Handbook of Speech-Language Therapy in Sub-Saharan Africa: Integrating Research and Practice

Description

This book synthesizes research on language development and communication disability in Sub-Saharan Africa and highlights best practices for providing speech and language therapy services to individuals with language, communication, and hearing disorders across the lifespan. The book brings together a wide range of international contributions from various disciplines, such as speech-language pathology, audiology, developmental psychology, language education, social work, neurology, neuropsychology, pediatrics, linguistics, pedagogy, and phonetics to provide perspectives on problems, challenges, ideas, concepts, and models to serve the people in Sub-Saharan Africa.  Key areas of coverage include: Challenges for speech-language therapists in the health sector. Community awareness and the sustainable delivery of services. Culture-specific support of communication and language development in early childhood. Malnutrition, dysphagia, feeding difficulties, pediatric HIV, and related issues. Communication disability treatments, including assessment and intervention, augmentative and alternative communication (AAC), and issues specific to bilingualism and biliteracy. Inclusive education of children with communication disorders with case studies from Rwanda, Tanzania, Kenya, and South Africa.  The Handbook of Speech-Language Therapy in Sub-Saharan Africa is an essential reference for researchers, professors, and graduate students as well as clinicians, therapists, and other professionals in developmental psychology, speech-language pathology and therapy, social work, neuropsychology, pediatrics, special education, community based rehabilitation, and all related disciplines. Foreword 1: Regaining a Voice Foreword 2: Revealing the Person Within Foreword 3: My Journey with Aphasia Back to Work Usemaji Aphasia Support Group A Silent Disability “New Normal” My Takeaway Foreword 4: Supporting Children at Risk Foreword 5: Living with Stuttering Foreword 6: The Potential of Rehabilitative Care Experiences at the Centre for Education and Community Based Rehabilitation (CERBBc), North-Eastern DR Congo Alio’s Testimony Introduction Motive History Structure Book Sections Distribution of Chapters Transdisciplinary, Global, and Multi-Level Approach Peer Review, Terminology, and Up-to-Dateness of Data Target Readership Key Subjects Speech-Language Therapy Sub-Saharan Africa History and Status of Speech-Language Therapy in Sub-Saharan Africa Thanks References Contents Authors and Reviewers List of Authors List of Reviewers List of Abbreviations Part I: Introduction: Professionalization 1 Ulrike M. Lüdtke Speech–Language Therapy in Sub-Saharan Africa: The Emergence of a Profession in a Diverse Multilingual and Multicultural Context Abstract Background: All over sub-Saharan Africa (SSA), evidence of the emergence of the profession of speech–language therapy (SLT) can be detected. This development can be illustrated through the availability of SLT in some major cap 2 Karen Wylie, Lindy McAllister, Bronwyn Davidson, and Julie Marshall Speech–Language Therapy in Sub-Saharan Africa: Development and Sustainability of Services for Persons with Communication Disability 3 Julie Marshall, Nana Akua V. Owusu, and Ryann Sowden Maximizing the Benefits and Minimizing the Risks from the Contribution of “Outsiders” to the Development of Services for Persons with Communication Disability in Sub-Saharan Africa 4 Ulrike Schütte, Chantal Polzin, Afizai Vuliva, and Ulrike Lüdtke Clinical Competence of Speech–Language Therapists in Culturally and Linguistically Diverse Contexts: A Qualitative Study of Intercultural Work Experiences Abroad 5 Bea Staley and Emma Shah The History of Speech–Language Therapy in Kenya: A Collective Memory 6 Sylvia Topouzkhanian and Palakiyém Abalo The Development of the Speech–Language Therapy Profession in West Africa: Over 10 Years of Experience 7 Abbie Olszewski, Verena Rossa-Roccor, Veronic Clair, Kate Tairyan, and Erica Frank A Revolution in Training Speech–Language Therapists in Sub-Saharan Countries and Globally 8 Ulrike Lüdtke and Chantal Polzin The Demands of Context: Development of a Relational In Vivo Methodology for Participative Speech–Language Therapy Research in Sub-Saharan Africa 9 Purity M. Nthiga and Eunice A. Nyamasyo Speech–Language Therapy in Kenya: Trends, Challenges, and Opportunities 10 Bea Staley, Ellen Hickey, Rachael Gibson, David Rochus, and Martin Nafukho Obulala Na-maani: Unity Is Strength – Speech–­Language Therapy and Community Engagement in Three Kenyan Communities References 1: Speech-Language Therapy in Sub-Saharan Africa: The Emergence of a Profession in a Diverse Multilingual and Multicultural Context Evidence: Speech–Language Therapy Emerges in Sub-Saharan Africa Needs: The Basics of Africa-Specific Professionalization Chances and Challenges: Cultural Uniqueness in a Global World Excursion in Scientific Theory Establishing Speech–Language Therapy in Sub-Saharan Africa as a Science: The Danger of a Neocolonial Approach Speech–Language Therapy in Sub-Saharan Africa in Crisis: Mismatch Issues in Problem-Solving Speech–Language Therapy in Sub-Saharan Africa in Model Revolution: Emergence of a Genuinely Independent Paradigm Key Concept for the Speech–­Language Therapy Dimension of the Individual Self and Family: Africa-Specific Linguistic Identity Grounded in a Specific Version of Multilingualism Key Concept of the Speech–Language Therapy Dimension of Society: Africa-Specific Cultural and Linguistic Diversity Shaped by Specifics of the Linguistic Market A Key Concept for the Speech–­Language Therapy Dimension of Culture: Africa-Specific Inclusion Tasks: Systematic Establishment of a Sustainable, Multilevel, Cross-Sector Speech–Language Therapy Approach (I) Uniquely Sub-Saharan African Tasks for the Diversity of Persons with Communication Disorders (II) Uniquely Sub-Saharan African Tasks for Future Speech–Language Therapy Practice (III) Uniquely Sub-Saharan