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Ongoing Research

Profiling objective video-fluoroscopic measures of swallowing in children

Dharmarathna, I., Miles, A., and Allen, J.

The current practice of instrumental assessment of swallowing in children is often criticized for its subjectivity in interpretation, resulting in lack of reliability and validity to identify respiratory and physiological manifestations of swallowing in children. As the gold standard swallowing assessment, Video-Fluoroscopic Study of Swallowing (VFSS) has the potential to objectively describe the process of swallowing, by visualizing oral, pharyngeal and oesophageal phases of swallowing along with airway protection during swallowing. The project aims to develop a protocol to obtain timing, displacement and respiratory objective measures of swallowing in children using Video-Fluoroscopic Study of Swallowing (VFSS), in order to describe swallowing physiology and underlying physiological manifestations leading to dysphagia in children. The study is anticipated to be the first study to develop objective normative VFSS measures for paediatric population and compare with a range of aetiologies. The findings will expand the clinicians’ knowledge on swallowing development across ages and aetiologies and to help identify swallowing disorders in children, which will lead to more individualised and focused intervention for children. (PhD research project 2017-2020, The University of Auckland, New Zealand)

Development of culturally and appropriate clinical assessment tools for paediatric dysphagia in Sri Lanka

Dharmarathna, I., Perera, S. and Jayawardane, D.

Prevalence of swallowing difficulties/ dysphagia is increasing, as the survival rates of children who are born prematurely or with severe medical complications increase, due to rapid progress in medical and surgical management for infants. Dysphagia in children leads to long-term consequences affecting physiological, nutritional and social aspects of children with dysphagia. Early detection and diagnosis of dysphagia by a qualified Speech and Language Therapist can lead to early intervention, reducing its long-term effect and improved quality of life. Instrumental investigation play a critical role in detecting dysphagia accurately, compared to less reliable clinical feeding assessment. However, access to instrumental assessment for dysphagia management is often non-existent in Sri Lankan clinical context, leaving the clinicians to depend on the clinical feeding assessment to diagnose the condition. The feeding behaviour of a child during clinical feeding assessment can be varied from his/ her feeding behaviour in natural environment. This has led to utilize parents/caregivers to aid clinical decision-making on child’s feeding behaviour, using parent-report tools worldwide. Due to its cultural and social sensitive nature, child feeding behaviour considered ‘typical’ or ‘discorded’ in one culture, is not applicable to another culture. The multi-tiered project aims to develop culturally appropriate assessment tools for clinicians in Sri Lanka. Most of the clinical tools used internationally in English has to be both culturally and linguistically appropriate to Sri Lanka. Therefore, the project focuses on to develop tools to be used in two Sri Lankan native languages, Sinhala and Tamil. In the first phase, two parent-rating tools were considered for validation and adaptation. The validation of the Behavioural Paediatric Feeding Assessment Scale (BPFAS, Crist, Napier- Phillips, 2001) in Sinhala language and utilization of the Paediatric Eating Assessment Tool (Pedi-EAT, Thoyre et al, 2014) are targeted in two undergraduate research projects of the BSc (Hons) Speech and Hearing Sciences. The BPFAS is translated to Sinhala language and norms are developed for Sri Lankan children between 2-4 years. The Sinhala version of the Pedi-EAT was used in order to identify feeding difficulties in children with Cerebral Palsy (CP) between 3-6 years in Sri Lanka, aiming to describe any atypical patterns of feeding in children with CP. This phase of the project is planned to be completed by September 2018, making both Sinhala-Pedi-EAT and Sinhala-BPFAS accessible to paediatric healthcare professionals in Sri Lanka. The next phase would aim to complete normative study of the BPFAS and translate the BPFAS and the Pedi-EAT to Tamil language. It also aims to use the tools to identify feeding difficulties in children with Down syndrome and Autism Spectrum Disorder in Sri Lanka. The BPFAS and Pedi-EAT can be used to gather information on feeding/ swallowing skills of children, which would lead to effective early identification and intervention.

Newborn Hearing Screening at the University Pediatric Unit of the North Colombo Teaching Hospital, Ragama

Jayasena, B.N., Ileperuma, D., Silva, D., Chathurika, L.K.E., Chadrasekara, J.M.A.U.

