Introduction and rationale: Clinical experience with infants presenting with feeding difficulties and increasing referrals of infants with colic led to this study. There is uncertainty whether the speechlanguage therapist should play a role in the management of this condition. Despite extensive clinical research into the multiple factors related to the condition, the etiology of infantile colic has not yet been established. Suck- swallow-breathing coordination (SSBC), which is key to successful feeding, has not yet been investigated as a factor in this condition. Goals: The goal of the study was to give a comprehensive description of the symptoms and the SSBC of a group of young infants with colic. Sub-goal 1 was to compile a list of symptoms based on a description by parents of infants with infantile colic, which could be used to compare symptoms of a group of infants with the condition to a group without the condition. Sub-goal 2 was to describe SSBC, in a group of infants with the condition, by conducting a clinical assessment. Sub-goal 3 was to compare SSBC in a group of infants with colic to a group without the condition of the same age. Method: A descriptive survey design and interview guide was used in Phase 1. The parents of 60 infants with colic participated in this study. A correlation research design (Phase 2) and the List of symptoms for Infantile Colic (compiled in Phase 1) as well as the Assessment Protocol for SSBC (compiled in Phase 2) were used. A new research group of 50 participants with infantile colic and a control group of 28 participants with the condition, whose ages correlated with those of the research group, was selected. An interview was conducted with the parents of all participants. SSBC was clinically assessed in all the participants. Results: Parental description of infantile colic resulted in a comprehensive list of 27 symptoms. Audible swallowing of air and a feeding duration of more than 20 minutes were described more by parents than found in the literature. Statistically significant differences were found when the postural control and SSBC of the research group were compared with the control group. The difficulties with SSBC differed across the age categories of the participants. Conclusion: The study indicated that infantile colic is related to a disturbance in postural control and components of SSBC, and infants with the condition have subtle feeding difficulties. The speech-language therapist therefore has a role to play in the clinical assessment of infantile colic and the development of treatment strategies. / Dissertation (MA)--University of Pretoria, 2014. / lk2014 / Speech-Language Pathology and Audiology / MA / Unrestricted

Infants, toddlers and young children with cleft lip and palate (CLP) often present with multiple risk profiles due to the complex interaction between genotypical, phenotypical and environmental risk factors influencing their communication development at different ages. Current research recommends the need for a comprehensive early communication intervention (ECI) approach to the treatment of young children with CLP. The areas of strength and weakness in communication development and the factors influencing children with CLP at specific age-group intervals are under-emphasized. The aim of this study was to identify and describe the age-specific risk factors and assets which could influence the communication development of young children with CLP visiting a university-based ECI clinic, the Clinic for High-Risk Babies (CHRIB). Furthermore, the developmental areas of strength and weakness in the child with CLP at three specific age-group intervals, ranging from 1 month to 48 months were described. A retrospective, descriptive, between-subject developmental design with a correlation approach was employed. Purposive sampling was implemented as a non-randomized sampling method and 227 participants were included in the study. The data was extracted from the CHRIB database and analyzed by means of basic descriptive and advanced inferential statistical methods. Extensive data processing of all the potential factors that could have an influence on the early communication developmental areas of children with CLP was performed. A final analysis of the most important associations was performed in the SPSS. The findings revealed that expressive and receptive language and listening skills presented as the most vulnerable communication areas across all three age-groups. The cumulative effect of the risk factors was the greatest in the *[12;24) months age-group since this age group presented with the highest frequency of delayed communication development. The majority of participants in all three age-groups presented with areas of strength, which include age-appropriate cognitive skills, pragmatic development, gestural development and gross motor development. Low birth weight presented as a persistent phenotypical risk factor which influenced the development of functions related to language use in the [1;12) and [12;24) months age groups, and gross motor development and receptive language in the *[12;24) months age group. The environtypical factors such as education and occupation of the mother, as well as the type of day care, indicated significant associations with listening skill development in the [1;12) months group and with the development of functions relating to language use in the [12;24) months age group. Parent-child interaction showed recurrent significant associations with receptive and expressive language across the three age groups. The findings indicated that young children with CLP have unique communication profiles at different age intervals and that these age-specific risk factors and assets should be recognized to ensure a comprehensive approach to ECI services to these young children and their families. / Dissertation (MCommunication Pathology)--University of Pretoria, 2011. / Speech-Language Pathology and Audiology / Unrestricted

