Theses and Dissertations (Centre for Augmentative and Alternative Communication (CAAC))

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Caregivers in residential care facilities’ perspectives on the communication needs of children with complex communication and their role in supporting communication
(University of Pretoria, 2024-02-09) Samuels, Alecia; maybuye@gmail.com; Ntimane-Halama, Maybuye Azania
Many children with complex communication needs (CCN) are unable to meet their communication needs owing to various challenges like their family circumstances, additional disabilities, and severity of their disabilities as well as barriers within the environment (Finke et al., 2008). Opportunities for meaningful social interactions and participation in the society is significantly limited. Children with CCN in residential care facilities are usually faced with additional challenges that restrict them from participating and contributing in the society when compared to their peers who live with their families. Caregivers working in residential care facilities have a crucial role in supporting the communication of the children as they are usually the most frequent and sometimes the only communication partners for the children (Beukelman et al., 2012). With factors like overcrowding, short staffing and the severe disabilities of the children, caregivers often struggle to fulfil their role in supporting communication of the children. Owing to the hurdles that children with CCN in residential care facilities are faced with, their communication needs remain unmet. The aim of this study is to understand the perspectives of caregivers in a residential care facility regarding the communication needs and skills of children with complex communication needs as well as the role that caregivers in the facility play to support their communication. Seven caregivers from one residential care facility in Tshwane agreed to be interviewed. The interview schedule was developed based on a range of previous studies and aimed to obtain information on (1) biographical information of the caregivers, (2) caregivers’ understanding of communication, (3) caregivers’ knowledge of the children’s communication needs and skills as well as (4) the views of caregivers regarding their roles in supporting communication. The qualitative data were transcribed and analysed using the thematic analysis method. The results obtained indicated that caregivers described the children at the residential facility as having severe to profound intellectually disability with a range of communication impairments. Dominant themes in the description of the children’s communication skills were emergent communicators, non-verbal communication with subthemes such as informal unaided communication. Caregivers reported that they used self self made unaided AAC strategies to communicate with children with CCN. However, no formal or aided AAC communication support strategies were mentioned despite the availability of some unused AAC laptops in the facility. Challenges and factors contributing to the limited communication support were identified, namely short staffing, the additional teaching role, the need for training to improve the knowledge and skills of caregivers in supporting communication, and the need for speech therapists knowledgeable of AAC.
The effects of unaided augmentative and alternative communication interventions on communication in children with autism spectrum disorders : a scoping review
(University of Pretoria, 2023-08) Dada, Shakila; aaliapatel@gmail.com; Patel, Aalia
Background: There is growing evidence regarding the benefits of Augmentative and Alternative Communication (AAC) systems in facilitating communication development in children with autism spectrum disorders (ASDs). Various reviews have been conducted on the effectiveness of AAC intervention for children with developmental disabilities and specifically ASD. However, previous reviews were limited in terms of reporting on the effect of unaided AAC interventions on the communication of children with ASD. Methods: The primary aim of this scoping review was to describe the evidence regarding the effects of unaided AAC interventions on communication in children with ASD. The review included a quality appraisal of the studies and a description of the effects of unaided AAC interventions. Results: Sixty-two studies were included in this scoping review. The studies were described in terms of three groups of effects: (i) the effect of unaided AAC interventions on expressive language, (ii) the effect of unaided AAC interventions on receptive language, and (iii) the effect of unaided AAC interventions on social communication. Furthermore, the studies were described in terms of number of publications, study designs, participant characteristics, unaided AAC interventions, intervention outcomes, and quality appraisal. Conclusions: Unaided AAC interventions offer meaningful improvements in expressive language, receptive language, and social communication skills for children with ASD. This scoping review provides valuable preliminary evidence and suggests promising results about the support of unaided AAC interventions towards the communication skills of children with ASD.
