구개열 환자 말 평가 시 검사어에 대한 고찰 : 임상현장의 말 평가 어음자료와 문헌적 고찰을 중심으로

최성희,최재남,남도현,최홍식,Choi, Seong-Hee,Choi, Jae-Nam,Nam, Do-Hyun,Choi, Hong-Shik 대한후두음성언어의학회 2005 대한후두음성언어의학회지 Vol.16 No.1

Differential diagnosis of articulation and resonance problems in the cleft lip and palate speech is required for evaluating various factors contribute to speech problems such as VPI, dental occlusion, palatal fistulae, learning. However, validity of speech stimuli is current issue to evaluate accurately each problem in cleft speech. This study was conducted to investigate speech stimuli using in the clinical setting and review the literatures and articles published 1990 to 2005 for helping develop standardized speech samples. The results were recommendation to evaluate properly velopharyngeal function when conducting a diagnostic evaluation as follows : 1) In identification hypernasality, the speech stimuli should be included low pressure consonants to eliminate effects of nasal emission, compensatory articulation. 2) Speech stimuli should be consist of visual, front sounds to eliminate compensatory articulation and to stimulate easily. 3) Regarding early diagnosis and treatment, speech stimuli need to develop for infants and preschooler. 4) Stimulus length on nasalance scores should be at least 6 syllables. 5) In phonetic context on nasalance scores, /i/ vowel should be take into consideration excluding paragraph. 6) Connected speech stimuli should be developed for evaluating intelligibility and VP function.

파킨슨증의 음성진전 : 감별진단을 위한 예비연구

최성희,김향희,이원용,최홍식,Choi, Seong-Hee,Kim, Hyang-Hee,Lee, Won-Yong,Choi, Hong-Shik 한국음성학회 2005 음성과학 Vol.12 No.3

Tremor is a main factor of parkinsonism. Voice tremor may be the first, later or the only symptom of a neurological disease and its frequency, amplitude, and regularity may differ among the diseases of different neural subsystems. Differential diagnosis between idiopathic Parkinson's disease (IPD) and multiple system atrophy (MSA) has been difficult. This study included three groups: (1) 6 IPD patients; (2) 6 MSA patients; and (3) 20 ageand sex-matched normal controls. The MDVP (Multidimensional Voice Program) was used to analyze the sustained /a/phonation. The results were as follows: (1) frequency perturbation parameters (jitter, sPPQ, Vf0) and FTRI of tremor parameter of two patient groups were statistically different from those of the controls (p < .01); (2) measures were higher in short-term and long-term f0 and amplitude perturbation in MSA than IPD; (3) however, any acoustic parameters between IPD and MSA were not statistically different; except for the rate of frequency tremor, 4$\sim$5 Hz in IPD, 5$\sim$11 Hz in MSA and (4) the pattern of regularity for voice tremor through histogram indicated that amplitude of IPD was irregular while both f0 and amplitude of MSA were irregular. In conclusion, F0, rate of frequency tremor, and pattern of f0 regularity may be predictors for differential diagnosis. These findings might signify that voice tremor of parkinsonism was resulted from modulation of f0.

경부형 전기인공후두 Blueton의 개발과 음향학적 성능 분석

최성희,박용재,박영관,김태정,남도현,임성은,이성은,김한수,최홍식,김광문,Choi, Seong-Hee,Park, Young-Jae,Park, Young-Kwan,Kim, Tae-Jung,Nam, Do-Hyun,Lim, Sung-Eun,Lee, Sung-Eun,Kim, Han-Soo,Choi, Hong-Shik,Kim, Kwang-Moon 대한후두음성언어의학회 2004 대한후두음성언어의학회지 Vol.15 No.1

Electrolarynx(EL), battery operated vibrators which are held against the neck by on-off button, has been widely used as a verbal communication method among post-laryngectomized patients. EL speech can produce easily without need of any additional surgery or special training and be used with any other methods. This institute developed a neck-typed EL named "Blueton" in commperation with EL Company Linkus, which consists of 3 parts : Vibrator part, Control part, Battery part. In this study we evaluated the acoustic characteristics of the produced voices by Blueton compared with Servox-inton using MDVP. Three EL users (2 full time users, 1 part time user) were participated. The results revelaed that NHR higher in Servox than Blueton and intensity is higher in Blueton than Servox. The spectra for vowels produced by EL speakers are mixed signals combined with talkers' vocal output and electrolarynx noise. The spectra pattern is similar with two ELs. High, SPI index and vowel spectra from MDVP demonstrated characteristics of both electrolarynxes related to noise signal. This finding suggests that Blueton helps to provide one of useful rehabilitation options in the post laryngectomy patients.

