텍스트 내 문장 제시 유형에 따른 초등학교 2학년 발달성 난독 아동과 일반 아동의 읽기 유창성 특성

김찬미 한림대학교 보건과학대학원 2022 국내석사

Background and Purpose: The development of reading fluency is important as decoding ability develops in the early stages of reading development and deciphering within text becomes automated as grades increase. Accuracy, speed, and prosody are recognized as important factors in reading fluency, but studies on reading fluency, including prosody, are rare. When evaluating reading fluency, reading performance varies depending on text factors. Few studies have examined visual density as sentence boundaries in children with developmental dyslexia. In this study, the characteristics of reading fluency between reading groups are examined according to vertical (sentence line breaking) and horizontal (general subject type) in which visual density is divided into new lines according to text type. Subjects and methods: The subjects of this study were second-grade students enrolled in elementary schools in Seoul, Gangwon-do, and Chungcheong-do, with 14 developmental dyslexia children and 13 general children, a total of 27 subjects. Children with no difficulty in intelligence, acceptance vocabulary, and listening comprehension were targeted, and children with developmental dyslexia and general children were divided according to KOLRA reading index 2. Accuracy, speed, and prosody total points were measured and analyzed according to the text type. Results and discussions: As a result of examining the difference in reading fluency according to the reading group and text type(F=9.517, p=.005), only the main effect according to the reading group was significant in reading accuracy. In the reading speed, an interaction effect was observed(F=6.720, p=.016), and the main effect on the reading group(F=18.579, p=<.001) and text type(F=5.302, p=<.030) was also observed. In the case of developmental dyslexia children, they read significantly slower in the horizontal type than in the vertical type(t=-2.873, p=.013). In the total prosody score, only the main effect according to the reading group was significant(F=10.400, p<.001). In conclusion, in the case of developmental dyslexia children, although text composed of self- and phoneme-matched words was presented and readable to some extent without being affected by the text type, both vertical and horizontal types showed differences in speed. In the total prosody score, children with developmental dyslexia also received significantly lower scores in the total score than ordinary children, showing difficulties in terms of prosody. This study examined visual density by dividing it into sentence boundaries according to text types, and it is meaningful to examine the characteristics of reading fluency in children with developmental dyslexia by accuracy, speed, and prosody. 배경 및 목적: 읽기가 발달하는 초기에 해독 능력이 발달하고 학년이 증가할수록 텍스트 내의 해독은 자동화가 되어 읽기 유창성의 발달이 중요하다. 읽기 유창성에서 정확도 및 속도, 운율은 중요한 요인으로 인식되지만, 운율을 포함한 읽기 유창성 연구는 드물다. 읽기 유창성을 평가할 때 텍스트 요인에 따라 읽기 수행력이 달라진다. 발달성 난독 아동을 대상으로 시각적 밀집도를 문장 경계로 살펴본 연구는 거의 없다. 본 연구에서는 시각적 밀집도를 텍스트 유형에 따라 문장을 새로 줄 바꿈으로 나눈 세로형(문장줄바꿈형)과 가로형(일반교과형)에 따라 읽기집단 간 읽기 유창성 특성을 살펴보고자 한다. 대상 및 방법: 본 연구의 대상자는 서울, 강원도 및 충청도의 초등학교에 재학 중인 2학년 학생으로 발달성 난독 아동 14명과 일반 아동 13명으로 총 27명 대상으로 하였다. 지능과 수용어휘력 및 듣기이해력에 어려움이 없는 아동을 대상으로 하였으며, KOLRA 읽기지수2에 따라 발달성 난독 아동과 일반 아동을 나누었다. 텍스트 유형에 따라 정확도, 속도, 운율 총점을 측정하여 분석하였다. 결과 및 논의: 읽기집단과 텍스트 유형에 따른 읽기 유창성의 차이를 살펴본 결과, 읽기 정확도에서 읽기 집단에 따른 주효과만 유의하게 나타났다(F=9.517, p=.005). 읽기 속도에서는 상호작용 효과가 관찰되었으며(F=6.720, p=.016), 읽기집단(F=18.579, p=<.001)과 텍스트 유형(F=5.302, p=<.030)에 대한 주효과도 나타났다. 발달성 난독 아동의 경우 세로형보다 가로형에서 유의하게 느리게 읽었다(t=-2.873, p=.013). 운율 총점에서 읽기집단에 따른 주효과만 유의하게 나타났다(F=10.400, p<.001). 결론적으로 발달성 난독 아동의 경우 자소와 음소 일치형 낱말로 구성된 텍스트를 제시하여 텍스트 유형에 따라 영향을 받지 않고 어느 정도 읽기 가능하였음에도 불구하고 세로형과 가로형 모두 속도면에서 차이가 있는 것으로 나타났다. 운율 총점에서도 발달성 난독 아동이 일반 아동 보다 총점에서 유의하게 낮은 점수를 받아 운율적 측면에서 어려움을 보였다. 본 연구는 시각적 밀집도를 텍스트 유형에 따라 문장의 경계로 나누어 살펴보았으며, 발달성 난독 아동의 읽기 유창성 특성을 정확도, 속도, 운율로 나누어 살펴본 것에 대해 의의가 있다.

