應用輔助溝通系統於中風非流暢型失語症者之研究

研究背景：越來越多的電腦化輔助溝通系統廣泛應用於臨床失語症者的復健，確實能有效地促進失語症者的整體溝通能力與效率。輔助溝通系統的使用，需要認知能力及長期訓練才能有效操作，而訓練目的在於有效地使用輔助溝通系統產生有效的溝通句子。對於中風非流暢型失語症者，藉由輔助溝通系統的使用訓練，隨著漸漸熟稔操作，最後是否能在不同溝通情境中獨立地使用輔助溝通系統做有效的溝通。研究目的：為了支持輔助溝通系統對於中風非流暢型失語症者的臨床應用，本研究使用國內研發的輔助溝通系統「圖文蘋果派」 (Voice Symbol for iPad)，探討中風非流暢型失語症者在溝通情境中溝通句子的正確完成率與訓練成效、以及不同溝通情境的類化成效。研究方法：以單一受試跨受試者多探試設計 (Multiple Probe Across-Subjects Designs) ，實施三位中風非流暢型失語症者的「圖文蘋果派」使用成效研究，分基線期、處理期與維持期三個階段。資料蒐集包括：(1)每個階段測驗的溝通情境下，溝通句子的正確完成率；(2)維持期類化的溝通情境下，溝通句子的正確完成率。研究資料以視覺分析圖來呈現與分析，並以C統計考驗來輔助分析。並使用中文化的溝通效益測驗，由主要照顧者評量參與者溝通獨立性的表現，以及調查社會效度與使用滿意度。結果：輔助溝通系統「圖文蘋果派」使用之後，所得結果如下：(1)三位參與者對於溝通情境溝通句子的正確完成率皆有顯著增加，並且維持顯著的使用訓練成效；(2)三位參與者皆有良好的類化成效，且認知功能較好者的類化成效比較好；(3) 參與者與主要照顧者皆滿意輔助溝通系統的使用；(4) 社會效度方面，治療人員比起主要照顧者更認同輔助溝通系統的使用效果；(5)主要照顧者對於參與者獨立溝通表現的感覺程度方面，除了一位參與者有些微減少之外，其他兩位皆有大幅增加。討論：臨床治療環境下，輔助溝通系統「圖文蘋果派」可協助中風非流暢型失語症者的溝通句子表達。「圖文蘋果派」的使用訓練會受認知功能與個人特質影響，而不同溝通情境下的類化成效會受認知功能影響。

關鍵字

輔助溝通系統；中風；非流暢型失語症

並列摘要

Background: Computerized augmentative and alternative communication (AAC) is increasingly applied in clinical aphasia rehabilitation because it has been proven effective at enhancing the communication skills and efficiency of people with aphasia. Effective use of AAC requires a strong cognitive ability and prolonged training, which is aimed at training people with aphasia to generate communicative sentences through the use of AAC device. This study attempts to determine whether people who developed non-fluent aphasia after a stroke can effectively use AAC device to independently communicate in different communication situations after becoming familiar with operating such device. Objective: To support the clinical application of AAC in treating people with non-fluent aphasia after a stroke, this study explored the effectiveness of training people who developed non-fluent aphasia after a stroke to use the AAC application software developed in Taiwan, the Voice Symbol for iPad. Subsequently, the accurately completed percentage of communicative sentences and the generalization outcomes of the AAC device were investigated under different communication situations. Method: This study adopted a multiple probe across-subjects design to investigate the effectiveness of training three people who developed non-fluent aphasia after a stroke to use the Voice Symbol for iPad. Three phases were explored in this study, namely the baseline, intervention, and maintenance phases. The following data were collected: the accurately completed percentage of communicative sentences during each phase under the tested communication situation; and the accurately completed percentage of communicative sentences during the maintenance phase under a generalized communication situation. The collected data were illustrated and analyzed using visual analysis, supplemented with the C statistical test. Before and after the research was conducted, a Mandarin version of communicative effectiveness index was employed to assess the perception of primary caregivers regarding the ability of the participants to communicate independently. After the research was conducted, the social validity and user satisfaction with the AAC were investigated. Results: After the participants used the Voice Symbol for iPad installed in the AAC, the following results were obtained: (1) the three participants exhibited significant improvement in the accurately completed percentage of communicative sentences, and the training effectiveness was significantly maintained; (2) the three participants exhibited good generalization effect, and better cognitive function resulted in better generalization effect; (3) the participants and primary caregivers were satisfied with using the AAC; (4) regarding the social validity, the therapists identified with the effect of the AAC device more than the primary caregivers did; and (5) the perception of primary caregivers regarding the ability of the participants to communicate independently, except that one participant showed slightly unsatisfactory performance, the other two exhibited substantially improved independent communication skills. Conclusion: In a clinical therapeutic setting, the Voice Symbol for iPad installed in the AAC can help people who developed non-fluent aphasia after a stroke to express communicative sentences. The training effectiveness of using the Voice Symbol for iPad was influenced by individual cognitive function and personal traits, and the generalization outcomes obtained under different communication situations were affected by cognitive function.