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EDITORIAL
Contextually relevant resources in speech-language therapy and audiology in South Africa – are there any?*
ABSTRACT
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 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 and
familiarity with the test situation, have to be considered, as well as
the population on which norms were obtained and 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.
Keywords: resources, development, speech-language therapy, audiology, culture
‘The responsibility to provide
culturally appropriate material for our work lies within the countries
to which the profession has extended.’ (Watson, 2006, p. 154).
Around the world, the professions of speech-language therapy (SLT)
and audiology (A) face challenges that have been well documented:
services for people with communication difficulties often have low
priority in health care systems; the professions straddle education and
health and are not always fully understood by each sector; resources
are limited; the professions are relatively small and relatively new
(Enderby & Emerson, 1995; Hartley, 1998; Nippold, 2010; Swanepoel,
2006). In South Africa these challenges are especially intense: there
are an insufficient number of SLTs and As to provide services to all
people; the qualified SLTs and As do not represent the linguistic and
cultural diversity of the country’s population and are unequally
distributed between the private and public sectors; the burden of
infectious disease is high; health priorities often centre on saving
lives rather than improving quality of life; and the research/evidence
base is lacking for the context (Penn, 2007).
Along with these challenges come opportunities. In this journal and
others, much has been made of the need for the professions of SLT and A
to transform and develop their practice, and to make our research and
practice relevant for the local context (Kathard, Naude, Pillay &
Ross, 2007). One way in which the professions can start to meet these
challenges is through the development of contextually relevant
resources tailor-made for the local context. In this paper we explore
what is meant by contextually relevant resources and practices, why
developing and disseminating such resources is important, and what has
already been done towards this goal, and finally we suggest ways to
participate in this process.
This editorial introduction grew from discussions about the papers that were submitted and accepted for publication in SAJCD
this year. In a seeming coincidence, each of these has innovation and
development of resources and practices for the South African context as
a linking theme. Rogers, De Wet, Gina, Louw, Makhoba and Tacon (this
issue) describe the translation of the Vertigo Symptom Scale into
Afrikaans, and its ability to differentiate between patients with and
without vertigo. Strasheim, Louw and Kritzinger (this issue) describe
the development of a locally relevant neonatal communication
intervention tool for use by clinicians in the neonatal nurseries of
public hospitals in South Africa. Uys and Van Dijk (this issue)
developed a music perception test for adult hearing aid users. Finally,
Crewe-Brown, Stipinovich and Zsilavecz (this issue) detail
communication difficulties in individuals who have experienced mild
traumatic brain injury, from a spouse’s perspective. This last
study focused on communication in everyday contexts and explored ways
in which communication can be evaluated in the absence of formal
assessment procedures and functional rating scales. Rather than being a
coincidence, this group of papers may serve to highlight the need for
development of locally relevant resources and the way in which local
researchers are rising to this challenge. Before describing what is
meant by contextually relevant resources, it may be helpful to provide
an overview of our current context.
The current context: speech language therapy and audiology in South Africa
South Africa has experienced major
socio-political changes over the past 20 years. In 1994, the first
democratic government was elected into power, and transformation of all
sectors – health, welfare, education – began. The impact of
Apartheid in South Africa prior to 1994 cannot be underestimated, and
many of today’s pressing social issues (e.g. poverty, illiteracy) are linked to its legacy. For
example, black and coloured South Africans experienced great
educational disadvantages that continue to have major consequences
today: an estimated 15 million people cannot read or write, and one in
every five South Africans over the age of 20 years has not received
formal education. High rates of migration, overcrowded living
conditions, family violence, teenage pregnancy and substance abuse
contribute to family and social difficulties in many communities
(Kagee, 2008).
In line with its progressive constitution, South Africa aims to
provide all of its citizens with equal access to quality health care
and education. But transformation is an ongoing process, not without
challenges: Despite a high incidence of HIV/AIDS and tuberculosis (TB),
the South African public health system is characterised by sub-optimal
provider-to-client ratios and insufficient material resources.
Education has been described as being in crisis, with national
benchmarking studies suggesting that reading and writing is not being
effectively taught in our schools (Mullis, Martin, Kennedy & Foy,
2007).
