Includes abstract. Includes bibliographical references.

Includes bibliographical references. / This study aimed to describe the typical development of speech in first language Setswana speaking children. Thirty-six children, aged 3;0 – 6;0 years, attending preschools in Hebron in the North-West Province of South Africa, participated in the study. The objectives of the study were documenting the children’s ability to produce consonants and vowels, different syllable structures, as well as the nature of phonological processes occurring at various ages. The study followed a cross-sectional design with six children grouped into each six month age band. Due to the preliminary and exploratory nature of the project, an assessment tool was developed and used to document speech development in Setswana-speaking children. This was done as none is currently available. Words and pictures selected for this assessment tool were culturally and linguistically appropriate for the study population, and an expert panel was used to ensure this. Assessments were transcribed online by a first language Setswana speaker using the IPA convention and were audio-recorded and re-transcribed by the same Setswana speaker to ensure reliability. Findings of this study indicate that the majority of Setswana consonants are acquired by 3;0 years. The rounded alveolar trill /rw/ is among the phonemes which continue to develop after 6;0 years, particularly in the penultimate syllable. Phonological processes found in the speech of younger children mainly occur in multisyllabic words and include deletion of marked and unmarked syllables, gliding of liquids, assimilation, as well as the simplification of -Cw- digraphs and words with five syllables. Older children (5;6 – 5;11 years) present with fewer phonological processes than the younger group of children (3;0 – 5;5 years). Findings of the study are discussed in relation to normative data from other languages, and in particular to those belonging to the same language group such as Sesotho. Knowledge of Setswana speech development will better equip Speech-Language Therapists working in Southern Africa to assess and manage speech difficulties in Setswana-speaking children. Future research may focus on developing a standardised Setswana speech assessment tool. The results contribute to an increasing body of locally relevant information about the typical development of children’s speech.

Background: Zulu, one of the eleven official languages in South Africa, is the most spoken language in the country. However, research on children's phonological development in Zulu is minimal. To date there are no published Zulu speech assessments and associated normative data that speech-language pathologists (SLPs) can use to identify children with speech sound disorders who speak this language. Method: This descriptive, cross-sectional study aimed to document the phonological development of thirty-two typically developing first language Zulu-speaking children between 2;6 and 6;5 years. Participants attended school or crèche in Manguzi, KwaZulu-Natal, and were grouped into six month age categories. A single-word Zulu phonology assessment was developed and used to assess the participants. Assessments were audio recorded, and field transcriptions made using the International Phonetic Alphabet (IPA). Speech development was described in terms of phoneme acquisition, word shape, phonological processes and percentage of vowels (PVC) / consonants correct (PCC). Consonant acquisition was assessed in the penultimate syllable only, according to the structure of Zulu.

Patients with dysphagia, who are unable to meet their daily hydration and nutritional needs orally, may require enteral nutrition, either via a nasogastric tube (NGT) as a short term provision, or via a gastrostomy tube for longer term provision. The presence of dysphagia, specific medical conditions and the presence of comorbidities place patients, who require enteral nutrition, at risk for mortality. High rates of mortality are reported in international literature, in patients following the placement of long term enteral nutrition via percutaneous endoscopic gastrostomy (PEG). High mortality rates following the placement of enteral nutrition in patients treated by Speech Language Therapists (SLTs) at Chris Hani Baragwanath Academic Hospital (CHBAH) were noted anecdotally. No study has previously been done to analyse the outcomes and risks of the placement of enteral nutrition in the adult population with dysphagia in the South African context. This study aimed to compare survival times in patients with dysphagia, who had a single morbidity and multiple morbidities, who were recommended for enteral nutrition to those who were recommended for oral palliative nutrition, and the risks associated with a higher risk of mortality postplacement of enteral nutrition. Design: The study employed an observational cohort design, using both retrospective and prospective methods. Three cohorts were included in the study.1) Participants with multiple morbidities who were recommended for enteral nutrition (n=212), 2) Participants with a single morbidity who were recommended for enteral nutrition (n=35) and, 3) Participants who were placed on oral palliative nutrition (n=10). Results: A high rate or mortality was noted in all participants who were placed on enteral nutrition (regardless of it being NGT or PEG). Survival time was longer in participants with a single morbidity (54 days) compared to those with multiple morbidities (24 days) who received a PEG. Survival of participants with multiple morbidities who were on oral palliative nutrition, was only five days less (19 days) than participants with multiple morbidities who had a PEG placed. Mortality rates were high following the placement of enteral nutrition which could be attributed to the participants underlying medical condition and level of morbidities present. Conclusion: Findings of this study highlight the need for greater consideration of the risk factors that may place a patient at risk of mortality following the placement of enteral nutrition. It brings into question the futility of some PEG procedures in a cohort of participants that show such poor survival, and encourages clinicians to explore the option of oral palliative nutrition as a recommendation for patients who are expected to have a high risk of mortality if recommended for and placed with enteral nutrition.

