腭裂患者术后语音障碍影响因素Logistic回归分析

目的:阐明腭裂术后语音障碍的病因,为腭裂术后预防和治疗语音障碍提供依据。方法:对腭裂术后来我院复查的语音障碍患者69名进行问卷调查和病例回顾,对各因素进行Logistic回归分析,分析各因素对发生腭裂术后语音障碍的作用。结果:手术年龄增大,腭裂的程度重,腭咽闭合不全为腭裂术后语音康复的不利因素;与此相反,语音训练,亲子交流为其保护因素。腭裂患者术后语音障碍风险模型:Y=-1.733+1.148X1-1.091X2+1.105X3-1.136X4-2.207X5。结论:早期手术、营造积极的家庭语言发育环境、术后进行正确的语音训练对防止腭裂患者语音障碍的发生具有重要意义。     

腭裂术后语音及心理康复模式的初步探讨

目的 改变腭裂患者术后语音及心理上的异常,帮助患者正常语言及人格的发育形成,探索腭裂术后语音及心理康复的新模式。方法 采用系统的语音及心理康复训练和治疗,通过集中与个体化的语音训练包括发声、共鸣、构音训练等,心理上通过自我认同及系统脱敏等方法治疗,评价康复治疗后语音及心理的改变。结果 绝大多数患者在康复治疗后的语音功能得到了不同程度的提高,同时在心理治疗后逐渐树立自信,消除自卑,敢于说话,加快了发音的改善。结论 说明集中与个体化相结合进行语言训练以及语音与心理治疗相结合是促进腭裂患者术后心身健康的一种较好方法。     

心理指导在腭裂患儿术后语音治疗中的作用

目的：研究腭裂患儿术后心理指导在语音治疗中的作用。方法：对46例腭裂患儿及家长在出院前进行语音治疗心理指导,出院后定期复查评价,并根据患儿情况再次给予心理指导。结果：经过指导训练,患者语言能力得到长足进步,心理健康状况良好,术后患者语音清晰度明显提高。结论：心理指导对腭裂术后的语音治疗有很大的促进作用,术后加强心理指导并及早地开展语音治疗,能明显地改善患者语言状况。     

腭裂术后边缘性腭咽闭合不全的语音训练特点

目的 探讨对腭裂术后边缘性腭咽闭合不全患者进行语音治疗的方法及其可行性.方法 对15例腭裂术后边缘性腭咽闭合不全的语音障碍患者,针对其腭咽闭合的情况和具体语音问题,进行个体化语音训练.结果 每位患者的辅音都能准确发出,语音清晰度由平均49.53%提高至95.38%.结论 腭裂术后边缘性腭咽闭合不全的语音障碍患者,通过针...     

应用计算机语音分析技术对腭裂语音元音音素的初步分析

应用计算机语音信号分析技术对１２例腭裂患儿和１１例正常儿童所发普通话汉语元音的特点进行了对比研究。文中讨论了元音共振峰模式改变的意义，并依据两组元音的声学参数绘制了声学元音图。结果表明：舌位及舌面高点向后移动是腭裂患儿普遍存在的发音动作。代偿性舌位后移是产生腭裂语音的重要原因。声学元音图表明：腭裂元音的发音舌位基本相同，因而元音的区别特征减弱，清晰度下降。文章还讨论了腭裂术前和术后腭咽闭合不全与分支声管和共鸣腔共鸣的关系问题，指出腭裂术后一定程度的腭咽闭合不全的存在不是影响语音效果的主要因素，腭裂术后语音训练应加强低元音鼻化的纠正。     

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     

语音训练在腭裂术后患者语音恢复中的价值

为探讨语音训练在腭裂术后患者语音恢复中的作用，本研究应用计算机语音信号分析系统对经语音训练的26例腭裂术后患者进行单元音头三个共振峰频率测试，语音训练重点对唇的协调性，舌的灵活性及下颌运动的准确性训练、结果表明，腭咽闭合完全者经语音训练代偿性不良习惯已基本矫正，语音清晰度显著提高。本文指出腭裂术后患者必须在腭咽闭合的基础上，语音训练才能打破异常的神经─肌肉模式，矫正代偿性不良发音习惯，获得清晰准确的语音。     

腭裂术后语音障碍患儿的语音清晰度及言语康复治疗效果分析

目的:探讨腭裂(cleft palate,CP)术后嗓音障碍(voice disorder,VD)患儿的语音特点及言语康复治疗效果.方法:选取我院2018年1月—2018年12月收治的40例行CP修复术的患儿,所有患儿均在CP修复术后1个月接受言语康复治疗,对比言语康复治疗前后/a/音声学特点参数和临床疗效.结果:腭裂修补术后,患儿经言语康复治疗后,其发/a/音时的基频(F0)值,与治疗前差异无统计学意义(t=0.661,P>0.05);言语康复后,谐噪比(harmonic-noise ratio,HNR)值明显大于治疗前,标准化噪声能量(normalized noise energy,NNE)、振幅微扰(Shimmer)、基频微扰(Jit-ter)值明显小于治疗前(t=1.690、3.974、2.287、24.558,P<0.05);言语康复治疗前,重度VD患儿语音清晰度(phonetic intelligibility,PI)明显低于轻度患儿(F=3.452,P<0.05),治疗后,不同程度术后VD患儿PI值均显著提升,组间对比,差异无统计学意义(F=1.153,P>0.05).CP术后重、中、轻度VD患儿临床治疗有效率分别为88.89％、100.00％、100.00％.结论:CP修复术后常存在VD,言语康复治疗可有效提升CP患儿嗓音音质;临床应重视腭裂术后的VD训练.     

