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What is the name of CN V and what does it intervate
- Trigeminal Nerve
- Sensation from face
- Motor to masseter, palate and pharynx
WIth the trigeminal nerve, the motor and sensory roots attach to what?
The lateral pons
WHere are the motor nuclei of the trigeminal nerve located?
Sensory nuclie of the trigeminal nerce extedn from what to what>
the mesencephalon to the spinal cord
With the trigeminal nerve there are how many motor nuceus and how many sensory nuclie
one and three
What is the trigeminal nuclear complex?
Refers to the location of the motor and sensory nuclei and associated tracts of the CN V
The trigeminal Nulear complex has how many branches and what are they
- V1 ophthalmic (eyes) (sensory)
- V2 Maxillary (upper face and sensory)
- V3 mandibular (lower face) (sensory and motor)
The V1 branch intervates what? Is it sensory or motor?
- forehead, eyes, and nose
The V2 branch intervates what and is it sensory or motor?
- upper lip mucosa, maxilla and upper teeth, cheeks, palate and maxillary sinus
The V3 branch intervates what?
anterior 2/3 tongue, mandible, lower teeth, lower lip, part of cheeks, part of the external ear.
The trigeminal ... contains neurons
The sensory information of the trigeminal nuclear complex is projected where?
to three different nuclei in the brainstem
The three sensory nuclei of the trigeminal nuclear complex are? They deal with what?
- Mesencephalic nucleus (proprioception)
- Pontine Nucleus (*main) (fine touch and pressure from face, and dental pressure
- Spinal nucleus (crude touch (itch), pain, temperature
The trigeminothalamic tract is what>
Fibers that decussate and synapse in the thalamus
The mesencephalic nucleus has what type of representation and of what?
unilateral representation of proprioception
The pontine nucleus is what? it has what representation of of what?
- Has bilateral representation of fine touch and pressure from face, dental pressure
Sinal nucleus has what representation of what and it is where what happens?
- Mots deficit is noticed
- Unilateral representation of crude touch, pain and temperature
The trigeminothalamic tract does what?
Fibers decussate and synapse in the thalamus.
Where are the motor nucleus of the trigeminal nuclear complex located?
close to the pontine (main) sensory nucleus in the pons
There is what type of innervation from the prrimary motor cortex (UMN) to the motor masticator nucleus (LMN) of the trigeminal nuclear complex?
What are the jaw closing muscles?
masseter, temporalis, medial pterygoid
What are the jaw lateralization mucscles
What are the jaw opening muscles?
Anterior belly of the digastric
What are the palatal muscles: and these are mostly what nerve?
- Tensor veli palatini (tense and flatten soft palate)
The middle ear muscle is the ?
The trigeminal nuclear complex motor function is primarily responsible for?
- jaw movement
- for flattening and tensing soft palate (cn X does the rest) and opening the eustachian tube (tensor veli palatine)
The trigeminal nuclear complex motor function is partially responsible for?
- the upward and anterior movement of the larynx (anterior belly of digastric)
- for acoustic reflex (tensor typmani)
If there is a lesion of the LMN of the motor nucleus of CN v in the pons and perifpheral nerve there will be what?
A deviation of the jaw toward the side of lesion
If the LMN is damaged of CN V then there is no what?
Innervation of the muscle, leading to death and damage on the ipsilateral side
If there is a lesion of the uMN or corticobulbar tract of the CN V and the innervation is bilateral then,
- ther is minimal spasticity in the masseter muscles
- chewing is minimally effected in cortical lesions
- Hyperreflexia may be positive when UMN lesion (jaw jerk reflex)
What is hyperreflexia? WHen could it occur.
Jaw jerk reflex, wwhen UMN lesion is present on CN V
Sensory to face =
Motor to face =
- Trigemnial nerve (V)
- Facial Nerve (VII)
The facial nerve is number what and it intervates what?
- CN V11
- Motor to muscles of facial expression
- Sensory= taste anterior 2/3 of tongue
THe motor and sensory roots of the facial nerve are attacted to ?
The motor and sensory nuclei of the facial nerve are located where?
within the pons near the reticular formation ( in tegmentum dorsal portion of pons)
How many motor and sensory nuclie are associated with the facial nerve?
two motor and two sensory.
The two motor nuclei of the facial nerve are?
- Volitional motor (sematic)
- Autonomic Motor (parasympathetic) - salivation, tearing , secretion in nose.
What does the superior salivarory (lacrimal) nucleus do?
The taste senssors of the tongue and palate are innervated by ? they converge with what on the what?
- CN VII
- CNIX and X on the nucleus solitarius
LMN damage is what impairment
The innervation of the Facial nerve for motor is what type for where and what muscles
- Muscles of facial experession, stapedius muscle an dpart of digastric muscle
- Bilateral innervation of upper facial muscles and only contralateral innervation of the lower facial muscles
What is the motor function of CN VII
- Control muscles of facial expresion
- assists in elevating the larynx
- stiffen the ossicular chain
What nerve controls most of the pharynx
The parasympathetuc axons of the motor (parasympathetic) facial nerve ariginate where and run to where? What does it innervate?
- superior salivatroy nucleus and run to the sphenopalatine ganglion and submandibular ganglion
- innervation of nasal passage, lacrimal glands, submandibular and sublingual glands
What is the function of the motor (parasympathetic) of the Facial nerve?
Secretion of saliva and tears
what nucleus recieves information regarding eye irritation and from where? What innitiates the tearing?
