share with the family. They also have really great AAC boards if you work with that population as well. So you can also create AAC boards in their program, which is pretty cool. But anyways, again, they don't even know I'm talking about this. This is not a partnership at all between them and I, I'm just sharing it in case it's an easy tool for you to use. I quite literally pop in there and go initial, like S initial words. And I find something somebody else created and I download it and boom, there are words for the week. And then I screen share it into Zoom. And I've even done this in the middle of a teletherapy session because it takes 30 seconds and then we just mark it up, we annotate it with the stars or I let them pick, do you want the check mark or the stars or you know, and they're like, oh, stars, I know. Okay, let's change this to check marks. Let's now do a heart, whatever. But I keep it simple And I figure out what works for my clients who are either need them, you know, they need a higher level of engagement. And then I use a couple of programs or activities across all of my clients each week. And again, I'm treating fewer kiddos. But this is what we recommended to our team as well. Like if you want to figure out boom cards, it's another one. Go figure out boom cards and then use the same set of boom cards. If you want to go find a website like Sesame street has some great stuff or you know, there's so many things out there that you can find and like find a couple of things for the week, not a couple different things per each child session. You will literally drive yourself into the ground. Don't recommend that. So I hope that that's helpful because it's kind of like, you know, wash, rinse, repeat, or however you say that we really want to reuse the same materials and not make this an extra task for you for every child, but rather, you know, let's just pick a few things to work on a week activity wise. Because if you remember, therapy is not about the activity you're doing, it's about the goal you're trying to achieve. So if you are focused on that goal, it doesn't matter what you're doing. I was taught in grad school to treat a child out of whatever I had in my purse. Like you, I basically was told you should be able to do therapy out of your purse. A good therapist can take anything. Like you could take a pencil and make a therapy activity out of it. So maybe that's just the place that I work from. I don't need all these big fancy materials like I created initially in grad school and when I first graduated and worked in the schools, I just don't do that anymore. I still have them all here. They've probably been sitting behind this closet since we moved into this house a year and a half ago. I have not looked at them other than to open the closet and get something else out. I just don't use them. Alright, so tip number three, Loom L O O M Again, no partnership here. Not to be confused with Zoom. Get friendly with it. It is free up to a certain storage point and I have not hit my storage point yet. And I've been using it for the past month to create instructional videos. You can make instructional videos for your team for families that have technical difficulties to show them something like how to use Zoom, for example, or how to troubleshoot something on Zoom or whatever platform you're using. Or you can record yourself demonstrating a skill that you want to show a family to work on for the week and then just email the link to the family. And this is not public. This is. It's private unless you make it a public link. So it's only viewable by the people that you send it to. So I would not give out, like, HIPAA compliant information on this platform. But you can record yourself saying, hey, this week when you work on this, do this without giving away any identifying information. I had a kiddo who I'll talk about in one of the cases where just literally recorded myself chewing a crunchy food for 30 seconds, like taking a bite, chew to another bite, chew, chew, chew. And sent that. And holy moly, it was super successful. So we'll talk about that in a second. I've also used it to create trainings for my team, both my online team and my therapy team. And when I say online, I mean, like for our feed the peds course, that team. So it's a great tool that's super simple to use. You literally go on there, you push, record, and you record and then it gives you a link. It could not be simpler. So get friendly with it. And then tip number four is educate and empower your families. When you're working with little kids or kids that have attention issues, expect, educate, empower, and expect. These should be like the three E's I just came up with that expect that they'll have a hard time sitting for an extended period of time. Young children should not sit that long. And so if you have a parent who's playing with a child on the floor and you're trying to, you know, play over the computer, and they have the computer or the phone or whatever set up there so the child can see you while they're playing. And that works awesome. If that's not working and the child sees it and they run away from the computer, well, maybe we need to create a scavenger hunt. Maybe we need to go for a walk and we need to talk about what we're seeing on our walk. One of my therapists created this for one of her kiddos, and it's brilliant. It is a simple book that, like, work that basically says, I see a green car, I see