South African Journal of Communication Disorders

Speech therapy students' perceptions of authentic video cases in a theory module on child language disorders

BACKGROUND: Undergraduate speech-language therapy students often find it difficult to see the relevance of theoretical module content, which may negatively influence their motivation to learn. The real world of their future profession can be brought to life in the theory classroom by including authentic case study examples. Video case studies are well suited to illustrating communication disorders and may also be easier to remember and relate to information already in the long-term memory. OBJECTIVES: This article describes the perceptions of undergraduate students regarding the inclusion of authentic video cases in a theoretical module on developmental communication disorders. METHODS: A qualitative, interpretivist research design was followed. Focus-group interviews were conducted with 22 second-year students in the programme B Speech-Language and Hearing Therapy. A modified contextualised content analysis approach was used to analyse interview data. RESULTS: The use of authentic video cases was perceived positively by participants. Seeing a realistic example of a person with communication difficulties made it easier to understand, remember and engage with the module content. Participants also felt they could more easily imagine themselves in that clinical context, which seemed to (re-) awaken in them a sense of purpose and motivation. Being presented with real-life communication problems made them realise the relevance of their profession. However, participants experienced cognitive overload at times when the processing requirements of a task exceeded their available cognitive capacity. CONCLUSION: Video cases are valuable tools to enhance students' engagement with theoretical content. To avoid cognitive overload, a scaffolded multimedia learning experience needs to be provided.

Statistical factors associated with utilisation of ototoxicity monitoring services for multi-drug-resistant tuberculosis patients in the Western Cape

BACKGROUND: South Africa is a high-burden multi-drug-resistant tuberculosis (MDR-TB) country. Previously, standard MDR-TB treatment regimen in South Africa included kanamycin, an aminoglycoside, which can cause permanent hearing loss in patients. South African National Tuberculosis Control programme's guidelines for the management of patients with MDR-TB were revised in 2011 to support outpatient-based models. This, in turn, required reorganisation of ototoxicity monitoring services to support these new models of service delivery. OBJECTIVES: The aim of this study was to determine factors associated with the utilisation of ototoxicity monitoring services for patients with MDR-TB who accessed treatment as outpatients. METHOD: A retrospective review of medical records of patients who attended ototoxicity monitoring clinic at a central TB hospital in Cape Town during 2012-2013 was conducted. A total of 801 medical folders were reviewed: 415 (51.8%) males and 386 (48.2%) females, median age 37 (range 7-85) years. RESULTS: Ten per cent of patients attended all the recommended six-monthly appointments. Patients who presented with hearing loss at baseline or developed hearing loss after treatment initiation were more likely to attend their appointments. Patients were also more likely to attend their appointments if a baseline audiometric assessment was conducted within 1 month of MDR-TB treatment initiation. CONCLUSION: This study revealed that outpatient-based ototoxicity monitoring services were largely underutilised by patients. Development of hearing loss and prompt determination of a baseline audiogram were associated with a higher likelihood of attendance of ototoxicity monitoring appointments. Therefore, utilisation of outpatient-based ototoxicity monitoring services is likely to be improved by identifying patients early and monitoring them closely.

Contributing factors to high prevalence of hearing impairment in the Elias Motsoaledi Local Municipal area, South Africa: A rural perspective

BACKGROUND: There is evidence that the factors contributing to the prevalence and aetiology of hearing impairment vary widely from one country to another. In South Africa, as in other low-income and middle-income countries, more context-specific information on the estimated prevalence of hearing impairment and the factors that contribute to its onset is required. AIM: The aim of this study was to provide decision-makers and hearing health professionals with local and accurate information on the prevalence of ear and hearing disorders in the Elias Motsoaledi Local Municipal (EMLM) area of the Limpopo province, South Africa. METHODS: The World Health Organization (WHO) protocol for population-based surveys of prevalence and causes of deafness, hearing impairment and other ear diseases was utilised. A random multi-stage cluster sampling strategy, two-stage sampling, was utilised to select the seven municipal wards and 357 households through the probability proportional to size method. A total of 850 participants were included in the study. RESULTS: The overall prevalence of hearing impairment was 19.88% (95% confidence interval [CI]: 0.15-0.2) and 8.94 (95% CI: 0.08-0.12) for disabling hearing impairment. The prevalence of ear disease was 13.19% (95% CI: 0.10-0.15), with impacted cerumen and otitis media reported most often. Associations with hearing impairment were established for age, gender and hypertension. CONCLUSION: The study has shown a higher prevalence of disabling hearing impairment in the rural EMLM area of the Limpopo province compared to global prevalence rates. In addition, known factors associated with hearing impairment were confirmed.

