Theses and Dissertations (Speech-Language Pathology and Audiology)

Permanent URI for this collectionhttp://hdl.handle.net/2263/33143

Browse

Now showing 1 - 20 of 299

Clinical utility of vestibular evoked myogenic potentials elicited by chirp stimuli
(University of Pretoria, 2024-09-06) Biagio-de Jager, Leigh; tarryn.reddy@up.ac.za; Reddy, Tarryn Marisca
The research explores the clinical utility of chirp stimuli in eliciting cervical and ocular vestibular evoked myogenic potentials (c&oVEMPs), with a focus on improving vestibular assessment protocols. Through a series of experimental studies, the dissertation evaluates response rates, waveform characteristics, test-retest reliability, and diagnostic accuracy for superior canal dehiscence syndrome (SCDS). The findings reveal that the 500 Hz narrowband CE-Chirp stimulus produces higher response rates, shorter latencies, and greater amplitudes compared to broadband CE-Chirp, tone bursts, and clicks, positioning it as a more reliable alternative for VEMP testing. By demonstrating the advantages of chirp stimuli in enhancing response consistency and diagnostic precision, this research contributes to advancing clinical vestibular assessments and optimizing protocols for detecting vestibular dysfunction.
Understanding hearing aid use and non-use in adult hearing aid recipients : a qualitative content analysis
(University of Pretoria, 2024-08-30) Swanepoel, De Wet; Mahomed-Asmail, Faheema; janecumming9@gmail.com; Cumming, Jane
The increase in hearing loss statistics continues to be a growing global health concern. Despite the critical role that hearing aids play in the clinical management of hearing loss, many recipients have reported that they do not use their devices consistently. However, over the past decade, there have been rapid advancements in the hearing aid industry with new innovations that aim to improve the functionality of the devices in general as well as user experiences. The aim of the present study was to explore the self-perceived reasons for hearing aid use and non-use among a large cohort of adult hearing aid recipients. Utilizing a cross-sectional survey design, the study analyzed qualitative responses from 680 adult American hearing aid users, aged 19 to 93 years, collected through the Hearing Tracker and Lexie Hearing platforms. The open-ended responses were examined using content analysis, which identified key themes related to the use and non-use of hearing aids. The findings were linked to two domains namely, hearing aid use and hearing aid non-use. Within these domains, three primary categories emerged: personal factors, situational aspects, and device-related issues. In the non-use domain, 24 sub-categories were identified, including self-consciousness, discomfort, the need for fine-tuning, and fears related to device damage or loss. Conversely, the hearing aid use domain comprised 11 sub-categories, highlighting reliance on the device for daily functioning, environmental safety and awareness, and the benefits of streaming and connectivity features. This study highlights the importance of addressing the personal concerns of hearing aid users, particularly in enhancing the comfort and practicality of devices. By providing targeted support in challenging situations, satisfaction with hearing aids can be improved, potentially leading to more consistent use and better overall outcomes for individuals with hearing loss.
Self-perception and clinical presentation of eating and swallowing abilities in elderly residents of residential care facilities
(University of Pretoria, 2024-08) Pillay, Bhavani; Kruger, Esedra; Vermeulen, Rouxjeanne; Masenge, Andries; caitlinbell99@gmail.com; Bell, Caitlin Shauna
PURPOSE : To describe the self-perception and clinical presentation of eating and swallowing abilities amongst the elderly who reside in residential care facilities. METHOD : Forty-four participants (mean age=80 years) were included in this comparative within-subject study. Participants were assessed using an oropharyngeal dysphagia assessment protocol. A cognitive screener, the Saint Louis University Mental Status examination was used when the level of cognitive impairment was unknown. The oropharyngeal dysphagia protocol included a medical history review, administration of the Eating Abilities Test – 10, the Mann Assessment of Swallowing Abilities, and the three-ounce water swallow challenge of the Yale Swallow Protocol. RESULTS : Twenty-one of 44 (n=21; 48%) participants indicated an overall self-perceived concern for oropharyngeal dysphagia when reporting within the Eating Abilities Test – 10. Evidence of compensatory eating behaviours, without receiving therapeutic intervention, were found. A negative, low correlation was present between the Eating Abilities Test – 10 and the Mann Assessment of Swallowing Abilities (r=-0.306, p<0.05) scores. CONCLUSIONS : Individuals who perceived eating and swallowing difficulties, demonstrated fewer clinical symptoms possibly due to self-mediated compensatory techniques. It is essential to integrate patient-reported outcome measures with clinical assessments for oropharyngeal dysphagia in residential care facilities. Collaboration between facilities’ staff and external professionals, such as speech-language therapists, could ensure timely interventions for dysphagia treatment.
