Perspectives of rehabilitation professionals on assistive technology provision to young children in South Africa: a national survey.

PURPOSE: Various factors influence the selection of assistive technology for young children within a context with limited resources, such as South Africa. Rehabilitation professionals are required to weigh up different factors as part of their professional reasoning process when making assistive technology (AT) selections. Insight into the perceived influence of different factors may assist in understanding how professionals make decisions about AT in this context. MATERIALS AND METHODS: An online survey with questions designed using best-worst scaling was distributed to rehabilitation professionals throughout South Africa. Factors influencing assistive technology selection included in the best-worst survey were identified in previous phases of a larger project. A total of n = 451 rehabilitation professionals completed the survey by selecting the factors that were most and least influential on their assistive technology provision. RESULTS: Results of the survey were obtained by calculating the number of times each factor was selected as most influential across the entire sample, and across all questions, enabling the researchers to sort the items in terms of the frequency of selection. CONCLUSIONS: Even though the rehabilitation professionals that participated in the study provide services in a context with limited resources, assessment and factors pertaining to the assistive technology itself were generally perceived to be of greater influence than environmental factors. It is recommended that these factors be reflected in frameworks and models of AT selection.IMPLICATIONS FOR REHABILITATIONThe family's ability to support the implementation of AT is an important resource that is perceived to influence the selection of AT by an RP.Insight into the mind-set of professionals that are used to selecting AT within settings with limited resources may provide RPs in well-resourced contexts with guidance on how to do more, with less.RPs should aim to determine child preference and attitude towards AT during the AT selection process.RPs should be aware of their own influence on AT selection. Existing AT Selection models should be adapted to clearly reflect the influence of the recommending professional.

Children in South Africa with and without Intellectual Disabilities' Rating of Their Frequency of Participation in Everyday Activities.

In a low-and middle-income country (LMIC) such as South Africa, not much is known about how children with intellectual disabilities (ID) participate in everyday activities, as no studies to date have compared their participation to peers without ID from the same background. Using a newly developed, contextually valid measure of participation, Picture my Participation (PmP), 106 children with (73) and without ID (33), rated their frequency of participation in activities of daily living. Previous international research has established that children with ID tend to participate less frequently than children without ID in everyday activities outside of the school setting. However, much of this research is based on proxy ratings from caregivers rather than children with ID themselves. There is a growing body of evidence that suggests children with disabilities have uniquely different views of their own participation than their caregivers. The existing research evidence is also delimited to studies conducted predominantly in high income contexts (HICSs). Since it is universally acknowledged that participation patterns are affected by the environment, it is important to evaluate the generalizability of the current evidence to LMICs. The current study found that there were many similar patterns of participation between the two groups although significant differences were noted in social, community, leisure and self-care activities. We compare these results to findings from studies conducted in HICs and find that there are similarities but also differences across contexts. This study highlights the importance of gaining a child's perspective of participation and understanding how intellectual disability can affect participation relative to peers without ID in LMICS.

Multilingualism and augmentative and alternative communication in South Africa - Exploring the views of persons with complex communication needs.

BACKGROUND: Augmentative and alternative communication (AAC) can assist persons with complex communication needs to communicate competently with a variety of communication partners in a variety of contexts. However, AAC systems and intervention often do not take multilingual aspects into consideration. OBJECTIVE: This small-scale exploratory study had three aims, namely: (1) to describe the self-reported language skills of multilingual South African adults using AAC, (2) to describe the languages and communication modalities they used in interaction and (3) to obtain their views regarding access to various languages. METHODS: Twenty-seven adults using AAC were recruited via an empowerment programme, as well as an email list for persons interested in AAC, and provided responses to a questionnaire. To compensate for access and written language challenges, the questionnaire was administered with help and/or as a face-to-face interview where needed. Responses were analysed using mostly descriptive statistics. RESULTS: Participants generally could not express themselves in all the languages they understood and were regularly exposed to. Speech-generating devices specifically gave access almost exclusively to English. Participants expressed a desire to increase their expressive language repertoire, and mentioned both limitations of communication technology as well as their own literacy skills as barriers to overcome in this regard. CONCLUSION: In order for multilingual South African adults using AAC to express themselves in multiple languages, appropriate AAC systems and interventions as well as literacy learning opportunities need to be developed and provided. KEYWORDS: adult, augmentative and alternative communication; multilingualism; complex communication needs, language and communication skills; self-report, views.

Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals.

