스크립트 기반 비대면 원격 중재가 실어증 환자의 명사 및 동사 수행도에 미치는 효과

Abstract

실어증은 후천적인 신경학적 의사소통장애로 언어적인 결함을 동반한다(McNeil & Pratt, 2001). 실어증자의 언어 결함은 이해, 표현, 문법, 이름대기, 유창성의 저하를 포함하며 적절한 시기에 치료를 받지 못할 경우, 원활한 의사소통과 사회 활동 참여를 저해한다고 보고되고 있다(Black-Schaffer & Osberg, 1990; LeDorze& Brassard, 1995; Sarno, 1993, 1997). 더불어, 신종 코로나 바이러스감염증-19 (COVID-19)의 확산은 교육, 의료, 사회복지 등 사회 전반에 영향을 주었고(Kim, 2020; Kim, 2020)대면 서비스의 한계를 드러냈다. 우리 사회의 대부분 영역에서 비 대면 시스템의 구축이 필요한 상황이며 언어 재활 서비스 분야도 이를 피할 수 없다. 특히, 발병 후 회복기까지 수개월에서 수년의 기간이 소요되며 적절한 평가 와 치료를 놓칠 경우, 병증의 악화, 의사소통 능력의 저하, 제한적인 사회참여로 이어질 수 있는 실어증 대상자들에게 비대면 치료의 도입과 적용이 필수적이다. 국외의 경우, 실어증 환자 대상 비대면 언어 중재가 지속적으로 이어지고 있고(Cherney & Van Vuuren, 2012; Fong et al., 2020; Tucker, 2012). 신경언어장애 군에서 실어증 환자를 대상으로 한 비대면 치료의 효과적인 적용도 보고되고 있는데(Dekhtyar et al., 2020; Guo, 2017; Theodoros et al., 2008) 특히, 전반적인 의사소통 능력을 높여줄 수 있는 스크립트 기반 중재가 주목을 받고 있다. 본 연구는 실어증자를 대상으로 스크립트 기반 비대면 원격 중재를 적용한 후 중재에 사용한 명사와 동사의 수행도 변화, 비중재 검사도구의 사전·사후 변화를 보고자 하였다. 그 결과 첫째, 스크립트 기반 비대면 원격중재를 적용하였을 때 중재 시 사용한 명사, 동사 내용어의 정확도에서 유의한 증가가 있었다. 이는 스크립트 기반 비대면 원격 중재가 실어증자의 명사, 동사 표현의 정확도를 높여줄 수 있음을 시사한다. 둘째, 스크립트 기반 비대면 원격 중재에 따른 전반적인 의사소통 능력의 차이를 알아보기 위하여 PK-WAB-R 과 K-BNT, ANT를 분석하였다. 중재 후 모든 과제에서 정확도 평균이 증가하였고 PK-WAB-R, ANT 과제에서 통계적으로 유의한 차이가 있었다. 이는 스크립트 기반 비대면 원격 중재가 실어증자의 전반적인 의사소통 능력을 높여줄 수 있음을 시사한다. 셋째, 본 연구에서는 실어증 환자들을 대상으로 스크립트 기반 비대면 원격 중재를 시행하였고, 중재, 비중재 도구의 수행도 개선을 나타내며 실어증 환자를 대상으로 한 원격 평가·치료의 효과적인 적용을 탐색할 수 있었다. ;Aphasia is a speech disorder commonly caused by acquired brain damage. Although accurate statistics on the incidence and prevalence of aphasia patients in Korea have not been reported, previous studies reported that aphasia caused by the aftermath of a stroke was about ⅓ among 119 stroke patients (Laska et al., 2001), and the average stroke incidence rate in Korea was reported as 132,970~229,950 people (Jeon Jung-seon, 1998). Combining the results of the studies above, the incidence of aphasia patients in Korea can be estimated to be about 40,000~70,000 per year. Aphasia with its high incidence rate displays difficulties in processing the overall language domain (reading, writing, and language comprehension and expression) (McNeil & Pratt, 2001). In particular, it has been reported that difficulties in language comprehension and expressions of aphasic people impede smooth communication and active participation in social activities (Black-Schaffer & Osberg, 1990; Hermann, Johannsen-Horback, & Wallesch, 1993; LeDorze & Brassard, 1995; Parr, 1994; Parr, Byng, Gilpin, & Ireland, 1997; Sarno, 1993, 1997). In addition, the spread of COVID-19 emphasizes social distancing and restraint from outdoor activities. This has had an impact on all fields of society, including health care, social welfare, and education (J. Kim, 2020; S. M. Kim, 2020; Sim, 2020). Speech rehabilitation services that emphasize face-to-face interaction between therapists and patients may not be able to continue treatment or even stop treatment (Kim et al., 2020). It can be more fatal to patients with aphasia because it takes months to years to recover from the onset, and if appropriate language therapy and treatment are not continued, it can lead to worsening conditions, a decline in speech and communication skills, and limited social participation. In other words, the introduction and application of non-face-to-face speech therapy for patients with disabilities is essential. Outside of Korea, non-face-to-face treatment studies for aphasia patients are continuously being conducted (Cherney & Van Vuuren, 2012; Fong et al., 2020; Tucker, 2012). The effective application of non-face-to-face treatment for aphasia patients in the neurolinguistic disorder group has been reported (Dekhtyar et al., 2020; Guo, 2017; Theodoros et al., 2008), and in particular, the script-based training that can enhance overall communication skills is drawing attention. The principle of script training is based on the instance theory of automatization (Logan, 1988), and automatization refers to aphasia patients that repeatedly practice words and phrases in a script, store them in memory, and express them verbally. The goal of the training is to improve communication skills in everyday life, and the training method consists of repeating words, phrases, and sentences in a monologue or conversational script. Several prior studies outside of Korea are reporting the effect of script training. Cherney et al., (2008) conducted a script training program, AphasiaScripts™, for three patients with Broca’s aphasia for 30 minutes a day, six days a week, for three weeks. The script training program is a computerized software program in which a virtual therapist presents accurate pronunciation and articulation, and communicates with aphasia patients. The script used for the training is one monologue, two dialogue scripts, 8-10 dialogue sequences, and the number of training words is 40-140. The measure of results was the accuracy of the content used for script training, and after the training treatment, two of the subjects improved in the above. In addition, in the post-interview, the subjects reported improved verbal language skills and increased confidence through script training. Using a computerized script training program, Cherney et al. (2021) conducted Web ORLA (Oral Reading for Language in Apache) for 90 minutes a day, six days a week, for six weeks to 16 training groups and 11 control groups, a total of 27 aphasia subjects. The program is the same as that of Cherney et al., (2008), and the script used for the training is one monologue, two dialogue scripts, 8-10 dialogue sequences, and 40-140 training words. WAB-LQ was used for pre and post-examination, and after the training, the training group had a higher WAB-LQ score than the control group. To sum up the research findings above, it suggests that non-face-to-face script training treatment can help improve speech and communication skills of aphasia patients, which can be considered for its positive application in domestic clinical practice. In conclusion, this study aims to examine the effectiveness of script-based mobile remote training for aphasia patients.