臨床語音學(Clinical Phonetics)
簡介
臨床語音學，顧名思義，主要在研究語音學理論與臨床診治言語缺陷的學科，研究對象的症狀可為先天失常（如唇、顎裂）或後天失調（如失語症、口吃），故多分為言語缺陷的矯治及言語失常的恢復；前者偏重於生理解剖，後者則著重於神經心理。這本屬醫學範疇，但因其都與恢復正常言語為目的，同時有許多發音矯正及鍛鍊的治療，都需要語言學及實驗語音學的背景知識，在現代語言學中亦把此門學科列為研究項目之一。
臨床語音學與一般語音學所不同的地方，是它比較注重應用層面。透過語音學的理論基礎，能幫助病患獲得診治之外，言語病理學的研究，亦有助於了解並幫助語音學理論的發展，兩者相得益彰。故要透徹了解語音學的實際應用，研究臨床語音學有很大的幫助。
Crystal (1987) defines clinical linguistics as “ the application of linguistic science to the study of communication disability, as encountered in clinical situations.” He then identifies seven specific aims for the subject, which constitute the linguist’s interpretation of the clinical demands made upon him. These aims, easy to state, more difficult to achieve, are as follows:
1. the clarification of areas of confusion arising out of the traditional metalanguage and classification of speech pathology;
2. the description of the linguistic behavior of patients and of the clinicians and others who interact with them;
3. the analysis of these descriptions, with a view to demonstrating the systematic nature of the disabilities involved;
4. the classification of patient behavior, as part of the process of differential diagnosis;
5. the assessment of these behaviors, by demonstrating their place on scales of increasing approximation to linguistic norms;
6. the formulation of hypotheses for the remediation of these behaviors, insofar as the therapy and management of patients require reference to linguistic variables, and evaluating the outcome of these hypotheses, as treatment proceeds;
7. the evaluation of the remedial strategies used in intervention, insofar as linguistic variables are involved.
Adapted from Tobin, Yishai’s Phonology As Human Behavior, 1997, 2
器質性障礙造成嚴重神經系統傳導不良以及無法控制發聲腔道或發聲機制的肌肉，在臨床治療上必須費很大的功夫才得以盡可能讓器質性障礙患者達到較好的溝通機制。
Organic difficulties cause a severe breakdown in communication usually in the central nervous system and in the control of the musculature of the articulatory tract or mechanisms. Even greater effort will be exerted in order to compensate wherever possible for these organic disorders in order to achieve better communication through clinical intervention.
語言失用症是在臨床語言學裡較常見的神經性障礙之一。它的定義為「神經性言語動作失調，而不利於執行有目的的言語活動」。語言失用症可進一步分為成人(後天)語言失用症和發展型語言失用症，定義及特徵如下：成人(後天)語言失用症是只因腦部受傷而導致中樞神經系統無法控制原本有協調能力的自由肌，表現在前後不一致的言語錯誤─替換、贅加、重複、拉長以及其他和說話無關的口腔活動。發展型語言失用症通常發生在兒童身上，而且被認為和神經系統缺失有關，患者無法魔法別人的發音和自然地說話，此類患者缺乏說話時不可缺少的動作控制的能力，但患者說話的肌肉功能並沒有喪失。
以下是器質性障礙患者主要的特徵：
1. 言語發聲機制不正常
2. 可察覺到語言與有關的神經功能失調
Apraxia is one of the more common neurological disorders found in the speech clinic. It has been defined as “a neurologically based motor speech disorder that adversely affects the abilities to execute purposeful speech movement.” Apraxia has been further divided into adult (acquired) and developmental apraxia, which have been defined and characterized as follows: adult verbal apraxia is a central nervous system disability in the planning and control of voluntary muscles without problems of weakness, coordination, and automatic actions of the muscles characterized by inconsistent speech errors: substitutions, additions, repetitions, lengthening, as well as other voluntary oral activities not connected to speech usually brought on by brain trauma. Developmental apraxia of speech is seen the children with articulatory problems in imitation and spontaneous speech production and is believed to be of neurological cause; children so afflicted lack the necessary mobile control for speech but have the necessary muscular functions for speech production.
