IN FOUCS: Building Collaborative Partnerships - 2023

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Parental experiences of the decision-making process regarding percutaneous endoscopic gastrostomy tube insertion and its post-management in children with developmental disabilities accessing a university clinic in Sri Lanka.
(University of Kelaniya, Sri Lanka, 2023) Kumarasinghe, J.K.S.T.; Hettiarachchi, S.
BACKGROUND: Feeding difficulties are common in children with developmental disabilities and the Percutaneous Endoscopic Gastrostomy tube is the most common long-term alternative feeding method used among them. Anecdotally in the Sri Lankan context, there appears to be a reluctance to go through a PEG insertion. There is a need to undertake a research study on the parental decision-making process and the post-management of PEG to understand how speech and language therapist can better support parents. OBJECTIVE/S: The main purpose of this study was to explore the parental experiences on the decisionmaking process regarding PEG insertion and its post-management in children with developmental disabilities accessing a university clinic in Sri Lanka. METHODS: This was a qualitative study using a phenomenological approach. Ten parents who have a child with a developmental disability, aged between one to eight years with one to three years of PEG experience with their children were the participants of this study. Semi-structured interviews were conducted using an interview guide which consisted of 10 questions. The qualitative data were analyzed using a simple thematic analysis. RESULTS: The study results indicate the lack of awareness and miscommunication with professionals throughout the decision-making process of PEG and the lack of parental satisfaction with it. However, they were satisfied with the speech and language therapist’s involvement in both decision-making and the monitoring process in the post-management of the PEG procedure. Also, negative societal views made the parents reluctant to consider a PEG and it affected post-PEG management as well by limiting societal participation in meal times due to visibility. The parents also described the strengths and challenges of post-PEG management. All the parents were satisfied with the decision that they made to go through with a PEG for their children with developmental disabilities due to the lack of complications on the PEG procedure and as a long-term alternative feeding method. CONCLUSION/S: Parental awareness on the PEG procedure supports the decision-making process. Professional involvement is important in providing adequate information with a key role for the speech and language therapist.
Knowledge of nurses regarding oro-pharyngeal dysphagia in the Badulla district.
(University of Kelaniya, Sri Lanka, 2023) Madushani, R.W.S.; Kodituwakku, G.K.
BACKGROUND: Oro-pharyngeal dysphagia is a condition with life threatening complications. In hospital settings, in most occasions nurses are the first health care professionals to come in contact with such patients. Knowledge of oro-pharyngeal dysphagia signs and symptoms, complications, and role of Speech and language therapists in dysphagia assessment and management are crucial for nurses working in such settings. A lack of knowledge of oro-pharyngeal dysphagia can result in detrimental consequences and this can be fatal for the patient. OBJECTIVE/S: The main purpose of this study was to determine the level of knowledge of nurses regarding oro-pharyngeal dysphagia in the Badulla district, Sri Lanka METHODS: A quantitative, descriptive cross sectional survey study was conducted. The study was conducted in the three types of hospitals in Badulla district. 138 nurses working in General, Base, and divisional hospitals in Badulla district were participants of the study. Data were collected through selfadministered questionnaire. The quantitative data were analyzed using descriptive and inferential statistics. RESULTS: Majority of the participants of the study were female (n = 121, 87.7%). Male participants were 17 (12.3%). The mean age of the participants was 34.92 years. The study findings specified that nurses demonstrate moderate knowledge of the signs, symptoms (Average correct response score = 8.1/13, 62.60%) and complications (Average correct response score = 6.1/10, 60.73%) of oro-pharyngeal dysphagia. Knowledge of nurses regarding role of speech and language therapists in oro-pharyngeal dysphagia was 5.4/8 (67.6%). There were no significant differences between the different types of hospitals for the knowledge on signs and symptoms of oro-pharyngeal dysphagia. CONCLUSION/S: The study provided that nurses’ levels of knowledge on oro-pharyngeal dysphagia had only moderate level. Further formal training on dysphagia and collaboration between speech and language therapists and nurses may improve early identification and management of oro-pharyngeal dysphagia
Measurement properties of instruments assessing Aphasia impact on social participation: A COSMIN systematic review
(University of Kelaniya, Sri Lanka, 2023) de Za, T.A.P.; Munasinghe, T.U.; Siriwardhana, D.D.
