subcortical component of the
limbic system (rhinencephalon); the mamillary bodies are
connected to the hippocampus, the thalamus, and the
fornix
masked
facies:
Parkinson's patients usually
display little facial expression, so their faces are described
as "mask-like."
massa
intermedia (thalamic adhesion):
the tissue that connects the
two thalamic bodies
masseter muscle of the oral cavity:
elevates and closes the
mandible
MTDDA: Minnesota Test
for Differential Diagnosis
medial:
toward the center
medial muscle of the oral cavity:
which also elevates the
mandible and aids in its closure
medial aspect:
the part of the motor strip
that extends down into the longitudinal cerebral fissure; it
controls the movements of the body from the hips
downward
medial
cut:
a section that divides the
brain into right and left halves of equal size; it separates
the hemispheres from each other; a medial cut is a type of
sagittal cut
medial
geniculate bodies:
the thalamic nuclei that
receive auditory information from the inferior colliculi of the
midbrain, process, and then transmit this information to the
cortex
medulla oblongata:
the most inferior structure of
the brain stem; the "bulb"; the medulla is involved in
circulation and respiration
Melodic Intonation
Therapy:
(Sparks & Holland, in
Chapey, 1994) Melodic intonation therapy, or MIT, uses
music to involve the non-dominant hemisphere in language
production. originally developed by Sparks and Holland for the
treatment of severe non-fluent aphasia. Currently, however, it
is frequently used to treat individuals with apraxia. This
technique involves teaching the patient to sing words or
phrases set to simple melodies. It is hypothesized that this
therapy is effective because the use of music helps involve the
right hemisphere in the production of speech.
Mendelsohn
Maneuver:
helps the patient gain some
voluntary control over the opening and closing of the p.e.
segment. The patient is told to pay attention to the way the
thyroid cartilage goes up and down during swallowing. Then he
learns to use muscles to keep the larynx elevated for several
seconds after the swallow. This should facilitate the opening
of the cricopharyngus muscle.
meninges:
dura mater, arachnoid and pia
mater, three layers of protective tissue that surround the
neuraxis; the meninges of the brain and spinal cord are
continuous and are connected through the magnum foramen
micrographia:
often seen with parietal lobe
lesion, the "tendency for handwriting to be very small in the
height of the letters and to get progressively smaller as the
person continues to write" (Love and Webb, 1992, p.
146).
the largest of the cerebellar
peduncles; the middle cerebellar peduncle connects the
cerebellum with the pons; through this connection the
cerebellum receives a copy of the information for muscle
movement that the pyramidal tract carries to lower motor
neurons
middle
cerebral artery:
a branch of the internal
carotids; the middle cerebral artery supplies blood to the
entire lateral aspect of each hemisphere (including the lateral
motor strip, lateral sensory strip, Broca's area, Wernicke's
area, Heschl's gyrus, angular gyrus) and to the corpus
striatum
middle meningeal
artery:
this artery sometimes ruptures
after traumatic brain injury
Minnesota Test for
Differential Diagnosis: (MTDDA)
developed by Schuell in 1965.
This comprehensive test assesses the patient's strengths and
weakness in all language modalities.
Mixed
dysarthria:
occurs when both upper and
lower motor neurons are injured, amyotrophic lateral sclerosis
(Lou Gehrig's Disease) is the most frequent cause of mixed
dysarthrias. Etiology is unknown and prognosis is poor.
Mixed Nonfluent
Aphasia:
diagnosis given to patients
who produce language that is similar to the telegraphic speech
characteristic of Broca's aphasia, but cannot be categorized as
actually having Broca's aphasia due to the severity of their
auditory comprehension deficits.
modified barium
swallow:
procedure used to image the
swallowing process is a modified barium swallow, not a true barium swallow. the patient consumes
foods of varying consistencies that have been coated with
barium.A true barium swallow is used to view the
esophagus
molecular
commotion:
(Love and Webb, 1992) a
disruption in the molecular structure of the brain which may
cause permanent changes in both white and grey matter
molecular layer:
the most superior layer of the
cortex; it contains the cell bodies of neuroglial cells
muscularis
uvula (oral
cavity):
shortens the velum. It is also
innervated by the spinal accessory (CN XI).
