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Doctoral Degrees (Speech Language Pathology)

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    The use of an English language assessment test on South African English additional language (EAL) speakers from an indigenous language and cultural background : a critical evaluation.
    (2013) Mdlalo, Thandeka.; Flack, Penelope Susan.; Joubert, Robin Wendy Elizabeth.
    The aim of the study is to provide an in-depth interrogation and critique of the use of language assessment tools on populations from indigenous language and cultural backgrounds, culminating in a framework for guiding the adaptation of language assessment tools to be culturally and linguistically relevant for the indigenous South African populations on which they are used. As South Africa is a multilingual and multicultural country, it contributes to understanding the factors that need to be taken into account for acquiring reliable and valid findings with multilingual and multicultural populations. The isiZulu language and culture is used as a basis for the study as the study is conducted in KwaZulu-Natal. This study critically evaluates the assessment of English Additional Language (EAL) speakers who are from an indigenous linguistic and cultural background, using an English expressive language screening tool, the Renfrew Action Picture Test (RAPT) as an example. The cultural and linguistic relevance of this commonly used screening tool is interrogated from four different viewpoints, firstly, the perspective of the children, who are the target population of the tool; secondly, that of the parents and community, who play a significant role in the socialisation of the children; thirdly, from the perspective of the academics from an indigenous language and cultural background, who provide an academic perspective of the tool; and finally, Speech-Language Therapists (SLTs) who administer the tool and interpret the findings. This study uses a mixed methods approach. Multiple data collection methods are used, such as a survey, focus group, individual interviews, test administration and consensus methods. The survey and Delphi technique form the quantitative parts of the research methodology. Patterns of responses from all the sources are analysed and interpreted. Methodologically, the research is unique as it uses children as a source of primary data collection. Children, in research, are usually only used in the administration of the test and their opinion of the tool is not sought. In this study the voice of the children is the main contributor to the data collection. The findings also show that adults, who are often relied on as primary data sources in research on language tools used on children, may have certain misconceptions about children’s knowledge and views. A key finding of this study is that the cultural and linguistic background of the child assessed plays a crucial role in determining and interpreting the responses to the presented material of the language assessment tool. The conscientisation of the Speech Language Therapist and the redefining of her role emerge as pivotal aspects facilitating change. Based on this finding, recommendations, such as that the therapist equips herself with knowledge of the language of the client, the cultural and linguistic background of the child assessed, the type of bilingual that the child is, are made so that the reliability and validity of the findings are not compromised.
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    Investigation of the effectiveness of an ecologically valid telerehabilitation system for the assessment and primary management of neurogenic dysphagia in a resource constrained country.
    (2017) Ayanikalathi, Narayanan Sona.; Pillay, Mershen.; Jayaram, Mannarukrishnaiah.
    India is undergoing remarkable industrialisation, economic and demographic changes resulting in a transition towards lifestyle related cardiovascular and cerebrovascular diseases and TBI. There is an increased number of individuals living with different physical, cognitive or affective sequelae of CVA and TBI. It leaves patients with several residual disabilities like physical dependence, communication impairment and dysphagia. Given the knowledge that CVA and TBI patients presenting with dysphagia are at a risk for pneumonia, there is even more need to manage dysphagia to prevent subsequent pneumonia. Intervention of dysphagia is scarcely available in resource constrained countries due to various reasons. There is a dearth of dysphagia experienced speech language pathologists in India due to the wide geographic range and increasing population. In such cases, when there is a shortage of trained staff in underserved areas, a feasible solution may be to adopt TR. This is in light that TR is an emerging novel method and various studies are being conducted using TR for speech language pathology services. TR studies on management of dysphagia have been conducted in economically developed countries like USA, Australia, etc. and mostly in controlled settings. Reports on impact of application of TR for management of dysphagia in resource constrained countries are almost absent. Ecological validity i.e. can results obtained under controlled research setting be generalised to those obtained in real life settings, and effectiveness, i.e. is it successful in producing desired outcome in dysphagia assessment, need to be assessed when considering developing a TR for use in India for the intervention of dysphagia, hence trying to investigate if the studies conducted successfully in the economically advanced countries be replicated in India. Hence the researcher deemed it necessary to conduct the current study with the aim to investigate the effectiveness of an ecologically valid TR system for the assessment and primary management of neurogenic dysphagia in India. The current thesis is a series of three phases. The first phase (Chapter 2) aimed to explore the current literature available regarding the use of TR in the intervention of dysphagia using a narrative literature review. The objectives were to investigate the current status and feasibility of TR in the assessment and/or management of dysphagia and to identify the benefits and limitations of the studies to explain ecological validity of TR. The narrative literature review aided the researcher to identify that TR is a feasible method for the intervention of dysphagia in economically developed countries. It emphasized the gap in knowledge on the use of TR for the intervention of dysphagia in resource constrained country as there are no studies reported. Hence, the researcher identified that the literature review augmented her idea that ecological validity of TR needed to be identified and thus its effectiveness when implementing it in resource constrained countries, because the patient, clinician, technology and context related factors do play a major role. The identified factors were explored in greater detail in phase two, to ensure that the TR implementation for the intervention of neurogenic dysphagia is contextually responsive and holistic, based on the paradigm shift to a constructivist one, ontologically, epistemologically and methodologically. The second phase (Chapter 4) aimed to investigate the ecological validity of TR in a resource constrained country such as India. Its objectives were to investigate the current status of TR in India through an understanding of the knowledge and attitude of TR personnel and to identify the variables that affect the ecological validity of TR in India based on the practice of the TR personnel. The semi structured interviews of TR personnel in India aided the researcher to acknowledge that