강원지역 교무행정사의 직무스트레스 영향요인에 관한 연구

원은주 한림대학교 보건과학대학원 2017 국내석사

PURPOSE: This study was conducted to investigate the factors that influence work-related stress of school administrators workers in Gangwon-do . METHODS: This study was conducted through an online community site joined by more than 400 members out of 1,192 school administrative workers. Theses administrators work in the Education Support Center, kindergartens, elementary schools, junior high schools, high schools, and special schools. An online survey was conducted for three months, June to September 2016 and the in-person survey was conducted for one month, June to July 2016, using snowball sampling method. The Korean version of the Job Stress Assessment Tool was used as a short form, and a multivariate logarithmic regression analysis was performed. I tried to capture the factors of work-related stress in greater detail through in-depth interviews with five school administrators. RESULTS: In the group of respondents over 40 years old, there was a significant difference in the job demands (OR = 1.77, 95% CI = 1.02 ~ 3.06) and organizationl system (OR = 1.64, 95% CI = 1.00 ~ 2.69) among 7 detail factors of job stress. For respondents below 40 years of age, there as a significant difference in job insecurity (OR = 0.56, 95% CI = 0.32 ~ 0.98). Also, in the low job satisfaction group, there was significant difference in the organizational system (OR = 6.07, 95% CI = 3.56 ~ 10.35) and lack of reward (OR = 7.98, 95% CI= 4.74 ~ 13.45). CONCLUSION: To improve work-related stress for school administrators, organizations should try to find solutions to job demands, organizational systems, job insecurity, and lack of reward, and further research should be conducted.