Myasthenia
Gravis:
According to Fitz Gerald
(1996), it is caused by the immune system producing antibodies
to the ACh receptor. This disease impairs the ability of nerve
fibers to synapse with the muscles by reducing the number of
acetylcholine (ACh) receptors at the neuromuscular junction. It
causes weakness in muscles throughout the body, especially
those involved in speech and swallowing. This weakness is
progressive. In the morning or after rest, the patient's speech
may sound clear. However, as he becomes fatigued, slurring of
speech will increase.
myelin:
a fatty insulating substance
that covers, at regular intervals, many of the axons in the
central and peripheral nervous system; myelin serves to
increase the speed of transmission of impulses, by allowing
them to jump from one unmyelinated segment to the next (this is
called saltatory conduction)
myotomy:
the procedure of cutting the
cricopharygeus muscle
N
neuraxis:
the brain and spinal cord; the
central nervous system
Neuronal
Unmasking:
(Bach-y-Rita, 1989) Neurons
which are normally quiescent may begin working again after
others have been destroyed. This means that brain processes
which are normally inhibited by higher level controls will be
able to function. This may help in recovery. Negative effects
of unmasking are reflexes and responses like the
startle
reflex which are
usually only seen in young children. The Babinski reflex and the patilla reflex may also be abnormal after head injury.
neurons:
the nerve cells of the central
and peripheral nervous systems; a neuron is composed of an
axon, a soma, and dendrites (while all neurons have one soma
and one axon, some neurons have many dendrites and others have
none)
neurological input for the
swallow
in the initiation in the
swallow comes from the trigeminal, facial,
and glossopharyngeal nerves
neocerebellum:
the posterior lobe of the
cerebellum; it is considered to be the newest part of the
cerebellum; it is involved in the coordination of muscle
movement through the inhibition of involuntary movement, it is
also involved in fine motor coordination
neologistic
paraphasias:
less than half of the intended
word is produced correctly. In some cases the entire word is
produced incorrectly. Neologisms are also common in the speech
of schizophrenics.
NG tubes and
swallowing:
naso-gastric feeding tube;
According to Logemann (1989), its not necessary to wait until
tubes are removed to begin therapy.
Nodes of
Ranvier:
the segments of axons between
areas of myelin, which are in direct contact with extracellular
fluid
nodulus:
the narrowest and most
inferior part of the vermis; it is part of the flocculonodular
lobe of the cerebellum
nonfluent
aphasias:
Nonfluent aphasias are the
result of damage to the area of the brain anterior to the central
sulcus (Broca's
area)
The flow of speech is more or
less impaired at the levels of speech initiation, the finding
and sequencing of articulatory movements, and the production of
grammatical sequences. Speech is choppy, interrupted, and
awkwardly articulated.
Comprehension appears to be
better than production and in a sense it is. The linguistic
competence underlying both comprehension and production of
language is the same, so both comprehension and production are
affected by a nonfluent aphasia. However, just as it is easier
to understand a second language than to produce it, it is
easier for the patient to understand what is said than to
speak. One can often get by with only comprehending the key
words and using non-verbal cues.
O
obicularis oris:
lip muscle, with the
buccinator and zygomaticus innervated by the facial nerve
(CN. VII).
occipital
lobe:
the most posterior lobe of the
brain; it is associated with vision
olfactory
pathways:
the olfactory pathways
originate in the nasal area and pass posteriorly to enter the
temporal lobe at the hippocampal gyrus; the olfactory tract is
immediately superior to the optic tract
olivary nuclei:
landmarks in the medulla which
lie posterior to the pyramids; the olivary nuclei are involved
in the processing and relaying of auditory information
operant
conditioning:
a form of behavior modification, used to remediate aphasia. This
approach involves shaping language behavior by helping patients
to progress through a series of tasks presented in fixed order,
from least to most difficult.
oral
apraxia:
an inability to make
voluntary, non-speech oral movements
oral preparatory phase of the swallow:
voluntary, mechanical phase that can be
by-passed by dropping liquid or food into the back of the
throat.In this stage, the food is chewed into smaller pieces
and tasted. It is also mixed with saliva from three pairs of
salivary glands, which are innervated by the glossopharyngeal
nerve. The food and saliva form a bolus of
material. The bolus is kept in the front of the mouth, against
the hard palate by the tongue. The front of the tongue is
elevated with its tip on the alveolar ridge. The back of the
tongue is elevated and the soft palate is pulled anteriorly
against it (the airway is open and nasal breathing
continues during this phase). Labial seal is maintained to
prevent food from leaking out of the mouth. Buccal muscles are
tense. Duration of the oral-preparatory stage is variable
(Logemann, 1983, 1997).
