强化双唇声门爆破音训练在腭裂术后语音治疗中的临床效果分析
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摘要
目的：通过借用不同方式的语音训练对山西省已行完全性腭裂(CPP)术后的患者进行临床语音治疗,进而分析加入强化双唇声门爆破音这一专项训练方法在语音治疗方面的临床效果。
方法：1.病例的收集及训练：收集从2010年1月到2012年1月到山医一院口腔外科就诊的山西腭裂患者,对其按一定标准完成口腔颌面部的规定检查后,确定为完全性腭裂术后语音功能障碍的患者50例,并录音,全部进行一期语音训练三个月(训练内容按表1进行),然后录音、主观分析。
2.一期训练后将50例患者随机分成两组,一组为常规训练组,一组为强化专项训练组。常规组进行常规语音训练(详见实验方法),强化组在常规训练基础上加入双唇爆破音(B\P\M)专项训练(按表2进行),并录音。
3.成立3-5人专家组,依照特定的表格,对所有患者相对应的录音凭经验进行判听,根据判听结果计算语音清晰度值,然后对两组接受不同训练方法后得到的结果值进行统计分析,比较两者最终的疗效有无差异。
4.利用计算机语音工作系统(CSL)对所收集的录音资料进行语音声学特点分析。已经存储于计算机内语音软件的语音信号,经过录入、辨别、统计语音声样,得到频率、时间和强度的三维声谱图形,并对其变化情况进行比较分析。
结果：1.一期语音训练三月后,50例患者整体语音效果经治疗后清晰度有所提高,从开始未训练的52.68±13.34%提高到训练后的73.54±10.52%,平均提高20.86±10.26%,t=-12.648,P<0.05,差异有统计学意义。
2.二期语音训练后对比两种方法的疗效,计算得出的语音清晰度值为定量资料,统计方法采用重复测量方差分析,常规训练组和专项训练组间对比(P<0.05),两种方法有差异,强化组专项训练提高语音效果较好；组内检验(P<0.05),各组内前后两次测量值的对比有差异,结果均具有统计学意义,说明训练前后语音清晰度均有提高。
3.正常儿童语图频谱不是一条孤立的谱线,而是多种音频信号频率的叠加,因此出现的谱纹规律且清晰,密度密集,线条连续光滑。对完全性腭裂患者双唇爆破音专项训练前后的语音频谱做对比,腭裂语音图谱的谱纹密度较不集中,呈现散乱趋势,很少有空隙并且频率信号叠加没有一定的规律,所呈图谱杂乱无章,训练后患者频谱接近于正常图谱,相对比训练前语音信号较强,频率叠加集中,图谱有一定规律且较连续。
结论：1.本实验对于山西患者具有可行性,证实加入强化性双唇爆破音训练较常规训练改善语音功能更佳,能使患者更快的入门语音训练,更好地提高语音清晰度的效果。
2.强化双唇爆破音训练作为语音入门学习的方法,让腭裂患者的发音能够得到较大的提升。3.本实验的结果为山西省统一腭裂语音治疗、评估程序标准的制定提供一定的客观依据。
Objective:Through the use of different ways speech training already does complete cleft in Shanxi Province (CPP) postoperative patients for clinical speech treatment, and then analyzes the subglottic lips to strengthen blasting the special training methods sound in the clinical effect of speech treatment.
Methods:1. Case collection and training:collect from January2010to January2012to a mountain of medical oral surgery clinic of shanxi cleft patients, according to the standard of the complete the provisions of oral and maxillofacial region after examination and determined that the completeness of the postoperative speech function obstacle of cleft50cases of patients, and the recording, a speech training of all three months (training according to table1), and then the recording, subjective analysis.
2. A period after training in50patients will randomly divided into two groups, one group of routine training group, one group of strengthen special training. Conventional group for regular speech training (see the experimental method), strengthen the group on a regular basis to join double lip blasting sounds (B\P\M) special training (in table2), and then recording.
3. Founded3～5people expert group, in accordance with the specific form of all patients corresponding with experience on the tape to listen, to hear the results calculated according to speech intelligibility value, and then in two groups to accept different training methods later got results value of statistical analysis, comparison of difference between both eventually curative effect.
