Final Flashcards
(319 cards)
1
Q
Frontal lobe
A
- contains primary motor cortex, prefrontal cortex, and Broca’s area
- reasoning, motor planning, movement, and higher-level cognitive functions
2
Q
Parietal lobe
A
- contains primary sensory cortex and angular gyrus
- semantic understanding, spatial recognition, complex language processing
- sensory information is received and processed
3
Q
Temporal lobe
A
- contains Wernicke’s area, hippocampus, amygdala, and fusiform gyrus
- processing auditory information, language comprehension, memory formation, emotional processing, recognizing sounds, storing visual memories
4
Q
Occipital lobe
A
- contains dorsal and ventral streams
- processes visual information
5
Q
Consciousness
A
the ability to be aware of self and surroundings
6
Q
Subjective definition of consciousness
A
internal, 1st person, mental (sense of ourselves); perceiving sensation, experiencing working memory, recovering and displaying space-time event memories, decision-making capacity
7
Q
Objective definition of consciousness
A
external, 3rd person, behavioral, wakefulness, background emotions
8
Q
Core consciousness
A
- sense of ourselves in the here and now
- sense of objects in the here and now
- sense of relationship b/w objects and ourselves
- does not depend on LTM
- location: cingulate cortex and projects to cortical regions to provide sense of self
9
Q
Extended consciousness
A
- sense of ourselves in the flow of time
- thinking about ourselves in the past
- forecast ourselves living in the future
- aka autobiographical self
- depends on LTM and core consciousness
10
Q
Reticular formation
A
- network of neurons located in brainstem, spans from medulla to midbrain
- receives sensory input from various parts of the body and sends signal into areas of the brainstem
- plays a role in regulating consciousness, arousal, breathing, and heart rate
- integrates information from all regions of CNS and supports consciousness through ascending reticular activating system
11
Q
4 groups of nuclei in the reticular formation
A
glutaminergic
monoaminergic
cholinergic
autonomic nuclei
12
Q
Glutaminergic
A
activates glutamate
13
Q
Monoaminergic
A
activates adrenaline, serotonin, and dopamine
14
Q
Cholinergic
A
activates acetylcholine
15
Q
Autonomic nuclei
A
innervates viscera
16
Q
Reticular activating system (RAS)
A
- part of reticular formation
- starts at reticular formation and sends information through the thalamus to cerebral cortex to play a role in wakefulness/alertness
17
Q
Functions of RAS
A
cortical arousal
cortical wakefulness
consciousness
fight/flight
attention
muscle tone
18
Q
Damage to RAS can lead to
A
coma
19
Q
Glasgow coma scale
A
- 15 point scale that attempts to measure a person’s level of consciousness
- 13+ = possible minor brain injury
- 9-12 = moderate brain injury
- < 9 = severe brain injury
- < 8 = coma
- eyes (E - 4)
- verbal (v - 5)
- motor (m - 6)
20
Q
Rancho level of cognitive functioning (RLCF)
A
- 8 level scale
- tracks a person’s emergence from coma
- level I = lowest level
- level VIII = highest level
21
Q
Pupillary light reflex
A
controls size of pupil in response to light
22
Q
Corneal reflex
A
causes eyelids to close when the cornea is touched
23
Q
Vestibulo-ocular reflex
A
stabilizes eye when move head
24
Q
Other brainstem reflexes
A
gag reflex
swallow reflex
laryngeal adductor reflex
sudden inspiratory gasp
25
Features of brain death
- no responses to stimuli
- no brainstem reflexes
- no sleep-wake cycle
- EEG patterns flat
26
Features of coma
- results from trauma (internal/external), infection, disease
- patients will die or shift to a different state within about 3 weeks
- no purposeful response to stimuli
- no brainstem reflexes
- no sleep-wake cycle
- demonstrate EEG patterns - severely depressed
27
Features of persistent vegetative state (PVS)
- no purposeful response to stimuli
- no brainstem reflexes
- demonstrate sleep-wake cycle
- demonstrate EEG patterns - severely depressed
28
Features of minimally conscious state (MCS)
- at times, purposefully response to stimuli, inconsistently
- demonstrate brainstem reflexes
- demonstrate sleep-wake cycle
- demonstrate variable EEG patterns
29
Features of locked-in syndrome
- eyes if not paralyzed
- demonstrate brainstem reflexes
- demonstrate sleep-wake cycle
- demonstrate variable EEG patterns
30
Aphasia in consciousness
both core consciousness and extended consciousness are preserved
31
Epilepsy in consciousness
both core consciousness and extended consciousness are impacted
32
Features of coma stimulation
- systematic application of stimulation to a person's 5 senses: vision, hearing, smell, taste, touch
- purpose: speed emergence from coma
33
Define consciousness
the awareness of one's self and surroundings
34
Describe consciousness from the third person, objective perspective
purposeful behavior, attention, background emotions, and wakefulness
35
Where is the reticular formation located/primary function?
- located in brainstem
- regulating arousal and consciousness levels
36
True or false: Glasgow coma scale assesses eyes, verbal, respiration
FALSE
eyes, verbal, motor
37
Damage to the reticular system can lead to
coma
38
True or false: The reticular activating system (RAS) and reticular formation (RF) are synonymous terms describing the same structure
FALSE
39
Which scale measures levels of cognitive function on an 8 level scale?