The professions of SLT and A have also changed considerably since
1994 in response to the changing milieu. Swanepoel (2006) describes
attempts to ‘improve imbalanced service delivery, redress
teaching programmes and focus … research endeavours on the
specific needs of the contexts’ (p. 264). Moodley, Louw and Hugo
(2000) describe the failure of traditional institution-based models of
service delivery to reach the majority of people, especially those
disenfranchised and disadvantaged, who may need our services the most.
Services are now focused on the community and delivered within a
primary health care framework, in an attempt to address the needs of
the population. In addition, the role of the SLT and A in schools is
being redefined. A special edition of this journal is due towards the
end of the year, and will have education as its focus.
South Africa has a diverse multicultural and multilingual
population. Of an estimated 47 million people, 79% are black, 9% are
coloured, 9% are white, and 2.5% are of Indian/Asian origin. Officially
there are 11 languages, but many more unofficial languages and dialects
are spoken. The most widely spoken languages in the country are isiZulu
(23.8%), isiXhosa (17.6%) and Afrikaans (13.3%) (Statistics South Africa, 2005). However, the
majority of SLTs and As working in the country are white English- or
Afrikaans-speaking; as a result, speakers of the indigenous languages
have invariably been under-served (Penn, Frankel, Watermeyer, & Muller, 2009). The
majority of health interactions are mediated by a third party, and more
than 80% of these interactions between clients, a third party and
health professionals take place across linguistic and cultural barriers
(Penn et al., 2009). In a small-scale survey of SLTs working in the Western Cape, Pascoe, Maphalala, Ebrahim, Hime, Mdladla, Mohamed & Skinner (2010)
found that a considerable proportion of SLTs are able to offer therapy
in only English or Afrikaans – even when working with children
for whom these are second or third languages. There is a fundamental
challenge here: ethical guidelines suggest that an individual should
not be denied intervention because of a language mismatch with the
clinician, but SLTs or As may not be competent to offer intervention in
all languages. A study by Jordaan and Yelland (2003) attempted to
determine how South African SLTs provide language intervention for
multilingual language-impaired children. The results indicated that the
majority of SLTs were providing language therapy to multilingual
children in the child’s second language only – usually
English. The authors attributed this to parental insistence and a lack
of another common language between the SLT and child.
What is meant by contextually relevant resources (and why are they important)?
Contextually relevant resources are any tools (assessments,
intervention programmes, guidelines and norms) that are available for
SLTs and As to use with a specific population in a specific setting,
and that have been developed with that population and setting in mind.
Many of the assessments and therapy resources in use in South Africa
today have been developed by clinicians and researchers in countries
such as Australia, the UK or the USA, and are used here in the absence
of contextually relevant resources, sometimes with adaptations that
make them more appropriate.
In the case of standardised assessments, these will be accompanied
by a set of norms against which clinicians can compare the performance
of the specific individual they have assessed on a given day. This
assessment procedure and comparison against norms requires a number of
assumptions on the part of the clinician-assessor: firstly that the
test was administered in the exact way described in the manual, and
secondly that the individual-client whose performance is compared with
the norms comes from the same population as that from which the norms
were obtained.
The first point is more easily addressed in our context, but to
address the second may not be possible, and therefore results must be
treated with caution. Stanczak, Stanczak and Awadalla (2001) found that
typical Sudanese adults attained scores on the Arabic version of the
Expanded Trail Making Test that were similar to those attained by US
adults with brain damage. This suggests that simply translating the
language of a test does not make it appropriate for another population
group, as the culture and context of the target population needs to be
considered to avoid misinterpretation of results. In another study,
Boivin (1991) found that children in Zaire performed significantly
below the norms of age-matched American children on a number of
non-verbal assessments widely held to be ‘culture-fair’
measures of cognitive abilities. He suggested that even supposedly
‘culture-fair’ assessments have to originate from
somewhere, in this case that of Western psychological research and
theory, which has several fundamental underpinnings and assumptions
about the way the world works that may be inappropriate when used
elsewhere.
In South Africa, Wilson and Moodley (2000) determined that the use
of the CID W22 wordlist (a speech discrimination test developed in the
USA and widely used by South African audiologists) was problematic
because normal-hearing, first-language South African English speakers
performed more poorly than their US counterparts on whom the norms are
based. Pahl and Kara (1992) assessed 60 typically developing children
in South Africa using the Renfrew Word Finding Scale, a test which has
been developed and standardised in the UK. Even though the South
African children were first-language speakers of English with no
language difficulties, a significant proportion of the children’s
test scores fell in the range suggesting language difficulties.
