听障儿童的听觉察知能力训练

听觉察知能力是最基本的听觉能力,要求患者对声音做出准确而及时的反应。听力障碍者要能够逐步形成利用残余听力、助听听力或重建听力的意识和能力。听觉察知能力训练分为无意察知能力诱导和有意察知训练两部分。训练内容和方法各有侧重。本文介绍了听觉察知能力训练的内容与方法,分享了一例听觉察知能力训练的个别化教育康复方案。     

上期答案

一、名词解释1.听觉功能听觉功能是指通过后天学习获得的感知声音的能力,尤其是感知言语声的能力。听觉功能主要经过听觉察知、听觉分辨、听觉识别和听觉理解4个发展阶段。2.双条件词语双条件词语是指在进行听觉理解技能训练时所选择的一组材料,     

传导方案促进低龄听障婴幼儿听觉发育的实践研究

目的 探讨传导方案促进低龄听障婴幼儿听觉发育的可行性和有效性.方法 对13名中重度以上听力损失的儿童助听后以传导方案的模式进行听觉能力康复.根据年龄划分为两组:7个月～1岁5个月5人;1岁6个月～3岁8人,两组教学侧重点不相同.使用婴幼儿有意义听觉整合量表(IT-MAIS)分别在干预前和干预后1、3、6、12个月对所有儿童进行评估.结果 13例儿童中12例经传导方案干预,总体听觉能力随时间的延续呈曲线上升(92.3%),各分项听觉能力均呈上升趋势.1岁6个月以下听障儿童的声音察知能力发展较快,发声情况及理解能力到6个月时才出现明显变化;1岁6个月以上听障儿童的声音察知能力及发声变化较快,而理解能力相对发展较慢.结论 针对低龄听障儿童康复的传导方案具有可行性和推广性,有利于他们的听觉发育及全面发展,但后续跟踪应进一步完善.     

对低龄听障儿童实施听觉口语法康复训练的个案研究

目的本研究通过对听障儿童个案实施听觉口语法康复训练,旨在探讨听觉口语法对低龄听障儿童听能发展的效果。方法对1名听障儿童实施听觉口语法早期康复课程,分别从听能、言语、语言、认知．沟通五大领域进行分析。结果个案从研究初期对声音没有反应到训练后能够正常与人沟通,与同龄儿童一起学习、生活和游戏,基本达到了阶段性康复目标。结论听障儿童的语言能力落后于听觉识别能力,在早期康复训练中要充分利用其听能,用听带动说,以增强其言语听觉能力,提高五大领域的训练效果。     

婴幼儿有意义听觉整合量表对人工耳蜗植入幼儿康复效果的评估

目的研究婴幼儿有意义听觉整合量表(infant-toddler meaningful auditory integration scale,IT-MAIS)对早期植入人工耳蜗(cochlear implant,CI)幼儿康复效果评估的价值。方法使用ITMAIS对开机年龄在18个月以内的12名人工耳蜗植入幼儿(CI组)于开机时及开机后3、6、12个月分别进行评估,并将其得分与同龄健听幼儿(健听组)得分比较。结果开机时CI组的听觉发育总体能力、声音察觉能力和声音识别能力得分分别为10.8%±7.6%、16.6%±12.6%、1.1%±2.4%,开机后1年时分别为78.0%±11.2%、76.6%±16.1%、80.0%±19.8%。从开机时到开机后1年内,CI组ITMAIS得分(即其对言语声的察觉和识别能力)值升高迅速且发展速度超过同龄健听幼儿,在开机1年时ITMAIS得分已达健听儿童水平。结论早期植入CI幼儿随着年龄增长,其听觉发育能力可接近同龄健听幼儿,ITMAIS可简单、有效地评估其初期康复效果。     

用有意义听觉整合量表评估儿童人工耳蜗植入后听觉能力

目的使用有意义听觉整合量表（meaningful auditory integration scale，MAIS）对学龄前儿童人工耳蜗植入术前后听觉能力的发展情况进行分析和讨论。方法共有82例语前聋儿童患者参加本次调查。手术年龄为3岁至6岁11个月。评估使用MAIS量表由经过培训的听力学专业人员进行评估。主要调查患者使用人工耳蜗的情况（问题1和2）、对声音的觉察能力（问题3～6）和对声音的理解能力（问题7～10）等三方面的内容。分别在术前和术后开机后1个月、3个月、6个月、1年、1年半、2年时对患者的上述情况进行评估。结果经单因素方差分析，问题1a和1b在术后各评估时间的得分的差异无统计学意义。问题2～10在术后各评估时间的得分的差异有统计学意义。结论学龄前儿童人工耳蜗植入术后听觉能力及其发展规律存在较大的个体差异。患者术前对日常生活中的声音不能做出准确的反应，而术后使用人工耳蜗能力、对声音的觉察能力和对声音的理解能力均有显著改善。患者术后对声音的觉察能力和理解能力的发展较使用人工耳蜗能力的发展慢。     

