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題名:代償構音治療方案對舌癌病人術後口語清晰度及聲學特徵之影響
作者:陳怡仁
作者(外文):CHEN, YI-JEN
校院名稱:國立高雄師範大學
系所名稱:特殊教育學系
指導教授:曾進興
學位類別:博士
出版日期:2018
主題關鍵詞:舌癌口語清晰度子音母音tongue cancerspeech intelligibilityconsonantvowel
原始連結:連回原系統網址new window
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摘要
本研究的目的是建立一套「代償構音治療方案」,以協助舌切除病人術後的口語清晰度,並利用知覺與聲學的方法,分析舌切除病人於接受語言治療後,口語清晰度及聲學特徵的變化情形及兩者間的相關性。以期語言治療師設計舌切除病人術後口語復健的治療計畫時能參考此方案,以協助舌切除病人術後口語清晰度的改善。
本研究的對象為40位接受全舌切除及近全舌切除術的舌癌病人,依據病人是否可以配合接受語言治療分成兩組,能接受語言治療者為實驗組,未能接受語言治療者為控制組,實驗組須接受研究者每週一次、每次40分鐘、為期三個月共12次的語言治療課程,研究者教導病人利用「下顎上抬前伸」、「咬」、「輕觸」、「迅速的上下分離」、「緩慢外推並且穩定持續送氣」、「快速外推並且送氣」、「雙唇緊閉並且咽部用力」等代償性的構音動作產生口語。由四位大學畢業、聽力正常、母語為台語、語言治療年資達10年以上且未曾接觸舌癌患者的語言治療師為口語清晰度的評分者,並由研究者分析病人語料中,子音及母音的聲學特徵。
結果顯示,語言治療介入的策略確實可以顯著提升舌切除病人術後的口語清晰度與改變部分子音及母音的聲學特徵。經語言治療後的實驗組口語清晰度變化顯著優於控制組的口語清晰度、實驗組病人語言治療後的口語清晰度亦顯著優於語言治療前的口語清晰度。實驗組病人經語言治療後,顯著改變的口語聲學特徵,包括:塞音/kʰ/VOT的減少、塞音/t/、/tʰ/、/k/、/kʰ/沖直線出現率的增加、塞擦音/ts/噪音時長的減少、塞擦音/ʨ/、/ʨʰ/、/ts/、/tsʰ/沖直線出現率的增加、擦音/s/噪音音段頻譜的平均頻率增加、母音/a/、/i/、/u/的時長增加、母音/a/F2的頻率增加等。另外,塞音/t/、 /tʰ/的沖直線出現率、擦音/ɕ/的噪音時長與口語清晰度間有顯著的相關性。
研究結果顯示,「代償構音治療方案」的語言治療,對於近全舌及全舌切除並接受皮瓣移植的舌癌病人,術後口語清晰度的提升有顯著的幫助,並能改變部分口語的聲學特徵,增加口語溝通時聽者的辨識度。
關鍵字:舌癌、口語清晰度、子音、母音
Abstract
This research aims to establish a compensatory articulation treatment program to improve the speech intelligibility of patients with glossectomy, and to investigate the changes and relationship between their speech intelligibility and acoustic features after receiving speech therapy in terms of perceptual and acoustic perspectives. It is expected that this study provides clinically practical program for SLPs who are planning oral rehabilitation for patients with glossectomy to improve their speech intelligibility.
The subjects were 40 patients with total and near-total glossectomy. Those who were able to receive speech therapy were included in the experimental group, and the others were in the control group. The experimental group received 12 40-minute sessions weekly for 3 months. They were instructed to produce speech sounds with compensatory articulation movements, including “elevating and protruding the lower jaw,” “the upper teeth biting the lower lip,” “the upper teeth lightly touching the lower lip,” “separating the upper teeth and lower lip rapidly,” “the lower lip pushing outwards slowly, and continuously aspirating stably,” “the lower lip pushing outwards rapidly and aspirating,” and “tightening the lips and strengthening pharynx.” The scorers on speech intelligibility were 4 SLPs with university degree and over 10 years of working experience. They are native speakers of Taiwanese with normal hearing, and they never work with patients with glossectomy. Data were collected and analyzed by the researcher for the acoustic features in consonants and vowels of the subjects.
The results showed that the intervention of this treatment program significantly improves the speech intelligibility of patients with glossectomy after surgery, and changes some acoustic features in the consonants and vowels produced by the subjects. The speech intelligibility of the experimental group was greatly improved than that of the control group. It was also found that the speech intelligibility of the subjects after speech intervention was magnificently improved than that before speech therapy. The acoustic features were markedly changed, including reduced VOT of stop /kʰ/, increased incidence of burst of stops /t/,/tʰ/,/k/,/kʰ/, reduced noise duration of affricate /ts/, increased incidence of burst of affricates /ʨ/,/ʨʰ/,/ts/,/tsʰ/, increased average frequency of noise spectrum in fricative /s/, increased duration of vowels /a/,/i/,/u/, and the increased F2 frequency of vowel /a/. In addition, the incidence of burst of stops /t/, /tʰ/ and the noise duration of fricative /ɕ/ are highly related to speech intelligibility.
The findings demonstrate that the compensatory articulation treatment program proposed in this research is beneficial to improve the speech intelligibility of patients with near-total and total glossectomy with flap graft. Some acoustic features are changed, so the speech recognition is increased hugely for the listeners in oral communication.
Key words: tongue cancer, speech intelligibility, consonant, vowel
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