Motor Speech DO Flashcards by Paula Borrero

Define Motor Speech Disorders

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

Apraxia and Dysarthrias

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What are the three processes that work together to produce speech?

Cognitive linguistic process- “decide what you want to say”intention to communicate
Motor speech programing- “motor speech planning”
Neuromuscular execution-“ execution” cns and pns innervate muscles

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How can you identify facciculations?

Tiching

Means nerve is dying

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What is dysarthria?

Group of motor speech disorders resulting from disturbances in muscular control over the speech mechanism due to damage of the CNS or PNS. 
Can result in:
Paralysis
Incoordination of speech musculature
Weakness

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What subsystems of speech can dysarthria affect?

Respiration
Phonation
Resonation
Articulation
Prosody

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T or F

Both apraxia and dysarthria can occur with aphasia.

True

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T or F

Apraxia co-occurs more commonly with aphasia

True

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What are the subsystems that apraxia can affect?

Articulation and prosody

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T or F

Transient course of disease means symptoms don’t last, they disappear completely

True

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Fill in the blank:

____________ means things are improving but some symptoms are still there- but not as severe

Improving

Course of disease

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When symptoms don’t get better, they continue to get worse or new symptoms appear is called:

A. Stationary
B. Exacerbating- remitting
C. Progressive

C. Progressive

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T or F

When symptoms occur, then get better, them occur again, then better, then worse is called exacerbating- remitting.

True

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______ symptoms remain unchanged after they have reached maximum severity

Stationary

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Match

A. Chronic
B. Acute
C. Subacute

Comes on within months
Comes on quickly within minutes.
Comes on within days.

A 1
B 2
C 3

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What is the main job of the Medulla?

Controls respiration

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4 main anatomic level of CNS

What constitutes the Supratentorial?

Ant and middle fossae 
Paired frontal, temporal, parietal, & occipital 
Basal ganglia 
Thalamus 
Hypothalamus
CN I & II

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4 main anatomic level of CNS

What contains the posterior part of CNS?

Posterior fossa
Brainstem
Cerebellum
CN III-XII

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Where do 10 of the 12 pairs of CNs originate?

Brain stem- at the posterior fossa level

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Refresher

What are the 3 Meninges?

Dura mater
Arachnoid mater
Pia mater

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What are the neurologic systems?

Ventricular system (where the ventricles are filled with CSF)
Vascular system (blood vessels )
Neurochemical system (amino acids, ACH, neuropeptides)
Consciousness system (maintaining consciousness, attention, etc)
Motor system (motor activity… Some areas or cortex, basal ganglia, cerebellum, CNS/PNS)
Sensory system (peripheral receptor organs)

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What does a motor unit contain?

Axon muscle fiber it innervates

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Fill in the blank

Supporting Glial Cells

_________ form myelin in CNS
_________ form myelin in PNS
_________ help move substances between blood and neurons of CNS, part of blood brain barrier

Oligdendroglia cells
Schwann cells
Astrocytes

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Refresher

This is the relay station of the brain

Thalamus

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Refresher

Contains globus palladus, putamen, caudate nucleus, lentiform nucleus

Basal ganglia

Initiation?

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______ damage found in single area

Focal

_______ damage found in more than one area

Multifocal

_______ damage involve bilateral symmetric parts of the nervous system

Diffuse

What are some of the etiologies that can produce MSD

``` Degenerative diseases- ALS Inflammatory diseases- meningitis Toxic Neoplastic dz- tumors Traumatic Injuries Vascular diseases- CVA neurons deprived from oxygen ```

If damage to UMN

Spastic

If damage to LMN

Facciculations Atrophy Weakness

From book: Final common pathway- LMN Direct Activation pathway- UMN Indirect Activation pathway-UMN Control Circuits- like the basal ganglia and cerebellum

...

Match 1. Direct = 2. Indirect = A. Extrapyramidal B. Pyramidal

``` Direct= pyramidal Indirect= extrapyramidal ```

Explain, concisely, the innavation for CN VII

Bilateral innervation for upper face | Contralateral innervation for lower face

T or F CN XII has bilateral innervation to most tongue muscles but CONTRALATERAL innervation for genioglossus

True

Deviation always goes to the A. Strong side B. Weak side C. Neither

B. Weak side

What is the largest CN?

Trigeminal CN V

``` The CN V is sensory and motor. Sensory from: A. Face B. Mouth C. Jaw D. Tongue E. All ```

E. All

``` CN V is sensory and motor. Motor for: A. Eyes B. Muscles of mastication C. Tensor palatini, tensor veli palatini mylohyoid, D. B & C ```

T or F | CN V has unilateral innervation

False. It has bilateral innervation

T or F CN V: If bilateral lesion then jaw hangs at rest-- profound affect to speech If unilateral lesion jaw deviates to weak side-- not as much

True

What does the Glossopharyngeal CN IX innervate?