African Tasks for Future Speech–Language Therapy Concepts (IV) Uniquely Sub-Saharan African Tasks for Future Speech–Language Theory (V) Uniquely Sub-Saharan African Tasks for a Future Meta-theory of Speech–Language Therapy Opportunities: International Speech–Language Therapy Research Cooperation Within a Global Ethical Framework References 2: Speech-Language Therapy in Sub-Saharan Africa: Development and Sustainability of Services for Persons with Communication Disability Speech–Language Therapy and Rehabilitation Services in SSA SLT Workforce Sustainability Issues in SSA SLT Workforce Availability Accessibility of SLT Services Acceptability of SLT Services Accessibility, Acceptability, and Availability of SLT Services: A Workforce Survey Aim and Objectives Methodology Results Demographics of Respondents Availability Job Availability: Permanent and Full-Time Jobs Service Stability Motivation and Support Factors: Working Alone Motivation and Support Factors: Mentoring Availability and Location Motivation and Support Factors: Strategies for Continuing Professional Development Motivation and Support Factors: Successes and Challenges in Continuing Professional Development Accessibility Structural Barriers: Employment Sector and Service Setting Geographic Barriers: Location of SLT Services Economic Barriers: Fee Structures Acceptability Cultural Distance Multilingualism and African Languages Language of Service Provision Challenges for the Development and Sustainability of Rehabilitation Services for Persons with Communication Disability Embedding SLT and Communication Disability in the Political Agenda Prevention and Intervention Models Committing to the Development of SLT and Community Workers in SSA Ensuring Culturally Relevant Services Limitations Conclusion References 3: Maximizing the Benefits and Minimizing the Risks from the Contribution of “Outsiders” to the Development of Services for Persons with Communication Disability in Sub-Saharan Africa Motive Introduction Background Part 1: A Written Dialogue Between Two Expert Speech–Language Therapists Part 2: Fictitious Case Examples of Insider/Outsider SLT Collaboration A Successful Example of an Outsider Joining an SLT Education Program in Sub-Saharan Africa An Unsuccessful Example of an Outsider Joining a Service Delivery Project in Sub-Saharan Africa A Successful Example of Bringing SLT Students in from a High-Income Country to Volunteer Short Term in a Sub-Saharan African Country An Unsuccessful Example of a Fly-In-Fly-Out (FIFO) Short-Term Project Part 3: Insider/Outsider Research in Uganda Background Methods Results Organizing Theme 1: “Unstable Support” Organizing Theme 2: “Developing Relationships” Organizing Theme 3: “Outgrowing Outsider Contributions” Risks Risks to Persons with Communication Disability Risks to Ugandan Services Risks to Ugandan Professionals Benefits Benefits to Persons with Communication Disability Benefits to Ugandan Services Benefits to Ugandan Professionals Discussion Recommendations and Considerations for Future Insider/Outsider Work References 4: Clinical Competence of Speech-Language Therapists in Culturally and Linguistically Diverse Contexts: A Qualitative Study of Intercultural Work Experiences Abroad Introduction: Service Delivery in Culturally and Linguistically Diverse Contexts Cultural and Linguistic Diversity Due to a Natural Broad Heritage of Indigenous Languages: The Case of Tanzania Cultural and Linguistic Diversity Due to Recent Migratory Movements: The Case of Germany Dealing Appropriately with CLD in the SLT Profession: The Global Perspective Research Findings on Work Stays and Diversity-Sensitive Competences in SLTs Theoretical Background: Diversity-Sensitive Clinical Competence and Its Acquisition Clinical Competences in SLT in CLD Contexts Acquisition of Diversity-Sensitive Clinical Competence Circular Process of Professionalization of SLTs in the CLD Context Constructivist Method: Relational Biographical Self-Reflections Research Questions Research Method and Design Participants Instruments Relational Biographical Self-Reflections for Data Collection Qualitative Content Analysis for Data Analysis Data Collection Husani’s Biographical Self-Reflection Claudia’s Biographical Self-Reflection Data Analysis Results Identification of the Most Relevant Challenging Experiences Gained Through Professional Stays in a Foreign Country Strangeness: “I Am a Stranger!” Heteronomy: “I Am Powerless!” Identity Conflict: “I Am Not Myself!” Professionalization of Diversity-Sensitive Clinical Competence as a Result of Reflecting Challenging Experiences in a Foreign Country Discussion and Study Limitations Recommendations for SLT Curricula Worldwide Implementation of Professionally Supervised Practical Internships Abroad for Promoting Direct Exposure to “Strangers” Implementation of a Module to Promote DSCC in SLT Training Programs Toward Intensive Self-Reflection for Dealing Appropriately with “Strangers” Toward Ethnorelativism for Promoting Acceptance Rather Than Suppression of “Strangers” References 5: The History of Speech-Language Therapy in Kenya: A Collective Memory Introduction Motive Problem Background Methodology Methods: A Qualitative Methodological Pastiche Situating the Authors The Development of the Speech–­Language Therapy Profession in Kenya A Collective Remembering From 1970 to 2000: An Overview From 1990 to Present: Special Education Professionals (SEP) From 2000 to 2014: A Building of Momentum The East African Conference on Communication Disability: 2005–2018 Establishing the Association of Speech and Language Therapists Kenya (ASLTK) Establishing SLT Training Programs: 2014 Onward Speech–Language Therapy in Kenya: A Contemporary Perspective Ongoing Challenges Issues of Language Building Awareness About the Profession Issues of Access Issues of Payment Resources and Innovations Dynamic and Creative SLT Practices Harnessing Technologies Looking to the Future: Considering the Next Steps Research and Material Development Strengthening and Supporting the Kenyan SLT Community Conclusions