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

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Caregivers’ experiences of collaborating with educators in inclusive education to support learners who use AAC in South Africa
Ramsamooj, Suvarna (University of Pretoria, 2025-12)
Background: Collaboration between parents and teachers has been documented as an essential component in learner educational outcomes. This is especially true for children with disabilities (CWD) including children with complex communication needs (CCN) who need augmentative and alternative communication (AAC). Inclusive education is widely documented within South African educational policies; however, its implementation has been found to be lacking. One of the key contributors towards successful inclusive education is effective collaboration between parents and teachers of CWD such as those who need AAC. However, parent-teacher collaboration of children who use or need AAC has been under researched in South Africa. Aim: This study aims to explore the experiences of parents of children who need AAC regarding their collaboration with educators to support their child’s education. The sub questions included: 1) How do parents perceive the current state of their relationship with the educators of their children who need AAC? 2) What are parents' perceptions and experiences of the communication between themselves and the educator of their child who needs AAC? 3) What do parents see as their roles in the education of their children who need AAC in South Africa? 4) What do parents of children who need AAC view as barriers in partnerships with educators? 5) What do parents of children who need AAC view as facilitators in partnerships with educators? 6) What are the recommendations of parents of children who need AAC for more effective collaboration with educators? Methods: An explorative, qualitative research design was employed. A purposive sampling strategy was used. Disability organisations were approached to recruit participants. Instruments included a biographical questionnaire and a semi-structured interview schedule. Semi-structured one-on-one interviews were conducted with five parents of children who need AAC and attend public special needs schools. These interviews were recorded and transcribed. Thematic data analysis was used to identify themes. The study was conducted in the Gauteng province of South Africa. Results: Mixed perceptions and experiences were described by parents, many that were negative and some of which were positive. Negative experiences were underscored by areas such as unequal power dynamics, poor communication, lack of trust in teacher skills and misaligned goals and priorities between parents and teachers. Some positive experiences of collaboration between parents and teachers were highlighted as a facilitator to achieving learner outcomes, whereby parents being seen as equal team members was significant. Positive collaboration occurred in instances in which parents supported teachers and were equally supported by teachers. Recommendations from parents were for teachers to improve communication, share parent goals, to ask and be open to parent input and to cultivate more empathy, respect and passion for teaching children with special needs. Conclusion: Successful collaboration between parents and teachers of children who need AAC is not yet optimal in public special needs schools in South Africa and requires significant improvement in order to support learners who need AAC. This implies that trainings for teachers in these settings need to be provided on how to include parents and ensure that they are equal partners for their child’s educational journey. Keywords: augmentative and alternative communication, collaboration, complex communication needs, inclusive education, parents, South Africa
Determining the Sepedi fringe vocabulary needed by foundation phase learners in special schools who require augmentative and alternative communication for participation in mathematics instruction
Poto, Puseletso A (University of Pretoria, 2025-11-28)
Background: Children who cannot use speech as their primary means of expression may benefit from graphic symbol-based Augmentative and Alternative Communication (AAC) systems to help them communicate effectively. Vocabulary for such systems needs to be preselected. Both core and fringe vocabulary items have been proposed to be useful and important to include AAC systems in order to allow for participation in age- and context-appropriate activities. While core vocabulary allows for generic expressions and sentence building, fringe vocabulary ensures that children can express specific messages and that they have access to vocabulary that is contextually and developmentally appropriate and motivating. School-aged children in need of AAC need to have access to vocabulary that allows participation in academic activities, such as mathematics instruction. This study therefore aimed (1) identify 20 - 35 vocabulary items appropriate for learners with special educational needs in the foundation phase related to each of the five content areas of Mathematics (as set out in South African curricula, namely Numbers, Operations and Relationships; Patterns, Functions and Algebra; Space and Shape; Measurement) by teachers consensus, and (2) describe teachers’ reasoning in selecting vocabulary for each content area and their perceptions of the utility of the lists generated. Methods: An adapted nominal group technique was used to obtain teachers’ consensus on vocabulary selection of fringe vocabulary for children in Grades 2 and 3 in special schools in Limpopo. The quantitative data was analysed using descriptive statistics. The qualitative data was analysed using inductive thematic analysis (codebook approach). Results: Teachers were able to reach consensus and compile a final word list of 20 - 35 words for the content areas of mathematics, namely, Number Operations and Relationships, Measurement, Space and Shape, and Patterns Functions and Algebra. Teachers were able to provide reasons as to why they chose the selected vocabulary items. Conclusions: This study introduced a new vocabulary selection method for stakeholders to reach consensus on what vocabulary should be used for an AAC system. The vocabulary selected in this study is relevant for children in need of AAC with special educational needs in the foundation phase in the subject area of Mathematics and may not be relevant for children in other grades. This study should be replicated to determine relevant vocabulary for other subject areas and grades.
