功能性构音障碍擦音异常患者的临床特征及语音治疗

The Clinical Characteristics and Speech Therapy of Patients with Abnormal Fricativeconsonant of Functional Articulation Disorders

目的 探讨功能性构音障碍（functional articulation disorders,FAD）擦音异常患者的临床特征和语音治疗方法。方法 采用美国Kay公司生产的Model 4 500计算机语音工作站和包含88个汉字的擦音评估字表对84例4-28岁FAD擦音异常患者进行语音评估,分析异常擦音/f/、/s/、/sh/、/r/、/x/、/h/的构音错误方式和错误表现形式;通过语音治疗针对性纠正擦音构音部位及构音方式的错误,并分析疗效。结果 FAD擦音异常患者以学龄前患儿为主,占70.24%（59/84）;/s/音错误频率最高,为89.29%（75/84）,其他依次为/sh/音（86.90%,73/84）、/r/音（67.86%,57/84）、/f/音（60.71%,51/84）、/h/音（50.00%,42/84）及/x/音（38.10%,32/84）。频率最高的错误构音方式为构音扭曲（77.38%,65/84）,其他主要为省略化（40.48%,34/84）、塞音化（35.71%,30/84）、塞擦音化（30.95%,26/84）、双唇音化（29.76%,25/84）。经过2-10次语音治疗,84例患者中完全治愈65例,部分治愈18例,无效1例,擦音错误字数由训练前的61.06±17.99个减少到训练后的4.12±3.06个,差异有统计学意义（t=30.389,P〈0.001）。结论 FAD擦音异常患者各个擦音均有不同程度的异常,主要的错误方式为构音扭曲;根据错误部位及错误方式开展针对性语音治疗可有效矫治擦音异常。

Objective To explore the clinical characteristics and speech therapy approaches of patients with abnormal fricative consonants of functional articulation disorders （FAD） .Methods A total of 84 patients of 4 to 28 years old with abnormal fricative consonants of FAD received the assessment of the clinical characteristics of their speech .The age characteristics ,erroneous articulation patterns and error forms of fricative consonants /f/,/s/,/sh/,/r/,/x/and /h/were analysed .The targeted speech therapy was established aiming at correcting the erroneous places and types of pronunciation .Results The preschool children accounted for 70 .24% as the highest among 84 cases .The highest error rate of /s/was 89 .29% ,followed by /sh/（86 .90% ） ,/r/（67 .86% ） ,/f/（60 .71% ） ,/h/（50 .00% ） and /x/（38 .10% ） .The highest error rate of distortion was 77 .38% ,followed by omission（40 .48% ） , plosive（35 .71% ） ,affricative（30 .95% ）and bilabial consonants（29 .76% ） .65 cases were completely cured ,and 18 cases partially cured while one case showed unsatisfied results after 2 to 10 times of therapy .The number of incorrect words of fricative consonants decreased to （4 .12 ± 3 .06） after speech therapy from （61 .06 ± 17 .99） the baseline .The differences were statistically significant （t=30 .389 ,P〈0 .001） .Conclusion All fricative consonants in patients with abnormal fricative consonants of FAD make mistakes in different degrees .The main erroneous pattern is distortion .The targeted speech therapy hereby established according to the erroneous places and forms of articulation is significantly effective .