Speech Language Pathology

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Test translation in a South African context using the peabody picture vocabulary test-revised.
(1994) Naidoo, Premanithee.; Jager, G. W.
This study explored the feasibility of using test translation to adapt a standard English vocabulary test for Zulu speakers. It was motivated by the difficulties associated with assessing speakers of the African languages, in the absence of Zulu speech-language therapists and Zulu assessment tools. The adaptation process in the present study began with a direct translation of the PPVT-R into Zulu by twenty Zulu university students. Based on the degree of consensus on translations and judgements of cultural appropriacy (using the committee approach), items were selected for the purposes of pilot testing of the translations on 107 Zulu pupils from six to eleven years, in the study area. The results of the first pilot study revealed that it was not feasible to standardise the first translated version of the test, as only seventeen percent of the items were found suitable for inclusion in a normative study. Further test development using translations from twenty educators, their judgements of cultural appropriacy of stimuli as well as application of the back translation test to determine semantic equivalence of translations resulted in the development of a revised translated version of the PPVT-R, consisting of mUltiple translations for some items. This was administered to 544, six to eleven year old Zulu children. The results of the second pilot study revealed that only 31.2% of the translations administered were appropriate for the purposes of developing norms, across all the age groups tested, with 80% of these translations applicable for six and seven year old Zulu children only. Therefore, the translated version of the PPVT-R, despite modifications, showed significantly reduced applicability for Zulu speakers. Using the information derived from the present study a test comprising thirty six Zulu words has been compiled for the purposes of screening the receptive vocabulary skills of six and seven year old Zulu children in the study area. The findings of the study confirmed the difficulties in using test translation as a procedural option in adapting a test for Zulu children; implications, further modifications and investigations are suggested in this regard.
An overview of speech-language therapy services for children with cleft lip and/or palate from birth to three years within the KwaZulu-Natal health sector.
(2011) Chetty, Marlene.; Karrim, Saira.; Pahl, Jennifer Ann.
A descriptive survey with 19 Speech-Language Therapists from public health and four from private health was used to obtain an overview of Speech-Language Therapy services for children with cleft lip and/or palate from birth to three years in the KwaZulu-Natal Health Sector. Results are presented for public health, as none of the four private based respondents worked with cleft lip and/or palate from birth to three years. The number of Speech-Language Therapists (9) working with cleft lip and/or palate (0-3 years) in KwaZulu-Natal appears not to have changed significantly over the past two to three years, similar to the incidence of cleft lip and/or palate births. Reasons for Speech-Language Therapists not working with this population included poor referrals and caseloads comprising of clients older than three years. A team approach to cleft care appears challenging but showing development. There are currently four institutions where professionals function as multidisciplinary teams, consisting mainly of Speech-Language Therapists, doctors and nurses. Speech-Language Therapists’ assessments include case history taking, oral peripheral examination, observational feeding assessment and speech-language assessment. Most therapists are consulted within a few days of the birth, which is consistent with international guidelines. Audiological assessment and assessment of resonance were mentioned by a minority of participants. Feeding devices for cleft lip and/or palate are not always available immediately, and hence appears contradictory to the National Rehabilitation Policy. Recommendations include undertaking similar research in other provinces, so as to build a nationwide overview of services for South African children with cleft lip and/or palate.
Early communication development : parenting beliefs and practices in a rural context.
(2011) Earl, Bronwyn.; John, Desiree Charmaine.; Moodley, Legini.
Many children in the foundation phase in rural schools in KwaZulu-Natal, South Africa struggle to acquire early literacy skills. A review of the literature demonstrates the link between early communication development and academic achievement, including literacy skills (Rossetti, 2001). This study explored the beliefs and practices of caregivers regarding early communication development as a means to providing culturally appropriate early communication intervention. The study drew on phenomenological and interpretive viewpoints to inform the qualitative design. Fifteen caregivers with healthy infants in the age range of 0-12 months were recruited from a post-natal clinic in Inanda, a rural community in KwaZulu-Natal. The study took place in three phases. Phase 1) Nine of the participants were divided between two focus groups. Focus groups used photo elicitation as a method of stimulating discussion on subjects relevant to the topic. Phase 2) Data from the focus groups was used to inform the development of an individual guided interview schedule. One participant took part in a pilot study of an individual interview. Phase 3) The remaining five caregivers participated in individual guided interviews. Data obtained through both focus groups and individual interviews was analyzed for themes using Creswell’s Data Analysis Spiral (1998). Five themes were identified as falling within the two study objectives: Parenting beliefs and parenting practices. The themes under parenting beliefs included: the role of the parent; needs and abilities of the infant and communication. Themes included under parenting practices were: daily activities and language stimulation. The results show that caregivers’ beliefs are guided by the desire for their infants to be accepted by community members, thus prioritizing issues of respect and observable health as their parenting goals. Caregivers’ daily activities facilitate the development of the maternal bond which serves as the foundation for the development of communication and provides language stimulation. These practices are however noted to be intuitive and lack a formal knowledge base. Practice and research implications for these findings are discussed.