4. Using a computer speech lab (CSL) to the recording of data collected for voice acoustic characteristics analysis. Has been stored in a computer voice software in the speech signal, after entry, identify, statistical speech sound kind, get frequency, time and intensity of3D graphics spectrograph carry, and its change was analyzed.
Consequence:1. A period after march speech training,50patients speech effect after therapy, improve clarity, from the first not training52.68%improved to training after73.54%, by an average of20.86%, a statistically significant difference (P<0.01).
2. The second phase of speech training after comparing the two kinds of methods of curative effect, calculations of the speech intelligibility value for quantitative material, statistical methods use repeated Measures Analysis of Variance, regular training group and contrast between the special training group (P<0.05), two kinds of methods are different and strengthen group specific training improve voice effect is better; Inspection in the group (P<0.05), the two times before and after within the contrast of the measured value have difference, the results are significant, explain before and after workouts speech intelligibility were increased.
3. Normal children's language is not an isolated figure spectrum of the spectral lines, but many audio signal frequency of superposition, so there's spectrum lines rule and clearly density populated, line is continuous and smooth. To complete cleft lips patients before and after the special training blasting sound speech spectrum do contrast, the risk of speech map density is not concentration spectrum lines, appear messy trends, there is very few gap and the frequency signals that are not certain laws, assumes the map desultorily, training patients after spectrum close to normal map and the relative training of speech signal than before, strong frequency superposition concentration, the map has a certain rule and more continuous.
Conclusion:1. The experiment for shanxi patients have feasibility, confirmed to strengthen the lips of blasting sound training more routine training to improve speech function better, can make patients faster introductory speech training, the better to improve the effect of speech intelligibility.2. Strengthen training as a speech sound lips blasting introduction to the methods of learning, let the risk of patients can get bigger promotion pronunciation.3. The results of this experiment of shanxi unified speech treatment, assessment program cleft standards provide certain objective basis.
方法：1.病例的收集及训练：收集从2010年1月到2012年1月到山医一院口腔外科就诊的山西腭裂患者,对其按一定标准完成口腔颌面部的规定检查后,确定为完全性腭裂术后语音功能障碍的患者50例,并录音,全部进行一期语音训练三个月(训练内容按表1进行),然后录音、主观分析。
2.一期训练后将50例患者随机分成两组,一组为常规训练组,一组为强化专项训练组。常规组进行常规语音训练(详见实验方法),强化组在常规训练基础上加入双唇爆破音(B\P\M)专项训练(按表2进行),并录音。
3.成立3-5人专家组,依照特定的表格,对所有患者相对应的录音凭经验进行判听,根据判听结果计算语音清晰度值,然后对两组接受不同训练方法后得到的结果值进行统计分析,比较两者最终的疗效有无差异。
4.利用计算机语音工作系统(CSL)对所收集的录音资料进行语音声学特点分析。已经存储于计算机内语音软件的语音信号,经过录入、辨别、统计语音声样,得到频率、时间和强度的三维声谱图形,并对其变化情况进行比较分析。
结果：1.一期语音训练三月后,50例患者整体语音效果经治疗后清晰度有所提高,从开始未训练的52.68±13.34%提高到训练后的73.54±10.52%,平均提高20.86±10.26%,t=-12.648,P<0.05,差异有统计学意义。
2.二期语音训练后对比两种方法的疗效,计算得出的语音清晰度值为定量资料,统计方法采用重复测量方差分析,常规训练组和专项训练组间对比(P<0.05),两种方法有差异,强化组专项训练提高语音效果较好；组内检验(P<0.05),各组内前后两次测量值的对比有差异,结果均具有统计学意义,说明训练前后语音清晰度均有提高。
3.正常儿童语图频谱不是一条孤立的谱线,而是多种音频信号频率的叠加,因此出现的谱纹规律且清晰,密度密集,线条连续光滑。对完全性腭裂患者双唇爆破音专项训练前后的语音频谱做对比,腭裂语音图谱的谱纹密度较不集中,呈现散乱趋势,很少有空隙并且频率信号叠加没有一定的规律,所呈图谱杂乱无章,训练后患者频谱接近于正常图谱,相对比训练前语音信号较强,频率叠加集中,图谱有一定规律且较连续。
结论：1.本实验对于山西患者具有可行性,证实加入强化性双唇爆破音训练较常规训练改善语音功能更佳,能使患者更快的入门语音训练,更好地提高语音清晰度的效果。
2.强化双唇爆破音训练作为语音入门学习的方法,让腭裂患者的发音能够得到较大的提升。3.本实验的结果为山西省统一腭裂语音治疗、评估程序标准的制定提供一定的客观依据。
Objective:Through the use of different ways speech training already does complete cleft in Shanxi Province (CPP) postoperative patients for clinical speech treatment, and then analyzes the subglottic lips to strengthen blasting the special training methods sound in the clinical effect of speech treatment.
