경직형 뇌성마비 아동의 하위그룹별 말속도와 쉼의 특성 및 말명료도와의 관계

정필연(Pil Yeon Jeong),심현섭(Hyun Sub Sim) 한국음성학회 2020 말소리와 음성과학 Vol.12 No.3

본 연구의 목적은 경직형 뇌성마비 아동의 하위그룹별로 말속도와 쉼에서 차이가 있는지 살펴보고, 말명료도와의 관련성에 대해서 알아보고자 하였다. 연구대상은 경직형 뇌성마비 아동 26명이 참여하였다. 말문제와 언어문제가 없는 NSMI-LCT 4명, 말문제는 없지만 언어문제가 있는 NSMI-LCI 그룹 6명, 말문제가 있지만 언어문제는 없는 SMI-LCT 6명, 말과 언어문제를 모두 동반하는 SMI-LCI 그룹 10명이 참여하였다. 연구과제는 문장 따라말하기였고, Praat을 통해 말속도, 조음속도, 쉼 시간의 비율, 평균 쉼 횟수, 평균 쉼 시간을 측정하였다. 연구결과, 첫째, 말속도와 조음속도는 언어문제의 유무와 관계없이 NSMI와 SMI 그룹 간에 유의한 차이가 나타났다. 둘째, NSMI에 비해 SMI 그룹에서에서 쉼 시간의 비율은 더 높고, 쉼 횟수는 더 빈번하였으며 쉼 시간은 더 길게 나타났다. 셋째, 말속도와 조음속도는 말명료도와 유의한 상관을 나타내었다. 본 연구의 결과는 느린 말속도가 SMI 그룹의 말산출 과정에서 나타나는 주요한 특성이고, 말명료도에 있어서 조음속도와 말속도가 중요한 역할을 함을 시사한다. The current study aimed to identify the characteristics of speech rate and pause in children with spastic cerebral palsy (CP) and their relationships with speech intelligibility. In all, 26 children with CP, 4 with no speech motor involvement and age-appropriate language ability (NSMI-LCT), 6 with no speech motor involvement and impaired language ability (NSMI-LCI), 6 with speech motor involvement and age-appropriate language ability (SMI- LCT), and 10 with speech motor involvement and impaired language ability (SMI-LCI) participated in the study. Speech samples for the speech rate and pause analysis were extracted using a sentence repetition task. Acoustic analysis were made in Praat. First, it was found that regardless of the presence of language impairment, significant group differences between the NSMI and SMI groups were found in speech rate and articulation rate. Second, the SMI groups showed a higher ratio of pause time to sentence production time, more frequent pauses, and longer durations of pauses than the NSMI groups. Lastly, there were significant correlations among speech rate, articulation rate, and intelligibility. These findings suggest that slow speech rate is the main feature in SMI groups, and that both speech rate and articulation rate play important roles in the intelligibility of children with spastic CP.