- Superior salivatory nucleus receives info from CN V
- But tering is initiated by CN VII
WHat nucleus recieves afferent information from olfactory (smell) and hypothalamus (hunger) and taste? Recieves fom where? Then what?
- Superior Salivatory nucleus
- from nucleus solitarius
- secretion of saliva nitiated.
The 1st order sensory neurons of the sensory facial nerve have cell bodies where?
(facial nerve sensory (taste))
The nervus intermedius enter the brainstem and travels in a bundle or fasciculus called? The tract also include tate fiver of what and what?
- tractus solitarius
- CN IX an X
The tractus solitarius split from facial nerve where? and runs with what?
- facial nerve in middle ear (chorda typmani)
- Runs with CN V lingual branch
The bundle (Facial nerve CN VII- Sensory -taste) synapses in the what? The projectiona re what the the what?
- nucleus of the tractus solitarius (gustatory nuclesu
- Bilateral to ventroposterior medial thalamic nuclei
The thalmic radiation synapse on what for taste
primary somatosensory cortex
Unilateral damage to CN VII of sensory (tate) =
lack of taste on one side, but due to way we eat a huge change is not noted.
Taste information from the anterior 2/3 of tongue includes?
salty, sour, sweet, bitter
Taste regions also incldues the
floor of mouth and hard and soft palate
What is the general sensory function of the facial nerve?
cutaneous sensation from walls of acoustic meatus and typmanic membrae.
Cell bodies for the general sensory function of the facial nerve are located where?
in geniculate ganglion
In the impulses for the general sensory function of the facial nerve travel through what and decend to what?
through nervus intermedius and descend to the spinal nucleus of CN V-located in the medula
For the facial nerve, if there are UMN and corticobulbar tract lesions what will the result be
contralateral paralysis of the face sparing the upper part of the face (forehead and eye region)
With the facial nerve, if you have a LMN and peripheral nerve lesions you will have?
ipsilaeral paralysis of the whole face.
Bell's palsy is associated with what nerve damage and what motor neuron. What does it result in and what is the etiology? Does it get resolved?
- Facial nerve
- Lower Motor Neuron and nucleus salivatory
- Paralysis of muscle of upper and lower part of one side of face
- Hyperacusis (stapedius reflex absent)
- Dry eye (parasympathetic function
- Dry mouth
- No known etiology (throught to be viral or immune deficiency
- Usually resolves spontaneously in 3 to 4 months.
What nerve are sensory nucleus lesions associated with and what is the result?
- Facial nerve
- taste function
A cortical lesion on the facial nerve affects taste only minimally due to what?
What is the CN IX? Innervation?
- Sensory and Motor
The Motor and Sensory roots of the Glossopharyngeal nerve attach to what?
The motor and sensory nuclei of the glossopharyngeal nerve are located where?
How many of each are there?
- In the medulla
- Two motor and one sensory
What is the largest salvitory gland?
The motor function of the glossopharyngeal nerve is from what nucleus?
The nucleus ambiguus (CN IX -motor) LMN recieves what type of innervation?
Bilateral innervation from UMN
The volitional control of motor function for the glossopharyngeal nerve is the control of what>
- Stylopharyngeus muscle controls the superior portion of the pharynx (elevates pharynx, contributes to shaping superior portion of pharynx and contribues to elevating the laynx)
- Portion of middle pharyngeal muscle.
What nerve is primaryily incharge of elevating the larynx?
What is the nucleus associated with the CN IX that is involved with motor (parasympahetic function?
WHat does it do?
- Salivary nucleus
- -A LMN innervated by hypothalamus (taste/hunger) and olfactory system (smell) (UMN)
- -Motor: Parasympathetic control for salivation
The nucleus that is involved with sensory function of the Glossopharyngeal nerve is ?
What does it do?
- Nucleus tractus solitarius
- -projections from nucleus are bilaterally represented in teh primary sensory cortex
- -Sensory: taste, posterior 1/3 of tonge (salt, sweet, sour, bitter)
- -Sensory (afferent) from posterior tongue, palatal arch, & upper pharynx elicits gag reflex
The motor portion of gag reflex is from what nerve?
-Motor (effernt) portion of gag reflex is from the vagus nerve (CN X)
IF have impairment to the Glossopharyngeal nerve what three things could result?
- Loss of taste of posterior 1/3 of the tongue
- Gag reflex- afferent limb of reflex
Does isolated damage to CN IX by a brainstem stroke usually result in dysphagia?
What is cranial nerve X? What does it innervate?
- Sensation from visceral
- motor to pharynx, larynx and visceral (lungs)
The motor and sensory roots of the vagus roots are located where?
The motor and sensory nuclei are located where? There are how many of each?
- two motor and one sensory
Damage to the 10th cranial nerve usually results in what? and has profound impact on what?
The parasympathetic nucleus of the vagus nerve innervate what?
The involuntary muscles of the bronchi, esophagus, heart, stomach, small intestine and a portion of the large intestine
The nucleus ambiguus is also associated with the vagus nerve. How?
- Volitional control
- - velopharyngeal port: except tensor palatine- medated by CN V and the pharyngeal branch
- -middle and inferior pharyngeal constrictors (pharyngeal branch
- -Cricothyroid muscle (superior laryngeal branch)
- -intrinsic muscles of the laryx (recurrent laryngeal branch)
- MOTOR Pharyngeal Gag reflex
The dorsal nucleus of the motor (parasympathetic) fucntion of the vagus nerve controls what?
Heart, lungs, digestive tract, slowing the rate of breathing
The sensory function of teh CN X comes from what nucleus?
