针刺配合言语康复训练治疗脑卒中后构音障碍临床研究进展

构音障碍是指由于发音器官神经肌肉的器质性病变而引起发音肌肉无力、肌张力异常以及运动不协调等,产生发声、发音、共鸣、韵律等言语运动控制障碍。构音障碍在脑卒中患者中的发生率为30%~40%,构音障碍依据神经系统损害部位和言语受损严重程度的不同可分为6型[1],分别为痉挛型、弛缓型、运动失调型、运动过少型、运动过多型、混合型。其中痉挛型最为多见,占87.8%[2,3]。传统医     

脑瘫儿童语言评价与干预训练的研究进展

脑瘫儿童语言障碍包括语言发育迟缓和构音障碍,是小儿脑瘫常见并发症,其发生率为80.4%,由于语言沟通困难,不仅影响患儿的语言及社会交往能力,也影响患儿的智力水平及社会心理发育[1].其中构音障碍足脑瘫儿童语言障碍最常见的类型,国外学者Suteliffe AG等研究发现脑瘫患儿的构音障碍是由于中枢或周围神经系统病变导致言语肌肉的麻痹或运动不协调所致[2],WangYT等将构音障碍分为6种类型:痉挛型、迟缓型、失调型、运动过强型、运动过弱型和混合型[3].     

重复经颅磁刺激治疗脑病损构音障碍的研究进展

<正>构音障碍是指一组神经肌肉病变引起的运动性言语障碍，是由中枢或周围神经受损引起的与言语相关的肌肉麻痹/收缩力减弱或运动不协调所致的言语障碍。病因常见于脑卒中、帕金森病、脑瘫、延髓背外侧综合征、多发性硬化症、脑肿瘤等。构音障碍根据神经解剖及言语声学特点分为六种类型：与上运动神经元损伤相关的痉挛型构音障碍；与下运动神经元损伤相关的弛缓型构音障碍；主要由小脑功能障碍引起的失调型构音障碍；以及运动过强型构音障碍和运动过弱型构音障碍，     

脑卒中所致痉挛型构音障碍的康复训练方法及疗效

目的探讨脑卒中所致痉挛型构音障碍的临床康复训练方法及疗效。方法对45例脑卒中所致痉挛型构音障碍患者给予针对性言语训练,采用改良Frenchay构音障碍评价法评定疗效。结果45例患者的康复训练总有效率为93%,其中病程在1个月内的患者有效率100%,病程1～3个月的患者有效率96%,病程3个月以上的患者有效率85%。结论针对性的言语训练可以恢复和改善脑卒中所致痉挛型构音障碍患者的言语功能,介入时间越早疗效越显著。     

30例重度痉挛型构音障碍患者的言语康复

目的观察言语训练对于重度痉挛型构音障碍效果分析。方法对于重度构音障碍的患者采用呼吸训练,头颈部放松训练,冰刺激训练,唇、舌、下颌训练,发音训练等言语训练,用中国康复研究中心构音障碍评定法进行评定。结果患者的改善率为90%。结论言语训练可以改善重度痉挛型构音障碍患者的症状。     

脑瘫患儿构音障碍特点与言语治疗

对５６例脑瘫患儿的构音运动和言语特点进行了分析与治疗。结果：４５例和存在运动性构音发生率为８０．４％,其中徐动型、失调型、痉挛型四肢瘫患儿构音障碍发生主高且程度较严重痉挛型双瘫次之。偏瘫型则较少运动异常构音障碍;对其中４５例患儿采用基础性训练、构音器官运动及构音训练后总有效率为９１．０％,提示运动性构音障碍是脑瘫患儿文言语的主要问题,早期正确评价和治疗具有重大意义。     

构音障碍的发音、言语表现与治疗

构音障碍 (ｄｉｓａｒｔｈｒｉａ)是由于中枢或周围神经系统病变导致言语肌肉的麻痹或运动不协调所致的言语障碍 ,从大脑通路到肌肉本身的病变都可引起 ,是临床上很常见的语言障碍。由于此异常的主要发病机理为运动障碍 ,所以又称为运动障碍性构音障碍。常见病因有脑卒中、颅脑外伤、脑肿瘤、脑瘫、肌萎缩性侧索硬化症、帕金森氏病等。Ｄａｒｌｅｙ等将构音障碍分为 6种类型 ,即痉挛型、弛缓型、运动减少型、运动过多型、失调型和混合型构音障碍。1口肌 (ｏｒａｌｍｕｓｃｕｌａｔｕｒｅ)由上运动神经元损伤引起的构音障碍称为痉挛型构音障…     

