Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item When No Speech Norms Exist: Observations From Sinhala(American Speech-Language-Hearing Association, 2024-11) Hettiarachchi, S.; Ranaweera, M.; Saleem, S.; Krishnaveni, K.PURPOSE A well-established set of language-specific norms for phonological development is imperative in the assessment of child speech sound difficulties. Currently, English norms are used clinically (in the absence of norms for local languages) to determine if a child displays age-appropriate, delayed or disordered speech patterns in Sinhala. This preliminary exploratory study aimed to document phonological processes observed in typically developing Sinhala-speaking children aged 3;0-6;11 (years;months).METHOD The Test of Articulation and Phonology-Sinhala, a picture-based assessment, was devised by the researchers and administered to 102 Sinhala-speaking children from three geographical locations (Colombo, Kandy, and Gampaha). The quantitative measures included percent consonants correct, percent vowels correct, and percent phonemes correct, while the qualitative analysis identified phonological processes.RESULTS The quantitative results showed a marked influence of age on phoneme production accuracy with over 75% consonants correct by 3 years 6 months. The qualitative findings demonstrate common typical phonological processes and less common phonological processes in Sinhala compared to the speech pathology and cross-linguistic literature. Common phonological processes included fronting, stopping, and weak syllable deletion widely documented in linguistic and speech-language pathology literature. Many shared phonological processes were observed between Sinhala and Sri Lankan Tamil, the two main local languages, including fronting of retroflex sounds and lateralization. The phonological process of denasalization of prenasalized stops was observed in Sinhala, with no documentation of the phonological process found within the mainstream speech-language pathology literature.CONCLUSION AND IMPLICATIONS: These findings reinforce the need to document and use language-specific typical phonological processes in Sinhala given the implications for early and accurate identification of speech difficulties and intervention.Item Parental expectations and perceptions of augmentative and alternative communication: A Sri Lankan perspective(Sage Publications In Association With The National Autistic Society, 2024-11) Hettiarachchi, S.; Nizar, S.; Kitnasamy, G.; Gopi, D.Item Communication disability in low and middle-income countries : a call to action(BMJ Publishing Group Ltd, 2024) Marshall, J.; Wylie, K.; McLeod, S.; McAllister, L.; Barrett, H.; Owusu, N.A.; Hettiarachchi, S.; Atherton, M.No abstract availableItem /t/ before /ʈ/ or /ʈ/ before /t/: Emerging trends from a preliminary study of consonant acquisition in typically developing sinhala-speaking children aged 3 to 6 years(Ubiquity Press., 2021) Hettiarachchi, S.; Ranaweera, M.; Rajapaksha, R.M.W.Purpose: Speech and language therapists use developmental norms established for consonant acquisition to determine whether a child has age-appropriate, delayed or disordered speech skills. There are currently no established norms for the acquisition of Sinhala consonants, which have implications for accurate diagnosis. The aim of this study was to document preliminary trends observed in the trajectory of consonant sound development in Sinhala-speaking young children so as to form a set of ‘working norms’. Method: A picture-based articulation assessment was administered to 70 typically developing children who were between 3 years and 6 years 11 months of age. Results: Regarding the rate of acquisition and order of acquisition, the findings displayed trends comparable to general patterns of consonant mastery reported within cross-linguistic studies. In addition, a different rate of acquisition and order of mastery was observed for both uncommon Sinhala language-specific speech sounds showing ambient language effects and for a few common sounds occurring in Sinhala and other languages. Conclusion & Implications: The convergence and divergence in the rate and order of Sinhala consonant acquisition compared to the cross-linguistic literature has important clinical implications for assessment, early identification of speech difficulties and intervention within speech and language therapy practice in Sri Lanka. © 2021, Vrije University. All rights reserved.Item The Effectiveness of using multi-sensory children’s stories on vocabulary development in young deaf and hard-of-hearing children(Taylor & Francis, 2021) Hettiarachchi, S.; Ranaweera, M.; Disanayake, H.M.L.N.ABSTRACT: Young deaf and hard-of-hearing children enrolling in school in Sri Lanka often display language delay due to limited amplification and limited language stimulation. The scarcity of speech and language therapy support within the educational context at present necessitates a rethink of service-delivery models to reach more children. Multi-sensory stimuli and traditional children’s stories have been used in speech and language therapy to promote vocabulary development in children experiencing language-learning difficulties. Fifteen deaf or hard-of-hearing children from three different educational contexts were offered a three week “Katha malu” multi-sensory children’s story programme