The involvement of children with communication disabilities in research: a scoping review
Mudaly, Verusha (University of Pretoria, 2026-11-30)
Background: Article 12 of the United Nations Convention on the Rights of the Child (UNCRC) highlights that children have the right to communicate their thoughts on matters concerning them. However, children with communication disabilities are often still marginalised and excluded from research. Children with communication disabilities may be at further risk of exclusion due to limitations in their communication, which may restrict their abilities to express their views in research. There is a paucity of research on how children with communication disabilities are involved in research. Methods: The purpose of this scoping review is to describe how children with communication disabilities are involved in the research process and the roles assigned to them in research. The scoping review was guided by a methodological framework and a multidimensional search strategy to ensure a rigorous and unbiased search. Screening was conducted against the eligibility criteria at title and abstract level and full text level by two independent reviewers. A total of 31 articles met the inclusion criteria. Data of the included studies were extracted according to study and participant characteristics, data collection methods and adaptations, and the stages and roles of involvement. Results: The review resulted in the inclusion of 31 studies. The included studies demonstrated a paucity of papers that include children with communication disabilities in research. Of the included studies, children with communication disabilities were mostly included in the execution stage of the research and least included in the implementation stage. Furthermore, in terms of involvement, the most common role for children with communication disabilities was that of co-thinker and the least involvement in a role was that of decision-maker. Conclusions: Although the number of studies in this area is growing, there is a need for children with communication disabilities to be more involved in research, especially in more than one stage of the research process. In addition, children with communication disabilities should be trusted with the role of decision-maker during research. Hence, it is strongly encouraged that further studies involving children with communication disabilities in research are pursued.
The effects of varied modes and levels of augmented input on the accuracy of following directives that contain prepositions in autistic children
Ngwira, Sheryll Philda Tebogo (University of Pretoria, 2025-11)
ENGLISH : Many autistic children experience challenges with following directives containing abstract concepts such as prepositions. Augmented input has been shown to be an effective means of facilitating understanding of directives in some autistic children, however, the level and mode of augmented input required to ensure effective understanding has not been determined. The primary purpose of this thesis was to compare the participants’ ability to follow directives containing prepositions under varied modes and levels of augmented input. The dissertation included two studies, one involving a processing study using a Latin-square research design with 40 autistic participants, and a second study, an intervention study, involving an Adapted Alternating Treatment Design (AATD) with 4 autistic participants. For the first study, the processing phase, participants were presented with directives under four conditions, with keyword (level) aided or unaided input (mode), or symbolate (level) aided or unaided input (mode). The keyword augmented input conditions provided augmented input for the preposition only, and the symbolate augmented input conditions provided augmented input for the subject, preposition and location of the directive. Results revealed no statistically significant difference between the four conditions, however, a higher number of participants benefitted from the keyword aided input condition than from any other condition. Additionally, a statistically significant positive change in preposition knowledge from before and during the processing tasks was observed. For the AATD, 15 prepositions were assigned to three equivalent sets of five prepositions each. Two sets were targeted in two interventions, one with keyword aided and another with symbolate aided augmented input, the third set was the control. Three participants had similar outcomes for the keyword and symbolate aided augmented input conditions, while one participant did not benefit from either intervention. Across the two studies, participants benefitted from the use of augmented input in general. That said, no significant difference was found between the varied modes and levels in the processing study (i.e. without teaching), although more participants benefitted from keyword aided augmented input. This suggests that providing aided augmented input for the target concept alone is sufficient to facilitate understanding of prepositions. Keyword input is arguably less involved to produce than symbolate, which is a more accessible choice for communication partners who wish to follow best practice. These findings suggest that there is, however, a need for larger studies to identify additional moderators that may affect the response accuracy to directives containing prepositions in autistic children. These findings contribute to evidence-based practice by informing how much aided and unaided augmented input is required to support receptive language development in autistic children.
