Voice for All - 2014

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Papers presented at the country’s first-ever international Conference on Speech Language Therapy, Audiology and Disability organized by the Department of Disability Studies in 2014

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Managing and Caring for Clients with Dysphagia: Caregivers’ Perspective
(Faculty of Medicine, University of Kelaniya, 2014) Dissanayake, D.M.S.K.; Ratnayake, S.
Dysphagia has been identified as a life threatening problem in many health care settings. The management of dysphagia usually involves a multidisciplinary team approach where caregivers, clients and various professionals contribute to the management. Caregivers came across a number of barriers during the caring process of dysphagia clients. The perception of the caregivers about the dysphagia, knowledge received by the professionals, effects and adaptations on social and personal life are important to consider as they have an impact on the management procedure in relation to dysphagia. A descriptive cross- sectional study design was implemented. Forty caregivers of neurogenic dysphagic clients who had been referred to the speech therapy unit in the last six months were recruited to the study using purposive sampling. The study consists of both qualitative and quantitative components. The data was collected through an interview administered through a semi structured questionnaire, which was analyzed using frequency analysis and thematic coding analysis. Majority (50%) of the professionals involved in advising caregivers were doctors and speech therapists. 18 doctors and 25 SLTs gave advice orally. Majority (n=14) of the caregivers preferred a combination of giving oral, written and practical advice. The frequency of following the adaptations on feeding techniques was limited as the caregivers thought it was not necessary to always follow the adaptations. Health, occupation, economy and social functions were found to be affected and required adaptations in the caregivers’ life. As most professionals in SL give advice orally, it is important to consider caregivers’ preferences. The importance of increasing awareness in following the adaptations on feeding and nutritional values among the caregivers is indicated in the study findings. The effects on caregivers’ social and personal life should also be considered in dysphagia management procedures.
Developing and validating a Sinhala phonology assessment for children aged between 3 to 6 years: trends observed and lessons learnt
(Faculty of Medicine, University of Kelaniya, 2014) Nonis, P.D.M.; Ranaweera, M.; Saleem, S.; Udugama, K.L.L.G.; Lokubalasuriya, T.; Hettiarachchi, S.
Clinical experience of speech and language therapists working in Sri Lanka has put into question the current reliance on norms for English (Grunwell, 1985) to determine a child’s speech skills and phonological acquisition in Sinhala. Cross-linguistic studies have revealed differences in ‘universal principles’ and ‘language-specific’ aspects (Amayreh & Dyson, 1998). At present, there is an urgent need to develop and validate formal language-specific standardized assessments for speech and phonology for Sinhala. The aims of the study were; 1)to develop and validate test items for a Sinhala speech and phonology assessment for children aged between 3;0 to 6;0 years, 2)to document the typical phoneme acquisition and typical phonological processes in Sinhala-speaking children aged between 3;0 to 6;0 years. The ‘Sinhala Speech and Phonology Assessment’ was devised based on the Diagnostic Evaluation of Articulation and Phonology (Dodd et al. 2002) and administered to 250 Sinhala-speaking children between the ages 3;0 to 6;00 years. The use of test items were determined by measures of content validity, test-retest reliability and inter-rater reliability. The trajectory of Sinhala speech sound acquisition showed universal sound acquisition sequences and language-specific features in both the order and rate of speech sound development. The sequence of speech sound acquisition for Sinhala showed early acquisition of plosives and some nasals with comparatively later acquisition of fricatives, the palatal nasal and flap/tap sound. Language-specific phonological processes of lateralization and denasalisation of prenasalised stops were also evident. The test items demonstrated effectiveness at generating target speech data and typical phoneme and phonological development in children between 3;0 to 6;0.
Effect of an Experiential Dysphagia Workshop on Caregivers’ Knowledge, Confidence, Anxiety and Behaviour during Mealtimes
(Faculty of Medicine, University of Kelaniya, 2014) Kitnasamy, G.; Bandara, M.M.M.K.; Subajini, A.A.N.; Hettiarachchi, S.
