Mid Term Review Flashcards
. What is the cerebral cortex, and why is it important?
• 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
What are cranial nerve nuclei, and where are they located?
Sites in the brainstem where the cell bodies of lower motor neurons in the cranial nerves are located.
bundles of axons found in the CNS
Tracts
Bundles of axons found in the PNS
Nerves
Describe the association cortex and its importance in formulating a movement.
- 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
The primary cortex is compromised of:
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
What role does the Basal ganglia play in creation of movement:
links the association cortex with the primary motor cortex
What role does the cerebellum play in the creation of movement:
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
How is it known that movements do not originate in the primary motor cortex?
Because the primary motor cortex receives neural motor impulses that have been processed, smoothed, and coordinated by basal ganglia, cerebellum, and thalamus.
carries impulses that control voluntary, fine motor movements; works at a conscious level
Pyramidal System
carries impulses that control postural support needed by fine motor movements ; works at more of an unconscious level, automatic in function
Extrapyramidal System
motor fiber within the CNS; damage results in spasticity
Upper Motor Neurons
motor fibers in the cranial and spinal nerves; damage results in muscle paralysis or paresis
Lower Motor Neurons
Point where axons of lower motor neurons make synaptic connections with muscle cells
neuromuscular junction
What are the two basic methods of evaluating motor speech disorders?
Instrumentation & Perceptual Analysis
relies on sophisticated devices to objectively measure components of speech production
Instrumentation
relies on clinicians ears and eyes to judge
Perceptual analysis
What are the two goals of any speech-language evaluation?
Understand a patients problem
Determine beginning level of treatment
What are the five components of speech production?
Respiration, Phonation, Resonance, Articulation, Prosody
Primary function for speech production
Respiration
Production of voiced phonemes through vocal-fold vibration in larynx
Phonation
Proper placement of oral or nasal tonality onto phonemes during speech accomplished by raising and lowering velum
Resonance
shaping of vocal air stream into phonemes
Articulation
Melody of speech, using stress and intonation to convey meaning
Prosody
Speech production deficit resulting from neuromotor damage to PNS or CNS
Strictly a speech production disorder caused by neuromotor damage
Dysarthria
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
Apraxia of speech `
6 Salient features of neuromuscular function
Muscle Strength, Speed of Movement, Range of Motion, Accuracy of movement, Motor Steadiness, Muscle Tone
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
AMR
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.
Sequential Motion Rate
Damage to lower motor neurons in the cranial or spinal nerves; Result of Damage to the PNS
Flaccid Dysarthria
Flaccid dysarthria can occur after damage to which part of the nervous system?
PNS
Why are lower motor neurons also known as the “final common pathway”?
last and only “road” neural impulses from the upper motor neurons travel to reach muscles
What are the six cranial nerves for speech production?
Trigeminal, Facial, Glossopharyngeal, Vagus, Accessory, Hypoglossal
Which cranial nerve innervates intrinsic muscles of the larynx?
Accessory Cranial Nerves
What role do the spinal nerves play in speech production?
Phrenic nerve important for speech production
How can a brainstem stroke cause flaccid dysarthria?
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
Bilateral damage to upper motor neurons of the pyramidal and extrapyramidal neural pathways
Spastic Dysarthria
Which nervous system tracts must be damaged before spastic dysarthria can occur?
Damage must be bilateral affecting both left and right tracts of the upper motor neurons
Damage in the pyramidal system will result in ____________________
weak/slow skilled movements
Damage in the extrapyramidal system will result in _________________________
weakness, increased muscle tone (spasticity), and abnormal reflexes
Most common cause of spastic dysarthria?
Stroke which will result in spastic dysarthria only when two or more strokes occur in certain combinations or single stroke occurs in brainstem
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
pseudobulbar affect
atrophy or weaknessin muscles innervated through medulla, including tongue, velum, larynx and pharynx; caused by damage to lower motor neurons
Bulbar Palsy
weakness and slowness in same muscles; caused by damage to upper motor neurons
Pseudobulbar palsy
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
Unilateral Upper Motor Neuron Dysarthria
Why does unilateral damage to the upper motor neurons result in such less severe symptoms as compared with bilateral damage to these neurons?
