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Motor Speech GRAD > Midterm > Flashcards

Midterm Flashcards

1
Q

Corticospinal

A
  • cortex to internal capsule then down through brainstem and to spinal cord.
  • Synapses at the spinal cord with the spinal nerves
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2
Q

Corticobulbar

A
  • cortex to the bulb-brainstem.
  • Axons go and terminate in brainstem and synapse with cranial nerves.
  • No decussation, no crossing midline. It is a bilateral innervation.
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3
Q

Purpose of a Motor Speech Examination

A
  • Describes what client is doing. Possibly exhibit a motor speech disorder are they structurally appropriate and functioning appropriately?
  • Establishing diagnostic possibilities
  • Establishing a diagnosis
  • Disease diagnosis
  • Specifying severity
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4
Q

Description of Motor Speech Exam

A

Look at structures is there any abnormality and functioning appropriately?
-look at features based on speakers perception. How do they perceive their speech what do they think is different.-perceptual characteristics.
Characterizes the features of speech and the structures and functions related to speech

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5
Q

Establishing Diagnostic Possibilities with a Motor Speech Exam

A

If speech is abnormal then a list of diagnostic possibilities be generated:
-neurologic
-organic or structural problem?
-recently acquired? – longstanding?
-what type of dysarthria?
When did if first start did it progressively get worse?

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6
Q

Establishing Implications for Localization and Disease Diagnosis With a Motor Speech Exam

A

Try to relate symptoms to medical diagnosis with type of dysarthria.
-standard medical conditions

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7
Q

Tests for Dysarthria and Apraxia

A

Apraxia profile
Apraxia battery for adults ABA-2
Franche dysarthria assessment FDA- used widely and has some subjective componenets
Dysarthria examination battery DEB

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8
Q

History of the Speech Condition

A

Make sure questions are specifically related to motor speech and things that can affect the client’s functioning. Understand when symptoms started, the course, the condition if it got worse or better in certain situations do symps get worse. Type and function and activity limitations like when they are speaking on the phone and participation in the environment don’t speak on the phone because know how their speech sounds.
-basic data-age, previous medical history, marital status, family and family involvement. Any other difficulties with speech or language prior to now. Know any other hospitalizations, allergies, and medications.
-consequences think of ICF model
Chart review and interview(nature and course of the condition, type and frequency of activity limitations, communication needs)
Basic data
Onset and course
Associated deficits
Patients perception
Consequences of the condition
Awareness of diagnosis and prognosis

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9
Q

Physical Exam

A 
Lips/tongue
Jaw
Soft palate
Phonation
Respiration
Examine strength, range of motion, coordination, tone)
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10
Q

Additional tasks of a motor speech exam

A

Stress testing of the motor speech mechanism
Testing for oral verbal and nonverbal apraxia
Count 1- 20 and 20 – 1
Connected speech sample

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11
Q

Description of Speech Characterisitics

A

Speech Dimensions used by the Mayo Clinic—see handout
Is the pitch appropriate for age and gender? Are there pitch breaks? Monopitch with no variation in connected speech or when reading?
Loudness: monoloudness, excessive loudness variation.
Vocal quality: harsh voice, breathy, hoarse, strained, hyponasal, or hypernasal
Respiration: forced, clavicular, adequate,
Prosody: is it too fast, too slow, reduction of stress in convo or reading, inapprop silences, stress on wrong syllable of word
Articulation: imprecise consonants and sounds like speech is slurred together?
Overall intelligibility

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12
Q

Assessment of Intelligibility

A

Single words
Sentences
Reading Passages-The Rainbow and The Grandfather Passages
Connected speech
How well the acoustic signal is received by the listener-intelligibility

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13
Q

Tests and Materials for Assessing Intelligibility

A

see handout

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14
Q

Analysis of Why Reduced Intelligibility

A

Important
Do they Vary across tasks?
How the Severity of the dysarthria affects the intelligibility?

