Scielo RSS <![CDATA[South African Journal of Communication Disorders]]> vol. 69 num. 2 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Conducting clinical research in the era of the COVID-19 pandemic: Challenges and lessons for Speech-Language Pathology and Audiology research</b>]]> BACKGROUND: The novel coronavirus disease 2019 (COVID-19) presented new and unanticipated challenges to the academic training and performance of clinical research at undergraduate and postgraduate levels of training. This highlighted the need for reimagining research designs and methods to ensure continued generation of knowledge - a core function of a research-intensive university. Whilst adhering to government regulations geared towards protecting both the research participants and researchers, innovative research methods are required OBJECTIVE: The purpose of this scoping review is to explore published evidence on innovative clinical research methods and processes employed during COVID-19 and to document challenges encountered and lessons that the fields of Speech-Language Pathology and Audiology can learn METHODS: Electronic bibliographic databases including Science Direct, PubMed, Scopus, MEDLINE, ProQuest were searched to identify peer-reviewed publications, published in English, between 2019 and 2021, related to innovative clinical research methods and processes applied where in-person contact is regulated RESULTS: Significant challenges with conducting research in the COVID-19 era were identified, with important lessons learned and numerous opportunities that have relevance for this pandemic era and beyond. These findings are presented under 10 themes that emerged that highlight important considerations for research methods and processes during a pandemic and beyond. The findings of this study also raise implications for telehealth from which low- and middle-income countries (LMICs), where resource challenges exist, can benefit CONCLUSION: Challenges and opportunities identified in this review have relevance for the field of Speech-Language Pathology and Audiology as far as current and future (beyond COVID-19) clinical research planning is concerned <![CDATA[<b>In pursuit of increasing the application of tele-audiology in South Africa: COVID-19 puts on the alert for patient site facilitator training</b>]]> BACKGROUND: The coronavirus disease 2019 (COVID-19) presented and highlighted new and unanticipated challenges to the provision of clinical services, raising an urgency for the application of different models of service delivery, including tele-audiology. In many tele-audiology encounters, a site facilitator is needed at the patient site to help with the hands-on aspects of procedures, and the implications of this requirement are significant for the resource-constrained African context OBJECTIVES: The aim of this scoping review was to investigate published evidence on training provided to patient site facilitators (PSFs) for tele-audiology application to guide the South African audiology community in tele-audiology application initiatives METHOD: Electronic bibliographic databases including Science Direct, PubMed, Scopus MEDLINE and ProQuest were searched to identify peer-reviewed publications, published in English, between 2017 and 2021 related to training of PSFs. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were followed during the screening process as well as for illustrating the process RESULTS: Findings are discussed under four key themes: (1) type of tele-audiology and the implications thereof, (2) length of training and its implications, (3) diversity in the range of PSFs used and its implications for the training, and (4) heterogeneity in the training CONCLUSION: The findings highlight important considerations for tele-audiology application within the African context, specifically decision-making around who can serve in the role of PSFs, as well as content and nature of training required, with implications for policy and regulations as well as human resource strategy. These findings are important for the COVID-19 pandemic era and beyond <![CDATA[<b>Feeding practices in public hospitals' neonatal intensive care units: An exploration into the ways in which COVID-19 affected the best practice in Gauteng</b>]]> BACKGROUND: South Africa's healthcare system has a multitude of pre-existing challenges prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic, ranging from reduced number of staff, lack of resources and units being at overcapacity both in the adult and paediatric populations. The neonatal intensive care units (NICUs) require a team approach to ensure best practice with vulnerable infants, but little is known about how the onset of the COVID-19 pandemic and the resultant lockdown restrictions impacted the feeding practices within the NICU OBJECTIVES: This study aimed to explore the impact that COVID-19 had on the feeding practices within the NICU settings in public hospitals in Gauteng METHODS: A qualitative design was employed with data collected in two NICUs in Gauteng. Data were collected in the form of observations and semi-structured interviews with healthcare workers (HCWs) in the NICU. Data were analysed using inductive thematic analysis RESULTS: Although the sample size of participants was limited, social distancing proved to be a challenge resulting in mothers and healthcare workers being given restricted access. This had effects on the ability to provide adequate feeding practices and resulted in anxiety for the mothers and mental health challenges for the HCWs when