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152 Cards in this Set
- Front
- Back
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What are the subsystems of speech?
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respiration, resonance, articulation, phonology, prosody
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A neurological motor speech impairment characterized by slow, weak, imprecise, or uncoordinated movements of the speech musculature
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dysarthria
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What are the aspects of speech production?
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production, planning, quality control, execution
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What are the 8 types of dysarthria?
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flaccid
spastic ataxic hypokinetic hyperkinetic unilateral UMN mixed undetermined |
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Where is the brain localization for flaccid dysarthria?
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LMN
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Where is the brain localization for spastic dysarthria?
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bilateral UMN
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Where is the brain localization for hypokinetic and hyperkinetic dysarthria?
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BG
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Where is the brain localization for ataxic dysarthria?
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cerebellum
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Where is the brain localization for unilateral UMN dysarthria?
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unilateral UMN
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Where is the brain localization for mixed/undetermined dysarthria?
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more than one/ ??
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A neurologic speech disorder featuring an impaired capacity to plan/program sensorimotor commands; can occur in the absence of physiologic/language disturbances; a motor speech disturbance involving disruption in motor planning/programming of sequential movement for volitional speech production
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apraxia
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What are the differences between apraxia & dysarthria?
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-Dysarthria is a disruption in motor control resulting from CNS/PNS lesions.
-Apraxia results from impaired ability to generate motor programming for speech movements. It follows damage to Broca's Area or Wernicke's Area and is always the result of a CNS lesion. |
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How are errors characterized in apraxia & dysarthria?
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-In dysarthria, errors are consistent & predictable, predominantly distortions & omissions
-In apraxia, errors are inconsistent & unpredictable, substitutions are the most common type of error. |
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What must we assess in differential diagnosis?
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-Other neurologic disorders (cognitive, linguistic, sensory)
-Nonneurologic disturbances i.e. musculoskeletal defects, voice disorders, psychogenic -Normal variations in speech production (age, gender-related, style variations) |
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What is the incidence?
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Schools: CP, CAS
Acquired disorders: 54% dysarthria, 4% apraxia; more common than any other S/L disorder in stroke/head injury |
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What are the methods for assessing MSD?
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perceptual
instrumental |
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What are some instrumental measures used to assess MSD?
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Acoustic: voice quality, loudness, hypernasality, baseline data
Physiologic: EMG, aerodynamics Visual imaging: videoflouroscopy, nasendoscopy, laryngoscopy, stroboscopy |
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How do we characterize MSD?
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-age of onset
-course (chronic v. stationary; improving v. progressive v. exacerbating-remitting) -site of lesion -neurologic diagnosis -pathophysiology |
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What are the variables relevant to speech disorders?
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speech components/ subsystems, severity, perceptual characteristics
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What is the WHO-ICF framework to assess clients?
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body structure
body function activity participation environmental factors |
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What is the CNS divided into?
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brain & spinal cord
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What is the PNS divided into?
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cranial nerves; somatic & automonimc- sympathetic & parasympathetic
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A collection of peripheral nerve fibers (axons) bound by connective tissue
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nerve
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A collection of nerve fibers
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tract
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What are the 3 CNS tracts and definitions?
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commissural- hemisphere to hemisphere
association- within one hemisphere projection- higher to lower in CNS |
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How many pairs of spinal nerves are there? Ventral section is _________ and dorsal is __________.
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31
motor sensory |
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What does the brainstem consist of?
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medulla, pons, midbrain
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This is connected through the pons to the rest of the CNS via peduncles, responsible for the smooth coordination of muscles and rapid & precise movements
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cerebellum
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This part of the body is responsible for the "drunk speech" of ataxic dysarthria, the "quality control" of speech production
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cerebellum
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What does the diencephalon include?
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thalamus
3rd ventricle @ midline hypothalamus subthalamus |
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Where are the amygdala & hippocampus contained, that is responsible for the emotions of survival?
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libmic system
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What does the basal ganglia contain?
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caudate nucleus
putamen globus pallidus substantia nigra subthalamic nucleus |
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Caudate nucleus + putamen = ?