Rancho Levels of Cognitive Function
40
PVS
no purposeful response to stimuli, no brain reflexes, demonstrates sleep-wake cycle, demonstrates EEG patterns although may be severely depressed
41
2 diseases associated with decreased loss of consciousness
dementia and coma
42
Core consciousness
- our sense of the relationship between objects/ourselves
- our sense of objects in the here and now
- does not depend on LTM
- projects to cortical regions to provide sense of self
- located in cingulate cortex
- our sense of ourselves in the here and now
43
Extended consciousness
- Known as autobiographical self
- Our sense of ourselves in the flow of time
- Forecast ourselves living in the future
- Depends on LTM
44
Semicircular canals
- 3 fluid filled canals that correspond to our 3D world
- anterior canal: coronal plane of space
- posterior canal: sagittal plane of space
- horizontal canal: transverse plane of space
45
Cristas
- hair cells similar to the cochlea
- these hair cells are sensitive to body movements in the different planes of space
46
Lateral leminiscus
- a fiber bundle located in the lateral tegmentum of the midbrain that carries the axons from neurons in the cochlear nucleus and superior olive to the inferior colliculus
- SOC projects 4 tracts and CNC also projects 2 tracts firectly to the LL total of 6 tracts
47
Inferior colliculi
- auditory center of the midbrain
- maintains the tonotopic organization that originated in the cochlea
- important for localization of sound, pitch discrimination
- regulates the acoustic startle reflex, our sudden movement when an unexpected sound occurs
48
Medial geniculate body (MGB)
- auditory center of the thalamus
- acts as a relay station that relays auditory tracts to the auditory parts of the cerebral cortex
49
3 parts of the MGB
- ventral division: specializes in relaying frequency, intensity, and binaural information to cortex
- medial division: specializes in relaying intensity and duration of sound
- dorsal division: specializes in establishing and maintaining our attention to a sound source
50
Primary auditory cortex (PAC)
- central auditory pathway ends at PAC
- PAC found on superior temporal gyrus (Heschl's gyrus)
- tonotopically organized, like the cochlea and the rest of the central auditory system
- perceives and discriminates sound
51
Cerebellopontine angle
a subarachnoid space centered within the posterior cranial fossa at the level of the internal auditory canal and bordered medially and laterally by the cerebellum and petrous temporal bone
52
Vestibular nuclei-to-cerebellum
- vestibular nuclei projects fibers to the cerebellum
- cerebellum coordinates motor movement
- these vestibular nuclei-to-cerebellum connections facilitate the coordinated movements necessary to preserve the body's balance
53
Parts of peripheral auditory system
outer ear, middle ear, inner ear, CN VIII
54
Parts of central auditory system
brainstem and brain
55
Progression of auditory stimuli through neuro structure (outer ear)
- the pinna located a sound in the environment
- the sound is funneled to the tympanic membrane (TM) via the external auditory canal (EAC)
56
Progression of auditory stimuli through neuro structures (middle ear)
- acoustic energy hits the TM
- TM begins to vibrate, indicating an energy change: acoustic to mechanical
- this mechanical energy is transmitted through the ossicles (malleus, incus, and stapes)
- footplate of stapes rocks in/out of oval window
57
Progression of auditory stimuli through neuro structures (inner ear)
- the rocking of the stapes creates waves in the cochlear fluids
- another energy change: mechanical to hydraulic
- waves disrupt hair cells in the Organ of Corti, causing a third energy change: hydraulic to electrochemical
58
Generation of nerve impulse
- 2 types of hair cells: stereocilia and kinocilia
- When waves in cochlear fluids disrupts basilar membrane and hair cells in the organ of Corti, the hair cells depolarize similar to neurons
- K+ enters hair cells and changes hair cell from negative to positive
- Signal moves down the hair cell, causing Ca++ channels to open, which stimulates the release of NT’s (glutamate)
- NT’s stimulate nerve endings that connect to bottom of hair cells
- if stereocilia bends towards kinocilia, hair cell depolarizes and signal goes to brain; bends away = inhibition, no signal sent
59
Nerve conduction
- Cochlear branch of CN VIII connects into the hair cells of the organ of Corti
- Conducts electrochemical impulse to brain
60
Cochlear nucleus complex
- CN VIII inputs into the brainstem's CNC, an area of specialized cells for auditory information
- cochlear nucleus lies where pons and medulla meet at cerebellopontine angle
- CN processes incoming auditory signals by differentiating frequencies and timing information which is critical for sound localization
61
Divisions of cochlear nucleus
- posterior cochlear nucleus: contains pyramidal cells of unknown function
- anterior cochlear nucleus: contains 3 different nuclei, which are each sensitive to different ranges of frequencies
- tonotopic organization of the cochlea is maintained in the CN
62
Superior olivary complex
- cochlear nucleus fibers project to the SOC in the pons
- has 2 parts
1. medial superior olivary complex
2. lateral superior olivary complex
- both involved in sound localization and the stapedius reflex
63
Medial superior olivary complex
specializes in low-frequency hearing and binaural hearing
64
Lateral superior olivary complex
specializes in higher-frequency hearing
65
Medial and lateral SOC
- responsible for stapedius reflex
- CN VII triggers stapedius to contract in response to loud noise - causes stapes to move out of oval window
- sound is dampened, lasts 45 seconds
- stapedius reflex triggered bilaterally
- used to diagnose sensorineural hearing loss, acoustic neuroma
- helps locate lesion in lower brainstem
- CN VII branches both ears
66
Arcuate fasciculus
enabling the link between language comprehension and language production, making it essential for fluent and meaningful speech
67
Stapedius reflex - diagnostic significance
- bilateral response
- triggered by facial nerve in response to intense noise causes stiffening of ossicular chain, pulls stapes away from oval window, dampens sound for 45 seconds
68
Function of Wernicke's area
- PAC projects to Wernicke's, also on the superior temporal gyrus
