Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Physiological differences between breast-feeding and bottle-feeding in pre-term infants(University of Kelaniya, Sri Lanka, 2022) Perera, D.T. K.; Dharmarathna, I.; Udugama, L.Background: Infants who breastfeed must have the ability to coordinate their sucking, swallowing, and breathing to achieve their nutritional and hydration needs while protecting their airways. The need for new non-invasive approaches to get objective physiological parameters of suck-swallow-breathe coordination is considerable because the gold standard, videofluoroscopy (VFSS) cannot evaluate breast feeding and FEES cannot evaluate suck-swallow physiology. Objectives: The objectives of the study were to obtain physiological parameters of the suck-swallow-breathe coordination in a cohort of premature milk-sucking infants; describe the physiological differences between breast and bottle feeding in premature infants; and determine the associations of the selected demographic factors with the physiological measures of suck- swallow-breathe coordination in premature infants. Methods: This observational cross-sectional study used a purposive sampling method to recruit sixty-two (n=62) premature (≤ 37 weeks) infants from birth to 12 months who are breastfeeding and/or bottle-fed. One-two minute video recordings of breast-feeding/ bottle-feeding capturing sucking and swallowing movements were obtained. A set of objective physiological parameters of suck-swallow-breathe coordination were measured by analysing the video recordings. Results: Excellent inter-rater reliability was reported for all the physiological parameters used in this study (ICC= .89-.98, 95% CI [.86-.1.00], p< .001). When means were compared, a significant difference was reported in the feed duration between breast-feeding and bottle-feeding (t= 3.667, df=39.765, P=.001). Further, significant differences were reported in the number of pauses (t= 4.011, df=54.813, P<0.001), changes in levels of oxygen saturation during feeding (t= 2.456, df= 59.919, P= .017), changes in heart rate during feeding (t= 2.441, df= 55.919, P= .018), milk intake per minute (t= 6.542, df= 44.636, P<0.001), suck frequency (t= 4.093, df= 52.175 , P<0.001) and swallow frequency (t= 4.339, df=50.867, P<0.001) between breast-feeding and bottle-feeding in premature infants. In the Pearson correlation test, duration of feeding decreased as the gestational age of infant increased (r (61) = -.252, P= .048). Similarly, feeding duration was significantly shorter in infants with a higher gestational week at birth (r (61) =-0.309 P = 0.015). Furthermore, with an increased chronological age of the infants, the number of pauses during feeding decreased significantly (r (61) = -0.308 P = 0.015). Further, in infants with higher gestational weeks at birth (r (61) = 0.351 P = 0.005) and infants with increased weight (r (61) = .273 P = 0.032), milk intake per minute increased significantly. Also, milk intake per minute showed a significant increase in premature infants with increased gestational age at birth (r (61) = .351 P = .005) and with the current weight of the premature infants (r (61) = .273 P = .032). Conclusion: This research showed that bottle feeding, and breastfeeding have been associated with significant physiological changes in premature infants, which is supported by the reviewed research. By providing objectivity to its findings and its interpretation, this study provides a reliable and feasible method for improving the accuracy and reliability of clinical feeding assessments of infants. This unique method is a safe and effective way to gather objective physiological parameters of coordinated suck-swallow-breathe for therapists who do not have access to instrumental swallowing assessment.Item Developing a protocol for quantitative analysis of liquid swallowing in children.(American Speech-Language-Hearing Association, 2022) Miles, A.; Dharmarathna, I.; Fuller, L.; Jardine, M.; Allen, J.Purpose: Objective measures in videofluoroscopic swallow studies (VFSSs) can quantify swallow biomechanics. There are a wide array of validated measures studied in infants, children, and adults. There is a need for a pediatric VFSS protocol that consists of a small number of vital, time efficient, and clinically relevant measures. In this study, we aimed to establish a standard protocol for quantitative VFSS analysis in children. Method: Protocol development began with a systematic literature review, which identified 22 quantitative and eight descriptive measures available in the literature. A pediatric VFSS database of 553 children was collected using a standardized VFSS protocol. Studies were evaluated using the 30 previously reported measures covering