Effect of premature infant oral motor intervention [PIOMI] combined with music therapy on feeding progression of preterm infants: a randomized control trial.

Prematurity may produce long-term complications in the physical and cognitive development of infants. There is a need for interventions that can improve feeding and reduce the length of NICU stay and separation time between the infant and mother. This study aimed to explore the clinical effect of premature infant oral motor intervention [PIOMI] combined with music therapy [MT] on feeding progression in premature infants.Premature infants with gestational ages between 26 and 30 weeks were included in the study. Fifty-two participants were randomly divided into intervention and control groups. All infants received PIOMI, and the intervention group received additional MT. The participants of the two groups were compared based on weight gain, feeding progression, Preterm Oral Feeding Readiness Scale [POFRAS], milk volume, and length of hospitalization. The data were analyzed using independent sample t-tests, covariance tests, and repeated measure ANOVA used to compare three group means.The intervention group reached independent oral feeding 8 days earlier [P = .018] than the control group. Length of hospitalization was 6 days shorter [P = .224] for the intervention group, and the mean volume of milk on the 10th day was 215.38 ± 56.4 in the intervention group and 155.69 ± 68.9 in the control group, respectively [P = .001]. The mean score of the POFRAS scale on the 10th day was 28.65 ± 3.0 in the intervention groups and 20.96 ± 3.3 in the control groups, retrospectively [P = .001]. There was no difference in weight gain between the two groups [P = .522].Conclusion: PIOMI combined with MT was effective for the feeding progression of premature infants, and infants who received both these interventions were discharged sooner than control infants. Thus, MT should be considered part of feeding interventions for preterm infants with gestational ages between 26 and 30 weeks.Trial registration: Clinical trial registration number: IRCT20210502051155N1 on 18/9/2021 What is Known -- What is New: • There is numerous study about the eff ect of music therapy or oral motor interventi on. However, premature Infants havenot been yet studied to determine whether music therapy and oral motor interventi ons may synergize to aid their feedingprogression.

Phonological development in first language Laki-speaking children aged 3 to 5 years: A pilot study.

PURPOSE: To date there are no studies of speech sound acquisition in Laki, a language spoken in western regions of Iran. Thus, we set out a pilot study to investigate the speech development of 56 first language Laki-speaking children (aged 3-5 years). METHOD: Single words were elicited through a picture naming test specifically developed for this study. After recording and transcribing of speech samples, percentage of consonants correct (PCC), percentage of vowels correct (PVC), and proportion of whole word proximity (PWP) were documented in four age groups (36-41, 42-47, 48-53, and 54-59 months) and both genders. Children's phonetic inventories and consonant and vowel accuracy were also described. RESULT: All the sounds were considered as emerging by 53 months of age. For speech sound accuracy, all the speech sounds except /ɢ, z, ŋ, ʒ/ were mastered by 5 years. The effect of age on PCC values was significant. Also, age groups showed significant differences for PWP but were not significant for PVC. Boys and girls did not differ for PCC, PVC, and PWP values. CONCLUSION: From a theoretical perspective, findings contribute to theories about phonological acquisition in general and will enable crosslinguistic comparisons. From an applied standpoint, language-specific characteristics are identified, which are much needed for clinical practice with Laki-speaking children.

Speech sound acquisition in Azeri Turkish-speaking children in Iran.

BACKGROUND: Currently no data exist on the acquisition of speech sounds in Azeri Turkish-speaking children in Iran. This investigation was conducted to describe phonological development in Azeri Turkish-speaking children. METHODS: A total of 120 typically developing Azeri Turkish-speaking children within the age range of 3;0 to 4;11 years were recruited. They were asked to name pictures in the Azeri Turkish Speech Test and their productions were analyzed to determine consonant acquisition, Percentage of Consonants Correct (PCC), Percentage of Vowels Correct (PVC), and Whole Word Proximity (WWP) according to sex and age. In addition, PCC values in terms of consonant position in the syllable (syllable-initial and syllable-final), and manner of articulation were calculated. RESULTS: For consonant acquisition, they mastered all consonants except [d, dÍ¡z, tÍ¡s, ʒ, v, ɟ] by 4;11 years of age. PCC values increased with increasing age (H(3)= 67.212, p <0.001). In terms of manner of articulation, PCC showed that nasals were most accurately produced and trill sound least accurate. The effect of sex on PCC values was not significant U (Nmales =60, Nfemales =60)= 1686.5, z = -0.600, p=.54). WWP values were also found to increase in older children H(3)=46.94, p<.001). Similarly, the effect of sex on WWP values was not significant U (Nmales =60, Nfemales =60)= 1782.5, z = -0.09, p=.92). CONCLUSIONS: Children acquiring speech sounds in the Azeri Turkish language show some similar tendencies to children acquiring other languages but are also different. Findings of the present research describe phonological development in Azeri Turkish-speaking children, which has not been documented before.

