IN FOCUS: Explore the future of profession - 2022

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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.
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.
Working with and learning from children with disabilities: Experiences of speech and hearing sciences undergraduates at the University of Kelaniya
(University of Kelaniya, Sri Lanka, 2022) Chandramali, S.P.D.; Athauda, L.
Background: Undergraduate Speech and Hearing Sciences students work closely with children with disabilities in their clinical training. When working with children with disabilities, there are many experiences that can be gained throughout the academic years. Objectives: The aim of this study was to describe the experiences of working with and learning from children with disabilities among Speech and Hearing Sciences (SHS) undergraduates at the University of Kelaniya. Methods: A total of 15 students participated in the study. These qualitative semi-structured interviews were conducted among SHS students at the University of Kelaniya. The experiences of the participants with regard to working with children with disabilities, how experiences affect their personal and career lives in the future, how experiences affect their academic lives, the availability of services for children with disability, the view of society towards children with disability were all discussed in the interviews. Interviews were transcribed, analysed, and translated using a narrative thematic analysis method. Inductive coding was conducted manually by the research student and the supervisor.Results: Four themes emerged from the collected data with both positive and negative aspects: ‘Positive and negative behaviour of children and parents,’ ‘Positive and negative impression of society on children with disabilities,’ ‘Positive and negative emotions of the students’ and ‘Positive and negative impact on self and future career ‘. Conclusion: The results of the study showed that positive and negative experiences have influenced their personal lives and future career. Participants highlighted the importance of increasing speech therapy services in Sri Lanka and raising awareness about children with disability and about the rehabilitation services for those children.
Primary caregivers’ satisfaction on the provision of Speech and Language Therapy services for adults via telehealth in Sri Lankan Clinical Context
(University of Kelaniya, Sri Lanka, 2022) Ginigaddara, S.N.; Panterliyon, N.A.; Dharmarathna, N.I.
Background: With the emergence of the COVID-19 pandemic, telehealth services became prominent as the main mode of service delivery, though it was not promptly practiced in Sri Lanka before. Therefore, speech and language therapists have started using social media platforms and social communication applications to deliver their services. In this context, the current study was conducted to determine the feasibility of utilizing telehealth for speech- language therapy services for adults with communication and swallowing difficulties in Sri Lanka. Mostly, adults with communication and swallowing difficulties may require support from a caregiver to facilitate telehealth sessions. Objectives: The study aimed 1-to determine the primary caregivers’ level of satisfaction on receiving speech- language therapy services for adults via telehealth, 2-to determine the socio-demographic factors which influence the primary caregivers’ level of satisfaction and 3- to identify the advantages and the limitations of telehealth from the perception of the primary caregivers. Methods: A mixed method study was conducted with one hundred and seven (n=107) participants who were identified from the two main adult rehabilitation hospitals and one private clinic in Sri Lanka. Study participants were Sinhala or English-speaking primary caregivers who had assisted the clients in receiving speech-language telehealth services. Every participant was asked to complete a self-administered online questionnaire which includes the adapted version of the "TeleMedicine Perception Questionnaire” (TMPQ), which was used as the main data collection instrument. Participants’ perceptions on the advantages and limitations of telehealth practices and the participants’ suggestions to overcome the limitations were collected as qualitative data. Quantitative data was analyzed using SPSS version 26.0 software. Qualitative data analysis was conducted using a simple thematic analysis to identify the themes of advantages and limitations and suggestions of telehealth practice as perceived by the caregivers. Results: The mean total score (mean=75, SD= +2.76) of the TMPQ scale revealed that most of the primary caregivers were satisfied with the service delivered. A significant negative correlation between the age of the primary caregiver and the TMPQ total score was found (r=-.27, p=.006). When comparing the mean TMPQ scores, a significant difference was reported between caregivers who are siblings of the client and caregivers who are the offspring of the client (F (3.103) = 3.107, p = .030). The satisfaction level was more when the caregiver was an offspring (mean= 75.50, SD= + 2.38) of the client than it was a sibling (mean = 72.43, SD = + 4.392). Qualitative thematic analysis revealed cost-effectiveness, time effectiveness and safety of the client due to minimum exposure to COVID were the most common advantages perceived by the primary caregivers in Sri Lanka. Conclusion: According to the researchers’ understanding, this is the first study conducted to evaluate caregivers’ perceptions on telehealth in speech-language therapy in Sri Lanka. As in any other challenging situation, there are novel and innovative approaches that people develop to continue their lifestyle. During this pandemic, the world has witnessed the utilizing of modern technology for improved healthcare provision, including various telehealth practice modes. Even in an under-resourced country like Sri Lanka, the families are satisfied with the care they received for their loved ones through telehealth modes.
