口唇裂・口蓋裂における構音重症度評価の試み:―構音正発率と構音点の後方化による評価―  [in Japanese] Scoring of Articulation Disorder in Patients with Cleft Palate:—Evaluation by Correction Ratio and Backing Score—  [in Japanese]

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Author(s)

    • 緒方 祐子 OGATA Yuko
    • 鹿児島大学大学院医歯学総合研究科顎顔面機能再建学講座口腔顎顔面外科学分野 Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences
    • 手塚 征宏 TEZUKA Masahiro
    • 鹿児島大学大学院医歯学総合研究科顎顔面機能再建学講座口腔顎顔面外科学分野 Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences
    • 今村 亜子 IMAMURA Ako
    • NPO法人ことばとリレーションシップの会(ことリ) Specified Nonprofit Corporation, Language and Relationship, KOTORI
    • 新中須 真奈 SHINNAKASU Mana
    • 鹿児島大学大学院医歯学総合研究科顎顔面機能再建学講座口腔顎顔面外科学分野 Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences
    • 松永 和秀 MATSUNAGA Kazuhide
    • 鹿児島大学大学院医歯学総合研究科顎顔面機能再建学講座口腔顎顔面外科学分野 Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences
    • 西原 一秀 NISHIHARA Kazuhide
    • 鹿児島大学大学院医歯学総合研究科顎顔面機能再建学講座口腔顎顔面外科学分野 Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences
    • 中村 典史 NAKAMURA Norifumi
    • 鹿児島大学大学院医歯学総合研究科顎顔面機能再建学講座口腔顎顔面外科学分野 Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences

Abstract

口唇裂・口蓋裂の言語評価において,構音障害の重症度は判定する評価方法が少ない。そこで,構音障害の重症度を判定するため,構音検査での構音正発率算定と構音点に着目したbacking scoreの評点化を試みた。<br>1.口蓋裂術後の構音障害の評価での構音正発率の算定<br>口蓋形成術後の口唇裂・口蓋裂患者67例を対象に,構音検査法での単語検査での構音正発率を算定し,構音障害の種類や会話明瞭度との関連を検討した。構音障害と構音正発率をみると,いわゆる口蓋化構音と声門破裂音は,有意に他の構音障害と比して,低い結果であった(p < 0.01,0.05)。会話明瞭度では,「よくわかる」の1°は有意に構音正発率が高い結果であった(p < 0.01)。<br>2.構音点のbacking scoreによる評価<br>構音点が後方化する口唇裂・口蓋裂患者13例を対象に,構音点がどの程度,後退しているか数値化するbacking scoreの評価表を考案し,聴覚判定に基づく構音点の後方化の程度の評価を試みた。[s],[t],[ts]および[ɕ]産生時の聴覚判定が評価された。次に,正常構音と構音異常の構音点のズレをbacking sore(0~12点)とした。その結果,声門破裂音や軟口蓋化構音などはbacking scoreが大きく,本来の構音点より後方化がみられた。構音正発率とbacking scoreの関連をみると,backing scoreが大きいほど構音正発率が低下していた。構音正発率とbacking scoreは相関していた(r= -0.8)。<br>以上のことから,共鳴の異常ではなく,構音点の同定が可能である構音障害であれば,構音正発率とbacking scoreで評点化することにより,構音訓練の効果を知ることが可能であることが判明した。それらは構音の重症度や明瞭度の客観的指標として有効なフィードバックとなるのではないかと考えられた。

There are few evaluation methods to judge the severity of articulation disorders in patients with cleft palate. Therefore, we investigated the correction ratio and backing score by articulation testing in order to assess the severity of articulation disorders.<br>1. Calculation of correction ratio in evaluation of articulation disorders <br>We included 67 patients (aged 4 to 18 years of age) with cleft palate who underwent palatoplasty. Then, we assessed the correction ratios in these patients by articulation testing and compared the correction ratios associated with different types of articulation disorders as well as the speech intelligibility during conversation in patients who underwent these procedures.<br>The correction ratios for glottal stop and mid-dorsum palatal stop were lower than those for other articulation disorders (p < 0.01, p < 0.05). In the speech understandability analyses, we classified the patients into five groups according to the intelligibility of their conversation. Group I, in which speech is always easy to understand, showed a high score (p < 0.01).<br>2. Evaluation of the backing score from the site of articulation<br>We included 13 patients (4 to 12 years of age) with cleft palate who had shown retraction of the site of articulation. Assessments were based on perceptual evaluation during utterance of /s/, /t/, /ts/ and /ɕ/. Then, the results were calculated as the backing score (0 to 12 points), which denotes the difference between normality and abnormality of the site of articulation. We observed high scores in the case of glottal stop and mid-dorsum palatal stop, which involve gaps retracting from the site of articulation.<br>Furthermore, we observed that the correcting ratio decreased when the backing score increased. There was a correlation between the correcting ratio and backing score (r = -0.8).<br>These results indicate that the correction ratio and backing score can provide information regarding the recovery process in articulation disorders and serve as objective indicators of articulation while providing feedback regarding the severity of the condition and the patient's intelligibility during speech therapy for articulation disorders.

Journal

  • Journal of Japanese Cleft Palate Association

    Journal of Japanese Cleft Palate Association 38(1), 77-85, 2013

    Japanese Cleft Palate Association

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