DAY VA HQC T l £ N G VHJT X A Y D \ T N G N Q I D U N G C f f l N H A M C H O T R E D l T ^ T B Q M A Y P H A T A M D O H Q I C H ^ N G T R E A C H E R C O L L I N 1 Van d i chinh am cho tri d j t f i[.]
DAY V A HQC T l £ N G VHJT X A Y D\TNG N Q I D U N G C f f l N H A M C H O T R E D l T ^ T B Q M A Y P H A T A M D O H Q I C H ^ N G T R E A C H E R C O L L I N TS NftllYftN T H I LY KHA PHAM HAI LE Van d i chinh am cho tri d j tfit bo may phat fim hoi chirng Treacher Collin 1.1 H d i chung Treacher Collin (TC) la "m6t r6i loan v i d i truyin uen nhiem sac t h i thuong, gen mang tinh troi, gay roi loan phat trien n i n sq m^t B i i u hign lam sang Id giam san phdn giua mdt, hdm nhd, tai nhd, mat dudng thinh gidc dan t r u y i n vd hd ham i c h " (Nguyen Dinh Nguyen, ykhoanet.com); "xucmg gd md cua ngudi b i n h b i hdp, mdt khdng cd hoc", "todn bp xucmg khung mgt cua benh nhdn d i u khdng phdt trien", hd hdm i c h vd hodc bi khe hd hau Ddy Id "mpt loai di tdt gene rdt hiem, t i lg xuat hign Id 1/50.000 ca sinh nd" ( D i i n dan Ykhoa.net) Nhung tinh uang tie da tdt ndi chung, tie di dang co quan phdt dm ndi rieng, anh hudng chit dqc da cam vd d nhiem mdi trudng khdng hiem, "theo cac bao cdo cua Vign Rang - Ham - Mdt Trung uong, tren cd nude hign cd g i n 200.000 tie bi di tdt ndy." Hang nam d Vigt Nam "cd khoang 3000 ca d i tdt bd mdy phdt dm (cu 500 tie sinh lai cd tie b i d j tdt) Hign Vigt Nam cdn khoang 15.000 tre em bi di tdt khe hd mdi, khe hd ham i c h vd cac d j tdt bam sinh vung ham mdt khac chua duoc p h l u thudf N h i i u tie duqc p h l u thudt t r i vd sau p h l u thudt khdng duqc can thiep tri ligu tdt phdt dm mqt each dung dan, kip thdi, gay khdng it khd khan vd thidt thdi cho tie 1.2 Tinh trang b i d i tdt bd mdy phdt am (BMP A ) khdng chi gdy khd khan cho tie k h i dn uong, hqc ndi md cdn gdy r i t n h i i u khd khan cho tie k h i giao t i i p Tre khdng t h i ndi "trdn vdnh, rd t i i n g " Su d\ dang cua B M P A vd guang mdt k h i i n tie dd cd y thuc v i ve ngodi cua minh thi s8 cang mdc cam, cang ngai giao t i i p N i u khdng duqc can thiep sdm (can thigp t u phat hign khuyit tdt) thi tdt phdt dm cua tie se cang ndng vd cang khd chinh sua Luygn tap phat am dung each, can thigp dung vd kip thdi se gdp phan cai thien dang k i vigc phdt dm, tdng khd ndng giao tiep, gdp phan tao d i i u kien thudn loi giup tie hda nhdp cdng ddng M $ t m d thuc duoc xem Id l i tuong nhat cdng tdc can thigp sdm cho tie khuyit tdt Id su ph6i hqp giua giao vien chuyen nganh gido due ddc bigt, giao vien day t r i binh Xay dyng thuang, giao vien ngdn ngu tri l i i u , chuyen v i i n y te, gia dinh va xa hdi d i thuc hien cac chuang trinh giao dye tre 1.3 Co t h i noi nhung khiem khuyit va d i dang B M P A cua tie bj h$i chung TC co n h i i u d i i m tuong ty voi tie bi di t i t BMPA dang thuang g$p (bi khe ho mdi va hodc bi khe hd h i m ich), tham chi tie bj hpi chung TC cd muc dd khiem khuyit va di dang B M P A n$ng han V i vdy, cd t h i suy doan: mgt nqi dung chinh dm cho tre bi hqi chirng TC cd hieu qua cung s& la ndi dung huu ich de chinh dm cho tre" bj khuyit tdt BMPA Tuy n h i i n , h i | n d V i f t Nam, ca cac y van, hdi chung TC hau nhu chua dugc phan tich, mien ta mdt each k i luang Va keo theo, van d i chinh am cho tie bi hdi chung TC cung chua dugc d i cdp din Vigc nghien cuu tri ligu tdt phat am cho tie khuyit t i t BMPA lau nay, d nude ta, hau nhu chi tdp trung chu y t r j hdu Ddnh l i v i cau am va am v i hoc, chua x i t d i n sy ph6i hop tri ligu ngdn ngu va can thigp tri ligu hanh v i Cdc tai ligu hudng dan thyc hanh can thigp sdm cho tie khuyit t | t hau h i t tdp trung vdo ndi dung can thigp hanh v i Theo tim h i l u cua chiing tdi, hign d Vigt Nam chua cd tai ligu ndo dua danh sach dm - tiing can luygn tdp vd quy trinh tri ligu tdt phdt dm cho tie cd khd khan v i ngu dm ndi riing vd ngdn ngu ndi chung (cflng nhu chua cd tai ligu nao ban d i n vigc tich hop can thigp trj ligu ngdn ngu va can thigp tri ligu hanh y\y N h u dd n i u tiin, xuat phdt tii 57 gid thuyit mqt ndi dung chinh dm cho tre bi hqi chung TC cd hiiu qud cung si Id nqi dung huu ich di chinh dm cho tre bi khuyit tgt BMPA, bdi v i i t ndy ciia chiing tdi ban d i n vigc xdy dung ngi dung, quy trinh, hinh thiic phuong phdp chinh dm cho til bi h$i chung TC d l gdp t h l m m0t gidi phdp cho vigc tri ligu tdt phdt dm cho til bi di tdt BMPA vd xa hon Id cho nhung tii cd khd khan v i phdt dm ndi chung, tiin