摘要
目的:探讨腭裂患者术后语音障碍的临床特点及综合性语言治疗的效果。方法:于2003-06/2005-10选择中山大学附属第三医院康复科门诊就诊的腭裂术后仍存在构音障碍的患者16例为观察对象。根据中国康复研究中心版构音障碍检查法进行构音障碍检查、根据王国民编“汉语语音清晰度测试字表”进行语音清晰度评价。采用VS9700语音工作站1.0版软件,以/te/,/pai/,/kan/,/si/为检测语音样本,进行语谱图分析,利用冲直条、乱纹的出现率及辅音结构中空白间隙来描述辅音的特征,观察患者语言训练前后辅音出现率,观察语音障碍的临床特点;并针对性地进行综合性语言训练,包括腭咽闭合功能训练、增强节制呼气功能训练、强化正确的构音器官运动训练,治疗开始每周一两次,后期每2周1次,30～60min/次,训练3～6个月。比较训练前后语音学指标。结果:纳入患者16例,均进入结果分析。①腭裂患者术后语音障碍临床特点主要包括:继发于腭咽闭合功能不全所致的结构性发音不清6例(38%),表现为鼻漏气、过重鼻音,韵母、声母均可发生;因不良代偿发音习惯而引起的功能性语音障碍16例(100%),主要表现为腭化构音16例(100%)、侧化构音14例(88%)、鼻咽构音13例(81%)和声母的歪曲16例(100%)、置换16例(100%)或省略14例(88%);言语呼吸障碍4例(25%),表现为最长声时缩短。②治疗前后平均语音清晰度由32.63%提高到79.50%,两者差异有显著性意义(P<0.001)。③测试音节声母频谱特征性指标冲直条、乱纹出现率治疗后较治疗前明显增加(P<0.05)。结论:腭裂修补术后语音障碍主要原因是不良代偿发音习惯而引起的功能性语音障碍;综合性语言治疗可以显著提高患者的语音状况;计算机频谱分析有助于腭裂术后语音状况评估及训练疗效分析。
AIM： To study the clinical characteristics of speech disorder and the efficacy of speech therapy on the postoperative patient with cleft palate.
METHODS： A total of 16 postoperative cleft palate patients with speech disorder were selected from the Outpatients Department of Rehabilitation Medicine, the Third Affiliated Hospital of Sun Yat-sen University from June 2003 to October 2005. They were assessed with dysarthria method from China Rehabilitation Research Center, and speech articulation was evaluated with Chinese Character Scale for Articulation Test edited by Wang Guo-min. Taking/te/, /pal/, /kan/and/si/as phone samples, spectrogram analysis was conducted with VS9700 phone workstation 1.0 software. The consonants were charactered by the presence rates of vertical or disarrayed striations as well as the blank interspace of consonant structures. All the patients were observed before and after speech training in the presence rates of consonant and clinical characteristics of speech disorder; Meanwhile, the comprehensive speech therapy that aimed directly at speech disorder was underwent, including trainings of velopharyngeal closure function, enhancing continence expiration function and strengthening exact articulation organs. The treatment duration was one or two times in one week at early period, and then once every two weeks at later period, 30-60 minutes for one time, totally for 3-6 months. In addition, the phonetic index was compared before and after receiving training.
RESULTS： Sixteen patients were all involved in the result analysis.（1）The main vocal characteristics on the postoperative cleft palate patient with speech disorder in clinical were the structural asophia （6 cases, 38%） due to the incomplete function of velopharyngeal closure, was expressed as rhinorrhea, hyperuasality in both initials and finals; the functional speech disorders （16 cases, 100% ） resulting from the bad compensatory phonological habit, was expressed as palatal articulation （16 cases, 100%）, lateral articulation （14 cases, 88%）, nasopharyngeal articulation （13 cases, 81%） and initial distortion （16 cases, 100%）, 16 permutationa （100%） or 14 omits （88%）; the speech-breath disorder （4 cases, 25.0%）, expressed as the shortening of the longest sound. （2）The mean intelligibility of the patients was enhanced from 32.63% to 79.50%, and there were significant differences between the scores of articulation before and after speech therapy （P 〈 0.001）.（3）The features of syllable spectrogram were obviously improyed after speech training （P 〈 0.05）. CONCLUSION： The main vocal characteristics of the postoperative cleft palate patient are the functional speech disorders because of the bad compensatory phonological habit. Speech therapy can improve the linguistic development of the patients significantly. Computer spectrum analysis is an effective method for evaluating the speech characteristics and the treatment efficacy.
出处
《中国临床康复》
CSCD
北大核心
2006年第44期33-35,共3页
Chinese Journal of Clinical Rehabilitation
作者简介
丘卫红，女，1966年生，广东省兴宁市人，汉族，副主任医师，中山大学公共卫生学院在读硕士，主要从事神经系统疾病和语言障碍康复的研究。
