成人运动性构音障碍言语清晰度评估的研究进展
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摘要
运动性构音障碍(简称构音障碍)在卒中后的发生率约为20%～30%,创伤性脑损伤后约为10%～60%。言语清晰度评估是构音障碍评估中不可缺少的一部分,是家属与专业治疗人员之间的沟通工具,可以用于制定训练计划、评估沟通表现及疗效。按照得出的清晰度数值是尺度数据还是计量数据,大致可分为尺度评估和项目辨认两种,还可以根据是否标准化分为非标准化评估和标准化评估。尺度评估主要包括:等距尺度、直接数值估计、言语样本对分级、百分比估算和视觉类比量表等。项目辨认评估主要包括:词汇清晰度测试、语音清晰度测试、汉语语音清晰度测试字表、汉语构音能力测试词表、句子清晰度测试、构音障碍清晰度评估和言语清晰度测试电脑软件等。其中构音障碍清晰度评估和言语清晰度测试电脑软件是综合性的标准化评估。目前国内可用的清晰度评估方法较少,本文检索近10年来清晰度评估方面的文献,总结各种评估方法,以提高大家对清晰度评估的重视,并根据工作和研究需要选用适宜的评估。
Dysarthria is a group of nerological speech disorder, which occurred in about 20%-30% after stroke, or 10%-60% after traumatic brain injury. The assessment of speech intelligibility is a necessary part of the evaluation of dysarthria, which can be used to communicate the patients' condition with their relations, and also in treatment planning, evaluating the communication performance and the treatment effects. The methods used to assess intelligibility can be divided into two groups: scaling methods and item identification methods. They are also divided into non-standard and standard methods based on whether a standard assessment or not. Scaling methods include interval scales, Direct Magnitude Estimation(DME), Speech Sample Pairs Scaling, Percentage Estimates, and Visual Analogue Scale(VAS), etc. The item identifica-tion methods mainly include: Word Intelligibility Test, Chinese Speech Intelligibility Test, Chinese Speech Intelligibility Test Character List, Chinese Articulation Ability Test Word List, Sentence Intelligibility Test, Assessment of Intelligibili-ty in Dysarthric Speakers(AIDS) and Speech Intelligibility Test(SIT) software. Among them, AIDS and SIT softwares are comprehensively standardized assessments. There are few methods can be used in China. The literatures on intelligi-bility assessment in the past ten years were reviewed.
Dysarthria is a group of nerological speech disorder, which occurred in about 20%-30% after stroke, or 10%-60% after traumatic brain injury. The assessment of speech intelligibility is a necessary part of the evaluation of dysarthria, which can be used to communicate the patients' condition with their relations, and also in treatment planning, evaluating the communication performance and the treatment effects. The methods used to assess intelligibility can be divided into two groups: scaling methods and item identification methods. They are also divided into non-standard and standard methods based on whether a standard assessment or not. Scaling methods include interval scales, Direct Magnitude Estimation(DME), Speech Sample Pairs Scaling, Percentage Estimates, and Visual Analogue Scale(VAS), etc. The item identifica-tion methods mainly include: Word Intelligibility Test, Chinese Speech Intelligibility Test, Chinese Speech Intelligibility Test Character List, Chinese Articulation Ability Test Word List, Sentence Intelligibility Test, Assessment of Intelligibili-ty in Dysarthric Speakers(AIDS) and Speech Intelligibility Test(SIT) software. Among them, AIDS and SIT softwares are comprehensively standardized assessments. There are few methods can be used in China. The literatures on intelligi-bility assessment in the past ten years were reviewed.
引文
[1]Duffy J R.Motor Speech Disorders Substrates,Differential Diagnosis,and Management[M].Missouri:Mosby,2013:4,65-87.
[2]Lawrence E S,Coshall C,Dundas R,et al.Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population[J].Stroke,2001,32(6):1279-1284.
[3]Lubart E,Leibovitz A,Baumoehl Y,et al.Progressing stroke with neu-rological deterioration in a group of Israeli elderly[J].Arch Gerontol Geriatr,2005,41(1):95-100.
[4]Mitchell C,Bowen A,Tyson S,et al.Interventions for dysarthria due to stroke and other adult-acquired,non-progressive brain injury[J].Co-chrane Database Syst Rev,2017,1:8-12.