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striatum
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Putamen + globus pallidus = ?
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lentiform nucleus
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What is the BG function in CNS?
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Structures are interconnected & work to regulate motor function
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What are the primary input & primary output structures of the BG?
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INPUT: all 4 lobes of the cortex
OUTPUT: through the thalamus back to prefrontal, premotor, & motor cortex |
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What is the afferent portion of the BG?
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STRIATUM (caudate & putamen)
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What are the 3 sources of afferent info for BG?
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neocortex
thalamus substantia nigra (dopamine) |
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What is the efferent portion of the BG?
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globus pallidus
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This influences activity of the descending motor pathways...lesions here cause...(4)
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extrapyramidal
motor disturbances (dyskinesia, hyperkinesia, hypokinesia) |
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Kinesia characterized by mpaired movement
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dyskinesia
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Kinesia characterized by Parkinson's Disease
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hyperkinesia
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Kinesia characterized by Huntington's Chorea
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hypokinesia
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What are the 3 meningeal layers?
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dura mater- periosteal & meningeal layers
arachnoid pia mater |
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What do MSDs stem from?
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infection, vascular disorders, hydrocephalus, hemorrhage, edema
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What is CSF produced by? Absorbed by?
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produced... choroid plexus
absorved... arachnoid villi |
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Speech is ________ directed and _____________ guided. _____________ work to facilitate the _______________ that result in specific _____________ and ___________ goals.
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goal; sensory
afferents; efferents spatial; acoustic |
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What are the 3 phrases of speech production?
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-speech motor planning
-speech motor programming -speech motor execution (control) |
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This is the formulation of the overall plan/strategy of action that involves specific motor goals
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motor planning
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What cortical areas are involved in motor planning?
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-cortical association area (premotor cortex, supplementary motor cortex, prefrontal association areas, parietal association areas, Broca's area) & the basal ganglia
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Motor planning is _____________ specific and not ____________ specific.
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articulatory
muscle |
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The motor plan of a phoneme is adapted to the ____________ of the planned unit
( _____________________________ ) |
context
coarticulation |
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The tern usually used to denote the set of muscle commands that are set before a movement begins and can be delivered without external feedback.
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motor programming
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________________ _________________ is used to change a motor program, as needed, as movement occurs.
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sensory feedback
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The execution stage that involves the actual physiologic act of muscle contraction, allowing movement of the structures involved in speech production
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motor execution
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What are the neural systems involved in motor execution?
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-motor cortex
-descending pathways -reflex mechanisms -final common pathway (LMN, peripheral nerve fiber, synapse, muscle fiber) |
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What makes up the LMN system?
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-paired cranial nerves
-paired spinal nerves |
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This is the peripheral mechanism through which all motor activity is mediated, the last link in the chain of events
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final common pathway
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These muscles are activated by efferent cranial or spinal nerves, they innervate extrafusal muscle fibers and branch for innervation
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alpha motor neurons
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These muscles innervate intrafusal muscle fibers, are part of the 'gamma loop', and are crucial to maintaining tone
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gamma motor neurons
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Damage to ___________________ ______________ pathways abolishes/reduces reflexes (i.e. gag reflex)
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peripheral sensory
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Damage to a peripheral motor unit can produce...?
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paresis
paralysis atrophy fasciculation (spontaneous motor unit discharges) |
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The final common pathway nerve cell with its process is referred to as the ________________ ________________ neuron.
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LM
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Where do motor nucleI of the CN receive impulses from the cortex?
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corticobulbar tract
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Final common pathway fibers end by synapsing directly with ___________ or indirectly via _______________________.
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LMN
interneurons |
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Bilateral connects are present for all CN motor nuclei except...
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lower facial nucleus of CN 7
hypoglossal motor nucleus |
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The largest of the cranial nerves; both sensory AND motor
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trigeminal
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Trigeminal mandibular branch is... sensory/motor?
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both
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What are the 3 jobs of the mandibular branch of CN 5?
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-mastication (jaw closure & rotation)
-upward & anterior movement of larynx -damping sound (tensor tympani) -flatten velum & open Eustachian tube |
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What are the 3 main sensory branches of CN 5?
