针刺咽部腧穴治疗脑梗死后真性延髓麻痹:随机对照研究

目的:比较针刺患侧与针刺双侧咽部腧穴治疗脑梗死后真性延髓麻痹的临床疗效。方法:将66例脑梗死后真性延髓麻痹患者随机分为单侧组和双侧组,每组33例,最后每组各有1例脱落。两组患者在常规药物和电项针治疗的基础上,单侧组针刺患侧的吞咽、发音和治反流穴,双侧组针刺双侧吞咽、发音和治反流穴。每天1次,每周连续针刺6 d,休息1 d,治疗21 d后评定临床疗效。采用吞咽困难分级量表、洼田饮水试验和GRBAS分级评价两组患者治疗前后的吞咽和构音情况。结果:治疗21 d后,两组患者吞咽困难分级量表评分均提高(均P<0.01),且单侧组改善程度大于双侧组(P<0.01);两组患者GRBAS分级、洼田饮水试验情况均改善(均P<0.01),且单侧组改善程度大于双侧组(P<0.05,P<0.01)。结论:针刺患侧咽部腧穴治疗脑梗死后真性延髓麻痹较针刺双侧咽部腧穴疗效更优。     

听觉辨别训练对儿童构音障碍的疗效

目的 观察听觉辨别训练对儿童构音障碍的康复治疗效果。方法 2017年7月至2019年7月,选取本院构音障碍患儿43例,随机分为对照组(n = 21)和治疗组(n = 22)。对照组每天行常规语言训练30 min,治疗组用其中10 min行听觉辨别训练,共4周。治疗前后行构音检查和言语清晰度测试。结果 治疗组治疗后辅音正确率和言语清晰度均显著提高(t > 7.919, P < 0.001),对照组仅辅音正确率显著提高( t = 7.047, P < 0.001)。 结论 听觉辨别训练可提高构音障碍患儿的治疗效果,可作为儿童构音障碍训练的常规内容。     

Voice changes in Parkinson’s disease: What are they telling us?

Emerging evidence suggests voice dysfunction is the earliest sign of motor impairment in Parkinson’s disease (PD). The complexity and fine motor control involved in vocalization may result in dysfunction here before the limbs. The voice in PD demonstrates characteristic changes on perceptual and acoustic analyses. The physiological and anatomical correlates of these have been investigated through laryngoscopy, stroboscopy, photoglottography, laryngeal electromyography, computed-tomography, pulmonary function testing and aerodynamic assessments. These have revealed numerous abnormalities including incomplete glottic closure and vocal fold hypoadduction/bowing to account for these voice changes. Many of these phenomena are likely related to rigidity or bradykinesia of the laryngeal muscles. The early onset of voice changes is resonant with the pathophysiological insights offered by Braak’s hypothesis and murine models of the disease. These physiological abnormalities and pathological models largely stand to support dopaminergic and non-dopaminergic mechanisms being implicated in the pathogenesis of voice dysfunction. This review focuses on characterizing the voice changes in PD. These stand as a promising area of enquiry to further our understanding of the pathophysiology of the disease and offer potential to be utilized as an early diagnostic biomarker or marker of disease progression.     

Nasality in Friedreich ataxia

Perceptual speech research in Friedreich ataxia (FRDA) has identified altered nasality as a key component of the dysarthria profile, however the incidence and severity of abnormal nasality remains unknown. Utilizing objective and perceptual methods, data on the relationship between resonance, disease duration, severity, age of onset and genetic profiles were collated. Thirty-seven participants with FRDA and 24 healthy controls provided contemporaneous speech samples for perceptual analysis, and single word samples for acoustic analysis. A subset of participants (eight participants with FRDA and eight controls) underwent nasometry assessment. Twenty-seven participants with FRDA presented with hypernasality and five with hyponasality on perceptual assessment. Acoustic analysis revealed participants with FRDA had greater nasality than controls (p?ρ?=?0.37, p?=?0.03). Findings highlight the variability of nasality in FRDA, potentially reflecting variation in the neuropathological profile. Data also suggest the influence of genetic profiles on nasality.     