[5]Miller N.Measuring up to speech intelligibility[J].Int J Lang Com-mun Disord,2013,48(6):601-612.
[6]Kent R D.Intelligibility in Speech Disorders Theory,Measurement and Management[M].Philadelphia:John Benjamins Publishing Co.,1992:11-56.
[7]Barreto Sdos S,Ortiz K Z.Intelligibility measurements in speech disor-ders:a critical review of the literature[J].Pro Fono,2008,20(3):201-206.
[8]Boutsen F,Park E,Dvorak J,et al.Prosodic improvement in persons with parkinson disease receiving SPEAK OUT!?Voice Therapy[J].Fo-lia Phoniatr Logop,2018,70(2):51-58.
[9]郭思荃,李华伟,陈兵,等.语后聋患者人工耳蜗植入后听觉行为及言语可懂度分级的相关因素分析[J].临床耳鼻咽喉头颈外科杂志,2014,28(13):955-957,960.
[10]娄皓,陈阳,岳波,等.50例语前聋患者人工耳蜗植入术后1年听觉言语能力分析[J].中国听力语言康复科学杂志,2016,14(1):20-23.
[11]沈茜茜,王林娥,龚树生,等.蜗神经管狭窄患者人工耳蜗植入术后听觉言语康复效果分析[J].中国听力语言康复科学杂志,2016,14(3):166-169.
[12]张雪媛,钟志茹,欧雪雁,等.语前聋儿童人工耳蜗植入术后听觉表现及言语可懂度变化特点分析[J].中国听力语言康复科学杂志,2016,14(3):174-177.
[13]陈玲,蔡玉立,王艾东,等.大龄听障儿童和听障成年人言语清晰度的研究[J].中国听力语言康复科学杂志,2017,15(5):397-400.
[14]韩军宁,陈雪清,郭倩倩,等.助听后耳聋儿童音乐能力与听觉能力、言语可懂度相关性的初步研究[J].听力学及言语疾病杂志,2017,25(1):58-61.
[15]马宁,王海宝,余永强,等.先天性耳聋脑灰质密度与人工耳蜗植入术后言语可懂度相关性研究[J].安徽医科大学学报,2018,53(7):1067-1071.
[16]王宇,潘滔,米思,等.中文版言语可懂度分级标准的建立及其信度检验[J].听力学及言语疾病杂志,2013,21(5):465-468.
[17]Cardoso R,Guimar?es I,Santos H,et al.Frenchay Dysarthria Assess-ment(FDA-2)in Parkinson's disease:cross-cultural adaptation and psy-chometric properties of the European Portuguese version[J].J Neurol,2017,264(1):21-31.
[18]Gurevich N,Scamihorn S L.Speech-language pathologists'use of in-telligibility measures in adults with dysarthria[J].Am J Speech Lang Pathol,2017,26(3):873-892.
[19]Kearney E,Giles R,Haworth B,et al.Sentence-level movements in parkinson's disease:loud,clear,and slow speech[J].J Speech Lang Hear Res,2017,60(12):3426-3440.
[20]Weismer G,Jeng J Y,Laures J S,et al.Acoustic and intelligibility characteristics of sentence production in neurogenic speech disorders[J].Folia Phoniatr Logop,2001,53(1):1-18.
[21]Kent R D,Weismer G,Kent J F,et al.Toward phonetic intelligibility testing in dysarthria[J].J Speech Hear Disord,1989,54(4):482-499.
[22]Yorkston K M,Beukelman D R.A comparison of techniques for measuring intelligibility of dysarthric speech[J].J Commun Disord,1978,11(1):499-512.
[23]Hustad K C.Estimating the intelligibility of speakers with dysarthria[J].Folia Phoniatr Logop,2006,58(3):217-228.
[24]严广斌.视觉模拟评分法[J].中华关节外科(电子版),2014(2):34-34.
[25]Makkonen T,Ruottinen H,Puhto R,et al.Speech deterioration in amyotrophic lateral sclerosis(ALS)after manifestation of bulbar symp-toms[J].Int J Lang Commun Disord,2018,53(2):385-392.
[26]Finizia C,Lindstr?m J,Dotevall H.Intelligibility and perceptual rat-ings after treatment for laryngeal cancer:laryngectomy versus radio-therapy[J].Laryngoscope,1998,108(1 Pt 1):138-143.
