IN FOCUS: Explore the future of profession - 2022

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    An evaluation of tele therapy services during the COVID-19 pandemic at a university-clinic in Sri Lanka; a preliminary study
    (University of Kelaniya, Sri Lanka, 2022) Parththeepan, V.; Bakmeewewa, D.A.
    Background: Tele therapy is really the delivery of a large variety of therapeutic interventions through the use of telecommunications technology to connect clinicians and clients. Tele therapy typically employs webcams, audio headsets, and videoconferencing software to enable synchronous interaction among clinicians and clients. The primary outcome of this study was describing a tele therapy program at a university clinic and an evaluation of patient satisfaction of speech and language therapy services. The study also aimed to document challenges faced by patients and their families in accessing SLT tele services at Ayati. Methods: The study methodology employed both quantitative and qualitative methods. Due to health-related restrictions in face-to-face direct meetings because of government regulations related to Covid 19, data were collected through self-administered online questionnaires and translated to Tamil and Sinhala. A purposive sampling technique was used to select participants. The data were collected in three languages (English, Sinhala, Tamil). The study included 100 participants who had registered for continuous paediatric or adult SLT services via tele therapy at the Ayati centre or had participated in at least one session of tele therapy and could complete a questionnaire with or without the assistance of a proxy. The quantitative data were analyzed with the Statistical Package for Social Science (SPSS) software, while the qualitative data were analyzed with the Ritchie Spencer (1994) framework analysis. Results: During the COVID -19 outbreak in Sri Lanka, the major purpose of this study was to assess the quality of teletherapy services and patient satisfaction at a university-based clinic. The overall satisfaction with teletherapy was positive, with a high level of satisfaction in using telehealth to get speech and language teletherapy services, a majority (n=82) noting to use telehealth services for SLT in the future. However, teletherapy patients confront difficulties such as insufficient internet connectivity, which was reported. Conclusion: Future research may focus on the specific issues described here in order to truly comprehend how to solve them. Future research could include physician experiences to better understand the current state of telehealth services for Speech and Language Therapy.
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    Knowledge and attitudes toward children with specific learning disabilities among primary school teachers in the Mathugama Educational Zone; a preliminary study
    (University of Kelaniya, Sri Lanka, 2022) Kumari, H.R.G.M.; de Silva, M.D.K.
    Background: The teachers’ role in identifying Specific Learning Disabilities (SLD) in primary grades is significant, and teachers play a unique role in this process. To make the education for the students with SLD successful, teachers require knowledge of different types of SLD and an understanding of their students with SLD.Objectives: The purpose of this study is to investigate primary school teachers’ knowledge and attitudes toward children with specific learning disabilities (SLD).Methods: This descriptive cross-sectional study was conducted with 248 primary school teachers. The self-selection sampling method was used to select participants from the Mathugama Educational Zone in Sri Lanka. An online questionnaire was used to collect data, and the questionnaire consisted of 3 sections: demographical details, teachers’ knowledge, and their attitudes toward children with SLD. Results: Most primary school teachers are conversant on some aspects of children with SLD such as characteristics of SLD and handling a child with SLD in the regular class. Teachers’ knowledge of SLD significantly changed according to gender (p < .05). This indicated that males have more knowledge about SLD than female teachers. However, there was no significant association between teachers’ knowledge with other demographical details such as age, teaching experience, educational level, teaching grade, training in special education, and having a student with SLD in the class. Overall, participants have positive attitudes about training programs.Conclusion: Overall, most of the study participants had average knowledge levels in areas such as management of children with SLD, risk factors, and some symptoms about SLD. However, knowledge level in some symptoms such as IQ level and aetiology of SLD were inadequate. Attitudes regarding their responsibilities in managing children with SLD were positive. On the contrary, a majority of teachers do not have positive attitudes to raise the quality of life of children with SLD and they reported that they felt more sympathy toward the student with SLD than the student without SLD. The study further revealed that most participants had not attended the training programs on teaching children with SLD. Therefore, the relevant institutes or authorities should implement frequent workshops to improving the above aspects regarding the knowledge and attitudes of SLD.
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    Teachers’ knowledge on symptoms, attitudes, and classroom teaching strategies for Specific Learning Disabilities: A study among Tamil speaking primary school teachers in the Nuwara Eliya Educational Zone, Sri Lanka
    (University of Kelaniya, Sri Lanka, 2022) Kanagendran, K.; Caldera, A.V.