听觉经验及康复时间对听障儿童语言发展的影响

目的：本研究探讨学语初期听障儿童的听觉年龄与接受听觉口语法治疗的时间对语言发展的影响。方法选取台湾雅文儿童听语文教基金会听障个案18名,听觉年龄为8～16个月,以华语婴幼儿沟通发展量表婴儿版测验其语言能力,与相同听觉年龄的健听儿童常模成绩进行比较,预测分析听觉年龄和听觉口语法治疗时间对语言测验成绩的影响。结果听障儿童词汇理解与相同听觉年龄的健听儿童没有差异（P〉0.05）,但词汇表达显著落后于相同听觉年龄健听儿童。听障儿童早期及晚期手势沟通能力比相同听觉年龄健听儿童表现优异。此外,听障儿童的听觉年龄及康复时间亦能有效预测其词汇理解及晚期手势沟通的表现。结论学语初期听障儿童接受与健听儿童相同时间的听觉和语言刺激,其词汇理解发展速度与健听儿童无差异。听障儿童早期及晚期手势沟通能力皆优于健听儿童,且词汇理解和晚期手势沟通的表现随听觉口语法治疗时间的增加而上升,表明听觉口语法治疗在听障儿童学语初期的效果首先反映在词汇理解和晚期沟通手势上。     

人工耳蜗植入儿童听觉康复效果跟踪评估

目的 通过对633例2～6岁听力障碍儿童植入人工耳蜗后的听觉康复效果跟踪评估,分析人工耳蜗植入年龄、性别及康复时间对康复效果的影响,探讨听障儿童听觉发展的规律性.方法 听觉能力评估方案采用全国聋儿康复系统通用的听力障碍儿童听觉能力评估标准及方法,评估内容包括声母识别、韵母识别.声调识别、双音节词识别、短句识别及在噪声环境中的言语识别等6项.本研究采用三因素混合实验设计,因变量为儿童听觉康复评估结果,自变量为儿童的年龄、性别、康复时间.应用统计学软件SPSS 16.0进行数据分析.结果 人工耳蜗植入儿童的听觉能力随康复时间延长,听觉能力显著提高(P＜0.001),其变异系数越来越小,2岁年龄组康复12个月评估时的CV系数为0.25,其余各年龄段的CV系数均小于0.2.听觉评估时间和儿童的年龄对听觉能力交互效应显著(P＜0.001),年龄段越小的儿童进步幅度越大.人工耳蜗植入儿童性别对听觉能力的主效应不显著(P＞0.05).结论 人工耳蜗术后听觉能力随康复训练的时间延长得到快速发展,儿童年龄越小提高幅度越大.听觉强化训练时间至少要经过12个月,听觉能力才相对稳定,2岁年龄组的听觉强化训练时间要超过1年.     

人工耳蜗术后言语听觉康复的阶段性个案评估

目的 验证人工耳蜗擅入后康复教育对聋儿言语听觉康复的重要性，并对阶段性康复教育的效果进行评定。材料采用单一被试，男童，3周岁，术前听力学评估包括行为测听以及听觉诱发电位，诊断为双耳极重度聋。术前经严格检查，符合手术指征，于2002年10月15日在全麻下接受右耳人工耳蜗植入术。方法 术后一个月之后，先后进行多次开机调试，求得量佳的听力重建效果，经评估证明，人工耳蜗模拟策略的听力重建效果较为显著，加上言语听觉康复教育及时跟进，教材为“启聪博士”中听觉学习的八个阶段，“启音博士”中的发声调练，以及言语的重读治疗法，为期三个月。结果 对采集的数据资料进行单一被试分析，分别对主要的辨音过程进行单基线A—B实验设计，均采用C检验。结论 实验处理即听力训练对该患儿辨音能力的康复有着显著的效果。     

蒙台梭利学前教育对低龄听障儿童智力、听觉能力的影响

目的：考察蒙台梭利学前教育对2～3岁听障儿童智力及听觉能力发展的影响。方法将14名2～3岁听障儿童随机分成实验组和对照组,每组7人。实验组接受常规听力语言康复教育和为期12个月的蒙台梭利幼儿课程训练,对照组只接受常规听力语言康复教育。采用Griffith精神发育量表和婴幼儿有意义听觉整合量表（IT-MAIS）测试两组儿童实验前后的智力和听觉能力。结果①Griffith精神发育量表评估总发育商上,实验组和对照组的前测成绩没有显著差异（t=-0.172, P〉0.05）,后测成绩实验组显著好于对照组（t=2.067,P〈0.05）;②听觉能力测试总分上,实验组和对照组的前测成绩没有显著差异（t=-0.273,P〉0.05）,后测成绩实验组显著好于对照组（t=6.041,P〈0.05）;③听觉能力后测中,实验组的声音发声情况及理解能力显著好于对照组（t值分别为3.421和2.056,P值均〈0.05）,两组声音察知能力无明显差异（t=0.038, P〉0.05）。结论蒙台梭利学前教育是听障儿童康复训练中可以选择使用的一种康复方式,对其智力发展及听力发展有一定的帮助。     