[27]Fletcher A R,McAuliffe M J,Lansford K L,et al.Predicting intelli-gibility gains in individuals with dysarthria from baseline speech fea-tures[J].J Speech Lang Hear Res,2017,60(11):3043-3057.
[28]Fletcher A R,Wisler A A,McAuliffe M J,et al.Predicting intelligi-bility gains in dysarthria through automated speech feature analysis[J].J Speech Lang Hear Res,2017,60(11):3058-3068.
[29]Ziegler W,Zierdt A.Telediagnostic assessment of intelligibility in dysarthria:a pilot investigation of MVP-online[J].J Commun Disord,2008,41(6):553-577.
[30]李胜利,孙喜斌,王荫华,等.第二次全国残疾人抽样调查言语残疾标准研究[J].中国康复理论与实践,2007,13(9):801-803.
[31]庞子建,李胜利.运动性构音障碍言语、声学、共鸣水平机制及康复疗效研究[J].中国康复理论与实践,2009,15(5):449-452.
[32]谢华顺,马芙蓉,樊东升,等.21例伴构音障碍的肌萎缩侧索硬化症患者嗓音特征分析[J].北京大学学报(医学版),2014,46(5):751-755.
[33]王国民,朱川,袁文华,等.汉语语音清晰度测试字表的建立和临床应用研究[J].上海口腔医学,1995,4(3):125-127,183.
[34]陈阳,王国民,俞立英,等.腭咽闭合功能不全语音清晰度评价[J].中华口腔医学杂志,2003,38(3):169-171.
[35]姜丽,王强,孟萍萍,等.构音障碍强化训练改善脑卒中患者构音障碍的疗效观察[J].中华物理医学与康复杂志,2014,36(5):367-370.
[36]黄昭鸣,杜晓新.言语障碍的评估与矫治[M].上海:华东师范大学出版社,2006:113-117.
[37]Sidtis D,Sidtis J J.Subcortical effects on voice and fluency in dysar-thria:observations from subthalamic nucleus stimulation[J].J Alzheim-ers Dis Parkinsonism,2017,7(6):1-22.
[38]Tripoliti E.Effects of deep brain stimulation on speech in patients with Parkinson's disease and dystonia[D].London:London UC,2010:67-72.
[39]Risch V,Staiger A,Ziegler W,et al.How does GPi-DBS affect speech in primary dystonia?[J].Brain Stimul,2015,8(5):875-880.
[40]Rusz J,TykalováT,Fe?íkováA,et al.Dualistic effect of pallidal deep brain stimulation on motor speech disorders in dystonia[J].Brain Stimul,2018,11(4):896-903.
[41]Liss J M,Spitzer S M,Caviness J N,et al.The effects of familiariza-tion on intelligibility and lexical segmentation in hypokinetic and atax-ic dysarthria[J].J Acoust Soc Am,2002,112(6):3022-3030.
[42]Lansford K L,Borrie S A,Bystricky L.Use of crowdsourcing to as-sess the ecological validity of perceptual-training paradigms in dysar-thria[J].Am J Speech Lang Pathol,2016,25(2):233-239.
[43]Lansford K L,Luhrsen S,Ingvalson E M,et al.Effects of familiar-ization on intelligibility of dysarthric speech in older adults with and without hearing loss[J].Am J Speech Lang Pathol,2018,27(1):91-98.
[44]Alexandre E,Barreto Sdos S,Ortiz K Z.[Predictability of sentences used in the assessment of speech intelligibility in dysarthria][J].[in Portuguese].J Soc Bras Fonoaudiol,2011,23(2):119-223.
[45]Kuruvilla-Dugdale M,Custer C,Heidrick L,et al.A phonetic com-plexity-based approach for intelligibility and articulatory precision test-ing:a preliminary study on talkers with amyotrophic lateral sclerosis[J].J Speech Lang Hear Res,2018,61(9):2205-2214.
[46]Lee J,Bell M,Simmons Z.Articulatory kinematic characteristics across the dysarthria severity spectrum in individuals with amyotrophic lateral sclerosis[J].Am J Speech Lang Pathol,2018,27(1):258-269.
[2]Lawrence E S,Coshall C,Dundas R,et al.Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population[J].Stroke,2001,32(6):1279-1284.
[3]Lubart E,Leibovitz A,Baumoehl Y,et al.Progressing stroke with neu-rological deterioration in a group of Israeli elderly[J].Arch Gerontol Geriatr,2005,41(1):95-100.