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15
Q

Physiological Assessment

A 
Respiratory-lung volumes and capacities to determine if there is enough respiratory capacity for speech production
Laryngeal-endoscopy, EMG
Velopharyngeal-ultra sound
Articulatory-EPG, EMG
pg 41-43
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16
Q

Frontal Lobe precentral gyrus

A

“homunculus” = mapped structures
Damage:
Paralysis/paresis
Speech → Dysarthria

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17
Q

Frontal Lobe: Premotor Area

A

Motor planning

If damage: Apraxia (problem with planning the movement)

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18
Q

Frontal Lobe: Prefrontal Cortex

A

Decision making
If damage:
Impaired judgment, impulsivity

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19
Q

Frontal Lobe: Broca’s Area

A 
(usually 
L hemisphere)
Important for speech production: 
Damage in this area
Expressive aphasia 
(=nonfluent aphasia):
Comprehension > Expression
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20
Q

Parietal Lobe

A
  • awareness of senses, comprehension of written material
  • Primary somastetic cortex (post central gyrus) where sensory input comes in
  • postcentral gyrus damage=sensation
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21
Q

Inferior Parietal Lobe

A

Integration area (inferior parietal lobule) auditory, visual, and sesnory information. Damage in this area have visual perceptual, dyslexia

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22
Q

Temporal Lobe

A
  • For auditory processing of information. Recognition of word meanings and auditory comprehension
  • Wernicke’s Area:Fluent aphasia long stream of speech that doesn’t make sense and has a lot of deficits in comprehension. Word salad. Grammatically correct output but doesn’t make sense.
  • Heschl’s Gyrus All auditory info received
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23
Q

Occipital Lobe

A

-Analyze visual information. High order visual processing of info. Dyslexia. Visual perceptual deficits and visual agnosia where they don’t recognize something.

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24
Q

Lobes: Limbic

A

2 limbic lobes separate. Hippocampus alzhiemers, fornix, maygdala, parahippocampal gyrus, thalamus. Function: memory, emotions, motivation.

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25
Q

Gray matter

A

neuron bodies

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26
Q

white matter

A

mylenated axon fibers

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27
Q

Fibers

A

Projection fibers, association fibers, and commisual.

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28
Q

Projection Fibers

A

Make up tracts (=pathways) connecting cortex with distant structures: brainstem and spinal cord (to and from)

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29
Q

Association Fibers

A

Allow for communication w.in same hemisphere. Conduction aphaisa ability to repeat is difficult. Comprehension and expression is ok.

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30
Q

Comissural Fibers

A

Aid in communication btwn 2 hemispheres. Corpus collosum composed of a lot of comissural fibers.

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31
Q

Subcortical Structures of the Brain

A

Basal Ganglia
Thalamus
Hypothalamus
Internal capsule

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32
Q

Basal Ganglia

A

Loosley constructed masses of gray matter. Related to initiation of movement caudate nucules. Putamen and globus pallidus aka lenticular nucleus. Striatum are caudate nuclues and putamen.

  • Extrapyramidal dysfunction: hyperkinetic/ hypokinetic dysarthria
  • prevents unwanted movements
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33
Q

Hyperkinetic Dysarthria

A

Huntington’s Disease
Hereditary disease. Movement disorder unwanted movements and progressively get worse eventually inhibiting their speech. Results from degeneration of caudate nucleus and putamen. Jerk like movements, rigid, ticks, twitching, tremors.

34
Q

Hypokinetic Dysarthria

A

Parkinsons

Slow and steady loss of dopamine. 3 symptoms: tremor, rigidity, and brady kinesia-slow initiation of movement.

35
Q

Thalamus

A

Relay center for sensory information on the way to the cortex. Axons from all sensory systems synapse here except sense of smell. Thalamus and hypothalamus work together for wakefulness and sleepiness.

36
Q

Hypothalamus

A

Makes floor of third ventricle. Organizational structure w. in limbic system. Function: control digestive system, regulating reproductive system, controlling metabolic functions (hunger, thirst) also emotions.

37
Q

Internal Capsule

A

Subcortical (deep within) structure. Broadband of white matter. Corona radiota connects cerebral cortex to spinal cord.

38
Q

Cerebellum

A
  • little brain, aids in voluntary movement movement
  • Has 2 hemispheres
  • affects walking, writing, and speech
39
Q

Damage to Cerebellum

A

Ataxic gait, problems with coordination, balance

40
Q

Circle of Willis

A

=arterial circle (interconnected arteries)
“Back up” system
Internal carotid and vertebral arteries connected

41
Q

Medulla

A 
Pyramidal decussation
Fibers from corticospinal tract cross from one side to another
Cranial nerves (CN): 
XII – hypoglossal
XI – spinal accessory
X – vagus
IX - glossopharyngeal
42
Q

Pons

A 
Bridge between medulla and midbrain and cerebellum (connections to cerebellum – peduncles)
CN’s
VIII – vestibulocochlear
VII – facial
VI – abducens
V - trigeminal
43
Q

Midbrain

A

Cerebral peduncles (in crus cerebri) – pathways to cerebrum
CN’s
IV - trochlear
III – oculomotor

44
Q

CN Classification

A

Sensory or motor or mixed. afferent efferent or mixed fibers. General (spread throughout their body) or special (specialized for different senses). Somatic vs. visceral. Somatic found in aid in skeletal muscle function. Visceral special sense function ie smell, taste.