    Background: A learning disability is a condition that is characterized by difficulties with listening, speaking, reading, writing or mathematics. Dyslexia, dysgraphia, and dyscalculia are the most common learning disabilities. The primary level teachers carry a significant responsibility in identifying children with Specific Learning Disabilities (SLD). Objectives: The objective of this study was to identify the teachers’ levels of knowledge and their attitudes towards children with specific learning disabilities, and their use of classroom strategies when working with children with specific learning disabilities in the Nuwara Eliya Educational Zone. Methods: A sample of 167 Tamil primary school teachers were recruited for the study. A descriptive cross-sectional quantitative study was used to collect information from the participants. The questionnaire was developed based on evidence-based research. In addition, a convenient sampling method was used. The Statistical Package for the Social Sciences (SPSS) Software was used to analyze the data. Results: The majority of the teachers were females (69.3%-n = 115). Most of the teachers were aware of SLD characteristics as 77.7% (n =129) of the participants believed that language-based learning disability is called dyslexia. Also, 23.5% (n=39) teachers reported that students with dysgraphia mix up upper/lower case/cursive writing. More than 42.2% (n = 70) teachers believe that pupils who have difficulty in measuring (weight/distance/time) have dyscalculia. Most of the teachers had a personal experience of at least one student with SLD who has difficulty taking notes in the class. Although most of the teachers understand the challenges, nearly 121 out of 165 primary teachers agree that they have insufficient time to teach students with SLD. Conclusion: Most of the primary teachers had a basic understanding of SLD identification and characteristics. Teachers are also aware of how to use classroom strategies for students with SLD. However, teachers frequently use those strategies for the entire class and are unaware of specific strategies like Individual Education Plans. In addition, the majority of the teachers had a reasonable understanding of the difficulties experienced by children with SLD.
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    Mobile applications for auditory verbal therapy: review of content and quality
    (University of Kelaniya, Sri Lanka, 2022) Dharmawardana, M.G.N.W.; de Silva, M.D.K.
    Background: The number of mobile health (mHealth) applications has been rapidly increasing recently (apps). Finding high-quality apps that are therapeutically beneficial is a challenge for health professionals and their families. We undertook a comprehensive search and evaluation of Auditory Verbal Therapy mobile apps. Also offered is an evidence-based strategy for locating appropriate apps in the Google Play and Apple app store. Objectives: This study mainly focused on assessing the quality appraisal of the mobile applications for auditory-verbal therapy. Methods: This study used the “Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews.” Between October 2021 and March 2022, we did a thorough scan of the Google Play and Apple app store app marketplaces. Results: A total of 1076 apps were found using eight predefined search criteria. After a thorough review, 39 apps were selected for further consideration. The Mobile Application Rating scale was used to assess them by two reviewers. None of them were very good. Six apps had good quality, 32 had mediocre quality, and three had bad or extremely poor quality. Conclusions: The rapid rise of mHealth emphasizes the importance of developing rigorous and efficient mechanisms for finding and retrieving apps, as well as evaluating their therapeutic effectiveness. Due to the difficulty in accessing auditory-verbal therapy services around the world, mHealth promises therapy benefits when apps are dependable, valid, and easy to find.
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    Translation and adaptation of a dysarthria assessment tool to be used in the Sri Lankan clinical context
    (University of Kelaniya, Sri Lanka, 2022) Perera, W.M.K.; Rathnayake, S.P.
