Scielo RSS <![CDATA[South African Journal of Communication Disorders]]> vol. 67 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Perceptions of mothers with preterm infants about early communication development: A scoping review</b>]]> BACKGROUND: Preterm infants are at risk of communication disorders or delays, and their mothers experience various difficult emotions and realities. These communication difficulties could be effectively prevented or addressed through the provision of appropriate maternal support. Maternal perceptions regarding early communication-interaction and development in preterm population should thus be well understood by health professionals. Previous studies have focussed on parents' and patients' perceptions of medical information received from health professionals. Limited research, however, has been undertaken on maternal perceptions of early communication development in preterm infants, specifically in the South African context. OBJECTIVES: The study aims to summarise the range and the nature of available research in the fields of early communication development and intervention in preterm infants, specifically maternal perceptions thereof. METHOD: A scoping review methodology comprising five phases was used. Data were extracted from the final selection of 12 articles and analysed through quantitative and thematic techniques. RESULTS: The results of the scoping review indicate that the defined research field is in a developing phase. Mothers mainly experience negative emotions and have limited knowledge regarding communication interaction with preterm infants. Furthermore, hospitalisation has been experienced as a barrier to natural communication-interaction between mother and infant. CONCLUSION: Based on these results, it is recommended that primary research be conducted with the mothers of preterm infants to establish the most effective strategies for communication-interaction training with this vulnerable population. A further recommendation would be to increase awareness of early communication development and intervention in the preterm population amongst both parents and health professionals. <![CDATA[<b>Prevalence of hearing loss and tinnitus in a group of adults with Human Immunodeficiency Virus</b>]]> BACKGROUND: The Human Immunodeficiency Virus (HIV) has become a global pandemic. With the improvement of antiretroviral (ARV) treatment regimens, life-expectancy of HIV-positive individuals has increased. HIV literature suggests that head and neck manifestations may be the first indication of supressed immunity. Therefore, research regarding the effects of HIV and new treatment regimens on auditory function remains a priority. OBJECTIVES: To describe the audiological characteristics and determine the prevalence of hearing loss and tinnitus in a group of HIV-positive individuals on ARV treatment residing in a rural province. METHODS: The study employed a cross-sectional descriptive research design. Participants were recruited from the clinic and pharmacy waiting areas of a medical centre in a rural area of Limpopo province, South Africa. Two participant groups, an HIV-positive group (N1 = 60) and an HIV-negative group (N2 = 32) were included in the study. The test battery comprised a comprehensive case history and a routine audiological test battery, which included otoscopy, tympanometry and pure tone audiometry (250 Hz to 8000 Hz). RESULTS: No statistically significant difference was found regarding the prevalence of hearing loss in the two participant groups (p = 0.709). However, the prevalence of tinnitus was significantly higher in the HIV-positive group (p = 0.05), CONCLUSION: The insignificant difference in the audiological test battery results found between the two participant groups may be due to improved ARV treatment regimens and management strategies employed at the medical centre. However, the increased prevalence of tinnitus in the HIV-positive group may also be attributed to the ARV regimen and/or the result of subtle damage to the auditory system, which was not identified by the current audiological test battery. More insight may be obtained about the effects of HIV on hearing by employing a longitudinal research design and inclusion of a more ototoxicity sensitive test battery. <![CDATA[<b>An audiological profile of a cohort of school-aged children with HIV and AIDS attending an antiretroviral clinic in South Africa</b>]]> BACKGROUND: Recent estimates reveal that there are approximately 280 000 children between the ages of birth and 14 years who are living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in South Africa. These children are living with a compromised immune system, are vulnerable to opportunistic infections and subsequent hearing loss. However, there is limited research on the nature and extent of this sensory impairment amongst school-aged children. OBJECTIVE: This study aimed to determine an audiological profile of a cohort of school-aged children attending an antiretroviral (ARV) clinic, describing the occurrence of hearing loss and nature in terms of degree, type, configuration and symmetry. METHODS: A