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帕金森病中的运动减少型构音障碍:一篇叙述性综述。

Hypokinetic Dysarthria in Parkinson's Disease: A Narrative Review.

作者信息

Atalar Merve Sapmaz, Oguz Ozlem, Genc Gencer

机构信息

Department of Speech and Language Therapy, University of Health Sciences Türkiye, Hamidiye Faculty of Health Sciences, Istanbul, Türkiye.

Department of Speech and Language Therapy, University of Uskudar, Faculty of Health Sciences, Istanbul, Türkiye.

出版信息

Sisli Etfal Hastan Tip Bul. 2023 Jun 20;57(2):163-170. doi: 10.14744/SEMB.2023.29560. eCollection 2023.

Abstract

Numerous disabling motor and non-motor symptoms occur during Parkinson's disease (PD), including speech disorders, often referred to as hypokinetic dysarthria. PD is the most common cause of this type of dysarthria. About 90% of PD patients experience hypokinetic dysarthria, which is exacerbated as the disease progresses and makes it very difficult for other people to understand the person with PD. This disorder is characterized by a monotonous speech pattern, reduced and monotonous loudness, decreased stress, a breathy or hoarse voice quality, an increase in speech rate, rapid repetition of phonemes, and impreciseness in consonant production. However, patients may also have sensory symptoms including inaccurate perceptions of their own loudness and decreased awareness of speech problems. Hypokinetic dysarthria in PD may not only result from dopamine degeneration in the nigrostriatal pathway but also from disturbances in the motor and somatosensory systems. All speech components, such as phonation, articulation, respiration, resonance, and prosody should be assessed carefully in PD patients with hypokinetic dysarthria. Taking medical history, an oral motor assessment, a perceptual evaluation of speech characteristics, intelligibility, efficiency, and participation in communication all need to be a part of the assessment. The tasks of maximum phonation time, diadochokinetic rate, reading sentences, words, and passages, describing pictures, and spontaneous speech are used to assess the features of speech components and intelligibility. The evaluation should include physiological, acoustic, or imaging modalities as well. Speech therapy is typically the main treatment of speech problems in PD. The management of PD-related hypokinetic dysarthria basically focuses on speaker-oriented and communication-oriented strategies. In addition to these strategies, Augmentative Alternative Communication (AAC) should be considered in patients with severe dysarthria. Loudness, intelligibility, and sound perception may all significantly improve with the Lee Silverman Voice Therapy LOUD (LSVT LOUD) program which is an evidence-based program. The beneficial effect of pharmacological and surgical treatment approaches has not been proven in improving speech. Deep brain stimulation may carry the risk of the deterioration of speech as the illness progresses.

摘要

帕金森病(PD)会出现许多导致功能障碍的运动和非运动症状,包括言语障碍,通常称为运动减少型构音障碍。PD是这类构音障碍最常见的病因。约90%的PD患者会出现运动减少型构音障碍,且随着疾病进展会加重,这使得其他人很难理解PD患者的话语。这种障碍的特征包括言语模式单调、响度降低且单调、重音减弱、声音质量带呼吸声或嘶哑、语速加快、音素快速重复以及辅音发音不准确。然而,患者也可能有感觉症状,包括对自己响度的感知不准确以及对言语问题的意识下降。PD中的运动减少型构音障碍不仅可能源于黑质纹状体通路中的多巴胺变性,还可能源于运动和躯体感觉系统的紊乱。对于有运动减少型构音障碍的PD患者,应仔细评估所有言语成分,如发声、发音、呼吸、共鸣和韵律。病史采集、口腔运动评估、言语特征的感知评估、可懂度、效率以及参与沟通等都应成为评估的一部分。最大发声时间、重复运动速率、朗读句子、单词和段落、描述图片以及自发言语等任务用于评估言语成分的特征和可懂度。评估还应包括生理、声学或成像方式。言语治疗通常是PD言语问题的主要治疗方法。与PD相关的运动减少型构音障碍的管理基本上侧重于以说话者为导向和以沟通为导向的策略。除了这些策略外,对于严重构音障碍的患者应考虑使用辅助替代沟通(AAC)。基于证据的李·西尔弗曼嗓音治疗法(LSVT LOUD)项目可能会显著改善响度、可懂度和声音感知。药物和手术治疗方法在改善言语方面的有益效果尚未得到证实。随着病情进展,深部脑刺激可能存在言语恶化的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86f1/10600629/2ae4c93e37fb/SEMB-57-163-g001.jpg

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