med speech final modul7, 8, and 9

What comes after motor programming?

-direct motor pathway
or
-indirect motor pathway

What is the direct motor pathway also called?

pyramidal system

What is the indirect motor pathway also called?

extrapyramidal system

Why are the direct and indirect motor pathways also called the pyramidal and extrapyramidal?

both tracts cross over at the pyramids of the medulla

Can the direct and indirect motor pathways be separated anatomically and functionally?

-yes anatomically
-no functionally

direct or indirect motor pathways can't work properly alone, WHY?

they constitute one motor system together

What is the pyramidal system (direct MP)?

the chief organizer and executor of voluntary movements. (Speech, motor activates like walking)

What does the extrapyramidal system (indirect MP) include?

all the motor centers and pathways that lie outside the pyramidal system and are beyond voluntary control

What does the extrapyramidal system (indirect MP) do?

-coordinates movements of various groups of muscles both in space and time

-regulates job/sport specific automatic movements consisting of periodic elements ex. driving a car

-controls emotional movements

-helps to control balance

-regulates muscle tone

What system does the direct motor pathway involve?

lateral motor system

What does the lateral motor system give rise to?

-lateral corticobulbar tract
-corticospinal tract

What is the function of the direct motor pathway?

voluntary motor movement of contralateral limbs/speech muscles

What are the direct activation pathways?

-corticobulbar
-corticospinal

Where do the direct pyramidal pathways originate?

level of the cortex

Where do the direct pyramidal pathways cross over?

medulla

What does the corticobulbar lead to?

cranial nerves

What does the corticospinal lead to?

spinal nerves

once the process leaves the brainstem it enters the ______ ______ ________

lower motor neuron

While the process is in or above the brainstem it is in the _______ _________ _______

UMN

Where does the corticobulbar tracts originate from?

the facial region of the motor homunculus within the primary motor cortex.

Corticobulbar Tract_______ extend to the brainstem

axons

Axons extend to the brainstem, where they...

synapse with lower motor neuron cell bodies

Where are the lower motor neuron cell bodies housed?

within brainstem cranial nerve nuclei

What do axons of the lower motor neuron help form?

the cranial nerves

What does the corticobulbar tracts transmit motor information to control?

-eye movement
-cranial, facial, and pharyngeal muscles
-some superficial muscles of the back and neck
-intrinsic and extrinsic tongue muscles

What cranial nerves control eye movement?

-CN III (oculomotor)
-CN IV (trochlear)
-CN VI (abducent)

What cranial nerves control cranial, facial, pharyngeal and laryngeal muscles?

-CN V (trigeminal)
-CN VII (facial)
-CN IX (glossopharyngeal)
-CN X (vagus)

What cranial nerves control superficial muscles of the back and neck?

CN XI (accessory)

What cranial nerve control intrinsic and extrinsic tongue muscles?

CN XII (hypoglossal)

What can damage to the direct motor pathway lead to?

-spastic dysarthria
-unilateral UMN dysarthria

If there is bilateral UMN damage to the direct motor pathway, what kind of dysarthria will occur?

spastic dysarthria

If there is unilateral UMN damage to the direct motor pathway, what kind of dysarthria will occur?

unilateral UMN dysarthria

What are the medial motor systems included in the indirect motor system?

-rubrospinal
-vestibulospinal
-reticulospinal
-tectospinal

Which medial motor systems cross over at the midbrain?

-rubrospinal tract
-tectospinal tract

Which medial motor systems are ipsilateral?

-reticulospinal tract
-vestibulospinal tract

Where does the indirect motor system originate from?

brainstem

What is the nucleus of the reticulospinal tract?
Where is it?

-reticular formation
-medulla

What is the nucleus of the vestibulospinal tract?
where is it?

-vestibular nucleus
-pons

What is the nucleus of the rubrospinal tract?
Where is it?

-red nucleus
-midbrain

Where is the nucleus of the tectospinal tract?
Where is it?

-superior colliculus
-midbrain

What motor control circuits can be included in the indirect motor system?

-basal ganglia circuits
-cerebellar circuits

What can damage to the extrapyramidal system (indirect MP) lead to?

-hyperkinetic dysarthria
-hypokinetic dysarthria

What comes after the direct and indirect motor pathways?

final common pathway (FCP)

What is the final common pathways?

the last leg of a motor signal's journey

Everything before the final common pathway is part of the ______ ______ ______

upper motor neuron

What is the final common pathway a part of?

lower motor neuron

What does the final common pathway involve?

•Cranial nerves in the case of speech
•Spinal Nerves in case of movements

What can damage to the final common pathway system lead to?

flaccid dysarthria

What cranial nerves can be affected when there is LMN damage?

•CN V trigeminal nerve
•CN VII facial nerve
•CN IX glossopharyngeal nerve
•CN X vagus nerve
•CN XI accessory nerve
•CN XII hypoglossal nerve

What nerves do you assess in a CN assessment?

•CN V trigeminal nerve
•CN VII facial nerve
•CN IX glossopharyngeal nerve
•CN X vagus nerve
•CN XI accessory nerve
•CN XII hypoglossal nerve

What can damage to multiple motor pathways lead to?

mixed dysarthria

What is mixed dysarthria common in?

ALS

You are done with module 7!! keep going

On to module 8

What are the subsystems affected by motor speech disorders?

-respiration
-phonation
-resonance
-articulation
-prosody

What are the types of breathing you want to look for?

-clavicle breathing
-shorth breath phrases
-irregular posture
-rapid shallow
-labored

What is clavicle breathing?

relies on the muscles of the chest, shoulders, upper back, and neck to elevate the upper rib cage and chest for each inhalation.

What is problem with short breath phrases?

-The patient may be easily fatigued resulting in shortness of breath
-Their speech may become slurred at the end of sentences

What is rapid shallow?

you take more breaths than normal in a given minute

What is labored breathing? Who is it common in?

patient works hard to breathe (ALS, MS)

What is one task that you can do to assess respiration?

ability to sustain /s/

What types of phonation are you looking for?

-strained
-breathy
-harsh

What is a task you would do for phonation?

ability to sustain /z/

What is something that you could do to test velar movement and phonation?

-saying "ah" as clearly and as quickly as you can
-sustained phonation of "ah"

It is normal for peoples /s/ to /z/ ratio to be ______

similar

If the pathology is at the level of the vocal folds, will /s/ or /z/ be shorter?

/z/

What do you assess with prosody?

-stress
-rate
-intonation

What do you assess with resonance?

-hyponasality
-hypernasality
-nasal emission
-velar movement assessment

What do you assess for with articulation in dysarthria?

-groping behavior
-articulation rate
-word length
-repetition

What would you treat for dysarthria?

-respiration
-phonation
-articulation
-resonance
-prosody

What are some breathing treatments that are done for dysarthria?

-Making postural adjustments
-Inhaling deeply before onset of speech utterance
-Using optimal breath groups when speaking
-Using expiratory muscle strength training
-Using inspiratory muscle strength training

What are some things you would try to do with phonation for dysarthria?

-Effort closure techniques to increase adductory forces of vocal folds (ex. squeezing palms together)
-Improved timing of phonation (initiating phonation at beginning of expiration)

What are some things you would try to do with articulation for dysarthria?

-Phonetic placement techniques (e.g., hands-on, descriptive, pictures) to work on positioning of the mouth, tongue, lips, or jaw during speech.
-Minimal contrasts to emphasize sound contrasts necessary to differentiate one phoneme from another.

What are some things you would try to do with resonance for dysarthria?

-Prosthetic management in collaboration with other disciplines
-Resistance training during speech using continuous positive air pressure

What are something you would do to treat prosody with dysarthria?

-Increasing awareness and ability to control respiration, rate, and pitch to vary emphasis within multisyllabic words and in connected utterances

-Improving intonation by signaling stress with loudness, pitch, or duration

-Extending breath groups to better align with syntactic boundaries

-Using contrastive stress tasks to improve prosody and naturalness

What is one approach for apraxia of speech treatment?

articulatory-kinematic approaches

What do articulatory-kinematic approaches provide?

frequent and intensive practice of speech targets

What do articulatory-kinematic approaches focus on?

accurate speech movement

What do articulatory-kinematic approaches include?

include external sensory input for speech production

What is one common articulatory-kinematic approach?

prompts for restructuring oral muscular phonetic targets (PROMPT)

What is prompts for restructuring oral muscular phonetic targets (PROMPT)?

a tactile method of treatment based on touch pressure, kinesthetic, and proprioceptive cues

How does prompts work? What does it help limit?

-Using this approach, the clinician uses finger placements on the individual's face and neck to cue various aspects of speech production
-help the individual limit unnecessary movements.

You are done with module 8!! Keep going

On to module 9

What are the normal swallow phases?

1. oral preparatory phase
2. oral phase/ oral transit phase
3. pharyngeal phase
4. esophageal phase

What phases of normal swallowing can you see without instrumentation?

-oral preparatory phase
-oral phase

What is the oral preparatory phase?

-The anticipation of eating or drinking
-food or liquid is taken into the mouth
-food is chewed and mixed with saliva

The oral preparatory phase is mostly a ___________ stage

cognitive

What phases is often affected with TBI patients?

oral preparatory phase

What is the oral phase?

-Food or liquid is collected in the mouth
-The tongue moves the food or liquid to the back of the mouth and into the throat with a stripping motion

What are complaints for the oral phase of swallowing?

-Food gets pocketed
-premature spillage into pharynx
-possible drooling
-can't move food to the back of the mouth (stripping motion affected)

What is the stripping motion?

-aka anterior to posterior motion
-anterior tongue (2/3) moves the bolus to the pharyngeal tongue (1/3)

What is the first step of the pharyngeal phase?

soft palate elevates to keep food/liquid from leaking into the nasopharynx

What is the second step of the pharyngeal phase?

-tongue contacts the pharyngeal wall
-larynx elevates and moves forward

What is the third step of the pharyngeal phase?

epiglottis tilts down and back to protect the airway and divert food/liquid into the esophagus

What is the fourth step of the pharyngeal phase?

vocal folds come together to add more airway protection

What is the fifth step of the pharyngeal phase?

muscles of the pharynx contract to push the food

What is the sixth step of the pharyngeal phase?

the upper esophageal sphincter relaxes, and the food moves into the esophagus

What are complaints for the difficulty with the pharyngeal phase?

-coughing
-gasping for air
-nasal regurgitation
-wet voice
-pocketing (piriform fossa and vallecula)

What is the upper esophageal sphincter?

cricopharyngeal muscle

What is higher laryngeal excursion?

larynx elevates (hypoid bone moves up) so the epiglottis tilts, and vfs close

What is the esophageal phase?

-Contraction in a wave pattern moves the food through the esophagus
-The lower esophageal sphincter relaxes and the food passes into the stomach