Test #1 Flashcards
0
Q
What are the two main tracts that UMNs run?
A
corticobulbar and corticospinal tracts
1
Q
Where do UMN run?
A
entirely within the central nervous system
2
Q
What type of neurons are corticobulbar neurons?
A
anything having to do with speech
3
Q
Is the UMN like the parent of child?
A
parent (instructs the LMN)
4
Q
What starts the process of initiating movement?
A
UMNs
5
Q
What does a lesion to the UMN cause?
A
spasticity and hypertonicity
6
Q
What are the two types of UMNs?
A
pyramidal and extra pyramidal
7
Q
explain the pyramidal UMN
A
- direct pathway
- goes directly from the motor strip to the LMN
8
Q
what would a lesion to the pyramidal tract cause?
A
weakness/inability to do skilled movement
9
Q
Explain the extrapyramidal UMN
A
indirect pathway
- goes from the motor strip and makes stops along the way
- gets a lot of feedback
10
Q
What would a lesion to the extrapyramidal tract cause?
A
spasticity
11
Q
What does UMN lesions almost always cause?
A
spasticity and weakness
12
Q
Where are LMNs?
A
the peripheral nervous system
13
Q
What is the LMNs job?
A
make the muscle contract
14
Q
What does a lesion to the LMN cause?
A
weakness
15
Q
Where is the lesion for flaccid dysarthria?
A
LMN
16
Q
For flaccid dysarthria, what does every symptom lead back to?
A
weakness
17
Q
What are the hallmark symptoms of flaccid dysarthria?
A
hypernasality and phonatory incompetence
18
Q
Explain hypernasality
A
weakness of the velopharyngeal mechanism
-palate can’t lift to the pharynx and/or can’t close around it
19
Q
What kind of nerve lesions cause flaccid dysarthria?
A
lesions to the cranial nerves
20
Q
Are all cranial nerves paired or unpaired?
A
paired
21
Q
Do cranial nerves innervate contralateraly or ipsilaterally?
A
ipsilaterally
22
Q
What is cranial nerve V?
A
trigeminal
23
Q
What is the trigeminal nerve responsible for?
A
jaw movement
24
How many branches does the trigeminal nerve have?
3
25
What is the only branch of the trigeminal that is important for speech?
the mandibular branch
26
What muscles does the mandibular branch innervate?
muscles used for mastication and the tensor veli palatini (assists with VP closure and tenses out the palate)
27
What would a lesion to the mandibular branch of the trigeminal nerve cause?
the jaw to hang open and hypernasality
28
What would happen if there were a unilateral lesion to the mandibular branch of the trigeminal nerve?
ipsilateral weakness of the jaw and velum (the other side can often compensate)
29
If there is a lesion to the trigeminal nerve would the patient open their jaw toward the good side of the affected side?
affected side
30
What does the VII cranial nerve do?
innervates muscles for facial expression
31
What is the main facial muscle that aids in speech?
the circular muscle that helps control lip movements
| -obicularis oris
32
if there is facial droop, will it be on the affected side or the good side?
the affected side
33
How many branches of the facial nerve are there?
two
34
Explain the branches of the facial nerve?
- the upper branch is for the upper face; gets bilateral innervation from the UMN
- the lower branch is for the lower face; only gets contralateral innervation
35
What is the IX cranial nerve?
the glossopharyngeal
36
What does the glossopharyngeal do?
helps with VP closure and creating more space in the pharynx
37
What muscle does the glossopharyngeal nerve innervate?
the stylopharyngeus (changes the shape of the throat when making sound-produces different resonance quality)
38
What is the X cranial nerve?
vagus
39
What does the vagus nerve do?
allows adduction, abduction and tension of the voice
| -also helps with VP closure
40
What are the three branches of the vagus nerve?
- pharyngeal
- superior laryngeal
- recurrent laryngeal
41
What does the pharyngeal branch of the vagus do?
innervates most of the muscles of the soft palate (important for VP closure)
42
Which branch should be thought of if there is hypernasality?
the pharyngeal branch
43
What does the superior branch of the vagus nerve do?
important for tensing the VFs for pitch change
| -innervates the cricothyroid
44
What does the recurrent laryngeal branch of the vagus nerve do?
innervates all other intrinsic muscles laryngeal muscles (posterior cricoid, thryoarytenoid complex, lateral cricoarytenoid)
-muscles for tensing, relaxing, abducting, and adducting
45
What would damage to the recurrent laryngeal branch cause?
adductor paralysis
| -breathiness or hoarseness
46
What is cranial nerve XII?
hypoglossal nerve
47
Does the hypoglossal get ipsilateral or contralateral information?
contralateral information
48
What will you see if there is weakness of the tongue?
fasiculations (happen during the process of atrophy)
49
Will the tongue point toward or away from the site of lesion if there is a lesion to the hypoglossal?
toward the site of lesion?** check!
50
What are some etiologies for flaccid dysarthria?
- brainstem CVA
- myasthenia gravis
- Guillain Barre Syndrome
- Polio
- muscular dystrophy
- progressive bulbar palsy
51
What are some characteristics of flaccid dysarthria?
- hypernasality
- phonatory incompetence
- shortened phrase length
- pressure incompetence
- if the vagus nerve is affected
- hypernasality and nasal emission
- imprecise consonants
- inspiratory stridor
- monopitch/monoloudness
- reduced glottal coup
- reduced or absent reflexes
52
What does AMR stand for?
alternating motion rates
| "pu pu pu pu"
53
What are SMRs?
sequential motion rates
| "putiku putiku putiku"
54
Where is the site of lesion for spastic dysarthria?