References 6: The Development of the Speech–Language Therapy Profession in West Africa: Over 10 Years of Experience Introduction Project Genesis and Course Design Implantation of a New Profession Within Western and Central Africa Professional Development and Growth Creation of the Fédération des Orthophonistes d’Afrique Francophone Challenges to Take On Oral Tradition and the Significance of Cultural Beliefs Importance of Raising Awareness About Speech–Language Disorders Advocating for the Recognition of the Profession of Speech–Language Therapy by the Governments of French-speaking African Countries Regulating Speech–Language Therapy Practice in Africa Working in Bilingual and Multilingual Settings Adapting Diagnostic and Therapeutic Materials Promoting Scientific Research on Speech–Language Therapy in Africa Conclusion References 7: A Revolution in Training Speech-Language Therapists in Sub-Saharan Countries and Globally Introduction Problem Background State of Speech–Language Therapy Higher Education in Sub-Saharan Africa West Africa East and Central Africa Southern Africa eLearning History of the DOOHICHE Model High Quality Accessibility Affordability Customizability Sustainability The DOOHICHE Model in Practice The DOOHICHE Model for Speech–­Language Therapy Step 1: Perform a Needs Assessment Step 2: Competencies Step 3: Locate Resources Step 4: Review with Advisory Group Step 5: Creation of Learning Modules Step 6: Teaching Platform Step 7: Locating Potential Students Step 8: Refine and Research Current State of the NextGenU.org Speech–Language Pathology Program in Sub-Saharan Africa Potential Impact Summary References 8: The Demands of Context: Development of a Relational In Vivo Methodology for Participative Speech–Language Therapy Research in Sub-Saharan Africa Introduction: The Necessity of Multilevel Research for Development of the Speech–­Language Therapy Profession in Sub-Saharan Africa Framework of Multilevel Research in Speech–Language Therapy SLT Research Needs in Sub-Saharan Africa Multilevel Research Needs in a Sub-Saharan Africa Clinical Context: Adults with Aphasia Multilevel Research Needs in the Sub-Saharan Africa Educational Context: Children with Autism Spectrum Disorder Background: Opportunities and Challenges for Research in Sub-Saharan Africa Opportunities: Uniqueness and a Fresh Start! Challenges: Lack of Cultural Adaptation and (Neo)colonial Shadows Proposing a Relational In Vivo Methodology for Participative Speech–Language Therapy Research in Sub-Saharan Africa Conceptual Dimensions of a Relational and Participative In Vivo Research Paradigm Practical Key Elements of a Relational In Vivo Approach Studying Persons with Communication Disorders Within the Sub-Saharan Africa Context: The Range of Relational Methods in a Multilevel Research Approach Epidemiological Studies (Level I): Getting Access to the People and the Field Intervention Studies on Speech–­Language Therapy Practices (Level II): Obtaining Different Perspectives on Daily Service Delivery Evaluation Studies: Promoting Standards for Evidence-Based Practice in Specific Contexts of Speech–Language Therapy Service Delivery Basic Research Studies: Investigating Early Communicative Dyads in a Non-Intrusive and In Vivo Way Epistemological Reflections Steps Toward a Relational In Vivo Methodology: An Everyday Participatory Research Checklist for Decolonizing SLT Research References 9: Speech-Language Therapy in Kenya: Trends, Challenges, and Opportunities Background Defining Communication Disorders and Speech–Language Therapy Persons with Communication Disability in Kenya: A Demographic Overview Research Questions Methods Results SLT Development Trends: Factors and Agencies Conceptualizing Communication Disability in Kenya Legal Framework for Disability in Kenya Advocacy and Professionalization of SLT Resources and Facilities for Persons with Communication Disability Challenges Facing SLT in Kenya Professional Development Legislative and Policy Frameworks Inadequate Resources and Facilities Language and Culture Access, Awareness, and Cost Conclusion Impact Future Research References 10: Obulala Na-maani: Unity is Strength Introduction Motive Problem Background Method Theoretical Background The Sustainable Development Goals Frameworks for Cultural Competence and Cultural Humility Results Description of the Projects Bahari Children’s Therapy Centre Kilima Children’s Community Centre Sukari Lessons Learned Context Is Imperative Community Partners and People Are Key Discussion Impact Considerations for the Future Conclusion References Part II: Introduction: Development and Prevention 11: Paradoxical Reflections on Bilingualism and Biliteracy: Relevance for Speech-Language Therapists in Sub-Saharan Africa Introduction The Discipline of Communication Disorders Components of Communication Theoretical Background: Bilingualism and Biliteracy Bilingualism Biliteracy Relationship Between Language and Literacy Bilingualism and Language Acquisition Bilingualism vis-à-vis Language Acquisition Bilingualism vis-à-vis Literacy Acquisition Literacy Acquisition in Non-Alphabetic Orthography Cross-Language and Cross-Script Skill Transfer in Bilingual-Biliterate Children Service Delivery for Bilingual-Biliterate Children Language Policy for Service Delivery in Bilingual Countries A Few Studies on Bilingual Teachers in India Challenges for SLTs with Bilingual-Biliterate Children Conclusion: Roadmap of Services to Bilingual-Biliterate Children in the Future References 12: Typical Phonological Development in Ugandan Language: A Case of Rukiga – A Pilot Study Introduction Theoretical Background Rukiga Language Phonology of Rukiga Consonant System Vowel System Syllable Structure Tones Speech Development Including Phonological Development General Overview Speech Development (Including Phonology) in Bantu-Speaking Children Speech Assessments Including Phonological Development Independent Analysis Relational Analysis Research Questions Methods Research Design Participants Selection Criteria Ethical Considerations Procedure