feeding these at-risk infants. A limitation of this study was the use of only two sites CONCLUSION: COVID-19 amplified the existing challenges in the NICU. A multidisciplinary and family-centred approach to address feeding challenges is required to offset the challenges resulting from the pandemic and subsequent lockdown <![CDATA[<b>Middle ear status - structure, function and pathology: A scoping review on middle ear status of COVID-19 positive patients</b>]]> BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is the latest public health emergency that has presented challenges globally. Limited evidence exists on the association between COVID-19 and middle ear pathologies, regardless of the respiratory nature of some of the core symptoms OBJECTIVE: This scoping review aimed at exploring evidence on the effects of COVID-19 on middle ear functioning as part of symptom mapping and preventive planning for ear and hearing care METHOD: Electronic bibliographic databases, including Medline, ProQuest, PubMed, Science Direct, ERIC and Scopus, were searched to identify peer reviewed publications, published in English, between December 2019 and January 2022, related to the effects of COVID-19 on middle ear functioning. The keywords used as MeSH terms included 'middle ear pathology', 'middle ear disorder', 'otitis media', 'hearing loss', 'hearing impairment', 'audiology' and 'COVID-19' or 'coronavirus' RESULTS: From eight studies that met the inclusion criteria, the findings revealed that middle ear pathologies occur in this population, with the occurrence ranging from 1.15% to 75%. Tympanic membrane structural changes, otitis media and conductive hearing loss (CHL) were commonly reported. The current findings must be interpreted with caution given that most of the studies reviewed had extremely small sample sizes or were case studies or series, thus limiting generalisability CONCLUSION: The findings highlight the value of strategic research planning to collate data during pandemics, ensuring that future studies use appropriate and well-designed methodologies. Trends and patterns of middle ear pathologies in this population must also be established to determine the need for periodic monitoring <![CDATA[<b>Health sciences students' perception of the communicative impacts of face coverings during the COVID-19 pandemic at a South African University</b>]]> BACKGROUND: The use of face masks and/or shields can pose a challenge during communication. They block facial expressions thus removing visual cues and affect sound transmission making it difficult to hear speech clearly. Given the widespread use of face coverings, it seems reasonable to clarify if communication in typical speakers and listeners has significantly differed. Health science students as future practitioners need to understand challenges that arise from using face coverings OBJECTIVE: This study aimed to determine health sciences students' perception of the communicative impacts of face coverings METHOD: The study employed a descriptive, self-administered online survey, obtaining information from 96 health science undergraduate students RESULTS: All participants changed their manner of speaking in that they spoke louder when wearing masks and focused more on eye contact when someone was wearing masks. These were statistically significant (p = 0.450 and p = 0.035 respectively). Fifty-three percent reported using more listening effort and feeling anxious when communicating. Approximately 33% indicated that it was challenging to read emotions, such as sad or unhappy, when someone wore a mask. Most, 61%, were positive or very positive about wearing masks. The level of difficulty differed depending on the listening environment. It was harder to understand the doctor, nurse, or other healthcare workers when they wore face coverings than when listening to their friends and family, which had little effect, this being statistically significant (p = 0.025 CONCLUSION: Challenges envisaged in practice included frequent communication breakdowns, inability to connect and build trust between patient and practitioner, and communicating in noisy environments. Coping strategies, future clinical and research implications were proposed, and limitations acknowledged <![CDATA[<b>Exploring the online learning experience of first-year speech-language pathology students in a Johannesburg-based university</b>]]> BACKGROUND: Understanding the learning experiences of first-year speech-language pathology (SLP) students during the coronavirus disease 2019 (COVID-19) pandemic is essential to ensure that academic staff are able to support and enhance the transition from secondary to tertiary education. An understanding of the student experience could lead to improved support strategies that could be beneficial for the blended learning environment that the University of the Witwatersrand will be entering from 2022 OBJECTIVES: This research explored the experiences of first-year SLP students in online learning during the COVID-19 pandemic METHOD: An exploratory mixed-method concurrent triangulation design was employed. Quantitative data were collected from likert scales. Qualitative data were collected from critical incident timelines. Themes were identified from both the Likert scales as well as the critical incident timelines using bottom-up thematic analysis RESULTS: The majority of participants reflected that their online learning through the pandemic in 2021 was successful. The themes that emerged from this year pertain to 2021 and the specific participants however, it provides an important insight that the students' needs change during a year. As a lecturer, one needs to consider these evolving needs to ensure students have the support that they require to be successful in their learning CONCLUSION: This research provided insights into the evolving nature of the support first-year SLP students require in the online learning space during the COVID-19 pandemic <![CDATA[<b>Increasing unemployment rate amongst health professionals: Will there be jobs for newly graduated South African audiologists post-COVID-19?