语言障碍患者出院后家庭语言治疗初探

为了寻找一种语言障碍患者出院后的语言治疗方案，作者观察了14例能坚持一年家庭语言治疗的脑损伤后语言障碍患者。这14例患者在住院期间由语言治疗师进行评估及治疗，同时培训家人，出院后由经过训练的家人继续进行一年的家庭语言治疗。结果表明：经过一年的家庭语言治疗，患者听与说的能力有了显著的提高（p＜0．05）。因此，语言障碍患者出院后的家庭语言治疗是一种有效的治疗方法。     

Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction

OBJECTIVE: Family members of critically ill patients report dissatisfaction with family-clinician communication about withdrawing life support, yet limited data exist to guide clinicians in this communication. The hypothesis of this analysis was that increased proportion of family speech during ICU family conferences would be associated with increased family satisfaction. DESIGN: Cross-sectional study. SETTING: We identified family conferences in intensive care units of four Seattle hospitals during which discussions about withdrawing life support were likely to occur. PARTICIPANTS: Participants were 214 family members from 51 different families. There were 36 different physicians leading the conferences, as some physicians led more than one conference. INTERVENTIONS: Fifty-one conferences were audiotaped. MEASUREMENTS: We measured the duration of time that families and clinicians spoke during the conference. All participants were given a survey assessing satisfaction with communication. RESULTS: The mean conference time was 32.0 mins with an sd of 14.8 mins and a range from 7 to 74 mins. On average, family members spoke 29% and clinicians spoke 71% of the time. Increased proportion of family speech was significantly associated with increased family satisfaction with physician communication. Increased proportion of family speech was also associated with decreased family ratings of conflict with the physician. There was no association between the duration of the conference and family satisfaction. CONCLUSIONS: This study suggests that allowing family members more opportunity to speak during conferences may improve family satisfaction. Future studies should assess the effect of interventions to increase listening by critical care clinicians on the quality of communication and the family experience.     

Are people with learning disabilities able to contribute to focus groups on health promotion?

AIM: This paper shows the differences between the success of three focus groups in promoting group discussion on health promotion and also the detailed effects of individual members with speech and language difficulties in participating. BACKGROUND: Conducting focus groups with people with learning disabilities can promote their social inclusion. CONCLUSIONS: We conclude that focus groups are an effective method of conducting exploratory research with adults with learning disabilities in the community, however, ability to participate with other members may be a limiting factor. Furthermore, special arrangements may need to be made for groups to be successful, including the use of an interpreter. The preparation of the moderator is also an important factor in group success.     

Quilting narrative: using repetition techniques to help elderly communicators

As we gain a better understanding of narratives presented by both normally aging adults and those with cognitive deficits, we are able to communicate more effectively. We can select more interactive ways to help construct meaning with individuals who appear to have lost the ability to communicate. We can listen for formulaic expressions or colloquial speech, furnish beginnings, echo details, add to endings. We can recall what we were told in an earlier conversation and reintroduce the topic so that the speaker with Alzheimer disease (AD) can recognize information and expand it instead of being asked to recall it. By using the repetition technique of quilting narrative, nurses can help family members see that the person with AD is trying to signal some part of a life event, which helps convey to others who he or she is.     

听障儿童听觉言语能力影响因素的研究

目的探讨影响听障儿童听觉言语能力的相关因素.方法对43名听障儿童的助听听阈、听觉能力、言语能力以及学习能力等方面进行测查.结果性别、助听方式对听障儿童的听觉言语能力无显著性影响(P>0.05);助听听阈对听障儿童的听觉能力有显著性影响(P<0.05);语言能力与学习能力呈显著正相关(P<0.05);听觉能力对言语能力有非常显著性正向预测作用(P<0.001).结论及时、有效地给予听觉补偿,抓住语言发展的关键期,尽早进行康复训练,有助于听障儿童听觉言语能力的康复.     

The Benefits of Triad Communication in Home Health Care

Triad communication can be used by the nurse to facilitate communication with a patient and a caregiver in home health care. The family members may be involved as listeners or in discussion with the patient, the nurse, or both. The caregiver is selected based on specific communication objectives and the third person's ability to assist in meeting these objectives. Triad communication can (a) support the family and patient, (b) increase the caregiver's understanding, (c) increase compliance, (d) increase the nurse's understanding, (e) reinforce instruction, (f) decrease manipulation, (g) promote communication between family members, and (h) facilitate positive patient-family relationships.     

