Intro to Motor Speech Flashcards
What does the CNS include?
Brain
Cerebral Cortex (outer surface)
Subcortical structures
-Thalamus, basal ganglia
Brainstem
-Midbrain, Pons, Medulla
Cerebellum
Spinal Cord
**Main highway of signal transmission
What does the PNS include?
12 pairs of cranial nerves
31 pairs of spinal nerves
**Transmit signals between the CNS & rest of the body. Has to go here to get to the musculature system
What is a Motor Speech Disorder?
“Speech disorders resulting from neurologic impairments affecting the planning, programming, control or execution of speech.” (Duffy)
**Any interruption in that pathway results in a motor speech disorder.
Dysarthria
Impaired production of speech due to disturbances in the muscular control of the speech mechanism.
**Issues that affect control and EXECUTION of speech. Plan is good but getting plan to the muscle is disrupted. Can affect ALL systems of speech.
Dysarthria can include impaired….
Articulation, resonance, phonation, and respiration.
What are the six subtypes of Dysarthria?
Flaccid, Spastic, Ataxic, Hypokinetic, Hyperkinetic, and Unilateral Upper Motor Neuron, plus a combo of these subtypes.
What is Apraxia of Speech?
A deficit in the ability to smoothly sequence the speech-producing movements of the tongue, lips, jaw, etc.
**PLAN & PROGRAM, getting the right sequence of commands.
Apraxia primarily affects…
Articulation and prosody
Areas of the Frontal Lobe
Dorsolateral Prefrontal Cortex
Orbitofrontal Cortex
Motor Areas
Dorsolateral Prefrontal Cortex
- Planning
- Reasoning
- Working memory
Orbitofrontal Cortex
- Emotions
- Reward
Motor Areas
- Planning & programming of movements (contralateral)
- Organized into homunculus
- Broca’s area involved in speech plan (also contributes to syntax, grammar, and phonological processing)
**Motor strip and somatosensory area- somatotopically organized
Motor and Sensory Homunculus
FATAL (Face, Arms, Torso, Legs)
Areas of the Parietal Lobe
Primary Somatosensory Area
- Sense of touch, pain, and temp (contralateral)
- Organized into homunculus
Superior Parietal Lobule
- Body awareness / proprioception
- Attention
Inferior Parietal
- reading processing & language
- spatial attention
Areas of the Temporal Lobe
Hippocampus
Herschel’s Gyrus
Wernickes Area
Visual Word Form Area
Hippocampus
- Inside temporal lobe
- Memory processing
Herschel’s Gyrus
Auditory Cortex
** Can cause issues with speech but NOT motor speech. Can lead to planning and programming issues that are not motor in nature but linguistic
Wernicke’s Area
Language Comprehension
**Can test with rainbow passage or grandfather, test Alexia or phonological errors (not motor).
Visual Word Form Area
Deciphers letters and words during reading
Areas of the Occipital Lobe
Primary Visual Cortex
Association Cortices
Dorsal Pathway
Ventral Pathway
Primary Visual Cortex
Organized like retina
** The retina is organized into three primary layers, the photoreceptive layer, the bipolar cell layer, and the ganglion cell layer.
Association Cortices
Process color, and shape
Dorsal Pathway
Understanding location and movement
Ventral Pathway
Identifying objects
Cerebellum (CNS)
Modify motor programs initiated elsewhere (cortex)
- Guides/coordinates the speech, timing, force, range, and direction of movement
The Cerebellum receives input from:
- Cerebral Cortex
- Peripheral sensory systems (e.g., vestibular)
**Cerebellum is not cerebral. Helps coordinate different muscles together, speech planning/ execution, motor learning.
Thalamus
- Relay system for afferent and efferent CNS
- Control and gaits where info goes in and out of the brain
- Involved in alertness, sleep, consciousness and learning
The Basal Ganglia is involved in:
- Voluntary motor control
- Motor and procedural learning, cognition, emotion
What does the Brainstem consist of?