non-experimental descriptive exploratory study was conducted, where 30 children aged between 6 and 12 years underwent diagnostic audiological assessments. Audiological procedures included case history, medical record review, otoscopic examination, immittance audiometry, pure-tone audiometry, speech audiometry, distortion product otoacoustic emissions (DPOAEs) and neurological auditory brainstem response (ABR) testing. The results were analysed descriptively using SPSS version 22 software. RESULTS: The results indicated abnormal otoscopic findings in half the participants, and consequently type C tympanograms were the most common. Of the 28 participants who could be assessed with pure-tone audiometry, 15 (54%) showed a hearing loss. A bilateral rising mild, conductive hearing loss was predominant. Thirteen (43%) of the participants could not be tested using DPOAE because of outer and middle-ear pathology. Neurological ABR testing revealed an abnormality in 18 (60%) of the participants suggesting the sensitivity of the ABR to detect subtle neurological changes. CONCLUSION: Half the children in this study showed hearing loss, which has serious implications for the holistic management of the children within the health and educational contexts. Therefore, there is a need for audiological monitoring of children with HIV and AIDS. <![CDATA[<b>The hearing function of sound engineers: A hearing conservation perspective</b>]]> BACKGROUND: Occupational activities performed by sound engineers are associated with hearing loss. However, there is a dearth of research on the hearing functions and the related hearing loss for sound engineers. OBJECTIVES: To determine the hearing function and early effects of noise on the hearing ability of sound engineers, and to establish whether there are hearing conservation programmes (HCPs) available for sound engineer participants in Johannesburg. METHODS: A quantitative cross-sectional design was used. Eight sound engineers from the Academy of Sound Engineering (ASE) participated in the study. The following data were collected from the participants: case history data, ear-related symptoms and hearing conservation data. Hearing screening followed by full diagnostic audiological assessments was conducted for each participant. Descriptive statistics and one-sample t-test were used to analyse the data (confidence interval [CI] = 95%. RESULTS: Participants reported tinnitus and aural fullness as common complaints. Only one participant had a unilateral impacted cerumen. All the participants presented with hearing within normal limits bilaterally, with a percentage loss of hearing (PLH) of 1.1% for all the participants. However, five participants presented with a notched configuration that was ≥ 10 decibel (dB), in the high frequency region at 3000 Hz and 6000 Hz bilaterally. One-sample t-test (p = 0.001) inferred that at a mean age of 27.6 years (standard deviation [SD] = 3.85), a notch at 3000 Hz and 6000 Hz was associated with an early sign of a hearing loss for the study participants. An HCP was not in place at the study site. CONCLUSION: The study indicated a younger age as an associated early sign of noise-induced hearing loss (NIHL) for the study participants, and that audiologists' clinical practice needs to explore HCP strategies specific for the sound engineers in order to prevent hearing loss <![CDATA[<b>A descriptive analysis of assessment measures on the effectiveness of a comprehensive stuttering intervention approach: A single case study</b>]]> BACKGROUND: For effective client outcomes, stuttering assessment and intervention approaches need to be aligned. This encompasses using assessment and intervention approaches that address the three multidimensional constructs of stuttering, namely core behaviours, secondary behaviours and negative feelings and attitudes. OBJECTIVE: The study aimed to explore whether multiple assessment measures could be used to describe the effectiveness of a comprehensive stuttering intervention approach, undergirded by the International Classification of Functioning, Disability and Health (ICF) framework. METHOD: A single-subject case design was employed with one male adult who stutters. Data was collected by administering the Stuttering Severity Instrument-Fourth Edition (SSI-4) and Overall Assessment of the Speaker's Experience of Stuttering-Adults (OASES-A) at three testing periods (pre-intervention, immediately post-intervention and 7 months post-intervention), and a semi-structured interview schedule immediately post-intervention. Descriptive statistics was used to analyse the SSI-4 and OASES-A, and thematic analysis was conducted to evaluate the participant's interview schedule responses. RESULTS: The participant's total scores, impact scores and severity ratings of both the SSI-4 and OASES decreased across the three testing periods. The main theme of effectiveness of the comprehensive stuttering intervention to reduce aspects of disability emerged from the participant's responses. CONCLUSION: Evaluation of the results from the assessment measures revealed that the comprehensive stuttering intervention approach