{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:57:05Z","timestamp":1792119425006,"version":"4.4.0"},"reference-count":33,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: This systematic review aimed to evaluate the effectiveness, caregiver satisfaction, and accessibility of telehealth-delivered speech\u2013language pathology (SLP) services for children with cleft palate and\/or velopharyngeal dysfunction (VPD). Methods: Based on PRISMA 2020, we searched PubMed, CINAHL, Scopus, PsycINFO, and the Cochrane Library (2000\u201331 May 2025) for studies enrolling participants \u2264 18 years of age with cleft\/VPD who received telehealth services (assessment, therapy, counseling\/follow-up), with or without in-person comparators. Screening and data extraction were performed in duplicate. Risk of bias was appraised using RoB 2 (randomized) and CASP checklists (non-randomized\/service designs). To account for heterogeneity, we conducted a SWiM-aligned narrative synthesis and summarized certainty with GRADE. Results: Eleven studies met the inclusion criteria. Telehealth delivery of SLP services was feasible and generally acceptable to families. Caregiver-mediated interventions frequently showed within-group improvements in speech outcomes, while remote assessment demonstrated moderate agreement with in-person ratings. However, the overall certainty of evidence was rated as very low to low because of small sample sizes, single-center designs, and heterogeneous outcomes. Conclusions: Telehealth is a feasible and acceptable mode for delivering SLP in pediatric cleft\/VPD patients, with encouraging signals for caregiver-mediated articulation therapy and maintaining multidisciplinary follow-up. Implementation is best embedded within hybrid pathways, reserving in-person visits for complex assessments. Adequately powered comparative studies with standardized outcomes, longer follow-up, and equity-focused implementation are needed.<\/jats:p>","DOI":"10.3390\/children12111523","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:57:41Z","timestamp":1762851461000},"page":"1523","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Telehealth Delivery of Speech\u2013Language Pathology Services for Children with Cleft Palate and Velopharyngeal Dysfunction: A Systematic Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1853-0398","authenticated-orcid":false,"given":"Nisreen Naser","family":"Al Awaji","sequence":"first","affiliation":[{"name":"Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alanoud Nawaf","family":"Alsinan","sequence":"additional","affiliation":[{"name":"Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja S.","family":"Alamri","sequence":"additional","affiliation":[{"name":"Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nourah A.","family":"Bin Ruaydan","sequence":"additional","affiliation":[{"name":"Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lama S.","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana T.","family":"Albesher","sequence":"additional","affiliation":[{"name":"Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Latifa","family":"Alrutaiq","sequence":"additional","affiliation":[{"name":"Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1080\/136828299247595","article-title":"GOS.SP.ASS.\u201998: An assessment for speech disorders associated with cleft palate and\/or velopharyngeal dysfunction (revised)","volume":"34","author":"Sell","year":"1999","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1080\/136828298247776","article-title":"Active versus passive cleft-type speech characteristics","volume":"33","author":"Harding","year":"1998","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_3","unstructured":"Peterson-Falzone, S.J., Hardin-Jones, M.A., and Karnell, M.P. (2010). Cleft Palate Speech, Mosby. [4th ed.]."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1080\/17549500802676859","article-title":"A systematic review of the association between childhood speech impairment and participation across the lifespan","volume":"11","author":"McCormack","year":"2009","journal-title":"Int. J. Speech Lang. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1597\/10-237","article-title":"Neuropsychological, behavioral, and academic sequelae of cleft: Early developmental, school age, and adolescent\/young adult outcomes","volume":"49","author":"Richman","year":"2012","journal-title":"Cleft Palate-Craniofacial J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/SAP.0b013e31823b6897","article-title":"Telemedicine as a Means of Effective Speech Evaluation for Patients With Cleft Palate","volume":"68","author":"Whitehead","year":"2012","journal-title":"Ann. Plast. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"American Cleft Palate-Craniofacial Association (2018). Parameters For Evaluation and Treatment of Patients with Cleft Lip\/Palate or Other Craniofacial Differences. Cleft Palate Craniofacial J., 55, 137\u2013156.","DOI":"10.1177\/1055665617739564"},{"key":"ref_8","first-page":"41","article-title":"Building a stronger child dental health system in Australia: Statistical sampling masks the burden of dental disease distribution in Australian children","volume":"14","author":"Tennant","year":"2014","journal-title":"Rural Remote Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1258\/135763302320272158","article-title":"Research into telehealth applications in speech-language pathology","volume":"8","author":"Hill","year":"2002","journal-title":"J. Telemed. Telecare"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1089\/tmj.2013.0295","article-title":"Telehealth technology applications in speech-language pathology","volume":"20","author":"Keck","year":"2014","journal-title":"Telemed. E-Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1089\/tmj.2008.0080","article-title":"Overview of telehealth activities in speech-language pathology","volume":"14","author":"Mashima","year":"2008","journal-title":"Telemed. E-Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1007\/s00455-016-9727-5","article-title":"The Use of Cervical Auscultation to Predict Oropharyngeal Aspiration in Children: A Randomized Controlled Trial","volume":"31","author":"Frakking","year":"2016","journal-title":"Dysphagia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1044\/2021_LSHSS-21-00071","article-title":"Parent\/Caregiver Views of the Effectiveness of Speech-Language Pathology for Children Born with Cleft Palate Delivered via Telemedicine During COVID-19","volume":"53","author":"Southby","year":"2022","journal-title":"Lang. Speech Hear. Serv. Sch."