patient, clinician, technology and context related factors can affect the ecological validity of TR in a resource constrained country, which in turn will affect its effectiveness. However, tele-mode service delivery in India is a feasible proposition, and in fact, several institutions have successfully implemented it. TR and TR for the intervention of dysphagia can be an answer to the needs of people in the underserved areas in India. With the outcomes from this phase, as well as based on the conceptual framework developed in phase one, factors such as devices and technology used for TR, the current internet speed available in the study location, materials used for the CSE and real-life outpatient clinical settings were used to establish the ecological validity of TR. Its effectiveness was then investigated. The third phase subsequently aimed to investigate the effectiveness of an ecologically valid TR for the assessment and primary management of neurogenic dysphagia in India. The objectives were to compare the results obtained using CSE through an ecologically valid TR mode and face-to-face mode with the intention to identify if the scores are reliable and to examine and explain the possible effects of the ecological validity variables i.e. patient, clinician, technology and context related factors on the effectiveness of TR in dysphagia assessment. Simulated patients (SP) were used for this phase, which was to avoid any harm to real patients (if used). This can be considered as a main limitation of the study. The quantitative data analysis using percent exact agreement and Cohen’s Kappa scores to rate the inter-rater reliability between the TR-SLP and FTF-SLP, showed that TR was effective in conducting neurogenic dysphagia assessment and primary management. There were high inter-rater reliability in all the cases studied. A descriptive analysis of the results obtained could explain the reason for the variation in scores on certain parameters of the CSE in each case, in relation to the factors affecting the ecological validity. This qualitative descriptive analysis could explain how the various factors could have influenced the performance of the patient and clinician. However, due the small sample size of four SP in study two, the findings cannot be generalised to broader clinical settings. However, there is no denial that the results provide valuable preliminary information for future research of TR in resource constrained country. The findings of the overall study identified the need for treating a new intervention as unique, developing in relation to a complex and potentially unique set of ecological conditions. The researcher identified the need for using a contextually guided framework when developing interventions such as TR, which in turn can improve its effectiveness. The results obtained from the current study feed motivation for future studies using real patients, first to be done in a controlled setting to reduce the risk of the consequences due to aspiration or choking during the assessment. The results of the current study will help and be an inspiration in future large-scale studies in resource constrained country and is food for thought for those already using TR for speech language therapy services in such settings.
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    An exploratory study of the efficiency of swallowing and communication management in tracheostomized populations in Sri Lanka.
    (2017) Ishak, Fathima Nuzha.; Pillay, Mershen.; Hettiarrachchi, Shyamani.
    Dysphagia, or difficulty in swallowing, is one of the main disorders experienced by people with tracheostomies (PWTs). It results in aspiration and increased risk of respiratory complications. A preliminary review of existing literature indicates considerable variation in practices involved in the management of this disorder. This scoping review aims to describe these processes in various countries and analyse them in relation to majority and minority world contexts. A scoping review was conducted using the Arksey and O'Malley (2005) framework, followed by a thematic analysis of the literature. An online databasesearch of articles published between 1 January 1990 and 1 April 2016 was performed, and those pertaining to surgery, general tracheostomy care and paediatrics were excluded. The results confirm that research on the subject comes mainly from minority world countries. Thematic analysis reveals evolving trends in practices that vary within and between majority and minority world contexts, and indicates increasing efforts by professionals in the latter regions to achieve global standardisation. The greatest variations appear in blue dye tests, cuff deflation status during oral feeding and the use of the speaking valve to manage swallowing. There are also discrepancies among the professionals involved. This review provides a comprehensive compilation of evidence on swallowing management for PWTs and indicates the need for further studies to understand practices in majority world contexts.
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    Development and validation of a bilingual language battery for language-based learning disabilities.
    (2018) Mazibuko, Xolisile Innocentia.; Flack, Penelope Susan.; Kvalsvig, Jane Dene.
    There are social, linguistic, cultural, and political dimensions that impact on health and education in South Africa. The evolving nature of these dimensions demand the use of language assessment tools that are developed and validated for the South African population. Speech-language assessment informs parents and educators of the nature of speech and language difficulties the learner may have and guides the intervention. IsiZulu is the most widely spoken African language in South Africa. Therefore, development of a tool to assess expressive, receptive, and written language skills of learners with language-based learning disorders in isiZulu, is imperative. The aim of this study was to develop and validate a tool for language assessment of isiZulu-English speaking learners in grades 1, 2, and 3 who may have language-based learning disabilities. An assessment tool was designed to assess core language skills and identify early indicators of language-based learning disabilities that may result in academic difficulties. The tool development process aimed to construct an innovative test that is linguistically and culturally sensitive to bilingual or isiZulu-English speakers while the content is rich for identifying indicators of language-based learning disability. Elements in expressive and receptive language, phonological awareness, listening, reading, and mathematically-based language concepts were considered. The conceptual tool development phase involved a systematic literature review, pretesting with two existing tools and consultation of a five member Delphi review panel for advice and reviews. Field trials contributed to the development of test items and procedures and tested the tool’s application in mainstream and remedial schools as well as rural and urban communities of learners in KwaZulu-Natal. A combination of qualitative and quantitative methods were used to collect and analyse data. The results indicated that the new tool was linguistically and culturally appropriate. The majority of the subtests provided good reliability and valid results. The study makes a worthy contribution to the body of knowledge in the field of speech-language therapy and basic education. The results and guidelines from this study set out the basic elements required for development of language assessment tools in other African languages. The development of the assessment tool will yield standardization of a bilingual language assessment tool in South Africa.