was effective in reducing the participant's core behaviours, secondary behaviours and negative feelings and attitudes. Assessment and management of fluency disorders should promote a client-specific multidimensional approach that extends beyond the core behaviours and secondary behaviours, by addressing the underlying social and emotional facets of fluency disorders. <![CDATA[<b>Perspectives and practices of ototoxicity monitoring</b>]]> BACKGROUND: Treatment of cancer with cisplatin can result in hearing loss. Given the increasing burden of cancer in Africa, appropriate and timely identification, intervention and management of hearing loss in affected patients is of paramount importance. OBJECTIVES: This study describes the perspectives and practices of healthcare professionals in relation to cisplatin-associated ototoxicity at an institution treating patients diagnosed with cancer. METHOD: A concurrent triangulation study design was used to collect quantitative data from seven oncologists, nine nurses and 13 pharmacists using self-administered questionnaires, and qualitative data from four audiologists through semi-structured interviews for this hospital-based study, conducted in South Africa. RESULTS: Levels of awareness of cisplatin-associated ototoxicity varied with only 33% of the nursing personnel being aware in comparison to the oncologists and pharmacists. Oncologists were identified as the main custodians for providing information to patients. Whilst 82% of the participants considered the audiologist to be part of the oncology team, there was no provision for ototoxicity monitoring in the chemotherapy protocols, nor any ototoxicity-monitoring programme in place. There was no evidence that knowledge of cisplatin-associated ototoxicity translated into an appropriate management strategy for such patients. CONCLUSION: Healthcare personnel overseeing the care and management of cancer patients need to improve their awareness of ototoxicity and refer timeously for audiological evaluation. Audiologists require greater awareness of monitoring programmes to appropriately implement and manage such programmes within a cancer platform and be part of a multidisciplinary team. <![CDATA[<b>Post-stroke dysphagia: An exploration of initial identification and management performed by nurses and doctors</b>]]> BACKGROUND: South African speech-language therapists are the only health professionals charged with dysphagia rehabilitation. However, registered nurses and doctors are often initial healthcare contact points for post-stroke dysphagia. Notwithstanding service concerns, they do indeed identify and manage post-stroke dysphagia. However, little is known about specifically what they do during these initial clinical encounters. OBJECTIVE: To explore how doctors and registered nurses, on initial clinical contact, identify and manage post-stroke dysphagia. METHOD: A quantitative descriptive survey design, with non-probability, purposive sampling, was used. Twenty-one registered nurses and four doctors at a private South African hospital self-administered a questionnaire. Univariate analyses were completed by calculating frequency distributions of nurses' and doctors' identification and management practices. RESULTS: Most (86%) did not use a formal screening tool. Indicators screened informally included: presence of drooling (84%) or gag reflex (76%), level of alertness (80%) and spontaneous saliva swallow (80%). Participants neglected important indicators like voluntary cough and vocal quality. Management provided included head of bed elevation (96%), speech-language therapist referrals (92%), nasogastric tube insertions (88%), intravenous fluids (84%) and positional adjustments (76%). Alternative management included total parenteral nutrition (52%), syringe feeding (48%), swallow muscle strengthening exercises (56%) and swallow manoeuvres (52%). CONCLUSION: Results indicated that doctors and registered nurses under-utilised important dysphagia indicators and used potentially harmful management practices like syringe feeding. Management practices further included out-of-scope methods like dysphagia rehabilitation exercises or manoeuvres. Recommendations include peer dysphagia screening training using formal tools and basic dysphagia management methods to better equip doctors and registered nurses when they clinically engage post-stroke patients. <![CDATA[<b>Challenges of teaching the deaf-blind learner in an education setting in Johannesburg: Experiences of educators and assistant educators</b>]]> BACKGROUND: Evidence suggests that educators of deaf-blind students in the South African context have specific challenges in the educational setting because of their lack of adequate knowledge on deaf-blindness and a lack of sufficient training on communication, teaching and learning strategies OBJECTIVES: The aim of this study was to describe the challenges experienced by educators and assistant educators of children with deaf-blindness METHOD: Ten educators and assistant educators were selected purposively to participate in the study (Male = 3; Female = 7; age range 31-49 years). Participants