Neuro Exam 3: Neurology Of Speech

Front 1

What are the five systems associated with speech?

Back 1

Respiration, phonation, resonance, articulation, and prosody

Front 2

What is respiration?

Back 2

-Creates a column of air during long, slow exhalation
-Controlled expiration produces a constant pressure airstream to larynx
-Respiration is controlled by the diaphragm, abdominal muscles, and passive qualities of lungs and airways

Front 3

What is phonation?

Back 3

-Phonation is the quality and characteristic of the voice created by the larynx
-The larynx contains two vocal folds and a complex set of muscles that move the folds; the vocal folds are brought closely together during speech to act as a valve
-Air is forced through the closed larynx, across the vocal folds. This sets the air into vibration, producing the quality of voice.
-Characteristics of the folds determine a sound's frequencies
-This sound can be described in terms of pitch, loudness, quality, and flexibility
-Qualities can be varied voluntarily
-Larynx innervated primarily by vagus nerve

Front 4

What is resonance?

Back 4

-The modification of voice as the expelled air stream encounters cavities with different sizes and shapes
-This creates an individual's characteristic voice
-Variations of size and shape of parts of focal tract above larynx alter harmonics and increase complexity of sound
-The muscles of the soft palate are supplied by the trigeminal, glossopharyngeal, and vagus nerves

Front 5

What is the most important resonator cavity?

Back 5

-Nasopharynx: the part of the pharynx above the soft palate
-Nasality, dependent on the amount of air that enters the nasopharynx and nasal cavity is the most important component of resonance
-Nasal resonance is an important, continuous modifier of voice quality
-The amount of nasal resonance is controlled by movements of the soft palate to open or close the communication between the oropharynx (mouth pharynx) and the nasopharynx

Front 6

What is articulation?

Back 6

The ability to modify the voice stream into specific sounds
-Requires lips, tongue, teeth, hard palate, and soft palate
-Movement of these parts modify the exiting airstream to produce phonemes (speech sounds)
-Tongue movements are dependent on the hypoglossal nerve
-Lip/cheek movements depend on the facial nerve
-Soft palate movements depend on trigeminal, glossopharyngeal, and vagus nerves

Front 7

What is prosody?

Back 7

The quality of extended speech, including rate, stress, and melody.
-enhances communication beyond the simple contact of the words produced
-Depends on cerebral cortex, basal ganglia, and cerebellum

Front 8

What does the examination of speech consist of?

Back 8

-Spontaneous speech
-Reading standard paragraph (e.g., my grandfather)
-Saying "ah" long, steady, clearly (further evaluates respiration and phonation)
-Rapidly repeat "puh", "tuh", "kuh" (tests for specific dysarticulation). Rapidly repeating "puh-tuh-kuh" tests for cerebellar control of speech.

Front 9

What is hypophonation?

Back 9

-Occurs when vocal folds not close enough together because of neuromuscular problems or local laryngeal disease
-vocal cords loose/floppy
-breathy quality of speech due to excessive escape of air

Front 10

What is hyperphonation?

Back 10

-Occurs when vocal folds too close/tight.
-Caused by upper motor neuron disease or local inflammatory disease of vocal cords
-speech is rough or strained

Front 11

What disorder of phonation is most common?

Back 11

-Mixed disorder
-Contains elements of both hypophonation and hyperphonation
-Speech is hoarse, rough, breathy

Front 12

What is hypernasality?

Back 12

-Excessive nasal resonance in speech
-Caused by poor closure of space between oropharynx and nasopharynx (due to weakness of muscles responsible for closure such as upper motor neurons, lower motor neurons, neuromuscular junction or muscle, or due to a structural abnormality such as a cleft palate)

Front 13

What is hyponasality?

Back 13

-Loss of normal nasal resonance
-Due to blockage of the space between oropharynx and nasopharynx or more commonly to blockage of the nasal cavity (e.g., stuffy nose)

Front 14

What are specific dysarticulations?

Back 14

-Difficulty with a specific group of phonemes
-Due to damage of one or more nerves or to local structural pathology (tongue/lip dysfunction often due to neuromuscular disease)

Front 15

What are general dysarticulations?

Back 15

-Difficulty with most are all phonemes
-Due to nervous system or systemic disease (e.g., brainstem stroke)

Front 16

What is hyperprosody?

Back 16

-Exaggerated prosody
-e.g., expressive "broca's aphasia"

Front 17

What is hypoprosody?

Back 17

-Reduced or absent prosody
-speech soft and monotonous with little variation in stress or pitch
-e.g., Parkinson's disease

Front 18

What is dysprosody?

Back 18

-Distorted prosody, with variable increased and decreased prosody during speech

Front 19

What is the general name for speech disorders?

Back 19

Dysarthria

Front 20

What is flaccid dysarthria?

Back 20

-Focal (specific nerve lesion) or diffuse (disorder of lower motor neuron, neuromuscular junction, or muscle)
-Hypofunction of respiration (insufficient air stream; decreased loudness/pitch, short phrases)
-Hypophonation (breathy)
-Hypernasality (nasal)
-General dysarticulation

Front 21

What is spastic dysarthria?

Back 21

-Occurs with bilateral upper motor neuron lesions
-Hyperfunction of respiration (shallow, rapid breathing; short phrases, decreased loudness and pitch, choppy speech)
-Hyperphonation (harsh, strained)
-Mild hypernasality
-Generalized dysarticulation
-Slow, monotonous hyperprosody or hyperprosody with excessive stress of all syllables

Front 22

What is ataxic dysarthria?

Back 22

-Occurs with bilateral lesions of the cerebellum
-Dysprosody (irregular speech output, limited & incorrect use of pitch and loudness for stress)
-Variable, generalized dysarticulation
-Hyperphonation

Front 23

What is hypokinetic dysarthria?

Back 23

-Occurs in Parkinson's disease
-Respiratory hypofunction
-Hypophonation or mixed phonation (soft with decreased variability of loudness, pitch, and flexibility)
-Generalized dysarticulation (assoc. w/ slow movements of speech muscles)
-Hypoprosody

Front 24

What is hyperkinetic dysarthria?

Back 24

-Chorea, dystonia, voice tremor
-Hyperfunction of respiration
-Hyperphonation
-Dysprosody
-General dysarticulation