行为疗法在腭化构音治疗中的应用

目的:利用行为疗法改善各类腭化构音异常患者的不良发音习惯,提高患者的语音清晰度。方法:收集不同类型腭化构音患者67例,年龄4～22岁(平均12.5岁);其中,腭裂术后腭化构音障碍患者28例,先天性腭咽闭合不全术后腭化构音患者22例,功能性腭化构音异常患者17例,智力均在75%以上,听力≤25dB,语音清晰度75%以下。所有患者均经过系统完善的行为治疗,并由3位资深医师/语音治疗师进行治疗前后语音清晰度判听、量分,并应用行为疗法进行治疗。采用SAS6.0软件包对数据进行配对t检验。结果:腭化构音多累及辅音,经系统性行为治疗后,语音清晰度均较治疗前显著提高,由治疗前语音清晰度均值51.85%提高到94.71%,改善率均值为42.87%(P<0.01)。结论:行为疗法用于各类腭化构音障碍患者,有效提高患者的语音清晰度。     

腭裂术后语音训练治疗方法的研究

腭裂术后语音治疗的目的是矫正不良发音习惯，提高语音清晰度。作者根据５０例腭裂术后功能性语音障碍患者发音障碍不同类型的分析，以各类发音错误特点为依据设置了相应的语音训练治疗方法，并用此法对其中３３例患者进行了系统性语音训练治疗，结果显示：经系统语音治疗后，３３例患者语音清晰度从治疗前的平均３８．４％提高到治疗后的８９．５％，治疗前后变化差异有极显著性（Ｐ＜０．０００１）。各辅音清晰度均提高到８２％以上。结果证明腭裂术后因不良发音习惯所致的语音障碍患者，采用此法可在较短时间内（平均６３天）取得良好效果。我们认为早期手术者应尽可能早地进行语音训练治疗，根据我国国情则以４～６岁进行为宜     

腭裂患者声门爆破音临床特点及其矫治

目的：了解声门爆破音对腭裂术后患者各辅音及语音的影响及其特点，探讨声门爆破音矫治方法及其效果。方法： 采用主观判断与语图检查相结合的方法对22例腭裂术后或二期咽成形术后腭咽闭合功能正常并确定有声门爆破音的患者进汉语辅音及音节发音分析，对伴有声门爆破音的辅音归类及统计分析。采用以汉语发音为基础的矫治方法对其中12例患者进行系统性矫治训练，并对训练前后语音及辅音清晰度进行统计学处理。结果：声门爆破音在腭裂患者普通话中主要影响不送气性塞音、塞擦音；其次是送气性塞音、塞擦音；然后是擦音，鼻辅音不受 其影响。对12例患者进行系统训练治疗后语音清晰度从训练前的平均32％提高到训练后的85．5％，辅音清晰度从平均41．2％提高到85．1％。语音效果恢复良好。结论：声门爆破音主要影响辅音尤其塞音、塞擦音等的清晰度进而影响语音清晰度。采用本课题设制的以汉语发音为基础的矫治方法可有效矫治声门爆破音习惯，提高语音清晰度。     

腭-心-面综合征患者语音治疗方法探讨

目的:探讨腭-心-面综合征异常语音患者有效的语音治疗方法。方法:选取腭-心-面综合征行咽成形术后患者57例(男30例,女27例),年龄4-17岁(平均10.6岁)。在汉语语音教学基础上,用简单易学的行为模式进行诱导,建立正确的发音部位与发音方法。比较治疗前、后的语音清晰度和过度鼻音,采用SPSS16.0软件包分别对数据进行t检验和Wilcoxon符号秩和检验,评价疗效。结果:57例患者经2-8个月的语音治疗,语音清晰度由治疗前的33.75%提高到治疗后的97.86%,差异显著(P<0.01)。治疗前轻度过度鼻音7例,中度33例,重度17例;治疗后异常鼻音消除者38例,轻度异常鼻音17例,中度异常鼻音2例,经秩和检验,两者具有显著差异(P<0.01)。结论:对存在严重语音障碍并伴有学习能力缺陷的腭-心-面综合征患者,在汉语语音教学基础上,应用行为诱导模式,可以恢复正常语音清晰度。     

