MD217Z - Method for diagnosis of subclinical disorders of verbal function in children with cerebellar tumors - Google Patents
Method for diagnosis of subclinical disorders of verbal function in children with cerebellar tumors Download PDFInfo
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- 230000001755 vocal effect Effects 0.000 title claims abstract description 39
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 title claims abstract description 18
- 208000030394 cerebellar neoplasm Diseases 0.000 title claims abstract description 11
- 238000000034 method Methods 0.000 title claims description 15
- 238000003745 diagnosis Methods 0.000 title abstract description 3
- 238000004458 analytical method Methods 0.000 claims abstract description 17
- 239000003814 drug Substances 0.000 abstract description 2
- 230000006870 function Effects 0.000 description 18
- 208000035475 disorder Diseases 0.000 description 13
- 230000008569 process Effects 0.000 description 8
- 230000002490 cerebral effect Effects 0.000 description 5
- 238000012360 testing method Methods 0.000 description 4
- 230000003902 lesion Effects 0.000 description 3
- 230000009467 reduction Effects 0.000 description 3
- 210000001638 cerebellum Anatomy 0.000 description 2
- 102000009854 cortexin Human genes 0.000 description 2
- 108010034906 cortexin Proteins 0.000 description 2
- 230000003100 immobilizing effect Effects 0.000 description 2
- 230000003557 neuropsychological effect Effects 0.000 description 2
- 230000002980 postoperative effect Effects 0.000 description 2
- 206010003591 Ataxia Diseases 0.000 description 1
- 230000008901 benefit Effects 0.000 description 1
- 238000004364 calculation method Methods 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 230000008482 dysregulation Effects 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 238000002474 experimental method Methods 0.000 description 1
- 238000003384 imaging method Methods 0.000 description 1
- 230000001771 impaired effect Effects 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
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- 230000002123 temporal effect Effects 0.000 description 1
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Abstract
Invenţia se referă la medicină, în special la neuropsihologie şi neurochirurgie, şi este destinată pentru diagnosticarea dereglărilor subclinice ale funcţiei verbale la copiii cu tumori cerebelare.Metoda, conform invenţiei, constă în evaluarea rezultatelor analizei fonematice efectuate de copil a 5 cuvinte percepute pe cale auditivă fără limitarea articulaţiei şi cu limitarea articulaţiei prin strângerea limbii între dinţi. Analiza include determinarea numărului de foneme din componenţa fiecărui cuvânt, totodată, fiecare răspuns corect se apreciază cu un punct, şi dacă copilul acumulează 5 puncte la efectuarea analizei fonematice fără limitarea articulaţiei, şi nu mai mult de 3 puncte cu limitarea articulaţiei, atunci se diagnostichează dereglare subclinică a funcţiei verbale.The invention relates to medicine, in particular to neuropsychology and neurosurgery, and is intended for the diagnosis of subclinical disorders of verbal function in children with cerebellar tumors. without limiting the joint and limiting the joint by tightening the tongue between the teeth. The analysis includes determining the number of phonemes in the composition of each word, at the same time, each correct answer is evaluated by one point, and if the child accumulates 5 points when performing the phonemic analysis without limiting the joint, and no more than 3 points with limiting the joint, then it is diagnosed subclinical disorder of verbal function.
Description
Invenţia se referă la medicină, în special la neuropsihologie şi neurochirurgie, şi este destinată pentru diagnosticarea dereglărilor subclinice ale funcţiei verbale la copiii cu tumori cerebelare. The invention relates to medicine, in particular to neuropsychology and neurosurgery, and is intended for diagnosing subclinical disorders of verbal function in children with cerebellar tumors.
Se cunoaşte o metodă de diagnosticare a dereglărilor funcţiei verbale la copiii cu tumori cerebelare prin diagnosticarea dereglărilor fonematice, care include aprecierea caracterului pronunţării şi rostirii sunetelor la citirea fişei-chestionar. Sunt examinate sunetele vocale, iar fiecărui sunet i se atribuie un coeficient de incidenţă la 100 de sunete. Dereglarea funcţiei verbale se diagnostichează printr-un calcul matematic [1]. A method of diagnosing verbal function disorders in children with cerebellar tumors is known by diagnosing phonemic disorders, which includes assessing the character of pronunciation and utterance of sounds when reading a questionnaire. The vowel sounds are examined, and each sound is assigned an incidence coefficient per 100 sounds. Verbal function disorders are diagnosed by a mathematical calculation [1].