聋幼儿听力语言康复评估

目的：探讨聋儿配戴助听器后不同的听力补偿效果与语言识别率、语音清晰度以及语言表达能力的关系。方法：应用统一试用的全国聋幼儿康复评估标准,分五个组对全国１４ 省市２０１ 名聋幼儿进行听力语言康复评估,并经统计分析处理。结果：聋儿配戴助听器后不同的听力补偿效果与其它３ 项均成正向相关,（ｒ ＞ ０．９,Ｐ＜ ０．０５）。聋儿的语言表达能力与康复训练时间亦呈正向相关（ｒ ＝ ０．９５, Ｐ＜ ０．０１） 。结论：为聋儿科学地选配助听器,保证其良好的助听效果,并使其坚持长期的听力训练及语言学习是促进聋儿早期康复的首要条件。     

运动性构音障碍言语声学水平客观评价的研究进展

构音障碍是由于中枢或周围神经损伤所致的与言语产生有关的运动控制障碍而引起的运动性言语障碍。构音障碍降低患者的言语清晰度和社会交流能力,并影响其生活质量。对构音障碍的评价分为主观评价及客观仪器检查,后者主要有电子喉镜、声门图、电子腭位图、鼻流量测定以及包括语图、轮廓声谱图、扰动和噪声测量在内的声学分析等。其中利用多维嗓音程序进行定量声学分析是国外常用的研究方法。国内多将此项技术用于正常人群及喉科疾病患者嗓音研究,也用于腭裂、帕金森病和脑瘫患者语音特征的研究,尚未见到关于运用多维嗓音程序对脑血管病及脑外伤所致构音障碍进行声学分析的报道。     

Speech input for handicapped patients

Depending on the remaining functions of the limbs, head, or articulation organs, various types of aids are available to motor impaired persons for controlling technical devices. For those with their speech organs and speaking ability unimpaired, an innovative approach has recently become available through voice input which uses speech recognition to automatically identify spoken input. This mode permits the largest possible information input per time unit, may however involve faulty recognition. Practical applications of speech recognition systems for motor impaired persons lie in the private and occupational settings, with purposes ranging from telecommunication, environmental control, to locomotion or computer control. Examples are the speech-controlled use of a television set or a wheelchair. Apart from controlling technical devices, voice input may, in other disabling conditions, also be employed to aid human communication. An overview of commercial speech recognition devices is given.     

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。     

An audiological profile of elderly Australians reporting speech affecting stroke

This study examined the audiological profile and hearing rehabilitation of 73 people who reported having had speech-affecting strokes. Participants were drawn from the Blue Mountains Hearing Study (BMHS), a population survey of age-related hearing loss in 2956 members of a representative elderly Australian community. While speech-affecting stroke did not seem to cause greater levels of hearing impairment or handicap than for other participants matched for age and gender, this may be due to a low prevalence of participants with severe effects on speech or language as a result of their stroke. Although 52% of participants self-reported a hearing loss, fewer than 23% had ever worn a hearing aid with only 15% wearing hearing aids for more than 1 hour per day. Pure tone audiometry identified 64% of participants with thresholds considered appropriate for hearing aid fitting when previously established criteria were applied. Questions concerning use of hearing aid/s and self reported hearing loss were not reliable in determining which participants with a speech affecting stroke met these audiometric criteria. The risks of uncorrected hearing loss compromising speech and language assessment and rehabilitation following stroke are discussed.     

语前聋儿童人工耳蜗植入分析

目的：通过对已植入人工耳蜗的语前聋儿童在手术中，手术后早期和调试中所遇问题的总结，探讨术中术后和调机中的特别注意事项。方法：9例在我院接受人工耳蜗植入，开机至少6月的语前聋儿童被纳入本次分析。采用回顾临床资料和进行自由声场测试纯音，言语察觉率和开放式，闭合式言语分辨率的方法评价人工耳蜗补偿听力的效果。结果：全部患者均被成功地植入了人工耳蜗。手术并发症计有电极滑出耳蜗1例，术中穿破外耳道后壁2例，术后出现术侧面肌抽动2例。自由声场纯音听阈测试，均在30～35dB SPL。言语察觉阈35～40dB SPL；言语分辨率(除3例外)，开放式大于50％，最佳者达到78％；闭合式大于80％。4例植入时间较长的学龄期儿童已进入普通小学学习。结论：人工耳蜗植入术加术后言语训练，能达到改善听力，提高语言能力的目的。并对术中寻找圆窗龛困难，术后出现的电极滑出和面肌抽动的原因及相应的对策进行了探讨。     

Experiments in the application of isolated-word recognition to secondary driving controls for the disabled.

Adaptive driving controls such as mechanical hand controls or electromechanical contact switches are now available which allow even the most severely impaired to drive. The residual functions, however, are all directed toward primary controls such as steering, braking, and accelerating, limiting the ability to operate secondary controls such as the horn, turn signals, ignition, and headlights, etc. In this paper, we discuss the application of speech recognition technology when operating these secondary controls. The performance of a speech recognition system inside a vehicle is studied, and the types of noise that degrade the recognition accuracy are also identified. Results are presented on the degradation in recognition performance caused by engine noise, fan noise, and interfering speech.     