Meaningful life changes following hearing aid use : a qualitative user perspective
(University of Pretoria, 2024-08) Swanepoel, De Wet; Manchaiah, Vinaya; Oosthuizen, Ilze; Le Roux, Talita; r.avierinos@gmail.com; Avierinos, Ruth Jayne
Objective: This study aimed to explore meaningful life changes due to hearing aid use in adult users. Design: A cross-sectional survey design was used with open-ended questions analysed using inductive qualitative content analysis. Study sample: US-based adult hearing aid users (n=653) from the Hearing Tracker website community and Lexie Hearing database. Results: Participants had a mean age of 65.4 years (13.6 SD), including 61.2% males, 38.3% females (0.5% other). Analysis of 2122 meaning units from responses identified two broad domains: 'meaningful benefits' (n=1709; 80.5%) and 'remaining difficulties' (n=413; 19.5%). The meaningful benefits domain included five categories (27 sub-categories): (a) psychosocial benefits, (b) improvements in hearing, (c) personal benefits, (d) hearing aid features and connectivity, and (e) situational benefits. Participants reported enhanced relationships and improved occupational functioning as key benefits. The remaining difficulties domain contained four categories (25 sub-categories): (a) hearing aid limitations, (b) hearing and communication issues, (c) situational difficulties, and (d) personal issues. Notable difficulties included hearing aid design issues and challenges in noisy environments. Conclusion: Hearing aid users reported diverse benefits and persistent challenges related to device use, illustrating the complexity of their lived experiences. These findings can inform empathetic, effective rehabilitation strategies and user-centric hearing aid technologies.
Auditory acclimatization in new adult hearing aid users : a systematic review
(University of Pretoria, 2024-10) Swanepoel, De Wet; Mahomed-Asmail, Faheema; Manchaiah, Vinaya; clarissawentzel@gmail.com; Wentzel, Clarissa
Background: Auditory acclimatization refers to gradual improvements in auditory performance over time due to changes in acoustic input from hearing aids, independent of task familiarity or training. This review examined acclimatization using behavioural, self-reported, and electrophysiological measures in studies of bilateral and unilateral hearing aid users. Objectives: To investigate the presence and extent of auditory acclimatization after hearing aid intervention and the factors influencing this process. Methods: A systematic search of CINAHL, PubMed, and Web of Science followed PRISMA 2020 guidelines. The protocol was registered on PROSPERO. Eligible studies included behavioural (e.g., speech recognition), self-reported (e.g., satisfaction), and electrophysiological outcomes. Results: Forty-four studies were included: 32 on speech recognition, 23 on self-reports, and 9 on electrophysiology. Among controlled studies, 53% found acclimatization effects in speech recognition, 29% reported improvements in self-reported outcomes, and 57% showed neural adaptation. Changes were small to moderate, with self-reported gains stabilizing over time. Influential factors included consistent hearing aid use, hearing loss severity, and device features, while cognitive abilities and age showed no impact. Conclusion: Auditory acclimatization had limited clinical significance, with variable and modest effects. Efforts should focus on promoting hearing aid adoption and consistent use through education, support, and counselling to enhance patient outcomes and quality of life.
Developmental outcomes of small infants at a South African high-risk follow-up clinic : a short-term longitudinal study
(University of Pretoria, 2024-08) Du Toit, Maria; Eccles, Renata; Van der Linde, Jeannie; taylaannie@gmail.com; Macaskill, Tayla-Ann
Small, preterm infants face more developmental risks than their full-term peers, necessitating early intervention and long-term monitoring. The study examined developmental and hearing outcomes of small infants at a high-risk clinic in a low-income setting, using developmental and hearing screening tools (PEDS tools and ABR MB11), and a developmental assessment (Vineland-3) at six- and 12-months corrected age (T1 and T2). All the participants underwent a hearing screening. Four participants (14.3%, n=4/28) failed the hearing screening test twice, at T1 and T2, and were referred for a diagnostic hearing evaluation. Concerns from the developmental screening at T1 were seen in communication, gross motor and social-emotional skills, where eight (28.5%) participants obtained a refer result. Concerns remained present across T1 and T2 in the PEDS screening tools. Fine motor skills were the highlighted domain of concern at T2 in the developmental screening. An improvement in developmental outcomes was noted when comparing T1 and T2 outcomes on the developmental assessment tool, the Vineland-3. At T1, the domains of concern were daily living skills (M=104.12; SD=38.99) and motor skills (M=88.82; SD=45.26). At T2, all the participants presented with age-appropriate developmental scores across domains. The findings emphasise the importance of holistic developmental monitoring and early intervention from birth and during follow-up opportunities. This will assist in identifying and addressing delays promptly in this vulnerable population, consider the continuum of care received, and enhance the developmental literacy of caregivers. This research contributes valuable insights for caregivers, healthcare policy developers, and early intervention practices, underlining the critical need for ongoing support for small infants from an early age.