Perceptions of occupational and physiotherapists regarding their communication with clients with post-stroke aphasia during rehabilitation
(University of Pretoria, 2023) Tonsing, Kerstin Monika; jessicapaigeslater@gmail.com; Slater, Jessica Paige
Background: Persons with post-stroke aphasia often require rehabilitation services, including those provided by occupational therapists and physiotherapists. Due to the communication impairments that persons with post-stroke aphasia experience, their interaction with such healthcare professionals is often challenging. Understanding how occupational and physiotherapists navigate such interactions can be a helpful starting point for possible interventions to support these interactions. Therefore, this study sought to investigate the perceptions of South African occupational and physiotherapists on their communication with clients with post-stroke aphasia during rehabilitation. Methods: An online questionnaire was developed to investigate the perceptions of occupational therapists and physiotherapists on their communication with clients with post- stroke aphasia. A combination of convenience and snowball sampling was used to recruit participants. Responses were received from 42 professionals. Descriptive statistics were used to analyse the results. Results: Participants reported that communication with clients with aphasia was very important during rehabilitation, but only perceived this communication to be somewhat effective. They reported using various strategies to support understanding and expression of clients with aphasia. The severity of the clients’ communication difficulty was rated as the most significant challenge to communication, while input from other professionals such as SLTs was perceived as a helpful asset to support communication with clients with aphasia. While many professionals had previously attended training in communication support strategies for clients with aphasia, all participants indicated that they would like more training in this area. Professionals in both groups indicated that they would like to receive training on communication support strategies for clients with aphasia. Conclusions: The results of this study demonstrate that professionals do value communication with clients with aphasia, and that they already implement communication strategies to support this process. However, the need for additional training is also clear to improve professionals’ skills and confidence. Institutional and organisational factors may also need to be addressed to optimise communication between rehabilitation professionals and their clients with aphasia. Keywords: Aphasia, rehabilitation, communication support strategies, person-centred care
AAC services for multilingual and non-English clients : perspectives of speech-language therapists in the public healthcare setting in Gauteng
(University of Pretoria, 2023) Tonsing, Kerstin Monika; wasifah.noorbhai@gmail.com; Noorbhai, Wasifah
Background: South Africa recognizes 12 official languages and despite its commitment to supporting them equally, English still dominates in the healthcare and education sectors. Discrimination against multilingual clients who do not receive services in their languages is a concern, making appropriate communication assessment and intervention challenging for speech-language therapists (SLTs). The study aims to explore the perspectives of South African SLTs on augmentative and alternative communication (AAC) service provision for multilingual and non-English clients with complex communication needs (CCN) in the public healthcare sector in Gauteng. Methods: This study was conducted using a qualitative research design. Semi-structured interviews were conducted via Zoom conferencing with nine SLTs working in the public healthcare sector who had more than one year of experience providing AAC to multilingual and/or non-English clients. Interviews were transcribed using the Happy Scribe software and transcriptions were checked by a research assistant. Thematic analysis (codebook approach) was used to analyse the data with the help of ATLAS.ti software. Results: Three themes were identified in the data, namely (i) current practice in assessment and intervention, (ii) factors influencing practice, and (iii) best practice. Thematic coding showed that SLTs hold positive views of multilingualism and attempt to provide linguistically and culturally congruent services. However, several systemic challenges impede this process. Several initiatives were suggested to address this situation, such as policy development, development of linguistically and contextually appropriate AAC systems, continuous professional development and up-skilling of SLTs on best practices, and the implementation of family- and client-centred practices. Conclusions: Understanding the perspectives of SLTs working in the public healthcare sector in Gauteng provides insights into the challenges they face in providing equitable services to all and the creative avenues they employ to overcome them. Gaps in policy, appropriate assistive technology provision and SLT training need to be addressed to ensure more appropriate AAC services for multilingual and non-English clients with CCN in South Africa. The findings highlight the pressing need for culturally sensitive and linguistically appropriate AAC practices for individuals from diverse backgrounds. Increased resources and support are essential to develop AAC systems that are linguistically and culturally relevant for multilingual clients. By actively involving individuals from multicultural communities, promoting cross-cultural competence among professionals, and tailoring interventions to specific linguistic and cultural contexts, we can bridge the gap between current AAC practices and the diverse needs of individuals, ensuring that everyone has equitable access to effective communication tools.
Participation of children with autism spectrum disorder : comparing the perspectives of children and their caregivers
(University of Pretoria, 2023) Dada, Shakila; samanthagayslt@gmail.com; Gay, Samantha Mary
Participation in activities in one’s home, school, and community setting is a human right that positively affects one’s well-being. However, children with disabilities often do not enjoy this human right. The bulk of existing participation research includes proxy interviews with caregivers to better understand the participation patterns of children with disabilities. There is a need to include the voices (self-reported) of children with all disabilities, including those with children with autism spectrum disorder (ASD) in participation research. Children with ASD present with sensory and communication challenges which may make obtaining information about their subjective participation experiences more methodologically challenging. The current study aimed to describe and compare the perceptions of children with mild to moderate autism spectrum disorder (ASD) and the perceptions of their primary caregivers regarding the children's participation, including barriers and facilitators of participation, in home, social and community activities.
