What three things is the PNS composed of?
31 pairs of spinal nerves and dorsal root ganglia, 12 pairs of cranial nerves and their ganglia, and the autonomic nervous system.
What structures protect the CNS?
Skull and vertebral column (boney structures)
Are spinal nerves sensory or motor?
What kind of neurons are in the ventral horn?
Lower motor neurons
What kind of neurons are outside the spinal cord?
Sensory neurons (dorsal root ganglions)
Where do the axons of sensory neurons end in the spinal cord?
What is the cervical plexus?
Part of the peripheral nervous system (spinal nerves) that supplies the skin and muscles of the head, neck and upper part of the shoulders
What spinal nerves form the cervical plexus?
C1-C4, with contributions from C5
What is the brachial plexus?
Part of the PNS (spinal nerves) that constitutes the nerve supply for the upper extremities and shoulder region.
What spinal nerves form the brachial plexus?
C5-C8 and T1
What is the lumbar plexus?
Part of the PNS (spinal nerves) that supply the anterolateral abdominal wall, external genitals and part of the lower extremities.
What spinal nerves form the lumbar plexus?
What is the sacral plexus?
Part of the PNS (spinal nerves) that supplies the buttox, perineum and lower extremities.
What are the 12 cranial nerves?
I-Olfactory, II-Optic, III-Oculomotor, IV-Trochlear, V-Trigeminal, VI-Abducens, VII-Facial, VIII-Auditory, IX-Glossopharyngeal, X-Vagus, XI-Accessory, XII-Hypoglossal.
On Old Olympic Towering Tops A Finn And German Viewed Some Hops.
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory, Glossopharyngeal, Vagus, Accessory, Hypoglossal.
Are cranial nerves motor or sensory?
They can be purely motor, purely sensory, or mixed.
Where do the bilateral nuclei of the cranial nerves pass through?
Foramina (the opening at the base of the skull)
Where do the bilateral nuclei of the cranial nerves originate?
The brain stem.
In what order are cranial nerves numbered?
The order they are in along the brainstem.
Is the V-Trigeminal cranial nerve sensory or motor?
What are the sensory functions of the V-Trigeminal nerve?
Touch, pressure, pain, proprioception, temperature in various areas of the face.
What are the motor functions of the V-Trigeminal nerve?
Muscles involved in mastication, some extrinsic laryngeal muscles, tensor veli palatini muscle and tensor tympani muscle.
Is the VII-Facial cranial nerve sensory or motor?
What are the functions of the VII-Facial cranial nerve
Motor functions - facial expression muscles, extrinsic laryngeal muscles, stapedious. Parasympathetic innervation of the lacrimal, submandibular, sublingual glands (salivary glands), mucous membranes of nasopharynx, hard and soft palate.
What are the functions of the VIII-Auditory/Vestibular nerve?
Balance (rotary and linear - V) and sound (A).
Is the IX-Glossopharyngeal nerve sensory or motor?
What are the sensory functions of the IX-Glossopharyngeal cranial nerve?
Taste, pain, touch and temperature ofthe posterior 1/3 of the tongue; external ear, Eustachian tube, tonsils and pharynx's pain, touch and temperature .
What are the motor functions of the IX-Glossopharyngeal cranial nerve?
Swallowing (pharyngeal muscles) and salivary glands.
Is the X-Vagus cranial nerve motor or sensory?
What are the motor functions of the X-Vagus cranial nerve?
Soft palate, pharynx, larynx - superior laryngeal and recurrent laryngeal. Involved in phonation. Heart, thoracic, abdominal smooth muscles and glands.
What are the sensory functions of the X-Vagus cranial nerve?
Thoracic and abdominal viscera, larynx, pharynx, trachea, esophagus, taste buds around epiglottis, external ear canal.
Is the XII-Hypoglossal nerve motor or sensory?
What are the motor functions of the XII-Hypoglossal cranial nerve?
Intrinsic and extrinsic muscles of the tongue, extrinsic laryngeal muscles.
What are the sensory functions of the XII-Hypoglossal cranial nerve?
Monitoring of the pharyngeal phase of swallowing.
