功能性语言沟通能力检查法及其在检测中风失语症中的应用——Ⅱ.与改良波士顿诊断性失语症评测法的比较

中国式功能性语言沟通能力检查法(CFCP)和改良波士顿诊断性失语症评测法(BDAE)同时应用于20名中风后失语患者的检测。结果显示,CFCP和BDAE均能反映失语患者残存的语言能力,CFCP能更好地评估失语患者日常生活功能沟通的变化和指导语言康复训练,而相对简便易行。     

发育性语音障碍儿童汉语普通话声调范畴性知觉研究

目的探讨发育性语音障碍儿童声调感知范畴化的特点及具体表现形式,为临床康复治疗提供理论依据。 方法选取4～6岁发育性语音障碍儿童30例设为患儿组,另选取年龄相仿的正常儿童30例设为正常组。要求2组受试者对通过语音分析软件Praat制作的从/bá/到/bà/的11个声调连续体语音材料进行声调辨认和区分实验。实验分别通过E-prime1.1版程序编程在电脑上呈现,根据2组受试者做出的行为来判断并比较2组在辨认率和区分率上的参数差异。 结果2组受试者在辨认曲线形态上均呈典型“S”型,即2组受试者在感知/bá/与/bà/时,均呈现出范畴化模式,正常组的范畴边界在刺激台阶6~7,而患者组范畴边界靠前,在刺激台阶5~6,其差异有统计学意义（P<0.05）;在区分曲线上,2组受试者均呈现出明显的峰值,且各峰值所对应的刺激台阶与辨认曲线的交叉中点位置基本相当。另外,患者组在辨认曲线绝对值（b1）和区分曲线峰陡峭度（DP）上均低于正常组,其差异有统计学意义（P<0.05）,而患者组的边界宽度（Wcb）明显高于正常组,差异有统计学意义（P<0.05）。 结论发育性语音障碍儿童声调感知范畴化程度与正常同龄儿童存在不对称,他们在声调感知上可能存在障碍,这有可能是导致发育性语音障碍儿童在发音时发生语音偏误的一个重要因素。     

Movement sequencing in normal aging: speech,oro-facial,and finger movements

The manner and extent to which normal aging affects the ability to speak are not fully understood. While age-related changes in voice fundamental frequency and intensity have been documented, changes affecting the planning and articulation of speech are less well understood. In the present study, 76 healthy, cognitively normal participants aged between 18 and 93 years old were asked to produce auditorily and visually triggered sequences of finely controlled movements (speech, oro-facial, and manual movement). These sequences of movements were either (1) simple, in which at least two of the three movements were the same, or (2) complex, in which three different movements were produced. For each of the resulting experimental condition, accuracy was calculated. The results show that, for speech and oro-facial movements, accuracy declined as a function of age and complexity. For these movements, the negative effect of complexity on performance accuracy increased with age. No aging or complexity effects were found for the manual movements on accuracy, but a significant slowing of movement was found, particularly for the complex sequences. These results demonstrate that there is a significant deterioration of fine motor control in normal aging across different response modalities.     

Speech acquisition predicts regions of enhanced cortical response to auditory stimulation in autism spectrum individuals

A continuum of phenotypes makes up the autism spectrum (AS). In particular, individuals show large differences in language acquisition, ranging from precocious speech to severe speech onset delay. However, the neurological origin of this heterogeneity remains unknown. Here, we sought to determine whether AS individuals differing in speech acquisition show different cortical responses to auditory stimulation and morphometric brain differences. Whole-brain activity following exposure to non-social sounds was investigated. Individuals in the AS were classified according to the presence or absence of Speech Onset Delay (AS-SOD and AS-NoSOD, respectively) and were compared with IQ-matched typically developing individuals (TYP). AS-NoSOD participants displayed greater task-related activity than TYP in the inferior frontal gyrus and peri-auditory middle and superior temporal gyri, which are associated with language processing. Conversely, the AS-SOD group only showed enhanced activity in the vicinity of the auditory cortex. We detected no differences in brain structure between groups. This is the first study to demonstrate the existence of differences in functional brain activity between AS individuals divided according to their pattern of speech development. These findings support the Trigger-threshold-target model and indicate that the occurrence of speech onset delay in AS individuals depends on the location of cortical functional reallocation, which favors perception in AS-SOD and language in AS-NoSOD.     

The effectiveness of Speech–Music Therapy for Aphasia (SMTA) in five speakers with Apraxia of Speech and aphasia

Background: Several studies using musical elements in the treatment of neurological language and speech disorders have reported improvement of speech production. One such programme, Speech–Music Therapy for Aphasia (SMTA), integrates speech therapy and music therapy (MT) to treat the individual with Apraxia of Speech (AoS) and aphasia. We have observed encouraging results in clinical practice, but there is still no empirical evidence of the effect of SMTA.

Aims: The current study investigated the effectiveness of SMTA on verbal communication in daily life.