Hearing help-seeking, hearing aid uptake and outcomes in adults : barriers, enablers and over-the-counter hearing aids
(University of Pretoria, 2024-08-05) Swanepoel, De Wet; Manchaiah, Vinaya; megan.knoetze@up.ac.za; Knoetze, Megan Clarissa
Hearing loss is a growing global health concern, with its prevalence increasing worldwide. In adults, unaddressed hearing loss can lead to various negative consequences, including reduced quality of life, cognitive decline, and economic disadvantages. Timely intervention with hearing aids can mitigate these consequences. However, despite their availability and effectiveness, help-seeking behaviors and hearing aid uptake have been notably low. In the past decade, significant efforts have been made to improve access to hearing healthcare, including establishing various types of direct-to-consumer (DTC) hearing devices, such as over-the-counter (OTC) hearing aids in the United States. Despite these advancements, the number of people seeking help for hearing difficulties and hearing aid uptake remains low. This may be due to various audiological and non-audiological factors that hinder or facilitate help-seeking behavior and the uptake of hearing aids. This project, therefore, explored factors influencing help-seeking behavior for hearing difficulties and the uptake of hearing aids, in addition to evaluating self-fitting OTC (OTC-SF) hearing aids for usability and effectiveness. Study I analyzed factors influencing hearing help-seeking and hearing aid uptake in adults with hearing loss through a literature review. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 42 articles from January 2011 to February 2022 were reviewed. Factors included 70 audiological and 28 non-audiological for help-seeking and 159 audiological and 66 non-audiological for hearing aid uptake. Hearing aid uptake had strong predictors, such as hearing sensitivity, while others showed conflicting results, such as self-reported health. Hearing help-seeking had clear non-predictive factors, such as education, and conflicting factors, such as self-reported health. New factors included cognitive anxiety associated with increased help-seeking and hearing aid uptake and urban residency and access to financial support with hearing aid uptake. Most studies were rated low evidence (67%) and fair quality (86%). The findings suggest further research to understand conflicting factors and factors with limited evidence to effectively promote help-seeking and hearing aid uptake among adults with hearing loss. Study II explored the main reasons for hearing aid uptake from a user perspective and provided recommendations for others with hearing difficulties. A cross-sectional survey gathered responses to an open-ended question, which were analyzed using qualitative content analysis. The study sampled 642 adult hearing aid users from the Hearing Tracker website and Lexie Hearing databases in the US. Participants cited reasons for hearing aid uptake in three domains: (a) personal impact, (b) social difficulties, and (c) auditory difficulties, encompassing 11 main categories and 48 sub-categories. Recommendations for others included eight main categories, such as timely help and affordability, with 32 sub-categories. The decision to take up hearing aids was influenced by intrinsic factors such as readiness to change and extrinsic factors such as financial availability. The most frequent recommendation was not to delay seeking hearing help. These findings may inform strategies to improve hearing aid adoption. Study III explored user perspectives on the relationship between hearing aid cost and uptake, along with cost-related recommendations for others with hearing difficulties, among prescription and OTC hearing aid users. A secondary analysis of a cross-sectional survey to an open-ended question were analyzed using the qualitative content analysis. Study participants included 241 adults, 179 prescription hearing aid users from the Hearing Tracker website and 62 OTC users from the Lexie Hearing United States database. Three domains were identified: (a) perceived enablers to hearing aid uptake related to cost, (b) perceived barriers, and (c) cost-related recommendations. Both groups cited high costs and lack of insurance coverage as major barriers. Prescription users noted external financial support as an enabler, while OTC users emphasized the affordability of OTC devices. Prescription users recommended seeking professional support, whereas OTC users advised researching hearing aids before purchasing. The study concludes that cost and insurance coverage are primary barriers to hearing aid adoption, suggesting that initiatives should address these financial challenges to enhance accessibility. Further research is needed on the relationship between cost and uptake, particularly for OTC users and those requiring financial assistance. Study IV compares the usability and performance of six OTC-SF hearing aids for individuals with mild-to-moderate hearing loss. In a cross-sectional study, 43 adults were pseudo-randomly assigned to self-fit two of the six devices