Maternal experiences during the establishment of feeding among infants who have feeding issues at selected neonatal and paediatric units in the Gampaha district
(University of Kelaniya, Sri Lanka, 2022) Fernando, W.L.M.; Weerasinghe, Y.
Background: Infants in neonatal care, infants born prematurely, low birth weight, and hypoxia are at risk of feeding and early communication difficulties. In paediatric care, there are also specific children who have feeding difficulties because eating is a complicated learned behaviour, which happens duration infancy. When the infant is in the neonatal unit, there is a lack of interaction between the infant and the mother, and therefore, family-centred care is encouraged by health professionals and so maternal experiences about feeding care is important to speech and language therapists (SLTs) as they specialize in feeding and swallowing evaluation and intervention. Objectives: The main objective of this study was to identify maternal experiences during the establishment of feeding among infants who have feeding issues at selected neonatal and paediatric units in the Gampaha district. The specific objectives were to discover maternal experiences of professional support, feeding methods and techniques and family support during the establishment of feeding among infants who have feeding issues. Methods: A descriptive cross-sectional study was carried out with a sample size of fifty participants. The study setting was neonatal and paediatric units of selected government hospitals with mothers of infants with feeding difficulties. The data was analysed using SPSS 23.0 statistical software. Results: Results suggested that the majority of the participants had good support from the professionals including doctors, nursing staff and speech and language therapists. Most of the participants had a fair experience about the feeding method and techniques. Considering the family support, most of the participants had fair, good or excellent support. The results found that there is poor experience and knowledge about the feeding method and techniques before coming into the NICU or PICU. Apart from this, the majority of the participants had fair experiences during hospitalization. Conclusion: The purpose of this study was to identify the maternal experiences during the establishment of feeding among infants who have feeding issues. Maternal experience is important to establish connectivity with infants who have difficulties because the mother is the main person who interacts and feeds the infants in the NICU or PICU and at home. According to results, some of the participants had poor knowledge and experiences about feeding methods and techniques. Therefore, it essential to offer more awareness to the mothers about knowledge and training of the feeding methods and techniques and provide the best support as health care professionals.
Development and validation of a documenting tool for an Instrumental Feeding Assessment; Fibreoptic Endoscopic Evaluation of Swallowing (FEES)
(University of Kelaniya, Sri Lanka, 2022) Amunugama, E.M.D.W.H.L.; de Silva, M.D.K.
Background: Fibreoptic Endoscopic Evaluation of Swallowing (FEES) is an emerging assessment in speech therapy practice in Sri Lanka. However, the absence of an appropriate documentation system has been a major issue due to a lack of consensus on the format of reporting the findings of FEES among different clinical settings and missing essential areas of assessment. The study focused on developing and validating a documentation system for FEES, which can assess people who have no prior clinical examination history.Methods: For this validation study (action research), the modified Delphi method with 2 rounds was conducted with 7 speech therapists who are involved in conducting FEES in government hospitals and in the private sector. Two independent rounds through online questionnaires were conducted to finalize and validate the developed tool. The first round focused on finalizing the developed tool and round two considered content face validation of the finalized tool. Results: The record sheet for FEES was finalized with the accepted components and suggestions from both Delphi panels. The Delphi panels agreed with the content with an excellent content validity index score for face validation of the tool. The finalized tool consisted of 3 subsystems: pre-FEES, FEES findings and post FEES. Conclusion: A comprehensive record sheet was developed during the study to address the lack of a proper documentation system for FEES in clinical settings in Sri Lanka. The tool was designed in a clinician-friendly manner where a clinician can evaluate an outpatient who has not gone through a bedside evaluation. The content and face validity reflected user-friendliness and reliability of included items.
Central Auditory Processing Skills in children with a history of early-onset Otitis Media: A scoping review
(University of Kelaniya, Sri Lanka, 2022) Damayanthi, T.G.J.L.; Umesha, T.; de Silva, M.D.K.; Jayasena, B.N.
