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Motor Speech Disorders > Mid Term Review > Flashcards

Mid Term Review Flashcards

1
Q

. What is the cerebral cortex, and why is it important?

A

• Vital part of the nervous system
• Surface of cerebrum
• Often described as “gray matter” of brain
• Performs higher cognitive activities
o Language motor planning problem solving sensory perception

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2
Q

What are cranial nerve nuclei, and where are they located?

A

Sites in the brainstem where the cell bodies of lower motor neurons in the cranial nerves are located.

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3
Q

bundles of axons found in the CNS

A

Tracts

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4
Q

Bundles of axons found in the PNS

A

Nerves

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5
Q

Describe the association cortex and its importance in formulating a movement.

A
  • Makes sense of sensory impulses initially analyzed by primary corticies
  • Not a single region of brain, but divided into four areas of cortex
  • Formulates initial planning of a voluntary movement
  • Sends rough sequence of motor impulses down to subcortical structures for further processing and refining
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6
Q

The primary cortex is compromised of:

A

oCortices that fist analyze sensory information in the primary auditory cortex, primary visual cortex, primary sensory cortex
oCortex that receives planned motor impulses from cortical and subcortical areas of the brain in the primary motor cortex
•planning and voluntary movement does not originate in the primary motor cortex

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7
Q

What role does the Basal ganglia play in creation of movement:

A

links the association cortex with the primary motor cortex

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8
Q

What role does the cerebellum play in the creation of movement:

A

takes rough motor impulses from the association cortex, smooths them out, coordinates them, and sends them (via the thalamus) up to the primary motor cortex

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9
Q

How is it known that movements do not originate in the primary motor cortex?

A

Because the primary motor cortex receives neural motor impulses that have been processed, smoothed, and coordinated by basal ganglia, cerebellum, and thalamus.

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10
Q

carries impulses that control voluntary, fine motor movements; works at a conscious level

A

Pyramidal System

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11
Q

carries impulses that control postural support needed by fine motor movements ; works at more of an unconscious level, automatic in function

A

Extrapyramidal System

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12
Q

motor fiber within the CNS; damage results in spasticity

A

Upper Motor Neurons

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13
Q

motor fibers in the cranial and spinal nerves; damage results in muscle paralysis or paresis

A

Lower Motor Neurons

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14
Q

Point where axons of lower motor neurons make synaptic connections with muscle cells

A

neuromuscular junction

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15
Q

What are the two basic methods of evaluating motor speech disorders?

A

Instrumentation & Perceptual Analysis

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16
Q

relies on sophisticated devices to objectively measure components of speech production

A

Instrumentation

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17
Q

relies on clinicians ears and eyes to judge

A

Perceptual analysis

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18
Q

What are the two goals of any speech-language evaluation?

A

Understand a patients problem

Determine beginning level of treatment

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19
Q

What are the five components of speech production?

A

Respiration, Phonation, Resonance, Articulation, Prosody

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20
Q

Primary function for speech production

A

Respiration

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21
Q

Production of voiced phonemes through vocal-fold vibration in larynx

A

Phonation

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22
Q

Proper placement of oral or nasal tonality onto phonemes during speech accomplished by raising and lowering velum

A

Resonance

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23
Q

shaping of vocal air stream into phonemes

A

Articulation

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24
Q

Melody of speech, using stress and intonation to convey meaning

A

Prosody

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25
Q

Speech production deficit resulting from neuromotor damage to PNS or CNS
Strictly a speech production disorder caused by neuromotor damage

A

Dysarthria

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26
Q

Motor speech disorder associated with damage to left hemisphere of brain
Deficit in the ability to sequence the motor commeands needed to correctly position the articulators during the voluntary production of phonemes

A

Apraxia of speech `

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27
Q

6 Salient features of neuromuscular function

A

Muscle Strength, Speed of Movement, Range of Motion, Accuracy of movement, Motor Steadiness, Muscle Tone

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28
Q

Rapid repetition of a single movment; usually obtained by timing patients as they repeat a syllable, such as “puh, puh, puh” as quickly, evenly, and clearly as possible

A

AMR

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29
Q

Rapid repetition of a sequence of movements; usually obtained by timing patients as they repeat syllablesm such as “puh, tuh, kuh,” as quickly, evenly, and clearly as possible.

A

Sequential Motion Rate

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30
Q

Damage to lower motor neurons in the cranial or spinal nerves; Result of Damage to the PNS

A

Flaccid Dysarthria

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31
Q

Flaccid dysarthria can occur after damage to which part of the nervous system?

A

PNS

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32
Q

Why are lower motor neurons also known as the “final common pathway”?

A

last and only “road” neural impulses from the upper motor neurons travel to reach muscles

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33
Q

What are the six cranial nerves for speech production?

A

Trigeminal, Facial, Glossopharyngeal, Vagus, Accessory, Hypoglossal

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34
Q

Which cranial nerve innervates intrinsic muscles of the larynx?

A

Accessory Cranial Nerves

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35
Q

What role do the spinal nerves play in speech production?

A

Phrenic nerve important for speech production

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36
Q

How can a brainstem stroke cause flaccid dysarthria?

A

Occurs with interruption of blood flow to brain; can affect the cranial nerves directly; degree of impairment will depend on the number of lower motor neurons that are lost during a stroke

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37
Q

Bilateral damage to upper motor neurons of the pyramidal and extrapyramidal neural pathways

A

Spastic Dysarthria

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38
Q

Which nervous system tracts must be damaged before spastic dysarthria can occur?

A

Damage must be bilateral affecting both left and right tracts of the upper motor neurons

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39
Q

Damage in the pyramidal system will result in ____________________

A

weak/slow skilled movements

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40
Q

Damage in the extrapyramidal system will result in _________________________

A

weakness, increased muscle tone (spasticity), and abnormal reflexes

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41
Q

Most common cause of spastic dysarthria?

A

Stroke which will result in spastic dysarthria only when two or more strokes occur in certain combinations or single stroke occurs in brainstem

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42
Q

Uncontrollable crying or laughing that can accompany damage to upper motor neurons of brainstem; caused by damage to part of brain important in inhibiting emotions

A

pseudobulbar affect

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43
Q

atrophy or weaknessin muscles innervated through medulla, including tongue, velum, larynx and pharynx; caused by damage to lower motor neurons

A

Bulbar Palsy

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44
Q

weakness and slowness in same muscles; caused by damage to upper motor neurons

A

Pseudobulbar palsy

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45
Q

Motor speech disorder caused by damage to upper motor neurons on one side of brain that supply cranial and spinal nerves involved in speech production
Weakness in lower face, lips, and tongue on opposite side of lesion, resulting in deficits, specifically imprecise consonants

A

Unilateral Upper Motor Neuron Dysarthria

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46
Q

Why does unilateral damage to the upper motor neurons result in such less severe symptoms as compared with bilateral damage to these neurons?

A

Because most cranial nerves serving the speech muscles receive bilateral innervation from upper motor neurons

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47
Q

Motor speech disorder often due to damage to cerebellum or its neural pathways
Results in articulatory and prosodic speech errors, making speech unsteady and slurred

A

Ataxic Dysarthria

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48
Q

Primary function of the cerebellum is what?

A

Coordinate timing and force of muscular contractions

Processes sensory information from all over the body and integrates information into execution of movement

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49
Q

transmits planned movements from the association cortex to the cerebellum

A

middle peduncle

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50
Q

transits cerebellar commands to the cortex and the extrapyramidal system

A

Superior peduncle

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51
Q

transmits sensory information from the entire body to the cerebellum

A

inferior peduncle

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52
Q

degenertive disease that can lead to ataxic dysarthria and other motor deficits.

A

autosomal dominant cerebellar ataxia of late onset

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53
Q

What is decomposition of movement?

A

manifestations of cerebellar dysfunction, where instead of smooth coordinated movements, they are distinct and jerky

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54
Q

Is hypernasality a significant problem in most cases of ataxic dysarthria?

A

No

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55
Q

Caused by any process that damages basal ganglia

Harsh vocal quality, reduced stress, monoloudness, imprecise consonants

A

Hypokinetic Dysarthria

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56
Q

What are the characteristic symptoms of parkinsonism?

A
  • Resting tremor
  • Bradykinesia: slow, reduced range of movement
  • Rigidity
  • Spasticity (Michael J Foxx)
  • Akinesia: delay in initiation of movements
  • Postural reflexes
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57
Q

Reduction of dopamine in the striatum causes too much acetylcholine which can be the primary cause of rigidity, bradykinesia, and other symptoms of parkinsonism

A

.

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58
Q

Chemical precursor of dopamine; used to treat the effects of parkinsonism

A

L-Dopa

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59
Q

side effects of L-Dopa treatment:

A

Minor: Dry mouth, dizziness, dilated pupils, and clumsiness
Major: inappropriate emotional outbursts, delusions, hallucinations, and confusion

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60
Q

caused by a virus; triggers the degeneration of nerve cells in the substantia nigra, which results in decreased amounts of dopamine in the basal ganglia

A

postencephalitic parkinsonism

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61
Q

perceptually distinguishable group of motor speech disorders manifested in any or all levels of speech
mostly caused by dysfunction in basal ganglia
“too much movement”
All produce involuntary movements that interfere with normal speech production.