腭裂咽成形术后患者语音治疗疗效评价

目的:对腭咽成形术后存在语音障碍的患者进行语音治疗,通过治疗前后语音清晰度比较,评价该方法的疗效。方法:咽成形术后患者82例,年龄4~31岁。采用汉语语音清晰度测试表对患者进行治疗前后语音清晰度检测,根据代偿性发音特点进行系统化语音训练:①腭咽闭合功能锻炼;②音素→音节→词组→短句→短文、会话。训练时按发音部位由前→后,按发音方法由易→难、送气音→不送气音、塞音→擦音→塞擦音。训练周期1.5~12个月,平均3.83个月。结果:以腭咽闭合不全型为特点的代偿性语音患者共71例;其中声门塞音患者语音清晰度由治疗前的46.27%提高到治疗后的97.16%;咽摩擦音患者由治疗前的57.19%提高到治疗后的97.72%。以腭咽闭合良好型为特点的代偿性语音共11例,腭化、侧化音患者语音清晰度由治疗前的71.10%提高到治疗后的98.55%;3组经t检验,P均<0.001,具有极显著性差异。结论:对咽成形术后腭咽闭合不全型的代偿性发音,首先加强腭咽闭合功能,再建立正确的发音部位和方法;对咽成形术后腭咽闭合良好型的代偿性发音,可直接建立正确的发音部位和方法。     

行为疗法在功能性构音障碍中的临床研究与应用

目的 :应用行为疗法提高功能性构音障碍患者的语音清晰度 ,提高语音治疗效果。方法 :17例功能性构音障碍患者中 10例为先天功能性构音障碍 ,7例为腭裂术后功能性构音障碍 ,采用行为疗法进行语音治疗 ,并在治疗前后测量汉语语音清晰度。结果 :治疗前后的汉语语音清晰度有显著提高 ,治疗效果满意。结论 :行为疗法是功能性构音障碍首选的、必要的语音治疗方法 ,应用中应注意因人而异 ,要根据患者实际情况适当选用。     

咽成形术后语音治疗效果的CSL评定

目的：运用计算机语音处理系统（computerspeechlab,CSL）对咽成形术后语音障碍患者的异常辅音（塞擦音、擦音）进行治疗前、后的语音频谱分析,以期对腭咽成形术后患者的语音治疗效果进行定量和图形化分析。方法：腭咽成形术后存在语音障碍患者（清晰度〈35%）40例,男24例,女16例,平均年龄11.48岁。语音治疗前、后分别将辅音音节、字表、词组和短句输入CSL,通过频谱图对含塞擦音（z、c、j、q）和擦音（s、x）的音节（zi、ci、si、ji、qi、xi）中的辅音除阻段的嗓音起始时间（VOT）进行分析,得出量化值,进行统计学分析;在频谱图上,根据治疗前、后有无冲直条和乱纹分布情况进行归纳,评价语音治疗效果,以此评判CSL的应用价值。用SPSS11.5软件包对数据进行t检验。结果：CSL测定结果显示,40例患者的VOT值由治疗前的0.0571s提高到治疗后的0.2262s,经t检验,P〈0.01,具有显著差异;频谱图结果显示,代表塞的冲直条由治疗前消失到治疗后清晰可见或以整齐乱纹开始（z36/40、c30/40、j34/40、q28/40）,代表擦音的乱纹由治疗前稀疏或消失到治疗后的均匀整齐,并有强频集中区。结论：运用CSL检测分析得出,腭咽成形术后严重语音障碍患者可通过语音治疗达到近似正常人的语音清晰度。CSL的定量和图形化分析,提高了语音治疗效果评价的水平。     

边缘性腭咽闭合不全异常语音治疗方法探讨

目的:探讨边缘性腭咽闭合不全异常语音的治疗方法。方法:选择15例边缘性腭咽闭合不全患者,男10例,女5例,年龄8~25岁,平均17.6岁。采用行为疗法及有效的语音治疗,治疗前后进行汉语语音清晰度检测和吹气试验。结果:经过12~20周的治疗,汉语语音清晰度和吹气试验结果较治疗前明显提高。结论:边缘性腭咽闭合不全异常语音患者只要通过系列行为疗法建立良好的腭咽闭合,并配合有效的语音训练,就可获得满意的疗效和语音改善。     

腭化构音语音训练方法的初步探讨

目的 通过对10名腭名化构音患者语音训练前后语音清晰度的变化,初步探讨腭化构音的训练方法。方法 腭化构音患者10名,年龄4－14岁（平均9．7岁）;其中腭裂术后腭咽闭合功能恢复良好患者4名,无器质性病变的功能性患者6名。所有患者在医师指导下进行系统、循序渐进的语音训练,并在治疗前后分别行语音清晰度检查。结果 腭化构音患者语音治疗后语音清晰度较治疗前显著提高。结果 腭化构音是构音器官异常运动所产生的异常语音,并使语音清晰度降低,需通过语音训练重建正确的发音部位和发音方法。而腭化构音训练的关键在于平展舌体和解除习惯性舌后缩。     

行为疗法在功能性舌根音障碍矫治中的应用

目的:探讨功能性语音障碍患者应用行为疗法矫治异常舌根音,提高舌根音清晰度的方法。方法:对12例功能性异常舌根音患者运用行为疗法进行语音治疗,收集治疗前后的语音资料进行对比评估。结果:患者舌根音的语音清晰度由治疗前的52.67±11.49提高到治疗后的77.67±6.11,差异具有统计学意义(P<0.05)。结论:应用行为疗法在矫治功能性异常舌根音,可达到提高语音清晰度,改善语音功能的目的。     

腭裂咽成形术后患者异常语音的发音特点研究

目的：对腭裂咽成形术后患者的发音特点和发生机制进行探讨。方法：本组病例82例(男46，女36)，年龄4～31岁(平均13.44岁)。采用汉语语音清晰度测试表(包含音节、词、词组、短句)对患者录音，并对其语音清晰度、异常语音、代偿性发音进行分析比较。结果：在82例患者巾，以腭咽闭合不全型为持点的代偿性语音71例：声门塞音60例、咽摩擦音11例；以腭咽闭合良好型为特点的代偿性语音11例：腭化音6例、腭化 侧化音2例、侧化音3例．清晰度：声门塞音46.27％、咽摩擦音57.19％、腭化音67．17％、腭化 侧化音74．67％、侧化音77．50％．异常辅音多见于塞音、擦音、塞擦音，辅音的弱化以送气音p66．67％(8／12)、t78.95％(15／19)、s60％(39／64)、sh60％(39／64)、c66％(43／65)、ch66％(43／65)、x62％(39／63)、q67％(43／64)、k76％(31／41)、b73％(43／59)所占比例较多；辅音的脱落则以不送气音z81％(56／69)、zh81％(56／69)、i80％(56／70)、g84％(48／57)所占比例较多。结论：咽成形术后仍以腭咽闭合不全型为特点的代偿性语音为主，主要表现为辅音的脱落与弱化。产生弱化的辅音多见于送气音，产生脱落的辅音则多见于不送气音．     

强化性语音训练在腭裂术后语音治疗中的应用

目的：采用强化性针对性语音训练以期缩短音训练治疗时间。方法：采用发音部位及发音方式异常针对性语音训练方法,声门停顿音矫治训练方法对患者进行每天１～２次训练,以能发对所有汉语辅音、音节、词组及短句为标准决定训练完成时间。结果：１６名患者经过平均２５ｄ的强化训练后,语音清晰度从平均４９．９％提高到平均８８．２％。平均提高３８．５％。统计学检查有极显著差异性（Ｐ＜０．００１）。结论：强化性针对性语音训练确能在较短时间内达到提高语音清晰度,改善语音功能的目的。     

Consonant intelligibility and tongue motility in patients with partial glossectomy.

