Speech-Language and Hearing Therapy

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'n Beskrywing van ouers, onderwyseresse, spraak-taalterapeute en oudioloë se persepsies oor die uitkomstes van 'n ouditief-verbale benadering tot opvoeding by jong kinders met 'n gehoorverlies
(Stellenbosch : University of Stellenbosch, 2011-03) Coetzer, Tarien; Gerber, Berna; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy.
ENGLISH ABSTRACT: Various approaches to the communication-development of the young child with a hearing impairment exist, of which the auditory-verbal approach is one. This approach is based on the principle that the child with a hearingimpairment develops speech- and language skills by using his/her residual hearing that is appropriately strengthened with the use of a hearing aid and/or cochlear implant. One of the most important requirements for the successful application of this approach is the appropriate transfer of the techniques and strategies that is used in institution-based intervention to the child’s home environment. Parents, teachers, speech-language therapists and audiologists are responsible for facilitating the transfer of intervention methods and acquired skills to the home environment and it is important that all team members are aware of his/her own, as well as each other’s roles, in the application of this approach. The principal aim of the proposed research project was to describe and explain the perceptions of parents/caregivers, teachers, speech-language therapists and audiologists, that are involved in the intervention of the hearing impaired child, regarding the auditory-verbal approach to education. Semi-structured interviews were conducted with nine parents of hearing impaired children younger than the age of four, and with four teachers that are involved in the education of the said children. Lastly, semi-structured interviews were held with four speech-language therapists and two audiologists that are involved in the provision of the intervention to hearing impaired children younger than four years. All the participants were affiliated with a specific centre for children with hearing impairment in the Western Cape province of South Africa. All the participants noted that parents must take part in the decision-making process with regards to the selection of the most suitable communication approach for their child with a hearing loss. Participants also agreed that most parents choose the auditory-verbal approach to communication development of their child because speech as a communication medium, is familiar to them and it is also associated with normality. Parents also indicated that the auditory-verbal approach is the most suitable approach for all children with a hearing loss. Teachers, speech-language therapists and audiologists did not completely agree with the parents as they mentioned some aspects, e.g. the presence of additional disabilities must be taken into account before a decision can be made regarding whether the child with hearing loss could follow the auditory-verbal approach to communication development. All participants displayed a positive attitude towards the auditory-verbal approach and it appears that parents, teachers, speech-language therapists and audiologists have good insight into the principles and outcomes of this approach.
Investigating the perceptions of speech-language therapists working in the public health and education sectors, about the services they provide to children with cerebral palsy in the greater Johannesburg region, from birth to six years
(Stellenbosch : Stellenbosch University, 2020-12) Lydall, Martha; Gerber, Berna; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : Background: Prior to entering the basic education system at six years of age, speech and language assessment, diagnosis, and treatment of children with cerebral palsy (CP), take place in hospitals and primary healthcare settings in the South African public sector. This is informed by governmental guidelines. Paediatric patients are directed through a referral pathway, ideally from a hospital setting to a primary healthcare facility for rehabilitation and issuing of appropriate assistive devices. Once children are of school-going age, they are referred to the education sector for schooling. Nearly twenty years since the establishment of the National Rehabilitation Policy, strides have been made to improve accessibility to rehabilitation services as well as the quality of life of children with CP in the health and education sectors. Shortfalls however still exist in implementing this policy. It is therefore important to explore the referral pathway that bridges these two sectors, to identify possible gaps that may occur and affect the continuity of therapy for children with CP. Aims and Objective: The main objective of this study was to investigate the perceptions of Speech-Language Therapists (SLTs) working in the Gauteng Department of Health (GDH) and Gauteng Department of Education (GDE), in Johannesburg region A, about the services they provide to children with cerebral palsy, from birth to six years of age. Participants and Methodology: A qualitative research design was followed, specifically the approach of phenomenology. A semi-structured interview protocol was employed, which consisted of open-ended questions and probes. This protocol was used to guide eight focus groups and one individual interview. A total of 31 SLTs working in public hospitals, clinics and Learners with Special Educational Needs (LSEN) schools participated. Interviews were audio-recorded for transcription and subsequent thematic analysis. Findings: The most prominent theme was that there was a perceived chasm between the GDH and the GDE in the referral process of young children with CP. Participants working in the health sector and participants in the education sector expressed frustration that highlighted the need to address the perceived lack of communication between these two sectors in the region. A recurring perception of the participants was that the GDE failed to address the specific needs of the child during school placement. Failure to place children into schools where the existing resources and infrastructure are aligned with the specific needs of the child, placed enormous strain on the rehabilitation systems, with outcomes such as increased caseloads in the health sector; strains on the curriculum; ineffective deployment of resources; and a breakdown in trust between the community and the education system. Conclusion: The results suggest that a cohesive plan should be formulated and executed in order to bridge the perceived chasm between the GDH and the GDE in the referral process of children with CP from the hospital or clinic setting, into the school environment. This may facilitate communication, collaboration, education, as well as resource sharing between the departments.
