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Motor Speech Disorders > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

neurologic process of speech production involves:

A

cognitive-linguistic process, motor speech programming, neuromuscular execution

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2
Q

cognitive-linguistic process

A

aspect of speech production involving an intention to communicate which is organized into the verbal symbols that follow the rules of language

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3
Q

motor speech programming

A

intended communication that has to be executed by the neuromuscular system. speaker selects and organizes the sensorimotor programs that cause the appropriate speech muscles to be activated at the right time

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4
Q

neuromuscular execution

A

the CNS and PNS innervate the necessary muscles of respiration, phonation, articulation, and resonance to produce desired words

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5
Q

def. of motor speech disorders

A

speech disorders resulting from neurologic impairment affecting the motor programming or neuromuscular execution of speech

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6
Q

what do motor speech disorders encompass?

A

apraxia of speech and the dysarthrias

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7
Q

what is dysarthria?

A

group of motor speech disorders resulting from disturbances in muscular control over the speech mechanism due to damage to CNS or PNS; results in paralysis, weakness, or incoordination of speech muscles

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8
Q

what subsystems can dysarthria affect?

A

ALL; respiration, phonation, resonance, artic, prosody

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9
Q

what is apraxia?

A

Neurogenic speech disorder resulting from impairment of the capacity to program sensorimotor commands for the positioning and movement of muscles for volitional production of speech. Occurs in the absence of weakness.

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10
Q

what subsystems can apraxia affect?

A

artic and prosody

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11
Q

what are the courses of the disease?

A

transient, improving, progressive, exacerbating-remitting, stationary

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12
Q

what are the 3 developments of symptoms?

A

acute (within minutes), subacute (within days), chronic (within months)

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13
Q

what does the cerebrum consist of?

A

4 lobes, cortex, gyri, sulci

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14
Q

what does the cerebellum do?

A

modifies cortical activity

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15
Q

what are the lobes of the cerebellum?

A

anterior, posterior, flocculonodular

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16
Q

what is the midportion of the cerebellum?

A

vermis

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17
Q

what does the brainstem consist of?

A

midbrain, pons, medulla

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18
Q

what does the midbrain do?

A

links cerebrum to brain stem

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19
Q

what does the pons do?

A

bridges to cerebellum

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20
Q

what does the medulla do?

A

controls respiration

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21
Q

what are the four main anatomical levels of the CNS?

A

supratentorial, posterior, spinal, peripheral

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22
Q

what is the supratentorial level made up of?

A

anterior and middle fossae, all 4 lobes, basal ganglia, thalamus, hypothalamus, CN I and II

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23
Q

what is the posterior level made up of?

A

posterior fossa, brainstem, cerebellum, CN III-XII

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24
Q

what are foramina?

A

holes in fossae where CN exit the skull

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25
Q

spinal anatomic level?

A

spinal cord begins at lower end of medulla, surrounded by bony vertebral column. ends at first lumbar vertebrae

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26
Q

peripheral anatomic level?

A

made up of 12 paiars of CN and 21 pairs of SN which exit through foramina

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27
Q

where do CN emerge from?

A

brain stem and penetrate skull through foramina to reach sensory-motor targets

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28
Q

what are the three layers of the meninges?

A

dura mater (outer membrane), arachnoid mater (loosely covers brain), pia mater (innermost layer, closely attached to surface of brain)

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29
Q

what are the spaces around the meninges?

A

epidural space (between dura and bone), subdural space (beneath dura), subarachnoid space (beneath arachnoid)

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30
Q

which of the three spaces around the meninges can develop infections?

A

subdural space

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31
Q

what is the subarachnoid space filled with?

A

CFS, connected to inner part of brain via ventricular system

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32
Q

what are the 6 neurologic systems?

A

ventricular, vasular, sensory, motor, consciousness, neurochemical

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33
Q

what are ventricles filled with?

A

cavities filled with CSF which cushions the brain

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34
Q

what are ventricles produced by?

A

choroid plexuses

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35
Q

are choroid plexuses found in each ventricle?

A

YES

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36
Q

what is the ventricular system made up of?

A

paired lateral ventricles in each hemisphere, third ventricle between 2 thalami, and 4th ventricle

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37
Q

what does the vascular system involve?

A

blood vessels which provide oxygen and nutrients to structures and removes waste

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38
Q

what two arterial systems does the brain receive blood from?