Central auditory processing perforance of male and female stutterers and nonstutterers.
(1992) Kathard, Harsha Mothilall.; Govender, Cyril Devadas.
Central auditory processing performance of male and female stutterers and nonstutterers was compared on a battery of central auditory tests. Thirty stutterers (15 male and 15 female) with a mean age of 23.10 years (17.2-31 years) comprised the experimental group, and 30 nonstutterers (15 male and 15 female) with a mean age of 22.2 years(17-32 years) comprised the control group. The test battery included dichotic (DCV test, ssw test, eST) and monotic (SSI-ICM test, ARLT) tests. Stutterers performed significantly poorer than nonstutterers on various parameters of individual tests. The stutterers' performance on the test battery was varied : 8(26.6%) stutterers passed all tests in the battery; 7(23.3%) failed dichotic tests only; 15(50%) failed dichotic and monotic tests of which 2(6.6%) failed monotic tests. Pass/fail rates indicated that although 15 (50%) nonstutterers failed the battery 22(73.2%) stutterers failed. This result confirmed that stutterers performed significantly differently from nonstutterers on the test battery( X?= 19.87 , df=l; p<0.05). Male/famale comparisons for nonstutterers indicated no significant differences (p>0.05) on individual tests except on the ARLT where males obtained longer latencies than females. Pass /fail rates on the test battery confirmed no statistically significant (X~= 0.133 , df=l; p> 0.05) performance differences between male and female nonstutterers. For stutterers, although male performance was poorer than female performance on various parameters of individual tests ,the performance differences were not significant (p>0.05). However, pass/fail performance on the test battery indicated that significantly more males (13) than females (9) failed the test battery ( X2 = 8.66 df=l, p<0.05). The results are discussed in terms of the literature and theoretical and clinical implications are presented and discussed.
The syntactic features of South African Indian English among students in Natal, with regard to use and attitudes towards usage.
(1987) Crossley, Susan L.; Brimer, Alan.; Mesthrie, Rajend.
Two tests were developed and administered to 122 South African students of Indian descent and 70 South African students of European descent. One test elicited use of certain syntactic constructions through requesting subjects to make specified grammatical changes to verbally presented sentences. The other test elicited attitudes regarding acceptability and beliefs about own and others' use of nonstandard syntactic forms. In both cases, test items were based on non-standard syntactic forms reported to occur in the speech of Indian South Africans. Results were analysed statistically and on the basis of significant group differences, fourteen syntactic features of South African Indian English were identified. These results, as well as those concerning language attitudes and beliefs, are discussed in terms of the literature and implications for clinical application and further research. Sex differences in use and attitudes were also investigated but were found to be of little significance.
The hallmarks of successful alaryngeal voice rehabilitation following a total laryngectomy using tracheo-esophageal puncture with voice prosthesis : perspectives of key role players.
(2012) Naidu, Suvaya.; Flack, Penelope Susan.; Rajaram, Priya.
A total laryngectomy (TL) affects the quality of life (QoL) of individuals who have undergone this surgical procedure, as changes are seen in respiration, swallowing and communication. The aim of this study was to gather perspectives of the hallmarks of successful alaryngeal voice rehabilitation by tracheo-esophageal puncture (TEP) with voice prosthesis of laryngectomy patients from key role players based at a public hospital in Gauteng Province, South Africa. A qualitative method of inquiry was used, namely a single-program, collective case study. A focus group, comprising of four individuals who had undergone a total laryngectomy, was held to identify the participants‟ views about successful voice rehabilitation. From this focus group, one successful communicator was identified to be interviewed individually. Five semi-structured, face-to-face individual interviews using open-ended questions were conducted with five key role players in alaryngeal voice rehabilitation. The interviewees comprised of the successfully rehabilitated person with total laryngectomy (PWTL), his caregiver, an ear, nose and throat surgeon, speech-language pathologist and specialist nurse, to gather their perspectives on the factors that contributed to successful alaryngeal voice rehabilitation using TES. The Thematic Framework Approach was used to qualitatively analyze the data. Factors identified as contributing to success included patient selection for tracheo-esophageal puncture, information provision, support in the form of support groups, spiritual as well as family support, stomal care, the skill of the team and key management issues. Issues related to finance adversely affect the provision of voice prostheses and/or the provision of correctly sized prostheses and accessories. Systems have been implemented at the hospital to provide the option of TEP with voice prosthesis without much consideration to the other two alaryngeal options; namely esophageal speech and electrolarynx speech. Implications for clinical practice have been identified especially the need to provide more social support services to persons with TL.