The availability and effectiveness of AAC training programmes for educators and paraeducators : a scoping review
(University of Pretoria, 2023) Dada, Shakila; Hartley, Rushdah; andreavissr1@gmail.com; Visser, Andrea
Background: A trans-disciplinary approach is required to implement Alternative and Augmentative Communication (AAC) for children with complex communication needs (CCN). Educators and paraeducators play an essential role in AAC implementation in the classroom context. Children who use AAC often spend most of their day with educators and paraeducators. Educators and paraeducators facilitate AAC use in the school setting and provide vital feedback regarding practical adjustments that need to be made to AAC devices, the child’s daily routine, and their needs and preferences related to AAC (Johnson et al., 2015). The study aims to i) identify and describe the currently available training programmes or studies that train educators and paraeducators in implementing AAC; ii) describe the training objectives and instructions of these programmes; iii) report the research design and outcomes of these programmes; iv) make a quality appraisal of the studies that were included in the review, and lastly, v) describe the effectiveness of the training programmes on AAC for educators and paraeducators. Methods: The scoping review framework by Arksey and O’Malley (2005), as refined by Levac et al. (2010), as well as the PRISMA checklist (Tricco et al., 2018) was used as the methodology in this study. This methodology was chosen since educator and paraeducator training on AAC is an emerging topic within the field of AAC. A scoping review allowed reporting on currently available studies (Munn, 2019). Results: A total of 15 (N=15) studies met the inclusion criteria between 2001 and 2022. Only one study defined or described what was meant by educators and paraeducators. Most of the training sessions were conducted face to face (n=12), while some authors used online platforms (n = 1) and others used a combination of both (n = 2) to conduct training. Few studies made use of an existing training programme. The quality appraisals of seven (n=7) studies were conclusive, three (n=3) were preponderant, and four (n=4) inconclusive. Thirteen (n=13) studies were rated highly effective and two (n=2) were rated fairly effective. Conclusion: Information gathered from these studies showed that face-to-face and online training can be effective when training educators and paraeducators on AAC implementation. Also, definitions of the terms used to refer to educators and paraeducators are needed to understand exactly who is being trained in these studies. Furthermore, while good quality research and effective training are reported in this review, only a limited number of studies (N=15) complied with the required inclusion criteria. Hence, there is a need for more research on the effectiveness of AAC training for educators and paraeducators in AAC implementation.
Teacher perceptions of literacy instruction for their learners with autism spectrum disorder
(University of Pretoria, 2023) Bornman, Juan, 1968-; hhuman7up@gmail.com; Human, Hannah Judith Winter
The development of literacy in learners with autism spectrum disorder (ASD) is unlike that of neurotypical children. Many individuals with ASD enter adulthood with no literacy skills, especially those with comorbid complex communication needs. Teacher perceptions on the abilities of their learners to develop literacy are known to have an impact on learner literacy outcomes. This study used a descriptive, cross-sectional paper-based survey design to investigate teacher perceptions of literacy instruction for their learners with ASD. The study focused on seven public schools for learners with special education needs in the broader Johannesburg metro, with a sample size of 67 teachers. Teachers provided their own definitions of literacy, and digital literacy, which provided information on how they view literacy for their learners with ASD. Teachers then identified factors that negatively and positively impacted literacy instruction. They also shared their positive and negative perceptions of their learners with ASD. They described the nature of literacy instruction provided, and the context in which they teach. It was found that most teachers did not believe that their learners with ASD could develop conventional literacy skills, and that their learners should not be exposed to digital literacy as they are not ready. Teachers also reported that they faced various barriers to literacy instruction. Additionally, many teachers used their knowledge of ASD teaching practices to guide how they taught literacy to their learners with ASD. The implications of this studies’ results indicate a need for teacher training regarding literacy development and approached to literacy instruction for learners with ASD.
Assisting persons with communication disabilities to access the criminal justice system: South African legal practitioners' perceptions of questioning strategy guidelines
(University of Pretoria, 2023) Bornman, Juan; ta.gibbs1@gmail.com; Gibbs, Tracy Ann
Background: An estimated 2.2 to 3.8% of individuals worldwide have communication disabilities (CD) (World Health Organization, 2001). In addition to being at an increased risk of crime and abuse, individuals with CD experience multiple barriers when attempting to access the criminal justice system (CJS). Despite provisions provided in both national and international policy documents and legislation, individuals with CD are often not offered the necessary accommodations to assist them in accessing justice on a fair and equal basis with others. This is due in part to legal practitioners not having received training to work with individuals with disabilities, which negatively impacts on their knowledge and skills regarding the challenges experienced by these individuals when they attempt to access the CJS. Therefore, legal practitioners are often unaware of the accommodations that can be offered to persons with CD. For example, using questioning strategies that are appropriate for individuals with CD, including those who use augmentative and alternative communication (AAC). Methods: Existing literature on questioning strategies recommended for use with both children and adults with CD in criminal courts was integrated using a synthesis matrix. Questioning strategy guidelines were developed from the synthesised data. Specific attention was given to those principles that would accommodate individuals using AAC. Individual interviews were conducted with expert South African legal practitioners regarding their perceptions of the clinical utility of these questioning strategies. Thematic analysis of the transcribed interviews was used to establish common themes in the interviews. Results: During the thematic analysis of the data, four overarching themes were identified as being important to the participants in the study, namely the person and their specific needs, preparation and support, court processes, and universally appropriate techniques. Within these themes, participants felt that no two witnesses with CD are the same and that questioning strategies need to be adjusted to suit each individual witness. Preparing the witness for their court experience is seen as vital for the witness to be able to testify effectively in court. This is particularly true in the South African adversarial system where the witness is likely to be cross-examined. In addition, participants noted that many of the accommodations recommended in the questioning strategy guidelines are already in regular use in the South African criminal courts. However, defendants with CD are not routinely offered the same accommodations as complainants with CD. Conclusions: A consolidated set of questioning strategy guidelines with a strong evidence base has been developed. The results of this study foreground the challenges faced by individuals with CD when questioned in criminal courts, particularly during cross-examination. More training of legal practitioners from the beginning of their studies and through continuing professional development is needed to improve their understanding of and sensitivity to the challenges faced by individuals with CD. Training must include disability sensitivity and skills-based training to ensure that communication challenges are accommodated rather than exploited. In addition, further research is needed to explore how cross-examination in the adversarial CJS can be tempered so that more appropriate questioning strategies can be used with those witnesses who have CD.