ca sd quan sdt, nghiin cuu kinh nghigm, chqn mau, phdn tich doi chieu, thii nghigm vd phuang phdp xin y k i i n chuyin gia Nqi dung vd quy trinh, hinh thnrc chinh dm cho t r i bj hqi chung Treacher C o l l i n Do ddc d i i m phdt dm cua tii bi di tdt bq mdy phdt am, vigc chinh dm duqc tudn thu theo nguyin tdc: tirng budc nhd, ddm bde tinh true quan, cu thi; theo quan diim tich hqp, ludn tgo moi trudng ngdn ngii, kit hop tri Hiu ngdn ngtt, gido due hdnh vi vd gido due kT ndng song Cdc nguyin tdc vua n i u s i chi ph6i ndi dung, quy trinh, hinh thuc, phuong phap chinh am cho tre bj hpi chung TC 2.1 Cdc y i u t6 ngu dm vd trinh t y dung d i thyc hign chinh dm 2.1.1 Dya tiin hg thong dm v i duqc nhiiu nhd Vigt ngu hqc thira nhdn vd duqc dua vao ndi dung chuong trinh, sdeh gido khoa day hqc dm van d bde t i i u hqc, chung tdi t i i n hanh Idp danh myc cdc y i u t6 ngu dm d i chinh dm cho tii Trudc h i t dd Id cdc dm v j d l luygn tdp phdt dm Nhung dm v j dugc dua vao danh sach luygn tdp phdt dm gdm 11 nguyen N g d n n g f r so n a m 2011 58 i m don I I , e, e, Y , Y , ra, u , o, o, a, a/; nguyen i m doi lie, nnr, uo/; 21 i m v j phu i m lb, m, f , v , t , t , h d , n , s, z, 1, t , g, z_, c, j i , k , r j , x , Y, h7 v i s i u ngang, huyen, nga, hdi, sdc, n$ng A Danh muc i m - tieng - tir - c i u duqc x i y dung theo nguyen t i c chia nhd timg npi dung v i luygn t i p tir don 16 den phuc hpp V i v i y trinh t u dupe lua chpn sg l i i m (nguyen i m -* phy i m ) -* i m tiet -* tir -* c i u ; cy the hon l i : • Nguyen i m don (hang trudc -* hang sau; cao, hep -* hoi cao, hoi hep -» hoi thap, hoi rqng - • thap, rqng) -» nguyen i m ddi hang trudc -* nguyen i m ddi hang sau -» phy i m (tic - » x i t mdi - • d i u ludi (thing) -» i m m i t ludi -* i m goc ludi -* i m hpng -» i m q u i t ludi; i m khdng b i t hoi -» i m b i t hoi) • A m -» i m tiet (md - • hod m d - • hoi khe"p -» khep; i m tiet khdng cd i m dgm -» am tiet cd i m dgm) -* tir (don - l i y - ghep) -» au (lupng ngin -» d i i ) C • Phan luygn t i p ve digu duqc tien hanh ddng thdi v d i luygn t i p phat i m i m tidt v d i nhftng dang thuc khic nhau, nhu l i p lai, dan xen, ddi chieu timg c i p Ching han, l i p thanh: ong ndu ndu ndu ndu bay di ddu di ddu , rua ri rd ri ram ri rd ri rdm; mua Id td Id td Id td, Id roi Id td Id td Id td, chii chich hat thich thich thich, ljch kich ljch kjch, cgch cgch cgch cgch cgch; l i p v i dan xen thanh: "Meo di hgc ban trua/ Non nan khdng dgi trdi mua ao ao/ Hien che khdng chju nep vao/ Toi vi sd mUi cdn gdo meo meo " ; ddi chieu tung c i p theo nhdm: ca - cd, va - vd, la - Id; bay - bay, md - md; chdy - chay, md - mg; ca - cd, da dd; cdu - cdu, nhd - nhd; nhan - nhgn, md - mg, v.v Hai hdi, n g i , nhat l i n g i sg duqc luygn t i p sau cic ngang, huyen, sdc, ndng Dong thdi vigc s i p xep uat ty i m can luygn t i p cung nhu vigc danh thdi luqng luygn t i p nhieu hay it cung p h i i dya vao myc dich cua mqt nghien cuu chinh i m v i nhftng khao sit vd thuc uang phat i m cua frg mau giao v i d i u tieu hqc (3-7 tudi), cung nhftng khao sit vd thuc Uang B M P A cua doi tuqng sg thy hudng cic nqi dung chinh i m , m i khdng lg thudc Uat t y ciia bang phan loai v i hg thdng h o i hg thdng i m v j nguyen i m , phy i m tieng Vigt; cung khdng lg thudc trinh t y b i i hqc i m van Uong sich giao khoa v i sich giao vien B d i lg Uong mdt hg thdng ngft i m , nhin chung khd cd the x i c quyet phat i m i m X I nao dd khd hon hay d l hem phat i m am X nao dd K h d hay de l i cam nhgn ngudi xet dung tir hg thdng ngft i m khic T h i dy i m Itl (bet, d i u ludi - khe rang) uong udng A n h (thing through, thunder, think, throw) l i khd ddi v d i ngudi Vigt, h o i c c i c digu t i i n g Vigt l i khd ddi vdi ngudi ndi cac tieng A n A u Ngay tieng Vigt, c i c i m l\, z» §/ l i khd v d i ngudi p h i t i m theo giqng phuong ngft B i c Bd, nhung lai khdng khd v d i ngudi p h i t i m theo giqng Xay dung 59 phuong ngu Trung B Q ; hodc phat am phan biet cac hdi ngd ndng khong c6 gi kh6 v o i nguoi n6i theo giong phuong ngu Bac B Q nhung lai kho voi nguoi n6i theo giQng phuong ngu Trung BO, v.v nen sg duqc xep luygn sau nhftng i m khdng mui Hodc vdi nhftng tig bi di t i t khe hd mdi thi cic i m mdi sg duqc luygn t i p sau v i luygn t i p nhidu hon so vdi cac i m ludi, v.v N h u dd neu, dua vao so ligu thu thap ve kha nang phat i m cua tie mau giao va tie dau tieu hoc (so i m tie thuong mac loi v i khdng mac loi rung dd