Employment in down syndrome : the experiences of individuals with down syndrome, their employers and families in KwaZulu-Natal.
(2013) Tod, Courtney Jayne.; Pahl, Jennifer Ann.; Karrim, Saira.
Employment is viewed as one of the pinnacle factors in enhancing quality of life. Despite being a right in South Africa, the employment opportunities available to individuals with Down syndrome are limited. This study aimed to explore the employment experiences of individuals with Down syndrome, their employers and their families in KwaZulu-Natal. This research provided valuable information for Speech-Language Therapists on enhancing communication in the workplace as effective communication in the workplace is crucial for employment. A qualitative approach and phenomenological design were used within the context of International Classification Framework, biopsychosocial model and critical paradigm. Individual semi-structured interviews were conducted and thematic analysis was used to analyse the data. Results revealed that individuals with Down syndrome valued their employment for the emotional and financial support it provided and the skill development opportunities available. Gaps were evident in legislation specific to the employment of individuals with Down syndrome as well as the implementation of these limited policies. Communication is necessary in the workplace; however, it is one of the areas that is severely impacted in individuals with Down syndrome. Employers and family members’ experiences indicated variability in speech intelligibility, language and literacy skills among the participants with Down syndrome linked to cognitive ability, intervention, education received, mood swings and memory loss. Intriguing trends relating to the positive use of technological devices for social and recreational purposes were evident. Employment success can be linked to successful job selection, visual and emotional support. Speech-Language Therapists, employers, family members and the Down syndrome association were found to have crucial roles in providing this support. The role of the Speech-Language Therapist continues to evolve and is required across the lifespan for different purposes.
The use of an English language assessment test on South African English additional language (EAL) speakers from an indigenous language and cultural background : a critical evaluation.
(2013) Mdlalo, Thandeka.; Flack, Penelope Susan.; Joubert, Robin Wendy Elizabeth.
The aim of the study is to provide an in-depth interrogation and critique of the use of language assessment tools on populations from indigenous language and cultural backgrounds, culminating in a framework for guiding the adaptation of language assessment tools to be culturally and linguistically relevant for the indigenous South African populations on which they are used. As South Africa is a multilingual and multicultural country, it contributes to understanding the factors that need to be taken into account for acquiring reliable and valid findings with multilingual and multicultural populations. The isiZulu language and culture is used as a basis for the study as the study is conducted in KwaZulu-Natal. This study critically evaluates the assessment of English Additional Language (EAL) speakers who are from an indigenous linguistic and cultural background, using an English expressive language screening tool, the Renfrew Action Picture Test (RAPT) as an example. The cultural and linguistic relevance of this commonly used screening tool is interrogated from four different viewpoints, firstly, the perspective of the children, who are the target population of the tool; secondly, that of the parents and community, who play a significant role in the socialisation of the children; thirdly, from the perspective of the academics from an indigenous language and cultural background, who provide an academic perspective of the tool; and finally, Speech-Language Therapists (SLTs) who administer the tool and interpret the findings. This study uses a mixed methods approach. Multiple data collection methods are used, such as a survey, focus group, individual interviews, test administration and consensus methods. The survey and Delphi technique form the quantitative parts of the research methodology. Patterns of responses from all the sources are analysed and interpreted. Methodologically, the research is unique as it uses children as a source of primary data collection. Children, in research, are usually only used in the administration of the test and their opinion of the tool is not sought. In this study the voice of the children is the main contributor to the data collection. The findings also show that adults, who are often relied on as primary data sources in research on language tools used on children, may have certain misconceptions about children’s knowledge and views. A key finding of this study is that the cultural and linguistic background of the child assessed plays a crucial role in determining and interpreting the responses to the presented material of the language assessment tool. The conscientisation of the Speech Language Therapist and the redefining of her role emerge as pivotal aspects facilitating change. Based on this finding, recommendations, such as that the therapist equips herself with knowledge of the language of the client, the cultural and linguistic background of the child assessed, the type of bilingual that the child is, are made so that the reliability and validity of the findings are not compromised.