- Nucleus Solitarius
- -pharynx (taste, sensory from middle and inferior portion of the pharynx)
- -Epiglottis (taste, sensory)
- -Laryngeal area
Another name for the CN X is the?
If there is LMN and peripheral nerve damage on the CN X you may have...
- Hypernasality (nasal emission)
- Decreased pharyngeal motility
- Breathy unilateral VF paralysis
- Decreased pitch control
- frequent coughing
If there is UMN and corticobulbar lesions on the CN X you may have...
Bilateral innervation therefore minimal motor function deficit
The nucleus ambiguus is what portion of the spinal accessory nerve?
The nucleus ambiguus has what type of innervation from the motor cortex? What tract?
- bilateral innervation
The nucleus ambiguus is associated with what nerves and what muscles?
- CN IX, X, XI
- palatal muscles (except tensor veli palatinie)
- All pharyngeal muscles
- All external laryngeal muscles groups (i.e., cricothyroid muscle and intrinsic laryngeal muscles
The nucleus Ambiguus controlls virtually all muscles of what from what to what?
- Soft palate to the larynx
With dysphagia from Nucleus Ambiguus damage what occurs?
- Sensation intact- but no protective cough
- Risk of aspiration due to insufficient glottal protection (motor innervation is lacking)
- Vocal cord paralysis
In a neurogenic motor speech disorder from damage on Nucleus Ambiguus what happens?
- Flaccid Dysarthria
- Hypernasality with audible nasal emissions
- Dysphonia (vocal cord paralysis--breathy voice, pitch changes--low pitch)
The tractus solitarius is associated with which nerves and is also known as?
Describe each association
- VII, IX, X
- Gustatroy nucleus - mainly information about taste
- CN VII- taste (for anterior 2/3 of tongue)
- CN IX- taste and sensation (posterior 1/3 of tongue and posterior oral cavity)
- CN X- taste and sensation (taste of posterior oral cavity and sensation from mid and lower pharyngeal areas and laryngeal area)
The tractus solitarius has what type of projection to the sensory cortex
What is the Motor System?
The components of the Central and Peripheral nervous system that control voluntary and automatic movements are collectively referred to as the motor system.
The voluntary movements of the motor system include what?
speaking, grasping objects, or walking
What is motor control?
Control of the motor system to coordinate volitional and automatic movements is referred to as motor control
What four things does Motor Control consists of:
- Motor programming
- Motor planning
- Motor execution
- Refinement of movement (sensory feedback)
What is coordination?
Coordination is the organization of muscle activity to perform a defined behavior
Is coordination the same as movement?
Movement is the result of?
= muscles working together
Coordination (organized muscle activity) is influenced by?
- Motor programming
- Motor planning
- Motor execution
- Refinement of movement
When coordination is influenced by motor programming, it is at the level of what? It does what? It does not monitor what?
- Cofnition and language
- retrieving and sequencing linguistic units
- Not monitoring speech output (TBI)
What are the disorders associated with Motor planning (coordination)
Dementia, Right Hemisphere Syndrom, TBI syndrome, and Aphasia
If there are problems with coordination in regards to motor programing, an individual can?
Follow a model fine.
When coordination is influenced by motor planning, it is at what level? It does what?
- Motor planning
- Translating linguistic units into planned motor movement
What disorders are associated with problems in coordination (motor planning)? What type of speech is better ?
- Aquired and developmental apraxia of speech
- Automatic speech is better than planned speech
When coordination is influenced by motor execution, it is at what level? It does what? What disorders are associated with it?
- Motor execution
- Executing the refined motor plan
- Flaccid, spastic, Unilateral upper motor neuron, hypokineti, hyperkinetic, and ataxic dysarthria
What is dysarthric speech? It occurs with coordination at what level? In what speech are symptomes present?
- Problems ith muscle tone, rate, motor steadiness and muscle strength.
- Motor execution
- Symptoms present in both volitional and automatic speech.
When coordination is influenced by refinement of movement it is at what level? It does what? What brain area is associated with it
- Motor refinement
- Motor adjustments modulated by afferent feedback
- Cerebellar control circuitry plays an important part in these adjustments
What disorders are associated with the refinement of movement in coordination?
Sensory and Ataxic Dysarthria?
WHat is sensory disarthria?
lack of ability to produce accurate speech due to lack of sensory information coming back to mouth.
Coordination is influenced by what?
different neural systems that become dynamically (at a given moment in time) linked to form a motor system for achieving a particular task, such as chewing or speech.
An example of coordination is?
Two networks required to chew and speak at same time.
What factors influence coordination?
- Components of the nervous system
- Task-dependent goals
- Oral structures function differently across behaviors
- Growth and development
Of factor 1 (components of the nervous system) that influence coordiantion what are the neural systems?
- Motor unit
- Different motor systems
- Cortical Areas
- Neural Networks
For motor units, how many types of motor units are there? How many kinds of muscle fibers? WHat are they?
- 3 motor units associated with three kinds of muscle fibers
The smallest alpha motor neurons innervate what muscle fibers?
red muscle fibers
Red muscle fibers are what type of muscle fibers? Characteristics?
- Type S (slow-twitch- contract slower), very fatigue-resistant.
- They are thin fibers that contract weakly and slowly
The function of red muscle fibers are what?
background muscle tone supporting coordinated movements (ex standing) and involved with coordinating movement
Medium size alpha motor neurons innervate what? What type of muscle fivers? What size fibers
- fast-twitch, fatigue resistant muscle fibers.
