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 中风后的言语治疗 – 香港微創腦及脊椎神經外科手術中心

中风后的言语治疗

中风后的言语治疗

在中风后的最初几天和几个礼拜，几乎有一半中风患者会有说话、阅读或书写文字上的问题，有些患者更会发生认字或理解字义的困难。此外，若有三分之一的中风患者会有吞咽困难。

当身体右半边部份受中风影响时，患者在沟通表达上的困扰就更常见了，原因是主要语言控制中心是位于大脑的左半侧。

当大脑语言中枢受到损伤，会出现语言障碍。语言障碍主要有两种，一种是失语症，另一种是运动性言语障碍。失语症患者多会在语言理解和语言表达上存在困难。在表达方面，命名困难比较常见，他们对某一件物品能说出用途，就是说不出名字，更有可能将「刀」说成「叉」。而运动性言语障碍是因神经肌肉受损以致构音器官不协调所致，主要表现为发音不准、吐字不清，例如将「刀」说成「高」。

神经性沟通障碍

中风令脑神经受损，可能导致以下沟通障碍：

（一）失语症：失去语言理解及表达能力；

（二）读写障碍：失去阅读书写能力；

（三）构音障碍：因发声和发音器官受影响令咬字发音、发声、呼吸、共鸣或韵律节奏出现问题，导致说话有口齿不清楚情况；
（四）失用症：协调和控制口腔肌能出现问题，说话时，好像控制不到口腔肌，如双唇、舌头、脸颊的活动；

（五）认知沟通障碍：因记忆力、专注力、解难能力、学习能力、思考能力等问题导致沟通障碍。言语治疗师评估患者情况后，会设计合适的治疗计划予患者。通过练习，可增强患者面部及口腔肌肉的控制能力，和增进沟通技巧。而家属也会接受训练，以掌握与患者沟通的技巧。如有需要，言语治疗师会使用其他沟通工具协助治疗。

吞咽障碍

吞咽困难的患者在协调和控制口腔肌运动出现问题，说话时，好像控制不到口腔肌，如双唇、舌头、脸颊的活动，而且，患者会容易错误地将食物吞进气管，引致呛咽或呼吸困难，严重者会导致肺炎及窒息。言语治疗师会与专科医生提供特别的吞钡X光造影检查（VFSS）或内窥镜吞咽检查（FEES）作深入综合吞咽评估，因应报告了解患者的情况，然后为患者设定个别的治疗计划；如改善食物的稀浓度及肌肉训练，以改善患者吞咽之能力。

中风患者的沟通困难各不相同，程度亦有差异，但亲属的帮助和鼓励肯定是十分要的。家属应多与病者沟通，使他有更多机会练习不同的沟通技巧，并多给予鼓励和体谅他所遇到的困难，使他较易适应，逐步重建自信。再配合言语治疗，病人的沟通能力或吞咽能力才能得到改善。

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