경직형 뇌성마비아동의 씹기능력에 따른 말명료도의 변화

정필연(Jeong, Pil Yeon),심현섭(Sim, Hyun Sub) 이화여자대학교 특수교육연구소 2015 특수교육 Vol.14 No.1

뇌성마비아동은 경도부터 심도수준에 이르기까지 씹기능력에서 어려움을 나타낸다. 본 연구의 목적은 경직형 뇌성마비아동의 씹기능력과 말명료도와의 관계를 알아보고, 비정상적 씹기능력의 중증도에 따라 말명료도에 미치는 영향에 대해 알아보는 것이다. 연구대상은 2~10세의 경직형 뇌성마비아동 21명이 참여하였다. PSAS를 사용하여 씹기능력을 분석하였고, 단음절 따라말하기과제를 통해 말명료도를 측정하여 두 변인 간 상관을 살펴보았다. 연구 결과 첫째, 경직형 뇌성마비아동의 씹기능력과 말명료도는 유의한 상관을 나타내었다. 둘째, 씹기능력의 중증도별로 살펴본 결과, 경도와 중도집단에 비해 심도집단의 말명료도가 유의하게 낮았다. 본 연구의 결과를 통해 말산출과 씹기기능이 정상적으로 이루어지기 위해서는 구강기관의 적절한 운동성과 협응이 중요하다는 것을 확인할 수 있었다. 따라서 경직형 뇌성마비아동의 섭식기능에 대한 조기 평가와 중재가 중요하며 구강기관의 발달순서를 고려한 운동체계학습이 이루어져야 한다는 것을 제안한다. Children with cerebral palsy (CP) frequently manifest chewing problems ranging from mild to severe. Human oral mechanisms serve for eating and speaking. Therefore chewing ability and speech intelligibility are important skills considered in assessment and intervention of CP. The purpose of the present study was to investigate relationship between chewing ability and speech intelligibility in children with spastic CP. This study method was performed as follows: The subjects were 21 children who were diagnosed with spastic CP aged 2 to 10 participated. Children"s chewing ability was examined using the biting and chewing portion of Pre-Speech Assessment Scale(PSAS). Chewing ability was analyzed using both abnormal and normal developmental range score for articulator movements, which were obtained based on the chewing activities involving jaw, tongue, and lip movements. And their speech intelligibility was examined via perceptual analysis of monosyllable stimulus. The results of this study were as follows: First, there was a significant correlation between chewing ability and speech intelligibility. Second, speech intelligibility and chewing ability were significantly reduced in the severe group of children with spastic CP compared to the others group. Our findings suggest that oral movement is related to speech intelligibility. Therefore, early assessment and stimulation of chewing functions should be a common element for rehabilitation of children with spastic CP.

경직형과 이완형 마비말장애아동에서 조음속도와 말명료도 및 작업기억능력 간의 관계

정필연(Jeong, Pil Yeon),심현섭(Sim, Hyun Sub),정숙회(Jeong, Sook Hwae),임동선(Yim, Dongsun) 한국음성학회 2016 말소리와 음성과학 Vol.8 No.2

The purpose of this study is to evaluate the association among articulation rate, speech intelligibility and working memory in children with dysarthria. Two subject groups of 11 spastic and 11 flaccid dysarthria, respectively, aged between 8 and 17 years of age participated in this study. All participants were administered the following tests: K-WISC III PIQ test, speech intelligibility, working memory and articulation rate. Group differences were compared by an independent t-test. Pearson correlation were computed between all measures. The results of this study are as follows: First, articulation rate and intelligibility were significantly lower for the spastic dysarthria than for the flaccid dysarthria. Second, there was a significant correlation between articulation rate and intelligibility in children with flaccid dysarthria. Lastly, there was no significant correlation between articulation rate and working memory in both groups. The results suggest that articulation rate is not necessarily accompanied by working memory capacity in children with dysarthria, and there are differences in the effect of articulation rate on intelligibility depending on the type of dysarthria.

경직형 뇌성마비 아동의 음질이 말명료도에 미치는 영향

정필연(Jeong, Pil Yeon),심현섭(Sim, Hyun Sub) 한국음성학회 2017 말소리와 음성과학 Vol.9 No.4

This study investigates the effect of voice quality on speech intelligibility and the relationship between voice quality and intelligibility for children with spastic CP. We recruited 36 children with spastic CP (mean age 10.43 year, 17 girls, 19 boys, spastic type 34, mixed 2) from a special school and a rehabilitation hospital. Voice samples for the perceptual analysis of voice quality were extracted from a sustained vowel /a/ and were rated on the GRBAS scales by two experienced speech language pathologists. Ten adult subjects with no hearing problems evaluated speech intelligibility for the 37 words listed in the Assessment of Phonology and Articulation for Children on a 7-point interval scale. The children with spastic CP were divided into three groups according to the rated G scores on the GRBAS scales (G1(n)=10, G2(n)=13, G3(n)=13). Analyses of ANCOVA and Pearson correlation showed that there was a significant difference in speech intelligibility among three groups. There was also a significant correlation in G scale (grade), A scale (asthenia), B scale (breathy) score, and speech intelligibility. These findings suggest that poor speech intelligibility of spastic CP might be related to asthenia and breathiness. Vocal intensity should be increased and vocal functioning should be improved for speech therapy to improve speech intelligibility of the children with spastic CP.