- Type FR (fast twitch, fatigue-resistant)
- Intermediate size fibers
What is the function of medium size alpha motor neurons?
Coordinating sustained motor patterns requiring moderate amounts of force such as walking
Largest alpha motor neurons inneravte what? Tpyes of muscle fibers?
- white muscle fibers
- Type FF (fast-twitch, fatigable)
- Thick fibers, contract forcefully and quickly
What is the function of largest alpha motor neurons?
Coordinating movement patterns requiring greater amounts of force such as running or jumping
With the largest alpha motor neurns, you have lots of what but need what?
Force, but need a reboost
What is the size principle of motor recruitment?
- As synaptic drive reaching the LMN increases, motor neurons reach threshold in order of increasing size
- smaller motor neurons and type S muscle fibers are activated prior to larger motor neurons & associated muscle fibers that produce greater force
The motor unit size principle allows readily contol of what?
In force of muscle contraction
When you move up in the motor size principle, you still have red muscle fibers, but you simply...
add on the larger ones.
For greater synaptic drive, what motor units are enlisted?
If you have damage to muscle fibers, what will it effect?
force producedd by body
How many movements are associated with motor systems?
What are the 3 movements associated with motor systems?
Reflex, Rhythmic central motor patterns, Voluntary movements
For the Reflex movement associated with motor systems, what does it do? How are the responses?It is associated with what?
- Reflex responses mediated by brainstem and spinal systems
- Quick and automatic responses, walking
- Regulate muscle tone (ex. standing)
For the rhythmic central motor patterns associated with the motor systems, what does it do? Produced by?
- Produced by brainstem and spinal networks
- Rhythmic behavior.
- Central Pattern Generator (CPG) ex: chewing, respiratory system.
What is the thrid type of movement associated with the motor systems? What is it controlled by? WHat does it do? And what does it include?
- Are controlled by cortical and forebrain systems
- Volitional control
- Exert an influence on brainstem and spinal systems
- Modulate reflexes and CPGs
- Includes: (extensive cortical regions, cerebellum, basal ganglia, thalamus)
The cerebellum and basal ganglia exert powerful control over what? But they do not influence what?
- cortical and brainstem motor systems
- motor neurons directly
- However, all systems are integrated
Influence from motor systems goes from what motor neuron to what other one?
UMN then LMN
What is the hieratchical processes from the descending organization of control
Succession of overlapping levels of control from cortex to subcortical systems to motor neuron levels
What is an example of the heirarchial processes that is associated with the motor systems?
The basal gangla influences cortical and brainstem motor systems but not lower motor neurons directly
What is the parallel processes in relation to the descending organization of control
Multiple, simultaneously active motor systems that operate somewhat separately to jointly control movement
approximatley how many what fibers are there? How many of the rest?
- 50%- WHite
- 50% - red and pink combined
How many of the fibers originate in the cortical areas?
WHat are the main cortical areas?
- Area 6 (Premotor-planning, Supplementary Motor Area-initiated movement)
- Area 4 (Primary Motor Cortex - Betz cells)
- Areas 1, 2, 3 (Primary somatosensory cortex)
Areas 4 and 6 contain how many fibers?
50 - 67% fibers
The premotor cortex
The primary motor cortex
Supplementary Motor Cortex
- = Execution
- = innitiate movement (thinking about doing somehting)
Whare is Somatotopic organization found?
Concentration of nuclei is associated with what?
- Premotor cortex, supplementary motor area, primary motor cortex, primary somatosensory cortex
- fine and gross motor control
What is normal function in the premotor cortex?
- Mediates movement seletion and sequencing
- influences primary motor cortex and LMN
- Independently influenced LMN
What happens when there is damage to the Premotor cortex
Unable to take the program, sequenced linguistic units, and plan the movement parameters, resulting in poor planning and orchestration of movements
What is the normal function of the supplementart motor area? The supplementary motor area is where what happens?
- Formation of intention to initiate movements, and initiation of movement
- Intention is formulated
What happens if there is damage to the supplementary motor area?
Problems initiating movement. Akinetic mutism- person has problems initiating speech, and when the person speaks-- brief episodes of fluent speech are noted. (Transcortical Motor Aphasia)
What is the normal function of the primary motor cortex?
- Neuronal pools (groups of neurons) enode focre and direction
- Neurons in motor cortex informed about the consequence of movement
- Alter activity in anticipation of movement
What happens when there is damage to the primary motor cortex?
The motor plan is fine- but the system is unable to execute these planned movement parameters- resulting in imprecise movement patterns, which are uncoordinated movements
The primary motor cortex gets info from?
primary somatosensory cortex
The neural networks across motor system include the?
UMNs and LMNs
The motor cortex (and other cortical areas) act on what directly and what indirectly? - Cranial
- act on cranial motor neurons directly
- the corticobulbar tract and indirectly through brainstem pathways
The corticbulbar tract is the ... What are the three parts of this?
- Pyramidal System or the direct activation system
- Direct connection with cranial nerves
- reticular formation important for controlling eye movement and other automatic behaviors
- Modulates reflexes (muscle tone) or central pattern generation (breathing, chewing)
If the pyramidal system does not modulate reflexes, what is the result?
The motor cortex (and other cortical areas) act on what directly? indirectly?- spinal
- Act on spinal motor neurons directly via the cortico spinal tract
- Indirectly through brainstem pathways (extra pyramidal system IAS)
The cortical bulbar tract contains?
pathways influencing the IAS at the level of the brainstem. Many nuclei within the reticular formation
The corticospinal tract is what?
