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Background: Rehabilitation services are scarce in low-income countries, where under-representation of some specialist professions has led to the role extension of others. An example of this can be found in Kilifi in Kenya where the role of speech and language therapy has been taken on by occupational therapists and teachers. Aims: To investigate the communication practices used by these professional groups to support children with complex communication needs in a rural part of Kenya and to explore the ways in which this might be seen to facilitate or obstruct improved communication by asking the following questions: What are the critical features of interactional discourse in practitioner-child dyads with caregiver-child dyads providing a natural comparison? What communicative modalities and practice techniques are invoked? And how does this information relate to extending professional roles? Methods & Procedures: An in-depth, descriptive study of a case series was conducted in a school for deaf children and the occupational therapy department of a district general hospital. A mixed methodology was used involving naturalistic observation and applied linguistics analysis. A convenience sample was established comprising six practitioner-child dyads assigned to partnership types: (A) three children with hearing impairment and their teachers; and (B) three children with cerebral palsy and their occupational therapists. As a natural comparator, the same three children in B were also observed with their mothers (partnership type C). Dyadic interaction was video recorded on three occasions. The video data were sampled, transcribed into standard orthography and translated. Codes were applied to determine turn structure, linguistic move types and communicative modalities. Sequential analysis was conducted on the move types. Outcomes & Results: Partnership type A dyads showed a fairly even turn distribution between teacher and child. A common pattern was teacher-initiated "Instruct" and "Model/Prompt", followed by child response in the form of an "Action". The most frequently used modality was "Sound Production" and "Hands-on-Articulators", which corresponded to articulation drill practice. Partnership type B dyads revealed a tendency towards adult domination of turns. The majority of adult-initiated moves required no response from the child. The practice technique "Hands-on-Articulators" involved manipulating the oral musculature of the child. Partnership type C dyads showed resonances of type B dyads, although focused more on "Motor-Action" in relation to task performance. Conclusions & Implications: The assignment of speech and language therapy duties to teachers and occupational therapists has resulted in suboptimal practice for children with complex communication needs.

Background: There is an increasing demand for the assessment of speech and language in clinical and research situations in countries where there are few assessment resources. Due to the nature of cultural variation and the potential for cultural bias, new assessment tools need to be developed or existing tools require adaptation. However, there are few guidelines on how to develop "culturally appropriate" assessment tools. Aims: To review the literature on cross-cultural assessment in order to identify the major issues in the development and adaptation of speech and language assessments for children and to illustrate these issues with practical examples from our own research programme in Kenya. Methods & Procedures: Five broad categories pertaining to cross-cultural assessment development were identified: the influence of culture on performance, familiarity with the testing situation, the effect of formal education, language issues and picture recognition. It was outlined how some of these issues were addressed in our research. The results of the review were integrated to produce a list of ten guidelines highlighting the importance of collaboration with mother tongue speakers; piloting; familiar assessment materials; assessment location; and practice items and prompts. Conclusions: There are few clinicians and assessors, whether in the UK or abroad, who do not assess or treat children from a culture different to their own. Awareness of cultural variation and bias and cooperative efforts to develop and administer culturally appropriate assessment tools are the foundation of effective, valid treatment programmes.

Cultural narratives on disability have received much attention over the past few decades. In contexts of poverty, limited information and everyday challenges associated with having, or caring for someone with a disability, different understandings have emerged. A project was set up to promote disability awareness in neighborhood communities in a rural part of Kenya, using a process of reflection and education. This paper reports on the first aspect–reflection. The aim was to investigate local understanding of disability as a co-constructed concept. The research questions were: 1. What cultural beliefs shape local understanding of disability? 2. What challenges are perceived to be associated with disability? A phenomenological approach was adopted. Focus group discussions were conducted with twenty-one community groups involving 263 participants and audio-recorded. The data were transcribed and thematic analysis was carried out. Visual maps were created to illustrate any interconnections, before establishing the final conclusions. Local beliefs attributed disability to: human transgression of social conventions, particularly concerning inappropriate family relations, which invoked a curse; supernatural forces affecting the child; the will of God; unexplained events; and biomedical factors. Challenges associated with disability related to the burden of caregiving and perceived barriers to inclusion, with stress as a shared bi-product. Local understanding of disability in this rural part of Kenya demonstrated overlapping explanations and plurality of beliefs. Two possible interpretations are offered. Firstly, oscillation between explanatory lines demonstrated instability, affecting broader acceptance of disability. Secondly, and more positively, in the face of challenges, the desire to make sense of the existing situation, reflected a healthy pluralism. [ABSTRACT FROM AUTHOR]

This study sought to adapt a battery of Western speech and language assessment tools to a rural Kenyan setting. The tool was developed for children whose first language was KiGiryama, a Bantu language. A total of 539 Kenyan children (males=271, females=268, ethnicity=100%Kigiryama) were recruited. Data were initially collected from 52 children (pilot assessments), and then from a larger group of 487 children (152 cerebral malaria, 156 severe malaria and seizures, 179 unexposed). The language assessments were based upon the Content, Form and Use (C/F/U) model. The assessment was based upon the adapted versions of the Peabody Picture Vocabulary Test, Test for the Reception of Grammar, Renfrew Action Picture Test, Pragmatics Profile of Everyday Communication Skills in Children, Test of Word Finding and language specific tests of lexical semantics, higher level language. Preliminary measures of construct validity suggested that the theoretical assumptions behind the construction of the assessments were appropriate and re-test and inter-rater reliability scores were acceptable. These findings illustrate the potential to adapt Western speech and language assessments in other languages and settings, particularly those in which there is a paucity of standardised tools. [ABSTRACT FROM AUTHOR]