- important for attaching meaning to heard speech
- decodes spoken language, allowing the listener to derive meaning from auditory stimuli
69
Parts of peripheral vestibular system
SSC's and CN VIII
70
Parts of central vestibular system
brainstem and brain
71
Ampulla
- each SCC has a swelling called an ampulla
- inside each ampulla is a structure known as the crista
- cristas have hair cells similar to the cochlea, sensitive to body movements in the different planes of space
72
Utricle and saccule
- the vestibule of vestibular system is located in the boney labyrinth between cochlea and SCC's
- found in the vestibule
- within macula are hair cells that have calcium carbonate crystals embedded in a gelatinous membrane
- some hair cells and crystals respond to their linear acceleration on the horizontal plane (head tilt left/right) and vertical plane (moving up/down)
73
Vestibular nuclei - eye movements
- VN projects fibers to nuclei in brainstem (pons) that control eye movements
74
Nuclei included in VN - eye movements
abducen nucleus in pons
trochlear nucleus in midbrain
oculomotor nucleus in midbrain
75
Vestibular nuclei - nausea
- VN projects to the RF throughout the brainstem
- RF coordinates visceral/autonomic functions
- VN to RF connection involves motion sickness and possible vomiting
76
Vestibular nuclei - spinal cord and head/neck movements
- VN projects to spinal cord as medial vestibulospinal tracts
- facilitate vestibucollic reflex
77
Vestibulocollic reflex
stabilizes head in space when head moves in opposite direction of the current head motion
78
Vestibular nuclei - spinal cord and arm/leg adjustments
- VN also projects to descending fibers as lateral vestibulospinal tract
- facilitates vestibulospinal reflex
79
Vestibulospinal reflex
maintain balance, posture, and stability via activating skeletal muscles (i.e., when bending over, lifting one leg to keep oneself balanced)
80
What are the components of the peripheral auditory system?
outer ear (pinna), middle ear, inner ear, CN VIII
81
What are the components of the peripheral vestibular system?
SCC's and CN VIII
82
Which of the following CN's carried auditory information to the cochlear nucleus?
CN VIII
83
What is the primary role of the CN in the auditory pathway?
frequency discrimination
84
How does Wernicke's area process incoming auditory language stimuli?
By converting auditory signals into meaningful words and sentences
85
Vestibulospinal reflex
maintain balance, posture, and stability via activating skeletal muscles (i.e., when bending over, lifting one leg to keep oneself balanced)
86
Vestibulocollic reflex
stabilizes head in space when head moves, command is to move head in opposite direction of the current head motion
87
Vestibulo-ocular reflex
keep eyes fixed/stable (visual field and retinal image) when moving head
88
Acoustic startle reflex
sudden movement when an unexpected sound occurs
89
Stapedius reflex (acoustic reflex)
bilateral response, triggered by CN VII in response to intense noise causes stiffening of the ossicular chain, pulls stapes away from oval window, dampens for 45 seconds
90
Conceptual level
- thoughts, feelings, and ideas
- prefrontal cortex and limbic system have primary role at this level
91
Linguistic planning level
- language content, form, and use (semantics, grammar, pragmatics)
- premotor cortex is important area for planning (frontal lobe)
92
Motor planning
plans and arrangement of phonemes
93
Motor programs
the execution of specific phonemes in time and space
94
Motor planning/programming level
- programs involve discrete movements of articulators
- many motor programs make up a motor plan
- cerebellum, basal ganglia, and SMA's are important to motor planning/programming
95
Motor control circuits - basal ganglia
- includes caudate nucleus, putamen, globus pallidus, substantia nigra, and subthalamic nuclei
96
Motor control circuits - cerebellum
- coordinates muscle movements so that they are skilled and sequential
- when this circuit is damaged, speech can become uncoordinated, resulting in a condition known as ataxic dysarthria
97
Direct motor pathway
- aka pyramidal system
- involves lateral motor system - lateral corticobular and corticospinal tracts
- function of pathway: voluntary motor movements of contralateral limbs/speech muscles
- makes few stops
- decussates at medulla/spinal cord juncture
- main center: primary motor cortex
98
Upper part of direct motor pathway
- brain and spinal cord
- UMN's
99
Lower part of direct motor pathway
- cranial and spinal nerves
- LMN's
100
Damage to direct motor pathway - UMN
- spastic muscles
- hypertonia/hyperflexia (+ reflexes)
- clonus
- + Babinski sign
- no atrophy
- no fasciculations
101
Damage to direct motor pathway - LMN
- flaccid muscles (hypotonia and hyporeflexia (- reflexes)
- no clonus
- no babinski sign
- marked atrophy
- fasciculations
102
Indirect motor pathway
- aka extrapyramidal system
- includes medial motor systems: anterior corticospinal, vestibulospinal, reticulospinal, tectospinal
- function: posture, muscle tone
- many stops
- main center: basal ganglia
103
Damage to indirect motor pathway
dyskinesias:
- tremors - rest tremors and action (intention) tremors
- chorea
- athetosis
- dystonia
- myoclonus
speech issues:
- hyperkinetic dysarthria
- hypokinetic dysarthria
104
Hyperkinetic dysarthria
Huntington's
105
Hypokinetic dysarthria
Parkinson's
106
Chorea
spasmodic, involuntary movements of limbs or facial muscles
107
Athetosis
slow, involuntary and continuous writhing movements; limbs/truck/neck/face/tongue
108
Dystonia
involuntary muscle contractions results in abnormal postures or repetitive movements
109
Myoclonus
brief, sudden, and involuntary muscle contractions or inhibitions
110
Final common pathway
- last leg of a motor signal's journey
- part of LMN's
- involves CN's in speech, alpha motor neurons, and gamma motor neurons
111
Alpha motor neurons
innervate extrafusal muscle fibers involved in muscle contraction
112
Gamma motor neurons
innervate intrafusal muscle fibers involved in proprioception
113
Components of speech
respiration
phonation
resonance
articulation
prosody
114
Respiration
power for speech
115
Phonation
raw sound for speech
116
Resonance
tonal qualities of speech
117
Articulation
speech sounds
118
Prosody
musical quality of speech
119
Which CN's can be affected where there is LMN damage?