PURPOSE: The primary determinants for good speech outcome after glossectomy are not well established. This study evaluated the effect of tongue motility, type of reconstruction, and affected muscles on speech intelligibility. METHODS: Fourteen German glossectomy patients participated in an intelligibility test, which targeted lingual consonants. Tongue motility was rated on nine 3-point scales. Surgical mapping documented type of reconstruction and affected muscles. RESULTS: Mean consonant intelligibility was 71.25% and mean tongue motility was 34%. There was a moderate correlation between tongue motility and consonant intelligibility (r = 0.619). Patients with platysma flap reconstructions (n = 6) had a tendency for more correctly identified consonants. Patients with an intact genioglossus (n = 4) had significantly better tongue motility scores. CONCLUSIONS: The findings support the hypothesis that good tongue motility is a precursor of good postglossectomy speech. Although flap reconstructions led to better consonant intelligibility in this study, this should be interpreted with caution due to the small sample size.     

Associations between dental occlusion and misarticulations of Finnish dental consonants in cleft lip/palate children

The purpose of this study was to examine whether malocclusions in terms of crossbites, large maxillary overjet, and deep bite are related to the articulatory problems with the Finnish dental consonants /r/, /s/ and /l/ in different cleft types and gender. The subjects were 260 (108 girls, 152 boys) 6-yr-old Finnish-speaking non-syndromic children with isolated cleft palate (CP, n = 79), cleft lip/alveolus (CL(A), n = 76), unilateral (UCLP, n = 78), and bilateral (BCLP, n = 27) cleft lip and palate. Occlusal anomalies were evaluated from dental plaster casts, and speech was analyzed by two speech pathologists with a high reliability. Altogether, 43% of patients misarticulated at least one of the studied sounds, and had crossbites significantly more often (73%) than subjects with correct /r/, /s/ and /l/ production (45%). Posterior crossbites were significantly associated with defective articulation, whereas anterior crossbite alone, large maxillary overjet, or deep bite were not. It was concluded that occlusal abnormalities in terms of posterior crossbites should be considered as a risk factor for correct dental consonant articulation in cleft-affected subjects.     

Timing of palatal surgery and speech outcome.

OBJECTIVE: To examine the impact of age and lexical status at the time of primary palatal surgery on speech outcome of preschoolers with cleft palate. PARTICIPANTS: Forty children (33 to 42 months) with nonsyndromic cleft palate participated in the study. Twenty children (Group 1) were less lexically advanced and younger (mean age = 11 months) and 20 children (Group 2) were more lexically advanced and older (mean age = 15 months) when palatal surgery was performed. MAIN OUTCOME MEASURES: Samples of the children's spontaneous speech were compared on 11 speech production measures (e.g., size of consonant inventory, total consonants correct, % correct for manner of articulation categories, compensatory articulation usage, etc.). Next, listeners rated a 30-second sample of each child's connected speech for articulation proficiency and hypernasality, separately, using direct magnitude estimation (DME). Results: Group differences were noted for 4 of the 11 speech production measures. Children in Group 1 exhibited larger consonant inventories (and true consonant inventories) and more accurate production of nasals and liquids compared to children in Group 2. On the DME task, significant group differences were found for ratings of articulation proficiency and hypernasality. Children in Group 1 exhibited better articulation and less hypernasality than children in Group 2. CONCLUSIONS: The findings suggested that children who were less lexically advanced and younger at the time of palatal surgery exhibited better articulation and resonance outcomes at 3 years of age.     