What are the two divisions of the ANS associated with?
Sections of the spinal axis.
What are the two divisions of the ANS?
Parasympathetic and Sympathetic.
What nerves is the parasymptathetic system associated with?
Cranial nerves and sacral spinal nerves.
What nerves is the sympathetic system associated with?
Thoracic and lumbar spinal nerves (thoraco-lumbar).
Where are the ganglions of the ANS located?
Outside of the cranium and vertebral column.
What is a ganglion?
Collection of cell bodies.
What is another name for ANS?
Visceral efferent system.
What does the ANS affect? How?
Internal environment of the body through efferent stimulation.
Which is the "flight or fight" system?
The sympathetic nervous system.
How does the sympathetic system prepare for flight or fight?
Sympathetic arousal forms distinctive pattern of changes to prepare the body for a flight/fight response.
Which is the "rest and digest" system?
What does the parasympathetic state result in?
Distinctive changes that create a "calming" state.
Which part of the ANS affects speech characteristics?
What may underlie many speech problems related to the ANS system?
Classical condition causing anxiety and fear.
Cardiovascular diseases affect...
blood flow, subsequently blood flow in the brain.
What are the best protected organs in the human body?
How much cardiac output does the brain consume?
How much oxygen does the brain consume at rest?
Why can heart conditions result in comas or death?
The heart pumps blood to the body, including the brain. The brain cannot survive without the oxygen being supplied by the heart.
How long can the brain survive without oxygen?
What is the source of energy of the brain?
Aerobic or oxidative metabolism (constant supply of oxygen and glucose)
What functions bring energy to tissues?
Breathing and Eating.
What is oxidative metabolism?
When oxygen is used to break down food into complex carbs.
What does anaerobic organism refer to?
Can survive without oxygen.
What results from anaerobic bacteria?
What do the majority of the adult patient load for SLPs suffer from (especially in hospitals and long-term care facilities?
Cerebrovascular incidents in the brain.
What is the third leading cause of death in American adults?
What is the number one cause of chronic functional disability requiring rehabilitative intervention?
What are the two systems that supply blood to the brain?
Anterior (Carotid) and Posterior (Vertebrobasilar)
Where do the two systems that supply blood from the brain come from?
What does the carotid system supply?
70% of blood supply to the brain. Superior 2/3 of the brain.
What does the vertebrobasilar system supply?
30% of blood supply to the brain. Inferior 1/3 of the brain and brainstem.
How many internal carotid arteries are there?
How doe the internal carotid arteries supply blood to the brain?
Evenly (35% of blood supply each)
Check the blood flow of the internal carotid arteries to make sure they are not clogged. Done typically to people with high cholesterol or diabetes
Why are the two internal carotid arteries connected systems?
Collateral circulation. A safety feature gives two sources of oxygen to the brain in case one doesn't work, the other still pumps blood.
What are the arteries in the carotid system?
Common carotid, internal carotid, carotid foramen, anterior cerebral artery (ACA) and middle cerebral artery (MCA).
Which are the most important arteries we need to know about from the Carotid system?
ACA (anterior cerebral artery) and MCA (middle cerebral artery)
What is a characteristic of the carotid artery for each cerebral hemisphere?
It is a bilateral system, each hemisphere has its own carotid artery.
What are the two divisions of the interior carotid artery?
ACA (anterior cerebral artery) and MCA (middle cerebral artery).
Where does the ACA flow?
Between two hemispheres.
Where does the MCA flow?
Enters the brain around the Sylvian fissure.
Why is the MCA important for the SLP profession?
Because it supplies the temporal lobe along with all areas along the Sylvian fissure.
What areas of the brain does the PCA (posterior cerebral artery) involve?
The occipital lobe and the back of the brain.
What area of the brain does the ACA supply?
Medial aspect of the hemisphere.
Area supplied by artery.
What are some signs and symptoms involved in ACA occlusion?
Affected contralateral leg, precentral gyrus paresis/paralysis, postcentral gyrus sensory impairment.
What are some signs and symptoms involved in MCA occlusion?