Însă metoda cunoscută permite de a diagnostica doar dereglările funcţiei verbale manifestate clinic, pe când la copiii operaţi în legătură cu o tumoare cerebelară, în majoritatea cazurilor au loc dereglări subclinice ale funcţiei verbale. However, the known method allows to diagnose only clinically manifested disorders of verbal function, while in children operated on for a cerebellar tumor, in most cases subclinical disorders of verbal function occur.
Problema pe care o rezolvă invenţia este evidenţierea dereglărilor subclinice ale funcţiei verbale la copiii operaţi în legătură cu tumori cerebelare în absenţa manifestărilor clinice ale funcţiei verbale. The problem solved by the invention is to highlight subclinical disorders of verbal function in children operated on for cerebellar tumors in the absence of clinical manifestations of verbal function.
Esenţa invenţiei constă în evaluarea rezultatelor analizei fonematice efectuate de copil a 5 cuvinte percepute pe cale auditivă fără limitarea articulaţiei şi cu limitarea articulaţiei prin strângerea limbii între dinţi, analiza include determinarea numărului de foneme din componenţa fiecărui cuvânt, totodată, fiecare răspuns corect se apreciază cu un punct, şi dacă copilul acumulează 5 puncte la efectuarea analizei fonematice fără limitarea articulaţiei, şi nu mai mult de 3 puncte cu limitarea articulaţiei, atunci se diagnostichează dereglare subclinică a funcţiei verbale. The essence of the invention consists in evaluating the results of the phonemic analysis performed by the child of 5 words perceived auditory without limitation of articulation and with limitation of articulation by clenching the tongue between the teeth, the analysis includes determining the number of phonemes in each word, at the same time, each correct answer is valued with one point, and if the child accumulates 5 points when performing the phonemic analysis without limitation of articulation, and no more than 3 points with limitation of articulation, then subclinical dysregulation of verbal function is diagnosed.
Examinarea copiilor sănătoşi a depistat că la efectuarea analizei fonematice cu participarea articulaţiei verbale interne numărul de cuvinte cu identificarea corectă a fonemelor este egal cu 5, adică 5 puncte, iar la efectuarea analizei fonematice cu limitarea participării articulaţiei verbale interne - 4…5 puncte. Examination of healthy children revealed that when performing phonemic analysis with the participation of internal verbal articulation, the number of words with correct identification of phonemes is equal to 5, i.e. 5 points, and when performing phonemic analysis with limited participation of internal verbal articulation - 4…5 points.
La efectuarea analizei fonematice la copiii cu tumoare cerebelară în perioada preoperatorie sau postoperatorie, în cazul dereglărilor subclinice ale funcţiei verbale s-a depistat că copilul acumulează 5 puncte cu participarea articulaţiei verbale interne şi 3 sau mai puţine cu limitarea participării articulaţiei verbale interne. When performing phonemic analysis in children with cerebellar tumors in the preoperative or postoperative period, in the case of subclinical disorders of verbal function, it was found that the child accumulates 5 points with the participation of internal verbal articulation and 3 or less with limited participation of internal verbal articulation.
