Online Speech Therapy: How Do Remote Sessions Work?

What is online speech therapy?

Online speech therapy refers to conducting assessment or rehabilitation sessions remotely, using a secure videoconferencing tool. The speech therapist and the patient are each at their home (or office, school, nursing home), and communicate via an adapted digital platform.

This practice is also called tele-speech therapy, tele-rehabilitation, or more broadly telehealth speech therapy. From a regulatory perspective, it falls within the broader framework of medical and paramedical teleconsultation, regulated in France by amendment 6 to the national convention and several regulatory texts.

A practice in full development

Online speech therapy existed before 2020 but remained marginal. The health crisis changed everything: with lockdowns and the need to continue care, thousands of speech therapists partially or fully transitioned to remote work. Many discovered that tele-speech therapy worked surprisingly well for many situations.

Since then, the practice has stabilized, legally and technically framed. Professional Orders and the HAS have published recommendations. Technical tools have improved. Today, it is estimated that 20 to 30% of French speech therapists practice at least partially through teleconsultation, and this proportion continues to increase each year.

Teleconsultation vs tele-expertise vs tele-monitoring

Several terms coexist and are sometimes confused:

• Teleconsultation: this is the most common format. A complete session (assessment or rehabilitation) takes place remotely between the speech therapist and the patient.
• Tele-expertise: a speech therapist asks a more experienced colleague for advice on a complex case, remotely.
• Tele-monitoring: between office sessions, the patient continues their exercises at home, and the speech therapist monitors the results remotely via an application.
• Downloading protocols: the speech therapist prescribes exercises to be completed on an application, without synchronous interaction.

This article focuses primarily on teleconsultation, the dominant format.

Who is online speech therapy suitable for?

Not all situations are suitable for teleconsultation. Here is an overview of indications, contraindications, and intermediate cases.

Good indications

Several profiles clearly benefit from remote speech therapy:

• Patients living in rural or underserved areas, where finding a speech therapist in an office is difficult (sometimes more than an hour's travel one way).
• Patients with reduced mobility: people with disabilities, post-operative patients, fragile individuals who struggle to move.
• Patients with constrained schedules: working adults, students in preparatory classes, very busy parents.
• Children being followed for written language disorders (dyslexia, dysorthographia): teleconsultation is well-suited for this type of cognitive-language rehabilitation.
• Patients in stabilized post-stroke rehabilitation, when office rehabilitation is complemented by remote sessions.
• Patients requiring intensive rehabilitation, which can thus be multiplied without logistical constraints.
• Francophone expatriates wishing to continue rehabilitation in French from abroad.
• Patients in long-term stabilized follow-up, where the relational dimension is already strong.

Relative contraindications

Several situations make teleconsultation difficult, if not impossible:

• Complete initial assessments: an initial assessment requires manipulations, fine observations, and situational setups that are difficult to reproduce remotely. Many speech therapists offer an initial assessment in the office, then follow-up remotely.
• Oro-myofunctional rehabilitation: swallowing, very specific articulation, voice in certain contexts — require direct manipulations and very fine observation.
• Very young patients (under 4-5 years) who have difficulty staying focused in front of a screen and require physical presence to maintain attention and build trust.
• Patients with severe cognitive disorders who cannot use the digital tool independently or with remote support.
• Patients hypersensitive to screens (especially those with ASD) for whom digital mediation is more constraining than facilitating.
• Patients without stable Internet access or without suitable equipment.
• Patients who are very socially isolated for whom the office session is also an irreplaceable moment of human connection.

Intermediate cases

For many situations, a mixed solution is optimal: alternating between office sessions and teleconsultations, depending on the phase of rehabilitation and current constraints. For example, assessment in the office, weekly rehabilitation remotely, and in-office check-ins every 2-3 months for specific manipulations.

How does an online speech therapy session unfold?

The unfolding of a remote session is significantly similar to that of an office session, with some specific adaptations to the digital format.

Before the session: preparation

A good session begins with rigorous preparation:

• For the speech therapist: preparation of digital educational materials, checking the Internet connection, opening the materials used (applications, documents, presentations), opening the patient file.
• For the patient: preparing a calm environment, without distractions, with sufficient lighting, checking the equipment (camera, microphone, headset if needed), preparing the materials requested by the speech therapist (notebook, pencils, tablet).
• A technical test is recommended 5 minutes before the session to ensure everything is working. The first appointments often include a dedicated technical time slot.

During the session: typical flow

A session generally lasts 30 to 45 minutes (duration comparable to the office) and unfolds in several stages:

• Welcome and weekly check-in (5 min): catching up, feedback on home exercises, discussion about the context.
• Targeted work (20-30 min): interactive exercises, reading texts, shared written productions via screen sharing, rehabilitation games, directed conversations.
• Summary and instructions (5-10 min): what has been done, what will be worked on at home, materials to use, next session.

The tools used vary according to pathologies: screen sharing for visual materials, collaborative whiteboard for writing together, synchronized applications where the speech therapist controls the exercises remotely, camera focused on a notebook to observe written production, recording of the voice to analyze articulation.

