Conferences and Symposia

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Conference papers presented at Conferences and Symposia organized by the Faculty of Medicine are collected under this subcommunity

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Subject: search.filters.subject.Dysphagia

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    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.
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    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.
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    Swallowing difficulties in healthy ageing-adults; A study in the colombo and gampaha districts.
    (University of Kelaniya, Sri Lanka, 2022) Liyanage, V.W.; Atapattu, B.A.D.S
    Background: Ageing affects swallowing with physiological, psychological, and functional changes. Disruption of any phase of the swallowing mechanism due to neurological, physiological, or psychological reasons can cause dysphagia. Swallowing disorders have a negative effect on health and quality of life, so early identification and early intervention are necessary for lifestyle support for elderly persons. This study aimed to gather data through a preliminary investigation of the presence of swallowing difficulties in otherwise healthy ageing adults in the Colombo and Gampaha districts. The findings of this study will contribute to raising awareness among these families/caregivers.Methods: A mixed method approach, including a descriptive cross-sectional survey was used. Participants of the study were a hundred (n=100) healthy ageing-adults of 60 years or above who live in the Colombo and Gampaha districts. A convenience sampling technique was used. Data was collected through the interviewer-administrated questionnaire developed based on demographic data, swallow symptoms, and adaptations during mealtime, including open-ended questions, close-ended questions, and rating scales and a video of a single trial of the participant drinking 30ml.Results: Of the 100 healthy ageing adults screened, 38 were males and 62 were females. Half (50%) of the participants (n=50) were aware that they had some difficulty during eating or swallowing. The interviewer-administered questionnaire, which included the Swallowing Disturbance Questionnaire (SDQ) with two sections was used to identify their swallowing difficulties. The more commonly reported characteristics were difficulty chewing solid foods and needing to masticate more before swallowing. The SDQ has a total score of 45, with higher scores indicative of a positive result suggesting the presence of swallowing difficulty. The subset 1 score was used to assess oral difficulties, and the subset 2 score indicated pharyngeal difficulties. A larger number of participants had pharyngeal difficulties than oral difficulties. Furthermore, people aged 70 and above had more difficulty swallowing than those aged between 60 to 69. Independent Mann-Whitney U test analysis showed statistically significant differences across age groups and sex. There was no correlation between the Swallowing Disturbance Questionnaire (SDQ) total and the Gugging Swallowing Screen (GUSS) total. In addition, changes to food choices (n = 37) and reduced food intake (n = 30) were the participants' most reported dietary habits and food preferences. Conclusion: The findings of the study reveal the presence of swallowing issues in the healthy elderly, characterize by the type of age-related swallowing difficulties, and identified healthy ageing-adults' mealtime adaptations in the local context. This study adds to the evidence of preliminary data about the presence of swallowing challenges, their nature, and adaptations to meet the nutritional demands of healthy older adults.
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    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.
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    Paediatric dysphagia assessments used by speech and language therapists in Low and Middle-Income countries: A Scoping Review
    (Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Sumanasiri, D.
    Introduction: Paediatric dysphagia is highly prevalent in low and middle-income countries (LMICs), where healthcare facilities have limited resources. The awareness of available resources for Speech and Language Therapists (SLTs) to assess paediatric dysphagia is useful to ensure early diagnosis and intervention. Objectives: To describe different types of paediatric dysphagia assessments used by SLTs in LMICs, characteristics of identified assessments and gaps in current evidence. Methods: This systematic scoping review was conducted using a modified version of Arksey and O’Malley’s framework. Keywords comprised ‘paediatric’, ‘dysphagia’. Two electronic databases were searched for relevant articles published from January 2005 to December 2020, and reference list of included studies were reviewed for missed articles. Two independent