exam 1 Flashcards
central nervous system (CNS)
brain and spinal cord
peripheral nervous system (PNS)
12 pairs of cranial nerves
31 pairs of spinal nerves
cerebrum
largest part of brain, split into 2 hemispheres
gyri
mountains
sulci
valley
gyri and sulci are most prominent parts of cerebrum
prominent sulci and prominent gyri
prominent sulci
lateral sulcus and central sulcus
prominent gyri
precentral gyrus and post central gyrus
precentral gyrus
primary motor cortex, motor strip
postcentral gyrus
primary sensory cortex, sensory strip
cerebral cortex
surface of cerebrum, “gray matter”, performs higher cogntive activities
brainstem
midbrain, pons, medulla
afferent
sensory
efferent
motor
brainstem controls
integrative and reflexive actions (respiration, consciousness)
cranial nerve nuclei
points where cranial nerves attach to brain on the brainstem
cerebellum
coordinates voluntary movements so muscles contract with correct amount of force and at appropriate times
monitors what im planning on doing and where im going
cerebellum
tracts
bundles of axons found in CNS
nerves
bundle of axons found in PNS
neurotransmitters
released at end points once charges reach axon’s terminals ramifications.
important neurotransmitters for motor function
acetylcholine and dopamine
nervous system cells
glial cells. schwann cells, micoglia, oligodendroglia, astrocytes
glial cells
supporting cells; support the neurons
schwann cells
produce myelin sheath in the PNS
oligodendroglia
produce myelin sheath in the CNS
planning of voluntary movement does not originate in primary motor cortex
true
___ birth place for motor movement
frontal love
cortices that first analyze sensory info.
primary auditory cortex, primary visual cortex, primary sensory cortex
association cortex
“makes sense” of sensory impulses initially analyzed by primary cortices; initial planning of voluntary movement; sends rough sequence of motor impulses down to subcortical structures for further processing and refining
basal gamglia
helps to filter unwanted motor movements
cerebellum
smooths out rough motor impulses, coordinates them, and sends them up to primary motor cortex
thalamus
“door way” through which subcortical systems communicate with cerebral cortex
what receives neural inputs of planned motor movements from basal ganglia and cerebellum
thalamus
sensory impulses from the body pass through the
thalamus
has important subcortical gray matter structure
thalamus
receives neural impulses that have been processes, smoothed, and coordinated by basal ganglia, cerebellum, and thalamus
primary motor cortex
descending motor tracts
pyramidal system & extrapyramidal system
pyramidal system
carries impulses that control voluntary fine movement; direct activation pathway - goes from point A to B
extrapyramidal system
carries impulses that control postural support need by fine motor movements and works at more of an unconscious level; indirect activation pathway
upper motor neurons
damage often results in spasticity
lower motor neurons
damage results in muscles paralysis or paresis; the final step before motor movement actually occurs
final common pathway
lower motor neurons
neuromuscular junction
point where axons of lower motor neurons make synaptic connections
instrumentation
relies on sophisticated devices to objectively measure components of speech production
perceptual analysis
rely on clinician’s ears (and eyes) to judge
gold standard for evaluating any speech disorder
perceptual analysis
2 goals of any speech eval.
understand a patients problem & determine beginning level of treatment
differential diagnosis
telling the difference between 2 similar diagnoses
5 components necessary for normal speech production
respiration, phonation, resonance, articulation, prosody
dysarthria
speech production deficit resulting from neuromotor damage to pns or cns
apraxia of speech
motor speech disorder often associated with damage to left hemipshere of the brain
apraxia is more commonly seen in individuals with
broca’s aphasia
nerve damage means weak muscles to move air in and out of lungs, which leads to less air for speech production, resulting in
short phrases and reduced loudness and breathy voice
normal phonation
complete adduction of vocal folds; sufficent sublgottic air pressure
neuromotor damage to nerve that innervate VF adductors effect speech production seen in
flaccid dysarthria, spastic dysarthria, neuromotor damage to laryngeal muscles
phonation
production of voiced phonemes through VF vibration in larynx
resonance
proper placement of oral or nasal tonality onto phonemes during speech accomplished by raising and lowering the velum
oral resonance
produced when velum is raised and closes off nasal cavity
nasal resonance
produced when velum is lowered and oral cavity is blocked by tongue or lips
damage to nerves innervating velar muscles for resonance may cause
hypernasal quality
articulation
shaping of vocal air stream into phonemes
neuromotor damage to articulators may affect
lips, tongue, jaw, velum or VFs and result in articulation errors
prosody
melody of speech, using stress and intonaton to convey meaning
neuromotor damage can affect prosody
monopitch and monoloud quality, involuntary movements can result in irregular pitch variations, loudness, and prolonger intervals
frenchay dysarthria assessment-2
