{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T12:41:01Z","timestamp":1790512861288,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,8,1]],"date-time":"2013-08-01T00:00:00Z","timestamp":1375315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp; Comm Disor"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Rehabilitation services are scarce in low\u2010income countries, where under\u2010representation 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>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\u2013child dyads with caregiver\u2013child dyads providing a natural comparison? What communicative modalities and practice techniques are invoked? And how does this information relate to extending professional roles?<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods &amp; Procedures<\/jats:title><jats:p>An in\u2010depth, 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\u2013child 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\u00a0C). 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes &amp; Results<\/jats:title><jats:p>Partnership type\u00a0A dyads showed a fairly even turn distribution between teacher and child. A common pattern was teacher\u2010initiated <jats:italic>Instruct<\/jats:italic> and <jats:italic>Model\/Prompt<\/jats:italic>, followed by child response in the form of an <jats:italic>Action<\/jats:italic>. The most frequently used modality was <jats:italic>Sound Production a<\/jats:italic>nd <jats:italic>Hands\u2010on\u2010Articulators<\/jats:italic>, which corresponded to articulation drill practice. Partnership type\u00a0B dyads revealed a tendency towards adult domination of turns. The majority of adult\u2010initiated moves required no response from the child. The practice technique <jats:italic>Hands\u2010on\u2010Articulators<\/jats:italic> involved manipulating the oral musculature of the child. Partnership type\u00a0C dyads showed resonances of type\u00a0B dyads, although focused more on <jats:italic>Motor\u2010Action<\/jats:italic> in relation to task performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Implications<\/jats:title><jats:p>The assignment of speech and language therapy duties to teachers and occupational therapists has resulted in suboptimal practice for children with complex communication needs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1460-6984.12042","type":"journal-article","created":{"date-parts":[[2013,8,1]],"date-time":"2013-08-01T18:10:49Z","timestamp":1375380649000},"page":"689-702","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Investigation of practices to support the complex communication needs of children with hearing impairment and cerebral palsy in a rural district of Kenya: a case series"],"prefix":"10.1111","volume":"48","author":[{"given":"Karen","family":"Bunning","sequence":"first","affiliation":[{"name":"School of Allied Health Professions Faculty of Medicine &amp; Health University of East Anglia  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph K.","family":"Gona","sequence":"additional","affiliation":[{"name":"Centre for Geographic Medicine Research (Coast) Kenya Medical Research Institute  Kilifi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Buell","sequence":"additional","affiliation":[{"name":"School of Allied Health Professions Faculty of Medicine &amp; Health University of East Anglia  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R.","family":"Newton","sequence":"additional","affiliation":[{"name":"Centre for Geographic Medicine Research (Coast) Kenya Medical Research Institute  Kilifi Kenya"},{"name":"Neuroscience Unit Institute of Child Health University College London  London UK"},{"name":"Department of Psychiatry University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Hartley","sequence":"additional","affiliation":[{"name":"School of Allied Health Professions Faculty of Medicine &amp; Health University of East Anglia  Norwich UK"},{"name":"Faculty of Health Sciences University of Sydney  Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2167\/le684.0"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/03057920120053238"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MRR.0b013e3280143ca4"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511527685"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9781139017343"},{"key":"e_1_2_9_7_1","first-page":"163","volume-title":"Speech and Language Therapy: The Decision\u2010Making Process when Working with Children","author":"Beazley S.","year":"2001"},{"key":"e_1_2_9_8_1","volume-title":"Report on Visits to Kilifi District Hospital and Wellcome\u2010Funded Kenya Medical Research Institute","author":"Bunning K.","year":"2007"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2788.2011.01513.x"},{"key":"e_1_2_9_10_1","volume-title":"HCRC Dialogue Structure Coding Manual","author":"Carletta J.","year":"1996"},{"key":"e_1_2_9_11_1","volume-title":"Profiling Linguistic Ability","author":"Crystal D.","year":"1992"},{"key":"e_1_2_9_12_1","volume-title":"Statistical Methods for Rates and Proportions","author":"Fleiss J. 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