Motor Speech Quiz 1

Explain why speech is a fine motor skill

o   Accuracy and speed

o   Uses knowledge of results

o   Improves with practice

o   Motor flexibility

o   Relegates to automatic control

Define motor learning:

Development of internal predictive models (core motor plans) that result from practice or experience

Explain the 4 motor learning characteristics

o   Improvement

o   Consistency/Stability

o   Persistence

o   Adaptability

Linguistic-symbolic planning

a.      Phonological planning: selection and sequential combination of phonemes in accordance with phonotactic rules of language

b.      Non-motor

c.      Language areas Wernicke’s and Broca’s are highly active during this level

d.      Impairment: aphasia

Motor Planning:

a.      Transformation of symbolic units to code for the motor system

b.      Goal-oriented, articulator-specific, motor goals: spatial and temporal

c.      During motor planning:        

                                                              i.     Core motor plans are recalled from sensorimotor memory during speech

                                                             ii.     Plan consecutive movements

                                                            iii.     Adaptation of specifications

d.      Articulator specific

e.      Impairment: AOS

Motor Programming

a.      Set of muscle commands structured before movement sequence begins that can be delivered without external feedback

b.      Muscle specific, what allows us to move our articulators

c.      Impairment: AOS and some dysarthria’s

Motor execution:

a.      Programs to muscles and joints to movement (with feedback)

b.      Motor cortex, lower motor neurons, peripheral nerves, motor units, control (basil ganglia and cerebellum)

c.      Execution and control of muscle commands

d.      Impairment: dysarthrias

Contrast motor planning from motor programming

o   Planning:

Strategy (articulator): what are we doing

High level

Dominant hemisphere

o   Programming:

Tactics (muscle): how are we going to do it

Middle level

Both hemispheres

Planning

Strategy (articulator): what are we doing

High level

Dominant hemisphere

Programming

Tactics (muscle): how are we going to do it

Middle level

Both hemispheres

Define motor speech disorders (MSDs)

• Speech disturbances resulting from neurologic impairments affecting the planning, programming, control, or execution of speech. MSDs include the dysarthrias and apraxia of speech.

Dysarthria

• collective name for a group of neurologic speech disorders that reflect abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for the breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production.

  • Can result from CNS and PNS damage, results in weakness, incoordination, involuntary movements, and changes in muscle tone

  • Lesion location determines speech deficits

  • Impaired execution and control

Apraxia of speech

• a neurologic speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech.

  • results from CNS damage

  • Results in inability to recall motor plans, relay motor plans, organize movements, and adapt motor plans

  • impaired planning and programming NOT due to weak musculature or fatigue

aphasia

language disturbance

Describe the 5 speech subsystems

Respiration

Phonation

Resonance

Articulation

Prosody

Respiration

• speak on exhalation (use expired airflow to produce speech)

  • Allows us the medium to produce speech

  • Disturbances may result in:

    • Decreased words per breath

    • Abnormal loudness

    • Abnormal vocal quality

Phonation

• voice (varying pitch)

  • Disturbances may result in:

    • Abnormal vocal quality (dysphonia)

Resonance

• degree to which voice is transmitted through oral versus nasal cavities

  • Disturbances may result in:

    • Hypernasality: Air escaping through nose during oral sounds

Articulation

• Specific, distinguishable sounds that when combined give meaning

  • Disturbances can result in:

    • Distorted speech

Prosody

• all of the speech systems working together, pertains to stress, intonation, and rhythm of speech to convey stress, emphasis, and emotion, important for speech naturalness

  • Disturbances can result in:

    • Prolonged phonemes, decreased/equal stress, monopitch/monoloudness, abnormal rate  

Define prosody

• all of the speech systems working together, pertains to stress, intonation, and rhythm of speech to convey stress, emphasis, and emotion, important for speech naturalness

  Identify the “gold standard” method for diagnosing MSD

• Perceptual methods rely primarily on the auditory perceptual attributes of speech. They are the gold standard for clinical differential diagnosis, judgments of severity, many decisions about management, and the assessment of meaningful temporal change.

