Face-to-face and Telespeech Therapy Services for Children during the COVID-19 Pandemic: A Scoping Review

Abstract

Objectives

There has been increased interest in using telepractice in clinical services during COVID-19. Using telepractice is little known in speech and language therapy. However, the parents and speech therapists were satisfied with this method. Therefore, this scoping review aims to compare tele speech therapy and face-to-face speech therapy during the COVID-19 pandemic and determine the efficacy of available telepractices in speech therapy.

Materials & Methods

This scoping review was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guideline. The authors systematically searched Web of Science, PubMed, and Scopus databases with specific eligibility criteria. The eligibility criteria were studies published from 1 January 2020 to 10 May 2023 from a peer-reviewed journal and written in English. In addition, the articles were about speech therapy in children during COVID-19.

Results

Fifteen articles were included in this scoping review. Results showed that approximately all speech therapists used tele practice during the pandemic. Parents and students are satisfied with this method but have problems with it. On the other hand, some parents and SLPs preferred tele practice accompanied by face-to-face intervention. Furthermore, few studies determined the efficacy of tele practice with clear structural methods in specific populations.

Conclusion

Although tele speech therapy is acceptable for providing speech and language therapy services to children with swallowing and communication disorder, speech-language therapists should increase their information and technology to achieve successful results. Moreover, parents must play an essential role in telepractice services to facilitate effective communication between clinicians and families.

Introduction

The speech-language pathologists (SLPs) are defined as the professional who engages in professional practice in the areas of communication and swallowing for various population. SLPs contribute to prevention, evaluation, intervention, and program design to a range of communication disorders in childhood (1). SLPs usually require face-to-face communication with their clients to provide their services; however, providing services by using online model of service delivery is an appropriate model for audiologists and SLPs (2) and this model could be the primary mode of service delivery or supplement in-person services (known as hybrid service delivery). Services delivered by audiologists and speech-language pathologists are included in the term telerehabilitation using tools such as telephone and video conferencing, mobile devices, and e-mails(3). Gabel et al. compared the effectiveness of tele practice services to in-person services for 71 school-age children with speech sound disorders. The results determined that children had similar improvement in their speech sound production as measured by the National Outcomes Measurement System (NOMS) (4). Similarly, Coufal et al. reported that there were no significant differences in students’ ASHA NOMS scores between those receiving in-person services and those receiving tele practice services for speech sound production(5).

The COVID-19 pandemic has resulted in global changes in healthcare systems and professional service delivery. Many professional services such as speech therapy services were pressed to adopt tele practice in response to the global coronavirus pandemic (9-10). SLPs usually require face-to-face communication with their clients to provide adequate assessment and treatment services. However, due to quarantine and social distancing, the speech therapy seriously has been interrupted. Very few SLPs had experience with tele practice before the pandemic (6, 7). However, challenges in implementing tele practice such as the lack of guidelines for maintaining and delivering the services have been reported (8). Some people who used telehealth reported that it was accessible and feasible. In addition, some researchers reported some barriers to accessing telehealth such as bandwidth, WiFi access, access to a device for the telehealth session, caregiver support as well as socioeconomic status can disturb providing services. Experience hearing or seeing difficulties on video calls are another challenge related to children with speech and language problems(9, 10).

To collect information about how to provide speech therapy services during the COVID-19 pandemic, the present scoping review performed to describe service provision to treat speech language disorders of children during the COVID-19 pandemic. Moreover, we tried to explain the access to speech therapy services during the COVID-19 pandemic.

Method

The present article is a scoping review. Scoping reviews are appropriate for answering much broader questions; so, should have different essential reporting items from systematic reviews (11). The main review questions were “how are speech therapy services for children being provided during the COVID-19 pandemic?”, “What are the barriers and facilitators in tele practice speech therapy?”, and “What is the efficacy of tele practice speech therapy during the COVID-19?” We reviewed articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines (11). This scoping review included experimental and observational studies published from 1 January 2020 to 10 May 2023 that were peer-reviewed or preprinted. We searched the three databases; Web of Science, PubMed, and Scopus systematically using MeSH/Index terms and included those terms in a Title/Abstract search to receive the most published articles. The search terms were "COVID-19, SARS-CoV-2, Child, Children, Adolescent, Students, teen*, Youth, kid, parents, parent, communication, Rehabilitation, Speech, language, swallowing, hearing, Therap*, service, intervention”. The PubMed syntax is shown in Appendix A. we selected the appropriate articles according to the inclusion criteria. Articles that were published in English were included. Our searching was restricted to studies that each domain of speech therapy services delivered to children and adolescents 0–18 years old. We selected the articles that include the self-report, speech therapist or caregiver report. We excluded case reports, case studies, opinions, editorials, commentaries, letters, conference abstracts, reviews, and qualitative studies. Moreover, we excluded articles about speech therapy services for adults. In addition, if the article was not published in English language or was not in the timeline of our research was excluded.

