Online therapy-friend or foe?

Ever since COVID has swept across the globe, being on the internet has become the norm. Be it attending schools or meeting friends, computers seem to have become inevitable in our lives. As online therapy emerges, it begs the question, should we opt for an online consultation or not? Is that as effective as the traditional way?

Online therapy plays an important part during these troubling periods where being outdoors can be difficult. What is even better is that it provides a great alternative for those living in remote areas. Online therapy also means that the less fortunate can afford therapy due to lower costs.

Online therapy or not, it is wise to start asking yourself the purpose of therapy. A weekly speech sound practice? An initial assessment? What kind of assessment are you looking for? The last therapy session upon leaving the clinic?

One example is swallowing, it is recommended to seek for a face to face assessments as professional machines are involved. If it is a speech sound issue, an online assessment would be sufficient.

Telehealth is the provision of specialist services via telecommunication technologies from a distance. These services include assessment, intervention, or consultation.

--- American Speech and Language Association (ASHA)

How Trustworthy is Telehealth?

Since the advent of technology, researchers have and show that telehealth is a successful alternative to traditional in-person consultation when it comes to ...

• Primary school students with speech sound difficulties and speech and language disorders (Rush et al., 2018).

• In stuttering, improvement in fluency is shown among both adults and primary schoolers (Lewis et al., 2008).

• Adults in voice therapy - online rehabilitation for patients with Parkinson's disease (Constantinescu et al., 2011).

• In children with Autism Spectrum Disorder (ASD), telehealth improves their emotional, social communication (Lee, 2019).

AS a virtual reality helps simulates a live interaction, my favorite example is a two-player virtual reality game where children have to communicate verbally and understand their perspective of another child to succeed in the game (Parsons, 2015).

The Awesome Parts!

Great online accessibility

Being online means that online resources are accesible. Speech pathologust can access to online media easily such as games, photos and videos, the sky is the limit! This makes therapy extra fun and creative. Session materials and homework can be shared simply with a click, without all the printing, transport, delivering.

Convenient

As mentioned, telehealth is an alternative for people in remote areas, this reduces the time and cost to commute. It makes everything easier, book the most suitable time, engage in sessions while in the comfort of their own home.

The Downsides:

Access to good internet

I had an online placement via Zoom, it was quite a pain, initially was the constant chopping of the video image, then it was the sizzling background sound. In the end, we wasted almost half an hour. This affected data collection and therapy delivery as great concentration on mouth movements and pronunciation is required. Not everyone has a computer let alone a stable internet. Hence, improvement of communication technologies e.g. audio output might be needed for some clients (Fairweather et al., 2016).

Attention difficulties

A session generally runs between 30 minutes to an hour depending on the client. Due to a shorter attention span, younger ones take less even in live sessions. Online sessions where live interactions are limited, can be challenging more youngers and those with attention difficulties e.g. ADHD to stay engaged. Reduced attention among primary schoolers is reported when an online session is held. (Isaki & Fangman, 2015). Yes, we can certainly incorporate online games into therapy to make things interesting but after all, nothing beats real live interactions, and plus technological problems can make things difficult, the mouse control is lagging, the internet is chopping...

Reference

Constantinescu, G., Theodoros, D., Russell, T., Ward, E., Wilson, S., & Wootton, R. (2011). Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non-inferiority trial. International journal of language & communication disorders, 46(1), 1–16. https://doi.org/10.3109/13682822.2010.484848

Fairweather, G. C., Lincoln, M. A., & Ramsden, R. (2016). Speech-language pathology teletherapy in rural and remote educational settings: Decreasing service inequities. International journal of speech-language pathology, 18(6), 592–602. https://doi.org/10.3109/17549507.2016.1143973

Isaki, E., & Fangman Farrell, C. (2015). Provision of Speech-Language Pathology Telepractice Services Using Apple iPads. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 21(7), 538–549. https://doi.org/10.1089/tmj.2014.0153

Lee, S. (2019). Virtual Speech-Language Therapy for Individuals with Communication Disorders: Current Evidence, Limitations, and Benefits. Current Developmental Disorders Reports, 6(3), 119–125. https://doi.org/10.1007/s40474-019-00169-7

Lewis, C., Packman, A., Onslow, M., Simpson, J. M., & Jones, M. (2008). A phase II trial of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention. American journal of speech-language pathology, 17(2), 139–149. https://doi.org/10.1044/1058-0360(2008/014)

Molini-Avejonas, D. R., Rondon-Melo, S., Amato, C. A., & Samelli, A. G. (2015). A systematic review of the use of telehealth in speech, language and hearing sciences. Journal of telemedicine and telecare, 21(7), 367–376. https://doi.org/10.1177/1357633X15583215

Parsons, S. (2015). Learning to work together: Designing a multi-user virtual reality game for social collaboration and perspective-taking for children with autism. International Journal of Child-Computer Interaction, 6, 28-38.

Rush, K. L., Hatt, L., Janke, R., Burton, L., Ferrier, M., & Tetrault, M. (2018). The efficacy of telehealth delivered educational approaches for patients with chronic diseases: A systematic review. Patient education and counseling, 101(8), 1310–1321. https://doi.org/10.1016/j.pec.2018.02.006

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It is of no denying that telehealth has its upsides over the old way. Though, time is still needed to determine whether telehealth is suitable for each patient. Plus, there are yet hurdles - technology, training of staff, and recognition in the speech pathology field.

Have you had any experience in telehealth? If so, how was it? What are your feedbacks? Let me know in the comments, I would love to hear all about it!

Have a great day and don't forget to smile!

Joyce Lau