Posterior fossa tumours (PFT), among the most common childhood brain tumours, place children at risk of speech, language, and communication difficulties, often described in relation to cerebellar mutism syndrome (CMS) but also seen in children without mutism. Narrative ability refers to the capacity to understand, create, and share stories. Narratives can be analysed at the macrostructural level, capturing structure and content, and the microstructural level, reflecting, for example, morphosyntax and lexicon. Narrative ability has not previously been investigated in children with PFT at both levels, including pre- and postoperative data, or in relation to CMS or dysarthria. The aims were to investigate narrative ability at macrostructural and microstructural levels in children with PFT compared with typically developing (TD) peers, to investigate pre- to postoperative changes at both levels in children with PFT, and to examine relations between macro- and microstructure and the presence of CMS and dysarthria. A story-generation task from the Expression, Reception and Recall of Narrative Instrument (ERRNI) was administered pre- and postoperatively, in the early postoperative phase (1-4 weeks after surgery). Macrostructure was analysed using ideascore, and microstructure using mean length of utterance in words (MLUw), grammaticality (GY), subordination index (SI), lexical diversity (MATTR), and words per minute (WPM). Group comparisons and associations with CMS and dysarthria were analysed using linear regressions, and changes over time with mixed-effects models. Children with PFT scored significantly lower than TD peers on the macrostructural measure ideascore and on several microstructural measures, including MLUw, GY, and WPM, both pre- and postoperatively (all p< 0.05). SI and MATTR did not differ between groups. Difficulties were most pronounced among older children. No significant pre- to postoperative changes were found, although individual variability was evident. The small group of children with CMS did not differ significantly from other children with PFT, while those with postoperative dysarthria showed a decline in both macro- and microstructure (p< 0.05). Children with PFT showed pre- and postoperative difficulties at macro- and microstructural levels, producing narratives with fewer story elements, shorter utterances, and more grammatical errors compared with TD peers. The age-related differences suggest that narrative difficulties become more prominent as language and cognitive demands increase. The findings underline the clinical importance of including narrative tasks encompassing macro- and microstructural aspects, together with motor-speech evaluation, in assessment and follow-up of children treated for PFT to guide appropriate interventions. What is already known on this subject Previous studies have described speech, language and/or communication difficulties following posterior fossa tumour surgery, particularly in association with cerebellar mutism syndrome (CMS). One aspect of language that may be affected is narrative ability, which can be analysed at two levels: the macrostructural level (content) and the microstructural level (form). Still, little is known about narrative ability in children with posterior fossa tumours (PFT), although a small study based on postoperative data has shown microstructural difficulties in children undergoing PFT surgery. What this paper adds to existing knowledge Our study adds new knowledge about language profiles in children with PFT, showing that they have narrative difficulties at macro- as well as at microstructural levels, present both pre- and postoperatively. These difficulties are most evident among older children and show individual variability. We did not find more pronounced difficulties in the small group of children with CMS compared with the other children undergoing PFT surgery. What are the potential or actual clinical implications of this work? The findings underline the importance of including narrative assessment in the evaluation and follow-up of children treated for PFT. Assessing macro- and microstructural aspects together with motor-speech evaluation can help identify children in need of interventions. Regular follow-up assessments are essential, as narrative difficulties may become more apparent as language and cognitive demands increase.

