SLP Praxis Review

Speech-Language Pathology Praxis Review

This study set was adapted from the user Anetz's practice set. She stated the following:

"This study set has at least 500 cards gleaned from as many SLP Praxis sets available on Quizlet as of August 2016. Then I added more as I studied various practice Praxis tests. Feel free to import this set into your own account so you can change personalize it.

This comes with no guarantees that it is 100% accurate! Check everything, and good luck!

Btw, I did pass the praxis."

As I have been studying, I have been confirming the information and insuring all information from the Advanced Review of Speech-Language Pathology Fourth Edition has been included. Subject areas that have been confirmed will include a "confirmed" in the subject heading.

NEUROANATOMY AND NEUROPHYSIOLOGY: THE NERVOUS SYSTEM (pg. 25-56)

NEUROANATOMY AND NEUROPHYSIOLOGY: THE NERVOUS SYSTEM- confirmed

Efferent/afferent neurons

transmit info away from brain (motor)/bring info to brain (sensory)

Nerve cells endings

Dendrites - receive signals

Axons - send signal on

Microglia

Scavengers to remove dead cells and other waste in brain

Autonomic nervous system

Components:

Sympathetic nervous system

Parasympathetic nervous system

Sympathetic nervous system

Activates fight or flight response

Parasympathetic nervous system

Returns body to state of relaxation

Pyramidal system vs Extrapyramidal

P: direct motor activation pathway, voluntary movement, directly signals nerve cells in spine or brainstem (fast, skilled, conscious movements)

E: maintains posture and tone for voluntary movements, indirectly regulates LMN movement activity (slow, postural, reflexive movements)

Damage results in involuntary and bizarre movement disorders; indirectly regulates nerve cells in spine or brainstem

Both are motor pathways. E is called that to distinguish it from the pyramidal system that reaches target locations by traveling through the 'pyramids' of the medulla.

Extrapyramidal composition

Subcortical nuclei: red nucleus, substantia nigra, subthalamus, basal ganglia, and their pathways

Pyramidal system componenets

Projection fibers from cortex divide into:

Corticobulbar tract

Corticospinal tract

Corticobulbar tract

Control all voluntary muscles of speech (except respiratory)

Decussate (cross) at brainstem where CN's III-XII transition from UMN to LMN

With the exception of lower muscles of facial expression, all functions of the corticobulbar tract involve inputs from both sides of the brain.

Corticospinal tract

Descend from motor cortex through the internal capsule, continue through midbrain and pons (UMN)

Decussate at the medulla, 80-85%, causing contralateral control

After medulla they are LMN but no longer corticospinal tract

Lower motor neurons

Motor neurons in the spinal and cranial nerves

Peripheral nervous system

Upper motor neurons

Motor fibers within the central nervous system

Cerebrum

Referred to as "gray matter"

Topmost portion of the brain (six layers)

Four lobes in the left and four lobes in the right

Lobes

Frontal

Parietal

Temporal

Occipital

Frontal lobe

Primary motor cortex (motor strip)- located on the precentral gyrus

Supplementary motor cortex

Broca's area

Parietal lobe

Also called the sensory cortex- somesthetic

Supramarginal gyrus- Damage= Conduction, agraphia (writing disorder)

Angular gyrus- Damage=writing, reading and naming impairment; transcortical sensory aphasia

Occipital lobe

Primary visual cortex and association

Temporal lobe

Primary auditory cortex (superior temporal gyrus)

Auditory association area (Heschl's)

Wernicke's (posterior temporal gyrus)

Brodmann's area 4

Primary motor cortex

Brodmann's area 44

Broca's area

Brodmann's area's 3, 1, 2

Somatosensory cortex

Brodmann's area 6

Supplementary motor cortex

Sound movement sequences

If damaged: Apraxia

Supramarginal gyrus

Parietal lobe, Brodmann's 40

Anterior to angular gyrus

Posterior to Wernicke's

Conduction aphasia, receptive aphasia

Language perception and processing

Agraphia

Angular gyrus

Pariental lobe (temporal edge), Brodmann's 39

Posterior to supramarginal gyrus

Transcortical sensory aphasia

Writing, reading, naming

Arcuate fascilicus

Connects Broca's to Wernicke's

Part of speech-production pathway

Anterior cingulate cortex

Brodmanns 24, 32, 33

Autonomic functions, blood pressure, heart rate

Higher-level function role: reward anticipation, decision making, impulse control, emotion

