基于世界卫生组织国际分类家族构建言语嗓音功能障碍的诊断、评估和康复体系

doi:10.3969/j.issn.1006-9771.2020.01.006

Abstract

Abstract:

Objective To explore diagnosis and assessment of voice function and develop a framework of rehabilitation for it based on International Classification of Diseases 11th Revision (ICD-11), International Classification of Functioning, Disability and Health (ICF) and International Classification of Health Interventions (ICHI).
Methods The diagnostic criteria of voice disorders and its complications were discussed with ICD-11 and ICF. The tools of assessment were analysed with ICF. A comprehensive intervention system was developed for the rehabilitation of voice function based on the joint use of ICF and ICHI.
Results and Conclusion Voice disorders are classified to Voice Disturbance (MA82), within the category of Symptoms or Signs Involving Speech or Voice. Voice disorders may be symptoms or signs of Speech Disturbance (MA80), Malignant Neoplasms of Larynx (2C23), Intracerebral Haemorrhage (8B00), Oedema of Larynx (CA0H.3), and the others. Voice disorder is impairment at body function, and influence activity and participation (d3, d7, d8 and d9), which may involve in environmental and personal factors. The evaluation of voice function involes in production of voice (b3100) and quality of voice (b3101). A structured rehabilitation solution has been developed with the interventions at body structure, body function, activities and participation, environmental factors and personal factors, including assessment (assessment, test, observation), training and treatment (training, assisting), educational counseling (education, advicing, counseling), and support (psychological and social).

Key words: voice disorder, production of voice, quality of voice, voice rehabilitation, International Classification of Functioning, Disability and Health

CLC Number:

R767.92

ZHANG Yi-wen,Lancy HUANG,QIU Zhuo-ying,HUANG Zhao-ming. Construction of System of Diagnosis, Assessment and Rehabilitation Interventions for Impairment of Speech and Voice Function Using WHO Family International Classificiations[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(1): 37-44.

Figures/Tables 3

ICF功能分析	ICHI干预方法分析
身体功能
b3100嗓音产生	评估类	如嗓音和言语功能的评估、嗓音和言语功能的测试、嗓音和言语功能的观察、言语功能的评估、言语功能的测试、言语功能的观察等
	训练治疗类	如呼吸放松训练、“嗯哼”法、拟声法、数数法、重读治疗法^[28]、呼气肌力量训练、快速用力呼气法、缓慢平稳呼气法、逐字增加句长法、唱音法、啭音法、颈部放松训练、声带放松训练^[29]、哈欠-叹息法^[30]、张嘴法、乐调匹配法、音调梯度训练、用力搬椅法、掩蔽法、碰撞法、响度梯度训练法^[31]、励-协夫曼嗓音训练等
	教育咨询类	如嗓音和言语功能的教育、嗓音和言语功能的建议等
	社会支持类及其他	如嗓音和言语功能的社会支持、嗓音和言语功能的心理支持、言语功能的社会支持、言语功能的心理支持等
b3101嗓音音质	评估类	如嗓音和言语功能的评估、嗓音和言语功能的测试、嗓音和言语功能的观察、嗓音功能的评估、嗓音功能的测试、嗓音功能的观察等
	训练治疗类	如发声放松训练、拟声法、快速用力呼气法、气息式发音法、吟唱法、喉部按摩法、咀嚼法、哼鸣法、气泡发音法、半吞咽法、重读治疗法^[28]、甩臂后推法、用力搬椅法、哈欠-叹息法、共鸣放松训练、后位音法、前位音法、伸舌法、口腔共鸣法、鼻音/边音刺激法、U声道法、头腔共鸣法、胸腔共鸣法等
	教育咨询类	如嗓音功能的教育、嗓音功能的建议等
	社会支持类及其他	如嗓音和言语功能的社会支持、嗓音和言语功能的心理支持、嗓音功能的社会支持、嗓音功能的心理支持等
活动和参与
d330说 d350交谈 d360使用交流设备与技术	评估类	如对言语、交谈和使用交流设备与技术的评估、测试等
	训练治疗类	如对言语、交谈、使用交流设备与技术的训练、辅导等
	教育咨询类	如对言语、交谈、使用交流设备与技术的教育、建议等
	社会支持类及其他	如说话、交谈、使用交流设备与技术的社会支持、心理支持等
d740正式人际关系 d750非正式社会关系	评估类	如对正式、非正式人际关系的评估、测试、观察等
	训练治疗类	如对正式、非正式人际关系的训练、辅导等
	教育咨询类	如对正式、非正式人际关系的教育、建议等
	社会支持类及其他	如对正式、非正式人际关系的社会支持、心理支持等
d845得到、保持或终止一份工作	评估类	如得到、保持或终止一份工作的评估、测试等
	训练治疗类	如得到、保持或终止一份工作的训练、辅导等
	教育咨询类	如得到、保持或终止一份工作的教育、建议等
	社会支持类及其他	如得到、保持或终止一份工作的社会支持、心理支持等
d920娱乐和休闲	评估类	如参与娱乐和休闲的训练、教育等
	训练治疗类	如参与娱乐和休闲的训练、辅导等
	教育咨询类	如参与娱乐和休闲的教育、建议等
	社会支持类及其他	如参与娱乐和休闲的社会支持、心理支持等
环境因素
e1用品和技术	用品和技术
e2自然环境和对环境的人为改变	包括人类变化在内的对自然环境的干预
e3支持和相互联系	对社会环境的干预:支持与协助
e4态度	对心理的干预:心理和态度
e5服务、体制和政策	对环境干预:服务、体制、政策
个人因素
健康相关行为因素	健康行为干预

