South African Journal of Communication Disorders
The South African Journal of Communication Disorders publishes reports and papers concerned with research, and critically evaluative theoretical, philosophical and conceptual issues dealing with aspects of human communication and its disorders, dysphagia, service provision, training and policy.
|Coverage||Vol 63 Issue 1 2016 - current|
Department of Higher Education and Training (DHET)
ScieLO SA (2016)
Background: Speech-language therapists are specifically trained in clinically evaluating swallowing in adults with acute stroke. Incidence of dysphagia following acute stroke is high in South Africa, and health implications can be fatal, making optimal management of this patient population crucial. However, despite training and guidelines for best practice in clinically evaluating swallowing in adults with acute stroke, there are low levels of consistency in these practice patterns.
Objective: The aim was to explore the clinical practice activities of speech-language therapists in the clinical evaluation of swallowing in adults with acute stroke. Practice activities reviewed included the use and consistency of clinical components and resources utilised. Clinical components were the individual elements evaluated in the clinical evaluation of swallowing (e.g. lip seal, vocal quality, etc.)
Methods: The questionnaire used in the study was replicated and adapted from a study increasing content- and criterion-related validity. A narrative literature review determined what practice patterns existed in the clinical evaluation of swallowing in adults. A pilot study was conducted to increase validity and reliability. Purposive sampling was used by sending a self-administered, electronic questionnaire to members of the South African Speech-Language-Hearing Association. Thirty-eight participants took part in the study. Descriptive statistics were used to analyse the data and the small qualitative component was subjected to textual analysis.
Results: There was high frequency of use of 41% of the clinical components in more than 90% of participants (n = 38). Less than 50% of participants frequently assessed sensory function and gag reflex and used pulse oximetry, cervical auscultation and indirect laryngoscopy. Approximately a third of participants showed high (30.8%), moderate (35.9%) and poor (33.3%) consistency of practice each. Nurses, food and liquids and medical consumables were used usually and always by more than 90% of participants.
Conclusion: Infrequent use of clinical components and high variability in clinical practice among speech-language therapists calls for uniform curricula in the clinical evaluation of swallowing at South African universities and for continued professional development postgraduation. Different contexts and patient symptoms contribute towards varied practice; however, there is still a need to improve consistency of practice for quality health care delivery. A research-based policy for the clinical swallowing evaluation for a resource-limited context is also needed.
Objective: The objective was to determine the preliminary psychometric performance of a new clinical feeding scale to diagnose oropharyngeal dysphagia (OPD) in neonates.
Methods: Twenty neonates with a median gestational age of 35 weeks were evaluated using the Neonatal Feeding Assessment Scale (NFAS) and modified barium swallow studies (MBSS). The results were compared.
Results: Nine of the 20 participants presented with OPD on the NFAS. Comparison of the scale’s results with instrumental MBSS indicated that all participants without OPD were correctly excluded (100% sensitivity). The specificity was 78.6%, indicating that three participants were falsely identified with OPD on the scale. Interrater reliability was determined on 50% (n = 10) of the sample. Substantial agreement (80%) was obtained between two raters in five of the six sections of the scale and on the diagnostic outcome.
Conclusion: The preliminary performance of the scale appears to be promising. A further validation study will take place.
Background: The PA skills of phonological blending and segmentation and auditory word discrimination relate directly to literacy and may be weak in English second language (EL2) learners. In South Africa, literacy skills have been found to be poor in especially EL2 learners.
Objectives: The purpose of this paper is to determine the effects of vowel perception and production intervention on phonemic awareness (PA) and literacy skills of Setswana first language (L1) learners. These learners are English second language (EL2) learners in Grade 3.Method: The present study employed a quasi-experimental, pre-test–post-test design.
Results: The findings of low–literacy skill levels concurred with previous investigations. However, post-test results of intervention in PA seemed to improve the literacy skills of EL2 learners.Conclusion: PA skills should be a crucial part of the literacy curriculum in South Africa.
The effect of methylphenidate-OROS® on the narrative ability of children with attention-deficit hyperactivity disorder
Background and objective: Children with attention-deficit hyperactivity disorder (ADHD) experience difficulty with expressive language, including form (e.g. grammatical construction) and content (e.g. coherence). The current study aimed to investigate the effect of methylphenidate-Osmotic Release Oral System® (MPH-OROS®) on the narrative ability of children with ADHD and language impairment, through the analysis of microstructure and macrostructure narrative elements.
Method: In a single group off–on medication test design, narratives were obtained from 12 children with ADHD, aged 7–13 years, using wordless picture books. For microstructure, number of words, type–token ratio and mean length of utterance were derived from narrative samples using Systematic Analysis of Language Transcripts conventions. For macrostructure, the narratives were coded according to the Narrative Scoring Scheme, which includes seven narrative characteristics, as well as a composite score reflecting the child’s overall narrative ability.
Results: The administration of MPH-OROS® resulted in a significant difference in certain aspects of language macrostructure: cohesion and overall narrative ability. Little effect was noted in microstructure elements.
Conclusion: We observed a positive effect of stimulant medication on the macrostructure, but not on the microstructure, of narrative production. Although stimulant medication improves attention and concentration, it does not improve all aspects of language abilities in children with ADHD. Language difficulties associated with ADHD related to language content and use may be more responsive to stimulant medication than language form, which is likely to be affected by cascading effects of inattention, hyperactivity and impulsivity beginning very early in life and to progress over a more protracted period. Therefore, a combination of treatments is advocated to ensure that children with ADHD are successful in reaching their full potential.
Parents are aware of the ototoxic effects of chemotherapy in paediatrics undergoing cancer treatment – Professional versus parental views : a pilot study
Background: The primary goal of chemotherapy is to cure cancer and its symptoms. Hence, in recent years, there has been an increase in cancer paediatric survival rate. However, there have also been adverse side effects such as ototoxic hearing loss because of chemotherapy. Therefore, this study aimed at exploring whether the parents of children undergoing chemotherapy are aware of ototoxic effects of chemotherapy.
Methods: A non-experimental quantitative study was conducted to collect data through questionnaires, one for paediatric oncologists and the other for parents. A convenience sampling strategy was employed to recruit 11 paediatric oncologists and 7 parents from two public hospitals in Gauteng. The questionnaires were analysed quantitatively, using descriptive statistics.
Results: About 55% of paediatric oncologists indicated informing parents about the ototoxic effects of chemotherapy. On the contrary, 71% of parents reported having been informed by paediatric oncologists about the possible hearing loss because of chemotherapy; however, 57% of the children are receiving a combination of cisplatin and cyclophosphamide despite being aware of their ototoxic nature.
Conclusion: This study paves the way for qualitative studies to ascertain how parents are informed about the possible side effects such as hearing loss because of chemotherapy treatment. The mode in which parents are informed about the possible side effects related to chemotherapy is critical, considering that a high number of children are still receiving chemotherapeutic drugs that are directly linked to hearing loss.