a green tree, I see a green plant. You know, whatever, whatever they were seeing on the walk, they put it into a little book and then they went out and they looked for it again the next time to go on a scavenger hunt and see if they could find Those things again or if they found different things. And this was for building language. So let's educate our families because this parent, I think, I believe, actually came up with the activity or created the book. It was one of the two. And this is because this therapist is a phenomenal human being. Just have to put that out there. Who is really educating the parent and empowering them and also being very realistic with this little kid's ability to sit in front of a computer screen. Right. So let's get them moving. So, you know, if you do want to start at the computer, then start there and see how long you can get the child to sit. Then, you know, if you feel like you're going to turn to more of a parent coaching model after the child is learning, just done, allow that child to walk away and be in the same room. And the parent can have a previously set up activity that they can just like grab from out, you know, under whatever the table or whatever and say, hey, you know, I brought this for you to play with, you know, or have a couple options for them to play with so that they're in the same room. But the parent is now going to be working with you as a therapist, whether their goal is myofunctionally related or oral, motor related or speech or language or OT or whatever. Okay? I've also seen a lot online where people say parents are not therapists and okay, no, they should not be doing assessments and setting treatment plans and yada, yada, whatever. However, parents are therapists. Parents are there the six days between sessions or if you see a kid twice a week for 30 minutes. Okay, let's say you see a kid between like 30 to 60 minutes a week on average. I know there's kids who get more therapy than that, but we'll just use that for all intensive purposes. Parents are with their kids 24 7. You see them for a tiny, tiny, tiny glimpse of their week. So the magic of therapy is what's actually happening between the sessions. Right. They can achieve a new sound, a new motor pattern, they can try a new food, they can get their tongue up on the spot, whatever. Like they can do this with us in a session. But if they don't carry that out at home between your sessions, what good are your sessions? They are not, you know, have there been kids who have never done their homework and who are able to move from one phase to the next and graduate myofunctional therapy or, you know, speech therapy or whatever? Sure. There's always outliers, right? That is not Traditionally our clientele that is in therapy with us. So you know, I have seen therapists getting their panties in a bundle trying to own that therapist title. And I'm sorry, but that parent is just as much a therapist between sessions as we are in that 30 to 60 minutes a week that we may be seeing that patient. So while we are creating and directing the plan, they are carrying it out and we need them, we need to educate them, we need to empower them and we need to allow them to step into that role instead of, you know, putting ourselves on a pedestal and basically hammering them into the ground and saying, well, you're not the therapist. This is the stuff that drives me up a wall. So anyways, I will share with you what's happening in my sessions when I take these approaches that I've shared here with you so that you can really see like in real life how things are going teletherapy wise. So case number one is a five year old MYO patient, initially turned speech and feeding patient came to me for myo and it took us quite a bit of time to get this patient ready for pre op for frenectomy with sutures. You could arguably say frenuloplasty, but it wasn't really plasti, it was just with sutures. And we had to work a lot in getting that jaw functional and getting the tongue working independent of the jaw. And so we were able to get the tongue independent of the jaw minimally, not as much as I would have liked to, but we, the parent went ahead and wanted to schedule the appointment. So we did do it, we went ahead with the frenectomy and then we've been working post op as well for quite a bit. The jaw and tongue can work independent of each other. However, this kiddo was running away from the computer for the past three sessions and so the tongue has now gone back to working with the jaw. Right. So basically this is that slide back that we see when kids do not engage in therapy. And this is why it's really important to continue therapy on a weekly basis. Now this is not the fault of the parent because this parent is an amazing person and this person is parent is phenomenal. And so they've been sitting with me and I've been coaching them on how to carry out the treatment plan regardless of what the child's willing to do with me or not do with me at each session. So by empowering this parent, they've been able to bring back ideas of what they are trying at home. And I'VE been able to then help direct the next steps, help them see whether the strategy that they're working with and that they've come up with is beneficial or not. And for example, like in speech, sometimes parents. And I've seen therapists do this will. Let's say we're working on bilabials, working on a B or a P sound at the end of a word, like pop. Sometimes