Supplemental motor area

Sound-movement sequences

Damage: Apraxia

Posterior right hemisphere damage result

Impaired facial recognition

Executive function location

Anterior cingulate

Dorsolateral pre-frontal corteces

Attention location

Frontal and parietal lobes

Hippocampus function

Memory

Integrates all sensations into experience

Memory location

Hippocampus

Pre-frontal cortex

Types of memory (7)

Working - ability to hold a given amount of info for immediate processing

STM - retention of info for longer than 30 seconds lasting hours

LTM - retention of info for months/years

Semantic - knowledge, words, meaning

Episodic - recollection specific events, etc

Declarative - facts

Procedural - how to do things, sequencing of task

Thalamus function

All ascending sensations pass through on way to brain except olfactory; Relays motor info

Hypothalamus function

Monitors emotion

Substantia nigra

One of four nuclei in BG

Dopamine secretion

Important for attention

Reticular activating system

CNS's primary mechanism of attention alertness and consciousness

Also maintains states of consciousness (sleep, wake, drowsiness, alertness, excitement)

Brainstem

Connects spinal cord with brain via diencephalon

Internally consists of longitudinal fiber tracts, cranial nerve nuclei, and the reticular formation

Reticular activating system integrates in and out neural activity in brainstem and upper spinal cord

Outwardly key structures include the midbrain, pons and medulla

Diencephalon (Brainstem)

Above midbrain between brainstem and cerebrum

Contains thalamus (regulates incoming sensory; relays motor info) and hypothalamus (integrates automatic nervious system, controls emotions)

Midbrain (Brainstem)

Reflexes

III, IV (Neither involved in speech)

Pons (Brainstem)

Hearing

Balance

V, VII

Medulla (Brainstem)

Automatic bodily functions

VIII-XII (Very important for speech production)

Corpus Striatum parts

Globus Pallidus, Caudate Nucleus, Putamen

Sections of Basal Ganglia - Extrapyramidal - regulate and modify cortically initiated motor movements

Cerebellum

Fine motor coordination

Received neural impulses from other brain centers and helps coordinate and regulate them; e.g."Modulator" of neural activity

Equilibrium, posture, coordinated fine motor movement

Damage to Cerebellum= Ataxia

Basal Ganglia function

Direct input from frontal lobe, facilitates motor movements, inhibits unneeded movements

Spatial-temporal aspects of speech

Damage: unusual body postures, dysarthria, change in body tone, involuntary uncontrolled movments interfere with voluntary speech, walk or other movements (dyskinesias)

Connecting fibers in brain

Projection - cortex to subcortical (cerebellum, BG, brainstem, spinal cord)

Association - connect within a hemisphere (arcuate fasciculus)

Commissural - connect left and right hemispheres (corpus collosum)

Medulla oblongata

Continuation of the spinal cord within the skull forming the lowest part of the brainstem, containing control centers for the heart and lungs.

Meninges of brain

Protective layers of the brain:

Dura mater ("tough mother") - adheres to skull and to arachnoid

Arachnoid ("spider web") - weblike and vascular

Pia mater ("tender mother")- adheres to brain following sulci/gyri; blood enters brain through it

Thrombosis vs embolism

Mneunomic: T not T

Thrombosis - local blockage

Emoblism - TRAVeling, gets lodged elsewhere

External carotid artery

Moves toward face and branches into smaller arteries

Supplies muscles of mouth, forehead and face

Internal carotid artery

Major supplier of blood to brain

Splits into 3 branches: (2 major) Anterior and middle cerebral arteries, and the posterior cerebral artery

Anterior cerebral artery

Supplies middle portion of parietal and frontal lobes, coropus callosum, BG

Damage: cog. deficits, impaired judgement, attn, reasoning, possible paralysis feet/legs