BACKGROUND: Aphasia is a language disorder that significantly limits a person's social participation. Patient-reported outcome measures (PROMs) of social participation play an important role in clinical practice to identify activity limitations and participation restrictions. Even though PROMs of the impact of aphasia on social participation are used to measure this aspect, their suitability is unclear. It is crucial that these PROMs demonstrate adequate measurement properties, such as validity, reliability and responsiveness for the intended population. Additionally, people with aphasia are excluded from research due to communication deficits. However, their involvement during assessment tool development is crucial to construct high-quality assessments. OBJECTIVE/S: The objective of this study is to critically appraise and summarize the measurement properties of instruments assessing the impact of aphasia on social participation using COSMIN criteria, to map the domains of instruments that assess the impact of aphasia on social participation against the social participation domains framework introduced by the ICF and to compare the measurement properties of the included instruments that are created with and without direct patient involvement. METHODS: The study protocol was developed with adherence to the statement of PRISMA-P, and the study was registered in PROSPERO (CRD-384044). A comprehensive electronic search was conducted in MEDLINE, EMBASE, CINAHL Plus, PsycINFO, AMED, and Web of Science Core Collection databases, and a secondary search was performed in Web of Science and Google Scholar. Studies on the development and testing measurement properties of instruments assessing the impact of aphasia on social participation were included in this review. The quality of evidence regarding measurement properties of the selected tools, including risk of bias, was evaluated against COSMIN criteria. RESULTS: Four articles featuring three instruments (Community Integration Questionnaire (CIQ), Social Activities Checklist (SOCACT), and Stroke Social Network Scale (SSNS)) assessing the impact of aphasia on social participation were identified. The quality of evidence for ‘CIQ’ development, reliability, and construct validity were ‘satisfactory’. The quality of evidence for ‘SSNS’ PROM development was ‘low- very serious risk of bias’. However, ‘satisfactory’ evidence was reported for construct validity. CIQ and SOCACT instruments showed good face validity. Compared to other instruments, SSNS reported satisfactory involvement of persons with aphasia during instrument development. The quality of evidence for internal consistency was only evaluated for two instruments due to a lack of evidence. There was no evidence for content validity, measurement error, measurement invariance, criterion validity and responsiveness. CONCLUSION/S: Instruments that exclusively measure the impact of aphasia on social participation have limited evidence of measurement properties. Further work is required to update and investigate the missing 13 measurement properties of these instruments. Based on the available evidence, the Community Integration Questionnaire can be recommended to measure the impact of aphasia on social participation.
Parents’ self- reported experience of feeding-related care of their premature infants while admitted to a neonatal intensive care unit in Sri Lanka: A qualitative study
(University of Kelaniya, Sri Lanka, 2023) Bandara, P.M.N.M.; Hettiarachchi, S.
BACKGROUND: Preterm infants experience various medical, neurological and developmental complications that may affect feeding skills. They are admitted to the neonatal intensive care unit (NICU) for special care and monitoring. Anecdotally, during the hospitalization in the local NICU, mothers’ and fathers’ involvement and confidence in the feeding-related care of their premature infants is low and there is a lack of interaction between the infant. OBJECTIVE/S: The main objective of this study was to explore both mothers’ and fathers’ experience of feeding-related care of their premature infants while admitted to a Neonatal Intensive Care Unit in Sri Lanka. METHODS: A qualitative study using a phenomenological approach was carried out with a sample of ten couples of participants including ten mothers and ten fathers who have premature infants (born between 28 -37 weeks gestational age) with feeding difficulties who have been hospitalized at a neonatal intensive care unit. A semi structured interview was conducted via telephone using an interview guide with 15 open ended questions. A simple thematic analysis was used to analyze the qualitative data. RESULTS: The findings were analyzed and main three themes and subthemes emerged. The main themes were Parental role, Parent- infant closeness and separation in NICUs and Speech and Language Therapy services support for feeding related care in a local NICU. The results illuminated that the majority of mothers had a minimal role in the NICU and all the fathers reported that they have been excluded from infant care in the NICU. CONCLUSION/S: Overall there is a lack of satisfaction on the minimal involvement in infant feeding care in the NICU which was a major parent. There is a difference between mothers’ and fathers’ perceived experience and knowledge they have received during hospitalization of their infant in the local NICU. In Sri Lanka (a Global South country) fathers are the ‘forgotten’ parent in terms of early feeding interventions. Parents show a satisfaction about the support of the NICU staff and SLT. Speech and language therapists need to take a lead in offering more information and training to parent and involve them more directly in feeding related infant care. The findings of the study will be helpful to make recommendations regarding feeding when working with parents and infants in the SLT clinical settings.
