溝通輔具對於慢性嚴重失語症成人之應用：個案報告

The Application of Augmentative and Alternative Communication on an Adult with Chronic Severe Aphasia: A Case Report

余鴻文(Hung-Wen Yu) ； 班迅雷(Ban-Shiun Lei) ； 蔡孟憑(Meng-Ping Tsai) ； 吳亭芳(Ting-Fang Wu)

《臺灣職能治療研究與實務雜誌》 12卷1期 (2016/06) Pp. 36-50

https://doi.org/10.6534/jtotrp.2016.12(1).36

摘要

失語症常是中風或創傷性腦傷導致的結果，影響語言的表達和接收。國外許多研究顯示，有效運用溝通輔具，對嚴重失語症者能補償喪失的語言功能、支持功能性溝通、促進生活參與、改善生活品質、降低社會性隔離。但國內尚缺乏實證研究，本研究目的在探討高科技溝通輔具對於成人失語症的成效。個案為一位跨皮質運動型失語症(transcorticalmotor aphasia)的中風成人女性，使用「圖文大師動畫語音版(picture master languagesoftware, PMLS)」，配合觸控式電腦，以個別化設計的溝通內容，每週三次、每次一小時，介入二個月，追蹤一個月。以簡明失語症測驗(Concise Chinese Aphasia Test, CCAT)；功能、障礙和健康國際分類(the International Classification of Functioning, Disability andHealth, ICF)的溝通與設備使用；功能性溝通活動量表(the Functional CommunicationActivities Questionnaire, FCAQ)來評估，以瞭解介入後對溝通能力和表現獨立性的成效。結果簡明失語症測驗的總平均分數從7.56進步到8.15；功能、障礙和健康國際分類的溝通與設備使用，44%的項目有進步；功能性溝通活動量表八個領域的總分數，分別進步8到13分不等。顯示個別化溝通需求設計的PMLS，配合觸控式電腦的研究方式，確實能改善個案整體的溝通能力、溝通設備與技術的使用和功能性溝通的表現獨立性。但自然性說話方面，雖有改善，仍無法獨力達成。追蹤期之後，功能性溝通的表現獨立性大部分皆退步，顯示成效維持不佳。

關鍵字

失語症 ； 中風 ； 圖文大師動畫語音版 ； 功能性溝通的表現獨立性

並列摘要

Aphasia is typical sequela of stroke/CVA or TBI. It may affect the expression and receipt of language. Many foreign studies suggest that a successful implementation of the technology of augmentative and alternative communication (AAC) can help the individuals with severe aphasia to compensate for the loss of linguistic function, support functional communication, promote more active involvement in life, improve quality of life, and decrease risk of social isolation. National reports on the results of studies by high-tech AAC solutions remain lacking in clinical evidence. The main goal of this study is to explore the effect of high-tech AAC for adult aphasia. This study used the Picture Master Language Software (PMLS) with touch screen computer on an adult female patient with stroke accompanied by transcortical motor aphasia (1hr/day, 3 days per week, a duration of two months, 1-month follow-up) for the purpose of confirming whether there was improvement in overall communicative ability and the level of performance in functional communication after tailor-designed PMLS intervention. The result was evaluated using the assessment tools of the Concise Chinese Aphasia Test (CCAT), the International Classification of Functioning, Disability and Health (ICF) and the Functional Communication Activities Questionnaire (FCAQ). The result showed that the interventions by personal designed PMLS with touch screen computer did improve overall communicative ability, use of communication devices and techniques, and the level of performance in functional communication. The total mean score of CCAT increased from 7.56 to 8.15. A proportion of 44% items was improved for use of communication devices and techniques of ICF. The total score in every field of FCAQ increased from 8 to 13 separately. However, natural speaking was improved but did not go back to normal. After follow-up, most functional communications appeared to be degenerative, suggesting maintenance of the effect was poor.

並列關鍵字

Aphasia ； Stroke ； Picture master language software ； Level in the performance offunctional communication