Stimuli Task Administration Data Analysis Results: Phonological System-Segmental Consonant Production Younger Age Group (2;4–3;4 Years) Older Age Group (3;7–4;1 Years) Phoneme Acquisition Younger Age Group (2;4–3;4 Years) Older Age Group (3;7–4;1 Years) Patterns and Processes Younger Age Group (2;4–3;4 Years) Older Age Group (3;7–4;1 Years) Variation Younger Age Group (2;4–3;4 Years) Older Age Group (3;7–4;1 Years) Discussion and Conclusions Developmental Trajectory Cross-Linguistic Similarities and Differences Context-Sensitive Voicing Gliding Pattern The Backing and Fronting Pattern Initial Consonant Deletion Vowel and Syllable Deletion Assimilation/Reduplication Affrication of Fricatives Cluster Reduction Vowel Development Word Structure Impact of this Study Considerations for Future Work and Research References 13: The Participatory Potential of Photovoice as a Relational In Vivo Research and Training Method: The Case of a Community-based Prevention Program on Early Communication and Language Disability in Underserved Rural Sub-Saharan Africa Introduction: Presenting Photovoice as an In Vivo Research and Training Method Background of Project Implementation: Situational Context and Methodological Approach Context of the Project: The Situation of OVCs and Concepts on Facing Their Needs Theoretical Approach of Photovoice: A Participatory Method for Relational In Vivo Research Method: Evaluation of Photovoice Implementation Phases of the Photovoice Process Phase 1: “Planning” Phase 2: “Preparation” Phase 3: “Shooting Photos” Phase 4: “Selecting Significant Pictures and Printing” Phase 5: “Photo Presentation and Moderated Group Discussion” Phase 6: “Reflection and Plan for Further Action” Phase 7: “Follow-Up” (Evaluation) Phase 8: “Accompanying Research” Results: Identified Participatory Involvement of Community Participants Discussion: Successes and Limitations of the Participatory Involvement References 14: A Network of Knowledge: Participatory Development of Culturally Sensitive Information, Education, and Communication Materials for the Prevention of Communication Disability in Rural Tanzania Introduction: Generating Local Knowledge and Resources for the Prevention of Communi- cation and Language Disability Project Outline The Role of Prevention in Underserved Regions Background: Participatory Development and the Creation of Information, Education, and Communication Resources Participatory Development and Sustainability Information, Education, and Communication Materials in the Context of Communication and Language Development in SSA Methodology: Project Background and Evaluation Criteria Methodological Background of IEC Material Development in the Project Participatory Feedback Loops Project Team and Participants Methodology for the Evaluation of IEC Material Development in This Chapter Leading Question Derivation of Evaluation Criteria Definition of Result Levels Results: IEC Materials from and for the Local Communities Activity: Phases and Steps of Material Development in Participatory Feedback Loops Step 1: Suggestion of Relevant Content from a Minority World Perspective Step 2: Joint Reflection and Adaptation of Content in the Bi-cultural Project Team Step 3: Presentation of Content to the Network of Multipliers in Multiple Training Sessions Step 4: Reflection of Content in Group Discussions Step 5: Adaptation of Content in Light of the Planned Materials Step 6: Material Production and Presentation Step 7: Pilot Test of Counseling Using the Developed Materials Step 8: Follow-Up Meeting and Discussion of Changing Needs Step 9: Continuing Counseling Activities with Regular Exchange Meetings Output: Information, Education, and Communication Materials Developed in the Project Primary Materials: Flyers, Posters, and Workbook Secondary Materials: First Care Bag and ID Badge Outcome: Counseling Settings and Strategies Based on the Developed Materials Discussion: Successes, Challenges, and Indicators for Long-Term Impact and Sustainability Activity: A Structured, Participative Method of Developing Information, Education, and Communication Materials Successes Challenges Output: Culturally and Contextually Appropriate Information, Education, and Communication Materials Successes Challenges Outcome: Fruitful Counseling Strategies Based on the Developed Materials Successes Challenges Conclusions: Directions Toward Sustainability Outlook: Future Perspectives for Sub-Saharan Africa References 15: Pediatric HIV/AIDS and Communication and Developmental Disorders in South African Children Introduction Medical Background Developmental and Cognitive Manifestations of Pediatric HIV World Health Organization Early Diagnosis Oral-Motor Development and Oropharyngeal Lesions and Infections Dysphagia and Feeding Otologic and Hearing Issues Preverbal and Language Development and Disorders Neurodevelopmental Studies of South African Children Intervention Services for Children with HIV/AIDS Challenges Outlook: Tasks Ahead for Speech–Language Therapists Working with Children with HIV/AIDS Case Study References 16: Hear Africa! Improving Language Development, Education, and Participation of Children with Severe Sensorineural Hearing Loss in Tanzania Introduction Background Hearing Impairment Frequency and Clinical Presentation Classification and Causes of Hearing Impairment Audiometric Diagnostics Subjective Tests Objective Tests Impact of Hearing Impairment on Language Development, Education, and Participation Speech–Language Therapy for Hearing-Impaired Children as an Interdisciplinary Care Approach Speech–Language Therapy Technical Devices for Hearing Support: Hearing Aids and Cochlear Implants Special Needs Education Information Technology Support for Remote Service Delivery Advantages of an Interdisciplinary Approach Methodology of a Multi-centered Cross-Method Project: Hear Africa! Aims Sustainability First Steps and Outcomes Aim 1: Clinical Research and Data Collection Aim 2: Professional Education and Capacity Building Aim 3: Building Up Speech–Language Therapy and Audiological