Speech-language pathologists have no clear guidelines on how to assess, diagnose or treat bilingual children with speech disorders. This thesis addresses this issue. The phonological development of 91 Cantonese-English and Punjabi-English bilingual children is described. Two Cantonese-English bilingual children's phonological development over the year they were first exposed to English is also presented. The bilingual children's phonological systems were clearly differentiated. The bilingual children's speech also included many phonological processes that would be considered atypical for a monolingual child. The use of these processes is argued to be characteristic of normal bilingual development. The longitudinal data showed that the atypical error patterns were transient and directly related to the introduction of the second language. Some `atypical' error patterns could be plausibly explained by referring to the nature of the two phonological systems. Other atypical processes could be explained by language-specific differences in normal developmental or adult variation patterns. This thesis argues that the differences evident in the bilingual children's phonological patterns are due to `hypothesis testing' resulting in underspecified realisation rules. There was no indication that bilingual children process phonological input and output differently to monolingual children. However, they differentiate the cognitive-linguistic information they abstract from the two languages, and they use separate phonological realisation rules for each language. This thesis argues that bilingual children use the same phonological processing mechanism for both languages, however they are able to filter each language through the appropriate language-specific phonological information. Case studies of 21 children with disordered speech and treatment case studies of 2 children are also presented. The disordered speech data supports current psycholinguistic models of speech processing the hypothesised levels of breakdown fit with the error profiles evident. The bilingual children with speech disorder validate Dodd's (1995) classification system: four different types of disorder were evident. The results of the two treatment case studies presented suggest that unless intervention targets the underlying deficit the effect of intervention will be language-specific. The investigation into bilingual children with disordered speech indicates that speechlanguage pathologists need to assess both languages of a bilingual child to determine the language-specific patterns and the type of disorder and that it is important to compare bilingual children to their bilingual normally developing peers, not to monolingual developmental data.

Late language emergence (LLE) may result from genetic and environmental factors. Little is known about environmental factors in LLE in South Africa. The study describes the nature of differences in language functioning between toddlers with LLE and without LLE, and which factors were associated with LLE in a middle-income area in South Africa. Toddlers, aged 24- to 36 months with LLE (n=20) were matched with a control group (n=21) for household income, age, gender, maternal education and parental employment. The research group showed moderate delays in expressive and receptive language, and play skills, while the controls exhibited no delay. Significant differences in early feeding history and multilingual exposure were found between the groups. As far as known it is the first study utilising a South African middle-income sample indicating that multilingual exposure may play a role in LLE. The study focusses the attention on environmental factors which are potentially modifiable in LLE. / Dissertation (MA (Speech-Language therapy))--University of Pretoria, 2021. / Speech-Language Pathology and Audiology / MA (Speech-Language therapy) / Unrestricted

Clinical Supervision is an important practice in speech language therapy and related health disciplines. Research in student clinician populations has found that supervisees value interpersonal, personal and teaching characteristics in a clinical supervisor. Research has also shown that perceptions of supervisor characteristics change as student clinicians gain clinical skills. However, there is a significant lack of research examining practising clinicians' perceptions of clinical supervisor characteristics. The current study aimed to 1) survey practising Speech Language Therapists (SLTs) and examine the knowledge, skills and attitudes valued in a clinical supervisor, and 2) determine if the characteristics valued by more experienced SLTs (greater than 5 years) differed from those valued by less experienced SLTs (less than 5 years). A cross-sectional survey design methodology was employed. A five-part survey was developed, and distributed nationally by email. Participants were 72 SLTs practising in New Zealand. Results indicated that practising SLTs valued interpersonal knowledge and skills, and personal values and attitudes most highly in a clinical supervisor. In addition, it was found that characteristics relating to professional knowledge and identity were least valued. Overall, almost no difference was found between characteristics valued by less and more experienced clinicians. Findings suggest that practicing clinicians' basic human-relationship needs must be met for safe and effective CS to occur. Findings also suggest that regardless of experience level all clinicians are learners. This means clinicians across all different levels of work experience require support from clinical supervisors, to learn reflectively from experiences in the workplace.

