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

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.

HIV (Human Immunodeficiency Virus) has been shown to have significant effects on the development of a child. Currently there is limited South African research regarding HIV and specific characteristics of communication development, and the treatment thereof, in the child infected with HIV. The objective of the research was to describe the communication characteristics of a group of children between the ages of 0 – 5 years infected with HIV at a hospital in Gauteng, South Africa. Clinic records of 203 children infected with HIV between the ages of 0-5 years were reviewed by using a pre-designed checklist within the outreach clinic of a large regional hospital. A questionnaire was completed by 4 medical practitioners working with this population within the outreach clinic. A total of 91.62% of the infected children were diagnosed as being either in Stage III or IV of the disease (according to the WHO classification system of 2005), with all infants presenting with a CD4 count of ≤ 60. The majority (75.37% of the total sample) were receiving HAART (Highly Active Antiretroviral Therapy) at the time the data was collected. According to their medical, social, communication and general development, almost all the children qualified for Early Communication Intervention (ECI) but were not recorded as being referred for such services. A large proportion of the target population presented with opportunistic infections and/or HIV associated conditions. The results highlight the developmental characteristics of children living with HIV, and identify the need for medical doctors and allied health professionals to be provided with relevant literature or training regarding the communication development of children infected with HIV. This will facilitate appropriate referrals for ECI services.

Comprehensive management in the neonatal nursery involves medical treatment of the infant, as well as developmental care and the provision of guidance, counselling and information to the family who are part of the decision-making process regarding the infant’s care. Neonatal communication intervention is of utmost importance in a country such as South Africa, which has an increased prevalence of infants at risk for disabilities and where the majority of these infants live in poverty. Speech-language therapists fulfil an important role in the neonatal nursery and are an integral part of the team involved with the high risk neonatal population. Local literature showed a dearth of information on the current service delivery and roles of speech-language therapists and audiologists in neonatal nurseries in the South African context. From an asset-based perspective it appears that the South African population receiving services in neonatal nurseries have unique characteristics. This provides speech-language therapists with ample opportunity to intervene, providing that intervention is well-timed in the neonatal nursery context. The country-wide initiative to implement the evidence-based technique of kangaroo mother care indicates that speech-language therapists should recognise its importance and develop communication based materials and tools to complement this successful neonatal intervention. The aim of the research was to establish whether speech-language therapists have needs for assessment and intervention tools/materials in this context. The study furthermore aimed to compile a locally relevant neonatal communication intervention instrument/tool for use by speech-language therapists in the neonatal nurseries of public hospitals in South Africa in order to propose a solution to address the shortage of tools in the public health context. The study entailed descriptive, exploratory research. During Phase 1, a survey was received back from 39 speech-language therapists and two audiologists in six provinces. The data revealed that participants performed different roles in neonatal nurseries, which were determined by the environment, tools, materials and instrumentation available to them. Many participants were inexperienced, but were resourceful in their attempts to develop and adapt tools/materials. Participants expressed a need 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 for use by speech-language therapists and justified by participants’ roles and needs as well as current early communication intervention (ECI) literature. The programme was piloted by three participants. Certain 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. The programme complied with the guiding principles for best practice in ECI (ASHA, 2008) and can therefore contribute to neonatal care of high risk infants in South Africa. Speech-language therapists and audiologists must contribute to neonatal care of high risk infants to facilitate optimal health and development and to support their families. AFRIKAANS : Omvattende intervensie in die neonatale sorgeenheid behels mediese behandeling van die neonaat, sowel as ontwikkelingstoepaslike sorg en die verskaffing van leiding, berading en inligting aan die gesin wat deel is van die besluitnemingsproses rakende die baba se sorg. Neonatale kommunikasie intervensie is van uiterste belang in Suid-Afrika aangesien daar ‘n hoër prevalensie van babas is wat ‘n risiko het vir ontwikkelingsafwykings en aangesien die meerderheid van hierdie babas in armoede leef. Spraak-taalterapeute vervul ‘n belangrike rol in die neonatale sorgeenheid en is ‘n integrale deel van die span wat betrokke is by die hoërisiko neonatale populasie. Plaaslike literatuur dui op ‘n tekort aan inligting rakende die huidige dienslewering van die spraak-taalterapeut en oudioloog in neonatale sorgeenhede in die Suid-Afrikaanse konteks. Vanuit ‘n bate-benadering kom dit voor of die Suid-Afrikaanse populasie wat dienste in neonatale sorgeenhede ontvang, unieke eienskappe het. Dit bied genoegsame geleenthede aan spraak-taalterapeute om intervensie te verskaf, solank die behandeling betyds in die neonatale sorgeenheid konteks aanvang neem. Daar is ‘n landswye inisiatief om die bewysgerigte tegniek van kangeroe moedersorg toe te pas. Spraak-taalterapeute moet dus die belang daarvan herken en kommunikasie gebasseerde terapiemateriaal ontwikkel om hierdie suksesvolle neonatale intervensie te komplementeer. Die navorsing se doel was om vas te stel hoe wyd spraak-taalterapeute en oudioloe ‘n behoefte aan evaluasie en intervensie instrumente en –materiaal in hierdie konteks het. Die navorsing het verder ten doel gestel om ‘n relevante terapie instrument saam te stel vir spraak-taalterapeute in die neonatale sorgeenhede as ‘n moontlike oplossing vir die tekort aan relevante terapiemateriaal in die plaaslike publieke gesondheidsorgkonteks. Die studie het beskrywende, eksplorerende navorsing behels. Gedurende Fase 1 is ‘n vraelys terug ontvang van 39 spraak-taalterapeute en twee oudioloë in ses provinsies. Die data het aangedui dat deelnemers verskillende rolle in hierdie konteks vervul, wat beïnvloed was deur die omgewing, die instrumentasie en materiaal wat tot hulle beskikking was. Die meerderheid van die deelnemers was onervare, maar was vindingryk in hulle pogings om terapiemateriaal aan te pas en te ontwikkel. Deelnemers het ‘n behoefte vir kultureel toepaslike- en gebruikersvriendelike instrumente en materiaal uitgedruk met die oog op ouerleiding en personeel/span opleiding oor die onderwerp van ontwikkelingstoepaslike sorg. Gedurende Fase 2 is ‘n terapie instrument naamlik “Neonatale kommunikasie intervensie program vir ouers” saamgestel vir die gebruik in die neonatale sorgeenhede deur spraak-taalterapeute. Die samestelling van hierdie program is verantwoord deur die deelnemers se rolbeskrywing en behoeftebepaling van Fase 1, sowel as deur huidige vroeë kommunikasie intervensie (VKI) literatuur. Die program is deur drie deelnemers in ‘n loodsstudie geëvalueer. Voorstelle vir die verbetering van die program is verskaf, naamlik die byvoeging van ‘n terminologielys, aanpassing van die program se taalgebruik en terminologie en verskaffing van meer illustrasies. Die program het ooreengestem met die beginsels vir beste praktyk in VKI (ASHA, 2008) en kan daarom tot neonatale sorg van hoërisikobabas in Suid-Afrika bydra. Spraak-taalterapeute en oudioloë moet bydra tot neonatale sorg van hoërisiko neonate om sodoende optimale gesondheidsorg en ontwikkeling te fasiliteer en gesinne te ondersteun. Copyright / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted