投影片 1

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1 唇腭裂溝通問題

2 唇腭裂分類完全 vs. 不完全唇裂 vs. 腭裂單側 vs. 雙側

4 可能影響發音的因素

5 講話鏈說話者聽眾

6 說話鏈發令系統回饋系統發聲系統構音系統共鳴系統

7 軟腭的功能吹口哨吹氣球說話吞嚥嘔吐反射

9 What is velopharyngeal dysfunction (VPD)? Velopharyngeal dysfunction refers to a condition where the velopharyngeal valve does not close/open consistently and completely during the production of oral sounds.

11 腭咽閉鎖不全的影響共鳴構音發聲

12 共鳴問題高鼻音 (hypernaslity) 低鼻音 ( hyponaslity) 混合鼻音 (mixed naslity) Cul-de-sac Resonance

13 鼻音過重 /u/ /i/ :

14 肇因於錯誤學習的腭咽閉鎖不全 /i/ /s/

15 鼻音不足 /m,n,an,en,on,ong/ :

16 Cul-de-sac 共鳴 :

17 構音問題 (VS )

18 鼻漏息,,

19 口內壓不足

20 代償性構音障礙,

21 代償性構音異常 1. glottal stops 2. pharyngeal stops 3. pharyngeal fricatives 4. pharyngeal affricates 5. mid-dorsum palatal stop 6. posterior nasal fricative 7. laryngeal fricative

22 其他構音錯誤 /n/l/l/ /h/

23 台灣唇腭裂患者常見的錯誤構音 1. glottal stop 2. laryngeal fricative 3. posterior nasal fricative 4. pharyngeal fricative 5. / mid-dorsal palatal stop/fricative 6. double articulation

24 發聲問題

25 與腭咽閉鎖不全相關之徵狀 (nasal regurgitation )

27 取得資訊

28 評估重點腭咽閉鎖功能言語功能 (speech problem) 語言功能 (language problem)

29 語音取樣 ( ) ( ) CV (pipipi) (1~10)

30 語音評估 /

31 可誘導性 (stimulibility) :,, i.e. /P/ /Pa/

32 口內檢查

33 簡易評估工具視覺偵測口鏡測試 See-Scape TM 觸覺偵測鼻側震動聽覺偵測捏住鼻子吸管 Listening tube

34 儀器評估 Cephalometrics Nasometer Videoflouroscope Nasopharyngoscope Pressure-flow technique Spectrography Electromyography

35 Instrumental Assessment (clinical practice) Cephalometrics Videofluoroscopy Nasopharyngoscopy

36 Instrumental Assessment (research tools) Computed tomography (CT) Magnetic resonance imaging ( MRI) Ultrasound Electromyography Phototransduction

37 鼻咽鏡的優點可以直接看到腭咽部的結構肌肉運動的對稱性呼吸道的暢通與否腭咽閉鎖的型態腭咽閉鎖的比例

38 腭咽功能的診斷閉鎖完全閉鎖不全結構不足功能不全錯誤習得

39 腭咽閉鎖不全的處理手術牙科膺復 (prosthesis ) 語言治療

40 腭咽閉鎖不全的處理 Prosthesis Speech bulb Palatal lift Nasal speaking valve Suwaki M Okayama University, J Oral Rehabil Jan;35(1):73-8

41 腭咽閉鎖不全的處理改變行為語言治療改變錯誤發音方式生物回饋

42 語言治療的原則挑選合適的目標音確立子音舌頭的位置發出正確的目標音與錯誤音做對比確立可以自我監測修正 (self-monitor) 逐漸增加困難度

43 目標音選擇的原則對語言清晰度影響最大的音可誘發性可見性舌頭位置 : 先選前置音送氣音先於不送氣音發音方式 : 磨擦音先對個人意義重大的音

44 Determining the Need for Intervention Error Patterns Common phonological pattern Final consonant deletion : 大下 / 大象 Unstressed syllable deletion: 摩 ( 托 ) 車 Metathesis: tou li/ 樓梯 Coalescence :buau/ 不知道 Assimilation :pupou/ 葡萄 Fronting Backing Stopping Affrication Denasalization Deaffrication Sound preference

45 Processes Disappearing by 3 years Unstressed syllable deletion Final consonant deletion Consonant assimilation Fronting

46 Processes Persisting after 3 years Stopping Epenthesis (schwa addition) Cluster reduction Stoel-Gammom & Dunn (1985)

47 Lesson plan

48 治療技巧 Shaping--building more complex skills Prompting---giving a gentle hint Verbal Prompts Nonverbal Prompts--tactile Manual Guidance--giving a helping hand Instructions--just telling theme Techniques to increase language Strengthening the Language Skills

49 類化 The occurrence of relevant behavior under different non-training conditions. Generalization does not occur automatically, nor do all persons have the same aptitude for it, but certain activities can increase the likelihood of generalization.

50 影響類化的因素 Situation (Carry-over) Activities :no evidence Settings: no evidence Self-monitoring: Steps to facilitate self-monitoring: External monitoring and verbal feedback External monitoring with cues provided for revision Self-revision by client when errors occur Anticipating when errors may occur Automatic usage of correct production

51 建立自我監測技巧 If the child's only monitor is the speech therapist, the child will not be able to internalize the sound contrasts to self-monitoring and self -correct.

52 Factors Affecting Retention Meaningfulness of the materials used during remediation Names of friends, family members, familiar objects, classroom vocabulary Amount of learning The greater the number of trials during the learning, the greater the retention Frequency of instruction Several short sessions are better than longer sessions

53 Therapy Techniques to Avoid 1. Blowing or palatal massage. 2. Using sign language, oral motor therapy 3. Sucking, swallowing, gagging, cheek puffing 4. Palatal exercises---icing, stroking, electrical stimulation. EMG activity of the velopharyngeal muscles is entirely different during speech and nonspeech activities. ===> The best " palatal exercise" is speech.

54 語言治療師的角色評估語言障礙的類別嚴重程度準確的判斷語言障礙的原因讓家長, 患者知道語言障礙的原因評估不同的治療方法讓家長, 患者知道不同的治療方法優缺點幫助患者用不同的發音方式講得更清楚 ( 語言治療 ) 讓家長, 患者知道如何評估學習的成效逐步進展

55 Reference Kummer A.W., 2008, Cleft palate and craniofacial anomalies :Thomson Delmar Learning Peterson-Falzone, Trost-Cardamone, Karnell, Hardin-Jones :2006, The clinician s guide to treating cleft palate speech: Mosby Peterson-Falzone, Hardin-Jones, Karnell, 2001 Cleft Palate Speech :Mosby

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