Methods & Procedures: Five participants with AoS accompanied by aphasia were included in an efficacy study using a case series design with multiple measurements. All participants received 24 SMTA sessions including two 30-min sessions per week. Pretreatment and posttreatment (immediately and 3 months after treatment stopped), verbal communication (intelligibility and comprehensibility) were tested with the Amsterdam-Nijmegen Everyday Language Test. The Aachen Aphasia Test (AAT) and the Diagnostic Instrument for Apraxia of Speech (DIAS) were also administered. The participants were tested four times before the start of the treatment (baseline) with a related test for progress on articulation (Modified Diadochokinesis Test (MDT)) and once with an unrelated control test (Psycholinguistic Assessment in Language Processing of Aphasia 12; repetition of number series). During the treatment, both tests were administered weekly.

Outcomes & Results: Intelligibility of verbal communication for all participating individuals, as well as comprehensibility in four out of five participants, improved after 24 SMTA treatment sessions. All measures of MDT and repetition of AAT showed significant improvement for all participants. Four participants also improved on the test for articulation of phonemes and the diadochokinesis test of the DIAS. Furthermore, two participants improved on the articulation of words (DIAS). The improvement remained stable after treatment ended (follow-up). For three out of the five participants, no improvement was found on the control tests. Two participants also showed improvement on almost all outcome measures, but also improved on the control tests. SMTA not only affected articulation but also positively influenced the severity of the aphasia in four out of five participants.

Conclusions: SMTA seems an effective treatment programme for at least three of the five individuals that were treated in the current study. This treatment led not only to better articulation, but more importantly, also to improvement in communication in daily life.     

Topographic recordings of auditory evoked potentials to speech: Subcortical and cortical responses

Topographies of speech auditory brainstem response (speech ABR), a fine electrophysiological marker of speech encoding, have never been described. Yet, they could provide useful information to assess speech ABR generators and better characterize populations of interest (e.g., musicians, dyslexics). We present here a novel methodology of topographic speech ABR recording, using a 32‐channel low sampling rate (5 kHz) EEG system. Quality of speech ABRs obtained with this conventional multichannel EEG system were compared to that of signals simultaneously recorded with a high sampling rate (13.3 kHz) EEG system. Correlations between speech ABRs recorded with the two systems revealed highly similar signals, without any significant difference between their signal‐to‐noise ratios (SNRs). Moreover, an advanced denoising method for multichannel data (denoising source separation) significantly improved SNR and allowed topography of speech ABR to be recovered.     

Scales of degree of facial paralysis: analysis of agreement

IntroductionIt has become common to use scales to measure the degree of involvement of facial paralysis in phonoaudiological clinics.ObjectiveTo analyze the inter- and intra-rater agreement of the scales of degree of facial paralysis and to elicit point of view of the appraisers regarding their use.MethodsCross-sectional observational clinical study of the Chevalier and House & Brackmann scales performed by five speech therapists with clinical experience, who analyzed the facial expression of 30 adult subjects with impaired facial movements two times, with a one week interval between evaluations. The kappa analysis was employed.ResultsThere was excellent inter-rater agreement for both scales (kappa > 0.80), and on the Chevalier scale a substantial intra-rater agreement in the first assessment (kappa = 0.792) and an excellent agreement in the second assessment (kappa = 0.928). The House & Brackmann scale showed excellent agreement at both assessments (kappa = 0.850 and 0.857). As for the appraisers’ point of view, one appraiser thought prior training is necessary for the Chevalier scale and, four appraisers felt that training is important for the House & Brackmann scale.ConclusionBoth scales have good inter- and intra-rater agreement and most of the appraisers agree on the ease and relevance of the application of these scales.     

功能康复训练在舌癌游离皮瓣修复术后护理中的应用

目的:探讨功能康复训练在舌癌游离皮瓣修复术后患者护理中的应用效果。方法:将100例行2/3舌缘和舌尖切除术的患者随机分为观察组和对照组各50例,观察组采用舌器官功能康复指导方案对患者的术后康复进行指导,对照组以患者完成简单的舌器官运动功能恢复练习为主。采用VS-9700语音工作站1.0系统对两组患者语音清晰度优良率进行检测。结果:观察组语音清晰度优良率为90%,对照组语音清晰度优良率为80%,两组比较差异有统计学意义(P0.05)。结论:舌器官功能康复指导能有效提升舌癌游离皮瓣修复术后患者的语音清晰度优良率。     

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。     

Mandibular movement during speech of two related Latin languages

Objectives/hypothesis: This study assessed the kinesiographic recordings of jaw movements during reading a text in Galician and Spanish language.

Study design: Cross-sectional blind study.

Methods: A homogeneous healthy group of 25 normal stomatognathic system and native Galician participants was studied. Frontal and parasagittal plane recordings of the intraborder lateral jaw movements and during reading Galician and Spanish texts were recorded using a calibrated jaw-tracking device, kinesiograph.

Results: Although movements were similar in both languages, a greater retrusion of the jaw in the Spanish language was shown; moreover, a tendency exists for a left-side motion envelope in this right-handedness preference sample.

Conclusions: This study supports the hypothesis that speech is controlled by the central nervous system rather than by peripheral factors and that the hemispheric dominance influences the asymmetry of the speech envelope.