Because most cranial nerves serving the speech muscles receive bilateral innervation from upper motor neurons
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
Ataxic Dysarthria
Primary function of the cerebellum is what?
Coordinate timing and force of muscular contractions
Processes sensory information from all over the body and integrates information into execution of movement
transmits planned movements from the association cortex to the cerebellum
middle peduncle
transits cerebellar commands to the cortex and the extrapyramidal system
Superior peduncle
transmits sensory information from the entire body to the cerebellum
inferior peduncle
degenertive disease that can lead to ataxic dysarthria and other motor deficits.
autosomal dominant cerebellar ataxia of late onset
What is decomposition of movement?
manifestations of cerebellar dysfunction, where instead of smooth coordinated movements, they are distinct and jerky
Is hypernasality a significant problem in most cases of ataxic dysarthria?
No
Caused by any process that damages basal ganglia
Harsh vocal quality, reduced stress, monoloudness, imprecise consonants
Hypokinetic Dysarthria
What are the characteristic symptoms of parkinsonism?
- Resting tremor
- Bradykinesia: slow, reduced range of movement
- Rigidity
- Spasticity (Michael J Foxx)
- Akinesia: delay in initiation of movements
- Postural reflexes
Reduction of dopamine in the striatum causes too much acetylcholine which can be the primary cause of rigidity, bradykinesia, and other symptoms of parkinsonism
.
Chemical precursor of dopamine; used to treat the effects of parkinsonism
L-Dopa
side effects of L-Dopa treatment:
Minor: Dry mouth, dizziness, dilated pupils, and clumsiness
Major: inappropriate emotional outbursts, delusions, hallucinations, and confusion
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
postencephalitic parkinsonism
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.
Hyperkinetic Dysarthria
What is one reason why the function of the basal ganglia is not well understood?
Different disorders are associated nd have nearly opposite effects on movement.
movement disorder distinguished by random involuntary movements of limbs, trunk, head, and neck
Chorea
Choreic motions:
appear dancelike, smooth, and coordinated, but actually unpredictable, purposeless, and sometimes jerky or abrupt
hyperkinetic movement disorder of muscle tone; causes involuntary, prolonged muscle contractionis tht interfere with normal movement or posture
Dystonia
Dystonic motions:
Slower more sustained quality, rather than chorea, with contractions that wax and wane during ongoing movement
What are the symptoms of Huntingtons disease?
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
Why do individuals with chorea sometimes have voice stoppages, unexpected inhalations, and sudden exhalations?
Involuntary movements of the chess or diaphragm
rapid movement that can be controlled voluntarily for a time, but performed frequently due to compulsive desire
Tic
What is a tic caused by?
Cause traced to mild brain damage or toxic reactions to medications in some cases, but no identifiable CNS disorder in most cases
Most common hyperkinetic movement disorder?
Essential or Organic Tremor
idiosyncratic strategies that can suppress involuntary movement for a time
Sensory Tricks
Top 4 Characteristics of Ataxic Dysarthria
Imprecise Consonants
Excess and Equal Stress
Irregular articulatory breakdown
Distorted Vowels
Describe the articulation of an Ataxic Dysarthric?
Imprecise consonant deletion Distorted vowels (slurred quality) Irregular articulatory breakdowns Decomposition of movement
Describe the Prosody of an ataxic dysarthric?
Equal and excess stress
Prolonged phonemes and prolonged intervals between phonemes
Monopitch and monoloudness
Describe the Phonation of an Ataxic Dysarthric?
Harsh voice quality (caused by decreased muscle tone)
Voice tremor
Describe the Resonance of an Ataxic Dysarthric?
Hypernasality (seldom)
Hyponasality (Intermittent, timing errors of muscles)
Describe the Respiration of an Ataxic Dysarthric?
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)
Top 4 Characteristics of Flaccid Dysarthria:
Hypernasality
Imprecise Consonants
Breathiness
Monopitch
Describe the Articulation in a Flaccid Dysarthric?