言语训练配合音乐疗法治疗Broca失语1例

目的观察言语训练配合音乐疗法治疗Broca失语的效果。方法采用言语训练配合音乐疗法,对1例52岁Broca失语症患者治疗4周,并用中国康复研究中心汉语失语检查表（CRRCAE）做治疗前后评价。结果治疗后患者听理解、复述、说、画面说明、出声读、阅读理解、抄写、听写、计算水平等都有很大提高。结论通过言语训练配合音乐疗法治疗Broca失语,可明显改善患者的表达与交流能力。     

伴脑白质病语前聋患儿人工耳蜗植入术后听觉言语康复效果分析

目的 探讨伴脑白质病的语前极重度感音神经性聋患儿人工耳蜗植入的可行性及术后听觉言语康复效果.方法 海南省人民医院耳鼻咽喉科2013年9~11月行人工耳蜗植入的14例伴脑白质病语前聋患儿为研究组(年龄1~6岁,平均3.79±1.93岁),同期无中枢神经系统病变的语前聋患儿16例为对照组(年龄1~6岁,平均4.38±1.93岁),术前均行临床听力学、影像学检查及语言能力、智力水平等评估,经乳突后鼓室面神经隐窝入路一期行人工耳蜗植入术,术后均到海南省聋儿康复中心进行言语康复训练;采用听觉行为分级标准(categories of auditory performance,CAP)和言语可懂度分级标准(speech intelligibility rate,SIR)对两组术后康复效果进行评估,比较两组患儿术后不同阶段的CAP和SIR分级.结果 所有患儿人工耳蜗植入术后均获得听觉反应和不同程度的言语交流能力,随着康复时间延长两组患儿CAP及SIR分级均呈上升趋势;研究组术后6、12和24个月CAP平均分级分别为2.571±0.416、3.714±0.496、5.000±0.492级,SIR平均分级分别为1.357±0.133、2.143±0.275、3.071±0.245级,与对照组CAP(分别为2.688±0.313、3.875±0.364、5.000±0.354级)及SIR(分别为1.500±0.129、2.313±0.176、2.875±0.221级)比较,差异均无统计学意义(P>0.05).结论 伴脑白质病的语前极重度感音性聋患儿经过术前充分评估后可以实施人工耳蜗植入,术后2年内听觉言语康复效果与不伴脑白质病的同龄患儿相当.     

人工耳蜗植入儿童听觉发展个案分析

目的通过对1例5岁听障儿童植入人工耳蜗后进行阶段性言语听觉反应评估（Evaluation of Auditory Response to Speech,EARS）,纵向比较、动态评价听障儿童在不同阶段的听觉发展情况,从而为制订康复训练计划提供依据。方法使用EARS评估词表及标准评估程序对该儿童进行评估,对评估成绩进行分析。结果该儿童的听觉言语发展水平整体上呈现出不断进步的趋势,尤其是在开放式单音节词、问句、语言细节句子3项测试上进步明显;听觉发展、音节、封闭式单音节词3项测试第一次测试成绩已较好,因而进步不明显;封闭式句子、声调成绩不稳定。结论EARS评估可动态监测听障儿童听觉发展的过程,为制订教学计划提供依据;经过人工耳蜗术后9个月的训练,该听障儿童具备了听觉识别能力,听觉理解能力也在逐步发展。     

Cochlear implantation in a Mandarin Chinese-speaking child with auditory neuropathy

Auditory neuropathy (AN) is a hearing disorder characterized by the preservation of outer hair cell function despite the absence of auditory brainstem responses. The pathophysiology and etiology of this condition remain unknown. Recent studies have shown that some patients with AN benefit significantly from cochlear implantation. These patients have all been native speakers of Western languages. A 3-year-old Mandarin-speaking boy was referred to our center because of speech delay. After a series of audiological surveys, retro-cochlear lesion was impressed. During the 2-year period of rehabilitation, poor speech discrimination out of proportion to aided hearing thresholds led to the diagnosis of auditory neuropathy. Because of the limited benefit from amplification, he received a cochlear implant. Significant improvement of speech perception skills assessed by a Mandarin auditory perception test was noted shortly after implantation. The post-implantation performance in this Mandarin-speaking child was consistent with that of reports for implantees speaking Western languages. For Mandarin-speaking children with AN who fail to benefit from conventional treatment, cochlear implantation may be a good alternative choice.     

