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成年卒中后非流畅性失语症患者言语韵律功能特征

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目的 探讨非流畅性失语症患者言语韵律组块、情感、焦点、交互韵律功能的特征.方法 2023年12月至2024年3月,于上海市第五康复医院招募卒中后非流畅性失语症患者(试验组,n=25)和健康被试(对照组,n=25),采用改编的言语韵律功能评估工具和声学分析仪器比较两组组块、情感、焦点、交互功能表现的差异.结果 组块韵律中,两组听分辨不同组块(Z=-4.856,P<0.001),听识别"2个组块"(Z=-3.024,P=0.002),模仿输出"2个组块"及自主输出"2个组块"和"3个组块"的主观得分、停顿总时长、平均停顿时长、平均音节时长和构音速率(|Z|>2.911,P<0.001)存在显著性差异.情感韵律中,两组听分辨不同情感(Z=-3.322,P=0.001),听识别"喜欢情感"(Z=-3.481,P=0.001),模仿输出"喜欢情感"的主观得分(Z=-6.214,P<0.001)、平均强度(Z=-3.581,P<0.001)、强度标准差(Z=-3.181,P=0.001),自主输出"喜欢情感"的主观得分(Z=-5.510,P<0.001)、平均强度(Z=-3.429,P=0.001)、强度标准差(Z=-4.777,P<0.001)、基频变化范围(t=1.852,P=0.029)存在差异.焦点韵律中,两组听分辨不同重音(Z=-2.658,P=0.008),听识别"句尾"重音(Z=-2.023,P=0.011),模仿输出"句首"重音的重音强度峰值(t=8.294,P<0.001),模仿输出"句中""句尾"重音的主观得分(|Z|>5.102,P<0.001)、重音强度峰值(t>8.298,P<0.001),自主输出"句首"焦点的主观得分(Z=-4.371,P<0.001)和重音强度峰值(t=8.842,P<0.001),自主输出"句中""句尾"焦点的主观得分(|Z|>4.970,P<0.001)、重音强度峰值(t>9.373,P<0.001)和重音持续时间(|t|>2.912,P<0.01)存在显著性差异.交互韵律中,两组听分辨和听识别均无显著差异(P>0.05),模仿复述及自主表达疑问语气的主观得分(|Z|>4.938,P<0.001)和基频斜率k(|t|>4.609,P<0.001)存在显著性差异.结论 非流畅性失语症患者言语韵律输入和输出功能均下降,在"2个组块""喜欢情感""句尾焦点""疑问语气"的识别和表达上明显异常.
Characteristics of speech prosody function in adults with non-fluent aphasia after stroke
Objective To explore the characteristics of speech prosody chunking,affect,focus and interaction function in patients with non-fluent aphasia after stroke.Methods From December,2023 to March,2024,patients with non-fluent aphasia after stroke(experimental group,n=25)and healthy subjects(control group,n=25)were recruited from Shanghai Fifth Rehabilitation Hospital,and the two groups were compared in terms of chunking,affect,focus and interaction performance using a self-ad-ministered speech prosody function assessment tool and acoustic analyzing instrument.Results In chunking prosody,there were differences in auditory discrimination(Z=-4.856,P<0.001),auditory recog-nition of"two chunks"(Z=-3.024,P=0.002),and subjective scores,total pause duration,average pause dura-tion,average syllabic duration and structural sonic rate(|Z|>2.911,P<0.001)of imitating"two chunks"and au-tonomously outputing"two chunks"and"three chunks"between two groups.In affect prosody,there were differ-ences in listening to distinguish different emotions(Z=-3.322,P=0.001),listening to identify"like emotion"(Z=-3.481,P=0.001),and the subjective score(Z=-6.214,P<0.001),average intensity(Z=-3.581,P<0.001)and standard deviation of intensity(Z=-3.181,P=0.001)of imitating"like emotion"between two groups;there were differences in the subjective score(Z=-5.510,P<0.001),average intensity(Z=-3.429,P=0.001),standard deviation of intensity(Z=-4.777,P<0.001)and fundamental frequency variation range(t=1.852,P=0.029)of autonomously outputing"like emotion"between two groups.In focus prosody,there were differences in listening to distinguish different focuses(Z=-2.658,P=0.008),listening to identify the"end of sentence"focus(Z=-2.023,P=0.011),and the peak stress intensity of imitating the"first sentence"focus(t=8.294,P<0.001);the subjective score(|Z|>5.102,P<0.001)and peak stress intensity(t>8.298,P<0.001)of imitating the"mid-sentence"and"end-sentence",and the subjective score(Z=-4.371,P<0.001)and peak stress intensity(t=8.842,P<0.001)of autonomously outputing the focus of the"first sentence"between two groups;there were differences in the subjective score(|Z|>4.970,P<0.001),peak stress intensity(t>9.373,P<0.001)and stress duration(|t|>2.912,P<0.01)of autonomously outputing the focus of the"mid-sentence"and"end-sentence".In the interaction prosody,there were no significant difference in auditory resolution and au-ditory recognition between two groups(P>0.05),however,there were significant differences in the subjective score(|Z|>4.938,P<0.001)and the fundamental frequency slope k(|t|>4.609,P<0.001)of the interrogative tone both in imitative output and autonomous output.Conclusion Patients with non-fluent aphasia showed significant abnormalities in the recognition and expression of"2 chunks""like emotion""sentence-final focus"and"questioning tone."

strokenon-fluent aphasiaadultsprosody functionspeech prosody

王哲、万勤、黄昭鸣、王勇丽、钱红

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华东师范大学教育学部康复科学系,上海市 200062

华东师范大学中国言语听觉康复科学与ICF应用研究院,上海市 200062

上海市第五康复医院康复医学科,上海市 201600

脑卒中 非流畅性失语症 成年人 韵律功能 言语韵律

国家社会科学基金项目

20AZD125

2024

中国康复理论与实践
中国残疾人康复协会,中国医师协会,中国康复研究中心

中国康复理论与实践

CSTPCD北大核心
影响因子:1.354
ISSN:1006-9771
年,卷(期):2024.30(8)