비단어 따라말하기와 연령, 어휘 및 조음능력과의 관계

정소미 한림대학교 보건과학대학원 2017 국내석사

Nonword repetition is a task of repeating proposed nonword immediately. Various capabilities including auditory information processing ability, phonology memory, and speech output ability are necessary in the task. Nonword repetition can precisely measure phonology memorization because it excludes information about meaning. To perform it, phonological loops that stores auditorily proposed phonological information in limited time in phonological storage by transforming it into phonological representation and rehearsals that maintains loops are repeated. Phonological loop that is required in nonword repetition is closely related with child's language, vocabulary, and reading development and shares influences with various factors like not only vocabulary, but also age and articulation ability. In this study, development pattern is researched with nonword repetition ability along with age. Correlation between nonword repetition ability and factors that were known to influence the ability, like age, vocabulary, and articulation ability, is measured. Estimation of other factors throughout nonword repetition syllable score is also examined. Above on that, through this research, fundamental data that can be utilized not only in sorting and early intervention of children who show difficulty in speech and language but also in further studies could be collected. Subjects of this research is 141 normal children who resides in Seoul, Gyeonggi-do, Gangwon-do, Gyeongsang-do, Choongcheong-do, Junra-do, and whose age is between 3;00 and 5;11(37 3-year-old, 52 4-year-old, 52 5-year-old). Regionally, 23 from Seoul, 6 from Choonchun, 3 from Daejeon, 0 from Miryang, 5 from Yeosu were subjects. Children of subjects were reported not having diagnosis of developmental abnormality, retardation, and other physical, emotional or neural disorder by nursery teachers or fosterers, and were above 16%ile in Assessment of Phonology & Articulation for Children (APAC). To measure vocabulary and articulation ability respectively, Receptive & Expressive Vocabulary Test (REVT) and APAC was conducted. Nonwords were elected from 2-5 syllable nonword repetition in Children Articulation and Phonology Assessment Tool by Ha and Kim's research, which is currently in development. The test of 2-5 syllable, which has maximum score of 76, is consisted of 25 items, composed of nasal and lateral sounds and plosives, which are known to be acquired early in development. Researcher sat in front of subject children, told the subject nonwords directly, and made them repeat nonwords. Test nonwords were assessed in units of syllable. Omission, substitution, and addition were considered as errors, and scores were measured by subtracting the number of errors from that of correct syllables. Nonword repetition score along with age was analyzed statistically with SPSS 23.0, by conducting one-way ANOVA. Post-analysis along with age was conducted with Tukey HSD post-analysis. Pearson correlation analysis and stepwise multiple regression was performed on nonword repetition score and estimated factors like age, REVT reception score, REVT expression score, APAC socre, APAC percentage of consonants correct (PCC), and articulation score of meaningful words. The result of the research is like followings. 1) By performing one-way ANOVA on age and nonword repetition score, nonword repetition score showed positive correlation with age. Meaningful gap in nonword repetition performance could be found in 3-year-old and 5-year-old children and also in 4-year-old and 5-year-old children. 2) As result of correlation analysis of nonword repetition ability and related factors, meaningful correlation could be found between nonword repetition score and factors of age, REVT reception score, REVT expression score, APAC PCC, and articulation score of meaningful words. 3) When estimation of nonword repetition score was performed based on factors that showed meaningful correlation, REVT expression score and articulation score of meaningful words were found to be meaningful variables. REVT expression vocabulary score can be said to be estimated with 17%(adj. R=16.3%) of nonword repetition score. REVT expression vocabulary score and articulation score of meaningful words can be said to be estimated with 20.3%(adj. R=18.9%) of nonword repetition score. This research offers development pattern of nonword repetition ability of normal children of age 3 to 5 and shows that nonword repetition ability reflects development of speech and language abilities. Children in age 3 to 5 show increase in nonword repetition ability as they age, and 5-year-old children show performance close to 90%. Also, correlation between nonword repetition ability and factors like age, vocabulary, and articulation ability can be found in the research. Expression vocabulary could be estimated with nonword repetition score, and it can be interpreted that articulation ability and vocabulary development can be estimated. Based on nonword repetition task, clinical information can be provided when assessing children with difficulties in speech and language development.

