食管发音康复训练

综述了食管发音的发音机制、发音要素变化、康复训练方法、影响食管发声训练的因素及其采取的相应对策,以及食管发音的优点.认为食管发音掌握简单,易于推广,是无喉者言语康复较理想的方法.     

胃食管反流的X线分期及诊断价值（附18例分析及文献复习）

目的：总结胃食管反流的X线诊断,评价X线钡餐检查对胃食管反流病的诊断价值。方法：对18例胃食管反流的患者进行回顾性分析,观察X线诊断检查可靠征象,分析其反流的情况。结果：X线钡餐诊断胃食管反流病,观察反流的程度、形式及清除情况与并发症进行分析。结论：X线钡餐造影检查方法简便易接受,能直接发现胃食管反流病,对胃食管反流的诊断和治疗有其重要的参考价值。     

电子内镜与硬管食管镜结合取食管异物200例

食管异物传统的诊治模式是用X线检查或吞钡棉X线检查确定异物存在及部位后,使用硬管食管镜取出异物。这种诊治食管异物模式在世界上已应用近百年。但这种模式有许多不足之处,如X线检查漏诊率高,硬管食管镜视野窄小等。随着近年来电子内镜的广泛普及,用电子内镜代替X线介入食管异物的诊断及配合硬管食管镜钳取异物,取得良好效果。     

胃镜对滑动型食管裂孔疝和食管裂孔机能不全诊断价值的探讨

我院1989年9月～1990年2月胃镜检查925例患者,检出滑动型食管裂孔疝21例和食管裂孔机能不全70例,其中部分患者又做了X线检查对照。对滑动型食管裂孔疝组21例均做了X线检查,其中胃镜诊断20例,诊断率为95.23%(20/21):X线诊断19例,诊断率为90.48%(19/21)。胃镜诊断食管裂孔机能不全组70例,其中有40例作了X线检查,行3例X线报告食管裂孔不宽,但有钡剂胃-食管返流,(都有食道裂孔机能不全)。作者提小胃镜对滑动型食管裂孔疝和食管裂孔机能不全的诊断标准,并进行了讨论。     

早期食管癌的X线征象及误诊原因分析

1 临床资料 我院1998～2003年经细胞学或纤维食管镜及X线照片综合诊断为早期食管癌27例,其中手术证实9例,纤维胃食管镜及活检病理证实11例,细胞学证实7例;误诊为早期食管癌9例,经2～6a的随诊,X线食管吞钡检查和X线照片、纤维食管镜复查,最后否定了食管癌的诊断.     

系统性硬化病的临床分型及相关X线表现

目的分析系统性硬化病(SSc)的临床分型及其相关的X线表现特征,旨在提高对其认识水平。方法回顾性分析19例经临床证实的SSc患者的X线检查资料,结合文献进行临床分型并观察手、肺部以及食管钡餐X线表现。结果 19例SSc患者中弥漫型13例,局限型6例,在受累手、食管和肺部的相关X线表现相同:多发指端皮下组织萎缩、指骨末端骨质吸收、可伴有骨质疏松和关节改变;食管蠕动减弱,管壁柔软度下降;双肺下野纹理增多、紊乱。19例SSc患者双手均出现多发指端皮下组织萎缩和指骨末端骨质吸收。13例弥漫型SSc中,食管钡餐检查9例异常,肺部X线表现异常10例;6例局限型SSc中食管钡餐检查和肺部X线表现异常各1例。结论 SSc累及手、食管和肺部时可出现一定特征性的X线表现,其中食管和肺部受累几率与临床分型相关,而手部骨关节受累几率与SSc临床分型无相关性。     

胃肠道多原发癌(附28例报告)

目的 :探讨胃肠道多原发癌病因及发病情况 ,分析误 /漏诊原因及X线检查注意事项。材料与方法 :收集经X线检查并经手术病理证实的 2 8例进行分析。结果 :贲门—胃癌 8例 ,食管双原发性癌 5例 ,食管—贲门癌 5例 ,结肠双原发癌10例。X线表现为管腔狭窄、粘膜中断、充盈缺损、龛影。结论 :X线检查具有重要的诊断价值。     