Infrastructures Including Remote Care Aim 4: Political Work and Community Empowerment Challenges The Way Forward: Digital and Remote Alternatives for Care Supply and Culturally Sensitive Adaptation References 11 Prema K. S. Rao Paradoxical Reflections on Bilingualism and Biliteracy: Relevance for Speech–Language Therapists in Sub-Saharan Africa 12 Precious Ahabwe and Sara Howard Typical Phonological Development in Ugandan Language: A Case of Rukiga—A Pilot Study 13 Kirsten Beta, Chantal Polzin, Afizai Vuliva, Julia Wu, and Ulrike M. Lüdtke The Participatory Potential of Photovoice as a Relational In Vivo Research and Training Method: The Case of a Community-Based Prevention Program on Early Communication and Language Disability in Underserved Rural Sub-Saharan Africa 14 Julia Wu, Chantal Polzin, Afizai Vuliva, Enna M. Mdemu, Kirsten Beta, Kirsten Beta, and Ulrike M. Lüdtke A Network of Knowledge: Participatory Development of Culturally Sensitive Information, Education, and Communication Materials for the Prevention of Communication Disability in Rural Tanzania 15 Elise Davis-McFarland Pediatric HIV/AIDS and Communication and Developmental Disorders in South African Children 16 Ulrike M. Lüdtke, Angelika Illg, Louisa Johanningmeier, Enica Richard, Reema Ruparellia, Lars Rumberg, Jörn Ostermann, Thomas Lenarz, and Anke Lesinski-Schiedat Hear Africa! Improving Language Development, Education, and Participation of Children with Severe Sensorineural Hearing Loss in Tanzania References Part III: Introduction: Assessment and Treatment 17: Development of Speech-Language Therapy Assessments for the Languages of South Africa Background Current Challenges The Languages of South Africa Assessment A Review of Current Assessments Description of Assessments by Language Description of Assessments by Clinical Domain Description of Assessments by Methodology Discussion and Future Plans References 18: Assessing Language in South Africa: Use of the Passive Construction Motive Theoretical Background Passive Constructions Reversible Passives Negative/Malefactive Passives Non-actional Passives Inanimate Passives Impersonal Passives Short and Long Passives Passive Constructions in Bantu Languages Spoken in South Africa Bantu Languages in South Africa Passive Constructions in Sesotho Age of Passive Acquisition in Bantu Languages Methods for Assessing Passive Constructions Comprehension Picture Selection Tasks Elicited Production Tasks Elicited Imitation Tasks Methods Research Questions Design Research Materials Comprehension Picture Selection Task Elicited Production Task Elicited Imitation Task Additional Qualitative Data Sources Pilot Testing Criteria for the Selection of Children Setting Ethical Clearance Data Analysis Results Developmental Passive Abilities in Different Assessment Tasks Elicited Imitation Task Comprehension Picture Selection Task Elicited Production Task Understanding and Production of Various Passive Categories Children’s Capabilities in Terms of Short and Long Passives Adult Verifier Protocol Service-Learning Reflection Journals Discussion: Usefulness of the Passive Construction as an Assessment Tool for Setswana-Speaking Children Impact Examination of the Passive in All Bantu Languages The Development of Appropriate Assessment Materials Elicited Imitation Elicited Imitation and Parent’s and Teacher’s Report Considerations for Future Work, Research, and Politics References 19: Methods for Devising a Standardized Language Assessment for isiZulu Preschoolers: Implications for Sub-Saharan Africa Motive Research Questions Problem Background Theoretical Motivation Importance of Standardized Language Assessment Epidemiology of Language Problems Features and Psychometric Criteria Necessary for Standardized Language Tests Structure of isiZulu Semantic Origin Agreement Subject and Object Prefixes Adjectives and Relatives Verb Morphology Varieties of isiZulu Methods Research Design Ethical Clearance Participants Research Assistants Data Collection Procedure ZERLA Materials Treatment of Data: Coding and Analysis Statistical Analysis Qualitative Analysis Results and Discussion Item Analysis Norms Impact Language Acquisition Epidemiological Implications Psychometric Results of the ZERLA Clinical Implications: Examiner Qualifications Considerations for Future Work, Research, and Politics Standardization of Assessments in Bantu Languages Rural Areas Development of a South African Multilingual and Multicultural Database References 20: Using Acoustic Phonetics in the Assessment and Treatment of Speech Disorders Introduction Background Speech–Language Therapy Services in Kenya Perceptual Assessment of Dysarthria Acoustic Assessment of Dysarthria Articulatory Gestures Research Question Methods Study Population Speech Materials Oral Diadochokinesis Test (DDK) Telephone Number Test Recordings and Data Annotation Measurements Voice Onset Time Fundamental Frequency (F0) Results Voice Onset Time Fundamental Frequency (F0) Discussion Voice Onset Time Fundamental Frequency Impact on Speech–Language Therapy Practitioners and Researchers in Sub-Saharan Africa Considerations for Future Work, Research, and Politics References 21: The Capacity to Assess and Treat Communication Disability in Kenya: Field-Based Evidence Introduction Communication Disabilities as Secondary Disabilities High Incidence of Communication Disabilities Versus Only Nascent Growth of Speech–Language Therapy Services in Kenya Theoretical Background Conceptualizing (Communication) Disabilities with Particular Focus on Kenya Assessment and Treatment of Communication Disabilities Educational Assessment and Resource Centers in Kenya Research Questions Methods Research Design Study Population Inclusion Criteria Exclusion Criteria Methods of Data Collection Interview Schedule Questionnaire Observation Schedule Document Review Data Analysis Ethical Clearance Results Sample Size Determination Training EARC Officers Teachers (SNE) SLTs Facilities, Equipment, Tools, and Resources for Assessment/Intervention Facilities Technical Equipment Assessment and