環境音提供聽者豐富且有用的資訊去覺知週遭環境，臨床上的研究也指出術前家長及即將接受電子耳移植的患者皆將環境音放入術前期待的重點之一。然而，針對新接受電子耳移植的患者，術後的聽能復健環境音的訓練常常只在剛接受電子耳手術完的初期進行，且通常只訓練少數種類的環境音。環境音訓練未受到太多的重視，相關研究依然很少。本研究的研究目的為 (1)人工電子耳兒童對環境音聽知覺情形 (2)了解經短期環境音聽能訓練後，對電子耳兒童辨識環境音的助益及是否能將效能類化至未經訓練的環境音
本研究以七位電子耳兒童為受試者，接受前測、五週訓練及後測。前、後測中，以四十二種環境音、每種環境音各有四個樣本(共168個環境音樣本)為辨識測驗材料，再選擇個別受試者正確率較低 (等於或小於50％)的環境音種類進行訓練（以下稱為「困難訓練組」），每種環境音兩個樣本作為訓練之用（以下稱為「困難訓練使用組」），另外兩個樣本不進行訓練，作為檢驗類化效果之用（以下稱為「困難訓練不使用組」）。訓練時受試者接受熟悉環境音及環境音辨識兩個階段的訓練。在環境音辨識階段時，每次受試者作答後立即給予正確與否的回饋。研究結果顯示未進行環境音訓練前，環境音的辨識正確率僅約六成五，而環境音訓練可以有效提升環境音的辨識能力。「困難訓練-使用組」的正確率由三成五進步至七成左右，其中以「困難訓練-使用組」進步最多，平均進步了52％（前、後測正確率分別為29％及81％），「困難訓練-不使用組」(即類化組)的聽辨正確率也有明顯的進步，平均進步了15％，此結果顯示訓練效果可以類化至同種類的其他聲音樣本。

Environmental sounds provide a rich and valuable source of information for listeners in establishing their sense of places and events around them. Although accurate recognition of environmental sounds is a major concern for users of cochlear implants, training of environmental sounds is often conducted for a short period time in the early stages of audiological rehabilitation. Only limited number of studies has been carried out on the perception of environmental sounds by implanted listeners. The aims of the present study were (1) to investigate the perception of environmental sounds by children with a cochlear implant (2) to examine whether perception of environmental sounds could be improved with a short-term training.
Seven implanted children were recruited in this study. They were tested in a pretest–posttest design with five training sessions. For both the pretest and posttest, subjects were tested using the entire stimulus set (42 sound sources, 4 exemplars each; a total of 168 stimuli). The training sounds were selected individually for each subject, and comprised one half of the sound sources with 50% correct or less (“Difficult-Trained” group). Two subgroups were further divided: Only two exemplars of each “Difficult-Trained” sound source were used in training (“Difficult-Trained-used” subgroup); the other two exemplars were not trained and used for examining the generalization of training effect (“Difficult-Trained-alternative” subgroup). During each training session, subjects were presented with all trained stimuli first, and then were asked to identify the stimuli. In the identification stage, feedback was given after each trial.


The results showed that the overall average recognition was about 65% in the pretest session, and perception of environmental sounds did improve with training. The biggest improvement was demonstrated for the sound samples used in training. The percentage correct improved 52% in the “Difficult-Trained-used” subgroup (from 29% on the pretest to 81% on the posttest).There was also a considerable improvement, about 15%, in the “Difficult-Trained-alternative” subgroup. The results indicated that training effects could generalize to alternative sounds which were not used in training.