Children with cerebral palsy who have associated feeding difficulties are at risk of aspiration and poor nutrition. This study aimed to measure the changes in knowledge, confidence and anxiety among 21 Sri Lankan caregivers with responsibility for feeding children diagnosed with cerebral palsy, after they attended an experiential workshop. Data collection was done through pre- and post-workshop questionnaires, observations and semi-structured interviews. There was a significant improvement in reported levels of knowledge and confidence and a decrease in the caregivers’ level of anxiety during mealtimes. The qualitative data analysis indicated changes in participant knowledge, particularly about the signs of aspiration and positioning during mealtimes. Observations showed better adherence to recommendations on communication, bolus size and utensils. The findings support the utility of experiential training for caregivers, to ensure that children with cerebral palsy are fed safely.
Language Skills of 2-5 Year Old Children with Profound Hearing Loss Undergoing Auditory-Oral Education Compared to Typically-Developing Peers.
(Faculty of Medicine, University of Kelaniya, 2014) Waidyasekara, C.; Rajapaksha, N.; Herath, K.; Hettiarachchi, S.
Hearing impairment is the most frequent sensory defect that leads to communication difficulties and critical to speech and language development, communication, and learning. The objectives were to compare the language skills of children with profound hearing loss using digital amplification and undergoing intensive Auditory Oral education with typically developing peers and to determine the correlation between the time period of receiving Auditory Oral education and language outcomes. Twenty-two children with profound hearing loss using bilateral Behind- The- Ear hearing devices, were selected from an Auditory Oral pre-school. 44 children whose age, gender and geographical area matched were selected from mainstream pre-schools. All participants were assessed using the informal assessment tool. Median scores of receptive vocabulary skills are higher than scores of expressive vocabulary skills in both groups. The difference was statistically significant between the two groups. Receptive vocabulary, understanding of quality, understanding of spatial concept, understand of sequencing concept, understand of sentence structure (syntax) and integrative thinking revealed significant (p<0.05) for each age range 2;0 – 2;11, 3;0 – 3;11 and 4;0 – 5;0. There is a significant difference in seventeen out of twenty linguistic components between the two groups (p<0.05). Only three categories; initiating (p=0.157), producing syllables (p=0.157) and expressing negations (p=0.157) did not show significance. There is a significant (p<0.01) correlation among the time period of having AO education and language skills. The study concluded that there is a significant difference in language skills compared to the typically developing peers. Increased language skills were observed with the early attendance of Auditory Oral education and with appropriate hearing aid. Hence, the children with hearing loss need effective intervention to enhance their language skills in spoken language.
‘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.
Audiovisual Segregation in Typically Developing Children
(Faculty of Medicine, University of Kelaniya, 2014) Jayasena, B.N.; Nanayakkara, S.; Illangasighe, C.; Jacob, J.
Learning in typical classrooms with high background noise is often difficult for children, where they may have to lipread the teacher to understand what is being said. In this scenario, it is assumed that a child should possess the ability to separate congruent information from incongruent information in an audiovisual signal. This study was aimed at investigating how well typically developing children can segregate visual information in the presence of auditory distracters, compared to young adults. 12 typically developing primary school children and 11 young adults with normal hearing and vision lipread 120 consonant-vowel-consonant-vowel (CVCV) nonsense syllable words presented in four conditions: (1) visual-only condition, (2) visual stimuli with a multi-talker babble, (3) visual stimuli with reversed speech sounds of the nonsense syllable words, (4) visual stimuli with non-altered speech sounds of the nonsense syllable words. Mean scores of children in all four conditions were lower than that of the adults, and also a significant difference for all the conditions between the two groups was noted. Results suggest that normal-like audiovisual segregation is difficult for young children because of maturation effects. The study findings can be used to encourage further research in audiovisual segregation. Also, if used constructively, these findings will be helpful in highlighting the importance of creating learner-friendly environments with minimal auditory distractions for children.
Noise Induced Hearing Loss and the Use of Personal Hearing Protection Devices among Liquefied Gas Cylinder Infusion Factory Workers in Biyagama Zone, Sri Lanka
(Faculty of Medicine, University of Kelaniya, 2014) Perera, K.P.A.; Fonseka, R.; Siriwardana, C.
