Quiz 1 Flashcards
Regions of the Brain
Frontal Lobe Parietal Lobe Occipital Lobe Temporal Lobe Cerebellum Brain Stem
Speech
Complex motor act:
- Disproportionate cortical sensorimotor space allotted to the larynx, palate, tongue and lips (Homunculus)
- Requires more motor fibers than any other mechanical behavior
- Multimodal feedback
- 140,000+ neuromuscular acts/second
- Temporal precision about 10msec
Somatosensory and Motor Cortex
Somatosensory is anterior to Motor Cortex
Motor Speech Disorders (MSD)
- An impairment caused by a lesion or dysfunction of the motor speech centers in either the PNS, CNS, or both.
MSD Result In…
An inability to regulate the movements required for speech:
- Planning
- Programming
- Control
- Execution of speech
- Includes the dysarthrias and apraxia of speech
MSD May Be…
- Congenital or acquired
- Static, improving, or degenerative
- Associated with lesions in various CNS and PNS structures
- Caused by numerous diseases/condition
MSD Descriptive terms of SLPs vs. Neurologists
- Weak/Slow vs. Paralysis
- Unsteady vs. Tremor
- Uncoordinated vs. Dymetria/Dyssergia
- Decreased Tone vs. Hypotonic
- Increased Tone vs. Hypertonic
Terms to Define Decrease in MSD Function
- Paresis: partial or incomplete paralysis
- Plegia: paralysis
- Monoparesis/monoplegia: weakness/paralysis of one limb
- Hemiparesis/hemiplegia: weakness/paralysis of one side of the body
- Paraparesis/paraplegia: weakness/paralysis of both lower extremities
- Quadriparesis/quadriplegia: weakness/paralysis of all four limbs
Two Major Categories of MSDs
Dysarthrias:
- In its extreme form also called anarthria
- Static, improving, degenerative
Childhood MSD
Terms vary/may be synonymous
- childhood dysarthria (CD)
- developmental verbal dyspraxia (DVD)
- childhood apraxia of speech (CAS
Dysarthria Definition
Neurogenic speech disorder caused by dysfunction of CNS or PNS
Reflects abnormalities in movements required for breathing, phonatory, resonatory, articulatory or prosody of speech production:
- strength
- speed
- range
- steadiness
- tone
- accuracy
Dysarthria Types
- Different types, each corresponding to damage to particular part(s) of the nervous system,
- Each having different underlying neuropathophysiology
- Each type has different auditory perceptual characteristics which can be distinguished clinically
Dysarthria Diagnosis
- Made independently by neurologist and SLP
- Can affect any of the speech production subsystems:
- Respiration
- Phonation
- Resonance
- Articulation
- Prosody
Dysarthria Casues
Common causes:
- Stroke (CVA)
- Brain Injury (TBI)
- Brain Tumor
- Conditions that cause facial paralysis or weakness
- Degenerative Disorders
Pharmacological Causes:
- Sedatives
- Narcotics
Dysarthria Clinical Challenges
- Educational
- Medical
- In children: must be differentiated from other developmental CMD
- Ind adults: must be differentiated from apraxia of speech, language and/or cognitive deficits
Dysarthria Types Definitions
- Each type has an identifiable etiology corresponding to site of lesion
- Each had a characteristic pattern
- Each reflects a breakdown in the normally synchronous and coexisting subsystems of speech
Flaccid Dysarthria
Location: Lower motor neurons (LMN)
Primary Deficit: weakness
Common Cause: Myasthenia Gravis
Spastic Dysarthria
Location: Upper motor neurons (UMN)
Primary Deficit: spasticity
Common Cause: Unilateral Stroke
Ataxic Dysarthria
Location: cerebellar control circuit
Primary Deficit: incoordination
Common Cause: Fredrich’s Ataxia
Hypokinetic Dysarthria
Location: basal ganglia control circuit
Primary Deficit: rigidity and decreased ROM
Common Cause: Parkinson’s Disease
Hyperkinetic Dysarthria
Location: basal ganglia control circuit
Primary Deficit: involuntary movements
Common Cause: Huntington’s chorea
Unilateral UMN
Location: unilateral UMN
Primary Deficit: weakness, incoordination, spasticity
Mixed Dysathria
Location: more than one
Primary Deficit: more than one
Common Cause: ALS
Apraxia Definition
Disruption in the ability to voluntarily sequence complex movements accurately
Two Types of Apraxia
- Nonverbal (Oral) Apraxia
- Verbal Apraxia
Nonverbal (Oral) Apraxia
Disruption in the sequencing of oral movements that are non-verbal (smiling, puckering the lips, protruding the tongue)
- May or may not coexist with apraxia of speech
- AKA: Bucco-Facial apraxia in adults
- ONLY in nonverbal tasks
Nonverbal (Oral) Apraxia Characteristics
- Hesitations, groping and revisions are displayed when attempting to perform nonverbal movements
- Inability to coordinate and/or initiate movement of articulators on command such as:
