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% - 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
= 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
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?
compensation for it
Dysarthria results from damage to what?
Unilataeral or bilateral?
Damage to the central or peripheral nervous system or both
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?
-speed of movement
-range of movement
accuracy of movement
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?
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
*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?
What are the three types of ideomotor 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
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?
Basal ganglia are involved in the
control of movement
The basal ganglia are part of what systema and damage is associated with ?
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)
The Extrapyramidal system includes the?
Basal ganglia circuitry
The cerebellar system contains the
Cerebellar control circuts
The PNS has how many motor systems
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)
What are the Flaccid dysarthria common speech characteristics?
Slow, labored, imprecise articulation
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?
slow rate of speech
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 ?
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?
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
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?
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?
Athetotic movements are...
dystonic movemetns are ...
writhing (slow) exaggerated
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
What are the common speech characteristics of ataxic dysarthria?
A disorder mainly disrupting the articulatory and prosodic features of speech