</b>]]> BACKGROUND: Before the coronavirus disease 2019 (COVID-19) pandemic in early 2020, the unemployment rate in South Africa was at its highest in history at 29.1%. During the COVID-19 pandemic to date, unemployment rose even higher to 35.3%. In this context, there has been an increase in the number of unemployed health professionals in South Africa OBJECTIVES: This study aimed to determine the employment rates of newly graduated South African audiologists and identify the challenges in obtaining and maintaining employment for audiologists in South Africa METHODS: A descriptive online survey design was used. Participants were recruited online through professional association webpages using the snowball sampling technique. All qualified audiologists registered with the Health Professionals Council of South Africa were eligible to participate RESULTS: A total of 132 audiologists completed the survey. In the first-year postgraduation, 16% of the participants were unemployed, and this increased to 19% in the second-year postgraduation. In the majority (81%) of employed participants, almost a fifth (19%) were working within non-audiology/healthcare fields. The most common workplace challenges reported were remuneration (37%) followed by lack of resources (18%), workload (18%), work environment (10%), working hours (9%) and, lastly, interprofessional relationships (8% CONCLUSION: Findings from this study are the first to document employment rates amongst South African audiologists. These findings have the potential to influence the critical discourse on hearing healthcare human resource planning, hearing healthcare labour capacity and potential for growth in the South African context post-COVID-19 <![CDATA[<b>Simulations as a mode of clinical training in healthcare professions: A scoping review to guide planning in speech-language pathology and audiology during the COVID-19 pandemic and beyond</b>]]> BACKGROUND: Simulation plays an important role as an alternative method for training of students, particularly in health education. As a result of coronavirus disease 2019 (COVID-19) restrictions of face-to-face interactions, traditional teaching methods have been disrupted, increasing the need for alternative methods to supplement modes of student clinical training in healthcare programmes OBJECTIVES: The scoping review aimed to determine what has been documented about simulation as a mode of clinical training in healthcare professions (HCPs) in order to guide speech-language pathology and audiology (SLP) professions during the COVID-19 pandemic and beyond METHOD: A scoping review was conducted. Electronic bibliographic databases including Science Direct, PubMed, Scopus MEDLINE, ProQuest, Google Scholar and WorldCat were searched to identify peer reviewed publications, published in English, between January 2011 and December 2021, and related to the use of simulation in HCPs clinical training programmes RESULTS: A total of 32 articles met the inclusion criteria for this scoping review. Three themes emerged when reviewing the studies: (1) face-to-face simulations as a mode of clinical training, (2) virtual reality simulation and telesimulation as modes of clinical training and (3) simulation as a complementary mode of clinical training. Evidence suggests that whilst simulations are cost-effective, accessible and efficacious as clinical training modes, they need to be combined with other modes of training such as the traditional clinical training to yield better learning outcomes CONCLUSIONS: Current findings highlight the role and value of simulation as a clinical training mode during COVID-19 and beyond. However, there are aspects that need to be considered to ensure that this mode of clinical training is effective, with endorsement and regulations by the SLP Professional Board of the Health Professions Council of South Africa (HPCSA). Simulations need to be complemented with traditional clinical training methods. In the context of SLP, particularly in low- and middle-income countries (LMICs), simulation can be used to better prepare students for their clinical placement where clinical training platforms are limited and where simulation combined with teletraining or telesupervision can be utilised to increase access to training <![CDATA[<b>Challenges to infection control in early communication intervention: A scoping review</b>]]> BACKGROUND: Personal protective equipment (PPE) and infection prevention and control (IPC) measures are crucial to preventing the spread of coronavirus disease 2019 (COVID-19). This study used a scoping review to investigate the challenges that exist when speech-language therapists (SLTs) use IPC measures for providing early communication intervention (ECI OBJECTIVES: To describe existing, recent literature on PPE and IPC measures used in early intervention through a scoping review (steps 1-5) and to consult local clinicians to investigate how SLTs who provide ECI in South Africa relate to these findings (step 6 of the scoping