A

Hyperkinetic Dysarthria

62
Q

What is one reason why the function of the basal ganglia is not well understood?

A

Different disorders are associated nd have nearly opposite effects on movement.

63
Q

movement disorder distinguished by random involuntary movements of limbs, trunk, head, and neck

A

Chorea

64
Q

Choreic motions:

A

appear dancelike, smooth, and coordinated, but actually unpredictable, purposeless, and sometimes jerky or abrupt

65
Q

hyperkinetic movement disorder of muscle tone; causes involuntary, prolonged muscle contractionis tht interfere with normal movement or posture

A

Dystonia

66
Q

Dystonic motions:

A

Slower more sustained quality, rather than chorea, with contractions that wax and wane during ongoing movement

67
Q

What are the symptoms of Huntingtons disease?

A

subtle intellectual deficits which progresses into a severe dementia; patients will show personality changes, impaired problem-solving abilities, and word-finding difficulties
eventually they will become inattentive, vague, withdrawn, and depressed

68
Q

Why do individuals with chorea sometimes have voice stoppages, unexpected inhalations, and sudden exhalations?

A

Involuntary movements of the chess or diaphragm

69
Q

rapid movement that can be controlled voluntarily for a time, but performed frequently due to compulsive desire

A

Tic

70
Q

What is a tic caused by?

A

Cause traced to mild brain damage or toxic reactions to medications in some cases, but no identifiable CNS disorder in most cases

71
Q

Most common hyperkinetic movement disorder?

A

Essential or Organic Tremor

72
Q

idiosyncratic strategies that can suppress involuntary movement for a time

A

Sensory Tricks

73
Q

Top 4 Characteristics of Ataxic Dysarthria

A

Imprecise Consonants
Excess and Equal Stress
Irregular articulatory breakdown
Distorted Vowels

74
Q

Describe the articulation of an Ataxic Dysarthric?

A 
Imprecise consonant deletion
Distorted vowels (slurred quality)
Irregular articulatory breakdowns
Decomposition of movement
75
Q

Describe the Prosody of an ataxic dysarthric?

A

Equal and excess stress
Prolonged phonemes and prolonged intervals between phonemes
Monopitch and monoloudness

76
Q

Describe the Phonation of an Ataxic Dysarthric?

A

Harsh voice quality (caused by decreased muscle tone)

Voice tremor

77
Q

Describe the Resonance of an Ataxic Dysarthric?

A

Hypernasality (seldom)

Hyponasality (Intermittent, timing errors of muscles)

78
Q

Describe the Respiration of an Ataxic Dysarthric?

A

Uncoordinated movements in respiratory muscles, contributing to speech deficits.
Paradoxical movements, occur when muscles work against each other rather than in coordination (increase rate of speech, decreased loudness, harsh voice quality)

79
Q

Top 4 Characteristics of Flaccid Dysarthria:

A

Hypernasality
Imprecise Consonants
Breathiness
Monopitch

80
Q

Describe the Articulation in a Flaccid Dysarthric?

A

Imprecise consonant production

81
Q

Describe the Prosody in a Flaccid Dysarthric?

A

Monopitch, Monoloudness

82
Q

Describe the Phonation in a Flaccid Dysarthric?

A

Phonatory competence

Breathy voice quality

83
Q

Describe the Resonance in a Flaccid Dysarthric?

A

Hypernasality
Nasal Emission
Weak pressure consonants
Shortened phrases

84
Q

Describe the Respiration in a Flaccid Dysarthric?

A

Weakened respiration
Reduced loudness
Shortened phrase length

85
Q

Top 4 characteristics of a Spastic Dysarthric:

A

Imprecise Consonants
Monopitch
Reduced Stress
harsh Voice Quality

86
Q

Describe the Articulation of a Spastic Dysarthric?

A 
Imprecise consonants
Voiceless consonants 
Imcomplete articultory contact 
Incomplete consonant clusters 
Vowel Distortion
87
Q

Describe the Prosody of a Spastic Dysarthric?

A 
Monopitch
Reduced Stress
Monoloudness
Short phrases
Slow rate of speech
88
Q

Describe the Phonation of a Spastic Dysarthric?