using manufacturer instructions and smartphone apps. Usability was assessed through fitting time, Hearing Aid Skills and Knowledge (HASK) scores, ease of the self-fitting process, and the Post-Study System Usability Questionnaire (PSSUQ). Performance was evaluated using the Judgement of Sound Quality (JSQ) test, and speech-in-noise benefit was assessed through the Digits-In-Noise (DIN) and Quick Speech in Noise (QuickSIN) tests. Results showed fitting times ranged from 14.4 minutes (HP Hearing PRO) to 27.1 minutes (Lexie Lumen), with varied HASK scores, the highest being Soundwave Sontro (8.9/10) and the lowest HP Hearing PRO (6.8/10). While self-fitting ease and PSSUQ scores were similar across devices, sound quality ratings varied, with Lexie B2 scoring highest and HP Hearing PRO lowest. Speech-in-noise benefit did not significantly differ. Participants generally found the devices user-friendly, though issues with Bluetooth connectivity, handling, insertion, and sound quality were noted. These findings can aid consumers and healthcare professionals in choosing OTC-SF hearing aids, highlighting the need for further research on long-term usability and selection processes. Study V compared in-situ audiometry and self-adjustment strategies for OTC-SF hearing aids in adults with mild-to-moderate hearing difficulties. Conducted as a cross-over, within-participant pseudo-randomized controlled trial, it involved 28 participants (mean age 60.2 years). Participants used both strategies for four weeks: self-adjustment with Lexie B2 hearing aids and in-situ audiometry with Lexie B2 Plus hearing aids. The primary outcome was the Abbreviated Profile of Hearing Aid Benefit (APHAB), with secondary outcomes including the International Outcome Inventory for Hearing Aids (IOI-HA), speech-in-noise tests (DIN and QuickSIN), and real-ear measurements (REMs). Results showed no clinically meaningful differences in APHAB benefit or overall IOI-HA satisfaction. However, self-adjustment users reported higher satisfaction and longer daily use. Both strategies produced similar results in speech-in-noise benefit and REMs. The findings suggest that self-adjustment may offer higher user satisfaction and engagement, indicating the potential benefits of active user involvement in the fitting process. Further research is needed to assess long-term outcomes. From these studies, it is evident that numerous factors, both audiological and non-audiological, influence the help-seeking behavior and uptake of hearing aids among adults with hearing loss. While advancements such as OTC hearing aids have improved accessibility, significant barriers, especially financial constraints, impede widespread adoption. The user perspectives highlighted in these studies underscore the importance of timely intervention, affordability, and the effectiveness of both self-adjustment and professional support in promoting hearing aid uptake. Continued research is essential to address these barriers and optimize strategies for enhancing hearing healthcare accessibility and user satisfaction.
Are listening difficulties in children related to speech recognition in noise and binaural intelligibility level difference?
(University of Pretoria, 2019-08) Swanepoel, De Wet; Mahomed-Asmail, Faheema; De Sousa, Karina; u15011985@tuks.co.za; Frisby, Caitlin
In both clinical practice and the literature, parent reports and poor speech recognition in noise performance are commonly associated with listening difficulty (LiD). However, the relationship between these reports and skills is unclear. This study investigated the relationship between questionnaire measures of LiD and psychoacoustic measures of speech recognition in noise. Four hundred and forty-six typically developing, normal-hearing (pure-tone thresholds ≤ 20 dB HL) school children (73.8% male), 6-13 years old, were recruited. Diotic and antiphasic speech reception thresholds (SRTs), and the difference between them, the digits in noise binaural intelligibility level difference (DIN-BILD), were determined using the South African English DIN. Parents completed the Evaluation of Children's Listening and Processing Skills questionnaire (ECLiPS) (246/446) and teachers the Children's Auditory Processing Performance Scale (CHAPPS) (429/446) questionnaires to identify children with possible LiD. The ECLiPS classified 36/246 (14.6%), and the CHAPPS 103/429 (23.1%) children with LiD by questionnaire published criteria. Both questionnaires were obtained for 229 participants, of which 3.1% (7/229) were classified with LiD based on both CHAPPS and ECLiPS scores. There was no significant relationship between the DIN-BILD or speech recognition in noise (antiphasic and diotic conditions) and ECLiPS or CHAPPS total scores across the 246 ECLiPS and 429 CHAPPS participants. Age had a significant effect on BILD, SRTs and CHAPPS total score. LID, determined by total scores on parent and teacher questionnaires, was not predictive of BILD or poor speech recognition in noise. LiD is a heterogeneous construct for which a DIN test could inform abilities but not identify the condition.