  • Important when reading the literature, did the authors appropriately describe the characteristics of the participants’ speech? This helps with external validity

Anatomy

• study of structures of the human body

Physiology

study of the function of each of these structures

Sagittal

right/left

Coronal (frontal)

front and back halves

Transverse

top and bottom

oblique

diagonal

Ventral

towards the front or belly

Dorsal

towards the back

CNS

Brain and spinal cord

PNS

Ganglia and Nerves

Gray matter

nerve cell bodies and dendrite

White

axons

Describe the 2 pyramidal tracts

Corticobulbar: head and neck

Corticospinal: trunk and limbs

Nerve:

groups of fibers that travel together in the PNS.

Tracts

groups of fibers that travel together in the CNS.

cell body

• integrates incoming impulses, maintains cell function

Dendrites

receives impulses from other cells and sends to cell body

Axon

Carries impulses from cell body to another cell

·        Explain importance of myelination and identify cells that provide myelin to the CNS and PNS

• Speeds up neural transmission (increases nerve’s conduction velocity by about 120 meters/sec), myelin also appears to protect axons from injury.

• Schwann cells in the PNS form myelin, which wraps around fibers in most peripheral nerves.

• Oligodendroglia cells are the source of myelin in the CNS.

Commissural

homologous areas between hemispheres

Association

areas within a hemisphere

Projection

higher and lower centers

Dura mater:

outermost membrane. It consists of two layers of fused tissues that separate in certain regions to form the intracranial venous sinuses, areas where blood drains from the brain.

Arachnoid

 lies beneath the dura and is applied loosely to the surface of the brain.

Pia mater

the thin innermost layer, is closely attached to the brain’s surface. The

Explain functions of CSF

• Its primary functions are to cushion the CNS against physical trauma and to help maintain a stable environment for neural activity.

  • Mechanical protection

  • Pathway for metabolic and nutritional compounds to reach CNS

  • Removes waste

  • Immune function

Frontal (lobe)

• Executive function, personality, learning, behavior, emotion, movement, language, sensation

Temporal

• Memory, language, hearing, learning

Parietal

• Touch, integration of sense, arithmetic and spelling, spatial relationships

Occipital

• Vision

  Identify the major function of thalamus

serves as a relay center, as all information entering the cortex goes through a specified part of this structure, depending on the type of information being conveyed. Relay center for motor and sensory information (except olfaction)

Explain the functional importance of the Circle of Willis

• Supplies both the cerebral lobes and the brainstem, cerebellum, and cervical spine. (provides blood flow to brain via 3 cerebral arteries)

Identify 3 parts of the brainstem

• Midbrain (upper)

• Pons (middle)

• Medulla (lower)

    Explain the functions of brainstem

• Provides a communicative link between the brain and the spinal cord

• Regulates critical life functions (respiration, heart rate, blood pressure, and swallowing)

• Houses majority of cranial nerve nuclei

Explain the functions of basal ganglia as it pertains to motor performance

• a group of subcortical nuclei involved in facilitating or inhibiting the initiation and amount of movement.

  • Important role in movement:

    • Initiation of movement

    • Amount, direction and sequence of movement

    • Supportive movements

    • Postural control

    • Muscle tone

  • Cognitive and emotional functions

Explain the functions of cerebellum as it pertains to motor performance

• important for maintaining muscle tone, balance, and coordination

• Regulates muscle tone

• Motor planning/programming

• Coordinates timing/sequence of movements and “smooths” movements (reciprocal connections with other structures and feedback)

• Language, cognitive, and emotional functions

Pyramidal

• direct motor system, only one synapse

  • Function: initiation of skilled, voluntary movement

  • Courses from the cortex -> internal capsule -> brainstem/spinal cord

• Extrapyramidal

• indirect motor system

  • Multiple synapses

  • Diffuse system of subcortical structures and pathways

  • Function: regulates and modulates (adjusts) movements; regulates reflexes

    • Posture, tone, balance, coordination

Identify 2 tracts of the pyramidal system (comprise the UMN system)

