Quiz 1 Flashcards
(57 cards)
1
Q
Regions of the Brain
A
Frontal Lobe Parietal Lobe Occipital Lobe Temporal Lobe Cerebellum Brain Stem
2
Q
Speech
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Complex motor act:
- Disproportionate cortical sensorimotor space allotted to the larynx, palate, tongue and lips (Homunculus)
- Requires more motor fibers than any other mechanical behavior
- Multimodal feedback
- 140,000+ neuromuscular acts/second
- Temporal precision about 10msec
3
Q
Somatosensory and Motor Cortex
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Somatosensory is anterior to Motor Cortex
4
Q
Motor Speech Disorders (MSD)
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- An impairment caused by a lesion or dysfunction of the motor speech centers in either the PNS, CNS, or both.
5
Q
MSD Result In…
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An inability to regulate the movements required for speech:
- Planning
- Programming
- Control
- Execution of speech
- Includes the dysarthrias and apraxia of speech
6
Q
MSD May Be…
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- Congenital or acquired
- Static, improving, or degenerative
- Associated with lesions in various CNS and PNS structures
- Caused by numerous diseases/condition
7
Q
MSD Descriptive terms of SLPs vs. Neurologists
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- Weak/Slow vs. Paralysis
- Unsteady vs. Tremor
- Uncoordinated vs. Dymetria/Dyssergia
- Decreased Tone vs. Hypotonic
- Increased Tone vs. Hypertonic
8
Q
Terms to Define Decrease in MSD Function
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- Paresis: partial or incomplete paralysis
- Plegia: paralysis
- Monoparesis/monoplegia: weakness/paralysis of one limb
- Hemiparesis/hemiplegia: weakness/paralysis of one side of the body
- Paraparesis/paraplegia: weakness/paralysis of both lower extremities
- Quadriparesis/quadriplegia: weakness/paralysis of all four limbs
9
Q
Two Major Categories of MSDs
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Dysarthrias:
- In its extreme form also called anarthria
- Static, improving, degenerative
10
Q
Childhood MSD
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Terms vary/may be synonymous
- childhood dysarthria (CD)
- developmental verbal dyspraxia (DVD)
- childhood apraxia of speech (CAS
11
Q
Dysarthria Definition
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Neurogenic speech disorder caused by dysfunction of CNS or PNS
Reflects abnormalities in movements required for breathing, phonatory, resonatory, articulatory or prosody of speech production:
- strength
- speed
- range
- steadiness
- tone
- accuracy
12
Q
Dysarthria Types
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- Different types, each corresponding to damage to particular part(s) of the nervous system,
- Each having different underlying neuropathophysiology
- Each type has different auditory perceptual characteristics which can be distinguished clinically
13
Q
Dysarthria Diagnosis
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- Made independently by neurologist and SLP
- Can affect any of the speech production subsystems:
- Respiration
- Phonation
- Resonance
- Articulation
- Prosody
14
Q
Dysarthria Casues
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Common causes:
- Stroke (CVA)
- Brain Injury (TBI)
- Brain Tumor
- Conditions that cause facial paralysis or weakness
- Degenerative Disorders
Pharmacological Causes:
- Sedatives
- Narcotics
15
Q
Dysarthria Clinical Challenges
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- Educational
- Medical
- In children: must be differentiated from other developmental CMD
- Ind adults: must be differentiated from apraxia of speech, language and/or cognitive deficits
16
Q
Dysarthria Types Definitions
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- Each type has an identifiable etiology corresponding to site of lesion
- Each had a characteristic pattern
- Each reflects a breakdown in the normally synchronous and coexisting subsystems of speech
17
Q
Flaccid Dysarthria
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Location: Lower motor neurons (LMN)
Primary Deficit: weakness
Common Cause: Myasthenia Gravis
18
Q
Spastic Dysarthria
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Location: Upper motor neurons (UMN)
Primary Deficit: spasticity
Common Cause: Unilateral Stroke
19
Q
Ataxic Dysarthria
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Location: cerebellar control circuit
Primary Deficit: incoordination
Common Cause: Fredrich’s Ataxia
20
Q
Hypokinetic Dysarthria
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Location: basal ganglia control circuit
Primary Deficit: rigidity and decreased ROM
Common Cause: Parkinson’s Disease
21
Q
Hyperkinetic Dysarthria
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Location: basal ganglia control circuit
Primary Deficit: involuntary movements
Common Cause: Huntington’s chorea
22
Q
Unilateral UMN
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Location: unilateral UMN
Primary Deficit: weakness, incoordination, spasticity
23
Q
Mixed Dysathria
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Location: more than one
Primary Deficit: more than one
Common Cause: ALS
24
Q
Apraxia Definition
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Disruption in the ability to voluntarily sequence complex movements accurately
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Two Types of Apraxia
- Nonverbal (Oral) Apraxia
| - Verbal Apraxia
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Nonverbal (Oral) Apraxia
Disruption in the sequencing of oral movements that are non-verbal (smiling, puckering the lips, protruding the tongue)
- May or may not coexist with apraxia of speech
- AKA: Bucco-Facial apraxia in adults