reviewers reviewed the articles and one reviewer extracted data on sample descriptors, paediatric dysphagia assessment types and characteristics of paediatric dysphagia assessments used by SLTs in LMICs. The same reviewer collected the results and resolved discrepancies with the support of the supervisor. Results: Six articles were included in this review (two from Brazil, two from Turkey and two from India). Samples and methods of identified articles were heterogeneous. There were 12 different paediatric dysphagia assessments used by three LMICs covering two main paediatric dysphagia assessments types; instrumental or non- instrumental. The non¬instrumental assessments were the most prominent assessment type among SLTs and the Video- fluoroscopic swallow study was the only assessment repeated in two countries: Brazil and India. Assessment’s characteristics were identified. Less information was available on results, interpretation and assessing time duration. Conclusions: Both instrumental and non-instrumental assessments for paediatric dysphagia are common among SLTs in LMICs.
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    Administering Sinhala Pedi-EAT to detect feeding difficulties in children with disabilities: Evidence from a university clinic in Sri Lanka
    (Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Priyadarshana, S.
    Introduction: Dysphagia in children with disabilities leads to aspiration and has a long¬term impact on a child’s development. The Sinhala Paediatric Eating Assessment Tool (Pedi-EAT) is a parent-report instrument developed to assess symptoms of feeding problems in children aged 6 months to 7 years. Objectives: To determine feeding related concerns of paediatric cohort with disabilities and the association between Sinhala Pedi-EAT scores and parental feeding experience of children with disabilities. Methods: A descriptive cross-sectional survey was conducted at the MDT clinic for children with disabilities and their families at a university clinic. The study population included parents of children between 6 months-7 years attending the MDT clinic from November to December 2019. The Sinhala Pedi-Eat was administered to 410parents of children with disabilities. Results: The most prevalent feeding concerns under the physiologic symptoms was cough during or after mealtime (71%, n=291). Under the problematic mealtime behaviours, rejection of the foods (54%, n=221) was the commonest. Mealtime was longer than 45 minutes for majority of the children (61%, n=149). They were red flagged for a diagnosis of dysphagia. Children who were diagnosed with developmental disorders (72%, n=296) presented higher risk for having dysphagia. Conclusions: Highest scored feeding difficulties were under the problematic mealtime behaviours of Pedi-EAT questionnaire. Educating parents/ caregivers regarding helpful and unhelpful behaviours on child’s feeding will aid in managing problematic feeding behaviours in children. Pedi-EAT can be reliably used to screen feeding difficulties in children in Sri Lankan clinical context.
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    Anxiety and Depression among the patients with Dysphagia following Oral Maxillofacial and Neck surgeries in four selected hospitals in Western Province, Sri Lanka.
    (Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Fernando, K.; Fernando, R.; de Silva, D.
    Introduction: Undiagnosed anxiety and depression are obstacles to effective management of post-operative dysphagia. In Sri Lanka, the prevalence of anxiety and depression among patients with postoperative dysphagia is not known. Objectives: This study aimed at determining the severity and the stage of dysphagia, presence of anxiety and depression, and to identify the association between the severity and the stage of dysphagia with anxiety and depression following Neck, Oral & Maxillo-Facial (OMF) Surgeries. Methods: A cross-sectional study was conducted among 97 participants, with post¬operative dysphagia following OMF and Neck surgeries at four selected hospitals. Oral-motor and cranial nerve examination, the 3 ml water test, Cervical auscultation, Dysphagia Severity Rating Scale and Hospital Anxiety and Depression Scale were used for data collection. Results: Among the participants 51% presented with pharyngeal phase dysphagia and severe dysphagia. Prevalence of depression was 51% and anxiety was 38%, while 35% and 45% were at the borderline range respectively. With the increasement of dysphagia severity, high levels of anxiety and depression were noted. There was a statistically significant association between the severity of anxiety with severity of dysphagia (p< 0.05). Conclusion: Psychological burden is high among the participants with dysphagia following OMF and neck surgeries. Holistic management of dysphagia following OMF and neck surgeries, should include an assessment of the mental state of these patients and the treatment of anxiety and depression if required.