CN V (trigeminal)
CN VII (facial)
CN IX (glossopharyngeal)
CN X (vagus)
CN XI (accessory)
CN XII (hypoglossal)
Select spinal nerves C3-C5, T2-T11
120
Sensory tracts and speech
- sensory tracts provide proprioception for speech
- proprioception is the body's eyes for itself for the body's knowledge of where its parts are in space
made up of:
- kinesthesia: brain's awareness of position and movement of structures (e.g., tongue)
- joint position sense
121
Upper motor neurons (UMN's)
- location: motor cortex and in central brainstem nuclei
- primary UMN pathways: corticospinal tract and corticobulbar tract
- send signals to LMN, which innervate muscles to produce movement
- also play a role in refining and modulating motor movements, including maintaining posture and muscle tone
122
Lower motor neurons (LMN's)
- location of spinal: anterior horn of spinal cord
- location of cranial: brainstem
- function: directly control muscle contractions by transmitting motor signals from the spinal cord or brainstem to the muscle fibers
- pathway: travel through the peripheral nerves to innervate specific muscles
123
Which areas contribute to apraxia of speech?
Broca's, basal ganglia, and SMA
124
Direct motor pathway
- Primary motor cortex is main neurological area
- Separated into UMN and LMN
- Includes lateral motor system (lateral corticobulbar and corticospinal)
- Voluntary motor movement of contralateral limbs/speech muscles
- May include spastic dysarthria
125
Indirect motor pathway
- Control of posture and muscle tone
- Damage associated dyskinesias
- Basal ganglia is in main neurological area
- Aka extrapyramidal system
- Only decussation at tectospinal
126
Upper motor neurons (UMN's)
No fasciculations
Hyperreflexia
(+) Babinski sign
Hypertonia
No atrophy
Spastic muscles
Clonus
127
Lower motor neurons (LMN's)
Flaccid muscles
Fasciculations
No clonus
Hyporeflexia
Flaccid muscles
No babinski sign
Marked atrophy
128
8 characteristics of language
1) A code; system of symbols
2) Used to respresent ideas about the world
3) Conventional – shared by speaking community
4) Systematic – rules and regulations for use
5) Use arbitrary symbols
6) Generative – speakers create novel utterance
7) Dynamic – change over time
8) Universal characteristics – noun, verb, adjectives, and rules
129
Parts of language
content
form
use
130
Content
- aka semantics
- meaning of language
131
Form
- aka grammar
- shape or form of language
- includes phonology, morphology, and syntax
132
Phonology
concerned with the study of phonemes, the smallest units in a language system
133
Morphology
concerned with the study of morphemes, the smallest units of meaning in a language
134
Syntax
concerned with the structure of sentences, specifically, word order and sentence organization
135
Use
- aka pragmatics
- practical use of language, in what matter the language is used with others
136
Perisylvian region
- border sylvian fissure (lateral fissure)
- inferior frontal gyrus, superior temporal gyrus, some of middle temporal gyrus, inferior parietal lobe
137
Auditory comprehension of language steps
1) Cochlea to CNC via CN VIII
2) CNC to thalamus
3) Thalamus to PAC
4) PAC to Wernicke’s
5) Wernicke’s to Broca’s
- Superior temporal gyrus highly connected to inferior frontal gyrus
- The dorsal and ventral streams known as dual stream meaning information flows back and forth between them
138
Cornea
outer layer of eye
139
Pupil
opening at center of iris
140
Dilate
pupil opens to increase amount of light that enters eye
141
Constrict
pupil shrinks to decrease amount of light that enters eye
142
Parasympathetic component
pupils dilate with nervousness
143
Iris
colored part of eye
144
Lens
helps focus light via changing shape
145
Accommodation
change of lens shape
146
Binocular cues
use of both eye (i.e., convergence)
147
Retina
- innermost layer of eye
- only extension of the brain that can be viewed outside of the body, contains 10 layers
- neural components of the eye, where light converts to electricity (aka transduction)
- transduction in eyes are action potential
148
Photoreceptors
- light reaches back of retina
- photoreceptors convert light into energy
- location: on retinas at the back of eyes
149
Rods
dim light, not perception of color, black/white
150
Cones
- under daylight, allow for color perception, visual acuity
- concentrated around fovea
- sensitive to wavelengths of red, blue, yellow
151
Fovea
- small depression in retina
- formed by skirting of optic nerve fibers
- center visual field is this area
- highest visual acuity level, center of gaze
- contains no rods
- cones are concentrated
- best, sharpest vision around fovea
152
Visual comprehension of reading steps
1. eyes to LGN of thalamus via optic tracts
2. LGN to visual cortex via geniculocalcarine tract
3. visual areas to ventral and dorsal streams of vision
153
3 cortical areas involved in reading
parietotemporal system
occipitotemporal system
anterior reading system
154
Parietotemporal system
- word analysis
- decoding semantics
155
Occipitotemporal system
- word form recognition
- sight reading
156
Anterior reading system
- word analysis
