目的 本研究旨在探讨学龄期脑瘫儿童在连续语音下的言语流利性特征及其与言语可懂度之间的相关性,为脑瘫儿童言语流利性的评估与康复提供理论依据。方法 于2021年1—2月分别纳入学龄期痉挛型脑瘫儿童与同年龄段正常发育儿童各15名,分析其在朗读语音均衡式材料下的言语流利性相关声学参数,包括言语速率、构音速率、平均停顿时长、异常停顿次数和重复次数,再通过转录法计算其言语可懂度。并将言语流利性参数与言语可懂度分数进行Spearman相关性分析。结果 脑瘫组的言语速率、构音速率、言语可懂度显著小于正常对照组(t=-21.650,-15.440,-4.447,P<0.05);平均停顿时长、异常停顿次数、重复次数显著大于正常对照组(t=19.639,20.347,3.767,P<0.05)。脑瘫儿童的言语速率(r=0.831)、构音速率(r=0.827)与言语可懂度均呈正相关(P<0.01);平均停顿时长(r=-0.849)异常停顿次数(r=-0.783)、重复次数(r=-0.672)与言语可懂度均呈显著负相关(P＜0.01)。结论 痉挛型脑瘫儿童的言语可懂度降低,言语流利性存在异常,体现在语速减慢、停顿次数、停顿时长与重复次数增加。痉挛型脑瘫儿童的言语流利性与言语可懂度呈正相关,在脑瘫言语治疗中应合理加入改善言语流利性的训练。
Abstract
Objective To explore the characteristics of speech fluency of school-age children with cerebral palsy in connected speech and its correlation with speech intelligibility, in order to provide theoretical basis for assessment and rehabilitation of speech fluency in children with cerebral palsy. Methods Totally 15 children with spastic cerebral palsy and 15 normal children with the same age were enrolled in this study from January to February 2021. The acoustic parameters related to speech fluency were analyzed by reading the speech-balanced reading materials, including speech rate, articulation rate, average pause duration, number of abnormal pauses, and number of repetitions. Speech intelligibility were judged by transcription. Spearman correlation analysis was carried out to analyze the correlation between the acoustic parameters related to speech fluency of children with cerebral palsy and their speech intelligibility. Results The speech rate, articulation rate, and speech intelligibility of children with cerebral palsy were significantly lower than those of the control group(t=-21.650,-15.440, -4.447, P＜0.05), while the average pause duration, the number of abnormal pause and the number of repetitions were significantly greater than those of the control group(t=19.639, 20.347, 3.767, P＜0.05). The speech rate (r=0.831), articulation rate (r=0.827), average duration of pauses (r=-0.849) were positively correlated with speech intelligibility, while the number of abnormal pauses (r=-0.783) and the number of repetitions (r=-0.672) of children with spastic cerebral palsy were negatively related to speech intelligibility (P<0.01). Conclusion Children with spastic cerebral palsy have lower speech intelligibility and abnormal speech fluency, which was reflected in the slower speech rate, the increasing number of abnormal pauses, average pause duration and the number of repetitions. Speech fluency in children with cerebral palsy is positively correlated with speech intelligibility, and the training of speech fluency should be reasonably added to the speech treatment of cerebral palsy.
关键词
脑性瘫痪 /
连续语音 /
言语流利性 /
言语可懂度 /
声学分析
Key words
cerebral palsy /
connected speech /
speech fluency /
speech intelligibility /
acoustic analysis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral palsy:Current opinions on definition, epidemiology, risk factors, classification and treatment options[J]. Neuropsychiatr Dis Treat, 2020, 16:1505-1518.
[2] 李晓捷,邱洪斌,姜志梅,等. 中国十二省市小儿脑性瘫痪流行病学特征[J]. 中华实用儿科临床杂志, 2018, 33(5):378-383.
[3] 彭桂兰,张端秀,胡恕香,等. 厦门市0～5岁儿童脑性瘫痪流行病学调查[J].中国妇幼保健,2016,31(24):5456-5458.
[4] Schölderle T, Haas E, Ziegler W. Dysarthria syndromes in children with cerebral palsy[J]. Dev Med Child Neurol, 2021, 63(4):444-449.
[5] Lee J, Dickey E, Simmons Z. Vowel-specific intelligibility and acoustic patterns in individuals with dysarthria secondary to amyotrophic lateral sclerosis[J]. J Speech Lang Hear Res, 2019, 62(1):34-59.
[6] 侯梅,罗光金,赵建慧. 脑瘫患儿言语障碍的评估与管理[J]. 中国听力语言康复科学杂志,2019,17(3):171-174,192.