    Background: Dysarthria is one of the commonest communication disorders that arise due to neuromuscular damage. Diagnosing dysarthria requires careful assessments. In the absence of a formal dysarthria assessment tool in the Sri Lankan (SL) clinical context, the translated and adapted Sinhala Language Newcastle Dysarthria Assessment Tool (SLN-DAT) was validated using a normative sample. Methods: This research study was conducted in three phases related to 3 objectives using a mixed methodology: (I) Identification of the relevant tool amongst FDA, DP and N-DAT to be adapted and translated to the SL context using views of 20 Speech and Language Therapists (SLTs) and 20 undergraduate final year students; (II) Initial translation and adaptation of assessment tool into Sinhala language based on WHO tool translation guidelines; (III) Face, content and concurrent validity of the tool using 10 subject experts and 50 normative samples of five age ranges (20-40,40–60,60–70,70–80 and 80+). Internal consistency and intra-rater agreement for the tool tasks were analysed by the subject specialists and concurrent validity were assessed comparing the scores of Dysarthria Profile (DP) and SLN-DAT tool. Data was analyzed using SPSS (Statistical Package for Social Sciences) statistical software and the thematic analysis was used for the qualitative part of the study. Results: N-DAT was selected as the most voted (SLTs=58% & students=55%), and relevant dysarthria assessment tool to be translated and adapted to the SL context. At the end of phase II, the assessment tool contained all related sections of the original N-DAT in Sinhala, which was adapted to suite to SL context. Overall, the SLN-DAT has the same conceptual meaning, semantics, idiomatic and score equivalences as the original version, yet SLT-DAT had one additional section related to ICF model. Statistical analysis showed higher agreement among graders (missing data 0%), including high internal consistency for tool items (Cronbach’s α = 0.8) including the new sections. Performance of the normative sample exhibited a predicted variation among age and tool performance with negative correlation for articulation r = -.32 (p<0.05), respiration r = -.70 (p<0.01), phonation voice r = -.33 (p<0.05), phonation pitch r = -.40 (p<0.01) and DDK rates r = -.33 (p<0.01). The concurrent validity of the SLN-DAT was very high for all subsystems. Each subsystem had higher ICC values ranging between r = 1.0 – 0.7 (p<0.01). Conclusion: The translated, adapted and validated formal dysarthria assessment tool; Sinhala Language Newcastle Dysarthria Assessment Tool (SLN-DAT) had higher face validity, higher internal consistently with items and satisfactory concurrent validity. Therefore, the SLN-DAT could be recommended to the SL context after it was validated among the dysarthria population, which will enable to identify dysarthria reliability in the Sri Lankan clinical context.
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    Communicative effectiveness and speech intelligibility among ageing adult population in the Kandy District
    (University of Kelaniya, Sri Lanka, 2022) Madapathage, M.T.; Rathnayake, S.P.
    Background: With typical ageing, specific communication skills change due to the physical changes and cognitive changes, which is one of the most common problems among ageing adults. The communicative changes consist of speech, hearing, language, and voice difficulties that directly influence the effects of functional communication. The result of the present study will help identify how communication and speech skills change and can be used as norms to differentiate age-related vs disease-related defects in assessment and intervention. Objectives: The aim of this study is to describe the communicative effectiveness and speech intelligibility among Sinhala speakers of ageing adult individuals 60 years or above in age in the Sri Lankan (SL) context. Methods: The research study was based on quantitative methods with a descriptive cross-sectional study design via a web-based platform. The study population was 78 ageing adults representing each age category of 60-69, 70-79, and 80≥ years and recruited using the purposive sampling method. Data collection was done based on an interviewer-administered questionnaire with rating scales and self-administered questionnaires. Data analysis was done based on the frequency distribution of study sample and other relevant statistical analysis was using the SPSS free version. Results: There were less communication and speech intelligibility difficulties shown at the age of 60-69 years compared to other age groups. However, at the age of 70-79 years and 80≥ years, there were more declines in the communication and speech intelligibility difficulties. At the age of 60-69 years, 70-79 years, and 80≥ years, the self-reported questionnaire communicative difficulties were highest when compared to clinician reported questionnaire results. In the speech intelligibility, self-reported difficulties were highest when compared to clinician reported difficulties at the age of 60-69 years and 70-79 years, but at the age of 80≥ years, clinician reported speech intelligibility difficulties were more when compared to the self-reported questionnaire results.Conclusion: This present study examined the communicative effectiveness and speech intelligibility among all three age groups (60-69 years, 70-79 years, and 80≥years). There was communicative and speech intelligibility decline observed with ageing. These norms could be used in language assessments to increase the validity of the diagnosis. The present study could become a foundation for future research on ageing and communication in the SL context.
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    Translation, cross-cultural adaptation, and validation of the autism family experience questionnaire into the sinhala language
    (University of Kelaniya, Sri Lanka, 2022) Thilakarathna, M.K.D.N; Danthanarayana, N.D.