心理障碍影响腭裂语音发育和治疗的临床研究

目的：探讨在腭裂语音治疗过程中，心理因素对语音发育及其治疗效果的影响。方法：对63例接受语音治疗的腭裂患者及其家长进行间卷调查，并对调查结果和治疗效果的关系进行分析。结果：心理基本正常者21例，其中19例语音恢复正常，2例语音恢复欠佳；轻度心理障碍者40例，其中23例语音恢复正常，14例语音恢复欠佳，3例仍存在明显的语音障碍；重度心理障碍者2例，均存在明显的语音障碍。结论：心理障碍对腭裂语音发育和治疗效果有明显的影响。     

腭裂术后塞音习得水平与语音发展的相关性研究

目的:探讨能够预测患儿良好构音能力的"敏感音"。方法:利用"西安交通大学口腔医院辅音广度评估表"对同一手术者,腭裂手术年龄在12~18个月的腭裂术后28例患儿的语音进行随访研究。分别计算了术后半年、一年半(最终语音评估年龄均不超过3岁)语料中的塞音的出现个数、声母(辅音)正确率(PCC),构音方法正确率(PCM),构音位置正确率(PCP)。并对塞音个数与PCC、PCP、PCM间的相关性进行了分析。结果:腭裂术后半年的塞音个数与患儿30个月时的PCC、PCM、PCP均具有相关性。其中与PCC的相关系数为0.535。结论:塞音在汉语腭裂语音发展中可以作为预测患儿良好构音能力的"敏感音"。根据患儿在2~3岁时语音评估结果,个性化合理安排患者再次就诊及语言治疗时间。     

腭裂患者手术前后语音频谱特点的研究

目的分析腭裂语音的频谱特点,提示其语音缺陷,为腭裂患者的语音评价及治疗提供理论及临床支持。方法应用语音频谱分析系统分别对正常儿童、腭裂术前患者和腭裂术后患者的元音共振峰频率值和辅音嗓音起始时间(VOT)的频谱特点进行分析。结果发元音/a/时,正常组及腭裂患者手术前、后组的前3个共振峰频率值无显著性差异(P>0.05);发元音/i/时,腭裂术前组F2、F3低于正常组,差异有显著性(P<0.05),腭裂术后组F2、F3低于正常组,高于术前组,但差异无显著性(P>0.05);发元音/u/时,腭裂术前组F2低于正常组,但无显著性差异(P>0.05)。对照组VOT的出现率达100.0%,而腭裂术前组仅25.0%(9/36),腭裂术后组42.1%(16/38)。结论声学频谱分析技术有助于找出腭裂患者的不良发音习惯及判断腭咽闭合的完善与否,从而对腭裂患者的语音评价和治疗提供一定的理论和临床价值。     

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。     

国内42家医疗机构腭裂术后语音治疗现状调查

目的: 探讨国内腭裂术后语音治疗现状及其主要影响因素。方法：针对来自28个省42家医疗机构的语音治疗师发放调查问卷,汇总问卷结果,统计各医疗机构语音门诊成立情况及语音设备配置,各语音师培训经历及执业资格,各语音门诊语音治疗现况等相关数据。结果：42家医疗机构均设置唇腭裂病房,共有语音治疗室36家,其中75%成立时间小于5年,接诊量平均每周10人以下,语音设备不完善,单次收费较低,治疗周期低于20次,语音师中约2/3为护理人员,其余为外科医师兼任,培训方式主要为短期进修。结论：起步较晚,重视不足,尚未成立语音病理学科,缺乏系统化培训和相应职称,专业设备和语音随访体系有待完善,是我国在腭裂术后语音治疗方面的基本现状。     

Habilitation of patients with clefts: parent and child ratings of satisfaction with appearance and speech.

This study examined ratings regarding satisfaction with facial appearance and speech performance from 495 parent-child pairs. Data were obtained from school-aged children (5-18 years old) and their parents using standardized independent interviews. Results revealed that 54 percent of the children with cleft lip (CL) or cleft lip and palate (CLP) were very pleased with their appearance, and 62 percent of the cleft palate or CLP subjects were very pleased with speech. Low, but statistically significant correlations exist between the female subjects and their parents in satisfaction with appearance. Although older cleft lip and/or palate patients reported increased satisfaction with speech, no age differences in patient satisfaction with appearance were observed in subjects with CL/CLP. Parents of females expressed more concern about their daughters' appearance than parents of males, while parents of males were more concerned about speech. Implications for craniofacial habilitation teams and research suggestions are discussed.     