Phonological acquisition in 3- to 5-year-old Kurdish-Speaking children in Iran.

BACKGROUND: given the lack of sufficient information and research about phonological acquisition in the Kurdish language, the aim of this study was to examine phonological acquisition in typically developing Kurdish-speaking children. Three analyses were performed: (1) the age of customary, acquisition and mastery production of Kurdish consonants; (2) phonological accuracy and the age of phonological pattern suppression; and (3) effect of age and sex on speech sound acquisition. METHODS: this research assessed 120 monolingual Kurdish-speaking children aged 3;0 to 5;0 years. The participants were selected randomly from the health center of Bukan city, Iran. Acquisition of 29 Kurdish consonants was assessed using the Kurdish Speech Test. FINDINGS: results found that Kurdish-speaking children had acquired all the vowels before 3;0 and all the consonants in the three positions of initial, medial and final up to 4;6 years old, with the exception of /ʤ/ in initial position, /ɣ/ in medial position and /ʒ/, /z/, /ɡ/, /ɣ/ in final position. Consonant production in initial position was more accurate than in medial and final positions. The accuracy of Kurdish vowels and consonants improves with increasing age as phonological patterns decrease. There was no significant sex difference within the age groups; however, overall, a statistically significant difference was noted for fricative production and for production of word final consonants in the older groups with females outperforming males. CONCLUSIONS: the present study is the first investigation of speech sound acquisition in Kurdish-speaking children. Knowledge of typical speech sound acquisition provides a basis for speech-language pathologists working with Kurdish-speaking children to differentiate children with typical development from those with speech delays and speech sound disorders.

Sociocultural Factors Affecting Vocabulary Development in Young South African Children.

Sociocultural influences on the development of child language skills have been widely studied, but the majority of the research findings were generated in Northern contexts. The current crosslinguistic, multisite study is the first of its kind in South Africa, considering the influence of a range of individual and sociocultural factors on expressive vocabulary size of young children. Caregivers of toddlers aged 16 to 32 months acquiring Afrikaans (n = 110), isiXhosa (n = 115), South African English (n = 105), or Xitsonga (n = 98) as home language completed a family background questionnaire and the MacArthur-Bates Communicative Development Inventory (CDI) about their children. Based on a revised version of Bronfenbrenner's (1977) ecological systems theory, information was obtained from the family background questionnaire on individual factors (the child's age and sex), microsystem-related factors (the number of other children and number of adults in the child's household, maternal level of education, and SES), and exosystem-related factors (home language and geographic area, namely rural or urban). All sociocultural and individual factors combined explained 25% of the variance in expressive vocabulary size. Partial correlations between these sociocultural factors and the toddlers' expressive vocabulary scores on 10 semantic domains yielded important insights into the impact of geographic area on the nature and size of children's expressive vocabulary. Unlike in previous studies, maternal level of education and SES did not play a significant role in predicting children's expressive vocabulary scores. These results indicate that there exists an interplay of sociocultural and individual influences on vocabulary development that requires a more complex ecological model of language development to understand the interaction between various sociocultural factors in diverse contexts.

Health resources for South Africa: A scoping review.

BACKGROUND: Healthcare is more effective when people are treated in their own language with respect for their culture. However, information about the availability and nature of health resources is fragmented and studies suggest few assessments, screening tools, or other health resources in many of South Africa's languages. AIM: This scoping review identified health resources written in the eleven official languages of South Africa for health professionals to use for patient assessment and management. METH ODS: Databases were searched and information about resources collated and analysed. RESULTS: Two-hundred-and-fifty two unique resources were found (444 items, if different language versions of the same resource were counted separately). All official languages were represented. The most widely used (excluding English) were Afrikaans (118 resources), IsiXhosa (80) and IsiZulu (55). CONCLUSION: Development of more health resources and critical evaluation of their validity and reliability remain important. This study contributes a preliminary database for South African health professionals, ultimately promoting improved service delivery.

