Voice for All - 2014
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/10377
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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Item 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.Item 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.Item 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.Item 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.Item 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.