语音训练对腭裂代偿性构音障碍的异常神经网络重塑脑成像研究

Cleft palate is one of the most common maxillofacial congenital malformation, which results in severe speech disorders. Compensatory articulation disorder (CAD) is considered as the major pathological changes among these patients. However, the outcome of speech therapy, an important treatment method, for the CAD was usually unsatisfied. This is due to the wrong articulation patterns and stubborn habits in the CAD patients, which need considerable training intensity and time. According to the preliminary results of our own study, as well as studies by others, structural and functional changes were clearly identified in some brain regions of CAD patients, which suggested that the abnormal neural networks were involved in the progression of CAD. Thus, we proposed the hypothesis that the speech therapy effectively correct the articulation disorders through reconfiguration of the pathological neural function and reorganization of the abnormal neural network involved in CAD. In this proposal, multimodal brain imaging techniques will be applied to investigate the differences in the brain functional connectivity and structural connectivity networks among the groups of non-CAD, different degree of CAD with postoperative cleft palate patients and health control. The relationship between the improvement of speech intelligibility and the alteration of brain network before and after intervention will be compared. We intend to reveal the substrates of the neural network associated with CAD and speech therapy. Overall, through this comprehensive study, we would like not only to provide new insight into the underlying neural mechanism of CAD, but also accumulate evidences for improving the effective speech therapy and finding new therapeutic strategy in clinical practice.

腭裂是颌面部最常见的先天性畸形，严重影响语音功能，其特殊的病理学改变可诱发代偿性构音障碍。该障碍目前的治疗手段以语音训练为主，但由于已代偿形成错误的构音模式，纠正十分困难，需要相当的训练强度与时间。前期研究及预实验发现腭裂代偿性构音患者大脑某些区域的结构和功能发生显著变化，提示异常构音患者的神经网络存在病理性改变。据此我们提出假设：语音训练可通过异常神经网络的重塑，改变已形成的病理性神经连接，达到其治疗效果。本项目拟对腭裂术后非代偿性构音、轻度及重度代偿性构音及正常对照四组被试进行研究，采用多模态脑成像技术分析大脑结构形态及功能网络的特征；比较代偿性构音异常患者在语音训练前后的变化，分析该变化与语音训练效果的相关性；揭示腭裂代偿性构音障碍以及语音训练相关的脑神经网络特征。该研究在网络水平解析腭裂代偿性构音异常的神经机制，将为提高疗效、探寻新的治疗策略提供理论依据和定量评估模型。

腭裂是颌面部最常见的先天性畸形，严重影响语音等功能，其特殊的病理学改变可诱发形成代偿性构音障碍。该障碍目前的治疗手段以语音训练为主，但由于已代偿形成错误的构音模式，纠正十分困难，需要相当的训练强度与时间。前期研究及预实验发现腭裂代偿性构音患者的大脑神经网络存在结构和功能的异常改变，据此我们假设：语音训练可重塑已形成的异常神经网络连接，探索对应的神经机制，有助于选择训练方案，优化治疗效果。本项目对腭裂术后非代偿性构音、代偿性构音异常及正常对照三组被试进行研究，采用多模态脑功能成像技术分析大脑结构形态及功能网络的特征。结果发现，腭裂术后代偿性构音障碍的发生与脑功能网络连接降低、言语调控脑区激活减弱密切相关；同时，脑灰质体积减少可能是其发生的解剖结构基础。通过语音训练能实现异常神经网络重塑进而改善言语功能。更为重要的是，视觉信息处理通路代偿性活跃及发音运动区域重塑提示语音训练辅以运动多感官刺激干预可能成为腭裂代偿性构音的新型治疗策略。