Transcribing and Transforming: Towards Inclusive, Multilingual Child Speech Training for South African Speech-Language Therapy Students.

OBJECTIVE: Phonetic transcription may encourage engagement with language diversity in multilingual settings. We describe how transcription can be used to help South African speech-language therapy (SLT) students engage with the many languages spoken in their country. Objectives were to describe (a) the local context, (b) transcription in the curriculum, and (c) participant observations from staff facilitating the Child Speech course. METHOD AND MATERIALS: A case study approach was used to investigate teaching and learning transcription in a real-life context, the undergraduate second-year Child Speech course in an SLT programme. Document review of curriculum and university documents, national policies, and international best practice guidelines took place, together with participant observations from facilitators. RESULTS: We describe 4 activities that show how transcription skills can be developed while introducing local languages into the curriculum. These activities give students the opportunity to develop transcription skills for a range of local languages, while at the same time encouraging them to learn the languages, construct communal resources, and promote a problem-solving attitude to their practice. CONCLUSION: Calls to transform higher education in South Africa and "decolonise" curricula are key drivers underpinning this work. Transcription may be a useful tool in preparing students to practise in a multilingual context.

Health resources for South Africa: A scoping review

Background: Healthcare is more effective when people are treated in their own language with respect for their culture. However, information about the availability and nature of health resources is fragmented and studies suggest few assessments, screening tools, or other health resources in many of South Africa's languages.Aim: This scoping review identified health resources written in the eleven official languages of South Africa for health professionals to use for patient assessment and management.Methods: Databases were searched and information about resources collated and analysed.Results: Two-hundred-and-fifty two unique resources were found (444 items, if different language versions of the same resource were counted separately). All official languages were represented. The most widely used (excluding English) were Afrikaans (118 resources), IsiXhosa (80) and IsiZulu (55).Conclusion: Development of more health resources and critical evaluation of their validity and reliability remain important. This study contributes a preliminary database for South African health professionals, ultimately promoting improved service delivery

The Practical Approach to Care Kit (PACK) training programme: scaling up and sustaining support for health workers to improve primary care.

There is an urgent need to depart from in-service training that relies on distance and/or intensive off-site training leading to limited staff coverage at clinical sites. This traditional approach fails to meet the challenge of improving clinical practice, especially in low-income and middle-income countries where resources are limited and disease burden high. South Africa's University of Cape Town Lung Institute Knowledge Translation Unit has developed a facility-based training strategy for implementation of its Practical Approach to Care Kit (PACK) primary care programme. The training has been taken to scale in primary care facilities throughout South Africa and has shown improvements in quality of care indicators and health outcomes along with end-user satisfaction. PACK training uses a unique approach to address the needs of frontline health workers and the health system by embedding a health intervention into everyday clinical practice at facility level. This paper describes the features of the PACK training strategy: PACK training is scaled up using a cascade model of training using educational outreach to deliver PACK to clinical teams in their health facilities in short, regular sessions. Drawing on adult education principles, PACK training empowers clinicians by using experiential and interactive learning methodologies to draw on existing clinical knowledge and experience. Learning is alternated with practice to improve the likelihood of embedding the programme into everyday clinical care delivery.

South African English Speech Development: Preliminary Data from Typically Developing Preschool Children in Cape Town.

English is one of eleven official languages in South Africa, but there is limited information on children's acquisition of English and other languages in this context. This paper describes speech development in 308 children aged 3;0-5;11 acquiring South African English in Cape Town. The study focused on English speech acquisition, although children were grouped by language background into monolingual, isiXhosa bilingual, Afrikaans bilingual and trilingual groups. The primary objective was to describe phonetic and phonological acquisition (percentage consonants and vowels correct (PCC and PVC); phonetic inventory and phonological processes) by children's age and language background. As a secondary objective we described the prevalence of speech disorders in the sample using Dodd's (2005) framework. The Diagnostic Evaluation of Articulation and Phonology was used to assess participants with modified scoring criteria appropriate for the context. Phonological processes and inventories were broadly comparable to normative data for English speech acquisition documented in the literature, and a progression was observed with increasing age. PCC and PVC were similar for children within age bands despite different language backgrounds. Bilingual children showed aspects of English phonological development linked to their L1, and some differences in phonological processes were observed. Approximately 9% of children (n = 28) had speech difficulties, with 75% of this group having a speech delay. The study highlights the importance of adapting speech assessments for use with populations that differ from the originally intended audience. This work contributes to knowledge of typical speech development in South Africa and in multilingual contexts more generally.