After searching the databases, a total of 3071 articles were collected. We removed the duplicated articles, after that two independent reviewers (M.T, H,M) screened the titles and abstracts of 2790 remaining articles in two steps. In the first step, they screened the title and abstracts of articles. In the second step, if it’s needed, the two reviewers (H.M, Z.N) independently screened the full texts of studies to investigate that they met the eligibility criteria. Finally, in cases of discordance, a third researcher (F.S.) was consulted to reach a final decision.

The data from all included studies were extracted by two independent reviewers (F.H, H.M). The extracted data for each article were first author, country, study design, sample size, measurement tools, and results.

Result

3071 papers were identified, 2790 abstracts were retrieved after the removal of duplicates. By reviewing the titles and abstracts of these articles, 140 articles were selected for reviewing the full text. Finally, 15 papers were included for analysis(12-25). This is outlined in the PRISMA Flowchart as shown in Figure 1.

Figure 1.

Characteristics of included studies

The number of 848 articles were published in Web of sciences, 571 articles in PubMed, and 1652 articles in Scopus. Among the included studies, two articles were published in 2020, six articles in 2021, four articles in 2022, and three articles in 2023. Ten articles focused on efficacy of special assessments or interventions. Five articles were about the parent/ caregiver or SLP view of the effectiveness of telerehabilitation and its facilitators and barriers.

How was the access to speech therapy services during the COVID-19 pandemic?”

This scoping review demonstrated that the SLPs used both online tele practice and face to face therapy during the COVID-19. The SLPs reported that there is no difference in the caseloads compared to face-to-face therapy (26, 27).

According to the opinion of parents and SLPs, most of the SLPs used tele practice speech therapy for children during the COVID-19 (14, 16, 28). In addition, the SLPs and parents believe that tele practice have a cost efficient up to 90%, and they preferred to continue the tele practice therapy after the COVID-19 pandemic (68%) (29). But they believed that face-to-face therapy is required after six months (16). More details are shown in Table 1.

Table1.

Access to speech therapy services during the COVID-19 pandemic; their facilitators and barriers

