Updated: Oct 22, 2020
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.
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.
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?
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 without the additional travel cost implications that would usually come with this; more frequent opportunities to observe those facilitating the completion of speech therapy tasks with clients and supporting this; able to distantly observe interactions between clients and their conversation partners – being able to turn off your camera and literally be a ‘fly on the wall’ was very beneficial. An added benefit of remote working has been the ability to hold more frequent multi-disciplinary team meetings again due to there being no travel costs associated with remote meetings.
Some of the disadvantages of remote speech therapy sessions we have found have been: ‘screen fatigue’ – looking at a screen intently during a session is noticeably tiring for both clients and therapists; missing the human connection element that a face to face session brings; not being able to provide a more comforting reaction when discussing challenging topics or when a client becomes upset in a session.
Thankfully lockdown measures were eventually eased. As speech and language therapists, we were very much missing the human contact, connection and warmth that you receive from a face to face speech therapy session. Clients were also missing this and were frequently asking when face to face sessions would resume.
Interestingly most clients, when asked, reported they would prefer a return to having all sessions face to face rather than remote sessions. Whether this was an immediate reaction to having had remote input for so long only time will tell. In practice, we have returned predominantly to face to face sessions at the moment though we have kept up a small percentage of remote sessions. As we now reach a point where a return to only being able to work remotely is a distinct possibility, we feel very prepared for this scenario thanks to the changes in service delivery and flexible working processes that were put in to place at the start of the pandemic.
So how will things look in a post pandemic world? With tele-therapy in speech therapy having become more prominent as a service delivery option given its extensive use during the pandemic, I feel it is definitely here to stay. As with any therapeutic intervention it will ultimately be about finding the right balance of service delivery options to meet an individual client’s needs and preferences in the most cost-effective way.
Anyway – enough from me, I need to Zoom off and Hangout with my Teams!
Author Bio: Matthew Nakonesky, Principal Speech and Language Therapist at Speech Therapy North East
Matthew trained as a Speech Pathologist in Australia. Since qualifying in 2009, Matthew has worked primarily with adult clients with communication and/or swallowing difficulties as a result of a neurological event or condition. Matthew is passionate about client-centred, goal-focused therapy. He is also very interested in technology in speech therapy; the use of speech therapy apps and the use of communication aids.