Teletherapy with a Language Focus
Language has always been my strongest area of interest. It takes on different forms from the spoken word to body language. It infuses every part of our daily lives; starting from the moment we arise and say, “Good morning,” to the dreams we have while asleep. One of the most intriguing characteristics about language, I find, is that it can be stimulated anywhere and at almost any time! The computer is a wonderful piece of equipment that allows us to travel anywhere and research unfathomable and infinite topics! People are drawn to computers to communicate whether it is through Facebook, Twitter, LinkedIn, etc. Providing language therapy via computer allows people to utilize something they normally interact with on a daily basis. What better way to contact others and address language goals than through a medium that everyone will need to employ and be comfortable with at some point in his/her student- and adult- life. A professor once told me, “A skilled Speech/Language Pathologist should be able to create and provide a therapy session armed with nothing more than a pencil.” Is this true of teletherapy? Could a computer be a substitute for a pencil? What are some ways to incorporate materials or techniques from my onsite experience into the teletherapy I provide?
What types of language goals can be addressed using teletherapy? I’d say almost any and/or all goals. Let’s break down the different areas of language that could be listed on an IEP and consider how to address them through the provision of teletherapy.
Vocabulary is one area that tends to be a focus of therapy for many clients. One option would be to use any vocabulary materials you may already own (from working onsite) with the help of a document camera. You have the choice of either scanning the document or taking a picture of the page with the document camera both resulting in a copy of the page on your computer to pull up and use with your web-based, video conferencing platform. Using the platform’s tools, you can interact with the vocabulary page in numerous ways such as coloring, circling, crossing out, and/or highlighting the information. If you prefer to introduce vocabulary using literature, you can read the story to your client using the document camera presenting the pages of the book to your client as you read it aloud. If there are specific vocabulary words, pictures, or both in the story that you want to focus on, you can scan in a page that contains that information, call it up onto your desktop using the “Paint” program, crop the page down to the section you want, and then cut/paste it into a new document, PowerPoint slide, etc. By creating a place to type next to or under the picture you pasted, you could ask the client to type the label of the item, use it in a sentence, etc. This is just one way to emphasize vocabulary.
What about concepts? Temporal, spatial, qualitative, and/or quantitative concepts can be addressed with your own, hard-copy materials using the document camera, or you could create a PowerPoint presentation. I personally enjoy creating my own PowerPoint slides requesting the client to identify the picture depicting the concept or by having the client click on the appropriate picture and moving it to the correct spot on the page following my directions (e.g., Can you put the box next to the blue car? See the bowl with apples in it? There are only 2 apples in it. Could make the bowl “full” of apples?). The more interactive the material, the more engaged your client will be and the better he or she will retain the information. Even while working on quantitative concepts, developing PowerPoint slides makes creating your own materials a breeze! I find PowerPoint (PPT) easier to work with than a WORD document. The interactive PPT document is user-friendly on a SMARTBoard too if the classroom teacher would like to carryover the lesson into his/her room! I’ve created short, interactive lessons using PPT for some math concepts such as “greater than” and “less than” to help provide a visual component to aid comprehension as well as motivating students to stay on task.
There is also inexpensive software available through LinguiSystems, SuperDuper Publications, Thinking Publications, and Lakeshore (to name a few). Any software program you can use on a computer or interactive whiteboard can be used for teletherapy (depending on the type of web-based, video conferencing platform you are using, of course). If the platform allows you to switch control from the clinician to the client, the client will have the ability to interact with the software even though it is loaded and running on your, the clinician’s, computer! Many of these programs, especially from Lakeshore, are provided in a “game” format which my students really enjoy. I will also use the software for positive reinforcement. If my student completes the tasks requested, I will typically save some time at the end of the session to play one of the software games. Thus, the client is really continuing to work but he or she views it as playing a game after completing his/her work. LinguiSystem has CD programs for their Autism and PDD population. This software is highly motivating for my students whether they have been diagnosed or display symptomology of Autism & PDD or not. “Buddy Bear” and/or “Bonnie Bunny” CD's work well for addressing concepts, vocabulary, sequencing, and predicting. There are free websites available online for students to use to reinforce a goal or for positive reinforcement as well. I will list a few at the end of this article for you to consider.