Title	First Author, (year)	Country	Study design	Sample size, male (N or %) & Diagnosis (N or %)	Measurement tools	Results
Barriers and facilitators: Clinicians’ opinions and experiences of telehealth before and after their use of a telehealth platform for child language assessment	Sutherland (2021)	Australia	Mixed-methods questionnaires	38 SLPs	questionnaires	-Change in confidence level of administering CELF-5 (The Clinical Evaluation of Language Fundamental) through telehealth (Z = –3.776, p = 0.000) -Comparison of the pre-trial questionnaire between SLPs who completed or did not complete CELF-5 assessment during the Trial: Variable (Level of comfort in conducting telepractice sessions) - Very uncomfortable: Yes (n = 27) =0 (0%) No (n = 11) = 1 (12.5%) -Somewhat uncomfortable: Yes (n = 27) =2 (8.3%) No (n = 11) = 0 (0%) - Neither comfortable nor uncomfortable: Yes (n = 27) =6 (25%) No (n = 11) = 2 (25%) - Somewhat comfortable: Yes (n = 27) =13 (54.2%) No (n = 11) = 4 (50%) - Very comfortable: Yes (n = 27) =3 (12.5%) No (n = 11) = 1 (12.5%) Variable (Level of confidence conducting CELF-5 via telehealth) - Not at all: Yes (n = 27) =5 (18.5%) No (n = 11) = 2 (18.2%) - Not confident: Yes (n = 27) =5 (18.5%) No (n = 11) = 6 (54.5%) - Neutral: Yes (n = 27) =8 (29.6%) No (n = 11) = 2 (18.2%) - Somewhat confident: Yes (n = 27) =8 (29.6%) No (n = 11) = 1 (9.1%) - Very confident: Yes (n = 27) =1 (3.7%) No (n = 11) = 0 (0%)
Psychosocial factors, but not professional practice skills, linked to self-perceived effectiveness of telepractice in school-based speech and language therapists during COVID-19 pandemic	Lam (2022)	Hong Kong	Online survey	72 school-based SLPs	Survey	Concerns of providing telepractice: - Student privacy= 85% -Lack of local professional standards= 59% -Student candidacy = 42% -Evidence-based practice = 39% Treatment areas: - Primarily for language intervention =100% - Speech =76% -Voice =67% - Fluency treatment =50% - Language cases= 3.80) 0.66) Student candidacy: -Student candidacy= 2.40(1.00) (Not important factor) -Communication and behavioral dysfunctions= 4.07(0.90) (Important factor) -Comorbidity= 3.00, (0.90) and progress and prognosis =2.58 (0.95) (Moderate importance) Difficulty of telepractice (Compared with onsite practice): - Therapy preparation= 4.73 (0.97) -Controlling students’ behaviours= 4.31 (0.71) -Students’ inadequate concentration= 4.18 (0.72) -Communicating naturally= 3.76(0.72) -Monitoring progress= 2.99 (0.89) -Scaffolding = 2.61(0.91) -Teaching=2.40 (0.94) - Difficulty in managing the behaviours of students= 4.31(0.71) -Unnatural communication = 3.76 (0.72) -Lacked adequate concentration of students during telepractice= 4.18 (0.72) Attitude of SLPs: - Unfavourable attitudes towards telepractice= 2.13 (0.78) -Telepractice difficult= 4.29 (0.67) -Telepractice to be slightly less effective= 2.92 (1.00) - Generally preferred on-site practice to telepractice= 4.50 (0.66) -Most would not consider using telepractice in the future=1.89 (1.08)
No other choice: Speech-Language Pathologists’ attitudes toward using telepractice to administer the Lidcombe Program during a pandemic	Santayana (2021)	Canada and the United States of America	Online survey	106 SLPs	Survey	Percentage of time telepractice was used by SLPs before and during the COVID: -Prior = 80 %of SLPs 0–10 % of the time -During = more than 50% of SLP more than 50% of time - Continue to use both telepractice and in-clinic treatment in the future= 68% -Preference to return to in-clinic= 5% Delivery model in the future: - Face to face= < 10% -Telepractice= < 5% -Mix of them= 60-70% -Depends on what suits the individual= 20-30% -Undecided= 1% Comments challenges: -Issues concerned the technology itself = 27% -Access to resources and learning to use the new platforms= 19% Issues related to the clinical relationship. -Challenges of establishing and maintaining the clinical relationship= 33% -Issues related to the clinical process Comments – positives: -Access to remote or underserved populations = 23.32 % -Less stress related to scheduling= 20.27 % -Observe treatment in home= 17.23 %
An exploratory study of speech-language pathologists’ clinical practice in the literacy domain: Comparing onsite practices with telepractice services during COVID-19	Furlong (2022)	Australia and New Zealand	Online cross-sectional survey	44 SLPs	Online survey	Caseload and service delivery prior to COVID-19: -Average= 6 and 10 (n=6) and 11–15 (n=6) students per Week -Larger caseloads= 36 and 40, or more than 50 students per week Caseload and service delivery during COVID-19: -Seeing fewer students= n=30 -For individual literacy sessions=most participants no change to session frequency (n=31) or duration (n=34) -Reasons of more frequent sessions= reduced travel for families + need for shorter and more frequent sessions due to students’ attention spans + to address parental concerns around the level of support their students were receiving through school during remote learning + student preference -Change in session duration for small groups= yes Literacy assessment for onsite delivery and telepractice delivery: More than half of the participants (n=25) = no change. Changes to intervention practices for telepractice Delivery: -Nearly half (n=20) = a little change= several changes (n=10) + significant changes (n=6) -Changes to intervention= resources or activities used in intervention, for example, finding web-based materials and converting documents for online use (e.g. scanning, use of document cameras, use of interactive PowerPoint presentations) -All participants= less use of games to varying degrees -Many participants= less handwriting and more typing for spelling and writing Telepractice literacy services: -Prior to the COVID-19= the majority (n=33) = none of literacy caseload= were seen via telepractice -During the COVID-19: more than half of literacy caseload=(n=29) =seeing more than 75% of their literacy caseload= via telepractice -Reasons caseload seen via telepractice changed during COVID-19: For most= due to government-enforced restrictions + change to schools closing and being unable provide onsite services + need for continued access to services -The main reason for continuing with telepractice= Student preference -Next most common reason: the flexibility and convenience of telepractice + reduced travel time for families + increase in referrals from rural -Reasons for not continuing preference for providing onsite services+ scheduling difficulties during school hours + limited access to internet and devices for some students. -Most participants (n=37) = differences between onsite and telepractice, -Most commonly differences: more difficulty maintaining students’ attention and engagement in telepractice sessions (n=11) + difficulties detecting nonverbal cues and seeing the student working in telepractice sessions + less able to provide timely and accurate feedback (n=8) + technological challenges in telepractice sessions (n=7), more reliance on parents to support students in telepractice sessions (n=3) + parents needed to be more involved (n=3) -More than half (n=24) = no difference in intervention outcomes Barriers with implementing telepractice: most= technological challenges+ families not wanting to Engage+ lack of appropriate resources -The most cited benefits relating to telepractice: Increased parent and/or teacher involvement and engagement in sessions + increased accessibility to services
Parent’s Perspective on Teletherapy of Pediatric Population with Speech and Language Disorder During Covid-19 Lockdown in India	Sikka (2023)	India	Surveys	100 parents of children with speech and language delays, Misarticulation, Stuttering, Voice disorder	A questionnaire with 12 close-ended questions	-95% of parents: the therapy call during the pandemic was a great motivation for them to continue the sessions. -92%: teletherapy helped them to improve their child’s language skills and positive regarding the teletherapy sessions. -97%: they could follow the clinicians very well, -96%: sufficiently understand the language strategies used, -86%: video calls should be the standard component, -96%: teletherapy was a handy alternative to face-to-face therapy. Comparison Between Teletherapy and Face-to-Face Intervention -90%: teletherapy were more cost-efficient. -88%: face-to-face consultation is required after six months