[7] Kim H, Hasegawa-Johnson M, Perlman A. Vowel contrast and speech intelligibility indysarthria[J]. Folia Phoniatr Logop, 2011, 63(4): 187-194.
[8] McAuliffe MJ, Fletcher AR, Kerr SE, et al. Effect of dysarthria type, speaking condition, and listener age on speech intelligibility[J]. Am J Speech Lang Pathol, 2017, 26(1):113-123.
[9] Zhang Q, Zhu X. The temporal and spatial features of segmental andsuprasegmental encoding during implicit picture naming: an event-related potential study[J]. Neuropsychologia, 2011, 49(14):3813-3825.
[10] Harmon TG, Jacks A, Haley KL. Speech fluency in acquired apraxia of speech during narrative discourse: GrouP comparisons and dual-Task effects[J]. Am J Speech Lang Pathol, 2019, 28(Suppl 2):905-914.
[11] Boliek CA, Fox CM. Therapeutic effects of intensive voice treatment (LSVT LOUD®) for children with spastic cerebral palsy and dysarthria: A phase I treatment validation study[J]. Int J Speech Lang Pathol, 2017, 19(6):601-615.
[12] 唐久来,秦炯,邹丽萍,等. 中国脑性瘫痪康复指南(2015):第一部分[J]. 中国康复医学杂志, 2015,30(7):747-754.
[13] 梁峻波. 学龄痉挛型脑瘫儿童语音清晰度特征及其与言语子系统的相关性研究[D].上海:华东师范大学,2016.
[14] Knowles T, Adams SG, Jog M. Speech rate mediated vowel and stop voicing distinctiveness in Parkinson'sDisease[J]. J Speech Lang Hear Res, 2021, 64(11):4096-4123.
[15] Allison KM,Hustad KC. Acoustic predictors of pediatric dysarthria in cerebral palsy[J]. J Speech Lang Hear Res, 2018,61(3):462-478.
[16] Barnett C, Green JR,Marzouqah R, et al. Reliability and validity of speech & pause measures during passage reading in ALS[J]. Amyotroph Lateral Scler Frontotemporal Degener, 2020, 21(1-2):42-50.
[17] Gilden DL, Mezaraups TM. Laws for pauses[J]. J ExPPsychol Learn Mem Cogn, 2022, 48(1):142-158.
[18] 葛胜男. 音位对比式实时重读治疗对脑卒中后言语可懂度的影响研究[D].上海:华东师范大学,2021.
[19] Ge S, Wan Q, Yin M, et al. Quantitative acoustic metrics of vowel production in mandarin-speakers with post-stroke spastic dysarthria[J]. Clin Linguist Phon, 2021, 35(8):779-792.
[20] Metz MJ, James LE.Specific effects of the Trier Social Stress Test on speech fluency in young and older adults[J]. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn, 2019, 26(4): 558-576.
[21] Chen LM,Hustad KC, Kent RD, et al. Dysarthria in Mandarin-Speaking Children with cerebral palsy:Speech subsystem profiles[J]. J Speech Lang Hear Res, 2018, 61(3):525-548.
[22] Ziegler W. Task-related factors in oral motor control:Speech and oral diadochokinesis in dysarthria and apraxia of speech[J]. Brain Lang, 2002, 80(3):556-575.
[23] 惠芬芬. 不同韵律层级下痉挛型脑瘫儿童停延特征及其与言语可懂度的相关性[D].上海:华东师范大学, 2017.
[24] 高晓慧,万勤,惠芬芬,等. 对听障儿童言语不流畅问题的干预研究[J]. 中国特殊教育, 2016,23(12):17-25.
[25] 尹敏敏,葛胜男,邱卓英,等. 运用世界卫生组织国际分类家族构建儿童构音障碍诊断、评估和整体康复方案[J].中国康复理论与实践,2020,26(1):28-36.
[26] Pennington L, Lombardo E, Steen N, et al. Acoustic changes in the speech of children with cerebral palsy following an intensive program of dysarthria therapy[J]. Int J Lang Commun Disord, 2018, 53(1):182-195.
[27] McCoy SW,Palisano R, Avery L, et al. Physical, occupational, and speech therapy for children with cerebral palsy[J]. Dev Med Child Neurol, 2020, 62(1):140-146.
[28] Bruckert L, Thompson PA, Watkins KE, et al. Investigating the effects of handedness on the consistency of lateralization for speech production and semantic processing tasks using functional transcranial Doppler sonography[J]. Laterality, 2021, 26(6):680-705.
[29] 张积家,陆爱桃. 语音回路和视空间模板对音位流畅性和语义流利性的影响[J]. 心理学报, 2007,39(6):1012-1024.
基金
国家社会科学基金重点项目(20AZD125)
PDF(503 KB)