tuoi), tren phuong dign chung cua danh muc c i c i m dung cho luygn t i p chinh i m , chung toi sS xep luygn c i c phy i m nhu I t , v, h t , §, z, %l cho tig luygn cic phu am nhu lb, m, s, h , d , tl v l phit am cic phy i m / t , v , t , g, z., z, trg thuong mdc loi nhieu hon (So ligu n i y n i y khong m i u thuan voi ket q u i khao sit cua cic nhi am ngu tig m i u g i i o v i am ngft tr} hgu Theo cic n h i g i i o dye ngdn ngft tig mdu g i i o v i cic n h i i m ngft trj ligu, d0 tuoi v i nhftng phy am ma tig phit i m duqc nhu sau: "3 tudi: m, n, h, w, p, b; tuoi: d, t, k, g; tudi: ng, d; tuoi: /, s, ch; tuoi: r, s; tudi: th, v " ) ; tig 3, tuoi "biet phit i m phy i m rd rang nhat l i p, b, m, n" Dya tien nhftng trudng hqp mang tinh udc djnh vua neu, rung tie m i n h i i m ngft tri ligu cd kd hoach gido dye c i n h i n rigng bigt phu hqp Chang han vdi tig bi di dang ve ludi, nhftng i m duqc luygn trudc sg l i nhftng i m mdi Cdn cic i m ludi sg duqc luygn sau v i duqc danh thdi gian luygn t i p nhidu hon Ho$c vdi tig bi khe hd vdm hau, thi nhftng i m mui thudng l i nhftng i m khd vdi trg s a u h 10 2.1.2 Tieng (tir) cd i m can luygn duqc chqn theo nguyen tic: tieng (tir) dd p h i i bieu thi sy v i t hign tuqng gan gui, quen thuqc, tranh nhftng tir ngft xa la, khd hieu v i khdng phai l i sy ghep i m luygn t i p mgt cich co hqc V i vigc tri ligu t i t phit i m khdng the t i c h rdi vigc g i i o dye ngdn ngft, giio dye hanh v i , tig chi hqp tac 1 luygn t i p va chi luygn t i p mgt cich thu tig ham thich ngn ngi dung trj l i g t§t phdt am bu0c p h i i l i n0i dung cd "nghia", khdng the u don thuan luygn i m mgt cich mdy mdc, tich rdi chu canh, ngft canh Nhu dd ngu tign, vigc luygn t i p phdt am am tiet duqc sdp xep theo trinh ty tir dm tiet md nhu: cd, me, thu, -* am tiet hoi md nhu: tai, chdu, sao; tir dm tiet hoi khgp nhu: ban, bang, nhanh, -* am tiet khgp nhu: bdt, viet, khdc, ; tir dm tiet khdng cd dm dgm nhu: la, he, khi, -» dm tidt cd am dgm nhu: loa, hoe, khuy Vd tuong ty sau luygn t i p phdt dm tir don tiet -* luygn tdp phdt i m tir da tiet Trong luygn phat am tir da tiet thi luygn tir tir ldy -» tir ghep Trong luygn phit dm tir ldy thi tir tir ldy hodn todn dang dien hinh: xinh xinh, xanh xanh, nhd nhd; dd, nho nhd, tim tim, -* dang khdng didn hinh: mum mim, chum chim; long lanh, dem dep, ; -» tir ldy van: boi N g d n n g i r sd n a m 1 60 roi, co ro, hoi hd; lao xao, lang thang Idc ddc, -» tir lay am: ri rao, nho nhe, nhanh nhen; khdp khinh, hdp benh, Rdi den luygn phat am tir ngir ghep: xe may, hon da, duong pho, gd, an com, v.v 2.1.3 Ngoai ra, cho tre luygn t | p phat am cau (chudi am n i t ) thi nhihig bai ddng dao, nhirng bai tho co am digu vui tuoi, gidu nhac tinh, d l thugc, nhu: Mdy xanh xanh xanh xanh xanh, ong bay nhanh nhanh; Ri rd ri rd, ddi nhd di choi, den toi trdi, up nhd ndm ngu, sg dugc chii y lua chgn 2.2 N g i dung, quy trinh, hinh thuc, bign phap chinh am Be chinh am cho trg bj hgi chung TC, khdng t h i chi day phat am ma cdn phai phdi hqp thuc hign cdc ngi dung luygn nghe, luygn phan bigt am thanh, luygn tap v$n dqng bg may phit am, luygn tdp cdc dm t i i n ngdn ngu uong su k i t hqp hdi hda thdng nhat v d i tri ligu ngdn ngu (nhu m d rgng vdn tir, giao dqc hanh v i ngdn ngu, ) vd gido dqc k i ndng sdng, gido dqc hdnh v i ndi chung 12 Vigc xay dung danh sach vd nhat Id t i i n hdnh tri ligu, xuat phdt tir quan d i i m tich hqp vd quan d i i m giao t i i p , chung tdi khdng theo tuan t u h i t nguyin dm sang phy dm, h i t Vigc td chuc chinh am sg theo cdch thuc dirng l d i ket hqp v o i cdc phuong tign day hoc n h u dd choi, m i u vgt, tranh anh minh hqa vd td chuc trd choi, nhu cdc trd: Phun mua, Ddnh dan ludi, Thdi bong bdng xa phdng, Gpi gd, Vgt tim bgn, v.v Chdng han, v d i ngi dung luygn phdt dm nguyen dm cd kem luygn giqng, gido v i l n ( G V ) lam m i u v d hudng d i n t r i Idp lai bang each m d i ru: "Cd vd cung hat xem hat hay hon nha?", tuygt ddi uanh dirng cdu Ignh k i i u nhu: "Hay xem!", "Hay "Hay lam theo cd!", ) Vigc t r j ligu cung dugc t i i n hanh sy phdi hgp cac phuong phdp: day qua Ud choi, bang Ud choi; day qua tranh dnh; lam m i u , bdt chudc m i u ; t i i p xiic vdi mdi trudng xung quanh; gido due cd bigt hod k i t hgp gido due uong nhdm nhd; k i t hop ren luygn kT ndng van dgng tinh; day tir don gian d i n phuc tap, thudng xuyen Idp lai, cung cd cdc ngi dung (Nhung ngi dung dugc trinh bay dudi ddy, vira cd tinh quy trinh (22.1 -»2.2.n; 2.2.1.a-*2.2.2.n) vua cd tinh tich hqp) am v j sang van, d i n dm t i l t , d i n tir 2.2.1 Luyen nghe vd luyen phdn md k i t hqp giua luygn tdp phdt dm biet dm dm lan phat dm tiing, tu, cau cd dung luqng ngan theo phuong chdm: ludn ludn tao mdi trudng giao t i i p ngheP\ Luy in chu $ nghe dugc tiin hanh v d i ngi dung nghe t i n gqi vdt, nghe dm md vdt phdt (chudng d i i n Xay dung .61 thoai, cdi xe, ) va gan quyen vdi hoat dqng luygn phan biet am 2.2.2 Luy$n vgn dgng bg mdy phdt dm qua t i n gqi vat, hoat dqng, tuc t u chi V$n dgng bg may p h i t i m giir vit, ho$c t u chi hoat dqng co c i u true vai trd quan trpng ddi v d i vigc phit am tiet tuong tq bq phan nao i m V d i tii di dang BMPA, can phai do, thi dy gidng am d i u , khac van: danh sy chu y die bigt cho ngi dung sau-sdc- niy Nhirng ngi dung luygn v i n dgng sdi; trdu - tran - trang; gidng van, khic am d i u : gd-cd- rd; trdu - sdu - rau; gidng i m doan, khac thanh: nhdn - nhdn - nhan; cd-cd- ca; phan biet i m qua udng keu cua vit/ v i t : meo (keu meo meo), chd (sua gdu gdu), g i trdng ( g i y d d o), d td (bin bin), tau hda (keu tu tu), bang each dung dd choi, mau v i t thit va cac phuong u?n ho trg khic (Tuy nham myc dich luygn nghe v i luygn phan bigt am nhung nhung tir duqc uu tien lya chqn l i nhirng tir bieu thj sy vgt hign tuqng, hinh dqng, trang thai g i n gui v d i tri v i cd the minh hqa duqc bang tranh anh hoic v i t that; bang phuong thuc Ud choi h o i , thi dy thi tim v i t qua tieng keu, thi tri ldi nhanh c i u hdi "AT keu thi ndo", td chuc Ud choi "Xgpi bgn /Xchdo bg m i y p h i t i m gdm: a) Luygn ham dudi: Hudng d i n tii h i migng ldn -» n g i m migng lai (lam nhanh din); dua ham dudi qua lai ben (lam nhanh din) b) Luygn mdi: Thyc hign dgng tic gqi g i ; lam dgng t i c phun mua: trdn migng; chum trdn mdi, dua mdi ve phia trudc; chanh mdi v i mep sang trai, sang phai; lam dqng tic thdi lua: chum trdn mdi rdi dua sang trai, sang phai, lam dqng tic mim mdi, dua mdi dudi ra, tie mdi, dua mdi dudi v i o c) Luygn rang: Chip hang ring cua -* nhe ring; nhai nhe bang hang ring cua; d i t rang cua ham tiin l i n phan mdi dudi -» vira thd hoi migng vira bit mdi dudi v i h i migng bgn", "Dgn den nhd mdi, lam quen d) Luygn ludi: H i migng -» dua bgn mm", v.v B d i lg, chi cd thd ldi ludi phia trade thit d i i -» thyt cudn tri luygn t i p tie hidu v i cd nhanh lai; h i migng -* dua ludi thu M$t khac, day cung l i sy phia trade t h i t d i i -* thyt lai tir tir; hign thyc h o i nguyin tic tich hqp dua d i u ludi sang hai b i n mep; dua giao due ngdn ngir Nhirng sd ligu chung diu ludi vdng theo hai mdi; chit ludi tdi thu thip dugc qua thyc td chinh tieng k i u ; rung ludi (gidng nhu i m cho til hoan toan phii hgp vdi phit i m i m 111 l i i n tyc); rung ludi dieu n i y ) v i b i t ludi l i i n tyc N g d n n g f r sd n a m 62 e) Luyen ngac mem: Lam dong 2011 chut chut, gqi gd: hdp hdp hdp, chap tac ho (dang hang nhe); ngiia mdt chdp chap; nhai tieng cdi xe: pin pin, sue migng; migng, hit hoi vao mui bin bin; udng gd: ooo; thd migng, hit hoi vao migng thd meo: meo meo meo; qua: qua qua, qua mui qua qua; tieng tau vao ga: uuu; choi 2.2.3 Luyen ho hdp vd luyen de: be be be; gid vd: u da u da, v.v 2.2.5 Luyen tgp phdt dm Cac nqi dung vira neu d cac myc Bgn canh luygn van dqng bg may phat am, vigc luygn ho h i p va 2.2.2, 2.2.3, 2.2.4, duqc tien hanh luygn giqng cung duqc cdc nhd dm ddng thdi vdi luygn tiip phdt am theo ngu Ui ligu quan tam Nqi dung duqc quy Uinh: am -* tieng -* tir -* cdu chiing toi lua chqn gdm: thdi b6ng (nhu dd ngu d myc 2.1.), tuan thu bay, thoi bong bong xd phdng, thoi theo nguygn t i c : timg buoc nhd, tich cdi, thoi cdc nude (thdi nhe -* manh); hop, ludn tgo mdi trudng hit vdo thdt sdu rdi thd tir tir; phdt kit hop vdi tri lieu ngdn ngu ndi chung am ldn luqt cdc am theo "kieu giai kit hgp vdi gido due hanh vi vd gido digu": ; ; i I i i i i i i i, o o o d o d o due kT ndng sdng V d tien hdnh Uong o, Neu ttg td cd thii vdi sy phdi hqp v d i cdc phuong phdp: am nhac thi khai thac tdi da vigc luygn dgy qua trd choi, bdng trd choi; dgy giqng v l nd sg ho Uq nhieu cho vigc qua tranh dnh; Idm mdu vd chinh am ddn tre bat chudc mdu; tdng tiip xuc 2.2.4 Luyen phdt dm cdc "dm tiin ngdn ngir" Cdc dm tien ngdn ngir Id qud ngdn ngu, hudng vdi mdi trudng xung quanh; gido due cd biet hod kit hop vdi gido due nhdm nhd; kit hop ren luyen kTndng Uinh t i t yeu ciia qua ttinh phdt trien vgn dgng tinh; dgy