人工耳蜗植入儿童早期词汇理解和表达能力研究

Comprehensive and Expressive Vocabulary Abilities in Children with Cochlear Implants

目的研究人工耳蜗植入儿童术后早期的词汇理解和表达能力发展过程,探讨两种评估患儿言语表达能力工具之间的相关性,为言语能力评估材料的选择提供参考。方法以行人工耳蜗植入术的44例内耳及蜗神经无异常的先天性重至极重度感音神经性语前聋儿童为研究对象,植入年龄为3.0±1.1岁,人工耳蜗使用时长(听力年龄)为11.4±1.5个月,测试时生理年龄为4.0±1.1岁,使用改良版汉语沟通发展量表短表(simplified short form versions of the Mandarin communicative development inventory,SSF-MCDI),根据适用年龄的不同分为词汇和手势(word&gesture,W&G,适用于8~16月龄)以及词汇和句子(word&sentence,W&S,适用于16~30月龄)两部分,评估所有对象的词汇理解能力得分和词汇表达能力得分,并使用正常等效年龄(normal equivalent age,NEA)描述人工耳蜗植入儿童的词汇理解能力和词汇表达能力,与有意义使用言语量表(meaningful use of speech scale,MUSS)评分进行相关性分析。结果人工耳蜗植入术后1年时患儿W&G词汇理解能力得分为89.1%±13.9%,平均NEA为15月龄,W&G词汇表达能力得分为64.6%±30.9%,平均NEA为16月龄;W&S词汇表达能力得分为42.4%±28.4%,平均NEA为18月龄;MUSS平均得分为35%±17%,患儿的W&G和W&S词汇表达能力得分均与MUSS得分具有相关性(R 2分别为0.6、0.7)。结论人工耳蜗植入儿童术后1年内词汇理解和表达能力均有非常明显的提高,其词汇理解及表达能力的正常等效年龄超过其听力年龄;W&S词汇表达能力得分与MUSS得分相关性更高,提示SSF-MCDI适用年龄范围更宽泛,而MUSS量表可能更适用于年龄稍大的人工耳蜗植入儿童的言语能力评估。

Objective To obtain the development of early comprehensive and expressive vocabularies in children with cochlear implants,and to explore the correlation between two tools for assessing children's verbal ability and to provide reliable data for clinical speech proficiency assessment.Methods Forty-four children with congenital severe to profound deafness who underwent cochlear implantation at our hospital were enrolled in the study.The age of implantation was 3.0±1.1 years,and the length of cochlear implants was 11.4±1.5 months(hearing age).The simplified short form versions of the Mandarin communicative development inventory(SSF-MCDI)was used to assess children's vocabulary abilities.The main indicators were words and gestures(W&G)comprehensive vocabulary score,W&G expressive vocabulary score,and words and sentences(W&S)expressive vocabulary score.The comprehensive vocabulary and expressive vocabulary abilities of children with cochlear implants were described using normal equivalent age(NEA).The meaningful use of speech scale(MUSS)was also used to evaluate the development of children's speech ability.Results The mean W&G comprehensive vocabulary scores of children with cochlear implants were 89.1%±13.9%at 1 year postoperatively,with an average NEA of 15 months;the W&G expression vocabulary score was 64.6%±30.9%with the mean NEA as 16 months.The W&S expressive vocabulary score was 42.4%±28.4%,and the average NEA was 18 months.The average MUSS score was 35%±17%.Both W&G and W&S expressive vocabulary scores were significantly correlated with MUSS scores(R 2 was 0.6,0.7,respectively).Conclusion Children with cochlear implants showed significant improvements in their ability to comprehend and express vocabularies within 1 year after surgery.The normal equivalent age exceeded their hearing age,indicating that the recipients of the cochlear implants had more comprehensive and expressive vocabulary abilities.In addition,the W&S expression scores of SSF-MCDI were more correlated with the MUSS scores,suggesting that the age range applicable to SSF-MCDI for assessing children's speech ability was broader,and the MUSS scale may be more suitable for older cochlear implants.