Communication and school readiness abilities of children with hearing impairment in South Africa: A retrospective review of early intervention preschool records

BACKGROUND: The national prevalence of hearing impairment in South Africa is estimated to be four to six in every 1000 live births in the public health care sector. An undetected hearing impairment in childhood can lead to delayed speech and language development as well as put the child at risk of not achieving the necessary school readiness abilities that will enable them to achieve academic success. However, through early hearing detection and intervention services, children with hearing impairment can develop communication and school readiness abilities on par with children with normal hearing OBJECTIVE: The aim of the study was to describe communication and school readiness abilities of children who were identified with hearing impairment and enrolled in early intervention (EI) preschools in Gauteng. METHODS: Within a descriptive research study design, a retrospective record review was conducted on files of eight children, ranging in age from 9 years and 7 months to 12 years and 7 months, identified with a hearing impairment and enrolled in EI preschools in Gauteng, South Africa. Descriptive statistics were used to analyse the data, using frequency distribution and measures of central tendency RESULTS: Current findings revealed that children with hearing impairment who were enrolled in EI preschools in Gauteng were identified late. This consequently led to delayed ages at initiation of EI services when compared to international benchmarks and the Health Professions Council of South Africa's (HPCSA) guidelines of 2018. Consequently, participants presented with below average communication and school readiness abilities, which are characteristic of hearing impairment that is identified late. CONCLUSIONS: Transference of current contextually relevant research findings into practice by both the Department of Health and the Department of Basic Education forms part of future directions from this study. This conversion of research findings into service delivery must be conducted in a systematic manner at all levels in these two sectors to facilitate achievement of Early Hearing Detection and Intervention (EHDI), resulting in better communication and school readiness outcomes.

The piloting of a specific support programme for Grade R teachers on attention deficit hyperactivity disorder: The process of development

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children and is generally identified and diagnosed during the preschool years. Preschool learners with ADHD are at risk of developing emergent literacy difficulties, crucial for the development of reading and writing. Many teachers have insufficient training to identify and address barriers to learning, such as ADHD. AIM: The aim of this article was to report on the process followed in the development of a specific support programme for Grade R teachers on ADHD and on the piloting of the programme METHOD: An adapted version of the intervention research model provided the structure and phases for the development, implementation and evaluation of the support programme. Current literature on ADHD training programmes, adult learning principles and Bronfenbrenners' ecosystemic framework was explored to develop the programme, training material, manual and method of presentation (Phase 1). Workshops were presented to 65 Grade R teachers working in an urban and semi-rural context (Phase 2). Participants were made aware of the symptoms of ADHD, and early identification and management of specific barriers to learning, such as ADHD, in order to reduce the risk of educational complications. Participants provided feedback (Phase 3) on the training, training material and manner of presentation following the workshops. RESULTS: The results obtained in phases 1 and 2 of the adapted intervention research model included the compilation of the information presented in the workshops and the training manual, as well as the instructional phase and piloting of the programme. The results obtained for Phase 3 include a summary of the feedback provided by the Grade R teachers on how they experienced the training. Participants' feedback confirmed that the programme was valued and that their training expectations were met. CONCLUSION: The intervention research model provided a valuable structure for the development and piloting of a specific support programme. This study can be replicated, and may pave the way for future support programmes for teachers. Capacity building of teachers is of the utmost importance in raising education standards in South Africa.