tir don gian den ngdn ngir ndi ciia tie V i vdy, vdi phuc tgp, thudng xuyen Idp lgi, cung nhirng tie cd khd khan ve phdt dm, cd cdc nqi dung Dong thdi vigc sii luygn tgp cdc am tien ngdn ngir Id dung cdc ling dung cdng nghg thdng mqt nqi dung can yeu khdng the bd tin de ho trq vigc t r i ligu tilt phdt dm qua Nhirng dm duqc lua chqn cho cho trg cung sS duqc chii y su dyng 13 tie luygn tdp gdm: thdi: phii phii phu; Sau day Id mqt vdi thi dy vd ngi ndi: mdm mdm mdm; ma ma, cha cha; dung luygn tdp phdt am (cd kgm theo chit ludi: chdc chdc chdc, chdt chdt anh rninh hoa dd duqc chuan bj vd su chdt; hdn cd phdt am thanh: chut dyng tien hanh cho tie luygn t$p) Xfiy dung 63 Thi dy (1): Luyen phat am am HI Buoc 1: Luygn phat am am - i , vira phat am ri6ng bigt va vira luygn giong theo kieu phat am HI theo cac c u n ^ m b e S c c a o ^ ^vrj vavdvavdvd, Xay dyng 65 Budc 2: Luyen phat am am Uong tieng (tir) M o rpng: vi, vi, ve, ve, ve, voi, vit vu, vui, vudng, vang, viet, vi$c, Buoc 3: Luygn phat am am Uong cau, Uong doan - Ve ve, vd vi vui ve vdng ve Vui vui he vi Ve ve he vi Thu* nghigm chinh am cho tre dj tat bo may phat am hgi chirng Treacher Collin 3.1 Tren co sd t i m hieu d£c diem co quan phat am, ddc diem ngir am ciia tie d j tilt bq may phdt am hqi chung TC, d£c diem tam sinh l i ciia tie, chung tdi tien hanh xay dung nqi dung, quy uinh vd tien hanh thu nghigm chinh dm cho tig B i tuqng nghien cuu ciia chiing tdi Id bg L M T , sinh 12/11/2003, be bj hqi chung TC, b'\ bd roi (song d lang Hda Binh, Khoa Phyc hdi chiic nang, Bgnh vign Tir Du, Hd Chi Minh) Qua quan sdt, chiing tdi thay bg L M T mang day dii cdc ddc diem dien lilnh ciia ngudi bj hgi chung TC (nhu dd u i n h bdy d myc 1) Ngodi hqi chung TC, bg L M T cdn cd nhirng bieu hign cua chiing A D H D (Attention deficit hyperactivity disorder), nhu N g d n n g f r so n a m 2011 "kh6 tri su tgp trung", "khong cham chu vao nhung diiu nguoi d6i thoai dang noi, khong theo ddi cac hudng d i n va khong lam het bai tgp", "mien cudng tham gia vao cdc hogt d0ng", "dg bi Idng bdi nhung kich thich ben ngodi", "ddng h i cdc hogt dpng hdng ngdy", khd ndng ghi nhd kem (Trdn Vdn Cdng, Tdm benh hqc tre em vd thiiu niin) (Mpt vdi be" khdc bi di dang B M P A md chung tdi tien hdnh thu nghigm t r i lieu theo npi dung luygn tgp ugn cung kgm mgt vdi chung bgnh khac lign quan d i n nhgn thuc, harm v i , nhu thieu ndng tri tug muc nhe, hodc A D H D ) Su dung test Denver, test IQ Raven danh cho trg - tuoi, vd dqa theo test ngdn ngu ciia Moira Pieterse, Robin Treloar vd Sue Cairns (1989), chiing tdi bign soan test khd ndng ngdn ngu ciia Ug (3-4 tuoi, 5-6 tuoi), va tien hanh danh gid kha ndng ngdn ngu, rihan thiic xd hpi cua Ug L M T Ket qud khdo sdt cho thay khd ndng ngdn ngu ciia tie L M T kem; khd ndng nhan thiic, xd hqi cung phdt h i i n chdm hon rat nhieu so v d i dq tuoi sinh hqc Ngdn ngu vd nhdn thiic xd hqi cua Ug chi tuong tuong v d i tie 2,5 tuoi Do B M P A bj di tgt ndng, ngn Ug phdt am rat kgm: tat cd cdc phu dm, nguyen am ddi vd rat nhieu nguygn dm don nhu le, O,Y, Y / , trg deu khdng phdt am duqc Tuong tu, tat cd cdc tieng cd phq dm dau vd cdc tieng khdng cd phy am dau nhung cd nguygn dm ddi, cd dm dgm hodc cd nguygn dm le, o, Y , f l , Ug deu khdng phdt dm duqc Mdt khac, luong hoi ciia Ug rat yeu Tre chi cd the ndi rung dm tiet mqt 3.2 Ngodi vigc thyc hign cdc nqi dung vd quy trinh chinh am nhu dd uinh bdy d myc 2, v l L M T cdn b\ chung A D H D , be it tgp trung theo GV, nhat Id GV yeu cau Idp lgi, ngn tien hanh cdc nqi dung chinh dm cho bg L M T , G V ludn phdi thay doi Ud choi, thay doi nqi dung vd hinh thiic Mdt khdc, tien hdnh tdc dqng Uong nhdm nhd toi thieu (2 Ug), kha ndng chii y, vigc luygn tgp cua Ug khd hon so v d i tdc dqng v d i mqt minh Ug Hon nua, thyc hign nhung nqi dung vua ngu Ugn, neu chi bang cdu lgnh "Hay lam theo co!" cung hinh thiic tdc dqng cd bigt hod, nhu v d i Ug binh thudng (vd nhu nhung chi dan Uong nhieu tai ligu Ui ligu tgt phdt am) thi tie it chiu hqp tdc Thdnh thii, thyc hign cdc nqi dung chinh dm, GV dd phai khdng chi thay doi cdu lgnh mang tinh dqng vign khuyen khich trg md cdn co gang "Ud choi hod", tac dqng Uong nhdm nhd de ldi cu6n Ug hqp tdc vdi minh Sau day Id mqt vdi so ligu so sdnh thdi gian chii y cua tie tdc dqng cd bigt hod vd tdc dqng Uong nhdm nhd v d i hinh thiic dung l d i ndi kgm phuong tign ho tig (do choi, tianh anh, mau vgt) vd to chiic Ud choi (duqc tinh theo muc dao dgng trung binh