558: Relevant Material Flashcards
name of the process of specifying spatial and temporal (sequencing) motor goals when formulating an action
motor planning
premotor cortex (BA 6) : motor planning of the limbs influenced by external triggers :: ___ motor area : motor planning of the limbs influenced by intentions
supplementary
name of the inability to execute skilled, learned motor acts NOT due to neurological or cerebellar damage; also referred to as an impairment of motor planning
apraxia
motor planning : articulator specific motor goals :: motor ___ : muscle specific commands
programming
according to ___, motor planning occurs first and is articulator specific as opposed to muscle specific
van der mewre
regions responsible for motor ___ include: premotor cortex, supplementary motor cortex, Broca’s area, parietal association cortex, portions of insula, portions of basal ganglia
planning
regions responsible for motor ___ include: basal ganglia, cerebellum, premotor and supplementary motor cortex
programming
the corticospinal and corticobulbar tracts make up the ___ system and are responsible for the execution of ___ movements
pyramidal, voluntary
name of the tract that originates in the cortex and descends toward lower motor neurons of the spinal cord; innervates muscles of the limbs
corticospinal
name of the tract that originates in the cortex and descends toward lower motor neurons of the brainstem; innervates muscles of the head and neck including those involving speech and swallowing - except muscles of respiration
corticobulbar
corticospinal : decussates at the pyramids of lower ___ :: corticobulbar : decussates at the level of the cranial nerve to be innervated
medulla
choose: if the corticospinal pathway is damaged above the level of the crossing over in the lower medulla, you will see paresis / paralysis on the ( contralateral / ipsilateral ) side
contralateral
choose: if the corticospinal pathway is damaged below the level of the crossing over in the lower medulla, you will see paresis / paralysis on the ( contralateral / ipsilateral ) side
ipsilateral, because the pathways have already crossed over
___ levels of the pyramidal pathways used to describe levels of descending white matter pathways include: corona radiata, internal capsule, and crus cerebri
subcortical
choose: lesions in the internal capsule have a ( greater / smaller ) chance of creating widespread impairments because fiber pathways are closely packed at this level
greater
name of the system whose pathways communicate directly with lower motor neurons to directly transmit the final message (final common pathway) to the muscles
direct motor system
upper motor neurons : central nervous system :: lower motor neurons : spinal nerves and cranial nerves
the motor unit consists of (1) the ___ motor neuron cell body in the spinal cord or brainstem (2) the ___ of nerve cell bodies becoming spinal nerves and cranial nerves (3) the point of ___ between the nerve and the muscle (4) individual ___ innervated by this nerve
(1) lower
(2) axon
(3) synapse
(4) muscle fibers
paresis : partial paralysis :: paralysis : ___ paralysis
complete
signs of ___ motor neuron damage include: hypertonia (spasticity), hyperreflexia, weakened and slowed speech, reduced range of motion in speech
upper
signs of ___ motor neuron damage include: hypotonia, paralysis / paresis, atrophy, hyporeflexia
lower
name of the system composed of two subsystems, including: the indirect activation pathway and control circuits (basal ganglia, cerebellum)
extrapyramidal system
name of the two-stage pathway that begins in the cortex, synapses on select nuclei in the brainstem, and then synapse on the cranial nerve nuclei (i.e. the lower motor neurons)
indirect activation pathway
the indirect activation pathways helps to regulate ___ and maintain posture and tone
reflexes
damage to the indirect activation pathways results in hyperreflexia and ___ - which results in slowness and hyper adduction of the vocal folds and sometimes, spastic dysarthria or unilateral UMN dysarthria
spasticity
name of the first stage pathway (of the indirect activation pathways) that begins in the motor, premotor, and sensory cortex and terminates in the reticular formation of the brainstem
corticoreticular
name of the first stage pathway (of the indirect activation pathways) that begins in the cortex and terminates in the red nucleus of the midbrain
corticorublar
choose: the ( first / second ) stage pathways (of the indirect activation pathways) run from the reticular formation, vestibular nuclei, and red nucleus to the cranial nerve nuclei