Methods:1. Case collection and training:collect from January2010to January2012to a mountain of medical oral surgery clinic of shanxi cleft patients, according to the standard of the complete the provisions of oral and maxillofacial region after examination and determined that the completeness of the postoperative speech function obstacle of cleft50cases of patients, and the recording, a speech training of all three months (training according to table1), and then the recording, subjective analysis.
2. A period after training in50patients will randomly divided into two groups, one group of routine training group, one group of strengthen special training. Conventional group for regular speech training (see the experimental method), strengthen the group on a regular basis to join double lip blasting sounds (B\P\M) special training (in table2), and then recording.
3. Founded3～5people expert group, in accordance with the specific form of all patients corresponding with experience on the tape to listen, to hear the results calculated according to speech intelligibility value, and then in two groups to accept different training methods later got results value of statistical analysis, comparison of difference between both eventually curative effect.
4. Using a computer speech lab (CSL) to the recording of data collected for voice acoustic characteristics analysis. Has been stored in a computer voice software in the speech signal, after entry, identify, statistical speech sound kind, get frequency, time and intensity of3D graphics spectrograph carry, and its change was analyzed.
Consequence:1. A period after march speech training,50patients speech effect after therapy, improve clarity, from the first not training52.68%improved to training after73.54%, by an average of20.86%, a statistically significant difference (P<0.01).
2. The second phase of speech training after comparing the two kinds of methods of curative effect, calculations of the speech intelligibility value for quantitative material, statistical methods use repeated Measures Analysis of Variance, regular training group and contrast between the special training group (P<0.05), two kinds of methods are different and strengthen group specific training improve voice effect is better; Inspection in the group (P<0.05), the two times before and after within the contrast of the measured value have difference, the results are significant, explain before and after workouts speech intelligibility were increased.
3. Normal children's language is not an isolated figure spectrum of the spectral lines, but many audio signal frequency of superposition, so there's spectrum lines rule and clearly density populated, line is continuous and smooth. To complete cleft lips patients before and after the special training blasting sound speech spectrum do contrast, the risk of speech map density is not concentration spectrum lines, appear messy trends, there is very few gap and the frequency signals that are not certain laws, assumes the map desultorily, training patients after spectrum close to normal map and the relative training of speech signal than before, strong frequency superposition concentration, the map has a certain rule and more continuous.
Conclusion:1. The experiment for shanxi patients have feasibility, confirmed to strengthen the lips of blasting sound training more routine training to improve speech function better, can make patients faster introductory speech training, the better to improve the effect of speech intelligibility.2. Strengthen training as a speech sound lips blasting introduction to the methods of learning, let the risk of patients can get bigger promotion pronunciation.3. The results of this experiment of shanxi unified speech treatment, assessment program cleft standards provide certain objective basis.
引文
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[21]Gibbon FE,Crampin L. An elect ropalat rographic investigation of middorsum palatal stops in an adult with repaired cleft palate[J]. Cleft Palate Craniofac,2001,38(2):96-105.
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苏焕香,张新华,张桂梅,孟效伶,刘志英.集中强化语音训练及心理护理在腭裂治疗中的床应用[J].全科护理,2009,(20).1834-1835.
