功能性构音障碍临床表现及语言训练疗效分析

背景：功能性构音障碍是在学龄前儿童和学龄期儿童中最常见的语言障碍．影响了患日常的交流能力、心理发育、学习，成年患甚至影响工作及社会交往。因此对功能性构音障碍患进行语言评价及语言训练具有重大意义。目的：探讨功能性构音障碍临床特点及康复治疗方法。设计：病例分析。单位：中山大学附属第三医院康复医学科。对象：中山大学附属第三医院康复医学科收治的25例功能性构音障碍患，其中15例为4～11岁学龄前期、学龄期儿童，10例为17～25岁成年人。方法：对15例功能性构音障碍儿童及10例功能性构音障碍成人进行语言评价及语言训练。主要观察指标：①功能性构音障碍临床特点。②儿童与成年患语言治疗的治愈率。③观察语言训练的次数。结果：构音检查方面，儿童与成人主要错误方式为歪曲、置换，主要错误音为舌尖前音、舌尖后音、舌根音、舌面音和舌尖音。平均错误音儿童与成人差别无显性意义(P=0．9100)。训练时，引出每个目标音正确发音平均需时儿童较成人长(P=0．003)，而每个目标音较熟练应用所需时间儿童较成人短(P=0．008)。经训练15例儿童患12例完全纠正，3例部分纠正；10例成人患9例完全纠正，1例部分纠正后失访。结论：功能性构音障碍临床特点儿童与成人差别不大，均以歪曲、置换的错误方式为主；语言训练效果好，但开始训练的时机应该适当，并非越早训练效果越好。     

功能性构音障碍语言评价及训练效果的分析

目的　探讨功能性构音障碍的临床特点及康复治疗。方法　对功能性构音障碍儿童 12例及功能性构音障碍成人 5例进行语言评价及语言训练 ,比较并分析儿童及成人功能性构音障碍患者的特点及疗效。结果　构音检查方面 ,儿童与成人的主要错误方式为歪曲、置换 ,主要的错误音为舌尖前音、舌尖后音、舌根音、舌面音和舌尖音。儿童与成人平均错误音差异无显著性 (P >0 .0 5 )。训练时 ,引出每个目标音正确发音平均需时儿童较成人长 (P <0 .0 0 1) ,而每个目标音较熟练应用所需时间儿童较成人短 (P <0 .0 0 1)。经训练后 ,12例儿童患者中有 10例完全纠正 ,2例部分纠正 ,治愈率为 83.33 % ,有效率为 10 0 .0 0 % ;5例成人患者全部纠正 ,治愈率为 10 0 .0 0 % ;总治愈率为 88.2 4% ,总有效率为 10 0 .0 0 %。结论　儿童与成人功能性构音障碍的临床特点差别不大 ,均以歪曲、置换的错误方式为主 ;语言训练效果好 ,但开始训练的时机应该适当 ,并非越早训练效果越好。     

65例功能性构音障碍儿童训练效果分析

目的研究功能性构音障碍儿童错误构音的特点与语音训练方案。方法对65例功能性构音障碍儿童进行回顾性分析。结果 65例儿童主要的构音错误方式为置换,其次为省略和歪曲音。经过2～6个月口腔功能训练、构音运动训练以及靶音位训练,58例全部纠正,7例部分纠正。结论置换音是儿童功能性构音障碍最主要的构音错误方式;语音训练是治疗功能性构音障碍的有效措施。     