Maternal experiences of prematurity, feeding and infant communication within a vulnerable population in South Africa
(Stellenbosch : Stellenbosch University, 2020-03) Buys, Kristen H. S.; Gerber, Berna; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH ABSTRACT : Background: The concept of vulnerability, as defined by Adger (2006), relates to an individuals’ “state of susceptibility to harm, powerlessness, and marginality” (p. 286). Respectively, the ‘vulnerable’ participants consisted of mothers of preterm infants, belonging to a largely marginalised indigenous cultural community (isiXhosa-speaking), living within low socioeconomic circumstances. Preterm birth remains a rising global threat to maternal and infant mortality and morbidity, with preterm birth accounting for 5-18% of births worldwide. Mothers, and other primary caregivers of preterm infants, face many day-to-day caregiving challenges. These mothers’ experiences are influenced both positively and negatively by a myriad of factors, including traditional/cultural, socioeconomic and contextual influences. Understanding the daily realities these mothers face is thus essential in designing and providing interventions that are contextually appropriate for the patient populations. A need for and striving towards culturally competent healthcare is being globally recognised, but studies with such vulnerable populations are difficult to source. Such knowledge is necessary for evidence-based practice, however, a notable knowledge gap in terms of such vulnerable populations is evident. Aims and Objective: The main objective of this study was to describe and explain the maternal experiences of having, caring for, feeding and communicating with their (the mothers’) preterm infants in low socioeconomic circumstances in South Africa. The study explored such experiences of those isiXhosaspeaking mothers; a vulnerable population about whom limited knowledge is available. This objective was achieved through eight sub-aims. Participants and Methodology: The study employed a qualitative cross-sectional design that was explorative in nature. A semistructured discussion schedule was used to guide 15 in-depth interviews that were later thematically analysed. The participants were vulnerable mothers of preterm infants who were born and received follow-up appointments at the tertiary hospital serving as the research site. The participants’ infants were of stable medical health and between the ages of three and six months chronological age (term – three months corrected age) and had spent a minimum of one week at home after hospital discharge. Findings: Briefly, caring for a preterm infant was difficult, with concerns about medical stability and negative perceptions of tube feeding contributing to this negative initial experience. In-hospital support systems such as nursing staff, kangaroo mother care (KMC), information sessions and religious services provided positive influences throughout the hospital stays. Furthermore, homebased support systems (for example, with caregiving and chore-based, emotional and financial support) appeared to be one of the most positive aspects of mothers’ overall experiences. Additionally, prematurity influenced maternal decision-making and mothers showed high perceptions of infant vulnerability. It was also found that the hospital staff’s poor understanding and knowledge of cultural traditions surrounding infant birth impacted mothers’ abilities to participate in certain traditional practices such as Imbeleko (the first ceremony that is performed when a baby is born). Conclusion: The findings highlighted both universally shared and population-specific aspects of having and caring for a preterm infant. Important information emerged regarding influential factors within such maternal experiences, as well as information that may assist healthcare workers in providing mothers with premature infants with culture-specific care.