A systematic review to determine if text messages about health and development in infants and young children affect caregiver behaviour
(University of Pretoria, 2019) Van der Linde, Jeannie; Pillay, Bhavani; Swanepoel, De Wet; richardson.brittany96@gmail.com; Richardson, Brittany Paige
Access to appropriate information can result in improved health and development outcomes for children. Providing information about health and developmental care via mobile devices (mHealth) can serve not only as curative healthcare but also as preventative health care in developing countries. Through mHealth programs, messages are sent by SMS or voice-recorded message. By reviewing the current state of evidence, the study aims to investigate if text messaging about health and development in young children has an effect on caregiver behaviour. This systematic review was conducted according to the PRISMA-P statement guidelines. Five databases were used to conduct this study and the search was not limited to a specific time period. Key words were used in various combinations within the different databases. Thematic analysis was used to organise and synthesize the information extracted from the selected studies.This review included 19 studies. Study designs included Randomised Control Trials (RCT’s) (n=13, 68.4%), observational studies (n=3, 15.8%), and non-randomised control trials (n=3, 15.8%). Message content included educational information regarding health and development (89.5%), reminders (36.8%) and caregiver support (52.6%). Current evidence summarised from this review supports text messaging as an effective tool to change caregiver behaviour and child outcomes across a range of health and Early Childhood Development (ECD) related topics as the findings suggest increased caregiver comfort with basic infant health and development decisions. This may be attributable to information received via text message from health care professionals. Early childhood development has more limited evidence in terms of quantity and quality. More research is required in ECD and generally in low-to-middle income (LMIC) contexts.
Developmental outcomes of HIV-exposed infants in a low-income South African context
(University of Pretoria, 2019-11) Kruger, Esedra; Van der Linde, Jeannie; carmen.vaneck@gmail.com; De Beer (nèe van Eck), Carmen Cornelia
Background: Effective Human Immunodeficiency Virus (HIV) transmission prevention strategies have led to a growing population of vulnerable HIV-exposed (HE) infants in sub-Saharan Africa, however uncertainty exists in literature regarding their developmental outcomes. Objective: The aim was to determine the developmental outcomes of six- to 12-month-old HE infants in a low-income South African context, when compared to HIV-unexposed (HU) counterparts. Method: In this prospective cross-sectional, group comparison study, the development of 41 HE and 40 HU infants (mean age = 8.4 months, SD = 2.1 months) from a low-income context was assessed. Caregivers were interviewed using a background interview and the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) to evaluate infants’ communication, daily living, socialisation and motor skills. Results: Based on the overall test scores, the majority of HE participants had age-appropriate development (90.2%; n=37). Some HE participants, however, presented with delays in the domains of communication (9.8%; n=4), daily living skills (2.4%; n=1), socialisation (19.5%; n=8) and motor development (7.3%; n=3). HU participants also demonstrated some domain-specific delays, thus delays were present in both groups. No statistically significant differences were found between the development of HE and HU participants. Conclusion: Findings were reassuring and suggested that the development of HE participants were similar to that of HU counterparts. Developmental differences may, however, only emerge with age, therefore large-scale longitudinal research is recommended. It is suggested that the entire sample was vulnerable, highlighting the importance of developmental surveillance and early intervention in low-income contexts, irrespective of HIV and antiretroviral exposure.
Characteristics and help-seeking behaviour of persons failing a national hearing screening test
(University of Pretoria, 2019-11) Swanepoel, De Wet; De Sousa, Karina; Mahomed-Asmail, Faheema; dannyschonborn11@gmail.com; Schönborn, Danielle
A digits-in-noise test was launched as the smartphone hearing screening of South Africa (hearZA™) in 2016. This study investigated characteristics, help-seeking behaviour, and follow-up actions of individuals who failed the hearing screening, considering their stage of behavioural change. The study had two phases; phase one was a retrospective, cross-sectional intervention readiness (stage of change) analysis of 3092 listeners who failed the test. Phase two was a prospective survey of 59 participants to investigate follow-up actions after a failed test. In the retrospective study, the majority of listeners were in the precontemplation stage (75.5%), while the remaining were in contemplation (9.7%), preparation (8.2%), and action (6.6%) stages. Age and stage of change were significant predictors of the digits-in-noise speech recognition threshold (DIN SRT) (p < .05). SRTs deteriorated significantly (p < .05) with increasing age, and listeners in the precontemplation stage were significantly younger than in other stages (p < .05). In the prospective study, 1007 potential participants were contacted through electronic mail or short message services to complete the survey; however, only 59 did so. Of those, most (82.4%) did not think they have a hearing loss. Only, 13.6% followed up with an audiologist. Older individuals presented with poorer DIN SRTs and were in a more advanced stage of change. The majority that did not follow up after failing the screening test did not believe they had a hearing problem. A combination of factors, including poor DIN SRT, older age, and more advanced stage of change predisposed participants to follow up with audiological care.
