뇌졸중 환자의 구음장애와 흡인과의 상관관계

Eun-Ho Yu,Myunghoon Moon,Ji-Hong Min,Hye-Kyung Kim,신용일,고현윤,So Jung Kim,고성화 대한연하장애학회 2020 대한연하장애학회지 Vol.10 No.1

Objective: This study examined the correlation between dysarthria and aspiration to determine if dysarthria canpredict aspiration in stroke patients. Methods: The medical records of 176 patients with first stroke, who underwent a videofluoroscopic swallowing study(VFSS) and Urimal test of articulation and phonology (U-TAP) at the same time between January 2012 and December2015 in the authors’ hospital, were reviewed retrospectively. The correlation between the penetration aspirationscale (PAS) score and U-TAP score was analyzed in all patients. The mean PAS score and frequency of each PAS scorein the dysarthria group and non-dysarthria group were compared. In addition, the aspiration was analyzed based onthe severity of dysarthria in the dysphagia group. All statistical analyses were performed using SPSS software. Results: The correlation between the PAS score and U-TAP score was not statistically significant in all the subjects. The mean PAS score was 3.46±5.52 and 3.07±5.49 in the dysphagia and non-dysphagia group, respectively. The meanPAS score of the dysphagia group was higher than that of the non-dysphagia group. On the other hand, it was notstatistically significant. In addition, there was no significant difference in the frequency of the PAS scores betweenthe two groups. The aspiration was compared with the severity of dysarthria according to the U-TAP score; therewas no statistically significant difference. Conclusion: No correlation was observed between dysarthria and aspiration in stroke patients. In addition, there wasno difference in the frequency of aspiration with or without dysarthria. According to the results of this study, aspirationcannot be predicted by dysarthria in stroke patients. Therefore, each diagnostic test and assessment shouldbe performed for each symptom.

마비성구어장애 화자의 조음밸브 교호운동에 관한 공기역학 및 음향학적 특징

박희준(Hee-June Park),권순복(Soon-Bok Kwon),왕수건(Soo-Geun Wang),정옥란(Ok-Ran Jeong) 한국음성학회 2008 음성과학 Vol.15 No.2

This study was to investigate diadochokinetic (DDK) rate, regularity and mean flow rate of articulation valves in dysarthria. DDK rate, mean airflow rate (MFR) and regularity of DDK syllable repetitions of vocal function /ihi/, tongue function /ta/, velopharyngeal function /bm/, and labial function /pa/ in 24 normal and dysarthric speakers were measured. Aerophone Ⅱ and Motor Speech Profile were used for data recording and analysis. The results of the findings were as follows: First, there were significant differences between the dysarthria and the normal group in DDK rate. DDK rates in ataxic dysarthria were the lowest and spastic, flaccid, and hypokinetic dysarthria followed in sequence. Second, there was a significant difference between the dysarthria and the normal group in DDK regularity. Third, there was a significant difference between dysarthria groups and normal group in DDK MFR. Finally, there was a significant difference between the 4 groups of dysarthria and the normal group in DDK air flow tracking. The results of this study can be guidelines for normal DDK rate, regularity and flow rate in dysarthria groups. In addition, their differential diagnoses and descriptions are important to make a decision on medical and behavioral management of the individuals with disorders according to DDK characteristics.

운동감소형 마비말장애의 조음교대운동 특성

정은영(EunYoung Jung),조성래(Sung-Rae Cho),김윤정(YunJung Kim),김향희(HyangHee Kim) 한국언어청각임상학회 2011 Communication Sciences and Disorders Vol.16 No.1