The traditional role of speech-language therapists as feeding specialists appears to have focused primarily on the mechanics of feeding disorders, without fully considering the impact of nutritional needs on a child's development and communication. The aim of the study was to investigate the experiences and perceptions of a group of speech-language therapists regarding nutritional issues in children requiring feeding therapy or early communication intervention. A qualitative research design was employed in the form of a descriptive survey and a questionnaire was compiled as the data collection instrument. Forty-nine questionnaires were delivered to speech-language therapists within the Johannesburg and Pretoria geographical areas, of which 32 were suitable for analysis. Closed ended questions were analyzed quantitatively using descriptive statistics while responses to open-ended questions were categorized thematically. Results indicated that all respondents came into contact with clients who had, or who were at risk for, feeding disorders and nutritional deficiencies. However, findings revealed that during assessment and treatment of these clients, respondents tended to neglect issues related to nutrition, as well as psychosocial issues pertinent to feeding disorders. Furthermore, respondents appeared not to have fully realized the importance of their role as communication specialists within the feeding context. It was found that the majority of respondents were involved within a multidisciplinary team approach; however, the application of the more effective transdisciplinary approach was limited. This was confirmed by results revealing that collaboration with other professionals, such as dieticians, did not consistently occur. In terms of training, it was evident that respondents received the majority of their training in feeding therapy from continued education, which included aspects of nutrition. However, undergraduate training was perceived as having limitations within the theoretical content as well as practical application, and did not incorporate nutritional aspects. In light of the apparent need for a more holistic view of paediatric clients with feeding disorders, suggestions were made regarding the inclusion of vital nutritional issues and psychosocial factors within training and transdisciplinary service delivery in South Africa. Furthermore, relevant research topics within the field of paediatric feeding were presented. Broadening perspectives by means of holistic research and training may enhance service delivery to children with paediatric feeding disorders. / Dissertation (MCommPath)--University of Pretoria, 2002. / tm2015 / Speech-Language Pathology and Audiology / MCommPath / Unrestricted

Research guides the parameters for assessment and treatment of individuals with cleft lip and/or palate (CL/P). Most developing countries cannot provide an adequate standard of cleft care, due to limited resources. Speech-language therapists and audiologists in developing countries can contribute to improving cleft care through early communication intervention to minimise/prevent the negative impact of a cleft on a young child’s communication ability and to support the families. However, they require linguistically and contextually relevant assessment instruments for early identification of communication disorders in these children. The aim of the research was to develop and evaluate a communication assessment protocol for young children with CL/P, for use in Mauritius, a developing country in the Indian Ocean with a multilingual and multicultural population. A further aim was to develop an electronic database of children with CL/P in the public health sector of Mauritius. Eighty-eight children, with CL/P, 0-6 years, were selected by consecutive sampling and their parents acted as participants. Four speech-language therapists and audiologists from the public health sector of Mauritius participated in the data collection and appraisal of the newly developed assessment protocol. A mixed methods research design was selected. Based on exploratory research of cleft care in Mauritius and international recommendations for assessment of young children with CL/P, a comprehensive Communication Assessment Protocol was compiled and speech elicitation materials in Creole and French were prepared. Speech-language therapists and audiologists conducted assessments, using non-invasive procedures to assess feeding, hearing, communication skills development, emergent literacy skills, speech production and voice of the participants. Digital video and audio recordings of the elicited speech samples were made and auditory-perceptual procedures for speech analysis and inter-rater comparisons for reliability were employed. The communication assessment protocol was useful in describing the characteristics of the children with CL/P treated in the National Health System in Mauritius. The speech-language therapists and audiologists together with the parents of the children as partners in assessment were successful in early identification of communication delays/disorders in children with CL/P (73%) and also referrals to other health care professionals. The protocol was evaluated and accepted for application in clinical practice. The newly developed Communication Assessment Protocol was applied by local speech-language therapists and audiologists with the possibility of implementing this assessment instrument nationally. This was an important contribution to improve cleft care in Mauritius where interdisciplinary team-based cleft care has not occurred to date. / Thesis (DPhil)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / Unrestricted

The focus of this book is on speech production and speech processing associated with cleft palate, covering phonetic (perceptual and instrumental), phonological and psycholinguistic perspectives, and including coverage of implications for literacy and education, as well as cross-linguistic differences. It draws together a group of international experts in the fields of cleft lip and palate and speech science to provide an up-to-date and in-depth account of the nature of speech production, and the processes and current evidence base of assessment and intervention for speech associated with cleft palate. The consequences of speech disorders associated with cleft on intelligibility and communicative participation are also covered. This book will provide a solid theoretical foundation and a valuable clinical resource for students of speech-language pathology, for practising speech-language pathologists, and for others interested in speech production in cleft palate, including researchers and members of multi-disciplinary cleft teams who wish to know more about the nature of speech difficulties associated with a cleft palate.