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1097\/SCS.0000000000001560","article-title":"Telemedicine in Cleft Care","volume":"26","author":"Costa","year":"2015","journal-title":"J. Craniofacial Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1177\/1055665620961904","article-title":"Evolution of a Virtual Multidisciplinary Cleft and Craniofacial Team Clinic During the COVID-19 Pandemic: Children\u2019s Hospital Colorado Experience","volume":"58","author":"Andrews","year":"2021","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1016\/j.bjps.2021.05.009","article-title":"Lockdown lessons: The virtual cleft multidisciplinary clinic","volume":"74","author":"Armstrong","year":"2021","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e20359","DOI":"10.2196\/20359","article-title":"Utilization Barriers and Medical Outcomes Commensurate with the Use of Telehealth Among Older Adults: Systematic Review","volume":"8","author":"Kruse","year":"2020","journal-title":"JMIR Med. Inf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1001\/jamainternmed.2020.2666","article-title":"Assessment of Disparities in Digital Access Among Medicare Beneficiaries and Implications for Telemedicine","volume":"180","author":"Roberts","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Philp, J., Ellis, P.K., Scherer, N.J., and Lien, K.M. (2021). Enhanced Milieu Teaching with Phonological Emphasis: A Pilot Telepractice Parent Training Study for Toddlers with Clefts. Children, 8.","DOI":"10.3390\/children8090736"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"110318","DOI":"10.1016\/j.ijporl.2020.110318","article-title":"Speech pathology telepractice for children with cleft palate in the times of COVID-19 pandemic","volume":"138","author":"Ysunza","year":"2020","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1111\/cga.12543","article-title":"Efficacy of telepractice, an alternative therapy tool during the coronavirus disease 2019 pandemic, for speech disorders related to congenital anomalies","volume":"63","author":"Hayakawa","year":"2023","journal-title":"Congenit. Anom."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1177\/10556656221106042","article-title":"Speech telepractice and treatment intensity in a Cantonese-speaking case with 22q11.2 deletion syndrome following late diagnosis and management of velopharyngeal dysfunction","volume":"60","author":"Pereira","year":"2023","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1001\/archfaci.2011.72","article-title":"Multidisciplinary Care of International Patients with Cleft Palate Using Telemedicine","volume":"13","author":"Glazer","year":"2011","journal-title":"Arch. Facial Plast. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"279","DOI":"10.7181\/acfs.2024.00479","article-title":"Is telepractice effective in speech therapy for children with cleft lip and palate during the COVID-19 pandemic?","volume":"25","author":"Duangprasert","year":"2024","journal-title":"Arch. Craniofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/1460-6984.12542","article-title":"Randomized controlled trial comparing Parent Led Therapist Supervised Articulation Therapy (PLAT) with routine intervention for children with speech disorders associated with cleft palate","volume":"55","author":"Sweeney","year":"2020","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"l6890","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline","volume":"368","author":"Campbell","year":"2020","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1089\/tmj.2017.0012","article-title":"Electronic Follow-Up of Developing World Cleft Patients: A Digital Dream?","volume":"23","author":"Walker","year":"2017","journal-title":"Telemed. E-Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/jamia\/ocaa221","article-title":"Racial and ethnic differences in self-reported telehealth use during the COVID-19 pandemic: A secondary analysis of a US survey of internet users from late March","volume":"28","author":"Anthony","year":"2021","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1597\/05-063.1","article-title":"Development of a Microportable Imaging System for Otoscopy and Nasoendoscopy Evaluations","volume":"44","author":"VanLue","year":"2007","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_31","first-page":"e44808","article-title":"Speech-Language Therapy Through Telepractice During COVID-19 and Its Way Forward: A Scoping Review","volume":"15","author":"Guglani","year":"2023","journal-title":"Cureus"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/ocr.12112","article-title":"The Cleft Care UK study. Part 4: Perceptual speech outcomes","volume":"18","author":"Sell","year":"2015","journal-title":"Orthod. Craniofac Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1597\/15-305","article-title":"Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery","volume":"54","author":"Hughes","year":"2017","journal-title":"Cleft Palate Craniofacial J."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/11\/1523\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T09:38:01Z","timestamp":1762853881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/11\/1523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":33,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["children12111523"],"URL":"https:\/\/doi.org\/10.3390\/children12111523","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,11]]}}}