Special education teachers’ perspectives on using individualized education plans for online education for children with Autism aged between 5 to 10 years in the Gampaha district.
(University of Kelaniya, Sri Lanka, 2023) Amarasinghe, W.M.A.G.A.S.; Hettiarachchi, K.K.Y.
BACKGROUND: Autism spectrum disorder is a development disability, with deficits in social communication and interaction along with restricted, repetitive behaviors or interests (Centers for Disease Control and Prevention, 2022). Education can benefit multiple skills development along with therapy sessions such as behavioral health services and vocational training services for children with autism. (Myers et al., 2007). With the outbreak of the COVID – 19 pandemic, many changes occurred in the education system with the commencement of online education. This study describes Special education teachers' perspectives on their practice, experiences, and impact on students' learning outcomes with regard to using Individualized Education Plan (IEP) during online education for children with autism. OBJECTIVE/S: This study aimed to explore special education teachers' experiences of using IEPs in online education, to describe the perspectives of special education teachers on the practices of using IEPs during online education, and to describe special education teachers' perspectives on the impact of online IEPs on students' learning outcomes compared to onsite education. METHODS: This cross sectional, mixed method study included 30 special education teachers who are using online IEPs for children with autism between 5 to 10 years of age in the Gampaha district. Participants were recruited from government schools, private schools and community centers using a snowball sampling technique. A Self- administered questionnaire with four main sections, including both openended and close-ended questions, was used to collect data. Qualitative data were analysed using thematic analysis and quantitative data were analysed using descriptive statistical analysis. RESULts: The majority of the participants (77%) had 0-1 year of experience of using IEPs in online education for children with autism. Among these participants, 70% believed that they do not have enough information and experiences regarding online IEP implementation. Also, online learning was perceived to have a negative impact on learning outcomes of students. Participants mainly shared their perspectives on the challenges faced during online education, the impact of caregiver involvement, specific advantages of online IEPs and suggestions to improve the outcomes of online education. CONCLUSION/S: Using IEPs in online education for children with autism was considered as unsuccessful according to the majority of the participants. However, through improving awareness of the teachers and caregivers, providing relevant facilities and by adding specific modifications to the IEP process, the teachers held that effectiveness of online learning can be improved.
Audiological profile of auditory neuropathy spectrum disorder in the paediatric population of a selected audiology clinic.
(University of Kelaniya, Sri Lanka, 2023) Farook, T.; de Silva, M.D.K.; Balasuriya, B.M.L.K.
BACKGROUND: Hearing loss is a major concern worldwide with an estimated prevalence of over 20% globally. Among the different types of hearing loss, this study focuses on Auditory Neuropathy Spectrum Disorder (ANSD). ANSD is characterized by the presence of intact outer hair cells and the absence of typical functioning in the auditory nerve. OBJECTIVE/S: To develop an audiological profile of patients with ANSD using audiological records of the paediatric population attending the audiology clinic, Faculty of Medicine, Ragama from 2017 2022, and to compare the risk factors for hearing loss and other associated factors between patients with ANSD and sensorineural hearing loss (SNHL). METHODS: The study design was a retrospective comparative case study conducted in the University Audiology Clinic, Faculty of Medicine, Ragama, Sri Lanka. The population for the study included all patients who attended (2017-2022) the University Audiology Clinic in the age range of 0-18 years. Data was collected from audiological records. The assessment findings were used to develop the profile while the medical history was used to compare the risk factors between ANSD and SNHL patients. Data analysis software (statistical package for social sciences (SPSS) version 26) was used for statistical analysis. Data related to risk factors for hearing loss among patients diagnosed with SNHL and ANSD were analysed, and a comparison was made between the two groups using the Chi-square test. RESULTS: A total of 1215 pediatric patients have attended the clinic. Out of them ANSD cases were found to be 2.7% of the pediatric population that completed the test, while 16.05% were of the SNHL population. Only one had unilateral ANSD. Distortion Product Oto-Acoustic Emissions (DPOAEs) were present in 44.2% (19) of the ears and inconsistent in 18.6% (8) of the ears. Cochlear Microphonics (CM) was present in all (43) ears. Tb-ABR was absent in 46.2% (12) of the ears while abnormal in 53.8% (14) of the ears. Click ABR was absent in 83.7% (36) of the ears and abnormal in 16.3% (7) of the ears. The degree of hearing loss varied between mild to profound in patients with ANSD. Comparison of the risk factors revealed a statistically significant difference for neonatal hyperbilirubinemia (p=0.003), administration of oxygen (p=0.040), neonatal sepsis (p=0.025), neonatal meningitis (p=0.014) and congenital anomalies (p=0.002). CONCLUSION/S: The proportion of ANSD found in the pediatric population with risk factors is significant and justifies the need to implement newborn hearing screening programs for early identification. Neonatal hyperbilirubinemia, administration of oxygen, sepsis including meningitis, and congenital anomalies can be used as predictors for infants at risk of ANSD. Children with ASD, speech delay, CVI, and GDD require to be screened for ANSD as well.