배경 및 목적: 객관적 측정을 통한 운동감소형 마비말장애 환자의 조음교대운동 수행력의 차이와 중증도에 따른 조음교대운동 수행력의 차이에 대한 연구는 부족한 실정이다. 이에 본 연구에서는 첫째, 운동감소형 마비말장애군이 정상군에 비해 조음교대운동의 속도 및 규칙성에서 차이를 보이는지 알아보았고, 둘째, 말명료도의 중증도에 따라 같은 변인에서 차이를 보이는지 살펴보았다. 방법: 경도의 운동감소형 마비말장애 환자 11명, 중등도의 운동감소형 마비말장애 환자 7명, 정상인 26명을 대상으로 '퍼', '터', '커', '퍼터커' 과제를 실시한 후, Motor Speech Profile Model 4500와 Window용 Praatⓡ 으로 분석하였다. 결과: 첫째, 운동감소형 마비말장애군이 정상군에 비해 AMR 과제에서 느린 속도를 보였으나, SMR 과제에서는 정상 속도를 보였다. 규칙성에 있어서 조음교대운동 과제 모두에서 운동감소형 마비말장애군이 정상군에 비해 불규칙적이었다. 둘째, 조음교대운동 과제에서 모두에서 중증도에 따른 속도의 차이를 보이지 않았다. 그런데 규칙성에 있어서 '퍼', '터', '퍼터커' 과제에서 경도의 환자군이 정상군에 비해 불규칙적이었고, '커' 과제에서 중등도의 환자군이 경도의 환자군에 비해 불규칙적이었다. 논의 및 결론: 본 연구의 결과는 객관적인 측정을 통하여 운동감소형 마비말장애 환자의 조음교대운동 과제에 대한 속도 및 규칙성의 특징을 살펴볼 수 있었다. 특히 중증도에 따른 운동감소형 마비말장애 환자의 조음교대운동 수행력을 제시하였다는 점에서 의의가 있다고 할 수 있다. Background & Objectives: There have been few studies on diadochokinetic performance in patients with hypokinetic dysarthria. In this study, differences in the rates and regularities of DDK tasks were compared between hypokinetic dysarthria patients and normal subjects. In addition, the differences between a mild and moderate form of the disorder were compared based on speech intelligibility. Methods: Eleven patients with mild hypokinetic dysarthria, seven with moderate hypokinetic dysarthria, and 26 normal controls were asked to perform DDK tasks. The subjects were asked to perform both AMR and SMR tasks which were acoustically analyzed using the Motor Speech Profile™(Model 4500) and the Praat computer program. Results: The hypokinetic dysarthria group demonstrated relatively slower rates of AMR compared to those of the normal group, while the rates of the SMR group were within the normal range. The hypokinetic group demonstrated irregular patterns in both AMR and SMR tasks compared to those of the normal group. In addition, hypokinetic dysarthria patients with different severities did not exhibit any differences in the rates of completion for the AMR and SMR tasks. However, the repetition of /p˄/ and /t˄/ in the AMR and the SMR tasks were more irregular in mild hypokinetic patients than they were in normal subjects, whereas the repetition of /k˄/ was more irregular in moderate hypokinetic patients than it was in the mild group. Discussion & Conclusion: The results of this study show the objective measurement of diadochokinetic performance in patients with hypokinetic dysarthria. Furthermore, these results made a significant contribution by analyzing the differences in diadochokinetic performance according to the severity of dysarthria.

뇌성마비로 인한 마비말장애 성인의 최대 혀 및 입술 강도와 자음정확도 및 말명료도의 관계

최여진(Choi, Yoejin),심현섭(Sim, Hyunsub) 한국음성학회 2013 말소리와 음성과학 Vol.5 No.2

The purpose of this study was to identify the relationship between the strength of the tongue/lip strength and speech production for dysarthric adults with cerebral palsy. The maximal tongue and lip strengths of 22 normal adults, 27 dysarthric adults (10 adults with mild dysarthria, 10 adults with moderate dysarthria, and 7 adults with severe dysarthria) were measured with Iowa Oral Performance Instrument (IOPI). The percentage of correct consonants (PCC) and speech intelligibility were calculated from the words and sentences spoken by the subjects. The results of the study are as follows: First, both the maximal tongue and the maximal lip strength differed significantly between the control group and the group with dysarthria. While the group with mild dysarthria did not show meaningful difference in maximal tongue and lip strengths from the control group, the group with moderate and severe dysarthria showed significantly weaker tongue and lip strength than the control group and the group with mild dysarthria. Second, the current study suggests the existence of a significant correlation between the maximal tongue and lip strength and the PCC and speech intelligibility within all subjects with dysarthria. These findings can serve as an effective foundation to diagnose dysarthria quickly and accurately. The results of this study also indicate that in addition to the maximal tongue strength, the maximal lip strength can prove to be an important index in predicting the speech intelligibility of dysarthric adults with cerebral palsy.