성악가와 훈련 받지 않은 일반인의 음도, 강도, 성구 변화 시 발성 및 호흡조절 특성

최성희,남도현,김덕원,김영호,최홍식,Choi, Seong-Hee,Nam, Do-Hyun,Kim, Deak-Won,Kim, Young-Ho,Choi, Hong-Shik 대한후두음성언어의학회 2006 대한후두음성언어의학회지 Vol.17 No.2

Background and Objectives : Training of breath support and laryngeal muscles control are important components in the development of the singing voice. The purpose of this study is to compare characteristics of respiratory and phonatory control on pitch, loudness, register change with untrained males and trained male singers. Materials and Methods : The 11 untrained males and 11 trained male singers participated. Closed Quotient(CQ), fundamental frequency (fo) and relative volume contribution of the rib cage (in percentage rib cage, % RC) and relative volume contribution of abdomen (in percentage abdomen, % AB) were measured during various pitch, loudness, register tasks using /a/ vowel phonation : Legato, staccato with C3-D3-E3-F3-G3 notes and crescendo and decrescendo with C3 note as well as modal register with C3 and falsetto register with C4 note using an integrated analysis system of Respiration, EGG and Voice. Results : (1) When pitch increased with legato task, loudness also increased in untrained male group but maintained in trained male singers. CQ was also increased both untrained and trained male singers but it was not significantly different ($p>.05$). The abdomen contribution to lung volume were significantly predominant both in inhalation and exhalation in trained males singers ($p<.05$). (2) When pitch increased with staccato task, CQ was not significantly different in untrained but significantly different in trained male singers. The respiratory function of male singers were characterized by significantly predominant abdomen contribution to lung volume in exhalation except for inhalation ($p<.05$) (3) When loudness increased with crescendo, fo was significantly increased with increasing CQ in untrained males but fo was relatively consistent with increasing CQ in trained male singers. The respiratory function of male singers were characterized by significantly predominant abdomen contribution to lung volume in exhalation except for inhalation ($p<.05$). (4) Most male singers were able to change register from modal to falsetto register, but untrained males were not. Thus, CQ was significantly different between modal and falsetto register in trained male singers ($p<.05$). The respiratory function of male singers were characterized by significantly predominant abdomen contribution to lung volume in exhalation except for inhalation ($p<.05$). Conclusion : Male singers were superior to untrained males in coordination of respiratory and phonatory control on pitch, loudness, register change. Implication are offered regarding how the results might be applied to the voice therapy as well as singing training.

각종 음성분석기에 따른 음성장애 환자의 주기간 주파수 및 진폭변동률 분석

최성희,남도현,이승훈,정원혁,김덕원,최홍식,Choi Seong Hee,Nam Do-Hyun,Lee Seung-Hoon,Jung Won-Hyuk,Kim Deok-Won,Choi Hong-Shik 대한후두음성언어의학회 2005 대한후두음성언어의학회지 Vol.16 No.2

Background and Objectives : Voice perturbation measures, such as jitter and shimmer has been importantly used for diagnosis and treatment efficacy of laryngeal dysfunction. This study was conducted to investigate validity of newly developed multi-channel voice analyzer program by comparing with MDVP, PRAAT, TF32. In addition, we compared the voice perturbation measures with different voice analyzer program by type of signals. Materials and Methods : Nineteen mild-severe dysphonic patients participated in our study. Fundamental frequency, jitter and shimmer values were obtained from different voice analyzer program using the same sustained/ah/phonation. Results : Fundamental frequency and shimmer were highly correlated whereas jitter was weakly correlated between newly developed multi-channel voice analyzer program and the others though different pitch computation algorithm except MDVP, In addition, Type 2 and 3 signals were weakly correlated than Type 1. Conclusion : In the clinical setting, clinician may have sufficient information of voice analyzer and control conditions properly for severity of pathologic voice before voice perturbation measure to obtain reliable results.