review METHOD: A scoping review was performed which followed the PRISMA-ScR framework. Because of limited literature on PPE and IPC measures used by SLTs in providing ECI, the inclusion criteria were adjusted to include PPE and IPC measures used by healthcare workers (HCWs) who provide early intervention to the population of infants and toddlers up to 3 years old. At the time of the review, articles were not older than 10 years and were published between 2011 and 2020. The scoping review included a consultation with South African SLTs who provide ECI, including during the COVID-19 pandemic. A pilot study was conducted prior to the consultations. Seventeen clinicians were included in total. Data from both the pilot study and main consultation were transcribed and analysed in the results using thematic analysis RESULTS: Fourteen articles were included in the study. The scoping review of existing literature identified challenges to implementing IPC measures, namely the care and behaviour of young children, infrastructure and system challenges, poor compliance and lack of training and a lack of standard IPC protocols. Clinicians in the consultation phase confirmed these challenges and reported that IPC measures did not consider ECI populations nor the settings in which services were provided. Suggestions from the literature for improved infection control included hand hygiene, improved supplies and infrastructure and education and training. Clinicians in the consultation added practical suggestions for implementing IPC measures within ECI, which included an increase in parent-led intervention as well as cleaning and disinfection strategies CONCLUSION: This study identified challenges and recommendations of SLTs who use PPE and IPC measures whilst providing ECI. Understanding these challenges can benefit ECI services and future research efforts focused on improving ECI services whilst maintaining IPC standards <![CDATA[<b>The effects of COVID-19 on the rehabilitation of persons with aphasia: A scoping review</b>]]> BACKGROUND: The impact of the Coronavirus disease 2019 (COVID-19) pandemic was more pronounced on the well-being of persons with disabilities, especially in low- and middle-income countries. There is documented evidence of the rippling effects of COVID-19 on persons with disabilities. However, not much is known about the impact of COVID-19 on the rehabilitation of persons with aphasia OBJECTIVE: The scoping review explores how COVID-19 affected the rehabilitation of persons living with aphasia METHOD: A scoping review was conducted using Arksey and O'Malley's framework. A search was conducted on Science Direct, PubMed, Medline, Scopus, ProQuest and Google Scholar, to identify relevant studies published between 2019 and 2022. Data were analysed using thematic analysis RESULTS: Most studies regarding the effects of COVID-19 on persons living with aphasia were conducted in the United Kingdom. Five themes emerged from the data, namely, (1) negative impact on rehabilitative care, (2) telehealth and its limitations, (3) impact on social participation, (4) compromised caregiver involvement and (5) mental health challenges CONCLUSIONS: Findings highlight the need for healthcare professionals to pursue innovative ways in which aphasia rehabilitation and conversational support programmes can be made accessible to persons with aphasia, despite the limitations brought about by a pandemic. Telerehabilitation programmes need to be tailored to the needs of persons with aphasia if they are to be successful. This study highlights the importance and need for the prioritisation of mental health services for persons with aphasia and their caregivers during a pandemic <![CDATA[<b>When uncertainty becomes the norm: The Chris Hani Baragwanath Academic Hospital's Speech Therapy and Audiology Department's response to the COVID-19 pandemic</b>]]> BACKGROUND: In March 2020 the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. Management of this pandemic had significant implications for clinical departments across the world. Healthcare systems were urgently required to reorganise and redesign patient care as well as repurpose staff OBJECTIVES: We will share the lived experience of our response as speech therapy and audiology (STA) clinicians to the COVID-19 pandemic METHOD: This study adopted an autoethnographic approach within Bronfenbrenner's bioecological model to describe STA clinicians' response to the COVID-19 pandemic RESULTS: Adaptations to practice were made to continue service provision whilst adhering to COVID-19 regulations. We assisted in other areas to meet the immediate needs of the hospital. Service delivery strategies consisted of a review of clinical and quality assurance protocols. We developed a telehealth service package which included a hybrid approach, within a context of digital poverty. We created resources to ensure continuity of care. Collaboration within our systems facilitated innovative solutions. Mental health and well-being of staff members were key to the response developed CONCLUSION: South African healthcare systems' inequalities were highlighted by the pandemic. The response showed that the needs of vulnerable populations were not accounted for when developing this public health response. Lessons learnt included the importance of adaptability, becoming comfortable with uncertainty and maintaining open and transparent communication. Consultation and collaboration within various levels of our healthcare system were critical in responding to the needs of patients. Commitment