- Stick out your tongue
- Whistle
- Kiss a baby
- Clear your throat
- Blow out the candle
Apraxia of Speech Definition
Disruption in the sequencing of voluntary movements for speech production
- ONLY in speech production
Apraxia of Speech Characteristics
- Errors of sequencing are displayed when saying multisyllabic words
- Errors include groping to position the articulators, transposition of syllables within a word and phoneme substitutions
- Automatic and emotional words are free of apraxic errors
Apraxia in Children
- Impaired ability to execute voluntarily the expected motoric and programming gestures required for speech in the absence of a muscular disturbance of the speech mechanism
- Disability of VOLUNTARY motor programming and sequencing of speech movements
- AKA: Developmental Verbal Dyspraxia (DVD), Developmental Apraxia of Speech (DAS), and Childhood Apraxia of Speech (CAS)
Apraxia in Adults (w/o CVA)
- Non-dysarthric, non-aphasic sensorimotor disorder of articulation and prosody
- Aphasia and dysarthria may coexist with apraxia but deficits in muscle strength and endurance do not account for specific errors
- Apraxic errors are inconsistent, trial and error responses are prevalent
Apraxia Continuum
Mild: Individual articulatory gestures are largely preserved
Approaches to Studying MSDs
- Psycholinguistic
- Neurological
- Social Constructionist
- Motor Control System
Psycholinguistic Approach
- Does not concern itself with SOL
- Psychological processes that underlie speech processing
- Early stages of the model could be described as cognitive-linguistic
- Planning and programming are a relatively early component of speech processing
- Motor execution is at a later stage
- Apraxia = disorder of planning and programming
- Dysarthria = disorder of motor execution occurring at the later stages of motor speech processing
Neurological Approach
- Verbal apraxic disturbances = higher level cerebral functioning
- Apraxia = lesions at the highest level of motor integration in the nervous system; in adults with apraxia are located in the left cerebral hemisphere
- Dysarthria = more peripheral; result of disturbances in the lower level motor integration in the nervous system
Social Approach
- Associated with long-term conditions
- A model of the consequences of a chronic disorder is helpful in developing a clinical perspective
Social Approach Definitions of Impairment vs. Disability
Impairment – is the functional limitation within the individual caused by physical mental or sensory impairment
Disability – is the loss or limitation of opportunities to take part in the “normal” life of the community on an equal level with others due to physical and social barriers
Social Approach Nature of Barriers
- Information
- Peer Support
- Housing
- Technical Aids
- Personal Assistance
- Transportation and mobility
- Access
- May be additional barriers that apply to speakers with MSD
Social Approach Time Barriers
- Not allowing enough time for the impaired person to express themselves
- In a meeting or classroom time needs to be scheduled to ensure that all participants are enabled to participate
Social Approach Organizational Barriers
- Barriers to communicate would lead the patient to having un-equal access to service ex) being unable to communicate meal preferences
- A school or university should ensure that sufficient time can be allocated to facilitate equality and ease in communication
- Allowing time for fully listening
- Be prepared to use a variety of communication aids and/or techniques
Social Approach Identity and Self-Expression Barriers
- Barriers to expressing one’s own sense of self development through interpersonal experiences
- A person’s sense of self is constructed through interactions with others- type of experiences had
- Dysarthric speech can often introduce an inequality in the interaction process, through its slow and unclear nature
- Typical speech can gain dominance in confrontational and non confrontational interaction- problems in group setting
Social Approach Personal Experiences
- Deep internal frustration and this in turn would lead to terrible temper tantrums – becomes behavioral
- Communication is noise in public spaces
Social Approach Effects of Working Lives
- Acceptance of AAC
- Limitations regarding job performance – teaching, telephone work, etc.
Motor Control Systems Approach
- Speech system is composed of sensory and motor regulators –monitoring system
- Cognition, language and neural representations are not the emphasis
- Theoretical basis from discussions that contrast the primate oral mechanism from the human oral mechanism.