Exploration of factors influencing the preservation of residual hearing following cochlear implantation

BACKGROUND: Increasing access to cochlear implants within the resource-constrained South African context calls for careful investigation of all factors that might influence benefit from this technological advancement. OBJECTIVE: The aim of this study was to investigate preservation of hearing following cochlear implant surgery and whether a relationship existed between the post-operative hearing findings and certain factors. METHODS: Within a quantitative paradigm, a retrospective data review design was adopted where a sample consisting of audiological records from 60 observations and surgical records from two cochlear implant units in South Africa was investigated. These records were selected using purposive sampling and consisted of records from participants ranging from 6 to 59 years. Comparative analysis of unaided audiological test results was pre- and post-operatively performed, where all paitents were implanted with cochlear devices. Factors documented to have a possible influence on post-operative outcomes were examined in an attempt to establish relationships that may exist. Findings were analysed by means of both inferential and descriptive statistics. RESULTS: The findings indicated 92% success rate in preservation of residual hearing. There was a direct correlation between surgical techniques, as well as cochlear implant type and the successful hearing findings, in the absence of surgical complications. Other factors explored did not have any negative effect on the hearing findings. CONCLUSION: The study findings suggest improved surgical outcomes with enhanced surgical techniques and advanced technology, with a clear negative impact of intraoperative complications on the outcomes.

The effects of combined exposure of solvents and noise on auditory function - A systematic review and meta-analysis

BACKGROUND: Chemical substances can negatively affect the auditory system. Chemical substances alone or combined with high-level noise have recently become a major concern as a cause of occupational hearing loss. OBJECTIVE: To assess the combined effect of solvents and noise versus solvents only, or noise only, on the auditory function of workers METHOD: Published articles which included noise and/or solvent exposure or combined effects of solvents and noise, studies conducted on human beings only and the use of audiological tests on participants. RESULTS: Thirteen papers were eligible for inclusion. The participants' ages ranged from 18 to 68 years. Results revealed that 24.5% presented with hearing loss as a result of noise exposure only; 18% presented with hearing loss owing to solvent exposure only; and a total of 43.3% presented with hearing loss owing to combined noise and solvent exposure. Furthermore, the prevalence of hearing loss in the noise and solvent group was significantly (p < 0.001) higher than the other groups in 10 out of the 13 studies analysed, with a pooled odds ratio (OR) of 2.754. Of the 178 participants (total of all participants exposed to solvents), a total of 32 participants presented with auditory pathology as a result of exposure to solvents only. There was a significantly higher pooled odds of hearing loss in noise and solvent-exposed group compared to solvent-only group (pooled OR = 2.15, 95% CI: 1.24-3.72, p = 0.006. CONCLUSION: The findings revealed significantly higher odds of acquiring hearing loss when workers were exposed to a combination of solvents and noise as opposed to solvents only, motivating for its inclusion into hearing conservation programmes.

The cat on a hot tin roof? Critical considerations in multilingual language assessments

BACKGROUND: In speech-language pathology (SLP), there is a paucity of resources to provide just and equitable services to South Africa's culturally and linguistically diverse population. Although South Africa is a multilingual country, English remains the dominant language. However, there is limited research on resources for English additional language (EAL) speakers. OBJECTIVES: This article addresses this gap by presenting the results of a critique of a commonly used language screening tool, the Renfrew Action Picture Test (RAPT), on EAL speakers. METHOD: This tool is used as an example to broadly critique the use of culturally biased assessment instruments with EAL speakers from an indigenous linguistic and cultural background. It is administered to children who are EAL speakers and then critiqued by the children too. Their voice, often ignored in research, is central to the research. A mixed methods approach is used, including focus groups and test administration. This article is based on the results of the thematic analysis used to closely examine the patterns that emerge. RESULTS: A key finding is that the cultural and linguistic background of the child assessed cannot be disregarded, as it plays a crucial role in understanding the response of the child. The interpretation of the response of the child to the presented material of the language assessment tool significantly influences the result of the assessment. CONCLUSION: The speech language therapist has a responsibility to avoid skewed results based on uninformed interpretation of the response of the child. These findings provide useful insights for clinicians regarding culture-fair assessment.

