儿童发音缺陷的诊断和治疗

Clinical analysis of 91 cases with articulation error

目的 研究儿童发音缺陷的类型与疗效的有关因素 ,不同类型发音缺陷的疗效比较 ,以及语音治疗的临床模式。方法 在排除了器质性发音障碍后 ,对 91例汉语辅音音素性发音缺陷按发音部位进行分类 ;发音缺陷儿童经治疗后按症状的消失与否分成治疗有效组和无效组 ;列出 10个分析因素 ,即性别、年龄、口腔运动功能问题、发育迟缓、语言发育迟缓史、中耳炎史、舌系带问题、智能迟缓、治疗频度和治疗次数。采用SPSS 8 0 (SPSSInc .,1997)统计软件进行Logistic多元逐步回归分析 ,以寻找与疗效有关的因素 ;比较了单一类型和广泛类型发音缺陷 (发音缺陷≥ 2类 )的疗效 ;探讨语音治疗的临床模式。结果 91例辅音音素性发音缺陷主要分为 4类 ,最多见的是广泛发音缺陷 ,共 37例 ,占 4 1% ;其次是舌后音 ,共 33例 ,占 36 % ;然后舌尖中音 ,共 12例 ,占 13% ;再就是舌尖音 ,共 8例 ,9% ,仅 1例为唇齿音 /f/的缺陷。Logistic多元回归分析表明发育迟缓、语言迟缓和治疗频度与疗效有关。单一类型发音缺陷的治疗有效率高达 87% ,而广泛发音缺陷的治疗有效率仅 2 7% ,二者疗效差异有非常显著意义 (P <0 0 0 0 1)。结论 临床音素性发音缺陷有 4类 ,发育迟缓、语言发育迟缓和语音治疗频度影响疗效 。

Objective To study classification of the articulation errors, find the related factors which affect the therapy effect, and compare the therapy effect in the different patterns of the phonemic errors and build up a clinical model of the speech therapy on the basis of more than 4 years speech therapy in the clinic.Method After excluding the organic articulation disorders, 91 cases of consonant phonemic errors were classified into different patterns according to the phonemic placement errors. The 91 cases were divided into two groups as effective one and ineffective one depending on whether the symptoms disappeared or not after the speech therapy. Ten factors including sex, age, oral-motor function problem, developmental delay, history of language development delay, history of middle ear affection, lingua frenata, mental retardation, the therapy frequency and times, were analyzed. The statistics software SPSS (SPSS Inc, 1997) was applied to show the factors related to the therapy effect by logistic multiple stepwise regression analysis. The therapy effect was compared between the single pattern (phonemic error<2 groups) and multiple pattern (phonemic errors≥2 groups). Results The 91 cases with consonant phonemic errors were classified into four groups. The multiple pattern of the articulation errors was the most common (37cases, 41%) among the 4 groups, followed by velar errors (33 cases, 36%). The third one was the apico-dental errors (12 cases, 13%) and the last one was the linguo-alveolar errors (8 cases, 9%). Only one case had labiodental error (/f/). The logistic multiple stepwise regression analysis showed that the history of the positive developmental delay, language delay and the frequency of the speech therapy were related to the therapy effect. The effective rate of the speech therapy in the single pattern of the phonemic error was as high as 87% while the one in the multiple pattern group was only 2.7%. The difference was significant (P<0.000 1) when the therapy effect in these two groups was compared. The clinical model of the speech therapy included speech assesssment, designing of the goal, choice of the target sound, sound production and oral-motor functional training.Conclusion The consonant phonemic errors in the clinic represent four groups. The developmental delay, the language delay and frequency of the speech therapy influence the therapy effect. The frequency of the speech therapy should be increased every week, for example not less two times a week. The therapy effect of the single pattern of the phonemic errors is much better than that of the multiple pattern. The primary model of the speech therapy has been built in the clinics.