The effect of Intensive Interaction on preverbal communication and cortical brain activity in persons with profound intellectual and multiple disabilities
Laher, Zakiyya (University of Pretoria, 2025-10-07)
Background: Intensive Interaction is a social communication intervention for persons with profound intellectual and multiple disabilities. The goal of Intensive Interaction is to establish human connectedness and improve communication. The aim of this thesis was to determine the effect of Intensive Interaction on preverbal communication and cortical brain activity. Method: This multimethod study consisted of Phase 1, the pre-experimental phase, consisting of Study 1 and Phase 2, and the experimental phase, consisting of Studies 2 and 3. Study 1 examined the evidence for Intensive Interaction through a scoping review. Study 2 aimed to determine the effect of Intensive Interaction on preverbal communication using a multiple probe across participant design. Study 3, used an interrupted time series design, aimed to determine the effect of Intensive Interaction on cortical brain activity, measured as the relative concentration of oxygenated haemoglobin in the dorsolateral prefrontal cortex using functional near-infrared spectroscopy, in persons with profound intellectual and multiple disabilities. Results: The scoping review highlighted that studies on Intensive Interaction should improve intervention reporting strategies and uniformity in the definition and measurement of its outcomes. Findings from the multiple probe design indicate participant gains in preverbal communication during Intensive Interaction. Measurement of cortical brain activity using functional near-infrared spectroscopy indicate a decrease in dorsolateral prefrontal cortex activity over time.
Cultural and linguistic adaptations in AAC interventions: a scoping review
Naidoo, Chané (University of Pretoria, 2025-10-31)
Background: Children with complex communication needs who utilize augmentative and alternative communication systems to compensate for severe impairments of speech comprehension or production should have access to augmentative and alternative communication systems that embrace their cultural and linguistic diversity. However, there remains a lack of commercially available, multilingual and culturally diverse augmentative and alternative communication systems. The inclusion of such systems will assist in providing improved access to communication opportunities for these children. Therefore, there is a need to review current cultural and linguistic adaptations that exist in augmentative and alternative communication intervention for children with complex communication needs from diverse cultural and linguistic backgrounds, to identify what gaps may exist in the research. Aim: To describe how augmentative and alternative communication interventions were adapted for children who require augmentative and alternative communication from cultural and linguistically diverse backgrounds using a published checklist. Methods: A multifaceted search strategy was conducted to ensure comprehensive search of the literature to identify studies that met the eligibility criteria. The scoping review identified 26 eligible studies. Data extraction, focusing on the cultural and linguistic adaptations made to augmentative and alternative communication interventions, were mapped according to the dimensions of the Cultural Adaptation Checklist (Lee et al., 2024). Results: The results of this review indicate that cultural and linguistic adaptations in augmentative and alternative communication interventions have been considered as a critical area of augmentative and alternative communication research. While most of the studies in this review mentioned an adaptation process, there was a paucity in reporting the process of implementation. Conclusions: The use of an adaptation framework, like the Cultural Adaptation Checklist, can be used in the field of augmentative and alternative communication to provide an approach for culturally and linguistically adapting augmentative and alternative communication interventions.