Middle cerebral artery

Supplies entire lateral cortex and major regions of frontal lobe

Damage: strokes, aphasia, reading and writing deficits, contralateral hemiplegia, impaired sensation

Largest branch of internal carotid artery

Posterior cerebral artery

Supplies surfaces of occipital and temporal lobes

Affects vision, reading, writing

Circle of Willis

At base of brain

Formed by two carotids and two vertebral arteries

Gives rise to: three pairs cerebral arteries

Common blood supply to all cerebral arteties so blocks below circle can be circumnavigated

MISC CRANIOFACIAL ANOMALIES

REVIEW FOR COMPLETENESS

Lingual frenulum

Structure at inferior portion of tongue connecting it to mandible/floor of mouth

Anyloglossia

Lingual frenulum too short and tongue tip mobility is reduced

Orofacial myofunctional disorder (OMD)

Tongue may exert some force against front teeth (tongue thrust) or push through teeth

May be deviant swallow

Artic errors involving /s/, /z/, /sh/...

Infancy has normal tongue thrust for sucking, usually thrust decreases after infancy

Tx tongue thrust

OMD

SLP works with team: Dentist, orthodontist, physician

SLP evals: swallow, rest postures, speech

Deviant tongue size impacts what?

NOT:

all speech sounds

stridency deletion

misarticulated fricatives

impair vowel production

DOES: have no sig impact

Tongue part names

Tip (teeth, lips), blade (alveolar ridge), dorsum (hard palate), root (pharyngeal wall)

Deciduous teeth (baby teeth)

Temporary teeth appear around 6-9 mo.

20- ten in each arch

Adults have how many teeth

32- 16 in each arch

Dental deviation types

Skeletal malocclusion: deviations in shape and dimension of mandible and maxilla

Dental malocclusion: deviations in positioning of individual teeth

Class I - mostly only teeth misaligned; arches ok

Class II -overjet, overbite, maxilla more forward

Class III - underbite, mandible more forward

Bones of nasal septum

Ethmoid

Vomer bone

Quadrangular Cartilage of Septum

Hard palate components

Premaxilla- front four teeth

Palatine process- two pieces of bone that grow and fuse at midline

Alveolar process- houses molar, bicuspid, and cuspid teeth

Bones of hard palate that fuse

Premaxilla - front 4 teeth

Palatine process of maxilla

Palatine bone

(Alveolar process of maxilla - side and back teeth - on lateral sides so not referenced in hard palate fusion)

Hard palate fuses in utero

8-9 week

Three pieces move to midline at this time: maxilla and two palatine bones

Lip closure in utero

5-6 weeks

If premaxilla isn't in place in time, then cleft lip, right, left or both.

Soft palate fuses in utero

10-12 weeks

Knits together last

If only a small cleft, it will be in this posterior section

Occult submucous cleft

Type of cleft that is only detectable by x-ray exam or nasopharyngoscopy.

Submucous cleft of the soft palate

Midline deficiency or lack of muscular tissue as well as incorrect positioning of the muscles; Usually also has a bifid uvula present.

Delayed hard palate closure

Surgery first to close soft palate, then later surgery to close hard palate

von Langenbeck method

Surgery to repair cleft palate by raising two bipedicled (attached at two ends) flaps of mucoperiosteum and bringing them together and attaching them to close the cleft.

Veau-Wardill-Kilner method

Surgery to repair cleft palate by raising two single-based flaps from palate, bringing together, pushed back close to cleft to lengthen palate, improves VP closure

VPI

Velar Pharyngeal Insuffiency - structural - not enough soft palate there

Velar Pharyngeal Incompetence - functional - muscles don't close velum sufficiently

Adam's apple

Laryngeal prominence on thyroid cartilage

Helps protect VF

Pharyngeal flap

Secondary palatal surgical procedure in which a muscular flap is cut from the posterior pharyngeal wall, raised, and attached to the velum

Openings on either side of the flap allow for nasal breathing, nasal drainage, and production of nasal sounds.

Helps close the VP port and reduces hypernasality.

