Clinical outcomes associated with speech, language and swallowing difficulties post-stroke.

BACKGROUND:  There is a lack of prospective research in South Africa's speech therapy private sector, specifically, in the acute stroke population. There is a need to understand the quality of speech therapy services and outcomes post-stroke in the private sector. OBJECTIVES:  This prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), and outcomes post-stroke (i.e. length of hospital stay [LOS], degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). METHOD:  A prospective design was used to determine the incidence of speech, language, and swallowing conditions post-stroke. Convenience sampling was used to select participants (N = 68). Various statistical tests were used and the alpha level was set at Bonferroni correction p  0.01. RESULTS:  Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to speech therapy later than 24 h post-admission (52.94%) stayed in hospital for a median of 3 days longer than those who were referred within 24 h (p = 0.042). Dysphagia was significantly associated with moderate to severe physical disability (p  0.01). Dysphagia with aspiration was significantly associated with poor functional level of oral intake, at admission and at discharge (p  0.01). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p  0.01, r = 0.70). CONCLUSION:  In South Africa's private sector, co-occurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed speech therapy referrals.Contribution: This article contributes data on speech therapy services, communication and swallowing disorders post-stroke, and outcomes in South Africa's private sector.

The occurrence of auditory dysfunction in children with TB receiving ototoxic medication at a TB hospital in South Africa.

OBJECTIVES: to describe the auditory dysfunction of children with tuberculosis receiving ototoxic medication at a residential TB hospital in the Cape Town metropolitan area. METHODS: A descriptive survey research design was adopted. The auditory status of participants was evaluated by otoscopy, immittance, audiometry or OAE and AABR (depending on the age). STUDY SAMPLE: 29 in-patients (7 months to 16.6 years). RESULTS: Fifty five percent of participants presented with middle ear abnormalities (n=16) and 48% (n=12) had sensorineural or mixed hearing loss. The degree of hearing loss ranged from mild to profound in 16% of the ears. The conventional pure-tone average of .5, 1, & 2 kHz did not allow for the determination of the degree of hearing loss in the remaining 18% which had high frequency hearing loss. CONCLUSIONS: The high occurrence of hearing loss necessitates the implementation of monitoring program for children receiving ototoxic medication. Consideration should be given to using the average of hearing thresholds at 4, 6 and 8 kHz to determine the classification of degree of hearing loss in cases of ototoxicity.