修正式循環音韻治療法介入以提升聽力損失兒童語音能力之研究

The Efficacy of the Modified Cycles Phonological Remediation to Enhance Speech for Hearing-Impaired Children

柯巧翊(Ciao-Yi Ke) ； 陳凱玫(Kai-Mei Chen) ； 鄧菊秀(Chu-Hsiu Teng)

《教育實踐與研究》 35卷2期 (2022/12) Pp. 103-137

摘要

本研究旨在探討透過修正式循環音韻治療法（The Modified Cycles Phonological Remediation Approach, MCPRA）提升學前聽力損失兒童之語音能力。研究採單一個案研究法之跨參與者多基準線設計，研究對象為三名年齡介於4歲0個月至6歲4個月的重度語音異常聽損兒童，以MCPRA為主要介入模式，進行2個循環階段，合計18次之課程。本研究使用「目標音類化單字正確題數」作為主要介入目標，並將資料記錄於基線期、介入期及維持期，再以目視分析、效果量及C統計進行分析。研究結果顯示，三位研究對象於治療後的「目標音類化單字正確題數」皆一致呈現立即及維持成效，亦能類化至非目標語音，使整體語音能力獲得改善。另外，三名研究對象介入後的聲母正確率、語詞正確率、清晰度百分比及音韻歷程出現率均明顯進步，整體語音異常嚴重度從重度轉為輕度或正常。本研究為聽損兒童之語音治療研究提供實證，亦提供臨床人員MCPRA詳細介入程序，包含語音分析方式、目標語音挑選原則、課程步驟等。最後，本研究闡述該治療法於臨床場域應用及未來研究建議，進而提供後續研究與臨床實務之參考。

關鍵字

音韻系統 ； 循環音韻治療法 ； 語音能力 ； 語音異常 ； 聽力損失

並列摘要

The purpose of this study was to investigate the efficacy of the Modified Cycles Phonological Remediation (MCPRA) to enhance speech for children with severe speech sound disorders (SSD) and hearing impairment (HI). A multiple baseline design across subjects was used to examine intervention effects. Three preschoolers with severe SSD and HI at age ranging from 4 year 0 month to 6 year 4 month participated in the study. All three children received two cycles with 18 hours of phonological remediation sessions. The target generalization probe words were administered during baseline, intervention, and follow-up phases to assess generalization and maintenance of phonological skills. Data were analyzed by visual analysis, effect size and C-statistic. The results indicated that all participants' target generalization probe words exhibited significant improvement by the end of the intervention, maintain, and follow-up phase. Furthermore, three children's speech rating has improved from severe to mild or normal. Their speech intelligibility increased as well. This study provides evidence-based research on speech therapy for children with HI, and clinical procedure for MCPRA, including sounds analysis method, target selection, and the intervention steps. Finally, the result of this study could provide clinical and research application of the articulation/phonological intervention for Mandarin-speaking children with HI.

並列關鍵字

Cycles Phonological Remediation Approach ； hearing loss ； phonological system ； speech ； speech sound disorders

參考文獻

Baker, E., & McLeod, S. (2011). Evidence-based practice for children with speech sound disorders: Part 1 narrative review. Lang Speech Hear Serv Sch, 42(2), 102-139. doi:10.1044/0161-1461(2010/09-0075)

Ertmer, D. J. (2011). Assessing speech intelligibility in children with hearing loss: Toward revitalizing a valuable clinical tool. Language, Speech, and Hearing Services in Schools, 42(1), 52-58. doi:10.1044/0161-1461(2010/09-0081)

Lin, C. Y., Tseng, Y. C., Guo, H. R., & Lai, D. C. (2018). Prevalence of childhood hearing impairment of different severities in urban and rural areas: A nationwide population-based study in Taiwan. BMJ open, 8(3), e020955. doi: 10.1136/bmjopen-2017-020955

王南梅、郭于靚、黃國祐、劉樹玉、劉俊榮（2009）。台灣電子耳兒童現況調查研究－電子耳使用、聽覺能力、口語溝通能力表現。台灣聽力語言學會雜誌，22，55-85。[Wang, N. -M., Kuo, Y. -C., Huang, K. -Y., Liu, S. -Y., & Liu, C. -J. (2009). Cochlear implanted children in Taiwan: Device use, auditory performance, and communication skills. Journal of the Speech-Language-Hearing Association of Taiwan, 22, 55-85]

鈕文英、吳裕益（2015）。單一個案研究法：研究設計與後設分析。台北：心理。[Niew, W. -I., & Wu, Y. -Y. (2015). Single-case research: Research designs & meta-analysis. Taipei: Psychological.]