The pyramidal system or direct activation system
The lateral pathways of the pyramidal system do what?
The medial (anterior) pathways of the pyramidal system do what?
- Muscle groups in the arms and legs
- Controlling axial muscle groups.
When the indirect and direct systems work together, the movement is?
The Pyramidal system (aka ...) and the extra pyramidal system (aka ..) do what ?
- work in parallel to refine coordination for movement.
For the upper motor neuron control of cranial and spinal lmn, if there is damage in one system what willhappen? Damage in the tracts?
- will disrupt movement, such as hypokinesia
- can cause atypical function such as spasticity.
Besides the components of the nervous system, what other factors influence coordination?
- Task dependent goals.
- Oral Structrures function differently across behaviors
- Growth and development
Task dependent goals that influence coordination are what?
For chewing, speech and jaw oscillation, what is important and not important?
- Chewing = high occlusal force; rate of movement not important
- Speech = rate of moement important; highocclusal force not important
- Jaw Oscillation = jaw movement for the sake of moving the jaw
For mandibular coordination, the degree of mucle group activity does what from task to task?
Which requires more force, chewing or speech
What is mandibular kinematics?
Jaw movement differs across speech tasks.
Which is more consistent across two people when concerning mandibular coordination and kinematics- Chewing and speech or jaw oscillation
Chewing and speech
Vocal tract structures must do what?
Organize to work together for performing a given task/
In relation to how the vocal tract structures must organize to work togehter for performing a given task, describe chewing.
Structures within the vocal tract must organize for manipulating the bolus and performing the steps involved in the swallow
In relation to how the vocal tract structures must organize to work togehter for performing a given task, describe Speech.
Structures within the vocal tract must organize for controlling aerodynamic energy during speech.
The coordination required across vocal tract structures will ...
differ across different tasks
An example of how coordination required across vocal tract structures will differ across different tasks is?
A tennis player and a golfer will differ in how body structures work together to perform each sport- as a result, coordination across various muscle group will differ between these individuals.
A person speaking and a person chewing will differ how? result?
- in how vocal tract structures work together to perform each behavior
- as a result, coordination across various muscles groups will differ between these individuals.
Describe the tow points of growth and development from 1 to 2 years of age for chewing.
- point of occlusion becomes more consistent because of growth of molars
- Degree of jaw excursion and speed of jaw movement becomes more variable because of development of the nervous system--perhaps changes in bolus texture and size
With growth and development, it starts with bolistic movements and then beocmes more
variable as the system becomes more reactive
Vowel babble is produced by wha and describe it in terms of growth and development
- by hearing and non-hearing infants
- Vowel babble is produced with reduced excursion of the jaw with jaw movement being primarily responsible for production of vowel babble
Describe canonical babble in terms of the growth and development affecting coordination
- Hearing influences the emergence of canonical babble, which is composed of more complex sound patterns in comparison to vowel babble.
- Jaw excursion is greater for canonical bablle- jaw excursion occurs in concert with the movement of other articulators
There is a disassociation between what and what? Ex?
- Coordination and kinematics
- Jaw muscle activity can be similar between individuals performing a specific tast- but jaw movement may be different because of an atypical structure. (temporomandibular joint disorder)
What is an important consideration of the disassociation between coordination and kinematics?
Atypical movement does not necessarily mean that coordination is atypical (cerebral palsy)
Is coordination good or bad? Explain
Coordination is neither good nor bad; instead it may be typical or atypical. Coordination reflects teh final product of many interdependent factors
What is coordination the product of?
interaction between many interdependent factors, such as the integrity of the nervous system, the task-dependent goals, the synergistic action among anatomic structures, growth and development of the body, and many ther factors --such as disease processes.
What are the two classifications of motor speech disorders? What do they deal with?
- Apraxia of speech= planning
- Dysarthria= execution
Apraxia of speech is the result of what damage? Is this acquired or developmental?
If there is no medical etiology it is?
- Result of brain damage to left hemisphere or dominant hemisphere in the opecular portion of inferior frontal gyrus
What is the definition of apraxia of speech?
A speech disorder resulting from the inability to program the positioning of articulators and sequencing of muscle activity for the volitional production of phonemes.
With apraxia there is no significant what?
weakness, slowness or incoordination of the muscles in reflex and automatic acts
Apraxia of speech is associated with
Arbitrary air plans which are a twisting motion or round about motion to do somehting.
With apraxia, prosodic alterations may be associated with what? and why?
- articulartory problm
- compensation for it
Dysarthria results from damage to what?
Unilataeral or bilateral?
- Damage to the central or peripheral nervous system or both
- either or.
What is the definition of dysarthria/
A group of speech disroders resulting from distrubances in muscular control - weakness, slowness, incoordination,. also includes, abnormal muscle tone, reduced range of motion, and decreased muscle steadiness
Dysarthria encompasses what?
coexisting neurogenic disorders disrupting several or all of the basic processes of speech: respiration, phonation, resonance, articulation, and prosody
Dysarthria is NOT the result of what?
abnormal anatomical structrues (eg cleft palate) sensory loss (eg deafness) or psychological distrubance,
What are the 5 speech subsystems?
- Respiratory system (aerodynamic energy)
- Laryngeal system (phonation)
- Pharyngeal system (shape)
- Velopharyngeal system (resonance)
- Oral articulation (shape and articulation)
What are the three structres associated with oral articulation?