What are the barriers and facilitators in tele practice speech therapy?

The most frequent barriers to providing teletherapy are children’s difficulty with WiFi access at home from 134.8% (30) to 70.4% (27), poor attendance for teletherapy sessions (68.8%) (27) , low levels of children’s engagement (64.9%)(27), and unclear voice (15.7%)(30). Many studies believe that lack of support or resource and lack of sufficient evidence for tele practice are important reason that SLPs didn’t use the tele practice speech therapy appropriatly(28, 29). In one study, all clinicians believed that online treatment is difficult specially for children with behavioral issues, autism spectrum disorders (ASD), hearing loss (HL), attention deficit and hyper activity disorder (ADHD) (31).

The most facilitators were mentioned in the Santayanan’s study such as access to remote or underserved populations (23.32 %), have less stress related to therapy program (20.27 %), and observed the treatment in home by parents and children (17.23 %)(29). Other studies determined other reasons such as best use of time (25.8%), use of audiovisual technique (16.9%), no need to travelling (13.5%), rapid progress (11.3%), Willingness of child to telehealth (77.0%), comfort level with videoconferencing ( 61.0%), and access to internet (58.1%) (30). (More reasons are in Table 1).

What is the efficacy of tele practice speech therapy during the COVID-19?

This scoping review revealed that few experimental studies were about the tele speech therapy during the COVID-19 pandemic (15, 17-25, 32). One of them studying about the taking language sample at home. The researchers found that there isn’t any significant difference between in person and video chat assessment (17). Furthermore, two studies about promoting language skills via telepractice showed that the tele interventions have potential to improve some aspect of language skills in children(18). On the other hand, studies that used the telepractice intervention for children with cleft palate (22), ASD (23), and stuttering(21) showed the significant main effect of these telerehabilitation. However, children with cochlear implant (CI) preferred the conventional rehabilitation(24). More details are shown in Table 2. Moreover, in one study 55% of participants didn’t report any significant differences between in person and tele practice intervention(28). One study used artificial intelligence to evaluate the speech therapy effects on the autistic children’s behavior. Results showed that the in-person treatment had 69.6% of satisfaction, but the telehealth intervention had the minimum effect(25).

Table 2.