Intervention for bilingual speech sound disorders: A case study of an isiXhosa-English-speaking child.

BACKGROUND:  Bilingualism is common in South Africa, with many children acquiring isiXhosa as a home language and learning English from a young age in nursery or crèche. IsiXhosa is a local language, part of the Bantu language family, widely spoken in the country. Aims: To describe changes in a bilingual child's speech following intervention based on a theoretically motivated and tailored intervention plan. Methods and procedures: This study describes a female isiXhosa-English bilingual child, named Gcobisa (pseudonym) (chronological age 4 years and 2 months) with a speech sound disorder. Gcobisa's speech was assessed and her difficulties categorised according to Dodd's (2005) diagnostic framework. From this, intervention was planned and the language of intervention was selected. Following intervention, Gcobisa's speech was reassessed. Outcomes and results: Gcobisa's speech was categorised as a consistent phonological delay as she presented with gliding of/l/in both English and isiXhosa, cluster reduction in English and several other age appropriate phonological processes. She was provided with 16 sessions of intervention using a minimal pairs approach, targeting the phonological process of gliding of/l/, which was not considered age appropriate for Gcobisa in isiXhosa when compared to the small set of normative data regarding monolingual isiXhosa development. As a result, the targets and stimuli were in isiXhosa while the main language of instruction was English. This reflects the language mismatch often faced by speech language therapists in South Africa. Gcobisa showed evidence of generalising the target phoneme to English words. Conclusions and implications: The data have theoretical implications regarding bilingual development of isiXhosa-English, as it highlights the ways bilingual development may differ from the monolingual development of this language pair. It adds to the small set of intervention studies investigating the changes in the speech of bilingual children following intervention. In addition, it contributes to the small amount of data gathered regarding typical bilingual acquisition of this language pair.

The Prevalence of Speech and Language Disorders in French-Speaking Preschool Children From Yaoundé (Cameroon).

Purpose: The purpose of this study was to determine the prevalence of speech and language disorders in French-speaking preschool-age children in Yaoundé, the capital city of Cameroon. Method: A total of 460 participants aged 3-5 years were recruited from the 7 communes of Yaoundé using a 2-stage cluster sampling method. Speech and language assessment was undertaken using a standardized speech and language test, the Evaluation du Langage Oral (Khomsi, 2001), which was purposefully renormed on the sample. A predetermined cutoff of 2 SDs below the normative mean was applied to identify articulation, expressive language, and receptive language disorders. Fluency and voice disorders were identified using clinical judgment by a speech-language pathologist. Results: Overall prevalence was calculated as follows: speech disorders, 14.7%; language disorders, 4.3%; and speech and language disorders, 17.1%. In terms of disorders, prevalence findings were as follows: articulation disorders, 3.6%; expressive language disorders, 1.3%; receptive language disorders, 3%; fluency disorders, 8.4%; and voice disorders, 3.6%. Conclusion: Prevalence figures are higher than those reported for other countries and emphasize the urgent need to develop speech and language services for the Cameroonian population.

Beyond lip service: Towards human rights-driven guidelines for South African speech-language pathologists.

Developed with a strong awareness of past injustices, South Africa's progressive constitution emphasises a full spectrum of human rights. While the constitution celebrates many languages and cultures, speech-language pathologists (SLPs) face challenges in translating these values into practice with a diverse clientele. Similarly, Article 19 of the Universal Declaration of Human Rights focuses on freedom of expression in one's language of choice, but is often perceived as a "Cinderella" right (i.e. one that is frequently neglected). This paper presents a literature review undertaken in association with the Health Professions Council of South Africa to produce guidelines to support SLPs in their practice with diverse linguistic and cultural groups. The aim was to identify key points for inclusion in a set of human rights-driven guidelines. Specific objectives were to critique: (1) current guidelines for SLPs working with diverse cultural and linguistic groups; and (2) equivalent guidelines for related professions. Content analysis of the datasets revealed key themes which formed the basis of an initial skeleton, to be further developed through a consultative process and discussion, ultimately aiming to provide supportive, practical guidelines to better equip South African SLPs to serve all the people of the country.