The following as the structural or organic requirements necessary for a disorder:
1. anatomical of physiological abnormalities of the speech-producing mechanisms
2. detectable neurological dysfunction relevant to speech production
Adapted from Grunwell’s Clinical Phonology, 1987.
功能性障礙包含多種異常的說話型態。「功能性 」一詞在普通生理學和語言治療上都暗示這種性質的溝通障礙原因不明，並非器官缺陷所造成。構音障礙表示在某些特定的發音有困難，可分成四種類型，省略音、替代音、歪曲音及贅加音，可以只有一種錯誤或同時有兩種以上的錯誤。
The term FUNCTIONAL ARTICULATION DISORDERS encompasses a wide variety of deviate speech patterns. “Functional” is the term used in both general medical science and speech pathology to imply that the disorder has no readily detectable structural or organic defect and no other known aetiology. “Articulation Disorder” indicates that there are specific pronunciation difficulties. These can all be described in terms of four possible types of acoustic deviations in the individual speech sounds: omissions, substitutions, distortions and additions. An individual may show one or any of these combinations.
Adapted from Grunwell’s Clinical Phonology, 1987.
一般人所說的「臭乳呆」（台語）是指一個人的構音動作在構音過程中發生錯誤或困難，造成咬音不準確，語音清晰度不良的情況。造成構音障礙的原因：1.構音器官有問題，譬如口腔的大小形狀、舌頭與舌繫帶的長度，牙齒排列、上下顎咬合情形及唇顎裂等構音器官的問題，都會造成構音障礙。2.唇舌動作協調差也會造成構音異常。3.聽力不好無法分辨相似的語音時，將無法準確發音。
與語音相關的兒童溝通障礙有以下幾種:
(一).語音語法障礙（phonologic-syntactic disorder）
這類兒童的口語理解力差，常聽不懂口語的指令，因此無法做出適切的回應，嚴重者
甚至對於口語指令完全沒反應。此外，口語表達有顯著的 遲緩現象，縱使發展出口語
技能，也常出現：發音不正確、電報式語彙（telegraphese）、語句表達困難等特質。
人際間的互動受語言能力的限制而表現不良，有些個案還會伴隨有
視線接觸不良（poor eye contact）的行為表徵。
（二）語音運用障礙（verbal dyspraxia）
當兒童有這樣的問題時，在他們的行為中會出現下列特質：一般而言，口語的認知與
理解是正常的，但是口語的表達有明顯的困難，且極不流暢，發音錯誤尤其明顯，
嚴重者甚至無法開口說話，成為名符其實的「有口難言」者。
(三)音韻構音障礙(speech programming disorder)
這類案例的口語理解也是正常的，口語表達比語音運用障礙者流暢，只是發音的正確性
極差。他們的發音問題往往不具有穩定且可以歸納的錯誤類型，與構音障礙者的發音
問題類似卻不同。
（四）語音聽覺缺失症（verbal auditory agnosia)
這是語言障礙中最為嚴重的一類案例。典型的個案會有正常的聽力，但是卻完全聽不懂
口語。因此，幾乎不會說話。與外界的溝通和了解外界的方式，多仰賴視覺或觸覺等
其他感官。因此手勢動作和面部表情就成為這類案例解讀他人意圖的重要依據。
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一般來說，兒童於兩歲便會學會所有的元音及音調，三歲以前要能發出ㄅ、ㄆ、ㄇ、ㄉ、ㄊ、ㄋ、ㄍ、ㄎ，三至四能發出ㄐ、ㄑ、ㄗ、ㄘ，四歲至五歲能發出ㄒ、ㄙ、ㄓ、ㄔ、ㄕ。
年歲 | 男 | 女 |
兩歲 | ｎ(你) | ｎ(你), p (爸), j (也), m (媽), w(蛙), ｈ |
兩歲三個月 | | t (蛋) |
兩歲半 | p (爸), t (蛋), j (也) | k (哥) |
兩歲九個月 | | ｌ(六) |
三歲 | m (媽), w (蛙) | f (髮) |
三歲三個月 | k (哥) | pｈ(婆) |
三歲半 | ｈ | ｋｈ(卡) |
三歲九個月 | | ｋｗ (瓜) |
四歲 | pｈ(婆), ｔｈ (他), ｋｈ(卡), ts (字), ｋｗ (瓜), ｌ(六) | ｔｈ (他) |
四歲三個月 | f (髮), ｔｓｈ(刺) | ts (字) |
四歲半 | s (灑) | s (灑) |
四歲九個月 | | khw (困) |
五歲 | khw (困) | ｔｓｈ(刺) |
Adapted from http://www.geocities.com/win1201/articu.htm
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Pamela Grunwell Thomas W. Powell
Andy N. Spencer
Professor of Department of Biological Sciences
Director of Bamfield Marine Station
Academic degrees
BSc: University of London (U.K.) Ph.D.: University of Victoria
Areas of Involvement
