Neuro Ch 9-12 test

conceptual level

deciding to communicate

linguistic planning

encoding what is to be communicated (left perisylvian cortex)

motor planning

creating the phoneme blueprint for what will be said (premotor cortex and SMA)

motor programming

execution of plans across time and space (cerebellum, BG, Broca’s/SMA)

motor control circuits

used for motor programming by coordinating, integrating, and refining movements; associated with indirect pathway and extrapyramidal system (BG and cerebellum)

direct motor pathway

aka pyramidal; include CB and CS; voluntary movements

indirect motor pathway

thalamic and extrapyramidal systems; influence posture, muscle tone, reflexes, coordination, and modulation of movements; made of many short tracts; stops along the way include BG, cerebellum, and thalamus

damage to extrapyramidal system results in…

dyskinesias

final common pathways

CNs and SNs involved in all speech subsystems

apraxia of speech def

impaired ability to order positioning and sequencing of speech musculature for production of phonemes and sequences of phonemes

SOL for AOS

broca’s, SMA, insula, or BG

AOS affects ___, ____, and ____ of articulators

timing, rate, ROM

11 salient features of AOS

• inconsistent erros

• artic groping

• pockets of correct speech

• pts aware of errors

• better automatic speech

• fewer errors w/ multi-modal presentation

• normal reflexive phonation and VFs

• more substitution errors

• more errors in imitation

• more errors in place than manner or voice

• more errors in back sounds

AOS vs. dysarthria

• AOS no problem with non-speech functions

• speaking contexts affect AOS

BG connects…

cortex and thalamus

What does BG do?

refines tone and posture, smoothes/refines muscle contractions, and dials down motor signals from cortex

4 BG pathologies

parkinson, huntington, tic disorders, dystonias

what does the cerebellum do?

coordinates and integrates sensory feedback for the purpose of performing skilled, sequential motor movements

8 ataxic dysarthria signs

• timing is off

• irregular artic breakdowns and AMRs

• excess and equal stress

• distorted vowels

• pronlonged phonemes

• harsh voice

• monopitch

• imprecise consonants

• sound drunk

What pathways do UMNs contain?

direct and indirect

UMN damage (6)

• spasticity d/t hypertonia

• signs contra to SOL

• clonus

• Babinski present

• reflex arc intact

• hyperreflexia

LMN damage (7)

• flaccidity d/t hypotonia

• signs ipsi to SOL

• atrophy and fasciculations

• toes do nothing in response to stimulus

• reflex arc damaged

• hyporeflexia

• areflexia

hypokinetic dysarthria signs (6)

• Parkinson

• imprecise consonants

• low volume

• monopitch

• reduced syllable stress

• slow speaking rate

hyperkinetic dysarthria signs (7)

• Huntington

• harsh voice

• monopitch

• loud volume

• imprecise consonants

• poor coordination of resp and phon

• intrusive motor movements affecting all subsystems of speech

____ controls respiration

brainstem (medulla and pons)

LMNs forming phrenic nerve

C3-C5

LMNs innervating accessory muscles for breathing

T2-T11

RLN

motor for all intrinsic laryngeal muscles except cricothyroid

SLN

motor for cricothyroid

CN VII bilateral representation

• upper part of face represented bilaterally in cortex

• lower face ipsi/uni

• uni UMN lesions - contra on bottom half of face

• bi UMN lesions - more devastating affect on speech

• uni LMN - full facial paralysis ipsi and uni

CN IX role in phonation

elevates and opens pharynx; sens for gag

how to tell if CN XII damage is ipsi or contra

look for fasciculations and atrophy

mixed dysarthria common in ALS

flaccid/spastic

mixed dysarthria common in MS

spastic/ataxic

dorsal column

medial leminscal (sens) pathway

ascending dorsal column contains 2 fasciculi (bundles) - gracilis and cuneatus fasciculi

fine touch, proprioception, vibration

spinothalamic tract

primary sens route for pain, temp, pressure, and crude touch

spinocerebellar tract

terminates in cerebellum and relays proprioceptive info from arms, legs, and trunk

consciousness

awareness of self and surroundings

is consciousness subjective or objective?

both

core consciousness

sense of self and objects in the here and now (and sense of the relationships b/w ourselves and objects)

extended consciousness

sense of self in the flow of time (past and future)

extended consciousness AKA

autobiographical self

extended consciousness depends on

long-term memory and core consciousness

What structures are involved in being awake and aware?

reticular formation

what does reticular mean?

like a web

what is the reticular formation?

4 groups of specialized nuclei in the core of the brainstem in the tegmentum that activate 5 diff NTs

Which two NTs work together to keep you awake?

glutatmate (stimulates cortical wakefulness) and Acetylcholine (hinders sleep)

damage to reticular formation leads to…

coma and other disorders of consciousness

reticular formation acts thru

ascending reticular activating system

reticular activating system projects to..

cerebral cortex

reticular activating system functions:

• cortical arousal

• cortical wakefulness

• consciousness

glasgow coma scale

15 point scale that measures a person’s level of consciousness at a point in time

(higher number is less severe, lower number is more severe)

3 domains the glasgow coma scale measures

• eye opening

• verbal response

• motor response

rancho levels of cognitive functioning

8-level scale that tracks a persons’s emergence from coma

Level 1 - lowest; level 8 - highest

comatose pts generally die or move to another stage within _______.

