Motor Speech Midterm

Motor strip/primary motor cortex is also called the?

Pre-central gyrus

What is the role of the internal capsule?

The pathway for corticospinal/corticobulbar tracts (both known as pyramidal tracts).

Strokes or damage to the internal capsule can result in what?

Unilateral upper motor neuron damage and may significant effects on motor function.

What travels through the internal capsule?

Tracts

Extrapyramidal tracts

outside the pyramidal tracts and originate in the brainstem

What is typically an extrapyramidal tract disorder?

Parkinson’s and Huntington’s Disease

Hyperkinetic dysarthria is associated with what lesions?

Extrapyramidal nuclei lesions

Upper motor neuron’s are inclusive of what tracts?

Pyramidal tracts including the corticopspinal and corticobulbar tracts.

Corticospinal Tracts

Play a large role in upper and lower extremities, postural stability.

Corticobulbar Tracts

Speech and Swallowing

Both corticospinal and corticbulbar tracts innervate the?

Spinal nerves

Speech Bulb

is also know as the medulla, part of the brainstem which houses the cranial nerves specific to speech and swallowing.

If the speech bulb is damaged the person will have what type of dysarthria?

Flaccid dysarthria because it is a cranial nerve nuclei damage

The neurons of the motor cortex will become active before the onset of the voluntary movement before the force can be exerted.

True

Subgroups of neurons in the motor cortex encode different aspects of the force and trajectory required for movement/

False

Neurons in the motor cortex are informed of consequences of movements by tactile joint rotation and muscle strength feedback by cortico-cerebellar pathways.

True

What type of respiration is associated with flaccid dysarthria?

Reduced pressure generation (limited excursion of the diaphragm- not moving with enough force to push air through vocal folds), shallow inhalation (limited excursion of the diaphragm), reduced exhalation control, slow breathing.

What type of respiration is associated with ataxic dysarthria?

Shallow inhalations, reduced exhalation control, rapid breaths (since breaths are limited to begin with), irregular and sudden forced patterns (trying and struggling to push air out of the lungs).

Lower motor neuron is also know as?

The final common pathway- because they are the last and only “road” that the neural impulses from the UMN can travel to reach the muscles.

There is no longer pyramidal or extra pyramidal influence on a motor impulse once it has started?

Traveling along a lower motor neuron

What can be caused by any disorder that disrupts the flow of neural impulses along the lower motor neurons that innervates the muscles of respiration, phonation, prosody or resonance?

Flaccid dysarthria

What disorders are associated with or may develop from mixed dysarthria?

ALS, MS, Wilson’s Disease, Multi-systems Atrophy

What causes mixed dysarthria?

Neurological damage that extends to more than one portion of the motor system.

Parkinson’s negatively impacts?

Movement- rigidity of muscles

Rigidity in Parkinson’s is caused by?

Not enough dopamine-dopamine depletion

Too much tone=

Rigidity and difficulty with movements

Parkinson’s disease effects on respiration include?

Limited excursion of diaphragm because is it impacted by rigidity, do not get a good amount of air in their lungs, insufficient vital capacity, lack of respiratory reserve.

Parkinson’s disease effects on phonation include?

Vocal cords have difficulty abducting and adducting- raspy and weak voice, loudness decay- hypokinetic dysarthria, cannot move vocal folds due to lack of respiratory reserve, slow movement- bradykinesia, continuous voicing (uncontrolled).

Dopamine suppresses muscle tone

True

Too much tone is caused by?

Dopamine depletion-rigidity

Extrapyramidal nuclei lesions will result in?

Rigidity (substantia nigra), tremor (resting tremors, PD).

In regards to PD, where is there a dopamine depletion?

Basal ganglia

Parkinson’s Disease facial musculature?

Looks and feels rigid

When doing an oralfacial exam for PD you are?

Feeling for degree of muscle tone and rigidity presence

If the level of dopamine from the substantia nigra is lowered in striatum what is the result?