oral transport
stage of the
swallow:
voluntary stage, starts with the jaws and lips
closed, and the tongue tip on the alvealor ridge. The
pattern-elicited response is initiated at the end of this
phase. Inspiration is reflexively inhibited at the beginning of
this stage. The food is moved to the back of the mouth by the
tongue via an anterior to posterior rolling motion. The
anterior portion of the tongue is retracted and depressed while
the posterior portion is retracted and elevated against the
hard palate. When the bolus passes the anterior faucial
pillars/touches the posterior wall of the pharynx, the oral
stage ends and the pharyngeal stage begins as the
tongue driving
force or the tongue's
plunger
action, forces the
bolus into the pharynx. Logemann (1997) describes the
"pharyngeal tongue" which extends from the velum to the hyoid
bone and valleculae. The "oral tongue" which extends from the
tip to the back, adjacent to the velum, functions during the
oral stage of the swallow while the "pharyngeal tongue"
functions during the pharyngeal stage. This stage lasts one
second (Logemann, 1989, 1998; Dobie, 1978).
P
pacing board
may be helpful for patients
with dysarthria, divided into sections, the patient must tap
one section every time he pronounces a syllable. As the fingers
cannot move nearly as rapidly as the articulators, this should
slow the rate of speech enough to improve intelligibility.
After reduced rate has been established using the board, the
client can begin to count syllables on his fingers. Eventually,
he should be able to maintain the proper rate without counting
syllables at all. A device called a graduated stick may be used instead of a pacing board. Graduated
sticks have bumps on them at regular intervals and the
patient must touch one bump every time he says a
syllable. Metronomes can also be used to slow speech rate.
Patients are taught to produce one syllable per "tick" on the
metronome.
palatoglossal muscle
(oral cavity):
with the levator veli palatini both raise the velum. They are
innervated by the vagus nerve (CN. X)
palatopharyngus muscle
(oral cavity):
depresses the velum and
constricts the pharynx. It is innervated by the spinal
accessory (CN. XI).
paleocerebellum:
the anterior lobe and second
oldest part of the cerebellum; the paleocerebellum receives
proprioceptive input from the spinal cord and controls the
anti-gravity muscles of the body, it thus regulates
posture
Pallilalia:
the compulsive repetition of
syllables sometimes present in hypokinetic dysarthria
paraphasia:
the production of unintended
syllables, words, or phrases during the effort to speak"
(Goodglass & Kaplan, 1983, p. 8). Patients with fluent
forms of aphasia exhibit many more paraphasias than do those
with nonfluent types. There are three types of paraphasias,
literal/phonological, neologistic, and semantic/verbal.
parasympathetic nervous system:
a division of the autonomic
nervous system; it helps to bring the body back to
normal
parenchyma
means "specific cells of a
gland or organ" (Stedman's Concise Medical Dictionary, 1997).
Parenchymal bleeding refers to the flow of blood into brain
tissue rather than into an existing space like the
subarachnoid
space or a potential
space like the subdural space. Parenchymal hemorrhages occur most frequently in
the putamen, thalamus, pons, and cerebellum (Coch & Metter,
1994).
paragrammatical:
(Goodglass and Kaplan, 1983)
patients with Wernicke's Aphasia make grammatical errors but
their speech cannot be considered agrammatical as it does
contain complex syntactical forms
parietal
lobe:
the lobe of the brain which is
immediately posterior to the central sulcus, anterior to the
occipital lobe, and superior to the posterior portion of the
lateral fissure (and thus the temporal lobe); it is associated
with sensation (touch, kinesthesia, perception of temperature,
vibration), writing, and some aspects of reading
Parkinson's Disease:
a degenerative disease, is
probably the most frequently occurring illness that results
from extrapyramidal tract lesions. It occurs when the
dopaminergic neurons of the substantia nigra are destroyed. Its
symptoms include:
Tremor, Festinating movements( these movements can also affect speech),
Hypokinetic
dysarthria, weak voice,
and mask-like facial expression. Recent research indicates that
those who acquire the disease prior to age 50 may have genetic
causation.
