目的 利用电磁发音动作描记仪(EMA)探讨脑受损后运动性构音障碍患者发音时构音器官的运动学特征。方法 收集2017年10月至2018年10月本院运动性构音障碍患者6例(构音障碍组)及年龄和性别相似的健康受试者10例(健康对照组)。运用Frenchay构音障碍评定法对患者构音障碍严重程度进行评定，运用EMA对两组构音器官运动学特征进行测评。采集运动数据的微型传感器分别粘贴于受试者唇、舌(舌尖、舌面、舌根)及下颌处，参考传感器粘贴于鼻梁处，所有微型传感器均粘贴于受试者矢状面中轴线上，以追踪和采集受试者各构音器官的运动学参数(包括持续时间、速度、加速度、运动距离及位移运动轨迹)，评估时所有受试者均进行音节重复任务，发音材料由声母(/d/、/t/、/j/、/q/、/g/、/k/、/b/和/p/)和韵母(/a/、/ia/或/iu/)构成，产生有汉语意义的不同音节，每个音节重复3次。利用Praat软件和Matlab软件对音频和运动数据进行处理。与健康受试者比较，分析构音障碍患者的构音运动学特征。结果 Frenchay构音障碍量表评估显示，患者构音障碍严重程度为中度到极重度。EMA测评结果显示，与健康对照组相比，构音障碍组发不送气音和送气音时，舌尖、舌面、舌根和唇的运动速度、加速度和运动距离减少(t > 2.422, P < 0.05)，下颌运动速度、加速度和运动距离两组比较无显著性差异(t < 1.016, P > 0.05)；舌尖、舌根和下颌运动持续时间延长(t > 3.369, P < 0.05)，舌面和唇运动持续时间两组比较无显著性差异(t < 2.146, P >0.05)。发不送气音与送气音相比，健康对照组发送气音时舌尖、舌根和下颌运动持续时间增加(t > 2.156, P < 0.05)，而构音障碍组各构音运动学参数比较均无显著性差异(t < 1.675, P > 0.05)。两组运动学参数和同步声音音频图像分析显示，构音障碍组构音运动速度和加速度随时间变化未呈现一定规律；声音音频变化无规律，连续发三个/da/音时持续时间不均等；构音运动上下位移与前后位移协调性差，运动轨迹与健康对照组相比存在明显差异，前后位移幅度较健康受试对照组偏小。结论 EMA通过对构音器官的运动学参数进行量化测评，可揭示脑损伤后构音障碍患者的构音运动学特征。
Objective To explore the kinematics characteristics of articulators (including lips, tongue and jaw) during articulation in dysarthric individuals post brain injury by using electromagnetic articulography (electromagnetic articulography, EMA). Methods From October, 2017 to October, 2018, six eligible individuals with dysarthria were recruited as dysarthria group, and ten age-gender matched healthy adults were recruited as healthy control group. Both groups received EMA assessment, and the dysarthria group was assessed with Chinese modified version of Frenchay Dysarthria Assessment before EMA assessment. To track and record kinematic parameters data (including duration, velocity, acceleration, distance) and displacement movement trajectories, a series of sensors were attached on the participant's lips, tongue (tip, blade and back of tongue) and jaw, the reference sensor was attached on the bridge of nose, all of the sensors were along midsagittal plane. During EMA assessment, each participant was received syllable repetition task, which containing consonants (/d/, /t/, /j/, /q/, /g/, /k/, /b/, /p/) at word initial position and vowels (/a/, /ia/, /iu/), to produce the single word with the Chinese linguistic meaning, every syllable produced was repeated three times. Then Praat software and Matlab software were used to process acoustic and kinematic data, so as to compare the differences of articulatory kinematic performance between two groups. Results The outcome of the Frenchay Dysarthria Assessment indicated that the severity of dysarthria was from moderate to extreme severe. EMA assessment demonstrated that, compared with the healthy control group, the dysarthria group showed a reduction of velocity, acceleration and distance of tongue and lip movement (t > 2.422, P < 0.05), and longer duration of tongue tip, tongue back and jaw movement (t > 3.369, P < 0.05). There was no statistical difference in duration of tongue blade and lip movement (t < 2.146, P > 0.05), the same as the velocity, acceleration and distance of jaw movement between two groups (t < 1.016, P > 0.05). Image analysis of kinematics parameters and synchronous audio data showed that, compared with the healthy control group, the dysarthria group varied unstably in velocity and acceleration, and the audio data showed that, when repeated /da/ three times, the duration of each syllable was not equal. The coordination of articulation movement displacement in the anterior-posterior dimension and inferior-superior dimension was poor, there were significant differences in visual inspection of movement trajectories between two groups, and a smaller displacement was found in the anterior-posterior dimension in the dysarthric group. Conclusion EMA assessment has significant advantages in evaluating kinematics parameters quantitatively, which could reveal the kinematics characteristics of articulators.
[1] Duffy J R. Motor Speech Disorders: Substrates, Differential Diagnosis, and Management [M]. 3rd ed. St Louis, Missouri: Elsevier Health Sciences, 2013: 3-4.
[2] Yorkston K M. Treatment efficacy: dysarthria [J]. J Speech Hear Disord, 1996, 39(5): S46-S57.
[3] Yunusova Y, Weismer G, Kent R D, et al. Breath-group intelligibility in dysarthria: characteristics and underlying correlates [J]. J Speech Lang Hear Res, 2005, 48(6): 1294-1310.
[4] Lee J, Littlejohn M A, Simmons Z. Acoustic and tongue kinematic vowel space in speakers with and without dysarthria [J]. Int J Speech Lang Pathol, 2017,19(2): 195-204.