3 weeks

levels of consciousness/stages of emergence determined by

• responsivity to stimuli

• presence of sleep-wake cycle

• quality of EEG pattern

minimally conscious state

severely altered consciousness but demonstrates minimal behavioral evidence that they’re aware of themselves and their environment

MCS characterized by…

• periods of wakefulness and core consciousness

• GCS score of 12 or 13

• have brainstem reflexes and sleep-wake cycle

MCS must who 1+ of the following

• follow simple commands (may be inconsistent)

• respond with gestures or yes/no answers (may be inaccurate)

• speak intelligibly at times

• demonstrate purposeful behavior

coma

• do not respond to stimuli

• have brainstem reflexes

• no sleep-wake cycle

• depressed EEG cycles

PVS

• “wakeful unawareness”

• do not respond to stimuli

• no core or extended consciousness

• have brainstem reflexes

• HAVE sleep-wake cycle

• depressed EEG cycles

diff b/w coma and PVS

PVS pts have sleep-wake cycle

brain death

irreversible cessation of clinical function of brain

• no activity on EEG

• absent core and extended consciousness

3 stages of coma

1. event that caused acute brain injury

2. coma

3. change after 3 weeks

Changes after 3 weeks in order of high cog impairment to no cog impairment

• brain death

• chronic coma

• PVS

• MCS

• LIS (Locked in)

disorders of impaired wakefulness and core consciousness

• general anesthesia

• coma

• deep sleep

disorders w persistent wakefulness but impaired core consciousness

• PVS

• akinetic mutism

• some forms of epilepsy

disorders w persistent wakefulness and core consciousness but impaired extended consciousness

• global amnesia

• alzheimers

dementia effect on consciousness

extended consciousness (loss of auto. self), but core consciousness also affected in later stages

aphasia’s effect on consciousness

none

epilepsy effect on consciousness

core and extended consciousness imparied during and after seizure

coma stimulation tx

systematic applicatin of stimulation to pt’s 5 senses to speed emergence from coma (SLP)

auditory brainstem response

objective test of hearing; measure electrical activity in aud. pathway as sound is introduced (Aud)

apraxia SOL can be in

• brocas

• insula

• BG

• SMA

• premotor cortex

in a sentence with a complicated syntactical structure, which area of brain is crucial to deducing meaning?

broca’s

what contains photoreceptors?

retina

Perisylvian area around

lateral fissure

damage to perisylvian area causes

lang problems, esp in L hemisphere

4 modalities of lang

• verbal formulation

• written expression

• reading comp

• aud comp

5 Steps of Aud comp

1. ear converts energy into electrochemical energy and transmits it from cochlea to cochlear nuclear complex in brainstem via CN VII

2. CNC sends it to thalamus

3. thalamus sends it to primary aud cortex for signal processing

4. PAC sends it to wernickes for meaning attachment

5. wernickes sends it to brocas for higher level syntax processing via arcuate fasciculus and long. fasciculus

Steps to visual comp

1. eyes project info to thalamus via optic tracts

2. thalamus projects to visual cortex

3. visual areas project ventral and dorsal streams of vision to reading systems

ventral stream

what stream

dorsal stream

where stream

iris

smooth muscle that contracts and dilates to let light in pupil

retina

in back; contains cones and rods (sens receptors) that transduce light into neural impulses that transmit along optic nerve to optic chiasm

___ retinas receive info from ___ visual fields

both, both

diff bw temporal and nasal fields of vision

nasal fibers cross at chiasm and temporal don’t

where do optic tracts begin, and what do they do?

begin at chiasm and most conduct to lateral geniculate nucleus of thalamus, while the rest goes to tectum at brainstem

where does visual info land?

contra primary visual cortex

3 cortical systems involved in reading patterns

1. parietotemporal

2. occipitotemporal

3. anterior reading

parietotemporal system

• decodes at phoneme level

• understanding spoken and written lang

occipitotemporal system

• visual word-form area (sight reading)

• converts graphemes to phonemes (sound it out)

anterior reading system

decoding spoken syntax, low freq words, silent reading

4 steps to oral production

1. decision to speak formed in prefrontal cortex

2. decision sent to brocas for lang encoding and speech planning

3. speech plans sent to SMA, which activates plans

4. SMA sends to primary motor cortex, which sends to speech muscles

is broca’s all that’s necessary for expression?

no, connected regions must be intact

LIFC stands for and used for

left inferior frontal cortex; many connected areas for lang production

5 steps to written expression

1. decision to write formed in prefrontal cortex

2. sent to brocas for lang encoding

3. writing plans sent to premotor cortex Exner’s area, which forms grapheme motor plans

4. premotor cortex sends to motor cortex, which sends to hand muscles

5. somatosensory association cortex aids in visual and spatial elements

anomia

inability to name

jargon

word salad

neologism

new word