Currently on contract until June 1998 as Director of Bamfield Marine Station on the west coast of Vancouver Island. The University of Alberta is a member of the consortium of five western universities which operate the Station. It is the major marine research and teaching facility on the Canadian West-Coast. In addition I have responsibility for an NSERC-funded research program (described below) operating at both the Marine Station and on campus in Edmonton. In 1995/96 I am the incumbent President of the Canadian Society of Zoologists. In addition to my research areas in neurobiology I have strong academic interests in invertebrate structure/function and evolution as well as general marine biology.
Current Research Interests
Our group is interested in the evolution of the nervous system in early metazoans with particular emphasis on hydrozoan jellyfish. We use a multidisciplinary approach to understanding the early evolution of the basic molecular and physiological building blocks of nervous systems. At present we are determining the structure and functional significance of "primitive" voltage-gated ion channels (K+, Na+, Ca++) using both electrophysiological and molecular biological techniques including: primary neuronal culture, current and voltage-clamp, oocyte expression assays, cloning by PCR, in situ hybridization. Other projects include ion channel modulation by transmitters and development of excitable cell lineages in cnidarians.
Selected Recent Publications
Jegla,T.,Grigoriev,N.,Gallin,W.J.,Salkoff,L.,and A N.Spencer. 1995. Multiple Shaker Potassium Channels in a Primitive Metazoan. Journal of Neuroscience 15:7989-7999.
Grigoriev,N.G.,Spafford,J.D.,Przysiezniak,J.,and A.N.Spencer. 1995. A cardiac-like sodium current in motor neurons of a jellyfish. Journal of Neurophysiology (in press).
Spafford,J.D.,Grigoriev,N.G.,and A.N.Spencer. 1995. Pharmacological properties of voltage-gated sodium currents in motor neurones from a hydrozoan jellyfish Polyorchis penicillatus. Journal of Experimental Biology (in press).
Przysiezniak,J.,and A.N.Spencer. 1994. Voltage-activated potassium currents in isolated motor neurones from the jellyfish Polyorchis penicillatus. Journal of Neurophysiology 72:1010-1019.
Przysiezniak,J.,and A.N.Spencer. 1992. Voltage-activated calcium currents in identified neurons from a hydrozoan jellyfish, Polyorchis penicillatus. Journal of Neuroscience 12:2065-2078.
Chung,J.M. and A.N.Spencer. 1991. Dopamine acts through a D2-like receptor on a jellyfish motor neuron. Journal of Comparative Physiology 169:599-606.
Spencer,A.N.,Przysiezniak,J.,Acosta-Urquidi,J.,and T.A.Basarsky. 1989. Presynaptic spike broadening reduces junctional potential amplitude. Nature 340:636-638.