DEFINE- Apraxia of speech
- An articulatory disorder in the abiity to program
- - positioning of speech musculature
- -sequencing of speech musculature
- -NO significant weakness, slowness, or incoordination in reflex and automatic acts
- Prosodic alterations are probably associated with articulatory problems-possibly as compensaory strategies.
What is the difference in apraxia of speech and phonological disorders?
- Apraxia is difficulty consistently producing speech sounds
- - sound sequences can be produced correctly at one time --then incorrectly another time
- - speakers struggle to position the articulators for a given sound sequence- that was produced correctly during a prior statement
Impairment is the difference between?
volitional and automatic acts
With apraxia, there is no impairment in what?
- Automatic acts
- -Muscle strength
- -speed of movement
- -range of movement
- accuracy of movement
- motor steadiness
- muscle tone.
The common speech characteristics of apraxia
- Speech erros are typically articulatory and prosodic in nature.
- Production of the prosodic features of speech require coordination across speech subsystems (no emphasis - just sounds)
What are the components of prosody?
- Rate/ Rhythm
For the Intonation component of prosody, what is intonation,what is the level and components?
- Intonation= change across entire utterance
- syntactic unit (breath group)
- change in pitch (fundamental frequency accross the utterance
For the Rate/ Rythm somponent of prosody, what is rate/ rythm, what is the level and what is the compoonents.
- Segmental changes of timing within the utterance
- segment durations
- *rate of movement accross segments within an utterance
- *segments contain eith speech or silence.
For the Stress component of prosody, what is stres, what is the level and what is the compoonents.
- Syllable changes within the segment or whole word stress within a given utterance.
- syllable and word
- *duration of syllable or word
- *changes in loudness (intensity)
- *Changes in pitch (fundamental frequency)
What are the two, larger, different types of apraxia?
- Ideational apraxia
- Ideomotor apraxia
What are the three types of ideomotor apraxia
- Limb apraxia
- Nonverbal oral apraxia
- Apraxia of speech (verbal apraxia)
What is ideational apraxia? Ex
- The person has lost the knowledge (idea) regarding the function of an object or gesture. The person no longer knows its purpose
- do not know why they wave goodbye
what is ideomotor apraxia?
Someone may have to what?
- The person exhibits problems performing the movements needs to gesture or to use and object.
- Problem with motor PLANNING
- Model it
With ideomotor apraxia, what four things may be associated?
- volitional versus automatic actions
- actual object use easier
- modeling improves performance
- sequencing errors are inconsistent
Apraxia of speech is what type of apraxia? it is associated with what tracts and systems?
- corticobulbar and corticospnal
- pyramidal and extrapyramidal system
Is right hemisphere damage apraxia of speech?
the planning for speech is in what hemisphere? Oral intake?
Developmental apraxia is damage where?
Not in one specific area
The insular cortex is important for? it is associated with?
The basal ganglia are composed of what?
- Caudate nucleus
- Globus Palidus
Basal ganglia are involved in the
control of movement
The basal ganglia are part of what systema and damage is associated with ?
- extra pyramidal
- hypokinetic disarthria
What are the common speech characteristics of the respiratory system?
uncoordinated preparatory inspirations
What are the common speech characteristics of the phonatory system?
- initiating phonation late during expiration for speech
- Uncoordinated phonatory control
What are the common speech characteristics of the resonance?
Hyper- or Hyponasal sounds due to lack of across subsystem coordination
What are the common speech characteristics of the Pharyngeal system?
Vowel distortions due to imprecise changes in vocal tract shape- wrong shaping
What are the common speech characteristics of the articulatory system?
- substitutions of consonants, imprecise consonants.
- Jaw lips and tongue coordination break down.
What are the 3 motor systems of the CNS?
- pyramidal system (DAS)
- Extrapyramidal system (IAS)
- Cerebellar system
The Extrapyramidal system includes the?
Basal ganglia circuitry
The cerebellar system contains the
Cerebellar control circuts
The PNS has how many motor systems
- motor unit
- Reflex system`
What is the Final common pathway?
Lower motor neuron spinal cord or cranial nerve
What is the function of the Final compn pathway?
- Motor unit recruitment for muscle activation.
- Reflex system: maintain and modulate muscle tone for posture upon which movements are coordinated. system apposes gravitational force.
What is the neurologic basis of flaccid dysarthria?
- Damage to lower motor neurons
- *Spinal nerves: respiration (breathing and speech breathing) and posture
- *Cranial nerves: vocal tract function and posture
- Damage to the lower motor neuron (cell body)
- *Fsciculation: uncontrolled movement of muscle fiber.
- Uncontrolled= nerve fibers start contracting on own because not getting signal.
What is the neurologic basis of flaccid dysarthra (continued)....
Necrosis to the lower motor neuron and/or the axon (nerve)- Muscle atrophy.
Damage to neuromuscular junction or to the muscle
What are the six sub categories of imparirment for dysarthria?
- Paralysis (muscle cannot contract- no movement)
- Weakness (Fibers in muscle cannot move)
- Hypotonicity (cannot produce force)
- Atrophy (Die back of muscle fiber, lack of innervation)
- Hypoactive reflexes
What are the Flaccid dysarthria common speech characteristics?
- Slow, labored, imprecise articulation
- Hypernasal resonance
- Audible nasal emission
- Breathy-hoarse phonation, monopitch
- Short phrase length, decreased vocal loudness, monoloudness
If there is damage to the vagus nerve one will sound? If it is bilateral?
- soft palate will hang down
The pyramidal system is also known as what. Is it UMN or LMN
- Direct activation system
What is the function of the Pyramidal motor system?
