“We’re going to Zoom what?” “Teletherapy?!” “Do our clients have WiFi at home?” These were some of the questions I heard buzzing around during our last in-person staff meeting at Abbott & Burkhart Therapy. That was over a month ago when 27 of our therapists and specialists gathered in the gym at our clinic for an urgent meeting to discuss the option of closing down the clinic and rethinking our service delivery practices. We talked all things COVID 19, social distancing and as anticipated, moving our sessions onto a teletherapy platform.

I was feeling calm among a sea of therapists who were clearly nervous and anxious about what was on the technology horizon. My perspective was not as daunting as the rest of the therapy staff as I have been utilizing teletherapy for the past several years with clients from around the country and the West coast.  A practice that I stumbled upon nearly a decade ago when I had a new client reach out to me from the East coast and thus began the first of many years of my teletherapy practice. Since then, a portion of my private practice for the handful of clients that I still see, remains online because of convenience, distance, illness and catastrophic incidents such as the Santa Barbara mudslides. 

At the beginning of this endeavor, the Coronavirus pandemic had therapists and families from ABT contemplating a teletherapy practice knowing that we were all in this for the long haul. The thought of it was a bit intimidating for everyone except for myself as I was the sole therapist with any teletherapy experience. Not only was I comfortable and at ease with this platform, but I saw this time as a challenge to step up my game in the teletherapy world and to see how to best serve my clients from screen to screen. After that meeting, we acted fast and pulled together a training module for staff and within 4 days, the majority of the ABT therapists were up to speed and ‘Zooming’ with our clients in the most amazing and creative ways.

A month in, teletherapy has many of us online for 5 to 8 hours each work day with our clients as we are now all settling into this very viable and productive practice. We sing songs, have scavenger hunts around client’s homes, set up obstacle courses, utilize online digital programs, play shoots and ladders while practicing speech sounds, do yoga poses and string beads: a surprisingly new norm for our entire staff that we never anticipated. Even my dog has gotten in on the act and frequently greets the kids and does tricks for them as they are signing on and starting their therapy with me. And although the in-person sessions may have become a thing of the past, at least for now, as sit on our perspective sides of a computer screen daily with toddlers and school-age children, we’re making this work in fun and creative ways.

From a ‘silver lining’ perspective, not only have we expanded our own therapeutic perspectives, be we have become a richer part of our client’s family structures during this global pandemic that we were not privy to in person. We have met family pets, visit with our clients in their backyards and have been introduced to extended family members previously unknown to us. And while this is an extremely sad and tragic time for society, these bonds with our clients now run at a much deeper level. There have been both tears and laughter from the stories and conversations. Recently, a kindergarten boy that I work with was beside himself when he first came onto our Zoom meeting because a bat had flown into their house and was hiding in his grandparent’s bedroom closet in the middle of our session. It made for an interesting conversation yet I couldn’t help but think to myself that I had no idea his grandparents lived with him.

  Who would have ever thought that our once buzzing clinic would turn into a ghost town and we’d all be in our perspective homes conducting therapy from our dining room tables, living room floors and backyards. But, we are truly making this work, stretching our creative juices and stepping up to the plate, beyond our own levels of comfort. And after 32 years of practicing as a licensed speech and language pathologist, I am grateful for this opportunity as I understand that we all have the honor of continuing to serve our clients and their families, even if in the most unexpected ways.

Dee Anne Barker, MA, SLP

• One Year of Age: Begin walking with a wide base of support, knees face forward and flexed or may be slightly externally rotated (until age 5 or 6). The hips are abducted and externally rotated. The pelvis is anteriorly tilted, feet appear flat (until age 3 to 5), and the arms are held in “high guard.”
• 18 months of age: Reciprocal arm swing emerges and the base of support begins to narrow. A heel strike becomes more consistent.
• Two Years of Age: The pelvic tilt decreases, as well as abduction and external rotation at the hip. Increased knee flexion is still present.
• Three Years of Age: The base of support begins to look more mature. They continue to demonstrate increased knee flexion and anterior pelvic tilt.

• Toe Walking: Occurs when a child walks on their toes and is more prevalent in boys than girls. There is often no cause for toe walking and it can resolve itself during childhood. Tight gastrocnemius muscles may be a cause, in which a stretching program is indicated. Serial casting and dynamic splints may be necessary, but surgery is rare.
• Intoeing: Walking with the toes turned inward can be caused by various conditions including: Femoral anteverison: an internal rotation of the hip causing the feet to appear to be turned inward. Ligament laxity in the hips is often a cause as well as the tendency of a child to “W” sit. Children who prefer to “W” sit often have difficulty sitting cross-legged. Stretching the internal rotator muscles of the hips and avoiding a “W” sit position will help to decrease femoral anteversion. The condition often resolves itself between 7-9 years of age. Internal Tibial Torsion: an internal twist of the tibia. It is normal in newborns but can often be seen in children who are walking. It may resolve itself by 4-6 years old. Metarsus Adductus: a problem that occurs in the foot. It is characterized by a curve of the forefoot, or toes, inward. It may be rigid or flexible. Stretching can be used if the foot is flexible. For rigid feet, reverse last shoes, or serial casting may be used. Surgery may be necessary for rigid metatarsus adductus.
• Outtoeing: May be caused by increased tightness of the hip external rotators, in which case the problem resolves itself. In other cases it may be due to femoral retroversion characterized by outward facing patella. It may also occur in the lower leg caused by external tibial torsion, which often resolves by 2-3 years of age.
• Bowlegs (Genu Varus): Bowlegs is normal in a young infant and should correct itself by the age of two as increased weight bearing and walking occur. If it does not correct, surgery or bracing may be necessary.
• Knock Knees (Genu Valgus): Common at 2-6 years of age. Should resolve by age 7 as a more mature gait pattern emerges.

1. Keen, Mary MD, Early Development and Attainment of Mature Gait; American Academy of Orthotists and Prosthetists; Journal of Prosthetics and Orthotics 1993;5:35-38.
2. Valmassy, RL, How to Recognize Pediatric Gait Abnormalities; Podiatry Today; 2002;15.
3. www.pediatric-orthopedics.com/topics/in-out-toe/in-out-toe.html. Accessed 4/26/09.
4. Bellett PS, The Diagnostic Approach to Symptoms and Signs in Pediatrics. Lippincott Williams & Wilkins, 2006.