Exam 1

Question 1

Define motor speech disorders

Answer 1

Speech disorders resulting from neurologic impairment that affects planning, programming, control, or
execution of speech.

Question 2

What is dysarthria?

Answer 2

Alterations in:
* speed
* force
* range
* accuracy
* coordination
of movements required for the different speech subsystems
The speech mechanism may also demonstrate involuntary
movements or alterations in muscle tone.

Question 3

What is apraxia of speech?

Answer 3

An articulatory disorder resulting from impairment of the capacity to program the positioning of the speech
musculature and the sequencing of muscle movements

Question 4

List the 3 types of internal white matter fibre tracts.

Answer 4

o Association tracts
o Commissural tracts
o Projection tracts

Question 5

List 2 supporting systems of the brain and describe their functions.

Answer 5

Meninges
o Protection
Ventricular system
o Nutrient supply & protection
Vascular system
o Oxygen & glucose supply

Question 6

What is a lower motor neuron?

Answer 6

a term that refers to
the nerves that connect from the spinal
cord out to the muscles. The lower motor
neurons relay the movement instructions
provided by the upper motor neurons, to
the muscles

Final Common Pathway:
* originates in the brainstem and spinal cord
* innervation directly to muscles
FCP

Question 7

What is an upper motor neuron?

Answer 7

Upper Motor Neuron
a) Direct Activation Pathway:
* voluntary, skilled movements
Sign of lesion:
* weakness and loss of skilled movement/dexterity
o distal and speech muscles
* hyporeflexia
o diminished initially and later evolves to be more pronounced.
* Release of primitive reflexes
o Babinski sign, jaw jerk, palmomental
* decreased muscle tone
o reduced initially and later evolves to increased tone

Upper Motor Neuron
b) Indirect Activation Pathway:
* posture, tone, and movements supportive of voluntary
movements
Sign of lesion:
* increased muscle tone
* spasticity
* hyperactive stretch reflexes
* clonus
o limbs, jaw
* decorticate or decerebrate posture

Question 8

Flaccid Dysarthria

Answer 8

Problem: Neuromuscular execution (reflexive, automatic,
and voluntary movements)
* Focal
* Multifocal
* Generalized
* Unilateral
* Bilateral

Question 9

Flaccid Dysarthria etiologies

Answer 9

1. Degenerative
2. Tumor/Cancer/Carcinoma
3. Vascular
4. Neuromuscular Junction Disease
5. Muscle Disease
6. Traumatic/Surgical
7. Demyelinating
8. Infectious/Inflammatory

Question 10

List 4 parts of the LMN that could be affected in flaccid dysarthria.

Answer 10

1. Cell body
2. Peripheral Nerve
3. Neuromuscular Junction
4. Muscle

Question 10

Role of acetylcholine in motor movements

Answer 10

Role of acetylcholine: neurotransmitter molecule that is released and taken up by postsynaptic endplate to cause a muscle contraction

Question 11

3 general symptoms associated with LMN damage/disease.

Answer 11

1. Weakness (distal more common)
2. Fasciculations (little muscle twitches)
3. Atrophy (muscle degeneration)

Question 12

Which cranial nerve is in facial palsy?

Answer 12

facial nerve (CN 7)

Question 13

List the non-speech features of facial palsy?

Answer 13

1. reduced strength of lip closure & drooling
2. mouth droops & fails to elevate during smile
3. nasolabial fold flattened
4. reduced forehead wrinkling
5. eyebrow lowered & fails to raise

Question 14

Name the cranial nerve involved in masticator palsy

Answer 14

Trigeminal Nerve (CN 5)

Question 15

List the non-speech features of masticator palsy.

Answer 15

Unilateral
1. may only be apparent during jaw testing
2. may have complaints of problems chewing
Bilateral
1. jaw may sag open
2. chewing & swallowing impairments
drooling

Question 16

List the non-speech features of palatopharyngeal palsy

Answer 16

Unilateral
1. weak side of palate hangs lower at rest
2. deviates to side of strength on elevation

Bilateral
1. palate symmetric but lower than normal
2. reduced or absent elevation
3. diminished or absent gag reflex
4. nasal regurgitation of liquids

Question 17

Name the cranial nerve involved in palatopharyngeal palsy.

Answer 17

Vagus Nerve (CN 10)- Pharyngeal branch

Question 18

Name the cranial nerve involved in laryngeal palsy.

Answer 18

Vagus Nerve (CN 10)- Recurrent Laryngeal Branch

Question 19

List the non-speech features of laryngeal palsy.

Answer 19

Unilateral
1. one vocal fold remains stationary and slightly abducted (paralysis) or makes very weak movements towards the midline
2. weak or incomplete contact between folds
3. reduced cough and aspiration problems

Bilateral
1. both vocal folds remain stationary and slightly abducted (paralysis) or make very weak contact
2. in paralysis the restricted airway opening requires surgical intervention - tracheotomy or arytenoid surgery

Question 20

Name the cranial nerve involved in hypoglossal palsy

Answer 20

Hypoglossal Nerve (CN 12)

Question 21

List the non-speech features of hypoglossal palsy.

Answer 21

Non-speech Features:
loss of tongue strength & atrophy
swallowing problems

Unilateral
-deviation to side of weakness on protrusion
Bilateral
-reduced range of movements if severe

Question 22

List the most distinctive speech features of flaccid dysarthria
according to Darley, Aronson, and Brown.

Answer 22

1. Hypernasality
2. Breathiness
3. Nasal Emission
4. Audible Inspiration

Question 23

Define the neuromotor basis of spastic dysarthria.