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ICF类目	评定类型	评估指标	测量方法	异常范围
b3100嗓音产生	客观	最长声时	深吸气后以舒适音调和响度持续发韵母/a/的最大发声时长	成年女性 < 16.7 s 成年男性 < 24.8 s
		最大数数能力	深吸气后,持续、旋转地发1或5的最长时间	成年女性 < 12 s 成年男性 < 18 s
		言语基频	交谈时患者回答“姓名及年龄”等问题,分析声波数据得到	成年女性 < 200 Hz或 > 260 Hz 成年男性 < 100 Hz或 > 150 Hz
		基频震颤	持续发稳定的元音[æ],分析声波数据得到	< 3 Hz或 > 6 Hz
		频段能量集中率		< 39%或 > 52%
		声带接触率	持续发稳定的元音[æ],分析电声门图得到	< 50%或 > 70%
		接触率微扰		≥3%
b3101嗓音音质	主观	GRBAS	从总嘶哑度、粗糙声、气息声、紧张嗓音、无力嗓音5个层面进行分级描述	1~3级
		CAPE-V	从整体严重程度、粗糙声、气息声、紧张嗓音、响度、音调6个层面通过视觉模拟量表进行评分	≥ 0 mm
		VHI	从功能、生理、情感三个部分自评嗓音异常对生活质量的影响	–
	客观	基频微扰	持续发稳定的元音/æ/,分析声波数据得到测量结果。	≥ 0.5%
		声门噪声		≥ -10 dB
		幅度微扰		≥ 0.3%
		第二共振峰频率F₂	测量/u/的F₂是否增大来判定前位聚焦。	成年女性 < 673 Hz 成年男性 < 660Hz
			测量/i/的F₂是否减小来判定后位聚焦	成年女性 < 673 Hz 成年男性 < 660 Hz
		鼻流量	测量言语时鼻腔声压级N和输出声压级(口腔声压级O和鼻腔声压级N之和)的比值	“我和爸爸吃西瓜。”的鼻流量 > 35% “妈妈你忙吗?”的鼻流量 < 50%

Construction of System of Diagnosis, Assessment and Rehabilitation Interventions for Impairment of Speech and Voice Function Using WHO Family International Classificiations

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