Clinical Supervision is an important practice in speech language therapy and related health disciplines. Research in student clinician populations has found that supervisees value interpersonal, personal and teaching characteristics in a clinical supervisor. Research has also shown that perceptions of supervisor characteristics change as student clinicians gain clinical skills. However, there is a significant lack of research examining practising clinicians' perceptions of clinical supervisor characteristics. The current study aimed to 1) survey practising Speech Language Therapists (SLTs) and examine the knowledge, skills and attitudes valued in a clinical supervisor, and 2) determine if the characteristics valued by more experienced SLTs (greater than 5 years) differed from those valued by less experienced SLTs (less than 5 years). A cross-sectional survey design methodology was employed. A five-part survey was developed, and distributed nationally by email. Participants were 72 SLTs practising in New Zealand. Results indicated that practising SLTs valued interpersonal knowledge and skills, and personal values and attitudes most highly in a clinical supervisor. In addition, it was found that characteristics relating to professional knowledge and identity were least valued. Overall, almost no difference was found between characteristics valued by less and more experienced clinicians. Findings suggest that practicing clinicians' basic human-relationship needs must be met for safe and effective CS to occur. Findings also suggest that regardless of experience level all clinicians are learners. This means clinicians across all different levels of work experience require support from clinical supervisors, to learn reflectively from experiences in the workplace.

Parallel Distributed Processing (PDP) modelling has simulated developmental learning across a range of domains such as reading (e.g. Seidenberg & McClelland,1989) or Semantics (e.g. Rogers et al. 2004). However aside from two notable exceptions (Plaut, 1996; Welbourne & Lambon Ralph, 2005b) modelling research has not addressed the simulation of relearning during spontaneous recovery or rehabilitation after brain damage, and no research has considered the effect of the learning environment. This thesis used an established PDP model of semantic memory (Rogers et al., 2004) to simulate the influence of the learning environment. A novel quantitative measure (called representational economy) was developed to monitor efficiency during learning. Developmental learning is considered to be multimodal (e.g. Gogate et al., 2000) whereas rehabilitation is normally carried out through therapy sessions employing unimodal learning tasks (Best & Nickels, 2000). This thesis hoped to discover whether multimodal rehabilitation may be more efficient (as suggested by Howard et al., 1985). Three sets of simulations were conducted: The first set contrasted multimodal and unimodal learning in development and recovery, and tested internal representations for robustness to damage finding multimodal learning to be more efficient in all cases. The second set looked at whether this multimodal advantage could be approximated by reordering unimodal tasks at the item level. Findings indicated that the multimodal advantage is dependent upon simultaneous item presentation across multiple modalities. The third set of simulations contrasted multimodal and unimodal environments during rehabilitation while manipulating background spontaneous recovery, therapy set size and damage severity finding a multimodal advantage for all conditions of rehabilitation. The thesis findings suggest PDP models may be well-suited to predicting the effects of rehabilitation, and that clinical exploration of multimodal learning environments may yield substantial benefits in patient-related work.

Script training is a technique that allows persons with acquired speech and language disorders, such as nonfluent aphasia, to have islands of fluent speech during which they can speak about a topic without pausing or having word-finding errors. Scripts relevant to specific functional situations are written and practiced until memorized. Script training delivered verbally has been effective with clients with aphasia but the role of written cues in the training has not been explored. Therefore the purpose of this study was to compare the effectiveness of script training taught verbally, or verbally with a written script, in persons with aphasia. Three adults, one with Broca’s aphasia and apraxia of speech (AOS), one with Broca’s aphasia, and one with Anomic aphasia were recruited for this study. Participants selected three topics for script training and with the clinician’s help wrote a script and a script prompt for each topic. Scripts were trained one sentence or phrase at a time until 95% repetition accuracy was achieved, then training began for the next script. The effects of two training procedures, verbal only and verbal + written script, were evaluated with a multiple baseline design across training procedures, the order of which was counterbalanced across participants. Maintenance data were collected after each script was mastered and after the study ended. Results revealed that 3 persons with aphasia (PWA) demonstrated mastery of 2-3 scripts each using V+W script training methods, but only 1 participant maintained script accuracy at 16 weeks post-study. More research is needed to explore the role of written and verbal cues on script mastery and generalization.

