ALL MSD CARDS

what is communication?

sending and receiving information

what is language?

a rule governed communication system

what is speech?

production or execution that is made up of phonetics

what are the five domains of speech?

respiration, phonation, resonance, articulation, prosody

what is respiration?

— needing to take in the right amount of air and coordinating it to produce a word

— lungs and diaphragm

what is phonation?

— vibration of vocal folds

— pharynx

what is resonance

— ensuring nasal cavity is closed off so words are produced orally (adding nasal opening when appropriate for nasal sounds)

— oral and nasal cavities

what is articulation

— getting the phonemes correct

— oral cavity

what is prosody

— emotion that we can express

— involves multiple subsystems

speech production is …

complex

the domains of speech are related to what?

subsystems

what are the subsystems of speech production?

respiratory, phonatory, resonatory, articulatory, prosody

what does it take to speak?

cognitive-linguistic (intent and understanding), motor speech, programming and control, and neuromuscular execution

motor programming is …

how am I going to coordinate things so I can speak

execution is …

actually implementing the plan

what are the impairments in the respiration domain of speech?

slow, restricted, weak, or uncoordinated muscle activity used in breathing for speech

what are the impairments in the phonation domain of speech?

sound production at the level of the pharynx

what are the impairments in the resonance domain of speech?

dampening or amplifying sound by changing the size, shape, and/or number of cavities

what are the impairments in the articulation domain of speech?

movement of speech structures employed in producing the sounds of speech

what are the impairments in the prosody domain of speech?

varying intonation, stress, and rhythm during speech

what are the two general motor speech disorders?

— dysarthria

— apraxia of speech

what is motor planning?

the process that define and sequence articulatory goals (prior to initiation of movement)

what is motor programming?

processes that establish and prepare the flow of motor information across muscles, as well as control timing and force of movement (prior to initiation of movement)

what is disordered motor planning/programming?

inability to group and sequence relevant muscles with respect to each other

what is the motor speech disorder that is associated with disordered motor planning/programming?

apraxia of speech (AOS)

what is motor execution?

processes that activate relevant muscles (during and after initiation of movement)

what is disordered motor execution?

deficits in physiology and movement abilities of muscles

what is the motor speech disorder that is associated with disordered motor execution?

dysarthria

what does acquired mean?

— damage to a previously intact nervous system

— speech production was already established

what does developmental mean?

— abnormal development of or damage to a developing nervous system

what is the definition of dysarthria?

a group of speech disorders resulting from disturbances in muscular control (weakness, slowness, or incoordination) of the speech mechanism

what is dysarthria caused by?

damage to the central or peripheral nervous system or both

what is the definition of apraxia of speech?

impaired capacity to plan or program sensorimotor commands necessary for directing movements that results in phonetically and prosodically normal speech

how is movement affected?

range of motion, accuracy, tone, strength, speed, steadiness (RATSSS)

what are the symptoms of dysarthria?

-abnormal speech rhythm

-articulation inaccuracies

-audible breathing

-reduced breath support for speech

-limited jaw movement

-limited tongue movement

-loudness inconsistencies/reduction

-nasal resonance changes

-rapid or slow speech rate

-slurred speech

-speech quality changes

what are the 6 types of dysarthria?

— flaccid

— spastic

— ataxic

— hypokinetic

— hyperkinetic

— unilateral upper motor neuron

what are the complications of motor speech disorders?

— communication problems

— social difficulty

— depression (quality of life)

how do we study/assess/evaluate dysarthria?

— perceptual methods

— instrumental methods

what are the 3 types of instrumental methods used?

— acoustic

— physiologic/kinematic

— visual imaging

which assessment method is considered the gold standard?

perceptual methods

what are the issues with audio-perceptual methods?

— subject to unreliability of judgements among clinicians

— may be difficult to agree on severity

— cannot directly test hypotheses about the pathophysiology underlying the perceived speech abnormalities

what is intelligibility?

information that is exclusively learned from the speech signal alone

what is comprehensibility?

information that comes from the speech signal plus context

what are the variables related to speech disorders?

— speech components involved

— severity

— perceptual characteristics

what are the variables related to neurologic and etiologic perspectives?

— age of onset

— cause

— course

— site of lesion

— neurologic diagnosis

— pathophysiology

what are the elements that make up the motor speech system?

-final common pathway

-direct activation pathway

-indirect activation pathway

-control circuits

-conceptual-programming level

when planning and programming happens, where does it send information?

to the direct and indirect activation pathways

where do the direct and indirect pathways send information?

to the final common pathway

what is the role of the sensory system in speech production?

allows the body to sense when something if off and make adjustments

direct and indirect pathways lead to the…

final common pathway

what is another name for the final common pathway?

lower motor neurons

what happens in the final common pathway?

the motor commands originate in the cortex then travel through the CNS or UMN system then synapse with LMNs then PNS carries messages to muscles

what are the two types of nerves that make up the lower motor neuron system (LMNs)?