脑瘫儿童的语言特征初探

目的 探讨各类型脑瘫儿童语言发育与构音的特点。方法 采用中国康复研究中心制定的S—S语言发育迟缓检查法和构音障碍检查法，对76例不同类型脑瘫儿童进行语言发育和构音能力的全面评定，并进行对比分析。结果 语言障碍见于73．1％的患儿。痉挛型双瘫患儿语言听理解与口语表达一致，语言发育迟缓和运动性构音障碍发生率分别为45．95％和48．65％，且二者常并存。痉挛型四肢瘫和徐动型脑瘫患儿听理解与口语表达发育分离，理解明显好于表达，语言发育迟缓发生率分别为90％和64．7％。徐动型、共济失调型和痉孪型四肢瘫构音障碍突出，见于所有息儿。偏瘫患儿较少发生语言问题。结论 语言障碍是脑瘫的主要临床表现之一，不同脑瘫类型的语言表现各有特征性，康复时应对患儿进行认真的语言—言语评定。     

脑瘫儿童辅音声母构音清晰度分析

构音清晰度(speech intelligibility)又称言语可懂度,即听众可以准确地获得说话者语音信号表达信息的程度,是言语一语言病理学(特别是在构音障碍)的重要概念[1].构音障碍患者言语清晰度下降,从而降低了其在日常生活中的交流能力.构音清晰度降低是构音障碍最重要的临床和社会学症状,改善构音清晰度是言语治疗的基本目标[2].在对脑瘫儿童构音障碍的相关研究中发现,脑瘫儿童构音障碍的发生率几乎为100%,即各类型的脑瘫儿童都存在不同程度的构音清晰度问题[3].     

重度痉挛型构音障碍语言训练2例

构音障碍是因神经病变、与言语有关的肌肉麻痹、收缩力减弱或运动不协调所致的言语障碍。重度构音障碍是严重的肌肉麻痹使运动功能严重障碍而难以发声，多见于急性期患者，或病程长、病情重并已形成后遗症或病情逐渐加重的退行性病变患者。笔者对2例重度构音障碍患者进行语言训练，现报道如下；     

Intrathecal baclofen therapy improves functional intelligibility of speech in cerebral palsy

OBJECTIVE: To assess the effect of intrathecal baclofen on spastic dysarthia in cerebral palsy. DESIGN: Single case study. METHODS: Functional outcome measures, including the Assessment of Intelligibility of Dysarthric Speech, were performed before and after a trial of intrathecal baclofen in an adult patient with spastic dysarthria due to cerebral palsy. The patient proceeded to intrathecal baclofen pump implantation and was reassessed after six months of continuous intrathecal baclofen therapy. RESULTS: Improvement in function including speech intelligibility was seen following the intrathecal baclofen trial. The improvement was sustained at six months post pump implantation. CONCLUSIONS: Intrathecal baclofen improved functional intelligibility of speech in a carefully selected subject. The Assessment of Intelligibility of Dysarthric Speech was found to be a useful quantitative tool to assess the effect of intrathecal baclofen on spastic dysarthria.     

The cognitive competence of speakers with acquired dysarthria: judgements by doctors and speech and language therapists

Background. Studies have shown that listeners make negative attributions towards people with communication impairments. This appears to be the case for healthcare professionals as well as non-professional listeners.

Aims. This study extends this line of research to speakers with acquired dysarthria. These clients often complain that listeners treat them differently after the onset of their speech impairment. The study examines judgements of the cognitive status of speakers with acquired dysarthria made by health care professionals.

Methods and procedures. Doctors, speech and language therapists and speech and language therapy students viewed videos of speakers with acquired dysarthria and of controls matched for age and gender who had acquired neurological deficits that did not affect their speech. Listeners judged whether speakers could carry out a number of everyday tasks. All the tasks were known to be within the speakers' competence.

Outcomes and results. Doctors were significantly less confident of the competence of speakers with dysarthria than of the controls. No difference was found for speech and language therapists or speech and language therapy students.

Conclusions Although caution is required in generalizing these results to other speakers, the results lend some support to the complaints of clients with acquired dysarthria that their speech leads others, in this case doctors, to misjudge their cognitive competence.     

The cognitive competence of speakers with acquired dysarthria: Judgements by doctors and speech and language therapists

Background.?Studies have shown that listeners make negative attributions towards people with communication impairments. This appears to be the case for healthcare professionals as well as non-professional listeners.

Aims.?This study extends this line of research to speakers with acquired dysarthria. These clients often complain that listeners treat them differently after the onset of their speech impairment. The study examines judgements of the cognitive status of speakers with acquired dysarthria made by health care professionals.

Methods and procedures.?Doctors, speech and language therapists and speech and language therapy students viewed videos of speakers with acquired dysarthria and of controls matched for age and gender who had acquired neurological deficits that did not affect their speech. Listeners judged whether speakers could carry out a number of everyday tasks. All the tasks were known to be within the speakers' competence.

Outcomes and results.?Doctors were significantly less confident of the competence of speakers with dysarthria than of the controls. No difference was found for speech and language therapists or speech and language therapy students.

Conclusions Although caution is required in generalizing these results to other speakers, the results lend some support to the complaints of clients with acquired dysarthria that their speech leads others, in this case doctors, to misjudge their cognitive competence.     

The epidemiology of cerebral palsy: Incidence,impairments and risk factors

Purpose.?Describing the epidemiology of cerebral palsy (CP), its impairments and risk factors.