Muscular rigidity, tremor, gait disturbances and difficulty initiating movement.

What are paradoxical movements of the muscles of inhalation and exhalation?

The respiratory muscles of the chest and diaphragm are not coordinated during breathing

What are some symptoms that can occur in the voice, articulation and respiration of PD patients?

Range of speech movements, harsh breathy phonation, imprecise consonants and abnormal prosody as well as increased speech rate

What do we strive for when dealing with spasticity or PD?

Optimal movement

Hypokinetic deficit in a oral motor exam

Rigidity deficit, will have difficulty moving tongue against a tongue blade

When you first begin an evaluation fro PD or any other disorder you are looking for/listening for?

Listening to the voice but also looking at the person’s gait (walk), problems with balance and when they sit look at their postural presentation, may have head down because of rigidity and have difficulty lifting their head up

ALS can show signs of mixed dysarthria because?

Some patients can experience both UMN and LMN manifestations.

Respiration is a?

Chemical process-exchange of gasses within the blood

If the diaphragm is not moving what could be compromised?

Speech/vocal function

Ventilation means?

Breathing

Inhalation

Stomach moves down, diaphragm moves down to pull air into the lungs

Exhalation

Diaphragm relaxes and forces air our of the lungs and moving air up our of the vocal cords

Parkinson’s negatively impacts?

Movement- rigidity of muscles

If a person had PD they may have limited excursion of the diaphragm so what will happen to their vocal folds?

The vocal folds won’t vibrate as well as they need to because they are rigid and stiff

What happens to the vocal folds as the air comes up through the larynx?

They vibrate

Dysphonia

No sound- but is really dysarthria

Dysarthria is a result of?

Dysfunction of the subsystems

What are the velopharyngeal structures?

Velum and pharyngeal wall

The velopharyngeal structures do what?

Modify resonance

The lateral pharyngeal walls move?

Medially and laterally

The velum moves?

Back and up

The oral articulators do what?

Interrupt airflow

Perceptual analysis

Where you can recognize what a certain speech signal sounds like, how it is received in relation to rigidity or spasticity, how do the vocal cords sounds, a very subjective analysis

Perceptually based indicators- respiratory function

abnormal loudness (too weak, too intense), often associated with insufficient diaphragmatic excursion, too loud caused by sudden bursts of movements of the diaphragm, Huntington’s disease, spastic dysarthria, hyperkinetic dysarthria.

What disorders can be associated with abnormal loudness, insufficient diaphragmatic excursion and too loud caused by sudden bursts of movements of the diaphragm?

Huntington’s disease, spastic dysarthria and hyperkinetic dysarthria

In spasticity, reduced muscle tone will result in?

Pushing too hard to produce your voice you will get sudden bursts of movement and diaphragm is pushing air out of lungs.

What disorder results in fatigue of vocal fold function?

Myasthenia Gravis

In Myasthenia Gravis what causes the fatigue of vocal fold function?

Deconstruction of acetylcholine is causing the prevention of innervation of the muscle so the diaphragm is not moving well and cannot move oral musculature, speech can be poorly unintelligible

Weakness is

a description/degree of movement

If a person has spasticity that is impacting the movement of the diaphragm of movement of the vocal cords the spasticity will create?

Some force but also contribute to weakness or limitations in movement

Varying degrees of tone can contribute to?

Weakness

Acoustic Analysis

Uses instrumentation to measure vocal loudness, phonation time and measure perturbation (evaluating using an acoustic measure to assess the degree of disruption in the phonatory signal.

What does a VisiPitch measure?

A vocal signal through a computerized engaged signal and it comes out on a page that tells you how long the phonation time is, can measure the quality of voice, pitch

Presbyphonia

Age related vocal cord bowing, these individuals do not get good airway protection when swallowing

Damage to CN7 can cause?