Imprecise consonant production
Describe the Prosody in a Flaccid Dysarthric?
Monopitch, Monoloudness
Describe the Phonation in a Flaccid Dysarthric?
Phonatory competence
Breathy voice quality
Describe the Resonance in a Flaccid Dysarthric?
Hypernasality
Nasal Emission
Weak pressure consonants
Shortened phrases
Describe the Respiration in a Flaccid Dysarthric?
Weakened respiration
Reduced loudness
Shortened phrase length
Top 4 characteristics of a Spastic Dysarthric:
Imprecise Consonants
Monopitch
Reduced Stress
harsh Voice Quality
Describe the Articulation of a Spastic Dysarthric?
Imprecise consonants Voiceless consonants Imcomplete articultory contact Incomplete consonant clusters Vowel Distortion
Describe the Prosody of a Spastic Dysarthric?
Monopitch Reduced Stress Monoloudness Short phrases Slow rate of speech
Describe the Phonation of a Spastic Dysarthric?
Harsh voice quality
Strained-Strangled vocal quality
Low-pitch
Describe the Resonance of a Spastic Dysarthric?
Hypernasality
Describe the Respiration of a Spastic Dysarthric?
Reduced inhalation and exhalation
Uncoordinated breathing patterns
Reduced vital capacity
Top 4 Characteristics of Unilateral Motor Neuron Dysarthria:
Imprecise Consonants
Slow Alternate Motion Rates
Harsh Voice Quality
Imprecise AMRs
Describe the Articulation of a Unilateral Motor Neuron Dysarthric?
Affects the tongue and lower face Imprecise Consonant Production: primary difficulty Irregular Articulatory breakdowns Slow alternate motion rates (AMRs) Irregular AMRs
Describe the Prosody of a Unilateral Motor Neuron Dysarthric?
Slightly slow rate of speech
Describe the Phonation of a Unilateral Motor Neuron Dysarthric?
Mild to Moderate harsh vocal quality
Describe the Resonance of a Unilateral Motor Neuron Dysarthric?
Hypernasality
Describe the Respiration of a Unilateral Motor Neuron Dysarthric?
Rarely affected
Top 4 Characteristics of Hypokinetic Dysarthia:
Monopitch
Reduced Stres
Monoloudness
Imprecise Consonants
Describe the Articulation of a Hypokinetic Dysarthric?
Imprecise consonants
Repeated phonemes
palilalia
Describe the Prosody of a Hypokinetic Dysarthric?
Monopitch
Reduced Stress
Monoloudness (most common)
Describe the Phonation of a Hypokinetic Dysarthric?
Harsh/breathy quality
Aphonia
Low-pitch
Describe the Resonance of a Hypokinetic Dysarthric?
Mild hypernasality
Top 4 Characteristics of Hyperkinetic Dysarthria:
Imprecise Consonants
Prolonged Intervals
Variable Pitch
Monopitch
distinguished by involuntary and brief contractions of part, whole, or group of muscles in same area
Myoclonus
Benign disorder that causes tremulous movements in affected body parts; idiopathic; most common
Essential Tremor
Describe the Articulation in a Hyperkinetic Dysarthric?
Imprecise consonants
Distorted Vowels
Irregular articulatory breakdowns
prolonged phonemes
Describe the Prosody in a Hyperkinetic Dysarthric?
Monopitch
Monoloudness
Inappropriate silences
shortened phrases
Describe the Phonation in a Hyperkinetic Dysarthric?
Harsh vocal quality
strained strangled quality
Excess loudness Variation
Simultaneous phonation of two sounds, usually the result of hyperadducted vocal folds that cause vibrations in the false and true vocal folds (Speech)
Diplophonia
Phonation on inhalation caused by the incomplete abduction of one or both vocal folds (Breath)
Stridor
Reduced vocal pitch variation during speech
Monopitch
Reduced vocal loudness variation during speech
monoloudness
Excessive amounts of nasal resonance on nonnasal phonemes (Velum does not seal off)
Hypernasal
Speech with too little nasal resonance on nasal phonemes (Velum seals everything up) (cold, Eric Cartman)
Hyponasal
Small spontaneous contraction of muscle tissue, of ten seen after lower motor neuron damage (mostly seen at rest)
Fasiculations
A disorder of phonation caused by incomplete adduction of the vocal folds, often associated with vocal fold paralysis or paresis.