Intervention Methods Cost and Funding From the Government Access Creating Awareness Easy Reach of Services Networks Discussion Facilities and Equipment Accessibility of Speech–Language Therapy Services in Different Areas and at Different Ages Professional Speech–Language Therapists and Materials Impact Considerations for Future Work, Research, and Politics References 22: Linguistically and Culturally Diverse Children with Language Disorders in Sub-Saharan Africa: Approaches to Service Delivery Motive Growing Up with Multiple Languages in Sub-Saharan Africa Language Disorders in Multilingual Children Issues in Language Intervention with Linguistically and Culturally Diverse Children with Language Disorder Approaches to Language Intervention Including Typically Developing Peers Peer-Assisted Intervention with Trained Peer Communication Partners Peer-Assisted Intervention with Untrained Peer Communication Partners Applying SLT-Mediated Interactions to Clinical Practice Action Points for Practice and Research References 23: Speech, Language, and Swallowing Difficulties in Neurology: A Sub-Saharan African Perspective Introduction Methods Neurological Disorders Central Nervous System Disorders Stroke Cerebral Palsy Parkinson’s Disease Peripheral Nervous System Disorders Myasthenia Gravis Myopathy/Myositis Combination of Central and Peripheral Nervous System Disorders Motor Neuron Disease Pitfalls Unusual Speech and Swallowing Background Mutism Hypophonia/Aphonia Stammer Vocal Tics Globus Sensation Dysphagia Culturally Determined Pitfalls Background Uvulectomy Frenulotomy Implications Discussion References 24: Active Aging with Aphasia: A Case of Kiambu County, Kenya Motive/Research Question Problem Background Theoretical Background Global Overview of Aphasia and Aged Adults Types of Aphasia Aphasia in the Sub-Saharan African Context Methods Research Design Participants and Sampling Methods Instruments Questionnaires Data Collection Data Analysis Results of the Study Demographic Information of the Respondents Sampled Respondents by Gender Age of the Respondents Severity and Type of Aphasia by Gender Ways in Which Aged Adults Receive Information and Interact with Others Without Aphasia Age Variations and the Methods Used for Receiving Information and Interacting Participation in the Community Economic Determinants and Their Influence on the Participants Discussion Gender and Aphasia Ways in Which Aged Adults Receive Information and Interact with Others Without Aphasia by Age Group Participation in the Community Economic Factors Influencing Persons with Aphasia Considerations for Future Work, Research, and Politics Improving the Well-Being of Aging by the Government Future Research References 25: Development of a Mobile SLT Clinic: A Case of East Africa Background: Lack of SLT Service Delivery in Rural SSA The General Concept of Mobile Clinics for Underserved Rural Areas in Majority World Countries Development of a Model Mobile SLT Clinic for the Rural East African Context Potential Outcomes and Functions Adapted Methodology Requirements for Design and Setup of SLT Clinic Conceptual Setup of a Mobile SLT Clinic Conceptual Areas Clinical Guidelines: ASHA Manuals for Different Communication, Swallowing, and Hearing Disorders Equipment Setup of a Mobile SLT Clinic General Setup for Mobile SLT Service Delivery Sustainability of the Mobile SLT Clinics Policy Guidelines Reflection and Recommendation Mobile Clinic Approach as an Outcome of an International Development Cooperation Mobile SLT Clinics as a Promising CBR Approach for Underserved (Rural) Communities in SSA References 26: The Organization of Cochlear Implant Programs in Tanzania: Assessment of Needs and Challenges Introduction Theoretical Background Pathophysiology Therapy Options Hearing Systems Outcome in Terms of Speech and Education Methods Universal Newborn Hearing Screening Hearing Aid Fitting Observed by Speech-Language Therapists, Specialized in Hearing Impairment Complete Audiological and Radiological Diagnostic Procedures, Independent from Age Cochlear Implant Indication Cochlear Implant Surgery Cochlear Implant Basic Speech-Language Therapy Lifelong Care Discussion Socioeconomic Aspects Hearing Disorders and Hearing Systems Development of a Countrywide Strategy Challenges Cochlear Implant Therapy Conclusion References 17 Michelle Pascoe and Shajila Singh Development of Speech–Language Therapy Assessments for the Languages of South Africa 18 Mellissa Bortz Assessing Language in South Africa: Use of the Passive Construction 19 Mellissa Bortz Methods for Devising a Standardized Language Assessment for isiZulu Preschoolers: Implications for Sub-Saharan Africa 20 Mathew Kinyua Karia Using Acoustic Phonetics in the Assessment and Treatment of Speech Disorders 21 Phyllis W. Mwangi and Gatitu Kiguru The Capacity to Assess and Treat Communication Disability in Kenya: Field-Based Evidence 22 Ulla Licandro, Tom Abuom, and Dennis Omari Linguistically and Culturally Diverse Children with Language Disorders in Sub-Saharan Africa: Approaches to Service Delivery 23 Ines Said, Anke Bulsink, and Marieke Dekker Speech, Language, and Swallowing Difficulties in Neurology: A Sub-Saharan African Perspective 24 Stephen Musila Nzoka, Elizabeth Wangui Kamau, Paul Kamau Mbugua, Molly Merrab Ogalloh, and Joyce Achieng Ogogo Active Aging with Aphasia: A Case of Kiambu County, (Kenya) 25 Lawrence Eron, Nelly Otube, Mathew Karia, Edward Kija, Becky Isanda, Charles Mugisa, Stuart Robert Oyesigye, Marlene Küthe, Rieke Meinen, Steffen Gremmelt, Geoffrey Karugu, and Ulrike M. Lüdtke Development of a Mobile SLT Clinic: An Example from East Africa 26 Anke Lesinski-Schiedat, Enica Richard, Rachel Mkumbo, Rukiya A. Mohamed, and Angelika Illg The Organization of Cochlear Implant Programs in Tanzania: Assessment of Needs and Challenges References Part IV: Introduction: Inclusion 27: Communication, Disability, and Human Rights: Exploring the Role of the Sustainable Development Goals Introduction Methods SDG 3: Good Health and Well-Being Scoping Review of Children’s