Palatal shelf surgery

Obdurator

Allows for nasal breathing

For non-nasal sounds, pharyngeal walls can push up to obdurator to close VP

Pharyngoplasty

Surgical procedure in which substances such as Teflon, silicone, dacron wool/silicone gel bag and cartilage may be implanted or injected into the PPW to make it bulge and thus close the VP port.

Palatometry

Pseudopalate fitted with electrodes to teach people place of articulation of consonants

CRANIAL NERVES (cont. pg. 25-56)

CRANIAL NERVES- confirmed

CNs that exit medulla

8-12

CNs that exit pons

V, VII

List all CN by name and most basic motor innervation for screening for function

V - name, S (sensory), M (motor)

Trigeminal nerve

S: 3 branches:

-Ophalmic:nose, eyes, forehead

-Maxillary:lips, cheek, upper teeth, palate

-Mandibular:jaw, lower teeth, tongue, part of cheek, part of external ear

M: Jaw muscles including teproalis, lateral and medial pterygoids, master, tensor veli palatine, tensor tympani, mylohyoid, anterior belly of the digastric muscle

Damage: inability to close mouth, difficulty chewing, trigemini neuralgia (sharp pain in face)

VII - name, S, M

Facial nerve

S: ant 2/3 tongue taste

M: Facial expression, speech; Including buccinator, zygomatic, orbicularis iris, obicularis oculists, platysma, stapedius, stylohyoid, frontally, procures, nasalis, depressor labii inferiors, depressor angel iris, auricular muscles, various labial bumbles, posterior belly of the digastric

Damage: Mask-like appearance

VIII - name, S, M

Auditory(Acoustic) / Vestibulocochlear nerve

S: (auditory) hearing, inner hair cells, and (vestibular) balance

M: outer hair cells

Damage: Hearing loss, problems with balance, or both

IX - name, S, M

Glossopharyngeal nerve

S: assists post 1/3 tongue taste, general sensation: tympanic cavity, ear canal, eustachian tube, soft palate, faucial pillars, upper pharynx (gag)

M: Stylopharyngeus, pharyngeal constrictors (clear throat)

Damage: Difficulty swallowing, unilateral loss of gag reflex, loss of taste and sensation from posterior 1/3 of tongue

Parasympathetic: some salivary glands

XI - name, S, M

Spinal Accessory

S: none

M: Trapezius and sternocleidomastoid muscles; head turn, shoulder shrug

Along with vagus: innervate uvula and elevator veli palatine muscles

Damage: Neck weakness, inability to turn head, in ability to shrug shoulders and raise arm above shoulder

X - name, S, M

Vagus nerve

S: digestive system, heart, trachea, pharynx, larynx

M: digestive system, heart, lungs

Splits into SLN and RLN- Innervation to larynx

Pharyngeal Branch: pharyngeal constrictors, muscles of the velum

Damage: difficulty swallowing, paralysis of velum, voice problems if the RLN is damaged

Recurrent laryngeal nerve (RLN)

All motor to remaining intrinsic laryngeal muscles (interarytenoid, posterior cricoarytenoid, thyroarytneoid, and lateral cricoarytenoid muscles)

All sensory to below VFs

RLN can be damaged in thyroid or heart surgery resulting in VF paralysis

Superior laryngeal nerve (SLN)

Internal and external branches

Internal- all sensory info to larynx

External- motor to solely cricothyroid

X and XI-name and function

Pharyngeal plexus

Supplies the upper pharyngeal musculature including salpingopharyngeus, stylopharyngess, superior pharyngeal constrictor, middle pharyngeal constrictor inferior pharyngeal constrict, circopharyngeus, inferior pharyngeal constrictor, thyropharyngeus)

XII - name, S, M

Hypoglossal

S: none

M: all of the intrinsic and the following extrinsic muscles of the tongue: styloglossus, hyoglossus, and genioglossus

Damage: Tongue paralysis, diminished intelligibility, and swallowing problems

Most pharyngeal muscles are innervated by cranial nerves:

X, XI (Vagus, Spinal Accessory)