The efficacy of available tele practice speech therapy during the COVID-19

Title	First Author, (year)	Country	Study design	Sample size, male (N or %) & Diagnosis (N or %)	Measurement tools	Results
Taking Language Samples Home: Feasibility, Reliability, and Validity of Child Language Samples Conducted Remotely With Video Chat Versus In-Person	Manning (2020)	United States	A mixed quasi-experimental and longitudinal design	All: 62 Normal In-person (n =16) Video chat (n = 46)	Assessment: -In-person language samples= two Panasonic PTZ HD video cameras + a Shure omnidirectional table microphone + recorded to a single file using an Extron switcher -Video chat samples: a smartphone, tablet, or computer Language Sample Transcription: using Systematic Analysis of Language Transcripts (SALT) software	-In person, Video chat: MLU (mean length of utterance) = (Mean (SD))1.69 (0.58), 1.75 (0.68), P value: 0.85 NDW (Number of different words) = (Mean (SD)) 37.13 (11.90), 37.59 (12.63), P value:0 .90 TTR (type–token ratio) = (Mean (SD)) 0.48 (0.09), 0.46 (0.09), P value: 0.30 -Within-subjects for the mixed visit structure group: -In person, Video chat MLU= (Mean (SD)) 1.90 (0.62), 1.90 (0.63), P value: 0.65 NDW= (Mean (SD)) 40.23 (10.42) ,41.65 (13.44) P value: 0.51 TTR= (Mean (SD)) 0.48 (0.07), 0.47 (0.11), P value: 0.81
Promoting Language Skills in Children with Neuromotor and intellectual Disorders: Telepractice at the Time of SARS-CoV-2	Micheletti (2021)	Italy	Longitudinal study	All: 9 Male:3 Diagnosis: Unilateral cerebral palsy (CP)=4 Bilateral CP=2 Ataxic syndrome =2 Severe motor coordination Disorder=1	Assessment all= -nonverbal intelligence: means of the Leiter International Performance Scale–Revised -Adaptive functions: Vineland Adaptive Behavior Scales -Gross Motor Function Scale - Peabody Motor Developmental Scale Assessment NDs: neurological examination, medical history, Gross Motor Function Scale, Peabody Motor Developmental Scale -Assessment after intervention= Assessment of Phonological Production of Children test + Italian adaptation of the MacArthur–Bates Communicative Development Inventory Italian-specific and Italian-normed test derived from the Test for the Reception of Grammar, sentence repetition test.	-Speech component (No. of stable phonemes): Prebaseline (outcome measures 3 months before the intervention) = M(SD)= 7.2 (4.1) Baseline (outcome measures 1 week before the Intervention) = 7.6 (4.4) T1 (outcome measures immediately after the intervention) = 10 (4.4) T2 (outcome measures at a 3-month follow-up) = 10.9 (4.6) -Lexical component (Word comprehension at PVB (Primo Vocabolario del Bambino, A language inventory) (no. of words): Prebaseline = 296.9 (111.7) Baseline= 315.9 (109.3) T1 = 412.3 (48.9) T2 = 478.7 (55) -Word reproduction at PVB (no. of words): Prebaseline= 191.6 (163.2) Baseline= 200.2 (165.2) T1 = 275.9 (180.4) T2= 304.1 (192.7) -Syntactic component Sentence comprehension: Prebaseline= 1.3 (0.7) Baseline = 1.6 (0.7) T1= 2.9 (0.8) T2= 2.9 (1.2) -Sentences repetition task (no. of repeated sentences): Prebaseline= 0.7 (1.1) Baseline= 1.4 (2.4) T1= 6.1 (6.9) T2= 7.9 (7.1) -The number of stable phonemes at prebaseline and baseline= (ratio: 1.05; 95% CI [0.68, 1.61]; p = .99) -At baseline and T1 = (ratio: 1.32;95% CI [0.89, 1.97]; p = .22) -At T1 and T2 = (ratio: 1.09;95% CI [0.76, 1.56]; p = .89) 1.06; 95% CI [0.74,1.50]; p = .963) -After the 3-month intervention: WC (word comprehension): ratio= 1.33; 95% CI [1.03, 1.71];p = .025 WP (word production): ratio= 1.39; 95% CI [1.00, 1.92]; p = .046) -At the 3-month follow-up: WC: ratio= 1.15; 95%CI [0.92, 1.45]; p = .293 WP: ratio= 1.09; 95% CI [0.81–1.45]; p = .825) -Syntactic component between prebaseline and baseline evaluations: sentence comprehension: ratio= 1.17; 95% CI [0.73, 1.90]; p = .76 sentence repetition: ratio= 2.17; 95% CI [0.63, 7.41]; p = .31 -After the telepractice program: sentence comprehension: ratio= 1.80; 95% CI [1.24, 2.35]; p < .01 sentence repetition: ratio= 4.23; 95% CI [1.96, 9.12]; p < .01) -At the 3-month follow-up: sentence comprehension, which remained stable: (ratio= 1.00; 95% CI [0.75, 1.35]; p = 1) sentence repetition: (ratio= 1.29; 95% CI [0.83, 2.02]; p = .31)
Effectiveness of cloud-based rehabilitation inchildren with developmental language disorder during the COVID-19 pandemicA prospective cohort study	Yi (2021)	China	Prospective cohort study	All = 162 Intervention group: 84 Control group: 78 intervention group: 44 control group:42	Assessment for test and retest= The Chinese version of the PPVT-R (The Peabody Picture VocabularyTest-Revised) Intervention= the JingYun Rehab CloudPlatform	-A significant main effect of pre-posttest: F (1,160) = 131.56, P < .001, η2 = 0.45 -Post vs prerehabilitation in PPVT-R test= significantly larger -Prerehabilitation between 2 groups: did not significantly -Main effect of group in post: (the intervention group vs the control group): F (1,160) = 2.88, P = .092, η2 = 0.018 -Interaction effect between the test time and group: F (1,160) =14.12, P < .001, η2 = 0.081 (a significant interaction effect) & (significant for postrehabilitation)
Feasibility and acceptability of a real time telerehabilitation intervention forchildren and young adults with acquiredbrain injury during the COVID-19 pandemic:an experience report	Oprandi (2021)	Italy	An experience report	All=13 Male=8 Diagnosis=	Instrument for intervention= a personal computer+ microphone+ Google Meet Measurement of treatment effects: Two questionnaires (parents + therapists)	Therapists’ Questionnaires Feasibility: Sound quality = M (SD): 4.4 (0.2) Signal reception= M (SD): 4.4 (0.2) Image quality = 4.3 (0.2) Acceptability: -Quality of the therapeutic relationship with the patient= 4.6 (0.2) -Degree of control over the patient during treatment= 4.3 (0.2) -Attainment of clinical goals= 4.5 (0.2) -Degree of patient’s compliance with the instructions given by the therapist= 4.5 (0.1) -Highest score= Sound and signal quality -Lowest= Image quality Parents’ Questionnaires Feasibility: -Image and sound quality= 2.6 (0.6) Acceptability: - relationship between them= 3.0 (0) -Concern about client treat from distance by therapist= 1.0 (0.2) -Usefulness of treatment= 2.9 (0.2)
