[[alternative]]Analysis of the Auditory Concept in Patients with Neurogenic Communication Disorders

[[abstract]]神經性溝通障礙（neurogenic communication disorders, NCD）族群在臨床上佔了很大一部分，此類患者在認知方面的損傷，會影響其溝通表現、功能性恢復，以及復健成效。對於該族群之溝通及語言能力的評估與治療，一直以來都是語言治療師及相關研究者關注的課題。由於概念是認知功能中的重要組成，也是連結語意的中心焦點。因此，為了適切擬定NCD者的治療計畫，在語言治療進行之前，完整評估個案現存的概念能力，是有其必要性的。 本研究納入之受試者包含62位NCD實驗組，及62位無神經性損傷對照組（non-neurologically impaired controls, NNIC）。NCD組均齡為56.18± 14.15歲而NNIC組為55.78± 13.95歲，兩組皆以年齡、性別相配對進行招募。而NCD組又再次分為認知型溝通障礙（cognitive communication disorders, CCD）及失語症（Aphasia, A）兩組以進行比較。測量工具則利用聽知覺概念辨識測驗（Assessment of Auditory Perception for ConceptualRecognition, AAPCR）、台灣版蒙特利爾認知篩檢工具（The Taiwanese version of Montreal Cognitive Assessment, MoCA-T）、雙耳異訊數字測驗（Dichotic Digits Test, DDT），來分別瞭解NCD的概念、認知與聽覺相關表現。研究變項包含AAPCR、環境聲音概念辨識測驗（Test 1）、情境聲音概念辨識測驗（Test 2）得分、Test 1各項錯誤類型（含語意相關、聲學相關、無相關）、Test 2各項錯誤特徵（含地點、人物、情境、聯想），以及作答時長。本研究以t-test探討A組與CCD組的錯誤類型、特徵，以及NCD組與NNIC組在AAPCR中的得分、錯誤類型、特徵與作答時長異同；再以Pearson積差相關分析NCD組與NNIC組於Test 1、Test 2及兩組各自於AAPCR之得分與作答時長表現的相關性。顯著水準均設定為p< .05。 研究結果發現NCD組的AAPCR與Test 1、Test 2成績顯著較NNIC組差、作答時長亦顯著比NNIC組長，且NCD組在Test 1與Test 2中的各類型和各特徵錯誤皆顯著較NNIC組多。然而在Test 2中，NCD組最主要的錯誤特徵是「聯想」，但NNIC組反而在「聯想」特徵中表現最佳。此外，NCD組在Test 1、Test 2間的表現有高度正相關（r= .609， p< .05），即NCD組若在Test 1表現愈好，其在Test 2的表現亦會愈好，反之亦然。另外，不論NCD組或是NNIC組，作答時長與AAPCR的成績皆呈現負相關，即作答時間愈長，其AAPCR成績反而愈差。在NCD次組中，CCD組的作答時長顯著較A組長，且CCD組於Test 1中出現較多聲學相關錯誤，在Test 2中則除了聯想錯誤特徵外，其他錯誤特徵皆顯著較A組為多。 根據研究結果，NCD者在腦部受到神經性損傷後，其聽知覺概念能力會受到不等程度的影響，尤其CCD者會出現聽覺處理歷程及概念統整方面的缺失。另外，NCD者在損傷後，進行聽知覺概念辨識所需花費的時間亦會大幅增加。因此，建議臨床治療師在進行正式評估前，或是在判斷NCD患者於腦傷後，所造成的溝通能力程度改變時，應釐清患者是否具備相對應的聽覺接收處理能力，以避免低估或高估NCD者的溝通異常狀況。此外在評估時，亦建議治療師給予患者較多時間處理及反應，以誘發他們最佳的表現。[[abstract]]Background: The neurogenic communication disorders (NCD) population accounts for a large part of the clinical situation. The associated cognitive impairment of these patients notably affects their communication performance, functional recovery, and rehabilitation effectiveness. Since the concept is an important component of cognitive function, the evaluation and treatment of communication and language skills in this group have always been taken as a big topic in the speech-language therapists and researchers. Therefore, in order to accurately make a differential diagnosis in patients with NCD, it is necessary to obtain their conceptual ability before setting up the treatment goal.Method: The participants included in this study were 62 each in the experimental group (NCD) and the non-neurologically impaired control group (NNIC). The mean age of the NCD group is 56.18± 14.15 years, and 55.78± 13.95 yearsin the NNIC group. Both groups were matched by age and sex. The NCD group was then subdivided into two groups: cognitive communication disorders (CCD) and aphasia (A) for the comparison. The study assessments included the Assessment of Auditory Perception for Conceptual Recognition (AAPCR), the Taiwanese version of Montreal Cognitive Assessment (MoCA-T), and the Dichotic Digits Test (DDT). The research variables include the scores of the AAPCR, Environmental Sound Concept Recognition Test (Test 1), Situational Sound Concept Recognition Test (Test 2), the error types in the Test 1and Test 2, and the total response time.Statistical analyses used the t-test to compare differences between the two groups across the total score of the AAPCR, scores of the Test 1 and Test 2, error types in each Test 1 and Test 2. And the Pearson Product- Moment Correlation determines the performance relationship between theTest 1 score and theTest 2 score. The significant level is set as p< .05.Results & Conclusion: The results show that the performance of the NCD patients in the AAPCR, Test 1 and Test 2 were significantly decreased than the NNIC group, and their total response time was significantly longer than the NNIC group. However, in Test 2, the main error type of the NCD group is “Association”, but the NNIC group made the fewest mistakes in this error type. Moreover, the performance of the NCD group between Test 1 and Test 2 is highly correlated (p< .001). In addition, both NCD group and NNIC group showed that there were negatively correlated relationship between the response time and the AAPCR scores; that is, the longer the response time, the worse the AAPCR score will be. In the subgroups of NCD, the CCD group significantly showed more errors in the acoustic domain in Test 1, and likely, more errors except for the Association type in Test 2, compared to the A group. In addition, the response time obtained from the CCD group was significantly longer than the A group.According to the results of the study, after the impact of neurological damages on the brain, the auditory concept of NCD patients will be affected in varying degrees. In particular, the CCD patients will have more problems in auditory processing and conceptual integration than the individuals with deficits other than right hemisphere. In addition, the reponse time of NCD patients to conduct auditory perception for concept is also greatly increased. Therefore, the study suggests that inorder to avoid underestimating or overestimating the communication deviations in the NCD patients, the clinicians should determine whether the corresponding auditory conceptual abilityis available before the therapy plan is designed. In addition, during the assessment, the therapist is also advised to give patients more time to response for the purpose of inducing their best performance