Transition to special education : the experiences of parents of children with communication disorders associated with intellectual disability in the province of KwaZulu-Natal.
(2015) Laalje, Sitha.; John, Desiree Charmaine.; Pillay, Mershen.
Millions of children around the world are affected by childhood disabilities, and are much less likely to participate in schooling than those not affected (Filmer, 2008). This study supports the global initiative to ensure that all children, including those with disabilities, are schooled. The aim of this study was to therefore explore the experiences of parents of children with communication disorders associated with Intellectual Disability (ID), specifically during their children‟s transition to special education. An understanding of the nature of the parents‟ experiences could lead to improved service delivery, which could result in better outcomes for the parent and the child. The researcher adopted a qualitative approach to the study and explored the perspectives of the parents. Focus group and individual interviews were conducted to obtain the data which was transcribed and analysed thematically. The results revealed that at a formal level, parents received inconsistent support from the education structures. Some of their children were removed from school registers, whilst others could not access appropriate education. Assistance was sought from public health facilities and from private psychologists. The parents indicated supportive and non-supportive responses from informal support systems. They also talked about their associated negative and positive emotional experiences during their children‟s transition to special education. The study limitations and implications have been discussed. This study made recommendations for stakeholders involved in the transition of affected children to special education. This new knowledge can be translated into action and act as a tool for improving service delivery.
The integration of multilingualism and culture into augmentative and alternative communication services for school-aged children in KwaZulu-Natal and Gauteng, South Africa.
(2016) Kistasamy, Charuna.; Karrim, Saira.; Pahl, Jennifer Ann.
Language and cultural diversity influence how individuals of different backgrounds interact. This heterogeneity can affect how Augmentative and Alternative Communication (AAC) services are provided to children with complex communication needs. This qualitative research study explored how Speech-Language Therapists (SLTs) integrate multilingualism and culture when providing AAC management to school-aged children. Twelve SLTs and parents from two provinces in South Africa provided insights into methods of obtaining language and cultural information from family members who are culturally and linguistically diverse (CLD), methods of AAC assessment and intervention, how SLTs provide cross-linguistic and cross-cultural services and the challenges experienced. The data which was gathered using journals, individual interviews and questionnaires revealed that SLTs integrate families’ language background into management by using ‘informal’ interpreters, enhancing their own proficiency in languages their clients speak and using informal assessment procedures. Culture was not explicitly explored at the outset of management leading to poor integration of culture in AAC services. School-aged children did not adequately communicate in multiple languages as the language of learning and teaching, English, was often promoted to the exclusion of multilingualism. Family collaboration in the school context was a challenge which leads to ineffective carryover and integration of language and culture in AAC service provision. The implications and limitations of the study are presented.
Investigation of the effectiveness of an ecologically valid telerehabilitation system for the assessment and primary management of neurogenic dysphagia in a resource constrained country.
(2017) Ayanikalathi, Narayanan Sona.; Pillay, Mershen.; Jayaram, Mannarukrishnaiah.