- decoding syntax
- low-frequency words
- silent reading
157
Oral production of language steps
1. Decision to speak formed in prefrontal cortex
2. Decision sent to Broca’s area for language encoding and speech planning
3. Speech plans sent to supplementary motor area (SMA), which activates the plans
4. SMA sends to motor cortex, which sends activated plans to speech muscles
158
Written expression of language steps
1. Decision to write formed in prefrontal cortex
2. Decision sent to Broca’s area for language encoding
3. Writing plans sent to premotor area, which forms grapheme motor plans
4. Premotor area sends to motor cortex, which sends plans to hand muscles
5. Areas 5 and 7 aid in visual spatial elements of writing
159
Aphasia - expressive language problems
agrammatism
anomia
jargon
neologism
paraphasia
verbal stereotypes
agraphia
160
Agrammatism
difficulties in using or understanding grammatical structures, such as word order, tense, plurality, and function words
161
Anomia
difficulty in retrieving and producing words
162
Jargon
speech that is fluent and grammatically correct but is nonsensical or meaningless, often filled with irrelevant or invented words, neologisms, or inappropriate jargon
163
Neologism
meaningless or invented words that replace real words
164
Literal/phonemic paraphasia
a person substitutes, omits, or adds sounds or letters within a word, resulting in distorted or incorrect words
165
Verbal/semantic paraphasia
a person substitutes a word with a semantically related but incorrect word
166
Verbal stereotypes
repeated phrases or expressions that individuals with certain language disorders, such as Wernicke’s aphasia, use frequently in speech, even when they are inappropriate or meaningless in the context of the conversation
167
Agraphia
loss or impairment of the ability to write, despite having the physical ability to do so and the intact understanding of language
168
Peripheral agraphia
writing difficulty due to visuospatial and attentional issues
169
Central agraphia
writing system is damaged
170
Aphasia - receptive language problems
auditory comprehension loss
alexia
171
Auditory comprehension loss
inability or reduced ability to understand spoken language despite hearing the words correctly
172
Alexia
loss of the ability to read due to brain damage, despite having the ability to see and recognize letters or words
173
Peripheral alexia
reading difficulty due to visuospatial and attentional issues
174
Central alexia
reading system is damaged
175
Broca's aphasia
- aka expressive aphasia
- difficulty finding and saying right word
- repeating words and phrases is often effortful
- speech is labored and telegraphic
- difficulty writing
- typically understand better
- may have right sided weakness in arm/leg; hemiparesis
- may experience increased frustration
176
Transcortical motor aphasia
- Stroke impacts but does not directly affect Broca’s
- Difficulty finding and saying right word
- Repeats words and phrases well
- Difficulty with sentence structure and functor words (articles & prepositions)
- Speech might be consistent content words (noun & verbs)
- Speech slow, halting, lacks intonation
- Comprehension often intact or mildly impacted
- Writing impaired; similar to speech
177
Global aphasia
- most severe
- reduced, nonfluent speech
- profound impairment on language comprehension
- may produce long and confusing utterances with neologisms
- may limit spoken utterances to spontaneous greetings and single word, inconsistently appropriate
178
Wernicke's aphasia
- aka receptive/fluent aphasia
- speech is fluent and long utterances but likely do not make sense
- speaking rate and intonation are generally intact
- increased paraphasic errors, neologisms
- comprehension is impaired
- difficulty repeating words, including their own utterances
179
Transcortical sensory aphasia
- Fluent speech but often contains paraphasic errors; increase use of concrete nouns compared to adjectives
- Severe comprehension difficulties
- Repetition intact; often echolalic
- Reading out loud contaminated but better than reading comprehension
180
Conduction aphasia
- speaks fluently, struggles to repeat words/phrases, substitutes phonemic paraphasic errors
- confrontation naming impaired, frequently attempt to self-correct, results in choppy speech
- comprehension intact
181
Anomic aphasia
- fluent, grammatically correct speech with difficulty finding correct words; especially nouns and verbs
- repetition and comprehension intact
182
What are the parts of language?
form, content, use
183
Components of language form include:
phonology, morphology, syntax
184
Name 3 of 4 structures associated with the Perisylvian region
inferior frontal gyrus
superior temporal gyrus
some of middle temporal gyrus
inferior parietal lobe
185
Auditory comprehension of language begins in the cochlea to CNC to thalamus. Which sequence continues the path to cortex?
thalamus to PAC to Wernicke’s area to portion of Broca’s area that processes syntax
186
The decision to write/speak begins in what part of the brain?
prefrontal cortex
187
What is known as an acquired writing disorder?