Selection of assistive technology for young children is a complex process. Within a context with limited resources, such as South Africa, research is needed to determine the factors influencing the assistive technology selection process, as these could ultimately either facilitate or hinder the availability and accessibility of affordable, adaptable, acceptable, and high quality assistive technology for this age group. METHOD: Two asynchronous online focus groups were conducted with 16 rehabilitation professionals to identify the factors they perceived to influence the selection and provision of assistive technology to young children within the South African context. DATA ANALYSIS: A process of deductive thematic analysis was followed by inductive analysis of the data. Components of the Assistive Technology Device Selection Framework were used as themes to guide the deductive analysis, followed by inductive analysis to create subthemes. DISCUSSION: The important role of the professional was highlighted in negotiating all the factors to consider in the assistive technology selection and provision process. Adaptation of the Assistive Technology Device Selection Framework is suggested in order to facilitate application to low resourced contexts, such as South Africa. Implications for rehabilitation Assistive technology selection is a complex process with factors pertaining to the users (child and family) of the assistive technology, as well as the rehabilitation professional recommending the assistive technology influencing the process. Although it may be an important factor, the availability of financial resources to purchase assistive technology is not the only determining factor in providing appropriate assistive technology to young children in contexts with limited resources. Formalized support, such as reflective supervision or mentorship programs should be facilitated and utilized by recommending professionals. Home and school visits during assessment ensure a good match between assistive technology and users within the particular context. Facilitating the availability of assistive technology for trial during assessment and/or for a period afterwards will increase the likelihood that appropriate recommendations for assistive technology are made.

AAC services for multilingual populations: South African service provider perspectives.

BACKGROUND: In South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these. AIMS: The study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds. METHODS & PROCEDURES: Fifteen AAC service providers were purposefully chosen to participate in one of three focus groups - two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. OUTCOMES & RESULTS: Four overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides' orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services. CONCLUSIONS & IMPLICATIONS: Although service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers' language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics.

Factors Perceived by Rehabilitation Professionals to Influence the Provision of Assistive Technology to Children: A Systematic Review.

BACKGROUND: The use of Assistive Technology (AT) by children with disabilities has been associated with significant development and improvement in outcomes within all spheres of life. However, AT is often underutilized. Appropriate selection of AT by rehabilitation professionals could improve the satisfaction of the user and their family with their AT. DATA SOURCES: A systematic search identified six studies that investigate the factors that occupational therapists, physiotherapists, as well as speech and language pathologists perceive to influence their provision of AT to children. Study appraisal: Two qualitative and four quantitative articles were identified. Both article types were appraised using the Mixed Methods Appraisal tool (Pluye et al., 2011 ). Synthesis method: A process of deductive thematic analysis by using themes from the Assistive Technology Device Selection Framework (Scherer et al., 2007 ), was followed by inductive thematic analysis to uncover subthemes. Data from all six articles are synthesized to provide a view of factors that are perceived to influence AT selection. Implications of findings: Within a family-centered perspective, both family and child expectations and preferences should be considered. Professionals should consider the influence of their own preferences and knowledge on the AT they recommend.

Eye gaze technology: a South African perspective.

PURPOSE: Based on the bioecological model by Bronfenbrenner, this paper will provide a broad perspective on factors that need to be taken into account in order to facilitate communication and participation in preliterate children making use of electronic Augmentative and Alternative Communication (AAC) systems accessed through eye gaze. METHOD: Two case studies of children who have been provided with the technology described are presented. The case studies were analysed using the four nested systems of the ecology as a framework to describe not only the environment, but also the processes and interactions between the persons and their context. RESULTS: Risk and opportunity factors are evident at all levels of the ecology. CONCLUSIONS: While a good fit between the person and the technology is an essential starting point, additional factors pertaining to the partner, the immediate environment as well as meso-, exo- and macrosystemic issues (such as societal attitudes and funding sources) have a significant influence on benefits derived. In resource-limited environments, the lack of support at more distal levels of the ecology (meso-, exo- and marosystemic levels) seems to be a factor that differentiates these environments from more resourced ones. Implications for Rehabilitation Within resource-limited environments lack of support from wider ecological systems pose a risk to the implementation of eye gaze technology. Attempts to improve collaboration between all role players could provide the opportunity for the establishment of an integrated plan for intervention and set the stage for information sharing and multiskilling between role players. Intervention should not only be aimed at addressing the needs of the individual client and their family, but also focus on building community capacity that could provide support to others.