This report investigates the efficacy of using constraint-induced language therapy (CILT) for treating acquired apraxia of speech (AOS). CILT is a treatment method used with individuals with aphasia in which communication is restricted to verbal output in order to isolate the damaged language areas of the brain and reactivate impaired neural connections (Pulvermuller et al., 2001). CILT employs repetitive, massed practiced stimuli and structured shaping of expressive output within the confines of verbal expression (Pulvermuller et al., 2001). Kirmess and Maher (2010) indirectly discovered that two patients with aphasia and apraxia of speech made gains in both language output and articulatory accuracy after receiving intensive CILT, suggesting possible efficacy for the use of CILT with patients with AOS. / text

The number of children with complex medical needs has risen in recent years, due to the increase in medical technology and subsequent increased survival rate of premature infants. This has led to an increasing number of children with complex neurological conditions, such as Cerebral Palsy, being seen by speech-language therapists to address their complex feeding and communication needs in schools (Arvedson 2008). Surface electromyography (sEMG) has been successfully used as a tool to facilitate therapy in adult dysphagia rehabilitation (Huckabee & Cannito 1999), and has been used in studies of dysarthric speech in children with Cerebral Palsy (Marchant, Mc Auliffe & Huckabee 2007). This case series report examines the effect of oral motor control therapy with sEMG biofeedback to increase motor control and inhibit increased muscle tone. Three participants aged 6, 16, and 18 were selected from the population of Kimi Ora Special School. Each of the three participants were offered sixty, twice daily treatment sessions of 30 minutes each focusing on active relaxation, and reducing duration of return to reset after recruitment of the masseter and submental muscles using sEMG biofeedback. After each session each participant was fed a prescribed amount of thin fluid and a range of food textures to encourage generalization of increased control of the submental and masseter muscles during eating and drinking. One participant was withdrawn after 42 sessions, and two participants completed all 60 sessions. Results showed variable improvement in feeding skills, with a notable improvement in anterior food loss. All participants were able to participate fully in the treatment and made significant gains in their ability to control their muscles during treatment sessions which was reflected in the reduction of sEMG amplitudes. This study demonstrated that oral motor control therapy with sEMG is a viable treatment tool, which warrants further larger scale research into its effectiveness.

Outcomes are critical for informing evidence-based, shared decision-making about health supports for children. These outcomes should be important and meaningful to all interested parties, particularly to children and their families, and should be included within research and practice. The work in the present manuscript represents three studies that 1) investigated how service outcomes were being used in school-based, speech-language therapy 2) explored what service outcomes were meaningful and important according to interested parties, and 3) identified a set of core service outcomes using the aggregate input of the interested parties to guide future research and practice. In the first study, I analyzed interview transcripts from 24 senior, school-based speech-language therapists and clinical managers to explore how clinicians working in schools determined the impact of their services. I identified seven outcomes and common facilitators and barriers to the meaningful use of outcomes to determine service impact through this qualitative analysis. In the second study, I interviewed 14 school-based speech-language therapists, teachers, and family members of children receiving supports. I asked participants to speak to the outcomes or impacts of these services they thought were most important or valuable. I identified six outcomes using both qualitative and quantitative analysis techniques. In the third study, I combined the perspectives of these three groups of interested parties into a single set of core outcomes for school-based, speech-language services. The result is a suggested set of impacts to include in research and practice. Including these core outcomes in research will improve the relevance of clinic-external evidence (research studies), providing more pertinent information to shared decision making about speech-language supports in schools. Their inclusion in clinical practice with strengthen clinic-internal evidence (data about specific programs or services) about the appropriateness of supports in context, and will assist the development of local, contextualized evidence for speech-language services. / Dissertation / Doctor of Philosophy (PhD) / School-based speech-language services provide important social and academic supports to children throughout their school years. To better understand if these services are achieving meaningful results for children and families, we wanted to know what people think is a meaningful result. In our first study, we asked speech-language therapists working in schools how they knew they were achieving meaningful results from their work. In our second study, we discussed what results were most important with family members, teachers, and speech-language therapists. Finally, in our third study, we combined all perspectives into a single list of most important service results to guide future research and quality improvement work. Together, these three studies provide important information on what results we want to achieve, which include important results for students, teachers and families, and the school system. The most important result was providing a holistic approach to support children, their families, and school communities.