Identificarea fonemelor cu participarea articulaţiei verbale interne (fără a strânge limba între dinţi) nu este dereglată în afectarea vermisului şi emisferelor cerebelare comparativ cu copiii sănătoşi. Însă în testul cu diminuarea participării articulaţiei verbale interne (cu strângerea limbii între dinţi) eficacitatea de identificare a fonemelor este mult mai redusă. Posibil că în procesul de identificare a fonemelor cu participarea articulaţiei interne (fără imobilizarea limbii) are loc implicarea conexiunilor atât cerebelo-frontale (articulaţia), cât şi cerebelo-temporale (limbajul oral), iar în testul cu diminuarea participării articulaţiei verbale interne, procesul de idenitificare a fonemelor este mai dificil, ca urmare a reducerii participării în proces a conexiunilor cerebelo-frontale. În contextul datelor obţinute prezintă interes studiile imagistice care au indicat faptul că în afara ariilor temporale posterioare, poate fi activată şi aria premotorie stângă, atunci când discriminarea solicită sarcini ale fonemelor vorbirii (Dănăilă L., Golu M. Tratat de neuropsiholologie. Vol 2, Bucureşti, 2006, p. 32-186). Acest efect a fost atribuit angajării proceselor articulatorii implicate în unele aspecte ale procesului vorbirii. În corespundere cu această ipoteză, decodificarea vorbirii nu este dependentă doar de analiza formei undei acustice, ci şi de compararea inputului auditiv cu reprezentarea motorie internă a gesturilor vocale necesare producerii sunetelor. The identification of phonemes with the participation of internal verbal articulation (without clenching the tongue between the teeth) is not impaired in the damage to the vermis and cerebellar hemispheres compared to healthy children. However, in the test with the reduction of the participation of internal verbal articulation (with clenching the tongue between the teeth) the effectiveness of identifying phonemes is much lower. It is possible that in the process of identifying phonemes with the participation of internal articulation (without immobilizing the tongue) the involvement of both cerebellar-frontal (articulation) and cerebellar-temporal (oral language) connections occurs, and in the test with the reduction of the participation of internal verbal articulation, the process of identifying phonemes is more difficult, as a result of the reduction of the participation of cerebellar-frontal connections in the process. In the context of the obtained data, imaging studies are of interest, which have indicated that, in addition to the posterior temporal areas, the left premotor area can also be activated when discrimination requires speech phoneme tasks (Dănăilă L., Golu M. Tratat de neuropsiholologie. Vol 2, Bucharest, 2006, p. 32-186). This effect has been attributed to the engagement of articulatory processes involved in some aspects of the speech process. In accordance with this hypothesis, speech decoding is not dependent only on the analysis of the acoustic waveform, but also on the comparison of the auditory input with the internal motor representation of the vocal gestures necessary for the production of sounds.
Experimentele efectuate au demonstrat pentru prima dată importanţa în diagnosticare a articulaţiei verbale interne şi externe în procesul identificării fonemelor la copiii cu tumori cerebelare. Suplimentar la semnele cunoscute ale leziunii cerebelului, identificarea fonemelor în cazul limitării participării articulaţiei verbale interne sporeşte veridicitatea diagnosticării manifestărilor clinico-neuropsihologice la bolnavii cu cerebelul afectat. Suplimentar la semnele cunoscute ale leziunii cerebelului, cum ar fi ataxia, starea funcţiei verbale este un criteriu neuropsihologic important. Aşadar, evidenţierea dereglărilor verbale subclinice la copiii cu afectări cerebelare extinde esenţial posibilitatea monitorizării funcţiilor verbale în procesul tratamentului neurochirurgical şi conservativ. The experiments performed have demonstrated for the first time the diagnostic importance of internal and external verbal articulation in the process of identifying phonemes in children with cerebellar tumors. In addition to the known signs of cerebellar lesions, identifying phonemes in the case of limited participation of internal verbal articulation increases the accuracy of diagnosing clinical and neuropsychological manifestations in patients with affected cerebellum. In addition to the known signs of cerebellar lesions, such as ataxia, the state of verbal function is an important neuropsychological criterion. Therefore, highlighting subclinical verbal disorders in children with cerebellar lesions essentially expands the possibility of monitoring verbal functions in the process of neurosurgical and conservative treatment.
Rezultatul invenţiei este determinarea corelaţiei dintre punctele acumulate la efectuarea analizei fonematice la copiii cu tumori cerebelare cu participarea articulaţiei verbale interne şi cu limitarea participării articulaţiei verbale interne, ce permite de a evidenţia dereglările subclinice ale funcţiei verbale. The result of the invention is the determination of the correlation between the points accumulated when performing the phonemic analysis in children with cerebellar tumors with the participation of internal verbal articulation and with the limitation of the participation of internal verbal articulation, which allows to highlight subclinical disorders of verbal function.
Avantajul invenţiei este sporirea veridicităţii diagnosticării stării funcţionale a cerebelului şi majorarea eficienţei terapiei, ţinând cont de restabilirea funcţiei verbale. The advantage of the invention is to increase the accuracy of diagnosing the functional state of the cerebellum and increase the efficiency of therapy, taking into account the restoration of verbal function.