Background: Central auditory processing is characterized by the perception and processing of neural information related to the auditory inputs through the human ears and it is vital for speech perception, language skills, and complex learning functions. Auditory deprivation in the early years of life impacts neural maturation of the central auditory nervous system and lowers the ability to process neural information related to aural inputs. Otitis media is known to be the most frequent middle ear infection and a common reason for auditory deprivation among the paediatric population worldwide. Hence, this study focused on auditory deprivation due to otitis media during the early years of life. Many primary pieces of research have been conducted to assess the long-term influence of auditory deprivation due to otitis media on central auditory processing, which lasts over years even after the resolution of the middle ear condition. This study reviewed literature where the long-term effect of otitis media is assessed through behavioural and electrophysiological measures, in children with a history of otitis media within the first five years of their lives. Objectives: To summarize Audiological assessments used to evaluate central auditory processing and to describe central auditory processing skills in children with a history of early-onset otitis media. Methods: This review followed the methodological framework outlined by Arksey & O̕̕Mally (2005) and developed by Levac et al. (2010). Studies conducted from 2000-2020 involving human participants aged ≤18 years, belonging to any gender or geographical context, having a history of otitis media within the first 5 years of life, having normal hearing and normal middle ear condition by the time of study conducted, were included in the review. Studies involving participants with any type of hearing loss before the age of 05 years due to other reasons except otitis media, comment/text literature, and studies with no free accessibility to the full text, and an English translation were excluded. Literature was searched in PubMed, EBSCO host, and Scopus databases, and eligibility was assessed by two reviewers independently. Included studies were critically appraised using standard tools. Extracted data were reported following the systematic reviews and meta-analyses extension for scoping reviews checklist.Results: The review resulted in 13 eligible articles. Some have used behavioural measures only (08), and electrophysiological measures only (03) while 02 have used both. Poor auditory processing skills and alterations in electrophysiological measurements were reported in children with a history of otitis media within the first five years of their lives, compared to children without a history. Conclusion: As per the reviewed studies, there is a negative association between central auditory processing and the history of otitis media within the first five years of life, which persists beyond its resolution.
Translation and cross-cultural adaptation of the quantitative checklist for autism in toddlers parental questionnaire into Sri Lankan tamil language
(University of Kelaniya, Sri Lanka, 2022) Thevathasan, M.; Danthanarayana, N.D.; Yahampath., N.
Background: The Quantitative Checklist for Autism in Toddlers (Q-CHAT) is a parent-report screening tool to detect autism spectrum disorder (ASD) symptoms in toddlers aged between 18-24 months. Early detection of ASD increases the chance of receiving timely intervention. The parent report questionnaire is a good way to screen for ASD. The Q-CHAT is a novel screening tool that has demonstrated to have various benefits over conventional screening techniques, because there is a lack of screening tools for the early screening of ASD traits in the Sri Lankan Tamil clinical context. Objectives: The objectives of this study were to translate and cross-culturally adapt the Quantitative Checklist for Autism in Toddlers Parental questionnaire into the Sri Lankan Tamil language. Methods: At the initial step of this study, the Delphi study design was used to translate and cross-culturally adapt into the Sri Lankan Tamil language and a cross-sectional study conducted for psychometric evaluation. Following this, an appropriate sample was selected, which included 30 typically developing Tamil speaking toddlers aged between 18-24 months and 30 ASD Tamil speaking toddlers aged between 18-24 months. Cronbach’s alpha coefficient was used to evaluate the internal consistency of the Tamil version of the Q-CHAT questionnaire. Furthermore, the Mann-Whitney U test was used to investigate whether the Tamil version of the Q-CHAT can adequately discriminate between typically developing toddlers and toddlers with ASD. Spearman’s’ rho correlation coefficient test was used to analyse the correlation between the background variables of toddlers with ASD and the Q-CHAT scores. Results: The typically developing group consisted of 30 toddlers with the mean age of 20.17 (SD=1.44) months and the ASD group included 30 toddlers with the mean age of 20.93 (1.05) months. The mean Q-CHAT score of the typically developing toddlers was 21.23 (SD=7.59) and the mean Q-CHAT score of toddlers with ASD was 53.30 (SD=6.88). The Cronbach’s alpha coefficient for the ASD group and the normative group was 0.64 and 0.07 respectively, which indicated poor reliability. Although the translated and adapted Q-CHAT had poor reliability, it can discriminate between the typically developing toddlers and toddlers with ASD since there was a statistically significant difference in Q-CHAT scores between the two groups. Conclusion: The Tamil version of the Q-CHAT has discriminative ability, and it can be used as a screening tool for detecting children who are at risk of autism. Further validation studies with large samples are required.