Midbrain
Pons
Medulla
Midbrain
- Pathways for hearing, vision, eye movement
- Sleep/wake cycle
- Eye movement
Pons
- Respiration control
- Pathways for face and eye movement, swallow, and taste
- Co2 levels in blood, determining rate of breathing
- Here we start seeing cranial nerves
Medulla
- Reflexes for coughing, sneezing, vomiting, and swallowing
- Parts of autonomic nervous system
- Pathways for throat, tongue, and neck movements
- Heart rate
- Muscle control for throat, tongue, neck
Brainstem Pathways
- These pathways (tracts) connect the cortical motor and sensory areas to the peripheral nervous system (nerves)
- Corticobulbar- Cranial Nerves
- Corticospinal- Spinal Nerves
** Information for/from each cranial nerve branches at different areas of the brainstem
** Information for/from the rest of the body continues down into spinal cord
Bulbar Tract
- Motor info to the cranial nerves
- Everything from level of injury and down is affected
Types of sides
- Ipsilateral= same side
- Bilateral= both sides
- Contralateral= opposite sides
Cranial Nerves
Name Mnemonic- Oh Oh Oh, To Touch And Feel Very Good Vagina, Such Heaven
Function Mnemonic- Some Say Marry Money, But My Brother Says Big Boobs Matter More
Olfactory –CN I- S
Optic –CN II- S-
Oculomotor –CN III- M
Trochlear –CN IV- M
Trigeminal –CN V- B
Abducens –CN VI- M
Facial –CN VII- B
Vestibulocochlear –CN VIII- S
Glossopharyngeal –CN IX- B
Vagus –CN X- B
Spinal Accessory –CN XI- M
Hypoglossal –CN XII-M
** Important for this class: CN V, CN VII, CN X, CN IX, CN XII (5,7,9,10,12)
Olfactory
CN I- S
Optic
CN II- S
Oculomotor
CN III- M
Trochlear
CN IV- M
Trigeminal
CN V- B
Abducens
CN VI- M
Facial
CN VII- B
Vestibulocochlear
CN VIII- S
Glossopharyngeal
CN IX- B
Vagus
CN X- B
Spinal Accessory
CN XI- M
Hypoglossal
CN XII- M
What CN’s are located in the Cerebrum?
CN I- Olfactory
CN II- Optic
What CN’s are located in the Midbrain?
CN III- Oculomotor
CN IV- Trochlear
What CN’s are located in the Pons?
CN V- Trigeminal
CN VI- Abducens
CN VII- Facial
CN VIII- Vestibulocochlear
What CN’s are located in the Medulla?
CN IX- Glossopharyngeal
CN X- Vagus
CN XI- Spinal Accessory
CN XII- Hypoglossal
What are the 6 CN for Speech Production?
CN V- Trigeminal- B
CN VII- Facial- B
CN IX- Glossopharyngeal B
CN X- Vagus- B
CN XI- Spinal Accessory- M
CN XII- Hypoglossal
What is the SENSORY function for CN V- Trigeminal?
SENSORY: Three branches of sensory information across the face, eyes, forehead and anterior 2/3 of tongue
What is the MOTOR function for CN V- Trigeminal?
MOTOR: Muscles of mastication (chewing) in the mandibular branch
- Masseter, pterygoid, mylohyoid, and digastric muscles
- Also motor for tensor tympani (dampens chewing sounds) and tensor veli palatini (help raise soft palate)
What is the function of the CN VII- Facial Nerve?
- Muscles of facial expression
- Stapedius muscles/reflex
- Taste from anterior 2/3 of the tongue
- Salivary glands and lacrimal gland
** Bell’s palsy
What is the function of the CN IX- Glossopharyngeal Nerve?