were recruited from a school for the deaf-blind in Johannesburg. Participants completed semi-structured interviews on the challenges that they experienced when educating learners who are deaf-blind RESULTS: Findings from the data after inductive thematic analysis suggested the following: (1) under-preparedness of educators and assistant educators, (2) communication challenges, (3) challenges related to the diversity of deaf-blind learners and (4) lack of support structures for educators and assistant educators CONCLUSION: There is a need for ongoing educator training on communication strategies, cultural diversity and inclusive strategies. A collaborative model of delivering training and inclusive education that will encompass educators and therapists as a means of supporting both the educator and the learner who is deaf and blind is needed. Such a collaboration may result in positive outcomes for both the educator and the deaf-blind learner <![CDATA[<b>The core vocabulary of South African Afrikaans-speaking Grade R learners without disabilities</b>]]> BACKGROUND: Augmentative and alternative communication (AAC) can enable individuals with little or no functional speech to communicate functionally in a variety of communication contexts. AAC systems for individuals who are not (yet) fully literate often require that the vocabulary for the system be preselected. By including the most commonly- and most frequently-used words (core vocabulary) in an AAC system, access to novel utterance generation can arguably be facilitated. At present, no Afrikaans core vocabulary list based on children's speech samples exists. OBJECTIVES: This study aimed to identify the most frequently- and commonly-used words of South African Afrikaans-speaking Grade R learners without disabilities. METHOD: Spontaneous speech samples were collected from 12 Afrikaans-speaking Grade R learners during regular preschool activities. Samples were transcribed and analysed to determine the number of different words used, the frequency with which each word was used, as well as the commonality of word use across the 12 participants. RESULTS: A total of 239 words met the criteria for inclusion in the core vocabulary (words used with a frequency of more than 0.05% in the sample, and used by at least half of the participants). These words accounted for 79.4% of words used in the entire speech sample CONCLUSION: The established core vocabulary consists of a relatively small set of words that was found to represent a large proportion of speech. AAC team members may consider including these words on Afrikaans AAC systems that are intended to give access to a measure of novel utterance generation. <![CDATA[<b>Maternal knowledge and views regarding early hearing detection and intervention in children aged 0-5 years at a semi-urban primary care clinic in South Africa</b>]]> BACKGROUND: South Africans have an increasing burden of hearing loss, especially in low-income rural areas. Limited information is available regarding caregivers' knowledge and views regarding infant hearing loss, which is essential for the successful implementation of early hearing detection and intervention (EHDI) programmes.OBJECTIVES: The main aim of the study was to describe the knowledge and views of mothers with children aged between 0 and 5 years old regarding hearing screening, risk factors, symptoms of hearing loss, and intervention options for hearing lossMETHOD: A survey was employed at a primary care clinic to gain insight into the maternal views on hearing loss and early intervention services for children aged 0-5 years old.RESULTS: The majority (83.2%) of the mothers believed that hearing can be tested at birth, 90.7% believed in the biomedical model of intervention which is based on cure, prevention, and pathology as opposed to traditional or alternative medicinal beliefs, and 95.3% indicated that they would seek medical attention if they noticed symptoms of hearing loss. Consequences of hearing loss, such as academic, communication and social problems, were indicated by 65.4% of mothers.CONCLUSION: The findings demonstrated that although cultural beliefs regarding superstitious causes of hearing loss and use of traditional medicine exist, satisfactory maternal knowledge regarding detection and intervention for hearing loss is present. Maternal views are favourable and a general willingness to participate in EHDI programmes was present. This study advocates for the implementation of EHDI programmes at all primary healthcare clinics across South Africa. <![CDATA[<b>South African speech-language therapists' opinion of their training in cleft lip and palate and craniofacial deformities</b>]]> BACKGROUND: Speech care of cleft lip and/or palate (CLP) and craniofacial deformities (CFD) is complex and lengthy and requires collaboration amongst different disciplines. Consequently, it is important to provide academic educational models that include didactics, online learning and clinical exposure in CLP and CFD treatment, and participation in established cleft palate multidisciplinary team management. OBJECTIVES: To obtain information regarding: (1) the