Evidence-based practice among speech therapists in Sri Lanka
(University of Kelaniya, Sri Lanka, 2022) Wanigasooriya, I.G.; Colonne, U.T.
Background: Evidence-based practice (EBP) is essential to providing quality health care. Evidence-based practice (EBP) is the process of providing high-quality health care through research findings, practical knowledge, and client preferences and values. Evidence-based health care is the careful application of current best evidence in making choices regarding individual patient care or health service delivery. Speech and Language Therapists (SLTs) treat communication difficulties and swallowing difficulties. Currently, their range of services provided is wide, and high-quality results can be obtained through EBP. Evidence-based practice provides superior service to people with speech, language, and swallowing difficulties. Objectives: Our study aimed 1- To identify the use of evidence-based practice among speech and language therapists in Sri Lanka, 2- To determine the speech and language therapists’ knowledge on evidence-based practice, 3- To determine the speech and language therapists’ skills on use of the evidence-based practice and 4- To determine the association between current knowledge skills and usage of EBP among SLTs, and their socio-demographic variables. Methods: A descriptive cross-sectional study was used to identify the level of knowledge, skills, and use of EBP among SLTs. Altogether 169 participants completed a self-administrative online survey questionnaire with 32 rank order questions (strongly agree to strongly disagree). Demographic characteristics of the participants were analyzed descriptively and presented as means, standard deviations (SD), frequencies, and percentages. The Chi-square test and Fisher’s exact test were used appropriately to determine the association of current knowledge, skills, and usage of EBP among SLTs with their socio-demographic variables (gender, age range, educational qualifications, client group, work setting). Results: The majority of SLTs had heard about EBP (71.9%) and had an idea about EBP (95.9%). However, 70% of responses (agreed or strongly agreed) were obtained for all other questions asked related to the knowledge of EBP. Forty percent to 55% of participants confirmed that they have average skills on EBP. 50% of participants confirmed that they use EBP, have access to EBP, or read research publications, sometimes. 30% of participants were using EBP, frequently. In general, a significant association was not revealed (P<0.05) between knowledge, skills, and usage of EBP among SLTs, and the five demographic variables. Conclusion: The present study showed that Sri Lankan SLTs have good to fair knowledge and skills toward EBP. The majority of participants confirmed that they are sometimes using EBP. All these current practices of EBP are not influenced by their gender, age, work setting, practicing client group, or highest educational qualification. However, there was a significant association between gender and current usage of EBP.
Adapting the colorado learning difficulties questionnaire into sinhala for the local context
(University of Kelaniya, Sri Lanka, 2022) Abeyrathne, M.K.A.U.; Danthanarayana, N.D.
Background: In Sri Lanka, there are only limited standardized tools to assess for learning difficulties. The purpose of this study was to translate, cross-culturally adapt, and validate the Colorado Learning Difficulties Questionnaire (CLDQ) into the Sinhala language. Objectives: The main objective was to translate and cross-culturally adapt the CLDQ into the Sinhala Language for children aged between 6 to 10 years. The study assessed the content validity, known group validity, and reliability and examined the association between scores of the tool and background variables. Methods: A Delphi study was conducted to cross-culturally adapt the CLDQ and a cross-sectional study was undertaken to assess the reliability and validity of the CLDQ. There were 30 parents of children with learning difficulties in a clinical setting in the Gampaha district and 30 parents of children with typical development aged between 6-10 years in a school setting in the Gampaha district using convenience sampling. Two Delphi rounds were conducted with 8 experts to adapt the questionnaire. The data was collected using an online survey. Results: The mean age of both groups was 8 years. The content validity was excellent in the translated and adapted CLDQ. It had excellent reliability in the group of children with learning difficulties. There was a significant difference in CLDQ scores between the normative and clinical groups, which emphasized known group validity. There was no significant difference in CLDQ scores and the gender of participants in the clinical group. There was a significant negative correlation between CLDQ scores and the duration of accessing therapy services by children with learning difficulties. Conclusion: This tool was effectively translated, adapted, and validated. It has excellent content validity and high reliability for children with learning difficulties. The tool was able to discriminate the children with learning difficulties via known group validity. It strongly correlated negatively with the tool's final score and access to therapy. The relevant information from the parents on their child’s earning difficulties could be gathered using this translated, adapted, and validated tool.
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.
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.
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.