Affected contralateral face and arm, precentral gyrus paresis/paralysis, postcentral gyrus sensory impairment.
What is the most common stroke?
What is the most common effect of an L-MCA stroke?
Right hemiplegia, face and UE.
If MCA perfuses the lateral aspect of hemisphere, how is the LE affected?
Occlusion occurs in the internal capsule.
What is the vertebrobasilar system derived from?
Subclavian, vertebral, foramen magnum, anterior spinal, posterior inferior cerebellar, basilar, anterior, inferior cerebellar, internal auditory, superior cerebellar, posterior cerebral artery.
The vertebrobasilar supplies the inferior 1/3 of the brain, what areas is this exactly?
Inferior surface of the temporal and occipital lobes and brainstem.
What are the importan arteries in the vertebrobasilar system?
Posterior central artery, basilar artery, vertebral artery, brachiocephalic artery, subclavian artery.
What are the three cerebellar arteries?
Superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery.
What are the effects of a brainstem stroke (vertebrobasilar occlusion)
Impaired life support systems, for example, including consciousness and heart rate.
What are the effects of basilar artery occlusion?
Impaired cranial nerve functions and long tract functions (motor/sensory)
What are the effects of a PICA occlusion?
Impaired pain sensation in ipsilateral face and contralateral body.
What is the Circle of Willis?
Circle of arteries that supply blood to the brain.
What arteries is the Circle of Willis comprised of?
Anterior Cerebral Artery, Anterior Communicating Artery, Internal Carotid Artery, Posterior Cerebral Artery, Posterior Carotid Artery, Basilar Artery and Middle Cerebral Arteries.
If a patient has a sudden inability to speak, weakness in the left cheek and jaw, hyperactive jaw-jerk reflexes, loss of nasal-labial fold on the left, where is the lesion causing this ?
Middle cerebral artery (stroke, area of lesion supplies the inferior frontal gyrus on the left, causing weakness in the lower part of the right face and tongue and Broca's aphasia).
What is Productive (Broca's) Aphasia?
Produced by a lesion of the inferior frontal gyrus of the dominant hemisphere.
If a patient presents hyperactive deep tendon reflexes in her left knee and ankle, positive Babinski sign in her left foot, flaccid left leg with no voluntary control over movement; mild impairment of light touch, pain and temperature sensation, where is the lesion causing this?
Right anterior cerebral artery (infarct, affecting motor strip and premotor strips).
If a patient suddenly develops the worst headache of their life, beginning in the bifrontal area and then spread all over the head and neck, no consciousness, no nausea/vomiting or vision changes, and a mild rigid head/neck, where is the lesion causing the symptoms?
Anterior communicating artery (aneurysm, subarachnoid hemorrage extending to medial longitudinal fissure, lateral fissure and brainstem)
Congenital defect in the arterial wall along the circle of Willis present from birth. Actual aneurysm takes years to develop, eventually causing rupture.
What is a major cause for subarachnoid hemorrhage?
If a patient has decreased vision in her right eye over the past few days, with 15-20 minutes episodes of sudden blurry wavy appearance the past six weeks and no pain, where is the lesion causing the symptoms?
Left posterior cerebral artery (infarct involving left primary visual cortex, intracranial atheroscleroitc disease and right hemianopia).
If a patient's left face, arm and leg experience plegia with positive Babinski's sighn, no blink to threat on the left, no voluntary gaze to the left past the midline and no response to pinprick on the left, where is the lesion causing the symptoms?
Right internal carotid artery (ischemic infarction).
What are the two parts of the malleus?
Head and handle.
What are the three parts of the incus?
Body, short process and long process.
What are the two parts of the stapes?
Head and footplate.
What part of the inner ear does the stapes' footplate connect to?
The oval window.
What are the two functions of the ossicular chain?
Impedance matching and protection.
If a sound wave travels from a less dense medium to a more dense medium, what happens?
Sound energy reflection at the boundaries.
What is the acoustic resistance of air?
What is the acoustic resistance of cochlear fluid?
What is the ratio of air/cochlear fluid resistance?
If the middle ear had no impedance matching capabilities, what would happen to the sound wave?