급성기 뇌졸중 환자의 훈련 방법에 따른 체간 조절 및 균형 효과 비교

박한주 한림대학교 보건과학대학원 2017 국내석사

연구목적: 본 연구의 목적은 급성기 뇌졸중 환자를 대상으로 동적 기립기를 이용한 체중이동 훈련군과 정적 기립기를 이용한 훈련군의 체간조절과 균형 능력 향상을 알아보고자 한다. 연구방법: 급성기 뇌졸중 환자 20명을 대상으로, 실험군은 동적기립기 훈련과 운동재교육 훈련을 수행했고, 대조군은 정적기립기 훈련과 운동재교육 훈련을 수행했다. 중재 기간은 4주 이며, 주 5회, 각 훈련은 60분 수행하였다. 동적균형 능력을 평가하기 위해 버그 균형 검사(Berg Balance Sacle)와 체간 조절능력을 평가하기 위하여 체간 장애평가(Trunk Impairment Scale), 하지기능평가(Fugl-Meyer Assessment-Lower Extremity)를 실시하였다. 일반적인 특성은 Kolmogorov-Smirnov test를 사용하여 정규성 검정을 실시하였다. 성별, 진단명, 손상측 분포는 카이제곱검정(chi-square test)을 사용하였고, 신장과 연령은 정규 분포하여 독립 t-검정을 사용하였다. 몸무게는 정규 분포 하지 않아 Mann-Whitney U검정을 사용하여 동질성 검정을 실시하였다. 두 군 간의 변수의 동질성 검정을 위해 Mann-Whitney U test를 실시하였다. 두 군 내 전·후 비교를 위하여 Wilcoxon’s Signed-ranks test를 이용해 분석하였고, 두 군간 변화량의 차이를 비교하기 위해 Mann-W hitney U test를 실시하였다. 자료의 모든 통계학적 유의수준은 p< .05로 하였다. 연구결과: 동적 기립기를 이용한 훈련 군과 정적 기립기를 이용한 훈련 군 모두 실험 전, 후 군내 비교에서 BBS, TIS, FMALE 유의한 차이가 있었지만, 군 간 비교에서는 유의한 차이가 없었 다. 결론: 동적 기립기 훈련 군과 정적 기립기 훈련 군의 군 간 변화량의 비교에서는 통계적으로 유의하지 않았지만, 동적 기립기 훈련 군이 정적 기립기 훈련 군보다 BBS, TIS 변화량이 조금 더 향상을 보여, 두 군의 차이가 있었다. Objective: This study amis to examine the effects of trunk control and balance on training methods intervention in patients with acute stroke Method: The present study was performed using a randomized controlled clinical trial. The subjects were twenty adults with hemiplegia following a acute stroke. The study group performed dynamic standing training method with motor re-training. the control group performed static standing training method with motor re-training. The intervention lasted four weeks. five times per week, 60 minutes per each time. balance was measured with Berg Balance Scale. motor function recovery was measured with Fugl-Meyer Assessment Lower-Extremity, trunk control was measured with Trunk Impairment Scale. In order to compare before and after the intervention within each group, Wilcoxon’s signed-ranks test was conducted and in order to compare differences in changes between the groups, Mann-whitney U test was carried out. Statistical significance level of all data was set at p<.05 Results: No statistically significant differences were found between two groups. In the intra-groups analysis, both groups demonstrated a significant improvement in after the intervention. Conclusion: Dynamic standing training combined with motor re-training led to a an improvement in trunk control, balance among acute stroke patients. However, the improvement was similar to that achieved with static standing balance group.