Translation, cross-cultural adaptation, and validation of the Rastreamento de Alteracoes Vocais em Idosos-RAVI (Screening for voice disorders in older adults) tool into Sri Lankan Tamil
(University of Kelaniya, Sri Lanka, 2022) Moganapriya,T.; Siriwardhana,D.D.
Objective: The objectives of the study was to translate, cross-culturally adapt and validate the Rastreamento de Alteracoes Vocais em Idosos-RAVI (Screening for voice disorders in older adults) instrument from English into Sri Lankan Tamil.Methods: The study was carried out as a tool adaptation and validation study. The study was conducted in three phases. Phase one involved the translation and cross-cultural adaptation of Rastreamento de Alteracoes Vocais em Idosos-RAVI (Screening for voice disorders in older adults), conducted under four phases. Stage 1 was forward translation; stage 2 was synthesis (T1 and T2) of the forward translated tools, stage 3 was backward translation of the synthesized version (T12) of the questionnaire totally blind to the original version. Stage 4 was the review of the translated questionnaires by the expert committee. The phase two involved a Delphi study to achieve content validity of the translated instrument, and a psychometric evaluation of the instrument. The psychometric evaluation was not able to be carried out due to time restrictions. Results: The RAVI tool was successfully translated and cross-culturally adapted to Sri Lankan Tamil. I-CVI (Item-level content validity index) values for all the items were acceptable (>_0.83) for all domains except for one item each in culturally appropriateness and sufficiency domains. S-CVI/Ave (scale-level content validity index based on the average method) values for all domains were satisfactory and above 0.90. Five older adults aged 60 years and above participated in the pre-test, and they understood all the items mentioned in the RAVI tool without any issues.Conclusion: The Rastreamento de Alteracoes Vocais em Idosos-RAVI (Screening for voice disorders in older adults) was successfully translated, cross-culturally adapted and content validated into Sri Lankan Tamil language. Overall, Sri Lankan Tamil translation of the RAVI instrument showed a satisfactory content validity.
Awareness of noise-induced hearing loss and usage of hearing protective devices among 18 to 35 years old residents in Puttalam, Sri Lanka
(University of Kelaniya, Sri Lanka, 2022) Fathima, I.F.; Ileperuma, L.D.
Background: Noise-induced hearing loss (NIHL) is the most common and preventable type of hearing loss. Exposure to NIHL contributes to causing hypertension, sleep disturbance, fatigue, and annoyance in addition to hearing loss. Preventive measures are available to mitigate such adverse effects. Implementing such preventive measures is desirable but often not achieved in our community. Objectives: This study aimed to evaluate the awareness of noise-induced hearing loss and usage of hearing protective devices among 18 to 35-year-old residents in Puttalam Sri Lanka. Methods: This was a descriptive cross-sectional study. A self-administered web-based questionnaire, consisting of 4 sections focusing on demographic details of participants; awareness of Noise-induced Hearing Loss; noise, exposure, and usage of hearing protective devices were used to collect data from the target population. A purposive sampling method was used to recruit voluntary participants for this study. The gathered data were analyzed quantitatively. Results: 100 participants (46 males, 54 female) aged between 18 – 35 years from Puttalam participated in this study. Hearing loss was regarded as a significant issue by 48% of participants of whom 63% were females and 37% were males. The study group included 42% of graduates and 61% of the total were employed. Regarding noise-induced hearing loss, 95% of participants believed that exposure to loud noise could cause hearing loss. 52% of participants felt that all age groups were at risk of NIHL. Around 53% of participants reported that they had used hearing protective devices. Conclusion: The results of this study show the need for action by the relevant authorities to enhance individuals’ knowledge of noise-induced hearing loss and recommend the usage of hearing protective devices. There is insufficient awareness regarding using hearing protective devices in a noisy environment. This study indicates the potential need for education within the population of Puttalam.
Identifying Sri Lankan mothers’ lived experiences of supporting a child with dyslexia: A pilot study
(University of Kelaniya, Sri Lanka, 2022) Yasora, C.A.W.H.; Perera, B.M.R.K.