perceived adequacy of CLP and CFD academic education of speech-language therapists (SLTs); (2) the professional services that SLTs offer to CLP and CFD patients; and (3) the educational needs of SLTs in this field METHOD: A 54-item online survey to collect quantitative data was conducted by telephone and email using a randomised sample of SLTs in different areas of South Africa. RESULTS: The questionnaire was completed by 123 SLTs, 70% of whom had more than 10 years of professional experience. Of the respondents, 81% acknowledged their limited clinical exposure during their academic education. Only 42% of the professionals offer treatment for CLP and CFD patients. Of the respondents, 96% agreed on the need to improve CLP and CFD academic education, and the majority recommended certified courses, continued-education workshops and online resources. CONCLUSION: The findings indicate that SLTs academic training is perceived to be significantly limited in the cleft palate and craniofacial fields. Thus, there is a strong need at the undergraduate level for clinical training and exposure to multidisciplinary management. At post-graduate level there is a need to establish an educational strategy to meet the needs of SLTs providing CLP and CFD care. Participants suggested that programmes for continuing professional education, degree courses and online resources be designed to provide practising clinicians with updated information and guidance in management of CLP and CFD patients. <![CDATA[<b>Dysphagia services in the era of COVID-19: Are speech-language therapists essential?</b>]]> In the era of coronavirus disease 2019 (COVID-19), many healthcare professionals are being faced with the question of what is considered to be an essential service. This opinion paper has attempted to answer this complex question by understanding the potential relationship between dysphagia and COVID-19 and how speech-language therapists (SLTs) in South Africa should tackle this. It also aims to answer the question through the lens of a risk-benefit discussion based around practices and decision-making. Important gaps in the field relating to how SLT practices need to move forward during this challenging time have also been highlighted. Reflective questions that can assist SLTs when seeing dysphagia cases have been provided. <![CDATA[<b>Nurses' knowledge of stroke-related oropharyngeal dysphagia in the Eastern Cape, South Africa</b>]]> BACKGROUND: Early identification of stroke-related oropharyngeal dysphagia (OPD) using screening by nurses can prevent adverse patient outcomes in lower middle-income countries. Nurses are essential in the OPD management team and should ideally be able to screen and prioritise dysphagia management in stroke patientsOBJECTIVE: The aim of this research was to describe nurses' practices related to identification and management of patients with stroke-related OPDMETHODS: Qualified nurses from various healthcare levels in the Eastern Cape, South Africa were invited to complete a previously published hard copy survey on the signs and symptoms, complications and management of stroke-related OPD. A sample of 130 participants completed the surveyRESULTS: The mean scores of correct responses for each section were: 8.7/13 (66.7%) for signs and symptoms, 4.7/10 (47.3%) for complications and 3.8/7 (54.2%) for management practices. Statistically, there were no differences between the levels of healthcare for the signs and symptoms section and the complications section. Regarding management of OPD, secondary-level (S) nurses demonstrated significantly better knowledge than primary-level (P) and tertiary-level (T) nurses (S-P: p = 0.022; S-T: p = 0.010). Secondary-level nurses also scored significantly higher across all three sections (S-P: p = 0.044; S-T: p = 0.025) than those at the other levelsCONCLUSIONS: The study found that nurses across all levels of healthcare had only moderate knowledge regarding identification and management of stroke-related OPD. Interdisciplinary collaboration between nurses and speech-language therapists may improve nurses' knowledge in identification and management of stroke-related OPD in lower middle-income settings such as South Africa <![CDATA[<b>Contextual influences on sentence repetition as a tool for the identification of language impairment in Grade 3 Sepedi-English bilinguals: A case against bilingual norms</b>]]> BACKGROUND: Specific language impairment (SLI) is difficult to identify because it is a subtle linguistic difficulty, and there are a few measures available to differentiate between typical and atypical language development in bilinguals. Sentence repetition (SR) has strong theoretical foundations and research evidence as a valid tool for the identification of SLI in bilingualsOBJECTIVE: This study assessed the value of SR using peer group comparisons to identify Sepedi-English bilingual children at the risk of SLIMETHOD: One hundred and two Grade 3 learners in three different contexts of education were assessed on equivalent English and Sepedi SR measuresRESULTS: Eleven participants who scored between 1 and 2 standard deviations (SD) below