Segmental phonology and Black South African English speakers : communicative success with standard dialect listeners

The study investigated the nature of the listener confusion which occurs when Black South African English (BSAE) speakers communicate a list of common English words to speakers of standard South African (StdSAE) English. BSAE and StdSAE subjects were grouped into 10 dyads. BSAE subjects read 120 monosyllabic English words to StdSAE subjects. Written data of StdSAE subjects were analysed to determine patterns of success and failure in the communication of single word items by BSAE subjects. Specific difficulties with vowels, dipthongs and consonants are discussed in terms of their effect on intelligibility. Findings are evaluated in the light of previous research, and in terms of Flege's Speech Learning Model (1987, 1991, 1995). It is suggested that all segmental features of BSAE relate to two distinct levels: a functional (meaning) level and an aesthetic level. This study focussed on the functional level, and aimed to describe the segmental features of BSAE speech which affect meaning. Such a distinction has particular relevance for speech and language therapists who need to have a clear rationale for their work with BSAE-speaking clients. Clinical implications specific to this emerging client group within South Africa are discussed

Contextually relevant resources in speech-language therapy and audiology in South Africa-are there any?

In this editorial introduction we aim to explore the notion of contextually-relevant resources. We argue that it is the responsibility of Speech Language Therapists (SLTs) and Audiologists (As) working in South Africa to develop contextually relevant resources, and not to rely on the countries or cultures where the professions originated to do so. Language is often cited as the main barrier to contextually relevant resources: most SLTs and As are aware of the need for more resources in the indigenous local languages. However, the issue is not as straightforward as translating resources from English into other languages. The challenges related to culture, e.g. formal education, familiarity with the test situation, have to be considered; as well as the population on which norms were obtained; the nature of vocabulary or picture items. This paper introduces four original research papers that follow in this edition of the journal, and showcases them as examples of innovative development in our field. At the same time we call for the further development of assessment materials, intervention resources, and contributions to the evidence base in our context. We emphasise the importance of local knowledge to drive the development of these resources in innovative and perhaps unexpected ways, and suggest that all clinicians have an important role to play in this process

Are we there yet? on a journey towards more contextually relevant resources in speech-language therapy and audiology

Audiologists and speech-language therapists working in developing contexts like South Africa have the opportunity to address a range of needs through their research. One of these needs is the development of assessments and therapy materials that are appropriate for their clients’particular language needs and cultural background. This editorial paper aims to introduce original research in speech-language therapy and audiology, which has been carried out in South Africa and other developing contexts and is presented in this volume of the journal. In addition we suggest that while the focus of much research is on the destination or end product that is developed, there is a need to share the methodologies that are used to reach that goal so that more research can be carried out by a wider pool of students, researchers and clinicians. We describe some of the methods that we have used in our research – often in small scale projects with budgetary constraints, which would be feasible for clinicians in their routine clinical contexts. Our hope is that others can build on these approaches, critique and share their own strategies for the ultimate advancement of the professions in southern Africa

'It’s not just the learner, it's the system!' Teachers’ perspectives on written language difficulties: Implications for speech-language therapy

The failure to achieve academic outcomes in linguistically diverse classrooms in poor areas of the Western Cape, South Africa, is well documented. A major contributing factor is the written language communication difficulties experienced in these classrooms. This paper describes the views of intermediate-phase teachers on why written language difficulties are experienced by learners and ways in which these difficulties might be overcome. A series of interviews were conducted with two class teachers in one urban school from which there had been a high number of referrals for speech-language therapy. The teachers were individually interviewed using an in-depth, semi-structured format. Teachers reported that 50 - 70% of learners in their classes were not meeting grade level academic outcomes. They were asked to explain the difficulties experienced with regard to written language, and the challenges and solutions linked to these. The findings suggest that there are barriers and opportunities at the school system, individual learner and home/social community levels. Major challenges identified at the school system level included limited training and lack of support for teachers, poor foundation skills in learners and difficulties with language. The current opportunities for the development of written language were insufficient and teachers identified further opportunities to promote the learners’ written language development. These included training and support for teachers, clear and consistent assessment guidelines, remedial assistance for learners and safe, nurturing home environments. There is a need to look beyond the learner as the site of the problem; a systemic approach is essential. In the light of these findings, suggestions are made for the role of the speech-language therapist