영양사의 직무스트레스가 정신건강에 미치는 영향

오은경 한림대학교 보건과학대학원 2017 국내석사

한국판 CSBS DP를 통한 한두낱말 단계 자폐스펙트럼장애 아동의 사회적 의사소통 특성

최소영 한림대학교 보건과학대학원 2022 국내석사

배경 및 목적: 자폐스펙트럼장애 아동은 사회적 의사소통에서 제한을 보이며 일반 아동보다 낮은 능력을 보인다. 이러한 자폐스펙트럼장애 아동이 한·두낱말 수준의 언어 산출을 보이는 발달단계에서의 사회적 의사소통을 평가하고 생활연령이 아닌 언어연령을 일치시킨 일반 아동과 어떠한 차이를 보이는지 살펴보기 위해 CSBS DP 행동표본 검사를 실시하였다. 방법:본 연구에서는 6세 미만의 한·두낱말 수준의 언어표현을 보이는 자폐스펙트럼장애 아동 10명과 이들과 언어연령을 일치시킨 일반 영유아 10명, 총 20명을 대상으로 실시하였다. 두 집단의 사회적 의사소통을 평가하기 위해 한국판 의사소통 및 상징행동 척도 발달 프로파일(한국판 CSBS DP) 행동표본 검사를 사용하였다. 측정된 점수를 총 점수, 구성영역, 세부요인별로 나누어 각각 독립표본 t-검정을 통해 분석하였다. 결과: 그 결과, 자폐스펙트럼장애 아동 집단이 총점에서 언어연령일치 집단보다 유의하게 낮은 점수가 나타났다. 구성영역 중 발화적 영역에서는 유의한 차이가 나타나지 않았으나 사회적, 상징적 영역에서는 유의한 차이를 보였고 세부요인에서는 발화적 영역의 말소리, 낱말의 세부요인에서는 유의한 차이를 보이지 않았으나 사회적 영역의 정서 및 눈응시, 의사소통, 몸짓과 상징적 영역의 언어이해, 사물사용에서는 유의한 차이를 보였다. 논의 및 결론:본 연구 결과 자폐스펙트럼장애 아동은 6세까지 생활연령이 증가하고 한·두낱말 수준의 언어를 산출하여도 언어연령을 일치시킨 자신보다 어린 일반 영유아보다 낮은 사회적 의사소통능력을 보인다는 것을 확인할 수 있었다. 이를 통해 한·두낱말 수준의 언어 산출을 보이는 자폐스펙트럼장애 아동의 사회적 의사소통 특성을 이해하고 평가와 중재에 활용하 수 있다는 시사점을 갖는다. Purpose: The children with autism spectrum disorder show limitations in social communication and have lower abilities than the ordinary children with typical development. CSBS DP behavior sample test is conducted to evaluate the social communication of the one or two-word level children with autism spectrum disorder, and to examine the difference between the children with autism spectrum disorder and the ordinary children with typical development who are matched to the language age rather than the living age. Methods: 10 children with autism spectrum disorder(ASD) who exhibited language expression at the level of one or two words like under the age of 6 years old, and 10 ordinary children(TD) matched to the language age participated in this study, which was the total of 20 children. To assess the social communication of the two groups, the Korean Communication and Symbolic Behavior Scales Developmental Profile(K CSBS DP) behavior sample test was used. The measured scores were divided by total score, three composites, and seven clusters, and analyzed through independent sample t-test. Results: The ASD group scored significantly low compared to the TD group on the overall score. Among composite, there was no significant difference in the utterance composite; on the other hand, social and symbolic composite show significant differences. In addition, when it comes to cluster, there was no significant difference in the speech and word, but emotion and eye gaze, communication, gesture, comprehension, and using objects show significantly meaningful. Conclusion: The study results show that the children with autism spectrum disorder have lower social communication skills than the ordinary children with typical development who are matched to their language age even after increasing their living age by the age of 6 years and producing language at the level of one or two words. Through the results, it implies that we should understand the social communication characteristics of the one or two-word level children with autism spectrum disorder, and the study result can be utilized in evaluation and mediation.