家属实施语义导航训练法改善失语症患者言语功能的疗效观察

目的:探讨家属采用语义导航训练(SNT)对失语症患者言语功能改善的作用。方法:20例失语症患者随机分为SNT组(n=10)和语义无关训练(US)组(n=10)。从中文联想词汇库中选取122个词汇,SNT组按照网络分析技术自动生成语义关联的词汇顺序,而US组按照随机排列的词汇顺序呈现给患者,并由患者家属进行为期10d,每天1次的言语训练。训练前后采用西方失语症成套测验(WAB)和微小交流活动量表(Mini-cal)评估患者的言语功能。结果:训练后SNT组WAB的自发言语和听理解子项目以及失语商(AQ)积分均较US组显著增加,SNT组训练后WAB四个子项目和AQ积分均较训练前显著增加。训练后SNT组Mini-cal的定性、定量1、定量2和总分均较US组显著增加,SNT组训练后Mini-cal的定性、定量1、定量2和总分均较训练前显著增加。结论:家属采用SNT可以显著改善失语症患者的言语功能,提示该方法适合于家庭开展言语治疗。     

It's the staff that keeps the patients talking.

This article is a critical look at the ingredients necessary to encourage chronic psychiatric patients to speak in a group setting. This study suggests that those chronically hospitalized patients with little speech can be encouraged to increase their verbalizations. Staff presence was the critical factor in the increase of patient speech. The opportunity to gain unusual privileges did not substantially increase the patient speech. In essence, this study indicates that as the amount of conversation from the nursing staff increases, a corresponding increase in patient verbalization occurs.     

Speech discrimination in noise for patients with cochlear implants

The aim of the study was to evaluate the speech discrimination ability of postlingually deaf adults implanted with the Combi 40 cochlear implant in noise and to compare the results with the speech discrimination ability of patients provided with hearing aids. The 12-month postoperative hearing performance of 12 consecutive patients was tested using a sentence discrimination test in quiet and noise. The results of the present study demonstrate that all patients obtained substantial benefit from their implants even in situations coupled with noise. The speech understanding of cochlea-implanted patients appears to be better than that of patients provided with hearing aids. Very high scores (mean, 40.2%) were achieved at a signal-noise ratio of 15 dB.     

Time-expanded speech and speech recognition in older adults

Speech understanding deficits are common in older adults. In addition to hearing sensitivity, changes in certain cognitive functions may affect speech recognition. One such change that may impact the ability to follow a rapidly changing speech signal is processing speed. When speakers slow the rate of their speech naturally in order to speak clearly, speech recognition is improved. The acoustic characteristics of naturally slowed speech are of interest in developing time-expansion algorithms to improve speech recognition for older listeners. In this study, we tested younger normally hearing, older normally hearing, and older hearing-impaired listeners on time-expanded speech using increased duration and increased intensity of unvoiced consonants. Although all groups performed best on unprocessed speech, performance with processed speech was better with the consonant gain feature without time expansion in the noise condition and better at the slowest time-expanded rate in the quiet condition. The effects of signal processing on speech recognition are discussed.     

Neural changes associated with speech learning in deaf children following cochlear implantation

Brain plasticity was investigated, which underlies the gaining of auditory sensory and/or auditory language in deaf children with an early onset deafness after cochlear implantation (CI) surgery. This study examined both the glucose metabolism of the brain and the auditory speech learning using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and the Central Institute of Deaf (CID) test, respectively, both before and after the CI surgery. In a within analysis comparing the pre-CI and the post-CI PET results, CI itself resulted in an increase in the glucose metabolism in the medial visual cortex, the bilateral thalamus, and the posterior cingulate. Compared with the normal hearing controls, the brain activity of the deaf children was greater in the medial visual cortex and bilateral occipito-parietal junctions after the CI. The better speech perception ability was associated with increases in activity in the higher visual areas such as middle occipito-temporal junction (hMT/V5) and posterior inferior temporal region (BA 21/37) in the left hemisphere and associated with decreases in activity in the right inferior parieto-dorsal prefrontal region. These findings suggest that the speech learning resulted in a greater demand of the visual and visuospatial processings subserved by the early visual cortex and parietal cortices. However, only those deaf children who successfully learned the auditory language after CI used more visual motion perception for mouth movement in the left hMT/V5 region and less somatosensory function in the right parieto-frontal region.     

ICU患者家属焦虑状况调查

目的 对ICU患者家属的焦虑状况进行调查，以了解ICU患者家属的心理焦虑水平，提高ICU护理人员对加强患者家属心理支持的认识，为ICU护理人员对患者家属这个特殊群体进行心理支持提供一定的理论依据。方法 本研究为描述性研究，应用Zung（1971）编制的焦虑自评量表（SAS）和自制问卷，采用便利抽样方法对70例患者家属进行问卷调查。结果 在所调查的70例患者家属中，有焦虑情绪者70例，达到100％。其中男性26例，女性44例。结果显示，性别、自己负担医药费用金额承受能力不同的患者家属之间焦虑程度有差异性，而不同年龄段的患者家属之间焦虑水平无显著差异。结论 重症患者家属在亲人入住ICU后，普遍存在较重的焦虑情绪，从事ICU工作的医护人员在临床护理患者的同时．必须兼顾ICU患者家属，为他们提供必要的心理帮助，增强他们的信心，加强重症患者的家庭支持能力，体现以人为本、全面护理的理念。     

Facing the fear of speaking in public

The tools and talents of public speaking can help in many ways that do not involve a lectern. The steps involved in preparing a speech can help organize any problem-solving discussion. Effective speaking ability is an asset in most professions, and your success or failure in this area affects the others' perceptions of your professional capacity.