Are we there yet? On a journey towards more contextually relevant resources in speech-language therapy and audiology

Audiologists and speech-language therapists working in developing contexts like South Africa have the opportunity to address a range of needs through their research. One of these needs is the development of assessments and therapy materials that are appropriate for their clients’particular language needs and cultural background. This editorial paper aims to introduce original research in speech-language therapy and audiology, which has been carried out in South Africa and other developing contexts and is presented in this volume of the journal. In addition we suggest that while the focus of much research is on the destination or end product that is developed, there is a need to share the methodologies that are used to reach that goal so that more research can be carried out by a wider pool of students, researchers and clinicians. We describe some of the methods that we have used in our research – often in small scale projects with budgetary constraints, which would be feasible for clinicians in their routine clinical contexts. Our hope is that others can build on these approaches, critique and share their own strategies for the ultimate advancement of the professions in southern Africa

Investigating intervention : phonological therapy in a psycholinguistic framework.

This thesis investigates intervention for school-aged children with speech and literacy difficulties. Many previous studies have used phonological analysis as a theoretical basis, while others have used psycho linguistic models. The present study combines these approaches to assessment, intervention and evaluation of outcomes using a single case pre-post design for five children, aged 5;6 - 8;6 years. The research aimed to determine if intervention could result in (a) specific and (b) generalised improvements in the speech processing skills of children with severe and persisting difficulties. Assessment took place at two levels. First, the macro level focused on global change in each child's speech processing skills using psycho linguistic speech profiling, phonological analyses and intelligibility evaluations. Second, the micro level assessment focused on specific, treated and matched control stimuli, and was used to evaluate generalisation for each child. Changes at each level are used to contribute to the clinical evidence base and to inform theory of children's speech processing. Key areas highlighted by individual cases include stimuli selection; connected speech; production and perception of consonant clusters, and links between speech and spelling difficulties. Themes emerging across the cases are the links between theory and therapy, the integration of developmental and information-processing perspectives, the complementary relationship between profiling and sub-grouping approaches as a means of dealing with the heterogeneity of the population and intelligibility as a clinical outcome measure. Intervention brought about significant improvements in each child's speech processing at the micro level. The extent of generalisation varied across children. For some, change extended to the macro level including significantly increased intelligibility. For others, change was limited to the micro level. The fundamentally different nature of the children's speech processing profiles is considered together with ways in which speech-processing models might be developed. The case studies collectively contribute towards the development of a theory of therapy grounded in a psycho linguistic framework

Maximising health literacy and client recall of clinical information: An exploratory study of clients and speech-language pathologists

Limited research has been carried out in the field of speech-language pathology with regard to ways of maximising health literacy and client recall. However, speech-language pathologists (SLPs) frequently provide vast amounts of information that clients need to understand, apply and review in order to manage their (or their child’s) health. This exploratory study aimed to contribute information about ways in which SLPs can overcome low health literacy and poor client recall so that treatment effectiveness is improved. A case-study design was used with specific focus on four clients receiving treatment for dysphagia, voice disorders (including laryngectomies) and cleft lip and/or palate management in Cape Town. Strategies which may be able to maximise health literacy and client recall of clinical information were trialled and evaluated by clients and their SLPs, using semi-structured interviews. The researchers proposed a combination of high-tech strategies which assisted in all the cases. No single solution or universal tool was found that would be appropriate for all. There is a need to evaluate the long-term effectiveness of the combined strategies across a wider population, at different stages of rehabilitation and in diverse contexts. Implications and suggestions for future related research are presented