Mothers’ experience of feeding their preterm infant during the first months of life within a vulnerable population in South Africa
(Stellenbosch : Stellenbosch University, 2021-03) Van Schalkwyk, Elanie Antoinette; Gerber, Berna; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : Background: Preterm birth is a rising and significant threat to maternal and child health globally. Being the mother of a preterm infant is universally described as a challenging and stressful experience. Mothers of preterm infants with low socio-economic status and from linguistic minority groups, such as poor Afrikaans speaking mothers, face additional challenges that may influence their experience of caring for their preterm infant, namely poverty and limited linguistic and cultural representation within the health constitution. The universal challenges of being a mother of a preterm infant, combined with the more specific challenges of living in poverty and experiencing poor linguistic and cultural representation, bring about risks for both mother and infant. This includes poor maternal mental health; poor mother-infant bonding and attachment; and potential suboptimal developmental outcomes for the child. Research aims: The main aim was to describe and explain how Afrikaans-speaking mothers, living in low socio-economic circumstances in the Western Cape, experienced caring for their preterm infant in the first months of life. The outcomes may facilitate better understanding of the early communication and feeding intervention needs of mothers of at-risk neonates from culturally and linguistically diverse contexts living in poverty. Method: The study entailed a cross-sectional, qualitative design which was exploratory and descriptive in nature. Eleven participants, selected through a purposive sampling method, participated in individual in-depth interviews where a semi-structured discussion schedule was implemented. Nine interviews were then thematically analysed. Participants were Afrikaans-speaking mothers with low socio-economic status who brought their preterm infant (chronological age range of three to six months) for a follow-up appointment at a High-risk Clinic at a public tertiary hospital in Cape Town. The participants were a vulnerable group about whom little information was available in the research literature. Findings: The task of feeding their preterm infant during the hospitalisation period was a significant experience for the participants. Feeding was perceived as a progressive task that is goal-driven and continuously demands a new method of feeding, higher volumes of milk, and increased weight gain in the infant to reach the eventual goal of discharge from hospital. This task was perceived as stressful due to various factors of which insufficient breastmilk supply was a significant contributor. Furthermore, the hospital setting was perceived as something that added to their anxiety surrounding feeding, but simultaneously had the potential to decrease their anxiety. The mothers felt that over time and with experience both they and their infants gradually became more comfortable and skilled in the task of feeding. When the mother-infant dyad was able to breastfeed successfully it was described as an ‘amazing experience’ and one that made the participants feel like mothers at last. Conclusion: The participants experienced feeding as one of the most significant stressors related to caring for their infant, especially in the first months of life while the infant was hospitalised. Various factors were identified that had positive and/or negative influences on this experience. The study findings have implications with regard to future research, as well as education and clinical practice for all healthcare professionals working with preterm mother-infant dyads from culturally and linguistically diverse contexts living in poverty.
The perceptions of a group of Sesotho mothers, from a low socio-economic group in the Free State, on early literacy
(Stellenbosch : Stellenbosch University, 2016-12) Botha, Lyndall; Gerber, Berna; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy.
ENGLISH SUMMARY : South Africa’s education system is under scrutiny regarding the continuous poor reading performance of pupils in primary schools. South African Grade 4 and 5 pupils continue to score below the international average of reading achievement. Poor reading skills have a negative influence on the attainment of knowledge and limit opportunities later in life. Research has indicated that the foundation phase of literacy development, known as early literacy or emergent literacy, plays an important role in literacy outcomes. Research has demonstrated that children of parents from non-mainstream cultural and linguistic groups and who have a low socio-economic status, seem to be at risk for compromised literacy achievement. Little research has addressed parental perceptions regarding early literacy, particularly perceptions within specific cultural and linguistic groups. The study aimed to address this need. A qualitative research design, guided by an ethnographic approach was followed. The main aim of the study was to describe and explain the perceptions of a small group of Sesotho speaking mothers, from a low socio-economic group in the Free State, regarding early literacy. The data was collected making use of 12 standardized open-ended interviews, combined with an interview guide approach. The data was analysed using a thematic analysis process, as described by Braun and Clarke (2006). Three central themes relating to the participants’ perceptions of early literacy were identified in the data. Education was viewed by most mothers as an escape from poverty and the key to a successful life. Poverty was identified as the greatest barrier to home literacy practices and had a direct influence on the resources available in the home environment. The participants held varying perceptions regarding early literacy differences within specific groups of people, such as rich and poor; young and old; and Black and White. The participants also discussed their perceptions regarding early literacy from a cultural point of view. Limitations of the study are discussed, as well as recommendations for future research. The results have wide-ranging implications for practice. Professionals, such as speech-language therapists play a vital role in identifying and serving children at risk for compromised literacy development, while government departments play a key role in the promotion of early literacy, better education and improved living conditions for all South Africans.