The study identifies the increase in populations at risk for communication disorders world-wide and in South Africa as one the reasons for research to develop early communication intervention (ECI) services as a societal responsibility in South Africa. Since ECI is largely an unknown entity in the South African health system, but shares several mutual objectives, the dire need for data of populations at-risk validates the development of a computer-based relational data system as a 21st century research tool for ECI. Underpinnings for the development of a research database for ECI were obtained from the use of database management systems for early intervention in the USA, identified as leaders in the application of database technology in the field of Speech-Language Pathology. The aim of the study was to develop and establish a computerized database system to describe the characteristics of young children at risk for communication disorders enrolled in an existing ECI programme. Using a descriptive survey as research design, a rich description of 153 subjects and their families was obtained. The findings relating to the multiple risk profiles of the subjects revealed results not extensively described or emphasized in the literature, indicating the in-depth analysis of results that is possible when utilizing a database approach to research. The complex risk profile found in the subgroup of subjects with cleft lip and palate is an example of a need for further investigation. The results also indicated the critical importance of early identification of risk events throughout a child’s life to improve the efficacy of ECI services. Further results emphasized the important role of parents to identify the early signs of risks for communication disorders in their children, provided they are equipped with the necessary knowledge. A conceptual framework for the early identification of risks for communication disorders is proposed for best practice in ECI in South Africa. The study concluded that the CHRIB database system was successfully applied in the empirical research and is now established as a versatile 21st century research tool to be utilized in second generation research in ECI in South Africa. / Thesis (DPhil(Communication Pathology))--University of Pretoria, 2005. / Speech-Language Pathology and Audiology / Unrestricted

AFRIKAANS : Rasionaal: Die Suid-Afrikaanse konteks is heterogeen van aard en word gekenmerk deur ʼn kontinuum van ontwikkelende tot ontwikkelde gesondheidsdienste. Daar word beraam dat 55% van kinders (0-3 jaar) in landelike Suid-Afrikaanse gebiede woon, waar armoede heers en die infrastruktuur onvoldoende is. Die ongunstige omgewings omstandighede van talle kinders woonagtig in Suid-Afrika verhoog die risiko vir gestremdhede en plaas babas en kleuters in ʼn groter gevaar vir die ontwikkeling van ʼn kommunikasieafwyking, wat die behoefte aan effektiewe Vroeë Kommunikasie Intervensie (VKI) dienslewering in dié konteks beklemtoon. Primêre Gesondheidsorgklinieke (PGS) kan beskou word as die ideale konteks binne die Suid-Afrikaanse realiteit waar VKI programme en VKI dienslewering geïmplementeer kan word. Deur VKI dienslewering binne die Primêre Gesondheidsorgklinieke te implementeer, kan samewerkende dienslewering tussen VKI en Primêre Gesondheidsorg verhoog word. Beide die Primêre Gesondheidsorgmodel en die VKI benadering stel voorkoming en die vroeë identifikasie van afwykings as sentrale doelwit voor. Die implementering van VKI in die Suid-Afrikaanse Gesondheidsorgsisteem is deur talle navorsers geïdentifiseer as die wyse waarop die dienste aan babas en kleuters wat ʼn risiko toon vir die ontwikkeling van ʼn kommunikasieafwyking bevorder kan word. Deur die implementering van VKI dienslewering op die vlak van Primêre Gesondheidsorgklinieke, kan die basiese beginsels van VKI naamlik, dienslewering wat gemeenskapsgebaseerd, familie-gesentreerd, omvattend en gekoördineerd is, geïmplementeer word. Doel: Die hoofdoel van hierdie studie was om te bepaal in watter mate Gesondheidsorgklinieke in die Wes-Rand streek as konteks vir die toepassing van VKI kan dien. Metode: ʼn Beskrywende kwantitatiewe opname is as navorsingsontwerp vir beide fases benut. Ten einde die doel van die studie te bereik, is die navorsing in twee fases uitgevoer, omdat die navorsingsproses kronologiese verloop het en daar eerstens in fase een gefokus is op die konteks vir diensverskaffing, en tweedens in fase twee op die diensverskaffers. Fase een het ʼn konteks analise behels om sodoende die fisiese konteks waarbinne die sorggewers en hul kinders wat ʼn risiko vertoon vir die ontwikkeling van ʼn kommunikasieprobleem dienste ontvang, te beskryf en te evalueer deur die voltooiing van ʼn afmerklys wat vooraf deur die navorser opgestel is. Fase twee het ʼn triangulasie navorsingsmetode benut deur gebruik te maak van ʼn gestruktureerde onderhoudskedule, sowel as die voltooiing van ʼn opgestelde vraelys. Die afmerklys in fase een, die gestruktureerde onderhoudskedule, en die vraelys in fase twee het as data-insamelingstegnieke vir die navorsingsprojek gedien. Respondente en Deelnemers: Vir Fase 1 is 12 Primêre Gesondheidsorgklinieke in die drie sub-distrikte van die Wes-Rand distrik benut vir die konteksanalise. Vir Fase 2 is agt terapeute in hulle gemeenskapsdiensjaar wat werksaam is in die Wes-Rand distrik as deelnemers benut vir die bespreking van die vooraf geïdentifiseerde temas gedurende die gestruktureerde onderhoudskedule. 