Telepractice in school-age children who stutter: A controlled before and after study to evaluate the efficacy of MIDA-SP	Tomaiuoli (2021)	Italy	A non-randomized controlled pre- and post-treatment trial	Experimental group (Telepractice Group): All=11 children who stutter Male=10 receiving telehealth adaptation of MIDA-SP (Multidimensional, Integrated, Differentiated and Art-mediated stuttering program) Historical control group (In-Clinic Group): All=11 children who stutter Male=10 receiving MIDA-SP at Center of Research and Cure (CRC) based in Rome	Intervention= The MIDA-Stuttering Program Primary outcomes: Stuttering Severity Instrument – Fourth Edition (SSI-4( End of the treatment: OASES (Overall Assessment of the Speaker’s Experience of Stuttering)	Telepractice Group: -SSI-4 total score pre and post treatment: t10 =3.978; p=0.003 and -OASES Total Score pre and post treatment: t10=4.224; p=0.002 and SSI-4 total score pre and - In-Clinic Group: -Post treatment t10=4.071; p=0.002 and OASES Total Score pre and post treatment t10=3.778; p=0.004 and Pre- and post-treatment assessments of the two groups on the SSI-4 test: SSI-4 pre: t20=-0.139; p=0.891 Mann Whitney U= 62.5; n1 = n2 = 11; p= 0.898 SSI-4 post: t20=-0.815; p=0.425 Mann Whitney U =75.5; n1 = n2 = 11; p= 0.332 Pre- and post-treatment assessments of the two groups on the OASES’s Total Score: Pre-treatment: t20=-1.288; p=0.213 Mann Whitney U = 86.5; n1 = n2 = 11; p= 0.088 Post-treatment: t20=-1.211; p=0.240 Mann Whitney U = 78; n1 = n2 = 11; p= 0.270 Comparison of Missed Appointment Rate for In-Clinic and Telepractice Group: t20=-0.64; p=0.530 Mann Whitney U =70; n1 = n2 = 11; p= 0.562
Speech pathology telepractice for children with cleft palate in the times of COVID-19 pandemic	Pamplona (2020)	Mexico City	Clinical trial	All=43 with VPI (velopharyngeal insufficiency) and CA (compensatory articulation) after palatal repair	Treatment: according to the phonologic principles of the WLM (Whole Language Model) Sessions of treatment= 2 sessions per week, 1 therapy session and 1 choir session The articulation strategies= Modeling, modeling with stress, cloze procedure with phonemic cues, phonetic changes, and think aloud in phonemic awareness	A Two tailed Wilcoxon rank sum test: -A statistically significant difference between the two-paired samples (onset as compared to end) = significant improvement in study group (p < 0.001)
An exploratory study of speech-language pathologists’ clinical practice in the literacy domain: Comparing onsite practices with telepractice services during COVID-19	Furlong (2022)	Australia and New Zealand	Online cross-sectional survey	44 SLPs	Online survey	Caseload and service delivery prior to COVID-19: -Average= 6 and 10 (n=6) and 11–15 (n=6) students per week -Caseload and service delivery during COVID-19: -Seeing fewer students, n=30 -For individual literacy sessions= most participants no change to session -Change in session duration for small groups= yes -Literacy assessment for onsite delivery and telepractice delivery: More than half of the participants (n=25) = no change. Changes to intervention practices for telepractice Delivery: -Nearly half (n=20) = a little change= several changes (n=10) + significant changes (n=6) Telepractice literacy services: -Prior to the COVID-19= none of literacy caseload were seen via telepractice -During the COVID-19= seeing more than 75% of their literacy caseload via telepractice -Reasons caseload seen via telepractice changed during COVID-19: government-enforced restrictions + change to schools closing and being unable provide onsite services + need for continued access to services -The main reason for continuing with telepractice= Student preference -Next most common reason= The flexibility and convenience of telepractice + reduced travel time for families + increase in referrals from rural -Reasons for not continuing= preference for providing onsite services+ scheduling difficulties during school hours + limited access to internet and devices for some students. -Most participants (n=37) = differences between onsite and telepractice, -Most commonly differences = more difficulty maintaining students’ attention and engagement in telepractice sessions (n=11) + difficulties detecting nonverbal cues and seeing the student working in telepractice sessions + less able to provide timely and accurate feedback (n=8) + technological challenges in telepractice sessions (n=7)+ more reliance on parents to support students in telepractice sessions (n=3) + parents needed to be more involved (n=3) -More than half = no difference in intervention outcomes -Barriers with implementing telepractice: most= technological challenges+ families not wanting to esngage+ lack of appropriate resources
The effectiveness of speech pathology telepractice during COVID-19 pandemic for Autistic children in Indonesia	Aliffia (2023)	Indonesia	Pre-post	16 ASD (autism spectrum disorder)	Speech therapy telepractic program	Differences between pre and post intervention: z=-2.529, P= 0.011
Outcome measures following tele-rehabilitation and conventional face to face rehabilitation in paediatric cochlear implant users during COVID-19 pandemic: A pilot study in a tertiary care setup	Verma (2022)	India	Pre-post	27 unilateral paediatric cochlear implants (two intervention groups: vis,tele & face-to-face intervention)	Assessment tools: ISD (Integrated Scale of Development), SIR (Speech Intelligibility Rating Scale), CAP-R (Revised Category Auditory Perception) Intervention: WhatsApp video calling platform, conventional face-to-face therapy	-Conventional rehabilitation better outcomes compared to teletherapy. -Rate of progress after one year of rehabilitation with respect to hearing-age: significant difference for the hearing-age group of 0-2 years across the domains of audition, speech and language
Artificial intelligence evaluation of COVID19 restrictions and speech therapy effects on the autistic children’s behavior	Sabzevari (2023)	Iran	Survey	87 children with ASD	3 treatment approaches of in-person, telehealth and public services along with no-treatment condition	-Restrictions alleviate externalizing problems, intensifying internalizing problems. - In-person speech therapy most effective and satisfactory approach to deal with ASD children during stay-at-home periods. -The effectiveness of the treatments in person= 69.6% -Satisfaction telehealth: minimum satisfaction -No treatment: have satisfactions. -Partial treatment from public health service: no impact on the satisfaction -Level of satisfaction: effects on change in behavior of their children