The perceptions of nurses regarding the communication and cognition of persons with mild Alzheimer’s dementia, within the Tygerberg district of Cape Town
(Stellenbosch : Stellenbosch University, 2017-12) Jeske, Corinna; Gerber, Berna; Bardien, Faeza; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : This South African study aimed to determine the perceptions of a group of nurses regarding the care of mild Alzheimer’s dementia (AD), with specific reference to the communication and cognitive abilities of these patients. A convenience sample, comprising of nurses, caring for persons with mild AD, was recruited, within five homes for the elderly in the Tygerberg district, within the Cape Town area, Western Cape. A qualitative research approach was used within the phenomenological tradition. Semi-structured interviews were conducted with 12 nurses. The data collected from the interviews was analysed qualitatively, using thematic analysis, with the components of inductive analysis, latent themes and constructionist epistemology. The findings of this study indicate that there are minimal funds available for the care of senior citizens, including persons with AD, in South Africa. Minimal funding for governmental homes for the elderly leads to a few nurses often being the only health care professionals employed at these homes. The findings of this study illustrate that the majority of these nurses never received formal training with regards to AD care. These nurses were aware of a range of behavioural changes persons with AD experience due to motor, perceptual, cognitive and communicative deterioration and personality changes. They discussed both, the benefits and the challenges that these behavioural changes created, as well as coping strategies helping them overcome these challenges. It became evident that whilst nurses were aiming to provide the best care to the persons with mild AD, their focus of care was mainly on the physical aspects of care. Even though the nursing staff, in these homes, is well positioned to provide intervention to persons with mild AD in terms of their communication and cognition, they seemed to have had limited to no exposure to such interventions. The findings of this study, highlight the need for the development, presentation and administration of cognitive and communicative training interventions, aimed at the specific needs of the nurses working in governmental homes in the Tygerberg district.
Perceptions of public service speech-language therapists in the Western Cape regarding early communication intervention
(Stellenbosch : Stellenbosch University, 2021-03) De Bruin, Marisa; Gerber, Berna; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
ENGLISH SUMMARY : Objectives: This qualitative research study aimed to investigate the perspectives of Speech-Language Therapists (SLTs) providing early communication intervention (ECI) services within the multicultural and multilingual environment of the Western Cape public healthcare sector. Background: Communication delays and disorders are the most common impairment in early childhood. Appropriate and early intervention can limit the negative impact of such impairments across the child’s lifespan. Little research knowledge is available regarding the nature of ECI services in the South African public health sector. Therapists’ perceptions can be valuable in understanding the facilitators, challenges, and opportunities to good quality ECI services. Method: Data was collected by means of semi-structured interviews with 7 speech-language therapists using an interview guide. Each interview was recorded and then transcribed verbatim. Finally, open coding was applied to the transcripts, and findings emerged in the form of several themes and subthemes. Findings: The main findings that emerged from the study were; the main differences between the current and ideal ECI; challenges and facilitators to ECI service delivery; and achieving ideal ECI service delivery. Several recommendations were made by the participants, including a renewed emphasis upon training candidates that represent the cultural and linguistic characteristics of the communities that they serve; revision of policies regarding the availability of posts; and use of a group therapy approach where possible. Conclusion: The findings of this study represent a clear contrast between the current realities that ECI interventionists face and the ideal service delivery to which they strive. Several recommendations were made by the participants in the light of these findings, especially with regards to the current needs and disparities evident in the field of ECI in the public sector.
Personal protective equipment and infection prevention and control measures used by healthcare workers for early childhood intervention : a scoping review with specific relevance for speech-language therapists practising in South Africa
(Stellenbosch : Stellenbosch University, 2024-03) Achmat, Bilqees; Gerber, Berna; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech-Language and Hearing Therapy.