A comparison of the LS CE-Chirp and click evoked auditory brainstem response stimuli for neuro-diagnostic assessment in order to determine the preferable stimulus
(University of Pretoria, 2019) Biagio de Jager, Leigh; Heinze, Barbara M.; paige.tucker77@gmail.com; Tucker, Paige
Purpose: To compare LS CE-Chirp and click evoked neuro-diagnostic auditory brainstem responses (ABR) for the purpose of determining the preferable stimulus for assessment. This is necessary for the improvement of neural synchrony and compensation for the delay of the sound wave whilst it travels through the cochlea. This will facilitate more successful, efficient and effective neurological ABR assessments. Method: This was a within subject comparative, exploratory research design. Participants included 34 normal-hearing individuals (aged 18-25 years, mean age 22.12 years). A comparison was completed between the ABR wave formations evoked by the click and LS CE-Chirp stimuli at 80 dBnHL at stimulus repetition rate of 27.4 Hz and 61.1 Hz with maximum permissible residual noise levels of 40 nV. Results: The LS CE-Chirp evoked ABR displayed later absolute latencies and shorter interpeak latencies compared to the click-evoked ABR. Significantly larger amplitudes were consistent for the LS CE-Chirp wave formations (p<0.001) with the exception of the wave I for the rarefaction polarity. Residual noise levels were consistently higher for the LS CE-Chirp stimuli, however, there was no correlation present between the amplitudes and the comparative residual noise levels. Conclusions: The LS CE-chirp stimulus elicited considerably larger waveform amplitudes, which facilitate more accurate and timely ABR assessments compared to the click. The lack of correlation between amplitude and residual noise levels suggested independence of residual noise levels, and therefore were likely due to the increased neural synchrony inherent to the chirp stimuli. The click stimulus is still advocated for during neuro-diagnostic assessments as despite the larger LS CE-Chirp amplitudes, further research regarding the correlation with auditory-neural pathology is required before the routine use of the LS CE-Chirp stimulus can be advocated over the well-established click stimulus for neuro-diagnostic purposes.
Nurses’ management of stroke-related oropharyngeal dysphagia in a rural province of South Africa
(University of Pretoria, 2019-10) Kruger, Esedra; Van der Linde, Jeannie; Pillay, Bhavani; kerryknight30@gmail.com; Knight, Kerry
Background: Early identification of stroke-related oropharyngeal dysphagia (OPD) using screening by nurses can prevent adverse patient outcomes in lower-middle-income countries (LMICs). Nurses are essential in the OPD management team and should ideally be able to screen and prioritise dysphagia management in stroke patients. Objective: The aim of this study was to describe nurses’ identification and management practices of patients with OPD following a stroke in a rural province of South Africa. Qualified nurses from various healthcare levels in a rural province of South Africa were invited to complete a previously published hard copy survey on signs, symptoms, complications, and management of stroke-related OPD. A sample of 130 participants were included. The majority of participants (n=66; 50.8%) had ten or more years of experience. Results: The mean scores of correct responses for each section were: 8.7/13 (66.7%) for signs and symptoms, 4.7/10 (47.3%) for complications and 3.8/7 (54.2%) for management practices. There were no significant differences between groups for the signs and symptoms section and the complications section. Secondary healthcare nurses demonstrated significantly better knowledge than primary (p=0.022) and tertiary (p=0.010) level nurses regarding management of OPD. Overall, secondary level nurses had significantly higher scores than the other levels. Conclusions: Moderate knowledge of identification and management of stroke-related OPD among nurses across all health care levels was evident. Interdisciplinary collaboration between nurses and speech-language therapists can improve team members’ continued professional development and refining of skills in decision-making regarding stroke-related OPD in LMICs.
Feeding characteristics of infants in a primary health care clinic in South Africa
(University of Pretoria, 2019-10) Kruger, Esedra; Van der Linde, Jeannie; nicholefuls@gmail.com; Fuls, Nichole
BACKGROUND There is a limited amount of literature on the feeding characteristics and nature of possible feeding difficulties of infants in a primary health care (PHC) in South Africa. OBJECTIVE To describe feeding characteristics and determine the nature of feeding difficulties of infants in a PHC setting in South Africa. METHOD Two hundred infants aged six to 12 months (mean age = 8.54, Standard Deviation = 2.18) received a feeding screening by a speech-language therapist at a well-baby clinic in a semi-urban area using the Montreal Children’s Hospital-Feeding Scale (MCH-FS). A clinical feeding evaluation using the Schedule of Oral Motor Assessment (SOMA) was completed with 13 infants who failed the screen. RESULTS The MCH-FS identified 13 participants with feeding difficulties (6.5%) of which 11 were diagnosed with oral motor dysfunction (OMD) using the SOMA. The 6.5% (n=13) that failed, had mild (n=8;61.5%), moderate (n=2;15.4%), and severe (n=3;23.1%) feeding difficulties, as reported by caregivers using the MCH-FS. The MCH-FS revealed that distraction during mealtimes/following (n=42;21%), food refusal (n=31; 15.5%), caregiver unease about feeding (n=29;14.5%), and problems with vomiting, gagging or spitting (n=28;14%), were characteristics of feeding in this sample. Participants in the age groups six (n=3;27.3%) and 10 months (n=3;27.3%) were prone to OMD. Complementary feeding was introduced appropriately between six and eight months in the majority of the sample (n=122;82%). CONCLUSION The study was the first of its kind to describe the feeding characteristics of a group of infants during the transitional feeding stage in late infancy in South Africa. The findings may be used as a starting point for larger scale studies in a similar setting, investigating the development of future caregiver education and health care professional training programmes regarding transitional feeding.