喉切除对叠式气-食管通路发音重建防治误咽的研究

目的晚期喉癌行全喉切除发音重建及防误咽一直是头颈肿瘤外科攻关难题,研究气-食管通路发声重建防治误咽的新方法,评价对叠式气-食管通路发声口重建及檐状会厌成形术防治误咽的疗效。方法将纵形切开的气-食管漏行衣襟样对叠缝合;保留带蒂环状软骨瓣并修成会厌形状;在重建气-食管通路发声口上方将会厌形状骨片植入食道前壁粘膜下,使曲面向下凸入食管腔形成檐状会厌”。结果33例喉鳞癌术后3,7或12d拔除鼻饲管,经6～11d常规进食适应后均无误咽。随访2～5年,28例无发声口漏,2例癌复发肺、骨转移死亡,3例失访。结论对叠式气-食管通路发声口及“檐状会厌”有效地防治误咽。     

喉癌术后病人食管发音康复训练影响因素的质性研究

目的:分析喉癌术后病人食管发音康复训练的影响因素,为线上食管发音康复训练方案的构建提供依据。方法:应用现象学研究方法,选取12例愿意参加食管发音培训的病人为访谈对象,采用面对面的半结构式深度访谈方式进行资料的收集,运用Colaizzi 7步分析法分析资料。结果:经过对访谈资料进行转录分析,共提取心理状态、面临困境、培训期待、线上培训可行性4个主题。结论:对喉癌术后病人食管发音康复训练影响因素的分析,可确定线上食管发音培训干预内容的导向,强化积极因素,降低阻碍因素,制定切实可行的线上食管发音培训实施方案,使其更有利于病人术后语言的康复。     

胃镜下食管裂孔疝的诊断

目的：分析内镜下诊断食管裂孔疝63例患者镜下的特点，并与X线造影结果进行对比，探讨内镜对该病的诊断价值。并且研讨食管裂孔疝与反流性食管炎的密切关系。方法：总结63例患者的临床表现、内镜检查所见，食管炎分级、病理检查及X线造影检查结果，内镜诊断的符合率，食管裂孔疝并发食管炎的百分率。结果：内镜下诊断食管裂孔疝的63例患者，经X线造影确诊60例，符合率为95．24％，并发食管炎56例，并发率90．5％。结论：食管裂孔疝与内镜下诊断和食管炎的发生有密切关系，X线造影检查具有很高符合率。     

应用腭大动脉岛式组织瓣修复腭部洞穿性缺损后的语音功能评价

目的：评价腭大动脉岛状瓣修复腭部洞穿性缺损术后患者的语音功能恢复情况。方法选取35例腭部肿瘤进行手术治疗的患者,按随机数字表法分为修复重建组（n＝19）与非修复重建组（n＝16）。修复重建组应用带腭大动脉的岛式黏骨膜组织瓣行硬软腭即刻修复重建,术后6个月进行患者自我语音评价及医师评定语音清晰度,并与腭部缺损未行修复重建组的术后语音功能进行比较。结果修复重建组患者的自我语音评价优良率为84.21％,医师语音清晰度评价语音障碍率仅10.53％,与非修复重建组比较,差异均有统计学意义（ P＜0.05）。结论腭大动脉岛式黏骨膜瓣修复腭部洞穿性缺损能够较好的重建口腔发音结构,恢复口腔语音功能。     

Tongue movement during speech: a real-time ultrasound evaluation

Tongue movement during production of the speech sounds /a/, /i/, and /k/ was examined with a real-time sector scanner positioned submentally. With this technique, it is possible to obtain excellent visualization of the tongue surface and to identify much of the intrinsic soft tissue anatomy of the tongue and floor of the mouth. Tongue movement and configuration were found to be consistent for 10 normal speakers, especially for /i/ and /k/. Three patients with neurological disease and dysarthria showed varying but significant differences in articulation compared to normals. It appears that real-time ultrasound imaging of the oral cavity is a potentially valuable technique for the clinical investigation of normal and abnormal speech.     

儿童语言治疗中的"互动"作用

目的观察儿童语言治疗中“互动”的作用。方法采用中国康复研究中[S-S]法语言发育迟缓评价和构音障碍评价诊断和治疗儿童语言障碍患儿90例。结果本组患儿在其原有的基础上都有不同的进步，目前正在康复治疗中。结论语言治疗“互动”方法方便、经济，可激发患儿学习言语的乐趣，达到巩固训练的目的。     

Ultrasonic evaluation of the uterus and uterine cavity after normal, vaginal delivery.