45
Q

CN

A 
I – 	Olfactory n.
II –  	Optic n
III – 	Oculomotor n.
IV – 	Trochlear n.
V – 	Trigeminal n.
VI – 	Abducens n.
VII – 	Facial n.
VIII – 	Vestibulocochlear n.
IX – 	Glossopharyngeal n.
X – 	Vagus n.
XI – 	Spinal accessory n.
XII – 	Hypoglossal n.
46
Q

Olfactory nerve

A

1
Afferent nerve. Sense of smell. Doesn’t pass through thalamus. Nuclei located in olfactory bulbs at base of brain. Not important for speech function. Anosmia no ability to smell. Hypo decreased, hyper increased.

47
Q

optic nerve

A

2
Afferent nerve, sensory. Not directly related to speech and swallowing. Responsible for transmitting info along optic tract. Along tract come across optic chiasm the retnal image crosses over. Need to know if there is a visual field deficit for our profession.

48
Q

Oculomotor nerve

A

3

Efferent nerve, motor. Nuclei in midbrain. Responsible for eye movements.

49
Q

Trochlear nerve

A

4

Efferent nerve. Also located in midbrain. Movement of eye.

50
Q

Trigeminal nerve

A

5
Aid in speech.
Mixed nerve.
Sensory info comes from face.
Motor innovation is to the muscles of mastication (chewing).
Neuclei is in pons. 3
branches: ophthalmic sensory info forehead upper eye nasal cavitiy, maxillary sensory info upper jaw and lower eye and lining of nasal cavity and buccual region , and mandibular provide info about mandible lips teeth floor of mouth has not only sensory but also motor aid in muscles for mastication.

51
Q

Abducens nerve

A

6

Efferent nerve, motor. Nuclei in pons. Responsible for inervation of occular muscles.

52
Q

Facial nerve

A

7
Mixed nerve sensory and motor function.
Nuclei in pons.
Afferent (sensory) sense of taste to anterior 2/3 of tongue. Efferent (motor) different facial expressions helps stylohyoid muscle posterior belly of digastric muscle.
Also muscles w.in middle ear.
Bells palsy, facial nerve paralysis comes on suddenly.
No definite known cause.
Assessment of sensory taste present patient w. different sweet vs. salty. Vs. sour to different parts of tongue.
Motor assessment protrude retract lips

53
Q

Vestibulocochelar nerve

A

8
Mixed nerve. Afferent transmits auditory and vestibular (balance) info. Efferent are the hair cells w.in inner ear. Some auditory pathways cross some don’t but damage to this nerve causes patients to have problems with hearing and equilibrium balance.

54
Q

Glosspharyngeal Nerve

A

9
Important for speech and swallowing. Mixed nerve. Sensory fibers for posterior 1/3 of tongue and also for portions of the soft palate, forcial arches. Sytlopharyngeus muscle and also pharyngeal constrictor for swallowing process. Assessment look at gag reflex absent or present look at excessive amnt of oral secretions look at loss of sensation and taste to posterior 1/3 of tongue and impaired pharyngeal swallowing function.

55
Q

Vagus Nerve

A

10
Mixed nerve. Afferent important for ear drums, larynx, pharynx, epligottis, esophagus, heartbeat, blood pressure. Efferent motor of intestines, stomach, kidneys, heart, liver, all organs.

56
Q

Different Branches of Vagus Nerve

A

1 Auricle branch for providing sensory info from tympanic membrane
2recurrent laryngeal branch afferent sensory function from laryngeal mucosa, intrinsic muscles of larynx, inferior pharyngeal constrictor below vocal folds.
3. pharyngeal branch: general taste sensation to the tongue, upper pharynx all afferent. Efferent part is for pharyngeal constrictors, the palatal muscles.
4. superior laryngeal nerve. Afferent sensation of larynx above vocal folds. Efferent for cricothyroid. Look at uvula and make sure symmetrical

57
Q

Accessory Nerve

A

11
Responsible for speech function. Efferent motor fibers. Helps of inervation of laryngeal and pharyngeal muscles and aids in accessory respiration process muscles sternocledomastoid and trapezius. Assessment: ask patient to turn head to right/left, raise shoulders

58
Q

Hyposglossal Nerve

A

12

Primary efferent functions very important for musculature of the tongue. Damage exhibit tremors of tongue