This study aims to examine the relationship between delayed speech, feeding, and swallowing performance in children with speech and language delay (SLD) by comparing their feeding and swallowing performance with typically developing children, and to assess the impact of swallowing performance on families. A total of 60 children aged 24-60months whose mother language was Turkish and their families participated in the study. Participants were divided into two groups: 40 children diagnosed with SLD and 20 typically developing children. Swallowing performance were assessed using the Pediatric Eating Assessment Tool (PEDI EAT-10), the Oral Speech Mechanism Screening Examination-Third Edition (OSMSE-3), and the Karaduman Chewing Performance Scale (KCPS). Nutritional status was assessed using the Functional Oral Intake Scale (FOIS), while family impact was measured using the Pediatric Quality of Life Inventory (PedsQL) and the Feeding/Swallowing Impact Survey (FS-IS). Results showed significant differences between the two groups in PEDI-EAT-10, OSMSE-3, and KCPS scores. The SLD group demonstrated significantly higher PEDI-EAT-10 scores (1.60±4.21) compared with the typically developing control (TDC) group (0.00±0.00; p=0.011). Similarly, KCPS scores were significantly elevated in the SLD group (0.60±0.59) relative to the TDC group (0.05±0.22; p=0.001). In contrast, the total OSMSE-3 score was significantly lower in the SLD group (40.40±7.49) than in the TDC group (48.80±2.07; p<0.001), indicating poorer oral sensorimotor function among children with SLD. However, no significant difference was found in FOIS scores (p=0.058). Regarding family impact, significant differences were observed in PedsQL and FS-IS scores (p=0.001; p=0.044). In conclusion, the swallowing performance and oral motor function of children with SLD were found to be significantly different from children without SLD. This suggests a possible association between motor planning deficits and the co-occurrence of speech and language disorders and swallowing dysfunction. In addition, families of children with SLD reported lower quality of life and greater concerns about feeding and swallowing. These findings underscore the importance of addressing both SLD and swallowing disorder concurrently in clinical practice. What is already known on this subject Speech and language delay (SLD) is among the most common developmental disorders in early childhood and often co-occurs with feeding and swallowing difficulties. Both speech and swallowing rely on shared neuromuscular and motor planning processes, suggesting a potential link between the two. Previous studies indicate that early feeding/swallowing challenges may serve as risk indicators for later language impairments. However, existing research has primarily focused on communication and learning outcomes, with limited attention given to swallowing performance in children with isolated SLD and the psychosocial impact on their families. What this paper adds to the existing knowledge This study demonstrates that children with SLD exhibit significantly poorer swallowing performance and oral motor function compared to typically developing peers, despite showing no clinically significant nutritional limitations. It also highlights that families of children with SLD experience lower quality of life and greater daily challenges related to feeding and swallowing. By excluding confounding conditions such as neurological disorders and autism, this study provides clearer evidence of the association between SLD and swallowing dysfunction, as well as its negative impact on families-an area that has been largely underexplored in the literature. What are the potential or actual clinical implications of this study? The findings underscore the need for clinicians to assess swallowing and oral motor skills in children presenting with SLD, even when overt feeding problems are not reported. Early identification of swallowing difficulties can support timely interventions that may mitigate developmental challenges. Moreover, given the demonstrated impact on families, clinical management should incorporate caregiver support and family-centered approaches. Integrating swallowing assessments into routine SLD evaluations could improve diagnostic accuracy, guide multidisciplinary interventions, and ultimately enhance both child outcomes and family quality of life.

A cut-point approach to classifying children's language abilities uses a specific threshold to determine whether an individual falls into a particular group, such as children with 'typically developing language' or 'language difficulties.' This method has been frequently used in longitudinal research to track language during the early school years. Findings have suggested that language difficulties may persist, emerge or resolve during this time. This longitudinal study with stratified sampling investigated oral language profiles using a multidimensional assessment framework, comparing results across multidimensional and cut-point approaches and exploring how language profiles relate to children's functioning in Year 1. We assessed 90 children across multiple dimensions of oral language at school entry and followed them up one year later. A statistical method of combining data sources to look for groups with common characteristics (latent profile analysis) was used to identify language profiles and transitions between them. To compare the results with a cut-point approach, children were subsequently reclassified into two groups using a single cut-point from an omnibus test of oral language. Profile-related differences in early academic and psychosocial outcomes were compared using a Multivariate Analysis of Variance. Follow-up analyses using McNemar's test examined whether differences in classifications from the two classification methods were statistically significant. Three language trajectory profiles were identified using the multidimensional approach: stable average, stable low and improving. The cut-point method identified these same profiles and a small declining profile. Notably, more children were classified in the stable low group using the multidimensional approach compared to the cut-point method, and this difference was statistically significant. In Year 1, children classified into language profiles characterised by average or above-average abilities exhibited significantly stronger early academic outcomes compared to those in profiles associated with language difficulties. The use of a multidimensional assessment may result in greater consistency of categorical classifications over time for students with language difficulties. Further research is needed to explore the potential clinical utility of this approach to support the accurate and early identification of students with language difficulties and disorders. What is already known on the subject Previous studies that used cut-point methods on scores from omnibus or domain-specific tests have shown that some children demonstrate improving or declining oral language trajectories throughout their years of school. However, these methods may not fully capture the complexity of language growth and change over time. What this paper adds to the existing knowledge This study offers new evidence on how a multidimensional assessment approach affects the classification and stability of language trajectories from school entry to Year 1. While a multidimensional approach identifies a greater number of children with language difficulties, it also reveals greater stability in language profiles over time, particularly for children with more significant challenges. What are the potential and actual clinical implications of this work? The findings reinforce the need to adopt multidimensional assessment practices in research and clinical settings. Importantly, the high stability of language profiles identified using this method may increase clinician confidence in accurately identifying language difficulties at school entry.

