#68 Telepractice Tips 'n Info (Part 1)

It’s been a while since we’ve connected; months, in fact.  So much has happened and so much has changed.  I sincerely hope you, your loved ones, and your therapy-kids are healthy and safe.  I’ve wanted to write something that might be helpful for you and the sweet-ones you work with but got stuck as to what that would be.  I, too, am not a fan of un-relatable blogs.  In Therapy Matters #67, I asked the question, Teletherapy: The New Normal?  Turns out, it is.

Greetings SLP!

It looks like school service delivery across the country is either total telepractice or a hybrid blend of telepractice and in-person instruction through a mask and/or acrylic shield or, just in-person.  Are you scrambling to adjust?  Can't blame you if you are.

The “tele” service delivery model has changed the face of how we do eval’s, therapy, meet with teachers and administrators, and hold parent/caregiver meetings.  It’s a major learning curve.

Over the next few months, every two weeks I’ll send you brief, practical teletherapy tips and information.  If you have a specific topic you’d like addressed, let me know:  char@speechdynamics.com.

With advice and insight from my very tele-experienced SLP friend, Sarah James (15-years worth of online experience) here’s the first tips ‘n info installment. 

If you are a newbie or experienced, Sarah sets the stage for us: “Remember, you are a service provider first.  Make the primary focus you and your client, not the mode of service delivery.  You are the professional and expert in your field, and therapeutic guide.  You know therapy.  You bring confidence, experience and personalization to your assessments and therapy.  With these key components in place, you’ve got your foundation.  It’s all up from there.” 

Attention & Focus 

Perhaps you’ve thought about this.  Online therapy is very different from, and in an odd way competes with kids’ passive television watching, Facetiming with grandma, and playing electronic games.  Video games are colorful, exciting, and present stimulating and competitive challenges.  They require focus and quick, instantaneous thinking and action.  They yield a sense of immediate pleasure and, quite possibly, may be addictive.  The research on video gaming addiction is probable, but inconclusive (Watkins, 2020).  

And there’s another downside.  A study conducted in 2010 (Swing, et al.) states: “Viewing television and playing video games each are associated with increased subsequent attention problems in childhood…[as well as] late adolescence.”  So, there’s that. 

To adjust for our therapy’s slower pace and more intensive interactions and learning (after all, we are doing therapy), we must consciously consider how we share information and instructions to motivate, shape, and maintain their interest and involvement.  Could this be one of the reasons why we SLPs scramble to find the latest, most colorful, action packed, super-fun game to do online with our kids?  My fear is that the therapy piece gets lost. 

Sarah weighs in on this important topic: “Minimize your searching and maximize building a relationship.  With the tsunami of distance learning accessories, e.g. tools and materials, continuing education options, articles, emails, forums, and online support groups, one could easily and understandably become consumed and frustrated.  To counteract the frenzy, maintain your priorities, and settle in on the simple and direct tasks.  Keep them at or slightly above the child’s ability level and keep them moving at the child’s “processing pace.”  Most importantly bond and build relationships with your children, their family and caregivers.  Your therapy-kids need you.” 

Expectations 

Every SLP knows this, but as a reminder, from the first session, lay out your expectations and ground rules to both the child and the ehelper, if you have one, and repeat them periodically over time.  For example:  

• Expect everyone to be on time, online, and ready. That means all are present, and have easy access to the lesson or materials you sent them, or supplement they were to access at home.  Otherwise, valuable minutes are lost. 

• Repeat these words often, LISTEN, LOOK, AND THINK: “Keep your ears sharp and listening, your eyes on the screen, and your brain focused and thinking.” 

• Emphasize your high expectations for their improvement. Let them know you expect to see progress every time you meet (Wright, 1995). 

Oral-Oriented Therapy Tips 

In speech therapy, regardless if you use a phonological single-sound or single-word approach, or a more oral-oriented capability-building placement approach, the origin of all speech is the mouth.  Can’t get away from it.  Most of us, at the very least, ask the child to listen to the sound and think about their tongue.  This is a good start and a good thing to do, especially during online therapy. 

In subsequent blogs, I’ll go more in-depth about the information and importance of focusing intra-orally, but for now, here are a couple doable suggestions to help accommodate and compensate for the sensory input differences we experience during online therapy.  

• Ask the child to close their eyes and focus and feel intra-orally to increase proprioceptive awareness (you use different words, of course!). Encourage them to think about their tongue.  Consider using the phrase (and it repeat it often), “Focus and feel; focus and feel….”

• Ask the child oral-focused questions. Throughout your session, ask them questions to encourage them to focus intra-orally:  What is your tongue touching?  Tell me what you feel.  Do you feel the sides of your tongue on the side of your teeth?  Close your eyes, focus and feel.  A note of precaution, as we all know, some kids tell us what they think we want to hear.  Emphasize:  “Because you and I are not in the room, I need you to accurately tell me what is going on in your mouth.”  Otherwise, they may not be doing it right—and nobody wants that.

Now, go do therapy, and enjoy it.  Thank youfor all you do for your therapy kids!

So glad to be back with you.

Take care, stay healthy, and be safe, 

Char

References

Swing, E.L., Gentile, D.A., Anderson, C.A., Walsh, D.A.  (2010).  Television and video game exposure and the development of attention problems.  Pediatrics, Vol. 126, (2),214-221.

 Watkins, M.  (2020).  Video game addition symptoms and treatment.  American Addition Centers, from https://americanaddictioncenters.org/video-gaming-addiction.