Masters Degrees (Speech-Language and Hearing Therapy)

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    The communication experiences of young adult stroke survivors with stroke-related communication difficulties
    (Stellenbosch : Stellenbosch University, 2024-03) Bester, Nena; De Beer, Alida; Bardien, Faeza; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech-Language and Hearing Therapy.
    ENGLISH SUMMARY: Background: The rising incidence of stroke among young adults has led to a growing population of survivors experiencing communication difficulties. Existing research highlights their frustration and feelings of invisibility, indicating a lack of acknowledgement of their unique needs in rehabilitation. This study employs the International Classification of Functioning, Disability, and Health (ICF) as a holistic framework to explore the significant impact of stroke-related communication difficulties on young adults. Research aim: The aim was to describe the communication experiences of young adult stroke survivors with mild to moderate stroke-related communication difficulties who attended a public healthcare facility for speech-language therapy services in the Western Cape. The objective was to obtain information about the participants’ 1) communication experiences, 2) communication rehabilitation experiences, 3) communication needs and 4) areas to consider in their communication rehabilitation. Methods: The study employed a cross-sectional, descriptive phenomenological design. The sample of five young adults, who ranged in age from 26 to 49 years was selected through purposive homogeneous sampling from three different healthcare facilities. Males and females were included with various communication difficulties and comorbid stroke symptoms represented. An interview guide was used for data collection via semi-structured interviews. Thematic analysis based on descriptive phenomenology was used as the data analysis approach. Findings: The data analysis yielded five main themes describing the experiences of these five young adult with stroke-related communication difficulties. The first two themes emphasize emotions they experienced in relation to communication difficulties as well as adaptation to these difficulties, aligning with the holistic perspective of the ICF. The third theme addresses intrinsic factors to consider when addressing communication difficulties in this population, relating to the ICF’s focus on personal factors. Subthemes related to this theme include awareness of their communication difficulties, insight related to the impact of these difficulties, help-seeking behaviour, physical abilities, and alternative and augmentative communication (AAC). AAC emerged as a notable coping strategy, highlighting the multifaceted nature of personal factors influencing its successful implementation. Beyond personal aspects, three subthemes related to the environment shaped the participants’ experiences, aligning with the ICF’s consideration of environmental factors. These include the environment's impact on participation, communication partners’ needs, and their influence on the independence of young adults with stroke-related communication difficulties. Lastly, the research findings illustrate the need for speech-language therapists (SLTs) to integrate the principles of the ICF into their approach to management of young adult stroke survivors with stroke-related communication difficulties. Considering both personal and environmental factors in training, feedback, and support is vital for facilitating participation in communication for young adult stroke survivors with communication difficulties. Conclusion: By exploring emotional aspects, personal factors, environmental influences, and the contribution of SLTs, it is possible to develop more nuanced and personalised rehabilitation strategies for young adults with stroke-related communication difficulties. Aligned with the principles of the ICF, such strategies hold the potential to enhance the quality of life, communication, and communication rehabilitation experiences for young adults with stroke-related communication difficulties.
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    Language assessment practices in the diagnosis of specific language impairment in school-age children from culturally and linguistically diverse backgrounds : a scoping review
    (Stellenbosch : Stellenbosch University, 2024-03) Moosa, Farzaana; Dawood, Gouwa; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech-Language and Hearing Therapy.