It is widely acknowledged that assessment is the cornerstone on
which intervention should be built. If assessment is inappropriate or
inaccurate and does not take cultural variation and the potential for
cultural bias into account, assessment results will not be accurate and
intervention may be inappropriate at best or harmful at worst (Carter,
Lees, Murira, Gona, Neville & Newton, 2004). Since it is the
ethical and professional responsibility of SLTs and As to provide an
equitable and quality service to all, the importance of using
culturally fair assessment tools cannot be overemphasised. Similarly,
using inappropriate assessment tools in research can confound results
and lead to biased conclusions. Irrespective of the languages involved,
it is clear that translation of a test does not necessarily make it
suitable for use in another setting with a different culture.
Not only assessment but intervention too should be appropriate for
the culture. Vocabulary, stereotypical concepts, high-frequency words,
body language and gestures differ between cultures and languages. It
may be necessary to look at the language structure of words in
different languages, because some intervention strategies commonly used
with one language may not be applicable when used with another. For
example, cuing words using the initial consonant sound as for English
(Greenwood, Grassly, Hickin & Best, 2010) may not work well with
languages such as isiXhosa or Sesotho, which typically begin with a
vowel sound (Gxilishe, 2004). We know that intervention is more valid
when it is relevant and culturally acceptable, and therefore it must be
tailored specifically to the culture of the individual and the
community culture (Hartley, Murira, Mwangoma, Carter & Newton,
2009).
There is growing recognition of the necessity for developing or
adapting assessment tools and procedures to match the needs of the
populations. Carter et al. (2004)
emphasise the need to develop culturally appropriate materials that
meet the needs of a specific culture, and to take cultural variation
and potential cultural bias into consideration. In their Kenyan-based
study they found that the following factors should be taken into
account by clinicians assessing or treating children from a culture
different to their own: the influence of culture on performance,
familiarity with the testing situation, the effect of formal education,
and picture recognition. Gladstone, Lancaster, Umar, Nyirenda, Kayira,
Van den Broek & Smyth (2009) described a qualitative methodology
using focus groups to identify contextually important concepts and
developmental milestones when creating a developmental assessment tool
for Malawian children, rather than simply translating and adapting
available ‘Western’ tools. The results from their focus
groups identified social milestones and social intelligence as
important aspects of development for the community, which would have
been neglected in a ‘Western’ test.
Local knowledge
Local knowledge refers to the ‘unique locally-available
knowledge, innovations, technologies, practices, resources and their
utilisation for improved livelihoods, beliefs and their contribution to
the wellbeing of communities’ (Nhemachena, Chakwizira, Dube, Maponya, Rashopola & Mayindi, 2011, p. 2). Authors such as Pillay (2003), Kathard et al.
(2007) and Joubert (2010) have variously described the origins and
flawed epistemologies of the SLT, A and occupational therapy (OT)
professions in South Africa. Essentially, in these (and other)
professions, ways of working have been developed in the Western world
that may not be appropriate for other cultures and contexts. Joubert
(2010), writing about OT, a profession that shares much in common with
ours, describes ‘a coming of age … a stage now when [we]
have used [our] resilience to really change those flaws of the past
… now recreating a new and more robust and appropriate
Africanised epistemology’ (p. 26). Kathard (2005) describes a
troubled and contradictory professional identity, but suggests that the
way we view ourselves as professions is not set in stone and is in the
process of transforming. We believe that the innovative development
work described in the journal signals a coming of age in our
professions, although clearly there is much more to be done.
Local knowledge must be valued and used to inform the development of
contextually relevant resources. To illustrate this, we use the case of
isiXhosa phonology. While there is a substantial amount of research
surrounding children’s speech sound acquisition in English, most
of this has been conducted with children in Europe, North America and
Australia. To date, there is no tool available to comprehensively
assess isiXhosa phonology. There are standardised assessments of
children’s speech that have been developed in other parts of the
world, e.g. the Goldman-Fristoe Test of Articulation (Goldman &
Fristoe, 1986). Using the picture stimuli from this test with
isiXhosa-speaking children would be helpful in providing some insight
into the child’s difficulties and can be used to provide some
qualitative information. In the survey by Pascoe et al.