second
true or false: the control circuits of the basal ganglia and cerebellum directly synapse on the lower motor neurons
false, the control circuits of the basal ganglia and cerebellum DO NOT directly synapse on the lower motor neurons
name of the group of subcortical nuclei involved in motor and cognitive behaviors, whose main nuclei include the striatum (caudate nucleus and putamen) and globus pallidus
basal ganglia
the function of the basal ganglia includes: motor and cognitive function, dampening cortical discharges and initiating ___
movement
damage to the basal ganglia may result in reduced movement or excess ___ movement
involuntary
Parkinson’s : reduced movement and trouble initiating movement :: ___ : excessive involuntary movements
Huntington’s
name of the disease caused by degeneration of the dopamine-producing neurons in the substantia nigra; results in ( increased / reduced ) drive / excitation of motor regions of the cortex
Parkinson’s, reduced
name of the genetic disease caused by damage to the striatum and cerebral cortex; results in ( increased / reduced ) excitation of the motor regions of the cortex
Huntington’s, increased
symptoms of ___ disease include: rigidity, akinesia, bradykinesia, hypokinesia, and resting tremor
Parkinson’s
*note: increased tone (rigidity), difficulty initiating (a-), slow movement (brady-), fewer movement (hypo-)
tremor, chorea, athetosis, dystonia, and myonucleus are all types of ___
dyskinesias
the term “dyskinesia” is associated with ___ damage; it is also used to describe ___ disorders
extrapyramidal, movement
this lobular structure has significantly more afferent pathways than efferent pathways
cerebellum
the main function of the cerebellum is coordination of different muscle groups and ___; it also plays a role in motor programming, maintenance of muscle tone, and motor learning
balance
the cerebellum helps to coordinate motor activity using feedforward and sensory feedback systems, which compares the ___ copy and actual sensory feedback to make error corrections as necessary
efference
name of the term referring to the lack of coordination of ___ motor acts - affects rate, range, timing, direction, and force of movement
ataxia, voluntary
name of the term referring to the inability to gauge the distance, speed, and power of movement
dysmetria
undershooting : hypometria :: overshooting : ___
hypermetria
true or false: hypertonia is a symptom of cerebellar damage
false, hypotonia is a symptom of cerebellar damage
name of the category of motor speech syndromes characterized by abnormalities in strength, speed, range, steadiness, tone, or accuracy of movements required for control of respiratory, phonatory, resonator, articulatory, and prosodic aspects of speech production
dysarthria
name of the category of motor speech syndromes whose central or PNS abnormalities most often reflect weakness, spasticity, incoordination, involuntary movements, slowness of speech, or excessive, reduced, or variable muscle tone
dysarthria
UMN lesions : UUMN dysarthria and spastic dysarthria :: LMN lesions : ___ dysarthria
*note: UUMN (unilateral upper motor motor neuron)
flaccid
name of the type of lesions responsible for both hypokinetic and hyperkinetic dysarthria
basal ganglia lesions
name of the type of lesions responsible for ataxic dysarthria
cerebellar and cerebellar pathway lesions
true or false: mixed lesions lead to mixed dysarthrias
true
name of the type of dysarthria characterized by the following symptoms:
very mild, relative mildness of speech impairment, usually due to stroke, imprecise articulation (harshness, reduced loudness, hyper nasality, slow rate of speech)
UUMN (unilateral upper motor neuron) dysarthria
re: UUMN dysarthria
where do these lesions occur?
unilateral upper motor neuron dysarthria; lesions in:
cerebral hemisphere (usually motor cortex), descending white matter pathways, internal capsule, brainstem
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
unilateral lower facial weakness, unilateral tongue weakness
UUMN (unilateral upper motor neuron) dysarthria
name of the type of dysarthria characterized by the following symptoms:
strained-harsh voice quality, monopitch, monoloudness, slow rate of speech (slow AMRs)
spastic dysarthria
name of the measurement of rate, rhythm, precision, and range of motion of rapid movements of the lips, jaw, and tongue; patient is asked to breathe and repeat: /p p p/ /t t t/ and /k k k/
alternate motion rate (AMR)
what is the AMR for normal adults?