alexia
188
The superior temporal gyrus is involved in:
processing syntactic structure
189
Broca's aphasia
difficulty word finding, repeating words/phrases often effortful, typically understands better, difficulty writing, may experience frustration because they understand they are making errors
190
Transcortical motor aphasia
speech slow, halting, and lacks intonation
191
Global aphasia
may produce long & confusing utterances with neologism, utterance often limited to social greetings & single words that may be errored, profound language deficit
192
Wernicke's aphasia
speaking rate and intonation generally intact, receptive aphasia that has difficulty repeating words, even their own utterances
193
Transcortical sensory aphasia
repetition intact, often has echolalia, fluent speech with paraphasia errors, uses concrete nouns, severe comprehension deficits
194
Conduction aphasia
speaks fluently but struggles to repeat, substitutes phonemic paraphasia errors, comprehension usually intact
195
Anomic aphasia
fluent, grammatically correct but with difficulty finding words, repetition & comprehension generally intact
196
Sequence of swallow
oral preparatory
oral
pharyngeal
esophageal
197
Oral preparatory stage
- voluntary
- timing variable
- CN V (chewing), IX (gland), and VII (gland)
- muscle involvement: mandibular elevators and depressors
198
Mandibular elevators
masseter
temporalis
pterygoid
199
Mandibular depressors
anterior belly of digastric muscle
mylohyoid
200
Oral stage
- voluntary
- 1 second
- CN VII (labial seal, taste), XII (anterior-to-posterior bolus movement)
- tongue retraction: CN V, controls digastric and mylohyoid
- muscle involvement: face muscles (e.g., obicularis oris), intrinsic and extrinsic muscles of the tongue
201
Pharyngeal stage
- involuntary
- 1 second
- CN V (soft palate closure, laryngeal elevation), VII (laryngeal elevation), X (laryngeal, velar closure, pharyngeal constriction), XI (soft palate closure, pharyngeal constriction), XII (laryngeal elevation)
- CN X and XI control superior, middle, and inferior pharyngeal constrictors
- muscle involvement: soft palate elevators and depressors, intrinsic laryngeal muscles, supra- and infrahyoid muscles, pharyngeal constrictors
202
As bolus contacts faucial arches:
1. soft palate elevates
2. VC adduct
3. respiration pauses
4. larynx elevates
5. cricopharyngeus relaxes
203
Esophageal stage
- involuntary
- timing variable
- CN X (upper esophageal sphincter control, esophageal peristalsis)
204
Nucleus tractus solitarius (NTS)
- located in medulla
- acts as swallowing sensory center
- receives afferent information from CN V, VII, IX, X
- afferent information includes taste and touch as well as respiratory/cardiovascular input
- sends information to second nucleus
205
Nucleus ambiguous (NA)
- located in medulla
- motor swallowing center
- innervates swallowing muscles via CN IX, X, and XII
206
What are NTS and NA referred to as?
functional units and the swallowing center of the medulla
207
Primary motor cortex - swallowing
activates voluntary muscles of swallowing
208
Primary sensory cortex - swallowing
processes sensation of eating
209
Insula - swallowing
may mediate motor and sensory information involved in swallowing as well as provide some level of swallowing control
210
3 main components of the cough response
1. afferent vagus fibers convey sensory information from cough receptors in swallowing tract
2. this information goes to a cough center in the brainstem, specifically in the medulla
3. efferent signals are sent from cough center to respiratory muscles and larynx to generate cough
211
Cough receptors
larynx and posterior wall of pharynx, especially epiglottis and where pharynx and esophagus meet
212
Aspiration
bolus penetrates the airway below the level of the vocal cords
213
Silent aspiration
- occurs without any signs (coughing)
- neurological damage can suppress cough response system
214
Clinical indicators of silent aspiration
dysphonia
dysarthria
abnormal gag reflex
abnormal volitional cough
cough after swallow
voice change after swallow
215
Dysphonia
a voice disturbance in the parameters of vocal quality, pitch, or intensity
216
Dysarthria
a speech disorder resulting from disturbances in muscular control affecting the areas of respiration, articulation, phonation, resonance, or prosody
217
Abnormal gag reflex
either absent or weakened velar or pharyngeal wall constriction, unilaterally or bilaterally, in response to tactile stimulation of the posterior pharyngeal wall
218
Abnormal volitional cough
a weak response, verbalized response, or no response when given the command to cough
219
Cough after swallow
cough immediate or within 1 minute of ingestion of calibrated volumes of water
220
Voice change after swallow
alteration in vocal quality following ingestion of calibrated volumes of water
221
Conditions caused by dysphagia - neurological causes
stroke
TBI
spinal cord injury
degenerative diseases
brain tumors
222
Conditions caused by dysphagia - mechanical causes
acute inflammations
cancer
cervical spine diseases
NG tubes
artificial airways
223
Stroke in cortex as it impacts swallow
weakness/paralysis and loss of sensory info of the oral structures result in:
- poor oral prep stage
- residue due to sensory deficits
- slow oral transit
- delayed swallow initiation
- weak pharyngeal phase
- weakness/paralysis of VC
224
Stroke in subcortex as it impacts swallow
impaired motor control of oral structures may result in:
- slow oral phase
- slow oral transit
- delayed pharyngeal phase
225
Stroke in brainstem as it impacts swallow
impaired center for automatic swallow response results in:
- functional oral and oral prep stage
- complete loss of or delayed swallow response
226
Stroke in cerebellum as it impacts swallow
loss of coordination results in:
- poor oral phase due to difficulty coordination of formation of bolus
- discoordination of swallow response in pharyngeal phase
227
What are the 4 stages of the swallow?
oral prep, oral, pharyngeal, esophageal
228
Which CN is responsible for innervating muscles to achieve the labial seal?