Praat을 이용한 마비말장애 환자의 음향학적 분석의 국내 선행연구 분석

강민구 사단법인 인문사회과학기술융합학회 2019 예술인문사회융합멀티미디어논문지 Vol.9 No.1

In the acoustical analysis, the Praat program is used in various areas of Speech & Language Disorders such as aphasia, Dysarthria, Articulatory & Phonological Disorders, and Voice Disorders. However, there is a lack of research on Dysarthria. This study analyzed the Korean literature published from 2002 to 2017 focusing on the analysis of acoustical features of patients with Dysarthria using the Praat program. There are 7 preceding studies on the acoustical features of patients with Dysarthria using the Praat program. The results of the analysis are as follows. The analysis using the Praat program for the patients with Dysarthria showed that basic voice recording and sound intensity, fundamental frequency and formant measurement were performed in order to analyze vowel and consonant characteristics, speech intelligibility, spoken speed and regularity. And the application of the acoustic parameter formula was made to speech analysis. Automatic measurement was made possible by formant slope and formant measurement. And analyzed the rate of speaking, articulation speed, speaking time, articulation time,pause time, and pause ratio. The purpose of study is to evaluate the degree of use of the Praat program in the acoustic analysis of dysarthria. In the future, expect to be able to use the Praat program as an effective speech analysis index for patients with dysarthria. 음향음성적 분석에 있어 실어증, 마비말장애, 조음음운장애, 음성장애 등 다양한 언어장애 영역에서 Praat 프로그램을 활용한 연구가 이루어지고 있지만, 마비말장애와 관련한 연구는 미흡한 실정이다. 본 연구는 마비말장애 환자의 음향음성적 특징을 분석한 연구들 가운데 Praat 프로그램을 활용한 연구를 중심으로 2002년부터 2017년까지 발표된 국내의 문헌을 분석하였다. 마비말장애 환자의 음향음성적 특징을 Praat 프로그램을 활용하여 분석한 국내의 선행연구는 총 7편으로 분석한 결과는 다음과 같다. 마비말장애 환자를 대상으로 Praat 프로그램을 활용한 분석은 모음 및 자음 특성, 말명료도, 구어속도, 규칙성 등을 분석하기 위해 기본적인 음성녹음 및 음강도 측정, 기본주파수 측정, 포만트 측정이 주를 이루었고, 응용적으로 음향파라미터 공식을 만들어 음성분석을 하였다. 또한 포먼트의 기울기 및 포먼트 측정에서 자동 측정이 가능하도록 세팅하거나 조음의 속도, 발화의 속도, 조음의 시간, 발화의 시간, 쉼의 시간, 쉼의 비율로 나누어서 분석이 이루어졌다. 본 연구는 마비말장애 환자의 음향음성학적 분석에 있어 Praat 프로그램의 활용의 정도를 알아보는데 의의가 있으며, 향후 Praat 프로그램의 활용도를 높여 마비말장애 환자의 효과적인 음성 분석 지표로 사용될 수 있기를 기대한다.

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.

경직형과 이완형 마비말장애의 명료도 비교

김수진,Kim Soo-Jin 대한음성학회 2003 말소리 Vol.48 No.-

Among the types of dysarthria, spastic and flaccid types are the most prominent manifestations. The objectives of the present research are (1) to discover the phonetic contrasts that differentiate spastic dysarthria from flaccid dysarthria, (2) to analyze the degrees of predictability of each phonetic contrast for intelligibility in spastic and flaccid dysarthrias and to compare them. The 'phonemic contrast word intelligibility pairs' for dysarthric speakers were tested and proved to be useful for clinical assessment of and research on dysarthria. In the group of spastic type, it showed that initial fricative vs. affricate and front vs. back vowel contrasts are transmitted relatively less effectively than flaccid type. In the group of flaccid type, initial glottal vs null contrast is transmitted less effectively than spastic type. The overall intelligibility of spastic dysarthria was predicted by multiple regression analysis with 88% accuracy by three phonetic contrasts(initial fricative vs. affricate; front vs. back vowels; initial consonant correlates). And the intelligibility of flaccid dysarthria was predicted by two phonetic contrasts(initial nasal vs. stop, front vs. back vowels) with 60% accuracy.