The effect of training early childhood development practitioners on the principles of UDL to adapt lesson plans for children with communication impairments in the communication ELDA of the National Curriculum Framework
(University of Pretoria, 2023) Samuels, Alecia; Swazie517@gmail.com; Hlatshwayo, Nomaswazi Zandile
Background: The understanding that the early years in a child’s life are crucial for laying a foundation for development and learning has led to a drive to ensure that all children need to access Early Childhood Development (ECD) services worldwide. In South Africa, the ECD sector is considered important and is responded to by the Department of Education (DoE), the Department of Health, and the Department of Social Development (DSD) through their various policies and services. Access to ECD services, however, remains a challenge for children with disabilities in this country and this can be attributed to the lack of interdepartmental collaborations and the lack of explicit guidelines in policies catering for children with disabilities. Access to Early Childhood Education (ECE) for children with disabilities, especially those with communication impairments, remains one of the biggest challenges within the ECD sector in South Africa. These challenges are in relation to the lack of explicit guidelines to guide ECE practitioners to accommodate children with disabilities within the Early Learning and Development Areas (ELDAs) of the National Curriculum Framework (NCF) policy and the lack of training for ECE practitioners. Universal Design for Learning (UDL) is a suggested framework to address the lack of flexibility in curricula in order to cater for learner diversity. This framework has also been proven to improve inclusivity when educators were trained on the implementation thereof. This study, therefore aims to evaluate the effectiveness of UDL training on ECE practitioners’ adapted lesson planning in the communication ELDA of the NCF policy for children with communication impairments. Methods: A single-case pretest-posttest study was conducted with a group of seven ECE practitioners. Participants were required to write a lesson plan to accommodate children with communication impairments before and after the UDL training. The two lesson plans were then scored and compared to measure the effectiveness of the UDL training. Results: The results of this study indicated that there was a statistical significance between the overall scores of the participants based on their pretest and posttest lesson plans. Conclusions: UDL training can make a substantial difference in enabling ECE practitioners to adapt lesson plans in the communication ELDA of the NCF policy to accommodate children with communication impairments. Keywords: children with communication impairments, children with disabilities, communication ELDA, diversity, Early Childhood Development (ECD), Early Childhood Education (ECE), inclusion, National Curriculum Framework (NCF), Universal Design for Learning (UDL)
The education and training on Augmentative and Alternative Communication for rehabilitation professionals working with people who have little or no functional speech : A scoping review
(University of Pretoria, 2022-11) Samuels, Alecia; smthonxa@gmail.com; Mthonxa, Sephiwe Selina
Background: Health professionals working in rehabilitative settings often encounter clients with little or no functional speech (LNFS) who would benefit from Augmentative and Alternative Communication (AAC), however, their lack of knowledge and skills in AAC limits their ability to assess and provide effective AAC interventions for this population. For collaborative intervention to happen, health professionals need to be equipped with knowledge and skills in AAC. However, there do not appear to be clear and consistent educational and training goals for various rehabilitation professionals working in AAC such as speech-language therapists (SLT), occupational therapists (OT), or physiotherapists (PT). Methods: The aim of this scoping review is therefore to explore and chart the literature relating to the education and training in AAC of the aforementioned professionals who are mainly involved with the rehabilitation of people who require AAC with a view to identifying any gaps within their education and training. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) was used to guide this study (Tricco et al., 2018). Databases searched included Medline, ERIC, CINAHL, Psych Info as well as hand searches using the forward and backward citation of the included articles. Titles, abstracts, and full texts were screened independently by two reviewers for inclusion. Results: Thirty-two studies met the inclusion criteria for entry into this scoping review. An extraction tool was used to extract the necessary data to answer the review questions. A sequential narrative data synthesis sketched how the results linked to the aims of the scoping review. A description of the studies in terms of their purpose, where studies took place and the AAC training undertaken or discussed in the studies was reported on. Discussion: A discussion of the studies was done in relation to the sub-aims of the study focussing on (i) the level at which AAC education and training was discussed or undertaken for rehabilitation professionals (SLTs, OTs and PTs); (ii) the extent to which the education and training of PTs in AAC was part of the included studies; and (iii) to understand unique and common knowledge and skills surrounding AAC that need to be addressed in the education and training of health professionals in undergraduate or continued education to prepare these professionals to be contributing members of an AAC rehabilitation team. Conclusions: There was limited literature that focused on the actual education and training of rehabilitation professionals in AAC. Future research should focus on AAC education and training of rehabilitation professionals and the AAC content that is covered in the education and training.
