| Summary: | 碩士 === 長庚大學 === 復健科學研究所 === 93 === Background and purpose Speech is a complex motor skill, it requires different muscles coordination in articulatory and phonation systems, including chest wall, larynx, and oral system, to produce precise oral motor control. To treat motor speech dysfunction, it is based on the understanding the mechanism underlying the speech development and motor control. Therefore, the purpose of this study is to use kinematic analysis to establish the speech motor control pattern in children with normal development (ND), and to investigate the speech motor control in children with cerebral palsy (CP) during speaking.
Methods Twenty-eight children with ND (16 males and 12 females) and twenty-three children with CP (16 males and 7 females) participated in this study, aged from 4 to 12 years. The children with ND were classified into three groups based on age, with group A aged 4 to 6 years, group B aged 7 to 9 years, and group C aged 10 to 12 years. The children with CP were classified into two groups based on clinical diagnosis, with spastic quadriplegia group (SQ group) and spastic diplegia & hemiplegia (SD/SH group). A motor analysis system (Vicon 370) and a mobile video were synchronized to collect kinematic data and video images during speaking. Each subject received seven experimental tasks. The kinematic parameters were analyzed, including the spatiotemporal indexes (STIs), duration, peak velocity of jaw, and peak displacement of lower lip during speaking. The clinical assessment included IQ test, language impairment scale, verbal motor production assessment for children (VMPAC), intelligibility, and gross motor function measure (GMFM). Correlate coefficient analysis, ANOVA, ANCOVA, Chi-square test, and nonparametric test were used in statistical analysis. Statistical significance was set as p less than.05.
Results The STIs and duration were decreased with age (p<0.05), but the peak displacements of lower lip and peak velocity of jaw in multiple and mono-syllable tasks did not change with age in children with ND during speaking (p>0.05). In comparing children with ND and CP, the CP with SQ had greater STIs, duration, peak velocity of jaw and some peak displacements of lower lip in multiple syllables and mono-syllable tasks than children with ND (p<0.05). CP with SD/SH had greater STIs, duration and some peak displacement of lower lip in multiple syllables and mono-syllable tasks than ND (p<0.05). However, the other parameters showed no significant differences between children with SD/SH and ND. Considering the correlation analysis of kinematic data and clinical assessment, in children with ND, the STIs was negatively correlated with age (r=-.663, p<0.001), and was positively correlated with duration (r=.483, p<0.001) in multiple syllables tasks. And it was positively correlated with peak displacement of lower lip (r=.747, p<0.001) in mono-syllable tasks. In children with CP, the STIs was positively correlated with peak displacement of lower lip (r=.747, p<0.001) in mono-syllable tasks. However, it was not correlated with duration. In children with ND, the duration was negatively correlated with age (r=-.630, p<0.001；r=-.730, p<0.001) in multiple syllables and mono-syllable tasks. In children with CP, the duration was negatively correlated with language impairment scale’s global preference (r=-.636, p=0.006) in multiple syllables tasks, and it was negatively correlated with language impairment scale’s global preference (r=-.571, p=0.017) and VMPAC’s focal oromotor control (r=-.558, p=0.013) in mono-syllable tasks.
Conclusions The brain and neuromuscular functions changed with increasing age. The cognition, language and oromotor control matured with age. Therefore, the oromotor control consistency was increased and the duration was decreased with age children with ND. In children with CP non-progressive brain damage may cause impairment in cognition, language, and motor speech functions. Therefore, CP children had greater STIs, duration, peak velocity of jaw, and peak displacements of lower lip during speaking. These kinematic parameters were correlated with their language function and oral motor control. The kinematic data of motor speech control provided in this study may allow clinicians to understand the motor speech control with children with ND. The kinematic analysis technique of motor speech may be used to assess motor speech control in children with speech impairment.
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