Metoda se realizează în modul următor. The method is carried out in the following way.
Pentru analiza fonematică se efectuează două teste: cu participarea articulaţiei verbale interne, adică fără imobilizarea limbii (fără a strânge limba între dinţi) şi cu limitarea participării articulaţiei verbale interne (cu strângerea limbii între dinţii). For phonemic analysis, two tests are performed: with the participation of internal verbal articulation, that is, without immobilizing the tongue (without clenching the tongue between the teeth) and with limiting the participation of internal verbal articulation (with clenching the tongue between the teeth).
Pacientul trebuie să determine numărul de foneme în fiecare cuvânt. În fiecare test se folosesc cuvinte care conţin de la trei până la cinci foneme. Pentru fiecare analiză fonematică efectuată corect se acordă 1 punct. The patient must determine the number of phonemes in each word. Each test uses words containing three to five phonemes. 1 point is awarded for each correctly performed phonemic analysis.
Analiza fonematică fără imobilizarea limbii: roată (5), tată (4), lampă (5), mal (3), stele (5). Phonemic analysis without tongue immobilization: wheel (5), father (4), lamp (5), shore (3), stars (5).
Analiza fonematică a cuvintelor cu imobilizarea limbii: carte (5), mama (4), avion (5), cal (3), stâlp (5). Phonemic analysis of words with tongue immobilization: book (5), mother (4), airplane (5), horse (3), pillar (5).
La fiecare examinare cuvintele se rostesc cu acelaşi interval de timp de 10 s în ordinea indicată. In each examination, the words are spoken with the same time interval of 10 s in the indicated order.
Exemplu Example
Bolnavul B, 11 ani, examinat în perioada postoperatorie. Diagnosticul: tumoare cerebelară cu lezarea vermisului şi a emisferei cerebelare drepte. Dereglări manifestate ale funcţiei verbale nu sunt atestate, bolnavul nu acuză careva dificultăţi ale funcţiei verbale. S-a realizat identificarea fonemelor după metoda propusă. În cazul identificării fără imobilizarea limbii a fost numit corect numărul de foneme în toate cuvintele, ceea ce constituie 5 puncte; în cazul imobilizării limbii a fost identificat corect numărul de foneme în două cuvinte, ceea ce constituie 2 puncte, care este cu mult sub indicii normei. Deci, la pacient este prezentă o dereglare subclinică a funcţiei verbale depistată la nivelul identificării fonemelor. În baza investigaţiilor efectuate a fost indicat tratamentul cu Cortexin în doză de 10 mg intramuscular, timp de 10 zile. Peste două săptămâni după tratament, copilul a fost examinat repetat: în condiţiile limitării articulaţiei verbale au fost identificate fonemele din trei cuvinte, ceea ce este sub normă. A fost repetat tratamentul cu Cortexin, după care numărul fonemelor identificate în condiţiile limitării articulaţiei verbale nu se deosebea de indicii normali (4 cuvinte). Patient B, 11 years old, examined in the postoperative period. Diagnosis: cerebellar tumor with damage to the vermis and the right cerebellar hemisphere. Manifested disorders of verbal function are not attested, the patient does not complain of any difficulties in verbal function. Identification of phonemes was performed according to the proposed method. In the case of identification without tongue immobilization, the number of phonemes in all words was correctly named, which constitutes 5 points; in the case of tongue immobilization, the number of phonemes in two words was correctly identified, which constitutes 2 points, which is well below the norm. So, the patient has a subclinical disorder of verbal function detected at the level of phoneme identification. Based on the investigations performed, treatment with Cortexin at a dose of 10 mg intramuscularly for 10 days was indicated. Two weeks after treatment, the child was re-examined: under the conditions of limited verbal articulation, phonemes from three words were identified, which is below the norm. Cortexin treatment was repeated, after which the number of phonemes identified under the conditions of limited verbal articulation did not differ from the normal indicators (4 words).
Astfel, metoda propusă permite a identifica gradul dereglărilor subclinice ale funcţiilor verbale, precum şi monitorizarea acestor funcţii în procesul tratamentului. Thus, the proposed method allows to identify the degree of subclinical disorders of verbal functions, as well as to monitor these functions during the treatment process.
1. RU 2005104063 A 2006.07.20 1. RU 2005104063 A 2006.07.20
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