Objectives: The purpose of Experiment 1 was to measure word recognition in younger adults with normal hearing when speech or babble was temporally or spectrally distorted. In Experiment 2, older listeners with near-normal hearing and with hearing loss (for pure tones) were tested to evaluate their susceptibility to changes in speech level and distortion types. The results across groups and listening conditions were compared to assess the extent to which the effects of the distortions on word recognition resembled the effects of age-related differences in auditory processing or pure-tone hearing loss. Design: In Experiment 1, word recognition was measured in 16 younger adults with normal hearing using Northwestern University Auditory Test No. 6 words in quiet and the Words-in-Noise test distorted by temporal jittering, spectral smearing, or combined jittering and smearing. Another 16 younger adults were evaluated in four conditions using the Words-in-Noise test in combinations of unaltered or jittered speech and unaltered or jittered babble. In Experiment 2, word recognition in quiet and in babble was measured in 72 older adults with near-normal hearing and 72 older adults with hearing loss in four conditions: unaltered, jittered, smeared, and combined jittering and smearing. Results: For the listeners in Experiment 1, word recognition was poorer in the distorted conditions compared with the unaltered condition. The signal to noise ratio at 50% correct word recognition was 4.6 dB for the unaltered condition, 6.3 dB for the jittered, 6.8 dB for the smeared, 6.9 dB for the double-jitter, and 8.2 dB for the combined jitter-smear conditions. Jittering both the babble and speech signals did not significantly reduce performance compared with jittering only the speech. In Experiment 2, the older listeners with near-normal hearing and hearing loss performed best in the unaltered condition, followed by the jitter and smear conditions, with the poorest performance in the combined jitter-smear condition in both quiet and noise. Overall, listeners with near-normal hearing performed better than listeners with hearing loss by ∼30% in quiet and ∼6 dB in noise. In the quiet distorted conditions, when the level of the speech was increased, performance improved for the hearing loss group, but decreased for the older group with near-normal hearing. Recognition performance of younger listeners in the jitter-smear condition and the performance of older listeners with near-normal hearing in the unaltered conditions were similar. Likewise, the performance of older listeners with near-normal hearing in the jitter-smear condition and the performance of older listeners with hearing loss in the unaltered conditions were similar. Conclusions: The present experiments advance our understanding regarding how spectral or temporal distortions of the fine structure of speech affect word recognition in older listeners with and without clinically significant hearing loss. The Speech Intelligibility Index was able to predict group differences, but not the effects of distortion. Individual differences in performance were similar across all distortion conditions with both age and hearing loss being implicated. The speech materials needed to be both spectrally and temporally distorted to mimic the effects of age-related differences in auditory processing and hearing loss.

Includes bibliographical references.

Bibliography: leaves 134-143. / With the shift away from evaluation of isolated aspects of linguistic performance, discourse assessment has become an important tool in assessing the communication competence of individuals following a neurological insult. The present research investigates the effects of mild to moderate aphasia on the dscourse performance of Creole speaking Mauritians. A control group was included so as to differentiate aspects of discourse from normal to pathological and with a view to discerning compensatory strategies of adults with aphasia in discourse.

The development of early literacy skills is critical for all children in South Africa. Children receive language and literacy development support in the home, school, and community environments. Vulnerable children, such as orphans, may receive this support from volunteers in their home environments. Additional language development support systems in the form of programmes run by volunteers are important. This study describes and analyses the process of collaboration between six volunteers who are involved in languageliteracy programmes by examining how volunteers negotiate collaboration in promoting literacy development. This qualitative research study used a participatory action cycle design to investigate collaboration. A range of research methods such as focus groups, interviews, reflections and observations were used. Findings from this study provided insight into the identity of volunteers. They were people who had strong values in respect of literacy, a positive experience of volunteering, a sense of civic responsibility and an empathetic personality. The collaborative process was established through the presence of a strong common cause, vulnerability and trust among volunteers, a structured and well-led action cycle process, the development of self-reflection, and a passion to be change agents. Volunteers were able to problem solve and act to make changes to the intervention programme which included actions at a programme and volunteer level. The speechlanguage therapist (SLT’s) role was critical in a literacy-related intervention as a support for volunteers. The expertise of SLTs, namely knowledge in language and literacy development, was valued in streamlining the process of taking appropriate actions to enrich the literacy programme.