Communication partner training to support persons in a minimally conscious state : identifying and adapting an intervention programme
(University of Pretoria, 2022) Bornman, Juan, 1968-; Johnson, Ensa; u12043193@tuks.co.za; Kuyler, Arine
Persons in a minimally conscious state (MCS+) often have fluctuating levels of alertness as well as varying self- and environmental awareness. They inconsistently follow concrete- one-step instructions, show a fluctuating understanding of yes/no questions, demonstrate the functional use of objects in an incongruent manner, use vocalisations inconsistently, and present with capricious intentional communication. Due to the dissonance of these behaviours, it is difficult for communication partners to observe early neuro-behavioural signs indicating signs of alertness and awareness as well as later unaided communication attempts. Although, communication partners indicate a willingness to interact with these persons, they may not have sufficient knowledge to identify the communication functions of unaided communication behaviours displayed by the person. Additionally, communication partners might not know which unaided communication behaviours to observe as these behaviours are subtle and consequently easily overlooked or misinterpreted by them. To support communication partners of persons in an MCS+, communication partner training is suggested as one possible intervention. Communication partner training typically focuses on equipping partners to observe, assess, and interpret unaided communication behaviours while also training them to provide appropriate responses. Furthermore, such an intervention may support partners to utilise their own communication strategies to facilitate communication with persons in an MCS+. The aim of this study is to identify and adapt an evidence-based intervention in the form of a communication partner training programme to facilitate interaction between communication partners and persons in an MCS+. This is achieved by empowering communication partners to observe, assess, interpret, and respond to the communication behaviours displayed by these individuals. A qualitative exploratory collective case study design with three sequential phases, each comprising distinct steps, is used to address this aim. From the findings of the study, the Connect+ was developed for communication partners of persons in an MCS+ based on E3BP principles. The clinical utility of this programme was also determined.
The perspectives of mainstream secondary school Japanese teachers towards inclusion
(University of Pretoria, 2022) Bornman, Juan, 1968-; Johnson, Ensa; krugermich.signups@gmail.com; Krüger, Michelle
Background: Disability is still a controversial topic in many nations, in part because of ongoing stigma. People with disabilities have been stigmatised throughout history as being morally unacceptable or unwell and in need of help. Before the establishment of the modern educational system in Japan in the late 19th century, people with disabilities were stigmatised as ‘useless’ and shunned by society. Since then, significant progress has been made in Japan's educational laws, most notably with the signing of the United Nation’s Convention on the Rights of Persons with Disabilities (CRPD) in 2008 and its adoption in 2013. Although Japan strives to establish a more inclusive educational system, the reality of implementation is significantly different from what is desired on paper. Therefore, this study aims to investigate the perspectives of mainstream Japanese secondary teachers toward inclusion. Methods: This study followed a quantitative non-experimental descriptive design by employing online surveys via Qualtrics. A total of 42 teachers working at three secondary schools in the Fukushima prefecture in Japan participated in the study. The perception of teachers regarding inclusion in mainstream classrooms were explored using biographic questions (both open- and closed-ended questions) and the published Teachers’ Attitudes toward Inclusion Scale (TAIS), a 5-point Likert scale. This scale was identified following a scoping review. Data from the surveys were downloaded into Excel and were then transcribed using descriptive analysis. The data were furthermore analysed using inferential statistics, that is, the t-test and an Analysis of Covariance (ANOVA) and an f-test to determine if more than two sets of cofactors were significantly different from each other. Results: The results indicated that Japanese teachers in the Fukushima prefecture were generally not positive and were not in favour of inclusion. The majority of participants were men, held an undergraduate degree, and taught at a suburban school. Only some participants were knowledgeable regarding the inclusive education policies which Japan is trying to implement. Overall, teachers were hesitant to include children with disability in their classrooms. Teachers of an older age and with more teaching experience were the most negative with regards to inclusion. Conclusions: Even though Japan has made strides with regards to inclusive education, there is still a lot of room left for improvement of the implementation of educational policies in mainstream classrooms. Furthermore, teachers need more training at university level as well as during their pre-service years as a means to be more tolerant and accepting of children with disabilities in their classrooms. More studies need to be conducted in Asian countries especially in Japan, in order to understand the social stigma associated with disability and why teachers generally have a negative view toward inclusion compared to Western countries.