Pain Vocabulary: Implications for AAC (Johnson et al., 2017b) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation An Exploration of Pain-Related Vocabulary: Implications for AAC Use with Children (Johnson et al., 2016) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation Nurses’ Perspectives Towards Patient Communication Using a Low-Technology Communication Board in an Intensive Care Setting (Gropp et al., 2019) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation Message Banking: Perceptions of Persons with Motor Neuron Disease, Their Significant Others, and Clinicians (Oosthuizen et al., 2018) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation Impact of the Presented Studies on SDG 3: Good Health and Well-Being SDG 4: Inclusive and Quality Education and Lifelong Learning The Challenges of Realizing Inclusive Education in South Africa (Donohue & Bornman, 2014) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation South African Teachers’ Attitudes Toward the Inclusion of Learners with Different Abilities in Mainstream Classrooms (Donohue & Bornman, 2015) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation South African Teachers’ Attitudes Toward Learners with Barriers to Learning: Attention-Deficit and Hyperactivity Disorder and Little or No Functional Speech (Bornman & Donohue, 2013) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation The Awareness of Primary Caregivers in South Africa of the Human Rights of Their Children with Intellectual Disabilities (Huus et al., 2016) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation The Effect of an Aided Language Stimulation Programme on Subtraction Word-Problem Solving for Children with Intellectual Disabilities: A Preliminary Study (Naudé et al., 2020) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation Comparing Two Response Modes in a Mathematics Test for Learners in Foundation Phase with Severe Physical Disabilities: A South African Example (Bornman et al., 2016) Introduction Aim of the Study Research Methodology Results Limitations and Future Research Implications for Implementation Impact of the Presented Studies on SDG 4: Quality Education and Lifelong Learning Conclusion References 28: Access to Early Childhood Development and Inclusive Education Services for Refugee Children with Communication Disability in Rwanda Introduction Background Refugees in Rwanda Disability and Humanitarian Response ECD and Education for Children with Disabilities in Sub-Saharan Africa Education Services Early Childhood Development Services Services for Children with Disabilities Inclusion in ECD and Education for Refugee Children ECD and Education Services for Refugee Children with Disabilities in Rwanda Refugees with Communication Disability: Access to Services Listening to the People Motive Aims, Objectives, and Research Methods Ethical Considerations Potential Impact of this Research Considerations for Future Developments Summary and Conclusion References 29: Inclusion of Children with Social Communication Disorder in Kenya Introduction Motive and Research Question Theoretical Background Global Overview of Social Communication Disorder Social Communication Disorder and Education Primary Education in Africa Primary Education in Kenya Methods Results Literature Related to Social Communication Disorder in  Sub-Saharan Africa Characteristics of Social Communication Disorder in Sub-Saharan Africa Perception of Causes of Social Communication Disorder in  Sub-Saharan Africa Supernatural Causes Biomedical Causes Inclusion of Children with Social Communication Disorder in Schools in Kenya Intervention Measures Discussion Characteristics of Social Communication Disorder Causes of Social Communication Disorder Inclusion of Learners with Social Communication Disorder in Kenyan Schools Intervention Measures and Educational Accommodations Impacts of the Study on Persons with Communicative Disabilities in Sub-Saharan Africa Considerations for Future Work, Research, and Politics References 30: Promoting Social Communication: Teaching Strategies for Students with Autism Spectrum Disorder in East Africa Introduction Teaching Students with Autism Spectrum Disorder in Tanzania Theoretical Background Challenges in Assessing Children for Autism in Eastern Africa The Role of the Community in Teaching Students with Autism Spectrum Disorder Didactic Methods Collaborative Strategic Reading to Provide Opportunities for Communication in the Classroom Communication Strategies for Children with ASD Who Are Minimally Verbal or Nonverbal Using Social Stories, Modeling, and Meaningful Activities to Improve Social Communication in Children with ASD Music Combined with Social Narratives to Address Communication Skills Conclusions References 31: Navigating Communication Difficulties Faced by Children with Autism Spectrum Disorder: Evidence From Kenya Introduction Problem Background Theoretical Background Motive Methods Participant Selection Data Collection Data Analysis Ethical Clearance Results The Number of Children with Autism Spectrum Disorder in the Sampled Schools The Number, Qualifications, and Experience of Teachers of Children with Autism Spectrum Disorder in the Schools Support Given to Teachers of Children with Autism Spectrum Disorder Challenges of Teaching Children with Autism Spectrum Disorder Communication Difficulties Faced by Children with Autism Spectrum Disorder Countering Communicative Difficulties The Effectiveness of These Strategies Discussion Communicative Difficulties That Children with Autism Spectrum Disorder Face Strategies Used to Help Children with Autism Spectrum Disorder Navigate Communication Difficulties Individualized Educational Program Peer Learning Information and Communications Technology Multimedia Approach Challenges Faced in the Teaching of Children with Autism Spectrum Disorder Suggestions on Areas of Improvement The Impact of Interventions Used to Help Children with Autism Spectrum Disorder Navigate Communication Difficulties Considerations for Future Work, Research, and Politics