Improving hearing aid access, use and outcomes in adults
(University of Pretoria, 2024-07-07) Swanepoel, De Wet; Mahomed-Asmail, Faheema; u13182006@tuks.co.za; Mothemela, Bopane
The thesis outlines how alternative audiology service delivery model including the community based hearing aid fitting model can be employed to improve access to hearing loss treatment. This overall promotes hearing healthcare wellness to broader communities, regardless of affordability.
Incidence and nature of functional voice disorders in adults at an Interdisciplinary voice clinic
(University of Pretoria, 2024-04) van Der Linde, Jeannie; Milton, Carmen; yusrabhaila@gmail.com; Bhaila, Yusra Mahmud
Abstract Introduction: Functional Voice Disorders (FVDs) are types of voice disorders that arise from improper use of the vocal mechanism. It is characterized by the absence of anatomical or neurological abnormalities. Despite their prevalence, the incidence and nature of FVDs, particularly among occupational voice users, have been inadequately reported globally. This study sought to address this gap by describing the incidence and nature of FVDs in adults attending an interdisciplinary voice clinic in Pretoria, South Africa. Methodology: A retrospective quantitative research design was employed. Data was sourced from a voice clinic's secure medical database. Patients over eighteen years with confirmed FVDs diagnosed between January 2017 and July 2022 were included. Statistical analysis was conducted using SPSS, utilising both descriptive and inferential statistics. Results: Of the total 516 patients with voice disorders seen between January 2017 and July 2022, 16.67% had FVDs, with muscle tension dysphonia being the most prevalent primary diagnosis. The most common secondary diagnosis was laryngeal pharyngeal reflux (39.5%). Patients with FVDs presented with a variety of signs and symptoms, with hoarseness being the most common. No significant differences were found between occupational voice users and non-occupational voice users. Conclusion: The study’s findings emphasised the need for understanding the landscape of FVDs in South Africa. It highlighted the importance of interdisciplinary care and the need for further research to optimise prevention and management strategies. Furthermore, it underscores the significance of addressing these disorders on a global scale, particularly in low- and middle-income countries, by outlining research gaps among these populations.
Adaptation of a developmental milestone resource for caregivers from low-income communities in South Africa
(University of Pretoria, 2024-02-19) Eccles, Renata; du Toit, Maria; Shabnam, Abdoola; ashleyrosechesworth@gmail.com; Bellini, Ashley
Caregiver access to relevant developmental milestone resources is critical in ECD. In this iterative design study, six members of an expert panel (n=6; female; 5 White, 1 Black) reviewed and adapted the CDC developmental milestone checklist for South African caregivers of children two months to three years 11 months, living in low-income communities. Participants found most of the developmental milestones to be applicable but requiring contextual adaptation to be relevant for use by caregivers in low-income communities. Four themes were identified from the adaptations made: language use, access to test items, context, and developmental literacy. International developmental milestone tools require adaptation and contextualization to address the unique challenges and circumstances that children in low- income communities face.
