CAJ | 학술논문

目的探讨脑瘫(CP)患儿伴发言语障碍的临床特点及其与颅脑磁共振影像(MRI)特征间的关联性.方法选取2011年6月至2013年3月期间在青岛市妇女儿童医院神经康复科住院治疗的CP患儿,其诊断及临床分型明确,年满1岁8个月,能配合完成言语及口运动检查.采用＜s-s＞语言发育迟缓检查法、汉语版构音障碍检查及口运动障碍评分法对入选CP患儿进行言语能力、构音特点及口运动能力检查,分析入选CP患儿颅脑MRI异常表现、言语理解与表达发育迟缓程度、口运动评分及构音障碍特点等.结果颅脑MRI检查结果显示:正常9例,非特异性异常3例(如髓鞘化延迟和/或脑外间隙增宽),特异性异常122例(异常率为91.04％).颅脑MRI异常患儿中其言语理解和言语表达发育迟缓率分别为51.6％和74.6％,运动性构音障碍发生率为71.3％,其中有8.7％的患儿完全没有言语能力.入选患儿主要MRI异常类型包括基底核损伤、小脑病变、脑室周围白质软化(PVL)、广泛性皮质/皮质下损伤和局灶性脑损伤等,所占比例依次为23.0％、11.5％、47.5％、6.6％和11.5％,对应CP患儿的口运动评分依次升高.言语表达发育迟缓和运动性构音障碍的发生率以基底核损伤和小脑病变患儿相对较高,其次是广泛性皮质或皮质下损伤及PVL患儿,局灶性脑损伤患儿其言语能力发展良好.12例完全没有言语能力的CP患儿有7例病变位于基底核部位.结论 CP患儿各种言语障碍发生率及严重程度与颅脑MRI异常类型有关,基底核损伤和小脑病变提示患儿容易伴发言语障碍且病情程度相对较重.
목적 탐토뇌탄(CP)환인반발언어장애적림상특점급기여로뇌자공진영상(MRI)특정간적관련성.방법 선취2011년6월지2013년3월기간재청도시부녀인동의원신경강복과주원치료적CP환인,기진단급림상분형명학,년만1세8개월,능배합완성언어급구운동검사.채용＜s-s＞어언발육지완검사법、한어판구음장애검사급구운동장애평분법대입선CP환인진행언어능력、구음특점급구운동능력검사,분석입선CP환인로뇌MRI이상표현、언어리해여표체발육지완정도、구운동평분급구음장애특점등.결과 로뇌MRI검사결과현시:정상9례,비특이성이상3례(여수초화연지화/혹뇌외간극증관),특이성이상122례(이상솔위91.04％).로뇌MRI이상환인중기언어리해화언어표체발육지완솔분별위51.6％화74.6％,운동성구음장애발생솔위71.3％,기중유8.7％적환인완전몰유언어능력.입선환인주요MRI이상류형포괄기저핵손상、소뇌병변、뇌실주위백질연화(PVL)、엄범성피질/피질하손상화국조성뇌손상등,소점비례의차위23.0％、11.5％、47.5％、6.6％화11.5％,대응CP환인적구운동평분의차승고.언어표체발육지완화운동성구음장애적발생솔이기저핵손상화소뇌병변환인상대교고,기차시엄범성피질혹피질하손상급PVL환인,국조성뇌손상환인기언어능력발전량호.12례완전몰유언어능력적CP환인유7례병변위우기저핵부위.결론 CP환인각충언어장애발생솔급엄중정도여로뇌MRI이상류형유관,기저핵손상화소뇌병변제시환인용역반발언어장애차병정정도상대교중.
Objective To investigate the clinical characteristics of speech disorders in children with cerebral palsy (CP) and any relationship between those characteristics and cranial magnetic resonance images.Methods A sample of 138 children with CP were given the ＜ s-s ＞ language development test,a Chinese-language articulation test and oral motor scores to quantify their functional speech and articulation.The characteristics of their speech disorders,articulation and oral motor dysfunction were then related with abnormalities in their cranial magnetic resonance images (MRIs).Results Of the 138 MRIs,only 9 were normal.Three showed non-specific abnormalities (delayed myelination and/or broadening of the space outside the brain) and 122 (91％) showed specific abnormalities.Among the children with specific abnormalities,51.6％ had speech reception delay and 74.6％ had speech expression delays.The dysarthria rate was 71.3％,including 8.7％ with no speech ability at all.The main MRI abnormalities were lesions of the basal ganglia (23％),lesions of the cerebellum (11.5％),periventricular leukomalacia (PVL) (47.5％),extensive cortical or subcortical lesions (6.6％) and focal cerebral injury (11.5 ％).The corresponding oral motor scores increased successively.The children with lesions of the basal ganglia or cerebellum were most likely to manifest speech expression delay and dysarthria.The children with cortical or subcortical lesions or PVL also showed speech expression delay and dysarthria.However,the children who had a focal cerebral injury generally performed well on the speech ability assessment.Twelve children had no speaking ability at all,and in 7 of them the lesions were of the basal ganglia.Conclusions The probability and severity of speech disorders in children with cerebral palsy relate with specific abnormalities detectable with cranial MRI.Those with lesions of the basal ganglia or cerebellum will be more likely to show more severe speech disorders.