A

Harsh voice quality
Strained-Strangled vocal quality
Low-pitch

89
Q

Describe the Resonance of a Spastic Dysarthric?

A

Hypernasality

90
Q

Describe the Respiration of a Spastic Dysarthric?

A

Reduced inhalation and exhalation
Uncoordinated breathing patterns
Reduced vital capacity

91
Q

Top 4 Characteristics of Unilateral Motor Neuron Dysarthria:

A

Imprecise Consonants
Slow Alternate Motion Rates
Harsh Voice Quality
Imprecise AMRs

92
Q

Describe the Articulation of a Unilateral Motor Neuron Dysarthric?

A 
Affects the tongue and lower face 
Imprecise Consonant Production: primary difficulty
Irregular Articulatory breakdowns 
Slow alternate motion rates (AMRs)
Irregular AMRs
93
Q

Describe the Prosody of a Unilateral Motor Neuron Dysarthric?

A

Slightly slow rate of speech

94
Q

Describe the Phonation of a Unilateral Motor Neuron Dysarthric?

A

Mild to Moderate harsh vocal quality

95
Q

Describe the Resonance of a Unilateral Motor Neuron Dysarthric?

A

Hypernasality

96
Q

Describe the Respiration of a Unilateral Motor Neuron Dysarthric?

A

Rarely affected

97
Q

Top 4 Characteristics of Hypokinetic Dysarthia:

A

Monopitch
Reduced Stres
Monoloudness
Imprecise Consonants

98
Q

Describe the Articulation of a Hypokinetic Dysarthric?

A

Imprecise consonants
Repeated phonemes
palilalia

99
Q

Describe the Prosody of a Hypokinetic Dysarthric?

A

Monopitch
Reduced Stress
Monoloudness (most common)

100
Q

Describe the Phonation of a Hypokinetic Dysarthric?

A

Harsh/breathy quality
Aphonia
Low-pitch

101
Q

Describe the Resonance of a Hypokinetic Dysarthric?

A

Mild hypernasality

102
Q

Top 4 Characteristics of Hyperkinetic Dysarthria:

A

Imprecise Consonants
Prolonged Intervals
Variable Pitch
Monopitch

103
Q

distinguished by involuntary and brief contractions of part, whole, or group of muscles in same area

A

Myoclonus

104
Q

Benign disorder that causes tremulous movements in affected body parts; idiopathic; most common

A

Essential Tremor

105
Q

Describe the Articulation in a Hyperkinetic Dysarthric?

A

Imprecise consonants
Distorted Vowels
Irregular articulatory breakdowns
prolonged phonemes

106
Q

Describe the Prosody in a Hyperkinetic Dysarthric?

A

Monopitch
Monoloudness
Inappropriate silences
shortened phrases

107
Q

Describe the Phonation in a Hyperkinetic Dysarthric?

A

Harsh vocal quality
strained strangled quality
Excess loudness Variation

108
Q

Simultaneous phonation of two sounds, usually the result of hyperadducted vocal folds that cause vibrations in the false and true vocal folds (Speech)

A

Diplophonia

109
Q

Phonation on inhalation caused by the incomplete abduction of one or both vocal folds (Breath)

A

Stridor

110
Q

Reduced vocal pitch variation during speech

A

Monopitch

111
Q

Reduced vocal loudness variation during speech

A

monoloudness

112
Q

Excessive amounts of nasal resonance on nonnasal phonemes (Velum does not seal off)

A

Hypernasal

113
Q

Speech with too little nasal resonance on nasal phonemes (Velum seals everything up) (cold, Eric Cartman)

A

Hyponasal

114
Q

Small spontaneous contraction of muscle tissue, of ten seen after lower motor neuron damage (mostly seen at rest)

A

Fasiculations

115
Q

A disorder of phonation caused by incomplete adduction of the vocal folds, often associated with vocal fold paralysis or paresis.

A

Breathy Voice Quality

116
Q

A disorder of phonation caused by abnormally tight adduction of the vocal folds.

A

Harsh Vocal quality

117
Q

Rapid repetition of a single movment; usually obtained by timing patients as they repeat a syllable, such as “puh, puh, puh” as quickly, evenly, and clearly as possible

A

AMR

118
Q

Rapid repetition of a sequence of movements; usually obtained by timing patients as they repeat syllablesm such as “puh, tuh, kuh,” as quickly, evenly, and clearly as possible.

A

SMR

119
Q

Neurologic deficit that results in movements that are slow and have reduced range of motion; often seen in parkinsonism

A

Bradykinesia

120
Q

delay in the initiation of movements; one of the most common characteristics of parkinsonism.

