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91 Cards in this Set
- Front
- Back
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Define dysarthria
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A neurologic disorder with abnormalities in perception: strength, speed, range, steadiness, tone, accuracy of movements.
Slow, weak, imprecise, and/or uncoordinated movements of speech musculature. |
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What are the types of dysarthria? (8)
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Flaccid
Spastic Ataxic Hypokinetic Hyperkinetic Unilateral UMN Mixed Undetermined |
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Where is the damage to brain in flaccid dysarthria?
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LMN
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Where is the damage to brain in spastic dysarthria?
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Bilateral UMN
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Where is the damage to brain in ataxic dysarthria?
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Cerebellum
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Where is the damage to brain in hypokinetic dysarthria?
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Basal ganglia
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Where is the damage to brain in hyperkinetic dysarthria?
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Basal ganglia
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Where is the damage to the brain in unilateral upper motor neuron?
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Unilateral UMN
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Define apraxia
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Neurologic speech disorder with impaired capacity to PLAN or PROGRAM sensorimotor commands.
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What are the normal variations in speech production?
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(1) Age (2) Gender (3) Variation in style
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What can be used to assess MSDs?
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(1) Perceptual methods
(2) Instrumental methods -Acoustic measures -Physiologic measures -Visual imaging measures |
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How are MSDs categorized?
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(1) Age of onset
(2) Course (stationary vs. progressing vs. exacerbating-remitting) (3) Site of Lesion (4) Neurologic diagnosis (5) Pathophysiology |
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What are variables relevant to MSDs?
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(1) Speech components (respiration, resonance, phonation, articulation)
(2) Severity (relative to management decisions & individual impacted) (3) Perceptual characteristics (assist with classification) |
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What variables are included in the WHO-ICF framework?
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(1) Body structure
(2) Body function (3) Activity (4) Participation (5) Environmental factors |
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Where do 10/12 of the cranial nerves emerge at this location?
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Brainstem
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This structure is connected to pons to the rest of the CNS via 3 pairs of peduncles
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Cerebellum
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This structure controls smooth coordination of muscles as well as rapid and precise movements?
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Cerebellum
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This structure includes: (1) thalamus, (2) third ventricle, (3) hypothalamus, (4) subthalamus
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Diencephalon
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This system contains: (1) amygdala, (2) hippocampus, (3) septum paludium, (4) cingulate gyrus, (5) fornix, (6) anterior commissure.
Also involved the emotions of survival |
Limbic system
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What structures make up the striatum?
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Caudate nucleus + Putamen
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What makes up the lentiform nucleus?
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Putamen + Globus pallidus
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What are the five structures that make up the BG?
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(1) Caudate nucleus (2) Putamen (3) Globus pallidus (4) Substantia nigra (5) Subthalamic nucleus
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What is considered the afferent portion of BG?
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Striatum
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What is considered the efferent portion of BG?
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Globus pallidus
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What does BG afferent input come from? (3)
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(1) Neocortex
(2) Thalamus (3) Substantia nigra |
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What happens with lesions in the BG?
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Motor disturbances such as: (1) dyskinesia, (2) hyperkinesia, (3) hypokinesia
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What are the three stages/phases of speech production?
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(1) Motor planning
(2) Motor programming (3) Motor execution |
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Where might blood or pus from an infection or injury be found?
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(1) epidural space
(2) subdural space |
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Describe motor planning:
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Formulation of the overall plan or strategy of action involves the specification of motor goals.
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Is motor planning articulatory specific or muscle specific?
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Articulatory specific
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Which cortical areas are involved in motor planning?
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(1) Cortical association area
-premotor cortex -supplementary motor cortex -prefrontal association areas -parietal association area -broca's area (2) Basal ganglia |
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Describe motor programming
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The set of muscle commands that are set before a movement begins and can be delivered without external feedback.
-Sensory feedback is utilized to change a motor program as needed, as movement occurs. |
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Describe motor execution
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Involves the actual physiologic act of muscle contraction allowing movement of the structures involved in speech production.
