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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 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.Item 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.Item /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 Oral feeding difficulties among children with cerebral palsy, aged between birth to 5 years: special challenges faced by primary caregivers during the COVID- 19 pandemic(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Serasinghe, C.S.D.; Hettiarachchi, S.Introduction: The COVID-19 pandemic has affected health service delivery, globally. Cerebral Palsy (CP) can be defined as a group of disorders affecting movements of limbs, muscles, hearing, vision and posture. Feeding and swallowing difficulties or oropharyngeal dysphagia commonly occurs in children with cerebral palsy. Use of telecommunication technologies are able to support long distance clinical health care. Objectives: To describe the perceived positive and negative experiences/ suggestions for getting speech and language therapy support of primary caregivers in managing oral feeding difficulties in children with cerebral palsy aged between birth to 5 years at a clinical setting during the COVID- 19 pandemic in Sri Lanka. Method: A qualitative study using a phenomenological approach in one clinical setting in the Western Province of Sri Lanka. Using a purposive sampling method, data was collected through semi structured tele- interview sessions by interviewing 12 participants. The qualitative data were analysed using thematic analysis. Results: Several themes emerged from the data as a result of qualitative analysis: challenges in accessing food, challenges in accessing medication, special challenges due to COVID-19 and transition of service delivery model. There are problems in accessing telehealth because of poor connectivity, technical issues and also the lack of awareness about the appointment. The knowledge about technology poorer than the other economically advanced countries. Conclusion: Parents across the country have different levels of access to technology and telehealth may not be accessible to all. However, the alternative methods of consultation by using a smart phone (Zoom, WhatsApp, Imo) are safer than the face-to-face consultations during the pandemic.Item Developing and pilot-testing an Oropharyngeal Dysphagia Screening Tool for children with cerebral palsy aged 4 – 6 years(Sri Lanka Medical Association, 2020) Hettiarachchi, S.; Ravihari, M.G.I.INTRODUCTION AND OBJECTIVES: Children with Cerebral Palsy (CP) demonstrate a variety of dysphagic symptoms. Speech and language therapists (SLTs) are mainly involved in the diagnosis and management of oropharyngeal dysphagia (OPD). Objectives were to develop a screening tool to detect OPD among children with CP aged 4 – 6 years, Pilot test the OPD screening tool with SLTs for children with CP aged between 4 – 6 years and to identify the test-retest reliability and inter-rater reliability of the developed screening tool. METHODS: The screening tool was developed based on the Dysphagia Disorder Survey (DDS) with the assistance of an expert panel of speech and language therapists (SLTs) and a pilot study. The study included 30 children with CP aged between 4;0 – 6;0 years. The OPD Screening Tool conduct together with expert SLTs to evaluate the inter-rater reliability and the study was conducted initially and 2 hours later by the researcher to evaluate test-retest reliability. RESULTS: The OPD Screening tool was shown to be reliable and applicable in detecting dysphagia amongst children with CP. The content validity was assessed by the five expert SLTs. The test-retest reliability and inter-rater reliability of the OPD Screening Tool was calculated and it was relatively high. CONCLUSION: The screening tool was shown to be a reliable tool and it was found to be a tool that easy administer in clinical setting to detect OPD in young children with CP.Item The Effectiveness of the adapted Box Clever language intervention programme in the development of vocabulary and narrative skills of deaf and hard of hearing children(Taylor & Francis, 2022) Hettiarachchi, S.ABSTRACT: Children who are deaf or hard of hearing (DHH) in Sri Lanka have inadequate access to early amplification and language stimulation. As a result, they are at risk of impoverished language development: spoken language and sign language. Thirty DHH children who use Sri Lankan sign language between the ages of 4;4-7;2 years from three classrooms of a School for the Deaf were included in this study. The culturally-modified Box Clever language-enrichment programme was offered as a whole-class approach twice a week during a 12-week school term through the class teacher. Pre- and post-intervention language measures and statistical analyses of language scores were undertaken of receptive and expressive vocabulary on picture-naming tasks of target vocabulary. In addition, content and syntactic analyses of narrative skills were undertaken using the Elephant Tales Narrative Assessment, an informal assessment created by the researchers, as no local formal standardised assessments exist currently. There were promising results with statistically significant positive gains in receptive and expressive vocabulary skills on target vocabulary items post-intervention by all the participants. Positive qualitative differences were observed in the content within the target narrative assessment post-intervention by all participants with evidence of the emergence of two to three sign combinations by many of the children. KEYWORDS: Deaf, vocabulary, narrative skills, language intervention, sign-language, Sri Lanka, whole-class, LMICItem 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 stories