OBJECTIVE: To describe uterine and uterine cavity changes throughout the puerperium, as revealed by ultrasound. METHODS: This was a prospective, longitudinal study in which 42 women with uncomplicated vaginal term deliveries were examined serially by ultrasound on postpartum days 1, 3, 7, 14, 28 and 56. The first four examinations were performed transabdominally and the last two transvaginally. The involution process of the uterus was assessed by measuring the anteroposterior diameter of the uterus and uterine cavity. Morphological findings were recorded. The influence on the involution process of parity, breast-feeding, maternal smoking and infant's birth weight were also evaluated. RESULTS: The maximum anteroposterior diameter of the uterus diminished substantially and progressively from 92.0 mm on day 1 postpartum to 38.9 mm on day 56. The maximum anteroposterior diameter of the uterine cavity diminished from 15.8 mm on day 1 to 4.0 mm on day 56. However, the anteroposterior diameter of the uterine cavity, 5 cm from the fundus, typically increased on days 7 and 14 postpartum. The position of the uterus and the shape and the appearance of the cavity change in a unique way during the normal puerperium. The uterus was most often retroverted and empty in the early puerperium. Fluid and debris in the whole cavity were seen in the middle part of the puerperium. In late puerperium the cavity was empty and appeared as a thin white line. Endometrial gas was occasionally visualized. No correlation was found between the involution of the uterus and parity, breast-feeding and the infant's birth weight. CONCLUSION: Transabdominal sonography is suitable for examination of the uterus during the first 14 days postpartum but from day 28 the transvaginal route is preferable. The uterine body and position, as well as the cavity, are easy to examine by ultrasound. Accumulation of fluid and debris in the uterine cavity is a common and insignificant finding of the involuting uterus. It is located in the cervical area in the early puerperium and in the whole uterine cavity in the middle part of the puerperium. Findings from uncomplicated vaginal deliveries are needed as a reference when the diagnostic efficacy of ultrasound for pathological conditions is to be tested.     

发展性口吃汉字朗读过程中语音产出的自动化程度

目的口吃者言语产出自动化问题是多年来理论的关键问题之一,研究此问题可揭示大脑言语产生的作用机制,并对口吃矫正的理论和方法具有实际的应用意义。方法应用双任务探测反应时的行为实验范式,通过复杂性不同的单字实验和两字实验,分别检测了22例发展性口吃者在朗读和默读汉字两种阅读状态下探测任务(语音搜索和语音比较)的按键反应时。结果朗读状态下探测任务的反应时在单字和两字实验中都较默读状态延长,其中单字实验中的差异有显著性意义(P<0.05),两字实验中的差异有非常显著性意义(P<0.001);而且单字与双字语音产出时间(朗读与默读探测反应时之差异量)的比较具有显著性(P<0.01),表明两字朗读状态下语音产出反应时较单字明显延长。结论发展性口吃者朗读时的语音产出为一种自动化程度较低的控制性加工,言语复杂性增加使不流利言语增多可能与语音产出需要的注意资源增加有关。     

Computerized monitoring of patient-reported speech and swallowing problems in head and neck cancer patients in clinical practice

Purpose

The purpose of this study is to evaluate computerized monitoring of speech and swallowing outcomes and its impact on quality of life (QoL) and emotional well-being in head and neck cancer patients in an outpatient clinic.

Methods

Sixty-seven patients, treated by single or multimodality treatment, completed the EORTC QLQ-C30 and QLQ-H&;N35 questionnaires and the Hospital Anxiety and Depression Scale in an outpatient clinic, using a touch screen computer system (OncoQuest), at baseline (at time of diagnosis) and first follow-up (1?month after end of treatment).

Results

Tumor sites included oral cavity (n?=?12), oropharynx (n?=?18), hypopharynx (n?=?8), and larynx (n?=?29). Tumor stage included carcinoma in situ (n?=?3), stage I (n?=?21), stage II (n?=?7), stage III (n?=?15), and IV (n?=?21). No speech or swallowing problems at baseline or follow-up were noted in 23?% (speech) and 41?% (swallowing) of patients. Twenty-one percent (speech) and 19?% (swallowing) had problems at baseline and returned to normal scores at follow-up, while 16?% (speech) and 19?% (swallowing) had normal scores at baseline and developed problems at follow-up. Forty percent (speech) and 21?% (swallowing) had persistent problems from baseline to follow-up. At baseline, speech problems were significantly related to tumor site and emotional distress. At baseline and follow-up, swallowing problems were significantly related to QoL and emotional distress. At follow-up, speech problems were significantly related to QoL, emotional distress, and swallowing problems.

