We reviewed the literature relating to the use of telehealth for paediatric speech and language assessment. Four databases, and relevant reference lists, were searched for articles published between January 2004 and July 2014. A total of 180 articles were identified, of which only five were relevant. All studies assessed efficacy using method comparison techniques; no studies assessed effectiveness. The method comparison studies investigated the validity and/or reliability of speech and language assessment via telehealth, when compared with face-to-face assessment. Studies varied in terms of participant group, assessment tools, statistical analysis and telehealth equipment. The papers reviewed presented some evidence that telehealth can be used to make valid assessments of oromotor function, speech intelligibility and language. Articulation screening via telehealth was found to be valid, but there was conflicting evidence about full articulation assessment. Intra- and inter-rater reliability was good for all speech and language tasks, with the exception of oromotor assessment, which also had reduced reliability when assessed face-to-face. There were discrepancies between the two modalities for individual oromotor tasks, judgement of individual speech sounds, detection of pluralisation, and discriminating between similar sounding words; these have the potential to be clinically important. Evidence regarding satisfaction was extremely limited, with only one study reporting parental satisfaction, and no studies reporting child or clinician satisfaction. Although there is limited evidence to support the validity and reliability of speech and language assessment via telehealth, it is probably not yet sufficient to influence clinical practice or policy development.

Children with cancer and nonmalignant hematological disorders may require speech pathology (SP) support; however, limited evidence is available describing prevalence and severity of swallowing/feeding and communication impairments in this population. A retrospective chart review of 70 children referred to SP at the newly formed Queensland Children's Cancer Centre was conducted to describe the prevalence and severity of swallowing/feeding and communication dysfunction, and the association between impairment, oncology and hematology diagnosis, and service utilization (time and occasions of service). Swallowing/feeding disorders were the most commonly observed impairments at initial assessment (58.6%). Children with central nervous system tumors (P = .03) and nonmalignant hematological disorder (P = .03) had significantly higher rates of feeding impairment than other oncology and hematology diagnostic groups. Children with central nervous system tumors had the highest rates of oral phase (P = .01) and pharyngeal phase (P = .01) dysphagia (swallowing disorder). No significant difference was found between diagnostic groups for intensity of SP service delivery. Prospective research is required to examine prevalence and severity of disorders, and service utilization in a more established clinic, and to investigate interactions between cancer treatment and swallowing/feeding and communication dysfunction.

Based on these findings, we recommend that clinicians perform measurements of static foot posture using the same standing foot placement between sessions to ensure a high level of measurement consistency.

Effective communication is vital for healthy development and successful educational and vocational outcomes. For children with medical complexity (CMC), the interaction between medical complexity and a speech and language impairment may put them at particular risk for adverse effects. It is important that these children are promptly assessed and diagnosed so that intervention can be started early. Medical complexity is rare in childhood, thus CMC usually access speech pathology services through tertiary facilities where staff have specialist experience and resources, and work as part of a coordinated tertiary team. Unfortunately these facilities are typically located in metropolitan centres, which may compromise service accessibility for CMC living in rural and remote locations.A potential solution to improve service accessibility is remote speech and language screening using telepractice. Telepractice screening allows the speech-language pathologist (SLP) to distinguish those children who need further assessment at the tertiary hospital from those with normal speech and language. This model is increasingly used for the delivery of tertiary medical services, however, there is little research to support the use of telepractice for paediatric speech and language screening, and very few studies have included CMC. Thus, the overall purpose of this research project was to investigate the role of telepractice for remote speech and language screening of CMC. To achieve this aim, two studies were carried out.The first study was an international survey of tertiary SLPs that aimed to describe access difficulties experienced by CMC, and to investigate the rate of telepractice adoption among SLPs who work with CMC. The survey was administered in 2011 (n = 46) and repeated in 2015 (n = 47). This survey identified widespread access difficulties experienced by CMC, highlighting a need for alternative service delivery models such as telepractice. Telepractice adoption among tertiary SLPs more than doubled between 2011 and 2015 (p < 0.05), and in 2015 the rates of telepractice adoption were higher (40%) than previously reported for the general speech pathology profession. Tertiary SLPs were willing to use telepractice with their CMC patients, and considered a wide range of patient groups and service types to be appropriate for telepractice delivery. However, some SLPs were reluctant to use telepractice for direct services such as screening, and a number of barriers to telepractice adoption were identified, including inability poor audio and image quality, lack of experience with telepractice, concerns about behaviour management and use of hands-on techniques, and concerns about the caregiver's inability to assist during telepractice sessions.ii The second study was an exploratory method comparison study that aimed to investigate the feasibility, validity, and acceptability of speech and language screening via telepractice for CMC.This study compared in-person speech and language screening with two telepractice screening ...