- ONLY in nonverbal tasks
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Nonverbal (Oral) Apraxia Characteristics
- Hesitations, groping and revisions are displayed when attempting to perform nonverbal movements
- Inability to coordinate and/or initiate movement of articulators on command such as:
- Stick out your tongue
- Whistle
- Kiss a baby
- Clear your throat
- Blow out the candle
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Apraxia of Speech Definition
Disruption in the sequencing of voluntary movements for speech production
- ONLY in speech production
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Apraxia of Speech Characteristics
- Errors of sequencing are displayed when saying multisyllabic words
- Errors include groping to position the articulators, transposition of syllables within a word and phoneme substitutions
- Automatic and emotional words are free of apraxic errors
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Apraxia in Children
- Impaired ability to execute voluntarily the expected motoric and programming gestures required for speech in the absence of a muscular disturbance of the speech mechanism
- Disability of VOLUNTARY motor programming and sequencing of speech movements
- AKA: Developmental Verbal Dyspraxia (DVD), Developmental Apraxia of Speech (DAS), and Childhood Apraxia of Speech (CAS)
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Apraxia in Adults (w/o CVA)
- Non-dysarthric, non-aphasic sensorimotor disorder of articulation and prosody
- Aphasia and dysarthria may coexist with apraxia but deficits in muscle strength and endurance do not account for specific errors
- Apraxic errors are inconsistent, trial and error responses are prevalent
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Apraxia Continuum
Mild: Individual articulatory gestures are largely preserved
Moderate: Automaticity of coarticulation will be impaired
Severe: Impairment of the ability to position the articulators time after time for speech production
- Severity determine by site of lesion (SOL)
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Approaches to Studying MSDs
- Psycholinguistic
- Neurological
- Social Constructionist
- Motor Control System
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Psycholinguistic Approach
- Does not concern itself with SOL
- Psychological processes that underlie speech processing
- Early stages of the model could be described as cognitive-linguistic
- Planning and programming are a relatively early component of speech processing
- Motor execution is at a later stage
- Apraxia = disorder of planning and programming
- Dysarthria = disorder of motor execution occurring at the later stages of motor speech processing
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Neurological Approach
- Verbal apraxic disturbances = higher level cerebral functioning
- Apraxia = lesions at the highest level of motor integration in the nervous system; in adults with apraxia are located in the left cerebral hemisphere
- Dysarthria = more peripheral; result of disturbances in the lower level motor integration in the nervous system
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Social Approach
- Associated with long-term conditions
- A model of the consequences of a chronic disorder is helpful in developing a clinical perspective
- The Social Model of Disability: developed by the disabled people based on their own experience
- Varying barriers
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Social Approach Definitions of Impairment vs. Disability
Impairment – is the functional limitation within the individual caused by physical mental or sensory impairment
Disability – is the loss or limitation of opportunities to take part in the “normal” life of the community on an equal level with others due to physical and social barriers
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Social Approach Nature of Barriers
- Information
- Peer Support
- Housing
- Technical Aids
- Personal Assistance
- Transportation and mobility
- Access
- May be additional barriers that apply to speakers with MSD
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Social Approach Time Barriers
- Not allowing enough time for the impaired person to express themselves
- In a meeting or classroom time needs to be scheduled to ensure that all participants are enabled to participate
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Social Approach Organizational Barriers
- Barriers to communicate would lead the patient to having un-equal access to service ex) being unable to communicate meal preferences
- A school or university should ensure that sufficient time can be allocated to facilitate equality and ease in communication
- Allowing time for fully listening
- Be prepared to use a variety of communication aids and/or techniques
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Social Approach Identity and Self-Expression Barriers
- Barriers to expressing one’s own sense of self development through interpersonal experiences
- A person’s sense of self is constructed through interactions with others- type of experiences had
- Dysarthric speech can often introduce an inequality in the interaction process, through its slow and unclear nature
- Typical speech can gain dominance in confrontational and non confrontational interaction- problems in group setting
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Social Approach Personal Experiences
- Deep internal frustration and this in turn would lead to terrible temper tantrums – becomes behavioral
- Communication is noise in public spaces
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Social Approach Effects of Working Lives
- Acceptance of AAC
| - Limitations regarding job performance – teaching, telephone work, etc.
