Anatomy Exam 2

articulation

totality of motor processes involved in the planning and execution of sequences of overlapping gestures that result in speech (all the pieces that come into play to make speech happen)

point of union between two structures

how does source-filter apply to articulation

source is the voice, filter is the manner/place

importance of proprioception in therapy for articulation

sensory receptors in the muscles, joints, and tendons send messages to the brain; head control and trunk control

what needs to develop prior to being able to articulate

reflexes, vestibular development, motor development, extension, trunk/neck stability, CV structures

Why are theories important (articulation)

involves emotions, language and cognition, motor speech

impact of dentition problems on articulation, mastication, and deglutition

trauma to teeth, cleft lip

impact of lips and palate problems on articulation, mastication, and deglutition

trauma to the lips, congenital lip issues, congenital palate issues, velopharyngeal insufficiency

impact of tongue problems on articulation, mastication, and deglutition

trauma to the tongue, oral disease, developmental tongue issues, cancer

impact of mandible or maxilla problems on articulation, mastication, and deglutition

retrognathia, prognathic mandible, trauma to the maxilla or mandible

impact of neurogenic problems on articulation, mastication, and deglutition

CVA, Parkinson's, cerebellar damage

lips (obicularis oris)

creates a labial seal, upper and lower lips, highly adaptable

jaw (mandible)

assists lips and tongue, changes position, opens, tightly closes

tongue

super strong, sensory make up, extremely sensitive, extrinsic and intrinsic muscles

velum

fast mover, closed (contracted levator veli palatini), open (relaxation of levator veli palatini), nasal assimilation

what is mastication

chewing

what is deglutition

swallowing

what is a bolus

ball of food

how many swallow stages are there

4

what procedures do we use to evaluate the swallow

swallow video test (MBSS or FEES)

MBSS (Modified Barium Swallow Study)

videofluoroscopic recording of swallowing

FEES (Fiberoptic Endoscopic Evaluation of Swallowing)

use of fiberoptic camera to view swallowing nasoendoscopy

changes in infant swallow pattern: 0-6 months

primitive basic reflexes; rooting and sucking reflex

changes in infant swallow pattern: (4) - 6 months

voluntary; sucking action

changes in infant swallow pattern: 10+ months

teeth erupt and the sucking action changes again

infant anatomy for swallowing

fat pads in the cheeks narrow the oral cavity laterally, tongue fills the oral cavity, hyoid and larynx much higher in the neck, velum hangs lower, uvula rests inside epiglottis forming a pocket in valleculae

infant physiology for swallowing: oral phase

reflexive sucking, no foods yet

infant physiology for swallowing: pharyngeal phase

less laryngeal elevation, more pharyngeal wall movement

changes in anatomy from infancy to adulthood

jaw grows down and forward, tongue descends and oral cavity enlarges, pharynx enlarges, larynx and hyoid develop, most enlargement occurs during puberty

What is laryngomalacia

tissues in the voice box (larynx) are floppy and collapse into the airway during inhalation, causing noisy breathing called stridor

Oral Stage I: Oral Preparation

voluntary; begins as soon as food or liquid enters the mouth and stops just before the bolus is formed; muscles of mastication (masseter, temporalis, pterygoid) to move the jaw, tongue pushes food to molar surfaces and mixes it with saliva to form bolus

Oral Stage II: Oral Transit

voluntary or involuntary; starts when the bolus is formed and propelled toward the faucial pillars and stops before the bolus is moved to the cricopharyngeus; tongue elevates forming a ramp, mastication and breathing stops

Stage III: Pharyngeal Stage

reflexive (involuntary); starts when the bolus is moved from the faucial pillars to the cricopharyngeus and stops when bolus enters the esophagus; fast and rhythmic, central pattern generators control this phase

Stage IV: Esophageal Stage

reflexive (involuntary); starts at the cricopharyngeus and ends at the stomach; peristaltic muscle contractions, gravity assist, 10-20 second transit time