After the session: follow-up

Follow-up between sessions is even more important in tele-speech therapy than in the office, as the human dimension is less strong, adherence may erode. Several tools allow for this follow-up:

• Our speech therapist-family liaison notebook, ideal for children followed remotely, where the family notes what has been done at home.
• Home rehabilitation applications: COCO for children, CLINT for adults, SCARLETT for seniors. The patient practices daily, and the speech therapist monitors the results remotely.
• The session follow-up sheet that the speech therapist fills out after each session to structure follow-up over time.

The necessary equipment for an online speech therapy session

A quality session relies on adequate equipment, without requiring excessive investment. Here are the essential needs.

Equipment for the patient

The patient (or their parents for a child) needs:

• A computer, tablet, or smartphone with integrated camera and microphone. The tablet is often the most practical option for interactive exercises (touch screen, stylus writing).
• A stable Internet connection: minimum recommended download speed of 10 Mbps. Wi-Fi may suffice, but a wired connection is preferable for stability.
• A headset with microphone: highly recommended for sound quality, especially in a noisy family environment. Standard in-ear headphones often suffice.
• Sufficient lighting: well-lit face, no backlighting (do not place the camera facing a window).
• A calm environment: isolated room, no television, no foot traffic, with a door that closes. Crucial for concentration.
• The materials requested by the speech therapist: notebook, pencils, specific book, tablet for complementary application.

Equipment for the speech therapist

The speech therapist's equipment is a bit more complete:

• A high-performance computer with integrated or external HD camera (image quality facilitates non-verbal communication).
• A quality headset with microphone: essential for finely hearing the patient's production, especially articulation.
• A touch tablet as a complement, allowing for stylus writing, sharing visual materials live, manipulating dedicated applications.
• A professional Internet connection: 100 Mbps recommended, ideally wired.
• A dedicated office environment: quiet room, neutral background, controlled lighting, "consultation in progress" signage on the door.
• A secure videoconferencing platform (see next section).
• Document and screen sharing tools.

The videoconferencing platform

The choice of platform is crucial. Not all solutions are suitable for medical use. Here are the key criteria:

• Security and GDPR compliance: end-to-end encrypted data, HDS (Health Data Hosting) in Europe.
• No unsolicited recording: the session should not be recorded by default.
• Audio/video quality: compression suitable for the bandwidth on both sides.
• Collaborative features: screen sharing, whiteboard, document sharing.
• Ease of use for the patient: ideally no installation, access via web link.
• Compliance with teleconsultation: the platform must be listed as an authorized teleconsultation tool.

Platforms used in France: Doctolib Teleconsultation, MaQuestion Santé, Hellocare, Qare, Livi, or dedicated professional platforms. Public tools (Zoom, Microsoft Teams, Google Meet) are not suitable for medical use in the absence of a professional version compliant with health standards.

The effectiveness of online speech therapy: what we know

The effectiveness of tele-speech therapy has been the subject of numerous studies since 2020. What do these research findings say?

Overall results

For the majority of language and cognitive pathologies, studies show that tele-speech therapy achieves results comparable to office care, provided that:

• The indications are well established (see above)
• The materials and environment are suitable
• The speech therapist is trained in this specific format
• Adherence to home exercises is good

Meta-analyses on post-stroke aphasia, dyslexia, and certain cognitive disorders show equivalent effectiveness between the two formats. For certain populations (rural areas, patients with reduced mobility), tele-speech therapy is even superior to in-office practice, as it allows for better consistency in follow-up.

The specific advantages of tele-speech therapy

Beyond comparable effectiveness, teleconsultation presents several specific advantages:

• Reduction in travel time: for the patient and their family, this saves several hours per week.
• Increased consistency of follow-up: fewer cancellations due to illness, bad weather, etc.
• Access to distant specialists: for rare pathologies, the patient can be followed by the national expert, wherever they are.
• Psychological comfort: some patients feel more at ease in their familiar environment than in an office.
• Facilitated parental involvement: for children, the parent can more easily attend the session and extend the work into daily life.
• Better inter-session follow-up: digital tools allow for continuous follow-up, not just occasional.

Limitations and precautions

There are also real limitations that should not be overlooked:

• Loss of subtle non-verbal signals: body position, micro-expressions, emotional climate are less effectively conveyed through a screen.
• Direct manipulations impossible: guiding the mouth, manipulating posture, providing tactile feedback are unachievable remotely.
• Cognitive fatigue from the screen: prolonged concentration in front of a screen is more tiring than in person.
• Risk of trivialization: the session may be perceived as less "serious," which can affect engagement.
• Technical fragility: breakdowns, interruptions, technical delays can disrupt the session.

A good practice is to periodically reassess the benefits of the remote format and to propose a return to the office if rehabilitation stagnates or if specific work justifies it.

The regulatory framework and reimbursement

Online speech therapy is legally framed and today benefits from reimbursement by Health Insurance under certain conditions.

Medical prescription

As with office speech therapy, a medical prescription is necessary to benefit from reimbursement. The doctor (general practitioner, pediatrician, neurologist, geriatrician, etc.) prescribes a speech therapy assessment, and rehabilitation can then take place in the office or via teleconsultation, at the discretion of the speech therapist and the patient.

