音聲異常的物理治療－病例報告

The Role of Physical Therapy in Voice Disorder-A Case Report

朱美滿(Mei-Mang Chu) ； 楊順安(Shun-An Yang)

《中華民國物理治療學會雜誌》 22卷4期 (1997/10) Pp. 277-290

https://doi.org/10.29616/JPTAROC.199710.0006

摘要

造成音聲異常(voice disorders)的原因狠多，其中良性聲帶病變，無論在小孩或大人之中都是最主要且常見的因素。針對這類病患最根本解決的治療方法統是音聲治療。音聲治療的基本原理都是依據發聲之生理解剖的基礎，即肌彈力－氣動力理論(myoelastic-aerodynamic theory)。良好的發聲是建立於聲帶的振動與呼吸系統的協調。即喉部內在肌與其外在肌，二者於肌力與長度維持在良好的關係，也正是代表正常肌的彈力。足夠的呼氣量與協調的肌肉控制以維持聲門下適度的壓力，即代表發聲的氣動力。不良的姿勢不僅使呼吸系統無法有效運作，且改變喉內外在肌正常的張力與長度，因而迫使頸部呼吸副肌過度使用，進一步造成聲帶、假聲帶的誤用，形成良性聲帶病變，而導致音聲異常。運用物理治療對於骨肌系統進行治療的理論，對音聲進行治療與再訓練是重要的復健模式。物理治療針對姿勢及相關動作功能的表現，予以評估與擬定治療計畫，以達到音聲治療目標。本文以病例討論的方式，說明臨床物理治療對於此類患者的評估、治療原則與方法，以及其效果；並就物理治療與語言治療，對因發聲誤用或濫用導致音聲異常之患者治療方式的異同加以討論，以期建立更好的團隊合作關係，更增進音聲治療的效果。

關鍵字

音聲異常 ； 發聲機轉 ； 姿勢 ； 物理治療

並列摘要

Voice disorders are very common in morden times. One of the most common causes for adults and children is the benign vocal fold change as a result of misuse, abuse, or overuse of phonation. Fundamental approach to the voice disorders is voice therapy. The concepts of the voice therapy are based on the mechanism of phonation- the myoelastic-aerodynamic theory. Phonation is built up in the coordination of the vibrator and the respiratory system; that is, the intrinsic and extrinsic laryngeal muscles (myoelastic components) should be maintained in a good length- tension relationship and have sufficient respiratory function to produce adequate epiglottic pressure (aerodynamic function). Malposture, which makes the respiratory system function insufficiently, changes the normal length-tension relationship of the intrinsic and extrinsic laryngeal muscles; thus, a misuse of phonation will occur and cause vocal cord injury. The models of rehabilitation from physical therapy and sports medicine are important in the application of musculoskeletal theory to the rehabilitation and retraining of the voice. The purpose of this case report is to describe the application of physical therapy for voice disorders and its effect. We will compare the approach of physical therapy for mechanical voice disorders with speech therapy and hope to set up an ideal model.

並列關鍵字

Voice disorders ； Mechanism of phonation ； Posture ； Physical therapy