Speech processing and production in two-year-old children acquiring isiXhosa: A tale of two children.

We investigated the speech processing and production of 2-year-old children acquiring isiXhosa in South Africa. Two children (2 years, 5 months; 2 years, 8 months) are presented as single cases. Speech input processing, stored phonological knowledge and speech output are described, based on data from auditory discrimination, naming, and repetition tasks. Both children were approximating adult levels of accuracy in their speech output, although naming was constrained by vocabulary. Performance across tasks was variable: One child showed a relative strength with repetition, and experienced most difficulties with auditory discrimination. The other performed equally well in naming and repetition, and obtained 100% for her auditory task. There is limited data regarding typical development of isiXhosa, and the focus has mainly been on speech production. This exploratory study describes typical development of isiXhosa using a variety of tasks understood within a psycholinguistic framework. We describe some ways in which speech and language therapists can devise and carry out assessment with children in situations where few formal assessments exist, and also detail the challenges of such work.

The acquisition of Setswana segmental phonology in children aged 3.0-6.0 years: A cross-sectional study.

PURPOSE: This paper describes typical speech development of Setswana. Although there is information on Setswana phonology, very little is known about the acquisition of segmental phonology in this language. METHOD: An assessment tool was devised to collect speech samples from 36 first language Setswana-speaking children aged 3.0-6.0 years in the North-West Province of South Africa. This study describes the acquisition of consonants, vowels, syllable structures and phonological processes at various ages. RESULT: Findings indicate a relatively early acquisition of consonants, although trill /r/ continues to develop after 6.0 years, particularly in the penultimate syllable. Phonological features such as rounding develop in the later pre-school years. Findings also suggest that girls may achieve accuracy before boys. The older group of children presented with fewer phonological processes. Processes found in the speech of younger children included deletion of syllables, gliding, assimilation and simplifying complex words. CONCLUSION: These findings are discussed in relation to normative data from other languages, in particular to those belonging to the same language group. Knowledge of Setswana development will help Speech-Language Pathologists working with Setswana-speaking children to identify and manage phonological difficulties in this population. The results contribute to an increasing body of locally relevant information on typical phonological development.

Swahili speech development: preliminary normative data from typically developing pre-school children in Tanzania.

BACKGROUND: Swahili is widely spoken in East Africa, but to date there are no culturally and linguistically appropriate materials available for speech-language therapists working in the region. The challenges are further exacerbated by the limited research available on the typical acquisition of Swahili phonology. AIM: To describe the speech development of 24 typically developing first language Swahili-speaking children between the ages of 3;0 and 5;11 years in Dar es Salaam, Tanzania. METHODS & PROCEDURES: A cross-sectional design was used with six groups of four children in 6-month age bands. Single-word speech samples were obtained from each child using a set of culturally appropriate pictures designed to elicit all consonants and vowels of Swahili. Each child's speech was audio-recorded and phonetically transcribed using International Phonetic Alphabet (IPA) conventions. Children's speech development is described in terms of (1) phonetic inventory, (2) syllable structure inventory, (3) phonological processes and (4) percentage consonants correct (PCC) and percentage vowels correct (PVC). RESULTS & OUTCOMES: Results suggest a gradual progression in the acquisition of speech sounds and syllables between the ages of 3;0 and 5;11 years. Vowel acquisition was completed and most of the consonants acquired by age 3;0. Fricatives/z, s, h/ were later acquired at 4 years and /θ/and /r/ were the last acquired consonants at age 5;11. Older children were able to produce speech sounds more accurately and had fewer phonological processes in their speech than younger children. Common phonological processes included lateralization and sound preference substitutions. CONCLUSIONS & IMPLICATIONS: The study contributes a preliminary set of normative data on speech development of Swahili-speaking children. Findings are discussed in relation to theories of phonological development, and may be used as a basis for further normative studies with larger numbers of children and ultimately the development of a contextually relevant assessment of the phonology of Swahili-speaking children.

Phonological development of first language isiXhosa-speaking children aged 3;0-6;0 years: a descriptive cross-sectional study.