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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 |
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This is described as peripheral mechanism through which all motor activity is mediated.
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Final common pathway
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How are LMNs divided?
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(1) Alpha motor neurons
(2) Gamma motor neurons |
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These neurons innervate extrafusal muscle fibers, branch out for redundancy of innervation, and muscles activated by efferent cranial/spinal nerves
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Alpha Motor Neurons
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These neurons innervate intrafusal muscle fibers, are part of the gamma loop, and are critical to maintaining tone (resistance to stretch)
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Gamma Motor Neurons
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What occurs when there's damage to peripheral sensory pathways?
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Abolishes or reduces reflexes (e.g. gag reflex)
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What occurs where there is damage to peripheral motor unit?
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Paredid, paralysis, atrophy, and fasciculation
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Motor nuclei of the CN receive impulses from cortex through ____________ tract
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corticobulbar
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Which CNs do not have a bilateral connection?
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(1) lower facial nucleus VII
(2) Hypoglossal motor nucleus |
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The mandibular branch of CN V is responsible for what?
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(1) Mastication, (2) upward and anterior movement of larynx, (3) damping sound, (4) flatten velum & open eustachian tube
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What are the sensory branches of the CN V?
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(1) Opthalmologic (2) Maxillary (3) Mandibular
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What occurs with a unilateral lesion to CN V?
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Minor effect on speech
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What occurs with a bilateral lesion to CN V?
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Jaw hangs open
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The facial nerve is motor and sensory. What does the motor component control?
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Buccal & Mandibular branches-- muscles of facial expression
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What are the sensory components of CN VII
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(1) glands: submandibular, sublingual, lacrimar, (2) taste: anterior 2/3 of tongue
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What occurs with a LMN/ CN VII lesion?
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Paralysis to entire ipsilateral side of face, atrophy & asymmetry, fasciculation
*Bells palsy |
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What does the motor component of CN IX control?
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Stylopharyngeus (elevates pharynx)
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What does the sensory component of CN IX control?
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Sensation from pharynx and tongue
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What is the reflex that CN IX controls?
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Gag reflex
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What may show damage to CN IX nerve?
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Absence of gag reflex
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What does the motor component of CN X control?
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(1) pharyngeal branch
(2) superior laryngeal branch (cricothyroid--pitch modification) (3) recurrent laryngeal nerve (innervate all intrinsic muscles of larnyx) |
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What occurs with a unilateral lesion of CN X?
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Hoarseness, difficulty swallowing, hypernasal
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What occurs with a unilateral lesion of recurrent laryngeal nerve (CN X- Vagus)?
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Ipsilateral weakness or paralysis of vocal fold; results in breathiness
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What occurs in lesion of superior laryngeal (CN X-Vagus)?
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Difficulty with pitch control
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What does the spinal portion of CN XI-Accessory supply?
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Sternocleidomastoid & trapezius (neck and shoulder muscles)
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What occurs with a lesion to CN XII (hypoglossal)?
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Atrophy, weakness, & fasciculations
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What nerves are responsible for respiration?
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Spinal nerves from C3-5 and they combine to form phrenic nerves
--These paired nerves innervate 1/2 of diaphragm |
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These neurons are contained entirely in the CNS, include direct & indirect activation pathways, does NOT include BG & cerebellar control circuits, connects cortex to FCP
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Upper Motor Neurons
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Upper Motor Neurons activation tract are AKA
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Pyramidal tract
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What are UMN activation tract divided into?
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(1) Corticobulbar tract: to CN
(2) Corticospinal tract: to Spinal Nerves |
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What occurs with a lesion of the corticobulbar tract?
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-Bilateral supply, esp CN V, VI, X, & VI reduces impact of unilateral UMN lesions
-Weakness contralateral to lesion -Bilateral UMN lesion : Spastic dysarthria bc it includes direct & indirect pathways |
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What is the UMN indirect activation pathway AKA?
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Extrapyramidal tract
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Which tract activate both gamma & alpha motor neurons of LMN?
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Extrapyramidal tract/ UMN indirect activation pathway
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Can BG and Cerebellum influence LMN?