The purpose of this study was to determine the prevalence of Noise Induced Hearing Loss (NIHL) and the use of Personal Hearing Protection Devices (PHPDs) among Liquefied Petroleum Gas (LPG) cylinder infusion factory workers in Biyagama, Sri Lanka. 79 workers who were exposed to noise in the working environment volunteered to participate in this cross-sectional study. Data were collected through screening audiological evaluations, diagnostic audiological evaluations, interviewer-administered case histories and a questionnaire. Four sound level meter measurements were taken in the open work area during a regular work shift and average noise exposure level in the worksite was calculated using those measurements. The mean age of the participants was 32.67 (SD=8.37) years. The mean work duration was 5.58(SD=4.62) years. The average noise exposure level in the worksite was 97.2dBA. 20.3% (n=79) of the workers had signs of NIHL. NIHL was associated with age (p=0.02) and the knowledge regarding the use of PHPDs as a prevention method was high (97.5%). Self-reported use of PHPDs was 69.6%. The major complaint of the non-users was discomfort. There was an association between work duration and PHPDs use (p=0.02). NIHL was associated with use of PHPDs (p=0.017). Despite having good knowledge of PHPDs, use of PHPDs was much less. Industrial authorities should institute hearing conservation programmes and should strictly monitor implementation of noise regulations.
Knowledge, Attitudes and Practices on Noise Induced Hearing Loss among Factory Workers of Two Dairy Product Manufacturing Factories in Gampaha District, Sri Lanka
(Faculty of Medicine, University of Kelaniya, 2014) Hansajie, S.T.K.; Jayasena, B.N.; Chathurika, L.K.E.
The main purpose of this study was to describe dairy product manufacturing factory workers’ knowledge, attitudes and practices on Noise Induced Hearing Loss. A cross-sectional study was conducted involving 187 factory workers in two factories in the Gamapaha District. A self-administered questionnaire was used to obtain information pertaining to knowledge, attitudes and practices related to Noise Induced Hearing Loss. In the study, it was found out that knowledge on risk factors of NIHL (23.5%) and symptoms of NIHL (38%) was weak. Even though most of the workers (76.5%) perceive noise as a usual phenomenon in the working area, 77% of the workers were willing to seek medical attention if the hearing starts to deteriorate. The overall practice level was not satisfactory. 80.2% of the workers have never used hearing protection devices (HPD) while working. 98.9% of the workers have never undergone a hearing evaluation and 99.5% of the workers have never attended to a hearing conservation program. 95% of the workers reported that the occurrence of hearing deterioration due to high level of noise was worrying. Only 0.5% of the workers reported wearing HPD while working. 80.2% of the workers never used HPD during work. There was a significant association between aspects of work experience and HPD usage (2= 5.193, p= 0.02). In conclusion, it was discovered that there is a need to have a hearing conservation program that stresses on the use of hearing protective devices to prevent the occupational noise induced hearing loss in the particular setting.
A Normative Study of Distortion Product Otoacoustic Emissions (DPOAEs) in a Sri Lankan Adult Population
(Faculty of Medicine, University of Kelaniya, 2014) Ranasinghe, B.S.T.
Distortion Product Otoacoustic emissions (DPOAEs) are used in hearing screening, differential diagnosis of sensorineural hearing loss, monitor ototoxicity and noise exposure. Due to the lack of evidence in normative data for OAEs within the Sri Lankan population, a normative study of DPOAE was conducted among Sri Lankans ranging from 18-30 years. Objectives of the study were to develop normative data of DPOAEs of adults which can be used in audiological clinical settings in Sri Lanka and to compare DPOAE amplitude levels in different age groups within the study sample as well as gender and right-left ear differences. Quantitative study using multi stage sampling was carried out with a sample size of 221(mean age = 23.97years) inclusive of 107 males and 114 females. Study setting was the Faculty of Medicine, University of Kelaniya, Sri Lanka. Prior to DPOAE test hearing, screening was done to confirm individual subjects with normal hearing, normal middle ear function without any exclusion factors. DPOAE was administered in a sound proof booth using calibrated instrument (Biologic navigator pro/scout software). Data was analyzed using SPSS software. Developed mean signal-to-noise ratio (SNR) value was 10dB SPL-25dB SPL in the frequency range 750Hz to 8000Hz. Results indicated a variety of significant effects, particularly in the higher frequencies. Developed DPOAE normative data for biologic scout can be used in audiological clinical settings in Sri Lanka. Repeating the test within a period of time would ensure the reliability and extensive research into variables such as gender differences and age in future studies are recommended.
