Telepractice and Language Impairments
If you’ve ever spoken with a speech therapist, you may have noticed that we typically use a really long term to describe what we do. That term is, “speech-language pathologist,” (or “SLP” for short). The “language” part of that title is very important. While the classic image of an SLP involves working with kids on speech sounds, most of what we do actually involves language-learning! To understand this a little better, let’s break language down into three general areas: Content, Form, and Use.
When we talk about “Content,” we refer to the meaning of language. This generally happens at the word level, like how big their vocabulary is or how deeply they understand the different meanings that words can have. A child with a Language Impairment may have a difficult time learning new words, understanding different language concepts, following complex directions, or catching on to the nuances of the different ways we can use one word.
“Form” refers to the different rules we use to put words and sentences together. For example, a child with a Communication Disorder may have a harder time learning things like irregular verbs, (“I goed to school,” vs. “I went to school.”). Appropriate word order can be tricky to figure out, (“You can pick it up.” = Statement / “Can you pick it up?” = Question). Putting together or understanding age-appropriate sentences, narratives, or text structures may also be difficult for these children.
Finally, “Use” has to do with the social aspects of language and is sometimes called “pragmatics.” This covers a pretty wide range of issues such as: Giving enough information when speaking to someone else, staying on a conversational topic or knowing how to change the topic, monitoring speaking volume and eye contact. Of course there is a lot of variation in what is considered typical and age-appropriate. However, SLPs work with children who perform outside of that “typical” range.
In some ways, providing telepractice services to children with Language Impairments can be even more straightforward than it is when working with some Speech Impairments. Although having a clear understanding of the child’s communication is always important, there isn’t the same need to be able to identify the subtle speech sounds or to model motor movements. So hardware or internet issues that sometimes come up tend to be less of an issue. Also, in my experience and in that of my colleagues, many of the activities and methods we would use for on-site language therapy translate well to the telepractice setting. An SLP can target listening comprehension and word-learning with the use of online books or other multimedia stories. There are various digital workbooks, software programs, and online activities that can help a child learn and practice word and sentence structures.
On the other hand, teletherapists may need to do some extra coordinating. Problems with comprehension or expression can dramatically affect a student’s participation in the classroom. The SLP should make efforts to connect with language that the child needs in school and other settings. For example, SLPs can teach word-learning strategies using vocabulary lists from science class or work on listening comprehension using a text from social studies.
In regards to social communication, (the “Use” mentioned earlier), speaking through videoconference isn’t the type of interaction that children usually engage in on a daily basis. Eye contact is certainly different when the speaker’s image and the web cam are in two different places. Conversational volume, turn-taking, and reading social cues are also affected by this type of interaction. The SLP’s role may be to teach some strategies directly, and then act as a coach during practice between the child and a conversational partner who is on-site. In this and other forms of language intervention, parents should collaborate with an SLP to understand the strengths and limitations of this mode of service delivery, and work together to modify activities so that the child is receiving the same benefit that they would from an on-site therapist.
Perhaps because language therapy seems a little more straightforward, the research that supports it isn’t currently as robust as it is for other areas of intervention. There is a lot of anecdotal and clinical experience in the field that tells us children can make gains through telepractice treatment. However, the formal research that has been done to date only looks at the effectiveness of language assessment through telepractice. Fairweather et al. (2004) reported success using formal and informal language assessments through on-site and telepractice means. Waite et al. also found that students could effectively be evaluated for language (2010a), and literacy skills (2010b), through telepractice. While this is different than evidence on the effectiveness of treatment, it does hold promise that future findings on intervention may be positive.
While our profession is waiting for more formal research to help guide what we do, telepractice SLPs and families are already having success by working together to serve children with Language Impairments. Parents of children who receive home-based services can help by:
- Understanding the technological platform used by their telepractice provider. Ask about advantages and limitations of the platform as well as the types of activities that can be presented.
- Facilitating communication between the SLP and the student’s school or other settings where the child has language needs.
- Being part of therapy where it’s appropriate. Be open to the SLP coaching you through some helpful interactions with your child. Learn strategies you can use offline to support the gains your child is making.
Coordinated efforts between telepractice SLPs, families, and others are helping children every day. Given the right team of a skilled telepractice SLP, engaged parents and teachers, state-of-the-art technology, and responsive technical support, children with Language Impairments can improve their ability to understand and express themselves effectively.
If you’re a therapist looking for a better way to work, check out our VocoVision Telepractice Services here!
Fairweather, C.; Parkin, M.; Roza, M. (2004). Speech and language assessment in school-aged children via videoconferencing. Paper presented at the 26th World Congress of the International Association of Logopedics and Phoniatrics, Brisbane, Australia.
Waite, M., Theodoros, D. G., Russell, T., Cahill, L. ( 2010a). Internet-based telehealth assessment of language using the CELF-4. Language Speech and Hearing Services in Schools, 41, 445– 458.
Waite, M., Theodoros, D. G., Russell, T., Cahill, L. ( 2010b). Assessing children’s literacy via an Internet-based telehealth system. Telemedicine and e-Health, 16, 564– 575.