In this study, our aim is to compare the effects of neuromuscular electrical stimulation (NMES) and other treatment methods for treating dysphagia after a stroke. A systematic search in Web of Science, PubMed, Scopus, Clinical Trials was conducted from their earliest record to 5 September 2024. The study included a randomised controlled trial design. The experimental group received NMES alone, while the control group received NMES and/or conventional dysphagia therapy. The Physiotherapy Evidence Database rating scale was utilized to evaluate the quality of the studies that were included in this analysis. We obtained the post-treatment mean differences (MD) and standard deviations (SD) for the selected outcomes recorded in both the experimental and control groups to facilitate subsequent meta-analyses. A total of sixteen studies were identified. In the comparison of swallow treatment that incorporates NMES versus swallow treatment that does not include neuromuscular electrical stimulation, the meta-analysis found a significant MD of -7.23, with a 95% confidence interval (CI) ranging from -13.62 to -0.84 (P=0.03) in the functional dysphagia scale (FDS). In Functional Oral Intake Scale, the MD=0.66, 95%CI ranging from -0.31 to 1.62 (P=0.18). In Penetration Aspiration Scale, the MD=-1.05, 95%CI ranging from -1.50 to -0.60 (P<0.00001). The application of NMES in swallow therapy appears to demonstrate greater efficacy in the management of post-stroke dysphagia compared to approaches that do not incorporate such stimulation, albeit the existing body of research is limited. Furthermore, the evidence currently available is inadequate to substantiate the assertion that NMES, when employed in isolation, surpasses swallow therapy. What is already known on this subject Post-stroke dysphagia is a common and debilitating condition, significantly impairing the quality of life for stroke survivors. Neuromuscular electrical stimulation (NMES) has gained attention as an adjunct to conventional dysphagia therapy, with prior studies indicating potential benefits. However, the clinical efficacy of NMES for improving swallowing functions specifically in stroke-induced dysphagia remains unclear due to inconsistent findings and methodological limitations in existing research. What this study adds to existing knowledge This study provides a comprehensive meta-analysis, confirming that NMES significantly improves functional swallowing outcomes, particularly on the Functional Oral Intake Scale (FOIS). Additionally, it highlights that NMES may enhance neuroplasticity and muscle coordination when used alongside traditional therapies. The study identifies specific benefits, such as improved oral intake and reduced aspiration risks, offering new evidence to guide therapeutic approaches. What are the potential or actual clinical implications of this work? NMES can be an effective component of dysphagia rehabilitation protocols, improving swallowing safety and efficiency for post-stroke patients. The findings support the integration of NMES into clinical practice, emphasizing its role in enhancing swallowing function and reducing the risks of complications like aspiration pneumonia. Future research should focus on optimising stimulation parameters and evaluating long-term effects to maximize patient outcomes.