through the class teacher. The programme focused on developing receptive and expressive vocabulary of a set of 30 target words. The programme was offered using a combination of Sri Lankan Sign Language and Spoken Sinhala. The participants' receptive and expressive vocabulary knowledge on the target words was assessed using a specially devised picture-based vocabulary assessment pre- and post-intervention. The results show positive gains at both group and individual levels on receptive and expressive vocabulary skills. There was a positive effect of familiarity with the story with the overall vocabulary gains more prominent for the older, more traditional story. The findings of this study highlight the possibility of offering access to language stimulation programmes at classroom-level facilitated by the class teacher, under the guidance of a speech and language therapist. KEYWORDS: Early childhood education, language facilitation, engagement of children with adequate or inadequate amplification, multi-sensory, traditional storiesItem Enabling access: A pilot study on access and use of assistive products in the Northern Province, Sri Lanka(VU e-Publishing, Netherlands, 2019) Hettiarachchi, S.; Subramaniam, V.; Rajah, E.; Nizar, S.; Saleem, S.PURPOSE: The need for suitable assistive technology is growing all over the world, not only for people with disabilities but also for the ageing population with functional decline and non-communicable diseases. Access to assistive technology promotes access to education, employment and active societal participation. The aim of this study was to assess the self-reported need by persons with disabilities and by people who were 65 years and older without disabilities in the Northern Province of Sri Lanka, for assistive products; and to identify barriers to accessing these assistive products. METHOD: This mixed-methods pilot study included 76 participants who were either persons with disabilities or their caregiver or persons 65 years and older, from the Northern Province of Sri Lanka, affected by the now-ended 30-year civil war. To ascertain trends in the local need for assistive products, a translated version of the World Health Organisation's Priority Assistive Products List of 50 items was used. In addition, semi-structured interviews with key participants were conducted, to gain some insights into the barriers to accessing assistive products. RESULTS: The most widely used assistive products among persons with disabilities were connected to war-related injuries. In contrast, those used by the older age group of persons without disabilities were connected to non-communicable diseases and age-related frailty. The assistive products requested by both groups were aids to promote independence in daily activities and to support access to education and employment. The emergent themes included affordability, employment, independence in activities of daily living, stigma and psychological impact, and a lack of awareness and guidance in the use of assistive devices. CONCLUSION: The findings highlight the need for policies and practices to be informed by local socio-cultural, historical and geographical realities. KEYWORDS: Assistive products, Global South, Sri Lanka, war, priorities the Assistive Products List, VersionItem Colour Me…Orange? incorporating aspects of the colourful semantics approach into a TESOL programme at preschool(The Chinese University of Hong Kong, 2018) Hettiarachchi, S.; Ranaweera, M.; Walisundara, D.C.Among the challenges faced by Sri Lankan children learning English as an additional or second language is the accuracy of word order and vocabulary knowledge. The Colorful Semantics approach has been used successfully in the UK and in Australia with children experiencing language-learning difficulties, with many programmes devised by Speech and Language Therapists. It uses thematic roles and a colour-coding system to support the development of syntax through a semantic route. The aim of this study was to evaluate the efficacy of using aspects of Colourful Semantics to develop expressive language skills (accurate responses to target wh questions, sentence length and syntactic complexity) in young learners of English. Twenty-one preschool children in TESL classrooms were included in the study. Key aspects of Colourful Semantics were introduced as a whole-class approach using children’s storybooks, colour-coding and signing with lessons offered thrice a week for a month together with supplementary activities. Pre- and post-intervention measures were undertaken on two expressive language measures of sentence-length and syntax. In this paper we will discuss the programme offered, the pre- and post intervention assessment results, and the benefits of incorporating aspects of the Colourful Semantics approach into the English language teaching classroom.Item The Effectiveness of using the colourful semantics approach to support language development with children who are deaf or hard-of-hearing(Taylor & Francis, 2019) Hettiarachchi, S.; Ranaweera, M.ABSTRACT: The lack of early identification, suboptimal language stimulation and limited remedial services in Sri Lanka for children who are deaf or hard-of-hearing place them at-risk of language delay. The reality for many preschool and primary school children entering formal education in Sri Lanka is a language delay