aids in differential diagnosis among the dysarthrias
assessment of intelligibility of dysarthric speech
provides an objective assessment of single-word speech intelligibility
speech intelligibility test for windows
computer version of AIDS
apraxia battery for adults - 2nd edition
is the only published adult apraxia test, contains 6 subtests, provides info on severity, treatment, suggestions, and changes over time
conducting motor speech eval
carefully assess the 5 components of speech production, and assess the 6 salient features
salient features
muscle strength, speed of movement, range of motion, accuracy of movement, motor steadiness, and muscle tone
muscle strength for accurate speech
requires adequate strength to perform speech production tasks
decreased muscle strength
can affect respiration, articulation, resonance, phonation, and prosodu
muscle strength assess by
asking patient to press tongue against tongue blade or to count aloud from 1 to 100
diagnoses with poor muscle strength
flaccid dysarthria and myasthenia gravis
speed of movement for accurate speech
requires very rapid muscle movements of tongue and vocal folds
reduced speed of movement is characteristic of most dysarthrias except
hypokinetic
speed assessment tasks:
alternate motion rates (AMR) & sequential motion rates (SMR)
amr
/p, t, k/ alternating between syllables
smr
/puh puh puh/ /tuh tuh tuh/
range of movement for accurate speech
requires range of movement of articulators
reduced rom may cause
inability to open jaw or completely adduct vocal folds
rom assessed by
asking patient to extend or hold articulators in various positions
accuracy of movement for clear speech
requires accurate movements of articulators
reduced accuracy of movement may cause
distorted consonants & hypernasalities; tremors -> red flag for involuntary movement; hyperkinetic dysarthria
accuracy of movement is assessed through
conversational speech and spoken paragraph reading
motor steadiness for accurate speech
requires ability to hold articulators still
reduced motor steadiness may cause
tremors and large, involuntary movements
motor steadiness assessed by
asking patient to hold a position of a prolong vowel
muscle tone for normal speech
requires muscles ready for quick movements
reduced muscle tone may cause
weakness or paralysis (decreased muscle tone); spasticity or rigidity (increased muscle tone)
very clenched, tight voice
spastic dysarthria
assessing face and jaw muscles at rest during movement, looking for
abnormal muscle tone, asymmetry, restricted rom
specific tasks during oral mech. exam for face and jaw muscles
- symmetry of mouth
-can lips be forced open
-expressionless, masklike appearance - wrinkling on both sides of forehead
-can patient pucker lips
-puff out cheeks and old air in oral cavity
-does jaw hang loosely or deviate to one side when mouth is wide open
-able to move jaw from right to left
-keep jaw closed while examiner attempts to open it
-keep jaw open while examiner attempts to open it
tongue at rest and during movement involves
hypoglossal cranial nerve
specific tasks during oral mech exam for tongue
-size appear normal?
-tongue symmetrical?
-are fasiculations present when the tongue is at rest?
- patient able to protude tongue completely?
-patient keep tongue tip at midline while examiner pushes tongue to left and right?
-patient able to touch upper lip with tongue tip?
-can patient keep tongue tip pressed against inside of cheeck as examiner pushes the cheeck inward
-can patient move tongue from side to side
fasiculations
visible, twitch-like movements; characteristic of flaccid dysarthria
velum and pharynx at rest and during movements
many of these muscles innervated by vagus
specific tasks during oral mech. exam for velum and pharynx
-velum rises symmetrically each time patient says /a/?
-pharyngeal gag reflux when back wall of pharynx is touched?
what does it mean when theres no pharyngeal gag reflux
sensory nerve is not intact
what does it mean when the pharyngeal reflux is heightened
spastic dysarthria occurs
larynx cannot be observed directly
true
specific tasks during oral mech. exam for larynx
- can patient produce sharp cough?
- can patient produce sharp glottal stop?
- is inhalatory stridor present?
glottal stop/coup
clearing your throat; only involves active participation of phontory system
stridor
think of like an asthmatic breath
specific tasks for phonatory-respiratory system
-deep breath and say /a/ as long as possible
-latency period between signal to say /a/ and initiation of phonation
-quality, pitch, loudness, and phonations
resonation system specific tasks
take deep breath and say /u/ as long as possible while clinician squeezes nose
combined systems: phonation, respiration, resonance, and artic.
AMR & SMR
stress testing for motor speech mechanisms
mysathenia gravis
non-verbal apraxia of speech
disruption in sequencing of oral movements that are nonverbal
specfic tasks for testing nonverbal apraxia
have patient perform voluntary, nonverbal oral movements without demonstrating beforehand
testing of apraxia
count from 1-20 backwards, read sentences, including spontaneous and on demand
analysis of connected speech
-clinician records patient reading a standard reading passage
-rate patient performance on the qualities listed