cua cdc lan Uong qud trinh tien hdnh thii nghigm): Xay dyng 67 TJidijrian chii y (phiit) Ca biet hoa (lue) Nhdm nhd (2 tig) Nhdm ldn (>3 tie) Loi n6i thuan tuy, khong kem phuong ngn ho trp va khong to chiic trd choi 0,0 - 0,5 0,5 - 1,0 0,0 - 0,5 Loi n6i kem phuong tign ho tip, nhung khdng to chuc U6 choi 0,5 - 0,75 0,75 -1,25 0,0 - 0,5 Ldi ndi kem phuong t i f n ho Uo va to chiic Ud choi 2,0 - 2,5 2,5-3,5 0,5 - 0,75 Phuong tien Xuat phat tii ddc diem tri nhd hinh anh cua tie t6t hon tii nhd am (ngdn ngu) va tiin dung the manh ciia cdng nghg thdng tin, de gay thii va tang su hqp t i c cua tie, chiing tdi sii dung kem theo mpt vai phuong tign dign h i ho tip (hinh anh tinh va dpng kem am thanh, dd "nhan vgt chinh" la tie cung ban be va ngudi than quen cua tie) N h u da u i n h bay d muc 2.1.2, "tieng (hi) cd am can luygn duqc chqn theo nguygn t i c : tieng (tii) dd phai bieu thj su vat hign tuqng gan gui, quen thuqc, tranh nhihig h i ngir xa la, khd hieu va khdng phai la sq ghgp am luygn tap mqt each co hqc", Uong q u i Uinh thii nghigm chinh am cho tig, chiing tdi da tien hanh so sanh doi chung giira vigc dgy tig phat am cac tieng (hi) cd nghia, gan gui v d i tig, xa lg vdi tig va nhirng 3m, tieng vd nghia Trg chi chii f va hqp tiic v d i giao vign tieng (tir) luygn tgp gqi tgn nhirng su v§t gan gui, quen thugc va nhat la gqi tgn nhirng su vgt, hign tuqng tig ua thich D u d i day la bang so sanh dq chii y va tinh tir giac phat am ciia tig doi vdi cdc logi am - tieng - tir ^ ^ D d chii y va tinh t u gidc Logi am, t i i n g , tir Dq chii y (thdi gian= phut) Tinh tir giac phdt dm Chi ngu lgnh (1 lan) Phdi nhdc nhd nhieu ldn 0) (2) 0) (2) Gqi tgn doi tuqng quen thugc 0,5 - 1,5 Gqi ten d6i tuqng quen thugc va ua thich 1,0-3,5 15 0 Gqi ten doi tuqng khdng quen thuqc 0-0,5 Tir gia (tieng vd nghia, thi dq: the, re, dd, ) 0-0,5 0 Chii thich: (1), (2): s6 t i i n g phdt dm toi t h i i u vd toi da tig hqp tdc thqc hign cho mqt nqi dung chinh dm N g o n n g i r so n a m 2011 68 Viec xay dung npi dung chinh am cho tre, duoc tien hanh ddng thai voi vigc t i m kiem cac phuang tign hd tip chinh am va each thuc tac dpng khien tie hpp tac - th\rc hign cac bai tiip chinh am So sanh muc chu y (tinh theo thoi gian) cua tig dung phuong tign dign tii hd tip chinh am v o i k h i dung phuong tign thong thuong (tranh, anh, bang chir, dd choi, gucmg soi) kem loi noi va chi dirng l o i n6i cho npi dung huan luygn chinh am, chung toi thu dupe cac ket qua sau: Thdi gian Dp chu y Phuong tign L o i noi (thuan tuy) - 0,75 L o i noi kgm phuong tign thong thuong 1,0-1,5 Loi noi kgm phuang tign dign h i hd tip chinh am Ghi chu chu y (phut) — 2,0 - 5,0 Dupe tinh theo muc dao dqng cua lan cho mqt nqi dung tii ligu Vigc kiem tra dq chii y ciia tig cdn cung cap thgm thdng sd: k h i sii dung phuong tign dign h i ho trq chinh am, tig ndi nhieu han, t u giac ndi hon so vdi GV luygn chinh am theo kieu truyen thdng ( G V dirng l d i va ygu cau tig lam theo, ndi theo) Theo tinh toan so bq, tig ndi nhieu gap - lan so vdi diing l d i va phuong tign thdng thudng Hon nua, tie tir giac ndi, khdng dqi GV ygu cau nhac nhd (nhu GV dung each thiic va phuong tign tac dqng truyen thdng) D u d i day la sd ligu ve nqi dung vira ngu So sanh tan sd l d i ndi ciia tig su dung phuang tign dign h i ho trq chinh am v d i su dung l d i ndi va phuong tign thdng thudng: Phuong tign So lan tie ndi/1 nqi dung tac dqng L d i ndi 0-1 Ldi ndi kgm phuong tign thdng thudng 0-1 Ldi ndi kem phuong tign dign tii hd trq 2-5 So sanh tinh tir giac (phat am) ciia tig dung va khdng dung phuang tign dign h i ho tiq: Xay dung 69 Phmrag tign l y giac noi (khong Khong tu giac noi can nhac nhd) (GV phai nhac nhd) Led n6i — + Led n6i kgm phuong tign thdng thuong - + Loi n6i kgm phuong tign dign h i h5 ug- + - Tuy nhign, theo chung tdi, dg chii y cua Ug k h i G V dung phuong tign dign h i de tac dgng cao hon (so vdi cdc phuong tign khdc), cd the cdn ddy Id phuong tign "la" doi vdi Ug K h i xem nhirng doan phim quay ve Ug, Ug td thu ddc bigt, Ug t u gidc ndi, ndi nhieu hon gap 2, lan so v d i Ug xem cdc doan phim hoat hinh Cd hign tuqng nay, cd lg khdng the gat bd nguygn Ug t h i i u hut tinh cam cua bo me, gia dinh; t h i i u hut cd nhirng y i u to binh thudng von cd cua ddi song ngudi " T h i g i d i " ciia trg hau nhu chi bd hep Uong b6n biic tudng cua khudn vign bgnh vign, khuon vign co sd h i thign, ngudi than quen cua tre Id cdc bac sT, hg li, diiu dudng