Speech Language Profile Group (SLPG) 분류체계에 따른 뇌성마비 아동의 하위그룹 분포 및 판별요인 분석

정필연(Pil Yeon Jeong),심현섭(Hyun Sub Sim) 한국언어청각임상학회 2021 Communication Sciences and Disorders Vol.26 No.2

배경 및 목적: 본 연구는 Speech Language Profile Group (SLPG) 하위그룹별 뇌성마비 아동의 분포를 알아보고, 이러한 분류체계를 가장 잘 판별해 줄 수 있는 요인이 무엇인지 알아보고자 하였다. 방법: 본 연구에는 4-16세 뇌성마비 아동 87명(경직형 67명, 불수의 운동형 4명, 실조형 3명, 혼합형 13명)이 참여하였다. 평가 과제는 말능력(모음연장발성, 아동용 발음평가, 문장 따라말하기), 언어능력(수용어휘력 검사), 인지능력(동작성 지능검사) 검사였고, 이 과제를 통해 최대발성 지속시간, 음성강도, 말명료도, 말속도, 수용어휘력 및 인지능력을 측정하였다. 기능적 분류를 위해 CFCS와 GMFCS 평정을 실시하였다. SLPG 하위그룹은 말장애 유무, 언어문제 유무에 따라 말과 언어문제가 없는 NSMI-LCT, 말문제는 없지만 언어문제가 있는 NSMI-LCI, 말문제가 있지만 언어문제는 없는 SMI-LCT, 말과 언어문제가 있는 SMI-LCI, 무발화이지만 언어문제는 없는 ANAR-LCT, 무발화이면서 언어문제가 있는 ANAR-LCI 등 6개 그룹으로 나누어 분석하였다. 결과: 첫째, SLPG 하위그룹별 분포비율은 NSMI-LCT는 11.5%, NSMI-LCI 8.0%, SMI-LCT 12.6%, SMI-LCI 19.5%, ANAR-LCI 11.5%, ANAR-LCI 36.8%를 나타내었다. SLPG와 CFCS 간에는 .875, SLPG와 GMFCS 간에는 .548의 상관을 나타내었다. 둘째, SLPG 하위그룹을 가장 잘 판별하는 함수는 말명료도, 말속도, 수용어휘력 순으로 나타났다. 논의 및 결론: SLPG 하위그룹별 분석을 통해 말, 언어능력에 따른 그룹 간 분포비율을 제시하였고, 기존의 운동능력 중심의 분류체계를 상호보완할 수 있는 말, 언어 및 의사소통능력에 근거한 분류체계의 적용이 필요함을 시사하였다. Objectives: This study aimed to identify the subgroups distribution of children with cerebral palsy (CP) by using Speech, Language Profile Group (SLPG), and examine discriminant factors that differentiate subgroups. Methods: Eighty-seven children aged 4-16 years with CP participated in the study (spastic 67, dyskinetic 4, ataxic 3, mixed 13). Data was collected from a speech production task (sustained vowel /a/, Assessment of Articulation and Phonology for Children, sentence repetition), language test (receptive vocabulary), and PIQ test (K-WISC-III, K-WIPPSI). Independent variables were maximum phonation time (MPT), intensity, speech rate, intelligibility, receptive vocabulary score, and cognition ability. For the analysis, children with CP were classified into six speech language profile groups; NSMI-LCT (no clinical speech motor involvement and age appropriate language, cognition abilities), NSMI-LCI (no clinical speech motor involvement and impaired language, cognition abilities), SMI-LCT (speech motor impairment and age appropriate language, cognition abilities), SMI-LCI (speech motor impairment and impaired language, cognition abilities), ANAR-LCT (anarthria and age appropriate language, cognition abilities), and ANAR-LCI (anarthria and impaired language, cognition abilities). Results: Descriptive study showed that of all children with CP, the proportion of NSMI-LCT was 11.5%, NSMI-LCI was 8.0%, SMI-LCT was 12.6%, SMI-LCI was 19.5%, ANAR-LCT was 11.5%, and ANAR-LCI was 36.8%. Very strong relationships were noted between SLPG and CFCS, and moderate relationships were noted between SLPG and GMFCS. Canonical discriminant function analysis revealed that the speech intelligibility variable accounted for 85.1%, the speech rate variable was 9.7%, and the language variable was 5.2%. Conclusion: This study suggested that the SLPG classification system helps us to stratify the subgroups for understanding speech, language features in children with CP.

