1. Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Western Province, Sri Lanka.
2. Cerebral Palsy Lanka Foundation, 127 5/4, St James Street, Colombo 15, Sri Lanka.
3. Cerebral Palsy Research Institute, The University of Sydney, Sydney Medical School, Disclipline of Child and Adolescent Health, PO Box 6427, Frenches Forest, NSW, Australia
4. CSF Global, Dhaka, Bangladesh and The University of Sydney, Sydney Medical School, Disclipline of Child and Adolescent health, Locked Bag 2001, Westmead NSW 2145
5. Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.
6. Lady Ridgeway Hospital for Children, Dr. Denister De Silva Mawatha, Colombo 08, Sri Lanka.
7. Faculty of Medicine, University of Colombo, Sri Lanka.
8. The University of Sydney and The Children’s Hospital at Westmead, Locked Bag 4001, The Children’s Hospital at Westmead, Westmead NSW 2145, Australia.
9. Child Sight Foundation Global, Apartment A1 and B3, House 09, Road 2/1,Banani R/A,Dhaka1213, Bangladesh

Cerebral palsy (CP) describes a heterogeneous group of non-progressive but permanent motor disorders. The motor disorders and accompanying co-morbidities of CP are due to an insult or injury to the developing brain. CP is common with a prevalence of 2.1 per 1000 live births in developed countries. In Sri Lanka, a LMIC, there have been no epidemiological studies of CP to date. Systematically collected CP data is required to identify opportunities for primary and secondary prevention, to plan and establish the necessary services to support children and adults with CP and their families and to act as a sampling frame for new research.

The aim of this preliminary study is to develop a platform for a national CP register in Sri Lanka to facilitate research on the prevalence, severity, aetiology, associated impairments and risk factors for CP in Sri Lanka. This is a collaborative project between the University of Kelaniya (UKel) and the Cerebral Palsy Lanka Foundation (CPLF) and the Cerebral Palsy Alliance Research Foundation of Australia.

This study has two independent and yet interconnected arms consisting in Phase 1 of i) hospital based surveillance in the Western province and ii) community based surveillance in the more rural Eastern province. The two arms of the study will provide opportunity for comparison of the epidemiology of CP in these two regions of Sri Lanka.

Our specific objectives for this study are to:

1. Establish a core data set of items that will be collected in both regions
2. Establish a shared data platform for Sri Lankan CP surveillance using infrastructure from the Australian CP Register (ACPR)
3. Compare the epidemiology of CP in the Western and Eastern provinces of Sri Lanka
4. Estimate the prevalence of CP in 15 DS divisions (Divisional Secretary’s Divisions) in the Eastern province
5. Describe the aetiology and risk factors for CP in the Western and Eastern provinces
6. Describe both the CP motor type, functional motor severity (i.e. GMFCS and MACS) and associated impairments of children with CP in the Western and Eastern provinces
7. Assess the availability and use of rehabilitation services for children with CP in the Western and Eastern provinces
8. Determine the strengths and challenges of the community and hospital based surveillance programs in the Sri Lankan context and
9. Identify opportunities for on-going collaboration beyond this preliminary study to expand this work to become a national program

Hypothesis/ Research question

We hypothesize that this study will provide the first high quality epidemiological data on CP in the Western and Eastern provinces of Sri Lanka; promote collaboration between clinicians and researchers both in Sri Lanka and internationally; create new opportunities to develop a community of both health professionals and families of children with CP; and provide important new opportunities to identify both the rehabilitation and equipment needs of children with CP at both the individual and provincial level.

The study sties of the hospital based are:

July 2016 ongoing till January 2020

Every year, approximately one million babies die from ‘neonatal encephalopathy’ in low and middle-income countries (LMICs) – a condition arising from unexpected lack of cerebral blood flow and oxygen supply to the fetal brain at the time of birth– a quarter of these deaths occur in India. Approximately a third of infants with oderate or severe encephalopathy will die during the newborn period, and up to three uarters of survivors develop long-term neurodisability. Until recently there was no effective treatment for this condition, and the management was limited to supportive care.