근로자의 자살에 영향을 미치는 사회·경제적 요인

김민경 한림대학교 보건과학대학원 2018 국내석사

After the financial crisis, the suicide rate of Korea has surged. Since then, the steady increase in suicide rates has been attributed to socioeconomic factors such as job problems and income problems. In recent years, suicide of workers has been on the rise due to the problem of contract workers or unstable work. The purpose of this study is to investigate the factors affecting the suicide rate of the workers by considering social and economic factors such as income inequality and employment instability. The researchers used the suicide rate per 100,000 people provided by the National Statistical Office until the age of 25-54, the prime age worker. We conducted a time series regression analysis to examine the factors influencing suicide rates by selecting social and economic factors. The data was provided by the National Statistical Office (NSO) and the period was from 1995 to 2014. As a result of the correlation analysis, real GDP, income differential, economic crisis, fertility rate, and female participation rate were found to be significantly correlated with suicide rate of workers and unemployment rate, employment rate and divorce rate were excluded. There was no significant correlation between female suicide rates and real GDP. The suicide rates of 25~29 years old and 30~34 years old were not correlated with the IMF financial crisis. Time series regression analysis showed that, except for suicide rate of women, 25~29 years old, 30~34 years old, and 25~39 years old, the most significant variable is the income differential. Except for female suicide rates, real GDP has an effect on worker’s suicide rates. The economic crisis and income inequality are the major factors affecting the suicide rate of workers. Therefore, economic factors and income inequality have a greater impact than social factors. The results of this study can be significant that provide evidence for the results of the study through a advanced Research.

중증화상 환자의 경관 영양 공급방법에 따른 위 잔여량(GRVs)과 임상적 특징 비교

안기영 한림대학교 보건과학대학원 2017 국내석사

Introduction: This study is the retrospective cohort study of which purpose is to investigate the impact of the continuous feeding on the nutritional support of the severely burned patients by comparison of the feeding failure rate and nutritional support rate between continuous feeding (CF) group and intermittent feeding (IF) group. Material and methods: From January of 2015 to August of 2016, we enrolled 74 severely burned patients who admitted to the Burn ICU and were applied enteral nutrition. Then we investigated the clinical outcome including length of hospital stay and survival, and the nutritional index including prealbumin, transferrine, total lymphocyte count, standardized body weight, feeding failure rate (feeding stop day/total feeding day) and nutritional support rate (real nutritional supply/ calculated nutritional requirement). Results: Mean age of total patients was 52 years and the mean total body surface area burned was 42.3%. There were no significant differences of general characteristics including gender, age and total body surface area burned between groups. Mean gastric residual amount was 17cc in CF group and 47cc in IF group. Mean feeding period of the CF group (20 days) was significantly longer than the IF group (13 days). Mean feeding stop day was 3.3 day in IF group and 2.1 day in CF group. There was no significant difference of mean feeding failure rate between IF group(14.8%) and CF group(19.7%). The calory supply rate was increased by 4.96% in IF group and 2.75% in CF group, and the protein supply rate increased 3.97% in IF group and 4.33% in CF group after enteral nutrition. But there was no significant differences of calory and protein supply rate after enteral nutrition between groups. The nutritional index including prealbumin, transferrine, total lymphocyte count was significantly increased after enteral nutrition in both groups, but there was no significant difference between groups. In the aspect of clinical outcome, there was no significant difference of mean length of hospital stay between IF group (44 day) and CF group (38 day), and there was no significant survival difference in Log ranks test with Kaplan-Meire survival analysis between groups. Conclusion: The nutritional supply of severely burned patient is one of the most important part of the treatment, because the nutritional supply has a critical role in wound healing and the severely burned patients develop hypermetabolic state. Therefore continuous efforts to maintain the enteral nutrition is important. But we could not observe the significant differences of nutritional supply and clinical outcome between intermittent feeding and continuous feeding. Nevertheless there are many reports that support the advantageous effect of continuous feeding. Therefore further study should be performed to assess the impact of the continuous feeding in severely burned patients.