Standardized assessments of children's isiXhosa phonology have not yet been developed and there is limited information about developmental norms in this language. This article reports on the phonological development of 24 typically developing first language isiXhosa-speaking children aged 3;0-6;0 years, in Cape Town, South Africa. The order and age of acquisition of isiXhosa phonemes, emergence and elimination of phonological processes and percentage consonants and vowels correct are described. A set of culturally and linguistically appropriate pictures was used to elicit single word responses that were recorded and transcribed. The study found that children had acquired most isiXhosa phonemes by 3;0 years although aspirated plosives, affricates, fricatives and clicks were still developing. In particular, the affricates and aspirated plosives were still developing in the 5-year-old children in this sample, suggesting that these may be the latest acquired segments. Children were able to produce basic word shapes by 3;0 years, but some of the words of 4-6 syllables were still being mastered by the 4- and 5-year-old children. Phonological processes that have been well documented for other languages were used by children in this sample (e.g. deaffrication, stopping and gliding of liquids). Findings presented for this pre-school-aged sample are related to theories of phonological acquisition to provide normative data on phonological development in isiXhosa-speaking children.

Masithethe: speech and language development and difficulties in isiXhosa.

IsiXhosa is the second most spoken language in South Africa and one of its official languages. Spoken mainly in the Eastern and Western Cape regions it is fitting that much of the research focusing on children's isiXhosa speech and language acquisition has been carried out at the University of Cape Town (UCT). We describe what is known about children's acquisition of isiXhosa, and highlight studies which inform our knowledge of the typical development of the language in relation to the acquisition of consonants including clicks and the isiXhosa noun class system. Little is known about the specific nature of speech and language difficulties in isiXhosa, and the development of isiXhosa resources for speech and language assessment and therapy is in its infancy. Suggestions are made for advancing knowledge and practice which is needed to provide a relevant and quality service to isiXhosa speakers.

Molecular and cellular characterization of a new α-thalassemia mutation (HBA2:c.94A>C) generating an alternative splice site and a premature stop codon.

The identification of α-thalassemia (α-thal) due to point mutations has been increasing significantly with the advancement of molecular diagnostic tools. We describe here the molecular and cellular characteristics of the thalassemia mutation HBA2:c.94A>C, a novel point mutation affecting the α2-globin gene, causing a mild α-thal phenotype in a male patient of undisclosed ethnicity, investigated for unexplained microcytosis. The detected mutation is located at the penultimate nucleotide (nt) of the first exon which we postulated might affect pre mRNA splicing. While an in silico analysis did not predict any aberrant splice variants, experimental analysis using our in vitro model for gene expression studies showed utilization of a cryptic splice site at codon 15 that resulted in an aberrant splice variant. As a result, a frameshift in the reading frame of the mature mRNA was produced, leading to the formation of a premature termination codon (PTC) between codons 48 and 49 in exon 2. This in turn leads to nonsense mediated mRNA decay (NMD) and the phenotype of α-thal.

Maximizing health literacy and client recall in a developing context: speech-language therapist and client perspectives.

BACKGROUND: In the field of speech-language therapy, limited research has been conducted with regards to health literacy and client recall. However, speech-language therapists frequently provide a considerable amount of information for clients to understand, apply and review in order to manage their (or their child's) health. AIMS: This study aimed to investigate (1) issues around clients' health literacy and recall of information; and (2) how these issues can be overcome in speech-language therapy in a developing context. METHOD & PROCEDURES: An exploratory study was undertaken with specific focus on speech-language therapists and their clients who had previously received treatment for dysphagia, voice disorders (including laryngectomies), and cleft lip and/or palate management. They were recruited at public tertiary hospitals and primary healthcare clinics in Cape Town, South Africa. Data were gathered through focus group discussions and qualitatively analysed using a content-driven immersion/crystallization style. OUTCOMES & RESULTS: Five themes and 13 subthemes were identified. Speech-language therapists currently use mostly low-technology strategies to manage issues of health literacy and client recall, and frequently view poor outcomes as being related to clients themselves and a lack of compliance. CONCLUSIONS & IMPLICATIONS: An understanding of context, intercultural health literacy and client-provider concordance are important factors that should inform the clinical practice of speech-language therapy. There is a need to develop effective strategies for information provision and review post-consultation. Speech-language therapists have an important mediating role in cross-cultural communication.