한국어판 마비말장애인의 삶의 질 척도의 신뢰도 및 타당도 검증에 대한 예비연구

홍새미,심현섭 한국언어치료학회 2016 言語治療硏究 Vol.25 No.2

Purpose: People with dysarthria experience communication difficulties due to the nature of their impairment. For this reason, understanding the psychosocial aspect of dysarthria is required. This study is a preliminary study for developing a Korean version of the Quality of Life in the Dysarthric Speaker (K-QOL-DyS). The purpose of this study was to identify reliability and validity of the K-QOL-DyS. Methods: The QOL-DyS, which contains 40 items subdivided into four areas with 10 questions each, was translated into Korean: (1) speech characteristics of the word (SD), (2) situational difficulty (SD), (3) compensatory strategies (CS), (4) perceived reactions of others (PR). The study was performed on 50 dysarthric speakers and 50 normal speakers. The internal consistency was assessed and the test-retest reliability was assessed for five people in each group. The scores obtained from the two groups were compared. A receiver operating characteristic curve was employed to assess the sensitivity and specificity of the K-QOL-DyS. A comparison of scores was made scores between mild dysarthria and moderate dysarthria. Results: An excellent internal consistency (Cronbach’s α=.981) and test-retest reliability (r=.962) were found. The score difference between the two groups was significant in the overall score and all categories (p<.01). The sensitivity of the K-QOL-DyS for four categories varied between 100% and 82%. The specificity varied between 100% and 96%. Significant score differences between mild dysarthria and moderate dysarthria were found only in the overall score, SC and PR (p<.01). Conclusions: The K-QOL-DyS was found to be an acceptable tool to assess quality of life in Korean dysarthric speakers. We expect that the K-QOL-DyS will be utilized widely to identify the psychosocial impact of dysarthria. 목적: 마비말장애인은 말명료도 저하로 인한 의사소통의 제한으로 사회심리학적 측면에서의 어려움을 경험한다. 따라서 마비말장애인의 사회심리학적 측면을 이해하는 것은 중요하다. 본 연구는 한국어판 마비말장애인의 삶의 질 척도(K-QOL-DyS)를 개발하기 위한 예비연구로 K-QOL-DyS의 신뢰도와 타당도를 검증하고자 하였다. 방법: QOL-DyS는 4개 범주(말 특성, 상황적 어려움, 보상전략 사용, 타인의 지각반응)로 구성되어 있으며, 각 범주별 10문항씩 총 40문항으로 구성되어 있다. 본 연구에서는 QOL-DyS를 한국어로 번안하여 마비말장애군 50명과 정상군 50명을 대상으로 설문을 실시하였다. 신뢰도 검증을 위해 문항 내적일관성 신뢰도를 측정하였고, 각 집단별 5명을 대상으로 검사-재검사 신뢰도를 측정하였다. 타당도 검증을 위해 두 집단 간삶의 질 점수 차이를 비교하였고, 수신자 조작 특성(receiver operating characteristic: ROC) 곡선을 분석하여민감도와 타당도를 측정하였다. 마비말장애 중증도가 삶의 질에 미치는 영향도 살펴보았다. 결과: K-QOL-DyS의 문항 내적일관성 신뢰도는 .981, 검사-재검사 신뢰도는 .962로 높게 나타났다. 마비말장애군과 정상군의 삶의 질 점수는 총점 및 모든 하위범주에서 통계적으로 유의한 차이를 보였다(p<.01). 총 검사및 각 범주별 민감도와 특이도는 모두 80% 이상으로 높게 나타났다. 마비말장애 중증도에 따른 삶의 질 점수의 총점은 유의한 차이를 나타냈지만, 하위범주 내에서는 말 특성과 타인의 지각반응 범주에서만 유의한 차이를 나타내었다(p<.01). 결론: K-QOL-DyS는 국내 마비말장애인의 삶의 질을 측정하는데 적절한 수준에서의신뢰성과 타당성이 제시된 도구임이 검증되었다. 이 척도가 향후 임상에서 마비말장애인의 사회심리학적 측면을 이해하는데 적극적으로 활용되기를 기대해본다.