Consumer perspective on improving hearing aids : a qualitative study
(University of Pretoria, 2024-06-19) Mahomed Asmail, Prof. Faheema; Swanepoel, Prof. De Wet; Manchaiah, Prof. Vinaya; desainabeelah@gmail.com; Desai, Nabeelah
Optimal hearing aid fittings are central to the management of hearing loss. While research studies using quantitative scales typically report high hearing aid user satisfaction rates, other studies show poor uptake and sustained usage of hearing aids. While quantitative research is valuable, nuanced factors influencing hearing aid user experiences can be minimised. This underscores a need for the qualitative exploration of holistic hearing aid experiences, to promote successful outcomes. In light of this, the present study aimed to describe user perspectives on desired changes to hearing aids, in order to make them more useful. An open- ended question from a cross-sectional online survey was retrospectively analysed using inductive, qualitative content analysis. Participants were adult hearing aid users in the United States (U.S.), who had obtained their hearing aids either through the traditional hearing healthcare professional (HHP) mediated prescription route, or through the OTC service delivery model. The survey was disseminated over email through the Hearing Tracker forum database and through Lexie Hearing, an OTC hearing aid company. Results showcased a rich variety of information and highlighted diverse viewpoints. 628 participant responses were manually coded and categorised to form domains. The mean age of the surveyed population was 66 years old (13. 4 SD). The majority were bilateral, behind-the-ear hearing aid users. Three domains illustrating desired hearing aid changes emerged from the data. The (i) hearing aid features domain (n= 635 responses) illustrated challenges surrounding hearing aid usability (appearance and comfort), durability (Ingress Protection (IP) ratings) and digital functionality (Bluetooth connectivity). The (ii) sound quality domain (n=282 responses) described challenges surrounding sound recognition and clarity (as an independent concept from volume) as well as the performance of noise reduction technology. The (iii) service- delivery domain (n=378 responses) described user concerns about affordability, audiologist credibility and overall hearing aid industry market transparency. Participants expressed satisfaction with hearing aid technological developments, similar to previous studies indicating high satisfaction rates, but expressed a strong desire for further improvements, to better align hearing aids and services with their needs. Key areas for improvement include cost accessibility, physical device aesthetics and comfort, technical functioning, user autonomy, sound clarity and collaboration and trust between patients and HHPs. While some participant suggestions such as those surrounding aesthetics are known, novel information regarding features enhancing user autonomy and promoting industry transparency, were highlighted. Against the backdrop of an evolving hearing aid industry, the findings of this study can assist HHPs in being informed facilitators for both, health consumers and their patients. Consideration should be given to intervention solutions which promote principles of Person- Centred Care (PCC), enhance patient self-efficacy and maintain transparency.
Preliminary normative data for adult English first and second language speakers in South Africa on the "RSA low linguistically loaded central auditory processing test battery"
(University of Pretoria, 2002) Campbell, Nicole Githa; Saleh, Safia
English: The lack of standardized test materials in the 11 official languages of South Africa led to the development of the "RSA low linguistically loaded central auditory processing test battery" as an interim measure until these tests can be developed. This study aimed at collecting and comparing preliminary normative data for English first and second language speakers in South Africa on this test battery and to compare the results with the available USA normative data. Thirty two participants were included in the study and were divided into two research groups depending on their proficiency in English. A between group research design was used to collate and compare the data. Results indicated that the two research groups performed equivalently on all tests apart from the Dichotic Digits test for the right ear and a qualitative comparison with the USA normative data showed lower scores for tests not involving speech stimuli. Accent and presentation levels affected the results but not significantly. Results point to the possibility of using the test battery reliably with population groups whose first language is not English but who have a good proficiency in the language and reiterates the need for development of specific test materials in all the official languages.
The hearing aid effect across socioeconomically diverse settings
(University of Pretoria, 2023) Mahomed-Asmail, Faheema; Swanepoel, De Wet; moipone.motlhamare.mm@gmail.com; Motlhamare, Cathrine
Hearing aids serve as the prescribed intervention for addressing the majority of hearing losses, yet their adoption and usage encounter resistance among individuals. This is largely attributed to the hearing aid effect (HAE), wherein negative stereotypes are linked to hearing aid users. While existing research has explored the HAE in relation several factors little is known about how factors like rural or urban settings and level of education influence it. This study aims to address this gap by investigating the hearing aid effect across diverse rural and urban populations with varying educational backgrounds. A quantitative cross-sectional questionnaire was completed by 322 participants (urban=161, rural=161) selected through purposive snowball sampling. Participants were required to complete the Bipolar Semantic Differential Scale based on photographs of a model wearing seven hearing devices, namely standard behind-the-ear hearing aid (BTE HA) with an earmould; mini BTE HA with a slim tube (ST), in-the-canal (ITC) HA, Airpod, receiver-in-canal (RIC); completely-in-canal (CIC) HA; and Personal sound amplification product (PSAP). Comparisons were made between the mean scores obtained for the various devices to those of the standard BTE hearing aid. Findings show that the hearing aid effect exists and there are significant differences (p < 0.01) between the rural and urban populations in ratings for attributes such as age and hardworking. Significant differences (p < 0.01) were also noted across levels of education; those with tertiary education, compared to those with primary and secondary education, found the model to be younger when wearing an Airpod and to be more hardworking when wearing a ST hearing aid. This study concluded that there is a neutral to positive view of hearing devices. These findings highlight the significance of considering patients' socioeconomic circumstances when prescribing hearing aids. Nevertheless, further research is required to investigate the underlying reasons behind the differences in perception between rural and urban residents.

Browse

Recent Submissions