they'll add a vowel after that, like pop. Well, we don't want to do that because that actually changes the position of the sound. It's a totally different treatment goal. And we then have, because we've now got created this additional issue, we then have to retroactively undo that. So, you know, but this parent is thinking, they're using their brain and they are coming to me with wonderful ideas. And most of the time I'm going, that's phenomenal. Let's keep doing that. And once in a while I'm able to say, hey, you know what, that was a great idea, but let's do it this way instead. So we don't have to, like, undo this extra work that we're going to create for ourselves if we do it this specific way. Right? So there's very gentle ways that we can coach our parents, but empower them, because what they're bringing to the table is what they're telling us they are willing to do right now. And we want to meet families where they're at so that treatment can actually be effective. So what's really cool is this kiddo is a kiddo who would be active and all over my office and we'd be rolling the kiddo on a peanut ball between. Between like jaw exercises and lingual movements. And, you know, this kiddo, after four sessions today, I think he joined us. The first session he, you know, the kiddos sat for a while, and then session two and three, he was like, yep, no, don't want to see Ms. Hallie today, and just ran away. And so those were pure parent coaching models. However, the child's been making progress every single week. So that's why I say our parents are just as much therapists between the sessions as we are therapists, you know, creating the plans and telling them what to carry out. So we all need to work as a team here. And what's been really cool is to see the progress this kiddos made, basically with me consulting with the parent. Right. And guiding them regardless of whether or not the kid was there to practice it in our session. The other thing that I will Say is that he joined us today for probably 10, 12 minutes of a 30 minute session, which was awesome. And I use that lesson picks example I gave earlier where I just took a sheet. He let you know this kiddo likes pictures. So I just grabbed pictures with some target sounds that we're working on right now and shared that on the screen in zoom. And we use the annotation option to stamp it when we practice the sound we said, you know, the number of syllables that we were targeting or the sound we were targeting. And this was a huge win today. So you know, we, like I said, we've used the other part of the session to educate and empower the parent on creative ways to work on speech. My goals and also lessen anxiety surrounding trying new foods. And what we're finding is that the child is now willingly touching foods that the parents putting on the table and accepting those foods into their personal space whereas they were not doing this before. So it's been great. Quite. There's been a lot of huge wins on this particular case. So I'm really excited about it because I would say that this is a case where some people would say child can't sit at the computer. Okay. You know, child runs away, child is not interested, can't really work with them. And I have seen a lot of instances like this. This is one of those cases and we are having success. And sometimes it takes three to four sessions before you get them to sit at the, to sit there for 10 minutes of your session. So keep working at it, right? Keep it simple, keep working at it. Value what you're doing, explain why you're doing it, explain how they can work on things between sessions. The more we educate and empower our families and tell them what the expectations are both in our sessions and between sessions, the more successful this will all be. So, okay, let's talk about case number two. So case number two is a toddler with down syndrome who I treat for feeding. This child was previously treated pre and post op for frenectomy and this kiddo had to learn skills for chewing post frenectomy and prepping a food bolus because that was never something that they had to do. There's definitely some low tone at play, but now this kiddo has the skills. And in in person sessions we were actually at a standstill with biting or chewing new foods. Wouldn't let us near the mouth, didn't want, you know, wouldn't. And that was because the child would not willingly try themselves. So we were trying to see if they would let us do it or if we could try new presentations or get crafty. I never sneak anything in. The child always knows what I'm doing to lessen anxiety so they know what to expect. But guess who is doing these things over teletherapy now? Like we were at a complete standstill. I mean, come on guys, this is not survival therapy. This is a real therapy and real progress. I sent this kiddo a video of me chewing. As I mentioned earlier, this is the one I sent the video of me just like chewing a crunchy food, moving it around on my tongue so the child could see like where I was putting it. And that way mom would have a tool to play throughout the week. Just casually and holy cow, can you believe this kid just popped a bomba in their mouth, started chewing it, breaking it down and actually, and you know, these are the kinds of things where mom and I would like nearly fall off our chair because holy cow, we haven't been able get this kid to do this for the past five months. And we've been constantly