行为疗法在语音治疗中的应用研究

目的 为提高语音障碍的治疗效果。应用行为疗法治疗腭咽闭合功能不全型（VPI）患者，方法 20例VPI患者，其中先天性腭咽闭合功能不全5例，咽成形术术后10例，腭成形术术后5例，男性10例，女性10例，年龄4.0-38.4岁，平均年龄17.8。采用行为疗法进行语音治疗，并在治疗前后定量检测汉语语音清晰度和吹气实验。结果 治疗效果满意，治疗后的汉语语音清晰度和吹气实验较治疗前有显著提高。结论 行为疗法是一种行之有效的语音治疗方法，但要注意严格掌握适应证和个体化应用。     

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...     

腭咽闭合功能不全语音清晰度评价

目的　研究腭咽闭合功能不全患者的语音清晰度。方法　 10 0例腭咽闭合功能不全患者 ,其中 15例为腭裂 ,2 1例为先天性腭咽闭合不全 ,5 6例为腭裂术后腭咽闭合不全 ,8例为咽成形术后腭咽闭合不全 ,对照组为 32名健康人。 3名语音专业人员共同评价汉语语音清晰度 ,并且分析语音障碍和语音清晰度的关系。结果　健康组的语音清晰度为 99 0 % ,腭咽闭合功能不全组为35 5 % ,其中未手术腭裂组为 19 9% ,先天性腭咽闭合不全为 32 8% ,腭裂术后腭咽闭合不全为4 0 3% ,咽成形术后腭咽闭合不全为 35 2 % ,统计分析显示健康组和病例组各类型之间差异有显著性 (P <0 0 1)。结论　①腭咽闭合功能不全异常语音的语音清晰度差 ,并伴过度鼻音 ;②腭咽闭合不全异常语音中 ,腭裂患者的语音清晰度最低 ,其余依次为先天性腭咽闭合不全、咽成形术后腭咽闭合不全和腭裂术后腭咽闭合不全     

异常语音的临床分类和治疗

目的:探讨异常语音的临床分类和治疗。方法:229例语音障碍患者,男130例,女99例,年龄4~36岁。将其分为腭咽闭合功能不全和非腭咽闭合功能不全型,分别采取不同的治疗方法。结果:完成治疗的134例患者的语音清晰度均达到正常人的水平。同一位异常语音患者可伴有二种以上的异常语音。结论:异常语音的治疗无固定和统一的模式,但只要准确地分类和合理地治疗,仍能获得满意的疗效。     

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。     

上颌骨牵引成骨对腭咽闭合功能的影响

目的:探讨牵引成骨技术(Distraction Osteogenesis,DO)前移上颌骨后对腭咽闭合功能的影响。方法:应用DO矫治14例上颌骨发育不足病例,牵引前后分别拍摄正中(牙合)位及发ⅰ位X线头颅侧位定位片,通过头影测量分析腭咽部组织的变化;同时采用吹气试验及语音清晰度测听比较牵引前后腭咽闭合功能的变化。结果:上颌骨平均前移11.39±7.15 mm。X线片测量结果显示:软腭厚度明显小于术前;咽腔深度较术前明显增大;而软硬腭夹角、静止位软腭长度及发音位有效软腭长度均明显高于术前;软腭上抬高度无明显降低;牵引前7例腭咽闭合者有2例引起腭咽闭合不全。7例腭咽闭合不全者牵引后腭咽最短距离平均增大2.5 mm。不捏鼻及捏鼻吹气试验持续时间牵引前后无显著性差异。语音测听显示语音清晰度牵引前后改变无显著性差异。对Crouzon综合征患者牵引后腭咽闭合变得更具生理性,且语音清晰度得到提高。结论:上颌骨牵引成骨在一定范围内不会引起腭咽闭合功能障碍,但牵引超过一定限度则会引起腭咽闭合不全。对Crouzon综合征患者牵引后腭咽闭合功能得以改善。     

吹气训练在74例腭裂患者语音治疗中的效果评价

目的 评价吹气训练在腭裂患者语音治疗中的效果。方法 选择符合纳入标准的腭裂咽成形术后表现为腭咽闭合不全（VPI）代偿性语音患者74例,平均年龄10.98岁,采用吹气训练行为疗法与汉语语音训练相结合原则,在运用屏气时吹水泡、吹气球训练基础上,进一步诱导辅音擦音、塞音送气方式。采用SPSS 21.0软件包对数据进行统计学分析。结果 4~6岁组、7~12岁组和≥13岁组患者吹水泡平均时间由训练前的6.37、7.0和9.96 s分别提高到24.87、26.96和29.07 s,差异有统计学意义（P<0.001）。训练前各组患者均无法完成吹气球动作,训练后各组吹气球成功率分别达到88.9%（4~6岁组）、84.0%（7~12岁组）和90.9%（≥13岁组）。训练前各组患者擦音f和s、塞音p均为脱落或弱化,训练后达到正常语音清晰度,差异有统计学意义（P<0.001）。结论 屏气的吹气训练方法对增强腭咽闭合功能及塞音和擦音的送气诱导有显著效果。     