(2010), it was found that Western Cape SLTs rely largely on informal
assessments when evaluating children’s speech. They make
adaptations to formal assessments, as well as using other informal
assessments of their own design. More than 50% of therapists indicated
that they make adaptations to formal tests to better suit the
population, e.g. translating the assessment and using more contextually
relevant pictures. These SLTs will often omit items or sections of
formal assessments that are not appropriate for their clients, and will
administer tests in non-standardised ways, e.g. repeating instructions
or test items.
However, the isiXhosa phonemic inventory contains consonants that do
not occur in English and may not be elicited by these pictures. The
clinician would need to know what the correct vocabulary items/names
were and what the correct production of the names are. S/he would need
to know what the vowel and consonant inventory of isiXhosa looks like
to know whether the child’s inventory was complete or not. Once
this information was gathered s/he would need to know whether the
child’s speech was acceptable/typical for the child’s age:
what are the typical processes used in isiXhosa and when do they
appear/disappear? These processes might not be the same as for English,
given that the language structures are different, e.g. isiXhosa does
not typically have closed syllables and therefore final consonant
deletion would not be expected. This illustration shows not only the
need for development of resources, but also the need for development of
local knowledge to drive the process. It illustrates that starting from
a blank page may in fact be easier than trying to adapt something that
has been developed for an entirely different population, in a different
place, speaking a different language.
Gxilishe (2004) conducted a study in the Western Cape, looking at
the acquisition of clicks by isiXhosa-speaking children. He found that
at the onset of speech (approximately 1 year of age) isiXhosa-speaking
children begin using three basic clicks. Such studies are important in
advancing our knowledge of speech and language development in the local
context; however, further research is needed.
Contextually relevant resources – what has been done (and where is it hiding)?
This edition of SAJCD showcases some original research around the development of locally relevant resources. The two audiology papers (Rogers et al., this issue; Uys et al.,
this issue) add to a small but growing body of research in the field of
South African audiology. Panday, Kathard, Pillay and Govender (2007,
2009) as part of an ongoing larger project have described the
development of isiZulu speech materials for use in speech audiometry,
and Khoza, Ramma, Mophosho, and Moroka (2008) have examined alternative
ways of carrying out speech audiometry with bilingual Tswana/English
speakers. While much of the research in audiology focuses on
development of assessment materials, there is also work that has
focused on development and evaluation of interventions (e.g. Pienaar,
Stearn & Swanepoel, 2010) and culturally relevant local knowledge
regarding hearing impairment (De Andrade & Ross, 2005).
In this issue, the paper by Strasheim and colleagues focuses on the
development of an early intervention tool applicable to the local
context. Both SLTs and As participated in the first phase of the study,
which aimed to identify specific needs regarding clinical resources for
use in neonatal nurseries. Participants noted that culturally
appropriate instruments were needed specifically for parent guidance
and staff/team training. In response, the next phase of the study
focused on development of a neonatal communication intervention
programme for parents, the aim of which was to inform parents about
prematurity and ways of developing early communication development.
Handouts were written in English and isiZulu. The final phase of the
study saw the piloting of the programme with two therapists. In
education, Wium, Louw and Eloff (2010) developed a continuing
professional development (CPD) programme for educators to support them
in their teaching of literacy and numeracy.
Other studies that have focused on development of SLT assessments
include Fouche and Van der Merwe (1999), who described the development
of a Sepedi speech intelligibility test, and Buitendag, Uys and Louw
(1998), who evaluated the suitability of the Afrikaanse Reseptiewe
Woordeskattoets (Afrikaans Receptive Vocabulary Test). Watt, Penn and
Jones (1996) examined the ecological validity of a test battery for
evaluating communicative effects of closed head injury. The study (this
issue) by Crewe-Brown and co-authors details the communicative
difficulties faced in their daily life by individuals with mild
traumatic brain injuries (MTBIs). Using a case study approach, the
authors show the value that ‘significant others’ can bring
to understanding and supporting the individual with MTBI, an approach
that could have far-ranging applicability in our context.