checking on skills to see what are we missing. What else, you know, okay, well this is not happening right now. What else can we work on? Where else can we support this child? Because maybe, you know, we need to work on some of the postural and OT based skills to give that property support for feeding. And so we've done a ton of things to help this kiddo and really set them up for success. But it was pretty cool to send this 30 second video of me chewing some foods. Exactly. It was like very exaggerated. And this kiddo was not progressing with chewing or biting. And then all of a sudden they're just doing it. So, you know, not everyone is going to need that personalized little video. But for kiddos who seem like, you know, I know that some of you can think of kiddos on your caseload that this might be a great idea for. So just do it. Just record a quick little video, personalized video. These are the kinds of things that are going to make parents lives easier right now. The kids are really going to enjoy it. Make it personalized, but don't create a ton of extra work for yourself. Like I said, this was like hair on my head, no makeup, tired after teletherapy, shot a quick 30 second video with a snack I had sitting on my desk from one of my mayo sessions and just sent it to mom and that was it. It literally took me 30 seconds to do. Keep it simple. As a side note, my MYO exercises, I will tell you are all pre recorded. I actually recorded those when I was pregnant with Mia. So those are fun to go back and look at. And I keep those in my Google share library. And we have, we have links to each of the exercises. And as I always say, it's not a cookbook recipe, but based on where a child's at or what they're working on. We can go in from any, any of the three different modules or phases, I should say, of the MYO program that we use. And we can send a link to an exercise to a parent and or a patient. We work with adults for MIO as well. And this has been amazing. It really helps compliance go up. It helps to move through therapy sessions quicker because not only are they reading on a piece of paper what they can do, but they're seeing you. And I happen to think that seeing somebody straight on in a teletherapy session or recorded video is extremely powerful for progress and extremely powerful for accuracy in helping that patient progress, helping them accurately achieve what they're trying to achieve and help them move on to the next step a bit faster. So I would arguably say that teletherapy actually speeds up progress in some cases, or actually in many cases, as I'm going to be sharing with you here. Okay, so case number three. Case number three was a teen who was in speech therapy for 13 years of this kiddo's life. He came to me because another SLP referred him who does not deal with MYO and tongue thrust stuff. They landed in that SLPs office after working with seven other SLPs over 13 years. Not one of them knew about tongue ties or identified a severe tongue tie and lip tie. Nor did the pediatrician, the dentist, the orthodontist. Somehow they all seem to miss this. And there was orthodontic relapse at play here. So we prepped, we prepped this patient, patient was released, we did post op, and then school restarted. So we ended up moving our sessions online. This was last fall. We completed the MYO program pretty quickly, which was cool. Flew through that, gained really good tongue control, was using everything independent of each other, was able to pull it all back together really quickly and just completely functional. And the tongue was where I needed to be. And this actually cleared up so many of the speech sound errors that this team was making. But we still had a couple of those testy sounds, like some Rs to address. Not all of them, but some and some other sounds as well, like a cha and sha, where we need to elevate the Lateral borders of the tongue. And that just had not been happening for 13 years of this or 14 years, if you want to count in utero of this teen's life. And so we really needed to address that. So we did through teletherapy and it was awesome. And that's why I say teletherapy is real, because I was able to graduate this patient actually before COVID 19, we think back in February. And when I tell you that the patient was highly intelligible, unintelligible, and I think scored like 2% on the Goldman Fristo Test of Articulation number three because of all the R errors for their age. I mean, incredible to go from that in such a short period of time because of our ability to connect over teletherapy and continue sessions and do this face to face therapy that was really challenging to try and do in person based on both of our schedules and all the traffic in the D.C. metro area. So teletherapy is powerful. You guys, are you guys starting to see and hear a trend here? All right, so let's talk about case number four. Case number four is a MYO patient with a cochlear implant. So cool. Really cool case. Really enjoyed working with this one. And I just decided to missed this patient today. And I'm a little sad about it because I really love this patient. Also a teen. This teen, like I said, just a rock star. But decreased sensory registration. What do I mean by that? Like, I would teach tongue to spot and this patient could do it, but could not tell me that she actually felt the tongue touching the palate. Right. And so this was an ongoing theme through pretty much all of