Method.?Literature review 1965?–?2004. Search terms: Cerebral palsy, incidence, prevalence, impairments, risk factors.

Results.?In the last 40 years the prevalence of CP has risen to well above 2.0 per 1000 life births. In this time span the proportion of low-birthweight infants rose, the proportion of diplegia decreased, while the proportion of hemiplegia increased. CP is more prevalent in more deprived socio-economic populations. The majority of people with CP have the spastic syndrome of which the diplegic group is the smallest. Dependent on the subgroup of CP, 25?–?80% have additional impairments. A large proportion has some kind of cognitive impairment; the prevalence varies with the type of CP and especially increases when epilepsy is present. Epilepsy is present in 20?–?40%; it is most common among the hemi- and tetraplegics. Sensibility of the hands is impaired in about half. Chronic pain is reported by more than a quarter of the adults. Up to 80% have at least some impairment of speech. Low visual acuity is reported in almost three-quarters of all children. Half of all children have gastrointestinal and feeding problems. Stunted growth occurs in a quarter, while under- or overweight problems are present in half of the children. Almost 70% of people with spastic CP have abnormal brain CT findings; abnormal cranial ultrasounds is most strongly associated with hemiplegia, normal cranial ultrasounds with diplegia. The most important risk factors for CP are low birthweight, intrauterine infections and multiple gestation.     

The epidemiology of cerebral palsy: incidence, impairments and risk factors

Purpose. Describing the epidemiology of cerebral palsy (CP), its impairments and risk factors.

Method. Literature review 1965 - 2004. Search terms: Cerebral palsy, incidence, prevalence, impairments, risk factors.

Results. In the last 40 years the prevalence of CP has risen to well above 2.0 per 1000 life births. In this time span the proportion of low-birthweight infants rose, the proportion of diplegia decreased, while the proportion of hemiplegia increased. CP is more prevalent in more deprived socio-economic populations. The majority of people with CP have the spastic syndrome of which the diplegic group is the smallest. Dependent on the subgroup of CP, 25 - 80% have additional impairments. A large proportion has some kind of cognitive impairment; the prevalence varies with the type of CP and especially increases when epilepsy is present. Epilepsy is present in 20 - 40%; it is most common among the hemi- and tetraplegics. Sensibility of the hands is impaired in about half. Chronic pain is reported by more than a quarter of the adults. Up to 80% have at least some impairment of speech. Low visual acuity is reported in almost three-quarters of all children. Half of all children have gastrointestinal and feeding problems. Stunted growth occurs in a quarter, while under- or overweight problems are present in half of the children. Almost 70% of people with spastic CP have abnormal brain CT findings; abnormal cranial ultrasounds is most strongly associated with hemiplegia, normal cranial ultrasounds with diplegia. The most important risk factors for CP are low birthweight, intrauterine infections and multiple gestation.     

帕金森病的言语障碍与治疗

运动减少性构音障碍是帕金森病的主要言语障碍。声音嘶哑是其主要言语特征。多数患者表现喉机能失调。粗糙声、气息音、声音震颤、单一音调和单一音量在一些患者也可以发生 ,鼻音化构音和言语速率的改变可能比较少见。声门照相测量法可以做为帕金森氏病言语障碍的一种现代评测技术。本文介绍了治疗轻度至中度构音障碍的生理康复途径 ,药物左旋多巴可以改善帕金森病患者的唇功能失常 ,一些研究还显示左旋多巴能改善帕金森病患者的喉机能失常和发音。     

脑病损后构音障碍的诊评：附65例临床报告

应用弗朗蔡构音障碍评法对６５例构音障碍患者进行诊评，发现脑血管病后构音障碍以痉挛型多见，共５７例占８７．８％，依次是弛缓型、运动失调型、运动过弱型。该评价法能比较全面系统地对脑病损后构音障碍进行诊断分型与鉴别诊断，为临动态的观察病情变化及疗效判定，提供可靠的客观依据，同时能对判断预后有一定指导作用。     

痉挛型双瘫的临床特征

目的：探讨痉挛型双瘫的临床特征,为脑功能的全面康复提供基础资料。方法：对５０ 例痉挛型双瘫患儿的临床资料进行回顾性分析。结果：５０ 例中３５ 例为早产儿（７０％）,高危因素依次为早产、低体重、缺氧、硬肿症、颅内出血;１５ 例为足月儿（３０％）,高危因素主要为窒息、缺氧缺血性脑病。５０ 例患儿运动神经功能异常,全部表现为骨盆带及下肢痉挛及由此所致的姿势异常,双上肢受累较轻。平均精细运动年龄１８．５ 个月,粗大运动年龄８．７５ 个月（Ｐ＜ ０．０１）。半数患儿同时合并斜视、语言发育迟缓和／ 或运动性构音障碍。结论：痉挛型双瘫的病因,运动神经系统表现具有特征性,对其正确的认识评价有助于康复计划的制订。