Fathers’ attitudes towards father-child interaction and how they interact with their children aged 2 - 2 ½ years in the home setting in the Puttalam District.
(University of Kelaniya, Sri Lanka, 2023) Perera, S.; Hamsa, S.
OBJECTIVE/S: The general objectives of this study were to describe fathers’ educational level and socioeconomic status and their effect on their attitudes about father-child interaction, and the quality and the frequency of home-based language strategies used by them with their children aged 2 - 2 ½ years in home setting in Puttalam District. The specific objectives were; To determine whether fathers’ educational level affects their attitudes about father-child interaction and home-based language strategies used by them. To determine whether the fathers’ educational level affects the frequency of home-based language strategies used by them. To determine whether fathers’ socioeconomic status affects their attitudes about father- child interaction and home-based language strategies used by them. To determine whether the fathers’ socioeconomic status affects the frequency of home- based language strategies used by them. METHODS: A Quantitative Cross-sectional study design was conducted with 300 participants who were fathers of typically developing children aged 2 - 2 ½ years. Participants were recruited from MOH clinics in Puttalam District. Data collection of the study was done onsite through a self- administered questionnaire including 4 parts as family demographics, fathers’ educational and socioeconomic status (SES), fathers’ attitudes towards father-child interaction, and quality and frequency of father-child interaction. Data was analyzed using SPSS software. RESULTS: Most of the participants with good attitudes about father-child interaction are fathers aged 40-50 years and fathers whose educational level is from Advanced to graduate level. Most home-based language strategies are also used by fathers aged 40-50 but by fathers with educational levels below Advanced Level. A minority of the participants with good attitudes about father-child interaction are young fathers aged 20-40. Most participants in the self-employing sector have good attitudes about father-child interaction. Fathers who work less than 8 hours per day interact more with their children than fathers who work more than 8 hours per day. CONCLUSION/S: The findings of this study conclude that the educational level and the SES of the fathers affect their attitudes about father-child interaction and the quality and frequency of home-based language strategies used by them. The findings describe that attitudes are ‘good’ when the educational level and the SES are high. But, the quality and the frequency of home-based language strategies are ‘good’ when educational level and SES are low. The age level of fathers directly affects their attitudes and usage of 25 home-based language strategies. The findings confirm that mature fathers have ‘good’ attitudes and high quality and frequency of home-based language strategies than young fathers. Furthermore, the findings describe that fathers’ working hours per day affect their time of interaction with their children. It contributes to determining that the interaction time decreases when the working hours per day increase.
Health-related quality of life of parents of children with feeding disorders in a tertiary care clinical setting in Western province, Sri Lanka.