    Objectives: The general objective of the study is to translate and cross-culturally adapt the Autism Family Experience Questionnaire into the Sinhala language. The specific objectives of the study consists of cross – culturally adapting and translating the Autism Family Experience Questionnaire into the Sinhala language, to pre – test the translational tool with parents of children with autism spectrum disorder, to evaluate the content validity of the Sinhala version of the Autism Family Experience Questionnaire, and to examine the association between total scores of the Autism Family Experience Questionnaire and age of the children, gender of the children, parental education, and duration of accessing intervention. Methods: The study design was translation, cross-cultural adaptation, and validation of the Autism Family Experience Questionnaire into the Sinhala language using the Delphi technique. The study setting was government and private clinical settings in Sri Lanka. The instrument was validated with a sample of 60 parents of children with autism, with the children aged between 3 to 10 years in Sri Lanka. This study indicated that the translated and adapted Autism Family Experience Questionnaire has acceptable content validity and moderate reliability. According to the pre-test, all six parents’ opinion was that the questions were clear and that the questions were well understood. According to the final objective, an association between scores of the AFEQ with children diagnosed with ASD and their background variables (age, gender, duration of accessing intervention and parental education) was also considered. Results: There was no statistically significant difference between the age of children with ASD, gender of the children with ASD, or parental education. The Autism Family Experience Questionnaire form was adapted to Sri Lankan context. Internal consistency Cronbach’s alpha was 0.559, which indicated a moderate reliability. However, the translated and adapted Sinhala version of the AFEQ indicates an excellent content validity. The mean age of the children with ASD who participated was 6.22 years (SD=2.08) and 21.6% of the children were at the age of 5 years. The AFEQ mean score was 123.30 (SD=12.12). The AFEQ scores ranged from 83 to 163. There were no statistically significant differences between AFEQ scores and the background variables of participants. Conclusion: The main objective of this study was to translate, cross-culturally adapt, and validate the Autism Family Experience Questionnaire (AFEQ) into the Sinhala language. This study indicated that the translated and adapted AFEQ has acceptable content validity and moderate reliability. Therefore, it can be used as a tool to understand the family experience of parents of children with ASD in different domains.
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    Effectiveness of vocal hygiene education among undergraduate music students with self-reported voice problems at University of Visual Performing Arts and University of Kelaniya
    (University of Kelaniya, Sri Lanka, 2022) Nagahawatta, W.M.M.D.; Jayasena, B.N.
    Background: Voice is the fundamental source of communication and plays an important role in daily life. Voice can indicate personal information such as the speaker’s social status, personal characteristics, and emotional state. Occupational voice users, such as singers, teachers, and lawyers are more likely than non-professionals to develop voice disorders. By abusing or misusing their voices, professional singers are more likely to acquire laryngeal signs and symptoms, as well as pathology. Objectives: To assess the Effectiveness of a Vocal Hygiene Program among undergraduate music students with self – reported voice problems in visual preforming university and Kelaniya University. This study aim was to determine the effectiveness of a virtual vocal hygiene education program on improving self-reported voice problems in undergraduate music students by comparing the Voice Handicap Index 10 score, Voice Related Quality of life score and acoustic parameters of voice before and after conducting the virtual vocal hygiene education program.Methods: This study included 30 undergraduate music students from the University of Visual and Performing Arts and the University of Kelaniya with self-reported vocal problems. The pre-scores were obtained after participants completed a self-administered voice case history, Voice Related Quality of Life, Voice Handicap Index -10, and voice samples. The study's participants were given a 30–45-minute vocal hygiene program that included basic voice production knowledge and 15 vocal hygiene tips. Participants in the study were required to follow the supplied vocal hygiene recommendations consistently for three weeks. At the end of the three weeks, all participants were given the Voice Handicap Index -10 and the Voice Related Quality of Life to collect post-test ratings, as well as voice samples to identify pre post results. Descriptive stats for demographic information of the participants mean and standard deviation of the pre and post voice handicap index -10, voice related quality of life and acoustic parameters. PRRAT software was used to analyse the voice samples. Inferential statistics for the mean difference in pre to post scores via paired t test was used to analyse the collected data.Results: There is a statistically significant difference between the pre- and post- tests (P < 0.05) suggesting a positive association between complying with a vocal hygiene program and the reduction of voice related symptoms. The jitter and the shimmer parameters were significantly lower in the post-test compared to the pre- test. Mean intensity, mean pitch and the HNR values were significantly higher in post- test compared to the pre -test.Conclusion: The conclusion of this study is that an effectively used vocal hygiene program can reduce the voice-related symptoms of undergraduate music students with self-reported voice problems.
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    Physiological parameters of breast-feeding in pre-term and full-term infants with feeding disorders
    (University of Kelaniya, Sri Lanka, 2022) Prasangi, N.T.P.G.B.; Dharmarathna, N.I.
