Study Guide: Know that... (w/ Elaborations)

Question 1

know where the primary motor cortex is

Answer 1

precentral gyrus (BA 4)

extra credit: source for descending motor pathways; voluntary movements; somatotopically organized

Question 2

know where the primary somatosensory cortex is

Answer 2

postcentral gyrus (BA 1, 2, 3)

extra credit: primary sensation receptor; somatotopically organized

Question 3

know what the subcortical structures are (4)

Answer 3

diencephalon (thalamus, hypothalamus, epithalamus, subthalamus), basal ganglia, substantia nigra, subthalamic nucleus

Question 4

know where the cerebellum and the brainstem are located

Answer 4

cerebellum : rear of brain, below cerebrum :: brainstem : between subcortical structures and the spinal cord

extra credit: the brainstem consists of the midbrain, pons, and medulla - origin of the cranial nerves

Question 5

know where, in general, upper and lower motor neurons originate and terminate

Answer 5

UMNs originate in the cortex and terminate on LMNs (in either the spinal cord or the brainstem); LMNs originate in either the spinal cord or the brainstem and terminate on the muscles they innervate

extra credit: all UMNs decussate to the opposite side before synapsing on LMNs

Question 6

know what motor planning is

Answer 6

to formulate a strategy of action by specifying motor goals (which are spatial-temporal targets rather than explicit commands re: which muscles should contract)

extra credit: premotor cortex (BA 6) and supplementary motor areas

Question 7

know the difference between motor planning and motor programming

Answer 7

motor planning : sequential motor goals (articulator specific and not muscle specific) :: motor programming : sets of muscle specific commands

Question 8

know the difference between motor planning and motor programming according to van der merwe (see lecture 4 also)

Answer 8

motor planning : transformation of phonemes into a code that is handled by the motor system :: motor programming : a set of muscle commands updated via sensory feedback

Question 9

know motor planning according to van der merwe (see lecture 4 also) (5)

Answer 9

highest level of motor hierarchy; speech context is anticipated with and w/o sensory feedback; core motor plans are recalled from sensorimotor memory; phoneme is the smallest unit - they each have a different motor plan; articulator specific and NOT muscle specific

Question 10

know motor programming according to van der merwe (see lecture 4 also) (3)

Answer 10

sensory feedback monitors interface between preplanned programs and real time updating; specific movement parameters are computed; timing and amount of muscle contraction is specific before movement onset

Question 11

know where the corticospinal tracts originates, where it crosses over and where it terminates (i.e. in the spinal cord at the level of the individual spinal nerves)

Answer 11

originates : cerebral cortex at different levels of the spinal cord (mostly primary motor cortex: BA 4) :: terminates : spinal cord at the level of the individual spinal nerves

extra credit: decussates at the pyramids in the lower medulla; innervates muscles of the limbs

Question 12

know where the the corticobulbar tract originates, where it crosses, and terminates

Answer 12

originates : cerebral cortex :: terminates : different cranial nerve nuclei located at different levels of the brainstem

extra credit: decussates at the level of the cranial nerve nuclei they innervate; innervates all muscles of speech and swallowing EXCEPT respiration

Question 13

know the terms paralysis / paresis

Answer 13

paralysis : gross limitation of movement :: paresis : incomplete paralysis

Question 14

know the signs of UMN damage (2)

Answer 14

hypertonia-spasticity; hyperreflexia

Question 15

know the signs of LMN damage (3)

Answer 15

hypotonia; paralysis / paresis; atrophy (fasciculations fibrillations)

Question 16

know the subdivisions of the extrapyramidal system (2)

Answer 16

indirect activation pathway; control circuits: basal ganglia and cerebellum (basal ganglia system and cerebellar control circuit)

Question 17

know the general pathways for the indirect activation pathways

Answer 17

originate in the cortex, synapse on nuclei of the brainstem, and the synapse on the cranial nerve nuclei

extra credit: helps to regulate reflexes and maintain posture and tone

Question 18

know some of the effects of spasticity on speech (e.g. slowness, hypernasality)