displacement and timing parameters as well as penetration-aspiration and residue. Measures were tested for rater reliability and internal consistency. Measures meeting acceptable values for protocol inclusion were included in the final protocol (Cronbach's alpha > .53). Results: Interrater and intrarater reliability of 17 measures met acceptable reliability levels. During internal consistency testing, we removed six further measures based on Cronbach's alpha levels indicating that two or more measures were equivalent in measuring the same aspect of swallow biomechanics in children. A VFSS protocol of reliable, valid, and obtainable objective quantitative (n = 6) and descriptive measures (n = 3) with separate protocols for young infants (≤ 9 months) and older children was established. Conclusions: A standardized quantitative VFSS protocol for children has been developed to suit two age groups (≤ 9 and > 9 months old). Consistent VFSS administration and reporting support assessment over time and across disease groups. Future research should focus on how this information can be used by clinicians to produce individualized treatment plans for children with swallowing impairment.Item Stakeholders' perspectives on the provision of vocational training for youth with disabilities in Sri Lanka: protocol for a mixed-methods study(BMJ Publishing Group Ltd, 2022) Colonne, U.T.; Dharmarathna, I.; Siriwardhana, D.D.; Handy, T.; Gamage, M.H.; Athawuda, N.; Sumanasena, S.P.Introduction: The quality and the range of vocational training (VT) courses offered to youth with disabilities (YwD) in low-middle-income countries are underexplored. This protocol describes a study designed to gather perceptions of a range of stakeholders related to the quality and relevance of VT programmes conducted by the Department of Social Services in Sri Lanka. The purpose of this study is to communicate with authorities the ways in which they can improve their services by paying close attention to the needs and recommendations of all stakeholders. Methods and analysis: A parallel mixed-methods study will be conducted at eight vocational training institutes (VTIs). A survey will be conducted with five participant groups; YwD presently enrolled in VTIs (n=358) and their caregivers (n=358), YwD who completed the VT (n=45) and their caregivers (n=45) and educators at VTIs (n=47). The qualitative component includes semi-structured interviews and focus group discussions. The three groups of participants include: educators, caregivers of potential YwD for future VT (6-10 per group) and key informants from state, corporate and non-governmental sectors (a total of 20). Quantitative and qualitative data will be analysed using descriptive and inferential statistics and cross-thematic analysis, respectively. Ethics and dissemination: This study received ethical clearance from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya (Ref. No: P/15/02/2021). All data collection processes will abide by health and safety measures required by the national government. Written informed consent will be obtained from all participants. Results from this research will be disseminated, to local stakeholders and participants, via local and international conferences and publications in peer-reviewed journals.Item Quantifying Bolus residue and its risks in children: A videofluoroscopic study(American Speech-Language-Hearing Association, 2021) Dharmarathna, I.; Miles, A.; Allen, J.ABSTRACT: Purpose Postswallow residue is a clinical sign of swallow impairment and has shown a strong association with aspiration. Videofluoroscopy (videofluoroscopic study of swallowing [VFSS]) is commonly used to visualize oropharyngeal swallowing and to identify pharyngeal residue. However, subjective binary observation (present or absent) fails to provide important information on volume or location and lacks objectivity and reproducibility. Reliable judgment of changes in residue over time and with treatment is therefore challenging. We aimed to (a) determine the reliability of quantifying pharyngeal residue in children using the bolus clearance ratio (BCR), (b) determine associations between BCR and other timing and displacement measures of oropharyngeal swallowing, and (c) explore the association between BCR and penetration-aspiration in children. Method In this single-center retrospective observational study, we obtained a set of quantitative and descriptive VFSS measures from 553 children (0-21 years old) using a standard protocol. VFSS data were recorded at 30 frames per second for quantitative analysis using specialized software. Results Good interrater (ICC = .86, 95% CI [.74, .961], p < .001) and excellent intrarater reliability was achieved for BCR (ICC = .97, 95% CI [.91, 