功能性构音障碍和构音障碍伴语言发育迟缓儿童辅音错误模式的研究

目的:研究功能性构音障碍和构音障碍伴语言发育迟缓儿童的辅音错误模式的分布特点、错误模式及形成特征,为设计语言、构音的康复方案提供理论指导。方法:选取31例功能性构音障碍和构音障碍伴语言发育迟缓儿童为研究对象,收集构音障碍诊治仪中受试者的错误辅音进行分析,分别计算患儿6个发音部位(唇音、舌尖前音、舌尖中音、舌尖后音、舌根音、舌面音)和5个发音方法(塞音、塞擦音、擦音、鼻音、边音)的辅音错误率。结果:发音部位上,16例功能性构音障碍儿童辅音错误率分别是21.87%、64.58%、46.03%、87.50%、31.25%、50.00%,15例构音障碍伴语言发育迟缓儿童辅音错误率分别是25.01%、80.00%、48.89%、90.57%、33.33%、53.33%;功能性构音障碍错误率最高的辅音均集中在舌尖后音(87.50%),构音障碍伴语言发育迟缓儿童错误率最高的辅音均集中在舌尖前音(80.00%),2组儿童错误率最低的辅音均集中在唇音,分别是21.87%和25.01%;4种辅音错误类型(替代、省略、歪曲、未习得)中,错误率最高者为替代性错误,2组儿童未习得率均低;功能性构音障碍儿童替代性错误较高的是舌尖前音(39.58%)和舌尖后音(39.06%),省略性错误最高的是舌尖后音(7.81%),歪曲性错误较高的是舌尖后音(35.94%);构音障碍伴语言发育迟缓儿童,上述6个发音部位的替代性错误较高的是舌尖前音(55.56%)、舌尖后音(33.96%)、舌面音(33.33%),省略性错误较高的是舌面音(8.89%)、舌尖后音(7.55%),歪曲性错误较高的是舌尖后音(35.85%)。发音方法上,功能性构音障碍儿童辅音错误率分别是35.42%、40.63%、54.17%、9.38%、81.25%,构音障碍伴语言发育迟缓儿童辅音错误率分别是35.56%、73.33%、57.78%、33.34%、60.00%;4种辅音错误类型中,功能性构音障碍儿童替代性错误较高的是边音(56.25%),省略性错误较高的是边音(6.25%),歪曲性错误最高的是塞擦音(26.04%);构音障碍伴语言发育迟缓儿童,替代性错误最高的是塞擦音(45.56%),其次是边音(33.33%),省略性错误较高的是擦音(7.78%),歪曲性错误较高的是边音(26.67%)、擦音(21.11%)。结论:发音部位方面,无论是功能性构音障碍儿童还是构音障碍伴语言发育迟缓儿童,发舌尖前音、舌尖后音和舌面音时的辅音错误率较高,发唇音时的辅音错误率最低;辅音错误方式以替代性错误和歪曲性错误为主。发音方法方面,功能性构音障碍儿童发边音的替代性错误和歪曲性错误较高,其次是塞擦音及擦音;构音障碍伴语言发育迟缓儿童发塞擦音的替代性错误和歪曲性错误较高,其次是边音的替代性错误较高。功能性构音障碍和构音障碍伴语言发育迟缓儿童习得语音与正常儿童相似,错误类型与发音部位、发音方法相关,制订康复计划时要兼顾辅音的错误特征。     

功能性构音障碍儿童构音特点分析及言语矫治

目的：探讨功能性构音障碍儿童错误构音的特点及言语矫治方案。方法：对52例功能性构音障碍儿童进行构音评价,分析错误构音的特点,针对性制定矫治方案并进行言语矫治。结果;52例儿童主要的构音错误方式为置换音,其次为省略音和／或扭曲音,其中声母的构音错误占绝大多数,主要为舌尖音、舌尖后音、舌尖前音及舌根音。经2周-7个月的言语矫治,45例全部纠正,7例部分纠正,治愈率86．5％。结论：置换音是儿童功能性构音障碍最主要的构音错误方式;言语矫治是治疗功能性构音障碍的有效措施,矫治效果与构音障碍严重程度及依从性有关。     