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-opthalmologic: forehead, eyes, nose
-maxillary: upper lip, maxilla, upper teeth, cheeks, palate, maxillary sinus -mandibular: anterior 2/3 of tongue, mandible, lower teeth, lower lip, part of teeth, part of external ear |
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Is CN 7 (facial) sensory or motor?
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both
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What are the sensory & motor designations of CN 7?
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motor: buccal & mandibular branches, muscles of facial expression
sensory: glands (submandibular, sublingual, lacrimar) tase: anterior 2/3 of tongue |
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What are the characteristics of a LMN lesion?
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-ipsilateral face paralysis
-atrophy & asymmetry -fasciculation: perioral & chin |
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What is the characteristic feature of Bell's Palsy?
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damage to the entire ipsilateral 3 parts of the face
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Is glossopharyngeal motor or sensory?
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Both
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What are motor & sensory designations of glossopharyngeal?
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motor: stylopharyngeus (elevates pharynx)
sensory: sensation rom pharynx & tongue reflex: gag reflex |
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How can you tell the integrity of the glossopharyngeal nerve?
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It is hard to isolate because of proximity to CN 10 and 11. Stroke the pharyngeal wall. Absence of the gag reflex may show nerve damage.
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Is vagus nerve motor or sensory?
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both
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What are motor and sensory designations for vagus nerve?
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motor: speech (pharyngeal branch, superior laryngeal branch, recurrent laryngeal nerve)
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What are characteristics of a unilateral lesion of the vagus nerve?
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-hoarseness (loss of function of intrinsic larynx muscles)
-difficulty swallowing -hypernasal |
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What are characteristics of a unilateral lesion of the laryngeal nerve?
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ipsilateral weakness or VF paralysis, results in breathiness
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What is a characteristic of a superior laryngeal lesion?
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difficulty with pitch control
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What does radical neck surgery often result in?
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LMN lesion of CN 11, causing downward rotation of scapula & shoulder drop from loss of trapezius action
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Is hypoglossal motor or sensory?
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motor
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What does hypoglossal motor unit supply?
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all intrinsic and all but one intrinsic; only one nucelus in the medulla
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What happens when you have a lesion to the hypoglossal nerve?
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atrophy, weakness and fasciculations on the side of the lesion, tongue deviates TOWARD the side of the lesion
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What are the 12 cranial nerves?
Oh Oh Oh To Touch And Feel Very Good Velvet Such Heaven |
Olfactory
Optic Occulomotor Trochlear Trigeminal Abducens Facial Vestibulocochlear Glossopharyngeal Vagus Spinal accessory Hypoglossal |
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What is the sensory/motor designation of the cranial nerves?
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Some
Say Matthew McConaughey's Butt. My Brother Says Brad's Butt Mmmm Mmmmmm |
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UMN system is contained entirely in the ________. It doesn't include the __________ ______________ & cerebellar control circuits. It includes _____________ & _____________ pathways.
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CNS
basal ganglia direct & indirect |
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The direct activation pathway is AKA the ____________________ tract. It connects the cortex to the ___________. It is divided into: (2)
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pyramidal
final common pathway corticobulbar tract: to cranial nerves corticospinal tract: to spinal nerves |
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The indirect activation pathway is AKA the ________________ tract. There are multiple synapses between the cortex & _______. It is divided into: (2)
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extrapyramidal
final common pathway corticoreticular tract: through reticular formation corticorubral tract: through red nucleus |
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What is the direct activation pathway of the corticobulbar tract?
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1) medulla
2) connect to CN trhough corona radiata 3) converges w/ internal capsule 4) mostly bilateral, some are contralateral |
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What are characteristics of UMN lesions?
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-bilateral supply reduces impact of unilateral lesions
-weakness is contralateral to the lesion -bilateral UMN lesion = spastic dysarthria because it often includes direct & indirect pathways |
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What does a bilateral UMN lesion result in?
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spastic dysarthria
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The UMN indirect pathway actives both ___________ & ____________ motor neurons of the LMN, following the _________ route. What are the 3 tracts?