CN VII (facial)
229
Which CN is responsible for tongue retraction during the second stage?
CN V (trigeminal)
230
Which CN innervates tongue and squeezes bolus anterior to posterior part of mouth?
CN XII (hypoglossal)
231
What are the 5 muscles involved in elevating soft palate during the third stage of the swallow and 3 CN's?
Levator veli palatini (CN X,XI)
Palatoglossal (CN X, XI)
Tensor veli palatini (CN V)
Musculus uvulae (CN X, XI)
Palatopharyngeus (CN X, XI)
232
What CN's are responsible for laryngeal constriction muscles that squeeze bolus through the pharynx?
CN X and XI
233
Which CN impacts both the VF's (abduction and adduction) and the upper esophageal sphincter controlled by the cricopharyngeus muscle?
CN X
234
Where are the NTS and NA located and by what functional unit are they known as?
located in the medulla, AKA functional unit swallowing center of the medulla
235
Function of a cough
defensive act that keeps food out of the airway
236
Where are the cough receptors?
larynx and posterior wall of pharynx (epiglottis and where pharynx/esophagus meet)
237
Where is the neurological cough center located?
brainstem, specifically medulla
238
List 3 signs and symptoms associated with silent aspiration
dysphonia
dysarthria
abnormal gag reflex
239
Which structure has weakness/paralysis & loss of sensory information of the oral structures resulting in poor oral prep stage, oral residue, slow oral transit, delayed swallow initiation, weak pharyngeal phase & weakness/paralysis of vocal cord
cortex
240
Which structure has impaired motor control of oral structures may result in slow oral phase & oral transit, delayed pharyngeal phase?
subcortex
241
Which structure has impaired automatic swallow response may result in functional oral and oral prep stage, complete loss of or delayed swallow response?
brainstem
242
Which structure has loss of coordination may result in poor oral phase due to difficulty coordinating formation of bolus, discoordination of swallow response in pharyngeal phase?
cerebellum
243
Which structure activates voluntary muscles of swallowing
primary motor cortex
244
Which structure processes the sensation of eating
primary sensory cortex
245
Which structure may provide the attention needed in swallowing
anterior cingulate cortex
246
Which structure may play a role in the motor planning of swallowing
premotor cortex
247
Which structures may incorporate sensory information from food and liquid into swallowing
thalamus and basal ganglia
248
Define cognition
the mental process of knowing in which we acquire and act upon knowledge
249
Mental process
things we can do with our minds
250
Knowing
to have some kind of information in your mind
251
Knowledge
understanding information and skills obtained through education and/or experience
252
General cognitive functions
perceiving
remembering
understanding
judging
reasoning
253
Perceiving
noticing something with your senses
254
Remembering
storing information gathered through perception
255
Understanding
to know the meaning of information
256
Judging
to form an opinion about the correctness of information
257
Reasoning
to do something with the information (e.g., to make an argument)
258
4 types of attention
sustained
selective
alternating
divided
259
Sustained attention
focus on a stimulus over a period of time
260
Selective attention
focusing on a stimulus while filtering out competing stimuli
261
Alternating attention
shifting focus from one task to another and then back
262
Divided attention
focus on 2 stimuli at the same time
263
Neurology of attention: visual
prefrontal cortex
frontal eye fields
parietal lobe (posterior)
pulvinar
superior colliculus
264
Prefrontal cortex - visual
divided attention
265
Frontal eye fields - visual
visual sustained attention
266
Parietal lobe - visual
selective attention
posterior = disengage our attention from stimuli
267
Pulvinar - visual
visual sustained attention, specifically selecting and prioritizing salient visual stimuli
268
Superior colliculus - visual
alternating visual attention, rapidly directs eyes and heads towards salient stimuli
269
Neurology of attention: auditory
prefrontal cortex
anterior cingulate cortex
270
Prefrontal cortex - auditory
- attention control, selective focus on sound in complex environment
- different prefrontal regions impact initiation, attention, sustained focus, and shifting attention
271
Anterior cingulate cortex - auditory
divided attention, specifically detecting and resolving when competing or conflicting stimuli demand attentional shifts
272
Working memory
active manpulation, neuro network includes prefrontal cortex ,cingulate cortex, and parietal lobe
273
Visuospatial sketchpad
stores visual and spatial information (objects, elements)
274
Phonological loop
includes phonological store (holds words) and articulatory processes (allows for repetition)
275
Central executive
controlled processing including directing attention, maintaining goals, decision making, and memory retrieval
276
Short-term memory
time in seconds, holding information, 7 elements +/-2
277
Long-term memory
time in days to years
278
Declarative memory
- aka explicit memory
- conscious, willfull recall of memories
- consciously declare facts or memories to others
279
Semantic LTM
recall of facts or general knowledge (impersonal)
280
Episodic LTM
conscious recollection of previous experiences including content, time, place, and associated emotions (personal)
281
Emotional memory
type of memory related to strong emotions
282
Nondeclarative memory
- aka implicit memory
- learning and retrieving information without conscious effort or involvement
283
2 types of nondeclarative memory
procedural memory and priming
284
Neurology of memory
prefrontal cortex
striatum part of basal ganglia
cerebral cortex
amygdala
cerebellum
hippocampus
285
Prefrontal cortex (memory)
working memory
286
Striatum part of basal ganglia (memory)
procedural memory