Background information: Tuberculous meningitis (TBM) is the most severe extra-pulmonary complication of tuberculosis (TB) and also the most common bacterial meningitis in the Western Cape. The consequences of childhood TBM include poor motor and neurological outcomes which could lead to dysphagia. Aims: The aim of the study was to describe dysphagia in children (0-12 years) recovering from TBM at Red Cross War Memorial Children's Hospital (RCWMCH) in the Western Cape, South Africa. The purpose of the study was to determine the occurrence and describe the nature of dysphagia as well as to investigate whether any associations existed between dysphagia and the severity of TBM, neurological sequelae, age, and radiological findings.

Background: South Africa experiences a severe shortage of speech-language therapists (SLTs) which results in individuals requiring Speech-Language Therapy (SLT) services having to travel long distances or being placed on long waiting lists to access services. Rehabilitation Care Workers can assist with bringing this service closer to the communities they serve. It is important to explore the experiences of these individuals to ensure that they are adequately supported and skilled. The University of Cape Town (UCT) has been training Rehabilitation Care Workers (RCWs) since 2012, however to there is currently no empirical data documenting the facilitators and barriers experienced by RCWs in their work. Aim: To explore RCWs (in the Mitchells Plain/Klipfontein sub-structure) perceptions of the facilitators and barriers in providing SLT related activities in their work context. Methods: A descriptive exploratory study was conducted. Eighteen RCWs were approached and 13 participated in 2 focus groups. Data was transcribed and analysed using thematic analysis. An inductive approach was used to develop meaningful themes and sub-themes. Results: The plot of “vital role players” best synthesized the 3 main themes namely scope of practice, RCW position and value as an intrinsic motivator and challenges. : The scope of practice theme included 4 sub-themes namely, RCW activities; awareness of broad scope; understanding family needs; including family as stakeholders in patient management. RCW position and value as an intrinsic motivator - included 4 sub-themes namely, integral members of the team; agents for change; community servants; go between formal structures and the community. Finally the theme challenges –included 4 sub-themes namely, training gaps; safety; lack of resources; feeling undervalued. The facilitators and barriers identified by the RCW’s aligned with perceptions of other mid-level health care workers as reported in the literature. Implications: RCWs work within a family centred care approach and see themselves as community servants who bring vital rehabilitation services into homes by transferring their skills to families and communities through education, support and advocacy. Despite their value and passion, RCWs feel undervalued by those around them, including management structures and the Department of Health (DOH). Conclusion: RCWs can bring much needed rehabilitation services into the homes of communities in Cape Town. For this reason, it is imperative to consider the facilitators and barriers experienced by these individuals in order to harness their natural skills and strengthen the current RCW service and solidify their roles within the Multidisciplinary Team (MDT).