Adapted from http://www.biology.ualberta.ca/spencer.hp/spencer.html
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Martin John Ball
Adapted from http://www.ucs.louisiana.edu/~mjb0372/mjball.html
語言學界地位：
Hawthorne-BORSF Distinguished Professor II in University of Louisiana at Lafayette
Chief Editor of Journal of Clinical Phonetics and Linguistics
研究重心：
以語音學與音韻學的研究為主，兼以對臨床語音學的研究為輔。故其著作多從生理機能的角度（Physiology）看語言的感知能力、言語失調（Speech disorder）、聽力失調（Hearing disorders）、言語治療（Speech therapy）及物理病理學療法（Physiopathology）。
重要著作：
Ball, Martin J. and Martin Duckworth. (eds.) 1996. Advances in clinical phonetics. Studies in speech pathology and clinical linguistics, v. 6. Amsterdam and Philadelphia: John Benjamins Pub. Co.
主要研究英語語音學、言語認知、言語失調與治療
Ball, Martin John. 1993. Phonetics for speech pathology. 2nd ed. London : Whurr.
從語音學及生理學的角度切入，研究言語及聽力失調
Ball, Martin John and Raymond D. Kent. 1997. The New Phonologies : Developments In Clinical Linguistics. San Diego:
Singular Pub.
主要研究發音、言語失調、採用所謂物理病理學療法
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Pamela Grunwell
重要著作：
1973. Test 384 Phonological Assessment of Child Speech, by Developmental speech disorders : clinical issues and practical implications. Edinburgh and New York : Churchill Livingstone.
1987. Clinical Phonology. 2ed ed. North Ryde, New South Wales: Croom Helm.
1995. (Editor). Developmental Speech Disorders, Clinical Issues and Practical Implications. London: Whurr Publishers, Ltd.
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Thomas W. Powell
Associate Professor and Interim Head of Louisiana State University, Department of Communication Disorders
Education and Training :
Ph.D. (1989) Indiana University, Bloomington, in Speech and Hearing Sciences
Major: Phonological Development and Disorders
Minor: Language Acquisition and Measurement Methodology
M.A. (1982) Indiana University, Bloomington, in Speech and Hearing Sciences
Major: Speech-Language Pathology
B.A. (1979) Indiana University, Bloomington, in Slavic Languages and Literatures, Journalism (Double Major)
Certificate (1977) Leningrad State University, Leningrad, U.S.S.R.
Russian Language Program
重要著作:
Powell, T.W. (In press). Phonetic transcription of disordered speech. Topics in Language Disorders.
Murrell, J.G., & Powell, T.W. (In press). Electronic learning for the allied health professions. The Journal of Louisiana Allied Health Professions.
Powell, T.W. (2000). The turn of the Scrooge: One Yank's perspective on accent reduction. Advances in Speech-Language Pathology: Journal of the Speech Pathology Association of Australia, 2, 145-149.
Powell, T.W., Elbert, M., & Dinnsen, D.A. (1999). A follow-up study of the linguistic and intellectual abilities of children who were phonologically disordered. In B. Maassen and P. Groenen (Eds.), Clinical Linguistics and Phonetics (pp. 82-90). London: Whurr.
Powell, T.W., Miccio, A.W., Elbert, M. Strike-Roussos, C., & Brasseur, J. (1999). Patterns of sound change in children with phonological disorders. Clinical Linguistics & Phonetics, 13, 163-182
Christensen, L.A., Morehouse, C.R., Powell, T.W., Alchediak, T., & Silio, M. (1998). Antiviral therapy in a child with pediatric human immunodeficiency syndrom (HIV): A case study of audiologic findings. Journal of the American Academy of Audiology, 9, 292-298.
Powell, T.W., Elbert, M., Miccio, A.W., Strike-Roussos, C., & Brasseur, J. (1998). Facilitating [s] production in young children: An experimental evaluation of motoric and conceptual treatment approaches. Clinical Linguistics & Phonetics, 12, 127-146.
