人工耳蝸植入術(shù)后聽覺言語訓(xùn)練方法-共27頁PPT資料課件

1、人工耳蝸植入術(shù)后聽覺言語訓(xùn)練方法研究Study for Auditory and Speech Therapy Postoperation of CI盧曉月提要Summary 從康復(fù)效果評估及語言學(xué)理論知識兩方面探討科學(xué)的聽覺言語康復(fù)方法.對目前國內(nèi)使用較為廣泛的三種康復(fù)方法（聽覺口語訓(xùn)練法、綜合感官訓(xùn)練法、音素辨聽訓(xùn)練法）效果進行了比較分析 Determine the appropriate approach for CI children on analysis the effect of three therapy model used in China: AV therapy, mul

2、tiple sensory therapy and phonematic recognizing and production therapy.聽覺口語訓(xùn)練法（方法一）AV Therapy (method one) 強調(diào)聽覺、言語和認(rèn)知依照自然發(fā)展之程序結(jié)合起來，在有意義的情境中透過會話式的互動學(xué)習(xí)說話。注重殘余聽力的運用和口語表達能力的培養(yǎng)。強調(diào)在訓(xùn)練中應(yīng)先將聽覺加以發(fā)展，否則聽覺或視聽并用的技巧不會建立起來。（在日常交流中不刻意回避視覺線索） Focus on the combination of hearing, speech and cognization according the

3、natural developmental process. Learning speech through communication in significative context. Emphasizing hearing remained 聽覺口語法認(rèn)為“聽”是發(fā)展說話能力的最佳途徑，通過“聽”對言語清晰度進行自我監(jiān)控和自我調(diào)整是最有效的。Listening is the best way to self-monitor and self-adjust on articulation. 應(yīng)以語音作為主要的聽覺刺激。Speech sounds is the most important

4、resource of auditory stimulation.要采用“整體語言”的原則。Applying the rule of “whole language”遵循語言發(fā)展的自然過程Follow the natural process of language development.語言是整體發(fā)展的一部分，語言的使用離不開語境。在語言交際過程中語言信息和非語言信息都同樣重要Language cant be separated from context.要用完整的句子講話。只聽單個詞語不利于感受超音段音位和完整語言的理解。連續(xù)性語音的聽辨是一個合成和分析的主動的心理過程。Talk to C

5、I with whole sentences. It will make against on perceiving suprasegmental and understanding whole language.綜合感官學(xué)習(xí)法（方法二）Multiple Sensory Therapy (method two) 強調(diào)從初始階段，在整個訓(xùn)練期及各個環(huán)節(jié)中都應(yīng)將視覺、聽覺、觸覺等多種感官相結(jié)合，來幫助聾兒感受聲音、學(xué)習(xí)語言。 Advocate integrating visual, auditory and tactile to help CI recognizing phonetics and

6、learning language from beginning and through whole therapy. 音素辨聽訓(xùn)練法（方法三）Phonematic Recognizing Therapy (method three) 注重術(shù)后聽覺功能的培建和漢語拼音的學(xué)習(xí)，以拼音音素為核心，組織相應(yīng)的詞匯、兒歌和故事等作為主要的辨聽學(xué)習(xí)內(nèi)容。從訓(xùn)練初期即強調(diào)語音清晰度的矯正。 Focus on phoneticize discrimination and learning, select vocabularies, nursery rhymes and stories around them

7、. Stress on articulation intervention from beginning. 材料和方法Materials and Methods觀察對象(Sample): 124人（2-7歲）分組(Grouping):依據(jù)不同教學(xué)方法分為三組(Divided in three groups according different intervention methods): 一組(Group 1)(聽覺口語法-AVT):54人 二組(Group 2)(綜合感官訓(xùn)練法-MST):34人 三組(Group 3)(音素辨聽訓(xùn)練法-PRT):36人控制因素Control Factors

8、術(shù)前聽力水平(Hearing Level Preoperation) 所有樣本雙耳裸耳純音氣導(dǎo)聽閾均大于90dBHL， ABR大于100dB SPL 佩帶助聽器后采用Lings sound test，組一中3人、組二中2人、組三中4人對2000HZ以下語音有反應(yīng)，其余人只對1000HZ以下語音有反應(yīng)或不能做出反饋。所有樣本均不能聽辨詞語?？刂埔蛩谻ontrol Factors 術(shù)前語言水平(Speech and Language Level Preoperation) 組一中10人、組二中9人、組三中11人術(shù)前有一定詞匯水平。其余人沒有任何口語基礎(chǔ)。智力水平(Intelligence Leve

9、l) 所有樣本均經(jīng)過希內(nèi)學(xué)習(xí)能力測試，智力水平均在正常范圍內(nèi)。三組樣本手術(shù)年齡和開機時間分布情況Contrast Operative Age and Length After Accepting CI In Three Groups材料和方法Materials and Methods本研究采用全國統(tǒng)一的聾兒聽覺言語康復(fù)評估標(biāo)準(zhǔn)及方法對三組聾兒進行評估測試。Evaluate by “Hearing and Speech Assessment Standard and Methods for Deaf Children”實驗者采用SPSS10.0軟件對評估數(shù)據(jù)進行統(tǒng)計分析。用General Lin

10、ear Model 中的Multivariate進行統(tǒng)計。Statistics and Analysis by General Linear Model.不同訓(xùn)練方法對聾兒聽覺和語言能力的影響Effect of Different Approaches on Deaf Childrens Hearing and Speech Abilities結(jié)果與分析:聽覺能力評估分析Analysis on hearing ability assessment在聽覺能力評估的雙音節(jié)詞識別、韻母識別、聲母識別這三項詞匯水平的辨聽測試項上：方法一、方法三與方法二存在顯著差異（p0.01)，方法一與方法三差異不顯