Coaching parents through parent-child interaction therapy (PCIT) is a key aspect of early communication intervention for children with Down syndrome. However, the evidence for its effect on child language outcomes is limited. Some research has indicated that more intensive, individualised interventions yield better outcomes; however, in Ireland many children receive less than the optimal dosage of intervention. The aim of the study was to investigate the effectiveness of an intensive PCIT intervention in a real-world clinical context using a structured coaching protocol. We also aimed to explore SLT and parental views/experiences of the intervention. We piloted a PCIT intervention incorporating keyword signing (JEMT+Sign) with four parent-child dyads. A multiple baseline, individual case series design was used to measure the intervention effects based on (1) accuracy of parental strategies; (2) frequency of parental strategies and (3) child communication acts. Four parent-child dyads took part in a twice-weekly intervention delivered by two trained specialist speech and language therapists over 11 weeks, via a hybrid in-person and tele-practice model. Parental coaching followed a 'teach-model-coach-review' protocol. Researchers not involved in delivering the intervention coded parent behaviours and child communication acts at baseline, during the intervention and at follow-up. In addition, interviews were conducted to gather parent and practitioner views on the intervention. Using structured visual analysis supplemented with single-case statistics, we found that the intervention resulted in an increase in parental accuracy and for some, increased frequency of JEMT+Sign strategy use, although with individual variation. The children's language and communication improvements were also variable. Clinicians noted that the intervention suited the families involved, but may not be feasible for all families and found the structured coaching protocol of this intervention to be particularly helpful and effective. Parents valued the more intensive and individualised intervention, although they recognised that their existing relationship with the clinician and the flexibility of delivery were beneficial. It was possible to implement this intensive intervention for children with Down syndrome in this Irish clinical setting. Parents and SLTs found the intervention to be valuable and reported that the hybrid nature of the delivery and clear coaching methods were helpful. Further research is needed to determine the longer-term effects and suitability of the intervention for a wider group of families and services. What is already known about this subject Individualised and intensive intervention has been found to be more effective for children with Down syndrome than more diluted services but is rarely available. This is particularly true of the Irish context where SLT services are under-resourced for children with disabilities. This study aimed to determine if it was possible to implement an intensive PCIT intervention for children with Down syndrome in Ireland and to determine whether it was effective and acceptable for the families and clinicians involved. What this study adds to the existing knowledge JEMT + Sign has been shown to be effective for children with Down syndrome in the US when delivered under controlled research conditions, but has yet to be tested in 'real-world' clinical contexts. This study examined whether it could be implemented by trained clinicians in an Irish context, measured the effectiveness for parents and children and gathered the views of those taking part. What are the potential or actual clinical implications of this work? Clinicians working in a specialised service for people with Down syndrome valued the intervention. They found it effective for families that they had an established and trusting relationship with and whom they knew had the capacity to engage with the demands required. They found the structured coaching protocol to be beneficial for wider aspects of their work. Parents learned the skills and could apply them to the required accuracy criteria. The children in general increased their language and/or communication skills, although this cannot yet directly be attributed to the intervention. Further research is necessary to determine if JEMT+Sign can be delivered in other contexts, the long-term effects of the intervention and whether it is effective for wider groups of families.

Laryngeal transplantation offers the potential for patients to regain vocal function, yet standardised voice rehabilitation protocols are lacking. We share the experience of our team in the regular follow-up of voice function evaluation and address this gap by establishing a multidisciplinary pathway for functional recovery. Four male transplant recipients (3 laryngeal cancers, 1 hypopharyngeal cancer) underwent protocolized assessments at 1/3/6/8 months post-op: subjective assessment (GRBAS scale) and objective evaluation (multiparametric acoustic analysis and electronic laryngoscopy). Personalized rehabilitation was delivered weekly by a licensed speech therapist. Protocol evolution occurred: Patients 1-2 received conventional training; Patients 3-4 received intensive neuromuscular reinnervation strategies. The voice of the four patients showed a gradual decrease in the degree of hoarseness, a gradual alleviation of breathiness, and a gradual decrease in asthenia score, with the overall condition improving. The MPT was about 1.8s at 1 month after surgery which kept increasing in all patients. The 3rd patient, who performed the best among the 4 patients, had an MPT of more than 10 s at 8 months after surgery. Laryngeal mucosa sensory function was gradually established in patients starting 3 months after operation, and compensatory vibration of ventricular band appeared at 8 months after operation with the assistance of voice training. This study anchored to neuromuscular reinnervation milestones