[4]Mitchell C,Bowen A,Tyson S,et al.Interventions for dysarthria due to stroke and other adult-acquired,non-progressive brain injury[J].Co-chrane Database Syst Rev,2017,1:8-12.
[5]Miller N.Measuring up to speech intelligibility[J].Int J Lang Com-mun Disord,2013,48(6):601-612.
[6]Kent R D.Intelligibility in Speech Disorders Theory,Measurement and Management[M].Philadelphia:John Benjamins Publishing Co.,1992:11-56.
[7]Barreto Sdos S,Ortiz K Z.Intelligibility measurements in speech disor-ders:a critical review of the literature[J].Pro Fono,2008,20(3):201-206.
[8]Boutsen F,Park E,Dvorak J,et al.Prosodic improvement in persons with parkinson disease receiving SPEAK OUT!?Voice Therapy[J].Fo-lia Phoniatr Logop,2018,70(2):51-58.
[9]郭思荃,李华伟,陈兵,等.语后聋患者人工耳蜗植入后听觉行为及言语可懂度分级的相关因素分析[J].临床耳鼻咽喉头颈外科杂志,2014,28(13):955-957,960.
[10]娄皓,陈阳,岳波,等.50例语前聋患者人工耳蜗植入术后1年听觉言语能力分析[J].中国听力语言康复科学杂志,2016,14(1):20-23.
[11]沈茜茜,王林娥,龚树生,等.蜗神经管狭窄患者人工耳蜗植入术后听觉言语康复效果分析[J].中国听力语言康复科学杂志,2016,14(3):166-169.
[12]张雪媛,钟志茹,欧雪雁,等.语前聋儿童人工耳蜗植入术后听觉表现及言语可懂度变化特点分析[J].中国听力语言康复科学杂志,2016,14(3):174-177.
[13]陈玲,蔡玉立,王艾东,等.大龄听障儿童和听障成年人言语清晰度的研究[J].中国听力语言康复科学杂志,2017,15(5):397-400.
[14]韩军宁,陈雪清,郭倩倩,等.助听后耳聋儿童音乐能力与听觉能力、言语可懂度相关性的初步研究[J].听力学及言语疾病杂志,2017,25(1):58-61.
[15]马宁,王海宝,余永强,等.先天性耳聋脑灰质密度与人工耳蜗植入术后言语可懂度相关性研究[J].安徽医科大学学报,2018,53(7):1067-1071.
[16]王宇,潘滔,米思,等.中文版言语可懂度分级标准的建立及其信度检验[J].听力学及言语疾病杂志,2013,21(5):465-468.
[17]Cardoso R,Guimar?es I,Santos H,et al.Frenchay Dysarthria Assess-ment(FDA-2)in Parkinson's disease:cross-cultural adaptation and psy-chometric properties of the European Portuguese version[J].J Neurol,2017,264(1):21-31.
[18]Gurevich N,Scamihorn S L.Speech-language pathologists'use of in-telligibility measures in adults with dysarthria[J].Am J Speech Lang Pathol,2017,26(3):873-892.
[19]Kearney E,Giles R,Haworth B,et al.Sentence-level movements in parkinson's disease:loud,clear,and slow speech[J].J Speech Lang Hear Res,2017,60(12):3426-3440.
[20]Weismer G,Jeng J Y,Laures J S,et al.Acoustic and intelligibility characteristics of sentence production in neurogenic speech disorders[J].Folia Phoniatr Logop,2001,53(1):1-18.
[21]Kent R D,Weismer G,Kent J F,et al.Toward phonetic intelligibility testing in dysarthria[J].J Speech Hear Disord,1989,54(4):482-499.
[22]Yorkston K M,Beukelman D R.A comparison of techniques for measuring intelligibility of dysarthric speech[J].J Commun Disord,1978,11(1):499-512.
[23]Hustad K C.Estimating the intelligibility of speakers with dysarthria[J].Folia Phoniatr Logop,2006,58(3):217-228.
[24]严广斌.视觉模拟评分法[J].中华关节外科(电子版),2014(2):34-34.
[25]Makkonen T,Ruottinen H,Puhto R,et al.Speech deterioration in amyotrophic lateral sclerosis(ALS)after manifestation of bulbar symp-toms[J].Int J Lang Commun Disord,2018,53(2):385-392.
