Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill.
Department of Communication Sciences and Disorders, University of Utah, Salt Lake City.
Am J Speech Lang Pathol. 2019 Feb 21;28(1):121-135. doi: 10.1044/2018_AJSLP-17-0186.
Purpose Loosely defined diagnostic criteria for acquired apraxia of speech (AOS) limit clinicians' ability to diagnose the disorder validly and reliably. The purpose of this study was to contribute to the development of more precise diagnostic guidelines by characterizing the frequency and quality of sound distortion errors in speakers with clinically diagnosed AOS. Method Audio-recorded motor speech evaluations from 24 speakers with AOS and aphasia were analyzed by trained listeners using a narrow phonetic transcription protocol that included 12 distortion categories. We calculated percentage of segments transcribed with phonemic error, distortion error, and a combination of phonemic and distortion error. Results Distortion frequency varied substantially across participants, distributing on a continuum from 5% to 22% of segments. The frequency of phonemic errors was significantly greater than the frequency of distortion errors, which, in turn, was greater than the frequency of distorted substitution errors. The most common distortion qualities were voicing ambiguity and segment lengthening, but over 40% of distortion errors were distributed across an assortment of tongue modifications. Conclusions The results replicated observations from previous studies of speakers with quantitatively defined AOS in a new sample of participants with clinically diagnosed AOS. Similar distortion qualities were observed across studies, offering focus for diagnosticians and guidance for operationalizing future measures. The broad performance continua we observed help explain why binary classification of the presence/absence of AOS can be challenging and indicate a need to develop quantitative norms.
目的 用于诊断获得性运动性言语失用症（AOS）的诊断标准界定较为宽泛，这限制了临床医生对该障碍进行有效和可靠诊断的能力。本研究的目的是通过描述具有临床诊断 AOS 的患者的语音失真错误的频率和质量，为制定更精确的诊断标准做出贡献。
方法 由经过培训的听力师使用包括 12 个失真类别在内的精细音标转录协议，对 24 名患有 AOS 和失语症的患者的音频记录的言语运动评估进行了分析。我们计算了带音位错误、失真错误以及音位和失真错误组合的转录段的百分比。
结果 失真频率在参与者之间差异很大，分布范围从 5%到 22%的段。音位错误的频率明显大于失真错误的频率，而失真错误的频率又大于失真替代错误的频率。最常见的失真质量是发声模糊和音段延长，但超过 40%的失真错误分布在各种舌位变化中。
结论 本研究结果在新的临床诊断 AOS 参与者样本中复制了以前对定量定义的 AOS 患者的研究中的观察结果。相似的失真质量在研究中被观察到，为诊断师提供了重点和指导，并为未来操作化措施提供了指导。我们观察到的广泛的性能连续体有助于解释为什么 AOS 的存在/缺失的二分法可能具有挑战性，并表明需要制定定量规范。
