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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 A short report on a preliminary interventional study to evaluate play-mediated interaction skills in caregivers of children with autism spectrum disorder from Sri Lanka(Sage Publishing, 2024) Wanniachchi, P.M.; Sumanasena, S.P.Most children with autism spectrum disorder live in low- and middle-income countries. Most of them do not have access to timely and culturally acceptable interventions. Research from high-income countries and low- and middle-income countries, such as Sri Lanka, show that parent-mediated intervention programmes improve functional outcomes, highlighting the importance of parents as partners. We undertook a preliminary study to evaluate how play-based parent coaching will enhance the parent interaction skills to promote social-emotional, cognitive and language skills in children with autism spectrum disorder aged 2-4 years. We evaluated how parents acquire interaction skills to engage with children using a caregiver skills assessment checklist adapted from freely accessible resources. Before and after training, all parent-child dyads participated in a 10-min video-recorded play session with a set of toys of their choice. Over the course of 2 weeks, all parents spent 2 h/day playing and interacting with the child to harness the desired skills. The results showed that the parental training had a positive effect on all 30 caregivers in gaining skills, with a significant improvement in all three domains with the highest impact on skills for social-emotional development. Overall, parents reported high levels of satisfaction on the training. The significant improvement in parent interaction skills was promising. However, further studies to look at the sustainability of the skills and the impact on children's overall development need to be looked into using larger and more generalised studies.Item Item Early interventions for infants at risk for developmental impairment: The South Asian perspective(All India Institute Of Medical Sciences, 2022) Vipulaguna, D.; Jahan, I.; Girish, M.; Chinnappa, G.D.; Gopalaswamy, S.; Shahidullah, M.; Sumanasena, S.P.ABSTRACT: Majority of under-five children with developmental disabilities live in low- and middle-income countries (LMIC). A considerable proportion of disabilities results from perinatal adversities. The neonatal and infant mortality rates in India, Bangladesh, and Sri Lanka have improved over the last two decades, implying survival of infants at risk for developmental impairments. The need to thrive beyond survival is a well-recognized concept and it is imperative to establish high-risk infant follow-up (HRIF) programmes to capture these infants within the first 1000 d of life. Many challenges are present within the LMICs to identify infants at risk and to ensure early intervention (EI) during the window of optimal neural plasticity. However, it is essential to acknowledge the strengths within such systems to understand the impact of these programmes and packages on the activity and participation of these infants and their families. The International Classification of Functioning, Health and Disability for Children and Youth (ICF-CY) version is a holistic framework that will enable the families, clinicians, and policymakers to measure the impact of these interventions. Though all three countries have national policies to reach for high-risk infants, there is lack of published evidence on the successful implementation of such strategies. Therefore, it is timely to establish universally accessible, culturally appropriate and sustainable HRIF programmes. It is also recommended to measure the outcomes of such programmes based on the ICF-CY to understand the impact on the activity and participation of children in South Asia. KEYWORDS: Disability and health for children and youth; Early intervention; High-risk infant follow-up; International classification of functioning; South Asia.Item Effect of intramuscular ACTH versus oral prednisolone on the developmental trajectories of children with West syndrome over 24 months: A randomised control study(Elsevier Science-Saunders, 2021) Sumanasena, S.P.; Wanigasinghe, J.; Arambepola, C.; Sri Ranganathan, S.; Muhandiram, E.OBJECTIVE: To assess the developmental progression and compare the developmental attainments of children treated with two hormonal therapies for infantile spasms (IS) over two years (seizure and EEG outcomes of this RCT published previously). METHODS: Newly diagnosed infants with IS were randomised to receive adrenocorticotrophin (ACTH) or prednisolone for 14 days. All underwent Bayley III Infant and Toddler Assessments in cognitive (Cog), receptive (RC) and expressive (EC) communication, fine (FM) and gross (GM) motor developmental subsets at baseline (T0), one-year (T1) and two-years (T2). RESULTS: 95 infants randomised to prednisolone (n = 48) and ACTH (n = 47) groups were eligible for developmental assessments. Mean age at initial assessment was 8.75 months (SD = 6.37, range 1.46-34.4 months). 48 children presented for all three assessments. Mean composite scores of each developmental domain improved across the three time points; but the progression was significant only in relation to motor development (p = 0.04). When comparing the treatment outcomes at 2-years, mean composite scores of children treated with ACTH were significantly lower in motor domain (p = 0.023). As for developmental delay, the ACTH group (n = 32) showed significant delay in expressive communication (adjusted OR 5.46, 95% CI: 1.1, 28.57; p = 0.04) and fine motor (adjusted OR 9.4, 95% CI: 1.1, 83.3; p = 0.04) at T2 compared to the prednisolone (n = 30) in a regression analysis. CONCLUSION: The number of children with delay at the 2 year follow up were significantly higher in two domains in the ACTH group compared to the prednisolone group. Overall results do not show a significant advantage of ACTH over prednisolone for developmental outcomes at two years, but further comparative studies over longer periods are required for more definitive conclusions. KEYWORDS: Developmental trajectories; Infantile spasms; Treatment with hormonal therapies.Item Designing a tool to monitor development of 2-5 year old children by preschool teachers in Sri Lanka: A preliminary report(Sri Lanka Medical Association, 2018) Caldera, A.; Mendis, M.; Muttiah, N.; Wijesinghe, T.M.; Godamunne, P.K.S.; Chathurika, L.K.E.; Jayasena, B.N.; Wickremasinghe, A.R.; Perera, K.M.N.; Tilakarathne, N.; Peiris, M.K.R.R.; Sumanasena, S.P.INTRODUCTION AND OBJECTIVES: Identifying neurodevelopmental impairments and providing early intervention positively impacts later academic and functional outcomes of children. Globally available child development screening tools are not readily accessible or validated for Sri Lanka. As a large proportion of Sri Lankan children aged 2-5 years attend preschools, teachers can complement developmental monitoring. The aim of this study was to design a tool to monitor the development of 2-5 year old children by preschool teachers. METHODS: Twelve local and global tools including the tool developed by Plan International and the Child Health Development Record (CHOR) were reviewed. All tools were mapped according to the domains and subdomains in the National Early Childhood Developmental Standards for Sri Lankan Children. A Delphi process was carried out by a panel of experts to include culture specific activities that assess all domains and subdomains across age groups. RESULTS: The existing tool developed by Plan International lacked indicators for health, daily living and social and emotional development. The CHOR was deficient in cognitive, receptive language, social and emotional indices. Several activities in some instruments were common to more than one age group. The domains incorporated into the proposed tool included motor, cognitive, language, social and emotional and self- help skills. Approximately 50 items per each age group were included in this tool CONCLUSION: A preliminary play-based tool for monitoring development of children 2-5 years of age across five main domains in natural settings for preschool children was developed. A pilot study is required to assess the validity of the tool.