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NO
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Which route does UMN/ indirect activation pathway take?
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Follow the "local route"--
reticulospinal tracts: excite or inhibit flexors & extensors, reflexes, and ascending sensory information |
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What are the "control units"?
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Basal Ganglia & Cerebellum
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How does basal ganglia serve as a control unit?
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(1) refinement of cortically generated activity (facilitation, inhibition)
(2) regulation of associated motor pattern (setting approximate positions through adjustment or larger muscles) (3) Suppression of accessory (4) Regulation of muscle tone |
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What is a critical function in deficits in motor control due to basal ganglia dysfunction?
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PATTERN, rather than the amount of activity is globus pallidus
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What does the pattern in BG include?
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Depends on balance between direct and indirect connections between striatum and globus pallidus and activity in subthalamic nucleus
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What effects the pattern balance in BG?
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Levels of dopamine in striatum affects the balance between direct and indirect connections.
Lack of dopamine impairs initiation of motor programs & excess of dopamine impairs suppression of unwanted movements |
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What occurs with dysfunction of BG control unit?
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Symptoms are experiences on body contralateral to the lesion site
-Consists of many feedback loops which refine movement by inhibiting or disinhibiting movement |
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What terms describe abnormal BG function?
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(1) Hyperkinetic -Choreiform -Hemiballismus -Athetosis
(2) Hypokinetic -Akinesia -Rigidity -Tremor |
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What is the excess of spontaneous, aimless, or unintentional movements?
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Hyperkinetic
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What is rapid, involuntary & purposeless jerks of irregular & variable location on the body
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Choreiform movements
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What is spontaneous & violent throwing of the contralateral extremities?
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Hemiballismus
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What is slower, continuous movements of the fingers, toes, tongue or other muscle group while at rest. *maintained posture is interrupted by these continuous purposeless movments
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Athetosis
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What is the disinclination to use an affected part of the body?
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Akinesia
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What is the resistance to passive movement is intense?
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Rigidity
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What is the involuntary 4-5 Hz movements when the limb is held at rest; disappears with voluntary movement
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Tremor
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How does the cerebellum serve as a control unit?
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(1) receives abundant info from sensory receptors, then performs a motor "regulatory function"
(2) significant contribution to synergy of muscle action (3) serves as a modulator--makes sure muscles contract @ the right time and with the right force |
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What occurs with a lesion in the cerebellum?
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(1) ipsilateral effects
(2) cause disturbance of motor function without voluntary paralysis (3) acute lesions--produce sudden severe symptoms & signs; often get a good recovery (4) chronic lesions--produce symptoms that are less severe, but continue to get worse |
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What are terms describe abnormal cerebellum function?
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(1) Ataxia (2) Dysmetria (3) Hypotonia (4) Tremor (5) Nystagmus
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What is the inability to gauge distance, speed, and the power of movements?
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Dysmetria
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What are the similarities between cerebellum and basal ganglia?
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(1) Major constituents of 2 important subcortical loops of motor system
(2) Both receive major projections from cerebral cortex (3) Both project back to cortex via thalamus |
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What are the differences in input with cerebellum vs BG?
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Cerebellum: input ONLY from the part of the cortex directly related to sensorimotor function
BG: input from ENTIRE cerebral cortex |
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What are the differences in output with cerebellum vs BG?
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Cerebellum: output to premotor and motor cortex
BG: output to premotor & motor cortex but also to prefrontal association cortex--ultimate influence on LMN is primarily through indirect pathways |
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What are the differences in localization of clinical findings with cerebellum vs BG?
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Cerebellum: clinical findings are ipsilateral in the cerebellum
BG: localization of clinical findings is contralateral to lesion |
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What are the differences in connections to brain stem & spinal cord with cerebellum vs BG?
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Cerebellum: out receives somatic sensory info directly from spinal cord & has major afferent and efferent connections with many brain stem nuclei that are directly connected with spinal cord
BG: relatively few connections to brain stem & no direct connections to spinal cord |