- Reflexes, valves, oscillators combine to produce speech
- Different mechanisms control speech and vegetative movement
- Practice is necessary to activate the specialized neuronal connections that control fine motor speech movements
Motor Control Systems Approach Tx Implications
- Based on how the regulators evolved for speech purposes
- Speech systems is viewed as a finite set of interconnected functional units capable of fine motor movement
- Movements are manifested by performance in strength, endurance, ROM and speech
- Goal of SLP: to evaluate the functional resources of each component of the speech system
- Critical points in the system were delineated
- Function at any point can be measured – the subsystems of speech
4 Subsystems of Speech Production
- Respiratory: airflow
- Phonatory: vocal production and intonation
- Resonatory: vibration of the airflow
- Articulatory: manipulation of airflow
The muscles and muscle groups in these subsystems must be coordinated in time and space
Respiratory System
- Speech production requires airflow
- Pulmonary airstream mechanism; pushes air out of lungs through trachea to produce airflow
- Ingressive: inhalation vs. Egressive: exhalation
- Exhalation cycle – needs to be extended in time (for completion of utterance) and modulation (to reflect stress/intonation)
Phonatory System
- Includes various muscles and structures in the larynx, and regulates the production of voice and the intonational aspects of speech
- Vocal folds are brought closely together (adduction), and airflow builds up (subglottal pressure) to set the vocal folds into vibration (undulation)
- Vocal folds are stretched lengthwise to manipulate the frequency or pitch of the voice
(longer the cords higher the pitch)
Resonatory System
- Regulates the vibration of the airflow as it moves from the pharynx into the oral and nasal cavity
- Manipulates shape and size of vocal tract for maintaining normal sound quality
- Manipulates the velopharyngeal port, (whether nasal cavity is used as a vibrating chamber) for determining nasality of sounds ex) oral vs. nasal sounds - /b/ and /p/ vs. /m/ and /n/
Articulatory System
- Control the articulators within the oral cavity to manipulate the outgoing airflow
- Major structures: lower jaw, lips, tongue (most important)
- Tongue:
- intrinsic muscles (fine-tuned movements)
- extrinsic muscles (coarse movements)
- Protrusion, retraction, elevation and depression
- Muscles contract to create constrictions in the oral cavity to produce varying sounds
MSD Measurement Methods
- Perceptual measures: judgments of intelligibility, accuracy and speech production (most common)
- Acoustic measures: visual representation of speech sound wave (spectrogram) for more detailed and objective view of speech problems
- Physiologic measures – measurement of physiologic aspects of speech motor system not easily perceived otherwise (muscle strength)
The Nervous System
CNS:
- includes brain and spinal cord
- center of integration and control
PNS:
- nervous system outside of CNS
- includes 12 pairs of cranial nerves (CN) and 31 pairs of spinal nerves (SN)
- CN carry info to and from the brain
- SN carry to and from the spinal cord
Brain = roots
Spine = trunk
CNS + PNS = branches
The Brain
Most complex part of the nervous system, where all activity originates or is ultimately processed
- Composed of: wrinkled, pinkish gray tissue
- Surface anatomy includes:
- Cerebrum: cerebral hemispheres
- Cerebellum
- Brain Stem
Cerebrum
- Largest, most conspicuous portion
of the brain. - 2 hemispheres connected by the corpus collosum
- Outer cortex of gray matter
- Interior that is mostly white matter, except for a few islands of grey matter
- Surface is marked by ridges called gyri and separated by grooves called sulci
Cerebral Cortex
- Made of superficial gray matter; accounts for 40% of the mass of the brain
- Consists of neuron cell bodies, dendrites, unmyelinated axons, no fiber tracts
- Conscious mind
- Enables sensation, communication, memory, understanding and voluntary movements
- Hemispheres are not equal in function
Lobes of Cerebrum
- Four lobes: frontal lobe, parietal lobe, temporal lobe and occipital lobe; divided by deep sulci
- Central sulcus: separates the frontal and parietal lobes
- Precentral gyrus: primary motor area
- Postcentral gyrus: primary somatosensory area
3 Types of Functional Areas of Cerebral Cortex
- Motor Areas: control voluntary movement
- Sensory Areas: conscious awareness of sensation
- Association Areas: integrate diverse information, bring info to major areas to be processed and responded to.