India is undergoing remarkable industrialisation, economic and demographic changes resulting in a transition towards lifestyle related cardiovascular and cerebrovascular diseases and TBI. There is an increased number of individuals living with different physical, cognitive or affective sequelae of CVA and TBI. It leaves patients with several residual disabilities like physical dependence, communication impairment and dysphagia. Given the knowledge that CVA and TBI patients presenting with dysphagia are at a risk for pneumonia, there is even more need to manage dysphagia to prevent subsequent pneumonia. Intervention of dysphagia is scarcely available in resource constrained countries due to various reasons. There is a dearth of dysphagia experienced speech language pathologists in India due to the wide geographic range and increasing population. In such cases, when there is a shortage of trained staff in underserved areas, a feasible solution may be to adopt TR. This is in light that TR is an emerging novel method and various studies are being conducted using TR for speech language pathology services. TR studies on management of dysphagia have been conducted in economically developed countries like USA, Australia, etc. and mostly in controlled settings. Reports on impact of application of TR for management of dysphagia in resource constrained countries are almost absent. Ecological validity i.e. can results obtained under controlled research setting be generalised to those obtained in real life settings, and effectiveness, i.e. is it successful in producing desired outcome in dysphagia assessment, need to be assessed when considering developing a TR for use in India for the intervention of dysphagia, hence trying to investigate if the studies conducted successfully in the economically advanced countries be replicated in India. Hence the researcher deemed it necessary to conduct the current study with the aim to investigate the effectiveness of an ecologically valid TR system for the assessment and primary management of neurogenic dysphagia in India. The current thesis is a series of three phases. The first phase (Chapter 2) aimed to explore the current literature available regarding the use of TR in the intervention of dysphagia using a narrative literature review. The objectives were to investigate the current status and feasibility of TR in the assessment and/or management of dysphagia and to identify the benefits and limitations of the studies to explain ecological validity of TR. The narrative literature review aided the researcher to identify that TR is a feasible method for the intervention of dysphagia in economically developed countries. It emphasized the gap in knowledge on the use of TR for the intervention of dysphagia in resource constrained country as there are no studies reported. Hence, the researcher identified that the literature review augmented her idea that ecological validity of TR needed to be identified and thus its effectiveness when implementing it in resource constrained countries, because the patient, clinician, technology and context related factors do play a major role. The identified factors were explored in greater detail in phase two, to ensure that the TR implementation for the intervention of neurogenic dysphagia is contextually responsive and holistic, based on the paradigm shift to a constructivist one, ontologically, epistemologically and methodologically. The second phase (Chapter 4) aimed to investigate the ecological validity of TR in a resource constrained country such as India. Its objectives were to investigate the current status of TR in India through an understanding of the knowledge and attitude of TR personnel and to identify the variables that affect the ecological validity of TR in India based on the practice of the TR personnel. The semi structured interviews of TR personnel in India aided the researcher to acknowledge that patient, clinician, technology and context related factors can affect the ecological validity of TR in a resource constrained country, which in turn will affect its effectiveness. However, tele-mode service delivery in India is a feasible proposition, and in fact, several institutions have successfully implemented it. TR and TR for the intervention of dysphagia can be an answer to the needs of people in the underserved areas in India. With the outcomes from this phase, as well as based on the conceptual framework developed in phase one, factors such as devices and technology used for TR, the current internet speed available in the study location, materials used for the CSE and real-life outpatient clinical settings were used to establish the ecological validity of TR. Its effectiveness was then investigated. The third phase subsequently aimed to investigate the effectiveness of an ecologically valid TR for the assessment and primary management of neurogenic dysphagia in India. The objectives were to compare the results obtained using CSE through an ecologically valid TR mode and face-to-face mode with the intention to identify if the scores are reliable and to examine and explain the possible effects of the ecological validity variables i.e. patient, clinician, technology and context related factors on the effectiveness of TR in dysphagia assessment. Simulated patients (SP) were used for this phase, which was to avoid any harm to real patients (if used). This can be considered as a main limitation of the study. The quantitative data analysis using percent exact agreement and Cohen’s Kappa scores to rate the inter-rater reliability between the TR-SLP and FTF-SLP, showed that TR was effective in conducting neurogenic dysphagia assessment and primary management. There were high inter-rater reliability in all the cases studied. A descriptive analysis of the results obtained could explain the reason for the variation in scores on certain parameters of the CSE in each case, in relation to the factors affecting the ecological validity. This qualitative descriptive analysis could explain how the various factors could have influenced the performance of the patient and clinician. However, due the small sample size of four SP in study two, the findings cannot be generalised to broader clinical settings. However, there is no denial that the results provide valuable preliminary information for future research of TR in resource constrained country. The findings of the overall study identified the need for treating a new intervention as unique, developing in relation to a complex and potentially unique set of ecological conditions. The researcher identified the need for using a contextually guided framework when developing interventions such as TR, which in turn can improve its effectiveness. The results obtained from the current study feed motivation for future studies using real patients, first to be done in a controlled setting to reduce the risk of the consequences due to aspiration or choking during the assessment. The results of the current study will help and be an inspiration in future large-scale studies in resource constrained country and is food for thought for those already using TR for speech language therapy services in such settings.
An exploratory study of the efficiency of swallowing and communication management in tracheostomized populations in Sri Lanka.
(2017) Ishak, Fathima Nuzha.; Pillay, Mershen.; Hettiarrachchi, Shyamani.