- Taste and touch for rear 1/3 of tongue, external ear canal, and parts of pharynx
- Includes sensory part of the gag reflex
- Saliva response for parotid gland
- Stylopharyngeus muscle elevates pharynx during swallow and speech
What is the function of the CN X- Vagus Nerve?
- Motor and sensory information for the larynx (phonation)
- Pharyngeal plexus with CN IX- Glossopharyngeal
- Sensory and motor - Muscles of the soft palate and base of tongue
- Parasympathetic branches to many internal organs
What are the MOTOR branches of CN X- Vagus Nerve?
Pharyngeal Branches
- Levator Veli Palatini
- Palatoglossus
Superior laryngeal branches
- Cricothyroid
Recurrent laryngeal branches
- All other intrinsic laryngeal muscles
What is the function of CN XII- Hypoglossal Nerve?
- Transmits motor information to the muscles of the tongue
- Needed for articulation of all vowels and non labial and/or dental consonants
What are the Spinal Nerves for Speech?
C3-C5 Phrenic Nerve
- Motor supply to the diaphram
Thoracic Nerves
- Intercostal muscles
- Abdominal muscles
What are the 4 major functional divisions of the Speech Motor System?
Final Common Pathway
Direct Activation Pathway
Indirect Activation Pathway
Control Circuits
Final Common Pathway
Lower motor neuron system (nerves)
Direct Activation Pathway
Upper motor neuron system a.k.a pyramidal tract
Indirect Activation Pathway
Extrapyramidal tract
Control Circuits
Basal ganglia & Cerebellum
Final Common Pathway
- Involves pairs of cranial nerves which communicate with the muscles of phonation, resonance, articulation and prosody
CN V- Trigeminal, CN VII- Facial, CN IX- Glossopharyngeal, CN X- Vagus, and CN XII- Hypoglossal - Also includes spinal nerves involved in respiration
Primarily C3-5 form the phrenic nerve, which is controlled by nuclei in the pons and medulla - Lower motor neurons originate in the brainstem at the cranial nerve nuclei and terminate in the musculature
- Damage to the final common pathway results in FLACCID DYSARTHRIA
Direct Activation Pathway
- Includes the primary motor cortex, premotor cortex, supplementary motor area as well as some somatosensory fibers
- Upper motor neurons from the pyramidal tracts
Corticobulbar Tract - Neurons connect from motor cortex to brainstem nuclei of CN V, VII, IX, X, and XII
Corticospinal Tract - Neurons project to spinal nerves affecting respiratory muscles - Cross the midline (decussate) in the medulla to connect to the contralateral final common pathway
- Damage to upper motor neurons on one side only results in Unilateral Upper Motor Neuron Dysarthria
- Bilateral damage to UMNs results in SPASTIC DYSARTHRIA
Indirect Activation Pathway
Also known as the extrapyramidal tract
Includes pathways between the cortex and:
- Reticular formation (Corticoreticular tract) – assists with sensorimotor integration and with muscle tone regulation
- Red nucleus (Corticorubral tract) – assists with muscle tone regulation
What are the Control Circuits?
Cerebellar
Basal Ganglia
Cerebellar
- Coordinate timing between adjacent steps in movements
- Scales the size of movements by coordinating agonists and antagonists
- Damage results in ATAXIC DYSARTHRIA
Basal Ganglia
- Posture and tone regulation
- Movement scaling
- Inhibition of excess movement
- Damage results in HYPERKINETIC or HYPOKINETIC DYSARTHRIA
What is Motor Planning and Programming?
Motor Planning: is goal oriented and general
Motor Programming: converts the plan to fine details of what to move and when
A very complex array of circuits are involved including motor areas, sensory areas, limbic system, Insula, Broca’s area, thalamus, etc.
Impairment of this process results in APRAXIA OF SPEECH
Damage to which cranial nerve would result in impaired laryngeal function?
CN X- Vagus
What is phonation?
The production or utterance of speech sounds
What is resonance?
The quality in a sound being deep, full, and reverberating