功能性构音障碍儿童辅音错误模式研究

目的:研究功能性构音障碍儿童错误辅音的分布特点、错误模式及形成特征,为设计语音康复方案提供一定的理论指导。方法:以90例3个年龄段(4、5、6及6岁以上年龄段)的功能性构音障碍儿童为研究对象,采用中国康复研究中心研制的汉语构音障碍评定法,对受试者的错误辅音进行分析,分别计算患儿6个发音部位(唇音、舌尖中音、舌根音、舌面音、舌尖前音、舌尖后音)的辅音错误率。结果:90例研究对象不进行年龄分组时,上述6个发音部位的辅音错误率依次为26.9%、41.7%、42.6%、38.9%、58.5%、55.0%;当对研究对象进行3个年龄段分组时,每个年龄段内错误率最高的辅音均集中在舌尖前音或舌尖后音上(47.4%~70.7%),错误率最低的辅音均集中在唇音上(25.0%~32.8%)。3种辅音错误类型(替代、省略、歪曲)中,错误率最高者为替代性错误。研究对象不进行年龄段分组时,上述6个发音部位的替代性错误占总错误的百分比依次为69.1%、45.3%、84.3%、77.1%、70.3%、74.2%;省略性错误在舌尖中音时百分比较高,为44.0%;而舌尖前音和舌尖后音中很少出现省略性错误,百分比仅为1.9%和1.5%,却较多出现歪曲性错误,百分比分别达到27.5%和24.2%。结论:无论是学龄前期还是学龄期,功能性构音障碍儿童发舌尖前音、舌尖后音时的辅音错误率最高,发唇音时的辅音错误率最低。辅音错误方式以替代性错误为主;发舌尖中音时较易出现省略性错误,发舌尖前音和舌尖后音时较易出现歪曲性错误。功能性构音障碍儿童习得语音与正常儿童相似,错误类型与发音部位相关,制订康复计划时要兼顾辅音错误特征。     

功能性构音障碍儿童56例构音特点及语音治疗分析

目的探讨功能性构音障碍儿童错误构音的特点及言语矫治方案。方法对56例功能性构音障碍儿童进行构音评价,分析错误构音的特点,针对性制定矫治方案并进行言语矫治。结果 56例儿童主要的构音错误方式为替代和省略,主要为舌尖前音、舌前后音、舌根音。经1－8个月的语音治疗,46例全部纠正,8例部分纠正,治愈率82%。结论替代和省略是儿童功能性构音障碍最主要的构音错误方式;语音治疗是治疗功能性构音障碍的有效措施。     

功能性构音障碍儿童舌根音发音状况分析

目的:舌根音的错误在功能性构音障碍儿童中普遍存在,探究学龄前和学龄期的功能性构音障碍儿童的舌根音发音状况,为临床的评估和治疗提供更多的依据.方法:按照年龄将45例功能性构音障碍儿童按照年龄分为两组,学龄前儿童和学龄儿童.并对45例儿童进行舌根音的发音评估.采用x2检验对学龄前和学龄期的儿童的三个舌根音的正确率进行分析....     

成年功能性构音障碍患者的语音训练及临床特点分析

目的探讨成年功能性构音障碍（FAD）患者的临床特点与语音训练方法。 方法对37例成年FAD患者进行语音评估,分析其临床特点并进行针对性的语音训练。 结果37例成年FAD患者主要的构音错误类型为置换、歪曲,其次为脱落。构音错误方式有舌前音化（19例）、非送气化（11例）、侧化构音（10例）、舌后音化（7例）、辅音脱落（7例）、混合型（4例）、唇齿音化（3例）、舌面音化（2例）。经过1～5个疗程的语音训练,28例治愈,8例好转,1例无效,训练后的语音清晰度测定值［（91.22±10.10）%］较训练前［（56.03±14.71）%］提高,差异有统计学意义（P<0.05）。 结论成年FAD患者主要的构音错误类型是置换和歪曲,基于构音错误方式开展针对性语音训练是治疗成年FAD的有效措施。     