34 gemeenskapsverpleegkundiges van die Wes-Rand distrik is as respondente gebruik vir die voltooiing van die vraelys. Bevindinge: Die bevindinge het daarop gedui dat die Primêre Gesondheidsorgklinieke nie voldoende toegerus is vir die verskaffing van VKI dienslewering nie, ten spyte van die teenwoordigheid van risikofaktore onder die kliniekpopulasie. Verder was daar geen VKI bemarkings-, evaluasie- en intervensiemateriaal in die klinieke beskikbaar nie. Resultate het egter daarop gedui dat daar op ʼn weeklikse basis by elkeen van die Primêre Gesondheidsorgklinieke die moontlikheid bestaan van ʼn VKI span, aangesien daar ʼn spraak-taalterapeut, arbeidsterapeut, fisioterapeut, dieetkundige, maatskaplike werker, mediese dokter en verpleegkundige weekliks op dieselfde dag beskikbaar is. Die gemeenskapdiensjaarterapeute was positief ten opsigte van vroeë identifikasie en sekondêre voorkoming as sleutelkomponente van VKI. In teenstelling met die terapeute se positiwiteit t.o.v. vroeë identifikasie en voorkoming en in ooreenstemming met die bevindinge in Fase 1, was die terapeute van mening dat VKI tans nie suksesvol binne die Primêre Gesondheidsorgklinieke geïmplementeer sal kan word. Die gemeenskapsverpleegkundiges se kennis rakende VKI en aspekte wat verband hou met VKI was nie bevredigend nie. Die verpleegkundiges se houding jeens ʼn spanbenadering was positief, wat aan die spraak-taalterapeute die geleentheid bied om in samewerking met die verpleegkundiges die implementering van VKI binne hierdie konteks te motiveer en te implementeer. Gevolgtrekking: Die resultate van die navorsing hou implikasies in vir die rol van die spraak-taalterapeut ten opsigte van gemeenskapsgebaseerde intervensie, voorkoming, vroeë identifikasie, en die opleiding en bemagtiging van sorggewers en spanlede wat betref VKI binne die Suid-Afrikaanse Primêre Gesondheidsorgklinieke. Die behoefte aan verdere navorsing in die veld is deur die bevindinge van die studie beklemtoon. ENGLISH : Rationale: The South- African context is a heterogeneous context that is characterized by a continuum of developing to developed health care services. It is estimated that 55% of children (0 to 3 years) live in rural areas with insufficient infrastructure and under extreme conditions of poverty. Children living in South Africa are at greater risk for the development of a communication disorder due to the unfavourable environmental circumstances that they live in, which emphasizes the need for Early Communication Intervention (ECI) services in South Africa. Primary Health Care Clinics can be seen as the ideal context within South Africa where ECI programs and service delivery can be implemented. Both the Primary Health Care Model and the principles of ECI service delivery focuses on prevention and early identification of developmental disorders as their main goal. Many authors view the implementation of ECI in South Africa’s health system as the way in which the appropriate services can be provided to babies and infants that are at-risk for a communication disorder. Implementing ECI on the level of the Primary Healthcare will allow for the provision of services that are in accordance with the basic principles of service delivery stipulated by ASHA (1989), namely services that are community-based, family-centered, coordinated and comprehensive. Aim: The main purpose of the study was to determine the degree in which the Primary Health Care Clinics in the West-Rand district can be used for the implementation of Early Communication Intervention (ECI). Method: An exploratory, descriptive and contextual research design was implemented for both phases, which incorporated both quantitative and qualitative paradigms. This study was conducted in two phases. In Phase One a context analysis was conducted, where by a checklist was completed by the researcher, in order to describe and evaluate the context where children who are at risk for the development of a communication disorder, and their parents, may receive services. In Phase two a triangulation method was followed and the researcher made use of a structured interview to discuss the themes and a questionnaire in order to obtain information regarding the perception of the nurses and community service therapists on ECI services and the implementation of ECI services in the Primary Health Care Clinics. The checklist in phase one, the structured interview, and the questionnaire in phase two were used as data collection methods during this research project. Respondents and Participants: For the context analysis in Phase One, 12 Primary Health Care Clinics in the West-Rand district were used. Phase Two utilized 8 therapists as participants that were employed by the Wes-Rand health district to complete their community service year. 34 community nurses, employed