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.

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.

Thesis (MPhil (Centre for Health Sciences Education)--University of Stellenbosch, 2010. / AFRIKAANSE OPSOMMING: Doel: Te min spraak-taalterapeute (STT’e) wêreldwyd spreek vlotheidsversteurings aan. Dit mag aan hul gevoelens van onbevoegdheid in die hantering van persone wat hakkel toegeskryf word. Nuut-gegradueerde STT’e, in die Suid-Afrikaanse konteks, het dikwels nie toegang tot ondersteuning en leiding van ervare klinici om hul vaardighede en bevoegdheid in die hantering van persone wat hakkel, te ontwikkel nie. Die doel van hierdie studie was om voorgraadse STTstudente se persepsies van hul eie bevoegdheid om persone wat hakkel te hanteer, te ondersoek en beskryf 1) direk na die voltooiing van hul teoretiese module en voor kliniese plasing, en 2) na blootstelling aan ‘n bykomende opleidingskomponent waar hulle waargeneem het hoe intervensieprosedures op ‘n gesimuleerde pasiënt toegepas word. Metodes: ‘n Beskrywende opnameontwerp, met pre- en post-intervensie-vraelyste is gebruik om die andragogiese benadering se impak op studente, voor en nadat hulle die bykomende opleidingsgeleentheid ontvang het, te evalueer. Resultate: Voor die intervensie het die meeste studente hulself nie as bevoegd geag om persone wat hakkel te evalueer of behandel nie. Na die intervensie is statisties beduidende veranderinge in die studente se self-ervare bevoegdheid vir die meeste aspekte verwant aan die evaluering en behandeling van mense wat hakkel, gerapporteer. Opsomming: Daar is tot die gevolgtrekking gekom dat die studente hierdie tipe innoverende opleidingsmetodologie hoog op prys stel en dat dit ‘n nodige aanvulling tot studente se bestaande kliniese plasings is.

Made available in DSpace on 2016-04-27T18:12:00Z (GMT). No. of bitstreams: 1 Marta Cecilia Rabinovitsch Gertel.pdf: 373314 bytes, checksum: cf2047b869df618d4c40f072b05b703b (MD5) Previous issue date: 2013-03-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / INTRODUCTION: The clinical experience has shown the importance of understanding Family and School in its mutual influence and interdependence in the development of children sent for speech-language therapy. Thinking the relationships between family and school implies to be attentive to the modes by which said instances are related and interfere in the subjective structure and development of a child´s (oral and graphic) language. It also implies to understand that the language disorder, even in the cases it arises from organic events and marks (either congenital or acquired), has the crossed influence of the family and school dynamics, in whose interactions tendencies for the sequence of child´s development is designed. The educational inclusion policy, which has been consolidating in the regular teaching network along the last years, points to the need of integrated actions between school, family and professionals dealing with children presenting language and/or apprenticeships difficulties, said professionals including the speech-language therapist. OBJECT: to present and discuss the pertinence of a speech therapy attention to children with language disorder, by means of an approach that includes the family and the school in the therapeutically process in a simultaneous form and by means of a triangle between speechlanguage therapy events of the child, his/her living experiences, routines and family and school routines. METHOD: This paper bears a clinical-qualitative nature and was designed by means of a reflection based on vignettes selected from clinical case records served by the researcher speech-language therapist, from 2010 to 2011. The utilized material was elaborated along the therapeutically process, from the records appearing in reports obtained from services to children, family and the school. The analysis of clinical material making up the vignettes in the selected cases was supported by the bibliographic review of the thesis, both by speechlanguage literature that considers the family and school dimension in the infantile development, or the conceptual operators inspired in a theoretical reference of Winnicott. For such, two complementary criteria have been followed: the way along the family history axis and the patient´s social-educational axis, and sections of significant moments favoring unfolding in the development of the speech-language therapeutic process. Results: The strategy of simultaneous service to family and school had a direct influence on the therapeutic process of the patients involved in this study. A significant development of each child´s behavior was noticed, mainly concerning the oral and/or graphic communication and the social circulation within the family and school environment. Final considerations: To think the relationships between the child, family and school, as made in this paper, implies to build and enhancing an attention able to apprehend the modes through which said instances go against each other, act in a triangle and interfere in the subjective structuring and development of the child´s (oral and graphic) language. It also assumes that the speech-language therapist is willing to deal with the tensions inherent to said constitutive environments, with the eventual overlapping of roles and functions and with the unavoidable divergences present and expressed about the infantile development. As we understand it, it is for the speech-language therapist to perform the important function of providing the family and the school with a middle way that promotes the acceptance, comprehension and the collaboration with the other, from the foreign perspective. Such mediation, as a willingness to live in the middle of instances and persons in a relationship, is what is liable to benefit and potentialize the child´s development. As the clinical experience has shown, this is possible and very productive in a large part of cases. / INTRODUÇÃO: A experiência clínica tem mostrado a importância de compreender Família e Escola em sua mútua influência e interdependência no desenvolvimento das crianças encaminhadas para atendimento fonoaudiológico. Pensar as relações entre família e escola pressupõe estar atento aos modos pelos quais essas instâncias triangulam e interferem na estruturação subjetiva e no desenvolvimento da linguagem (oral e gráfica) da criança. Implica também compreender que o transtorno de linguagem, mesmo nos casos em que é decorrente de questões e marcas orgânicas (congênitas ou adquiridas), está simultaneamente atravessado pela dinâmica familiar e escolar, em cujas interações se desenham tendências para sequência do desenvolvimento da criança. A política de inclusão educacional, que vem se consolidando na rede regular de ensino nos últimos anos, sinaliza para a necessidade de ações integradas entre a escola, a família e os profissionais que lidam com crianças que apresentam dificuldades de linguagem e/ou aprendizagem, entre eles o fonoaudiólogo. OBJETIVO: apresentar e discutir a pertinência de uma proposta de atendimento fonoaudiológico às crianças com transtorno de linguagem, por meio de uma abordagem que inclui a família e a escola no processo terapêutico, de modo simultâneo e por meio da triangulação entre acontecimentos da terapia fonoaudiológica da criança, de suas vivências, rotinas e dinâmicas familiares e escolares. MÉTODO: Esta pesquisa é de natureza clínico-qualitativa e foi desenvolvida por meio de reflexão baseada em vinhetas selecionadas a partir de registros de casos da clínica atendidos pela fonoaudióloga-pesquisadora no período de 2010 e 2011. O material utilizado foi elaborado ao longo do processo terapêutico, a partir de registros em forma de relatórios obtidos nos atendimentos à criança, à família e à escola. A análise do material clínico, que compõe as vinhetas dos casos selecionados, foi subsidiada pela revisão bibliográfica da tese, tanto pela literatura fonoaudiológica que considera a dimensão familiar e escolar no desenvolvimento infantil, quanto pelos operadores conceituais inspirados em referencial teórico de Winnicott. Para tanto, seguimos dois critérios complementares: o percurso ao longo do eixo da história familiar e do eixo sócio-educacional do paciente; e o recorte de momentos significativos que favoreceram desdobramentos no desenvolvimento do processo terapêutico fonoaudiológico. Resultados: A estratégia de atendimento simultâneo à família e à escola influiu diretamente no processo terapêutico dos pacientes envolvidos neste estudo. Observou-se desenvolvimento significativo no comportamento de cada criança, sobretudo no que se refere à comunicação oral e/ou gráfica e à circulação social no ambiente familiar e escolar. Considerações finais: Pensar as relações entre criança, família e escola, tal como foi feito nessa pesquisa, pressupõe construir e aguçar uma escuta capaz de apreender os modos pelos quais essas instâncias incidem umas nas outras, triangulam e interferem na estruturação subjetiva e no desenvolvimento de linguagem (oral e gráfica) da criança. Também pressupõe que o fonoaudiólogo se disponha e se prepare para lidar com as tensões inerentes a esses ambientes constitutivos, com as eventuais sobreposições de papeis e funções, e com as inevitáveis divergências que se apresentam e se manifestam acerca do desenvolvimento infantil. Em nosso entender, ao fonoaudiólogo cabe exercer a importante função de propiciar à família e à escola um caminho pelo meio, que promova o acolhimento, a compreensão e a colaboração com o outro, com a perspectiva alheia. Essa mediação, como disposição de habitar o entre das instâncias e pessoas em relação, é o que pode beneficiar e potencializar o desenvolvimento da criança. A experiência clínica tem mostrado que isso é possível e muito produtivo em boa parte dos casos