(University of Kelaniya, Sri Lanka, 2023) Nirmani, N.; Dharmarathne, N.I.;
BACKGROUND: Parents of children with Feeding Disorders (CFD) have to be much stronger in their lives by keeping good Health-Related Quality of Life (HRQoL), as they are primary caregivers of children. It is extremely beneficial for clinicians and researchers to explore the HRQoL of parents of CFD to continue optimal care for children in Sri Lanka. OBJECTIVE/S: The aim of the study was to examine the impact of children’s Feeding Disorders (FD) on their parents’ health-related quality of life (HRQOL) in Sri Lanka. METHODS: Demographic, economic, and feeding history were obtained from 246 parents of CFD, aged between 6 months and 7 years, who receive feeding therapy at a community multidisciplinary care center. Participants completed standard adapted assessments on identifying the severity of feeding disorders (Pedi-EAT) and its impact on their HRQoL (FS-IS). Statistical analysis was performed on data using the Statistical Package for the Social Sciences (SPSS) version 26.0. RESULTS: The results indicated that caring for CFD issues negatively affected the caregivers’ health-related quality of life (HRQoL). Independent sample t-test revealed that mothers of CFD have significantly lower HRQoL compared to fathers (t (245) = .947, p=.001). HRQoL of parents has not significant different when the severity of feeding disorders of their children was higher. But socio-demographic factors directly affect HRQoL. Similarly, long-term FD in children showed significantly higher worry among parents and restrictions to their daily activities, reducing their HRQoL. CONCLUSION/S: In conclusion, this is the first study of this nature conducted in Sri Lanka to investigate parents’ HRQoL of CFD. The findings of the study expand our understanding of the impact of pediatric feeding disorders on the parents and families, which is a critical element in determining the effectiveness of healthcare intervention for CFD and their prognosis. Clinicians need to pay attention to factors that could improve the HRQoL of parents of CFD, in order to offer more effective care.
Experiences and expectations of adults who stutter attending speech and language therapy for stuttering in Sri Lanka.
(University of Kelaniya, Sri Lanka, 2023) Ampemohotti, A.M.N.L.; Nonis, D.
BACKGROUND: Over the years, the role of adults who stutter in stuttering treatment has evolved from being a passive recipient to an ‘expert’ partner in the collaborative therapeutic process. Therefore, understanding the client’s experiences and expectations regarding stuttering treatment has been recognized as an integral element of an effective therapeutic process. Although several global studies have explored the experiences and expectations of adults who stutter in relation to stuttering treatment, it is an uncharted area related to speech and language therapy in the Sri Lankan context. OBJECTIVE/S: The study explored experiences and expectations of adults who stutter attending speech and language therapy in Sri Lanka. METHODS: This study used a generic qualitative approach. Online semi-structured interviews were conducted with 12 adults who stutter who were attending or had attended speech and language therapy within the past two years at a state university clinic in Sri Lanka. All interviews were conducted in Sinhala language via Zoom. The interviews were audio recorded, transcribed verbatim, translated into English language, and analyzed using a thematic analysis. RESULTS: Four themes emerged from the data: 1) limited awareness of stuttering and its management, 2) impact of stuttering on adults who stutter, 3) experiences of coping with stuttering before attending therapy, and 4) perceptions towards successful management of stuttering. Most of the participants’ experiences before successful management depicted narratives of negative emotions and reactions followed by a lifestyle dominated by avoidance and restriction. The majority of the participants’ expectation of therapy was to improve fluency. Many participants reported that their expectations for therapy were met and that therapy made a positive difference in their lives. Furthermore, the participantsm indicated multiple personal, therapeutic, and social factors that contribute to achieving successful outcomes from therapy. CONCLUSION/S: The current study emphasizes the importance of individualized therapy, designed by considering all the unique perceptions and needs of individuals related to their quality of life to improve the likelihood of successful therapeutic outcomes. The study reveals that being absolutely fluent is not a necessary criterion for the successful management of stuttering. In addition, the findings highlight the need to promote awareness of stuttering and its management and the profession of speech and language therapy among the Sri Lankan public.
Parents’ attitudes and experiences related to speech and language therapy among Sinhala-speaking children with down syndrome attending the Ayati Center for children with disabilities.
(University of Kelaniya, Sri Lanka, 2023) Kiriella, K.Y.W.; Athauda, L.K.
BACKGROUND: Down syndrome is the most common genetic disorder associated with speech and language delay. From the time a child with Down syndrome is born, parents struggle to develop their child's speech as it is one of the most important components that need to be developed in this population. OBJECTIVE/S: This study aims to describe parents’ attitudes and experiences regarding speech and language therapy for their Sinhala-speaking child with Downs Syndrome attending the Ayati Centre. METHODS: This study included fifteen parents of Sinhala-speaking children with Down syndrome between birth to 5 years of age attending Speech and language therapy clinics at the Ayati Centre. Data was collected through 30–45-minute face-to-face semi structured interviews with each parent. The interviews were coded, categorised and key themes were identified. Initially, the data was transcribed into Sinhala. The narratives were analysed in order to understand the parental attitudes and experiences on the topic. RESULTS: According to the analysis, 12 content codes were identified and the following four main themes emerged; parental commitment to improving speech, the disappointment of being a parent with a child with disability, parents moving forward despite challenges, influence of family towards speech development (both positive and negative). CONCLUSION/S: Parents face many challenges when dealing with their children with Down Syndrome, especially due to the speech delay. All parents are keen to improve their child’s speech abilities and pay special attention to achieving it. Social stigma is an important issue that affects parents. Immediate and extended family support can be crucial for parents when dealing with challenges associated with speech development among babies with Down Syndrome.
