# Telehealth Delivery of Speech–Language Pathology Services for Children with Cleft Palate and Velopharyngeal Dysfunction: A Systematic Review

## TL;DR

This review finds that telehealth can effectively deliver speech therapy for children with cleft palate or velopharyngeal dysfunction, though more research is needed.

## Contribution

The study systematically evaluates telehealth's role in speech-language pathology for children with cleft palate and velopharyngeal dysfunction.

## Key findings

- Telehealth delivery of SLP services is feasible and acceptable to families.
- Caregiver-mediated interventions show improvements in speech outcomes.
- Remote assessments show moderate agreement with in-person evaluations.

## Abstract

Background/Objectives: This systematic review aimed to evaluate the effectiveness, caregiver satisfaction, and accessibility of telehealth-delivered speech–language 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 (2000–31 May 2025) for studies enrolling participants ≤ 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.