뇌졸중 환자의 활동성 증진이 보행기능과 심폐기능에 미치는 영향

이은경 한림대학교 보건과학대학원 2017 국내석사

Purpose: : It intends to find the effect that the activity change of hospitalized stroke patients produces on the gait and cardiopulmonary functions and further reveal the importance of the activity increase and physical activity of stroke patients. Method: First, selected 50 hospitalized stroke patients fit for the selection criteria, then made them wear the pedometer, and lastly conducted the experiment after classifying them into two groups of high activity and low activity. Each training group participated five times per week for eight weeks in total. Due to the discharge or withdrawal, finally 45 patients completed the experiment. The test items included the gait capacity (step length, stride length, step width, stance phase, double stance, cadence, step time, stride time) and functional gait capacity (10 meter walking test, 6 minute walking test, timed up and go), and cardiopulmonary capacity using peak-flow meter, which were measured three times totally at the 0th week, 4th week, and 8th week. Result: After the 8 week experiment, in the gait components, namely, step time, stride time, step length, and stride length, there was a significant difference between two groups (p<.05), in the functional gait components such as 10 m WT, 6MWT, and TUG, there was a significant difference between them (p<.05), and lastly there was also a significant difference between them in the cardiopulmonary capacity (p<.05). Among two groups, the high activity group showed the significant improvement (p<.05). Conclusion: It is suggested that the high activity group is more influential than the low activity group in the gait and functional gait capacities, and cardio pulmonay function. Consequently, it is expected that for the hospitalized stroke patients, the efficiency of the gait and cardiopulmonary functions can be enhanced by increasing their activity through the method besides the medical treatment. 연구 목적: 본 연구의 목적은 뇌졸중으로 입원중인 재활병원에 입원중인 환자의 활동성 증진의 차이가 보행기능과 심폐기능에 미치는 영향을 알아보고 뇌졸중 환자의 활동성을 증진시키고 신체활동의 중요성을 알리는데 그 목적이 있다. 연구 방법: 독립적 보행이 가능한 뇌졸중 환자 50명을 선발하여 1일당 만보기의 숫자를 기반으로 활동량이 많은 군과 활동량이 적은 군으로 나누어 실험을 하였다. 각 환자군은 8주간 만보기를 착용하였으며 퇴원, 중도포기로 인하여 최종적으로 45명이 실험에 참여하였다. 각 환자군은 0주, 4주, 8주 총 3회 보행능력(step length, stride length, step width, stance phase, double stance, cadence, step time, stride time)와 기능적 보행능력(10 m WT, 6MWT,TUG), Peak-flow meter를 사용한 심폐능력을 평가하였다. 연구 결과: 8주간의 실험 후 보행요소 step time, stride time, step length, stride length에서 두 군 간 유의한 차이가 있었고(p<.05) 기능적 보행 요소에서는 10 m WT, 6MWT, TUG 모 두 두 군 간 유의한 차이가 있었으며(p<.05) 심폐능력 또한 두 군 간 유의한 차이가 있었다(p<.05). 결론: 입원중인 뇌졸중 환자에서는 활동성이 많은 군이 활동성이 적은 군보다 보행능력, 기능적 보행능력 그리고 심폐기능에서 더 많은 영향을 미친다고 할 수 있다. 따라서 뇌졸중 환자 의 기능적 보행능력 및 심폐기능을 증진시키기 위해서는 치료외적으로 활동량을 증진시키는 것이 보다 더 효율적인 치료방법이 될 것으로 기대되어 진다

