Effect of Hybrid Telepractice and In-Person Speech Therapy on Speech Outcomes in Persian-Speaking Children with Cleft...

ObjectiveThis study examined the effects of intensive hybrid telepractice and in-person speech therapy on speech characteristics in Persian-speaking children.DesignSingle-subject experimental design (ABA type).SettingMobasher Speech Therapy Clinic, Hamadan, Iran.ParticipantsFour Persian-speaking children aged 3 to 12 years with CP ± L and at least one active cleft-type characteristic (CTC).InterventionThirty intensive hybrid sessions (three in-person and two telepractice sessions per week) over six weeks.Main Outcome MeasuresPercentage of active oral/nonoral CTCs, percentage of correct consonants (PCC) in sentence imitation, word imitation, and word naming, percentage of stimulable consonants, hypernasality and nasal air emission were evaluated using the cleft audit protocol for speech-augmented protocol. Visual analysis, the two-standard deviation (2SD) test, and effect size indices, percentage of nonoverlapping data (PND) and Improvement Rate Difference (IRD), were used to assess outcomes.ResultsAll participants demonstrated reductions in active CTCs, hypernasality, and nasal air emission, alongside increases in PCC and stimulable consonants. These gains were maintained during the follow-up. PND and IRD indices reached 100% for all participants across all variables, except for hypernasality and nasal air emission. Hypernasality showed moderate treatment effects (PND/IRD = 40-60%), while the PND and IRD values for nasal air emission were 80%. The 2SD test confirmed statistically significant improvements (α = 0.05) in interval-level variables such as PCC and active CTCs, supporting the robustness of treatment effects.ConclusionIntensive hybrid telepractice and in-person therapy can improve multiple speech characteristics in Persian-speaking children with CP ± L, supporting the value of integrated, accessible treatment approaches for this population.