Early detection and intervention of hearing impairment in newborns has gained worldwide recognition in the recent years. Adverse consequences of late detection is minimized when hearing is screened by as early as 1 month of age, hearing loss detected by 3 months of age and intervention for hearing impairment is employed by 6 months of age. Sri Lanka lags behind in implementing newborn hearing screening programmes in a wider scale. The proposed descriptive cross-sectional study aims to initiate a newborn hearing screening programme at the North Colombo Teaching Hospital, Ragama by identifying hearing impairment among all newborn well-babies at the University Pediatric Unit and the Neonatal Intensive Care Unit (NICU) – University Pediatric Unit. Hearing screening will be conducted using Otoacoustic Emission (OAE) for well-babies and a combination of OAE and Auditory brainstem Response (ABR) for babies admitted to the NICU. Those who fail the initial screen before discharge from the hospital will be rescreened at not later than 1 month of age. Those who failed the rescreen will be referred to the Audiology Clinic of the Faculty of Medicine, Ragama by 3 months of age for detailed audiological evaluation. The gathered data will be analyzed by using descriptive and inferential statistics. Statistical significance will be set at p<0.05, all analyses will be performed using SPSS statistical software version 21.0. All babies will be recruited to the study with permission from hospital officials and consent from parents. Measures to ensure the safety of the babies and confidentiality of the information gathered will be taken. The study findings will be used constructively to highlight the importance including newborn hearing screening in to the routine newborn hearing care services in hospitals.
Ongoing (2015 -)

Completed research

Development of Sinhala Spondees and Sinhala Paired Words for Testing of Speech Recognition Threshold

D., Silva, Chadrasekara, J.M.A.U., Chathurika, L.K.E., Jayasena, B.N., Ileperuma,D., Colonne, U.

Speech audiometry provides information pertaining to sensitivity to speech and the understanding of speech. Speech recognition threshold (SRT) testing is the procedure that assesses an individual’s hearing threshold level for speech. For speech audiometry findings to be precise in assessing a person’s understanding of speech, individuals should be tested with stimuli of their native language. There are various stimuli for testing speech recognition threshold developed in different languages. With reference to Sinhala, empirical data representing the appropriateness of the stimuli used for testing SRT is not available. The purpose of this study is to develop speech material in Sinhala (word lists) for testing SRT. Four lists of Sinhala spondiac and paired words will be developed and equivalence analysis of difficulty between the word lists will be evaluated for a group of subjects with normal hearing and hearing impaired.

Completed (2013)

Noise Induced Hearing Loss, where do we stand? ; A survey of the prevalence of Occupational and Non occupational Noise Induced Hearing Loss in and around Colombo city limits and a review into Sri Lanka’s current position in managing the menace

Bakmeewewa, A.D.S., Jayasena, B.N., Chathurika, L.K.E.

The study investigated the presence of hearing loss in individuals exposed to environments with elevated/hazardous levels of continuous noise in and around Colombo city limits. 292 participants, aged 20-40 years, were divided in to two groups; occupational and non-occupational, based on the environment in which they experienced noise. The occupational group comprised of 59 factory workers, 50 full time three wheeler drivers, 67 professional musicians and 47 traffic police officers, with a noise exposure of at least 8 hours per day. The non-occupational group comprised of 69 who use public transport systems for travel on a daily basis with a minimum of 2 hours of travel each day. All participants were subjected to a series a of tests which included a brief medical history, otoscopy examination, Weber and Rinne tuning fork tests and Distortion Product Otoacoustic Emission (DPAOE) screening. Failing the DPOAE screen with a positive Rinne and Weber lateralized to the better ear, with a negative medical history and normal otoscopy findings indicated hearing loss due to noise exposure. Of all occupational groups, three wheeler drivers (40%) had the highest prevalence of hearing loss followed by traffic police officers (30%), factory workers (24%) and musicians (19%). The group tested for non-occupational hearing loss demonstrated a considerable number of referrals (19%). Greater loss was observed at 4 kHz and 5 kHz in both the groups, indicating a possibility of hearing loss due to noise.

Trends observed suggest that continuous exposure to noise while with minimal auditory protection, to be a key factor in causing hearing loss in healthy young adults. It is possible that the prevalence of occupational hearing loss is under estimated due to the small sample numbers and also as the groups were selected from within a limited working location. Therefore, it is suggested that a large-scale longitudinal study with greater sample diversity, would help confirm the suggestions drawn here.