ENGLISH SUMMARY: Background: Within low-to-middle-income countries (LMICs) such as South Africa, there is an increased risk of children acquiring developmental delays due to the prevalence of infectious diseases and high-risk environments. Early childhood intervention (ECI) can provide long-term benefits to children at risk of developmental delays and has a positive impact on brain maturation, as it takes place during the peak of neural plasticity from birth to three years of age. Since a delay in language acquisition is often the first sign of a developmental delay, speech-language therapists (SLTs) have a key role in developing communication skills through early communication intervention. A delay in the provision of ECI can negatively impact the success of services. During the Covid-19 pandemic, all routine healthcare services were disrupted. One clear strategy to reduce the spread of infectious diseases is the use of personal protective equipment (PPE) and infection prevention and control (IPC) measures. All healthcare workers (HCWs) involved in ECI should be aware of effective PPE and IPC measures to ensure the continuation of services in the event of future infectious disease outbreaks. Research aims: This research study aimed to identify and describe the PPE and IPC measures used by HCWs in ECI as reported in the existing international literature, using a scoping review (steps 1-5). In addition, South African stakeholders were consulted to investigate how SLTs who provide early communication intervention in the local context relate to the research findings (step 6 of the scoping review). Method: A scoping review was conducted in accordance with the PRISMA-ScR framework. A total of 14 studies, none of which were older than 10 years at the time of review, were included in steps 1-5 of the scoping review. Due to limited available literature on PPE and IPC measures used by SLTs in early communication intervention, the researcher included a consultation phase (step 6) which investigated the perceptions of South African SLTs with regard to the research findings. The consultation took the form of focus group discussions. A pilot study and main study were conducted involving altogether 17 clinicians. The data from steps 1-6 were analysed using numerical and thematic analysis. Findings: The scoping review of existing literature highlighted the need for infection control in ECI, as infants and toddlers are highly susceptible to infectious diseases. The main barriers to infection control in ECI included infrastructure and system challenges, poor IPC compliance, and a lack of HCW training. There was little reflection on the nature of care and behaviour of young children which can reduce the effectiveness of IPC measures (e.g., close physical contact, increased exposure to bodily fluids, and the reliance on caregivers). Stakeholders agreed with the research findings and reported additional challenges to using PPE and IPC measures in early communication intervention. These included face masks which reduced the quality of the SLTs’ speech signal and ability to provide visual cues as a therapy technique, as well as a lack of consideration for populations with special needs. There was an evident need for guidance on providing optimal early intervention services without reducing the effectiveness of IPC measures. Conclusion: This study described PPE and IPC measures available to HCWs providing ECI, including early communication intervention. Several challenges were identified which may reduce the effectiveness of early intervention services and/or IPC measures. An awareness and understanding of these challenges can benefit future research efforts which focus on improving ECI services whilst maintaining IPC standards.
A revision of a maternal interview questionnaire used in fetal alcohol spectrum disorder prevention programmes in South Africa
(Stellenbosch : Stellenbosch University, 2014-04) Breytenbach, Elizabeth; Gerber, Berna; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy.
ENGLISH ABSTRACT: This study was done in collaboration with the Foundation for Alcohol Related Research (FARR), a non-governmental organization whose primary objective is to develop and maintain Fetal Alcohol Spectrum Disorder (FASD) prevention programmes across South Africa. Research has shown the occurrence of FASD in South Africa to be much higher than in other parts of the world. As part of their prevention programmes, FARR uses a three part diagnostic process, including a maternal interview, a dysmorphological examination, as well as a general developmental assessment. The maternal interview questionnaire that FARR currently uses takes an average of two hours per interviewee to complete. Even though a recent study indicates that FASD prevention programmes administered by FARR can potentially reduce FASD prevalence, shorter maternal interviews could improve the use of FARR resources and the ability of FASD research studies to gather meaningful information and inform future prevention efforts. The main purpose of this study was to adjust the maternal interview questionnaire used by FARR in order to make interviews with mothers shorter while delivering the information needed for successful FASD prevention programmes. Data related to the adequacy of the adjusted maternal interview questionnaire was collected and analysed according to an action research approach in four consecutive phases. The research procedures consisted of two separate focus group interviews with five key role players from FARR. During the first focus group interview the main problems with the questionnaire was identified as being (i) the length of the questionnaire, (ii) the unsuitability of the questionnaire to interview someone other than the biological mother, and (iii) inconsistency between interviewers when using the questionnaire. During the second phase of the study the questionnaire was adjusted and revised as part of a second focus group interview. The interviewers, data capturer and data analyst who used the adjusted questionnaire as part of a larger FASD prevention programme made several suggestions on how the questionnaire could be further adjusted to suit the needs of FARR. These suggestions were addressed during the final phase of the study, after which the adjusted questionnaire was finalized. Findings from the study suggest that identified problems with FARR’s original maternal interview questionnaire were successfully addressed by the adjusted questionnaire, while simultaneously satisfying the objectives of a maternal interview as identified by participants during the first focus group interview. Results confirmed that more maternal interviews could be conducted in the same time period using the adjusted interview questionnaire compared to when the original questionnaire was used, due to the fact that the questionnaire was shorter and took less time to administer. As part of this study an additional questionnaire was developed specifically for caregiver interviews. According to FARR role players, inconsistency between interviewers was for the most past successfully addressed by the development of this additional questionnaire and the development of an interviewer guideline. Recommendations for future research include the further development and evaluation of the caregiver questionnaire and interviewer guideline.

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