探索学龄前儿童言语与口颌面功能之间的发育性相互作用：一项横断面研究

文献信息

中文摘要

背景： 言语与口颌面功能（呼吸、吞咽和咀嚼）均在口颌系统中发育，并共享共同的解剖结构和运动控制机制。理论模型提示，早期口颌面运动经验可能塑造言语发育。然而，在学龄前阶段检验这些关系的实证证据仍然很少。
目的： 本研究探讨学龄前儿童言语与口颌面功能之间的关系。我们假设这种关系不是直接的，而是间接的，其中以非言语口颌面运动（NSOMs）操作化的口腔运动能力作为候选中介变量。我们检验了（a）典型发育（TD）儿童与言语障碍（SSD）儿童在口颌面功能和NSOMs上是否存在差异，（b）言语清晰度、NSOMs与口颌面功能之间的关系，以及（c）NSOMs是否预测言语清晰度和口颌面功能，以及口颌面功能是否预测言语清晰度。
方法与程序： 对168名3至5岁9个月的法语学龄前儿童（118名TD，50名SSD）进行了横断面研究。言语清晰度采用辅音正确百分比（PCC）测量。NSOMs和口颌面功能（呼吸、吞咽和咀嚼）采用标准化方案（OMES、TEST B、ABPA）评估。组间比较采用MANCOVA，关系通过控制年龄的偏相关分析检验，并进行多元线性回归分析。
结果： SSD儿童在NSOMs（F(1162) = 11.45，p = 0.001）和口颌面功能（F(1162) = 11.66，p < 0.001）上的得分均显著低于TD同龄儿童。偏相关分析显示三个变量之间均存在显著关联（NSOMs-口颌面功能：r = 0.36，p < 0.001；NSOMs-PCC：r = 0.36，p < 0.001；口颌面功能-PCC：r = 0.19，p < 0.05）。回归分析表明，NSOMs显著预测言语清晰度（β = 0.87，p < 0.001）和口颌面功能（β = 0.21，p < 0.001），而口颌面功能也预测言语清晰度（β = 0.78，p = 0.015）。
结论与意义： 言语与口颌面功能在学龄前早期似乎通过双重模式相互关联：一种间接联系，其中口腔运动能力（NSOMs）是候选中介变量；同时存在一种直接关联，最好解释为共现。这些解释仍属初步，需要纵向研究确认。若得以重复，研究结果提示口颌面筛查可为因言语困难转诊儿童的言语评估提供信息，而当怀疑口颌面肌功能紊乱时也可考虑言语筛查。
本文的贡献： 关于该主题已知的内容：理论模型提出言语与口颌面功能依赖共享的运动控制机制，且早期口颌面运动经验可能为言语发育提供支架。实证研究主要在学龄儿童和临床人群中考察这种关系，且多将其视为直接联系。间接联系的可能性——以口腔运动能力作为候选中介变量——很少被探索，在学龄前儿童中几乎从未被研究。本研究对现有知识的补充：本研究是首批在学龄前儿童中考察言语清晰度、NSOMs与口颌面功能之间关系的研究之一，将此前主要在较大样本中研究的问题扩展至该年龄组。它将该关系重新构建为间接而非直接联系：以NSOMs为指标的口腔运动能力作为候选中介变量出现，同时存在一种最好理解为共现的言语-口颌面直接关联。本研究的临床意义是什么？若在纵向研究中得以重复，这些发现提示评估口颌面功能可在评估因言语困难转诊的儿童时提供补充信息。反之，当怀疑口颌面肌功能紊乱时，可考虑进行言语筛查。此类筛查将丰富而非替代全面的言语评估。不应假定NSOMs和肌功能训练可直接治疗言语，因为本研究未考察治疗效果。

英文摘要

BACKGROUND: Speech and orofacial functions (breathing, swallowing, and chewing) both develop within the stomatognathic system and share common anatomical structures and motor control mechanisms. Theoretical models suggest that early orofacial motor experiences may shape speech development. However, empirical evidence examining these relationships during the preschool years remains scarce.
AIMS: This study explored the relationship between speech and orofacial functions in preschool children. We hypothesised that this relationship is not direct but indirect, with oral motor competence, operationalised through non-speech orofacial movements (NSOMs), acting as a candidate mediator. We examined (a) whether typically developing (TD) children and children with speech sound disorders (SSD) differ in orofacial functions and NSOMs, (b) the relationships among speech sound accuracy, NSOMs, and orofacial functions, and (c) whether NSOMs predict speech sound accuracy and orofacial functions, and whether orofacial functions predict speech sound accuracy.
METHODS AND PROCEDURES: A cross-sectional study was conducted with 168 French-speaking preschool children aged 3-5; 9 years (118 TD, 50 SSD). Speech sound accuracy was measured using percentage of consonants correct (PCC). NSOMs and orofacial functions (breathing, swallowing, and chewing) were evaluated using standardised protocols (OMES, TEST B, ABPA). Group comparisons were performed using MANCOVA, relationships were examined through partial correlations controlling for age, and multiple linear regression analyses.
OUTCOMES AND RESULTS: Children with SSD demonstrated significantly lower scores than TD peers on both NSOMs (F(1162) = 11.45, p = 0.001) and orofacial functions (F(1162) = 11.66, p < 0.001). Partial correlations revealed significant associations among all three variables (NSOMs-orofacial functions: r = 0.36, p < 0.001; NSOMs-PCC: r = 0.36, p < 0.001; orofacial functions-PCC: r = 0.19, p < 0.05). Regression analyses demonstrated that NSOMs significantly predicted both speech sound accuracy (β = 0.87, p < 0.001) and orofacial functions (β = 0.21, p < 0.001), whilst orofacial functions also predicted speech sound accuracy (β = 0.78, p = 0.015).
CONCLUSIONS AND IMPLICATIONS: Speech and orofacial functions appear interconnected early in the preschool years through a dual pattern: an indirect link, for which oral motor competence (NSOMs) is a candidate mediator, alongside a direct association best interpreted as co-occurrence. These interpretations remain preliminary and require longitudinal confirmation. If replicated, the findings suggest that orofacial screening could inform speech assessment in children referred for speech difficulties, and that speech screening could be considered when orofacial myofunctional disorders are suspected.
WHAT THIS PAPER ADDS: What is already known on this subject Theoretical models propose that speech and orofacial functions draw on shared motor control mechanisms, and that early orofacial motor experience may scaffold speech development. Empirical work has examined this relationship mainly as a direct link, in school-age children and clinical populations. The possibility of an indirect link, with oral motor competence as a candidate mediator, has rarely been explored, and almost never in preschoolers. What this study adds to the existing knowledge This study is among the first to examine the relationship between speech sound accuracy, NSOMs, and orofacial functions in preschool children, extending to this age group a question previously studied mainly in older samples. It reframes the relationship around an indirect rather than a direct link: oral motor competence, indexed by NSOMs, emerges as a candidate mediator, alongside a direct speech-orofacial association best understood as co-occurrence. What are the clinical implications of this study? If replicated in longitudinal studies, these findings suggest that assessing orofacial functions could provide complementary information when evaluating children referred for speech difficulties. Conversely, speech could be screened when orofacial myofunctional disorders are suspected. Such screening would enrich rather than replace comprehensive speech assessment. NSOMs and myofunctional exercises should not be assumed to treat speech directly, since treatment effects were not examined.