Conclusions

Monitoring speech and swallowing problems through OncoQuest in an outpatient clinic is feasible. Many patients report speech and swallowing problems, negatively affecting their QoL and emotional well-being.     

The irrelevant speech effect and working memory load

Irrelevant speech impairs the immediate serial recall of visually presented material. Previously, we have shown that the irrelevant speech effect (ISE) was associated with a relative decrease of regional blood flow in cortical regions subserving the verbal working memory, in particular the superior temporal cortex. In this extension of the previous study, the working memory load was increased and an increased activity as a response to irrelevant speech was noted in the dorsolateral prefrontal cortex. We suggest that the two studies together provide some basic insights as to the nature of the irrelevant speech effect. Firstly, no area in the brain can be ascribed as the single locus of the irrelevant speech effect. Instead, the functional neuroanatomical substrate to the effect can be characterized in terms of changes in networks of functionally interrelated areas. Secondly, the areas that are sensitive to the irrelevant speech effect are also generically activated by the verbal working memory task itself. Finally, the impact of irrelevant speech and related brain activity depends on working memory load as indicated by the differences between the present and the previous study. From a brain perspective, the irrelevant speech effect may represent a complex phenomenon that is a composite of several underlying mechanisms, which depending on the working memory load, include top-down inhibition as well as recruitment of compensatory support and control processes. We suggest that, in the low-load condition, a selection process by an inhibitory top-down modulation is sufficient, whereas in the high-load condition, at or above working memory span, auxiliary adaptive cognitive resources are recruited as compensation.     

低强度激光鼻腔内照射联合综合言语训练治疗 脑梗死后失语症

目的:探讨低强度激光鼻腔内照射(LINC)联合综合言语疗法治疗脑梗死后失语症的疗效。方法:脑梗死后失语症患者78例,随机分为常规治疗组38例和联合治疗组40例。常规治疗组采用基础药物治疗和Schuell刺激疗法言语训练。联合治疗组在常规治疗组基础上,加用LINC治疗,30 min/次,1次/d,6 d/周,30 d/疗程,治疗1个疗程。治疗前、后采用西方失语成套测验(WAB)评价患者语言功能,并检测血液流变学指标变化情况。结果:治疗后,2组WAB评分中的自发言语、复述和命名得分均高于同组治疗前,且联合治疗组高于常规治疗组(P<0.05);2组血粘度、纤维蛋白原含量和红细胞压积低于同组治疗前(P<0.05),且联合治疗组低于常规治疗组(P<0.05)。结论:LINC联合综合言语治疗有益于脑梗死后失语症患者的言语功能恢复,且对血液流变学有明显影响。     

Neural correlates of the processing of co-speech gestures

In communicative situations, speech is often accompanied by gestures. For example, speakers tend to illustrate certain contents of speech by means of iconic gestures which are hand movements that bear a formal relationship to the contents of speech. The meaning of an iconic gesture is determined both by its form as well as the speech context in which it is performed. Thus, gesture and speech interact in comprehension. Using fMRI, the present study investigated what brain areas are involved in this interaction process. Participants watched videos in which sentences containing an ambiguous word (e.g. She touched the mouse) were accompanied by either a meaningless grooming movement, a gesture supporting the more frequent dominant meaning (e.g. animal) or a gesture supporting the less frequent subordinate meaning (e.g. computer device). We hypothesized that brain areas involved in the interaction of gesture and speech would show greater activation to gesture-supported sentences as compared to sentences accompanied by a meaningless grooming movement. The main results are that when contrasted with grooming, both types of gestures (dominant and subordinate) activated an array of brain regions consisting of the left posterior superior temporal sulcus (STS), the inferior parietal lobule bilaterally and the ventral precentral sulcus bilaterally. Given the crucial role of the STS in audiovisual integration processes, this activation might reflect the interaction between the meaning of gesture and the ambiguous sentence. The activations in inferior frontal and inferior parietal regions may reflect a mechanism of determining the goal of co-speech hand movements through an observation-execution matching process.