Teletherapy has moved from pandemic-era stopgap to mainstream service delivery model. For many SLPs and students, it offers real advantages: access for students in rural or underserved areas, reduced travel time, and for some students, a lower-anxiety environment than pulling out of class. But a session that works beautifully in person can fall completely flat on screen if you've just moved your materials to a webcam without thinking through the adaptation. Here's how to make teletherapy actually work.
Core Challenges of Teletherapy
Understanding what makes teletherapy hard helps you adapt intelligently rather than just working harder:
- Attention fragmentation: Students at home are surrounded by competing stimuli. Without the physical separation of a therapy room, staying focused requires more active effort from both the student and the SLP
- Technology barriers: Variable internet quality, unfamiliar platform interfaces, and technical glitches disrupt flow and consume session time
- Physical prompting limitations: You cannot physically guide a student's articulators, provide tactile cues, or use physical proximity to redirect behavior — which eliminates entire prompting hierarchies
- Relationship building at a distance: The subtle, non-verbal warmth that builds therapeutic rapport is harder to convey through a screen. It requires deliberate effort
- Data collection complexity: It's harder to count trials accurately while also managing the technology and monitoring the student's engagement simultaneously
General Principles for Teletherapy Adaptation
Before getting into specific activity types, these principles apply across the board:
- Short segments, frequent transitions: Attention windows are shorter on screen. Plan for 5-7 minute activity segments rather than 15-minute blocks. Build in natural transition points
- Maximize student interaction: Every 30 seconds without active student participation is 30 seconds of passive viewing, which accelerates disengagement. Design activities where the student is doing something (clicking, speaking, moving, writing) continuously
- Visual variety: Alternate between your video feed, shared screen, whiteboard, and the student's camera. Static visual environments lose attention quickly
- Over-communicate engagement cues: Since you can't use body language and physical proximity normally, narrate your attention: "I'm watching your mouth carefully," "I noticed that — that was really close," "You're working hard right now"
- Involve a communication partner when possible: A parent, aide, or paraprofessional in the room can provide physical cueing, hold materials, and help manage behavior — extending what you can do remotely
Adapting Flashcards and Picture Materials
Physical flashcards are the workhorse of articulation and vocabulary therapy, but you can't hold them up to a webcam reliably. Adaptations:
- Virtual whiteboard picture sets: Use your platform's whiteboard (Google Slides, Jamboard, Canva, or built-in whiteboard tools) to create click-through picture sets. You click to advance; the student names each one. The click gives you control of pacing and creates a natural rhythm
- Shared screen PDF decks: Build PDF decks of your flashcard sets, share screen, and advance manually. Annotate on the PDF to track correct/incorrect trials in real time
- Student-side physical materials: For regular students, mail or send home a set of physical materials tied to current goals. The student has tangibles; you direct the activity remotely. This works especially well for home practice carryover
- Interactive platform tools: Boom Cards, Teach Your Monster, and similar platforms have click-and-reveal formats that work natively in a browser and can be shared via link
Adapting Games
Games are among the hardest in-person activities to translate online because they rely on physical manipulation. But the game structure — turns, challenge, reward — is worth preserving because it drives engagement.
- Screen-share versions: Many popular game formats have online versions. Jeopardy-style templates in Google Slides, digital Snakes and Ladders, online bingo generators — all can be run through screen share with the SLP controlling the display
- Virtual dice rollers: Sites like random.org or built-in platform tools provide virtual dice. Pair with a game board shown on screen; students advance based on dice roll after completing a trial
- Virtual spinners: Custom spinner tools (Wheel of Names, Flippity Spinner) can be configured with target words, activities, or game elements. Students spin by request; you spin for them visually
- Points and token economies: A simple running tally on a shared whiteboard serves as a digital token economy. Visual progress toward a reward maintains motivation through the session
Adapting Sorting and Matching Activities
Sorting and categorization tasks are core to vocabulary and language work. In teletherapy:
- Drag-and-drop on shared slides: Build Google Slides activities where images can be dragged into category boxes. Share editing access with the student; they drag items while you observe. Works for categorization, sequencing, and matching
- Cursor-pointing for younger students: If drag-and-drop is too complex for younger or lower-tech students, have them verbally indicate where each item goes while you move it on screen — preserving the interactive element
- Platform annotation tools: Use your platform's annotation feature to circle, highlight, or draw arrows on shared content. This also gives the student a tool to interact with screen content without needing full edit access
Keeping Students Engaged
Engagement in teletherapy requires more active management than in-person sessions. Specific strategies:
- Reaction buttons: Most video platforms have built-in reaction buttons (thumbs up, raised hand, emoji reactions). Assign them a function: "press thumbs up every time you hear the /r/ sound"
- Virtual backgrounds: Changing your background to a scene relevant to a session activity (a farm, a kitchen, a space station) creates visual interest and can be integrated into language activities ("Let's name everything you see in my background")
- Virtual reward boards: Use a shared Google Slide or Jamboard as a visual reward chart. Students earn stickers or stamps they can see accumulating across the session
- Turn-taking with camera: Ask students to show you something in their room related to the session topic. This breaks the passive-viewing pattern and involves their physical environment
Documentation in Teletherapy
Data collection is harder when you're managing technology, monitoring the student's face, and tracking trials simultaneously. Strategies:
- Use a second device (phone or tablet) for your data collection app while your primary device runs the video session
- Build data collection directly into your activity slides — a notes section on each slide where you record performance as you go
- If your platform allows recording (with appropriate consent), review recordings post-session to verify trial counts
- Keep session notes simpler for teletherapy: document the activity, overall accuracy estimate, and key observations. Detailed trial-by-trial data can be collected more efficiently in person
SLPDesk's mirrored activity mode allows you to run the same activity interface on both your screen and a student's device simultaneously — both parties see the same materials in real time without requiring screen sharing. This reduces lag, improves visual quality on the student's end, and keeps the session interface clean and distraction-free.
Parent Involvement in Teletherapy
Teletherapy creates a natural opportunity to involve parents in therapy in a way that in-person pull-out services don't. When a parent is visible in the background or participating, consider:
- Briefly explaining the activity and the target before beginning, so the parent can observe with context
- Inviting the parent to observe the last 5 minutes and modeling how to do a home practice activity
- Sending a brief written summary after the session with one home practice idea — a consistent habit that parents come to rely on
Teletherapy, when adapted thoughtfully, can be just as clinically effective as in-person services for many goal types. The research is increasingly supportive of this, particularly for articulation, language, and fluency at the word and sentence level. The gap narrows further as SLPs build their teletherapy-specific skill set and material libraries. The platform is different; the clinical expertise is the same.