Effectiveness of Telehealth‐Based Speech Therapy in Improving Articulation, Resonance, Nasal Emission, and Intelligibility in Children With Repaired Cleft lip and Palate: A Systematic Review

BACKGROUND: Cleft lip and palate (CLP) is a prevalent congenital anomaly associated with persistent speech disorders, including articulation errors, resonance imbalances, and nasal emission, despite surgical repair. Access to specialized speech-language pathologist care remains limited, particularly in remote and underserved regions. Telehealth has emerged as a scalable solution, yet systematic evidence on its efficacy, technological reliability, and implementation in CLP-specific speech therapy is lacking. AIMS: This systematic review critically evaluates the effectiveness of telehealth-based speech interventions in improving articulation, resonance, nasal emission, and intelligibility in children with repaired CLP, while examining technological modalities, feasibility, data security, and barriers to adoption. METHODS: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar from inception to 30 December 2025 using structured Boolean terms combining CLP, speech therapy, and telepractice. Interventional studies in English reporting paediatric speech outcomes were included. Data were extracted on study design, sample characteristics, intervention delivery, outcomes, and risk of bias using RoB 2.0, ROBINS-I, and SCED tools. Narrative synthesis was applied due to heterogeneity. MAIN CONTRIBUTION: Eleven studies demonstrated consistent improvements in articulation accuracy (e.g., PCC increases of 15%-30%), resonance, and intelligibility via synchronous (Zoom, WhatsApp) and hybrid platforms. AI-assisted feedback and acoustic optimization enhanced fidelity. High caregiver satisfaction, reduced costs, and continuity during restrictions were key resilience factors. Connectivity issues, audio distortion, and small sample sizes were common limitations. Risk of bias was moderate overall. CONCLUSIONS: Telehealth is a clinically effective, feasible, and secure modality for CLP speech rehabilitation, comparable to in-person therapy when technologically optimized. Hybrid models and caregiver integration are recommended. Large-scale RCTs are needed to confirm long-term efficacy and cost-effectiveness WHAT THIS PAPER ADDS: What is already known on this subject Telehealth has been used for speech therapy in various paediatric populations, with evidence of comparable outcomes to in-person care during the COVID-19 pandemic. However, prior to this review, no systematic synthesis existed specifically evaluating telepractice for speech disorders in children with repaired cleft lip and/or palate, despite their unique needs for targeted articulation and resonance intervention. What this paper adds to existing knowledge This review demonstrates that telehealth-based speech therapy consistently improves articulation accuracy, resonance, and intelligibility in children with repaired cleft lip and palate, with gains equivalent to in-person therapy across synchronous and hybrid models. It identifies platform-specific acoustic fidelity (e.g., Google Meet, optimized hardware) and caregiver engagement as critical enablers, while highlighting connectivity and audio distortion as manageable barriers. These findings establish telepractice as a viable, scalable standard for cleft-related speech rehabilitation. What are the potential or actual clinical implications of this study? Clinicians can confidently implement hybrid telepractice models with encrypted platforms and external microphones to maintain treatment continuity, especially in underserved areas. Routine integration of caregiver training and AI-assisted feedback is recommended to enhance adherence and outcomes. Health systems should prioritize low-bandwidth protocols and standardized acoustic calibration to ensure equitable access.