Exploring clinical reasoning in child language assessment through decoloniality.

PURPOSE: Clinical reasoning has been taught, practised, and researched under Western epistemologies, which have been fallible in addressing the complexity of clinical reasoning within Indigenous cultures and societies. We explored how speech-language pathologists in Sri Lanka negotiate and value Indigenous and Western perspectives in clinical reasoning within a decolonial framework. METHOD: This study used participatory research methodology within the decolonised qualitative research paradigm to produce data collaboratively with eight Sri Lankan speech-language pathologists. Oral history narratives and object-based textual reflections generated the necessary data for the study. Systematic visual-textual analysis and reflexive thematic analysis were carried out iteratively, and the data analysis and interpretation were undertaken collaboratively with the participants. RESULT: We generated four key themes about professional education, individuality in practice, holistic thinking, and balancing interests and priorities. The results demonstrate that social, political, and economic forces impact practitioners' clinical reasoning. CONCLUSION: Practising science in its original form within Indigenous contexts is challenging. Colonial roots and imperialism impact the delivery of appropriate services in socially and politically marginalised communities. Practitioners' self-awareness about authentic identities and practical wisdom can develop culturally relevant knowledge for equitable practice.

Availability of rehabilitation services for communication disorders in Sri Lanka: a cross-sectional survey.

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.

Parent perspectives on augmentative and alternative communication in Sri Lanka.

Parental support is an important part of introducing an augmentative and alternative communication (AAC) system to a child. Professionals providing AAC services to children with complex communication needs should practice family-centered service provision. The aim of this study was to explore Sri Lankan parents' perspectives on AAC and their lived experiences. Semi-structured interviews were conducted with 10 parents of children with complex communication needs. Thematic analysis was used to analyze the findings, with the following themes identified: (a) External Systems, (b) Impact on the Family, (c) Impact on the Child, and (d) Communication (including AAC). Findings from this study provide important information for speech-language therapists providing services to families from low- and middle-income countries. In particular, parents reported several positive aspects of AAC. However, parents also reported challenges, including speech-language therapist's lack of knowledge of and training in AAC.

A scoping review of Augmentative and Alternative Communication (AAC) interventions in Low-and Middle-Income Countries (LMICs).

Currently, a small number of studies discuss augmentative and alternative (AAC) interventions in low- and middle-income countries (LMICs). The primary purpose of this scoping review was to summarize the current evidence base on communication-based interventions and partner training in LMICs, to explore and identify gaps in the AAC evidence base and guide future research. A total of 18 studies were identified. The results revealed many positive outcomes arising from AAC interventions, including increased communication, improved participation, increased knowledge about communication, and increased use of partner communication strategies, thus adding to the evidence base that AAC can be successfully implemented in LMICs. However, these studies did not broadly represent most LMICs and there were only a handful of indirect intervention studies training communication partners. To this end, there is an urgent need to expand the level of AAC intervention research conducted in LMICs in order to better serve individuals with complex communication needs living in these countries.

Protocol for the Sri Lankan Cerebral Palsy Register pilot study.

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.

AAC Technologies with Visual Scene Displays and "Just in Time" Programming and Symbolic Communication Turns Expressed by Students with Severe Disability.

BACKGROUND: The current study investigated the impact of an intervention that included aided augmentative and alternative communication (AAC) technologies on the frequency of symbolic communication turns of school-age children, adolescents, and young adults with severe disability. METHOD: Nine students ages 8-20 were engaged in interactive activities using an aided AAC system with visual scene displays (VSDs; concepts embedded within a photograph of a naturally occurring event), and "just-in-time" (JIT) programming (the capability to add new contexts "on the fly"). Effectiveness was evaluated using a single subject multiple probe across participants design. RESULTS: All participants demonstrated increases in symbolic communication turns upon introduction of the AAC technologies with VSDs using JIT technology. CONCLUSIONS: AAC with VSDs and JIT programming may be effective in increasing symbolic communication for students with severe developmental disability. The fast and easy creation of VSDs and hotspots to provide communication may be a valuable tool for interventionists.

Evaluating an AAC training for special education teachers in Sri Lanka,a low- and middle-income country.

A majority of people with disabilities live in low- and middle-income countries where communication services for individuals with complex communication needs are scarce. It is essential that communication partners of individuals who have complex communication needs receive training to support communication. To address this issue, the current study evaluated an augmentative and alternative communication training for special education teachers living in a low- and middle-income country, Sri Lanka. The training was based on four key practices identified when training in low- and middle-income countries: investigate learner needs, provide contextually relevant instructional content, use engaging instructional activities, and assess the impact of instructional activities. This investigation implemented an interrupted time-series design with nine teacher-student dyads. Special education teachers were taught to provide evocative communication opportunities. Following the training, all nine special education teachers significantly increased the number of evocative communication opportunities provided to students with complex communication needs. Additionally, all nine students with complex communication needs significantly increased their number of communication turns.

Providing instructional support for AAC service delivery in low- and middle-income (LAMI) countries.

PURPOSE: The majority of individuals with disabilities live in low- and middle-income (LAMI) countries; typically these individuals receive limited, if any, communication rehabilitation services. The present study investigated the experiences of eight augmentative and alternative communication (AAC) professionals who had provided instructional support for AAC service delivery in LAMI countries. METHOD: An online focus group was used to explore the training experiences of eight AAC professionals. RESULT: A thematic analysis of the focus group discussion resulted in four major recommendations when providing training for AAC service delivery in LAMI countries: (a) investigate learner needs, (b) provide contextually relevant instructional content, (c) use engaging instructional activities and (d) assess the impacts of instructional activities. CONCLUSION: The instructional recommendations of the focus group participants are discussed within a theoretical framework of recommended best practices in supporting adult learning. The information shared by the focus group participants will benefit others providing instructional support for AAC service delivery in LAMI countries.

Clinical and research perspectives on nonspeech oral motor treatments and evidence-based practice.

PURPOSE: Evidence-based practice (EBP) involves the incorporation of research evidence, clinical expertise, and client values in clinical decision making. One case in which these factors conflict is the use of nonspeech oral motor treatments (NSOMTs) for children with developmental speech sound disorders. Critical reviews of the research evidence suggest that NSOMTs are not valid, yet they are widely used by clinicians based on their expertise/experience. This investigation presents detailed descriptions of clinicians' and researchers' views and opinions on NSOMTs and EBP. METHOD: Individual interviews with 11 clinicians who use NSOMTs and 11 researchers in child phonology were conducted. The interviews were transcribed and organized into themes, following a phenomenological research design. RESULTS: Five themes were identified: (a) NSOMTs are effective, (b) EBP is useful, (c) there is no published research supporting NSOMTs, (d) research evidence may change clinical use of NSOMTs, and (e) researchers and clinicians have separate but shared roles in clinical decision making. CONCLUSIONS: The participants' responses provided detailed and complex insights into each group's decisions regarding NSOMTs. These responses also suggested questions that should be considered when making decisions about approaches that are not fully supported by EBP.