to compassionate leadership and staff well-being were crucial <![CDATA[<b>'All of a sudden, you know, you can't go to these services, because of the risk of infection': Audiological service considerations at residential care homes for older persons during COVID-19</b>]]> BACKGROUND: Residential care homes for older persons were especially affected during the coronavirus disease 2019 (COVID-19) pandemic lockdowns which resulted in limited social interactions and service provision. Communication became challenging due to the prophylactic use of masks and social distancing OBJECTIVES: This qualitative research study set out to explore audiological service considerations in residential care homes for older persons during the COVID-19 restrictions METHOD: Through purposive sampling, nine managers from residential care homes for older persons in Johannesburg participated in semi-structured, online interviews. The transcriptions of these recorded interviews underwent thematic analysis RESULTS: Managers employed various strategies to attend to residents' audiological needs, audiological health, hearing aid use, and hearing aid provision. Furthermore, it transpired that other health related services were prioritised over audiological services in general, but especially during the pandemic lockdowns. Managers reported that staff had to use various communication strategies due to COVID-19 precautions and that masks and social distancing made communication more challenging for residents with hearing loss. Moreover, isolation and modified service provision were extremely taxing on residents CONCLUSION: This study highlights the need for continued audiological services at residential care homes, but also the need to balance audiological needs with other health needs because these seem to be prioritised over hearing loss, especially in this population who may have limited agency and choice in the health care options available to them. Furthermore, adapted strategies need to be considered to support communication considering COVID-19 precautions so that communicative difficulties do not exacerbate lockdown isolation <![CDATA[<b>The perspectives of speech-language pathologists: Providing teletherapy to patients with speech, language and swallowing difficulties during a COVID-19 context</b>]]> BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a huge impact on every facet of life. This directly included the delivery of health care from allied health professionals such as speech-language pathologists (SLPs) in South Africa. Research has shown that there is limited research done locally on the impact of COVID-19 relating to stroke care. Consequently, this results in a lack of research on the provision of speech, language and swallowing intervention using teletherapy after a stroke from an SLP point of view OBJECTIVES: The aim of this study was to explore the experiences of SLPs with regard to their use of teletherapy in a COVID-19 context when providing speech, language and swallowing intervention for patients after a stroke METHODS: This study made use of a qualitative approach. An electronic questionnaire was sent to SLPs inviting them to participate in the study. Purposive sampling was used to recruit participants and thematic content analysis was used to analyse the open-ended qualitative questions RESULTS: The findings show that SLPs experienced a variety of facilitators and barriers to using teletherapy. Additionally, issues of access differ across the private and public sector SLPs for both the clients and the SLPs CONCLUSION: The current study provided research in the field of teletherapy, which is relatively new in the South African context. The study, whilst small in scale, provided some insight into the changes experienced from the shift to teletherapy <![CDATA[<b>Cochleovestibular findings linked to COVID-19: A scoping review for clinical care planning in South Africa</b>]]> BACKGROUND: On 30 January 2020, the World Health Organization (WHO) officially declared an outbreak of the coronavirus disease 2019 (COVID-19) to be a global health emergency. Research has focused on the impact and response to life-threatening symptoms of COVID-19 across the lifespan; however, there is a need to investigate the effects of COVID-19 on the cochleovestibular system, as viral infections are known to impact this system. This is particularly important for contexts where resources are limited and prioritisation of resources requires strong risk versus benefit evaluations OBJECTIVE: Therefore, the purpose of this scoping review was to investigate published evidence on the impact of COVID-19 on the cochleovestibular system across the lifespan in order to allow for strategic clinical care planning in South Africa, where capacity versus demand challenges exist METHODS: Electronic bibliographic databases such as CINAHL, EBSCOHost, MEDLINE, ProQuest, PubMed, Scopus and ScienceDirect were searched for peer-reviewed publications between January 2020 and January 2022. These had to be published in English and related to the impact of COVID-19 on the cochleovestibular system, where the question was: 'what evidence has been published on the impact of COVID-19 on the cochleovestibular system?' Review selection and characterisation was performed by the researcher with an independent review by a colleague using pretested forms RESULTS: Of a total of 24 studies that met the inclusion criteria, the current scoping review revealed limited conclusive published evidence linking COVID-19 to permanent hearing function symptoms. Current