Key word: cochlear implants , environmental sounds , short-term auditory training

目次
目次 ………………………………………………………… i
表次 ………………………………………………………… iii
圖次 ………………………………………………………… iV
附錄 ………………………………………………………… Vi
第一章 緒論 ……………………………………………… 1
第一節 研究動機 ……………………………………… 2
第二節 研究目的 ……………………………………… 3
第三節 待答問題 ……………………………………… 4
第四節 名詞釋義 ……………………………………… 4
第二章 文獻探討……………………………………………… 6
第一節 聽覺障礙與人工電子耳 ………………………… 6
第二節 環境音的重要角色 ……………………………14
第三節 影響環境音知覺的因素 …………………………16
第四節 人工電子耳使用者的環境音聽知覺表現 ………21
第五節 人工電子耳術後之環境音聽能訓練 ……………29
第三章 研究方法………………………………………………33
第一節 研究架構及流程 ………………………………33
第二節 環境音施測及訓練材料的選擇 ………………… 37
第三節 環境音訓練及測驗 …………………………… 40
第四節 資料處理 ……………………………………53

第四章 結果分析………………………………………………54
第一節 環境音聽能訓練之結果分析 …………………54
第二節綜合討論 ………………………………………63
第五章 結論與建議 …………………………………………73
第一節 結論 ……………………………………………73
第二節 研究限制與建議 ………………………………74

參考文獻 …………………………………………………… 76
表次
表2.1 術前術後環境音表現聽知覺統整………………………26
表2.2 環境音聽能研究…………………………………………32
表3.1 受試者基本資料表………………………………………39
表3.2 CAPR聽覺能力階層 ……………………………………42
表3.3 困難訓練-使用組及困難訓練-不使用組之分類表格…47
表4.1 前測環境音知覺情形……………………………………54
表4.2 訓練前後於不同組別(簡單-不訓練、困難-不訓練、
困難訓練)下之平均數與標準差 ………………………56
表4.3 訓練前後於是否用於訓練(「困難訓練-使用組」、
「困難訓練-不使用組」)下之平均數及標準差 ………58
表4.4 個案在各訓練組別之聲音種類，聲音樣本數、前後測
正確率統整………………………………………………60













圖次
圖2.1 聽覺傳導路徑 …………………………………………7
圖2.2 電子耳各部位組件及安裝位置…………………………9
圖2.3 人工電子耳電極在耳蝸內的放置情形…………………9
圖2.4 連續插入取樣法（CIS）訊號處理機制………………13
圖3.1 研究架構圖 ……………………………………………36
圖3.2 環境音編製步驟 ……………………………………… 39
圖3.3 訓練材料分組條件及組別 …………………………… 44
圖3.4 環境音訓練材料分組範例 …………………………… 45
圖3.5 環境音測驗電腦界面範例 …………………………… 48
圖3.6 環境音訓練電腦介面的範例 ………………………… 49
圖 3.7 增加小考選項標準實例 ……………………………… 51
圖4.1 全部受試者於全部環境音、簡單-不訓練、困難-不訓練
、困難訓練之前後測正確率長條圖 …………………56
圖4.2 「困難訓練-使用組」及「困難訓練-不使用組」
之前後測正確率長條圖 ………………………………57
圖4.3 受試者在各組別之前後測正確率長條圖 ……………61
圖4.4 訓練前後的平均正確率折線圖 ………………………63
圖4.5 「簡單-不訓練組」前後測正確率折線圖 ……………64
圖4.6 「困難-不訓練組」前後測正確率折線圖 ……………64
圖4.7 「困難-訓練組」前後測正確率折線圖…………………65
圖4.8 「困難訓練-使用組」前後測正確率折線圖……………66
圖4.9 「困難訓練-不使用組」前後測正確率折線圖…………66
圖4.10 本研究與Shafiro(2008)各組別前後測正確率長條圖
比較 ……………………………………………………70
























附錄
附錄一 受試者同意書 ………………………………………81
附錄二 基本資料問卷 ………………………………………83
附錄三 Shafiro(2008)以頻譜分析頻道數分類表…………84
附錄四 環境音篩選表 ………………………………………85
附錄五 命名統整 ……………………………………………88
附錄六 訓練紀錄表 …………………………………………90
附錄七 42種環境音前後測正確率及分布組別 ……………97
附錄八 施測紀錄 ……………………………………………99
附錄九 環境音辨識測驗及環境音訓練流程 ……………102

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