    ENGLISH SUMMARY: Background: As cultural and linguistic diversity increases due to the rise of global migration, the emphasis on providing equitable speech therapy services intensifies. The diverse nature and complexity of each language makes it challenging for clinicians to accurately diagnose Specific Language Impairment (SLI) in children from diverse backgrounds. It has been an active topic in the literature for more than a decade, yet appropriate countrywide assessment practices have still not been clearly defined, due to the cultural and linguistic diversity (CLD) of South Africa. Speech language therapists (SLTs) face universal challenges regarding the lack of appropriate and comprehensive assessment measures that accurately represent the CLD population and are unbiased. The challenges further include navigating diagnostic procedures for use by clinicians who do not possess proficiency in their client's home language, as well as a shortage of explicit guidelines. Research aim: Given the limited clinical guidelines available to assess this population, the scoping review aimed to determine the extent of available research regarding language assessment practices for the diagnosis of SLI in CLD school-aged children. The study further aimed to investigate the perception of South African SLTs concerning the feasibility of the assessment practices identified in the review. Method: The scoping review consisted of two phases. Phase one comprised the literature review investigating language assessment practices for the diagnosis of SLI (steps one to five). Thereafter, Phase two, the consultation phase (step six), was conducted using questionnaires. Eight South African SLTs working within the private and state sectors with school-aged learners from CLD backgrounds participated in the stakeholder consultation phase. Findings: A total of 32 articles were reviewed and included in the scoping review. The following themes were identified based on the literature: criteria for the diagnosis of SLI, procedure of assessment, and language assessment tools for the diagnosis of SLI. Although the eight SLTs who were consulted shared standard criteria for diagnosis, there were differences in the procedures and materials used for assessments. Conclusion: This scoping review provides summarised evidence from existing literature about assessment practices and drawing together the experiences of South African SLTs, who have resorted to informal language assessment approaches by amending existing tests to be more culturally inclusive. The current review highlighted the need for CLD-appropriate language assessment resources and specific evidence-based guidelines for the diagnosis of SLI in children from CLD backgrounds. These resources should optimally include contextually relevant norms in each language, which would ensure a more precise determination of diagnostic criteria cut-off points on language assessments.
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    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.
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    Translation and adaptation of the multilingual assessment instrument for narratives into isiZulu
    (Stellenbosch : Stellenbosch University, 2024-03) Ndlovu, Blessing Ntokozo; Klop, Daleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech-Language and Hearing Therapy.
    ENGLISH SUMMARY: South Africa faces a shortage of linguistically and culturally appropriate speech and language assessments for its multilingual and multicultural population. Clinicians and educators often struggle to differentiate between language impairment, language delay and second-language learning characteristics. The Multilingual Assessment Instrument for Narratives (MAIN) (Gagarina, Klop, Kunnari, Tantele, Valimaa, Balciuniene, Bohnacker & Walters, 2012) was developed for use in multilingual and multicultural contexts, like South Africa, for assessment of narrative comprehension and production. The MAIN’s theoretical basis is the Stein and Glenn (1979) story grammar model, which is hypothesised to be invariant across languages. The goals of this study were to translate and adapt the English version of the MAIN into isiZulu, and to determine the linguistic, cultural and functional equivalence between the two language versions. The study was conducted in three phases. Phase one aimed to translate the English MAIN into isiZulu using a double translation and reconciliation method, guided by the International Test Commission (ITC) Guidelines for Translating and Adapting Tests (second edition). Phase two aimed to describe 5 translation reviewers’ perspectives regarding the linguistic and cultural equivalence of the newly translated Zulu MAIN to the English MAIN. Phase three aimed to determine the functional equivalence of the Zulu MAIN to the English MAIN for the Cat and Dog and Baby Birds and Baby Goats story combinations using the telling elicitation mode. Phase three used a quantitative within-subject, repeated measures study design. Twenty-eight participants in Grade 4 (aged 9-11 years) were recruited from a dual medium school in Katlehong, Gauteng. Inferential statistics was used to analyse the scores for macrostructure, structural complexity, internal state terms and comprehension. The study showed that linguistic and cultural equivalence was achieved by the adaptation of the Zulu MAIN to not only make it equivalent to the English version, but also appropriate for the Zulu population. Translation reviewers pointed out linguistic differences namely, difference in commonality of the Zulu words (linked to varieties of isiZulu), changes in translation and differences in the length of story scripts across the two languages. Phase 3 found that the Zulu and English versions of the MAIN are functionally equivalent for the Cat and Dog story combination only, thus supporting the theory of language invariance of story grammar particularly the Stein & Glenn (1979) model. Participants had higher macrostructure scores, more complex narratives, more internal state terms (ISTs) and higher comprehension scores for the Baby Birds and Baby Goats narratives that they told in isiZulu than those they told in English. The study found that the Baby Birds and Baby Goats for isiZulu and English are not functionally equivalent and recommended the use of the Cat and Dog story combination for bilingual comparison.