功能性构音障碍患者侧化构音特点分析及语音训练疗效观察

目的 探讨功能性构音障碍（FAD)患者侧化构音语音特点及语音训练疗效。 方法 选取52例FAD侧化构音患者为研究对象,分析其侧化构音语音特点并进行针对性语音训练（包括基础训练、舌位稳定训练、舌位诱导训练、引导送气居中训练等）。 结果 入选患者舌尖前音（71.2%）、舌尖后音（63.5%）、舌面音（61.5%）侧化构音比例较高,其次为舌尖中音（17.3%）及双唇音（13.5%）;FAD侧化构音可合并不送气化、辅音置换等错误发音方式。入选患者经15~50课时针对性语音训练后,通过朗读普通话声韵母及音节表发现其侧化构音字数由训练前（90.35±41.59）个减少至训练后（10.37±7.81）个,其间差异具有统计学意义（P=0.000）。 结论 FAD患者侧化构音主要涉及舌尖前音、舌尖后音、舌面音;侧化构音可合并其他异常发音方式;基于侧化构音发生机制采取综合性语音训练方法是纠正FAD侧化构音的有效措施。     

The phonological skills of Samoan speaking 4-year-olds

To date there has been little research on the typical developmental patterns for children speaking Samoan. The research outlined in this paper serves to fill this gap by reporting on the phonological development of Samoan speaking children growing up in the English dominant language environment of Auckland New Zealand. In this study 20 children aged between 4;0 and 4;11 were assessed using a picture naming task that probed their knowledge of the Samoan phonemic inventory. The findings presented here give an indication of what children in their fifth year have as speech sounds in their phonetic inventory and the types of errors that they may still produce. These results demonstrate the similarities and differences that Samoan phonological development shares with other languages. In particular the differences that seem “atypical” when compared with studies on English are discussed. It is tentatively concluded that these differences may well be typical for Samoan speech acquisition given language specific factors and the bilingual context in which these children are growing up.     

高能震波治疗肌肉骨关节的慢性疼痛

背景目前有关用高能震波治疗肌肉骨关节慢性疼痛的报道不少,但其治疗的确切效果及作用机制不明确,有待进一步探讨.目的探讨高能震波对骨关节肌筋膜炎的治疗效果、作用机制及临床应用效应.设计以诊断为依据的非随机化同期对照研究.单位中山大学附属第一医院康复医学科.对象2001-07/2002-04中山大学第一附属医院康复科门诊救治的肌肉骨关节慢性疼痛患者90例,按就诊次序分为治疗组45例,男17例,女28例;平均年龄54岁;对照组45例,男15例,女30例,平均年龄63岁.方法治疗组采用体外冲击波治疗;对照组采用常规物理因子治疗.用简式MeGill疼痛问卷(MPQ)评估患者对疼痛的综合反应,并对肩关节活动范围及临床疗效进行评定.主要观察指标①两组治疗前后疼痛改善程度.②关节活动度的变化.③综合临床疗效.结果治疗组在治疗后感觉类,情感类,疼痛总分,目测类比定级(VAS),现有痛强度(PPI)方面与治疗前比较差异有显著性意义(t=5.69,5.67,7.06,8.37,6.21,P＜0.01).在感觉类,疼痛总分,VAS方面与对照组比较差异也有显著性意义(t=4.66,P＜0.01;t=2.52,3.40,P＜0.05).结论体外高能震波对骨关节肌筋膜炎等慢性疼痛疗效确切,临床应用上具有高效、快速、安全的特点.     

A dynamic approach to phonological assessment

Dynamic and static assessments in phonological disorders provide different information about a child's skills and development. Dynamic assessments evaluate a child's phonological system when given support, whereas static assessments evaluate skills without support. The Scaffolding Scale of Stimulability (SSS), described in this article, is one example of a dynamic assessment used to evaluate phonological disorders. The SSS comprises a 21-point hierarchy of cues and environmental manipulations that can be used to support a child in the production of phonemes. Use of the SSS is illustrated by a case study of a 4-year-old boy with moderate phonological disorder. The SSS is compared to a static assessment, a probe of 60 single words based on the child's error patterns. The two assessments are compared across treatment at three time intervals: prior to treatment, after 3 months of treatment, and after 6 months of treatment. Results indicated that scores on the SSS could differentiate the boy's phoneme productions based on the amount of support needed, while phoneme scores on the probe were at 0% accuracy. As a composite score, the SSS showed a greater percentage of change earlier in treatment and across time when compared to the probe.     

