Neural Exam 3 Swallowing & Speech

Front 1

What is the chewing process and preparing food for swallowing?

Back 1

Mastication
- mandibular branch - V3

Front 2

What is the swallowing of the food?

Back 2

Deglutition

Front 3

Feeding is a ________ ________.

Back 3

Neurological process

Front 4

Feeding involves:

Back 4

- Desire for food/liquid
- Desire for nutrition/hydration
- Cognitive
- Physical (motor) skills
- Sensory responses
- Visceral responses
- CN VII & CN IX - salivary glands

Front 5

Eating involves:

Back 5

Hunger & Pleasure

Front 6

First stage of swallowing:

Back 6

Oral preparatory
(chewing, mixing bolus with saliva)

Front 7

Second stage of swallowing:

Back 7

Oral transit
(final formation of bolus into convenient shape & posterior movement of bolus through faucial pillars into pharynx)

Front 8

Third stage of swallowing

Back 8

Pharyngeal
(movement of bolus through pharynx and UES)

Front 9

Fourth stage of swallowing:

Back 9

Esophageal
(movement of bolus through esophagus through lower esophageal sphincter [LES] to stomach)

Front 10

Oral Prep stage includes:

Back 10

- Sensory input from PNS to CNS
- Olfaction (CN I)
- Taste (CN VII, IX, & CN X)
- Chemesthesis (chemical irritation) (CN V)
- Temperature (CN V)
- Touch, stereognosis, proprioception (CN V, IX)

Front 11

Markers of Embryonic Development Related to Swallowing

Back 11

-Epiglottis & larynx identifiable by 6 weeks
- Swallowing at 12 weeks
- VFs at 13 weeks
- Taste buds start at 7 weeks & receptors are in them by 12 weeks
- Can tell bitter from sweet at 12 weeks
- Gag reflex at 26 weeks
- Rooting reflex at 32 weeks
- Coordination of swallowing and breathing 34+ weeks

Front 12

Swallowing CN Innervations:

Back 12

- Mouth held shut by CN VII
- Sensory input via CN V relays position of bolus in mouth
- Motor CN V controls chewing movements
- CN IX senses the arrival of bolus at the palate
- CN XII pushes the chewed bolus up and back against the soft palate

Front 13

Swallowing CN Innervations:

Back 13

- CN V (with CN VII & XII) pulls hyoid up and forward, bringing the larynx beneath the back of the tongue
- CN IX is efferent to stylopharyngeus muscle only. Assists in hyoid elevation as well as dilation of the pharynx
- CN X: elevates palate to occlude nasopharynx, closes laryngeal vestibulates by approximation of vfs, ventricular folds, & aryepiglottic folds, contracts middle and inferior pharyngeal constrictors to narrow pharynx and initiate peristalsis, relaxes cricopharyngeal sphincter to allow bolus to enter esophagus, and initiates peristalsis in the esophagus

Front 14

Cortical stroke affects swallowing by:

Back 14

right or left hemisphere - swallowing is not localized to one side
- not just concerned about the sensory/motor components but also cognitive, language, visual/perceptual, physical impairments, and fatigue

Front 15

LEFT CVA results in:

Back 15

- Difficulty initiating oral phase
- Searching movements of the tongue

Front 16

RIGHT CVA results in:

Back 16

- Some report more pharyngeal phase deficits
- Also dealing with reduced insight, impulsiveness, memory, and left neglect

Front 17

What is paresis/paralysis characteristics?

Back 17

- bilateral lesions may be characterized by significant spasticity and weakness on one or both sides
- Unilateral lesions - more likely to be weak on one side

Front 18

Sensory recognition (perception) problems lead to?

Back 18

residue and "silent" penetration/aspiration of bolus into airway

Front 19

Brainstem Lesion can present with these swallowing characteristics?

Back 19

- Severe pharyngeal phase dysphagia including absent swallow
- As the individual progresses, swallow is triggered (delayed but triggered), but with decreased pharyngeal physiology

Front 20

What is an absent or delayed pharyngeal response?

Back 20

- Pharyngeal Dysphagia

Front 21

Speech General Facts:

Back 21

- Speech is complicated & fast
- Disproportionate cortical sensorimotor space allotted to larynx, palate, tongue, and lips
- Recruits more motor fibers than any other human mechanical behavior
- Generates multimodal feedback, probably more than any other routine motor behavior
- 140,000 + neuromuscular events per sec
- Temporal precision in range of 10 msec

Front 22

What is a collective name for a group of motor speech disorders associate with disturbed muscular execution or control of the speech mechanism due to CNS and/or PNS damage?

