Establishing a computer-based data system for early communication intervention in South Africa

The study identifies the increase in populations at risk for communication disorders world-wide and in South Africa as one the reasons for research to develop early communication intervention (ECI) services as a societal responsibility in South Africa. Since ECI is largely an unknown entity in the South African health system, but shares several mutual objectives, the dire need for data of populations at-risk validates the development of a computer-based relational data system as a 21st century research tool for ECI. Underpinnings for the development of a research database for ECI were obtained from the use of database management systems for early intervention in the USA, identified as leaders in the application of database technology in the field of Speech-Language Pathology. The aim of the study was to develop and establish a computerized database system to describe the characteristics of young children at risk for communication disorders enrolled in an existing ECI programme. Using a descriptive survey as research design, a rich description of 153 subjects and their families was obtained. The findings relating to the multiple risk profiles of the subjects revealed results not extensively described or emphasized in the literature, indicating the in-depth analysis of results that is possible when utilizing a database approach to research. The complex risk profile found in the subgroup of subjects with cleft lip and palate is an example of a need for further investigation. The results also indicated the critical importance of early identification of risk events throughout a child’s life to improve the efficacy of ECI services. Further results emphasized the important role of parents to identify the early signs of risks for communication disorders in their children, provided they are equipped with the necessary knowledge. A conceptual framework for the early identification of risks for communication disorders is proposed for best practice in ECI in South Africa. The study concluded that the CHRIB database system was successfully applied in the empirical research and is now established as a versatile 21st century research tool to be utilized in second generation research in ECI in South Africa.Thesis (DPhil(Communication Pathology))--University of Pretoria, 2005.Speech-Language Pathology and AudiologyUnrestricte

Suck, swallow and breathing coordination in infants with infantile colic

BACKGROUND : There appears to be a perception amongst parents and in popular literature that infantile colic is caused by feeding difficulties. Limited support for this perception is found in scientific literature. Whilst there is scientific evidence that suck, swallow and breathing are key components of successful feeding, these components and the coordination thereof in infants with colic have not been extensively researched. OBJECTIVE : The objective of the study was to explore the suck, swallow and breathing coordination in infants with infantile colic and compare it with infants without the condition. METHOD : An assessment protocol for suck, swallow and breathing coordination was compiled from literature. This protocol was performed on a research group of 50 infants, independently diagnosed with infantile colic, and a control group of 28 infants without the condition. All participants were from two rural towns in the North–West province, South Africa, selected with a snowball selection method and strict selection criteria. The study followed a static comparison group design. RESULTS : A significant difference in the key components of feeding and the presence of colic in participants of four age categories were found. The correlation between postural control and the presence of infantile colic were sustained in participants from 2–19 weeks old. CONCLUSION : Suck, swallow and breathing were found to be significantly associated with infantile colic. The findings should be investigated further. It appears that speech-language therapists may play an expanding role in infantile colic.http://www.sajcd.org.zaam2016Speech-Language Pathology and Audiolog

The effect of formal, neonatal communication-intervention training on mothers in kangaroo care

BACKGROUND: Due to low-birth-weight, preterm birth, HIV and/or AIDS and poverty-related factors, South Africa presents with an increased prevalence of infants at risk of language delay. A Kangaroo Mother Care (KMC) unit offers unique opportunities for training. AIM: The aim of the present study was to determine if formal, neonatal communication-intervention training had an effect on mothers' knowledge and communication interaction with their high-risk infants. METHODS: Three groups of mothers participated: Group 1 was trained whilst practicing KMC; Group 2 was not trained but practiced KMC; and Group 3 was also not trained but practiced sporadic KMC. Ten mothers per group were matched for age, education level and birth order of their infants. The individual training was based on graded sensory stimulation and responsive mother-infant communication interaction, which emphasised talking and singing by the mother. RESULTS: Significant differences were found in mother-infant communication interaction between all three groups, which indicated a positive effect on Group 1 with training. Group 2, KMC without training, also had a positive effect on interaction. However, Group 1 mothers with training demonstrated better knowledge of their infants and were more responsive during interaction than the other two groups. CONCLUSION: The present study suggests that neonatal communication-intervention training adds value to a KMC programme.http://www.phcfm.orgtm201

Early identification of learners with autism spectrum disorder : drawing on developmental histories

This article examines early developmental histories of learners who attended a government-funded school for children with autism spectrum disorder (ASD) in South Africa from 1992 to 2014. A total of 141 complete historical admission records of learners were analysed. Frequencies, means and correlations were determined for perinatal conditions and developmental milestones. Low birth weight and preterm birth did not occur more than in the general South African population. Only 7.6% of the participants had delayed motor development. Self-help skills, except for feeding, were mostly achieved according to typical developmental criteria. Half of the participants started talking after the age of three years and that was the main reason why parents became concerned about their development. The percentage of participants who were non-verbal and had regressed speech was higher than that reported in other studies. Public information should focus on early developmental factors associated with ASD risk to expedite early identification and diagnosis.http://www.tandfonline.com/loi/gecd20hj2020Speech-Language Pathology and Audiolog

Breastfeeding and swallowing in a neonate with mild hypoxic-ischaemic encephalopathy