demonstrates that standardised evaluations coupled with individualized training progressively restore vocal function. Our protocolized framework guides evidence-based rehabilitation for institutions pursuing laryngeal transplantation WHAT THIS PAPER ADDS: What is already known on this subject Laryngeal transplantation surgically restores laryngeal anatomy but faces functional recovery challenges due to delayed neuromuscular reinnervation. Existing literature focuses predominantly on immunosuppression and graft viability, with sparse evidence guiding postoperative voice rehabilitation. Standardised protocols for phonatory recovery-routine in other neurogenic voice disorders (e.g., vocal fold paralysis)-are absent. Fewer than 20 human cases have been reported globally, and only two publications detail voice outcomes. Consequently, rehabilitation strategies remain ad hoc, lacking consensus on intervention timing, exercise biomarkers, or psychological support frameworks. What this study adds to existing knowledge This study establishes the first protocolized voice rehabilitation framework for laryngeal transplantation, anchored to neuromuscular milestones: Pharyngeal reflex recovery (3 months) signalling sensory reinnervation; Ventricular band compensation (8 months) indicating motor adaptation. We demonstrate that early, structured rehabilitation (initiated at 1 month) enables significant voice restoration (MPT: 1.8s → >10s). Critically, we identify modular design principles accommodating clinical interruptions (e.g., ICU admissions) without compromising core outcomes. We anticipate these findings will guide evidence-based rehabilitation for institutions pursuing laryngeal transplantation and inform standardised pathways for complex laryngologic rehabilitation. What are the potential or actual clinical implications of this work? Rehabilitation Standardization: Provides evidence-based timelines (1/3/6/8-month assessments) and neuromuscular biomarkers to guide intervention intensity. Broad Applicability: The protocol shows cross-utility for bilateral vocal fold paralysis and post-traumatic neurogenic dysphonia, leveraging shared reinnervation mechanisms. Contingency Management: Modular training design maintains efficacy despite clinical interruptions (e.g., 40% cohort ICU/oncology transfers). Technology Integration: Validates objective metrics (MPT, mucosal wave symmetry) as targets for future AI-assisted biofeedback tools. Clinicians should prioritise early sensorimotor retraining (<3 months) while monitoring compensatory strategies (ventricular vibration) as functional proxies.

Self-efficacy for communication, defined as confidence in one's ability to communicate, is a construct grounded in social cognitive theory and has demonstrated relevance in research on communication disability. Its role in the communicative participation of people with Parkinson's disease (PwPD) has not been explored. To explore if self-efficacy for communication for PwPD differs across communicative activities, changes over time and following speech therapy, and is associated with communicative participation. Self-reported data for self-efficacy for communication and communicative participation were collected from 40 community-dwelling PwPD (half who received new speech therapy and half who did not) two times, 6 months apart. Participants demonstrated higher communication self-efficacy with friends and when ordering food or drinks, and lower confidence when talking in a large group or giving a speech at an informal group. Self-efficacy for communication did not differ between groups who did and did not receive speech therapy, nor did it change after speech therapy; but it significantly declined for participants who did not receive therapy during the study. Self-efficacy for communication was significantly associated with communicative participation. Self-efficacy for communication varies across some situations but not others. PwPD may be vulnerable to declining self-efficacy in the absence of communication intervention or support. What is already known on this subject Self-efficacy, or confidence in one's ability to perform a task, is a well-established construct within social cognitive theory. In research on communication disability, particularly in aphasia and stuttering, communicative self-efficacy has been shown to be sensitive to therapy effects and linked to outcomes such as participation, anxiety, and depression. However, little is known about communicative self-efficacy in Parkinson's disease, how it may vary across situations and time, or how it relates to other rehabilitation outcomes. What this paper adds to the existing knowledge This study is the first to examine communicative self-efficacy in PwPD. Self-efficacy varied across situations, with higher ratings in casual, familiar contexts and lower ratings in more demanding contexts such as public speaking. Participants who did not receive speech therapy experienced significant declines in self-efficacy over 6 months, while those who received treatment remained stable. Self-efficacy was strongly associated with communicative participation, suggesting that beliefs about communicative ability may shape real-world participation outcomes in PwPD. What are the potential or actual clinical implications of this work? These findings underscore the importance of routinely addressing communication self-efficacy in the management of PD. Declines in self-efficacy may occur in the absence of intervention, placing individuals at risk for reduced participation. Speech-language pathologists can support clients not only by targeting physical symptoms of speech and voice, but also by promoting self-efficacy as part of intervention. Assessment tools and counselling approaches that capture communicative self-efficacy may help clinicians identify individuals at risk, track progress beyond impairment measures, and tailor interventions that enhance participation in everyday communication contexts.