Enhancing professionals’ knowledge and self-efficacy in AAC assessment using a co-designed training programme : comparing the effectiveness of two online training methods
Flores, Catherine Alexandra (University of Pretoria, 2025-05)
Background: Effective and successful augmentative and alternative communication (AAC) service delivery relies on the knowledge and competence of professionals in the field of AAC. Sufficient training in AAC is therefore required for professionals to deliver quality AAC service. However, structured opportunities for professional development in AAC are critically needed, particularly in AAC assessment. Such opportunities should consider the realities of the working professional as well as the principles of andragogy. The main aim of this study is to develop a training programme on AAC assessment, using a process of co-design, and subsequently to determine the effectiveness of the training programme delivered by using two online training methods on professionals’ knowledge of and self-efficacy in AAC assessment. Method: An exploratory sequential mixed-methods research design was conducted in three phases. Phase 1 of the study reviewed the current literature on training programmes for professionals who provide AAC services, followed by two asynchronous online focus group discussions to understand the experiences and training needs of professionals in AAC. The focus groups formed part of the pre-design phase in the co-design process. Phase 2 developed an online training programme on AAC assessment, which was guided by the results of Phase 1 and a co-design process. Phase 2 formed part of the generative phase in the process of co-design. Phase 3 involved the delivery of the online training programme by means of two online training methods. These included the evaluative and post-design phases of the co-design process. Phase 3 involved the delivery of the online training programme using two methods, namely the combined (asynchronous and synchronous) online training method and the purely asynchronous online training method and a comparison of these two training methods. Results: The effects that the two methods of online training had on professionals’ knowledge of and self-efficacy in AAC assessment were determined using a two-arm group control trial with wait-list control. Regardless of the online training method, both studies revealed a significant increase in knowledge as well as self-efficacy in AAC assessment. Although some suggestions for improvement were made, participants mainly perceived both online training methods positively. The process of developing training programmes followed in this study could be used to guide the development of other online training programmes in AAC. This will address the critical need for professional development opportunities in AAC.
Evidence-based clinical practice guidelines for communication strategies to support end-of-life decision-making by persons with Aphasia
Stipinovich, Alexandra Maria (University of Pretoria, 2025-07)
Background: Everyone has the right to participate in important life decisions. This includes decisions about end-of-life, which are relevant not only to those for whom death seems imminent. Persons with aphasia (PWA) may experience communication barriers that present challenges to their participation in such decisions. With appropriate communication support, PWA may be able to participate in end-of-life decision-making. Aim: The purpose of this research was to develop evidence-based clinical practice guidelines for communication strategies to assist speech-language pathologists (SLPs) in supporting PWA to make end-of-life decisions. Method: An exploratory sequential mixed method design was implemented. Guided by the framework of evidence-based practice, the study comprised three phases. Phase 1 (exploratory phase) entailed gathering data regarding communication strategies to support end-of-life decision-making by PWA. Phase 2 (development phase) involved synthesising the information gathered in Phase 1 in developing the guidelines. In Phase 3 (evaluation phase) the guidelines were appraised. Results: The outcome of this study is evidence-based clinical practice guidelines for SLPs to use when supporting PWA to make end-of-life decisions. The guidelines comprise a list of end-of-life decisions that PWA may be confronted with to make, as well as a list of communication strategies that support the different components of the decision-making process. An indication is given of the sources of evidence from which these decisions and communication strategies were derived. A description is given of challenges and facilitators to the decision-making process, and of ways to approach difficult conversations. The guidelines were appraised to be of a high quality. Conclusion: When provided with communication support, PWA can be included in complex decision-making. With their skills in facilitating the exchange of information, SLPs are in an ideal position to support complex decision-making by PWA. By informing clinical activities, these clinical practice guidelines aim to foster optimal participation by PWA in end-of-life decision-making.
Development and evaluation of a non-electronic Sepedi graphic symbol-based AAC system for use with preliterate children
Mothapo, Ngwanamashiane Rahab Blondie (University of Pretoria, 2025-02)
Background: Assistive technology must be contextually and culturally appropriate to avoid abandonment and rejection from end-users and communities. AAC systems must be aligned to the languages and cultures of the users. Currently, a significant number of South Africans requiring AAC are unable to use their home language through appropriate, aided AAC systems. This project aims to develop and evaluate a non-electronic Sepedi graphic symbol-based AAC system for children from Sepedi language backgrounds requiring AAC through the use of the HCD design. Methods: A three-phase human centred design process was followed. The first phase consisted of a needs analysis and the determination of design requirements through focus groups and interviews with 21 adult participants. The second phase consisted of two adult iterative design cycles (involving 11 adults) and one child iterative design cycle (involving 14 children) of prototyping and stakeholder feedback, employing methods such as experience prototyping and nominal group technique. The third phase consisted of an evaluation phase where three special school teachers shared their perspectives about the system through individual interviews with the researcher after a two-week implementation period of the system. Each teacher implemented the system with one child in need of AAC in their classroom. Findings: Phase 1 showed findings in the system categories such as a) a need for such a system; b) various contexts of use such as the home, school and community environment; c) various purposes of use such as to enable communication access, facilitating learning and improving self-esteem; d) design requirements regarding vocabulary, graphic symbols, layout and organisation, and physical properties were obtained. The findings of Phase 1 guided the development of the first prototype during Phase 2. Phase 2 findings showed how the system was examined on first impression, used in communication activities during the session and evaluated. Changes to the design requirements of the system were suggested and implemented. In Phase 3, the participants evaluated the system in terms of the whole design and implementation process. They highlighted that the system may be used in a Sepedi-speaking context as it conformed to the cultural and linguistic considerations of the language. The participants also evaluated the 16 system in terms of constructs such as usability and user-experience and highlighted that the system was usable and evoked positive impacts on the users. Conclusion: The use of a human-centred design process was found useful in the development and evaluation of a non-electronic Sepedi graphic symbol-based AAC system for children from a Sepedi language background requiring AAC. HCD principles state that the design of an assistive technology device should be based on a thorough understanding of the user, context and activities to be performed. It also emphasises that the design process should be informed by and driven by the design team who possessed various types of knowledge. The design team members should be active participants in the whole design process, and aim to address the user’s experience holistically. Participants in this study, found the developed non-electronic Sepedi graphic symbol-based AAC system to be valuable and acceptable to the Sepedi-speaking community.
