《中国康复理论与实践》

《中国康复理论与实践》 ›› 2009, Vol. 15 ›› Issue (05): 449-452.

• 临床研究 • 上一篇    下一篇

运动性构音障碍言语、声学、共鸣水平机制及康复疗效研究

庞子建1,2;李胜利1,2   

  1. 1.首都医科大学康复医学院，北京市 100068;2.中国康复研究中心北京博爱医院听力语言科，北京市 100068
  • 收稿日期:2009-01-06 修回日期:2009-04-06 出版日期:2009-05-01 发布日期:2009-05-01
  • 通讯作者: 李胜利

Speech, Phonation, Resonance Evaluation and Intervention for Dysarthria

PANG Zi-jian， LI Sheng-li   

  1. Department of Speech and Audiology, Capital Medical University School of Rehabilitation Medicine, Beijing Charity Hospital, China Rehabilitation Research Centre, Beijing 100068, China
  • Received:2009-01-06 Revised:2009-04-06 Published:2009-05-01 Online:2009-05-01

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摘要： 目的 观察汉语普通话应用者运动性构音障碍的特点及康复疗效。方法 选取31例运动性构音障碍患者，63名性别年龄匹配的正常人作为对照组。采用喉发声空气力学分析仪检测患者及正常人的最长发声时间(MPT) 、频率、音量、平均气流率（MAR）;肺功能检测仪检测用力呼气肺活量( FVC) 、第1秒用力呼气量、最大呼气中期流速、最大呼气流量；鼻流量检测仪检测鼻流量；测定发音轮替运动速度(AMR)；用言语清晰度测试卡检测患者言语清晰度。对所有患者均应用康复生理法进行康复治疗。对其中16例进行复测。结果 患者喉发声功能、肺功能低于对照组（P<0.05）；元音、非鼻音单音、单词及句子鼻流量值高于对照组（P<0.05）；鼻音单词及句子鼻流量值无显著性差异；轮替运动速度明显低于对照组（P<0.01）；言语清晰度明显降低。患者治疗后最长发声时间明显延长，呼吸功能明显改善，发声轮替运动速度明显增加，言语清晰度明显提高（P<0.01）；而音调、音量、平均气流率及各测试音的鼻流量值治疗前后均无显著性差异。言语清晰度的相关因素包括最长发声时间和轮替运动速度。元音/i/及非鼻音句子鼻流量测定与鼻音化主观判定之间有一定的一致性。结论 运动性构音障碍患者呼吸功能、喉发声功能显著降低；共鸣功能异常，存在鼻音化现象；轮替运动速度显著降低；言语清晰度差。康复生理法治疗可以改善运动性构音障碍患者的发声、呼吸、构音及交流能力，但对共鸣功能无明显效果。最长发声时间越长、特定时间内说/pa、ta、ka/ 次数越多，言语清晰度越高。鼻流量测定可作为判定运动性构音障碍患者鼻音化情况的客观指标。

关键词: 运动性构音障碍, 康复生理法, 言语清晰度, 鼻流量, 空气动力学, 评定

Abstract: Objective To explore the characteristics and rehabilitation of Chinese dysarthria. Methods 31 patients and 63 normal controls were measured with maximum phonation time (MPT), pitch, intensity and mean airflow rate (MAR), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum midexpiratory flow (MMF), peak expiratory flow rate (PEFR); Nasalance was tested with Nasalance Acquisition System (NasalView); Speech intelligibility was tested with mandarin words card. And alternative movement rate (AMR) were also tested. All the patients were rehabilitated with physiologic approach, 16 patients who finished the course were tested again after rehabilitation. Results MPT, MAR, aspiratory function, AMR of the patients was remarkable lower than those of the control; the nasalance scores of vowel and nonnasal sounds, words, and sentence were remarkable higher than those of the control; the speech intelligibility was also lower. After intervention, MPT, aspiratory function, AMR, and speech intelligibility improved. In the index, only MPT and AMR were correlated with the speech intelligibility. The nasalance of /i/ and nonnasal sentence related with the listener perceptions of hypernasality. Conclusion The aspiratory and phonation function of the patients with dysarthria are impaired. The patients show hypernasality which is a type of resonance abnormity. AMR is declined. Speech intelligibility is much lower. Physiologic approach can improve their phonation, aspiration, articulation and communication ability, but can't for resonance. The longer the MPT, the more /pa、ta、ka/ in specific time, the higher the speech intelligibility. Nasalance could be used for evaluating the hypernasality.

Key words: dysarthria, physiologic approach, speech intelligibility, nasalance, aerodynamic, assessment