Neuro Exam I Study Guide

Front 1

Define DYSARTHRIA.

Back 1

A neurological motor speech disorder characterized by slow, weak, imprecise, or uncooridinated movements of the speech musculature. It includes a group of disorders marked by impaired execution of the movements of speech production.

Front 2

Define APRAXIA OF SPEECH.

Back 2

A motor speech disorder caused by a disturbance in motor planning, or programming of sequential movement for VOLITIONAL speech production. The musculature itself is not impaired; individuals with apraxia of speech have difficulty completing sequences of movements for sound production.

Front 3

Describe the origin, destination, and function of the LOWER MOTOR NEURONS.

Back 3

-Origin: Brainstem and Spinal Cord
-Destination:Muscle
-Function: Produce muscle contraction for reflex and tone, Other motor divisions must act through it to influence movement, Carries out UMN commands for voluntary movements and postural adjustments

Front 4

Describe the origin, destnation, and function of the DIRECT ACTIVATION PATHWAYS.

Back 4

-Origin: Cerebral cortex
-Destination: Cranial & Spinal nerve nuclei
-Function: Influences consciously controlled, skilled voluntary movements

Front 5

Describe the origin, destination, and function of the INDIRECT ACTIVATION PATHWAYS

Back 5

-Origin: Cerbral Cortex
-Destination: Cranial & Spinal nerve nuclei
-Function: Mediates subconscious, involuntary, automatic muscle activities including posture, muscle tone, and movements supportive of voluntary movement.

Front 6

The gamma loop can be alpha motor neuron-mediated or gamma motor neuron-mediated. Explain these two methods of maintaing sensitivity to stretch in the muscle spindles.

Back 6

Alpha Mediated Loop:
-contraction of extrafusal muscle
1. Action potential in AMN
2. Innervates extrafusal MF causing it to contract
3. This causes muscle spindle to relax, become loose, loses tension and is floppy. Now stretch receptor can't detect stretch (not good!)
4. Sensory neuron sends action potential to spinal cord to increase tension in spindle.
5. Action potential through gamma motor neuron.
6. Innervates intrafusal MF, contracts and tension is increased.
Gamma Mediated Loop
-contraction of intrafusal muscle fiber
1. Action potential in GMN
2. Innervates intrafusal MF causing it to contract, goal is posture/tone (which is accomplished ultimately by extrafusal MF)
3. Sensory neuron sends action potential to spinal cord to increase or decrease tension in extrafusal MF.
4. Action potential through alpha MN.
5. Innervates extrafusal MF, contraction causes tension or stops tension.

Front 7

List the six cranial nerves and the spinal nerves involved in speech production. Include a description of the function of each of these nerves.

Back 7

(V) Trigeminal - Sensation from face. Motor to masseters, palate, pharynx.
(VII) Face - Sensation from anterior tongue. Motor to facial muscles.
(IX) Glossopharyngeal - Sensation from posterior tongue, soft palate, pharynx. Motor to pharynx.
(X) Vagus - Sensation from viscera. Motor to larynx, pharynx, viscera.
(XI) Accesory - Motor to larynx, chest, shoulder.
(XII) Hypoglossal - Motor to tongue.
Spinal Nerves - Motor to muscles of repiration.

Front 8

Two structures make up the control circuits. Name them, and discuss each of their functional roles in speech production.

Back 8

Basal Ganglia Control Circuit
Functions include:
-initiation of movements; controlling initiation of movements (Parkinson's)
-dampening electrical signals to prevent that are in excess of what it needs (hyperkinetic dysarthria)

CEREBELLAR CONTROL CIRCUIT
-Cooridinates the timing of movements (graceful)
-Very important for rapid, sequences, fine motor movements of speech

Front 9

List and discuss the 5 steps of the conceptual-programming level and speech production. Include description of the function, structures, and disorders affecting speech at each of the 5 levels.

Back 9

1. Conceptualization
-function:Intention and desire to do something, purpose for action.
-Localization: Cortex (probably bilateral and widespread)
-Disorders: Dementia, psychosis, confusion
2.) Linguistic Planning
-Function: Language system activates to formulate the verbal message (Semantics & syntax, then phonology)
Localization: Left perisylvian cortex
Disorders: Aphasia
3.) Motor planning & programming
-Function: Formulation and retrieval of motor commands for production of phonetic segments and syllables at particular rates and w/ particular patterns of stress and prosody, based on acoustic goals and feedback.
-Localizatin: Premotor cortex, supplementary motor area, Broca's area, somatosensory cortex, supramarginal gyrus, insula
Disorders: Apraxia of speech
4.) Performance
-function: Motor execution
-localization: LMNs
-disorder: Dysarthrias
5.) Feedback
-function: Provides sensory info about ongoing and completed movements. Permits modification of ongoing and future movements using that information.
-localization: peripheral & central sensory pathways
-disorder: Dysarthrias & peripheral sensory based speech disturbances
-function:

Front 10

Amyotrophic Lateral Sclerosis
-general characteristics and cause

Back 10

-Motor neurons (voluntary movements) from brain to muscles generate but can't fire.
-progressive weakness of arms and legs
-progressive weakenss of muscles of speech, swallowing,
and breathing
-mixed dysarthria (spastic - UMN and flaccid -LMN)

Front 11

Dystonia
-general characteristics and cause

Back 11

-involuntary muscle contractions (in neck, tongue or jaw) *increased movements
-Abnormalities in basal ganglia
-May be due to body's inability to process neurotransmitter's
-spasmatic torticollis (neck turns involuntarily)
-spasmatic dysphonia - vocal folds stay in either the abducted or adducted state

Front 12

Guillain-Barre'

Back 12

-acute!
-progressive paralysis, typically beginning in lower extremeties (PNS)
-flaccid dysarthria
-later involvement of muscles of speech, swallowing, and breathing
-Immune response to foreign antigens
-progressive destruction and regeneration of myelin sheath of peripheral nerve axons

Front 13

Friedrieich's Ataxia

Back 13

-autoimmune recessive genetic disorder
-muscle weakness in arms and legs, problems with cooridination, vision, hearing, and speech problems (slurred speech)

Front 14

Huntington's Disease

Back 14

-Chorea, dementia, emotional instability
-inherited via an autosomal dominant trait; half of the offspirng will develop disease
-hyperkinetic dysarthria

Front 15

Multiple Sclerosis

Back 15

-muscle weakness or incooridination
-visual problems
-pain, fatigue, depression, cogntive change
-no definitive cause; likely a combination of environmental and genetic factors
-mixed dysarthria (spastic/ataxic) -UMN

Front 16

Myasthenia Gravis

Back 16

-muscle weakness during periods of activity the improves with rest
-frequently involves muscles of the eye and eyelid, face, and swallowing mechanism
-Autoimmune disorder
-nerve to muscle communication interrputed at the neuromuscular junction-
-flaccid dysarthria (PNS)

Front 17

Parkinson's Disease

Back 17

-caused by loss of dopaminergic neurons in the basal ganglia
-dementia
-changes in cognitive function
-poor handwriting (micrographia)
-slowness of motor initiation

Front 18

Stroke

Back 18

-paralysis or weakness
-spasticity
-aphasia
-pain
-blockage of bloodflow in brain
-ataxic dysarthria (cerebellum)

Front 19

Traumatic Brain Injury

Back 19

-cognitive problems
-cranial nerve injury
-motor problems (spasticity,ataxia, tremors, rigidity)
-traffic accidents, falls, etc
-Mixed dysarthria (spastic and flaccid)
-Ataxic dysarthria