Dans la littérature, relativement peu d’études ont porté sur les processus de rééducation en situation naturelle. La majorité des recherches ont été menées surtout comme une évaluation de l’efficacité de certaines méthodes d’intervention (e.g. méthode métalinguistique, guidance parentale) ou modes d’intervention (e.g. recast, imitation, modelage) sur l’acquisition d’une forme ou d’une structure linguistique ou de manière plus générale sur le développement de l’enfant. Or la compréhension des processus par lesquels les enfants se développent nécessite de travailler sur ce qui se passe pendant la rééducation sur le plan interactionnel et dans la façon dont émergent des pratiques orthophoniques dans l’interaction.L’objectif de notre étude est de comprendre la manière dont les interventions des orthophonistes soutiennent le développement langagier des enfants dysphasiques dans l’interaction. Cette étude s’inscrit dans une approche interactionniste en s’inspirant des travaux de Vygotski (1936/1997) et de Bruner (1983a).L’étude porte sur l’observation de quatre dyades orthophoniste-enfant dysphasique d’âge scolaire suivies lors de séances de rééducation pendant sept mois. Au début et à la fin de cette phase d’observation, une phase de test a été mise en place pour évaluer les compétences langagières des enfants et leur évolution. Les résultats montrent que les orthophonistes mettent en place des activités portant sur divers aspects du fonctionnement du langage. Leurs pratiques s’inscrivent dans la dynamique de l’échange et elles sont fortement influencées par les interventions des enfants et leurs difficultés à accomplir une tâche langagière. En outre, elles sont efficaces car elles permettent aux enfants de réaliser à deux ce qu’ils ne pouvaient accomplir seul. Nos analyses mettent en évidence des gestes professionnels communs aux orthophonistes relevant ainsi leur appartenance à une communauté de pratiques. / The literature reports relatively few studies that focused on Speech-Language pathologists’ (SLPs) interventions in natural context. Most of the studies explored the clinical effectiveness of intervention strategies with children with Specific Language Impairment (SLI) by assessing language outcomes (e.g. the acquisition of a particular form or structure, improvements on particular language measures) both studying particular features (e.g. recast, imitation, model, etc) or entire clinical methods and programs (e.g. metalinguistic approach, parental guidance, etc.). However, to better understand the processes underlying children’s development, it is necessary to analyse in detail what happens during SLP sessions at an interactional level and focus on the emergence of practices during Speech-language pathologist- child interactions. The aim of the present study was to better understand how clinical interventions support the language development of child with SLI during interactions. In line with Vygotski (1936/1997) or Bruner (1983a), we adopted a socio-interactionist approach/perspective.This study observed four school-aged children with SLI interacting with their SLP during clinical sessions. The dyads were followed-up for seven months. At the beginning and the end of the observation period, children’s linguistic, discursive and interactional abilities were assessed through standardized language tests and through the analysis of mother-child interactions.The results showed that SLPs enrolled the children in activities focusing on various aspects of language. Their practices were part of the dialogical dynamic and were strongly influenced by the accomplishment of the task (by children). In addition, the effectiveness of these practices was proven by the fact that children achieved, supported by the SLP, tasks that they were not able to accomplish by themselves. Our analyses also highlighted common professional gestures, such as discursive strategies, among all the SLP who participated in the study, showing that they belong to a community of practice.