Conditions for reimbursement

For a teleconsultation session to be reimbursed, several conditions must be met:

• The speech therapist must be contracted with Health Insurance.
• The platform used must be compliant with security and data protection requirements.
• The patient must be known to the speech therapist (at least one assessment or in-person session in the previous 12 months, unless exceptions apply).
• The patient must reside in France.
• The rate applied is the same as in the office (contracted AMO rate).

For children seen only via teleconsultation, specific rules may apply; check with your speech therapist or Health Insurance.

Mutuals and complementary insurance

Most complementary health insurance reimburse teleconsultation speech therapy sessions on the same basis as office sessions. However, check with your mutual, as some older contracts may specifically exclude teleconsultations.

Online speech therapy outside the convention

Some speech therapists practice teleconsultation outside the contracted framework, particularly for patients residing abroad or who do not wish to go through Health Insurance. In this case, rates are free, and reimbursement by the mutual depends on the contract.

Tips for successful teletherapy

Whether you are a patient or a professional, several best practices significantly improve the quality and effectiveness of remote sessions.

Advice for patients and families

• Prepare the space: quiet room, without distractions, with sufficient lighting. For children, ideally the same room for each session to create a reassuring environment.
• Check the equipment before the session: camera, microphone, connection. Do a technical test 5-10 minutes beforehand.
• Prepare the requested materials: notebook, pencils, book, tablet. Within reach before the start.
• Inform other household members that a speech therapy session is taking place, ask for silence and no disturbances.
• For children: a parent stays nearby (but not in the camera view) to intervene if necessary, without taking the place of the speech therapist.
• Be on time: respect the schedule as for an in-office session. Delays cut into the effective duration.
• Do the exercises at home diligently: this is even more important in teletherapy than in-office.
• Communicate with the speech therapist between sessions, via the communication book or a defined channel, to report difficulties or progress.

Advice for speech therapists

For professionals starting out or wishing to improve their practice in teletherapy:

• Get specific training: teletherapy is not just "speech therapy via Zoom." It has its specificities, tools, and pitfalls. Dedicated training in e-learning or in-person.
• Invest in good equipment: this is your main working tool. HD camera, quality microphone, headset, dual screen if possible.
• Choose a serious platform that complies with health requirements. Do not use public Zoom or WhatsApp for consultations.
• Structure your sessions: a typical framework with welcome, work, summary — perhaps more necessary than ever to avoid drifting remotely.
• Take care of your image and background: neutral background, professional attire, flattering lighting. You are more visible than in-office.
• Combine multiple tools: interactive application, screen sharing, whiteboard, shared document. Vary the supports to maintain attention.
• Carefully monitor adherence at home: without direct contact in the office, the risk of disengagement is higher.
• Have regular check-ins with the patient and family about the format: is it working? Should we return to the office? Mix formats?
• Reserve slots for in-person sessions: even 100% remote, planning 1 in-person session every 3-6 months remains valuable to anchor the relationship.

Specifically for children

Online speech therapy with children requires particular adaptations:

• Shorter duration: 25-30 min rather than 45 min, especially for younger ones. Screen fatigue is real.
• Maximum variety of activities: change the support every 5-10 minutes to maintain attention.
• Adjusted parental presence: present nearby, sometimes in the same room for a very young child, but without constantly intervening.
• Rewards and motivation systems: even more important remotely, where the human dimension is lesser.
• Dedicated children's applications: COCO is particularly suited to this format, with fun games that the child does at home between sessions.

Frequently asked questions about online speech therapy

To go further

Online speech therapy opens new possibilities for access to care, without replacing in-office practice. Here are the resources that can support you:

• DYNSEO applications for tele-speech therapy: COCO (5-10 years), CLINT (adults) and SCARLETT (seniors). Perfectly adapted to the remote format, with home exercises and real-time monitoring by the speech therapist.
• Free DYNSEO tools: to structure remote follow-up, our session follow-up sheet, our speech therapist-family liaison notebook and all our freely accessible tools are valuable.
• Online cognitive tests: our free cognitive tests can be used for pre-assessment or follow-up, remotely, for memory, attention, executive functions.
• Professional training: for speech therapists wishing to train in teleconsultation or digital tools, our Qualiopi training addresses these emerging topics.
• Related DYNSEO articles: to delve deeper, check our comparison of speech therapy software, our complete guide to training, and our articles on specific pathologies (verbal dyspraxia, word finding difficulties, verbal fluency).

Online speech therapy is not a simple degraded version of classical speech therapy: it is a standalone modality, with its indications, best practices, and tools. When well conducted, it opens access to care for populations that were previously excluded, multiplies opportunities for regular follow-up, and frees up valuable time for both patients and caregivers. Of course, it does not replace the direct human contact of the office, and its use should be considered as complementary rather than substitutive. Whether you are a patient curious to try this modality, or a speech therapist looking to diversify your practice, do not hesitate to take the plunge by surrounding yourself with the right tools and training. Remote rehabilitation is now part of the French therapeutic landscape, sustainably.