In terms of grammar skills, I enjoy creating my own materials to mix in with the interactive software I’ve purchased. The software tends to be a bit “dry,” so, to liven up the session, I’ll look for videos demonstrating the tense form, adjective, noun, etc. that we’re working on. CAUTION: YOU SHOULD WATCH THE COMPLETE VIDEO BEFORE SHOWING IT to your clients to be sure it is completely appropriate. Watch the commercials along the sidebar (if the site displays a loop of advertisements) because inappropriate advertisements can suddenly appear. Videos from PBS.org are usually safe, but I still view them ahead of time making sure that the video is culturally appropriate. “Pixar’s Shorties” DVD is an excellent source for short, cute video stories to practice grammatical forms. For example, you could teach “past tense” verb forms and what that means. Then, supplement your lesson with, “For The Birds” Pixar Shortie, and when it is finished, you could discuss the things that happened in the video. The more areas of language you can incorporate into your lesson or that you can practice simultaneously (once your student has reached this point in the therapy process), the more relevant the information will seem which will aid in the retention of the material. This, in turn, can help increase progress.
If you are working on categorization, comparing/contrasting, grouping, etc., you can use the same approach mentioned previously (i.e., software, self-made PPT materials). To address following directions, all you really need is a shared whiteboard (one of the tools supplied by the web, video-conferencing platform). You can “unshare” your desktop but still use the whiteboard to play a “Barrier Game” where one person gives a direction and you both have to draw or write it. When everyone is finished taking multiple turns giving directions, you can “share” your whiteboard once again to compare the results of how the each person interpreted the directions.
Pragmatics (i.e., social skills) can be addressed through teletherapy as well. Onsite, language therapy provides an extra avenue to aid the communication process because of the fully-observable, “body language” component of social skills. While providing teletherapy, I am able to notice upper-body “body language,” but activity that occurs below the chest is difficult to see (e.g., hyper- or happy- feet, wiggling due to needing a bathroom break) due to the restricted amount of space the computer’s camera can afford. Since clients receiving Speech/Language therapy via telepractice tend to enjoy staying in one spot, in front of the computer, having to see below the chest area is not crucial. If a client points to something in the room during teletherapy or if there is some type of disruption off to the side of the room, I rely on my eHelper to tell me what is happening since it is typically outside of the camera’s view. Many times I will incorporate the information the eHelper provides into the therapy session because of its immediate relevance. I’ll ask “Wh” questions (e.g., What is making that squeaking noise?), incorporate verb tenses (e.g., Something squeaked a few seconds ago. Was it an animal that squeaked?), and concepts (if the situation promotes them) (e.g., Did the squeak come from a door when it was opened? What about when it is being closed? No? It was a mouse? Did the mouse run under your chair?).
Using some type of language to communicate is a common bond between everyone. Whether language therapy is provided onsite or via teletherapy, some of the same techniques can be used in both contexts. Based on my experience, it is just as easy, if not easier, to work on language skills via teletherapy because of the clients’ attraction to computer-based activities. We, as Speech/Language Pathologists, need to consider collecting or creating a different therapy-material library as we enter this new professional frontier! We need to “think outside the box” in terms of our “box of materials and tricks” and consider your computer's capability in terms of creating self-made materials as well as considering the types of materials the world-wide-web has to offer!
Links for Activities on the Web
· http://freebies.about.com/gi/o.htmzi=1/XJ&zTi=1&sdn=freebies&cdn=hobbies&tm=8&f=00&su=p284.13.342.ip_&tt=3&bt=5&bts=5&zu=http%3A//krazydad.com/mazes/If some of the activities are not made for use online, print & scan or just “copy” the page (save it to your computer to call up during teletherapy using your web-based, video conferencing platform). You will then be able to use the tools to interact with the material.