What happens to our swallow as we age: anatomy

teeth loss and decay, muscle deterioration, mucosa deterioration

What happens to our swallow as we age: physiology

oral: more/longer chewing, dentures

Pharyngeal: larynx/hyoid don't elevate as well

esophageal: delayed emptying of the esophagus, feeling of fullness/food stuck

function of outer ear

collector of sound energy, helps with localization, resonating cavity

function of middle ear

increase pressure and match impedance

function of the inner ear

hearing and balance

energy change in the ear

starts as acoustic energy and is transformed into electrochemical energy

where are the acoustic sounds waves transformed to mechanical energy

middle ear; sound waves enter ear and cause eardrum to vibrate, vibrations amplified by the ossicles

where is mechanical energy transformed to electrochemical energy

inner ear; vibrations from the stapes cause the fluid in the cochlea to move, which sends impulses to the brain through the OHC's

Inner ear is made of

cochlea and the vestibular system (semicircular canals and vestibule)

Where is the inner ear fluid made

epithelial lining of the bony labyrinth (endolymph)

otitis media

fluid in the middle ear, ET doesn't drain middle ear effectively, ME becomes anaerobic, pressure in ME doesn't equalize (creates negative pressure)

mastoiditis

inflammation of the mastoid bone by bacteria from the ET; unilateral deafness, brain infections, death

otitis externa (swimmer's ear)

inflammation of the skin of the external ear, edema from bacterial infection, facial paralysis, hearing loss

CNS

brain and spinal cord

PNS

cranial and spinal nerves

Types of synapses

axo-dendritic, axo-somatic, axo-axonic, dendro-dendritic

Myelin sheath purpose

insulation surrounding axons that promotes impulse; speeds up process

myelin sheath: CNS

Oligodendrocytes

myelin sheath: PNS

Schwann cells

Is regeneration possible for nerves in CNS or nerves in PNS?

PNS

Purpose of the meninges

protect the brain and spinal cord

layers of the meninges

dura, arachnoid, pia

parietal lobe

touch, taste, temperature (sensory/space)

occipital lobe

vision

cerebellum

balance and coordination

brainstem

breathing, heart rate, blood pressure

frontal lobe

"executive" functions (motor, intention)

temporal lobe

hearing, memory, language

prosencephalon

forebrain

prosencephalon turns into...

telencephalon and diencephalon

mesencephalon

midbrain

Rhombencephalon

hindbrian

Rhombencephalon turns into...

metencephalon and myelencephalon

gyri

bumps

sulci

grooves

cortex

outermost layer of the cerebral hemispheres

gray matter

cell bodies

white matter

axons

Diencephalon

superior to the brainstem

diencephalon: thalamus

sensory and motor integration

diencephalon: hypothalamus

body temperature, emotions, hunger, thirst, circadian rhythms

diencephalon: basal ganglia

motor movement; caudate, putamen, globus pallidus

Importance of brainstem in swallowing and sleep/wake

breathing, heart rate, and blood pressure which are all important parts of sleep/wake; regulation

Purpose/function of ventricular system

protection for brain and spinal cord, nutrition, waste removal, pressure regulation

Purpose of arterial system

supply blood to the brain

purpose of the Circle of Willis

connect all the arterial blood supplies together

purpose of the anterior supply (Internal carotid arteries)

supply blood to the front and sides of the brain

purpose of the posterior supply (vertebral arteries)

supply blood to the back of the brain

CN I

olfactory (smell), sensory

CN II

optic; sensory; vision

CN III

oculomotor; eye movement; motor

CN IV

trochlear; eye movement; motor

CN V

trigeminal; motor and sensory; muscles of mastication, head and neck

CN VI

abducens; eye movement; motor

CN VII

facial; motor and sensory; facial expression, taste, sensory for eaer

CN VIII

vestibulocochlear; sensory; hearing, balance, and equilibrium

CN IX

glossopharyngeal; motor and sensory; swallowing, blood pressure, taste

CN X

vagus; motor and sensory; swallowing, regulation, taste

CN XI

spinal/accessory; motor; elevates shoulders, turns head

CN XII

hypoglossal; motor; movement of the tongue

most important cranial nerves for speech and swallowing

Trigeminal (V), Facial (VII), Glossopharyngeal (IX), Vagus (X), Accessory (XI), and Hypoglossal (XII)

aphasia is a disorder of...

language

what broad area of brain damage might cause aphasia

left temporal lobe, specifically Broca's and Wernicke's areas

motor speech disorders

dysarthria and apraxia

dysarthria

problems with neuromuscular execution (primary motor strip); Damage to CNS and/or PNS; Speech problems result from paralysis, weakness, incoordination, sensory loss, etc. of speech musculature

Verbal paraphasias example

fork for spoon, pen for pencil, etc.

jargon

new made-up words