287
Cerebral cortex (memory)
perceptual and semantic
288
Amygdala (memory)
emotional memory
289
Cerebellum (memory)
conditioned timing
290
Hippocampus (memory)
declarative memory (episodic and semantic)
291
Internal memory strategies
repetition
visualization
association (mnemonics)
grouping
writing it down
292
External memory strategies
calendars
to-do lists
journals
electronic organization
electronic reminders
293
Executive function components
restraint
initiative
order
294
Restraint
- inhibition of inappropriate behavior
- judgment, foresight, perseverance, delaying gratification, inhibiting socially inappropriate responses, self-governance, concentration
295
Initiative
- motivation to pursue positive, productive activities
- curiosity, spontaneity, motivation, drive, creativity, shifting cognitive set, mental flexibility, personality
296
Order
- capacity to correctly perform sequence tasks and other cognitive operations
- abstract reasoning, working memory, perspective taking, planning, insight, organization, sequencing, temporal order
297
Neurology of executive function
prefrontal cortex/frontal lobe
basal ganglia
thalamus
298
Basal ganglia in executive function
filter mechanism selecting actions to inhibit or initiate; planning, organization, and flexible execution; communicates to prefrontal cortex
299
Thalamus in executive function
relays information to PFC to allow for smooth integration of information needed for planning, decision-making, working memory, and cognitive flexibility
300
Right hemisphere disorder
communication and cognitive problems
301
Communication problems in RHD
- linguistic: rambling speech, poor coherence in producing and comprehending conversation and narratives, poor comprehension of abstract language and humor, and poor pragmatic skills
- extralinguistic: aprosody and a lack of producing and interpreting emotion
302
Cognitive problems in RHD
- attention: all forms of attention may be impacted
- memory: deficits in episodic memory, most likely due to attentional problems
- executive functions: under restraint, they may demonstrate poor judgment and lack foresight in how their actions affect others; under order, demonstrate anosognosia or denial of deficits; also, synthesis and inference impaired
303
Emotional intelligence
- the ability to perceive, appraise, and express emotions accurately
- the ability to access and evoke emotions when they facilitate cognition
- the ability to comprehend emotional messages and to make use of emotional information
- the ability to regulate one's own emotions to promote growth and well-being
304
Clinical important of emotional intelligence
- Clinicians need to perceive, appraise, and understand the emotions of their clients
- Clinicians must respond on an emotional level to client’s emotional intents; a lack of this kind of response leads to client frustration of “not being heard”
- Clinicians must be aware of their own emotions
- Clinicians must regulate their own emotions so as to not “leak out” on their clients
305
Components of limbic system
amygdala
cingulate cortex
hippocampus
hypothalamus
thalamus
basal ganglia
306
Amygdala
emotional processing, feeding and drinking, fighting, mating, providing maternal care, responding to physical/environmental stress
307
Cingulate cortex
emotional processing and cognitive processing, helps identify negative emotions and resolve emotional conflict
308
Hippocampus
process and consolidate memories
309
Hypothalamus
regulates vital body functions: body temperature, hunger, thirst, sexual arousal - essential in maintaining homeostasis
310
Thalamus
processes and relays information to other parts of the brain - especially those involved in emotion and memory
311
Basal ganglia
- processes reward signals, emotional regulation influences behaviors associated with pleasure, motivation and habit formation, role of cognitive functions like decision making and learning with other structures of the limbic system
- Acts as a bridge between motor control and emotional processing
312
Function of limbic system
the brain’s emotional system network of brain structures, deep in brain, responsible for regulating emotions, motivation, learning, and memory
H - homeostasis
O - olfaction
M - memory/motivation
E - emotion
313
Damage to amygdala
flattened emotions
abnormal fear
aggression
anxiety
may be connected to depression, anxiety, PTSD
314
Damage to cingulate cortex
decreased social behavior
reduced time spent with others
decreased vocalizations
315
Damage to the hippocampus
memory loss
cognitive dysfunction
loss of ability to make new, long-term memories
316
Damage to the hypothalamus
- hormonal imbalances (diabetes, hypothyroidism)
- autonomic dysfunction (body temperature regulation, sweating disturbances, gastro-intestinal problems)
- neurological disorders (sleep disturbances, seizures, headaches, vision problems)
- psychological effects (mood disorders, emotional instability, appetite changes, cognitive impairment, fatigue)
317
Damage to thalamus
- multiple symptoms: sensory issues, memory disorders, sleep disorders, behavioral changes
- damage to thalamus can be life threatening
- cannot survive without thalamus
318
Damage to basal ganglia
- movement disorder (starting/stopping and sustaining movement)
- speech problems (slurred speech, dysnomia)
- cognitive deficits (memory and processing problems)
- balance and coordination problems (difficulty walking)
- visual problems (hallucinations)
- psychiatric symptoms (delusions, mood lability, agitation, and psychotic symptoms)
319
Lability
- an involuntary display of emotion that sometimes is a result of neuropathology
- disruptions in prefrontal cortex and limbic system connections may lead to limbic system being under regulated by prefrontal cortex
- some patients may display sudden outbursts of laughing or crying
- patients report these episodes as distressing and socially disabling