11、著；但是在“短句辨聽”項上，三者的成績都有顯著差異。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 thre

12、e methods. 結(jié)果與分析:言語能力評估分析Analysis on Speech Ability Assessment 從言語能力三項評估（可唇讀）來看：方法一和方法二在“模仿句長”、 “主題對話”上與方法三有差異顯著；方法一和方法二差異不顯著。在“語音清晰度”的成績上三者沒有顯著差異(p=0.941)。Method one has obvious difference with method three on “sentence imitation” and “topic conversation”, whereas resemble method two. There are no

13、obvious difference on “articulation” in all the three methods.結(jié)果與分析: 不同訓(xùn)練方法對不同手術(shù)年齡的聾兒聽覺和語言能力的影響Effect of Different Approaches on Deaf Childrens Hearing and Speech Ability with Varied Operated Age結(jié)果與分析:手術(shù)年齡對聽覺能力發(fā)展的影響Effect of Operated Age on Hearing Ability Development不同手術(shù)年齡組在韻母識別、聲母識別和短句識別三個分測驗上差異達到

14、顯著水平，但在雙音節(jié)詞識別上差異不顯著(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.在韻母識別、聲母識別和短句識別3個方面，均為2-3歲組與6-7歲組差異顯著，4-5歲組與6-7歲組差異顯著，而2-3歲組與4-5歲組差異不顯著。此結(jié)果表明5歲前開機者語言辨聽能力發(fā)展較好。（亦不能排除評估

15、內(nèi)容對結(jié)果可能有一定影響）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 ab

16、ility development.結(jié)果與分析:手術(shù)年齡對言語能力發(fā)展的影響Effect of Operated Age on Speech Ability Development不同手術(shù)年齡組對語音清晰度影響顯著。手術(shù)年齡小則清晰度發(fā)展好。2-3歲與6-7歲、4-5歲與6-7歲差異顯著，2-3歲與4-5歲差異不顯著。Varied operated age has obvious effect on articulation. Operated more younger, articulation development more better.對主題對話和模仿句長影響不顯著。 Varied

17、operated age has no obvious effect on topic conversation and sentences imitation.可能影響評估結(jié)果的因素：Factors those maybe impact the assessment result: 評估內(nèi)容和開機時間的局限（最長2年半） Limited assessment items and there are no sample received CI longer than half and two years.結(jié)果與分析:不同訓(xùn)練方法對不同開機時間的聾兒聽覺和語言能力的影響Effect of Dif

18、ferent Approaches On Deaf Childrens Hearing and Speech Ability with Varied length After the Operation結(jié)果與分析:開機時間對聽覺能力發(fā)展的影響Effect of length After Received CI on Hearing Ability Development 不同開機時間在聽覺能力評估的4個分測驗 成績上的差異均達到顯著水平。說明開機時間對聾兒聽覺能力的提高作用顯著。開機時間越長，聽覺水平越高。The length after accepting CI can effect dea

19、f childrens hearing ability enormously. 結(jié)果與分析:開機時間對言語能力發(fā)展的影響Effect of Length After Accepting CI On Speech Ability Development 不同開機時間在言語能力評估3個分測驗的成績上差異均達到顯著水平。說明開機和訓(xùn)練時間越長，患者言語水平越高。There are obvious difference on assessment for speech ability in varied length after accepting CI. The longer training ta

20、kes after the operation, the higher children can get on speech level.結(jié)果與分析:訓(xùn)練方法與開機時間的交互作用The Interact of Intervention Approaches and The Length After Accepting CI訓(xùn)練方法與開機時間兩因素的交互作用在聽覺能力評估的4個分測驗成績上均有顯著差異：The interact of intervention approaches and the length after accepting CI have obvious difference

21、on all the four items of hearing ability assessment. 在開機時間較短時，不同訓(xùn)練方法的效果差異較大，而隨著開機時間的增加，不同訓(xùn)練方法在聽覺能力發(fā)展上的差異在逐漸縮小。 The difference of the hearing development in varied approaches get smaller and smaller over time.結(jié)果與分析:訓(xùn)練方法與開機時間的交互作用 The Interact of Intervention Approaches and The Length After Accepting

22、CI由于言語發(fā)展存在敏感期，所以此結(jié)果并不能說明不同訓(xùn)練方法對聾兒最終的康復(fù)水平?jīng)]有影響。We cant elicit from the result just mentioned that theres no effect on rehabilitation with varied approaches, because the key period is existed in speech development.該結(jié)果與本實驗的評估內(nèi)容有關(guān)。在后續(xù)調(diào)查中顯示：聽覺口語法訓(xùn)練組聾兒在開放式交流方面的成績明顯優(yōu)于另兩組，而且隨開機時間的延長，該差異有增大趨勢。The result was a

23、ffected by the limited assessment items. The later research shows group one got much better achievement than other two groups on opening communication assessment. 結(jié)果與分析:結(jié)論Result綜合感官訓(xùn)練法能有效地幫助聾兒提高言語水平，但在聽覺能力的發(fā)展上效果不夠理想。Multiple sensory therapy can advance the speech level, but not satisfied on hearing ability development.音素辨聽訓(xùn)練法可以促進聾兒對語音細致辨聽的能力，但對言語能力的發(fā)展幫助有限。Phonetimatic recognizing therapy can improve the phonetic careful hearing ability, whereas limited in facilitating the speech ab