Only 1/10 of the energy of incoming sound would make it into the cochlea. The rest would be reflected at the boundary.
What is the area of the tympanic membrane when compared to the oval window?
The tympanic membrane is 17 times larger than the oval window.
As the area of the middle ear decreases, the pressure...
What are two important concepts about impedance matching?
Area advantage, curved membrane buckling.
What is curved membrane buckling?
When the eardrum curves from its rim at both ends to its attachment. The middle of the eardrum doesn't move as far, causing an increase in force.
Explain the lever action similarities of impedance matching.
Sound force (pressure) increased when the incus (fulcrum) is moved closer to the inner ear fluid (mass moved).
A given sound pressure achieves greater mechanical advantage in terms of moving the inner fluid because of...
What is the travelling wave theory?
The closer the sound wave is to the apex of the cochlea, the lower the frequencies that travel.
What is the auditory pathway to the auditory cortex?
Cochlear nucleus, contralaterally goes to the superior olive, inferior colliculus, medial geniculate body, auditory cortex.
The organization of higher cortical functions depend on...
supplementary cortical functions.
When is the brain inactive?
What is the way the brain analyzed based on?
Certain assumptions on the background information about the brain (algorithmic procedures based on analysis).
What are the higher cortical functions?
Thinking, reasoning, planning, complex movements and language.
Where are higher cortical functions localized?
In the cortex, with imputs from other centers, influencing their output.
Only one function approach. Theory has some truth to it in Neurology but also has some indirect evidence that isn't.
Broca's patient who could only say "tan" and symptom-lesion correlation was researched in his brain post-mortem.
What is a problem with symptom-lesion correlation?
May not be the only area involved if one function is not localized. Limiting area.
Does Broca's discovery deal with localization?
What is the opposite of the localization theory?
The brain works as a whole. It is one thing to localize symptoms, but another to localize functions.
What are the partial truths of each theory of the localization of the brain?
There are specialized functions and there are areas that contribute to other functions (tertiary areas, for example).
Which areas of the brain are more modular: primary, secondary or tertiary?
Does the brain appear to be symmetrical or asymmetrical at the gross level?
At a finer level, is the brain symmetrical or asymmetrical?
Where are hemispheric asymmetries seen?
Anatomical asymmetries that underlie hemispheric specializations (functions).
Many aspects of the perisylvian region (area surrounding the lateral fissure) are asymmetric. The right sylvian fissure curves upward and more anteriorly than left. The left has a gentler slope.
The region in the superior temporal lobe, which has marked leftward volume asymmetry (primary and secondary auditory cortices, superior temporal gyrus).
The degree of hemispheric asymmetry is related to...
the degree of handedness.
Left handers have a weaker...
but leftward asymmetry.
Why is Planum Temporale important?
For phonological coding and speech perception.
Where is Broca's area?
Left frontal lobe.
Which is larger, the Broca's area or its homolog on the right hemisphere?
Broca's area in the left hemisphere.
According to Edinburgh, does handedness relate to language dominance?
Why might a right hand preference be expected?
Results from asymmetries in the motor cortex.
Are motor cortex asymmetries subtle or obvious?
Hand preference strongly correlates with structure and functional asymmetries of....
Which hand dominant people typiclaly display strong leftward specialization for speech and language processing?
How did prehistoric man communicate language?
Approximately 97% of right-handers have...
left language dominance.
70% of left-handed individuals have...
left language dominance.
Do gender differences suggest gender differences related to hemispheric specialization and handedness?
What gender suggests more lateralization for hemispheric specialization and handedness?
Male (Planum Temporale more lateralized/asymmetrical than female)
Frequently organs bleed in the body, why doesn't it turn into a hemorrage?
They are small enough for the body to respond properly.
What is the primary motor cortex's modality-specific function?
Details of movement plans.
What is the primary sensory cortex's modality-specific function?
Sensory analysis from the special senses (exteroreceptors).
What are the only cortices the primary motor and sensory cortical areas synapse with?
What is the function of the secondary motor and sensory cortices?
Modality-specific; synthesize motor plans/percepts.