5 - 6 syllables per second
name of the type of lesions responsible for spastic dysarthria
central nervous system lesions and lesions affecting the upper motor neuron pathways
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
slow rate of orofacial movements, reduced range of motion, hyperactive gag reflex, pseudo bulbar effect, pathologic laughter and crying, drooling, dysphagia
spastic dysarthria
name of the type of dysarthria whose symptoms vary depending on the location of LMN damage, potentially affecting: respiration, phonation, resonance, and articulation
flaccid dysarthria
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
bilateral trigeminal weakness (reduced jaw movements, weakened closure, articulatory contacts between the tongue, lips, and teeth)
CN V
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
imprecise articulation of sounds requiring facial movements, paresis or bilateral weakness resulting in distortion of sounds, prevented production of bilabials and labiodentals if paralysis occurs bilaterally
CN VII
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
voice and resonance changes
CN X
*note: occurs because this cranial nerve innervates both the muscles of the larynx and soft palate
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
vocal cord paralysis, hoarseness, breathiness, diplophonia
CN X
*note: diplophonia is when two pitches are perceived rather than one because the two vocal cords are vibrating at different rates
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
vocal breathiness and / or inhalators stridor
CN X
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
restricted control of vocal pitch
CN X
true or false: unilateral lesions of the superior laryngeal nerve produce significant dysphonia
false; they do not produce significant dysphonia
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
nasality, audible nasal emission, significant weakness of sounds requiring intramural pressure
CN X
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
articulatory tongue imprecisions (weakness, atrophy, and fasciculations)
CN XII
*note: unilateral hypoglossal lesions : mild articulatory imprecision :: bilateral lesions : severe articulatory imprecisions
lesions in which areas often lead to flaccid dysarthria?
cell bodies, axons, or neuromuscular junction of the LMNs, CN V, VII, X, XII, cervical and thoracic spinal nerves
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
damage expressed as weakness and loss of muscle tone, oral reflexes reduced or absent, atrophy of affected muscles, fasciculations
flaccid dysarthria
name of the type of dysarthria characterized by the following speech symptoms:
“drunken” speech, slow speech rate, unsteady vowel prolongations, slow and irregular AMRs
ataxic dysarthria
lesions in which areas often lead to ataxic dysarthria?
cerebellum or cerebellar control circuits / pathways
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
normal size, strength, symmetry, and reflexes; slow, irregular jaw, face, and tongue movements during non-speech AMR tasks
ataxic dysarthria
name of the type of dysarthria characterized by the following speech symptoms:
accelerated speech, hypophonia, arctic errors due to reduced range of motion, rapid (and “blurred”) speech AMRs
hypokinetic dysarthria
lesions in which areas often lead to hypokinetic dysarthria?
basal ganglia control circuit (when diseased); frequent in persons with Parkinson’s disease
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
expressionless face even during social interaction; tremors in the jaw, face, or tongue at rest; reduced range of motion of the jaw, face, and tongue during speech AMRs
hypokinetic dysarthria
the following are two subtypes of which kind of dysarthria?