Responsive communication coaching for early childhood practitioners in underserved South African contexts: Clinical perspectives

Children spend longer hours with early childhood development (ECD) practitioners who are well-placed to facilitate critical early language development. ECD classrooms include a growing number of children at risk for communication delays. Greater collaboration between speech-language therapists (SLTs) and ECD practitioners is needed. Research highlights that responsivity coaching improves communication development. Therefore, responsive communication coaching was identified as a possible approach to early communication development within the classroom. This clinical perspective serves as a reflection on the programme by examining ECD practitioners' perceptions thereof. Responsive communication coaching was identified as a means to improve practitioner-student collaboration within classrooms. This reflection aimed to describe ECD practitioners' perceptions of responsive communication coaching implemented by student SLTs. Early childhood development practitioners were recruited from three sites in low to middle socio-economic settings, where most children were English additional language learners. Coaching was presented to 15 practitioners via 16 sessions conducted by student SLTs under supervision. Practitioners completed a custom-designed survey regarding their skill development and experiences of the coaching. All practitioners expressed benefit from coaching. Half of the practitioners (50%) rated coaching as very helpful, while 37% perceived it as helpful. The remaining practitioners (13%), based at the special needs preschool, perceived coaching as quite helpful. Thematic analysis identified the following benefits: enhanced interaction, improvements in children's communication and the use of responsive communication strategies. Speech-language therapists need to collaborate with and support ECD practitioners in novel ways. The exploratory findings suggest that ECD practitioners benefit from SLT student-led responsive communication coaching sessions.

Public awareness of ear health and hearing loss in Jeddah, Saudi Arabia

BACKGROUND: Knowledge of ear health and hearing loss is essential for early intervention and treatment, but the state of public knowledge of such in Jeddah, Saudi Arabia, remains unknown OBJECTIVES: To measure public knowledge of ear health and hearing loss METHOD: This cross-sectional study was conducted during August 2018 in Jeddah, Saudi Arabia. An electronic survey questionnaire was distributed to 2372 residents of various districts in Jeddah. The survey was created in 2013 by adopting previously published World Health Organization material, designed to assess knowledge and perception of ear health. All males and females aged 10 years or older living in Jeddah had the chance to participate in this study. A total of 2372 people participated. Percentages mean ± standard deviation, one-way analysis of variance (ANOVAs) and independent t-tests were applied to determine the significant difference. p-values of 0.05 or less were considered significant RESULTS: The overall mean number of correct responses on the survey's true/false questionnaire was 10.66 ± 1.92 out of 14. Female participants gave a higher mean number of correct answers than did male participants (10.73 ± 2.03 vs. 10.54 ± 2.03, respectively). Participants with a family history of hearing loss gave a higher mean number of correct answers compared with participants who reported a negative family history (10.89 ± 1.82 vs. 10.53 ± 1.97, respectively CONCLUSION: Overall awareness of ear health and hearing loss management is fair. However, the results indicate a need for more integrated educational materials to be made available both to the general population as well as to hearing loss individuals and their families

Community service speech language therapists practising in adult dysphagia: Is the healthcare system failing them?

Performing community service is a necessity prior to practising speech language therapy in South Africa. This system allows for improved access to these specialised services in the more rural areas. The current challenges of practising in complex settings with little access to mentorship can result in these community service therapists feeling underprepared to assess and manage patients presenting with adult dysphagia (swallowing disorders). This paper explores this topic through the theoretical lens of decision-making, from both clinical and academic perspectives. It aims to pose potential solutions on how to better transform the current practices to be contextually responsive to these challenges.

Corrigendum: Gestational age and birth weight variations in young children with language impairment at an early communication intervention clinic

Knowledge of final year medicine, pharmacy, audiology and nursing students in South Africa on drug-induced ototoxicity: A pilot study

BACKGROUND: There is a high prevalence of human immunodeficiency virus (HIV), tuberculosis (TB), cancer and malaria in South Africa, and the drugs used to treat these conditions can be ototoxic. It is therefore important that healthcare professionals are able to identify and understand these drugs and their effects to ensure effective care of the patient. OBJECTIVE: This study aimed to assess the knowledge regarding pharmacotherapy-induced ototoxicity amongst final year, medicine, pharmacy, audiology and nursing students across South African universities. METHODS: A descriptive cross-sectional study design was used, and data were collected via a self-administered online questionnaire. Non-probability purposive sampling was used to identify the participants at the universities which train audiologists, pharmacists, medical and nursing students. RESULTS: An overall response rate of 41% (n = 720) was obtained. Sixty-four per cent (n = 461) of respondents were women (median age: 23 years). The majority of the respondents (95%) knew what pharmacotherapy-induced ototoxicity was, but a few (39%) knew the general signs and symptoms of ototoxicity. Furthermore, just less than half of the sample (48%) could identify the specific ototoxic medicines and the type of damage caused by this medication. CONCLUSION: To manage pharmacotherapy-induced ototoxicity effectively, a multidisciplinary healthcare team must have sufficient knowledge about ototoxicity. Therefore, efforts should be made to introduce extensively concepts of pharmacotherapy-induced ototoxicity into the undergraduate curricula of pharmacy, medical, nursing and audiology programmes.