A

carotid and vertebral basilar system

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39
Q

where do the carotid and vertebral basilar system join?

A

the Circle of Willis at base of brain

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40
Q

what does the neurochemical system influence?

A

all anatomic levels of the nervous system

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41
Q

what does the neurochemical system include?

A

amino acids, ACH, neuropeptides

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42
Q

what is the consciousness system important for?

A

maintaining consciousness, attention, and awareness of environment

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43
Q

what structures does the consciousness system involve?

A

those found at the suprtentorial and posterior fossae level

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44
Q

what is the motor system responsible for?

A

all motor activity for speech

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45
Q

what does the motor system include?

A

efferent connection to cortex, basal ganglia, cerebellum, CNS/PNS pathways

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46
Q

what does the sensory system include?

A

peripheral receptor organs

47
Q

nerves

A

collection of many nerve fibers (axons). Cell bodies stay in CNS, nerves travel between cell bodies and peripheral end organ to be innervated.

48
Q

neurons

A

dendrites/axons projections. Axons end in synapses which release neurotransmitters. AcH is an important neurotransmitter in neuromuscular synapses. Release of AcH results in contraction of muscle fiber.

49
Q

what are groups of fibers called in PNS?

A

nerves

50
Q

what are groups of fibers called in CNS?

A

pathways/tracts

51
Q

in PNS, where is the impulse carried?

A

to the end organs

52
Q

what is a motor unit made up of?

A

axon and the muscle fiber it innervates

53
Q

name and describe the supporting (glial) cells?

A

oligdendroglia cells (form myelin in CNS), schwann cells (form myelin in PNS), astrocytes (found in CNS, part of blood-brain barrier, keeps toxins out and nutrients in)

54
Q

what diseases attack myelin?

A

multiple sclerosis and Guillain Barre disease

55
Q

what happens in LMN innervation to muscle is lost?

A

muscle will atrophy

56
Q

what happens if axons become separated from cell body?

A

motor speech problems

57
Q

disruption in blood supply causes what?

A

neuron can be damaged due to lack of oxygen (ischemia)

58
Q

what does the thalamus do?

A

acts as relay station, helps to mediate speech, language, and cognitive function

59
Q

where is the basal ganglia located?

A

deep inside cerebrum

60
Q

what does the basal ganglia consist of?

A

globus pallidus, striatum (putamen, caudate nucleus), lentiform nucleus (globus pallidus, putamen), substantia nigra, subthalamic nuclei

61
Q

what is the reticular formation part of?

A

brain stem; important for motor control

62
Q

where are the substantia nigra and subthalamic nuclei primarily located?

A

midbrain; important for motor control

63
Q

what are the different localizations of neurologic lesions?

A

focal, mulitfocal, diffuse

64
Q

what are the etiologies of motor speech disorders? (broad categories)

A

degenerative (gradual decline in neuronal function), inflammatory (meningitis), toxic (metabolic dz, vitamin deficiencies), neoplastic (tumors), traumatic (car accidents), vascular (CVA, neurons deprived of oxygen)

65
Q

what are motor neurons?

A

nerve cells involved in motor movement

66
Q

where do motor neurons originate?

A

brain stem or spinal cord from a cranial or spinal nerve

67
Q

what are motor neurons also called?

A

lower motor neurons

68
Q

describe what happens to the axons on lower motor neurons?

A

they leave cell bodies and travel to specific muscles; they subdivide into branches that connect with muscle fibers; can innervate several muscle fibers; each fiber may receive input from branches of different motor neurons

69
Q

what happens to LMN without proper innervation?

A

muscles atrophies; may result in fasciculations

70
Q

upper motor neurons

A

cell bodies in motor cortex and their descending axonal processes that synapse on cranial and spinal motor neurons

71
Q

lower motor neurons

A

motor nuclei through which CNS sends impulses to muscles and glands

72
Q

where do UMN originate?

A

upper brain levels

73
Q

where do LMN originate?

A

brainstem or spinal cord

74
Q

what are the four main parts to speech motor system?

A

final common pathway, direct activation pathway, indirect activation pathway, control circuits

75
Q

what is the FCP also called?

A

LMN system or PNS

76
Q

why is it called the FCP?

A

the last link in sequence of motor events that lead to motor movement and all other components have to go through it

77
Q

what 2 nerves have unilateral innervation?

A

facial nerve VII to lower face and hypoglossus nerve XII to genioglossus

78
Q

unilateral lesion is UMN, where does the structure deviate to ?

