聽覺失認症之復健：腦機制、亞型、評估與介入

The Rehabilitation of Auditory Agnosia: Brain Mechanism, Subtype, Assessment and Intervention

趙培均(Pei-Chun Chao) ； 李冠樺(Kuan-Hua Li) ； 黃苑捷(Yuan-Chieh Huang) ； 施琬諭(Wan-Yu Shih) ； 孟令夫(Ling-Fu Meng) ； 王靜誼(Ching-I Wang)

《台灣聽力語言學會雜誌》 35期 (2016/04) Pp. 1-19

https://doi.org/10.6143/JSLHAT.2016.04.01

摘要

聽覺失認症為可聽到卻無法辨識聲音內容的一種症候，因病例少，縱有優質且具深度的個案報告說明其臨床症狀與受損機制，卻缺乏臨床復健的訊息，更遑論統整基礎理論、病理機制與臨床復健的論述。研究文獻指出，聽覺皮質路徑如視覺路徑般呈現雙流的模式，其一行經大腦背側：分辨聲音位置的何地路徑，另一行經大腦腹側：分辨聲音內容的何物路徑；前述雙流受損可分別導致聲音位置與聲音內容的認知困難。此外，左右半球受損所導致的聽覺失認症類型也不同，左半球以分辨語音訊息為主，如純詞聾（pure word deafness）為與此有關的症候；右半球以分辨聲音、音樂與情緒為主，相關的聽覺失認症包括聽覺聲音失認症（auditory sound agnosia）、音樂失認症（amusia）與聽覺情感失認症（auditory affective agnosia）等。評量方面，以環境聲音、語言聲音、音樂處理、聲音情緒知覺、聲音區辨與熟悉聲音辨識等作為評量素材，可對個案聽覺認知功能做出更細膩的判斷。介入方面，可依個案症狀特性，決定介入方式：一、選擇不同聽覺訊息的輸入作為治療內容；並依活動分級的精神決定治療內容的難度，以提升個案的能力；二、採取內在代償策略，運用較優勢的聽覺認知能力來協助較弱的表現；三、對於無法復原的情形，亦可選擇外在代償策略，如溝通輔具、手語、唇語或減少環境噪音干擾等。

關鍵字

聽覺認知 ； 聽覺失認症 ； 腦機制 ； 評量 ； 治療

並列摘要

Auditory agnosia is the inability to recognize sounds in the present of intact hearing. Although the clinic syndromes and brain mechanism have been reported via excellent case reports, the rehabilitation information is still insufficient. Here we describe brain functioning, pathological phenomena, and adequate assessments and interventions about auditory agnosia. The brain ventral route is used to recognize sound content and the dorsal route is responsible for sound locations. Additionally, auditory agnosia can be divided into different subtypes such as inability to process verbal sound, pure word deafness, and nonverbal sound, auditory sound agnosia, amusia, and auditory affective agnosia .We can choose different stimuli combined compensatory strategies such as environmental sound, verbal sound, music, and vocal emotion to assess and improve the ability. Furthermore, integrating theory with pathological mechanism and clinical intervention can promote foundation of systemic rehabilitation.

並列關鍵字

Auditory perception ； Auditory agnosia ； Brain mechanism ； Assessment ； Intervention

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