Management of adult patients with tinnitus: Preparedness, perspectives and practices of audiologists

BACKGROUND: Audiologists, globally, are generally challenged when assessing and creating intervention plans to help patients suffering from tinnitus. Tinnitus is very common among individuals and may significantly affect one's quality of life, especially if not addressed by health care professionals. In South Africa, there seems to be limited published studies regarding the current practices of tinnitus management by audiologists. This is mainly because of limited training and a lack of guidelines and strategies for the management of tinnitus. In particular, some participants reported being unfamiliar on how to approach the identification of tinnitus and difficulty is also encountered when counselling tinnitus patients. AIM: The aim of this study was to describe the preparedness, perspectives and practices of audiologists who manage adult patients with tinnitus. METHOD: Two hundred and forty-three registered Health Professions Council of South Africa (HPCSA) participants were involved in the study by responding to an electronic questionnaire survey. Data were collected online from Survey Monkey and were exported to Statistical Packages for the Social Sciences (SPSS) (Version 23) for statistical analysis. Data were analysed using descriptive and inferential statistics. Closed-ended questions were analysed within a quantitative framework and thematic analysis for open-ended questions that were descriptively quantified. RESULTS: The results of the study are presented according to the objectives. Approximately 44% of participants (44.3%) disagreed that the undergraduate university training had sufficiently prepared them to manage adult patients with tinnitus. Very few (12.3%) had the opportunity to attend specialist training on how to assess patients with tinnitus. Similarly, only 11.6% received any specialist training with regard to tinnitus intervention. With regard to its overall management, 49.4% felt adequately informed in the assessment of patients with tinnitus, while a further 39.2% rated their experience as being limited with regard to tinnitus intervention. There is no statistical significance relationship between participants' years of experience and tinnitus intervention (p = 0.075). Most participants did not follow any standard guidelines for its management. Some participants (26.8%) reported that further education and training are required in the overall management of patients with tinnitus, while a further 17.7% required training in all areas of tinnitus CONCLUSION: The feedback relating to the study suggests that overall management of tinnitus seems to be a challenge among South African audiologists, irrespective of their years of experience. Audiologists in the study perceived that tinnitus services are limited mainly because of a lack of or limited knowledge, training and guidelines, these being affected by contextual restraints.

Shifting and transforming the practice of audiology: The inclusion of traditional healing

BACKGROUND: Societal diversity encompasses an array of cultural, religious and spiritual beliefs that influence an individual's perspective of illness and diseases. Healthcare providers are challenged with the task of considering these diversities in clinical practice. The symbiotic relationship between the healthcare provider and the traditional healer in any healthcare field is rare. OBJECTIVES: The aims were to determine the perspectives of audiologists with regard to traditional healing in South Africa (SA) and to document if and how the audiologist engages with traditional healing in practice. METHOD: A questionnaire containing closed and open-ended questions was utilised. Thematic analysis was conducted on the qualitative data, and the quantitative data were displayed using tables and figures. RESULTS: Forty-one audiologists working at public and private hospitals and clinics in SA were included in this study. The personal experiences of audiologists resulted in varying definitions of a traditional healer. Audiologists reported that patients utilised traditional healing methods such as pouring urine or motor oil into the ear. Strategies of accommodation included being culturally appropriate during conversations, respecting and acknowledging the individual's cultural and religious beliefs. Twenty-seven audiologists were willing to collaborate with traditional healers to support the patient. CONCLUSION: There is a need for an integral holistic model of care in Audiology. There is a lack of communication structures to facilitate the implementation of a collaborative model of care in the current medical model of practice of Audiology. The global trend of holistic and person-centred care is evident, and the field of Audiology cannot negate the role of traditional healers as alternate healthcare providers in SA.

