Teletherapy has a specific failure mode: the session where the clinician spends four minutes sharing a screen, the student loses attention during the loading, and the activity that was supposed to drive engagement ends up costing more attention than it produces. The fix is not better slides. It is a repertoire of games that require nothing but a webcam, a voice, and at most a piece of paper on each end.
These are game structures rather than materials. Each one is described with what it targets, how to run it, and what to count for data. All of them work with no screen share, which also makes them the ones that survive a bad connection.
Why No-Prep Matters More on Screen
In-person, a fumbled transition costs a few seconds. On video, it costs the student's attention, and getting it back is significantly harder. Every additional layer between you and the activity — a file to open, a site to load, a permission dialog, a screen share to negotiate — is a place where the session can lose its footing.
There is also a caseload argument. With a national median school caseload of 50 students against a median manageable caseload of 40 (ASHA 2024 Schools Survey), and 76% of school-based SLPs ranking paperwork volume as their top challenge, teletherapy sessions that require individual digital material preparation do not scale. Structures that work for any target do.
Camera Games (Nothing But the Webcam)
Scavenger Hunt
"Find something in your room that starts with your sound. You have 30 seconds." The student leaves the frame, returns with an object, and produces the target word five times. Works for articulation targets, categories, describing, and function vocabulary. The physical movement is a genuine asset — the built-in movement break is one of the few advantages teletherapy has over a therapy room.
Data: productions correct out of five per item, items retrieved per session.
Guess What I Have
Hold an object just outside the frame. The student asks yes-or-no questions to identify it, then switches roles. Targets question formation, categorical reasoning, and turn-taking. Cap the questions at ten to keep pace.
Data: well-formed questions produced, information-seeking versus random guesses.
Freeze Frame
Student poses as a character in a scenario you describe, then explains what the character is thinking and feeling. Strong for perspective-taking and inference, and it works well with students who resist sitting still.
Simon Says With Language Targets
Directions embed the language target — spatial concepts, temporal concepts, conditional statements. "Simon says put your left hand above your head before you touch your nose." Then reverse roles so the student generates the directions, which is where the expressive work lives.
Data: directions followed correctly by concept type; directions generated with correct structure.
Paper Games (One Sheet Each)
Battleship Grid
Both draw a five-by-five grid and label rows and columns. Student hides three items; you take turns guessing coordinates, and every guess requires a target production first. Nearly universal in appeal, and the grid takes 20 seconds to draw. Works for articulation trials, sentence targets, or fluency technique practice.
Data: productions per turn, which is naturally high — this format generates a lot of trials.
Barrier Drawing
The classic barrier game translates to teletherapy better than almost anything else, because the camera is a natural barrier. One person describes a drawing while the other reproduces it, then both hold papers up to compare. Targets descriptive language, spatial concepts, clarification requests, and following directions all at once. The reveal moment is genuinely fun for students.
Data: features accurately conveyed, clarification requests produced, spatial terms used correctly.
Tic-Tac-Toe and Connect Four Grids
Each mark earned by a correct production. Trivially simple, endlessly reusable, and the turn structure paces the session for you.
Roll and Build
Student rolls a physical die at home (or you roll for both). Each number corresponds to a sentence element to add — who, doing what, where, when, why, how. The group builds one increasingly elaborate sentence. Excellent syntax work with a die and nothing else.
Talking Games (No Materials at All)
- Would you rather, with justification. Every answer requires a because clause. Reliable complex-syntax practice and students will keep it going indefinitely
- Story swap. You tell a 30-second story with a clear problem; the student invents the resolution and then tells one back. Narrative structure without a book
- The lying game. Three statements, one false; peers or clinician question to identify it. Targets question formation, inferencing, and pragmatics
- Category speed round. 45 seconds to name as many category members as possible. Add a phoneme constraint for articulation students
- Absurd sentence detective. You produce a sentence with something impossible in it; the student identifies the problem and explains why. Targets semantic reasoning and verbal explanation
- Interview. Student interviews you about a topic they choose with a required minimum number of follow-up questions. Genuinely functional pragmatics practice, and students take it seriously
Running Teletherapy Groups Without Chaos
Group teletherapy fails on turn management more often than on content. A few structures that hold up:
- Name the next speaker explicitly, every time. Visual turn cues that work in a room do not transmit over video
- Use a fixed rotation order and say it out loud at the start of the activity so students can predict their turn
- Give non-speaking students a job — score keeper, judge of accuracy, question asker. Idle time on video becomes disengagement in about eight seconds
- Set a mute norm and be consistent about it. Inconsistency costs more attention than either policy
- Keep any single activity under eight minutes and plan two or three per session. Attention windows are shorter on screen for most school-age students
When the Connection Fails
Every teletherapy SLP needs a fallback that works with audio only. Category speed rounds, would-you-rather, absurdity detection, story swap, and twenty questions all run fine with video off. Knowing you have five audio-only activities is what lets you keep a session going through a bad ten minutes instead of ending early and owing a make-up.
That last point is not incidental. ASHA's 2024 Schools Survey found 79% of school-based SLPs are required to make up missed sessions. A salvaged session is time you do not have to find later in the week.
Documenting a Teletherapy Session
Teletherapy documentation often needs to specify the delivery mode, the platform, whether an adult facilitator was present, and any technical disruption affecting service delivery. Build those fields into your note template once rather than remembering them per session, and record trial data live during the activity rather than reconstructing at the end of a back-to-back block.
The clinicians who find teletherapy sustainable are, almost without exception, the ones whose activity list is short, whose materials are nearly nonexistent, and whose data collection happens inside the session. Everything else is optional.