Facial weakness and can have flaccid dysarthria or speech difficulties

Basal Ganglia

Collection of subcortical gray matter structures that play an important role in the refinement of movements

Collective name for three large subcortical structures located near the lateral ventricles- caudate nucleus, putamen and globus pallidus

What is the basal ganglia important for?

Planning and refining of slow continuous movements

Damage to the basal ganglia can cause what?

Hypo and Hyperkinetic dysarthria

Parkinson’s Disease and Huntington’s Disease

The basal ganglia acts as a filter to do what?

Prevent unwanted movements

When the basal ganglia is hyper excited because of decreased levels of dopamine what can occur?

Voluntary movements are greatly compressed and attenuated aka Parkinson’s

When the basal ganglia neurons degenerate and lose their ability what can occur?

Movements can be exaggerated and purposeless aka Huntington’s Disease.

Subcortical lesions in the basal ganglia, substantia nigra and the thalamus would result in?

Dysarthria

Lesions in the basal ganglia can resultin voluntary movements that seriously interfere with?

An individuals voluntary attempts to speak, walk or do any number of other things

Ataxic cerebral palsy

Uncoordinated movements, poor muscle control that causes clumsy, voluntary movements, incoordination, dysmetria, DDK’s, dyrythmeia, hypotonia, intention tremor

What are the laryngeal characteristics of ataxic cerbral palsy?

Hoarse, breathy, hoarse vocal tremor, monopitch, monoloudness

What are the velopharyngeal characteristics of ataxic cerbral palsy?

Normal

What are the orofacial characteristics of ataxic cerbral palsy?

Imprecise, slow and irregular

What are the characteristics of ataxic cerbral palsy?

Explosive syllable stress, loudness and pitch outburst, abnormal prolongations of phonemes and intervals between sounds and words

What are the respiration characteristics of ataxic cerbral palsy?

Shallow inhalations, reduced exhalation control, rapid breath, irregular and sudden forced patterns (trying and struggling to push air out of lungs

Spastic cerebral palsy

Hear spasticity in vocal folds (strain), spasticity in diaphragm (difficulty to obtain sufficient breath to support to speech)

What are the velopharyngeal dysfunction manifestations?

Resonatory structure, nasal emissions, hypernasality, hyponasality, short phrases, difficulty with voices/voiceless distinction, poor pressure sound productions

A 35 year old woman had a stroke that caused hyper-nasality what would be the site of lesion?

The stroke would have had to occur in a lower motor neuron in the medulla in CN 9 and 10

A stroke that occurred in the brainstem in the medulla in CN9 and CN10 can cause?

Velopharyngeal insufficiency and hyper nasality

Corticobulbar lesions can cause what?

Velopharyngeal insufficiency and hyper nasality caused by weakness caused by too much tone by spasticity

Valving structure deficits causing insufficient vocal closure insufficiency velopharyngeal function due to?

The individual losing air

How does vocal fold function negatively impact respiratory function?

Poor functional reserve, insufficient vital capacity, respiratory fatigue, poor coordination of respiratory function/swallowing (major risk factor for aspiration), poor coordination of breathing/speech production

Poor functional reserve

Air that the person is taking in cannot stay in there because they have poor glottal pressure

Insufficient vital capacity

Parkinson’s due to rigidity of the diaphragm

In spastic dysarthria the person will have difficulty with?

Speaking and breathing

Sarcopenia

Age related muscle weakness, vocal folds become atrophic (lose muscle mass)

Bowing of vocal folds will create a limited?

Functional reserve and vital capacity

If an individual has unilateral vocal fold paralysis as speech therapist we can?

Do hypertensive exercises- move the vocal fold across the midline to contact with the paralyzed cord

EMST-150

Expiratory muscle strength trainer- using intercostal muscles, great for those with limited excursion, COPD, help building subglottal pressure

What are the motor speech subsystems?

Respiratory system, phonatory system, resonance system oral articulators

Apraxia of speech (AOS)

Movement planning disorder, premotor cortex

Movement is a product of

Motor and sensory problems