vien, va nhirng ban bg cung canh ngq 3.3 Qua thdi gian thii nghigm chinh am cho Ug vdi nhirng nqi dung va each thiic nhu dd Uinh bdy, chiing t6i nhdn thay khd ndng d i i u k h i i n ludi, mdi, hdm, vd ngir ndng cua tre thay doi rd rgt (tuy thdi gian thii nghigm chua n h i i u , m d i thang), cy t h i Id: h i khdng thuc hign cdc bdi % luygn vdn dgng B M P A trg thyc hign GV ygu cau; tir vigc t h i i cdi, thoi bong bdng rat kgm (luong hoi y i u vd rat ngdn, thdm chi nhirng buoi tdp luygn ban dau, M T khdng ngam duqc cdi, migng bg thudng hd vd thudng chdy ddi), tie dd thoi gidi (ngam duqc cdi, luong hoi manh hon, ddi hon); tir khdng phdt dm duqc nguygn dm ddi, den trg dd phdt dm diing vd rd ba nguygn dm ddi ia, ua, ua; tir cho khdng phdt am duqc cdc nguygn dm u, e, e, tig dd phdt dm duqc, tir khdng phdt am duqc bat c i i mqt phy dm ndo Uong so 21 am v j phy dm cua tiing Vigt, tig dd phdt dm duqc am v j phy am lb, m, n , d , hi; thinh thodng, tig ndi duqc chuoi - dm t i i t (Minh Thanh ne, Co Giang ddu roi, Xong rdi ne); tir cho chi biep Idp lai ldi GV d i n thinh thodng ty gidc biit chao gdp mdt vd chia tay, biit "da" nghe gqi, Tir cho khdng b i i t dung cdu hdi, cdu cdu khien, khdng hieu cdu hdi "cd khdng", hign (8/2010), tig dd biet dirng cdu hdi, thinh thodng b i i t dirng cau cau k h i i n , h i l u duqc cdu hdi "cd khang (chua b i i t t y ddt cdu hdi "cd khdng) V n tii cua tig duqc tdng thgm, vd nhdt Id sy tri nhdn v i mdi trudng xung quanh cua tig duqc ndng cao rd rgt N g d n n g f r so n a m 70 2011 Hpi chii Thdp VietNam, Operation Ket luan Qua ket qua budc dau thu duqc, cd the ndi rang vigc su dung cdc bdi tap vd cdc nqi dung luygn tdp (luygn Smile Vigt Nam dem ny cudi din vdi trg tho, http./Avww viett ht.vn/red cross/ vn/home/ InfoDetailjsp? area=l& cat= 1077&ID=2055 chu y nghe, luygn vdn dgng bq mdy phdt am, luygn am, ) phoi hqp mqt Nhung npi dung vd quy trinh, hinh each hai hda khdng tach rdi, thuc hign thirc, bien phdp dupe md td dudi day chia nhd ygu cau, nqi dung; thuc hign oang dupe chung toi ciing mpt nhdm sinh Idp lai, tien hdnh qua trd choi vd bang vien Khoa Gido due Mdm non Trudng DHSP Ud choi, k i t hqp giua tac dqng cd bigt Tp Ho Chi Minh tien hdnh thir nghiem hod vd tac dqng Uong nhdm nhd, tgi Idng Hda Binh, Khoa Phuc hoi chuc Id nhung nqi dung vd bign phdp huu ndng, Benh vien Tir Du, thdnh Ho higu de t i i n hdnh chinh dm cho Ug Chi Minh Mdt khdc, k i t qud cung cho thay vigc chinh dm sg thu duqc k i t qud khd quan nd duqc t i i n hanh cung vdi nhihig nqi dung can thigp sdm khac (nhu can thigp hanh v i , trj ligu ngdn ngir ndi chung: m d rgng von tir, su dung cau ngdn hanh, hanh v i ngdn hanh, ) Viec tach dm v/ de luyen tgp a day chi cd tinh tuang doi, nhdt Id luyen tgp phdt dm dieu vd luyen tgp phdt dm phu dm, tinh chinh the cua cdu true dm tiet tieng Viet, nu)t khdc d$c diem dieu vd nguyen dm la hai thdnh to khdng the vdng mgt cdu true dm tiet tieng Viet - chung tdi Ngoai ra, ta cd the ndi ring khdng theo gidi phdp dm ddu, dm dem vd dm t h i tham vqng ld gich hod, l i cuoi co the vdng mdt cdu true dm hod tat cd Tuy nhign, Uong U j ligu tiet Them vdo do, nhu dd trinh bay, tdt phdt dm ndi rigng vd t r j ligu tdt muc dich cua nghien ciru tri lieu tgt phdt ngdn ngir ndi chung cdn co gang tao dm nen viec tach ndy nhdm luygn tdp d i i u kign cho cdc y i u to phdt t r i i n chinh am mqt cdch chuyen bigt hod mqt cdch t y nhien, nghia Id tao d i i u Ciing ddc diem cdu tgo cua dm tiet kign cho Ug khuyit tdt duqc s6ng tieng Viet, chiing tdi khong tdch cdc dm mqt ddi song tinh thdn, ddi sdng ngdn cudi de luyen tgp rieng biet md ket hop ngft thudn Iqi thi ngdn ngft ciia Ug luyen tgp phdt dm cdc khuon vdn sg cd thgm co hqi duqc cdi thign, duqc phdt h i i n vd dm tiet Theo bdi hat cho tre mdu gido S CHU THICH ' Xin xem http://www vn/ Tianyon/Index.aspxl Nhung bdi ddng dao, ve, tha, si dugc tienphong chii y khai thdc cho tre luyen tgp Tha Nguyin Hoang Mai Xay dyng Viic lya chon phat dm cdc dm, dm tiet, chudi dm tiet theo trinh tit nhu 71 ndo dgt vdn de dm ndo phdt dm khd hon dm ndo mQt hi thdng ngu ami viia trinh bay dupe chung tdi dya tren Ddn theo Nguyen Tuong Anh, Thac nhirng nghien cuu ve khd ndng phdt dm si Ngdn ngu tri liiu, ciia tre lua tuoi mdm non, tre mdu gido Be" n6i ngong? Giiip be" the nao? http:/ (trong cdc tdi liiu phdt trien ngdn ngir /www concuame com/index.php?option= cho tre mdm non); nhdt Id dyca theo sd com_content&view=article&id=75&It li?u dieu tra