the peer group means on both the English and Sepedi SR tests were identified with possible SLI. Learners in the English language of learning and teaching (LoLT) - Sepedi additional language (SAL) context obtained similar scores in both languages, a higher score in English than the English LoLT group and a higher score in Sepedi than the Sepedi LoLT - EAL group. The English LoLT group obtained a significantly higher score in English than in Sepedi and a significantly lower score than the other two groups in Sepedi. The Sepedi LoLT group obtained a significantly higher score in Sepedi than in English, their additional language, in which they obtained a significantly lower score than the other two groupsCONCLUSION: Sentence repetition tasks are valid screening tools to identify bilingual children with SLI by comparing them to peer groups. The SR tests were sensitive to language practices in different educational contexts. It was observed that a bilingual approach that uses both English and the home language as academic languages leads to better language outcomes <![CDATA[<b>Perceived barriers to compliance with speech-language therapist dysphagia recommendations of South African nurses</b>]]> BACKGROUND: Literature has shown that there is limited compliance amongst nurses with the dysphagia recommendations made by speech-language therapists (SLTs). Poor compliance could have a significant impact on the health outcomes of patients with dysphagiaOBJECTIVES: This study aimed to determine the specific barriers to compliance with dysphagia recommendations experienced by South African nurses, with the goal of identifying viable strategies to overcome these barriersMETHOD: This cross-sectional study made use of a self-administered questionnaire to obtain quantitative data on nurses' perceptions of barriers to the implementation of SLT dysphagia recommendations. Eighty-one nurses were recruited from two tertiary hospitals in two South African provinces. Descriptive statistics were used to analyse the reported barriers to complianceRESULTS: Three main barriers to compliance were identified, namely a lack of knowledge regarding dysphagia, patient-related barriers and workplace concerns. Knowledge barriers included poor familiarity with the role of the SLT in dysphagia management, lack of knowledge regarding SLT terminology, disagreement with dysphagia recommendations and insufficient dysphagia training. Workplace concerns included staff shortages, heavy workloads and time constraints. Poor patient cooperation was emphasised as a patient-related barrierCONCLUSION: For dysphagia recommendations to be followed by nurses, SLTs need to be aware of the barriers experienced by nurses within the relevant facility. Speech-language therapists need to consider the provision of appropriate in-service dysphagia training and include nurses in the decision-making process when recommendations are made. Speech-language therapists need to consider their role in both clear communication with the nurses and the development of supporting material, such as glossaries and visual aids <![CDATA[<b>'A blender without the lid on': Mealtime experiences of caregivers with a child with autism spectrum disorder in South Africa</b>]]> BACKGROUND: Evidence suggests that caregivers of children with autism spectrum disorder (ASD) and associated feeding difficulties have specific mealtime challenges in the home environment because of the limited interventions that are appropriate and responsive to the needs of the child as well as the family OBJECTIVES: To describe: (1) common feeding difficulties in children with ASD, (2) mealtime challenges for the caregiver and (3) mealtime strategies used by the caregiver METHOD: Forty caregivers were purposively sampled to participate in the study. Participants were recruited through ASD-specific schools in Johannesburg, South Africa. Participants completed an online questionnaire focusing on their mealtime experiences with their child with ASD RESULTS: Findings from the data after thematic analysis indicated the multitude of challenges caregivers have when feeding their child with ASD as well as their individualised way of dealing with these difficulties CONCLUSION: The findings emphasised the importance of incorporating the family's beliefs, values and needs into feeding management and highlight the importance of a holistic approach to intervention. The study also provided information about mealtime strategies that are being used in the home environment to support the child as well as the caregiver. This information can be used to inform management to improve therapeutic outcomes and feeding challenges in the home environment <![CDATA[<b>Grammatical number inflection in Arabic-speaking children and young adults with Down syndrome</b>]]> BACKGROUND: Individuals with Down syndrome (DS) have more difficulties with the structural aspects of language, including morphology (concatenation and non-concatenation) and syntax (word order and grammatical/concord rules), than with other language components (e.g. vocabulary, phonetics and pragmatics. OBJECTIVES: This study investigates the