Determining the core vocabulary of Setswana-speaking Grade R learners as used during school activities
(University of Pretoria, 2022-11) Tonsing, Kerstin Monika; Morwane, Refilwe; gmogatusi@gmail.com; Mogatusi, Morwesi Gaopalelwe
Background: When designing AAC systems for children who have not yet developed conventional literacy skills, a process of vocabulary selection is employed. Core vocabulary is a list of words used frequently by particular age group in spontaneous conversation. Core vocabulary lists are one of the useful lists consulted when selecting vocabulary for AAC systems. South Africa is a multilingual country having 11 official languages and only three studies have explored the core vocabularies of the following South African languages: Afrikaans, isiZulu and Sepedi. Due to the uniqueness of languages, the core vocabulary list of a language cannot simply be translated to another language for AAC use because linguistic meaning and will be lost. This study was therefore conducted to determine the core vocabulary of Setswana speaking Grade R learners, which then can be added to the pool of multilingual vocabularies available for use by individuals in need of AAC. Methods: Language samples of six preschool children recruited from three different schools were collected during regular school activities through recordings. Covid-19 regulations were adhered to at all times during collection of data. Body worn audio recording devices were used to record the spontaneous speech of preschool children and was then transcribed, coded and analyzed. The data was analyzed using Microsoft Excel™. Results: From a composite script of 18,099 intelligible words, a total of 1,112 different words were identified. The type token ratio of this sample was 0.06. An analysis was conducted on these number of different words used, how frequently used the words were and how commonly used the words were among the participants. A total of 249 core words and 863 fringe words were identified. Conclusions: The findings of this study were comparable and consistent with those found in other core vocabulary studies of other languages, in that the Setswana core vocabulary consisted of a smaller proportion of words which were used more frequently and represented a large portion of the composite sample. The Setswana core vocabulary list used in this study can be consulted and used as a resource during vocabulary selection of designing an AAC system for children with Setswana language backgrounds.
Development and evaluation of an augmentative and alternative communication training for caregivers of young children in a low-income rural context of South Africa
(University of Pretoria, 2022) Tonsing, Kerstin Monika; Bornman, Juan, 1968-; vuledzani.madima@yahoo.com; Ndanganeni, Vuledzani Princess
This study employed an exploratory sequential mixed method design to develop and evaluate a programme aimed at training Vhavenda caregivers of children living in low-income contexts to implement augmentative and alternative communication strategies with their children aged 2-6 years living with complex communication needs. In the exploratory phase, a scoping review of the literature as well as interviews with cultural stakeholders generated data that informed program design undertaken during the development phase. The development phase also comprised an expert review and pilot study to further refine the programme. The evaluation phase entailed testing the effects of the programme on three caregiver and two child variables by means of a single case multiple probe design across three caregiver-child dyads. The social validity of the programme was also evaluated. Medium to strong effects of the intervention on the five variables were established but were not maintained three weeks post intervention. Social validity of the programme was found to be high. The caregivers were able to implement the strategies taught during the guided practice phase, attesting to the effectiveness of the intervention. The fact that skills were not maintained post intervention may point to a need for a longer period of support in order to firmly establish the behaviours
Parents’ perceptions of barriers and facilitators to the implementation of Augmentative and Alternative Communication : a scoping review
(University of Pretoria, 2022) Dada, Shakila; Johnson, Ensa; azimabhorat@gmail.com; Bhorat, Azima
Background: Parents’ involvement is essential for their children’s successful use of augmentative and alternative communication (AAC) devices. When implementing AAC in their daily lives, children with complex communication needs (CCN) and their parents face multiple barriers, which may impact their use of AAC. Parents also report facilitators of AAC implementation which may increase the use of AAC. The aim of this qualitative meta-synthesis was to describe parents’ perceptions of barriers and facilitators in the implementation of aided and unaided AAC for children with CCN who use AAC. Methodology: A qualitative meta-synthesis approach was used summarize the literature. A systematic approach was used to identify studies that met the inclusion criteria. The 14 studies that met these criteria were critically evaluated using the JBI Critical Appraisal Checklist. Barriers and facilitators as reported in the studies were mapped onto the Participation Model. The Participation Model is a systematic approach used to implement AAC through assessment and intervention. The approach emphasizes the necessity for professionals to identify barriers and facilitators to participation for children who use AAC. Results: Results indicate that the majority of studies included the perspectives of both parents (i.e., mothers and fathers). Aligned with the Participation Model, most barriers and facilitators reported by parents were opportunity related, specifically practice barriers and/or facilitators. Access barriers were only mentioned in four studies. The most significant barriers to AAC implementation as reported by parents were (a) professionals’ lack of knowledge of AAC; (b) professionals’ lack of skills regarding the use of AAC devices; (c) time constraints that hampered parents’ effective implementation of AAC; (d) the financial cost of AAC devices; and (e) parents’ acceptance of AAC devices. Conclusions: By identifying the barriers to and facilitators of the use of AAC as experienced by children with CCN and their parents, professionals can be better equipped to provide the necessary support for the successful implementation of AAC devices. Suggestions are provided for future research directions.