利奈唑胺治疗社区获得性耐甲氧西林金黄色葡萄球菌肺炎老年患者一例并文献复习

目的 探讨利奈唑胺治疗老年社区获得性耐甲氧西林金黄色葡萄球菌(MRSA)肺炎的效果.方法 采用回顾性调查方法,对1例应用利奈唑胺治疗社区获得性MRSA感染的老年肺炎患者的临床资料进行分析,记录其治疗前后的临床症状变化.结果 对于MRSA感染的老年肺炎患者,使用利奈唑胺能够有效抑制病原菌,并且不良反应少,治疗效果明显.结论 在治疗MRSA感染的社区获得性肺炎患者过程中,早期、正确使用抗生素能够提高患者治愈率.

Abstract：

Objective To investigate the clinic effect of Linezolid for community acquired methicillin resistant staphylococcus aureus (MRS A) pneumonia. Methods The clinic data of the patient- were collected from the First Affiliated Hospital of Sun Yat-Sen University, in addition, the body temperature and white blood cell counts were obtained as the index of treatment. Results It was proved that Linezolid was effective in treating community acquired MRSA pneumonia and showed well tolerance with few adverse events. Conclusion Linezolid demonstrated good clinical and antibacterial activity but very few adverse reactions in elderly patients with community acquired MRSA pneumonia.     

Effects of phonological awareness and semantic intervention on word-learning in children with SLI

This study examined the effects of phonological awareness and semantic intervention on word-learning abilities in children with Specific Language Impairment (SLI) and whether treatment order influenced outcomes. An alternating treatment design was implemented to evaluate whether phonological awareness, semantic awareness, or a combination of both interventions positively influenced children's word-learning ability and whether the order of the treatments influenced outcomes. Nineteen children with SLI, aged between 6;3 and 8;2 years, and 19 age-matched children with typical language development participated in this study. The children with SLI were randomly assigned either to treatment condition A (phonological awareness intervention followed by semantic intervention) or treatment condition B (same interventions in reverse order). A word-learning paradigm was applied at pre-, mid-, and post-testing to evaluate which condition accelerated the receptive and expressive learning of novel words. Positive treatment effects on producing new words were found for the children who received phonological awareness intervention followed by semantic intervention. There was no improvement on the comprehension of new words for either group. The findings suggest that phonological awareness intervention may not only improve children's phonological skills, but may help to facilitate some aspects of word-learning when followed by an additional semantic based intervention.     

Effects of phonological awareness and semantic intervention on word-learning in children with SLI

This study examined the effects of phonological awareness and semantic intervention on word-learning abilities in children with Specific Language Impairment (SLI) and whether treatment order influenced outcomes. An alternating treatment design was implemented to evaluate whether phonological awareness, semantic awareness, or a combination of both interventions positively influenced children's word-learning ability and whether the order of the treatments influenced outcomes. Nineteen children with SLI, aged between 6;3 and 8;2 years, and 19 age-matched children with typical language development participated in this study. The children with SLI were randomly assigned either to treatment condition A (phonological awareness intervention followed by semantic intervention) or treatment condition B (same interventions in reverse order). A word-learning paradigm was applied at pre-, mid-, and post-testing to evaluate which condition accelerated the receptive and expressive learning of novel words. Positive treatment effects on producing new words were found for the children who received phonological awareness intervention followed by semantic intervention. There was no improvement on the comprehension of new words for either group. The findings suggest that phonological awareness intervention may not only improve children's phonological skills, but may help to facilitate some aspects of word-learning when followed by an additional semantic based intervention.     

注意力训练对功能性构音障碍的疗效

目的:观察注意力训练在功能性构音障碍(FAD)患儿中的疗效。方法:将52例FAD患儿分为观察组32例和对照组20例,2组均给予构音训练,观察组增加注意力训练。治疗8～24个月后比较2组疗效。结果:治疗8～24个月后,观察组治愈率及总有效率明显优于对照组(P<0.05)。结论:对FAD患儿在传统构音训练的基础上予注意力训练极大提高了FAD患儿的疗效。