不同溝通障礙程度學齡腦性麻痺兒童語言功能及聲學分析之研究

Speech Functions and Acoustic Analysis in Children with Cerebral Palsy Having Different Communication Levels

黃苡晴(Yi-Ching Huang) ； 陳嘉玲(Chia-Ling Chen) ； 鍾佳英(Chia-Ying Chung) ； 吳佩璇(Katie Pei-Hsuan Wu) ； 劉惠美(Huei-Mei Liu) ； 陳協慶(Hsieh-Ching Chen)

《台灣復健醫學雜誌》 45卷1期 (2017/06) Pp. 35-44

https://doi.org/10.6315/2017.45(1)05

摘要

腦性麻痺兒童通常會有語言、言語和溝通的問題。本研究主要探討不同溝通障礙程度學齡腦性麻痺兒童的語言功能和聲學分析的差異。本研究收集24位腦性麻痺兒童(17個男孩，7個女孩；平均年齡8歲4個月，範圍6-12歲)，以溝通功能分類系統(Communication Function Classification System, CFCS)分為溝通能力較佳組(等級I、II)和溝通能力較差組(等級III、IV)兩組，所有受試者須接受臨床(認知、語言、動作言語)和聲學評估。認知能力以「魏氏兒童智力量表第四版」（WISC-IV）評估，語言能力以「修訂學齡語言障礙評量表」和「修訂畢保德圖畫詞彙測驗」來評估；動作言語以「兒童口語產出動作評估」評估口腔動作功能；利用「華語構音/音韻臨床測驗工具」收集語料，計算子音正確百分比(PCC)。聲學分析以語音分析軟體分析第一共振峰(F1)、第二共振峰(F2)、母音構音空間、嗓音起始時間、無聲子音嗓音起始時間、噪音持續時間、沖直條比例、鼻音共振峰等參數。使用t-test比較兩組在臨床評估和聲學的差異，若p 值＜ .05表示具有統計顯著差異。溝通能力較佳組在認知、語言能力、兒童口語產出動作評估(局部口腔動作、連續性、整體)和子音正確率皆優於溝通能力較差組，並且達顯著差異(p＜.05)；而口腔動作功能中的一般動作控制和聲學分析參數，兩組則沒有差異，但聲學分析中的擦音沖直條比例接近統計上的顯著(p=.083)。本研究結果顯示腦性麻痺兒童的溝通能力和認知、語言及動作言語功能有顯著相關，因此不同溝通能力的兒童需選擇不同的介入策略，以提升說話清晰度及溝通效度。

關鍵字

腦性麻痺(cerebral palsy) ； 溝通功能分類系統(communication function classification system) ； 語言功能(language function) ； 聲學分析(acoustic analysis)

並列摘要

Children with cerebral palsy (CP) often exhibit problems with language, speech, and communication. The aim of this study was to examine speech functions and perform an acoustic analysis of speech in children with CP having different levels of proficiency in communication. This study recruited 24 children with CP (17 boys, 7 girls; mean age: 8 years and 4 months, age range: 6-12 years). Children with CP were classified into two groups based on the Communication Function Classification System (CFCS): the mild group (levels I and II) and the severe group (levels III and IV). Children with CP underwent clinical assessments for cognition, language, and motor speech. Acoustic analysis of the speech of these children was also performed. Cognition was evaluated using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). The Language Impairment Scale and Peabody picture vocabulary Test-Revised (PPVT-R) were used to assess language functions. Motor speech functions were evaluated using the Verbal Motor Production Assessment for Children (VMPAC) and Percentage of Correct Consonant (PCC) tests. Acoustic analysis included the examination of the frequencies of the first and second formants (F1 and F2), vowel spaces, voice onset time (VOT), noise durations, percentage of burst, and nasal formants. An independent t test was used to compare the results of the clinical and acoustic analysis between the two groups. A p-value ＜.05) was considered to denote statistical significance. Results showed that the mild group had better cognition, language ability, motor speech control (focal oromotor control, sequence, and total score), and speech intelligibility than did the severe group (p ＜.05). There were no significant differences in the global motor control and the acoustic analysis parameters between the two groups. However, the difference in the percentage of burst fricative between the two groups was marginally significant (p =.083). These findings suggest that the communication function in children with CP is correlated with their cognition, speech, and motor speech functions. Therefore, clinicians may use different treatment strategies to promote speech intelligibility and communication efficiency in children with CP based on their communication abilities.

並列關鍵字

cerebral palsy ； communication function classification system ； speech function ； acoustic analysis

參考文獻

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