Masithethe: Speech and language development and difficulties in isiXhosa

IsiXhosa is the second most spoken language in South Africa and one of its official languages. Spoken mainly in the Eastern and Western Cape regions it is fitting that much of the research focusing on children’s isiXhosa speech and language acquisition has been carried out at the University of Cape Town (UCT). We describe what is known about children’s acquisition of isiXhosa, and highlight studies which inform our knowledge of the typical development of the language in relation to the acquisition of consonants including clicks and the isiXhosa noun class system. Little is known about the specific nature of speech and language difficulties in isiXhosa, and the development of isiXhosa resources for speech and language assessment and therapy is in its infancy. Suggestions are made for advancing knowledge and practice which is needed to provide a relevant and quality service to isiXhosa speakers

Catheter-directed thrombolysis for acute limb ischaemia: An audit

Background Acute limb ischaemia (ALI) is commonly managed with surgical intervention but catheter-directed thrombolysis (CDT) is a proven treatment alternative. CDT as a treatment for ALI is not common and is dependent on local practice. All patients receiving urokinase infusions at our institution currently require a bed in the high-dependency unit (HDU). Administering the infusion requires significant nursing time and this can be accommodated in HDU where the nurse-to-patient ratio is higher than it is on general wards. Aims To report the outcomes of the initial admission of patients who received CDT to manage ALI, and to give a cost estimate of their care. Method A retrospective audit was undertaken of all patients who received CDT with urokinase for the management of ALI over a four-year period. Success of thrombolysis was defined as a patient’s survival with no need for any surgical intervention prior to discharge. Outcome measures included the requirement for further vascular procedures in the same admission, the complication rate, and the median urokinase dose and duration. Cost estimates were based on hospital pharmacy and administration data. Results Seventy-three patients (median age 66 years, range 27–93 years) were included in the audit. The median urokinase dose was 2.3 million units (range 0.9–5.0 million units) with a median duration of treatment of 26 hours (range 3–96 hours). Fifty-seven patients did not require any further intervention prior to discharge, 14 had further intervention, and two died (one from a brainstem haemorrhage and one who deteriorated despite thrombolysis). The total cost per CDT case at our institution is currently approximately AUD $4,500 and AUD$6,700 for a patient being treated in HDU for one and two days, respectively. If patients were treated on a general ward, the cost would be approximately AUD $2,600 and AUD$3,000, respectively. Conclusion Rates of clinically acceptable clot lysis were high for patients treated with urokinase for ALI. Complication rates were comparable with published studies. Infusions can be required for prolonged periods of time and given the low complication rate, managing patients on a general ward rather than in the HDU is a feasible alternative and would reduce costs substantially

Children with speech difficulties: An exploratory survey of clincial practice in the Western Cape

This paper is based on a study by Joffe and Pring (2008) which investigated assessment and therapy methods used by Speech Language Therapists (SLTs) in the United Kingdom for children with phonological difficulties. Joffe and Pring reported SLTs’ most favoured assessments and therapy approaches in that context. Children with speech difficulties are likely to form a considerable part of SLT caseloads in South Africa, but the choice of assessments may not be so clearcut given the linguistic diversity of the region and the fact that few assessments have been developed specifically for the SA population. Linked to difficulties with assessment, selection of intervention approaches may also pose challenges. This study aimed to investigate the methods of assessment and intervention used by SLTs in the Western Cape when working with children with speech difficulties. A questionnaire was sent to SLTs working with pre and/ or primary school- aged children. Twenty-nine clinicians of varying experience responded. The majority of SLTs (89%) use informal assessment tools in combination with formal assessment. When using formal assessments, more than 50% of SLTs make modifications to better suit the population. Participants use a variety of intervention approaches, often in combination, and based on a child’s individual profile of difficulties and available resources. Forty-six percent of SLTs felt unsure about the selection of assessments and intervention for bi/multilingual children with speech difficulties. SLTs suggested that guidelines about accepted / typical speech development in the region would be helpful for their clinical practice. Clinical implications of the findings are discussed together with some suggestions for developing knowledge of children’s speech difficulties in the South African context