Dysphagia, or difficulty in swallowing, is one of the main disorders experienced by people with tracheostomies (PWTs). It results in aspiration and increased risk of respiratory complications. A preliminary review of existing literature indicates considerable variation in practices involved in the management of this disorder. This scoping review aims to describe these processes in various countries and analyse them in relation to majority and minority world contexts. A scoping review was conducted using the Arksey and O'Malley (2005) framework, followed by a thematic analysis of the literature. An online databasesearch of articles published between 1 January 1990 and 1 April 2016 was performed, and those pertaining to surgery, general tracheostomy care and paediatrics were excluded. The results confirm that research on the subject comes mainly from minority world countries. Thematic analysis reveals evolving trends in practices that vary within and between majority and minority world contexts, and indicates increasing efforts by professionals in the latter regions to achieve global standardisation. The greatest variations appear in blue dye tests, cuff deflation status during oral feeding and the use of the speaking valve to manage swallowing. There are also discrepancies among the professionals involved. This review provides a comprehensive compilation of evidence on swallowing management for PWTs and indicates the need for further studies to understand practices in majority world contexts.
The work place experiences of individuals with cerebral palsy who have communication difficulties and their colleagues.
(2015) de Vries, Vivian Claire.; Pahl, Jennifer Ann.; Karim, Saira.
Employment is a form of independence and self-acceptance which, for many individuals with disabilities, is crucial to improving quality of life. Communication underpins quality of life and, for individuals with cerebral palsy, communication may act as a barrier to successful employment. This study aimed to explore the employment experiences of individuals with cerebral palsy who have communication difficulties and their colleagues. A phenomenological qualitative approach was used within the context of the International Classification Framework and a critical paradigm. Individual semi-structured interviews were conducted with six individuals with cerebral palsy who had full-time employment and a colleague of each. Data was analysed using thematic analysis. Results revealed that individuals with cerebral palsy had reduced speech intelligibility that varied with the nature and severity of the cerebral palsy and led to communication breakdowns with colleagues. Communicating in a group and over the phone produced feelings of nervousness and one-on-one conversations were preferred. Gaps were noted in implementing legislation regarding inclusion and equal opportunities for individuals with disabilities in education and employment. Individuals with cerebral palsy faced numerous barriers to employment which included accessibility, communication, transportation, limitations in education, and a lack of opportunities. Employment opportunities included financial independence, social aspects, contributing to society, educating others about disability, improved self-perception and the impact of employing a person with cerebral palsy. A Speech-Language Therapist can assist with some of these barriers and is recommended across stages of life for different purposes. There are implications for improving service delivery and employment opportunities for individuals with cerebral palsy.
Development and validation of a bilingual language battery for language-based learning disabilities.
(2018) Mazibuko, Xolisile Innocentia.; Flack, Penelope Susan.; Kvalsvig, Jane Dene.
There are social, linguistic, cultural, and political dimensions that impact on health and education in South Africa. The evolving nature of these dimensions demand the use of language assessment tools that are developed and validated for the South African population. Speech-language assessment informs parents and educators of the nature of speech and language difficulties the learner may have and guides the intervention. IsiZulu is the most widely spoken African language in South Africa. Therefore, development of a tool to assess expressive, receptive, and written language skills of learners with language-based learning disorders in isiZulu, is imperative. The aim of this study was to develop and validate a tool for language assessment of isiZulu-English speaking learners in grades 1, 2, and 3 who may have language-based learning disabilities. An assessment tool was designed to assess core language skills and identify early indicators of language-based learning disabilities that may result in academic difficulties. The tool development process aimed to construct an innovative test that is linguistically and culturally sensitive to bilingual or isiZulu-English speakers while the content is rich for identifying indicators of language-based learning disability. Elements in expressive and receptive language, phonological awareness, listening, reading, and mathematically-based language concepts were considered. The conceptual tool development phase involved a systematic literature review, pretesting with two existing tools and consultation of a five member Delphi review panel for advice and reviews. Field trials contributed to the development of test items and procedures and tested the tool’s application in mainstream and remedial schools as well as rural and urban communities of learners in KwaZulu-Natal. A combination of qualitative and quantitative methods were used to collect and analyse data. The results indicated that the new tool was linguistically and culturally appropriate. The majority of the subtests provided good reliability and valid results. The study makes a worthy contribution to the body of knowledge in the field of speech-language therapy and basic education. The results and guidelines from this study set out the basic elements required for development of language assessment tools in other African languages. The development of the assessment tool will yield standardization of a bilingual language assessment tool in South Africa.
The effectiveness of role-play as a therapy approach targeting pragmatic skills in learners with language learning disability.
(2015) Abdoola, Fareeaa.; Flack, Penelope Susan.; Sayed Karim, Saira Banu.