in spoken language and/or sign language compared to their age-matched hearing peers. The aim of this study was to evaluate the effectiveness of the Colourful Semantics approach as a whole-class language enrichment programme to develop the use and responses to target wh questions. Thirty primary school children who are deaf or hard-of-hearing between the ages of five-ten years were included. The programme was offered once a week for 12 weeks through the class teacher. Individual pre- and post-language measures and statistical analyses were undertaken on receptive knowledge and expressive use of the target wh questions using a picture naming task and tasks based on three local children’s story books. A statistically significant improvement was observed in the understanding of target wh questions post-intervention by all the children. There was also a positive change in the responses to the target wh questions by all the children post-intervention with many combining signs or spoken words with signs. The Colourful Semantics approach has potential as a whole-class language-teaching approach to strengthen the understanding and use of wh question forms. This study emphasizes the benefits of collaborative partnerships between speech and language therapists and teachers in delivering intervention particularly in resource-limited contexts. KEYWORDS: Deaf, children, language delay, Sri Lankan sign language, Colourful SemanticsItem Efficacy of a low-cost multidisciplinary team-led experiential workshop for public health midwives on dysphagia management for children with cerebral palsy(VU e-Publishing, Netherlands, 2018) Hettiarachchi, S.; Kitnasamy, G.; Mahendran, R.; Nizar, F. S.; Bandara, C.; Gowritharan, P.PURPOSE: Over the past decade there has been a growing focus on offering appropriate training to healthcare professionals and caregivers to support safe feeding practices for children with cerebral palsy. Early and consistent multidisciplinary intervention is required to minimise the risks of aspiration pneumonia. The high incidence of complications from aspiration pneumonia among children with cerebral palsy in Sri Lanka has made it necessary to conduct low-cost multidisciplinary team-led dysphagia awareness workshops for healthcare professionals and caregivers.METHOD: A group of 38 Public Health Midwives (PHMs) was offered an experiential workshop by a small multidisciplinary team (MDT). To determine changes in knowledge, a self-administered questionnaire that included a video-based client scenario was administered pre- and post-workshop. The data were analysed statistically using non-parametric within-participant t-tests.RESULTS: The post-workshop responses to the questionnaire indicated a significant increase in the level of knowledge. This included positive changes in the understanding and knowledge of cerebral palsy (t (37) =-7.44, p=.000), effects of cerebral palsy on eating and drinking skills (t (37) =-3.91, p=.000), positioning (t (37) = -9.85, p=.000), aspiration (t (37) =-3.46, p=.001), food categorisation (t (37), -3.85, p=.000) and client video observation (t (37)-3.91, p=.000) at a p=.05 level of significance. While there was also an increase in the knowledge on general guidelines during mealtimes, this did not reach statistical significance.CONCLUSION: The low-cost MDT-led experiential workshop was effective in increasing knowledge of feeding and dysphagia-related issues in cerebral palsy among a group of PHMs. This workshop could serve as a model for training PHMs and Community-Health Workers across the country in order to reach the Sustainable Development Goal of ‘good health and well-being’ for children with cerebral palsy and all children experiencing feeding difficulties. Follow-up workshops and continued professional development courses for midwives on dysphagia care are strongly recommended, in addition to collaborative clinical practiceItem Headache: an important symptom possibly linked to white matter lesions in thalassaemia.(Wiley-Blackwell, 2019) Premawardhena, A.; Ranawaka, U.; Pilapitiya, T.; Weerasinghe, G.; Hapangama, A.; Hettiarachchi, S.; Salvin, K.; Silva, I.; Hameed, N.; Weatherall, M.; Olivieri, N.; Weatherall, D.Neurological manifestations are reported only occasionally in patients with thalassaemia and are given much less prominence than the complications related to anaemia and iron overload. White matter changes (WMCs) on magnetic resonance imaging (MRI) in patients with thalassaemia were first reported two decades ago but the significance of these lesions remains unclear. We studied the neurological and cognitive manifestations in 82 older patients with thalssaemia [25 Thalassaemia major (TM), 24 thalassaemia intermedia (TI) and 33 haemaglobin E β thalassaemia (EBT)] and 80 controls, and found that headaches were more common in thalassaemia patients (50/82, 61%) than in controls (18/80, 22·5%: P < 0·001). WMCs on MRI were found in 20/82 (24·3%) patients and 2/29 (6·9%) controls had (P = 0·078). WMC were more common among those with headaches (17/50: 34%) than in those without headache (3/32; 9·3%) (P = 0·023). WMCs were not associated with reduction of cognition. Nevertheless, cognition was lower in the TI and EBT groups compared with those with TM (P = 0·002). The association of headache with WMC in thalassaemia has not been reported before and warrants further study.