A

contralateral to side of lesion

79
Q

unilateral lesion is LMN, where does the structure deviate to?

A

ipsilateral to side of lesion

80
Q

if the lesion is bilateral, what is the result?

A

decreased ROM and strength

81
Q

what 2 tracts make up the UMN system and DAP?

A

corticobulbar and corticospinal

82
Q

where does the corticobulbar tract originate and terminate?

A

originates: cortex; mainly at primary motor cortex
terminates: brainstem at level of cranial nerve nuclei involved with speech

83
Q

where does the corticospinal tract originate and terminate?

A

originates: cortex
terminates: level of spinal nerve nuclei

84
Q

where do the corticobulbar and corticospinal tracts descend through?

A

descend from cortex, through corona radiata and internal capsule in brainstem

85
Q

what is the DAP important for?

A

controlled skilled, discrete, and often rapid voluntary movements in speech

86
Q

with UMN unilateral lesion, where is the weakness typically?

A

on the opposite side of the body

87
Q

what do control circuits do?

A

integrate or help control the structures and pathways involved in motor movement

88
Q

do control circuits have direct contact with LMN?

A

NO

89
Q

what are the 2 control circuits?

A

Basal ganglia and cerebellum

90
Q

what does the basal ganglia depend on?

A

balance among neurotransmitters (AcH, dopamine, GABA) for aiding motor activity

91
Q

what does the basal ganglia provide input to?

A

cerebral cortex to coordinate motor movement

92
Q

what is the basal ganglia involved in?

A

regulating muscle tone and maintaining normal posture

93
Q

what can damage to the basal ganglia cause?

A

hypokinetic and hyperkinetic dysarthria

94
Q

what does the cerebellum do?

A

integrates and coordinates movements for speech, including timing, size of muscular action and sequences of movement to provide smoothly flowing well-timed coordinated speech

95
Q

what does damage to the cerebellum cause?

A

ataxic dysarthria

96
Q

flaccid dysarthria is a lesion where?

A

LMN system

97
Q

With the LMN system, it only takes one lesion to wipe out the function because it all comes together in the LMN system. True or false?

A

TRUE

98
Q

what is the primary deficit in flaccid dysarthria?

A

weakness to muscles

99
Q

what is a result of the palate being too weak to close?

A

hypernasality

100
Q

what does UMN damage usually result in?

A

spastic dysarthria

101
Q

what happens when all of the LMN input is lost to a muscle?

A

paralysis (partial loss leads to paresis)

102
Q

what are defining characteristics of flaccid dysarthria?

A

hypotonia and weak reflexes, atrophy, fasciculations, fibrillations, progressive muscle weakness

103
Q

what neuromuscular junction disease cause the muscle to fatigue quickly when used?

A

myasthenia gravis

104
Q

what are etiologies of flaccid dysarthria?

A

neuromuscular junction disease,vascular disorders, infectious processes, demyelinating disease, muscle disease, degenerative disease, anatomic anomalies, radiation treatment

105
Q

what is myasthenia gravis?

A

chronic disease characterized by rapid weakness in voluntary movement of muscles and improvement with rest; AcH receptors are destroyed so receptors aren’t receptive to AcH which triggers muscle contraction
with rest, muscle functions normally

106
Q

what test is given for myasthenia gravis?

A

tensilon: injections of this after pt shows signs of fatigue when talking

107
Q

what are examples of vascular disorders?

A

brain stem stroke, Wallenberg’s lateral medullary syndrome

108
Q

what is an example of an infectious process?

A

polio (LMN cell bodies get infected)

109
Q

what are examples of muscle diseases?

A

muscular dystrophy, genetic, inherited, and degenerative (muscle fibers degenerate)

110
Q

what is an example of a degenerative disease?

A

motor neuron disease, ALS

111
Q

what are examples of anatomic anomalies?

A

arnold chiari malformation (congenital)-results in distortion of brain stem which can result in impairment of cranial nerves

112
Q

what is an example of a multiple cranial nerve lesion?

A

bulbar palsy (can be caused by other etiologies)

113
Q

what are the best distinguishing features of flaccid dysarthria according to Duffy?

A

hypernasality, nasal emission, continuous breathiness, audible inspiration, isolated articulatory imprecision, atrophy, fasciculations, diplophonia

Motor Speech Disorders (3 decks)

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