- quick or slow, rhythmic or arrhythmic, involuntary movements that interrupt, distort, or slow speech movements
- affect respiration, phonation, resonance, and articulation - often, prominent affects on prosody
hyperkinetic dysarthria
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
rhythmic, quavering waxing, and waning vocal character; possibly abrupt voice arrests and slowed speech rates
tremor
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
quick, unsustained, and unpredictable movements where abnormal speech characteristics depend on the structures (jaw, face, tongue, palate, larynx, respiratory system) affected
chorea
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
quick, involuntary adductor or abductor movements; voice arrests with strained quality or transient breathiness; hyper nasality and nasal emissions; irregular articulatory breakdowns; prosodic abnormalities; irregular AMRs
chorea
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
slow and sustained speech movements; slow, adventitious movements of lips, tongue, or jaw; can be confined to muscles for speed hand swallowing and triggered only by the act of speaking
dystonia
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
__ductor spasmodic dysphonia : waxing / waning strained-harsh voice quality :: __ductor spasmodic dysphonia: breathy / aphonic segments of speech
layngeal dystonia;
[fill-ins] ad, ab
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
hypernasality, significantly impaired articulation, abnormalities of prosody
dystonia
lesions in which area often lead to hypokinetic dysarthria?
basal ganglia control circuits
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
normal size, strength, and symmetry; no hyper or hyporeflexia; involuntary movements only observed during the oral motor exam
hyperkinetic dysarthria
name of the category of motor speech syndromes characterized by disorders in motor planning
apraxia
a disorder of learned movement
apraxia
true or false: apraxia is caused by paralysis, weakness, or incoordination and is accounted for by sensory loss, comprehension deficits, or inattention to commands
false;
“disorder of learned movement, NOT caused by paralysis, weakness, or incoordination and CANNOT be accounted for by sensory loss, comprehension deficits, or inattention to commands”
name of the kind of apraxia characterized by the following speech symptoms:
difficulty carrying out volitional, oral non-speech movements (not due to weakness, incoordination, sensory, or cognitive-linguistis impairment)
oral apraxia; also called nonverbal oral apraxia (NVOA)
name of the kind of apraxia characterized by the following speech symptoms:
imprecise / distorted articulation (SODA); slow speech rate; prolonged consonants and vowels; syllabic production of speech
apraxia of speech (AOS)
lesions in which areas often lead to apraxia of speech (AOS)?
middle cerebral artery, posterior portions of the frontal lobe (Broca’s area), parietal lobe, sometimes basal ganglia
*note: rarely seen in isolation; usually paired with aphasia and / or a unilateral UMN dysarthria
___ is a function of the dominant hemisphere, and apraxia of speech is associated with left (___) hemisphere damage
praxis, dominant
name of the type of apraxia characterized by the following non-speech oral mechanism findings:
right lower facial and tongue weakness due to involvement of the nearby corticobulbar pathway; co-occurance of nonverbal oral apraxia (but may also occur independently)
apraxia of speech (AOS)
given that a patient has basal ganglia lesions, they will likely have a ___
hypokinetic : little excitation :: hyperkinetic : excess excitation
dysarthria
UUMN (unilateral upper motor neuron) dysarthria is often ___ with lesions in the ___
mild; internal capsule
dysarthrias due to UMN lesions include (2)
unilateral UMN dysarthria, spastic dysarthria
dysarthrias due to LMN lesions include (1)
flaccid dysarthria
dysarthrias due to cerebellar damage include (1)
ataxic dysarthria
dysarthrias due to basal ganglia damage include (4)
hyperkinetic dysarthria, hypokinetic dysarthria (tremor, chorea, dystonia)
in flaccid dysarthria, damage to this CN is expressed by reduced jaw movement and jaw closure; affected articulatory contacts between the tongue, lips, and teeth
trigeminal V
in flaccid dysarthria, damage to this CN is expressed by imprecise articulation of sounds requiring facial movement, such as bilabials and labiodentals
facial VII
in flaccid dysarthria, damage to this CN is expressed by vocal cord paralysis, hoarseness, breathiness, diplophonia, restricted vocal pitch, hypernasality
vagus X
in flaccid dysarthria, damage to this CN is expressed by weakness, atrophy, fasciculations of the tongue; articulatory imprecisions of all lingual consonants
hypoglossal XII
