语音评估在腭裂外科治疗中的应用

本文根据我国语音师的工作特点和腭裂临床治疗需求,论述了在目前腭裂语音师培养与发展过程中,开展语音评估的意义。认为语音评估应是语音师的主要职责,需加强其语音评估能力的建设。本文报道了语音评估标准化流程,及其在腭裂外科治疗中初步应用的结果。     

心理指导在腭裂患儿术后语音治疗中的作用

目的：研究腭裂患儿术后心理指导在语音治疗中的作用。方法：对46例腭裂患儿及家长在出院前进行语音治疗心理指导,出院后定期复查评价,并根据患儿情况再次给予心理指导。结果：经过指导训练,患者语言能力得到长足进步,心理健康状况良好,术后患者语音清晰度明显提高。结论：心理指导对腭裂术后的语音治疗有很大的促进作用,术后加强心理指导并及早地开展语音治疗,能明显地改善患者语言状况。     

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。     

腭裂患者术后语音障碍影响因素Logistic回归分析

目的:阐明腭裂术后语音障碍的病因,为腭裂术后预防和治疗语音障碍提供依据。方法:对腭裂术后来我院复查的语音障碍患者69名进行问卷调查和病例回顾,对各因素进行Logistic回归分析,分析各因素对发生腭裂术后语音障碍的作用。结果:手术年龄增大,腭裂的程度重,腭咽闭合不全为腭裂术后语音康复的不利因素;与此相反,语音训练,亲子交流为其保护因素。腭裂患者术后语音障碍风险模型:Y=-1.733+1.148X1-1.091X2+1.105X3-1.136X4-2.207X5。结论:早期手术、营造积极的家庭语言发育环境、术后进行正确的语音训练对防止腭裂患者语音障碍的发生具有重要意义。     

强化性语音训练在腭裂术后语音治疗中的应用

目的：采用强化性针对性语音训练以期缩短音训练治疗时间。方法：采用发音部位及发音方式异常针对性语音训练方法,声门停顿音矫治训练方法对患者进行每天１～２次训练,以能发对所有汉语辅音、音节、词组及短句为标准决定训练完成时间。结果：１６名患者经过平均２５ｄ的强化训练后,语音清晰度从平均４９．９％提高到平均８８．２％。平均提高３８．５％。统计学检查有极显著差异性（Ｐ＜０．００１）。结论：强化性针对性语音训练确能在较短时间内达到提高语音清晰度,改善语音功能的目的。     

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。     

语音训练在腭裂术后患者语音恢复中的价值

为探讨语音训练在腭裂术后患者语音恢复中的作用，本研究应用计算机语音信号分析系统对经语音训练的26例腭裂术后患者进行单元音头三个共振峰频率测试，语音训练重点对唇的协调性，舌的灵活性及下颌运动的准确性训练、结果表明，腭咽闭合完全者经语音训练代偿性不良习惯已基本矫正，语音清晰度显著提高。本文指出腭裂术后患者必须在腭咽闭合的基础上，语音训练才能打破异常的神经─肌肉模式，矫正代偿性不良发音习惯，获得清晰准确的语音。     

Speech outcome following treatment in cross-linguistic cleft palate studies: methodological implications.

OBJECTIVE: In cross-linguistic studies of cleft palate speech outcome following treatment, treatment is the independent variable, speech outcome is the dependent variable, and the speakers' language background is a background variable, like sex, age, and cleft type, which must be eliminated. This article focuses on language as a background variable and how it should be treated. The methodological problems are illustrated through a presentation of two cross-linguistic speech outcome studies. CONCLUSION: When speakers of different language background are included in cleft palate studies of speech outcome following treatment, speech outcome data should be based on speech units that are phonetically identical across languages. This affects the make-up of the speech material used in the study. In practice, the requirement of phonetically identical speech units may not be totally met, and detailed information regarding the interaction between the cleft condition and speech sound production is still required to fully understand how the validity of data is affected if this requirement is not met.     

The application of nasometer on the analysis of normal and cleft palate speech]

This paper reports the use of for assessment of speech by oronasal acoustic measures. Nasal energy during speech is reflected by nasolance value and graph pattern. The degree of velopharyngeal closure and the situation and movement of other speech organs can be demonstrated. The speech of 120 normal children and 60 preoperation cleft palate patients are studied. The scales of normal value and graph pattern are recorded. Comparing with normal speech, the scale of nasolance value and characteristics of graph pattern of cleft palate speech are obviously changed and may be assessed by this apparatus. The treatment and speech therapy plan can be made with the results obtained by this method as the basis.     

