The Benefits of Using Telepractice for Speech Sound Disorders

by Nate Cornish on September 18, 2014

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speech-telepractice-telespeechAs telepractice becomes more widely available as a method for serving individuals with communication impairments, family members may wonder if it is a good fit for their child. One of the most commonly-addressed conditions that is addressed through telepractice is the area of Speech Sound Disorders. Caretakers who are considering telepractice may ask, “What are the benefits of pursuing treatment through telepractice?” “Are there any limitations?”

First of all, it’s helpful to understand what Speech Sound Disorders are: In children, this type of impairment generally falls into two categories: Articulation and Phonology.

Articulation: A child with an Articulation Impairment experiences difficulties with movement of their speech mechanism, (e.g., their tongue or their lips). It might be that there is some weakness, difficulty with range of motion, or the movement may be out of sync with other movements. (This is different than motor planning issues, which we will cover in another article on Apraxia of Speech.) An example of an Articulation Impairment would be those kids who have a hard time making the /s/ sound.

Phonology: Phonological Impairments are related to the child’s ability to recognize and follow the patterns and rules of speech production. A child with a Phonological Impairment may struggle to produce all the consonant sounds when there are two (or more) next to each other, (like when a child says “boo” instead of “blue”). It could also include children who regularly substitute sounds in one part of their mouth for sounds that are produced in another, (such as a child who makes /t/ and /d/ sounds in place of /k/ and /g/).

In both cases, treatment usually involves helping the child to hear when sounds are made correctly or incorrectly, demonstrating how to make the sound, and learning the patterns and rules of production. It is also important to get a lot of practice making correct sounds in different structures, (like syllables, words, and sentences), as well as in different settings, (with the speech-language pathologist, other adults, friends).speech-telepractice-telespeech

A speech-language pathologist (SLP) in a school will generally help their students work on speech sounds in as many settings as possible. This might include working with the child one-on-one, in a group with other children, in the classroom, or by consulting with teachers and parents and sharing strategies that they can work on. Unfortunately, the individual follow-up a school SLP can provide in a variety of settings may be limited by their caseload size and other constraints. At first glance, a telepractice SLP may seem even more limited in their ability to provide practice in various settings. However, home-based services let the SLP directly into the child’s family environment. A telepractice SLP can involve siblings, friends, and parents in therapy activities. Caretakers also have the ability to directly observe the strategies that the SLP is using, and follow those that are appropriate after the session.

It is also very important for a telepractice SLP to be able to accurately hear the sounds a student is making, observe the child’s motor movements, and clearly model correct movements. Again, this may appear to be an area where in-person therapists have the advantage. However, a growing body of research shows that telepractice SLPs can provide comparable services given proper equipment, audio/video quality, internet connection, and support from on-site adults. For this reason it’s important for parents to consider the equipment, systems, and technical support that an organization offers when considering at-home services for their child.

speech-telepractice-telespeechI mentioned evidence that supports treatment of Speech Sound Disorders through telepractice. The existing research is fairly recent, but all very positive. Grogan-Johnson and her group, (2011), provided computer-based speech sound treatment to children in both on-site and telepractice settings. They saw that both sets of children made comparable gains. Two additional studies by Grogan-Johnson, (2010 & 2013), provided direct speech sound treatment to children in both on-site and telepractice settings. The 2010 study even switched the service method half way through the study, (that is, the telepractice group started receiving on-site services and vice-versa). Both studies showed that children made comparable progress, no matter what setting they were in.

Telepractice holds a lot of potential for helping children with Speech Sound Disorders. Not only is there growing evidence that children can receive the same level of services as they would in an on-site session, but there may be some distinct advantages in being able to connect practice to different settings and people!

telepractice-telespeechIf you’re a therapist looking for a better way to work, check out our VocoVision Telepractice Services here!

References

Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16, 134-139.

 Grogan-Johnson, S., Gabel, R., Taylor, J., Rowan, L., Alvares, R., & Schenker, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children. International Journal of Telerehabilitation,3(1), 31-42.

 Grogan-Johnson, S., Schmidt, A. M., Schenker, J., Alvares, R., Rowan, L. E., & Taylor, J. (2013). A Comparison of Speech Sound Intervention Delivered by Telepractice and Side-by-Side Service Delivery Models. Communication Disorders Quarterly34(4), 210-220.

{ 8 comments… read them below or add one }

Jami Keller October 21, 2014 at 12:21 pm

Excellent article. I appreciate how you break down and explain the different speech disorder areas and outline treatment. I hope that telepractice becomes the norm rather than an exception. It seems like an excellent way for therapists who specialize in niche areas to have greater access to patients.

Candace Brown October 22, 2014 at 8:53 am

“Caretakers also have the ability to directly observe the strategies that the SLP is using, and follow those that are appropriate after the session.”

Given the importance of reinforcement, being able to watch the therapy session in the familiar environment of the home and then practice afterwards is a huge difference maker.

Janice Trundlepaugh October 22, 2014 at 8:57 am

Does this tele-therapy treatment work well for homebound stroke patients?

Susan Turner October 22, 2014 at 1:15 pm

Have you used this type of telespeech for students that are home-schooled? I home school our four children and one of them goes to the speech therapist once a week.

Nate Cornish October 22, 2014 at 4:05 pm

Thanks, Jami! We hope that, too. I know that a lot of people don’t start considering telepractice unless they’ve run out of on-site options. However, the more we learn about the outcomes of telepractice, the more we see that this medium doesn’t make for “Plan B Therapy.”

Nate Cornish October 22, 2014 at 4:11 pm

I’m glad you agree, Candace! For as much as we focus on generalization, SLPs don’t often get the opportunity to work directly with families. This is one of the things I like most about telepractice.

Nate Cornish October 22, 2014 at 4:31 pm

That’s a good question, Janice. Telepractice in our profession was initially embraced more strongly by SLPs who worked in medical settings with patients who had conditions like stroke or brain injury. So there is actually more published research on these outcomes than there is for school-based populations. A good review of that research can be found here:

Theodoros, D. (2011). Telepractice in speech-language pathology: The evidence, the challenges, and the future. Perspectives in Telepractice, 1(1):10-21.

In short, what she says is that: We are learning more about how this works for clients with stroke. There have been a number of studies looking at telepractice assessment for stroke-related conditions like aphasia, apraxia and dysarthria. There are fewer studies that examine telepractice treatment for these conditions. However, the evidence that exists is positive.

So what we know so far is that tele-therapy can be a good solution for homebound stroke patients.

Nate Cornish October 22, 2014 at 4:53 pm

Thanks for the question, Susan! I am familiar with several state programs that provide speech and language services to remote students, including some who are home-schooled. So the precedence is there; however, the mechanics of it depend on the child’s circumstances.

If the child has an IEP and is receiving speech-language services through a local education agency (LEA), the telepractice provider typically needs to be contracted directly by the LEA. In this scenario, those services are covered by the LEA and the minutes count toward the ones guaranteed by the IEP. VocoVision has worked with many school districts to provide services to their students under similar conditions.

If the child does not have an IEP, or if the LEA has a system in place for providing services to home-schooled children with IEPs, VocoVision can work directly with families to provide private services in the home. These services can either be primary services or a supplement to those provided by the LEA. In any case, telepractice and VocoVision are pretty flexible solutions to the unique needs of families!

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