전기성문파형검사를 이용한 모음과 공명 자음의 발성특성

최성희,남도현,임재열,임성은,최홍식,Choi, Seong-Hee,Nam, Do-Hyun,Lim, Jae-Yol,Lim, Sung-Eun,Choi, Hong-Shik 대한후두음성언어의학회 2004 대한후두음성언어의학회지 Vol.15 No.2

Background and Objectives : Vowels and resonant including nasals and liquid are produced with vocal folds vibration have been used for voice therapy of hyperadduction patients. This study was conducted to investigate phonatory characteristics of vowels and resonant consonants through the EGG measures from Lx. Speech studio (Laryngograph Ltd, UK). Materials and Method : 7 male adults produced sustained vowel /a/, /i/, /u/, nasals /m/, /n/, /${\eta}$/and liquid /I/ and read the sentences (1nasals-liquid sentence, 1 non-nasals-liquid sentence) and tongue-tip trill and humming. Fx(Hz), Ox(%) were obtained of vowels, nasals, liquid and each of the posterior vowel /a/ of /ma/, /na/, /la/, /ha/ with same F0(around F#165Hz) and amplitude (75${\pm}$5db). And also DFx(Hz), DQx(%), CFx(%) and CAx(%) were obtained from reading two kinds of sentences. Results : Qx(%) was the highest in /u/ of vowels, and nasal/n/ of the resonant consonants and nasals-liquid sentence was higher Qx than non-nasals-liquid sentence but significant differences were not found. Qx(%) of the posterior vowel /a/ of nasal consonants/n/ was higher than in the isolated vowel/a/ and other posterior vowel of resonant consonants and fricatives /h/. Regularity or periodicity and higher Qx were observed in the nasals-liquid sentence than non-nasals-liquid sentence in graphs of QxFx & CFx produced by Quantiative analysis. In the nasalance score, /u/vowel was significant higher among the vowels and /I/ liquid was significant lower among the resonant consonants and nasals-liquid sentence is higher than non-nasals -liquid sentence. CQ(%) was not significantly correlated with nasalance(%). Conclusion : These findings might signify resonant phonation was not correlated with nasalance.

경련성 발성장애 환자의 의사소통태도 연구

최성희(Seong Hee Choi),심현섭(Hyun Sub Sim),최흥식(Hong Shik Choi) 한국언어청각임상학회 2004 Communication Sciences and Disorders Vol.9 No.3