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。     

改良咽后壁组织转移瓣在VPI患者的临床应用和研究

目的：客观评价改良咽后壁组织转移瓣效果。方法：对30例行改良咽成形术者术前、术后的吹气试验，汉语语音清晰度以及过度度鼻音进行了定量分析。结果：改良咽后壁组织转移瓣术后的吹气试验，汉语语音清晰度以及过度鼻音有了明显的改善。结论：改良咽后壁组织转移瓣能有效地改善VPI患者的腭咽闭合功能。     

先天性腭咽闭合功能不全的语音清晰度评价

目的:本研究通过检测51例先天性腭咽闭合功能不全(CVPI)患者的语音清晰度,评定其异常语音的严重 程度,为其诊断提供重要的信息,也为其治疗计划的制定和估计预后提供了重要的依据。方法:由三名经验丰富 的语音病理师,按汉语语音清晰度测试字表对51例CVPI患者行语音清晰度的审听,并对其语音的严重程度进行 分类,将其结果同56例腭裂术后VPI患者,15例腭裂患者及30例正常者进行对照比较。结果:用汉语语音清晰 度测试字表,51例CVPI患者的语音清晰度均值为31.3％,其中43.1％为中度语音障碍,52.90k,为重度。结论:通 过上述研究方法可知CVPI虽没有明显的腭咽腔解剖异常,但其语音障碍程度主要集中在中度到重度,对改善其语 音所需的时间显然长,困难大。     

不同年龄组咽成形术后异常语音治疗的效果

目的通过对不同年龄组咽成形术后异常语音治疗效果的分析,为病理语音治疗年龄选择提供参考。方法选取271例咽成形术后进行异常语音治疗的患者（4~25岁）,按年龄分为4组: 幼儿（4~6岁）、儿童（7~12岁）、少年（13~17岁）和青年（18~25岁）。所有患者均按腭咽闭合功能、音素、音节、短句进行系统性语音训练。用清晰度测试表对治疗前后语音清晰度和过度鼻音进行检测,采用SPSS 16.0软件包对各年龄组治疗前、后的上述2个指标进行统计学分析。结果271例患者中,幼儿组62例、儿童组59例、少年组43例、青年组107例。各组治疗前、后语音清晰度分别为幼儿组（35.91%、98.22%）、儿童组（38.11%、98.63%）、少年组（45.59%、98.51%）和青年组（39.78%、98.21%）;每组治疗前、后语音清晰度均有显著差异,各组治疗后语音清晰度均无显著差异。各组治疗前、后过度鼻音改善,改善率分别为幼儿组70.97%,儿童组62.71%,少年组44.19%和青年组43.93%;各组治疗后过度鼻音改善均存在显著差异。结论咽成形术后异常语音治疗后语音清晰度与年龄大小无关;而过度鼻音改善程度与年龄大小有关,年龄越小,改善程度越高。     

腭-心-面综合征的诊断与治疗的临床研究

目的:回顾分析110例腭-心-面综合征患者的病例资料,和其中20例患者的治疗结果,为明确临床诊断和确立有效的治疗方法提供依据。方法:收集110例腭-心-面综合征患者(男性57例,女性63例,平均年龄为13.9岁)的临床及影像学资料进行分析,并比较了其中20例患者在接受改良咽后壁组织瓣手术及语音治疗前后的语音清晰度和blowing test结果。结果:110例腭-心-面综合征患者均有过度鼻音,语音清晰度差,临床检查软腭形态正常,但运动功能差,33例患者的IQ值平均为73,20例患者在接受了手术及语音治疗后,语音清晰度均值从治疗前的47%改善到治疗后的98%,吹水泡试验从治疗前的17s提高至治疗后的38s,治疗周期平均为8月。结论:腭-心-面综合征虽然临床表现错综复杂,但所有的患者均有过度鼻音,腭咽部活动度弱等,通过咽成形术及术后的语音治疗可得到令人满意的治疗效果,但治疗周期长,难度较大。     

成年腭裂患者语音治疗的特点和方法探讨

目的 通过回顾20例成年人的语音治疗，总结其治疗规律，探讨有效的治疗方法。方法 20例成年异常语音患者，男10例，女10例，年龄20—38岁，平均23．5岁。所有患者在语音治疗前均接受常规的专科检查、汉语语音清晰度测试和吹水泡试验，其中17例患者曾行咽后壁组织瓣转移术。语音治疗采取辨听训练、行为治疗、唇音训练、送气音和摩擦音训练、舌外伸训练和综合训练等方法，由浅入深，由简单到复杂。结果 所有患者在语音治疗后异常语音基本恢复正常，辅音脱落和过度鼻音完全消失。其中4例患者在语音治疗中出现并发症。结论 成年人语音治疗虽较儿童困难，但只要治疗方法正确，也能取得令人满意的效果。     

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。     

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。     

Investigations of a pressure-sensitive theory of marginal velopharyngeal inadequacy.