by the West-Rand district were utilized as respondents and completed the questionnaire. Results: The findings of the study indicated that the Primary Health Care Clinics were not appropriately equipped for the implementation of ECI service delivery, despite the presence of risk-factors under babies and children visiting the clinics. There were no available ECI marketing-, assessment-, and intervention material at the clinics. It is promising to have found that there is the possibility of the implementation of an ECI team at each of the clinics, seeing that there is a speech-language therapist, occupational therapist, physiotherapist, dietician, social worker, medical doctor and nurse available on the same day on a weekly basis. The community service therapists were positive regarding early identification and the secondary prevention of communication disorders as key components of the ECI process. In contrast with their positive attitudes towards these aspects, they were of the opinion that due to proposed challenges in this context, at this stage, it will not be possible to implement the ECI process in the Primary Health Care Clinics. The community nurse’s knowledge regarding ECI and the aspects related to ECI were not appropriate. Despite this, they demonstrated a positive attitude towards the implementation of a team approach, which gives the speech-language therapist’s the opportunity to work with the nursing staff in a team approach, to implement ECI within the Primary Health Care Clinics. The participants in Phase Two were aware of the importance of ECI and the need for ECI services in this context, but they were of the opinion that the implementation of ECI in this Primary Health Care Context would not be possible due to a variety of reasons. The respondents in Phase Two demonstrated inappropriate knowledge and awareness regarding ECI, communication development, communication disorders and the role of the speech-language therapist and audiologist in the Primary Health Care Context. The majority of the respondents were positive about in-service ECI training, regardless of their limited knowledge thereof. Conclusion: The results have implications for the role of the speech-language therapist in terms of community-based intervention, prevention, early identification, parent training and informing colleagues about ECI within the South African Primary Health Care Clinics. The need for further research in this field is emphasized. Copyright / Dissertation (MComm Path)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / Unrestricted

Although the importance of early identification and intervention of infants at risk for communication delays and disorders have been advocated and emphasized in literature, case finding and service delivery in rural areas in South Africa appears to be problematic. The implementation of early communication intervention (ECI) within public service delivery has been proposed in the past. The primary health care (PHC) package had to be considered as a possible vehicle to be utilized for the implementation of ECI functions in rural communities. Against this background the existing identification methods and referral systems, utilized in Ditsobotla sub-district, were described in the current study to determine the limitations in case finding, and the feasibility of the implementation of ECI functions in collaboration with other PHC programmes. A descriptive dominant-less-dominant model provided the design to describe the identification process and teamwork in Ditsobotla sub-district. Data triangulation was utilized to improve reliability and validity of results which entailed a rating scale, face-to-face interviews with PHC personnel (participants in Group 1) and face-to-face interviews with PHC programme managers (participants in group 2). The results indicated that the capacity of facilities and human resources to support the implementation of ECI functions vary within the sub-district. Therefore an incremental implementation of ECI functions is feasible in collaboration with the existing PHC package. The current identification methods and referral systems are limited and a great need for collaboration exists. ECI functions need to be implemented formally within the PHC package and guidelines for such an implementation are provided. Furthermore the identification process to be introduced needs to form part of the incremental implementation of ECI functions. The implications are discussed in terms of ECI service delivery in rural South Africa. The proposed process of incremental implementation of ECI functions in rural areas, i.e. Ditsobotla sub-district, within the PHC package is provided. The need to develop identification methods, referral systems and guidelines for the implementation of ECI in PHC are emphasized. Future practice-based research is recommended in order to improve ECI service delivery in rural areas in South Africa. Copyright / Dissertation (MCommunication Pathology)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / Unrestricted

