个性化多媒体家庭治疗儿童功能性构音障碍

Individualized multimedia family treatment in children with functional articulation disorder

目的:探讨个性化多媒体的应用在功能性构音障碍儿童家庭康复中的意义。方法:于2002-03/2004-10选择中山大学附属第一医院康复科和附属第二医院康复科的门诊就诊的功能性构音障碍患者44例为观察对象。按随机数字表把患者分为对照组和观察组,每组22例。两组患者均每周接受一次门诊治疗,由家长陪同整个治疗过程,治疗时间为30～40min/次,对照组利用简易言语治疗处方指导患者家属进行听觉语音辨析、构音运动训练、语音训练等治疗。观察组则在每次治疗后同样开出言语处方,并附上辅音发音图卡和用可擦写光盘刻录的教学光碟,内容包括言语治疗师的示范动作,相应的辅音发音剖面图和包含有靶音的儿歌及电脑游戏,让家长每天陪孩子看光碟进行训练,时间为30～40min,并在日常生活中注意纠正其错误的构音,尽量采用游戏的方式在不知不觉中纠正孩子的构音。两组儿童治疗期间为4～9个月,治疗前后分别用汉语语音清晰度表进行评估。语音清晰度90%以上为优,75%～89%为良,60%～74%为中,60%以下为差。结果:两组患者全部完成治疗,均进入结果分析。①治疗前两组患儿的错音表现相似,主要的错音为g、k、z、c、s,其次是d、t、l。②治疗前两组患者语音清晰度接近[(45.47±8.69)%,(47.23±8.30)%,t=0.685,P=0.497];治疗后两组患者语音清晰度均有提高,对照组患者语音清晰度为(80.26±10.49)%,观察组为(95.59±4.29)%;均显著高于治疗前,差异有显著性意义(t=17.459,P<0.0005);(t=6.34,P=0.000);观察组治疗后效果优于对照组(t=-29.823,P<0.0005)。③治疗后对照组语音清晰度优3例(14%),良13例(59%),中4例(18%),差2例(9%);观察组语音清晰度优19例(86%),良3例(14%)。观察组优良率明显高于对照组(100%,72%,P=0.000043)。结论:个体化多媒体家庭康复可有效节约康复资源,是功能性构音障碍儿童可行有效的康复途径之一。

AIM： To investigate the significance of the application of individualized multimedia in the family rehabilitation of children with funetional articulation disorders. METHODS： Forty-four children with functional articulation disorders, who were treated in the Department of Rehabilitation of the first and second affiliated hospitals of Sun Yat-sen University between March 2002 and October 2004, were enrolled and divided into observational group （n=22） and control group （n =22）. Patients in both groups all received the outpatient treatment once every week accompanied by the parents in the whole treatment, 30-40 minutes for each time. In the control group, simple therapeutic prescription was used to guide the parents of the patients to perform vocal resonance differentiation, articulation training and voice training; besides, language prescription was also given after each treatment, cards for articulation of consonants and teaching disc written with erasable CD were also provided, the contents included the demonstration of speech therapist, sectional drawing for corresponding articulation of consonants, nursery rhymes and computer games containing target voice, the children trained while watching the CD accompanied by the parents for 30-40 minutes every day, and wrong articulations should be corrected in daily life unconsciously by means of playing games. The children in both groups were treated for 4-9 months, and they were assessed with Chinese Phonology Veracity Assessment and Chinese Consonant Table before and after training respectively. The voice clearness was above 90% for excellent, 75%-89% for good, 60%-74% for fair, below 60% for poor. RESULTS： All the patients in both groups finished the treatment and entered the analysis of results. ① Before treatment, the children in both groups had similar manifestations of wrong voices, the main wrong voices were g, k, z, c and s, followed by d, t and 1. ② The voice clearness was similar between the two groups before treatment [（45.47±8.69）%, （47.23±8.30）%, t=0.685, P=0.497], which were significantly increased to （80.26±10.49）% in the control group and （95.59 ±4.29）% in the observational group respectively （t=17.459, P 〈 0.000 5; t=6.34, P=0.000）, and the effect after treatment was better in the observational group than in the control group （t=-29.823, P 〈 0.000 5）. ③ After treatment, the voice clearness was excellent in 3 cases （14%）, good in 13 cases （59%）, fair in 4 cases （18%） and poor in 2 cases （9%） respectively in the control group; and it was excellent in 19 cases （86%） and good in 3 cases （14%） respectively in the observational group. The excellent and good rate was obviously higher in the observational group than in the control group （100%, 72%, P=0.000 043）. CONCLUSION： Individualized multimedia family rehabilitation is one of the effective feasible rehabilitative measures for children with functional articulation disorders, it can effectively save rehabilitation resources and should be spread.