PURPOSE: This two-part project was designed to test a pressure-sensitive theory of marginal velopharyngeal inadequacy (MPVI). Specifically, are select subgroups of children with MPVI perceived as hypernasal because they fail to achieve consistent closure during vowels and semivowels while demonstrating adequate closure during pressure consonants? METHODS: In part one, 36 children with cleft palate and other craniofacial anomalies were examined using a clinical assessment protocol that included nasometry and perceived ratings of hypernasal resonance. Children with nasalance percentages above threshold during low-pressure (LP) productions and below threshold for high-pressure (HP) productions were placed in one group (group 1), while children with nasalance percentages below threshold for both LP and HP sentences were placed in another (group 2). Children in the two groups were age- and sex-matched. In part two, endoscopic data were examined for 10 additional children who received nasometry, perceived hypernasal resonance scores, and videoendoscopy on the same day and who received higher mean nasalance measures during production of LP sentences than during production of HP sentences. RESULTS: The results of part one confirmed that children in group 1 were perceived as being significantly more hypernasal than children in group 2 (mean(group 1) = 2.17, mean(group 2) = 1.50; t = 2.75, p =.01). However, results of endoscopic testing failed to demonstrate a consistent observable physiologic pattern of velopharyngeal inadequacy that would confirm the theory that some patients with MVPI are perceived as being hypernasal because of difficulty achieving velopharyngeal closure during vowels and semivowels. CONCLUSIONS; The findings provide partial support for a pressure-sensitive theory of MVPI and demonstrate the value of using both HP and LP sentences to evaluate patients with MVPI.     

Management of velopharyngeal insufficiency by modified Furlow palatoplasty with pharyngeal flap: a retrospective outcome review

The surgical approach for the correction of residual velopharyngeal insufficiency requiring secondary surgery at Chang Gung Memorial Hospital is the modified Furlow palatoplasty with pharyngeal flap (mFP-PF). The aim of this study was to describe the mFP-PF technique and to determine the results obtained with regard to improvements in velopharyngeal function in patients undergoing this surgery. This retrospective analysis included 58 non-syndromic patients treated during the period 1992–2015 who complained of hypernasal speech after primary cleft palate repair and failed postoperative speech therapy. All of them underwent mFP-PF surgery. Preoperative and postoperative perceptual speech assessment results were obtained. The male to female ratio in the study group was 1.2:1, and the mean patient age at the time of surgery was 8.27 years. The patients underwent nasoendoscopic examination and the velar closing ratio was categorized as 0.1–0.4 in 53.4% and 0.5–0.7 in 46.6%. The assessment of speech after mFP-PF showed statistically significant changes for all perceptual speech outcomes. The incidence of repeat surgery was 3.4%. This study revealed that 96.6% of patients did not require second surgery for velopharyngeal insufficiency. Further studies on obstructive sleep apnoea in post-mFP-PF patients and improvements to the surgical technique should be considered.     

Speech outcome after closure of oronasal fistulas with bone grafts.

PURPOSE: The purpose of this prospective study was to evaluate the outcome of speech after complete closure of oronasal fistulas with bone grafts and to determine the possible relationship between outcome of speech and the size and location of the oronasal fistulas. PATIENTS AND METHODS: Ten unilateral cleft lip and palate patients with postoperative oronasal fistulas, ranging in age from 7 to 14 years, underwent secondary alveolar cleft repair and closure of the oronasal fistulas with an iliac bone graft. All patients underwent videofluoroscopic evaluation of the velopharyngeal valve, audiologic assessment, and speech evaluation (resonance, nasal emission, articulation, intelligibility, and nasalance) preoperatively. The examinations were repeated 3 months postoperatively. RESULTS: Six patients had preoperative velopharyngeal competency (60%). Of the 4 patients with slight to mild velopharyngeal incompetency preoperatively, 2 developed velopharyngeal competency postoperatively. All patients had satisfactory audiologic function preoperatively. Every patient also was intelligible before and after surgery. Eight patients (80%) showed nasal emission before surgery and 7 of these patients improved postoperatively (P <.01). Nine patients had articulation errors before surgery, with no significant improvement postoperatively. Nasalance was significantly improved in selected sequences. All patients had variable levels of nasality preoperatively; 8 showed a significant decrease of nasality postoperatively (P <.002). The results were not related to location or size of the oronasal fistulas. CONCLUSION: A significant improvement in speech is noticeable after closure of oronasal fistulas. Early oronasal fistula closure might prevent permanent speech distortions acquired by the cleft palate patients at an early age.