Exam 1 Flashcards
Define motor speech disorders
Speech disorders resulting from neurologic impairment that affects planning, programming, control, or
execution of speech.
What is dysarthria?
Alterations in:
* speed
* force
* range
* accuracy
* coordination
of movements required for the different speech subsystems
The speech mechanism may also demonstrate involuntary
movements or alterations in muscle tone.
What is apraxia of speech?
An articulatory disorder resulting from impairment of the capacity to program the positioning of the speech
musculature and the sequencing of muscle movements
List the 3 types of internal white matter fibre tracts.
o Association tracts
o Commissural tracts
o Projection tracts
List 2 supporting systems of the brain and describe their functions.
Meninges
o Protection
Ventricular system
o Nutrient supply & protection
Vascular system
o Oxygen & glucose supply
What is a lower motor neuron?
a term that refers to
the nerves that connect from the spinal
cord out to the muscles. The lower motor
neurons relay the movement instructions
provided by the upper motor neurons, to
the muscles
Final Common Pathway:
* originates in the brainstem and spinal cord
* innervation directly to muscles
FCP
What is an upper motor neuron?
Upper Motor Neuron
a) Direct Activation Pathway:
* voluntary, skilled movements
Sign of lesion:
* weakness and loss of skilled movement/dexterity
o distal and speech muscles
* hyporeflexia
o diminished initially and later evolves to be more pronounced.
* Release of primitive reflexes
o Babinski sign, jaw jerk, palmomental
* decreased muscle tone
o reduced initially and later evolves to increased tone
Upper Motor Neuron
b) Indirect Activation Pathway:
* posture, tone, and movements supportive of voluntary
movements
Sign of lesion:
* increased muscle tone
* spasticity
* hyperactive stretch reflexes
* clonus
o limbs, jaw
* decorticate or decerebrate posture
Flaccid Dysarthria
Problem: Neuromuscular execution (reflexive, automatic,
and voluntary movements)
* Focal
* Multifocal
* Generalized
* Unilateral
* Bilateral
Flaccid Dysarthria etiologies
- Degenerative
- Tumor/Cancer/Carcinoma
- Vascular
- Neuromuscular Junction Disease
- Muscle Disease
- Traumatic/Surgical
- Demyelinating
- Infectious/Inflammatory
List 4 parts of the LMN that could be affected in flaccid dysarthria.
- Cell body
- Peripheral Nerve
- Neuromuscular Junction
- Muscle
Role of acetylcholine in motor movements
Role of acetylcholine: neurotransmitter molecule that is released and taken up by postsynaptic endplate to cause a muscle contraction
3 general symptoms associated with LMN damage/disease.
- Weakness (distal more common)
- Fasciculations (little muscle twitches)
- Atrophy (muscle degeneration)
Which cranial nerve is in facial palsy?
facial nerve (CN 7)
List the non-speech features of facial palsy?
- reduced strength of lip closure & drooling
- mouth droops & fails to elevate during smile
- nasolabial fold flattened
- reduced forehead wrinkling
- eyebrow lowered & fails to raise
Name the cranial nerve involved in masticator palsy
Trigeminal Nerve (CN 5)
List the non-speech features of masticator palsy.
Unilateral
1. may only be apparent during jaw testing
2. may have complaints of problems chewing
Bilateral
1. jaw may sag open
2. chewing & swallowing impairments
drooling
List the non-speech features of palatopharyngeal palsy
Unilateral
1. weak side of palate hangs lower at rest
2. deviates to side of strength on elevation
Bilateral
1. palate symmetric but lower than normal
2. reduced or absent elevation
3. diminished or absent gag reflex
4. nasal regurgitation of liquids
Name the cranial nerve involved in palatopharyngeal palsy.
Vagus Nerve (CN 10)- Pharyngeal branch
Name the cranial nerve involved in laryngeal palsy.
Vagus Nerve (CN 10)- Recurrent Laryngeal Branch
List the non-speech features of laryngeal palsy.
Unilateral
1. one vocal fold remains stationary and slightly abducted (paralysis) or makes very weak movements towards the midline
2. weak or incomplete contact between folds
3. reduced cough and aspiration problems
Bilateral
1. both vocal folds remain stationary and slightly abducted (paralysis) or make very weak contact
2. in paralysis the restricted airway opening requires surgical intervention - tracheotomy or arytenoid surgery
Name the cranial nerve involved in hypoglossal palsy
Hypoglossal Nerve (CN 12)
List the non-speech features of hypoglossal palsy.
Non-speech Features:
loss of tongue strength & atrophy
swallowing problems
Unilateral
-deviation to side of weakness on protrusion
Bilateral
-reduced range of movements if severe
List the most distinctive speech features of flaccid dysarthria
according to Darley, Aronson, and Brown.
- Hypernasality
- Breathiness
- Nasal Emission
- Audible Inspiration
Define the neuromotor basis of spastic dysarthria.
