{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:35:55Z","timestamp":1787016955523,"version":"build-2736575974"},"reference-count":9,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,12,6]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Cleft lip and palate (CLP) significantly impact speech and language development in children. In remote areas, access to specialised services is often limited, necessitating innovative approaches for effective service delivery. This case report explores the potential of tele-supervised intervention provided by community-based rehabilitation workers (CBRWs) to enhance communication outcomes for children with CLP. A comprehensive therapy programme was developed, targeting the child\u2019s speech needs and led by a CBRW under remote supervision from speech-language pathologists (SLPs). The SLPs provided real-time guidance to the CBRWs in stimulus selection, trial administration, response monitoring and reinforcement strategies. The tele-supervised intervention led to significant improvement in the child\u2019s communication outcomes by encouraging active participation and correct exercise execution. This approach also enhanced service delivery in remote areas by improving access to specialised services, building the capacity of local healthcare providers and facilitating ongoing professional development.<\/jats:p>","DOI":"10.1136\/bcr-2024-263399","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T01:30:34Z","timestamp":1735867834000},"page":"e263399","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Remote guidance: enabling tele-supervised community-based rehabilitation worker intervention to facilitate communication in a child with cleft lip and palate"],"prefix":"10.1136","volume":"18","author":[{"given":"Aishwarya","family":"Nallamuthu","sequence":"first","affiliation":[{"name":"Department of Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vandhana","family":"Prabhu","sequence":"additional","affiliation":[{"name":"Department of Audiology and Speech Language Pathology, SRM Medical College Hospital and Research Centre, SRM Institue of Science and Technology, Kattankulathur, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivamani","family":"Jayakumar","sequence":"additional","affiliation":[{"name":"Department of Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1954-6786","authenticated-orcid":false,"given":"Krupa","family":"Venkatraman","sequence":"additional","affiliation":[{"name":"Department of Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,2]]},"reference":[{"key":"2025082711455547000_18.1.e263399.1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00268-014-2628-6","article-title":"Unmet burden of cleft lip and palate in rural Gujarat, India: a population-based study","volume":"39","author":"Khajanchi","year":"2015","journal-title":"World J Surg"},{"key":"2025082711455547000_18.1.e263399.2","doi-asserted-by":"crossref","first-page":"371","DOI":"10.5005\/jp-journals-10005-1542","article-title":"Incidence and Demographic Patterns of Orofacial Clefts in Mysuru, Karnataka, India: A Hospital-based Study","volume":"11","author":"Dhull","year":"2018","journal-title":"Int J Clin Pediatr Dent"},{"key":"2025082711455547000_18.1.e263399.3","doi-asserted-by":"crossref","first-page":"111","DOI":"10.5372\/1905-7415.0501.013","article-title":"Speech camp for children with cleft lip and\/or palate in Thailand","volume":"5","author":"Prathanee","year":"2011","journal-title":"Asian Biomed (Res Rev News)"},{"key":"2025082711455547000_18.1.e263399.4","doi-asserted-by":"crossref","first-page":"130","DOI":"10.22469\/jkslp.2022.33.3.130","article-title":"Current Status and Perspectives of Telepractice in Voice and Speech Therapy","volume":"33","author":"Lee","year":"2022","journal-title":"J Korean Soc Laryngol Phoniatr Logop"},{"key":"2025082711455547000_18.1.e263399.5","doi-asserted-by":"crossref","first-page":"4360","DOI":"10.1007\/s12070-021-03032-7","article-title":"Challenges in Delivering Tele-Practice Services for Communication Disorders Among Audiologists and Speech Language Pathologists","volume":"74","author":"Bhattarai","year":"2022","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"2025082711455547000_18.1.e263399.6","unstructured":"Lakkanna S , Venkatesh K , Bhat JS , et al . Assessment of Language Development: A Manipal Manual. Manipal Universal Press, 2021."},{"key":"2025082711455547000_18.1.e263399.7","unstructured":"Nagarajan R , Savitha VH , Navitha U . Development of controlled speech stimuli across indian languages, sri ramachandra university- smile train speech training initiative (srusti). 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