Back 22

The Dysarthrias

Front 23

Dysarthrias may:

Back 23

- include abnormalities in strength, speed, range, tone or accuracy of speech movements
- affect respiration, phonation, resonance, articulation & prosody

Front 24

What are the four subsystems of speech production?

Back 24

- Respiratory
- Phonatory
- Resonatory
- Articulatory

Front 25

The muscles and muscle groups in the speech subsystems must be coordinated in ______ and _________.

Back 25

time & space

Front 26

Respiratory System:

Back 26

- Speech production requires airflow
- Pulmonary airstream mechanism (air flows out of lungs through trachea)

Front 27

What is the inhalation:exhalation ratio during speech production?

Back 27

1:6

Front 28

Phonatory System:

Back 28

- Laryngeal structures
- VFs brought together by CN X recurrent laryngeal branch
- VFs lengthened/shortened for pitch by CN X superior laryngeal external branch

Front 29

Resonatory System:

Back 29

- 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, for determining nasality of sounds CN X

Front 30

Articulatory System:

Back 30

- Control of articulators within the oral cavity to manipulate the outgoing airflow (CN VII)
- Major structures: lower jaw, lips, tongue
- Tongue: intrinsic mms (fine tuned) & extrinsic mms (protrusion, retraction, elevation)
- Muscles contract to create constrictions in the oral cavity to produce sounds

Front 31

Which neural structures carry out commands delivered by UMNs as issued by cortex & influenced by basal ganglia & cerebellar control circuits?

Back 31

LMN

Front 32

LMN's in speech:

Back 32

- Respiration - transmission medium
- Spinal (cervical & thoracic) - phrenic nerve (CN III - V) & spinal intercostals
- Phonation - sound source & articulation (Vagus X) - larynx
- Resonance - tone, quality, & articulation (Vagus X (+ IX & XI) - velopharynx & larynx (CN X opens velum)
- Articulation - speech sounds & resonance

- Trigeminal V - jaw
- Facial VII - face
- Hypoglossal XII - tongue

Front 33

Which dysarthria is characterized by hypotonia (low muscle tone) & weakness or paralysis of the muscles? With speech characteristics of shallow breathing, breathy voice, aphonia (no voice), reduced pitch & loudness, monotone, hypernasality, and imprecise articulation?

Back 33

Flaccid LMN Dysarthria

Front 34

What is responsible for skilled, discrete, quick movements in speech?

Back 34

UMN
- Lesions cause weakness & loss of skilled movements

Front 35

"Direct" UMN pathway for speech

Back 35

- Project from cortex to cranial & spinal nerve with few synapse
- Corticobulbar tracts cranial nerves
- Corticospinal tracts spinal nerves
- Arise in primary motor cortex, premotor cortex, & supplementary motor area of frontal lobes

Front 36

"Indirect" UMN pathway for speech

Back 36

- Project from cortex with numerous synapses before reaching cranial & spinal nerves
- Intermixed with direct activation pathways
- Major contributions from premotor cortical areas
- Crucial for regulating reflexes & maintaining posture, muscle tone, & assoc. activities that provide framework for skilled movements (tell LMN not to overdo it)

Front 37

What is characterized by hypertonia commonly caused by stoke and paresis/paralysis? With speech movements that are difficult and speech is characterized by slow, jerky, imprecise articulation and reduction of rapid accuracy of speech?

Back 37

Spastic Dysarthria

- Bilateral UMN lesions of both direct & indirect pathways - released inhibition of tone

Front 38

Speech Execution Summary:

Back 38

- Successive specifications from BG and cerebellar control circuits are relayed from UMN to the LMN nuclei that control muscles
- LMNs carry coded directions for precise movements and appropriate postural stability

Front 39

_____________ interaction is integral to movement control

Back 39

Sensorimotor

Front 40

_________ is what the brain mainly uses for movement control. _________ is mostly ignored.

Back 40

Feedforward
Feedback

Front 41

The brain uses a predictive model based on what it already knows about postural tone, mm tone, position in space. This is FASTER & more EFFICIENT.

Back 41

Feedforward

Front 42

If an unexpected perturbation occurs, or demands change we switch to this. We also use it during motor learning.

Back 42

Feedback

Front 43

What are contextual factors of Movement Control?

Back 43

- Automaticity
- Initiation mode
- Sound or syllable structure
- Motor complexity
- Familiarity vs. Unfamiliarity
- Length of utterance
- Linguistic complexity