Determining the proportion of dysphagia in post-stroke patients admitted to a teaching hospital in Sri Lanka.
(University of Kelaniya, Sri Lanka, 2023) Fonseka, O.D.S.; Dharmarathne, N.I.
BACKGROUND: Post-stroke dysphagia (PSD) is one of leading cause to increase the number of deaths in stroke patients in worldwide. By today, early identification and detection of post-stroke dysphagia is increased due to its severity. Sri Lanka is low-middle income country (LMIC) and currently there is no study about proportion of post-stroke dysphagia in Sri Lanka. Dysphagia is one of severe complications following stroke. And also, PSD can lead to even death. OBJECTIVE/S: The purposes of the study are to evaluate the proportion of patients with PSD admitted to North Colombo Teaching Hospital, Sri Lanka and to determine the association between communication impairments and post-stroke dysphagia. This is novice research question to Sri Lankan context. METHODS: This analytical cross-sectional study recruited seventeen (n=17) adults age ranging from 18 and above male and female who were consecutively admitted to stroke unit with the diagnosis if ischemic or hemorrhagic stroke during acute period of stroke. Stroke was confirmed by either CT or MRI. Patients who were admitted between 29th of November to 23rd of December 2022 were recruited. GUSS, EAT- 10 were administered to evaluate swallowing. Communication was evaluated when SLT record were not available. Period prevalence was measured to evaluate proportion of post-stroke dysphagia. Chi-square test, Mann-Whitney U test, and Kruskal-Wallis one way ANOVA were used to discover the association between dysphagia and communication impairment and other relevant variables. RESULTS: The proportion of dysphagia following stroke in a teaching hospital in Sri Lanka is 70.58%. Twelve (n=12) were presented with PSD. Mean age was 62.06 (SD=8.86) years. Majority of the sample was male (76.5%). The proportion of dysphagia in ischemic stroke is 52.94%. Association between PSD and communication impairment portrayed statistically significant association (x2 (1) = 5.4 , p=.020). Dysarthria is more prominent communication impairment of the sample (n=14). Overall, 88% of patients having communication impairment. Association between dysarthria and dysphagia (p=.707). CONCLUSION/S: Proportion of post-stroke dysphagia is in critical level and it significantly associates with communication impairments. In order to improve outcomes and minimize post-stroke period complications, immediate evaluation or detection of dysphagia is significant.
Translation, cross-cultural adaptation and validation of the abbreviated profile of hearing aid benefit questionnaire with a sample of Sinhala speaking adult hearing aid users in Sri Lanka.
(University of Kelaniya, Sri Lanka, 2023) Hewapathiranage, S.H.; Karunarathne, W.G.S.S.; Balasuriya, B.M.L.K.
BACKGROUND: Hearing aid amplification plays a crucial role in audiological rehabilitation. The quantification of the benefit of hearing aids in further enhancement is necessary for effective management. The Abbreviated Profile of Hearing Aid Benefit (APHAB) is one of the most widely used self-report questionnaires, used to quantify disability subjectively in everyday life caused by hearing loss as well as to examine the effect of hearing aid intervention in adult hearing aid users. OBJECTIVE/ The purpose of this study was to translate, cross-culturally adapt and validate the Abbreviated Profile of Hearing Aid Benefit (ABHAB) questionnaire in Sinhala. METHODS: A cross-sectional study was conducted to pre-test the validity of the translated ABHAB questionnaire. Authorization from the original authors of the questionnaire was sought and gained. The APHAB was translated into Sinhala and 30 adult participants (male = 56.7% and female = 43.3%) were recruited with a mean age 60.4 years to assess its face validity. The content validation of the APHAB questionnaire was assessed by the degree of relevance and the cultural appropriateness. The Content Validity Index (CVI) was calculated by using item – CVI (I-CVI) and scale – CVI (S-CVI). S-CVI was calculated under Scale CVI Average (S-CVI/AVE) and Scale -CVI Universal Agreement (S-CVI/UA) RESULTS: The obtained responses for face validity indicated a high percentage of agreement. Obtained ICVI for degree of relevance was greater than 0.79 for all the items in the questionnaire, S-CVI/AVE indicated an excellent content validity as it obtained 0.94, while the S-CVI/UA value was lower than 0.8, was not indicated an excellent content validity. For cultural appropriateness, 21 items obtained an I-CVI value greater than 0.79 as relevant items; 3 items obtained values lower than 0.70. As S-CVI/AVE and SCVI/ UA values did not indicated a good content validity for cultural appropriateness, modifications were applied to the items that obtained lower I-CVI values by conducting a review. CONCLUSION/S: The translated, culturally adapted and validated APHAB questionnaire in Sinhala, is a simple and quick instrument to measure the self-reported effectiveness of hearing aids use by people with hearing loss in Sri Lanka. Thus, it can be used in aural rehabilitation and to direct people to relevant therapeutic approaches.
