The Journal of the Korea Contents Association (한국콘텐츠학회논문지)

The Korea Contents Association (한국콘텐츠학회)
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Possibility of Motor Speech Improvement in People With Spinocerebellar Ataxia via Intensive Speech Treatment

집중치료를 통한 소뇌운동실조증 환자의 말운동개선 가능성

  • 박영미 (동명대학교 언어치료학과)
  • Received : 2018.10.15
  • Accepted : 2018.11.19
  • Published : 2018.11.28
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Abstract

People with spinocerebellar ataxia, a hereditary and progressive neurogenic disorder, suffer from ataxic dysarthria due to cerebellar dystrophy. This study was designed to examine if intensive motor speech treatment yields improvement in progressive ataxic dysarthria and if then, to investigate magnitude of therapeutic effect. SPEAK $OUT!^{(R)}$ was provided to a 55-year old female diagnosed with SCA for improving motor speech functions. Magnitude of therapeutic effect was large in changes of MPT and vocal intensity across speech tasks. Small effect size was found in changes of fundamental frequency, however, large therapeutic effect was observed in changes of frequency range. In addition, improvement of vocal quality based on jitter, shimmer, and HNR was observed with large therapeutic effect size and vowel space was expanded, particularly, due to F1. Lastly, VHI scores were decreased. Intensive motor speech treatment, called as SPEAK $OUT!^{(R)}$ was effective enough to observe improvement in vocal intensity, frequency range, and vocal quality, expanding vowel space and lowering VHI scores. Based on the results of this case study, further efficacy evaluation of SPEAK $OUT!^{(R)}$ for improving progressive ataxic dysarthria in people with SCA is required.

소뇌운동실조증(SCA)은 유전성, 진행성 신경장애로 SCA 환자는 소뇌위축으로 인한 실조형 마비말장애를 보인다. 본 연구는 집중 말운동치료를 통해 SCA환자의 진행성 실조형 마비말장애의 개선의 유무를 확인하고, 개선이 있는 경우, 치료전후의 변화의 정도를 보고하고자 한다. 55세의 SCA 여성 환자를 대상으로 말운동 기능 개선을 위한 SPEAK $OUT!^{(R)}$ 치료프로그램을 시행 후, 큰 효과크기 수준에서 MPT와 과제별 음량의 개선이 관찰되었고, 음도의 경우 적은 효과크기의 변화를 보였다. 그러나 음도의 폭은 큰 효과크기의 변화를 보였다. 음질은 jitter, shimmer, HNR 모두에서 큰 효과크기 수준에서 긍정적 개선을 보였고, 모음면적도 넓어졌는데 이때 F1의 변화가 두드러졌다. 또한 심도 수준의 VHI점수는 치료 후 경도 수준으로 낮아졌다. 집중 말운동치료 프로그램인 SPEAK $OUT!^{(R)}$의 시행을 통해 SCA 환자의 음량, 음도, 음도의 폭, 음질, 모음면적의 증가를 관찰하였고, 음성장애에 관한 주관적 인식의 변화도 긍정적으로 감소하였다. 기초연구로서의 본 결과를 바탕으로 SCA환자의 진행성 실조형 마비말장애 개선을 위한 SPEAK $OUT!^{(R)}$에 대한 좀 더 체계적인 검증을 위한 후속 연구가 필요하다.

Keywords

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그림 1. 치료 전, 후의 모음 삼각도

표 1. 최대연장발성 비교

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표 2. /아/연장발성, 표준문단 읽기, 생성이름대기, 독백 시음량과 기본주파수의 평균과 표준편차, 그리고 효과크기

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표 3. 최고와 최저 음도, 음도 차이의 평균과 표준편차, 그리고 효과크기

CCTHCV_2018_v18n11_634_t0003.png 이미지

표 4. /아/ 연장 발성 시 주파수변동률, 진폭변동률, 조화음대소음비

CCTHCV_2018_v18n11_634_t0004.png 이미지

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