Background: The profession of speech-language therapy (SLT) continues to struggle with challenges around equity and service delivery. The dominant medical model, characterised by one-on-one, individualised health care, is struggling to serve the large population in need of services. As such, there is a need to reconceptualise SLT practices toward a social justice focus. The study used clinical education as the entry point of exploration into how emerging professional practices (EPPs) may be developed. Aims/Objectives: The study aimed to describe and analyse a case study of an emerging professional practice in SLT as part of a university-school partnership in a peri-urban settlement in South Africa. The objectives were: 1. To describe and analyse the practice methods of the EPP, 2. To describe and analyse the educational and knowledge bases which support the EPP, and 3. To describe and analyse the underlying epistemology, ontology and methodology underpinnings shaping the EPP. Method: A qualitative case study methodology, guided by critical theory and decoloniality, was used. Final year SLT students were the primary participants for the study. Data were collected in the form of document analyses, participant observations, interviews, photovoice, and experiential drawings from a number of stakeholders (including SLT students, a school principal, a project coordinator, a library assistant and a clinical educator) from January to December 2017. The data were analysed using reflexive interpretation (Alvesson & Sköldberg, 2009) as a guiding frame. Findings: The three-level analysis process was used to generate the thesis offering. The first level of analysis was the construction of the overall case narrative - documenting the practice methods of the EPP through the experiences of the SLT students. The second level of analysis used thematic analysis approach to identify key themes emerging from the case narrative. Four key themes were explored in the form of narratives, collages and paintings. The third level of analysis used decoloniality (i.e. coloniality of power, knowledge and being) and the Relationship of Labouring Affinities (RoLA) as critical lenses to deepen my understanding of the case. Through using both RoLA and decoloniality, dialogue emerged as a critical form of engagement toward developing EPPs. The study specifically puts forward the concept of critical dialoguing as a necessary process for conscientisation and change. Conclusion: The findings of the study illuminated how SLT students navigated through their experiences of disruption of their traditional practice. The findings weave together participant narratives, drawings and collages to engage the reader in the EPP. The findings showed how critical engagement with political, historical, social and linguistic influences underlying their work in communication, facilitated new learning and insight into SLT practice. The thesis offering discusses the role of critical dialoguing in opening up space for critical discussions about the profession. In conclusion, supported disruption provided students with a platform to interrogate current SLT practices, re-examine the viability of practices to serve populations, and reflect on how the SLT profession can adapt and change with the changing needs of the population.

Includes bibliographical references (p. 398-428). / This study set out to evaluate the effectiveness of an intervention programme, in a developing context within an ecological framework that involves parents througp parent training adopting a parent-child interaction approach to intervention. This short-term, group intervention programme was developed specifically for hearing primary caregivers of profo,undly deaf signing children from low socio-economic backgrounds. A naturalistic approach to .intervention that followed a conversational model was applied. The programme was deSigned to enhance dyadic communicative interaction and to empower the caregivers as effective change agents, primarily through the programme components of communication skills and sign language, information and knowledge, educational advocacy and support. A broader perspective was adopted through addressing socio-economic factors and adapting to cultural differences. A team of people was involved in programme development, implementation and evaluation and included professionals from a range of disciplines, Deaf signing adults, and an English-isiXhosa interpreter. A shortterm longitudinal, before-and-after group design was used in programme implementation and evaluation. This design encompassed constructivist-interpretive and positivist/post-positivist research paradigms. The group of sixteen caregiver-child dyads reported on in this study was its own control, constituting a quasi-experimental design. An estimate of the effect of the programme was determined by analysing pre-post-intervention comparisons of videotaped dyadic interactions during play and storytelling, and the post-intervention evaluation questionnaire and focus group interview data. A coding system was compiled for the investigation of communication and sign language parameters that were not part of an occurrence of communication breakdown. Investigation of breakdown and repair as well as aspects of caregiver sign production constituted a separate analysis. Both quantitative and qualitative analyses were Icarried out in the evaluation process and certain procedures were adopted to enhance the reliability and validity of the findings. It is believed that the aims I of this study and the specific goals/objectives of the programme were met. The analyses carried out indicated positive change and that this change was most likely due to the programme. In particular, it is believed that the style of caregiver-child interaction changed over the course of the intervention and so the programme was effective to the degree that it improved caregiver-child communicative interaction. More so, it is believed that the programme resulted in empowerment of the caregivers. Numerous aspects are believed to contribute towards the uniqueness of this study and of the communicative intervention programme. The numerous clinical and theoretical implications and implications for future research arising from this study are discussed in detail.