In general, studies reported that approximately 100% of SLPs use online services primarily for language intervention(33). Furthermore, the pediatric intervention is most difficult tele practice intervention(16) and the language difficulty had minimum tele practice speech therapy(34).

Discussion

The present scoping review aimed to compare the amount of tele practice and face-to-face speech therapy delivery for children during the COVID-19, as well as the barriers and the facilitators of tele practice speech therapy delivery during the pandemic. Furthermore, we reported the efficacy of present tele practice speech therapy during the COVID-19.

The included studies showed that approximately all SLPs used the tele health for assessment, intervention, and counseling for children with swallowing and communication disorders during the pandemic. This finding is consistent with other reports such as a May 2020 survey by ASHA (ASHA, 2020) that revealed over 80% of school-based SLPs surveyed were routinely using teletherapy whereas prior to COVID-19 only 5.2% of those SLPs provided services via teletherapy(27).

The SLPs and parents believed that tele practice had many advantages and they preferred to continue the tele practice therapy after the pandemic, moreover they need to apply the face-to-face therapy too. In this way, Lam et al. demonstrated that tele practice services improved students’ speech and language abilities as well as increased students’ engagement with speech-language therapy and their motivations for learning(34). Grogan-Johnson et. al. applied the conventional speech therapy in a rural setup in the USA. They reported that online speech therapy cannot substitute face-to-face speech therapy but can be used along with it for achieving the better outcome(35).