The effectiveness of a communication partner training program for parents of children with complex communication needs: A pilot study.
(University of Kelaniya, Sri Lanka, 2023) Jayathilake, S.A.H.D.; Muttiah, N.A.;
BACKGROUND: Augmentative and alternative communication (AAC) is an evidence-based intervention that addresses the complex communication needs (CCN) in children with various developmental disabilities. A majority of the communication partners of children who use augmentative and alternative communication (AAC) do not have sufficient knowledge and skills to facilitate effective communication opportunities. With the limited resources in low and middle-income countries, attending in-person training programs is challenging. OBJECTIVES: The study focused on evaluating the effectiveness of “Vivesa: Let’s read storybooks” an online, self-paced training intervention for Sinhala-speaking parents of children with complex communication needs. Specifically, the study aimed to determine the effectiveness of the communication partner training program on parents’ ability to implement the targeted communication partner intervention during a shared storybook reading activity. METHODS: The study used the one-group pretest-posttest study design with eight parent-child dyads recruited from the Ayati National Center for Children with Disabilities in Ragama, Sri Lanka. A pretest was conducted at the baseline and after the completion of the online training and the subsequent online coaching sessions, a post-test was conducted with each parent-child dyad. The training intervention aimed to promote the effective incorporation of the children’s AAC systems when engaging in shared storybook reading activity through the implementation of Read, Ask, Answer, Prompt (RAAP) strategy. The training was composed of seven short instructional videos and two one on one online coaching sessions. The video recordings collected during the pre and post-tests were coded to count the number of accurate RAAP strategy implementations and a paired samples t-test was conducted to test the statistical significance of the participants’ improvement. RESULTS: All the participants of the study were females and their children involved in the study presented with a range of conditions such as Autism Spectrum Disorder, Cerebral Palsy and Specific Language Impairment resulting in complex communication needs. The findings of the paired sample t-test suggested that there was a statistically significant increase in the parental RAAP strategy use during the post-test (M = 3.57, SD = 1.718) when compared with the pre-test (M = 0.00, SD = 0.000) with a larg effect size of 2.08. CONCLUSIONS: The results of the study provided evidence that an online, self-paced training intervention could be effectively used to improve the target strategy use among parents during a shared storybook reading activity. This implies that technology can be effectively incorporated into communication partner training programs even in the context of low and middle-income countries.
Measurement properties of frenchay aphasia screening test across different languages: A COSMIN systematic review.
(University of Kelaniya, Sri Lanka, 2023) Jayasingha, J.A.P.P.; Ariyasena, A.D.K.; Siriwardhana, D.D.