References 32: Using Augmentative and Alternative Communication Strategies in Schools in Namibia Introduction Understanding the Namibian School Context Educational Opportunities in Namibia Challenges Within the Namibian Educational Context Classroom Size and Composition Lack of Teaching Assistants Lack of Trained Teachers in Special Education Limited Special Schools/Lack of Special Schools in Rural Areas Language Barriers/Suitability of the Educational Program Opportunity Barriers An Introduction to Augmentative and Alternative Communication What Is Augmentative and Alternative Communication? Benefits of Augmentative and Alternative Communication Within the School Context Augmentative and Alternative Communication Systems and Strategies Unaided Systems Five Steps to Teaching Keyword Signing Aided Systems Conclusions References 33: Critical Components in the Inclusion of Learners with Cerebral Palsy and Associated Communication Disorders Introduction: Cerebral Palsy Background: Inclusion of Learners with Cerebral Palsy in Sub-Saharan Africa Research Questions Method Desk Review Strategy Selection of Studies Exclusion Criteria Results The Learning Environment Attitude Toward Learners with Cerebral Palsy Therapy Augmentative and Alternative Communication Discussion Learning Environment Attitudes Toward Learners with Cerebral Palsy Therapy Augmentative and Alternative Communication Considerations for Future Work, Research, and Politics References Sampled Reviewed Papers 34: Stuttering’s Hidden Side: The Need for an Empathetic School Climate for Disfluent School-Age Children in Public Primary Schools in Kakamega, Kenya Introduction Problem Background: Childhood Stuttering Characteristics Psychosocial Challenges Causes of Disfluent Speech Genetics Developmental Factors Environmental Factors Prevalence and Incidence School-Age Children Who Stutter: Psychosocial and Academic Challenges Psychosocial Effects Bullying and Teasing Academic Impact of Stuttering Research Questions Methods Research Design Participants Instruments Data Collection Data Analysis Results Causes of Stuttering Disorder as Perceived by Children Who Stutter Stuttering Disorder as Perceived by Teachers Stuttering Prevalence as Reported by Teachers Effect of the Disorder as Reported by Teachers Nature of Psychological Experiences Related to Stuttering as Perceived by Children School-Age Children Who Stutter: Psychosocial Effects and Academic Challenges Coping Strategies Discussion Causes of Stuttering as Perceived by Children Who Stutter Stuttering Disorder as Perceived by Teachers Nature of Psychological Experiences Related to Stuttering as Perceived by Children School-Age Children Who Stutter: Perceptions Related to Psychosocial Effects and Academic Challenges Coping Strategies Impact Study Limitations and Considerations for Future Work, Research, and Politics References 35: Ugandan Sign Language Interpretation Services for Learners with Hearing Impairment in Inclusive Secondary Schools in Uganda: Challenges and Successes Introduction Background Sign Language Interpreting Universal Secondary Education Teacher and Sign Language Interpreter Training Bilingualism and Language Structure Motive and Objectives of the Study Methodology Design and Setting Sampling Procedures Participants Instruments Data Collection Formal Interviews Participant Observation Focus Group Discussions Data Analysis Ethical Considerations, Validity, and Reliability Results Challenges Faced by Sign Language Interpreters During Their Work in an Inclusive School in Uganda Challenges Arising from Internal Factors Challenges Arising from Learners Challenges Arising from Teachers and School Administration Challenges Arising from the Environment and Context Influence of These Challenges on the Work of the Sign Language Interpreters in an Inclusive Secondary School in Uganda Coping Strategies to Minimize the Challenges Encountered by the Interpreters in Inclusive Settings Discussion Challenges Faced by Sign Language Interpreters During Their Work in an Inclusive School in Uganda Challenges Arising from Internal Factors Challenges Arising from Learners Challenges Arising from Teachers and School Administration Challenges Arising from the Environment and Context Challenges Faced by Sign Language Interpreters and the Influence on Their Work in an Inclusive Secondary School in Uganda Coping Strategies to Minimize the Challenges Encountered by the Interpreters in Inclusive Settings Conclusions, Impact, and Considerations for Future Work References Epilogue: Speech-Language Therapy in Sub-Saharan Africa Revisited: Visions for Theory, Training, and Practice 27 Juan Bornman Communication, Disability and Human Rights: Exploring the Role of the Sustainable Development Goals 28 Helen Barrett, Julie Marshall, Juliet Goldbart, and Nathalie Bussien Access to Early Childhood Development and Inclusive Education Services for Refugee Children with Communication Disability in Rwanda 29 Joyce Achieng Ogogo, Molly Merrab Ogalloh, and Beatrice Bunyasi Awori Inclusion of Children with Social Communication Disorder in Kenya 30 Diane Rodríguez and Geraldine Arquer Haddock Promoting Social Communication: Teaching Strategies for Students with Autism Spectrum Disorder in East Africa 31 Martin C. Njoroge and Augustus Nyakundi Navigating Communication Difficulties Faced by Children with Autism Spectrum Disorder: Evidence from Kenya 32 Juan Bornman, Helindi Gouws, Enid Moolman, Anna Robberts, and Kerstin Tönsing Using Augmentative and Alternative Communication Strategies in Schools in Namibia 33 Nelly Were Otube and Mathew Kinyua Karia Critical Components in the Inclusion of Learners with Cerebral Palsy and Associated Communication Disorders 34 Atieno Rose Opiyo Stuttering’s Hidden Side: The Need for an Empathetic School Climate for Disfluent School-Age Children in Public Primary Schools in Kakamega, Kenya 35 Julius Patrick Omugur Sign Language Interpretation Services for Learners with Hearing Impairment in Inclusive Secondary Schools in Uganda: Challenges and Successes References Index