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Motor Control Systems Approach
- Speech system is composed of sensory and motor regulators –monitoring system
- Cognition, language and neural representations are not the emphasis
- Theoretical basis from discussions that contrast the primate oral mechanism from the human oral mechanism.
- Reflexes, valves, oscillators combine to produce speech
- Different mechanisms control speech and vegetative movement
- Practice is necessary to activate the specialized neuronal connections that control fine motor speech movements
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Motor Control Systems Approach Tx Implications
- Based on how the regulators evolved for speech purposes
- Speech systems is viewed as a finite set of interconnected functional units capable of fine motor movement
- Movements are manifested by performance in strength, endurance, ROM and speech
- Goal of SLP: to evaluate the functional resources of each component of the speech system
- Critical points in the system were delineated
- Function at any point can be measured – the subsystems of speech
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4 Subsystems of Speech Production
- Respiratory: airflow
- Phonatory: vocal production and intonation
- Resonatory: vibration of the airflow
- Articulatory: manipulation of airflow
The muscles and muscle groups in these subsystems must be coordinated in time and space
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Respiratory System
- Speech production requires airflow
- Pulmonary airstream mechanism; pushes air out of lungs through trachea to produce airflow
- Ingressive: inhalation vs. Egressive: exhalation
- Exhalation cycle – needs to be extended in time (for completion of utterance) and modulation (to reflect stress/intonation)
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Phonatory System
- Includes various muscles and structures in the larynx, and regulates the production of voice and the intonational aspects of speech
- Vocal folds are brought closely together (adduction), and airflow builds up (subglottal pressure) to set the vocal folds into vibration (undulation)
- Vocal folds are stretched lengthwise to manipulate the frequency or pitch of the voice
(longer the cords higher the pitch)
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Resonatory System
- Regulates the vibration of the airflow as it moves from the pharynx into the oral and nasal cavity
- Manipulates shape and size of vocal tract for maintaining normal sound quality
- Manipulates the velopharyngeal port, (whether nasal cavity is used as a vibrating chamber) for determining nasality of sounds ex) oral vs. nasal sounds - /b/ and /p/ vs. /m/ and /n/
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Articulatory System
- Control the articulators within the oral cavity to manipulate the outgoing airflow
- Major structures: lower jaw, lips, tongue (most important)
- Tongue:
- intrinsic muscles (fine-tuned movements)
- extrinsic muscles (coarse movements)
- Protrusion, retraction, elevation and depression
- Muscles contract to create constrictions in the oral cavity to produce varying sounds
51
MSD Measurement Methods
- Perceptual measures: judgments of intelligibility, accuracy and speech production (most common)
- Acoustic measures: visual representation of speech sound wave (spectrogram) for more detailed and objective view of speech problems
- Physiologic measures – measurement of physiologic aspects of speech motor system not easily perceived otherwise (muscle strength)
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The Nervous System
CNS:
- includes brain and spinal cord
- center of integration and control
PNS:
- nervous system outside of CNS
- includes 12 pairs of cranial nerves (CN) and 31 pairs of spinal nerves (SN)
- CN carry info to and from the brain
- SN carry to and from the spinal cord
Brain = roots
Spine = trunk
CNS + PNS = branches
53
The Brain
Most complex part of the nervous system, where all activity originates or is ultimately processed
- Composed of: wrinkled, pinkish gray tissue
- Surface anatomy includes:
- Cerebrum: cerebral hemispheres
- Cerebellum
- Brain Stem
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Cerebrum
- Largest, most conspicuous portion
of the brain.
- 2 hemispheres connected by the corpus collosum
- Outer cortex of gray matter
- Interior that is mostly white matter, except for a few islands of grey matter
- Surface is marked by ridges called gyri and separated by grooves called sulci
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Cerebral Cortex
- Made of superficial gray matter; accounts for 40% of the mass of the brain
- Consists of neuron cell bodies, dendrites, unmyelinated axons, no fiber tracts
- Conscious mind
- Enables sensation, communication, memory, understanding and voluntary movements
- Hemispheres are not equal in function
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Lobes of Cerebrum
- Four lobes: frontal lobe, parietal lobe, temporal lobe and occipital lobe; divided by deep sulci
- Central sulcus: separates the frontal and parietal lobes
- Precentral gyrus: primary motor area
- Postcentral gyrus: primary somatosensory area
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3 Types of Functional Areas of Cerebral Cortex
- Motor Areas: control voluntary movement
- Sensory Areas: conscious awareness of sensation
- Association Areas: integrate diverse information, bring info to major areas to be processed and responded to.