Early identification of speech, language, and literacy difficulties in preschool-aged children is crucial for timely intervention and prevention of long-term academic challenges. This study aimed to evaluate the Speech Language and Early Literacy Screening Checklist (SLELSC), a tool designed to assess key developmental milestones in 5- to 6-year-old children before they enter elementary school. The checklist was developed based on critical aspects of language acquisition, narrative discourse, phonological development, and emergent literacy skills, which collectively support the transition to formal education. A total of 155 children participated in this study, including 45 typically developing children and 110 children identified as at risk for speech, language, or literacy difficulties. The SLELSC demonstrated strong content validity (average CVI = 0.91) and clinical validity, with a significant difference in scores between the at-risk and typically developing groups. ROC curve analysis identified an optimal cut-off score of 19.5, yielding a sensitivity of 84.4% and specificity of 76.4%. The checklist also showed high diagnostic accuracy, with a positive predictive value of 92.31% and a comparatively lower negative predictive value of 59.38%, indicating that while the tool is effective in identifying children at risk, further refinement may be needed to improve its ability to rule out difficulties. The findings of this study provide strong evidence for the SLELSC as a valid and reliable tool for use in clinical and educational settings. By facilitating early assessment, this checklist contributes to the timely provision of support services, helping to mitigate the long-term effects of language and literacy delays. What is already known on this subject Early identification of speech, language, and literacy difficulties is essential for academic and social development. Approximately 10%-20% of preschoolers experience such challenges, which can lead to long-term educational and psychosocial difficulties. While various developmental screening tools exist, they often lack a specific focus on key linguistic domains for children nearing school entry. In South Korea, there is no standardised screening tool for 5- to 6-year-olds. The Speech Language and Early Literacy Screening Checklist was developed to address this gap, demonstrating initial reliability and validity, but further validation is needed to confirm its diagnostic accuracy.What this study adds to existing knowledge This study confirms the Speech Language and Early Literacy Screening Checklist as a valid and reliable tool for identifying preschool-aged children at risk for language and literacy difficulties. The checklist demonstrated strong clinical accuracy, with high sensitivity and specificity, making it effective for early detection. Additionally, it highlights the need for domain-specific cut-off scores to enhance diagnostic precision. By facilitating timely intervention before school entry, this screening tool provides a practical solution for educators and clinicians, helping to mitigate long-term academic and social challenges associated with early speech and language delays.What are the potential or actual clinical implication of this work? The Speech Language and Early Literacy Screening Checklist provides a clinically valid and reliable tool for early identification of at-risk children before school entry. Its high sensitivity ensures that most children with speech, language, or literacy difficulties receive timely intervention. The checklist can be effectively utilised in preschool settings by educators and clinicians to support early screening and referral. Additionally, refining cut-off scores for specific domains may further improve diagnostic accuracy. Future research should explore its application across diverse populations and its long-term impact on academic and social outcomes, strengthening early intervention strategies in clinical and educational settings.

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. 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. 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. 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. 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.

Children with developmental language disorder (DLD) experience difficulties with receptive and expressive language, which can affect their participation in everyday interactions with others. This, in turn, can impact their ongoing language development and ability to form and maintain friendships. This paper describes the development of a complex intervention, 'Better Conversations with Developmental Language Disorder' (BCDLD), designed with and for school-aged children with DLD and their main carers. Medical Research Council guidelines for developing complex interventions were used to inform the design and early-stage evaluation of BCDLD, including consultation with key interest holders at each stage of the project; appraisal of relevant literature and articulation of programme theory. A review of the evidence for communication partner training revealed a gap in the research and clinical practice for school-aged children with DLD. Research with other clinical groups suggests potential for enhancing everyday interactions through work with conversation partners. Theory underpinning the proposed intervention, which was identified from the review, included social interactionist and constructivist accounts of child language acquisition, behaviour change theory and applied conversation analysis. Children and parents with experience of living with DLD identified barriers to their everyday conversation to inform intervention content and delivery. Speech and Language Therapists gave feedback on the draft intervention protocol and advised on how BCDLD could be implemented in clinical practice. This paper reports the development of a theoretically-informed, conversation-based intervention for children with DLD and their conversation partners, which aims to improve the content and flow of their everyday interactions, whilst supporting children's language development. Synthesising knowledge from the literature, input from children living with DLD, parents and professionals in the field enabled the design and early-stage evaluation of BCDLD. What is already known about this subject There is a gap in the literature and clinical practice for a conversation-based intervention, designed for school-aged children with DLD and their parents or carers. What this paper adds to existing knowledge This project followed Medical Research Council guidelines for early development of a novel intervention, 'Better Conversations with Developmental Language Disorder'. What are the potential or actual clinical implications of this work? The programme is ready to progress to the next stage of development, including manualisation and training, leading to feasibility studies within NHS and education settings.