Prevalence and associated prenatal and perinatal risk factors for oropharyngeal dysphagia in high-risk neonates in a South African hospital

BACKGROUND: The prevalence of neonatal oropharyngeal dysphagia (OPD) in high-risk infants in lower-middle-income countries is unknown. OBJECTIVES: To determine the prevalence and associated risks for OPD in high-risk neonates in order to allow timely intervention for OPD, minimising negative outcomes. METHOD: A prospective cross-sectional observational study was conducted in an urban hospital in South Africa. Clinical feeding assessments were conducted using the Neonatal Feeding Assessment Scale with all available neonates in neonatal care RESULTS: The sample of 81 high-risk neonates (mean chronological age = 11.7 days; standard deviation = 15.6 days) had been feeding orally for 2 days and were approaching discharge. Fifty-two participants (64.2%) had OPD. Risks likely associated with OPD included breech presentation, septicaemia and other infections, spending more than 1 day on a warm table or incubator, neurological conditions, prenatal exposure to maternal smoking, siblings with mental or neurological disability, participants with congenital disorders, preterm birth (< 37 weeks), low birth weight (< 2500 g), or retinopathy of prematurity. CONCLUSION: An unexpected high prevalence of OPD was found in neonates already deemed ready for oral feeding and approaching discharge. Timely early involvement of the Speech-Language Therapists (SLTs) in decision-making about feeding readiness may prevent serious complications of neonatal OPD. Findings may inform South African neonatal clinicians. The study provides motivation for early intervention from SLTs before the infant and mother are discharged from high care and dispersed to communities where intervention services may be scarce.

Towards a South African model of language-based learning disability

BACKGROUND: This conceptual article is inspired by the first phase of a doctoral research project that aimed to develop and validate a bilingual language assessment test for IsiZulu-English-speaking children in grades 1, 2 and 3 with language-based learning disabilities (L-b LDs) in South Africa. OBJECTIVES: Phase 1, systematic literature review, pretesting and formulating of a theoretical framework, with the aim to determine early indicators of L-b LDs; this is important for developing a clinical language test as it determines its constructs METHOD: Thematic analysis was used to develop the models. RESULTS: This article reviews the literature on indicators and definitions of L-b LD, introduces models that were developed in the study to conceptualise L-b LD and discusses implications for language test development. CONCLUSION: The models provided in this article conceptualise L-b LD and identify its early indicators. The application of these models in both educational and clinical settings is proposed for differentiation of L-b LD.

Infection prevention and control measures in audiology practice within public healthcare facilities in KwaZulu-Natal province, South Africa

BACKGROUND: Audiologists have a clinical and ethical responsibility to create a working environment, designed to reduce the potential for cross-contamination or transmission of infections OBJECTIVES: To describe the infection prevention and control (IPC) measures utilised and the opinions of audiologists and speech therapists, and audiologists (A/STAs) towards IPC in public healthcare facilities in KwaZulu-Natal province, South Africa. METHOD: A quantitative, descriptive survey was utilised and entailed completing an online questionnaire. The Cronbach's alpha (0.82) indicated good internal consistency of the tool. Forty-nine A/STAs from 29 public healthcare facilities responded. RESULTS: Most participants (82%) followed a generic Department of Health policy on IPC, while 67% alluded to a discipline-specific policy. Participants had received training in infection control but indicated that further instruction was required for audiology-specific infection control procedures. Only 57% indicated that they 'sometimes' wore gloves with every patient during direct clinical contact. An association between the healthcare facility level and the wearing of gloves was found to be statistically significant (p = 0.025). Participants at regional and tertiary levels contended that gloves should be worn during most procedures versus those at district levels of care. While 96% washed their hands after each patient, only 76% washed their hands before each patient. Twenty-nine per cent indicated that they only 'sometimes' wore masks when in contact with patients with communicable diseases. Approximately one-third disinfected touch surfaces and toys, based on the clinician's discretion. The majority (86%) of participants, however, always followed the correct protocol for medical waste disposal. Despite training and the availability of policies, some practitioners displayed poor IPC practices in terms of universal precautions, personal protective equipment, handwashing and sterilisation. CONCLUSION: Further education, training and awareness related to appropriate IPC measures are recommended for audiologists. It is envisaged that this will lead to more effective IPC measures in audiology practice thereby reducing the risk of infection transmission.