目的 研究腭裂术后患者双唇音构音障碍的语音特点及康复训练方法。方法 分析2012年1月至2016年1月腭裂术后存在双唇音构音障碍的腭咽闭合不全(VPI)患者51例和腭咽闭合完全(VPC)患者57例的语音特点。对患者进行针对性的康复训练。对双唇音构音障碍与年龄进行相关性分析。结果 /b/在两类患者中主要表现为弱化,VPI患者中/p/主要表现为弱化,VPC患者中/p/主要置换为/b/。VPI患者经1~6周的针对性康复训练,46例治愈,2例好转,总治愈率为90.20%(46/51),轻、中和重度组治愈率分别为100%(13/13)、93.75%(15/16)和77.27%(17/22);VPC患者经1~5周的针对性康复训练,53例治愈,4例好转,总治愈率为92.98%(53/57),轻、中和重度组治愈率分别为100%(17/17)、90.48%(19/21)和89.47%(17/19)。VPC患者双唇音构音错误字数与年龄存在负相关(r=-1.000,P<0.001)。结论 腭裂术后患者双唇音构音障碍主要发生于/b/和/p/,/b/主要表现为弱化,/p/主要为弱化和置换;针对性的语音康复训练是矫治腭裂术后患者双唇音构音障碍的有效措施。
Objective To investigate phonological characteristics and rehabilitation training approaches of bilabial consonant articulation disorders in patients after repaired cleft palate. Methods From January, 2012 to January, 2016, 51 patients with velopharyngeal incompetence (VPI) and 57 patients with velopharyngeal competence (VPC) after cleft palate repaire were enrolled. Their phonological characteristics of bilabial consonants articulation disorders were analyzed. They accepted specific rehabilitation training. The correlation between bilabial consonants articulation disorders and age was analyzed. Results /b/ showed mainly weak pressure in both VPI and VPC patients, /p/ showed mainly weak pressure in VPI patients, /p/ was mainly substituted by /b/ in VPC patients. 46 cases were cured and 2 cases improved in VPI patients after 1-6 weeks of rehabilitation, and the overall cure rate was 90.20% (46/51), and was respectively 100% (13/13), 93.74% (15/16), 77.27% (17/22) in those with mild, moderate and severe disorder. 53 cases were cured and 4 cases improved in VPC patients after 1-5 weeks of rehabilitation, the overall cure rate was 92.98% (53/57), and was respectively 100% (17/17), 90.48% (19/21), 89.47% (17/19) in those with mild, moderate and severe disorder. The number of incorrect words negatively correlated with age in VPC patient (r=-1.000, P<0.001). Conclusion Bilabial consonant articulation disorders occurs mainly on /b/ and /p/ in patients repaired cleft palate, /b/ shows mainly weak pressure, /p/ shows mainly weak pressure and substitution. Specific speech rehabilitation training is significantly effective.
[1] 刘纲,蒲高成,李万山. 早期腭裂修复术对患者腭咽闭合功能的影响[J]. 重庆医学, 2015, 44(34): 4805-4809.
[2] 彭兆伟,马莲,贾绮林,等. 腭裂手术年龄对腭咽闭合运动连续性的影响[J]. 北京口腔医学, 2012, 20(5): 281-283.
[3] 陈仁吉. 中国腭裂语音训练的现状与思考[J]. 国际口腔医学杂志, 2012, 39(1): 1-5.
[4] Mildinhall S. Speech and language in the patient with cleft palate [J]. Front Oral Biol, 2012, 16: 137-146.
[5] Karnell MP. Instrumental assessment of velopharyngeal closure for speech [J]. Semin Speech Lang, 2011, 32(2): 168-178.
[6] Lipira AB, Grames LM, Molter D, et al. Videofluoroscopic and nasendoscopic correlates of speech in velopharyngeal dysfunction [J]. Cleft Palate Craniofac J, 2011, 48(5): 550-560.
[7] 石冰,郑谦. 唇腭裂综合治疗学[M]. 北京:人民卫生出版社, 2011: 956-957.
[8] 李胜利,陈卓铭. 语言治疗学[M]. 2版. 北京:人民卫生出版社, 2013: 59.
[9] 李宁毅. 腭裂语音训练学[M]. 北京:人民卫生出版社, 2009: 181.
[10] 林焘,王理嘉. 语音学教程[M]. 2版. 北京:北京大学出版社, 2013: 202-203.
[11] 王国民,朱川,袁文化,等. 汉语语音清晰度测试字表的建立和临床应用研究[J]. 上海口腔医学, 1995, 4(3): 125-127.
[12] 江茹,赵生全,张铁松,等. 功能性构音障碍儿童言语异常及矫治效果研究[J]. 听力学及言语疾病杂志, 2011, 19(3): 260-262.
[13] 王正昊. 腭裂术后患儿语音训练前后普通话塞音的强频集中区频率及冲直条分析[D]. 南宁:广西医科大学, 2015.
[14] 马思维,任战平,文抑西,等. 110例腭裂术后患者代偿性构音的特点及治疗策略探讨[J].实用口腔医学杂志, 2012, 28(5): 619-622.
[15] Liu Q, Jiang LP, Chen Y, et al. [A preliminary study on speech therapy for marginal velopharyngeal insufficiency] [J]. [in Chinese]. Shanghai Kou Qiang Yi Xue, 2011, 20(6): 611-614.
[16] Forrest K, Iuzzini J. A comparison of oral motor and production training for children with speech sound disorders [J]. Semin Speech Lang, 2008, 29(4): 304-311.
[17] 翟瑛,靳利敏,李峰,等. 大龄腭裂患者语音训练的临床疗效及近期随访观察[J]. 实用医学杂志, 2012, 28(21): 3573-3575.
[18] 王国民,杨育生. 唇腭裂序列治疗学[M]. 杭州:浙江科学技术出版社, 2014: 242-244.
[19] 尹恒,郭春丽,石冰,等. 大龄腭裂患者术前辅音构音特点的初步研究[J]. 华西口腔医学杂志, 2013, 31(2): 182-185.
[20] 吕自愿,李峰,徐丽娜. 双唇音构音障碍的临床特点和语音训练[J]. 中国康复理论与实践, 2014, 20(8): 763-766.
[21] Ma L, Shi B, Li Y, et al. Velopharyngeal function assessment in patients with cleft palate: perceptual speech assessment versus nasopharyngoscope [J]. J Craniofac Surg, 2013, 24(4): 1229-1231.
[22] 李青云,袁文化,王国民,等. 腭化构音语音训练方法的初步探讨[J]. 上海口腔医学, 2001, 10(3): 204-206.
[23] 高楠,李峰,吕自愿,等. 视觉反馈联合触觉反馈在腭裂术后患者语音训练中的应用[J]. 郑州大学学报(医学版), 2016, 51(1): 103-105.
[24] Dobbelsteyn C, Bird EK, Parker J, et al. Effectiveness of the corrective babbling speech treatment program for children with a history of cleft palate or velopharyngeal dysfunction [J]. Cleft Palate Craniofac J, 2014, 51(2): 129-144.
[25] 黄莹莹,李新明,李峰,等. 家长在低龄腭裂患者语音训练中的作用分析[J]. 河南医学研究, 2013, 22(6): 845-847.
[26] 朱译,黄迪炎,朱国雄. 腭裂术后语音训练[M]. 北京:人民军医出版社, 2007: 5-7.