UMN
55
What does spastic dysarthria cause?
weakness and spasticity
56
What does spasticity cause?
increased muscle tone (hypertonicity)
57
Why is there often weakness AND spasticity?
because the extrapyramidal and pyramidal routes often follow each other so a lesion to one will often means a lesion to the other
-extrapyramidal lesion causes spasticity and pyramidal causes weakness
58
Where is the spasticity for spastic dysarthria?
often in the phonatory system
59
What causes the harsh, tight, and strained sounded of the voice the spastic dysarthria?
spasticity in the phonatory system
60
What kind of damage MUST there be to get spastic dysarthria?
bilateral damage to the UMN
61
What are some etiologies of spastic dysarthria?
- TBI
- degenerative diseases
- cumulative affects of UMN damage (stoke, or tumors)
- brainstem CVA
- infections
- meningitis
- ALS
- multiple sclerosis
- cerebral anoxia
62
What are the symptoms of spastic dysarthria?
- imprecise consonants (may be because of reduced or short voice onset time)
- tight, strangled sounding voice
- reduced ROM, which leads to imprecise contact of the articulators
- harsh voice, caused by hypertonicity
- low pitch
- monopitch (caused by ROM of the cricothyroid)
- hypernasality
63
What are the two hallmark symptoms of spastic dysarthria?
harsh voice and reduced rate of speech
64
What do all the symptoms of spastic dysarthria lead back to?
spasticity
65
What are some comorbid symptoms of spastic dysarthria?
- drooling
| - pseudobulbar affect (emotional lability)
66
How do you differentiate flaccid from spastic dysarthria?
flaccid: LMN lesion; leads to overall weakness, muscles are hypotonic
* *hallmark symptoms are phonatory incompetence and hypernasality
spastic: bilateral UMN lesion; causes spasticity and weakness, muscles are hypertonic
* *hallmark symptoms are are harsh voice and slow rate of speech
67
Does severe hypernasality point to flaccid or spastic dysarthria?
flaccid
68
Does a harsh or strangled voice point to spastic or flaccid dysarthria?
spastic
69
Is emotional lability a sign of spastic or flaccid dysarthria?
spastic dysarthria
70
are slower AMRs and SMRs a sign of spastic or flaccid dysarthria?
spastic
71
Explain unilateral UMN dysarthria?
very mild; mild articulation problems are most common
| -contralateral weakness
72
Where does most of the weakness occur with unilateral UMN dysarthria?
the contralateral tongue or the contralateral lower face
73
What are the cranial nerves that get contralateral innervation and will be affected with unilateral UMN dysarthria?
the facial and hypoglossal nerves
74
What are you likely to see with unilateral UMN dysarthria?
lower facial droop and tongue weakness
| -slightly slowed movements and reduced ROM to the tongue and the articulators
75
What may co-occur with dysarthria if there is a unilateral lesion to the left hemisphere?
apraxia or aphasia
76
What may co-occur with dysarthria if there is a unilateral lesion to the right hemisphere?
cognitive deficits and vision problems
77
What are some etiologies for unilateral UMN dysarthria?
- stoke (about 95% of cases)
| - focal lesion (GWS, tumor)
78
What are the symptoms of unilateral UMN dysarthria?
- main=mild imprecise articulation
- weakness
- reduced ROM
- decreased fine motor control of the tongue and lower face
- irregular articulatory breakdown
79
Where is the lesion for unilateral UMN dysarthria?
the unilateral UMN
80
What do all symptoms of unilateral UMN dysarthria relate back to?
mild face and lower tongue weakness
81
Where is the site of lesion for ataxic dysarthria?
cerebellum
82
What are the main changes in ataxic dysarthria?
articulation and prosody
83
What is the main speech symptoms of ataxic dysarthria?
slurred or unsteady speech
84
What is the cerebellum's job?
to coordinate the timing and force of muscle movements
| -gages appropriate force and coordination with a lot of sensory information
85
How does the cerebellum communicate with the rest of the central nervous system?
the three cerebellar peduncles
86
what are the names of the three cerebellar peduncles?
- superior
- middle
- inferior
87
What is the job of the superior peduncle?
send corrections to coordinate the task
88
What is the job of the middle peduncle of the cerebellum?
brings the motor request into the cerebellum from the motor strip
89
What is the job of the inferior peduncle of the cerebellum?
brings in proprioceptive information about the body
90
What does the cerebellum do with the information from the middle and inferior peduncles?
refines the movements
91
What are some non speech signs of ataxia?
- decreased balance or equillibrium
- intention/action tremor
- muscles are hypotonic
- difficulty with motor learning
- truncal instability
- nystagmus
- pendulousness
92
What is an intention/action tremor?
only see the tremor when the person goes to do something
93
What is nystagmus?
darting of the eyes
94
What is pendulousness?
swaying back and forth
95
What are some etiologies of ataxia?
- stroke to the cerebellum
- degenerative diseases
- lead poisoning
- mercury poisoning
- alcoholism
- exposure to cyanide
- dilantin toxicity
- TBI
- hypothyroidism
96
What is Friedreich's ataxia?
a hereditary degenerative disease that affects the cerebellum and spinal cord
-may affect gait, dexterity, speech, and vision
97
What does ETOH mean on a medical chart?
ethonal abuse
98
What is Dilantin toxicity?
- Dilantin is a drug used for seizure control
| - if it gets overloaded in the system it will cause irreversible ataxia
99
What is especially prone to twisting during a TBI?
the cerebellar peduncles
100
What are the hallmark symptoms of ataxia?
- scanning speech (robotic speech)
- irregular articulatory breakdown
- irregular AMRs and SMRs
101
What do all signs of ataxia relate back to?
incoordination