Role based learning involves the process whereby learners acquire skills, knowledge and understanding through the assumption of roles within real-life settings. Role-play holds potential as an effective learning strategy for children. However, there is limited research and practice within the field of speech-language pathology. The aim of this study was to determine the effectiveness of role-play as a therapy approach targeting the pragmatic skills of stylistic variation and requesting for clarification in learners with language learning disability (LLD). Children with LLD typically present with difficulties in social communication, which can negatively impact their social and academic achievement. The use of combined positivist and interpretivist paradigms allowed for the implementation of an embedded mixed methods design. An experimental pre-test post-test design was implemented. Eight participants, who were learners with a diagnosis of LLD, were purposefully selected. Data collection was conducted over five phases, utilising the Clinical Evaluation of Language Fundamentals (4th Ed.) Pragmatics Profile, discourse completion tasks, session plans and session records. Quantitative data was analysed using descriptive statistics and was supplemented by qualitative data from session records. Results revealed improvements in stylistic variation and requesting for clarification post role-play intervention, with minimal changes in the control group. Limitations and implications of the study were identified, and recommendations for the implementation of role-play as a therapy approach were made. Keywords: Role-play, stylistic variation, requesting for clarification, language learning disability
Feeding abilities of HIV-exposed uninfected neonates in KwaZulu-Natal, South Africa: a decscriptive exploratory study.
(2017) Eybers, Tessa.; Pillay, Mershen.; Pahl, Jennifer Ann.
Background: HIV-exposed uninfected (HEU) children born to HIV-positive mothers have poorer developmental and health outcomes than their HIV-unexposed peers. Feeding ability is a critical component when considering the health of HEU neonates. The aim of the study was to describe the feeding abilities of HEU neonates born to HIV-positive mothers accessing health care at a public sector hospital in KwaZulu-Natal. Methods: A descriptive exploratory study was conducted with 10 HIV-positive mothers and their neonates. A screening tool was utilised to evaluate the HEU neonates’ feeding abilities. Information regarding mothers’ health during pregnancy was gathered retrospectively from hospital medical records. All data were entered into SPSS and analysed using descriptive statistics. Results: All 10 HIV-exposed neonates were confirmed to be HIV uninfected by HIV PCR tests. Four out of the 10 neonates failed the screening tool and presented with feeding difficulties such as prolonged feeding time (n = 1), reduced feeding time (n = 2), swallow-breathe discoordination (n = 2), weak sucking (n = 1), insufficient oral intake (n = 1), inappropriate state of arousal for feeding (n = 1), inspiratory stridor (n = 1), signs of distress (n = 1), and regurgitation (n = 1). Mothers’ CD4 counts ranged from 205 to 820 cells/mm3(μl). Five neonates were exposed to ARVs in-utero from 24 weeks gestational age. Three of these neonates failed the screening tool. Seven of the 10 mothers experienced health concerns during pregnancy, including pregnancy related anaemia (n = 3), preterm labour without delivery (n = 2), vaginal warts (n = 2), vaginal ulcers (n = 1), asthma (n = 1), and epilepsy (n = 1). Conclusions and recommendations: The findings of the study show that HEU neonates are at risk for feeding difficulties. Health care professionals should regard this population as at-risk. In order to facilitate early identification and intervention and to prevent adverse health sequelae, appropriate screening and follow up measures should be implemented. Keywords: HIV/AIDS, Feeding, Neonates, HIV-exposed uninfected
Percutaneous endoscopic gastrostomy feeding decisions made by caregivers for children with cerebral palsy who experience feeding and swallowing difficulties in a public health care setting in Pietermaritzburg, South Africa: an exploratory study.
(2018) Naidoo, Lavanya.; Pillay, Mershen.; Naidoo, Urisha.
Abstract available in pdf.
Educating learners with communication disorders: an exploration of the experiences of mainstream educators in rural KwaZulu-Natal.
(2017) Ngcobo, Nomfundo Peaceful.; John, Desiree Charmaine.