Background: Dyslexia is a pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities. Having a reading difficulty can affect children’s academic achievements as well as social success. Mothers play an important role in speech and language therapy programs especially when speech and language therapists provide reading intervention for children with dyslexia. Objectives: The main purpose of the study was to identify Sri Lankan mothers’ lived experience of supporting children with dyslexia. Methods: This research was a qualitative study. Private clinics in Sri Lanka which have clients with dyslexia-related caseloads were taken as the study settings for this study. Ten parents of 7 – 10-year-old children with dyslexia were the study population. Semi-structured interviews were conducted using an interview guide which consisted of 15 questions. Data collection interviews were conducted via telephone. Data received from the interviews were analysed using thematic analysis. Results: Three main themes have emerged from the transcripts of the interviews which are awareness about dyslexia, experience mothers face when teaching children with dyslexia, and expectations of mothers. Under the main 3 themes, eight subthemes have emerged from the collected data. Findings have shown mothers' lack of awareness and knowledge about dyslexia, the challenges, and strengths mothers face during teaching before and during the Covid 19 pandemic, and also mothers' expectations for their children. Conclusion: The current study revealed the experience mothers face when teaching a child with dyslexia. Besides, this study provides insights and information for speech and language therapists to support mothers who have children with dyslexia.
Speech and Language Therapy interventions for dysarthria in Parkinson’s Disease: An Updated systematic review
(University of Kelaniya, Sri Lanka, 2022) Ariyasena,W.A.A.D.K.; Umesha, M.A.T.; Siriwardhana,D.D.
Background: Parkinson’s Disease (PD) is the second most common neurodegenerative disorder in the world. Also, Parkinson’s Disease Collaborators emphasized that it has become the fastest growing neurological disorder in the world. About 90.0% of people with Parkinson’s disease (PwPD) develop dysarthria following Parkinson disease. There are five systematic reviews have conducted to evaluate the effectiveness of Speech and Language Therapy intervention for Dysarthria in PD. A considerable number of Randomized Control Trials (RCTs) that were included in the two reviews published in 2012 were conducted before the introduction of CONSORT guideline in 1996. Numerically, two out of three RCTs of the first review and two out of six RCTs of the second review are conducted before the introduction of CONSORT guideline. In the third review published in 2015, electronic database search has only been performed in PubMed. The fourth study have only searched three electronic databases. Also, this systematic review of RCTs has included a non RCT which leads to a serious issue in the methodological quality of the systematic review. The second systematic review published in 2020 has searched six electronic databases. However, four of them were available in Chinese language only. Both reviews of 2020 had not included three recent related RCTs. Therefore, high possibilities of bias are concerned in systematic reviews published after 2012. Objective(s): To systematically review and summarize the currently available Speech and Language Therapy interventions for dysarthria in Parkinson’s disease. Methods: This updated systematic review was conducted through adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol (PRISMA-P, 2015) with a PROSPERO registration number of CRD42020208936. Only RCTs were included that compare two types of SLT intervention or SLT intervention with placebo or no intervention. Patients with a proper diagnosis of Parkinson's disease were included in the review without any restrictions of age, severity, duration of post-diagnosis or drug therapy. Electronic databases of CINAHL, EBSCOhost, PubMed, Scopus, The Cochrane Library and Web of Science Core Collection were searched. Additionally, the search was performed in WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov to identify the clinical trials. Eligible studies between 2011-2020 were included and the search was manually performed on the 23rd of December 2020 with no language restriction. Further, dissertations, theses and conference abstracts were manually searched to identify the available grey literature. Two reviewers independently performed the study selection process and data extraction from 20% of the articles. A narrative synthesis was performed with the extracted data. The modified Cochrane Collaboration's risk of bias tool (RoB-2) was utilized to assess the quality of included studies. The overall quality of this systematic review was rated as moderate using the AMSTAR-2. Results: A total of 1069 studies were identified through database searches and other sources. 438 duplicated studies were removed, and 631 studies were assessed during the title and abstract screening. 509 studies were excluded against the eligibility criteria and 122 studies were selected for full-text review. A total of six studies were included in quality assessments and narrative synthesis. LSVT LOUD is the most effective SLT intervention for dysarthria in Parkinson's disease. Both standardized LSVT and modified LSVT are effective in improving vocal sound pressure level, VHI score, CETI-M and other types of primary and secondary outcome measures. Further, effectiveness of LSVT LOUD does not depend on the mode of delivery (face-to-face or online). Conclusion: LSVT LOUD appears to be the most effective SLT intervention for dysarthria in Parkinson's disease. However, evidence is scarce to generalize the effectiveness of SLT intervention for treating people with Parkinson's Disease due to the small sample size, possibility of biases and heterogeneity of included studies. RCTs with rigorous methodology are needed to draw a firm conclusion.