디지털 치료제 개발을 위한 자폐스펙트럼장애 아동 부모교육 프로그램의 효과

정필연(Pil Yeon Jeong),연석정(Seok Jeong Yeon),홍기형(Ki-Hyung Hong) 한국언어청각임상학회 2023 Communication Sciences and Disorders Vol.28 No.1

배경 및 목적: 본 연구는 메타분석을 통해 부모교육 프로그램이 자폐스펙트럼장애 아동의 언어 및 의사소통에 미치는 효과는 어떠한지, 프로그램 전달 방식(대면 대 원격)에 따른 효과는 어떠한지, 부모교육 프로그램 중재모델에 따른 효과는 어떠한지 알아보고자 하였다. 방법: 문헌검색을 위해 국내외 7개의 데이터베이스(RISS, DBpia, Academic Search Complete, CINAHL Plus with Full Text, ERIC, PsyINFO, PudMed)를 검색하였고, 2012년-2022년 7월까지 출간된 두 집단 비교연구를 대상으로 포함 및 제외 준거에 따라 총 21편의논문이 선정되었다. 메타분석을 위해 CMA3 (Comprehensive Meta-Analysis 3) 프로그램을 사용하였고, 평균 효과크기의 산출을 위해 무선효과모형을 적용하였으며 Hedge’s g로 분석하였다. 결과: 연구결과 첫째, 부모교육 프로그램은 자폐스펙트럼장애 아동의 언어능력에서 작은 효과크기를 나타내었다. 둘째, 대면에 비해 원격치료에서 더 높은 효과를 나타내었다. 셋째, 중재모델 가운데 PRT와 ABA 프로그램에서 유의한 효과가 있는 것으로 나타났다. 논의 및 결론: 연구결과를 통해 부모교육이 ASD 아동의 언어능력 향상에 도움이 되고, 원격 방식을 통한 부모교육의 효과성을 확인하였다. 따라서 본 연구결과는 디지털 치료제 개발을 위해 필요한 근거기반의 자료를 제시하였다는 점에서 의의가 있다. Objectives: The purpose of this meta-analysis study was to systematically investigate the extant literature on parent training and to evaluate its effectiveness on children’s language and communication skills, and to identify the difference of effect sizes between tele-therapy and in person therapy. Methods: Seven electronic databases, RISS, DBpia, Academic Search Complete, CINAHL Plus with Full Text, ERIC, PsyINFO, and PudMed were searched through to July 2022 for analysis. Using Meta-Analysis (CMA3: comprehensive meta-analysis version 3, 2022), a systematic literature review approach was taken to analyze 21 studies which met the inclusion and exclusion criteria of our research. Effect sizes for children’s language and communicative skills were analyzed via the random effect model. Results: There were three main findings. First, parent training programs had a small effect size on language ability in children with ASD. Second, tele-therapy had higher effect size than in-person therapy. Lastly, two intervention models, Pivotal Response Treatment and ABA, showed large treatment effects. Conclusion: The results from the present study suggest that parent training programs are helpful for children with ASD in increasing language ability. Tele-therapy showed more efficacy than the in-person therapy. These findings support the efficacy of tele-therapy compared with in-person therapy. Therefore, this study provides preliminary evidence for the use of a digital therapeutics.