Selected Presentations:
by Thomas W. Powell
A Personal Perspective
When I seek to assess a child's language skills, I employ both quantitative and qualitative procedures. I analyze the child's performance on standardized tests before I analyze the spontaneous sample of language. High scores on a standardized test may help us to rule-out certain types of problems. Low scores beg for an explanation and prove to be a challenge to interpret. A low score could be related to low language ability (it could also be related to other factors such as attending, hearing, vision, compliance, etc.) The standardized test allows me to develop hypotheses, which can then be tested using qualitative approaches (and/or additional follow-up testing). Qualitative approaches are less time-consuming and more likely to provide insight when I have an idea as to what I am looking for. As a diagnostician, I am like a detective who tries to make sense of clues obtained through quantitative and qualitative procedures. I strive to identify the explanation that best accounts for the patterns I observe.
We must always remember that the diagnosis of communication disorders is complicated because such impairments may affect any or all of the five linguistic subsystems and/or the various speech parameters. It is important to understand, too, that language and speech are interdependent in the sense that certain language problems will result in problems that appear related to speech output. For example, some children do not use the plural -s suffix, and will say things like two cat rather than two cats. It may be difficult to determine whether the error is associated with a language skill (morphology) or is due to a speech skill (articulation of [s]) or both. Likewise, a child with a severe speech problem may omit grammatical words such as the, is, etc. because the act of producing speech is laborious. For example, the child may say, cat run rather than the cat is running. It is often difficult to determine whether the child's production is due to a speech problem, a language problem (morphology, syntax), or both.
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1.Dual Channel Electroglottagraphs(EGGs)
For non-invasive measurement of vocal fold vibration in speech or singing and for measurement of vertical laryngeal movements.
Advantages of two-channel over single-channel units:
- Verification of proper electrode positioning
- Verification of waveform accuracy
- Measurement of vertical laryngeal movement
2. Laryngo Stroboscopes(喉部頻閃觀測器)
3. NAGASHIMA Phonatory Function Analyzer(嗓音功能分析器)
4. NASOMETER(鼻音計量器)
圖片取材自http://www.kellehermedical.com/kellehermedweb/speech.htm
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Ball, Martin J.(ed.). 1988a. Theoretical Linguistics and Disordered Language. London: Croom Helm.
Ball, Martin J. 1988b. The Contribution of Speech Pathology to the Development of Phonetic Description. In Ball, 168-88.
Ball, Martin John and Orla M. Lowry 2001. Methods in Clinical Phonetics. Whurr Pub Ltd
Chiat, Shula and Eirian V. Jones. 1988. Processing Language Breakdown. In Ball, 31-50.
Connolly, John H. 1988. Theoretical Linguistics and Clinical Assessment. In Ball, 189-210.
Crystal, David. 1987. Clinical Linguistics. (2nd ed.) London: Edward Arnold.
Grunwell, Pamela. 1987. Clinical Phonology. 2ed ed. North Ryde, New South Wales: Croom Helm.
Obler, Loraine K. and Kris Gjerlow. 1999. Language and the Brain. Cambridge: Cambridge University Press.
Perkins, William Hughes. 1978. Human Perspectives in speech and Language Disorders. Saint Louis: C. V. Mosby Company.
Tobin, Yishai. 1997. Phonology as Human Behavior: Theoretical Implications and Clinical Applications. Durham and London: Duke University Press.
Clinical Linguistics And Phonetics
Publisher: Taylor and Francis Ltd
Brain and Language
Publisher: Academic Press to the top
國外：
http://www.apraxia-kids.org/indexes/index2.html
Apraxia-kids Web 網站上有與溝通障礙相關的文章及溝通障礙的治療方法等相關資訊
http://www.synapseadaptive.com/laureate/llsmain/desc3/speechdc.html
Dr.Speech公司的網站，Dr.Speech為一家設計語言治療相關軟體的公司，網站上有Dr.Speech軟體產品的介紹 ，如video imaging software, vocal assessment software等
http://www.defeatingdeafness.org
The UK's only national medical research charity for hearing impaired people
Dr Earos
國內：
http://www.csmc.edu.tw/slp/public_html/
中山醫學大學與語言治療與聽力學系的專屬網站，所有國內與臨床語言學相關的最新資訊和活動
都可以在此找到。
http://www.hearingaid.com.tw
科林聽力保健中心
