人工耳蜗植入术后听觉言语训练方法

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,人工耳蜗植入术后听觉言语训练方法研究,Study for,Auditory and Speech Therapy,Postoperation,of CI,卢晓月,提要,Summary,从康复效果评估及语言学理论知识两方面探讨科学的听觉言语康复方法,.,对目前国内使用较为广泛的三种康复方法（听觉口语训练法、综合感官训练法、音素辨听训练法）效果进行了比较分析,Determine the appropriate approach for CI children on analysis the effect of three therapy model used in China:AV therapy,multiple sensory therapy and,phonematic,recognizing and production therapy.,听觉口语训练法（方法一）,AV Therapy(method one),强调听觉、言语和认知依照自然发展之程序结合起来，在有意义的情境中透过会话式的互动学习说话。注重残余听力的运用和口语表达能力的培养。强调在训练中应先将听觉加以发展，否则听觉或视听并用的技巧不会建立起来。（在日常交流中不刻意回避视觉线索）,Focus on the combination of hearing,speech and,cognization,according the natural developmental process.Learning speech through communication in,significative,context,.,Emphasizing hearing remained,听觉口语法认为“听”是发展说话能力的最佳途径，通过“听”对言语清晰度进行自我监控和自我调整是最有效的。,Listening is the best way to self-monitor and self-adjust on articulation.,应以语音作为主要的听觉刺激。,Speech sounds is the most important resource of auditory stimulation.,要采用“整体语言”的原则。,Applying the rule of“whole language”,遵循语言发展的自然过程,Follow the natural process of language development.,语言是整体发展的一部分，语言的使用离不开语境。在语言交际过程中语言信息和非语言信息都同样重要,Language cant be separated from context.,要用完整的句子讲话。只听单个词语不利于感受超音段音位和完整语言的理解。连续性语音的听辨是一个合成和分析的主动的心理过程。,Talk to CI with whole sentences.It will make against on perceiving,suprasegmental,and understanding whole language.,综合感官学习法（方法二）,Multiple Sensory Therapy(method two),强调从初始阶段，在整个训练期及各个环节中都应将视觉、听觉、触觉等多种感官相结合，来帮助聋儿感受声音、学习语言。,Advocate integrating visual,auditory and tactile to help CI recognizing phonetics and learning language from beginning and through whole therapy.,音素辨听训练法（方法三）,Phonematic,Recognizing Therapy(method three),注重术后听觉功能的培建和汉语拼音的学习,，,以拼音音素为核心，组织相应的词汇、儿歌和故事等作为主要的辨听学习内容。从训练初期即强调语音清晰度的矫正。,Focus on,phoneticize,discrimination and learning,select vocabularies,nursery rhymes and stories around them.Stress on articulation intervention from beginning.,材料和方法,Materials and Methods,观察对象,(Sample):124,人（,2-7,岁）,分组,(Grouping):,依据不同教学方法分为三组,(Divided in three groups according different intervention methods):,一组,(Group 1)(,听觉口语法,-AVT):54,人,二组,(Group 2)(,综合感官训练法,-MST):34,人,三组,(Group 3)(,音素辨听训练法,-PRT):36,人,控制因素,Control Factors,术前听力水平,(Hearing Level,Preoperation,),所有样本双耳裸耳纯音气导听阈均大于,90dBHL,，,ABR,大于,100dB SPL,佩带助听器后采用,Lings sound test,，,组一中,3,人、组二中,2,人、组三中,4,人对,2000HZ,以下语音有反应，其余人只对,1000HZ,以下语音有反应或不能做出反馈。所有样本均不能听辨词语。,控制因素,Control Factors,术前语言水平,(Speech and Language Level,Preoperation,),组一中,10,人、组二中,9,人、组三中,11,人术前有一定词汇水平。其余人没有任何口语基础。,智力水平,(Intelligence Level),所有样本均经过希内学习能力测试，智力水平均在正常范围内。,三组样本手术年龄和开机时间分布情况,Contrast Operative Age and Length After Accepting CI In Three Groups,材料和方法,Materials and Methods,本研究采用全国统一的,聋儿听觉言语康复评估标准及方法,对三组聋儿进行评估测试。,Evaluate by“Hearing and Speech Assessment Standard and Methods for Deaf Children”,实验者采用,SPSS10.0,软件对评估数据进行统计分析。用,General Linear Model,中的,Multivariate,进行统计,。,Statistics and Analysis by General Linear Model.,不同训练方法对聋儿听觉和语言能力的影响,Effect of Different Approaches,on Deaf Childrens Hearing and Speech Abilities,结果与分析:,听觉能力评估分析,Analysis on hearing ability assessment,在听觉能力评估的双音节词识别、韵母识别、声母识别这三项词汇水平的辨听测试项上：方法一、方法三与方法二存在显著差异（,p0.01),，,方法一与方法三差异不显著；但是在“短句辨听”项上，三者的成绩都有显著差异。,Achievement on identification of double syllables,vowels and consonants:Method one and three have obvious difference with method two(p0.01);method one is similar with three.,Achievement on“identification of short sentences”:There are obvious difference in all the three methods.,结果与分析:,言语能力评估分析,Analysis on Speech Ability Assessment,从言语能力三项评估（可唇读）来看：方法一和方法二在“模仿句长”、“主题对话”上与方法三有差异显著；方法一和方法二差异不显著。在“语音清晰度”的成绩上三者没有显著差异,(p=0.941),。,Method one has obvious difference with method three on“sentence imitation”and“topic conversation”,whereas resemble method two.There are no obvious difference on“articulation”in all the three methods.,结果与分析:,不同训练方法对不同手术年龄的聋儿听觉和语言能力的影响,Effect of Different Approaches on Deaf Childrens Hearing and Speech Ability with Varied Operated Age,结果与分析:,手术年龄对听觉能力发展的影响,Effect of Operated Age on Hearing Ability Development,不同手术年龄组在韵母识别、声母识别和短句识别三个分测验上差异达到显著水平，但在双音节词识别上差异不显著,(p=0.39),。,Groups with different operated age have obvious diversity on identification of vowels,consonants and short sentences;but resemble on identification of double syllables.,在韵母识别、声母识别和短句识别,3,个方面，均为,2-3,岁组与,6-7,岁组差异显著，,4-5,岁组与,6-7,岁组差异显著，而,2-3,岁组与,4-5,岁组差异不显著。此结果表明,5,岁前开机者语言辨听能力发展较好。（亦不能排除评估内容对结果可能有一定影响）,Group of 2-3years and 6-7years,4-5years and 6-7years have obvious difference on identification of vowels,consonants and short sentences;not in group 2-3years and 4-5years.This result documents that children with CI switched on before 5years old have better language identification ability development.,结果与分析:,手术年龄对言语能力发展的影响,Effect of Operated Age on Speech Ability Development,不同手术年龄组对语音清晰度影响显著。手术年龄小则清晰度发展好。,2-3,岁与,6-7,岁、,4-5,岁与,6-7,岁差异显著，,2-3,岁与,4-5,岁差异不显著。,Varied operated age has obvious effect on articulation.Operated more younger,articulation development more better.,对主题对话和模仿句长影响不显著。,Varied operated age has no obvious effect on