경직형과 불수의운동형 뇌성마비아동의 /아/ 모음 음향학적 비교

정필연(Pil Yeon Jeong),심현섭(Hyun Sub Sim) 한국음성학회 2020 말소리와 음성과학 Vol.12 No.1

본 연구의 목적은 경직형과 불수의운동형 뇌성마비 아동의 음향학적 특성에서 차이가 있는지 알아보는 것이다. 연구대상은 만 4~12세의 뇌성마비 아동 34명이 참여하였다(경직형 26명, 불수의운동형 8명). 연구과제는 모음 ‘아’ 연장발성하기이고, Praat을 사용하여 MPT, F0, Jitter, Shimmer, NHR과 F1, F2를 측정하였다. 두 유형 간 음향학적 차이를 알아보기 위해 두 독립표본 t-검정과 등분산가정이 충족되지 않는 경우 Welch-Aspin 검정을 사용하여 통계분석을 실시하였다. 연구결과, 첫째, 경직형 뇌성마비아동에 비해 불수의운동형에서 유의하게 낮은 MPT를 나타내었다. 둘째, Shimmer에서 불수의운동형의 측정치가 유의하게 높았다. 셋째, F1과 F2에서는 두 유형 간에 유의한 차이를 보이지 않았다. 이러한 결과는 경직형에 비해 불수의운동형의 호흡능력과 호흡조절능력이 더 제한적이고, 음성의 불안정성과 불규칙성도 더 많이 나타난다는 것을 시사한다. 본 연구의 결과는 뇌성마비 유형 간 말운동통제능력의 차이를 확인하고, 유형에 따른 중재계획을 수립하는데 필요한 정보를 제공해 줄 수 있을 것이다. This study aims to compare the acoustic characteristics of vowel phonation in children with spastic and dyskinetic cerebral palsy (CP). Thirty-four children aged 4-12 years with CP participated in the study (spastic 26, dyskinetic 8). Voice samples for the acoustic analysis were extracted from a sustained vowel /a/. All acoustic measures were made using Praat. Group differences were compared by an independent t-test or Welch-Aspin test, if the equivalence assumption was not met. The results of this study are as follow. First, maximum phonation time(MPT) was significantly shorter for the dyskinetic CP than for the spastic CP. Second, shimmer percent was significantly increased in the dyskinetic CP than in the spastic CP. Lastly, there were no significant group differences in both the first formant and the second formant. These findings indicate that the dyskinetic CP has a poorer respiratory capacity and poorer laryngeal function than the spastic CP. On the other hand, both groups have a comparable ability to articulate the vowel /a/. The results of the present study help speech language pathologists identify the speech motor control ability of children with two types of CP (spastic and dyskinetic) and help to make an intervention plan associated with a specific type of CP.

Comparison of Perceptual Assessment for Dysarthric Speech: The Detailed and General Assessments

홍새미(Sae Mi Hong),정필연(Pil Yeon Jeong),심현섭(Hyun Sub Sim) 한국언어청각임상학회 2018 Communication Sciences and Disorders Vol.23 No.1

배경 및 목적: 미국 메이요 클리닉(Mayo Clinic)에서 제안한 마비말장애 청지각적 평가요소는 임상에서 널리 사용되고 있지만, 소요시간이 길고 신뢰도가 낮다는 제한 때문에 평가 항목의 수를 조정하고 신뢰도를 향상시키는 방안이 요구된다. 따라서 본 연구는 세부요소를 평가하는 방법과 요소들의 범주만을 평가하는 방법 간의 차이를 살펴보고, 청지각적 평가요소들과 말의 전반적 인상 간의 관련성을 알아보고자 하였다. 방법: 28명의 준전문가 집단에게 다양한 유형의 마비말장애 화자 15명의 표준화 문단 읽기 샘플을 일주일 간격으로 2회 들려주고 세부평가와 범주평가를 실시하도록 하여 평가자 간 신뢰도, 검사-재검사 신뢰도, 평정치 차이를 각각 비교하였다. 각 평가 내 요소들과 전반적 인상을 나타내는 요소 간의 상관관계도 살펴보았다. 결과: 평가자 간 신뢰도와 검사-재검사 신뢰도 모두 범주평가가 각각 .967, .620으로 세부평가보다 높았다. 두 평가 방법을 통해 측정된 평균 평정치는 유사하였으나, 평정점수별 분포비율에서는 차이를 보였다. 두 평가 모두에서 조음과 관련된 요소들이 전반적 인상과 높은 상관을 나타냈고, 공명과 관련된 요소들은 낮은 상관을 나타냈다. 논의 및 결론: 범주평가는 소요시간이 짧으며, 세부평가보다 높은 신뢰도를 갖추고 있지만, 마비말장애의 말 특성을 세밀하게 평가하는 것은 제한적이므로 세부평가 내 일부 요소들에 대한 평가가 병행되어야 할 것이다. 말의 전반적 인상을 결정하는 데 관련이 높고 낮은 평가요소들을 살펴본 결과는 추후 효율적인 청지각적 평가요소를 선정하는 근거 자료로 사용될 것이다. Objectives: The Mayo Clinic rating of dysarthria is widely used in the clinical practice. However, because of its low reliability and extensive time requirement, it is necessary to reduce the number of components and improve its reliability. The present study was designed to investigate the difference between a general and detailed assessment protocol and the association of perceptual dimensions with overall impression of speech. Methods: Twenty-eight inexperienced clinicians were asked to perform both protocols twice, separated by a one week interval, with samples of standardized paragraph readings of 15 patients with various degrees and types of dysarthria. The inter-rater reliability, test-retest reliability, and different of rating values were compared between both protocols. The correlation between perceptual dimensions and overall impression of speech was also examined. Results: The general assessment protocol showed higher inter-rater reliability (=.967) and test-retest reliability (=.620) than the detailed assessment protocol. The mean rating values were similar between the two protocols, but there was a difference in the distribution ratio of rating values. For both protocols, dimensions related to articulation were highly correlated with overall impression of speech, and those related to resonance had low correlation. Conclusion: The general assessment protocol takes less time and has higher reliability than the detailed assessment protocol. However, since it is limited to evaluating speech characteristics of dysarthria in detail, it should be accompanied by other assessment protocols. The results of the present study are expected to be the basis for further studies.