Aim: To explore mainstream educators’ experiences of educating learners with communication disorders in rural KwaZulu-Natal. An exploration of mainstream educator’s experiences provided insight into the current status of service delivery for learners with communication disorders in rural mainstream schools of the iLembe South Circuit District. Background: The researcher’s personal experience has revealed that learners with communication disorders are promoted based on age. Such learners are not literate when they exit the secondary education system. Inclusive policies have been developed to facilitate the process of transformation but the implementation of such policies remains a challenge. Design: A qualitative, phenomenological approach was adopted. Method: Eleven Black African mainstream educators were interviewed individually using a semi-structured interview schedule. Results and Discussion: A thematic analysis yielded three superordinate and nine subordinate themes. Positive educator experiences were related to individualizing educational practices, accessing support teams and collaborating with private and public health professionals. Negative educator experiences were related to large classes, poor quality of educator training, implementation of the National Education Policy on Promotion, non-existent and dysfunctional support teams and poor collaboration amongst professionals. A few of the educators experienced a shift in their thinking and embraced inclusive practices. It is argued that paradigm shifts are facilitated in the context of increased support and hindered when the system is flawed by many challenges. The proper implementation of South African Educational policies is emphasized, as well as collaborative teamwork for the learner with a communication disorder. The limitations of the study are highlighted.
The oral hygiene status of people with dysphagia: a descriptive study.
(2018) Weimers, Merryl Justine.; Pillay, Mershen.
The aim of the study was to assess and describe the oral hygiene problems of adults admitted to a sub-acute rehabilitation hospital who presented with dysphagia. A descriptive, cross-sectional survey study design was followed and took place at a sub-acute rehabilitation hospital, based in the private sector. The 40 participants, 57.50% (n=23) male and 42.50% (n=17) female, were identified using non-probability, purposive sampling and underwent various assessments during the two phases of data collection. Phase I consisted of three steps: (1) assess the swallow function of participants, using the Mann Assessment of Swallow Ability (MASA), (2) screening the oral hygiene of participants with confirmed dysphagia, using an adapted version of the Oral Health Assessment Tool to identify any oral hygiene problems, and (3) sample the oral microbia to detect bacteria not considered part of the normal oral flora. Phase II of the study refers to the descriptive and statistical analysis of the data. A high likelihood for aspiration was a common feature for most participants who presented with dysphagia (42.50%). The main swallowing problems were related to lingual strength, the ability to manage saliva, bolus clearance and effectiveness of the cough. A high prevalence of deficient oral hygiene and oral colonization (62.50%) was found. The most commonly occurring bacteria groups and species were: (1) Candida albicans and (2) respiratory pathogens, e.g. Klebsiella pneumoniae and Staphylococcus aureus growth. The oral hygiene status of people who presented with dysphagia showed that it increases the likelihood for poor oral hygiene, which creates favourable environments for bacteria to flourish, as well as the prevalence of pathogenic oral bacteria, which is associated with the development of aspiration pneumonia. The management of oral health issues for persons with dysphagia should receive greater attention during hospitalization.
Caregiver’s expectations of their non-verbal children who present with Autism Spectrum Disorder in rural KwaZulu-Natal.
(2021) Haffejee, Fatima.; Karrim., Saira Banu Sayed .; Pahl, Jennifer Ann.
Caregiver expectations have been shown to have an effect on child outcomes. There is limited research regarding caregivers of individuals with non-verbal Autism Spectrum Disorder particularly in rural South Africa. The aim of this study was to explore caregivers’ expectations for their non-verbal child with Autism Spectrum Disorder in rural KwaZulu-Natal. Individuals with ASD form part of a larger environment, which they may influence and in turn impacts them. Caregivers form part of this environment. Bronfenbrenner’s ecological and bioecological systems theory framed the study and allowed these environments to be understood through implementing a qualitative study design. Eleven participants, who were caregivers of non-verbal children with ASD, aged from 5 to 7 were purposefully selected. Data were collected via semi-structured interviews and analysed thematically. Ten themes included caregivers, journey to diagnosis, feelings regarding diagnosis, caregivers understanding of ASD, caregivers’ experiences raising a child with ASD, communication, education, social participation and employment, therapy and societal responses. Caregivers had varied expectations of their non-verbal children with ASD. The microsystem was fluid and changed regularly with grandparents often being the primary caregivers. Relationships within the mesosystem (caregiver and therapists) impacted how caregivers understood the diagnosis, this in turn affected their feelings and expectations which also changed over time (chronosystem). Education was the predominant expectation for most caregivers, taking precedence over communication and social participation. However, limited resources within in the exosystem (limited schools) made viable schooling options difficult. Communication was less of a priority in comparison to education and toileting. There is need for caregiver counselling regarding non-verbal ASD in rural South Africa, a need for more (special) education options and caregiver support groups. No participant who had a child with ASD in the 8-18 year old age-range was a study limitation.

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