evidence supports the possibility of COVID-19, similar to other viral infections in adults, impacting the cochleovestibular system and causing tinnitus, vertigo and sudden sensorineural hearing loss (SSNHL), with the symptoms being generally temporary and resolving either partially or completely following therapy with steroids, with very inconclusive findings in the paediatric population CONCLUSION: These findings raise global implications for properly designed studies, which include longitudinal follow-up of cases across the lifespan, examining this link with some focus on establishing the pathophysiologic mechanisms at play as well. In the meanwhile, current findings raise the value of polymerase chain reaction (PCR) testing for all patients presenting with unexplained cochleovestibular symptoms during the pandemic, as these may be the only presenting symptoms indicating COVID-19, thus requiring careful treatment and management <![CDATA[<b>A descriptive case report of telesupervision and online case-based learning for speech and language therapy students in Vietnam during the COVID-19 pandemic</b>]]> BACKGROUND: Vietnam's first speech and language therapy (SLT) degrees commenced in 2019 utilising international educators. Continuity of the degrees was impacted by travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic OBJECTIVES: This article presents a descriptive case report exploring the viability of online learning to continue clinical education (CE) of SLT students in Vietnam during the pandemic METHOD: Students were scheduled for face to face placements throughout 2021. International SLT educators were to travel to Vietnam and work with interpreters and locally trained certificate level therapists to provide placement supervision. When travel became impossible, tele-supervision by international therapists working remotely and in partnership with local therapists and interpreters was arranged. The second wave of Covid-19 excluded students from healthcare settings early in their placements. To conclude these placements, tele-supervisors led online case-based discussions with students. For subsequent placements, Vietnamese and international therapists facilitated two to three weeks of online case-based group discussions for students, using cases with videos or avatars RESULTS: Learning outcomes for students, as evidenced in written and oral assessments demonstrated attainment of many of the learning objectives of the placements. Satisfaction for all participants (students, tele-supervisors, online group facilitators) was high. Students will undertake face to face placements in the future; however they will commence these placements with heightened clinical reasoning and planning skills CONCLUSION: Online CE is possible in LMIC and, as part of a program which includes face to face placements, can support essential CE outcomes and enhance preparation for subsequent direct experiences with patients <![CDATA[<b>Is a hybrid of online and face-to-face services feasible for audiological rehabilitation post COVID-19? Findings from three public health patients</b>]]> BACKGROUND: The global coronavirus disease 2019 (COVID-19) pandemic has pushed many audiologists to incorporate remote service delivery methods to adhere to mandatory health and safety protocols. The use of tele-audiology for audiological rehabilitation may provide a sustainable, cost-effective modality to suit the existing need, particularly in low-resourced countries OBJECTIVES: This study aimed to investigate the feasibility of implementing a hybrid tele-rehabilitation programme in a South African public health context. An online auditory training (AT) programme was used to determine (1) compliance, (2) clinical benefit, (3) participant experience and (4) costs METHOD: A convergent mixed methods design with a feasibility approach was utilised. Data collection was done through questionnaires, in-booth assessments, online AT, and face-to-face interviewing. Participants undertook online AT over 4 weeks. For pre- and post-online AT, the Abbreviated Profile of Hearing Aid Benefit (APHAB), QuickSIN, entrance and exit questionnaires, interviews and a system usability scale were administered RESULTS: Key findings of this study included (1) a high compliance rate (84.82%) with minimal clinician contact time at 3 h 25 min over 5-6-weeks; (2) improvement in perceived hearing aid (HA) benefit, and improvement in listening skills; (3) reported positive experiences; and (4) minimal programme costs at an average of R1350.00 per participant CONCLUSION: The results showed positive indicators that the use of hybrid tele-rehabilitative strategies may provide a viable alternative to the traditional face-to-face modality. The hybrid approach showed clinical benefits, cost-effectiveness, minimal contact time as well as COVID-19 compliance. Further large-scale research is still needed <![CDATA[<b>A proposed artificial intelligence-based real-time speech-to-text to sign language translator for South African official languages for the COVID-19 era and beyond: In pursuit of solutions for the hearing impaired</b>]]> BACKGROUND: The emergence of the coronavirus disease 2019 (COVID-19) pandemic has resulted in communication being heightened as one of the critical aspects in the implementation of interventions. Delays in the relaying of vital information by policymakers have the potential to be detrimental, especially for the hearing impaired OBJECTIVES: This study aims to conduct a scoping review on the application of artificial intelligence (AI) for