[5] Brady M C, Clark A M, Dickson S, et al. The impact of stroke-related dysarthria on social participation and implications for rehabilitation [J]. Disabil Rehabil, 2011, 33(3): 178-186.
[6] Johns D F. Clinical Management of Neurogenic Communicative Disorders [M]. Boston: Little, Brown and Company, 1978: 251-310.
[7] Mefferd A. Articulatory-to-acoustic relations in talkers with dysarthria: a first analysis [J]. J Speech Lang Hear Res, 2015, 58(3): 576-589.
[8] Kearney E, Giles R, Haworth B, et al. Sentence-level movements in Parkinson's disease: loud, clear, and slow speech [J]. J Speech Lang Hear Res, 2017, 60(12): 3426-3440.
[9] Goozee J V, Murdoch B E, Theodoros D G, et al. Kinematic analysis of tongue movements in dysarthria following traumatic brain injury using electromagnetic articulography [J]. Brain Inj, 2000, 14(2): 153-174.
[10] Chen Y T, Murdoch B E, Goozee J V. Electromagnetic articulographic assessment of tongue function in dysarthric and non-dysarthric speakers following stroke [J]. J Med Speech Lang Pa, 2008, 16(1): 21-32.
[11] Lee J, Pond A L, Sincavage J. Tongue and lower lip movement in semivowel/w/production [J]. Folia Phoniatr Logop, 2016, 68(1): 46-51.
[12] Mefferd A S. Tongue- and jaw-specific contributions to acoustic vowel contrast changes in the diphthong /ai/ in response to slow, loud, and clear speech [J]. J Speech Lang Hear Res, 2017, 60(11): 3144-3158.
[13] Green J R, Moore C A, Higashikawa M, et al. The physiologic development of speech motor control: lip and jaw coordination [J]. J Speech Lang Hear Res, 2000, 43(1): 239-255.
[14] Bartle C J, Goozee J V, Scott D, et al. EMA assessment of tongue-jaw co-ordination during speech in dysarthria following traumatic brain injury [J]. Brain Inj, 2006, 20(5): 529-545.
[15] 吴民华,陈旸,王芷琪. 电磁构音图谱仪对神经控制异常性构音障碍粤语患者说话时舌头运动的研究[J]. 康复学报, 2016, 26(5): 8-16, 24.
[16] 张清丽. 言语语言障碍的现代康复[J]. 中国康复, 1996, 11(2): 87-90.
[17] 张丞然. 对构音障碍的发音空间和声学特征的分析研究[D]. 天津:天津大学, 2014.
[18] Murdoch B E. Dysarthria: A Physiological Approach to Assessment and Treatment [M]. Cheltenham, UK: Stanely Thornes, 1998: 337-372.
[19] Kuehn D P. A cineradiographic study of VC and CV articulatory velocities [J]. J Phon, 1976, 4(4): 303-320.
[20] Rudzicz F, Namasivayam A K, Wolff T. The TORGO database of acoustic and articulatory speech from speakers with dysarthria [J]. Lang Resour Eval, 2012, 46(4): 523-541.
[21] Goozee J V, Murdoch B E, Theodoros D G. Interlabial contact pressures exhibited in dysarthria following traumatic brain injury during speech and nonspeech tasks [J]. Folia Phoniatr Logop, 2002, 54(4): 177-189.
[22] Eisenfeld J, DeLisi C. Mathematics and Computers in Biomedical Applications [M]. Amsterdam: Elsevier, 1985: 363-371.
[23] Ziegler W. To speak or not to speak: distinctions between speech and non-speech motor control [J]. Aphasiology, 2003,17(2): 99-105.
[24] McClean M D, Clay J L. Activation of lip motor units with variations in speech rate and phonetic structure [J]. J Speech Hear Res, 1995, 38(4): 772-782.
[25] McAuliffe M J, Ward E C, Bruce E M. Articulatory function in hypokinetic dysarthria: an electropalatographic examination of two cases [J]. J Med Speech Lang Pa, 2005, 13(2): 149-168.
[26] Kent R, Netsell R. Articulatory abnormalities in athetoid cerebral palsy [J]. J Speech Hear Disord, 1978, 43(3): 353-373.
[27] Lee J, Bell M, Simmons Z. Articulatory kinematic characteristics across the dysarthria severity spectrum in individuals with amyotrophic lateral sclerosis [J]. Am J Speech Lang Pathol, 2018, 27(1): 258-269.
[28] Mooshammer C, Geumann A, Hoole P, et al. Coordination of lingual and mandibular gestures for different manners of articulation [C]. Barcelona, Spain: 15th International Congress of Phonetic Sciences, 2003: 81-84.
[29] Green J R, Moore C A, Higashikawa M, et al. The physiologic development of speech motor control: lip and jaw coordination [J]. J Speech Lang Hear Res, 2000, 43(1): 239-255.
[30] Weismer G, Yunusova Y, Bunton K. Measures to evaluate the effects of DBS on speech production [J]. J Neurolinguistics, 2012, 25(2): 74-94.
[31] Yunusova Y, Weismer G, Westbury J R, et al. Articulatory movements during vowels in speakers with dysarthria and healthy controls [J]. J Speech Lang Hear Res, 2008, 51(3): 596-611.
[32] MacKenzie C, Muir M, Allen C, et al. Non-speech oro-motor excises in post-stroke dysarthria intervention: a randomized feasibility trial [J]. Int J Lang Commun Disord, 2014, 49(5): 602-617.
[33] Lansford K L, Liss J M. Vowel acoustics in dysarthria: speech disorder diagnosis and classification [J]. J Speech Lang Hear Res, 2014, 57(1): 57-67.