Corticobulbar

Corticospinal

Corticobulbar tract

• muscles of the head and neck, eye movements, speech and swallowing

  • Cortex -> brainstem -> cranial nerves

Corticospinal tracts:

lateral corticospinal fibers cross at medullary pyramids, anterior corticospinal fibers cross in spinal cord

Typical CNs

• UMNs innervate brainstem nuclei on both sides

• CNs V, VII, IX, X, XI, XII (most)

Atypical CNs

• UMNs innervate brainstem nuclei on contralateral side

• CNs VII, XI, XII

Agonist

muscle that causes specific movements to occur through its own contraction

Antagonist

muscle that acts in opposition to the specific movement by the agonist

Slow Motor (Type I):

• slowly fatiguing red fibers (10-20 impulses/sec)

Fast Motor (Type II):

• rapidly fatiguing white fibers (30-60 impulses/sec)

Spatial summation

more motor units activated, the greater strength and force

Temporal summation

• faster a motor unit is stimulated, the greater the strength and force

Define muscle tone

internal state of muscle fiber tension at rest

Proprioceptive Feedback:

• All speech muscles are striated, most striated muscles have muscle spindles, but, NOT all speech muscles have muscle spindles

Focal

involving a single area or continuous group of structures (e.g., left frontal lobe)

Multifocal

2+ areas of >1 group of contiguous structures

Diffuse

• involving roughly symmetric portions of the nervous system bilaterally (e.g., generalized cerebral atrophy associated with dementia)

Acute

• within minutes (as related to development of symptoms)

Subacute

within days

Chronic

• within weeks/months (as related to development of symptoms)

UMN Lesions

• spastic paralysis

• hypertonia

• weakness

• hyperreflexia

• Pathological reflexes

• Atrophy

• Normal nerve conduction belocity

• No denervation potentials on EMG

• Clonus

LMN Lesions

• Flaccid paralysis

• hypotonia

• (more Weakness)

• Hyporeflexia

• Areflexia

• Fasciculations

• (More) atrophy

• Abnormal nerve conduction velocity

• Denervation potentials on EMG

Paralysis

results if a muscle is deprived of input from all of its LMNs (complete loss of movement)

Paresis

incomplete loss of movement

CHI (closed head injury)

often associated with more diffuse abnormalities.

PHI (penetrating head injury)

can produce relatively focal neurologic abnormalities, dura mater was penetrated

Coup injuries

Focal lesion often occur at the site of impact and result in focal neurologic deficits

Coup Contrecoup injuries

injury associated with acceleration, the motion of the brain may also cause trauma at sites opposite the point of impact, focal lesion at site of impact AND lesion at opposite point

Ischemic Stroke

Due to a blockage

Thrombosis:

narrowing/occlusion (type of ischemia)

Embolism

traveled embolus

Hemorrhagic

due to a bursting vessel/bleeding

Aneurysm

ballooned blood vessel

Arteriovenous malformation (AVM):

abnormally formed blood vessels

Hypokinesia

• Reduced mobility, (too little movement)

  • associated with disease of the SN substantia nigra, which results in a deficiency of dopamine in the basal ganglia. The effect is an increase in muscle tone that, unlike in spasticity, is not velocity dependent and is present throughout the range of motion of limbs; the result is increased resistance to movement, a condition known as rigidity.

  • Parkinson’s disease

Hyperkinesia

• Excessive movements, (too much movement)

  • result from excessive activity in dopaminergic nerve fibers, thereby reducing the circuit’s damping effect on cortical release of unwanted, competing motor programs. This results in involuntary movements (e.g., chorea, athetosis, and dystonia) that can vary considerably in their locus, speed, regularity, and predictability.

  • Huntington’s disease

Ataxia

abnormal, uncoordinated movements, cerebellar damage

Myoclonus

involuntary single or repetitive brief, lightning-like jerks of body part(s)

Chorea

involuntary rapid, nonstereotypic, random, purposeless movements of a body part

Dystonia

involuntary abnormal postures resulting from excessive co-contraction of agonist and antagonist muscles

Ballismus

gross, abrupt contractions of axial and proximal extremity muscles