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    Verwantskappe tussen leksikale en narratiewe begrip en produksie en vroee ontwikkelingsmetings
    (Stellenbosch : Stellenbosch University, 2024-03) Swart, Anike; Klop, Daleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech-Language and Hearing Therapy.
    AFRIKAANSE OPSOMMING: Hierdie studie ondersoek die verband tussen vroee taalontwikkeling en vroee algemene ontwikkeling in ʼn voorskoolse bevolking van ʼn laer sosio-ekonomiese agtergrond in die Wes-Kaap, Suid-Afrika. Twee dimensies van vroee taalontwikkeling, naamlik leksikale ontwikkeling en narratiewe ontwikkeling, is in terme van vier komponente ondersoek: leksikale produksie en begrip, asook narratiewe produksie en begrip. Verder is vroee algemene ontwikkeling oor vyf dimensies geassesseer: grofmotoriese ontwikkeling, fynmotoriese koordinasie en visueel-motoriese integrasie, vroee syfervaardigheid en wiskunde, kognisie en uitvoerende funksionering, en vroee geletterdheid en taal. Die vier hoofdoelwitte van die navorsing was: 1) om verwantskappe en korrelasies tussen die dimensies en komponente van vroee taalontwikkeling en vroee algemene ontwikkeling te ondersoek deur beskrywende statistiek, kruistabulering en korrelasies; 2) om die invloed van waarneembare veranderlikes (leksikale ontwikkeling en narratiewe ontwikkeling) as dimensies op die latente konstruk van vroee taalontwikkeling te ondersoek deur gebruik te maak van bevestigende faktoranalise (CFA); 3) om die impak van waarneembare veranderlikes (grofmotoriese ontwikkeling, fynmotoriese koordinasie en visueel-motoriese integrasie, vroee syfervaardigheid en wiskunde, kognisie en uitvoerende funksionering, en vroee geletterdheid en taal) as dimensies op die latente konstruk van vroee algemene kognitiewe ontwikkeling te verken (gebruik ook CFA); en 4) om die a priori-hipotese van ʼn oorsaaklike verband tussen vroee taalontwikkeling en vroee algemene kognitiewe ontwikkeling te toets deur gebruik te maak van strukturele vergelykingsmodellering (SEM). Die teoretiese raamwerk van hierdie studie is gebaseer op CFA, wat aangewend is om die dimensionaliteit van vroee taalontwikkeling te ondersoek. Die studie bou voort op die bevindinge van Massonnie et al. (2022). Daar word ondersoek of CFA se struktuur vroee taalontwikkeling voldoende kan vasvang, met inagneming van linguistiese aanwysers van geassesseerde taalvaardighede. Die komponente van vroee taalontwikkeling (leksikale ontwikkeling en narratiewe ontwikkeling) en hul modaliteite (produksie en begrip) is as dimensies van vroee taalontwikkeling geklassifiseer. Die volgende meetinstrumente is gebruik: Cross-Linguistic Tasks (CLT) (Southwood, 2012), Multilingual Assessment Instrument for Narratives (MAIN) (Klop & Visser, 2020) en Early Learning Outcome Measure (ELOM) (Dawes et al., 2016). Ten slotte werp hierdie navorsing lig op die ingewikkelde wisselwerking tussen vroee taalontwikkeling en algemene ontwikkeling by voorskoolse kinders. Die studie bevind dat daar beduidende korrelasies tussen leksikale ontwikkeling en narratiewe ontwikkeling is, asook ‘n oorsaaklike verband tussen vroee taalontwikkeling en algemene ontwikkeling is. Deur die gebruik van CFA en SEM, verskaf die studie insig in die onderliggende dimensies en oorsaaklike verbande tussen hierdie ontwikkelingsdomeine. Die bevindinge le klem op die belangrikheid van vroee taalvaardighede as kritieke voorspellers van latere kognitiewe en geletterdheidsuitkomste, wat die potensiaal beklemtoon vir geteikende intervensies om sosio-ekonomiese ongelykhede aan te spreek en optimale ontwikkeling by jong kinders te bevorder.