Breathy Voice Quality
A disorder of phonation caused by abnormally tight adduction of the vocal folds.
Harsh Vocal quality
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
AMR
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.
SMR
Neurologic deficit that results in movements that are slow and have reduced range of motion; often seen in parkinsonism
Bradykinesia
delay in the initiation of movements; one of the most common characteristics of parkinsonism.
Akinesia
Deficit in the ability to sequence oral movements that are not related to speech production
Nonverbal Oral Apraxia
Deficit in the ability to sequence the movements of the articulators, resulting mainly in problems of articulation and prosody
Apraxia of Speech
Structure is not enough; Cleft palate; nasality is an issue
Velopharyngeal Insufficiency:
does not work its functionally based; Deaf speech
- Incomplete closure of the velopharyngeal port, usually resulting in hypernasal resonance
Velopharyngeal Incompetance
Inhibits movement; Important neurotransmitter in the central nervous system, with considerable localization in the basal ganglia
Dopamine
Neurotransmitter at several sites in the nervous system, including at the neuromuscular junction and in the basal ganglia
Acetylcholine
5 Components of speech:
Respiration Phonation Resoance Articulation Prosody
Six Salient Features of Speech:
Muscle strength Speed of movement Range of motion Accuracy of movement Motor steadiness Muscle tone
Produced when velum is raised and closes off nasal cavity from vocal air stream
Oral Resonance
Produced when velum is lowered and oral cavity is blocked by the lips or tongue
Nasal Resonance
Damage to the Lower Motor Neurons
Flaccid
Bilateral Damage to the Upper Motor Neurons
Spastic
Damage to the Basal Ganglia
Hyper & Hypo
Unilateral Damage to the Upper Motor Neurons
Upper Motor Neuron
Damage to the Cerebellum
Ataxic
Name the Six Cranial Nerves involved in Speech:
V - Trigeminal VII - Facial XI - Accessory IX - Glossopharyngeal X - Vagus XII - Hypoglossal
Trigeminal
V - Chewing and sensation to face, tech, anterior tongue
- Elevate/ lower the jaw
- soft palate acts stiffer
- helps open the eustachian tube
Facial
VII - Movement of facial muscles, taste, salivary glands
Accessory
XI - work w/ vagal nerve
- innervate intrinsic muscles of velum, pharynx, and larynx
Glossopharyngeal
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
Vagus
X -Taste, swallowing, elevation of palate, phonation, parasympathetic outflow to visceral organs
-palatal movement
Hypoglossal
XII - Movement of Tongue
-Intrinsic & Extrinsic motor function for tongue
Branches of the Facial Nerve:
Ceriofacial: innervates muscles of lower face
Temporofacial: innervates muscle of upper face
Branches of the Trigeminal Nerve:
Mandibular, Maxillary, Ophthalamic
Branches of Vagus Nerve:
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
Tasks for V CN:
- Jaw at rest
- Bite
- Move Jaw Laterally
- Open mouth
- Examinar provides resistance to the patient opening mouth
- Speech Eval through diadochokinesis
Tasks for VII CN:
- Examine structure at rest
- Wrinkle forehead
- Pucker lips
- Frown - show teeth pull down hard with corner of mouth
Task for IX CN:
- Velopharynx @ rest
2. Velopharynx during movement prolong /a/
Tasks for X CN:
- Sharp glottal stop/grunting sounds
2. Laryngeal excursion upon swallow
Tasks for XII CN:
- Examine tongue @ rest
- Tongue retraction/ tone
- Protrude/ lateralization
- Retract
- Elevation
- Approximation/ Coordination
Tasks for XI CN:
Assists Vagus