59
Q

ICF Framework

A

Functional and structural integrity
Activity limitation
Participation
Environment

60
Q

Dysarthria

A
  • speech production deficit result from neuromotor damage to PNS or CNS.
  • may affect any 5 components of speech
61
Q

Apraxia

A

-motor speech disorder defined as a deficit in ability to sequence motor commands needed to correctly position artics during voluntary production speech

62
Q

Speech Production Components

A

Respiration-is air supply is not full or steady, affects speech production
Phonation-vf vibration weakness may cause breathy or harsh quality
Resonance-oral or nasal tonality. hypernasal quality of movements are weak or slow
Articulation- damage affecting lips, tongue, jaw
Prosody-melody of speech, stress, intonation. damage may cause monopitch or monoloud quality

63
Q

CNS consists of

A

brain and spinal cord

64
Q

PNS consists of

A

cranial nerves and spinal nerves

65
Q

Autonomic Nervous System

A 
Involuntary
Internal organs
Sympathetic NS- Body response 
to stress
Parasympathetic NS-Reversing body response to stress 
(therefore preserving energy)
66
Q

Somatic Nervous System

A

Voluntary-Control all skeletal muscles
Pyramidal motor system-Initiating voluntary movements
Extrapyramidal motor system- Background support for motor system(for ex: coordinating muscle groups for motor act)

67
Q

Neurons

A
  • electrochemical charge travels along the length of its axon.
  • reaches axon’s terminals, neurotransmitters are released.
  • neurotransmitter crosses synaptic cleft
  • dendrites receive neurotranmsitter
  • axons send electrical signals from the neuron’s cell body to the synaptic buttons. Electrical signal causes buttons to release a chemical (neurotransmitter) which is then received at dendrite of next neuron.
  • chemical transfer of neurotransmitter that is picked up by the dendrite and sent to the cell body which tells cell body what electrical signal to send to next neuron.
68
Q

motor neurons

A
  • transmit neural impulses that cause contraction in muscles.
  • afferent
69
Q

sensory neurons

A
  • carry info related to sensory stimuli.

- efferent

70
Q

efferent neurons

A
  • transmit impulse away from CNS

- sensory

71
Q

afferent neurons

A
  • send impulse toward CNS

- motor

72
Q

glial cells

A

-provide myelin sheath around axoxns in PNS and CNS, remove dead cells, and make up connective tissue of CNS

73
Q

UMN

A
  • descending motor fibers coursing through CNS and make synaptic connection to motor neurons in PNS
  • pyramidal and extrapyramidal system
  • damage= spastic dysarthria spacticity and weakness, hypernasality, harsh
74
Q

LMN

A
  • motor neurons in cranial and spinal nerves

- damage= flaccid dysarthria, breathy, hypernasality

75
Q

conducting a motor speech exam look for

A
  • muscle strength
  • speed of movement
  • range of movement
  • accuracy of movement
  • motor steadiness-ability to hold a body part still
  • muscle tone
76
Q

Face and Jaw muscles at rest and during movement motor exam

A
  • mouth symmetrical?
  • can examiner force lips open
  • expressionless face
  • wrinkling in forehead when look up
  • pucker lips
  • puff out cheeks-could have leakage of air
  • jaw hang loosely
  • jaw deviate to one side when open
  • able to move jaw right and left
  • keep jaw closed/open
77
Q

tongue at rest and during movement motor exam

A
  • size of tongue normal
  • symmetrical
  • fasciculations
  • remain still at rest
  • able to protrude tongue
  • touch upper lip w tongue
  • move side to side
78
Q

velum and pharynx at rest and during movement motor exam

A
  • velum rise when say /a/

- gag reflex

79
Q

laryngeal function motor exam

A
  • sharp cough
  • sharp glottal stop
  • inhalatory stridor present?
80
Q

combined systems motor exam

A
  • puh puh puh

- sequential motion rate

81
Q

Desire to Move

A

Association cortex: Get info from frontal association area, parietal, temporal, and occipital association area and takes info and sends to basal ganglia and cerebellum which are both responsible for movement in different ways. Cerebellum regulation of the muscle tone and maintaining balance and coordinating the skilled movements together. Basal ganglia plans slow continuous movement. Both send info to thalamus and then to primary motor cortex
Primary motor cortex: many pathways. These axons that make direct to the spinal cord. Which leads to pyramidal system which sends info to cranial nerves, spinal nerves, and neuromuscular junction.

Motor Speech GRAD (1 decks)

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