语前聋儿童人工耳蜗植入术后前语言交流能力发展

摘要

目的：分析人工耳蜗植入后儿童前语言交流能力的发展规律，探讨其与其它听觉及言语评价指标的相关性，为早期听觉言语康复评估提供依据。方法对23例接受国产人工耳蜗植入术的语前聋儿童进行一年的随访，手术月龄12～66个月，平均35±3个月。分别于开机时及开机后1、3、6、9、12个月使用录像分析法对患儿的轮流交流、主动交流、视觉交流及听觉注意4项前语言交流能力进行分析和评估；同时使用听觉行为分级（CAP）、言语可懂度分级（SIR）问卷对其听觉和言语能力进行评估。结果随术后开机时间延长，患儿的轮流交流和听觉注意能力呈显著增长趋势（P＜0．05），前6个月增长较快（P＜0．05），后6个月缓慢增长（P＞0．05）；患儿主动交流和适时的视觉交流能力得分较低，两者差异无统计学意义（P＞0．05）；患儿 CAP 和 SIR 得分与轮流交流和听觉注意能力相关。结论随着人工耳蜗使用时间的延长，患儿逐步建立了听/说的交流模式；前语言能力评估结果与CAP 和 SIR 得分有相关性，三者结合可相互印证并能更全面准确地对人工耳蜗植入术后儿童早期听觉、语言和交流能力进行评估。%Objective The aim of this study is to summarize preverbal communication skills in children with cochlear implants,and to provide a clinical baseline of assessment in early stage after cochlear implantation.Methods 23 prelingually deaf children with homebred cochlear implants participated in this study.The age at cochlear im-plantation ranged from 12 to 66 months with a mean of 35 months.The evaluation was performed at switch-on ses-sion and 1,3,6,9 and 12 months after the first programming session.Tait video analysis was used to assess the preverbal communication skills including turn-taking,autonomy,eye contact and auditory awareness.CAP and SIR were used to evaluate the auditory and speech abilities.ResuIts The skills of turn-taking and auditory aware-ness increased significantly,especially in the first six months after switch-on session (P<0.05).The scores of autonomy and eye contact were relative low and there were no significant differences during the first year after surgery (P>0. 05).There was a correlation between the score of CAP/SIR and turn-taking or auditory awareness.ConcIusion Children with cochlear implants established vocal-auditory mode of early communicative behavior over time.Pre-verbal communication skills CAP and SIR have relativity and can comprehensively evaluate the auditory,speech and communication skills of children with cochlear implants.