Current Clinical Practice on Dysphagia Management in Sri Lankan Context: Speech - Language Therapists’ Perspective
(Faculty of Medicine, University of Kelaniya, 2014) Priyadarshani, K.W.K.N.; Ratnayake, S.
The field of speech language therapy is a relatively new, developing service in Sri Lanka. Since the establishment of the service, no researches have been conducted to identify Speech-Language Therapists’ (SLT) perception of the practice on dysphagia management. The objectives of the study were to identify training and current clinical practice on dysphagia management, to describe the challenges faced by the SLTs when managing dysphagic clients and to describe the coping strategies used by SLTs to overcome the challenges they faced when managing dysphagic clients. A descriptive cross-sectional study design was implemented. All SLTs who were practicing in Sri Lanka were included. A semi-structured, self-administrative questionnaire that included both qualitative and quantitative components was used. Among 44, 86%, (n=38) of SLTs saw clients with dysphagia in their caseload. Thirty-two (32) SLTs saw adults, 28 SLTs saw paediatrics and only seven (7) SLTs saw neonates with dysphagia. Assessing neonates was the most significantly challenging area. Lack of clinical exposure, limited recognition of SLT service among medical professionals and lack of awareness among clients and families on the gravity of the problems associated with dysphagia were also identified as significant challenges. Only 47.5%% (n=18) SLTs had participated in CPDs to improve their skills relevant to dysphagia and 13.88% (n=5) liaised with overseas SLTs. Adding a section or module for neonatal dysphagia management in the academic curriculum, developing a recognized body to conduct training to enhance the SLTs’ skills and knowledge, establishing a formal framework to gain internationally required clinical norms of practicing in Sri Lanka, continuing awareness programs with relevant professionals for the benefit of the society and continuing further researches on the particular area were recommended.
Prevalence of External and Middle Ear Pathologies among Students with Hearing Impairment in School Settings
(Faculty of Medicine, University of Kelaniya, 2014) Perera, N.C.S.; Chandrasekara, J.M.A.U.; Jayasena, B.N.
Hearing impairment is a major health problem in children. The incidence of external and middle ear diseases is greater for children with severe to profound hearing impairment. This study was aimed at determining the prevalence of external and middle ear pathologies among students with hearing impairment in school settings. A descriptive cross sectional study was carried out in two selected schools for children with hearing impairment (6-9, 10-13 and 14-16 years). A total of 195 participants were selected using two stage stratified sampling method. Otoscopy and Tympanometry were performed. Intact tympanic membranes were found in 316 ears (81 %), which was high in the age group of 14 -16 years. 74 (19 %) reported non occluded ear cerumen, occluded ear cerumen, tympanic membrane perforation, bulging tympanic membrane, external ear infection, foreign bodies and discharge. Most common pathology was non occluded ear cerumen in 49 (12.6 %), and high in 10 -13 age group. Only 383 ears were examined by Tympanometry due to occluded ear cerumen, presence of foreign bodies and external ear infection in 7 ears. Type “A” tympanograms were found in 282 ears (74%) and those were normal middle ears. Remaining 101 ears (26%) were pathological middle ears. Type “As” (47 ears; 12%) and type “Ad” (23 ears; 12%) were the most frequent pathological tympanograms, which was high in the 14 -16 group. There is a noticeable prevalence of external and middle ear pathologies among students with hearing impairment. The study findings highlight importance of regular ear examinations and promoting hearing hygiene in children with hearing impairment.
Caregiver Adherence to Speech and Language Therapists’ Advice on Management of Dysphagia in Children with Neuro-disabilities
(Faculty of Medicine, University of Kelaniya, 2014) de Silva, G.; de Silva, H.