    Background: Breastfeeding is the most effective technique of supplying nutrients to young infants for proper growth and development. This method uses a variety of instruments and procedures, but they all rely on factual observation. The purpose of the study was to describe physiological parameters of breast-feeding in pre-term and full-term infants with feeding disorders, in order to identify physiological manifestations of breast-feeding leading to feeding disorders in infants, as well as to determine the physiological differences of breast-feeding between preterm and full-term born infants. Methods: This research was an observational, cross-sectional study. The study setting was the Feeding/ Swallowing Support Clinic, Ayati Center, Ragama. Fifty-three (n=53) breast feeding infants from 0-12 months were used for this quantitative research study to collect video recordings of breast-feeding sessions. The videos were recorded at the middle of the breast-feeding sessions and the duration was about two minutes. Twenty (20) videos were randomly selected for the Inter-rater reliability test. The physiological parameters were collected after analysing the videos. Quantitative data analysis was conducted using SPSS (version 26.0) software. Results: We found excellent inter-rater reliability to obtain the selected set of physiological parameters of breast feeding in infants. Significant differences were reported in oxygen saturation measures (t=2.848, df =14.967, P=0.019), respiratory frequency (t=2.635, df=14.967, P=0.019) and changes in pulse rate (t= 2.933, df=50.967, P=0.005) during feeding between pre-term infants and term infants. Significantly higher oxygen saturation levels were reported in full-term infants compared to that of pre-term infants, which may indicate atypical suck-swallow-breathe coordination in pre-term infants. Pearson correlation test revealed that milk intake per feed significantly increased when the gestational age increased (r (52) = 0.444, P = <.001). Conclusion: This study shows that understanding breast-feeding with objective parameters is feasible and reliable during clinical feeding assessment, with an innovative approach to incorporate video recorded data. These measures are easy-to-obtain and no additional cost is required. This method highlights the importance of understanding the unique suck-swallow-breathe coordination in breast-feeding infants. Further, the significant physiological differences of the breast-feeding mechanism between pre-term and full-term infants will help clinicians to understand whether a preterm infant is ready to be orally fed and to compare their suck-swallow skills over time and over intervention objectively.
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    Speech therapy interventions for acquired apraxia of speech: An updated systematic review
    (University of Kelaniya, Sri Lanka, 2022) Umesha, M.A.T.; Ariyasena,W.A.A.D.K.; Siriwardhana,D.D.
    Background: Apraxia of speech (AOS) is a motor speech disorder following brain damage, typically the dominant hemisphere, mostly due to a stroke. This results in impaired planning and programming of sensorimotor commands that need for speech to be phonetically and prosodically normal. This leads to a decrease in the quality of life of a person as well as their social and vocational participation. Of 8101 individuals with neurologic motor speech disorders, 6.9% reported AOS. Several systematic reviews have been published related to the treatment of apraxia. To best of my knowledge, no systematic review has been conducted to update the systematic review published in 2015 which included studies conducted until up to December 2012. At present, a limited amount of evidence is available on interventions for AOS. As a considerable body of literature for treatments of apraxia is available since 2012, present systematic review provides evidence for approaches that will help for an in-depth examination of particular interventions on AOS. Objectives: The primary objective of this systematic review was to evaluate and summarize the available literature on speech and language therapy interventions for acquired apraxia of speech since 2013. As a secondary objective, the clinical phase, and the level of evidence of each study was evaluated. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. It was registered with the International Prospective Register of Systematic Reviews (CRD42020209014). A systematic search in six electronic databases; PubMed, The Cochrane Library, Web of Science, Scopus, EBSCOhost and CINAHL was performed. The search period was from January 2013 to December 2020. Unpublished and ongoing trials were searched in ClinicalTrials.gov and the metaRegister of controlled trials. The primary outcomes of the study including a) improvement in treated behaviours, b) generalization and c) maintenance were evaluated and the studies were evaluated for the level of evidence and the clinical phase. The systematic review was assessed for its methodological quality. Results: Of the 3845 records yielded after the search, 3070 records were left after removing duplicates. Seventy-four studies were selected as eligible studies for full-text review. Twenty records were selected for the quality assessment and included in the present review. Studies of randomized control trials, single case experiments, group experiment trials were included in this review. All the studies used articulatory kinematic approaches and no study was found to use any other treatment approach. According to the classes defined by the Clinical Practice Guidelines Process Manual developed by the American Academy of Neurology, one study was identified in class II, five studies were identified in class III and fourteen studies were identified to fulfil all the criteria of class III except for independence of assessors’ criterion. In terms of clinical phase, one study was in phase III, ten studies were in phase II and nine studies were in phase I. Conclusion: Among the intervention of apraxia of speech, articulatory kinematic treatments have become prominent. Publication of a randomized controlled trial has strengthened the level of evidence of the apraxia of speech literature. Focusing on self-administrative therapies, use of technology for therapy administration, development of treatments that focus on apraxia of speech and aphasia simultaneously were identified as the new advancements of the apraxia of speech literature.