Perceptions of appearance and speech by adolescent patients with cleft lip and palate and by their parents

This study surveyed 102 patients with cleft lip, cleft palate, or cleft lip and cleft palate (ages 13 to 19) and their parents to assess satisfaction with appearance, speech ability, and intelligibility. The data were based upon standardized interviews conducted at a cleft palate treatment center, using simple questions with high face validity. Surgical experience was high among this sample, as reflected by the finding that the majority of patients (55.7%) had had three or more operations on the face or mouth. Patient ratings of facial appearance showed that most patients were very pleased (59.3%) or moderately pleased (13.2%); others were somewhat (18.7%) or very (8.8%) disappointed. Many parents indicated that their children expressed occasional (22.0%) or frequent (27.5%) concerns about appearance. Nearly all patients (91.9%) felt that their operations had accomplished what they expected, though some of the cleft lip patients (35.7%) and their parents (43.9%) were less than very pleased with the appearance of the lip. When asked how pleased they were with the way they presently talked, most patients (69.1%) were very pleased, though some disappointment was expressed. Although often pleased with their current speech status, many patients rated themselves as only moderately understandable (19.1%) or as not understandable (8.5%). No significant gender effects were found in satisfaction, appearance, or speech ratings. There were no significant differences found between parent and child ratings. The findings indicate that at a center delivering team-based cleft palate care, both adolescent patients and their parents have considerable concerns about appearance and speech results.     

Parent and child ratings of satisfaction with speech and facial appearance in Flemish pre-pubescent boys and girls with unilateral cleft lip and palate

The purpose of this controlled study is to determine satisfaction with speech and facial appearance in Flemish pre-pubescent children with unilateral cleft lip and palate. Forty-three subjects with unilateral cleft lip and palate and 43 age and gender matched controls participated in this study. The Cleft Evaluation Profile was used to assess the perceived satisfaction for individual features related to cleft care. Both the cleft palate subjects and their parents were satisfied with the speech and facial appearance. The Pearson χ(2) test revealed significant difference between the cleft palate and the control group regarding hearing, nasal aesthetics and function, and the appearance of the lip. An in depth analysis of well specified speech characteristics revealed that children with clefts and their parents significantly more often reported the presence of an articulation, voice and resonance disorder and experienced /s/ /r/ /t/ and /d/ as the most difficult consonants. To what extent the incorporation of specific motor oriented oral speech techniques regarding the realisation of specific consonants, attention to vocal and ear care, and the recommendation of secondary velopharyngeal surgery, with the incorporation of primary correction of the cleft nose deformity simultaneously with primary lip closure, will aid these patients are future research subjects.     

电腭图在异常构音训练中的初步应用

目的 :尝试在腭化构音、侧化构音患者语音治疗中使用电腭图视觉化训练 ,并观察治疗前后的变化 ,为电腭图进一步应用于语音训练及推广提供经验。方法 :腭裂术后腭咽闭合功能良好 ,腭化构音 (伴 /不伴侧化构音 )患者 4名 ,其中 3名女性 ,1名男性 ,平均年龄 12 .5岁。采用电腭图视觉反馈诱导训练加常规语音训练方法 ,对比治疗前后语音清晰度和腭图表现。结果 :治疗后语音清晰度提高 ,腭图治疗后表现为舌与腭前部接触增加 ,与腭中、后部接触减少 ,接近于正常腭图。结论 :电腭图作为常规语音训练的补充手段 ,借助其视觉反馈效应可诱导患者建立正确的舌位反馈 ,在对腭化构音、侧化构音这类异常构音训练中 ,其效果优于单纯使用传统的一对一语音训练 ,也缩短了语音治疗的疗程     

Assessment of patients' level of satisfaction with cleft treatment using the Cleft Evaluation Profile.

OBJECTIVES: Determination of the psychosocial status and assessment of the level of satisfaction in Malaysian cleft palate patients and their parents. DESIGN: Cross-sectional study. PARTICIPANTS AND METHODS: Sixty cleft lip and palate patients (12 to 17 years of age) from Hospital Universiti Sains Malaysia and their parents were selected. The questionnaires used were the Child Interview Schedule, the Parents Interview Schedule, and the Cleft Evaluation Profile (CEP), administered via individual interviews. RESULTS: Patients were teased because of their clefts and felt their self-confidence was affected by the cleft condition. They were frequently teased about cleft-related features such as speech, teeth, and lip appearance. Parents also reported that their children were being teased because of their clefts and that their children's self-confidence was affected by the clefts. Both showed a significant level of satisfaction with the treatment provided by the cleft team. There was no significant difference between the responses of the patients and their parents. The features that were found to be most important for the patients and their parents, in decreasing order of priority, were teeth, nose, lips, and speech. CONCLUSIONS: Cleft lip and/or palate patients were teased because of their clefts, and it affected their self-confidence. The Cleft Evaluation Profile is a reliable and useful tool to assess patients' level of satisfaction with treatment received for cleft lip and/or palate and can identify the types of cleft-related features that are most important for the patients.