[26]Finizia C,Lindstr?m J,Dotevall H.Intelligibility and perceptual rat-ings after treatment for laryngeal cancer:laryngectomy versus radio-therapy[J].Laryngoscope,1998,108(1 Pt 1):138-143.
[27]Fletcher A R,McAuliffe M J,Lansford K L,et al.Predicting intelli-gibility gains in individuals with dysarthria from baseline speech fea-tures[J].J Speech Lang Hear Res,2017,60(11):3043-3057.
[28]Fletcher A R,Wisler A A,McAuliffe M J,et al.Predicting intelligi-bility gains in dysarthria through automated speech feature analysis[J].J Speech Lang Hear Res,2017,60(11):3058-3068.
[29]Ziegler W,Zierdt A.Telediagnostic assessment of intelligibility in dysarthria:a pilot investigation of MVP-online[J].J Commun Disord,2008,41(6):553-577.
[30]李胜利,孙喜斌,王荫华,等.第二次全国残疾人抽样调查言语残疾标准研究[J].中国康复理论与实践,2007,13(9):801-803.
[31]庞子建,李胜利.运动性构音障碍言语、声学、共鸣水平机制及康复疗效研究[J].中国康复理论与实践,2009,15(5):449-452.
[32]谢华顺,马芙蓉,樊东升,等.21例伴构音障碍的肌萎缩侧索硬化症患者嗓音特征分析[J].北京大学学报(医学版),2014,46(5):751-755.
[33]王国民,朱川,袁文华,等.汉语语音清晰度测试字表的建立和临床应用研究[J].上海口腔医学,1995,4(3):125-127,183.
[34]陈阳,王国民,俞立英,等.腭咽闭合功能不全语音清晰度评价[J].中华口腔医学杂志,2003,38(3):169-171.
[35]姜丽,王强,孟萍萍,等.构音障碍强化训练改善脑卒中患者构音障碍的疗效观察[J].中华物理医学与康复杂志,2014,36(5):367-370.
[36]黄昭鸣,杜晓新.言语障碍的评估与矫治[M].上海:华东师范大学出版社,2006:113-117.
[37]Sidtis D,Sidtis J J.Subcortical effects on voice and fluency in dysar-thria:observations from subthalamic nucleus stimulation[J].J Alzheim-ers Dis Parkinsonism,2017,7(6):1-22.
[38]Tripoliti E.Effects of deep brain stimulation on speech in patients with Parkinson's disease and dystonia[D].London:London UC,2010:67-72.
[39]Risch V,Staiger A,Ziegler W,et al.How does GPi-DBS affect speech in primary dystonia?[J].Brain Stimul,2015,8(5):875-880.
[40]Rusz J,TykalováT,Fe?íkováA,et al.Dualistic effect of pallidal deep brain stimulation on motor speech disorders in dystonia[J].Brain Stimul,2018,11(4):896-903.
[41]Liss J M,Spitzer S M,Caviness J N,et al.The effects of familiariza-tion on intelligibility and lexical segmentation in hypokinetic and atax-ic dysarthria[J].J Acoust Soc Am,2002,112(6):3022-3030.
[42]Lansford K L,Borrie S A,Bystricky L.Use of crowdsourcing to as-sess the ecological validity of perceptual-training paradigms in dysar-thria[J].Am J Speech Lang Pathol,2016,25(2):233-239.
[43]Lansford K L,Luhrsen S,Ingvalson E M,et al.Effects of familiar-ization on intelligibility of dysarthric speech in older adults with and without hearing loss[J].Am J Speech Lang Pathol,2018,27(1):91-98.
[44]Alexandre E,Barreto Sdos S,Ortiz K Z.[Predictability of sentences used in the assessment of speech intelligibility in dysarthria][J].[in Portuguese].J Soc Bras Fonoaudiol,2011,23(2):119-223.
[45]Kuruvilla-Dugdale M,Custer C,Heidrick L,et al.A phonetic com-plexity-based approach for intelligibility and articulatory precision test-ing:a preliminary study on talkers with amyotrophic lateral sclerosis[J].J Speech Lang Hear Res,2018,61(9):2205-2214.
[46]Lee J,Bell M,Simmons Z.Articulatory kinematic characteristics across the dysarthria severity spectrum in individuals with amyotrophic lateral sclerosis[J].Am J Speech Lang Pathol,2018,27(1):258-269.