Developing a ‘red flag’ checklist to identify ASD intervention programmes without a clear evidence base : a scoping review with expert panel social validation
Manack, Zakkiyya (University of Pretoria, 2024-10)
Background: Due to its ability to distribute information to a vast consumer audience, the mainstream mass media has globally played an essential role in increasing public awareness of Autism Spectrum Disorder (ASD) and the myriad of interventions that accompany it. This increased media focus often makes it difficult for stakeholders to separate legitimate science-based intervention options with a clear evidence-base from pseudoscience and/or anti-sciences. Subsequently, there has also been an increased awareness as to the importance of so-called ‘red flags’ (i.e., warning signs) to identify such pseudoscientific intervention programmes. However, no clear guidelines could be found in the literature that stakeholders could utilise to guide them in recognising inaccurate or questionable sources of information that represent pseudoscientific ASD intervention programmes. Aims: This study aims to firstly synthesise and describe the warning signs (i.e., red flags) that have been introduced and described in the literature for stakeholders to gauge the research evidence-base of intervention programmes for children with autism by means of a scoping review. Secondly, to socially validate these red flags with experts with the intention of proposing a ‘red flag’ checklist that can be used by all stakeholders to gauge the scientific basis of ASD intervention programmes. Method: This study utilises a six-step scoping review methodology to map out the broad body of relevant literature concerning the outlined research question. Search terms were entered into eight databases and two journals were hand searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping reviews (PRISMA-ScR) guidelines. A total of 171 records were identified. Following the removal of duplicates and applying the inclusion and exclusion criteria, seven publications remained from which data were extracted and synthesised. A qualitative content analysis framework was used to categorise data into main themes (i.e., red flags). Step 6 included a custom-designed survey based on the results of steps 1 to 5 of the review. It required experts within the field of autism to comment on the retention, adaption, or removal of the specific red flags. Descriptive statistics were utilised to analyse the survey data. Results: Results from the scoping review indicated that publications regarding the ‘red flags’ or warning signs associated with intervention programmes have increased over the last decade, and were mostly aimed at practitioners. In total, 87 red flags were mentioned in the literature, which were then collated under 13 main themes. During the social validation phase, participants agreed that more than half of the proposed red flags could be retained in their current format and none of the red flags needed to be removed. Adaptations were proposed for five signs, and these were primarily focused on linguistic and conceptual changes. Conclusion: The availability of a freely accessible, easy-to-understand-and-use ‘red flag’ checklist may assist stakeholders to identify and distinguish between ASD intervention programmes with and without a credible evidence-base.