real-time speech-to-text to sign language translation and consequently propose an AI-based real-time translation solution for South African languages from speech-to-text to sign language METHODS: Electronic bibliographic databases including ScienceDirect, PubMed, Scopus, MEDLINE and ProQuest were searched to identify peer-reviewed publications published in English between 2019 and 2021 that provided evidence on AI-based real-time speech-to-text to sign language translation as a solution for the hearing impaired. This review was done as a precursor to the proposed real-time South African translator RESULTS: The review revealed a dearth of evidence on the adoption and/or maximisation of AI and machine learning (ML) as possible solutions for the hearing impaired. There is a clear lag in clinical utilisation and investigation of these technological advances, particularly in the African continent CONCLUSION: Assistive technology that caters specifically for the South African community is essential to ensuring a two-way communication between individuals who can hear clearly and individuals with hearing impairments, thus the proposed solution presented in this article <![CDATA[<b>Students' experiences of using a writing-intense programme to facilitate critical thinking skills on an online clinical training platform: A pilot study</b>]]> BACKGROUND: Coronavirus disease 2019 (COVID-19) and the subsequent lockdown altered traditional clinical training for speech language pathology students, thus forcing training institutions to implement innovative and responsive clinical training strategies in the midst of the pandemic. As such, a writing-intense programme was piloted in an online clinical training programme with second-year speech language pathology students OBJECTIVES: This study explored speech language pathology students' experiences with a writing programme used during an online clinical training programme implemented during the COVID-19 pandemic METHOD: The study used a qualitative survey design. Purposive convenient sampling was used to recruit 29 second-year speech language pathology students. Online student reflections guided by 10 open-ended questions were used to elicit responses from students. Data were analysed using deductive thematic analysis RESULTS: Findings revealed that the written component of the programme facilitated the acquisition of clinical knowledge and improved clinical processes of writing among students. Feedback that students received on their written tasks improved learning. The clinical component of the course enabled students to learn in a less stressful environment and helped them gain confidence in their knowledge and clinical skills. Connectivity challenges and the lack of motivation from some students negatively impacted the programme CONCLUSION: Using a writing programme to clinically train students can have positive effects in applying theory to clinical application because it affords students time to consolidate and process theory with practice as the jump from first year to second year can be cognitively taxing. A writing-intense programme can also improve students' writing skills <![CDATA[<b>Application of machine learning approaches to analyse student success for contact learning and emergency remote teaching and learning during the COVID-19 era in speech-language pathology and audiology</b>]]> BACKGROUND: The onset of the COVID-19 pandemic across the globe resulted in countries taking several measures to curb the spread of the disease. One of the measures taken was the locking down of countries, which entailed restriction of movement both locally and internationally. To ensure continuation of the academic year, emergency remote teaching and learning (ERTL) was launched by several institutions of higher learning in South Africa, where the norm was previously face-to-face or contact teaching and learning. The impact of this change is not known for the speech-language pathology and audiology (SLPA) students. This motivated this study OBJECTIVES: This study aimed to evaluate the impact of the COVID-19 pandemic on SLPA undergraduate students during face-to-face teaching and learning, ERTL and transitioning towards hybrid teaching and learning METHOD: Using course marks for SLPA undergraduate students, K means clustering and Random Forest classification were used to analyse students' performance and to detect patterns between students' performance and the attributes that impact student performance RESULTS: Analysis of the data set indicated that funding is one of the main attributes that contributed significantly to students' performance; thus, it became one of the priority features in 2020 and 2021 during COVID-19 CONCLUSION: The clusters of students obtained during the analysis and their attributes can be used in identification of students that are at risk of not completing their studies in the minimum required time and early interventions can be provided to the students <![CDATA[<b>The experiences of speech-language therapists providing telerehabilitation services to children with autism spectrum disorder</b>]]> BACKGROUND: There has been an increased emergence of the use of telerehabilitation by speech-language therapists (SLTs) in South Africa since the COVID-19 pandemic in 2020 OBJECTIVES: To explore the criteria that SLTs use when recommending telerehabilitation for children with autism spectrum disorder (ASD), the technical skills required, strategies used by SLTs, the restrictions encountered when conducting telerehabilitation and the views of