본 연구는 경련성 발성장애 환자의 의사소통태도를 평가하기 위해 한국판 의사소통태도의 표준화를 위한 예비검사문항(심현섭.신문자, 2002)을 이용하여 성과 연령이 비슷한 정상 집단 37명과 37명의 내전형 경련성 발성장애 환자의 의사소통태도를 비교하였다. 그 결과 경련성 발성장애 환자 집단이 통계적으로 유의하게 부정적인 의사소통태도를 갖는 것으로 나타났다. 항목별로 볼 때 집단 간 가장 큰 차이를 보인 것은 말할 때의 불안감이 가장 컸으며, 자신의 말에 대한 부정적인 자기인식, 말에 대한 회피나 청자의 반응, 낮은 자아상, 대인관계에 대한 어려움 등이 경련성 발성장애 환자의 주된 의사소통태도로 나타났다. 또한 경련성 발성장애의 가장 효과적인 치료법으로 널리 사용되고 있는 보틀리눔독소 주입술 시 단기간 내의 치료 결과에 따른 의사소통태도의 변화를 보기 위하여 경련성 발성장애 환자 중 보툴리눔독소 주입술 치료 경험이 전혀 없는 9명을 대상으로 보툴리눔독소 주입술 전과 1개월 후 의사소통태도를 비교한 결과, 보툴리눔독소 주입술 후 환자 대부분이 부정적인 의사소통태도가 감소하여 말 개선이 의사소통태도에 변화를 줄 수 있음을 시사하였다. 따라서 경련성 발성장애 환자의 의사소통태도평가는 객관적인 검사와 더불어 치료의 효과를 검증하는 데 유용한 검사도구임이 입증되었다. The purpose of the present study was to investigate the communication attitude for adductor spasmodic dysphonia(ADSD). Thirty seven ADSD female patients(mean age: 31.3 yrs) and thirty seven age-matched normal females(30.8 yrs), participated in the study. Each subject was asked to be interviewed and respond to the Korean Communication Attitude Scales(2002). The severity of tremor and breathiness was measured by 2 experienced speech-language pathologists using a visual analog cales(10㎝). The comparison of communication attitude was analyzed with an independent t-test and each item’s response between the 2 groups was analyzed with Fisher’s test. The major findings from this study were: (1) The total score of ADSD group was higher than normal group(p<.05) and the ADSD group had more negative communication attitude than the normal group. (2) Most of the items showed a significant difference between the 2 groups, and item 24 was especially the most prominent. (3) The adjusted total scores as a function of severity within the ADSD groups showed the severe ADSD group was significant highest(F = 4.571, p < .05). (4) The adjusted total scores as a function of the frequency of Botox injection did not show any difference(F = .568, p < .05). (5) Communication attitude after Botox injection treatment was changed to the decreased negative communication attitude than before the injection. Botox injection treatment is useful for the positive attitude of communication. But repeated injections, the breathy voice for the side-effect, the expectancy level of treatment effect, the maintenance period, and patients satisfaction all affect the long-term communication attitude of ADSD patients. Consequently, the evaluation of communication attitude is useful to prove the treatment efficacy for ADSD.

정상인과 음성질환자의 호흡 패턴 및 호흡 기능의 운동학적 특성

최성희(Seong Hee Choi),남도현(Do-Hyun Nam),최흥식(Hong-Shik Choi) 한국언어청각임상학회 2006 Communication Sciences and Disorders Vol.11 No.3

본 연구는 정상적인 발성 중에 호흡의 신호를 측정할 수 있으며 발성 시 공명, 조음기관에 영향을 주지 않고 호흡과 성문 및 발성 기능을 동시에 측정할 수 있는 음성, 성문 및 호흡 통합 검사 장치를 이용하여 정상 성인 집단 55명, 성문의 불완전한 폐쇄를 보이는 양성성대질환자 20명 및 성대마비환자 15명을 포함한 총 90명을 대상으로 /아/모음 연장발성 시 호흡의 패턴과 호흡의 운동학적 특징을 분석하였다. /아/모음 연장 발성 시 성별과 연령을 통제한 상태에서 다중희귀분석 결과, 호흡의 동적 기능 중 전체 폐용량에 대한 흉부와 복부의 상대적인 기여도를 비교햇을 때, 흡기와 호기 시 흉부의 기여도는 양성성대 질환군이 정상군에 비해 높았으나, 통계적으로 유의하지는 않았고, 성대마비군은 정상군에 비해 통계적으로 유의하게 높았다(p<.05). 최대 흡기량 및 호기량은 통계적으로 유의한 차이가 없었다. 그리고 호흡 패턴의 형태를 성별과 연령을 통제한 상태에서 다항 로지스틱 분석한 결과, 통계적으로 유의미한 차이를 보이지는 않았으나, 양성성대 질환군과 성대마비환자는 정상군에 비해 역행(paradoxical)호흡, 흉식호흡, 그 다음으로 복식호흡을 하는 경향성이 관찰되었다. 성대 내전 위치와 질량 변화로 인하여 호기류의 밸브 기능인 후두에 문제가 생길 때, 적절한 성문하압을 형성하기 어려우므로, 기존의 흉부를 주로 사용하는 호흡 패턴으로는 효율적인 음성 산출이 어렵다. 따라서 일상 대화와 같이 긴 발화나 큰 소리를 내기 위해서는 복식 호흡을 통해 적절한 성문하압을 형성하고, 호기류를 증가시켜 성대 진동이 잘 이루어질 수 있도록 음성치료 시 호흡 훈련이 병행되어야 함을 확인할 수 있었다. .