therapy. We hit a wall, we talked through a lot. I used to multiple different modalities to teach all of the skills that we needed to learn. We were having success, but then we kind of hit a wall at a certain point. This patient also ended up having a lingual release relatively early on, maybe after a month of therapy initially, and then maybe it was like six to eight weeks of therapy initially. But anyways, we were trying to. It was very borderline. We were trying to avoid it, but I think it was absolutely necessary. Again, there was some orthodontic relapse at play and concerns of that here, but we did have a lot of repetition, a lot of weeks of just the same skills we were addressing. And so we didn't fly through super fast. And this was in person. Right. And then we moved online when all of this stuff happened. Gosh, what was that like five weeks Ago now. And I will tell you. Oh, my gosh. Like, we. We were only two thirds of the way through the program and where I wanted her skills to be. And phase three is not really new skills, but it basically means we need to habituate what we're doing so we don't have to think about it anymore. So we're ready for dismissal, and we' we'll follow up, you know, in a couple months, make sure it's maintained. This teen, oh, my goodness. Like, went from being stuck about 2/3 of the way through the program to graduating in four weeks. Like what? Teletherapy propelled this teen forward, sitting and looking at my face, even though this teen was sitting across from me, focused on me in our sessions, like, looking right in my face, like, sitting literally 12 inches away from me. Okay. Because this table I have between us is very skinny, so we can focus and look right at each other. I don't know what it was about the teletherapy, but we just. It just propelled this case forward. And I got to graduate another MYO case today, so yay for that. I have another one graduating next week who I assessed in person, and she's not one of the cases I'm really going to dive into because she's been really straightforward. But I assessed in person, and then we ended up moving online again for scheduling reasons and just flying. And this is an elementary school student just flying through the program all over teletherapy. Okay, so teletherapy works. So I'm just. I'm sharing this with you guys to show you so you can see what is possible. Right? Not every session will be a win. Not. Not every session will have a cooperative child on the other end. The video or computer or phone or whatever. But the message here is to keep pushing forward and not to give up. Like, my mentor, who I cited earlier, always says, 70% is success and 100% is failure. Let that sink in. I become really good with taking imperfect, like, messy action. Okay, if you're watching this on YouTube, you can see my hair is not done. You can see I'm not wearing makeup. Like, that's. That's just who I am right now. Imperfect action. It was more important to me to record this and get this message out to you than it was to blow dry my hair after my kids were asleep and put on makeup and look presentable according to what some people consider presentable. I think I look fine. But the point here is imperfect, messy action. 70% is success, you guys. Okay? And this is coming from Someone who was once a perfectionist. Everything had to be done perfectly and I could only I could do it because it had to be done a certain way. And that went from everything in just life. From like cooking in my kitchen to a written paper to therapy to whatever, it didn't matter. Like everything was done a certain way. Like I was. Like I was an ocd. But I was a perfectionist. Okay? To a Z. Birthing children, birthing a private practice, and now birthing this podcast and online business. There's just no time for perfection. If I focused my energy there on being perfect, then all those things I just mentioned would not exist. So let that sink in, guys. Progress, not perfection. Okay, so that's your bonus tip for today. I want you guys to just get out there, own what you're doing, value your own services so that your families value it too. Right? Keep it simple, figure out what works and apply it across all of your patients to the best of your ability. Don't make yourself nuts. Like set a timer. Don't let yourself spend more than like an hour each week prepping sessions. If you must take time to prep, use Loom. Not to be confused with zoom and things like lesson picks like I shared or I briefly mentioned boom cards. Like there's so many things out there and if one doesn't feel like a good fit for you, find something else. But use Loom to make demonstrations for families and educate and empower your families and tell them what to expect. Right? Educate, empower and expectations. Parents are therapists. Teletherapy is real. My parents and my patients, their kids are having amazing results. 70% of success. Progress, not perfection. OK, that is the big summed up message today. I hope that that all sinks in and that this is helpful for you. I wish everybody continued success in teletherapy and lots of light and peace and health in both your home, your patients homes, your family's homes and just across the world. So I know this was a bit more of a woo woo episode, but my goal for you guys is to step into your role and serve others and hopefully be that light in their life. I hope you guys have an awesome day. This is Hallie signing off and we'll chat soon.