腭裂术后语音训练方法初探

目的提高腭裂术后患者的汉语语音清晰度。方法对２０例患者进行系统语音训练，包括训练前后语音清晰度测试、吹气训练及序列语音训练（单音→音节→词组→短句→短文）。结果患者的语音清晰度从训练前的平均４８．１％提高到训练后的平均９７．１％，平均提高了４９％，经ｔ经验，具有极显著差异（Ｐ＜０．０００１）；小年龄组训练平均周期比大年龄组平均周期短，有显著性差异Ｐ＜０．０５）。结论语音训练能纠正腭裂术后患者的代偿性发音习惯，使语音清晰度提高到与正常人基本一致     

Speech after partial glossectomy: a comparison between reconstruction and nonreconstruction patients.

PURPOSE: This study was undertaken to compare the articulation intelligibility of patients after hemiglossectomy or minor glossectomy within the hemitongue with or without reconstruction. MATERIALS AND METHODS: The articulation intelligibility of 19 patients who underwent hemiglossetomy or minor glossectomy within the hemitongue was investigated at least 6 months after surgery with an articulation intelligibility test with 40 sensitive Chinese sounds. Patients were divided into group 1 (those undergoing reconstructive surgery after glossectomy) and group 2 (those not undergoing reconstructive surgery after glossectomy). Defects of the tongue (in group 1) were reconstructed immediately with free radial forearm flaps or pedicled flaps after glossectomy and closed primarily without reconstruction in group 2. The articulation intelligibility scores were compared between the 2 groups. RESULTS: The mean articulation intelligibility score for group 1 was 77.0% (blade portion glossal sounds), 76.3% (mid portion glossal sounds), and 84.7% (rear portion glossal sounds), and those of group 2 were 94.6%, 92.1%, and 95.3%, respectively. The intelligibility of articulation of group 2 was significantly higher than that of group 1 in blade portion glossal sounds (P <.05), mid portion glossal sounds (P <.05), and rear portion glossal sounds (P <.01). CONCLUSION: The articulation intelligibility was better in patients not receiving grafts than in those receiving grafts. Reconstruction with flaps, which may interfere with the flexibility and mobility of the tongue, may contribute to articulatory impairment. If speech is the outcome of interest, reconstruction may be unnecessary with hemiglossectomy or other partial (minor) glossectomy within the hemitongue.     

腭裂术后腭咽闭合完全患者的语音治疗效果及影响因素分析

目的 对术后腭咽闭合完全、经过语音治疗获得正常语音的腭裂患者进行语音治疗方法、治疗时间及相关因素分析。方法 对2012—2013年在四川大学华西口腔医院唇腭裂外科采用音韵治疗改变构音位置的方法进行规范的语音治疗后获得正常语音的32例腭裂患者进行回顾分析。分析辅音错误构音的类型、语音治疗总次数、语音治疗前辅音错误个数、语音治疗距离手术的时间、语音治疗时的年龄等。采用SPSS 16.0对治疗次数与语音治疗距离手术的时间、辅音错误个数及类型以及训练时的年龄进行相关因素分析。结果 32例患者中,治疗次数≤5次者10例;6~10次者17例;11~20次者5例。治疗次数与错误音节数呈正相关（r_s=0.394,P=0.026）,错误音节数每增加1个,治疗次数平均增加0.570次,可信区间为0.137~1.004。治疗次数与年龄呈负相关趋势（P=0.055）,5~10岁的患者比大于10岁的患者治疗次数更少,需要的时间更短。治疗次数与治疗距离手术的时间无相关性（r_s=-0.136,P=0.459）。结论 术后腭咽闭合完全的腭裂患者经过规范的语音治疗,语音都能康复至正常水平或接近正常,但所需治疗时间有差异。错误音节数越多的患儿,治疗次数越多;10岁以上的患者比10岁以下患者所需的治疗时间更长。