利用語音輔助溝通系統促進布洛克型失語症者語句產生之學習成效

Learning Effect of Sentence Production by a Voice-Output Communication Aid in Patients with Broca´s Aphasia

鑑於中風常導致失語症，造成溝通障礙，影響生活和社會參與，有愈來愈多的輔助溝通系統應用於臨床失語症者的復健，以促進失語症者的溝通效能。然而，要能成功地使用輔助溝通系統，需要合適的輔助溝通系統設計與充足的訓練。為此，本研究利用語音輔助溝通系統訓練布洛克型失語症患者學習產生溝通語句，探討其學習及類化成效。本研究以單一受試研究法之跨受試多探試設計，招募三位布洛克型失語症患者參與。研究者利用社會溝通網絡調查搜集參與者的基本溝通需要，並以此為基礎設計語音輔助溝通系統。利用語音輔助溝通系統探討介入後參與者溝通語句產生的正確率，並用視覺分析法和C 統計分析所得資料。最後並調查參與者與主要照顧者對於語音輔助溝通系統的使用滿意度。研究結果：一、經過訓練後，三位參與者利用語音輔助溝通系統產生語句的正確完成率皆有顯著增加，並有維持及類化成效。二、參與者與主要照顧者對語音輔助溝通系統的使用非常滿意。三、訓練過程中，研究者提供的提示與線索逐漸減少，顯示臨床治療環境下，使用語音輔助溝通系統可協助布洛克型失語症者完整表達溝通語句。語音輔助溝通系統的學習成效除溝通系統的設計與使用訓練外，亦會受到參與者的認知功能、上肢動作控制能力與個人動機之影響。未來研究可擴大收案對象，包括不同類型或不同認知功能的失語症個案，以探討不同族群在使用語音輔助溝通系統時溝通表現或支持策略的差異。

Purpose:Aphasia is a common symptom in stroke patients and often leads to communicative disability. Aphasia can affect stroke patients’ daily living and social participation. Applying augmentative and alternative communication systems (AACs) in clinical rehabilitation has proven effective in enhancing the communicative efficiency of stroke patients with aphasia. The successful implementation of AACs requires not only appropriate system design but also sufficient training in system operation. This study explored the learning and generalized effects on sentence production of training stroke patients with Broca’s aphasia to use a voice-output communication aid. Methods: This study adopted a multiple probe across-subjects design to investigate the effect of a voice-output communication aid on the accuracy rate of sentence production. Three stroke patients with aphasia consented to participate in this study. The researchers used the Social Networks Communication Inventory to establish the basic communicative needs of the participants, and employed this information to design the communicative sentences for practice and training. The main procedures of this study entailed investigating the communicative needs of the participants, designing the communication boards of the voice-output communication aid, confirming participants’ recognition of communicative symbols, training the participants to use the voice-output communication aid, and investigating the accuracy rate of sentence production in different communicative situations. In the training process, some cues and prompts were provided by the researchers to facilitate the learning outcomes. The data were illustrated and analyzed using visual analysis and the C statistical test. After the research was conducted, the satisfaction of the participants and primary caregivers with the AAC was also investigated. Results/Findings: In accordance with the basic communicative needs of the participants, the researchers designed a two-level layout for the voice-output communication aid that included 138 communicative symbols and three different communicative situations. All participants exhibited significant improvement in the percentage of communicative sentences accurately completed. The learning and generalized effects persisted in the maintenance phase. The participants and primary caregivers were satisfied with using the voice-output communication aid. The number of cues and prompts given by the researchers decreased during the training process. Conclusions/Implications: The results demonstrated, in a clinical therapeutic setting, that the voice-output communication aid training can assist stroke patients with Broca’s aphasia to completely express communicative sentences. The learning effectiveness of using the voice-output communication aid was influenced by the participants’ cognitive function, motor control of upper extremities, and personal traits. Additional influencing factors were the design of the communication system, and training in its use. Further research can extend this study to different severity levels of Broca’s aphasia and to various neurological diseases.