Cooling therapy in high-income countries

A number of high quality cooling trials have been conducted in high-income countries in the past decade. The meta-analyses of these trials have convincingly demonstrated that selective head or whole body cooling along with optimal tertiary intensive care reduce mortality (risk ratio (RR) 0.8; 95% confidence interval (CI) 0.7 to 0.9; p=0.005), and improve survival with normal neurological outcome (RR 1.5; 95% CI 1.2, 1.9; p<0.001) after neonatal encephalopathy in high income countries. The protective effect of cooling persists into later childhood. Whole body cooling is now widely used as a standard therapy for encephalopathy in the UK and other high income countries.

Although the burden of neonatal encephalopathy is far higher in low and middle-income countries, the safety and efficacy data on cooling therapy from high income cooling trials cannot be extrapolated to these settings.

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)

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.

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 -)

Samanmali P. Sumanasena¹
MBBS, MD Paediatrics, MSc (Disability Studies)
Senior Lecturer
¹Department of Disability Studies, Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama
Tel: 0094777256768, 0094115753721
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Iranthika WKH¹
B.Sc (Speech and Hearing Sciences)
Speech and Language Therapist
Tel: 009471599749
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Lokubalasuriya LBTC¹
B.Sc (Speech and Hearing Sciences)
Lecturer and Speech and Language Therapist
Tel: 0094 31 2257711, 0094 713227184
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Sooriyaarachchi DCC¹
B.Sc (Speech and Hearing Sciences)
Research Assistant and Speech Therapist
Tel: 0094719607312
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Widanapathirane WP¹
BSc. Psychology, Diploma in Cognitive Behavioral Therapy
Research Assistant
Tel: 0094 77 127 0241, 009411 297 3505
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Godamunne P²
BSc. (Hon) Psychology, M.A. (Psychology)
PhD. (Psychology and Disability Studies),
Developmental Psychologist and Senior Lecturer in Medical Education,
²Department of Medical Education
Faculty of Medicine, University of Kelaniya, Ragama
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Kumarendran B³
MBBS (Jaffna), M.Sc. in Community Medicine (Colombo)
MD in Community Medicine (Colombo)
Consultant Community Physician and Senior Lecturer
3 Faculty of Medicine,University of Jaffna, Jaffna
Tel: 0094777277552 / 0094112953411
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Introduction

Reading difficulties are seen in approximately 19 -21% of the population according to global research. It is essential to identify children with reading difficulties early to ensure early intervention strategies to uplift academic and economic progress of the societies. These children may show difficulties in precursor cognitive and language skills during the early school years. Therefore, a study was undertaken to identify children with reading difficulties in the Gampaha District as the first phase of a larger randomized control trial.

Objectives

1. Estimate the prevalence of dyslexia.
2. Describe the associated difficulties in cognitive and language skills.

Methodology

Community based descriptive cross sectional quantitative assessments were undertaken as the first step of a RCT, in randomly selected schools in the Gampaha District. All consenting children in each classroom in grade 1 and 2 were assessed by trained research assistants in the areas of basic cognitive concepts, visuomotor and language skills. Children also underwent letter recognition in grade 1 and reading and writing tasks in grade 2. Ethical clearance was obtained for the study. Data was analysed by using SPSS.

Results

A total of 3483 students were screened. 48 % were girls and 52 % were boys. There were 65 % with deficits in cognitive concepts, 48 % with oral language difficulties and 13 % with visuo motor skills difficulties. There was a significant association between these attributes and reading difficulties (&lt;0.001). The prevalence of reading difficulties was 18%.

Conclusion

This is the first study reporting reading difficulty prevalence from a district in Sri Lanka. The findings are keeping with the global figures. The difficulties in early precursor skills may be a good predictor for early screening of reading skills.

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)

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.