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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item Translation and adaptation of a dysarthria assessment tool to be used in the Sri Lankan clinical context(University of Kelaniya, Sri Lanka, 2022) Perera, W.M.K.; Rathnayake, S.P.Background: Dysarthria is one of the commonest communication disorders that arise due to neuromuscular damage. Diagnosing dysarthria requires careful assessments. In the absence of a formal dysarthria assessment tool in the Sri Lankan (SL) clinical context, the translated and adapted Sinhala Language Newcastle Dysarthria Assessment Tool (SLN-DAT) was validated using a normative sample. Methods: This research study was conducted in three phases related to 3 objectives using a mixed methodology: (I) Identification of the relevant tool amongst FDA, DP and N-DAT to be adapted and translated to the SL context using views of 20 Speech and Language Therapists (SLTs) and 20 undergraduate final year students; (II) Initial translation and adaptation of assessment tool into Sinhala language based on WHO tool translation guidelines; (III) Face, content and concurrent validity of the tool using 10 subject experts and 50 normative samples of five age ranges (20-40,40–60,60–70,70–80 and 80+). Internal consistency and intra-rater agreement for the tool tasks were analysed by the subject specialists and concurrent validity were assessed comparing the scores of Dysarthria Profile (DP) and SLN-DAT tool. Data was analyzed using SPSS (Statistical Package for Social Sciences) statistical software and the thematic analysis was used for the qualitative part of the study. Results: N-DAT was selected as the most voted (SLTs=58% & students=55%), and relevant dysarthria assessment tool to be translated and adapted to the SL context. At the end of phase II, the assessment tool contained all related sections of the original N-DAT in Sinhala, which was adapted to suite to SL context. Overall, the SLN-DAT has the same conceptual meaning, semantics, idiomatic and score equivalences as the original version, yet SLT-DAT had one additional section related to ICF model. Statistical analysis showed higher agreement among graders (missing data 0%), including high internal consistency for tool items (Cronbach’s α = 0.8) including the new sections. Performance of the normative sample exhibited a predicted variation among age and tool performance with negative correlation for articulation r = -.32 (p<0.05), respiration r = -.70 (p<0.01), phonation voice r = -.33 (p<0.05), phonation pitch r = -.40 (p<0.01) and DDK rates r = -.33 (p<0.01). The concurrent validity of the SLN-DAT was very high for all subsystems. Each subsystem had higher ICC values ranging between r = 1.0 – 0.7 (p<0.01). Conclusion: The translated, adapted and validated formal dysarthria assessment tool; Sinhala Language Newcastle Dysarthria Assessment Tool (SLN-DAT) had higher face validity, higher internal consistently with items and satisfactory concurrent validity. Therefore, the SLN-DAT could be recommended to the SL context after it was validated among the dysarthria population, which will enable to identify dysarthria reliability in the Sri Lankan clinical context.Item Speech and Language Therapy interventions for dysarthria in Parkinson’s Disease: An Updated systematic review(University of Kelaniya, Sri Lanka, 2022) Ariyasena,W.A.A.D.K.; Umesha, M.A.T.; Siriwardhana,D.D.Background: Parkinson’s Disease (PD) is the second most common neurodegenerative disorder in the world. Also, Parkinson’s Disease Collaborators emphasized that it has become the fastest growing neurological disorder in the world. About 90.0% of people with Parkinson’s disease (PwPD) develop dysarthria following Parkinson disease. There are five systematic reviews have conducted to evaluate the effectiveness of Speech and Language Therapy intervention for Dysarthria in PD. A considerable number of Randomized Control Trials (RCTs) that were included in the two reviews published in 2012 were conducted before the introduction of CONSORT guideline in 1996. Numerically, two out of three RCTs of the first review and two out of six RCTs of the second review are conducted before the introduction of CONSORT guideline. In the third review published in 2015, electronic database search has only been performed in PubMed. The fourth study have only searched three electronic databases. Also, this systematic review of RCTs has included a non RCT which leads to a serious issue in the methodological quality of the systematic review. The second systematic review published in 2020 has searched six electronic databases. However, four of them were available in Chinese language only. Both reviews of 2020 had not included