Improving the accuracy of automated cleft speech evaluation

An automated cleft speech evaluator, available globally, has the potential to dramatically improve quality of life for children born with a cleft palate, as well as eliminating bias for outcome collaboration between cleft centers in the developed world. Our automated cleft speech evaluator interprets resonance and articulatory cleft speech errors to distinguish between normal speech, velopharyngeal dysfunction and articulatory speech errors. This article describes a significant update in the efficiency of our evaluator.Speech samples from our Craniofacial Team clinic were recorded and rated independently by two experienced speech pathologists: 60 patients were used to train the evaluator, and the evaluator was tested on the 13 subsequent patients. All sounds from 6 of the CAPS-A-AM sentences were used to train the system.The inter-speech pathologist agreement rate was 79%. Our cleft speech evaluator achieved 85% agreement with the combined speech pathologist rating, compared with 65% agreement using the previous training model.This automated cleft speech evaluator demonstrates good accuracy despite low training numbers. We anticipate that as the training samples increase, the accuracy will match human listeners.     

游离皮瓣修复舌癌术后缺损联合语音训练的语音功能评价

目的探讨舌癌术后缺损经游离皮瓣同期修复并结合语音训练后的语音功能恢复情况。方法舌癌患者15例,其中男8例,女7例,平均年龄54岁,T2期13例,T3期2例。均行舌癌扩大切除及患侧颈淋巴清扫术,根据舌体缺损大小制备游离前臂皮瓣或股前外侧皮瓣,完成舌体缺损重建,术后1个月行语音训练,术后6个月后行语音清晰度检查,分析患者术后语音功能恢复情况。结果15例患者皮瓣均完全成活,均获得创口一期愈合。重建后的舌均具有良好的活动度,15例患者的语音清晰度为90％—100％,平均语音清晰度为94.5％。结论游离皮瓣同期修复舌癌术后缺损结合术后语音训练,能够较好地恢复患者的语音功能。     

Speech Therapy with Obturator

Rehabilitation of speech is tantamount to closure of defect in cases with velopharyngeal insufficiency. Often the importance of speech therapy is sidelined during the fabrication of obturators. Usually the speech part is taken up only at a later stage and is relegated entirely to a speech therapist without the active involvement of the prosthodontist. The article suggests a protocol for speech therapy in such cases to be done in unison with a prosthodontist.     

The effect of timing of surgery for velopharyngeal dysfunction on speech

The timing of surgery for velopharyngeal dysfunction has been based on assumptions about the relation between age, speech development, and velopharyngeal dysfunction. Cleft palate teams often counsel parents to have an intervention for velopharyngeal dysfunction performed earlier rather than later, believing that earlier interventions result in more rapid or better normalization of speech. The objective of this retrospective chart review study is to determine whether the age at surgical intervention for velopharyngeal dysfunction has an effect on the subsequent length of speech therapy. Of 174 patients included in the study database, 36 had velopharyngeal dysfunction for which further velopharyngeal management was required. Of the 36 patients who received surgical velopharyngeal dysfunction management, 27 had verifiable speech therapy records. These 27 patients represent the study population. The outcome measure was the total length of subsequent speech therapy until speech normalization. The data suggest that there is no relation between the age at velopharyngeal dysfunction surgical management and the amount of speech therapy needed to achieve normalization of the speech impairments secondary to velopharyngeal dysfunction after that management. In conclusion, 1) the age at surgical velopharyngeal dysfunction management (pharyngeal flap or sphincter pharyngoplasty) does not have an effect on subsequent normalization of speech as measured by the duration of speech therapy necessary to achieve normalization of the speech impairments secondary to velopharyngeal dysfunction after that management, and 2) the age at surgical velopharyngeal dysfunction management does not affect the likelihood of subsequent surgical velopharyngeal dysfunction management procedures.     

