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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Availability of rehabilitation services for communication disorders in Sri Lanka: a cross-sectional survey(BMJ Publishing Group Ltd, 2023) Caldera, A.V.; Wickremasinghe, R.; Munasinghe, T.U.; Perera, K.M.N.; Muttiah, N.; Tilakarathne, D.; Peiris, M.K.R.R.; Thamilchelvan, E.; Sooriyaarachchi, C.; Nasma, M.N.; Manamperige, R.M.; Ariyasena, A.D.K.; Sumanasena, S.P.OBJECTIVES: To describe the rehabilitation services available for communication disorders in Sri Lanka and to estimate the adequacy of the services in provinces and districts of the country. SETTING: The study considered government and private institutions, which provide rehabilitation services for communication disorders in Sri Lanka. PARTICIPANTS: Institutions providing services of speech-language pathologists, audiologists and audiology technicians in Sri Lanka. PRIMARY AND SECONDARY OUTCOME MEASURES: We investigated the number of government hospitals and private institutions, which provide speech-language pathology and audiology services in Sri Lanka as the primary outcome measure. A number of speech-language pathologists, audiologists and audiology technicians working in the institutions were obtained from records and institution-based inquiries to identify the adequacy of the services in the country as the secondary outcome measure. RESULTS: Of the 647 government hospitals that provide free healthcare services in the country, 45 and 33 hospitals had speech and language therapy and audiology units, respectively. Government hospitals do not have audiologists but only have audiology technicians. The number of speech and language therapists and audiology technicians in the government sector per 100 000 population in the country was 0.44 and 0.18, respectively. There were wide variations in specialist to population ratio between districts. 77 private centres provide speech therapy services in 15 out of the 25 districts; 36 private centres provide audiological evaluations in 9 districts. CONCLUSIONS: The number of specialist speech and language therapists and audiologists is not sufficient to provide adequate rehabilitation services for communications disorder for the Sri Lankan population. Not recruiting audiologists to the government sector affects the management of hearing impairment in the affected.Item REACh for the preschoolers; a developmental assessment tool for 2-5 year old children in Sri Lanka(BioMed Central, 2023) Caldera, A.V.; Wickremasinghe, A.R.; Muttiah, N.; Godamunne, P.K.S.; Jayasena, B.N.; Chathurika, L.K.E.; Perera, K.M.N.; Mendis, M.; Tilakarathne, D.; Peiris, M.K.R.R.; Wijesinghe, T.; Senarathna, N.E.; Saubhagya, W.D.L.; Chandraratne, M.; Sumanasena, S.P.BACKGROUND: Preschool children in low resource settings are at higher risk of missing developmental potential due to the lack of standardized and validated methods for the timely detection of children with developmental delays or neurodevelopmental disorders. The preschool teacher is a non-specialist resourceful link within the community to detect and offer interventions early. This paper discusses the preliminary iteration of designing and testing the psychometric properties of a developmental assessment for children aged 24 to 60 months in Sri Lanka. This assessment is designed to be conducted by preschool teachers in their preschool setting. METHODS: Three processes followed: 1. Designing and development of the Ragama Early Assessment for Children (REACh) complete preschool developmental assessment and a tool kit 2. Testing and training teachers on conducting the REACh assessment 3. Preliminary assessment of the psychometric properties including content validity, internal consistency, interrater reliability and concurrent validity. RESULTS: A literature search identified 11 assessments and 542 items representing cognitive, social-emotional and adaptive, language and motor domains. Content validity was assessed to select and adapt items. A complete assessment tool was designed to be administered in four settings within the preschool. This was further improved during pre and pilot testing and teacher training. Cronbach's alpha measuring internal consistency was > 0.70 for cognitive, language, social-emotional and adaptive domains across all three age groups in 1809 children. Interrater reliability was > 65% for age groups 36-47 and 47- 60 months. Concurrent validity using a clinical gold standard demonstrated sensitivity of more than 0.75 for all age groups with variable specificities (24-35 months: 0.71, 36- 47 months: 0.43 and 48-60 months: 0.67) assessed in 75 children. CONCLUSIONS: This culturally and linguistically adapted tool was tested nationally in Sri Lanka. The inte-rrater reliability between teachers and research assistants was higher than 65% for all domains in children more than 36 months. The preliminary iteration confirms it as an acceptable screening assessment for all age groups but with significantly lower specificity in the 36-47 month age group. Further improvement in certain domains together with intense teacher training is likely to enhance the validity and