In this section we have highlighted some of the work that has been
done in our fields, rather than carrying out an exhaustive review. Our
survey focused on studies that have been published, but there is a
wealth of unpublished work that has been carried out by undergraduate
students for their final-year projects or by postgraduate students. The
old adage ‘publish or perish’ may be particularly pertinent
here, not only to individual academic careers but also to the
professions as a whole: we have to share what we have done in order to
advance our knowledge. Numerous authors have urged us to carry out more
research and publish our findings: Swanepoel (2006) calls for more
studies in the local context to determine the prevalence of hearing
loss and accurately describe the status of services currently available
for those with hearing impairments in South Africa. Without this
information, Swanepoel argues, legislative support and associated
funding will not be forthcoming. Penn (2007) decries the lack of
quality, local research and urges all SLTs and As – and
especially clinicians – to carry out research. While our agenda
may be to develop local knowledge and resources, we should not be
limited to publishing our work in local journals only, since many of
the issues relevant to our context will have relevance for other
developing settings, and there is worldwide interest in the unique
languages and mix of cultures of our country.
Re-inventing the wheel or borrowing from our friends?
Indigenous knowledge can be effectively combined with external or scientific knowledge during the innovation process. Hartley et al.
(2009) reviewed the literature related to service development for
individuals with communication difficulties in developing contexts.
They suggest that Western techniques and interventions cannot be rolled
out to African countries without appropriate adaptation because of
cultural and language differences; environments and climates and stages
of social development. However, they also noted that ‘with
cooperation, flexibility and humility, nations could work together to
their mutual advantage using the underlying principles learnt in the
West, together with local knowledge to develop appropriate training and
services (p. 279)’. While it may be necessary to start from a
blank page, free of assumptions, there is of course much valuable
information and many lessons to be learnt from resources and knowledge
developed elsewhere. Publishing or presenting work at conferences is a
valuable way to share resources and knowledge through a common forum
which could advance the development of such assessments in a systematic
manner and ensure that new SLTs and As or those setting up services
would not have to ‘re-invent the wheel.’ Joubert (2010)
acknowledges the importance of developments around the world and
suggests that it would be ‘both naïve and foolish not to
prepare South African occupational therapists to be able to work
anywhere in the world. It is however of foremost importance that they
are competent in dealing with the particular health needs of South
Africa’s diverse population where the need for appropriate health
care is greatest’ (p. 22). We believe the same is true for South
African SLTs and As, whether working in education or health.
Priorities and next steps
In South Africa there is a great need to develop contextually
relevant resources for our professions. Clinicians in the study by Pascoe et al. (2010)
noted that an assessment tool in the most dominant languages in the
Western Cape would be of value to them, and they suggested that this
would increase their level of confidence when working with multilingual
children. There is also a need for intervention resources and studies
on the South African population in order to build an evidence base for
the different approaches used. It may be that the natural order of this
development is for assessment materials to be most needed and developed
first, followed by the intervention tools and then the systematic
evaluations thereof. But clinicians should be driven by their own
needs. What is it that is needed to maximise our role? How can we add
more value and relevance to the work we do with individuals with
communication and swallowing difficulties? We should not only look to
others to meet these needs, but should use our own knowledge, that of
our colleagues and that of the clients we serve to move forward in this
task. There is nothing wrong in starting small: modifying wordlists,
devising new protocols and reflecting on our daily practice – all
are valuable beginning points. We must collaborate with each other at a
national level and share the gains we make. A national project under
the leadership of Associate Professor Shajila Singh of the University
of Cape Town focuses on the development of materials in the indigenous
local languages and aims to encourage such collaborations and develop
knowledge of the process. This is not a project for academics only, but
also for all SLTs and As, as well as colleagues working in disciplines
such as linguistics and psychology.
In essence, our answer to the question posed in the title of this
paper is: Yes – there are contextually relevant resources for
SLTs and As. However, as for Mahlalela-Thusi and Heugh (2010), who
examined the development of textbooks in the indigenous languages in
Southern Africa, there is a great need for development of more
resources, and further work to improve quality of the resources
available for local populations. Further, these resources need to be
published and shared so that we can build on what has been done. This
paper has aimed to move away from mere rhetoric and focus on the
practicalities of our challenge. Our hope is that all SLTs and As
– especially clinicians who bemoan the lack of suitable resources
– will be inspired to start innovating, collaborating and
sharing. The papers that follow showcase some of the varied ways in
which this can be done.
