Neurology Competency Exam Study Guide

Be familiar with Broca’s area, especially its functions

o   Left frontal lobe

o   Responsible for motor programming or planning for speech production

o   Plans the message and sends it to the primary motor cortex

o   This area does not tell muscles of articulation to contract

• Broca’s aphasia

Be familiar with Wernicke’s area, especially its functions

o   Housed in left temporal lobe

o   2 functions –

• Responsible for comprehension of spoken lang

• Responsible for formulation of linguistic thought

o   It thinks of the message a person wants to say

o   An association area, meaning it allows for the interpretation of what a person has heard

Be familiar with the function of the lower motor neuron (LMN) system and what structures comprise/make up it

o   Lower Motor Neuron – 2^nd neurons, last link in neural pathway, leads to skeletal muscle contractions

o   Originates in the brainstem or spinal cord and travels out as a CN or SN to innervate skeletal muscles (only motor)

o   Forms the somatic motor part of the NS

• All 31 SN and CN that have a motor part (except I and II)

o   Terminate into the muscles that they innervate

o   Responsible for all movement

o   Signal for all voluntary muscle contraction, will begin in the brain

o   Damage to the LMN can produce flaccid dysarthria (motor speech disorder, perceived as slurred speech)

o   Also –

• Loss of reflexes (hyporeflexes)

• Loss of muscle tone (flaccidity or hypotoncity)

• Fasiculations/involuntary twitches in the muscles

• Weakness/paresis (more profound when it occurs in the LMN)

o   3 categories – alpha, beta, and gamma

o   Skeletal muscles are made up of 2 fibers – extrafusal and intrafusal

• Extrafusal – direct motor system (alpha)

• Intrafusal – indirect motor system (gamma)

Be familiar with the cerebellum, especially its functions

o   Base of brain

o   Posterior to the brainstem

o   Very important in motor control

o   2 hemispheres

o   Functions –

• Smooth movement and speech

• Overall tone and truncal

• Posture, balance, and coordination

• Regulates force and timing of movements

o   Lobes –

• Anterior – processes proprioceptive info and regulates posture

• Posterior – coordination muscles movement by inhibiting involuntary movement, imp in fine motor coordination

• Flocculonodular – maintains equilibrium

• Vermis – regulates muscle tone

Be familiar with the brainstem, especially its functions

o   At the base of the brain

o   Articulates with spinal cord so it can control the flow of neural impulses between the brain and the body

o   Responsible for like-sustaining functions

o   All CN nuclei are here expect for I and II

o   3 parts –

• Medulla oblongata

·      Most inferior

·      Damage here is life-altering/ending

·      Regulates all life-sustaining functions

·      Also responsible for reflexes like vomiting, sneezing, and coughing

• Pons

·      Bridge for MO and M

·      Respiration pneumotaxic center (controls the amount of air that’s breathed and the number of breaths per minute)

• Midbrain

·      Most superior

·      Relay center for visual, auditory, and motor system info

·      Regulates functions like digestion, heart rate, and blood rate

Be familiar with the primary motor cortex, especially its functions

o   Housed in the precentral sulcus in the frontal lobes

o   Tells skeletal muscles to contract

Be familiar with middle cerebral artery, especially its functions

o   MCA

o   Extremely important to an SLP

o   It supplies blood to all of the areas devoted to lang in the left hemisphere of the brain

o   Stroke in the left MCA would result in speech problems

o   Supplies part of the FL and lateral surfaces of the TL and PL, including primary motor cortex and all areas devoted to speech and lang and sensory areas of face and throat region and hand and arm

o   Most common pathologically affected artery in the brain

o   Has the largest branch of the internal carotid artery

o   Left side → largest and most affected by strokes

Be familiar with the circle of Willis, especially its functions

o   Forms a circle of communicating arteries on the ventral side

o   Willis forms connections b/w the anterior and posterior cerebral circulations (provides a backup system)

o   When there is an occlusion in an artery, Willis can redirect blood flow to another artery and can maintain adequate perfusion to the brain

o   Plays a passive role

o   Reducing the impact of blood flow reduction

Be familiar with the anterior communicating artery, especially its functions

o   Anterior cerebral artery gives rise to the anterior communicating artery

o   Connects the anterior cerebral arteries along the floor of the cerebral vault

o   Primarily supplies the midline regions of the frontal lobes, prefrontal cortex and the anterior portion of the parietal lobes

o   Very common site for an aneurysm to occur

Be familiar with the relationship between hand dominance and dominance of hemispheres in the brain

o   Right-handed = left hemisphere

o   Left-handed = left for most, but right for some, % is not fully known

Be familiar with the roles of each cerebral hemisphere for language

o   Frontal – primary motor cortex, prefrontal cortex, Broca’s area (planning)

o   Parietal – primary somatosensory area, angular gyrus, supramarginal gyrus (sensory information)

o   Temporal – Heschl’s gyrus, Wernicke’s Area, fusiform (comprehension)

o   Occipital – visual processing areas (visual)

Be familiar with Heschl's gyrus and angular gyrus

o   H’s is housed in the left temporal lobe and makes a person aware they have heard something, it is a primary area also called the primary auditory cortex

o   A’s regulates reading and math skills in the left hemisphere (parietal lobe)

• Reading – visual word form processing

Be familiar with the executive functions of the frontal lobe

o   Higher-level cognitive functions that mediate lang function and operate in the background

o   Things like –

• Memory and attention

• Impulse control

• Selective attention

• Planning and organization

• Reasoning and judgement

• Ability to consider pros and cons and outcomes

• Ability to predict

• Mental flexibility

• Knowledge of social rules

• Problem solving

• Set shifting