| The elderly in China is the most over the world,who cause serious damage to health of body and mind of nervous system diseases including alzheimer’s disease,cerebrovascular disease,Parkinson’s disease,amyotrophic lateral sclerosis.These nervous system diseases often causes various types of dysarthria.The force,speed,range/amplitude,stability,or accuracy of the movement required for breathing,phonation,resonation,articulation,or prosody produced by speech may be abnormal.Among them,prosodic abnormalities have been recorded in dysarthria of various languages,different types and different severity,which seriously affect their communication.Identifying and exploiting the prosodic control of speech in dysarthria may improve the efficiency of communication.Effective assessment is the starting point of training.The assessment of speech prosody needs to combine subjective and objective methods.Subjective assessment provides a framework for speech prosody in dysarthria,and then accurate analysis can be carried out through quantitative methods to construct subjective and objective assessment indicators for dysarthria.Based on this,the prosodic features of dysarthria were studied and analyzed.In summary,this study was consisted of the following three parts:The first part was about the construction and characteristics of the subjective evaluation index of speech prosody in dysarthria.In order to extract the subjective evaluation index of speech prosody in dysarthria,the development of speech prosody function evaluation tool was developed.According to the principles of developing scales commonly used in the world and combining with the characteristics of Mandarin,the reading materials of speech prosody assessment were compiled,and the main dimensions of speech prosody assessment were determined by rhythm,stress,intonation and overall prosody impression.It has passed the verification of reliability and validity,content validity was 0.96,the consistency of raters was above 99.67%,the alpha coefficient was 0.92,and the retest reliability wasabove 0.90 In addition,140 normal adults who aged 20-90 years were taken as subjects to convert their original score of speech prosody into ICF limit value.As a result,this study established the reference standard of speech prosody function,and completed the standardization of speech prosody scale.In clinical practice,abnormalities of speech prosody can be widely,quickly and comprehensively evaluated with dysarthria.The second part was based on the extraction of objective acoustic parameters of speech prosody based on subjective evaluation of dysarthria.The objective acoustic parameters of speech prosody were extracted by three steps.Firstly,the subjective evaluation scale of speech prosody was used to analyze the characteristics and errors of speech prosody in patients with 27 spastic dysarthria,34 hypokinetic dysarthria.Compared to normal adults who were age-and sex-matched,It is concluded that the characteristics of speech prosody are different in different types of speech disorders.Patients with spastic dysarthria is more obvious in all dimensions of subjective prosody,and patients with hypokinetic dysarthria is more prominent in rhythm and intonation.And the direction of the mistake is also different.Secondly,referring to the study of speech prosody acoustic parameters at home and abroad and combining with the characteristics of Mandarin,the author selected the speech prosody acoustic parameters of rhythm,stress and intonation.30 patients with dysaethria and 15 normal adults were recruited,the correlation between the selected objective parameters and the score of the subjective prosody assessment was analyzed,and the acoustic parameters with a high degree of relevance to the subjective prosody assessment were retained.Thirdly,through a comparative study of speech prosodic acoustic parameters in 15 patients with spastic dysarthria and 15 normal subjects matched with their age and sex,15 patients with hypokinetic dysarthria and 15 normal subjects matched with their age and sex,four parameters such as the number of unnatural pauses and the average duration of syllables were extracted from spastic dysarthria to identify abnormal rhythm.The average fundamental frequency and duration of focus stress are used to identify abnormal stress,and the speech fundamental frequency and slope K of the whole sentence are used to identify abnormal intonation.The abnormal rhythm was identified by extracting the number of unnatural pauses in hypokinetic dysarthria;the speech fundamental frequency standard deviation of focus stress was used to identify abnormal stress;the whole sentence pitch slope K and the boundary tone fundamental frequency slope K were used to identify the abnormal intonation.This part completes the extraction of objective acoustic parameters of dysarthria on the basis of subjective evaluation,which can not only accurately evaluate the speech prosody damage of patients,but also monitor the rehabilitation effect of patients in the process of intervention training.The third part was about the intervention strategy of speech prosody in dysthria.First of all,this paper discusses the influence of the presence or absence of rhythmic cues on rhythm,the different positions of front,middle and back on stress and four tones on intonation.The results show that the rhythm,stress and intonation of spastic dysarthria and hypokinetic dysarthria are affected by cue,position and tone,so when designing speech prosody intervention programs,the above influencing factors need to be considered.At the same time,combined with the subjective and objective prosodic characteristics of dysarthria obtained in study 1 and 2,a basic and comprehensive speech prosodic rehabilitation strategy was developed for dysarthria.Finally,A single subject study of 2 patients with spastic dysarthria was conducted to verify the effectiveness of the rehabilitation strategy from both subjective and objective data.The innovation and theoretical and practical significance of this study are as follows :(1)to develop a set of speech prosody assessment tools suitable for dysarthria in Mandarin.(2)to extract subjective and objective evaluation indexes of speech prosody in dysarthrias.It is of reference value for the subsequent clinical diagnosis and evaluation of prosody in dysarthrias.(3)The characteristics of speech prosody of different types of dysarthria were analyzed,which enriched the theoretical knowledge and practical contents of the study of speech prosody in China.(4)The main factors influencing prosody expression were analyzed,which had reference value for the subsequent clinical rehabilitation training of prosody in dysarthria.(5)This study designed intervention strategies that conformed to the prosodic features of speech in dysarthrias,and provided clear and effective intervention methods for clinical therapist and other relevant personnel. |
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