Majority of children with Cerebral Palsy (CP) have feeding difficulties that affects not only their quality of life but also their caregivers and family. As caregivers carry out most feeding interventions, it is important to design an intervention that caregivers find it possible to integrate in to their daily life. The study aimed to determine the care-giver adherence to speech and language therapists’ advice on six selected strategies, in the management of dysphagia in children with neuro-disabilities. Fifteen caregivers of 1 to 10 year old children with moderate to severe CP and feeding difficulties, and whose current feeding methods required interventions were selected as participants. Caregivers were video-recorded while feeding their child pre-intervention and then introduced and demonstrated the six management strategies i.e., head position, trunk position, utensils, food consistency, bolus size, and pacing. They were video-recorded after 4-6 weeks post-intervention. A score was given for the six selected strategies both pre- and post-intervention. Results showed a significant difference between pre- and post-intervention for all six strategies (p<0.005). All care-givers were able to adhere to all six strategies post-intervention. However, some strategies were adhered to better than others; utensils, food consistency, and bolus size. Least adherence was seen for head position. Thus, the current study is expected to help speech and language therapists prioritize their goals in the management of pediatric dysphagia in children with neuro-disabilities.
Communication related quality of life in oral cancer patients after surgery
(Faculty of Medicine, University of Kelaniya, 2014) Jayasinghe, K.S.D.; Kalupahana, S.
Oral cancer patients undergone surgery, experience communication difficulties due to poor functioning of articulators. A study of communication related quality of life (CRQOL) of oral cancer patients was not found in Sri Lanka. Hence this study was planned to assess the variation of their communication following surgery and identifying the affected areas. This is helpful in identifying the potential targets for individuals and setting aims to improve their CRQOL. A cross sectional descriptive study was undertaken to assess CRQOL in oral cancer patients after surgery. The questionnaire was modified, adopted and pilot tested. 100 patients (35- 84 years age range) who had undergone surgery for oral cancer completed the questionnaire. The effect on CRQOL on patients undergone surgery was not statistically significant. Only 7% of people had impact on their CRQOL after surgery for oral cancer when their overall score is considered. In a higher portion of patients with oral cancer, the emotional status regarding communication was affected than the physical and functional status. Functional communication scored better when compared to the physical status. The total score and physical status regarding communication score strongly correlate with the site of the tumor. The site of the tumor also correlates with the emotional and functional status. Patients who have undergone surgery for oral cancer have an impact on their communication related quality of life. Emotional status and physical status regarding communication were the most affected. People who have posterior tumors have worse impact on their CRQOL than people who have anterior tumors.
Association between Mobile Phone Usage and Hearing Sensitivity among Third Year Students; (of) University of Kelaniya, Sri Lanka
(Faculty of Medicine, University of Kelaniya, 2014) Sivaramalingam, V.; de Silva, D.
With advancement of Global System for mobile (GSM) communication, mobile phones (MP) have become an essential communication tool. Mobile networks operate in frequencies which fall in the microwave range of electromagnetic spectrum. The close proximity of a mobile phone antenna, radio frequency electromagnetic radiation can penetrate into organic tissues causing health hazards. In Sri Lanka, the number of MP users is over 20.3 million and the majority of users are young adults. Up to date, no study has been conducted regarding MP usage and its effects on hearing in Sri Lanka. The objective was to determine the association between MP usage and hearing sensitivity among third year students, University of Kelaniya, Sri Lanka. A descriptive cross sectional study was conducted among 223 students who filled a self-administered questionnaire regarding MP usage and hearing related symptoms. All participants underwent otoscopic examination, and a Distortion Product Otoacoustic Emission (DPOAE) screening at 3 kHz, 4 kHz and 5 kHz frequencies. The mean MP usage hour per day was 1.41 hours (SD 1.22) and the mean MP usage duration was 5.57 years (SD 1.72). The majority of students preferred the right ear for MP conversation, while highest prevalence of hearing loss was observed at 4 kHz (5.6%) and 5 kHz (6.7%) in the right ear. There was no significant difference in hearing loss between the ears of the two sides. A significant association between hearing loss and prolonged usage (more than 5.57years) of MP or excessive usage of MP (more than 1.41 hours per day) could not be found. Symptoms such as warmth, tinnitus, need of repetition and muffled sensation were associated with excess usage of MP.