-cranial nerves

-spinal nerves

what are the cranial nerves?

an axon that leaves the brainstem and becomes a LMN

what are the spinal nerves?

an axon that leaves the spinal cord and becomes a LMN

what is the purpose of the LMN?

to control muscless and control their movement

what are the two types of neurons that make up the LMN system

-alpha motor neurons

-gamma motor neurons

what is every muscle innervated by?

by both alpha and gamma motor neurons

what is the way the motor system communicates with the muscles?

through the motor neuron

what happens if there is damage to the LMN?

muscle is unable to move

neurons are composed of…

-cell body

-dendrites

-axons

sensory (afferent) neurons

send information from sensory receptors toward the central nervous system

motor (efferent) neurons

send information away from the central nervous system to muscles or glands

interneurons

send information between sensory neurons and motor neurons

these muscles are striated

skeletal muscles

flexion

contraction of a flexor muscle draws a limb in

extension

contraction of an extensor muscle moves the limb outward

alpha motor neurons

-do a lot of the work

-originate in cranial nerve nuclei in the brainstem and in spinal nerve nuclei in the spinal column

— axon is located inside cranial and spinal nerve

— innervate skeletal muscle and cause the muscle contraction that generate movement

— innervate the extrafusal fibers of skeletal muscles

• large majority of muscle fibers that allow the muscle to do the work

— contract muscle fibers

• very important in terms of muscle contraction

gamma motor neurons

-same origin, destination, and location as alpha motor neurons

-smaller size, fewer in numbers

-innervate the intrafusal fibers of skeletal muscles

contract muscle spindles (slight movement)

-help keep muscles ready

-involved in maintaining muscle tone

what happens if there is damage to a single alpha motor neuron?

weakness or paresis

what happens if a muscle loses all input from it's LMNs?

paralysis

atrophy

muscles lose their bulk

fasciculations

brief, localized twitches

fibrillations

-can’t be seen

-slow, repetitive action potentials which cause regular contractions

damage to the LMN system results in which dysarthria?

flaccid dysarthria

is the direct pathway (pyramidal tract/system) voluntary or involuntary?

voluntary

is the indirect pathway (extrapyramidal tract/system) voluntary or involuntary?

involuntary

in the direct pathway, when do axons synapse with other cells?

when they reach their final destination (cortex to final common pathway)

the direct pathway is crucial to what?

voluntary movement activity (conscious, controlled, skilled, discrete, and rapid voluntary movement)

the direct pathway is also called the?

the pyramidal tract

the direct pathway can be divided into…

-corticobulbar tract

-corticospinal tract

corticospinal tract

-spinal nerves

-starts in cerebral cortex and connects LMNs for voluntary movement

-primary motor cortex and premotor cortex (in each hemisphere)

corticobulbar tract

-cranial nerves

-starts in cerebral cortex and connects with motor nuclei of cranial nerves

-UMN generally innervate LMN on the opposite side of the body

-speech cranial nerves are mostly bilaterally innervated, except for the protrusion of the tongue and the lower face

what is the function of the primary motor cortex?

controls individual (or sequences of) movement that require activity of multiple muscle groups

what is the function of the premotor cortex

-selection of motor plans for voluntary movement

-sends axons to primary motor cortex and spinal cord

what is the function for the supplementary motor area?

-involved in programming complex sequences of movements and coordinating bilateral movements

-selects movements based off remembering sequences of movements

-active during mental rehearsal

each hemisphere’s UMN pathway innervate LMN on the _______ side of the body

contralateral

left hemisphere controls the _________

right side of the body

right hemisphere controls the _______

left side of the body

what does damage to the direct activation pathway cause?

weakness and loss or reduction of skilled movements

what are the components of the indirect activation pathway?

basal ganglia, red nucleus, substantia nigra, reticular formation, cerebellum

what is another name for the indirect activation pathway?

exrtrapyramidal tract

what is the function of the indirect activation pathway?

-involved in automatic motor movements, gross (not fine) movements

-works with the autonomic nervous system to help with posture and muscle tone

what are lesions to the indirect activation pathway called?

UMN lesions

what do lesions to the indirect activation pathway do?

affect muscle tone and reflexes, spasticity, and hyperreflexia

what happens if a lesion in the indirect activation pathway is unilateral?

-can cause mild spasticity in speech, slow movement, or hyperadduction of the vocal folds during phonation

-can result in UUMN

what does UUMN mean?

unilateral upper motor neuron dysarthria

what happens if a lesion in the indirect activation pathway is bilateral?

-impact can be mild to severe spasticity in speech, slow movement, hyperadduction of the vocal folds during speech

-can cause spastic dysarthria

what makes up the control circuits?

basal ganglia and cerebellum

what tract do the control circuits belong?

extrapyramidal tract