循環音韻治療法應用遠距科技復健模式於偏遠地區重度語音異常兒童成效之研究

本研究旨在探討循環音韻治療法應用遠距科技復健模式，介入國內偏遠地區學前重度語音異常兒童以提升構音及音韻能力之成效。本研究採平行單一個案跨行為多基線設計，將遠距語音方案應用於2名住在國內偏遠地區的重度語音異常兒童，年齡介於5歲0個月至6歲9個月，進行兩個週期，每週期三個階段，每階段4堂課，每堂課約60分鐘，共24堂課的循環音韻治療療程，以同步視訊方式進行，輔以預錄影音教材供個案在家長的陪伴下於課餘時間自主練習。本研究以「自編類化測驗」評量音韻模式的「音素正確數」作為主要依變項指標，並將資料記錄於基線期、介入期（第一週期）、介入期（第二週期）、維持期與追蹤期，分析目視分析與效果量。此外，其他相關依變項：（1）音韻歷程發生率；（2）聲母正確率；（3）詞語正確率；（4）言語清晰度；及（5）社會效度，亦納入分析，以了解本遠距語音介入方案對研究對象整體語音能力的改變效果。研究結果顯示，2名個案在接受本遠距語音治療方案後，3種「音韻模式的音素正確數」皆一致獲得明顯立即成效及維持成效，能將新技巧類化至自發性言語當中，改善整體言語清晰度。此外，2名個案在治療後語音障礙嚴重度從重度轉為正常，音韻歷程也幾乎不再發生。家長對遠距語音治療方案感到非常滿意，認為透過遠距接受服務對偏遠地區來說是便捷有效的方式，整體改善生活情境之日常溝通功能。

關鍵字

循環音韻治療法；遠距科技復健模式；語音異常；偏遠地區；音韻歷程；音韻模式

並列摘要

The purpose of this study was to investigate the efficacy of the Cycles Phonological Remediation Approach via telepractice to expedite speech intelligibility for children with moderate to severe speech sound disorder living in rural areas. A parallel multiple baseline design across behaviors was used to examine intervention effects. Three preschoolers with severe speech sound disorder living in rural areas at age 5;0 to 6;9 participated in two cycles with 24 hours sessions of phonological remediation. The treatments were delivered by online conferencing software, and pre-recorded videos were provided for children and parents to practice as their homework. The word probes were administered during baseline, intervention (Cycle I), intervention (Cycle II), maintenance, and follow-up phases to assess generalization and maintenance of phonological skills. Data were analyzed by visual analysis, and effect size. Other dependent variables, including: (1) Percentages of Phonological Process Occurrence, (2) Percentages of Consonants Correct, (3) Percentages of Words Correct, (4) Percentages of speech intelligibility, and (5) social validity, were analyzed to compare the differences between pre- and post-intervention. The results of the study showed that all participants exhibited significant improvement by the end of the intervention phase and these effects were maintained at follow-up. On the other hand, other variables also exhibited significant gains. The participants’ speech has improved from rating of severe to ratings of normal. The percentages of Phonological Process Occurrence were decreased. Also, all participates speech intelligibility increased. The parents were very satisfied with this program, and believed that receiving services through telepractice was convenient and effective way for rural areas to improve the daily communication function.