Background: Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) to improve expressive communication. EMT produces favourable long-term results in both vocabulary growth and linguistic structure after a relatively short intervention period. However, very little research has been conducted to prove its effectiveness in culturally and linguistically diverse populations. Furthermore, before interventions can be implemented in different contexts, there is a need to determine if any adaptations are needed to maximize the fit of the intervention to the novel context. Tension exists between the need for implementation fidelity and the flexibility or fit of an intervention into novel settings, populations and contexts. A single proof of concept study exists which indicates that a trained therapist can implement EMT to fidelity in a South African special school context with English-speaking children. However, very little research exists which documents stakeholder perspectives of the perceived fit of naturalistic developmental behavioural interventions in the South African context. This study adds to this important body of literature by documenting the perceptions of bilingual Speech and Language Therapists, as well as bilingual parents of children with developmental disabilities, regarding the applicability of EMT within the South African context. Aim: To determine bilingual parents’ and Speech and Language Therapists’ perceptions regarding the acceptability and appropriateness of implementing EMT with young children with developmental disabilities who reside in the Western Cape and speak Afrikaans or isiXhosa at home. Methods: A descriptive exploratory study was conducted using two qualitative methods. Five bilingual SLT’s were interviewed, and two focus groups with eleven bilingual parents of children with developmental disabilities was conducted thereafter. Data was transcribed and analysed using thematic analysis according to the approach suggested by Braun & Clarke, (2006). The findings of the thematic analysis were then merged as subthemes within the adaptome framework (Chambers & Norton, 2016) in order to present diverse parent and SLT perspectives adequately. The adaptome framework comprises four sources of adaptations, namely: service setting, mode of delivery, target audience and cultural adaptations. vi Results: The barriers and facilitators to implementing EMT, together with the areas for potential adaptation within a multilingual and/or multicultural context, were reported in this study. Both parent and professional stakeholders reported that the core components of EMT are appropriate within their contexts and would not require adaptations. The data obtained from both parent and professional participants pertaining to potential adaptations were grouped into ten subthemes which were assigned within the four sources of adaptation. Bilingual SLTs highlighted aspects such as limited resources and limited parent-professional collaborations as barriers to sustained implementation across diverse service settings. Parents expressed concerns regarding the resources and the mode of intervention delivery used during EMT implementation. The facilitators and barriers, together with the areas for potential adaptation identified by the participants, align with perceptions of parents and professionals as reported in previous literature. Implications: Bilingual parent and professional stakeholder participants found that the core components of EMT would be appropriate in the South African context. However, participants suggested that adaptations to the peripheral elements of EMT would be required, with the majority of the adaptations relating to preferred service delivery settings and the mode of intervention delivery. Conclusion: Bilingual parents and Speech and Language Therapists view EMT as an appropriate and potentially valuable intervention in the South African context.

The purpose of this study was to perform the cultural adaptation of the Brazilian version of the Vocal Fatigue Index (VFI). Two Brazilian bilingual speech-language pathologists (SLP) translated the original version of the VFI in English into Portuguese. The translations were reviewed by a committee of five voice specialist SLPs resulting in the final version of the instrument. A third bilingual SLP back-translated this final version and the same committee reviewed the differences from its original version. The final Portuguese version of the VFI, as in the original English version, was answered on a categorical scale of 0-4 indicating the frequency they experience the symptoms: 0=never, 1=almost never, 2=sometimes, 3=almost always, and 4=always. For cultural equivalence of the Portuguese version, the option "not applicable" was added to the categorical scale and 20 individuals with vocal complaints and dysphonia completed the index. Questions considered "not applicable" would be disregarded from the Brazilian version of the protocol; no question had to be removed from the instrument. The Brazilian Portuguese version was entitled "Índice de Fadiga Vocal - IFV" and features 19 questions, equivalent to the original instrument. Of the 19 items, 11 were related with tiredness of voice and voice avoidance, five concerned physical discomfort associated with voicing, and three were related to improvement of symptoms with rest or lack thereof. The Brazilian version of the VFI presents cultural and linguistic equivalence to the original instrument. The IFV validation into Brazilian Portuguese is in progress.