For most of us, COVID-19 business closures have been little more than an inconvenience. But for children like Elijah Hudson, the closures can mean a major step backward.
For the past 10 years, Elijah has been receiving speech language therapy and occupational therapy from Lowcountry Therapy. A mischievous, bowtie-wearing, movie-loving 16-year-old, he has learned to communicate using an adaptive app on his iPad. Elijah is non-verbal due to Down syndrome and autism.
"When COVID hit, we were concerned about Elijah regressing," said his mother, Michelle Hudson, of Bluffton. "With Elijah, bad habits can be made very quickly and can be very hard to break. For a while, I felt we were going to go back to grunting and groaning as his way of communicating."
The good news for Elijah and others at Lowcountry Therapy was that their therapy could continue even during quarantine.
Jessi Dolnik, a pediatric speech language pathologist who founded Lowcountry Therapy in 2010, closed her clinics only a week and a half before starting teletherapy. She has facilities in Bluffton and Port Royal and she provides services in area schools.
"My first thought was, I need to find a way to continue medically necessary services," Dolnik said.
"It's very common to see children who miss one or two weeks of therapy to experience setbacks in their therapy goals that can last for months," she said. "That's especially true for kiddos who are needing a regular schedule of therapy, like those on the autism spectrum or babies."
For example, she explained that an infant born with torticollis, a condition of the neck muscles that causes the head to tilt down, needs regular stretching exercises by a physical therapist.
"If they miss a week of therapy, they can be right back where they started. They need to be constantly stretched into new positions," Dolnik said.
Teletherapy brings the therapist into the child's home via an encrypted app parents download to a laptop, tablet or smartphone. The child enters the therapist's virtual waiting room where they can see and interact with each other on camera.
"It's different because the parents become the hands of the therapist," Dolnik said. "It can be intimidating for parents. But with teletherapy, parents learn what they can do."
Before occupational therapy visits, parents get a list of materials their child will need. Most sessions require a parent to either participate in the therapy or be nearby in case they are needed.
"It's fun and eye-opening," Dolnik said. "They're getting direct feedback from the therapist."
Dolnik isn't just a therapist - she's a client too. Her 5-year-old daughter Hattie, who is one of six children, currently receives speech and occupational therapy via teletherapy. It has given Dolnik a unique perspective.
"I've been working with her as a parent, but she's not into her mom doing therapy with her," she said. Since Hattie began virtual speech therapy two months ago, she has mastered all her goals, her mother said.
Occupational therapy helps children and adults learn to perform activities of daily living. Adults who have suffered a stroke or had a serious accident might need to relearn how to button a shirt, drive or balance their bank account. For children, the focus is different.
"A child's job is to learn and play - that's an important part of daily living," Dolnik said.
With the therapist's help, they learn to identify emotions and react appropriately. Mastering those behavioral skills is a key focus right now for Elijah Hudson.
"Behavior is critical," said his mom. "At school, his behavior can impede his education. If he doesn't want to comply, no learning takes place. For our family, it's critical, too. It affects our decisions on where we go and what we do."
Elijah has made progress, though. For his birthday last January, Elijah - a big fan of musical theater - and his family flew to Fort Lauderdale, Fla., to see a touring Broadway production of Disney's "Aladdin."
Dolnik credits the prompt response of Josh Baker, director of the South Carolina Department of Health and Human Services, and the South Carolina Speech Language Hearing Association for making teletherapy available so soon. She reached out to Baker shortly after she closed her clinics to request his help in securing insurance coverage for virtual visits.
Now Lowcountry Therapy's 32 speech, occupational and physical therapists conduct 475 virtual sessions weekly, according to Dolnik. While they appreciate the flexibility of working from home and setting their own schedules, they miss seeing their young clients in person.
But for all its benefits, teletherapy is not ideal, Dolnik concedes.
"The way we were looking at teletherapy was as a means to an end," she said. "It works, but not as well as face-to-face therapy."
Dolnik cautiously began a phased reopening of her clinics June 1. "We've opened with social distancing, masks, gloves and regular sanitizing," she said. "Our therapists are so happy to have their clients in the same room."
For now, the therapists work on staggered schedules and each has her own therapy room. There are no shared spaces.
With the success of teletherapy, Dolnik said it might be around for quite some time. She thinks a combination of in-person and teletherapy would benefit most of her clients.
"There are areas near us that are underserved or not served by any therapists," she said. "If we can reach out through teletherapy to those children, we can make a world of difference."
Michelle Hudson says teletherapy has certainly impacted Elijah's life.
"Elijah's world has shrunk so much since COVID," she said. "Teletherapy has been good for him - he took to it like a duck to water. We're more in touch with what's going on with him. And I have quite enjoyed not being a taxi back and forth."
The physical distance hasn't tempered Elijah's mischievous side. During one session, he was ready to end it early. His solution: he threw a shirt over the camera and walked away.
Laura Gray is a freelancer who writes about life in the Lowcountry.