Public health approaches to communication disability : a scoping review
Naidu, Deshni (University of Pretoria, 2024-10)
BACKGROUND : Low therapist to population ratio is widely reported in the literature, together with the impact of communication disability. This has resulted in personnel other than speech therapists being proposed to support the prevention of communication disabilities. It is therefore necessary to understand the nature of public health interventions for communication disability and define key concepts related to public health and communication disability. AIM : The main aim of the study is to explore how public health approaches to intervention are described and used in the existing literature on communication disability. METHODS : A systematic search using six electronic databases was conducted. The eligibility criteria were applied by two reviewers to the articles at title and abstract and full text level. Data were extracted from included articles and analysed against the general characteristics of the study and specific areas of public health. RESULTS : A total of 60 studies were included in the review. The majority of studies concerning public health and communication disability were conducted in high income countries. The main concepts of public health and the prevention levels were not defined extensively in the included studies. Public health approaches were frequently conducted in the home setting. Primary prevention activities were implemented more frequently than secondary prevention activities. Children together with their families were the most frequently targeted recipients of public health approaches, mainly due to risk factors such as language delay and low socio-economic status. Adults who were at risk of voice disorders due to being professional voice users were also recipients of prevention activities. Speech therapists were the most widely reported implementers of the interventions in the included studies. Measures to report outcomes varied, with standardised measures used most frequently in the studies to measure outcomes. CONCLUSIONS : Globally agreed-upon definitions of public health as they relate to communication disability are required. Future research should focus on the long-term impact of public health programmes for communication disability, the resource requirements for public health programmes, training of personnel who administer public health approaches and the use of social media in public health approaches to communication disability. Additionally, future research should consider polices and funding models of public health models for communication disability.
Determining the core vocabulary of Sepedi-speaking Grade R learners from the Sekhukhune district during regular school activities
Moswathupa, Mmoto Charmaine (University of Pretoria, 2024-10)
BACKGROUND : Augmentative and alternative communication (AAC) systems has been used widely to improve the communication of individuals with reduced or no functional speech. Customising AAC systems for children with limited literacy skills requires others to pre-select a restricted number of words as their vocabulary, which can be challenging. Various resources, including core vocabulary lists, have guided the vocabulary selection process. Core vocabulary are words that are frequently used in conversations amongst a group of people. These words are language-specific and are influenced by geographical features. So far, there is only one Sepedi core vocabulary list based on speech samples collected in the Capricorn district in Limpopo province, South Africa. Thus, the current study aims to determine the core vocabulary of Sepedi-speaking Grade R learners in the Sekhukhune district in Limpopo province. This core vocabulary list can provide dialect-specific words and supplement the existing Sepedi core list when designing AAC systems. METHODS : Six preschool children from two schools without speech/language difficulties were audio-recorded during regular school activities. Over the period of a week, their language samples were collected using small body-worn audio recording devices. The samples were then transcribed and tagged using Microsoft WordTM. The data was analysed using Microsoft WordTM and Microsoft ExcelTM. RESULTS : The combined sample comprises 19,316 intelligible words and 1,068 different words were identified. The core vocabulary list consists of words with a minimum frequency of 0.05‰ and used by at least half the participants. This resulted in a core vocabulary list of 255 words. The 255 core words accounted for 88.7% of the composite sample. CONCLUSIONS : The results are consistent with findings in the existing literature on core vocabulary in other languages, as it comprises a small set of words that are commonly and frequently used. The Sepedi core vocabulary list compiled in this study can serve as a vocabulary resource when designing AAC systems for Sepedi-speaking children from the Sekhukhune district and may be used in conjunction with the existing Sepedi core words list to provide a core vocabulary resource for the larger Sepedi speaking population.