What do secondary cortices synapse with?
In the left hemisphere is the junction between which secondary cortices?
Auditory, somesthetic and visual cortices and corresponds to the region along the angular gyrus in teh left hemisphere.
What is the tertiary cortex involved in?
Non-modality conceptual processes, critical for language function.
Transmission of a message from a speaker to a listener with the goal of stating and requesting information, influencing a listener.
What is a communication process?
Starts with a main intent, which is transmitted to the listener through a vehicle of language through one or more modalities of expression (speech, writing, signing)
What does developing intent involve neurologically?
Process of cognition, memory and emotion.
What kind of memories are rules?
What part of language itself has its own specific memory?
Is speech production an open-loop or closed-loop system?
What is an open-loop system?
Once an act unfolds, it proceeds to a logical conclusion without influence of the consequences.
What is a closed-loop system?
Once an act unfolds, it can be updated by immediate and long-term consequences, through feedback.
From a neurological perspective, is producing a sentence simple or complex?
What areas are involved in language and speech processing in the left hemisphere?
Broca's, Wernicke's, perisilvanian fissure and surrounding areas, arcuate fasiculus, pre and post central gyri.
Do specific lesions to language and speech areas affect specific language aspects?
What does Broca's aphasia severely affect?
Oral manifestation of language.
What is the traditional view of the Broca's aphasic experience?
They retain the ability to comprehend language, while exhibiting effortful severly impaired speech.
What similar symptoms can lesions of the insula and supramarginal gyrus of the parietal lobe cause?
Broca's aphasia symptoms.
What is another name for Wernicke's aphasia?
The individual with Wernicke's Aphasia exhibits relatively normal syntactic structure, but...
content will be markedly reduced by substituting words (verbal paraphasias) or creating new words (neologisms).
Is it easy for Wernicke's Aphasia patients to understand and repeat the speech of others.
Why would a purist dislike the term "aphasia" in reference to disturbance of language?
A - is a prefix for "no", which means loss of language, no language at all.
Where is the lesion in conduction aphasia?
What is the language function of the arcuate fasciculus?
Provides a strong link between receptive and expressive language components.
Do patients with conduction aphasia retain good comprehension of speech and written material?
What level of fluency do conduction aphasics have?
Relatively fluent speech.
Do conduction aphasias have difficulty repeating utterances?
Where is the lesion for Global aphasia?
Broca's and Wernicke's areas.
What is impaired with Global aphasia?
Both the expressive and receptive abilities of speech and language. Speech will be grammatically deficient with significant comprehension.
Damage to the Thalamus results in difficulty...
Naming objects (anomia).
Damage to the Putamen and Caudate nucleus may result in which kind of aphasia?
What is dyspraxia?
Deficit in the ability to program the articulators for speech and non-speech productions in the absence of muscular weakness/paralysis.
What type of aphasia typically occurs with dyspraxia?
What are the kinds of errors typical in dyspraxia?
Inconsistent phoneme substitutions.
Is the person with dyspraxia aware of their errors? Why or why not?
Yes, because they have comprehension and can understand feedback.
What is the main result of dyspraxia?
Loss of speech articulation, fluidity and possible speaker frustration.
What brain regions are involved in dyspraxia?
Insular cortex and Supramarginal gyrus.
How is the insular cortex involved in dyspraxia?
Individuals have difficulty producing even the simplest movement with articulators (a.k.a. executive dyspraxia)
How is the supramarginal gyrus of the parietal lobe involved in dyspraxia?
The region is thought to be involved in sequencing more complex articulatory movements (a.k.a. planning dyspraxia)
What is a concise definition of cognition?
How we process information.
What lobe is intimately involved in cognitive and executive functions?
What is the frontal lobe involved in?
Integrating informaiton from various sources, comparing stored memories to plan appropriate responses, controlling impulses, setting goals, sequencing motor activities and self-monitoring behaviors.
What system is the amygdala a part of?
What controls the emotional component of speech?
What structure is important for memory functions?
What kind of memory is the hippocampus responsible for?
Once a memory is consolidated, the memory may be found in...
the cortex and the cerebellum.