Execution of fine and gross motor control
The extrapyramidal system is also known as what? is it an UMN or a LMN?
- Indirect activation system
- refines motor control of the DAS
- Modulates muscle tone of the reflex system for coordinated muscle movement.
What is the neurologic basis of spastic dysarthria
Bilateral damage to the upper motor neurons and neural pathways associated with the pyramidal and extrapyramidal systems
WIth spastic dysarthria, if no modulation occurs, what happens?
when a muscle stretches it contracts and person has to fight to extend it.
What are the three neurologic basis of spastic dysarthria?
- The lower motor neurons are receiving little or no activity from the DAS or IAS (weakness) (lack of synaptic drive)
- Modulation of the DAS by the IAS is impaired (Precision)(refinement of motor system decrease-damage extra and signal to refire never reaches)
- The lower motor neurons or reflex system is not being odulated by IAS (spasticity) (reflex not inhibited)
What are the four impairments associated with spastic dysarthria?
- Weakness due to lack of UMN input and muscle faigue due to spasticity
- Slow movements due to spasticity
- Hypertonicity due to spasticity
- Abnormal reflexes (suck reflex)
What are the 7 common speech characteristics of spastic dysarthria?
- imprecise consonants
- distorted vowels
- slow rate of speech
- hypernasaliy (spasticity)
- Harsh-strained strangled phonation
- Low pitch and monpitch
- Short phrase length, monloudness
What is UUMN dysarthria?
Unilateral damage to the upper motor neurons associated with the pyramidal and/or extrapyramidal systems.
Most lower motor neurons are modulated because? Except?
- of bilateral innervation
- CN VII, XI, XII, X
Can fine motor control be disrupted despite bilateral innervation?
What are the three neurologic basis of UMN dysarthria?
- Contralateral, lowermotor neurons are not receiving activity from the DAS or IAS (weakness)
- Modulation of the DAS by the IAS is impaired (precision)
- Contralateral, lower motor neurons or reflex system are not being modulated by IAS (spasticity)
With UUMN, why are the tongue, lower face and neck damaged?
There is no spacticity in the face. why?
No muscle spindals
What are the four impairments (contralateral side) associated with dysarthria?
- CN VII: lower face (lips)= weakness, slow and reduced range of movements
- CNXII:Tongue = weakness, slow and reduced range of movements
- CN XI: neck muscles = unable to turn head toward unaffected side. Possible, laryngeal impairment
- Reduced coordination across speech subsystems.
What are the common speech characteristics (contralateral side): 5
- Lower face (lips) = imprecise consonants (bilabials / plosives)
- Tongue = imprecise consonants
- Resonance = seldom is there hypernasality
- Phonation = breathy or harsh vocal quality
- Breakdown in coordination is more severe than predicted by muscular deficits.
What are concomitant disorders?
- Unilateral damage to primary motor cortex (unilateral upper motor neuron dysarthria)
- Possible concomitant disorders in dominate hemisphere (apraxia of speech, aphasia)
If there is damage in the extrapyramidal system (IAS) it is likely there will be a... what are the two options ?
- neurotransmitter imbalance
- Option 1: If decrease dopamine the basal ganglia worke overtime and good signal is overfiltered (hypokinetic)
- Option 2: If more dopamine and less acetyle choline, basal ganglia work less and get hypermovemtns.
With damage in the IAS you can also have what two things?
- Destruction of neuronal sites producing neurotransmitters
- damage to basal ganglia and related circuitry
The basal ganglia and the related stuctures normally produce what>
an inhibitory influence on the DAS
What is hypokinetic>
only excitatory neurotransmitters are available for the IAS. The IAS works overtime to inhibit the DAS
What is hyperkinetic:
Only inhibitory neurotransmitters are available for the IAS. Activity of the IAS is reduced allowing the IAS to produce extra movements
What are teh two extra pyramidal system speech disroders
- Akinesia (hypokinetic dysarthria) = reduced movement
- dyskinesia (hyperkinetic dysarthria)= additional muscle activity not associated with the volitional movement. Movements may be fast or slow, and range of movement may be exaggerated or redduced.
Akinesia is what?
Dyskinesia is what?
Brady Kinesia is what?
- lack of movement
- a typical movement patterns
- slow reduced movement
Damage or dysfunction to the basal ganglia is?
reduced force and range of movement; variable rate (timing) of movement; rigidity among antagonist muscle groups
lead pipe ridgititiy=
- tension during movemetn
- tension followed by release
What are the two characteristics of impairment of respiration due to hypokinetic dysarthria
- 1. Rapid breathing rate: decreased breath cycles and poor control during expiration (fast repetitive movement with a reduced range of motion)
- 2. Shallow inhalations: decreased lung volume per breath group (reduced range of movemetn
Describe the laryngeal structures with an impariment of phonation due to hypokinetic dysarthria? what do they sound like?
- incomplete vocal fold adduction-reduced range of movement
- Increased tone of laryngeal muscle groups
- breathy and harsh
Descrie the oromandibular structures (what are they) with an imparimen of articulation due to hypokinetic dysarthria
- Jaw, lips, tongue
- reduced range of movement
- reduced muscle force
- alternating rate (lack of smoothness PAPAPA)
what are the three other impairments associated with hypokinetic dysarthria?
- Repeated phonemes
- Palilalia (repeating words) Paliphrasia (repeating phrases)
- Mask face (expressionless)
what are the common speech characteristics of Akinesia
- errors entail prosody and articulation. dysmetria results in undershooting articulatory target
- Muscle groups across speech subsystems exhibit rigidity causing reduced range of movement. Muscle weakness is also noted.