This scoping review determined some barriers and facilitators for online speech therapy during the pandemic. Some barriers are about the technology and lack of any clear resource for connecting between SLPs and their clients. For these kinds of problems, the health policy maker should be used from the experience of COVID-19 pandemic and predicted the necessary resources for similar disasters.

On the other hand, SLPs reported some barriers(12, 28). Some SLPs reported the lack of any guidelines for tele practice speech therapy, lack of any experience about tele practice, or difficulty of online speech therapy for children, and so on. In this way the (ASHA) demands that quality of service provided through tele practice speech therapy must be equivalent to face-to-face speech therapy but not less than face-to-face speech therapy(36). So, if the clinicians have been decided to continue the tele practice must be provide adequate resource such as various applications and programs for children with different disabilities. In addition, the speech and language associations provide the tele practice guidelines and hold educational courses for clinicians. Furthermore, parents and students reported some barriers such as difficulty of children management, need more time for involving to intervention, and less child’s concentration in online sessions. In tele practice sessions, parents need to solve technological problems and control students’ behaviors throughout the session. Therefore, parents must allocate more time and energy in tele practice sessions than they do in on-site sessions that its unavoidable (34, 37). In addition, it seems that more communication between parents and SLPs is needed for achieving more efficacy of tele speech therapy, because parents are responsible of treatment transfer to their children. However, presence of face-to face communication is needed for more efficacy. In addition, the nature of online communication is so difficult for children. This negative opinion can be explained by the lack of effective communication in telehealth. Due to the lack of personal interaction that occurs in telehealth services, extra communication and visual features for communication are needed to build an adequate communication (38). According to the included studies in this scoping review, there are few experimental studies were about the online speech therapy for children during the COVID-19 pandemic. The results of these studies support the effectiveness of a tele practice-based speech and language therapy intervention or no differences between online and face-to-face speech therapy. Large number of previous studies indicated that tele practice programs improve communicative functions in children with neurodevelopmental disorders(39-41). On the other hand, the efficacy of face-to-face therapy was more than tele rehabilitation in children with CI. Chadd et al. assessed the impact of COVID-19 on the Speech-Language Pathologists and their patients and reported that tele-therapy for pediatric population is a challenging task(42).

Reviewing the related articles revealed some weakness in their methodologies and structures, such as lack of control group, or sufficient participants in study as well as no comparing the tele practice and face-to-face intervention. Moreover, they didn’t report the tele practice structure clearly.

Conclusion

This study revealed tele practice services limited prior COVID-19 compared to during COVID-19, however access to the service is challenging. SLPs and caregivers in general showed a willingness to use telehealth speech therapy despite its advantages and disadvantages. However, due to the lack of appropriate training for service delivery through tele mode, the quality of service being provided is questionable.

Limitation

In this scoping review, we revealed some gaps in these available studies about their methodology. For future studies, we suggest using control group and comparing the tele health and face-to-face treatment. In addition, researcher should assessment an outcomes measure by follow up of participants skills.

In addition, some articles were published in other languages and inevitably were excluded from our studies.

Author’s contribution

F.Hassanati: contributed to searching the databases, Data analysis, and preparing this article; M. Takaffoli: Searching the database; H. mowzoon: Data analysis; Z. Nobakht: Searching the databases, Data analysis; and F. Soleimani, M. Vameghi: revise the manuscript.

Conflict of interest

The authors have declared that they have no competing or potential conflicts of interest.

Appendix A: The search strategy of PubMed

("COVID-19"[Title/Abstract] OR "COVID-19"[MeSH Terms] OR "SARS-CoV-2"[MeSH Terms] OR "SARS-CoV-2"[Title/Abstract]) AND (Child[MeSH Terms] OR Child[Title/Abstract] OR Children[Title/Abstract] OR Adolescent[MeSH Terms]OR Adolescent[Title/Abstract] OR Students[MeSH Terms] OR Student[Title/Abstract] OR teen*[Title/Abstract] OR Youth[Title/Abstract] OR kid[Title/Abstract] OR parents[MeSH Terms] OR parent[Title/Abstract]) AND ((communication[Title/Abstract] OR Rehabilitation[Title/Abstract] OR Speech[Title/Abstract] OR language[Title/Abstract] OR swallowing[Title/Abstract] OR hearing[Title/Abstract]) AND (Therap*[Title/Abstract] OR Rehabilitation[Title/Abstract] OR service[Title/Abstract] OR intervention[Title/Abstract]))