Bibliography: leaves 130-145.

Includes bibliographical references / The Classroom Communication Resource (CCR) intervention was developed to improve peer attitudes towards children who stutter (CWS). This pilot study will inform the feasibility of a Randomised Control Trial (RCT) through the following aims: 1. To analyse selected procedural aspects including recruitment, participation and re tention rates and questionnaire-questionnaire completion trends. 2. To observe treatment and cluster effect of the CCR intervention at one and six months post-intervention. An experimental, quantitative cluster randomised trial design was used. Pre-intervention - post-intervention data was collected from control and intervention groups. The sample comprised 273 mixed-gender Grade 7 participants in the Western Cape (WC) Metro urban area in classrooms across quintiles. Data was collected and analysed at pre-intervention, one and six months post-intervention. The Stuttering Resource Outcomes Measure (SROM) was used to measure attitude changes. Descriptive and inferential statistics were used to describe the procedural aspects and treatment effect. A positive school-recruitment rate (90, 91%) was observed while the participation (59.6%) and retention rates (44.8%) decrease d over time. Participants were excluded due to poorly completed questionnaires, consent, assent, absenteeism and administrative errors. Questionnaire completion trends at six months post-intervention showed that errors were noted on all items. These procedural challenges could be reduced in future studies through rigorous planning. The positive treatment effect was minimal at one month post-intervention, while more evident in magnitude and direction of change in attitude scores on the SROM at six months post-intervention. A constant group effect was noted at pre-intervention, one and six months post-intervention. This study therefore concluded that a future RCT is feasible with several recommendations.

Includes bibliographical references (leaves 153-165).

Bibliography: leaves 113-117. / The medical interview is often the first point of contact between doctors and patients. For patients who have suffered a stroke, this interaction is often a frustrating attempt to tell the doctor how they are feeling and a struggle on the part of the doctor, to obtain the necessary facts. In this study, a group of 6th year medical students were trained to use supportive communication strategies for the specific purpose of obtaining a case history from an adult with aphasia. These strategies were based on principles of Supported Conversation for Adults with Aphasia (SCA [TM]) (Kagan, 1998b). Results showed that students who received communication skills training as opposed to a theory lecture improved significantly in their abilities to acknowledge the abilities of their patient, reveal their competence through different modalities and verify patient responses. In addition, students in the experimental group were significantly better at establishing initial and developing rapport with their patients, exploring their patients' problems and providing structure to the interview as compared to the students in the control group. Further, the experimental group rated their post-training interviews and the quality of their interactions with their patients as significantly better following their training. The results of this study provide strong evidence that medical students show significant improvements in a number of skills following supportive communication training. These findings have implications for medical education and service delivery.

Includes bibliographical references. / The challenges of communication in the multilingual and multicultural South African health care context are exacerbated by the complexities and demands introduced by HIV/AIDS. Despite the wealth of information on aspects related to the doctor-patient relationship, communication in HIV/AIDS care settings has received very little attention in the literature. South Africa leads the HIV/AlDS pandemic in numbers, yet almost no locally relevant information is available on the nature of communication in HIV/AIDS care settings. The study has aimed to address this need. A qualitative research design within an interpretive paradigm was followed. The primary aim of the study was to describe and explain communication in a paediatric outpatient HIV I AIDS clinic from the multiple perspectives of caregivers, counsellors and doctors. Semi-structured interviews with 11 caregivers of HIV positive children, four NGO trained HIVI AIDS counsellors and four doc1Drs were conducted. A phenomenological data analysis procedure was followed. Rich descriptions of the communication experiences of the three groups of participants were constructed and five central themes were identified. Communication in the clinic meant sharing meaning across differences. The language and cultural divide between caregivers and doc1Drs could be successfully bridged by a doctor facilitative conversational style and the participation of counsellors in communication. Effective communication was dependant on systemic support and infrastructure. Communication in the clinic involved more 1I1an words, was shaped by context, required the collective effort of all role players, and was transactional in nature and powerful to affect the lives of caregivers, counsellors and doctors. Recommendations regarding practice and education were made.

Includes abstract. Includes bibliographical references.