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.
Self-ear cleaning and associated risk of ear injuries and ear related symptoms among students in the University of Kelaniya, Sri Lanka
(University of Kelaniya, Sri Lanka, 2022) Ranathunaga, R.M.L.C; Ileperuma, L.D.
Background: Self-ear cleaning (SEC) is recognized as a common habit where it tends to remain a hidden healthcare complication with respect to its potential ability to compromise the integrity of the ear by causing damage to the hearing apparatus. This has high prevalence rates among low- and middle-income countries compared to high income countries. Objectives: To determine prevalence, practices and associated risk of ear injuries and ear related symptoms following SEC among students in the University of Kelaniya, Sri Lanka. Methods: A quantitative descriptive cross-sectional study was conducted within the University of Kelaniya (six faculties and one institute). The target population indicated was 11,672 where the purposive sampling technique was utilized to select participants. Data was collected from 170 internal undergraduate students with Sri Lankan nationality, regardless of their academic year of study. An online self-administered semi-structured questionnaire was used to collect data from the participants. Results: Prevalence of SEC was 98.8% among all students and all faculties/institute presented with a 100% prevalence rate except in the Faculty of Medicine (96.5%). The majority perceived SEC to be beneficial and a family influence regarding encouragement of the practice was observed. The commonest object used was cotton buds to self-clean ears and the majority of participants had engaged in this practice between 1-5 years. Ear wax was the commonest reason given to engage with SEC. 7.1% of the students reported ear injuries caused by forceful use of various objects to self-clean ears. Overall, no association was observed between SEC and ear injuries as well as with SEC and ear related symptoms. Nonetheless, a statistically significant association was obtained with each presenting ear, ear itchiness, feeling fullness of the ear after SEC (p=0.006, 0.008, 0.031) as well as with experiencing earache and feeling fullness of the ear with use of cotton buds (p=0.024, 0.021). Conclusion: SEC has a potential to cause damage to the ear structure. Large scale awareness programmes are recommended to be undertake from the lowest to the highest education levels due to a lack of knowledge presented regarding this habit.
Effectiveness of an educational workshop for improving ICU nurses` knowledge on managing dysphagia in patients with tracheostomy at government hospitals in Sri Lanka
(University of Kelaniya, Sri Lanka, 2022) Karunarathna, W.K.L.; Perera, K.D.R.D.; Rathnayake, S.P.
Background: Adult patients with tracheostomy are a medically complex population. Tracheostomy insertion is a common procedure seen in Intensive Care Unit (ICU} settings to manage many critical patients by means of an artificial airway. But the tracheostomy indication is associated with several complications. Therefore, dysphagia is one of the main complications that tracheostomy leads to, where 11% to 93% of patients following tracheostomy have been identified with dysphagia in various studies. The management of dysphagia is a multidisciplinary team approach, and the nurses are one of the health professionals in this team. Therefore, the nurses` knowledge of the management process of dysphagia is important to improve the Quality of Life (QoL) of patients with tracheostomy. Objective/s: The objectives of this study were to describe nurses` knowledge regarding dysphagia management in patients with tracheostomy before and after conducting an educational workshop and to describe the nurses’ perspectives on the effectiveness of the educational workshop. Methods: The pre-post interventional study design compared nurses' knowledge differences after attending an educational workshop on dysphagia management in tracheostomy patients. There were sixty participants (n = 60) included, and they were selected by purposive sampling and the snowballing technique. The data was gathered through an online survey. The educational workshop was planned based on the outcomes of the needs assessment and the nurses` knowledge assessed by providing pre and post-test questionnaires. Paired-sample t-tests were used to identify whether there is a significant improvement in the nurses` knowledge after the educational workshop. Results: The findings showed that the designed online workshop significantly improved nurses’ knowledge of managing dysphagia in tracheostomy patients t (59) =-25.755, p =.000. Further, the perceived effectiveness of the workshop, as reported by nurses, indicated that the workshop is highly effective and helpful in improving their knowledge regarding dysphagia management in patients with tracheostomy. Conclusion/s: The results of the present study showed that the nurses had moderate knowledge regarding dysphagia management in patients with tracheostomy before conducting the educational workshop. However, after conducting the educational workshop, the mean scores of nurses increased to the high knowledge level. Therefore, the study concludes that the educational workshop undertaken is an effective method to improve nurses' knowledge on the management of dysphagia in patients with tracheostomy.