혀 강도가 뇌성마비 아동의 말 산출에 미치는 영향

이영미(Youngmee Lee),정필연(Pil Yeon Jeong),성지은(Jee Eun Sung),심현섭(Hyun Sub Sim) 한국언어청각임상학회 2018 Communication Sciences and Disorders Vol.23 No.4

배경 및 목적: 본 연구에서는 혀 강도가 뇌성마비 아동의 자음 산출에 미치는 영향을 살펴봄으로써, 뇌성마비 아동의 말 평가와 재활 계획 수립에 유용한 정보를 제공하고자 한다. 방법: 본 연구에서는 검사 당시 연령이 5-15세인 뇌성마비 아동 20명을 대상으로 하였다. 대상 아동의 조음위치 및 조음방법에 따른 자음정확도는 아동용 발음평가를 이용하여 평가하였으며, 혀 강도는 Iowa Oral Performance Instrument (IOPI)를 사용하여 평가하였다. 결과: 혀 강도를 기준으로 뇌성마비 아동을 중앙치 반분법에 따라 고집단(10명)과 저집단(10명)으로 나누어서 Mann-Whitney U-test를 실시한 결과, 모든 조음위치와 조음방법에서 고집단의 자음정확도가 저집단에 비해 유의하게 높았다. 전체 뇌성마비 아동을 대상으로 혀 강도, 조음위치 및 조음방법에서의 자음정확도 간의 상관계수의 범위는 .549-.680이었으며(all p < .01), 뇌성마비 아동의 혀 강도는 단어 수준에서의 자음정확도를 유의하게 예측하는 변수로 나타났다(p < .05). 논의 및 결론: 혀 강도가 높은 뇌성마비 아동이 낮은 아동에 비해서 더 정확하게 자음을 산출할 수 있었으며, 뇌성마비 아동의 혀 강도는말 산출 능력을 예측할 수 있는 유의한 변수였다. Objectives: The aims of this study were to examine the tongue strength of children with cerebral palsy (CP) and to identify the relationship between tongue strength and speech production skills at word level in children with CP. Methods: Twenty children with CP participated in this study, and they ranged in age from 5 to 15 years. The children were median-split into two groups (children with higher tongue strength vs. children with lower tongue strength) based on maximal tongue strength. The maximal tongue strength was obtained using the Iowa Oral Performance Instrument. The speech production skills were measured using the Assessment of Phonology and Articulation for Children, and the percentage of consonants correct (PCC) of all children was calculated according to the place and manner of articulation. Results: Children with higher tongue strength obtained significantly higher PCC than children with lower tongue strength. The maximal tongue strength was significantly correlated with PCC of all places and manners of articulation (all p < .01). Maximal tongue strength was a significant predictor of speech production skills in children with CP. Conclusion: Children with higher tongue strength had significantly better speech production skills than children with lower tongue strength. Tongue strength was an important factor accounting for individual differences in speech production skills for children with CP. The results indicate that tongue strength may serve as a clinically critical index in predicting speech production skills in children with CP.

자폐스펙트럼장애 아동의 장면 기반 감정상징 인식 및 표현능력

김민서(Min Seo Kim),연석정(Seok Jeong Yeon),정필연(Pil Yeon Jeong),홍기형(Ki-Hyung Hong) 한국보완대체의사소통학회 2023 보완대체의사소통연구 Vol.11 No.2