Acknowledgements. The authors gratefully acknowledge the support of Lucretia Petersen, and helpful comments from two anonymous peer reviewers.
Michelle Pascoe
Vivienne Norman
Department of Health and Rehabilitation Sciences
University of Cape Town
*This
title is adapted from the title of a paper by Mahlalela-Thusi and Heugh
(2010) entitled ‘Terminology and school books in southern African
languages: aren’t there any?’
References
Boivin, M.J. (1991). The effect of culture on a visual–spatial memory task. Journal of General Psychology, 118, 327-334.
Buitendag, M., Uys, I., & Louw, B. (1998). Afrikaanse Reseptiewe Woordeskattoets (ARW) : Suitability for a group of non-standard Afrikaans speaking children. South African Journal of Communication Disorders, 45, 11-29.
Carter, J., Lees, J., Murira, G., Gona, J., Neville, B., & Newton,
C. (2004). Issues in the development of cross-cultural assessments of
speech and language for children. International Journal of Language and Communication Disorders, 40(4), 385-401.
De Andrade, V., & Ross, E. (2005). Beliefs and practices of black
South African traditional healers regarding hearing impairment. International Journal of Audiology, 44(9), 489-499.
Enderby, P., & Emerson, J. (1995). Does Speech and Language Therapy work?
A Review of the Literature Commissioned by the Department of Health
. London: Whurr Publishers.
Fouche, S., & Van der Merwe, A. (1999). Sepedi test for speech intelligibility. South African Journal of Communication Disorders, 46, 25-35.
Gladstone, M., Lancaster, G., Umar, E., Nyirenda, M., Kayira, E., Van
den Broek, N., & Smyth, R.L. (2009). Perspectives of normal child
development in rural Malawi – a qualitative analysis to create a
more culturally appropriate developmental assessment tool. Child Care Health and Development,
36(3), 346-353.
Goldman, R., & Fristoe, M. (1986). Goldman-Fristoe Test of Articulation. AGS: Circle Pines, MN.
Greenwood, A.L., Grassly, J., Hickin, J., Best, W. (2010). Phonological and orthographic cueing therapy: A case of generalised improvement. Aphasiology,
24(9), 991-1016.
Gxilishe, S. (2004). The acquisition of clicks by Xhosa speaking children. Per Linguam, 2, 1-12.
Hartley, S. (1998). Service development to meet the needs of
‘people with communication disabilities’ in developing
countries. Disability and Rehabilitation,
20(8), 277-284.
Hartley, S., Murira, G., Mwangoma, M., Carter, J., & Newton,
C.R.J.C. (2009). Using community/researcher partnerships to develop a
culturally relevant intervention for children with communication
disabilities in Kenya. Disability and Rehabilitation, 31(6), 490-499.
Jordaan, H., & Yelland, A. (2003). Intervention with multilingual language impaired children by South African SLTs. Journal of Multilingual Communication Disorders, 1, 13-33.
Joubert, R. (2010). Exploring the history of Occupational
Therapy’s development in South Africa to reveal the flaws in our
knowledge base. South African Journal of Occupational Therapy, 40(3), 21- 26.
Kagee, A. (2008). Adherence to antiretroviral therapy in the context of
the national roll-out in South Africa: Defining a research agenda for
psychology. South African Journal of Psychology, 38, 413-428.
Kathard, H. (2005). Clinical education in transition: Creating viable futures. International Journal of Speech Language Pathology, 7(3), 149-152.
Kathard, H., Naude, E., Pillay, M., & Ross, E. (2007). Improving
the relevance of speech-language pathology and audiology research and
practice. South African Journal of Communication Disorders,
54, 5-19.
Khoza, K., Ramma, L, Mophosho, M., & Moroka, D (2008).Speech
reception threshold testing in second language English speakers in
South Africa. South African Journal of Communication Disorders, 55,
26-39.
Mahlalela-Thusi, B., & Heugh, K. (2010) Terminology and school
books in southern African languages: aren’t there any? In B.