The perspectives of South African speech- language therapists on the implementation of augmentative and alternative communication for persons with post-stroke aphasia
(University of Pretoria, 2022-07) Tonsing, Kerstin Monika; ingeoden@gmail.com; Odendaal, Inge
Background: It is necessary to advance the integration of augmentative and alternative communication (AAC) into rehabilitation plans to improve communication and social participation outcomes for persons with post-stroke aphasia. Although research studies have demonstrated AAC’s positive outcomes for this population, AAC is not always implemented. The incorporation of AAC into aphasia rehabilitation by South African speech-language therapists (SLTs) is currently not well-understood. Accordingly, the purpose of this phenomenological study is to explore SLTs' perspectives on the implementation of AAC for persons with post-stroke aphasia with a specific focus on the: (i) current AAC practice; (ii) influencing factors; and (iii) success and relevance of AAC interventions. Methods: A qualitative phenomenological design was used to study the perspectives of 10 SLTs who had at least 10 years of experience working with persons with aphasia post-stroke using open-ended interview questions. The interview data was transcribed and analysed thematically, using a six-phase process (Fereday & Muir-Cochrane, 2006). A combination of inductive and deductive analysis was used. Synthesised member checking was employed to increase trustworthiness. Results: The three a-priori themes aligned to the interview questions were identified in the data. In terms of current practice, nine participants reported that AAC was applicable and that they implemented AAC for all persons with post-stroke aphasia. Participants reported using a combination of unaided, low-tech, high-tech and partner-supported interventions. All participants reported on factors that influence the successful implementation of AAC, including factors related to: (1) the person with aphasia; (2) the AAC system; (3) the communication partner; (4) the therapist; (5) the physical and social environment; (6) the service organisation; (7) policy; and (8) scientific evidence. Participants provided descriptions of the success and relevance of AAC for persons with post-stroke aphasia. Some reported poor generalisation, but nine of the 10 maintained that AAC was relevant for this population. According to the data, the primary facilitators of successful generalisation included sustained practice and a communication-accessible environment through communication partner support. A fourth theme was inductively identified, namely the definition of AAC. This theme emerged as some participants highlighted the importance of the definition of AAC and indicated some misconceptions and disagreements about the definition amongst SLTs, other healthcare providers (HCPs), funders, and policymakers. Conclusions: The finding that all the participants implemented AAC with some of their clients with post-stroke aphasia is positive and aligns with the current evidence and best practice recommendations. It was evident that AAC implementation is complex, and therapists make conscious choices regarding the implementation considering various factors corresponding to previous literature. Despite barriers to implementation, most participants still had a positive view of AAC and actively worked to circumvent barriers to implementation. The data reflected the vital role of partners in communication interactions. Participants' comments about the definition of AAC highlighted the need to view AAC in the broad sense to ensure optimal outcomes for persons with post-stroke aphasia.
A scoping review of primary caregivers'perceptions of their involvement in augmentative and alternative communication of their children
(University of Pretoria, 2022-05) Johnson, Ensa; gonda@iway.na; Olivier, Gonda
BACKGROUND: Augmentative and alternative communication (AAC) intervention is pivotal for obtaining functional outcomes in communication and participation of children with complex communication needs (CCN). Various studies focused on the experiences and perceptions of parents as primary caregivers with regards to their involvement in AAC intervention and implementation of their child with CCN. The value of the findings of these studies lies therein that from the findings it could be derived how parents view their involvement and how their nature of involvement could possibly influence the successful and beneficial implementation of AAC intervention. Since the primary caregiver is the only constant factor in the life of a child with CCN, it has proven to be feasible to investigate the primary caregivers’ perception of their involvement in AAC intervention. METHODS: A scoping review was used during which articles were screened from various databases using predetermined Boolean search terms. In a pilot study, the search terms were refined to obtain optimal selection of articles after selecting articles on abstract level, selection was done based on full text which eventually led to 10 articles being identified on a full text level using a qualitative method based on tables generated from the data. Data were extracted from these 10 articles using a self-developed data extraction tool and then organised into various tables which led to compiling the final findings and conclusion for the review. RESULTS: The results indicated the benefit of AAC intervention when involving the parents in AAC intervention of their child with CCN. It mainly indicated the needs of parents not involved in their child’s AAC intervention, not only the influence on them as parents but on the family system and the various ecological systems of the family and the child. The knowledge and skills required by the parents are prominent needs and the lack thereof as well as not being consulted on their opinion often leaves them feeling disempowered and unvalued. CONCLUSIONS: A family-centred approach to AAC intervention is of the utmost importance in AAC intervention of a child with CCN. If the parent as primary caregiver and the members of the family system are not included in decision making, goal setting, and planning, AAC intervention will most likely not be successful and lead to the abandonment of the selected AAC system. This abandonment will impact on the family system as well as the ecological systems of the child which in turn, will impact negatively on the child’s development and communication. Keywords: Augmentative and alternative communication; communication intervention; family and ecological systems; involvement; perceptions; primary caregivers