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gamma & alpha
local reticulospinal: vestibulospinal rubrospinal |
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Role of reticulospinal tract?
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excite/inhibit flexors & extensors, reflexes & ascending sensory info
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Role of vestibulospinal tract?
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reflex & spinal activity controlling muscle tone
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Role of rubrospinal tract?
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facilitate flexor, inhibit extensor of limbs > speech mechanism
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What is the BG responsible for?
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-refining cortically generated activity (faciliation/inhibition)
-regulating motor patterns: setting approximate positions through adjustment of larger muscles -suppressing accessory -regulating muscle tone |
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What is the critical factor in deficits in motor control due to BG dysfunction? What does it depend on?
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the pattern, rather than the amount of activity in the GP
depends on activity in internal segment, balance between direct and ID connections between striatum & GP & subthalamic nucleus activtiy |
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What affects the balance?
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levels of dopamine; lack of dopamine impairs initiation of motor programs, excess of dopamine impairs the suppression of unwanted movement
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What is BG function dependent upon?
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several major NTs: dopamine, GABA, etc
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What are diseases related to major NTs?
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dopamine- Parkinson's Disease
GABA- Huntington's Disease |
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Where are symptoms of BG dysfunction experienced?
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on the side of the body contralateral to the lesion
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What are the major classes of BG dysfunction?
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hyperkinetic
hypokinetic |
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Dystonic syndrome; characterized by an excess of spontaneous, aimless, or unintentional movements; what is it characterized by?
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hyperkinetic
chorea hemiballismus athetosis |
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Rapid, involuntary, purposeless jerks of irregular and variable location on the body
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choreiform movements (chorea)
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spontaneous & violent throwing of the contralateral extremities
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hemiballismus
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slower, continuous movement of fingers, toes, tongue, or other muscle groups while at rest. Maintained posture is interrupted by these continuous, purposeless movements
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athetosis
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Rigid syndrome (Parkinson's Disease); What is is characterized by?
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hypokinetic
akinesia, rigidity, tremor |
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disinclination to use an affected part of the body
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akinesia
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resistance to passive movement is intense
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rigidity
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involuntary 4-5 Hz movements when limb is at rest; disappears with voluntary movement
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tremor
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This controls the smooth contraction of voluntary muscles, then coordinates the contraction together with relaxation of antagonists; receives info from ____________ receptors; is a synergizer & modulator
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cerebellum
sensory synergizes muscles that act in a group; making sure that muscles contract at the right time with the right force |
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What are some characteristics of cerebellum lesions?
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ipsillateral effects
disturb motor function without voluntary paralysis acute lesions chronic lesions |
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What is common with cerebellum lesions?
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ataxia
dysmetria hypotonia tremor nystagmus |
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not "ordered in rank & file"
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ataxia
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inability to guage distance, speed, power of movements
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dysmetria
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usually intention tremor
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tremor
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rhythmic oscillations of the eyes
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nystagmus
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What are similarities of cerebellum & BG?
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-constituents of 2 subcortical motor loops
-both receive projections from cerebral cortex -both project back to cortex via thalamus |
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What are the input differences between BG & cerebellum?
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BG: input from the entire cerebral cortex
cerebellum: input only from part of cortex related to sensorimotor function; receives proprioceptive info fro the periphery |
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What are the output differences between BG & cerebellum?
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BG: output to premotor & motor cortex, also to prefrontal association cortex, influence on LMN is through indirect pathways
cerebellum: output to premotor & motor cortex |
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What are differences between BG & cerebellum related to SC?
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cerebellum: receives somatic sensory info from SC
BG: few connections to brain stem & no direct connections to SC |
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What are differences between BG & cerebellum lesions:
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BG: localized clinical findings contralateral to lesion
cerebellum: ipsillateral |
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What are the neural areas that are crucially involved in motor programming?
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BG
cerebellum SMA primary motor cortex |
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The term motor _______________________ is used to denote the set of muscle commands that are set before a movement begins and can be delivered without external feedback.
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programming
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The ____________________ stage involves the actual physiological act of muscle contraction allowing movement of the structures involved in speech production.