What is dysmetria?
Range of motion is disrodered. Unable to control it
Damage or dysfunction of the basal ganglia in hyperkinetic dysarthria is:
involuntary and variable movements are present. Muscle tone hyper- or hypotonic and or variable
what is Chorea? What does it affect? Disease?
- Hyperkinetic movements that are added to volitional movement. quick, random movemetns that appear to be organized- but these movemetns are not volitional
- facial muscles, vocal tract muscles, respiration and extrmeities
- Huntington's chorea
What is athetosis?
- slow irregular, coarse, writhing, squirming, puposeless movemetns that seem to flow into a sequence of actions. Extended muscle contracions.
- Facial musclse, vocal tract muscle, respiration, and extremities
What is choreoathetotic movmenet
Combination of choleric and athetotic movement patterns.
what is the movemetn continuum?
- = quick movment and brief muscle contractions
- = slow movements and prolonged contractions.
What is dystonia?
abnormal muscle tone. involuntary and prolonged contraction of muscle groups which interferes with normal movements.
Dytonia is slower more sustained movemenst compaired to?
The muscle contractions will be?
There is what of dystonic muscle contrations across different sets of muscle groups
- unprdictable during a given movement or the contractions may become constant.
- waxing and waning
What is spasmodic dysphonia?
Dystonia of the vocal folds and laryngeal muscle groups.
What is muscle tone in association to dytonia?
unpredictable hypertonicity, hypotonicity, and variable tonicity of muscle groups.
Muscle contraction for athetotic movements are also prolonged- but the movements are exaggerated and prolonged (time) exhibiting what? Dystonic movementa are?
- the writhing characteristic
- mainly exaggerated in nature
present in one anatomical strucrure, such as teh tongue
present in two or more structures
present in all 4 limbs. torso, and neck
- present in 2 or more structrus on the same side of the body.
- basal ganglia damage.
what are the four classifications of dystonia?
- focal dystonia
- segmental dystonia
- generalized dystonia
What is myoclonus?
abrupt, brieff, quick contraction of muscle gropus affecting muscle tone and interrupting movement. Repetitive contractions may occur at a frequency of 10-50 Hz. These non-volitional contractions slow-stop movement- the brakes are on.
What is action myoclonus?
brought on by movement (single muscles or groups of muscles)
Myoclonus can be induced by what?
visual, tactile or auditory stimuli
What is the continuum of rate of muscle firing?
myoclonus is raptid, dystonic is prolonged
Myoclonc contractions are usually?
Dystonic contractions are usually>
slow, halt, movements
What is the continuum of exaggerated movemetns?
- dystonia= fast
Athetotic movements are...
dystonic movemetns are ...
- writhing (slow) exaggerated
- faster, exagerated
The involuntary movemetns of chorea or athetosis interfere with what? what may be affected?
- the voluntary movemetns of speech
- All of the speech subsystems may be affected with these involuntary movements
Chorea and athetosis involuntary movemets are? what may be affected>
- speech subsystems may be affected differently from moment to moment
- or some of the subsystems may be affecteddifferent degrees of severity for atypical movemetns obswerved across speech systems.
Common speech characteristics of chorea / athetosis are?
- common errors related to unexpected, exaggerated movments occurring across speech subsystems.
- Choreic movements are quic--dance like
- athetotic movemetn are slower -- exaggerated
Dystonia is mainly?
abnormal muscle tone causing unpredictable hypotonicity, hypertonicity, variable tonicity of muscle groups.
- Unpredictable contraction of muscles--exaggerating movemetn
- interfering, halting, and slowing movement.
what are the common speech characteristics of dystonia?
Common errors are related to unexpected prolonged contractions of muscles groups or changes in muscle tone that interfere with coordinated movemtn within and across speech subsystems. Exaggeate, unidirectional movement of a given articulator.
what are the common speech characteristics of myclonus?
common errors are related to unexpected, rapid, repetitive, contractions of muscles groups, changing muscle tone that halts and disrupts coordinated movement within and across seech subsystems.
What are the two parts of the cerebellar control circuitry?
- cerebellar peduncles (tracts input and output)
The major tracts that goi into the cerebellum -
The major tracts that go out of the cerebellum-
- inferior and middle
Functionof the cerebellar control circuitry is?
Coordinate and modify the timing and force of muscle contraction, which influences organized movement, such as range and direction
Synergistic function =
cooperative action of muscle groups
Asynergia or dys-synergia=
uncoordinated or disorganized action among agonist and antagonist muscle groups
What is the function, in terms of speech, of teh cerebellar control circuity?
Coordinates and modifies planned and ongoing speech movemetns
Ataxic dysarthria is from damage to?
the cerebellum or its input or output connections
- Controlled movement toward or away from the source of stimulus
- movemetn without disorder
Timing and force of muscle contraction is impaired, result is?
disordereed range and direction for coordinated movement
Decompostion of movement (ataxic dysarthria): AMR? SMR?
- 1. AMR= slow rate, sepeed up and speed down
- 2. SMR= breakdown of sequencing revert to AMR
- Alternate motion rates
- sequential motion rates
With decomposition of movement what is easier? what weakens? there is what?
- Simple tasks are easier
- hypotonia or muscle weakness
- intentional tremor
What are the common speech characteristics of ataxic dysarthria?
A disorder mainly disrupting the articulatory and prosodic features of speech