ve khd ndng phdt dm ciia e 150 tre mdm non (3, 4, 5, tudi) a TP Ho Chi Minh (do chung tdi vd nhdm sinh vien Khoa Gido dye Mam non Truang DHSP TP HCM, tien hdnh vdo thdng 4-5/2010), vd sd liiu dieu tra ve y thiic dm vf cua 161 tre (4, , tudi vd tuoi, ndm 2009 - 2010) a dia ban Qugn vd Qudn TP Ho Chi Minh cua Huynh Mai Trang (nghien ciru sinh Dgi hoc Ty Vuong quoc Bi, mdt nghien ciiu chua cong bo) Qua so li$u dieu tra, chiing tdi nhgn thdy tre mdc ldi phdt dm a timg mdng nhu sau: phy dm > nguyen dm, nguyen dm ddi > nguyen dm don, phy dm xdt > phy dm tdc, phy dm gdc ludi > phy dm mdi, qudt ludi > phy dm khdng qudt ludi, phy dm bdt hoi > khdng bgt hai (ddu > de chi miic nhiiu hon > it hon); hai hdi nga, nhdt Id ngd bi phdt dm sai nhieu hon so vai cdc cdn lgi; dm tiet cd dm dim bi phdt dm sai nhieu han so vdi dm tiet khdng cd dm dim (tren 90% sd tre 4-5 tudi phdt dm sai cdc dm tiet cd dm dim, trin 70% sd tre 4-5 tuoi ConCiiaMe.com, mid=ll 10 Xin xem @ Dien dan nhjp ciu y khoa, Phdng ngira rdi loan ngdn ngii cho tre em, http://www treem net/ apm/ index.p hp?menu= detail&mid =47 & nid=252 Ket qud ciia mQt khdo sdt mdi day ciia chiing tdi ciing mdt sd sinh vien ciia Khoa GDMN, Truong DHSP Tp HCM vd ket qud khdo sdt ciia Huynh Mai Trang, nhu dd neu chii thich 7, ve thyc trgng phdt dm cua tre mdm non cung thu dupe kit qud tuong ty: tren 95% tre tuoi khdng phdt dm dupe cdc phy dm / t , X, t c, %/, tren 80% tre h tuoi chua phdt dm dupe cdc phy dm / f , v/; 35% tre tuoi chua rd cdc dm /t, s, I/; tren 98% tre tuoi ldn ldn hai hdi/nga, Tren 75% tre tuoi chua phdt dm dupe dm tiit cd dm dim, " Do gidi hgn phgm vi tri lieu tgt phdt dm nen vdn de tri liiu ngdn ngu tien hdnh tich hpp vdi gido dye hdnh vi, chiing tdi si ban den mQt bdi viet khdc, cd dieu kiin 12 O cdc tdi lieu luyen ndi cho tre phdt dm sai ngd, tren 60% tre 6- mdm non vd mdu gido cung thudng neu tuoi phdt dm sai nga), v.v ten cdc hogt ddng * Cd li day la nguyen cua hiin trgng hdu nhu chua cd mQt nghien ciru 13 Chiing tdi dang xdy dyng cdc hinh dnh tfnh vd dong (cdc video clip) N g d n n g i r s6 n a m 72 di hd trg chinh dm Hau het cdc hinh dnh minh hog bdi viet dugc khai thdc tie nguon Internet TAl LI$U THAM KHAO Bg Gido due vd Ddo tgo, sach gido khoa vd sach gido vien Tieng Viet 1, Tgp 1, 2, Nxb GD, H, 2006 Trdn Van Cdng, Tam benh hoc tre em va thieu nien, http://ww w webtretho.com Vu Thf Bich Hgnh, Ddng Thdi Thu Huong, Huong dan thuc hanh am ngir Ui lieu, Nxb Yhgc, H, 2000 2011 cham sdc va luygn ndi (Sach dung cho cha me vd cgng tdc vien ngdn ngu trj lieu "Harelips-care and talking practicesb Handbook for parents and language therapeutic collaborators") 10 Vuong Hieu Li, Hoang Dung, Ngir am tieng Vigt hign dgi, Nxb DHSP, H, 1993 11 Nghiem Chi Phuong, Bai giang dj tat bam sinh vung mat, http./Avww slides hare 12 Dodn Thien Thugt, Ngu am tieng Vigt, Nxb DH&THCN, H, 1977 VO Thf Bich Hgnh, Luygn ndi cho tie bj khe hd vdm migng Nxb Y hgc, 1988 Nxb GD, H, Cao Xuan Hao, Am vj hoc tuyen tinh, Nxb DHQG, H, 2001 vi Hgi chung Treacher Collin, d j tilt Ngd Van Luong, Rdi loan tang dpng giam chu y, httt/Avww.ykhoa netcom 15 Cdc tdi lieu vi giao due tig Gray Miller, Goi y ve ngdn ngu trj ligu, trich Autism, love to know com, Nguyin Tudng Anh djch, Con CiiaMe.com Moira Pieterse and Robin Treloar with Sue Cairns, Tung budc nhd mpt, Dgi hgc Macquarie, Sydney, 1989, Ton Nu Thuy Nhung dich, Trung tdm NCGD Tre khuyit tdt Tp HCM, 1998 Nhd xudt bdn Quy* bdo trg tre em Vi^t Nam, Vu Thi Hgnh, Dgng Thdi Thu Huong (dfch), Khe hd vdm migng 13 Under, Ngir am hoc dai cuong, 1964 14 Dien dan ykhoa.com cdc bdi vung mat khd khan ve ngdn ngir tren cdc trang: • http://www.autismusaba.de - http://www.codeproject.com - http://www.concuame.com - http://en.wikipedia.org/wiki - http://vnspeechtherapy.com - http://www.teaccher - http://www.the nurture group nework - http://www.treem.net ... mqt ndi dung chinh dm cho tre bi hqi chung TC cd hiiu qud cung si Id nqi dung huu ich di chinh dm cho tre bi khuyit tgt BMPA, bdi v i i t ndy ciia chiing tdi ban d i n vigc xdy dung ngi dung, quy... dang B M P A n$ng han V i vdy, cd t h i suy doan: mgt nqi dung chinh dm cho tre bi hqi chirng TC cd hieu qua cung s& la ndi dung huu ich de chinh dm cho tre" bj khuyit tdt BMPA Tuy n h i i n ,... chqn mau, phdn tich doi chieu, thii nghigm vd phuang phdp xin y k i i n chuyin gia Nqi dung vd quy trinh, hinh thnrc chinh dm cho t r i bj hqi chung Treacher C o l l i n Do ddc d i i m phdt dm