Advances in neonatology have led to increased numbers of high-risk neonates surviving and intensified interest in the developmental outcomes of this population. In the South African context prematurity and low birth weight are the most common causes of death in the perinatal period and the same risk factors that contribute to infant mortality also contribute to the surviving infants’ increased risk for developmental delays. As a result of the interacting biological and environmental risk factors of prematurity, low birth weight, poverty and HIV and AIDS in the South African context Kangaroo Mother Care (KMC) has been developed as best practice to promote infant survival and to facilitate mother-infant attachment. Mother-infant attachment may lead to synchronous interaction patterns between the mother and infant which forms the basis of early communication development. Early communication intervention (ECI) services are recommended as early as possible as high-risk infants are especially at risk for feeding difficulties and communication developmental delays. It is, however, not clear what the content of an ECI programme should be and how it should be implemented according to the changing communication and feeding developmental needs of the infant while receiving KMC. There appears to be a dearth of research on the earliest stages of communication development in high-risk neonates, which should form the foundation of such a programme. A descriptive survey was conducted to describe the development of 25 high-risk infants and their mothers’ changing needs from admission to discharge from a KMC unit. Each participant and mother dyad was followed up over an average of 11 days of data collection with three to four data collection sessions. Data was collected by means of direct observation during routine care-giving activities. The different developmental subsystems of the participants’ feeding, communication, neuro-behavioural organization and mother-neonate interaction were described. The results demonstrated that subtle, but definite changes could be observed in the participants’ development. Development in all the different areas occurred over time as the participants progressed through the three developmental states of the in-turned state, coming-out state and reciprocity state. As the participants progressed during the 11 days of data collection and were increasingly able to attend to their environment, they also developed the ability to regulate and organize their own behaviour in order to develop more complex communication, feeding and interaction skills with their mothers. The functioning of the participants’ sensory systems developed in a specific order namely tactile, auditory and then visual. Although the participants developed consistently throughout their stay in the KMC unit, mother-neonate interaction never reached optimal levels. The importance of an individualized training programme for each mother is reflected in the finding that the neonate’s developmental level and progress needs to be considered when implementing the ECI programme. The need for speech-language therapy involvement in KMC is emphasized in the light of a shortage of practicing speech-language therapists in South Africa. It is therefore imperative that the prevention of communication delays and feeding difficulties in high-risk neonates as well as parent training assume priority. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / unrestricted

Neonatal communication intervention is important in South Africa, which has an increased prevalence of infants born with risks for disabilities and where the majority of infants live in poverty. Local literature showed a dearth of information on the current service delivery and roles of speech-language therapists (SLTs) and audiologists in neonatal nurseries in the South African context. SLTs have the opportunity to provide the earliest intervention, provided that intervention is well-timed in the neonatal nursery context. The aim of the research was to compile a locally relevant neonatal communication intervention instrument/tool for use by SLTs in neonatal nurseries of public hospitals. The study entailed descriptive, exploratory research. During phase 1, a survey was received from 39 SLTs and 2 audiologists in six provinces. The data revealed that participants performed different roles in neonatal nurseries, which depended on the environment, tools, materials and instrumentation available to them. Many participants were inexperienced, but resourceful in their attempts to adapt tools/materials. Participants expressed needs for culturally appropriate and user-friendly instruments for parent guidance and staff/team training on the topic of developmental care. During phase 2, a tool for parent guidance titled Neonatal communication intervention programme for parents was compiled in English and isiZulu. The programme was piloted by three participants. Suggestions for enhancements of the programme were made, such as providing a glossary of terms, adapting the programme's language and terminology, and providing more illustrations. SLTs and audiologists must contribute to neonatal care of high-risk infants to facilitate development and to support families.