气压,气流测定仪对发音辅助器功能的评价

目的客观评价发音辅助器的功能。方法对１２例置发音辅助器患者进行了分析。结果用发音辅助器后增加了口腔压力，降低了鼻腔气流和缩减了腭咽腔闭合的面积。结论发音辅助器能改善腭咽闭合功能，为临床治疗腭咽闭合功能不全提供非手术方法。     

A functional speech impression used to fabricate a maxillary speech prosthesis for a partial glossectomy patient

Surgery for cancer of the floor of the mouth often results in alteration of the muscles of the tongue and floor of the mouth. Both primary and secondary surgical procedures often result in scar formation with reduced mobility of the tongue during speech and deglutition. Speech is often used as a diagnostic tool in the placement of the anterior teeth during fabrication of a prosthesis. Speech can similarly be used to help determine the proper placement of a speech portion of the prosthesis. The prosthetic rehabilitation approach described lowers the palatal vault with a false palate to enable the tongue to function against it during speech (Fig. 15). Group studies have shown that the design and fabrication of speech prostheses for partial glossectomy patients have significantly improved speech and swallowing for these patients. A speech pathologist is helpful during diagnosis, and speech therapy is necessary for significant speech improvement. Prosthetic rehabilitation alone cannot be expected to improve speech.     

声学技术对腭裂语音构音异常的分析研究

目的：利用声学技术分析腭裂构音异常。方法：分析７２名腭裂术后患者伴有典型错误构音时的／s/t/g/k/强频区位置,频率。以正常组为对照,研究腭裂时错误构音误图表现,结果：伴有错误构音的素高频区域的噪半强度衰尊明显,频率值相对下降,而低频区域常常出现强频区,能量与较大。结论：语音声学技术是一种较发的裂语音错误构音评价方法,还可用于分析腭裂错误形成的病理生理基础。     

心理障碍影响腭裂语音发育和治疗的临床研究

目的：探讨在腭裂语音治疗过程中，心理因素对语音发育及其治疗效果的影响。方法：对63例接受语音治疗的腭裂患者及其家长进行间卷调查，并对调查结果和治疗效果的关系进行分析。结果：心理基本正常者21例，其中19例语音恢复正常，2例语音恢复欠佳；轻度心理障碍者40例，其中23例语音恢复正常，14例语音恢复欠佳，3例仍存在明显的语音障碍；重度心理障碍者2例，均存在明显的语音障碍。结论：心理障碍对腭裂语音发育和治疗效果有明显的影响。     

Prosthetic treatment for speech disorders due to surgically acquired maxillary defects

To evaluate speech following prosthetic obturation of surgically acquired maxillary defects, the speech intelligibility of eight patients was measured preoperatively and postoperatively, with and without prostheses. Oro-nasal separation and velopharyngeal function were also evaluated by use of a specially designed spirometer and endoscope. Following placement of maxillary obturator prostheses, four patients achieved dramatic improvement in speech intelligibility, while four patients did not. In the latter, insufficient improvement in speech intelligibility was attributed to velopharyngeal incompetence or unstable prosthesis. Two of three patients with velopharyngeal incompetence did achieve adequate improvement in speech following placement of a speech appliance in combination with maxillary obturator prostheses.     

腭裂患者家长对语音康复需求的调查分析

目的:调查腭裂患者家长对患儿语音康复的需求。方法:设计腭裂患者语音康复需求调查表,对我院连续收治的58例腭裂患儿的家长进行了语音康复需求调查。结果:虽然家长对患儿语音的重要性关注度较高,但是对如何进行语音康复存在一定的认识误区。通过调查发现,时间和路途问题是不能接受语音治疗的最重要原因,大部分家长希望在周末和假期等时间通过小班课的形式接受语音治疗。结论:入院时对患儿家长应加强宣教,使家长对语音训练的必要性有清晰的认识,同时应针对路途远、复诊困难的患者设计合适的语音训练方法,提高术后患者参加语音训练的数量,帮助患者获得正常的语音。     

Mandibular movement capacity in 19-year-olds with and without articulatory speech disorders

Associations between articulatory speech disorders and mandibular movement capacity, as well as between malocclusions and jaw movements, were examined in two groups of adolescents, i.e. 52 individuals with and 45 without misarticulations of speech. The mean age of the whole sample was 19.2 years. Articulatory speech disorders and functioning of the speech articulators were diagnosed by a phoniatrician. Mandibular movement capacity, malocclusions, occlusal interferences, and signs of temporomandibular dysfunction were recorded by an orthodontist. Multiple regression analyses showed that subjects with articulatory speech disorders were likely to have smaller opening capacity than subjects with a correct speech articulation. Excessive overjet, lateral cross bite, and a tendency to anterior open bite were associated with large movements of the jaw. These results suggest that in young adulthood mandibular movement capacity seems to vary depending on occlusion and is related to misarticulations of speech.