SLTs on telerehabilitation in comparison to face-to-face therapy for children with ASD METHOD: A descriptive, phenomenological, qualitative study design was utilised. Purposive and snowball sampling techniques were employed. Six SLTs from the private sector, who had experience providing telerehabilitation to children with ASD, were recruited from three provinces in South Africa. Data were gathered via semistructured online interviews and analysed using thematic analysis RESULTS: Two out of five themes that emerged from this study are presented in this paper, i.e. approaches to telerehabilitation and the benefits of telerehabilitation. Results revealed that telerehabilitation was used to provide assessment and therapy during the COVID-19 pandemic lockdowns as an alternative method of service delivery. Assessment and treatment strategies included synchronous and asynchronous methods, family collaboration, social stories, frequent breaks and interactive sessions. Telerehabilitation reduced the client's and SLT's travel costs and increased caregiver and clinician satisfaction. Client progress and increased awareness of SLT were viewed as further benefits CONCLUSION: Telerehabilitation was found to be beneficial to most children with ASD, and in most cases, the benefits far outweighed the challenges encountered. Clinical implications included the need for caregiver support in facilitating effective carryover, an increase in SLTs' knowledge and the opportunity to provide services to a broader geographical range. Limitations of the study are included <![CDATA[<b>Speech-language therapy educator reflections on the planning and implementation of education and training during the COVID-19 pandemic</b>]]> BACKGROUND: Universities across the world experienced lockdown and closure of all learning institutions around March 2020 because of the advent of the coronavirus disease 2019 (COVID-19). This lockdown and closure presented challenges to the traditional pedagogical approaches in the health sciences, which typically include both campus-based and clinical site-focused activities involving face-to-face interactions and work integrated learning. The onset of the COVID-19 pandemic resulted in a shift to emergency remote teaching (ERT) and learning OBJECTIVES: This study aimed to explore speech-language pathology (SLP) educators' experiences of the planning and implementation of ERT and learning during the COVID-19 pandemic METHOD: A qualitative, descriptive narrative design was adopted to meet the objectives of the study. Seven SLP educators from a single university in South Africa participated in this study by constructing narratives on their experiences. The narratives were analysed using thematic analysis RESULTS: Five themes emerged from the data analysis, and these included (1) uncertainty, (2) educator feelings, (3) capacity development, (4) influence of circumstances on teaching, learning and assessment and (5) troubleshooting. Current findings provide insight into the challenges encountered and strategies utilised by educators in planning and implementing ERT and learning CONCLUSION: Beyond the COVID-19 pandemic, most educators believe that a hybrid model would address some concerns identified, such as that of missing face-to-face contact, but that it would still allow for the full exploitation of online activities for teaching, learning and assessment required during clinical training <![CDATA[<b>The impact of COVID-19 on speech-language and hearing professions in low- and middle-income countries: Challenges and opportunities explored</b>]]> BACKGROUND: Since the advent of the coronavirus disease 2019 (COVID-19), the speech-language and hearing (SLH) professions globally have been confronted with novel and unexpected challenges. OBJECTIVE: The aim of this article was to explore the impact of COVID-19 on SLH professions in low- and middle-income countries (LMICs) as presented in the Special Issue of the South African Journal of Communication Disorders in the year 2022. METHOD: Divergent from the standard editorial writing style, this editorial adopted a research approach where a qualitative, descriptive scoping review design was conducted to meet the objectives of the study. Three specific objectives were targeted: (1) exploring the challenges to SLH research, teaching and practice; (2) establishing evidence-based solutions available for these challenges that can be used to improve the professions' response in the post-pandemic era; and (3) determining the areas that require further investigation, alternative solutions and innovation for improved readiness for future pandemics. A total of 21 manuscripts were reviewed that covered three predetermined themes - research, teaching and practice - that were constructed through a deductive approach as part of the call for papers for the special issue. These manuscripts were from academics, researchers and clinicians from various institutions in LMICs. The review is presented using thematic analysis. RESULTS: The review raised important challenges, presented under various subthemes, to the three key themes. These challenges reflect on the impact of COVID-19 on the SLH professions in terms of research, teaching, service provision and ethical challenges, as well as its impact on speech language, hearing, swallowing and balance functions. The review also advanced solutions and future directions during and beyond COVID-19. CONCLUSION: These findings raise global implications for research, teaching and practice that are not only relevant to the SLH professions.