Methods used to make print and electronic information more accessible to persons with acquired commuincation disabilities in health and social care settings : a scoping review
Nxoko, Andisiwe (University of Pretoria, 2024-10)
Background: The ability to access information is key to making informed decisions about one’s life and results in superior quality of life and health outcomes. Existing literature focusses on how to make information accessible for persons with intellectual disability with a paucity of research focused on persons with acquired communication disabilities. Aims/objectives: To scope and synthesize current literature regarding strategies and methods for making information more accessible to persons with acquired communication disabilities within health and social care contexts. The objectives of this scoping review were to describe the general characteristics of the included studies; define print and electronic information accessibility; describe the methods/strategies currently used to make print or electronic information accessible; describe the standardized measures used in the studies, describe the outcomes of these studies and evaluate the acceptability of these methods to users. Methods: A scoping review was conducted. A multi-faceted search strategy was conducted and included database searches, hand searching, and forward citation and ancestry searches. Two reviewers did a double-blind screening of studies at the title/abstract and full-text level, during which the eligibility criterion was applied. Data was extracted by a single reviewer and independently verified by reviewers at title and full-text level. Results: Most studies originated from high-income countries. The review revealed a limited number of dementia studies (with acquired aphasia being the most prevalent condition) and no precise definition of print or electronically accessible information. The review suggested that visuographic aids, text font, layout support, text-to-speech, and plain language summaries enhance comprehension for those with acquired communication disabilities, while high-context photographs, a straightforward arrangement, serif fonts (notably Verdana 14-point), and 1.5 line spacing enhance their comprehension of both printed and electronic text. Incorporating computer-generated speech assisted persons with acquired communication disabilities to comprehend text. Research related to the perceptions of persons with acquired communication disabilities of these methods proved to be limited. Conclusions: Persons with acquired communication disabilities have limited access to information due to their disabilities. All persons with disabilities have the right to access information, and methods/strategies such as visuographic supports, text font, plain language summaries, text-to-speech and layout (word or page arrangement) currently support them to access printed or electronic information.
A survey of learners with complex communication needs (CCN) in the foundation phase of selected special schools in the Western Cape Province of South Africa
Gill, Charne Edwina (University of Pretoria, 2024-08)
Background: Persons with complex communication needs (CCN) can be described as individuals who require augmentative and alternative communication (AAC) to compensate for impairments in speech-language production and/or comprehension. In South Africa, children with CCN often attend public special schools that are mandated by the Department of Basic Education to provide rehabilitation services and communication support, including AAC. Although previous studies helped describe the provision of aided AAC and communication support at certain special schools in the Gauteng province, not much is known about it in other parts of the country. The lack of prevalence data on children with CCN in Western Cape special schools may result in the inadequate provision, monitoring and implementation of AAC and communication supports. Thus, the aim of this study was to gather province-specific data regarding the prevalence of learners with CCN at public special schools in the Western Cape, as well as to describe some of the AAC support made available for them. Methods: An online questionnaire was developed to determine the prevalence of learners with CCN in the foundation phase at selected special schools in the Western Cape, to describe their concomitant difficulties, the communication support provided to them, and teacher training in AAC. A non-experimental quantitative survey research design and a combination of purposive and comprehensive sampling were used in this study. The responses from 56 teachers were analysed using descriptive statistics. Results: A prevalence of 23% of learners with CCN was found among learners in the foundation phase of 17 selected special schools in the Western Cape. Learners with CCN had concomitant difficulties such as difficulties remembering or concentrating for the purpose of learning and difficulties with self-care activities, such as washing and dressing themselves. A higher proportion of learners with CCN used informal methods of communication as opposed to AAC methods that are formally introduced and taught (e.g., keyword signing or speech generating devices), and a higher proportion of learners used unaided AAC rather than aided AAC. The majority of aided AAC communication boards/books and speech generating devices were provided by private individuals or outside institutions and not by the education department. Based on a subsample, about three-quarters of learners with CCN had communication support mentioned in their Individual Education Development Plan or Individual Support Plan but less than half received communication support from speech-language therapists based at the school. In addition, only two-thirds of the 56 teachers indicated that they had received AAC training, while one-third of teachers indicated that they had not received any AAC training. Conclusions: The results of this study indicate the significant need for efficient monitoring of communication support in the Standardised Identification, Assessment and Support policy, the need to consider alternative therapeutic communication support practices (i.e., classroom-based intervention and a focus on upskilling teachers), as well as considering increased departmental funding towards aided AAC provision and AAC teacher training. Improved AAC service delivery must thus be driven by impactful policy, effective AAC practice, and sufficient and appropriate funding. More research is needed in the other provinces of South Africa.
Caregivers in residential care facilities’ perspectives on the communication needs of children with complex communication and their role in supporting communication
Ntimane-Halama, Maybuye Azania (University of Pretoria, 2024-02-09)
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
Patel, Aalia (University of Pretoria, 2023-08)
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
Slater, Jessica Paige (University of Pretoria, 2023)
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
Noorbhai, Wasifah (University of Pretoria, 2023)
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
Gay, Samantha Mary (University of Pretoria, 2023)
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
Visser, Andrea (University of Pretoria, 2023)
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.

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