Answer 18

in general, spasticity results in slow movements and reduced range of motion

Question 19

know the structures that make up the basal ganglia (BG) system (5)

Answer 19

BG : caudate nucleus, putamen, globus pallidus :: BG functional network : subthalamic nucleus, substantia nigra

Question 20

know the function of BG (2)

Answer 20

dampens cortical discharges; helps to initiate movement

Question 21

know the results of damage to BG (2)

Answer 21

reduced movement OR excess involuntary movement

Question 22

know the term dyskinesia

Answer 22

describes movement disorders usually associated with extrapyramidal damage

Question 23

know the role of the feedforward and sensory feedback mechanisms in coordination of muscle activity

Answer 23

feedforward mechanism contains information concerning volitional movement from the muscles, tendons, and joints; the efferent copy is compared to the actual sensory feedback and error corrections are made if necessary

Question 24

know what ataxia is

Answer 24

lack of coordination of voluntary motor acts; affects rate, range, timing, direction, and force of movement

Question 25

be able to write out a simple definition of dysarthria

Answer 25

“a collective name for a group of neurologic speech disorders that reflect abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonator, articulatory, or prosodic aspects of speech production” (duffy, 2013)

Question 26

be able to write out a simple definition of apraxia of speech

Answer 26

“a neurologic speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech”

Question 27

know the general lesion locus for each of the dysarthria types, e.g. flaccid = LMN lesion, ataxic = cerebellum (cerebellar control circuit) etc.

Answer 27

flaccid = LMN; spastic = (B)UMN; ataxic = cerebellum; hypokinetic / hyperkinetic = basal ganglia; UUMN = UUMNs

Question 28

be able to list the components of a MSD exam (4)

Answer 28

hx; ID of salient movement characteristics and their production of normal / deviant speech characteristics; ID of confirmatory signs; Assessment of Intelligibility, Comprehensibility & Efficiency

Question 29

know what the salient motor characteristics are (e.g. symmetry, strength, etc) (6)

Answer 29

symmetry, strength, speed of movement, range of motion, steadiness, accuracy

Question 30

know the difference between AMRs and SMRs

Answer 30

AMR : alternating motion rates :: SMR : sequential motion rates

Question 31

know the difference between intelligibility, comprehensibility, and naturalness

Answer 31

intelligibility : the degree to which a listener understands the acoustic signal produced by a speaker (duffy, 2005) :: comprehensibility : the degree to which a listener understands speech on the basis of the acoustic signal plus all other information that may contribute to understanding what has been said (duffy, 2005) :: naturalness : refers to the normality of speech

Question 32

be able to list the 5 discreet stages of van der merwe’s model of speech production

Answer 32

intention, linguistic-symbolic planning, motor planning, motor programming, neuromotor execution

Question 33

know the relationship between the cranial nerves damaged and the speech subsystem affected, e.g. damage to CN X results in impaired phonation and resonance, CN XII in articulation, etc.

Answer 33

CN V : reduced jaw movement-closure (only if bilateral :: CN VII : impaired articulation of sounds involving facial movements (paralysis-paresis)

CN X : impaired phonation and resonance :: CN XII : impaired articulation involving lingual movements

Question 34

know the confirmatory signs of flaccid dysarthria (6)

Answer 34

paresis / paralysis; atrophy; fasciculations; fibrillations; reduced / absent reflexes; hypotonia

Question 35

also know that the signs of cranial nerve damage are ___ to the damage, e.g. a left recurrent laryngeal nerve lesion would result in a true ___ vocal cord paralysis / paresis

Answer 35

ipsilateral; left

Question 36

define apraxia of speech

Answer 36

a neurological speech disorder that impairs the ability to plan sensorimotor commands for movements; causes abnormal articulatory and prosodic speech

Question 37

define dysarthria

Answer 37

a group of neurological speech dx that affect strength, speed, symmetry, steadiness, ROM, or accuracy of movements required for (1) phonation (2) articulation (3) resonance (4) respiration of speech production