Speech-Language Pathologists’ Voice Assessment and Voice Therapy Practices: A Survey for Standard Clinical Guideline and Evidence-Based Practice

최성희(Seong Hee Choi) 한국언어청각임상학회 2013 Communication Sciences and Disorders Vol.18 No.4

배경 및 목적: 현재까지 한국의 언어재활 현장실무에서 음성장애를 다루는 음성언어재활사들이 임상현장에서 일반적으로 사용하는 음성평가와 치료 및 이들의 직무 분석에 대한 자료는 거의 없는 실정이다. 본 연구의 목적은 한국의 임상현장에서 음성평가와 치료에 대한 증거기반중재를 위한 예비 연구로서 음성언어재활사들이 담당하는 음성평가와 치료에 대한 절차와 내용에 대해 분석하고자 한다. 방법: 3차 기관급 병원이나 1차(또는 2차) 기관급 병원의 목소리 전문 이비인후과에서 음성장애 환자를 다루는 음성언어재활사 29명에게 설문 조사를 실시하고 그 내용을 분석하였다. 결과: 다차원적 음성을 평가하기 위하여 음성언어재활사의 대부분이 임상가 중심과 환자 중심의 주관적 평가를 객관적 평가와 병행하여 사용하고 있었다. 청지각적 평가와 음향학적 검사인 CSL의 다차원적 음성프로그램(multi-dimensional voice program, MDVP)이 일상적으로 가장 많이 사용되는 보편화된 음성평가 방법이었다. 대부분의 음성언어재활사들은 성인과 아동환자 모두에게 직접적 음성치료법과 간접적 음성치료법을 병행하여 사용하였다. 음성치료법에서는 ‘성대기능훈련’과 ‘호흡훈련’이 각각 총체적 음성치료기법과 음성촉진기법 중 가장 많이 사용되었다. 그러나 평가의 절차나 말자료는 시설이나 임상가 간에 다양하였으며, 주관적 평가뿐 아니라 객관적 검사의 절차나 기기 사용 및 치료 기법들에 대한 임상 능력은 표준화된 절차보다는 개인의 임상 경험이나 다른 경험 있는 음성언어재활사나 사용자 매뉴얼에 의존하는 경우가 많았다. 논의 및 결론: 본 연구는 우리나라 음성장애 임상 현장에 대한 기초 조사로서 의의가 있다. 본 연구 결과를 통해 음성언어재활사들이 시행하고 있는 음성평가와 음성치료에 대한 향후 규준을 마련하고, 음성평가의 임상적 사용의 개선과 증거기반의 임상 중재를 제공하기 위하여 통일된 표준화된 임상지침이나 프로토콜의 개발이 필요하다고 사료된다. Objectives: Currently, there is minimal information regarding the voice assessment and the voice therapy of clinical practices that speech-language pathologists (SLPs) use routinely and for their job analysis in Korea. This is a preliminary study for evidence-based practices of voice disorders in order to investigate common voice assessments and therapy techniques that SLPs use for the patients. Methods: Twenty-nine SLPs have completed a 37-item survey, and then the data was being analyzed. Results: The majority of SLPs routinely used clinician-based and patient-based subjective assessments with the objective method. Specifically, the auditory-perceptual analysis and the Multi-Dimensional Voice Program of Computerized Speech Lab in acoustic analysis were most commonly used for voice assessments. The procedures of recording voice were diversed depending on SLPs and facilities. In voice therapy, most SLPs used a combination of indirect and direct treatment methods for both adults and children with voice disorders. The vocal function exercises were most frequently used in holistic voice therapies, and the most widely used voice facilitation technique was respiration training for patients with hypofunctional and hyperfunctional voice disorders. Additionally, many SLPs relied on their senior SLPs or user manuals when developing skills of subjective and objective measures as well as the therapy itself. Conclusion: The results suggested that a consensus for standardized protocol or a guideline of voice assessment is essential to provide effective treatments based on evidence-based practice.

음성 장애 치료 연구의 최근 동향

최성희(Choi Seong Hee) 한국음성학회 2010 말소리와 음성과학 Vol.2 No.1