Made available in DSpace on 2016-04-27T18:12:38Z (GMT). No. of bitstreams: 1 Patricia Trinta e Farias.pdf: 1110472 bytes, checksum: 1739798374fb2dd30939aeadadc88368 (MD5) Previous issue date: 2008-11-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present paper had the objective of describing the transformation in the clinical-therapeutical perspective occurred during the ambulatory speechlanguage treatment of a young child with feeding problems that used an exclusive alternative feeding via gastrotomy. The difficulty concerning the feeding dynamic was understood beyond the organical and functional aspects, considering the patient s familial context. Being applied a clinical exploratory methodology, to collect the data there were used registrations (handbooks) of the attendances, including the parents interviews. In order to reflect about the transformation in the attendance process contemplating the child s life history, there were applied concepts of the Winnicottian theory, namely: holding, object management and presentation. Finally, it was possible to conclude that the speech-language therapist that deals with feeding problems, based on a favorable setting, may offer the patient conditions to a safe pleasant feeding / O presente estudo teve como objetivo descrever a transformação na perspectiva clínico-terapêutica ocorrida durante o tratamento fonoaudiológico ambulatorial de uma criança pequena com problema alimentar que utilizava uma via de alimentação alternativa exclusiva gastrostomia. A dificuldade em torno da dinâmica da alimentação foi compreendida para além dos aspectos orgânicos e funcionais, considerando-se o contexto familiar da paciente. Sendo a metodologia clínica exploratória, para a coleta dos dados foram utilizados registros (prontuário) dos atendimentos, incluindo as entrevistas com os pais. Para refletir sobre a transformação no processo de atendimento, contemplando a história de vida da criança, foram abordados conceitos da teoria winnicottiana, a saber: holding, manejo e apresentação de objeto. Por fim, foi possível concluir que o fonoaudiólogo que atua com problemas alimentares, a partir de um setting favorável, pode oferecer ao paciente condições para uma alimentação segura e prazerosa