Answer 23

Damage tocorticobulbar/upper motor neuronpathways.
Problem: Neuromuscular execution

Can manifest in any or all of the respiratory, phonatory, resonatory, and articulatory components of speech.
rarely only a single component.

Question 24

Describe the concept of neural redundancy in the UMN pathways as it relates to speech/swallowing musculature

Answer 24

Direct/pyramidal pathways provide contralateral innervation for muscles of the lower face and tongue. All other muscles for speech and swallowing receive bilateral UMN input from both direct and indirect pathways

Question 25

List 3 etiology that could lead to spastic dysarthria.

Answer 25

1. Degenerative 2. Vascular 3. Congenital 4. Traumatic 5. Demyelinating

Question 26

Describe 3 general symptoms associated with UMN damage/disease

Answer 26

1. Loss of skilled movement 2. Slowness 3. Spasticity 4. Weakness 5. Hyperreflexia

Question 27

List a patient’s speech-related complaint that could help differentially diagnose spastic dysarthria from other dysarthria types

Answer 27

Effortful/Feels resistance*** also can see slow, fatigue with speaking need to speak slowly to be understood but unable to speak fast

Question 28

List the most distinctive speech features of spastic dysarthria according to Darley, Aronson, and Brown.

Answer 28

Harsh Voice Low Pitch Slow Rate (ALS) Strained-Strangled Pitch Breaks

Question 29

Describe the movement parameters that could distinguish spastic dysarthria and flaccid dysarthria

Answer 29

Rate and Tone Rate in flaccid is normal, but slow in spastic Tone in flaccid is reduced, but excessive in spastic

Question 30

Discuss why cognitive concerns may be apparent in people with spastic dysarthria and why this is relevant to SLPs

Answer 30

Spastic dysarthria is typically a result of bilateral, multifocal or diffuse CNS injury/disease Therefore, cognitive and/or cognitive-communication disturbances are common dementia aphasia

Question 31

Define the neuro motor basis of ataxic dysarthria

Answer 31

Damage to the cerebella’s control circuit Problems in motor control; breakdown in the timing and coordination

Question 32

Describe lateralization of motor control as it relates to the cerebella’s control circuit

Answer 32

Medial Zone (vestibulocerebellum and spinocerebellum): Connections to vestibular and brain stem nuclei and regions of the spinal cord Lateral Zone (cerebrocerebellum): Connections to the motor and premotor cortex

Question 33

Describe the neural components of the cerebella’s control circuit

Answer 33

Cerebellum and it’s connections

Question 34

Describe 3 key functions of the cerebellum

Answer 34

Medial Zone (vestibulocwrebellum and spinocerebellum) -contributes to axial and trunk control, balance and posture, gait and locomotion, vestibular reflexes, coordination between head and eye movements, muscle tone Lateral Zone (cerebrocerebellum) contributes to coordination of voluntary movements, planning and initiation of movement, sensorimotor learning, muscle tone and tremor

Question 35

List 3 etiology that could lead to ataxic dysarthria

Answer 35

Degenerative, vascular, traumatic/demyelinating, tumor

Question 36

Describe 3 general symptoms associated with cerebella’s control circuit/damage

Answer 36

1. Inaccuracy of voluntary movements 2. Slowness of movement 3. Hypotonia 4. Other (ataxic gait, pendular reflexes, muscular fatigue/reduced strength, occult motor dysfunction

Question 37

List a patient’s speech related complaint that could help differentially diagnose ataxic dysarthria from other dysarthria types

Answer 37

Drunken quality of speech, drastic deterioration of speech with limited alcohol consumption, difficulty coordinating speaking with breathing

Question 38

List the most distinctive features of ataxic dysarthria according to darley, aronson, and brown

Answer 38

Most distinctive: Excess and equal stress/scanning speech Irregular articulately breakdowns Prolonged phonemes

Question 39

Describe the movement parameters that could distinguish ataxic dysarthria from spastic/flaccid

Answer 39

Direction of ataxic: inaccurate (vs normal) Rhythm: Irregular (vs regular) Range: excessive to normal (vs reduced)

Question 40

Purpose of vestibulocochlear nerves

Answer 40

Balance and hearing

Question 41

Glossopharyngeal nerves (9)

Answer 41

Taste sensation

Question 42

Vagus nerve

Answer 42

General sensation from external ear, palate, pharynx, larynx Motor control: palatial, pharyngeal, laryngeal muscles

Question 43

Accessory nerves

Answer 43

Motor control for palatal, pharyngeal, laryngeal muscles Motor control for trapezius and sternocleidomastoid muscles

Question 44

Hypoglossal nerves

Answer 44

Motor control of muscles of the tongue

Question 45

Trigeminal nerves

Answer 45

Sensory info related to pain and temperature from majority of head and face

Question 46

Midbrain Cranial Nerve Nuclei

Answer 46

Occulomotor, trochlear, trigeminal

Question 47

Pons cranial nerve nuclei

Answer 47

Trigeminal nerves, abducens nerves, facial nerves

Question 48

Medulla cranial nerve nuclei

Answer 48

Vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal, Trigeminal

Question 49

LMN Pathway/Final Common Pathway

Answer 49

Brainstorm and spinal cord to the muscles!

Question 50

Control Circuits Pathway

Answer 50

Input to and from cerebral cortex via the indirect & direct pathways

Question 51

Upper Motor Neuron Pathway

Answer 51

Originates in the cerebral cortex, and travels down to the brain stem/spinal cord