- Stylopharyngeus which elevates pharynx in speech and swallowing - bilateral innervation... If lesion then may reduce gag reflex and pharyngeal sensation

How many branches does the Vagus CN X have? And which ones are they?

3 branches. They are: Pharyngeal branch Superior laryngeal branch Recurrent laryngeal branch Has bilateral innervation for all branches

What is the job of CN XI Accessory?

Hean and neck mvmnt | Bilateral innervation

What does the Hypoglossal CN XII innervate?

All intrinsic and extrinsic (except palatoglossus which is innervated by Xth )tongue muscles. All muscles have bilateral innervation but the genioglossus (receives contralateral input)

Refresh What are the two tracts that make up the UMN system and Direct Pathways?

Corticobulbar Corticospinal

Why is the dierect activation pathway important?

Bc it controlls skilled, discrete, and rapid voluntary movements like speech

What is more damage UMN lesion or LMN lesion?

Depends on innervations. If there is bilateral innervations then LMN lesion are more severe than UMN lesions.

Where do messages originate?

Motor strip of the cortex

What type of lesion can cause flaccid dysarthria?

LMN system

What does flaccid mean?

Weak

If a patient has hypernasality, what can it mean?

Weakness of the muscle

What are some other characteristics of flaccid dysarthria?

Hypotonia Weak reflexes Atrophy Fasciculations (visible) and fibrillation (not visible)

T or F Atrophy and Fasciculations are only seen in LMN

True

Name the etiologies of flaccid dysarthria

``` Neuromuscular Junction DZ- Myasthenia Gravis Vascular Disorder Infectious DZ Demyelinating DZ Muscle diseases Degenerarive DZ Anatomic anomalies radiation treatment **REMEMBER: ALL SYMPTOMS OF DAMAGE IN FLACCID DYSARTHRIA ARE DUE TO LESIONS IN THE LMN SYSTEM.** ```

What is Myasthenia Gravis?

is a chronic neuromuscular junction dz characterized by rapid weakness of voluntary movement of muscles & improvement with rest is seen.

what are the e branches of trigeminal nerve V?

Sensory opthalmic branch Sensory Maxillary branch Motor & Sensory Mandibular branch

What do the three branches of the trigeminal nerve V innervate?

Sensory opthalmic branch- upper face Sensory Maxillary branch- midface Motor & Sensory Mandibular branch- jaw muscles, tensor tympani, tensor veli palatini

T or F | Trigeminal Nerve V is sensory to jaw, face, lip, and tomgue and motor to jaw

True

What is more damage to speech, | a unilateral lesion to trigeminal nerve V or a bilateral lesion to Nerve V? explain

Bilateral lision.... Jaw hangs down. Pt. may not be able to close the jaw

If patient complaints of drooling and difficulty chewing and decrease sensation from the face, cheeks, tongue, teeth and palate, what nerve may be damage?

Trigeminal nerve V

What assessments can you do to assess the effects on speech if CN V is damage?

Pt. closes eyes and touch face Listen to speech Do AMR's puh tuh kuh, if imprecise or slow on puh then problem is present

What does CN VII innervate?

Face lip muscles sensory information from anterior 2/3 tongue

If unilateral damage occurs in CN VII Facial nerve, what are some pt characteristics that we may see?

side sagging hypotonic forehead may be unwrinkled eyebrow dropped

If bilateral damage occurs in CN VII Facial nerve, what are some pt characteristics that we may see?

rare facial symmetry pt may not be able to retract lips or puff out cheeks (bilabials and labiodental may not be done) drooling pt may complain of not being able to move lips well in speech and while eating synkinesis- abnormal contraction of muscle next to muscle that is normally moving.

What is synkinesis?

abnormal contraction of muscle next to muscle that is normally moving.

How can we assess CN VII Facial nerve?

``` Stress testing conversation reading AMRs may see "flutter cheek" due to less resistance of intraoral pressure ```

T or F | If pt. has a bilateral lesion to CN VII they may substitute lingual alveolar sounds for bilabial t/p

True

T or F | If pt. has a unilateral lesion to CN VII they may exaggerate jaw closure to make bilabials

True

What does Glossopharyngeal Nerve IX innervate?

stylopharyngus muscle which raises pharynx in speech and swallowing Sensory from pharynx and posterior 1/3 of tongue responsible for some gag reflex

T or F | If Glossopharyngeal nerve IX damage, Vagus is usually affected as well

True

T or F | Hypoglossal Nerve XII is reponsible for some gag reflex

False CN IX Glossopharyngeal is in charge

What can you do to assess CN IX?

Elicit gag reflex (not always reliable) | Pt. may have pain in throat- to trigger pain ask to swallow or stick out tongue

T or F | Speech tasks are a good way to assess function of Glossopharyngeal Nerve IX

False this nerve cannot be assessed directly through speech tasks