Cortical reorganisation and tinnitus: principles of auditory discrimination training for tinnitus management

Scientific evidence has proved reorganisation processes in the auditory cortex after sensorineural hearing loss and overstimulation of certain tonotopic cortical areas, as we see in auditory conditioning techniques. Acoustic rehabilitation reduces the impact of these reorganisation changes. Recent theories explain tinnitus mechanisms as a negative consequence of neural plasticity in the central nervous system after a peripheral aggression. Auditory discrimination training (ADT) could partially reverse the wrong changes in tonotopic representation and improve tinnitus. We discuss different studies and their efficacy on tinnitus perception and annoyance. Indications, method, dose and sound strategy need to be implemented.     

Assessing auditory capabilities in young children

OBJECTIVE: Early detection of hearing loss in infants and toddlers has created a need for age-appropriate tests that assess auditory perceptual capabilities. This article describes a progressive test battery we have developed to evaluate phonetic contrast perception, phoneme recognition, and word recognition in children 6 months to 5 years. This battery is part of a clinical research protocol designed to track auditory development in this population. METHODS: The progressive test battery originated from a model of auditory perceptual development to assess phonetic discrimination and word recognition. Phonetic discrimination is evaluated using the Battery of Auditory Speech Perception Tests for Infants and Toddlers (BATIT). The BATIT is composed of four measures (VRASPAC, PLAYSPAC, OLIMSPAC, and VIDSPAC) intended to assess the child's ability to distinguish between phonologically significant contrasts using developmentally appropriate tasks. Designed for children aged 6 months and up, performance is represented either by percent correct or by the level of confidence that the child's responses are not random. Phoneme and word recognition are assessed in children 4 years and older using lists of consonant-vowel-consonant (CVC) phonemes in words and lexically controlled words both in and out of sentence context (LEXSEN). RESULTS: Cross-sectional data show that children with normal hearing may be assessed by the age of 7 months on VRASPAC; by 3 years on PLAYSPAC and OLIMSPAC; and by 4-5 years on VIDSPAC, CVC phonemes in words, and LEXSEN words in isolation and in sentences. Data from infants with hearing loss show that VRASPAC is sensitive to degree of hearing loss, but performance with normally hearing children declines after 12 months of age. CONCLUSION: Assessment of phonetic discrimination and word recognition is, for the most part, attainable in young children using a progressive test battery, but none of the tests used here is effective between 1 and 3 years of age. Continued development will be required to fill this gap and to separate auditory from non-auditory influences on performance.     

父母和教师使用《听觉整合问卷》 评估听障儿童的一致性研究

目的 考查父母和教师使用《听觉整合问卷》(meaningful auditory integration scale,MAIS)评估听障儿童听觉发展情况的一致性.方法 请81名听障儿童的父母和康复教师分别利用MAIS中的父母问卷和教师问卷对儿童进行评估,对父母问卷和教师问卷的得分进行统计分析.结果 ①整体上,父母问卷的得分高于教师问卷的得分,差异极显著(t=4.970,P=0.000);②在信心分、警觉分和意义分3个维度上,父母问卷的得分也显著高于教师问卷得分(t1=2.115,p1=0.037;t2=5.340,P2=0.000;t3＝3.553,p3=0.001).结论 父母和教师在使用MAIS评估听障儿童的听觉发展情况时存在不一致,有待于扩大样本量或追踪进行进一步研究.     

Auditory Neuropathy / Auditory Dyssynchrony in children with Cochlear Implants

The electrical stimulation generated by the Cochlear Implant (CI) may improve the neural synchrony and hence contribute to the development of auditory skills in patients with Auditory Neuropathy / Auditory Dyssynchrony (AN/AD).AimProspective cohort cross-sectional study to evaluate the auditory performance and the characteristics of the electrically evoked compound action potential (ECAP) in 18 children with AN/AD and cochlear implants.Material and methodsThe auditory perception was evaluated by sound field thresholds and speech perception tests. To evaluate ECAP's characteristics, the threshold and amplitude of neural response were evaluated at 80Hz and 35Hz.ResultsNo significant statistical difference was found concerning the development of auditory skills. The ECAP's characteristics differences at 80 and 35Hz stimulation rate were also not statistically significant.ConclusionThe CI was seen as an efficient resource to develop auditory skills in 94% of the AN/ AD patients studied. The auditory perception benefits and the possibility to measure ECAP showed that the electrical stimulation could compensate for the neural dyssynchrony caused by the AN/AD. However, a unique clinical procedure cannot be proposed at this point. Therefore, a careful and complete evaluation of each AN/AD patient before recommending a Cochlear Implant is advised. Clinical Trials: NCT01023932