Psychosocial Impact of Puberphonia
(Faculty of Medicine, University of Kelaniya, 2014) Premarathna, M.S.S.; Wijeratne, L.T.; Perera, I.; Wickremasinghe, A.R.
The persistence of adolescent voice even after puberty in the absence of an organic cause is known as puberphonia. This condition is commonly seen in males. Voice plays an important role in the socialization process. The pychosocial effects of puberphonia has not been explored extensively. Aims of the study were to identify psycho-social challenges faced by young adults with puberphonia and coping strategies used to overcome these challenges. The study was carried out as a descriptive cross-sectional study. A self-administered questionnaire consisting of 20 questions was used. The first part of the questionnaire inquired about functional communication and social participation and second part focused on emotional responses. All participants filled out the General Health Questionnaire (GHQ 30) and also took part in individual interviews to gather in depth information. Conversing over the telephone was a problem for 87% while 73% experienced difficulties when talking to same age girls. 60% reported difficulties in work place or place of education. 77% had difficulties in social situations. Only 20% experienced difficulties when interacting with family members. More adolescent participants reported that puberphonia was a problem than the young adult participants. When considering the coping strategies, 73% didn’t talk to others when they are in a group. 60% avoided talking to strangers while 20% communicated using gestures and signs. 10% communicated by writing on paper and 87% used text messages to communicate. 70% of the participants showed psychological distress in the GHQ. Psychosocial difficulties are common in people with puberphonia. Different coping strategies are used to overcome these difficulties. Adolescents are more affected than young adults. It is important to identify these issues and provide psychological counseling for those who need support.
The perspectives of a selected group of families and teachers from Sri Lanka on high- technology augmentative and alternative communication devices
(Faculty of Medicine, University of Kelaniya, 2014) Weerasinghe, Y.; Sumanasena, S.P.
Weerasinghe, Y. and Sumanasena, S.P., 2014. The perspectives of a selected group of families and teachers from Sri Lanka on high- technology augmentative and alternative communication devices. In: Voice for All – Speech and Language Therapy, Audiology and Disability Conference Book of Abstracts, Department of Disability Studies, Faculty of Medicine, University of Kelaniya, p. 24.
Intervention Procedures and Outcome Measures of Neurogenic Dysphagic Clients seen by Speech and Language Therapists in Two Hospital Settings
(Faculty of Medicine, University of Kelaniya, 2014) Perera, K.D.R.D.; Ratnayake, S.
Dysphagia is a common problem in clients with neurological impairments. In Sri Lanka, managing dysphagic clients by speech therapists is a new and emerging field in the healthcare sector. However, no in-depth analyses concerning intervention procedures for neurogenic dysphagic clients have yet been conducted in the Sri Lankan context. Intervention procedures, outcome measures in use, and the discharge criteria of adult neurogenic dysphagic clients were studied retrospectively using 80 records of neurogenic dysphagic clients from two hospital settings. Semi-structured interviews were also conducted with the speech and language therapists working in the two selected hospital settings to identify their views on the intervention processes of managing dysphagic clients. Both compensatory and therapeutic modalities were used to manage 35 (43.75%) of clients whereas 29 (36.25%) of clients were managed using compensatory strategies only. Among the compensatory procedures, texture modification (n= 65, 81.25%) was identified as the most common strategy and swallow maneuvers were recommended less frequently (n=8, 10%). Outcomes were measured mainly through subjective measurements on level of aspiration, respiratory status, food intake, weight gain and hydration. The clients were discharged from therapy services when they were safe with oral feeds or when an alternative feeding method was recommended for a long duration. Intervention procedures were mainly based around a compensatory approach. Despite the limited resources in these settings, the speech therapists have been able to provide intervention for dysphagic clients and gain positive outcomes.
The Impact of Dysphagia and its Management Strategies on Clients’ Life Style; Clients’ Perspective
(Faculty of Medicine, University of Kelaniya, 2014) Panterlyon, N.; Ratnayake, S.