Brock-Utne, Z. Desai, M.A.S. Qorro,& A. Pitman (Eds). Language of instruction in Tanzania and South Africa: highlights from a project. (Comparative and international education: a diversity of voices, v. 5; pp. 113-132). Rotterdam: Sense Publishers.
Moodley, L., Louw, B., & Hugo, R. (2000). Early identification of
at-risk infants and toddlers: a transdisciplinary model of service
delivery, South African Journal of Communication Disorders,
47, 25-40.
Mullis, I.V.S., O’Martin, M., Kennedy, A.M., & Foy, P. 2007. IEA’s progress in international reading literacy study in primary schools in 40 countries. Boston College: TIMSS & PIRLS International Study Centre.
Nhemachena, C, Chakwizira, J, Dube, S, Maponya, G, Rashopola, R., & Mayindi, D.
(2011). Integrating indigenous knowledge systems (IKS) in improving
rural accessibility and mobility (in support of the comprehensive rural
development programme in South Africa). Southern Africa Transport
Conference. International Convention Centre (ICC), CSIR, Pretoria,
11-14 July 2011.
Nippold, M. (2010). Back to school: Why the speech-language pathologist belongs in the classroom. Language Speech and Hearing Services in Schools, 41, 377-378.
Pahl, J., & Kara, M. (1992). The Renfrew Word Finding Scale: Application to the South African context. South African Journal of Communication Disorders,
39, 69-73.
Panday, S., Kathard, H., Pillay, M., & Govender, C. (2007).
Development of a Zulu speech reception threshold test for Zulu first
language speakers in Kwa Zulu-Natal. South African Journal of Communication Disorders, 54, 111-122.
Panday, S., Kathard, H., Pillay, M., & Govender, C. (2009). The
homogeneity of audibility and prosody of Zulu words for speech
reception threshold (SRT) testing. South African Journal of Communication Disorders, 56,60-75.
Pascoe, M., Maphalala, Z., Ebrahim, A., Hime,
D., Mdladla, B., Mohamed, N., & Skinner, M. (2010). Children with
speech difficulties: An exploratory survey of clinical practice in the
Western Cape. South African Journal of Communication Disorders, 57, 66-75.
Penn, C. (2007). ‘Don’t give me the theory, just tell me
what to do in therapy!’: The slippery slope challenge for the
South African professions of speech-language pathology and audiology. South African Journal of Communication Disorders, 54, 13-17.
Penn, C., Frankel, T., Watermeyer, J., & Muller, M. (2009).
Informed consent and aphasia: Evidence of pitfalls in the process. Aphasiology, 23, 3-32.
Pienaar, E., Stearn, N., & Swanepoel, D. (2010). Self-reported
outcomes of aural rehabilitation for adult hearing aid users in a South
African context. South African Journal of Communication Disorders, 57, 4-14.
Pillay, M. (2003). Cross-cultural practice: What is it really about? Folia Phoniatrica et Logopaedica,
55, 293-299.
Stanczak, D.E., Stanczak, E.M., & Awadalla, A.W. (2001).
Development and initial validation of an Arabic version of the Expanded
Trail Making Test: implications for cross-cultural assessment. Archives of Clinical Neuropsychology, 16, 141-149.
Statistics South Africa (2005). Census 2001: Census in brief. Retrieved on 10 May 2009 from http://www.statssa.gov.za/census01/ html/CInBrief/CIB2001.pdf
Swanepoel, D. (2006). Audiology in South Africa. International Journal of Audiology, 45, 262-266.
Watson, R.M. (2006). Being before doing: The cultural identity (essence) of occupational therapy. Australian Occupational Therapy Journal, 53: 151-158.
Watt, N., Penn, C., & Jones, D. (1996). Speech-language evaluation
of closed head injured subjects in South Africa: Cultural applicability
and ecological validity of a test battery. South African Journal of Communication Disorders, 43, 85-92.
Wilson, W.J., & Moodley, S. (2000). Use of the CID W22 as a South African English speech discrimination test. South African Journal of Communication Disorders, 47, 57-62.
Wium, A.M., Louw, B., & Eloff, I. (2010). Speech-language
therapists supporting foundation phase educators with literacy and
numeracy in a rural and township context. South African Journal of Communication Disorders, 57(1), 14-22.