통합적 음운인식 조음중재법

강예림 한림대학교 보건과학대학원 2022 국내석사

Objectives: This study aimed to verify the effect on the improvement of articulation ability and phonological recognition ability of children with speech sound disorder when the integrated phonological recognition articulation intervention method was applied to 5-6 year old children in preschool age when phonemic development begins in earnest. Methods: Data were collected from a total of 3 children who showed consonant accuracy of about 50-80% in the APAC test and had no prior experience in speech therapy or specific phonological recognition training. Using the multi-baseline design of the single-subject research method, stable baselines were simultaneously collected for various target phonemes and phoneme recognition tasks for each child. After the baseline collection was completed, the treatment goals according to each child's performance ability and priority were applied to the intervention in a different order. Post-intervention evaluation and maintenance evaluation were conducted after the intervention, the contents of intervention in all sessions were analyzed through intervention fidelity, and the children's performance was analyzed through inter-observer reliability analysis. In addition, in order to measure the magnitude of the intervention effect, it was analyzed using the PND index of non-overlapping ratio. Results: As a result of the study, it was confirmed that the integrated phonological recognition articulation intervention had a positive effect on the improvement of articulation ability by improving the consonant accuracy of all children with speech sound disorders. Although the degree of progress for each target phoneme varied from child to child, consonant accuracy improved in all target phonemes introduced into the intervention, and the intervention effect was maintained even in the maintenance evaluation after the intervention. In addition, it was confirmed that the articulation intervention using phonological recognition had a positive effect on the improvement of phonological recognition ability by improving the phonological recognition ability of all children with speech sound disorders. All three children had limitations in the performance of the phonological recognition task before the intervention, but after the intervention, they showed great progress in the syllable-level and syllable-body-form-level tasks, and still showed difficulties in the task consisting of individual phonemes. Conclusion: This study showed that integrative phonological awareness articulation interventions are effective not only in improving articulation ability but also in phonological awareness performance when provided to children with speech sound disorders. These results support that it can be effective when applied to children who show difficulties in phonological recognition and articulation production in clinical settings. It also shows the need for early intervention to prevent future reading and learning disabilities. 배경 및 목적: 본 연구는 음소발달이 본격적으로 시작되는 취학전기의 만 5-6세 아동을 대상으로 통합적 음운인식 조음중재법을 적용하였을 때 말소리장애 아동의 조음능력 개선 및 음운인식 능력 개선에 미치는 효과를 검증하고자 하였다. 방법: APAC 검사에서 약 50-80%의 자음정확도를 보이며, 이전에 언어치료나 구체적 음운인식 훈련을 받은 경험이 없는 아동 총 3명을 대상으로 자료를 수집하였다. 단일대상연구법의 중다기초선 설계를 사용하여 각 아동 별 여러 목표 음소와 음운인식 과제에 대한 안정적인 기초선을 동시에 수집하였다. 기초선 수집이 끝난 이후 각 아동 별 수행능력과 우선순위에 따른 치료목표를 순서를 다르게 적용하여 중재에 도입하였다. 중재가 끝난 이후 사후평가와 유지평가를 실시하였으며, 모든 회기의 중재 내용을 중재충실도를 통해 분석하였고, 아동의 수행능력을 관찰자 간 신뢰도 분석을 통해 분석하였다. 또한 중재 효과의 크기 정도를 측정하기 위해 비중복 비율의 PND 지표를 사용하여 분석하였다. 결과: 연구 결과, 통합적 음운인식 조음 중재가 모든 말소리장애 아동의 자음정확도를 향상시킴으로써 조음 능력 개선에 긍정적인 영향을 미쳤음을 확인하였다. 아동마다 목표 음소 별 진전 정도는 다양하나, 중재에 도입한 모든 목표음소에서 자음정확도가 향상되었으며 중재 이후 유지평가에서도 중재 효과를 유지하였다. 또한 음운인식을 활용한 조음 중재는 모든 말소리장애 아동의 음운인식 능력을 향상시킴으로써 음운인식 능력 개선에 긍정적인 영향을 미쳤음을 확인하였다. 세 아동 모두중재 전에는 음운인식 과제의 수행에서 제한이 있었지만, 중재 후 음절 수준과 음절체-종성 수준의 과제에서 큰 진전을 보였고, 개별 음소만으로 이루어진 과제에서는 여전히 어려움을 보였다. 결론 및 논의: 본 연구는 통합적 음운인식 조음 중재가 말소리장애 아동에게 제공하였을 때 조음능력 개선 뿐 아니라 음운인식 수행 능력에도 효과적이라는 것을 보여주었다. 이러한 결과는 임상현장에서 음운인식과 조음 산출에 어려움을 보이는 아동에게 적용하였을 때 효율적일 수 있다는 것을 뒷받침한다. 또한 추후 읽기 및 학습장애 예방을 위하여 조기 중재의 필요성을 보여준다.