Damage tocorticobulbar/upper motor neuronpathways.
Problem: Neuromuscular execution
Can manifest in any or all of the respiratory, phonatory, resonatory, and articulatory components of speech.
rarely only a single component.
Describe the concept of neural redundancy in the UMN pathways as it
relates to speech/swallowing musculature
Direct/pyramidal pathways provide contralateral innervation for muscles of the lower face and tongue. All other muscles for speech and swallowing receive bilateral UMN input from both direct and indirect pathways
List 3 etiology that could lead to spastic dysarthria.
- Degenerative
- Vascular
- Congenital
- Traumatic
- Demyelinating
Describe 3 general symptoms associated with UMN damage/disease
- Loss of skilled movement
- Slowness
- Spasticity
- Weakness
- Hyperreflexia
List a patient’s speech-related complaint that could help differentially
diagnose spastic dysarthria from other dysarthria types
Effortful/Feels resistance***
also can see slow, fatigue with speaking
need to speak slowly to be understood but unable to speak fast
List the most distinctive speech features of spastic dysarthria
according to Darley, Aronson, and Brown.
Harsh Voice
Low Pitch
Slow Rate (ALS)
Strained-Strangled
Pitch Breaks
Describe the movement parameters that could distinguish spastic
dysarthria and flaccid dysarthria
Rate and Tone
Rate in flaccid is normal, but slow in spastic
Tone in flaccid is reduced, but excessive in spastic
Discuss why cognitive concerns may be apparent in people with
spastic dysarthria and why this is relevant to SLPs
Spastic dysarthria is typically a result of bilateral, multifocal or diffuse CNS injury/disease
Therefore, cognitive and/or cognitive-communication disturbances are common
dementia
aphasia
Define the neuro motor basis of ataxic dysarthria
Damage to the cerebella’s control circuit
Problems in motor control; breakdown in the timing and coordination
Describe lateralization of motor control as it relates to the cerebella’s control circuit
Medial Zone (vestibulocerebellum and spinocerebellum):
Connections to vestibular and brain stem nuclei and regions of the spinal cord
Lateral Zone (cerebrocerebellum):
Connections to the motor and premotor cortex
Describe the neural components of the cerebella’s control circuit
Cerebellum and it’s connections
Describe 3 key functions of the cerebellum
Medial Zone (vestibulocwrebellum and spinocerebellum)
-contributes to axial and trunk control, balance and posture, gait and locomotion, vestibular reflexes, coordination between head and eye movements, muscle tone
Lateral Zone (cerebrocerebellum) contributes to coordination of voluntary movements, planning and initiation of movement, sensorimotor learning, muscle tone and tremor
List 3 etiology that could lead to ataxic dysarthria
Degenerative, vascular, traumatic/demyelinating, tumor
Describe 3 general symptoms associated with cerebella’s control circuit/damage
- Inaccuracy of voluntary movements
- Slowness of movement
- Hypotonia
- Other (ataxic gait, pendular reflexes, muscular fatigue/reduced strength, occult motor dysfunction
List a patient’s speech related complaint that could help differentially diagnose ataxic dysarthria from other dysarthria types
Drunken quality of speech, drastic deterioration of speech with limited alcohol consumption, difficulty coordinating speaking with breathing
List the most distinctive features of ataxic dysarthria according to darley, aronson, and brown
Most distinctive:
Excess and equal stress/scanning speech
Irregular articulately breakdowns
Prolonged phonemes
Describe the movement parameters that could distinguish ataxic dysarthria from spastic/flaccid
Direction of ataxic: inaccurate (vs normal)
Rhythm: Irregular (vs regular)
Range: excessive to normal (vs reduced)
Purpose of vestibulocochlear nerves
Balance and hearing
Glossopharyngeal nerves (9)
Taste sensation
Vagus nerve
General sensation from external ear, palate, pharynx, larynx
Motor control: palatial, pharyngeal, laryngeal muscles
Accessory nerves
Motor control for palatal, pharyngeal, laryngeal muscles
Motor control for trapezius and sternocleidomastoid muscles
Hypoglossal nerves
Motor control of muscles of the tongue
Trigeminal nerves
Sensory info related to pain and temperature from majority of head and face
Midbrain Cranial Nerve Nuclei
Occulomotor, trochlear, trigeminal
Pons cranial nerve nuclei
Trigeminal nerves, abducens nerves, facial nerves
Medulla cranial nerve nuclei
Vestibulocochlear, glossopharyngeal,
vagus,
accessory,
hypoglossal,
Trigeminal
LMN Pathway/Final Common Pathway
Brainstorm and spinal cord to the muscles!
Control Circuits Pathway
Input to and from cerebral cortex via the indirect & direct pathways
Upper Motor Neuron Pathway
Originates in the cerebral cortex, and travels down to the brain stem/spinal cord