three recent related RCTs. Therefore, high possibilities of bias are concerned in systematic reviews published after 2012. Objective(s): To systematically review and summarize the currently available Speech and Language Therapy interventions for dysarthria in Parkinson’s disease. Methods: This updated systematic review was conducted through adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol (PRISMA-P, 2015) with a PROSPERO registration number of CRD42020208936. Only RCTs were included that compare two types of SLT intervention or SLT intervention with placebo or no intervention. Patients with a proper diagnosis of Parkinson's disease were included in the review without any restrictions of age, severity, duration of post-diagnosis or drug therapy. Electronic databases of CINAHL, EBSCOhost, PubMed, Scopus, The Cochrane Library and Web of Science Core Collection were searched. Additionally, the search was performed in WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov to identify the clinical trials. Eligible studies between 2011-2020 were included and the search was manually performed on the 23rd of December 2020 with no language restriction. Further, dissertations, theses and conference abstracts were manually searched to identify the available grey literature. Two reviewers independently performed the study selection process and data extraction from 20% of the articles. A narrative synthesis was performed with the extracted data. The modified Cochrane Collaboration's risk of bias tool (RoB-2) was utilized to assess the quality of included studies. The overall quality of this systematic review was rated as moderate using the AMSTAR-2. Results: A total of 1069 studies were identified through database searches and other sources. 438 duplicated studies were removed, and 631 studies were assessed during the title and abstract screening. 509 studies were excluded against the eligibility criteria and 122 studies were selected for full-text review. A total of six studies were included in quality assessments and narrative synthesis. LSVT LOUD is the most effective SLT intervention for dysarthria in Parkinson's disease. Both standardized LSVT and modified LSVT are effective in improving vocal sound pressure level, VHI score, CETI-M and other types of primary and secondary outcome measures. Further, effectiveness of LSVT LOUD does not depend on the mode of delivery (face-to-face or online). Conclusion: LSVT LOUD appears to be the most effective SLT intervention for dysarthria in Parkinson's disease. However, evidence is scarce to generalize the effectiveness of SLT intervention for treating people with Parkinson's Disease due to the small sample size, possibility of biases and heterogeneity of included studies. RCTs with rigorous methodology are needed to draw a firm conclusion.Item A scoping review on psychosocial impacts on adults with dysarthria(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Sankalpani, G.Introduction: Dysarthria can cause a wide range of psychosocial impacts, but limited researchers have documented the psychosocial impacts in the people who have dysarthria. Objectives: To conduct a scoping review on psychosocial impacts among people with dysarthria Methods: This study was conducted using the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The following online databases PubMed, EBSCOhost, Scopus and Web of Science were searched to identify the research papers, ‘dysarthria’ and ‘adults’ were used as the two key search terms. Cross-sectional studies and qualitative studies were considered in this review. Two reviewers independently screened the titles and abstracts, based on the inclusion and exclusion criteria. The AXIS critical appraisal of cross-sectional studies and Quality assessment for the systematic review of qualitative evidence were followed as the methodological quality assessments. Synthesis of the data was reported by presenting a summary of findings about psychosocial impacts of dysarthria. Results: Seven studies from United Kingdom, Italy, France and Brazil were selected for the narrative synthesis. Social isolation, reduced self-confidence and self-perception, reduced listener reactions, changes in social life, negative effects on different social situations and negative effects of the emotions are the key findings of the studies. Conclusions: The results presented details about psychological and social impacts in people with dysarthria and how those negatively affected a person’s quality of life. And the findings indicate that psychosocial impacts are influenced by how people with dysarthria feel about how others perceive them. Further studies are required to thematically identify the psychosocial impacts of people with dysarthria.