BACKGROUND : Specific breastfeeding and swallowing characteristics in neonates with hypox-icischaemic encephalopathy (HIE) have not yet been well described in the literature. Considering the relatively high incidence of HIE in resource-poor settings, speech-language therapists should be cognisant of the feeding difficulties in this population during breastfeeding. OBJECTIVE : To systematically describe the breastfeeding and swallowing of a single case of a neonate diagnosed with mild HIE from admission to discharge. METHOD : A case study of a 2-day old neonate with mild HIE in a neonatal intensive care unit at an urban teaching hospital, is presented. Data were prospectively collected during four sessions in a 12-day period until the participant’s discharge. Feeding and swallowing were assessed clinically, as well as instrumentally using a video-fluoroscopic swallow study. RESULTS : After parenteral feeding, nasogastric tube feeding commenced. Breastfeeding was introduced on Day 6, as it was considered a safe option, and revealed problematic rooting, shallow latching, short sucking bursts, infrequent swallowing, and a drowsy state of arousal, with coughing and choking. No penetration or aspiration was identified instrumentally. After 13 days, the neonate was breastfeeding safely. CONCLUSION : Although the pharyngeal stage of swallowing was intact, symptoms of oral stage dysphagia were revealed using a combination of clinical and instrumental measures. Breastfeeding difficulties were identified, exacerbated by poor state regulation, which lead to prolonged hospitalisation. The case study highlights the unexpected long duration of feeding difficulties in an infant with mild HIE and indicates further research.http://www.sajcd.org.za/index.php/SAJCDam2018Speech-Language Pathology and Audiolog

Oropharyngeal dysphagia in breastfeeding neonates with hypoxic-ischemic encephalopathy on therapeutic hypothermia

PURPOSE : To identify symptoms of oropharyngeal dysphagia (OPD) in breastfeeding neonates with hypoxic-ischemic encephalopathy (HIE) on therapeutic hypothermia (TH). Early identification of feeding problems in neonates with HIE by speech-language therapists (SLTs) may prevent secondary complications of OPD such as aspiration pneumonia and death. MATERIALS AND MATHODS : Twenty-eight full-term neonates with HIE (mean chronological age = 4.5 days) and 30 healthy term controls were prospectively recruited for this case–control study. Participants with HIE (mild [n = 15], moderate [n = 11], severe [n = 2]), diagnosed by pediatricians, received whole-body TH. Feeding was clinically evaluated by an SLT using the Preterm Infant Breastfeeding Behavior Scale. RESULTS : Twenty-five neonates (89.2%) had at least one symptom of OPD. Falling asleep during feeding, noticeable oral secretions, coughing, and flaring nostrils were symptoms of OPD most frequently identified. The HIE group displayed limited arousal during breastfeeding and had less obvious rooting, shallower latching onto the breast, and more single sucks in comparison to term newborns. The HIE group had significantly more closed eyes and minimal movement during breastfeeding, while controls showed the quiet-alert state ideal for breastfeeding. CONCLUSIONS : OPD was identified in the majority of infants with HIE. Underlying the appearance of an inactive neonate with HIE may be OPD that could be overlooked if not investigated. Interprofessional collaboration between SLTs, pediatricians and nurses to determine feeding-readiness is imperative. SLTs may assist in decision-making to improve safety of breastfeeding in this population. This study contributes to the small body of research on early breastfeeding of neonates with HIE.Vice Chancellor’s Academic Development Grant (2016) University of Pretoria, South Africa.https://www.liebertpub.com/loi/bfm2020-12-06hj2020Speech-Language Pathology and Audiolog

Les opinions du personnel de soins de santé primaires sur le développement des interventions en troubles précoces de la communication