A

Akinesia

121
Q

Deficit in the ability to sequence oral movements that are not related to speech production

A

Nonverbal Oral Apraxia

122
Q

Deficit in the ability to sequence the movements of the articulators, resulting mainly in problems of articulation and prosody

A

Apraxia of Speech

123
Q

Structure is not enough; Cleft palate; nasality is an issue

A

Velopharyngeal Insufficiency:

124
Q

does not work its functionally based; Deaf speech

- Incomplete closure of the velopharyngeal port, usually resulting in hypernasal resonance

A

Velopharyngeal Incompetance

125
Q

Inhibits movement; Important neurotransmitter in the central nervous system, with considerable localization in the basal ganglia

A

Dopamine

126
Q

Neurotransmitter at several sites in the nervous system, including at the neuromuscular junction and in the basal ganglia

A

Acetylcholine

127
Q

5 Components of speech:

A 
Respiration
Phonation
Resoance
Articulation
Prosody
128
Q

Six Salient Features of Speech:

A 
Muscle strength
Speed of movement
Range of motion
Accuracy of movement
Motor steadiness
Muscle tone
129
Q

Produced when velum is raised and closes off nasal cavity from vocal air stream

A

Oral Resonance

130
Q

Produced when velum is lowered and oral cavity is blocked by the lips or tongue

A

Nasal Resonance

131
Q

Damage to the Lower Motor Neurons

A

Flaccid

132
Q

Bilateral Damage to the Upper Motor Neurons

A

Spastic

133
Q

Damage to the Basal Ganglia

A

Hyper & Hypo

134
Q

Unilateral Damage to the Upper Motor Neurons

A

Upper Motor Neuron

135
Q

Damage to the Cerebellum

A

Ataxic

136
Q

Name the Six Cranial Nerves involved in Speech:

A 
V - Trigeminal 
VII - Facial
XI - Accessory
IX - Glossopharyngeal 
X - Vagus 
XII - Hypoglossal
137
Q

Trigeminal

A

V - Chewing and sensation to face, tech, anterior tongue

  • Elevate/ lower the jaw
  • soft palate acts stiffer
  • helps open the eustachian tube
138
Q

Facial

A

VII - Movement of facial muscles, taste, salivary glands

139
Q

Accessory

A

XI - work w/ vagal nerve

- innervate intrinsic muscles of velum, pharynx, and larynx

140
Q

Glossopharyngeal

A

IX- Taste, swallowing, elevation of pharynx and larynx, parotid salivary gland, sensation to posterior tongue, upper pharynx

  • courses to pharynx
  • innervates muscles to assist with elevation and opening of upper pharynx
141
Q

Vagus

A

X -Taste, swallowing, elevation of palate, phonation, parasympathetic outflow to visceral organs
-palatal movement

142
Q

Hypoglossal

A

XII - Movement of Tongue

-Intrinsic & Extrinsic motor function for tongue

143
Q

Branches of the Facial Nerve:

A

Ceriofacial: innervates muscles of lower face
Temporofacial: innervates muscle of upper face

144
Q

Branches of the Trigeminal Nerve:

A

Mandibular, Maxillary, Ophthalamic

145
Q

Branches of Vagus Nerve:

A

Pharyngeal: Velum (affect resonance)
External superior laryngeal- Stretch and tense VF (pitch)
Reccurent laryngeal: motor innervation to all intrinsic muscles of larynx
- Unidamage - breathy and dec. loudness
- bi damage - breathy and hoarse

146
Q

Tasks for V CN:

A
  1. Jaw at rest
  2. Bite
  3. Move Jaw Laterally
  4. Open mouth
  5. Examinar provides resistance to the patient opening mouth
  6. Speech Eval through diadochokinesis
147
Q

Tasks for VII CN:

A
  1. Examine structure at rest
  2. Wrinkle forehead
  3. Pucker lips
  4. Frown - show teeth pull down hard with corner of mouth
148
Q

Task for IX CN:

A
  1. Velopharynx @ rest

2. Velopharynx during movement prolong /a/

149
Q

Tasks for X CN:

A
  1. Sharp glottal stop/grunting sounds

2. Laryngeal excursion upon swallow

150
Q

Tasks for XII CN:

A
  1. Examine tongue @ rest
  2. Tongue retraction/ tone
  3. Protrude/ lateralization
  4. Retract
  5. Elevation
  6. Approximation/ Coordination
151
Q

Tasks for XI CN:

A

Assists Vagus

Motor Speech Disorders (2 decks)

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