online speech therapy

Online speech therapy: A case study from a small rural town

This case study is part of our collection of resources and training materials for online speech therapy. If you are an allied health professional see our free online therapy training course for more online speech therapy resources. If you are a family or provider wanting to know more about the online speech therapy services we offer see our frequently asked questions.

Ed Johnson, Clinical Innovation Advisor

Matt (not his real name) was 17 when I met him for the first time. He was from a small town in western NSW and came to me with goals about getting more involved with conversations with the people around him. Matt was non-verbal, so although he understood what other people were saying to him, he used a speech generating device (like a computer) that would talk for him. Sometimes it would take some time for him to respond using his device because of the complexity of the program, and the conversation around him would often move on before he could get involved. This meant that Matt wouldn’t talk to people as much, and tended to get left on the sidelines of conversations that were happening at school or at home.

What struck me about Matt when I first met him was his sense of humour. He was always joking, and loved telling people his jokes, or learning new jokes. When I spoke with Matt’s parents, they told me that he was a funny kid, and loved having a laugh with anyone he met. But I got the impression that Matt’s parents were worried that he really was being left behind, and not being involved in conversations sometimes left him feeling dejected and lonely.

Matt loved his teacher, Mrs. Jay (not her real name) and was always motivated in anything he did when she was there to support him. When I was talking with Matt he made it very clear to me that he didn’t want his parents’ help with his communication, which is pretty typical of any teenager. So instead, we arranged to get Mrs. Jay to support us in our sessions. The 3 of us met together via video, and after a couple of meetings and discussions, Matt decided that he wanted to work on using simple iPad app to tell jokes, which would get him more involved in conversations, and wouldn’t be as complex or slow as his other device which he needed to use for more technical conversations.

I coached Mrs. Jay and Matt through how to use an app called Pictello. Very basically, Pictello allows you to show series of slides which each have a photo and can include an audio clip. Over a series of 30-60 minutes’ sessions via video every 1-2 weeks when Matt was at school, coaching Mrs. Jay allowed her to build confidence in how to use the app, and make sure she could prompt and guide Matt in his practice in-between sessions. We used knock-knock jokes initially, since there’s lots of back-and-forth in them which can include other people actively in the joke, making it more like a conversation.

As Mrs. Jay got more confident in guiding Matt to practice and engage with other people with his jokes, our sessions got less frequent (maybe once a month), and we would also get Matt to show me how he was telling his jokes to people in the playground over video. Mrs. Jay would share video or email updates with me and Matt’s parents, and I would offer advice on how to improve or adjust the app or the kinds of jokes Matt was telling.

It seemed to be a revelation to Mrs. Jay that actually learning what Matt was doing through a coaching process allowed her to build her confidence, and support Matt more closely in developing his social interaction skills. After a year of working together, Matt was telling his own jokes, and he now actively involves himself in conversations with many more people than he did before he began to develop his confidence through telling jokes to people at school, at home, and in the community. His confidence, and simply having a means to communicate quickly has meant that he’s also begun to involve himself in conversations (with Pictello and with his speech generating device) more broadly about other people’s lives and interests, as well as his own.

“Working with [clinician] has been terrific… this has been a fun, worthwhile, and educational experience for me personally, and valuable and helpful for [Matt].”