构音障碍强化训练对脑梗死患者构音障碍的影响

目的：探讨构音障碍强化训练对脑梗死患者构音障碍的影响。方法选取2013年1月—2014年6月在该院接受治疗的脑梗死伴构音障碍患者68例,采用随机数表法将68例患者分为观察组和对照组,每组34例。对照组患者只进行常规治疗,观察组患者在常规治疗的基础上采用强化构音障碍训练。对比两组患者构音障碍训练前后的言语清晰度和 Frenchay 评定分数,训练后的临床治疗疗效。结果察组患者的言语清晰度为（57．15±15．95）％,对照组患者的言语清晰度为（51．31±22．95）％。构音障碍训练前观察组患者言语清晰度与对照组患者无差别,差异无统计学意义（P ＞0．05）。构音障碍训练后,观察组患者的言语清晰度为（82．54±19．89）％,对照组患者的言语清晰度为（73．00±14．66）％。构音训练后两组患者的言语清晰度均优于训练前,比较差异具有统计学意义（P ＜0．05）。观察组患者在构音障碍强化训练后言语清晰度显著优于对照组患者,比较两组间差异具有统计学意义（P ＜0．05）。构音障碍训练前,两组患者 Frenchay 各项指标评定分数比较两组间差异不具有统计学意义（P ＞0．05）。构音障碍训练后,观察组患者的 Frenchay 评定总分数为（88．69±13．14）分,对照组患者的Frenchay 评定总分数为（77．38±13．97）分。构音训练后两组患者的 Frenchay 评定总分数均优于训练前,比较差异具有统计学意义（P ＜0．05）。观察组患者构音障碍训练后的 Frenchay 各项评定分数显著高于对照组患者,比较两组间差异具有统计学意义（P ＜0．05）。构音障碍训练后,比较两组患者临床疗效,观察组患者总有效率为85．3％,对照组患者总有效率为64．7％,比较两组间差异具有统计学意义（P ＜0．05）。观察组患者构音强化训练后临床疗效显著优于对照组患者。结论对于脑梗死患者构音障碍采用构音障碍强化训练能够有效改善构音障碍患者的临床病症,可以在临床上进一步推广使用。     

Acoustic analysis of voice in dysarthria following stroke

Although perceptual studies indicate the likelihood of voice disorders in persons with stroke, there have been few objective instrumental studies of voice dysfunction in dysarthria following stroke. This study reports automatic analysis of sustained vowel phonation for 61 speakers with stroke. The results show: (1) men with stroke and healthy elderly men exhibited an identical voice profile, and men with stroke had only one significantly larger noise parameter (SPI—soft phonation index) than young healthy men; and (2) women with stroke and healthy elderly women exhibited an identical voice profile, except that women with stroke exhibited a significantly higher SPI than healthy elderly women. Although there were no significant differences in smoothed pitch perturbation quotient (sPPQ) and SPI between healthy elderly women and healthy young women, women with stroke exhibited significantly larger sPPQ and SPI than healthy young women. It is suggested that studies on sub‐groups of the stroke population that use a combination of perceptual and acoustic analyses will better illuminate the voice dysfunction in dysarthria following stroke.     

Motor speech impairment in a case of childhood basilar artery stroke: Treatment directions derived from physiological and perceptual assessment

The perceptual and physiological characteristics of the speech of a nine year old child who suffered a basilar artery stroke at the age of five years were investigated using a battery of perceptual and physiological instrumental measures. Perceptual tests administered included the Frenchay Dysarthria Assessment, a perceptual analysis of a speech sample based on a reading of the Grandfather Passage and a phonetic intelligibility test. Instrumental procedures included: spirometric and kinematic analysis of speech breathing; electroglottographic evaluation of laryngeal function, nasometric assessment of velopharyngeal function and evaluation of lip and tongue function using pressure transducers. Physiological assessment indicated the most severe deficits to be in the respiratory and velopharyngeal sub-systems with significant deficits in the articulatory sub-system, all of which resulted in severely reduced intelligibility. These results were compared and contrasted with the subject's performance on the perceptual assessment battery. In a number of instances the physiological assessments were able to identify deficits in the functioning of components of the speech production apparatus either not evidenced by the perceptual assessments or where the findings of the various perceptual assessments were contradictory. The resulting comprehensive profile of the child's dysarthria demonstrated the value of using an assessment battery comprised of both physiological and perceptual methods. In particular, the need to include instrumental analysis of the functioning of the various subcomponents of the speech production apparatus in the assessment battery when defining the treatment priorities for children with acquired dysarthria is highlighted. Treatment priorities determined on the basis of both the perceptual and physiological assessments for the present CVA case are discussed.     

Speech motor program maintenance,but not switching,is enhanced by left-hemispheric deep brain stimulation in Parkinson's disease

Speech reaction time (SRT) was measured in a response priming protocol in 12 participants with Parkinson's disease (PD) and hypokinetic dysarthria “on” and “off” left-hemispheric deep brain stimulation (DBS). Speech preparation was measured during speech motor programming in two randomly ordered speech conditions: speech maintenance and switching. Double blind testing was completed in participants with DBS of globus pallidus pars interna (GPi) (n?=?5) or subthalamic nucleus (STN) (n?=?7). SRT was significantly faster in the maintenance vs switch task, regardless of DBS state. SRT was faster in the speech maintenance task “on” stimulation, while there was no difference in speech switching “on” and “off” DBS. These data suggest that left-hemispheric DBS may have differential effects on aspects of speech preparation in PD. It is hypothesized that speech maintenance improvements may result from DBS-induced cortical enhancements, while the lack of difference in switching may be related to inhibition deficits mediated by the right-hemisphere. Alternatively, DBS may have little influence on the higher level motor processes (i.e., motor planning) which it is believed the switch task engaged to a greater extent than the maintenance task.