accuracy of grammatical number inflection produced by Jordanian Arabic-speaking children and young adults with DS. The work also examines the correlation between age and the correct production of singular, dual and plural numbers METHODS: The study involved 60 monolingual Arabic children and young adults with DS, 30 males and 30 females, enrolled at the Nazik Al Hariri Welfare Centre for Special Education, Amman. The participants were divided into three groups: KG2 (7.1-12.5 years old), school (13.10-17.6) and vocational training (18.3-27.3). The participants' data were collected from a picture elicitation task and free speech, and the answers were recorded using a smartphone. Tokens were classified into correctly used, incorrectly used or not recognised. Proficiency percentage in using the correct number in correlation with age was calculated adopting Jia's (2003) composite score of proficiency. The one-way analysis of variance was used to trace the impact of age on the correct performance of number. Post hoc comparisons (guided by the Scheffe test) were calculated for the cumulative results of the scale as a whole to examine the difference in the arithmetic mean between the three groups. RESULTS: The singular form was the most used by all age groups (83.3%), followed by the plural (27%); the most delayed was dual (10.3%). Intriguingly, the dual form is the most difficult plural pattern because it was the least frequently used pattern in everyday language. Results were in line with other research on morphological markers in individuals with DS (e.g. Penke, 2018). The cumulative results statistically prove the influence of age on the correct use of grammatical number, in favour of the older two groups (total F = 29.865, at the level of significance P = 0.000), with a higher arithmetic mean of all categories (AM: KG2 = 9.00, school = 15.10, VT = 16.25). Hence, sensitivity to the correct number option increases with age although children and young adults with DS do not reach adult-like performance. The non-recognition cases of the proper number category significantly mark language delay in participants with DS. CONCLUSION: The study concluded that inflection for grammatical number is evidently delayed in individuals with DS. Linguistic teaching and training of children with DS (involving families, caregivers and educators) should start from childhood and continue to adulthood to improve their use of dual and plural numbers. <![CDATA[<b>The validity of an isiZulu speech reception threshold test for use with adult isiZulu speakers</b>]]> BACKGROUND: This study continued the development of an isiZulu speech reception threshold (zSRT) test for use with first language, adult speakers of isiZulu. OBJECTIVES: The objective of this study was to determine the convergent and concurrent validity of the zSRT test. METHODS: One hundred adult isiZulu first-language speakers with normal hearing and 76 first-language, adult isiZulu speakers with conductive or sensorineural hearing losses ranging from mild to severe were assessed on pure tone audiometry and a newly developed isiZulu SRT test. Convergent validity was established through agreement of the zSRT scores with pure tone average (PTA) scores. Concurrent validity was assessed by examining the steepness of the psychometric curve for each word in the zSRT test for each type and degree of hearing loss. RESULTS: Intraclass correlation coefficient analyses showed zSRT scores were in substantial to very high agreement with PTA scores for the normal hearing and hearing loss groups (NH - right ear ICC consistency = 0.78, left ear ICC = 0.67; HL - right ear ICC consistency = 0.97, left ear ICC consistency = 0.95). The mean psychometric slope (%/dB) at 50% correct perception for all words in the zSRT test was 4.92%/dB for the mild conductive hearing loss group, 5.26%/dB for the moderate conductive hearing loss group, 2.85%/dB for the moderately severe sensorineural hearing loss group and 2.47%/dB for the severe sensorineural hearing loss group. These slopes were appropriate for the degree of hearing loss observed in each group. CONCLUSION: The zSRT test showed convergent and concurrent validity for assessing SRT in first language, adult speakers of isiZulu. <![CDATA[<b>Development and evaluation of the Ingwavuma receptive vocabulary test: A tool for assessing receptive vocabulary in isiZulu-speaking preschool children</b>]]> BACKGROUND: This study used local resources- community members, photographer and speech therapists to develop a new test for screening receptive language skills and sought to determine its feasibility for use with a larger population in KwaZulu-Natal province, South Africa. OBJECTIVES: The aim of this study was to develop a one-word receptive vocabulary test appropriate for screening and diagnosis of isiZulu-speaking preschool-aged children. The objectives were (1) to determine sensitivity and specificity of the Ingwavuma Receptive Vocabulary Test (IRVT) and (2) to determine the relationship of IRVT scores with age, gender, time and the confounding variables of stunting and school. METHOD: The study was quantitative, cross-sectional and descriptive in nature. The IRVT was piloted before being administered to 51 children (4-6 years old). Statistical analysis of test item prevalence, correlations to confounding variables and validity measurements were conducted using Statistical Package for Social Scientists version 25 (SPSS 25). RESULTS: The IRVT was able to profile the receptive skills for the preschool children in Ingwavuma. The mean raw score for boys was 35, and 32 for girls. There was a significant Pearson correlation between test scores and age (0.028, p < 0.05) with a high effect size (Cohen's d = 0. 