BACKGROUND: Early communication intervention services rendered by speech-language therapists and audiologists to families of infants and young children with feeding difficulties, hearing loss or emerging communication disorders should be implemented throughout South Africa. Early intervention can ameliorate risks, enhance development and may prevent further delays. Based on research initiated during a community-service year experience in a rural subdistrict, an incremental process of establishing accessible early communication intervention services was deemed feasible. Such a process cannot be successful if the collaboration of primary healthcare personnel and managers is not ensured. OBJECTIVES: The aim of the article was to describe the perceptions of primary healthcare personnel with regard to expansion of early communication intervention services to infants at risk of developmental delay. METHOD: A qualitative descriptive survey design was followed. Semi-structured interviews were conducted with 20 primary healthcare nurses and sisters and eight primary healthcare programme managers in Ditsobotla subdistrict in the North West province of South Africa. RESULTS: The participants indicated that by improving team work, developing training programmes and evaluating identification methods and resources, the step-by-step rollout of early communication intervention functions on four organisational levels may be a realistic goal for sustainable services in the resource-limited district. CONCLUSION: The positive perceptions and contributions by participants promise a rich human-resource basis for transdisciplinary collaboration between speech-language therapists, audiologists and primary healthcare personnel in order to reduce the burden of early communication disorders in a rural district.CONTEXTE: Les services d’intervention en troubles précoces de la communication fournis par les orthophonistes et audiologistes aux familles de nourrissons et jeunes enfants présentant des difficultés d’alimentation, une perte auditive ou des débuts de troubles de la communication devraient être mis en place dans toute l’Afrique du Sud. L’intervention précoce peut limiter les risques, améliorer le développement et contrer des retards supplémentaires. Sur la base d’un travail de recherche entrepris pendant une expérience d’un an de service communautaire dans un sous-district rural, un processus progressif d’établissement de services accessibles d’intervention en troubles précoces de la communication a été jugé faisable. Un tel processus ne peut réussir si la collaboration du personnel et des cadres de soins de santé primaires n’est pas assurée. OBJECTIFS: Le but de l’article était de décrire les opinions du personnel de soins de santé primaires quant au développement des services d’intervention en troubles précoces de la communication chez les nourrissons à risque de retard du développement. METHODE: Un modèle d’étude descriptive quantitative a été suivi. Des entretiens semi-structurés ont été conduits avec vingt infirmiers/-ières et soeurs et huit responsables de programme de soins de santé primaires dans le sous-district de Ditsobotla, dans la province sud-africaine du Nord- Ouest. RESULTATS: Les participants ont indiqué qu’en améliorant le travail d’équipe, en développant des programmes de formation et en évaluant des méthodes et ressources d’identification, le déploiement étape par étape de fonctions d’intervention en troubles précoces de la communication à quatre niveaux organisationnels pouvait être un objectif réaliste pour des services durables dans ce district aux ressources limitées. CONCLUSION: Les opinions et contributions positives des participants laissent promettre une base fournie de ressources humaines pour une collaboration transdisciplinaire entre les orthophonistes, les audiologistes et le personnel de soins de santé primaires afin de réduire le poids des troubles précoces de communication dans un district rural.http://www.phcfm.org/am201

Breastfeeding characteristics of late-preterm infants in a kangaroo mother care unit

OBJECTIVE : To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care (KMC) unit. MATERIALS AND METHODS : In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs' (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants' mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 on observation. RESULTS : Only 13.7% of participants were directly breastfeeding without supplementary naso- or orogastric feeding/cup-feeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (standard deviation: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes, but most participants breastfed for less than 10 minutes (76.7%). No statistically significant differences in breastfeeding characteristics were detected between participants of different chronological ages. A general trend toward more mature behaviors in participants' breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). CONCLUSION : LPIs in this sample presented with subtle breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs.https://www.liebertpub.com/loi/bfm2018-12-01hj2018Speech-Language Pathology and Audiolog

The development of a neonatal communication intervention tool

Neonatal communication intervention is important in South Africa, which has an increased prevalence of infants born with risks for disabilities and where the majority of infants live in poverty. Local literature showed a dearth of information on the current service delivery and roles of speech-language therapists (SLTs) and audiologists in neonatal nurseries in the South African context. SLTs have the opportunity to provide the earliest intervention, provided that intervention is well-timed in the neonatal nursery context. The aim of the research was to compile a locally relevant neonatal communication intervention instrument/tool for use by SLTs in neonatal nurseries of public hospitals. The study entailed descriptive, exploratory research. During phase 1, a survey was received from 39 SLTs and 2 audiologists in six provinces. The data revealed that participants performed different roles in neonatal nurseries, which depended on the environment, tools, materials and instrumentation available to them. Many participants were inexperienced, but resourceful in their attempts to adapt tools/materials. Participants expressed needs for culturally appropriate and user-friendly instruments for parent guidance and staff/team training on the topic of developmental care. During phase 2, a tool for parent guidance titled Neonatal communication intervention programme for parents was compiled in English and isiZulu. The programme was piloted by three participants. Suggestions for enhancements of the programme were made, such as providing a glossary of terms, adapting the programme’s language and terminology, and providing more illustrations. SLTs and audiologists must contribute to neonatal care of high-risk infants to facilitate development and to support families.http://www.sajcd.org.za/index.php/SAJCDnf201

Variables associated with Grade R English additional language acquisition in multilingual rural Mpumalanga schools

In a previous study Moodley, Kritzinger and Vinck (2014) found that formal English Additional Language (EAL) instruction contributed significantly better to listening and speaking skills in Grade R learners, than did a play-based approach. The finding in multilingual rural Mpumalanga schools was in agreement with numerous studies elsewhere. Additional extraneous variables such as teachers’ first language, qualifications, age and experience, and learners’ first language and gender may also relate to EAL performance. The aim of the present study has been to determine whether these variables were significantly associated with learners’ EAL performance scores. A matched two group comparison study was conducted, utilising 175 learners and 10 teachers from isiNdebele, isiZulu, Sepedi, siSwati and Xitsonga first language backgrounds. The English Language Proficiency standards assessment tool was used. Learners of IsiNdebele teachers and young qualified teachers performed better than other learners. Learners with isiNdebele as first language performed better than learners from other languages. No association between gender and learner performance was found. The advantage of isiNdebele speaking teachers and learners in EAL teaching and learning may relate to the many borrowed phonemes and words from English. Further research is required to strengthen the evidence.http://www.sajournalofeducation.co.za/hb2016Speech-Language Pathology and Audiolog