1.000], p = 001). Significant correlations between BCR and pharyngeal constriction ratio and total pharyngeal transit time were reported (p < .05). Using binomial logistic regression modeling, we found BCR was predictive of penetration-aspiration in children, χ2(13) = 58.093, p < .001, 64.9%. Children with BCR of ≥ 0.1 were 4 times more likely to aspirate. Conclusion BCR is a reliable, clinically useful measure to quantify postswallow residue in children, which can be used to identify and treat children with swallow impairments, as well as to measure outcomes of intervention.Item A Comparison of errors in languages spoken by Sinhala-English bilinguals with post-stroke Aphasia(Faculty of Medicine, University of Kelaniya, 2014) Dharmarathna, I.; Atapattu-Bakmeewewa, A.D.S.Bilinguals are defined as those who use two languages in daily communication. Aphasia as an acquired language disorder virtually affects all languages of the bilingual speaker, often in varying degrees. The Clinical picture of the bilingual aphasic is of great interest to researchers, as the bilingual population of the world continues to increase. Many studies have focused on the language recovery patterns and comparison of language errors in bilingual aphasia in overseas contexts. As a multi- ethnic country, bilingualism continues to grow in Sri Lanka. The knowledge of multiple languages has led to the functional elaboration of all languages known especially in Sinhala-English bilinguals. Yet, there is a severe dearth of bilingual aphasic literature in the Sri Lankan Speech & Language Therapy context. This descriptive cross-sectional study analyzed the language errors in twelve (n=12) Sinhala- English bilinguals with aphasia post stroke in order to determine the more preserved language. It also discussed the determination of language preference of the participants for Speech & Language Therapy (SLT). A language assessment was administered to elicit the required language samples in Sinhala and English including four major linguistic components; discourse/spontaneous speech, confrontational naming, repetition and translation. The test stimuli were adapted from Western Aphasia Battery (Kertesz, 1982) for English and Pre-AphSL (2012) for Sinhala. Data were used to compare and analyze the errors across the two languages. The results showed no significant difference between Sinhala and English language performances. Neologisms, paraphasias, circumlocutions and perseverations were observed in both languages. The study results revealed a significant effect of age at onset on word finding difficulties. Other variables indicated notable trends, yet failed to demonstrate statistical significance.Item ‘Giving Voice’: The Effectiveness of an experiential workshop to increase the knowledge and use of alternative augmentative communication (AAC) devices among teachers(Faculty of Medicine, University of Kelaniya, 2014) Bandara, M.M.M.K.; Subajini, A.A.N.; Kitnasamy, G.; Udugama, K.L.L.G.; Dharmarathna, I.; Hettiarachchi, S.Many children/ adults who use AAC need to develop the ability to socialize, answer yes/no questions, respond to a wide variety of questions, offer and request for assistance, and express views, feelings and attitudes (Glennen & DeCoste, 1998). Children/ adults who require access to AAC may be at risk of reduced social opportunities, isolation, psycho-social issues and poor quality of life (Hamm & Mirenda, 2006). There is a need to address conceptual explanations of ‘communication’, ‘disability’ and ‘AAC’ and the over-reliance on speech therapy sessions within teacher-caregiver training to create communication opportunities for AAC users. This study was assessed the effectiveness of an experiential training workshop on AAC for teachers. The workshop was offered to 20 teachers from a Special School and 10 teachers from a Special Centre and it covered the right to communicate, modes of communication and communication devices available at present in the country and. Participants’ interaction with children using AAC devices was observed within the classroom before and after the workshop and their knowledge and use of AAC measured through a questionnaire pre- and post-workshop. The results indicated a significant increase in awareness of the concept of AAC, the right to communicate and different modes and AAC devices available at present. There was also an increase in the interaction of participants with children using AAC devices in the classroom immediately following the workshop. The key qualitative finding is a clearer understanding of the right to communicate using any means available. Post-workshop follow-up is required to ascertain whether the knowledge and skills gained from the workshop are carried over into practice with time.