Task Specific Lingual Dystonia: An Uncommon Cause of Isolated Dysarthria

권미선(Miseon Kwon),신혜원(Hae-Won Shin),김종성(Jong S. Kim) 한국언어청각임상학회 2013 Communication Sciences and Disorders Vol.18 No.2

배경 및 목적: 마비말장애는 다양한 신경학적 질환들로 인해 초래되며 그 특성에 따라 여러 유형으로 분류된다. 과다운동형 마비말장애는 기저를 이루는 불수의적 움직임이 매우 다양하기 때문에 보통 복수형으로 표시하며 그 중에서도 근긴장이상증은, 특히 말산출과 같은 특정과제에서만 나타나는 국소적 혀의 근긴장이상증은, 과다운동형 마비말장애를 일으키는 매우 드문 원인으로 알려져 있다. 사례: 55세 남자 환자가 말을 할 때 혀가 꼬인다는 것을 주소로 병원에 내원하였다. 고혈압이나 기타 의학적 심리학적 질환에 대한 기왕력은 전혀 없었다. 신경학적 검사에서 감각이나 운동이상도 없었으며 뇌 자기공명 영상검사나 근전도검사 등 다른 검사상에서도 이상소견은 보이지 않았다. 그러나 언어평가 결과, 말산출 시와 구강기능평가 시에 입을 벌리고 있는 과제에서 혀의 근긴장이상 증상이 관찰되었고 이러한 증상은 다른 구강기능 평가과제 시나 씹기, 삼키기와 같은 말산출 이외의 활동 중에는 나타나지 않았다. 논의 및 결론: 말산출과 같은 특정과제에서 혀에 단독적으로 나타나는 근긴장이상증은 드문 장애로마비말장애를 일으키는 원인이 될 수 있다. 마비말 장애 이외의 다른 증상이 동반되지 않는 환자의 경우 혀 근긴장이상증의 가능성도 고려해 보아야 할 것이다. Objectives: Dysarthria is a common neurologic symptom and is produced by a variety of neurologic disorders. Hyperkinetic type of dysarthria is indicated as a plural disorder because it includes many heterogeneous involuntary movements including dystonia. Isolated dysarthria due to lingual dystonia is rarely encountered. We describe a patient presenting with isolated dysarthria caused by lingual dystonia. Case: A 50-year-old man visited our hospital due to dysarthria. His medical and psychological history was not remarkable. The results of neurological examinations did not reveal any motor or sensory abnormalities. However, on speech examination, he demonstrated dystonic movements of the tongue aggravated on speaking and during rest with mouth opening. The dystonic movements disappeared when he protruded his tongue and did not occur during chewing or eating behaviors. After exclusion of other causes of tongue dystonia, he was diagnosed as having primary lingual dystonia. Conclusion: We presented a patient with isolated dysarthria caused by dystonia specifically involving the tongue. Our case illustrates that task specific lingual dystonia should be considered as one of the causes of isolated speech disturbances.

마스크 착용이 뇌졸중 환자의 음성에 미치는 효과

박희준,이재석 한국언어치료학회 2024 言語治療硏究 Vol.33 No.1

Purpose: With the normalization of mask-wearing due to COVID-19, the impact of masks on speech has become a subject of interest. Individuals with dysarthria, characterized by paralysis of speech production muscles, may be more affected by masks. This study aimed to compare the acoustic characteristics of speech before and after mask-wearing in 15 individuals with dysarthria. Methods: Fifteen individuals with dysarthria were included in the study. Acoustic measures including fundamental frequency (F0), jitter, shimmer, noise-to-harmonics ratio (NHR), cepstral peak prominence (CPP), vowel space area index (VAI), formant centralization ratio (FCR), and formant transition measures (F2 magnitude, F2 rate, F2 regularity) were measured to compare speech characteristics before and after mask-wearing. Results: Firstly, individuals with dysarthria did not show statistically significant differences in acoustic measures (F0, jitter, shimmer, NHR, CPP) before and after mask-wearing. Secondly, mask-wearing led to lower performance in vowel space area (VAI, FCR) and formant transition measures (F2 magnitude, F2 rate) compared to no mask-wearing. Conclusions: These results suggest that the presence or absence of a mask does not significantly impact the acoustic quality of speech in individuals with dysarthria. However, it is observed that masks subtly interfere with lip protrusion and jaw opening during vowel production, specifically affecting vowel articulation. Therefore, for a comprehensive understanding of the acoustic characteristics of individuals with dysarthria, utilizing formant variables rather than acoustic quality variables is considered more informative. Language rehabilitation specialists recommend removing masks during conversations for individuals with dysarthria, and for situations where mask-wearing is necessary, practicing vowel exercises that involve lip protrusion and jaw movement to enhance pronunciation clarity is advised.