The need for social distancing, isolation, quarantine, and ultimately lockdown due to COVID-19 has presented a major challenge to the field of neurodisability, for which personal interaction has always been a key element. These restrictions have resulted in many services being transferred to telehealth consultations. Does this way of working fill an enduring need and what can be learnt from it? The question of ‘What really matters?’ should be uppermost, whether it be about service delivery for those in the education and health sectors, or the basics of life, family, and work practices. Remote delivery of services has longevity in my home country of Australia. Inspired by the Royal Flying Doctor Service (which used radio as its contact medium), School of the Air was the way in which children were educated in the far-flung outback and rural communities, over millions of square kilometres. More recently, technology has replaced radio to enable online schooling and has extended to health service delivery with online consultations and advice routine process for remote areas. With COVID-19, ways to deliver neurodisability therapy services online have had to be found, and professionals also had to grapple with the need to adopt personal protective equipment (PPE) in their face-to-face sessions. For the new parent of a high-risk infant there could be heightened anxiety on receiving bad news from professionals in head-to-toe PPE, where the empathy so often conveyed by facial expression and body language is absent. For the families of children with neurodisability, telehealth might simply seem too hard as they are juggling the needs of home schooling, social issues, and mental health. Therapists at KidsPlus Foundation (https:// www.kidsplus.org.au/) report that 80% of the families embraced telehealth during lockdown, and that therapists appreciated being able to easily access the home environment in real time to best optimize functional goals. Telehealth has given those families flexibility and choice in how they receive services and will now be an integral part of service delivery. Discussion has also centred on the identification of the essential skills required by therapists to deliver this type of remote service. There has been an ongoing conversation over the last 10 or more years about what therapy works best for children and young people with cerebral palsy—and of course there is no one answer to that. Clearly, a combination of strategies that address the objective of what really matters for each child and family to ensure optimal participation in life is needed. The greatest lesson I learnt from my Bobath training in London was that what you do is not the most important thing, but why you do it. Equipped with an analytical ‘how and why’ approach to typical development and the framework of the International Classification of Functioning, Disability and Health, the therapist applies critical powers of observation, analysis, and interpretation, to what the person can do and wants to do but finds challenging. From that, decisions are made about what is possible and essential to enable optimal participation in daily life now and in the future, always in partnership with the child and family. For effective telehealth this analytical collaborative approach is essential. Telehealth is here to stay and will be an option for families in their choice of how they receive services. There are many positives to telehealth that merit its continuation, while at the same time recognizing that it is not the answer for some families. What works best and for whom is an ongoing quest, and whichever mode of delivery is offered the question of what really matters for the child or young person and their family is key to the achievement of best outcomes.

中文翻译：

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残疾管理远程医疗：真正重要的是什么？

由于 COVID-19 导致的社会疏远、隔离、隔离和最终封锁的需要，对神经残疾领域提出了重大挑战，其中个人互动一直是一个关键因素。这些限制导致许多服务被转移到远程医疗咨询。这种工作方式是否满足了持久的需求？可以从中学到什么？“什么真正重要？”的问题 应该是最重要的，无论是为教育和卫生部门的人员提供服务，还是生活、家庭和工作实践的基础知识。远程服务交付在我的祖国澳大利亚长期存在。受到皇家飞行医生服务（使用无线电作为其联系媒介）的启发，空气学校是偏远的内陆和农村社区儿童接受教育的方式，面积超过数百万平方公里。最近，技术取代了无线电以实现在线教育，并通过为偏远地区提供在线咨询和建议常规流程扩展到医疗服务提供。对于 COVID-19，必须找到在线提供神经障碍治疗服务的方法，而且专业人员还必须应对在面对面会议中采用个人防护设备 (PPE) 的需求。对于高危婴儿的新父母来说，从头到脚 PPE 专业人士那里收到坏消息时可能会更加焦虑，因为面部表情和肢体语言往往缺乏同理心。对于神经障碍儿童的家庭，远程医疗可能看起来太难了，因为他们要兼顾家庭教育、社会问题和心理健康的需求。KidsPlus 基金会 (https://www.kidsplus.org.au/) 的治疗师报告说，80% 的家庭在锁定期间接受了远程医疗，并且治疗师很高兴能够实时轻松访问家庭环境以最好地优化功能目标. 远程医疗为这些家庭提供了如何获得服务的灵活性和选择，现在将成为服务提供的一个组成部分。讨论还集中在确定治疗师提供此类远程服务所需的基本技能上。在过去的 10 年或更长时间里，一直在讨论哪种疗法最适合患有脑瘫的儿童和年轻人——当然，对此没有一个答案。显然，需要一系列策略来解决对每个儿童和家庭真正重要的目标，以确保最佳地参与生活。我从伦敦的 Bobath 培训中学到的最重要的一课是，你所做的不是最重要的事情，而是你为什么这样做。配备了典型发展的分析性“如何和为什么”方法和国际功能、残疾和健康分类的框架，治疗师运用观察、分析和解释的批判性力量，来解决人们可以做什么和想要做什么但觉得很有挑战性。由此，决定什么是可能的和必不可少的，以实现现在和未来的日常生活的最佳参与，始终与儿童和家庭合作。对于有效的远程医疗，这种分析协作方法是必不可少的。远程医疗将继续存在，并将成为家庭选择接受服务方式的一种选择。远程医疗有许多值得延续的积极因素，但同时也认识到它不是某些家庭的答案。什么最有效，对谁最有效，无论采用哪种分娩方式，对儿童或年轻人及其家庭真正重要的问题是实现最佳结果的关键。始终与孩子和家人合作。对于有效的远程医疗，这种分析协作方法是必不可少的。远程医疗将继续存在，并将成为家庭选择接受服务方式的一种选择。远程医疗有许多值得延续的积极因素，但同时也认识到它不是某些家庭的答案。什么最有效，对谁最有效，无论采用哪种分娩方式，对儿童或年轻人及其家庭真正重要的问题是实现最佳结果的关键。始终与孩子和家人合作。对于有效的远程医疗，这种分析协作方法是必不可少的。远程医疗将继续存在，并将成为家庭选择接受服务方式的一种选择。远程医疗有许多值得延续的积极因素，但同时也认识到它不是某些家庭的答案。什么最有效，对谁最有效，无论采用哪种分娩方式，对儿童或年轻人及其家庭真正重要的问题是实现最佳结果的关键。同时认识到这不是某些家庭的答案。什么最有效，对谁最有效，无论采用哪种分娩方式，对儿童或年轻人及其家庭真正重要的问题是实现最佳结果的关键。同时认识到这不是某些家庭的答案。什么最有效，对谁最有效，无论采用哪种分娩方式，对儿童或年轻人及其家庭真正重要的问题是实现最佳结果的关键。