The extent to which children and young people with disabilities are involved in the design of assistive technology : a scoping review
(University of Pretoria, 2021) Samuels, Alecia; aimee_dj@hotmail.com; De Jager, Aimee
Background: Assistive Technologies (AT) are often abandoned. As technology is an expanding and vast field, it should be utilised optimally for vulnerable populations. Research shows that to address this, there is an increasing need to involve end-users in the design process of AT. This study aimed to investigate the extent of research available pertaining to the involvement of children and young people with disabilities in the design of ATs and further analysed the extent of their involvement. Methods: A scoping review of the literature was therefore conducted. Limitations included a risk of publication bias on English articles, and accessibility from 2007 to 2020. Results: The results revealed that minimal research was available that actively involved children with disabilities in a Participatory Design (PD) framework in the field of AT development including Augmentative and Alternative Communication (AAC). Children and young people’s levels of involvement were mainly at a symbolic level in terms of the type of participation. This research highlights the need for intensified efforts towards increasing the participation and engagement of the children and young people as they voice their opinions, which could then be considered by the decision-makers. Conclusions: The findings shed light on the disparity in the research which may hinder the effective implementation of ATs. Future research is needed to establish optimal methods of involvement of children and young people with disabilities in AT design. Keywords: assistive technology, Augmentative and Alternative Communication (AAC), children with disabilities, the extent of involvement, involvement, participatory design
Impact of AAC interventions on participation outcomes in children with complex communication needs : a scoping review
(University of Pretoria, 2021-08) Dada, Shakila; Bastable, Kirsty; paulinezwiegelaar7@gmail.com; Prinsloo, Pauline
Participation or taking part in life situations, is a fundamental human right. Participation is a complex and multidimensional construct. The importance of participation on health, education, and well-being for children and youth with disabilities have extensively been indicated by literature. Being able to communicate is an essential component of full participation in various life situations such as at school, with peers and in the community. Communication provides a means to participate and specially to participate socially. Complex communication needs usually limit the opportunities of children or youth with disabilities to have social interaction with peers. Augmentative and Alternative Communication (AAC) interventions aim to facilitate communication competency and effectiveness to increase social interaction and independence. Importantly, participation in all aspects of life – which is considered the ultimate goal of AAC intervention – is a complex and multifaceted construct. Evidence suggests that there is little research on participation-related intervention outcomes for children who use AAC. The purpose of the current study was to use the family of Participation and Related Constructs (fPRC) framework to review and describe the reported outcomes of AAC intervention for children and youth with complex communication needs. The scoping review identified a total of 270 studies for inclusion and the data was extracted and mapped onto the fPRC. The results indicate that although many studies report on participation-related constructs such as activity competence and context, there is still a paucity of focus on the constructs of attendance and involvement, sense of self and environment-related constructs. The study therefore highlights the need for future research on these constructs. Participation should be the primary focus of intervention and the long-term wellbeing of children and youth using AAC should be enhanced by developing comprehensive participatory goals in collaboration with all stakeholders.
The development and validation of the parental roles in intervention task tool for use with parents of children with a disability
(University of Pretoria, 2021) Samuels, Alecia; smithkatherine12@gmail.com; Smith, Katherine Alice
This study develops and preliminarily validates the PRITT, an instrument to measure the parental role in intervention, for use with young children with a disability. Parental roles in intervention, i.e., the tasks and responsibilities that parents perform in intervention, are widely reported to be important for intervention outcomes. A quantitative instrument to measure parental roles in intervention has potential clinical applications to initiate negotiations about the roles parents may want to assume and the supports they require to perform the tasks associated with these roles. Additionally, the measure has applications as a research tool to empirically test relationships implied in the literature. A mixed method design was employed for the instrument development and validation. Phase 1 included instrument construction whereby items were generated from a scoping review and a Likert-type response scale was selected. In Phase 2 content and face validity of the PRITT were established and the survey questionnaire was piloted. During Phase 3, the online survey questionnaire was administered to parents of young children with a disability enrolled in rehabilitation interventions (i.e., occupational therapy, physiotherapy, and speech-language therapy) in South Africa. In Phase 4 of the study, the underlying factor structure of the PRITT was explored and internal consistency and test-retest reliability analyses were conducted. Results indicate that the preliminary validity and reliability have been established for the PRITT for use with parents of young children with a disability. Refinements of the PRITT are recommended based on future administrations with a more diversely representative sample of South African parents.

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