reliability of the assessment.Item Translation, adaptation and, validation of the Communication Matrix parent version to use with Sinhala speaking parents(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Kumarage, C.; Muttiah, N.Introduction: The Communication Matrix is a widely used objective AAC assessment worldwide. Objectives: The major objective of the study was to translate, adapt and validate the Communication Matrix parent version to Sinhala. Methods: The Sinhala translated Communication Matrix was developed through a forward-backwards translation procedure. Six experts including 04 SLTs and 02 linguists contributed to validate the translated tool in 02 rounds using an open-ended questionnaire and a four-point rating scale. The Modified Delphi technique was used for this procedure. Face and content validity was determined. A group of 10 parents contributed to pretest the translated tool by answering an open-ended questionnaire. Results: The face validation was evaluated qualitatively based on the answers provided to the open-ended questionnaire given to the expert panel round 01 and it was adequate. In the expert panel round 02, the item content validity index (I-CVI) and the scale validity index (S-CVI) were measured and both I-CVI and S-CVI s were equal to 1. Pre-testing the translated tool was also successful as the parents provided mostly positive answers to the questions. Conclusions: The Sinhala translated Matrix is an appropriate self-administrative, objective AAC assessment which could be used in local clinical settings. Moreover, this can be used to involve parents in decision-making procedures with professionals despite their educational background when selecting the most suitable AAC for their children.Item Ground realities of autism spectrum disorders in Sri Lanka(Ubiquity Press., 2021) Muttiah, N.ABSTRACT: Autism spectrum disorders (ASD) are a group of developmental disabilities that impact children and adults globally. The majority of children diagnosed with ASD live in low- and middle-income countries (LMICs). There is, however, inadequate understanding of the prevalence, screening, diagnosis and treatment for these children in LMICs. As most of the current evidence comes from high-income countries, this narrative review will focus specifically on children with ASD living in Sri Lanka, a lower-middle-income country. It will discuss the prevalence of ASD, current screening and diagnostic assessments, and services available for these children, with a focus on speech therapy and augmentative and alternative communication (AAC). KEYWORDS: Autism spectrum disorders, low- and middle-income countries, augmentative and alternative communication, Avaz Sri LankaItem Protocol for the Sri Lankan Cerebral Palsy Register pilot study(BMJ Publishing Group Ltd., 2020) Heiyanthuduwage, T.M.; Sumanasena, S.P.; Kitnasamy, G.; Sheedy, H. S.; Khandaker, G.; Fernando, R.; Wijesekara, S.; Jagoda, J.; Ratnayake, P.; Wanigasinghe, J.; Mclntyre, S.; Goldsmith, S.; Waight, E.; Badawi, N.; Muhit, M.; Muttiah, N.INTRODUCTION: Cerebral palsy (CP) describes a heterogeneous group of motor disorders resulting from disturbance in the developing brain. CP occurs in approximately 2.1 per 1000 live births in high-income countries, but in low- and middle-income countries (LMICs) the prevalence and severity of CP may be greater and aetiological risk factors different. In Sri Lanka, a LMIC, there have been no epidemiological studies of CP to date. Systematically collected data are required to identify opportunities for primary and secondary prevention, to plan and establish services to support children and adults with CP and their families and to act as a sampling frame for new research. Here we describe a pilot study protocol for a CP register in Sri Lanka. METHODS AND ANALYSIS: The aim of this study is to establish a CP register in Sri Lanka. We will use different surveillance methodologies in two provinces of Sri Lanka: hospital and community surveillance in the Western Province and community surveillance in the Eastern Province. A common record form will collect demographic, clinical and service data for children with CP <18 years living in these two provinces. Data will be transferred to a secure online data repository and used to describe the epidemiology of CP in these regions. We will describe the strengths and challenges of the surveillance mechanisms and estimate the resources required for ongoing hospital and community based surveillance in the Western and Eastern provinces and to include additional provinces across the country. ETHICS AND DISSEMINATION: This study has ethical clearance from The University of Kelaniya, National Health Research Council, the Institutional Ethics Review Committee of the Lady Ridgeway Hospital, Colombo South Teaching Hospital and the Director of the North Colombo Teaching Hospital. Results from this research will be disseminated through local and international conferences and through publications in peer-reviewed journals. KEYWORDS: developmental neurology & neurodisability; perinatology; public health; rehabilitation medicine.Item 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.