949), gender (r = -0.032, p < 0.05) with a medium effect size (Cohen's d = 0.521) and school (r = 0.033, p < 0.05) with a small effect size (Cohen's d = 0.353). The sensitivity and specificity values were 66.7% and 33%, respectively. The test reliability (Cronbach's alpha) was 0.739, with a good test-retest reliability. CONCLUSION: The IRVT has potential as a screening test for isiZulu receptive vocabulary skills amongst preschool children. This study contributes to a development of clinical and research resources for assessing language abilities. <![CDATA[<b>The use of diet modifications and third-party disability in adult dysphagia: The unforeseen burden of caregivers in an economically developing country</b>]]> BACKGROUND: One of the interventions for dysphagia is diet modifications, involving a variety of resources and consumables. In South Africa, where 49% of the population live below the poverty line, the necessities for it are not always feasible for the patient and their family. This coupled with the responsibility of caring for a loved one with disability can culminate into caregivers experiencing third-party disability (TPD). OBJECTIVE: To describe the experiences of TPD of caregivers when implementing dysphagia management strategies at home within an economically developing country context. METHODS: This was a qualitative study using phenomenological principles. Data were collected using a semi-structured self-developed interview tool at three tertiary level public sector hospitals. Seven participants and six caregivers were interviewed. Rigour was obtained through credibility, triangulation, transferability, dependability and confirmability. The data were analysed using a thematic content analysis technique following a top-down approach to coding. RESULTS: The use of diet modification is an appropriate management strategy if the patients' access and contextual limitations have been taken into consideration. It was evident that the caregivers had multiple International Classification of Functioning, Disability and Health domains affected, which restricted their daily functioning including activities, participation and environmental and personal factors CONCLUSION: The management of dysphagia needs to be family centred and the caregiver's role and needs have to be considered by all team members when determining long-term management plans. The specific area of how the caregiver's quality of life was experienced also required further exploration. <![CDATA[<b>A retrospective review of speech-language therapy services provided to adult inpatients at a central-level hospital in Gauteng, South Africa</b>]]> BACKGROUND: The quadruple burden of disease (BoD) and multimorbidity reflected in South Africa's public health sector challenges speech-language therapists (SLTs) to optimise patient management in this context. For planning and delivery of appropriate services, it is important to understand the profile of speech-language therapy (SLT) patients and the public healthcare services provided by SLTs. OBJECTIVES: This study aimed to describe the prevalence of inpatient adult speech, language and swallowing disorders associated with various medical conditions and South Africa's BoD, in addition to the target areas and duration of SLT interventions provided at a central public hospital. METHOD: A retrospective review was conducted on records of 2549 adult inpatients who received SLT services between January 2014 and December 2015 at Chris Hani Baragwanath Academic Hospital. Data, including demographics, medical and SLT diagnoses, and treatment recommendations, were analysed using descriptive and inferential statistics. RESULTS: Non-communicable diseases (NCDs) were most prevalent (77.48%), with multimorbidity of BoD categories in 29.27% of patients. Cerebrovascular disease (CeVD) comprised 52.45% patients, with CeVD, traumatic brain injury, other neurological conditions, cancer and burns comprising 88.74% patients. More than a third of the patients with CeVD were < 56 years (n = 486; 36.35%). Dysphagia (48.96%), aphasia (30.95%) and dysarthria (23.62%) were the most common, with 44.68% of patients having multiple SLT diagnoses. The number of SLT sessions significantly correlated with SLT comorbidity (r s = 0.4200; p = 0.0000), but not BoD comorbidity (r s = 0.0049; p = 0.8058). CONCLUSION: Speech-language therapy patients reflected a heavy NCD burden and multimorbidity. Provision of SLT services should take into consideration a profile of increased complexity of medical conditions and SLT diagnoses.