Dysphagia refers to difficulty with delivering food from the mouth to the stomach (Logemann, 1998). Clients’ perceptions and their level of awareness of the condition needs to be explored in Sri Lanka in order to understand more effective methods of service delivery. A descriptive cross sectional study with both quantitative and qualitative components was undertaken with thirty-two participants. A semi-structured, interview administered questionnaire was used to gather data, which was developed with five speech therapists, currently practicing dysphagia in the Sri Lankan context, and ‘Swallowing quality of life questionnaires’ were referred to (SWAL-QOL and MDAI) during the process. According to their level of understanding, the dysphagia management focuses on improving general health, to improve swallowing function in particular and to prevent a life threatening risk. The mean score for the impact of dysphagia on ADL was 47.88 (SD=16.50) out of 100. The degree of impact on a client’s ADL does not depend on gender or the onset of the condition. Dysphagia has an impact on their emotional, functional and social life. Clients expect the speech therapists to help accelerate the recovery. The implications include organizing client supportive groups and workshops to minimize the emotional, functional and social impact.
A Descriptive Study on Profile of Clients with Dysphagia Referred to Speech Therapy Units in Two Government Hospital Settings
(Faculty of Medicine, University of Kelaniya, 2014) Weerasinghe, W.A.M.A.; Ratnayake, S.
The study was aimed at identifying commonly presented initial symptoms and feeding method on the initial session of dysphagic clients. A descriptive cross-sectional study design was used with a retrospective chart review. Data of 100 completed records of dysphagic patients who were above the age of 12 years were studied. Participants included patients referred to speech therapy units of two hospital settings within a 6-month period. Mean and standard deviation of age of the participants was 61.12 years and 14.36 years respectively. Median time duration between on set to referral is 11 days. Most prevalent cause for dysphagia was cerebrovascular accident (79%). Additionally, progressive neurological disorders and ‘other’ causes were observed. 32% were in severely dysphagic, while another 32% were moderately severe and 9% were mild. Of all the participants, oral and pharyngeal phase was affected in 52% of participants. At the time of admission to the speech therapy unit, 58% of patients relied only on non-oral feeding methods. Commonly presented symptoms were impaired trigger (63%), coughing (52%) and voice quality changes (29%). According to chi square test, there was no association between presence / absence of dysarthria and severity of dysphagia. Most of the clients were older and referrals were taking a long duration. The study findings suggest the importance of early referral and also the need to generate awareness about the symptoms to help in early identification. Recommendations are made such that screening assessment should be done for all stroke clients to identify any risk of aspirations.
Evaluating an AAC Training Program for Special Education Teachers Based in a Developing Country
(Faculty of Medicine, University of Kelaniya, 2014) Muttiah, N.; Drager, K.D.R.
There is limited research conducted on Augmentative and Alternative Communication (AAC) in developing countries (Srinivasan, Mathew, & Lloyd, 2011). We have only a limited understanding of how best to support the development of knowledge and skills of individuals who provide AAC support in developing countries with low resource settings. Research has documented that providing AAC training to communication partners can equip them with strategies that can facilitate increasing both the frequency and quality of communication interactions with children who have Complex Communication Needs (CCN). The current study evaluated the effectiveness of implementing training best practices identified by Muttiah et al. (2014) for special educators in Sri Lanka. The training was based on principles of adult learning. A one-group interrupted time series design was utilized with nine teacher-children dyads to measure the effectiveness of the AAC training. The special education teachers were taught to promote interactions with children who have CCN by providing evocative communication opportunities that included asking an open-ended question, comment or choice, providing a means for the child to respond, and waiting five seconds or more for a response. Results of the study indicated that teachers provided an increased number of evocative communication opportunities following the training. An increase was also seen in the number of communication turns that were taken by children with CCN. The results of this study provide preliminary evidence for a training framework that could be implemented in developing countries and other low-resource communities. The training content and format identified in this study can serve as a guide for others planning trainings in similar contexts. In addition, this study adds to the limited research base on AAC in developing countries.