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execution
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What are the neural systems involved in motor execution?
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motor cortex
descending pathways reflex mechanisms final common pathway (LMN, peripheral nerve fiber, synapse, muscle fiber) |
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What can damage to a peripheral motor unit produce? (4)
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paresis
paralysis atrophy fasciculation- spontaneous motor unit discharges |
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Where does the corticobulbar tract originate? Where does it descend to?
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from the pyramidal cells in the precentral gyrus & postcentral gyrus
through the corona radiata & genu of internal capsule |
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What are the 2 portions of the CN 22 (accessory)?
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cranial portion
spinal portion |
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What structure plays a role in the physical expression of affect?
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basal ganglia
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What are the indicators of assessment for MSDs?
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-patient has been given a certain medical diagnosis/condition
-patient's speech is unintelligible -patient's speech is unnatural |
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What is the purpose of assessment?
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establish is there's a problem, differential diagnosis, determine site of lesion, determine severity, prognosis, impact on function, impact on activity participation, detail treatment, establish criteria for termination of tx
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What are all the things you need to evaluate MSDs?
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light
tongue blade small mirror stopwatch audio/video recorder |
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What are the 4 critical points of assessment?
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-when initial medical diagnosis is made
-after psychological acceptance of disease -when MSD becomes a functional limitation -speech is so severely involved that AAC is required |
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What is the danger of only relying on perceptual info to assess MSDs?
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if you rely on perceptual info it can fool you into forgetting the nature of the problem; dangerous to simply listen to what you hear & make a judgement because there can be many causes for the same perceptual features
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What is the ASHA national outcome measure?
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0 unable to test
1 production of speech is unintelligible 2 spontaneous production is limited in intelligibility; some automatic speech & imitation or CV combos may be intelligible 3 spontaneous production consists of automatic words/phrases without consistent intelligibility 4 spontaneous production is intelligible @ phrase level in familiar contexts, unintelligible unless self-cueing & monitoring are used 5 spontaneous production is intelligible to meet daily needs; out of context speech requires repetition, rephrasing, or cueing 6 spontaneous production of speech is intelligible in & out of context but production is distorted 7 production of speech is normal in all situations |
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What are the components of assessment?
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-case history
- physical exam - motor speech exam - review of results with patient & family - education: compensatory strategies if appropriate |
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What is the Mayo Clinic Severity Scale?
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Level 0 no impairment
Level 1 mild impairment Level 2 moderate impairment Level 3 severe impairment |
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What does case history consist of?
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- intro & goal setting
- basic data - onset & course - associated deficits - patient's perception of deficit - consequences of disorder - management - awareness of diagnosis & progress |
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Assess the function of each component in isolation, primarily during nonspeech tasks
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goal of physical examination
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What does the physical exam assess?
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- at rest
- range of motion - strength - rate & coordination of movement (diadochokinetic performance) - muscle tone & availability to vary muscular tension - response to instructions |
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What does the physical exam assess?
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- jaw
- lips - tongue - velopharyngeal mechanism - respiratory system - phonatory system |
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What does the examination of the speech mechanism (nonspeech: face/lips) involve?
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- at rest
- range of motion: retraction, pursing, cheek puffing, lip rounding - strength: against pressure, plose (nasal seal) - spontaneous observations: emotion, speech, following directions |
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What does the speech mech exam (jaw) involve?
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- at rest
- range of motion: open, close, lateralize - strength: against pressure, assess for symmetry, atrophy - spontaneous observations: emotion, speech, following directions |
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Speech is ____________ directed and _____________ guided.
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goal; sensory
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Formulation of the overall plan/strategy of action that involves the specification of motor goals; What areas are involved?
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motor planning
cortical areas & BG |
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Motor goals for speech production are related to the _______________ & _______________ specifications of movements needed for the sequential target sounds.
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motor planning
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Motor planning is _____________________/______________ specific and not ___________________ specific.
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phonological/articulatory; muscle
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The motor plan of a phoneme is adapted to the context of the planned unit (______________________________).
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coarticulation (motor planning)
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