BACKGROUND: Aphasia is a language disorder that occurs due to damage to the brain; the left side of the brain contributes more towards language. Aphasia may cause problems in understanding, speaking, reading, or writing (American Speech-Language-Hearing Association, 2022a). The main goals of speech therapy treatments are to enhance communication, restore speech and language ability as much as possible, and teach different communication strategies (Schulman, 2020). Frenchay Aphasia Screening test (FAST) is used to identify aphasia (Enderby et al., 1987). The best-evaluated and most widely used aphasia assessment is the Frenchy aphasia screening test (Salter et al., 2006). No matter how valid this original tool is, a systematic review is yet to be conducted collating the psychometric properties of the FAST test across different languages. It is therefore important to summarize the measurement properties in those studies to analyzed the methodological quality of those validation studies. It will aid in identifying research gaps and inform future research. The study describes the measurement properties of Frenchay Aphasia Screening Test across different languages. OBJECTIVE/S: This systematic review aimed to appraise and summarize the psychometric properties of the Frenchay Aphasia Screening Test across different languages. METHODS: This study was conducted as a systematic review and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 guideline. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD - 383989). Research studies were searched using the following electronic databases: MEDLINE, EMBASE, PsychInfo, AMED, CINAHL Plus, and Web of Science. Reference lists of selected articles were also searched, and a forward citation search was done through Google Scholar. Studies were included if they presented at least one psychometric measurement property described in the consensus-based standards for the selection of health states measurement instrument (COSMIN) risk of bias checklist. Study selection involved two stages: 1) title and abstract screening and 2) full-text review. Disagreements between the two reviewers were discussed in both stages until a consensus was researched. The inter-rater reliability between the two raters was good (kappa=0.76) during the full-text review. The methodological quality of studies on measurement properties was assessed using the COSMIN risk of bias checklist. Data were synthesized according to the COSMIN guidelines. RESULTS: One hundred fifty-two articles were screened; 143 articles were excluded, and nine articles were selected for full-text review; four articles were included from full-text review. Overall, seven articles were included. This review included the original English version and six translations/adaptations of FAST. Two independent reviewers were involved in the article selection to avoid bias. According to the results, the PROM development studies on FAST were low. When considering the methodological quality of 16 measurement properties, hypothesis testing was rated as high as it was analyzed in four studies, and in each of those studies, it was rated as sufficient. The results were inconsistent and insufficient for other measurement properties to make conclusions. CONCLUSION/S: Based on the overall findings, only hypothesis testing demonstrated high-quality evidence for Frenchay Aphasia Screening Test. Furthermore, due to insufficient results, it was not possible to come to a conclusion about the measurement properties of content validity, internal consistency, cross-cultural validity, reliability, and criterion validity of the Frenchay aphasia screening test.
Translation, cross-cultural adaptation, and validation of Dysphagia Handicap Index (DHI) into Sinhala language.
(University of Kelaniya, Sri Lanka, 2023) Karunarathne, I.L.P.; Panterliyon, N.A.
BACKGROUND: Dysphagia Handicap Index (DHI) is one of the self-evaluation instruments used for assessing patients with dysphagia. It is a reflection of the patient's quality of life in physical, emotional, and functional aspects. Although it is well-known and most used among English-speaking people, there is no available Sinhala version to be used in Sri Lankan context. The aim of this study was to translate, cross-culturally adapt and validate the DHI into the Sinhala Language. OBJECTIVE/S: The objectives of this study are to translate and cross-culturally adapt the original version of the DHI from English to Sinhala, to evaluate the internal consistency of the Sinhala Dysphagia Handicap Index (S-DHI) and to evaluate the content validity of the S-DHI. METHODS: This study comprised two phases. Phase 1 translation and cross-cultural adaptation of the DHI. It was explained under five stages such as forward translation of the DHI from English to Sinhala, synthesis of the translation, back translation of DHI from Sinhala to English, expert committee review, and pre-testing. Phase 2 involved evaluating the psychometric properties of the scale that was included testing the reliability and validity of the scale. Purposive sampling was the sampling method. A crosssectional was conducted with 125 adults (above 20 years) with dysphagia (target group) and 125 adults without dysphagia (control group). The target group was recruited from four dysphagia clinics at government hospitals in Sri Lanka (District hospitals of Gampaha, Ragama Rehabilitation, and Wathupitiwala). The control group was recruited from Mahara Niladhari Division. Cronbach’s alpha coefficient was implemented to measure the internal consistency of the DHI. The expert panel performed the content validity, including nine speech and language pathologists with three years working experience with dysphagia disorder. The convergent validityof the DHI was assessed using hypothesis testing. RESULTS: The S-DHI and all subscales (physical, emotional, functional) showed higher internal consistency (Cronbach’s alpha o.975, 0.96, 0.979 0.991) respectively. The S-DHI scores between the target group and the control group were significantly different (p<0.05). Content validation test revealed higher validity scores for the degree of relevance, degree of cultural appropriateness, and degree of simplicity (I-CVI= 0.99, 0.98, 0.98). CONCLUSION/S: The S-DHI has achieved higher internal consistency, convergent validity, and content validity. This scale can be used in both clinical and research settings in Sri Lanka.