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[11]陈仁吉,孙勇刚,张震康,等.鼻咽纤维镜生物反馈治疗在腭裂术后语音治疗中的应用[J].北京口腔医学,2008,16(2)：94-96
[12]Sultana A, Rahman MM, Rahman MM, etal. A feeding aid prosthesis for a preterm baby with cleft lip and palate. Mymensingh Med J,2011,20(1):22-27.
[13]彭兆伟,马莲,贾绮林.腭裂手术年龄对腭咽闭合功能影响的研究.现代口腔医学杂志,2008,22(3)：225-228.
[14]Eichhorn W, Blessmann M, Vorwig O, etal. Influence of lip closure on alveolar cleft width in patients with cleft lip and palate. Head Face Med,2011,7(1):3.
[15]陈为民,冀予心,朱声荣,等.腭裂患者术后语音训练介入时机的研究[J].中华物理医学与康复杂志,2009,14(9)：73.
[16]Karayazgan B, Gunay Y, Gurbuzer B, etal. A preoperative appliance for a newborn with cleft palate. Cleft Palate Craniofac J,2009,46(1):53-57.
[17]Brunner M, Stellzig-Eisenhauer A, Proschel U, etal. The effect of nasopharyngoscopic biofeedback in patients with cleft palate and velopharyngeal dysfunction. Cleft Palate Craniofac J,2005,42(6):649-657.
[18]Boscariol M, Andre KD,Feniman MR. Cleft palate children:performance in auditory processing tests. Braz J Otorhinolaryngol,2009,75(2):213-220.
[19]Ilgner, J., P. Duwel, and M. Westhofen."Free-Text Data Entry by Speech Recognition Software and Its Impact on Clinical Routine." ENT—Ear, Nose and Throat Journal85, no.8(2006):523-27.
[20]Sultana A, Rahman MM, Rahman MM, etal. A feeding aid prosthesis for a preterm baby with cleft lip and palate. Mymensingh Med J,2011,20(1):22-27.
[21]Gibbon FE,Crampin L. An elect ropalat rographic investigation of middorsum palatal stops in an adult with repaired cleft palate[J]. Cleft Palate Craniofac,2001,38(2):96-105.
[22]Karayazgan B, Gunay Y, Gurbuzer B, etal. A preoperative appliance for a newborn with cleft palate. Cleft Palate Craniofac J,2009,46(1):53-57.
[23]张文芝.腭裂修复术后256例语音训练[J].齐鲁护理杂志,2008,14(18：)83-84
[24]Jobe LA, Jobe PR. Speech training manual-A speech training tool for children and adults with surgically corrected cleft lip/palate, Unpublished Manual, California,2000.
[25]Noordhoff MS. Establishing a craniofacial center in a developing country. J Craniofac Surg,2009,20(2):1655-1666.
[26]王国民,朱川,袁文化,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,1995.4：125-128.
[27]徐秀清,孙彩红,刘婕.整体护理在腭裂整复术后语音治疗中的运用[J].护士进修杂志,2010,6：1011-1013
苏焕香,张新华,张桂梅,孟效伶,刘志英.集中强化语音训练及心理护理在腭裂治疗中的床应用[J].全科护理,2009,(20).1834-1835.
[28]Lee A, Whitehill TL,Ciocca V. Effect of listener training on perceptual judgement of hypernasality. Clin Linguist Phon,2009,23(5):319-324.
[29]Iwasaki H, Kudo M,Yamamoto Y. Intrinsic effects of congenital cleft palate on craniofacial morphology and growth characteristics in puberty. J Craniofac Surg,2010,21(5):1480-1487
[30]Goudy S, Lott D, Canady J, Smith RJ, Conductive hearing loss and otopathology in cleft palate patients. Otolaryngol Head Neck Surg2006;134:946-8.
[31]张文芝.腭裂修复术后256例语音训练[J].齐鲁护理杂志,2008,14(18：)83-84
[32]王国民,杨齐生,张勇,等.唇腭裂治疗现状与展望.上海口腔医学,2006,15(2)：113-116.
[33]Joan D'Mello&Sanjay Kumar. Audiological findings in cleft palate patients attending speech camp. Indian J Med Res125, June2007,777-782