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Teletherapy in Speech Therapy for Adults: Practice Changes due to COVID19

Updated: Oct 22, 2020

Teletherapy in speech therapy for adults

As the United Kingdom, Europe and other countries around the world face an unfortunate second wave of the Covid-19 pandemic, I thought it was a good time to reflect on tele-therapy in speech therapy, the changes in work practices that Speech Therapy North East and the wider speech and language therapy profession have implemented since the pandemic began, and how these changes have made our team well prepared for whatever restrictions may come with this second wave.

As a very new business and only recently taking the plunge to become a full-time independent speech and language therapist, dealing with the ramifications of a global pandemic was certainly not on the agenda. I am very grateful that as a business we have managed to navigate through some very difficult waters and really feel for businesses that have found things too difficult.

At the start of the pandemic my thoughts were “What are we going to do?!” “How are we going to still provide input to all of our clients?!” Even though pre-pandemic I have always been keen to explore tele-therapy, at that moment in time it was difficult to imagine how it would work on such a large scale - providing tele-therapy to our entire caseload! But in the blink of an eye, remote working was EVERYWHERE. Words such as Zoom, Teams, Google Hangout were flying about and though alien to me at the time, they are now a core component of my vocabulary.

The wonderful world of Twitter was invaluable with people sharing their knowledge and experiences of different video conferencing platforms and how to use them therapeutically. The Royal College of Speech and Language Therapy provided timely and detailed pandemic advice, and some people, like Lorraine from Aptus Speech Therapy, were also very generous with their time by providing fantastic resources for setting up remote therapy sessions for both therapists and clients to easily follow.

Check out the following teletherapy resources by Aptus Speech Therapy: "How to Use Zoom: A Guide for People with Aphasia", "9 Teletherapy Activities for Aphasia" and "How to Mirror an iPad app using Zoom".

Fortunately, we were able to transfer the majority of our caseload over to tele-therapy speech therapy sessions using a variety of platforms based on client preference - though this was generally a mixture between using Zoom and FaceTime. The main barrier preventing some of our clients from accessing this approach was their location i.e. being in a residential care setting which was unable to support client access either due to lack of equipment/technology or time pressures on staff to be able to support clients during a session.

Online speech therapy for adults

One of our clients was reluctant to participate in a video call because they didn’t want to see themselves on the call. We were able to ease this particular client in by teaching them how to access the call without having their camera on until they felt happy to try switching it on. Once switched on they never looked back – with the ultimate outcome of them wearing an elaborate 80s fancy dress costume for an 80s music inspired therapy session!

Ultimately we were able to maintain the majority of our therapeutic aims either directly with the client or by observing and supporting family members/support workers to carry out speech therapy tasks.

In the very early days of the national lockdown, tele-therapy sessions also served simply as an important social interaction opportunity for clients who had been starved of these experiences.

Speech therapy apps are wonderful for teletherapy. Image of speech therapy apps on a tablet
Speech therapy apps for teletherapy: example on iPad

One aspect of this new way of working that has worked particularly well has been the use of speech therapy apps. I have always been a strong advocate for the use of speech therapy apps as part of a wider therapy approach with clients. As a profession we are very fortunate to have access to some fantastic speech therapy apps – obviously the Aptus Speech Therapy range of apps but also other app developers too. The use of speech therapy apps became even more useful as part of tele-therapy sessions especially when utilised via a screen sharing function which enabled a collaborative approach to completing the therapy tasks.

Having the option to screen share was in fact very high on the preference list when selecting the best video call platform to use. The ability for the speech therapy apps to email results again proved their worth for tracking progress between sessions. I’m often asked what my ‘go to apps’ are and this is difficult to answer given every client understandably has different speech therapy app needs. However, in terms of the Aptus Speech Therapy range of apps I must admit I am a huge fan of the Verb Toolbox as I always find it difficult to find a good range of stimulus for verb related therapy. I also frequently use the Inference Pics app with my acquired brain injury caseload.

Did you know that the Inference Pics app is available for £14.99/$14.99 and that there is a lite version you can try for free?
Inference Pics has over 300 social inferencing activities for speech therapy
Social inferencing activities: Inference Pics app

Unexpectedly, the number of new referrals we received during the initial lockdown continued to flood in which led to the need to complete assessments remotely. This proved to be more difficult, initially, compared to providing tele-therapy. More adaptations to the assessment process are required compared to face to face speech therapy sessions particularly in terms of how to present stimulus from formal assessments whilst adhering to copyright legislation.

Not all formal assessments lend themselves to being completed remotely and I found assessing written language skills particularly difficult – though ultimately there were ways around this, often using the chat function for the client to type their response. I also didn’t feel that completing an oro-motor/cranial nerve assessment or swallowing screen was as effective as a face to face assessment though in the climate we were working, “something was better than nothing”. In most cases, recommendations were made that further face to face assessment of certain areas would be required once lockdown measures were eased.

Overall, we have found some of the advantages of tele-therapy sessions have been: the ability to provide shorter and less fatiguing sessions more frequently wit