pattern-elicited
response:
the swallow was previously
classified as a reflex, most sources now disagree and label it
pattern-elicited
perilymph:
fluid of the inner ear; it
surrounds the utricle, saccule, and semicircular canal
peripheral
lesions:
lesions to the axons of the
cranial nerves; these are considered to be lesions of the final
common pathway
peripheral nervous
system:
the cranial nerves and spinal
nerves
peristalsis:
wave-like motions of muscles
that occur in the esophagus. In some of the literature, the
action of the pharyngeal constrictor muscles is mistakenly
called peristalsis, rather than a stripping action.
pharyngeal-esophageal
(P.E) segment or cricopharyngus m.:
separates the pharynx from the
esophagus. At the end of the pharyngeal stage of the swallow,
it must relax to allow the bolus to enter the esophagus. (It is
normally closed to prevent the reflux of food and to keep air
out of the digestive system.)
pharyngeal recesses:
the valleculae is a space or depression between the base of the
tongue and the epiglottis, two pyriform sinuses are located in the pharynx, beside the larynx.
They are formed by the shape of muscle attachments to the
pharyngeal walls. Food boluses can lodge in these
recesses.
pharyngeal
stage of the swallow:
(Logemann, 1989, 1997, 1998; Cherney, 1994)
involuntary, and most critical stage of the swallow; airway
closure must occur to prevent the bolus from entering the
respiratory system. Almost simultaneously: 1.Sensory
information from receptors in the back of the mouth and in the
pharynx goes to the swallowing center in the medulla via CN.
IX. The palatopharyngeal folds pull together medially to form a
slit in the upper pharynx. The bolus passes through this slit.
2. The velum is raised, primarily by the levator and tensor
veli palatini muscles. 3. The tongue is retracted
Has a laryngeal substage in
which three actions occur simultaneously (Obviously,
inspiration is inhibited during the pharyngeal stage of the
swallow.) 1.The larynx and the hyoid bone are pulled both
upward and forward. 2.The true and false vocal folds
adduct. (Closure begins at the level of the true vocal folds
and progresses up to the false vocal folds and then to the
ari-epiglottic folds.) 3.The epiglottis drops down over the top
of the larynx, The bolus passes down on both sides of
the epiglottis. If the bolus is liquid, the epiglottis acts as
a ledge to slow its movement through the pharynx, giving the
vocal folds time to adduct and the larynx time to
elevate.
Three factors cause food to move down the pharynx during the
rest of the pharyngeal stage (Cherney, et al., 1994; Logemann,
1983, 1989, 1997): The tongue driving force using the
"pharyngeal tongue", the stripping action of the pharyngeal
constrictors and the presence of negative pressure in
the laryngopharynx
The pharyngeal stage ends when the cricopharyngus muscle
relaxes.
pia
mater:
the innermost layer of the
meninges; it adheres closely to the brain, descending into the
sulci and fissures of the cortex and fuses with the ependyma to
form the choroid plexes
Pill-rolling
tremor:
Parkinson's patients
move their thumbs and forefingers together as if rolling a
small pill between them. This movement occurs at rest, but
subsides during voluntary movement and sleep.
pituitary gland:
an endocrine gland of the
central nervous system; secretes a number of different
hormones
plaque:
composed of cholesterol build
up and smooth muscle cells
plunger action or
or the tongue driving force:
plays a major role in this
process.in the movement of food down the pharynx, according to
the latest research on swallowing disputes the action of
the pharyngeal constrictor muscles as the most critical
factor
pneumoencephalography:
a technique used prior to the
introduction of CT, MRI, and PET technology, in which a small
amount of cerebrospinal fluid is removed from the ventricles
and replaced with an inert gas, allowing the examiner to view
the ventricles in a scan and assess brain pathology
polycythemia:
a thickening of the blood due
to an increase in the number of cells.
pons:
the brain stem structure
located between the midbrain and medulla; fibers in it connect
the brain stem to the cerebellum; pons is Latin for
"bridge"
Porch Index of
Communicative Ability: (PICA)
(Porch, 1967) samples fewer
language behaviors than the MTDDA. However, it is known for its
elaborate scoring system, which allows the examiner to
differentiate between responses elicited with different degrees
of cueing, various types of errors, and also to note the
immediacy of the response.
the area of the brain located
in the parietal lobe immediately posterior to the central
sulcus; this area receives sensory feedback from the muscles,
joints and tendons in the body; the postcentral gyri have
lateral and medial aspects
posterior:
toward the back (opposed to
anterior)
posterior
cerebral arteries:
arteries that arise from the
basilar artery (before it divides); the posterior cerebral
arteries supply blood to the posterior areas of the brain,
including the medial parts of the occipital lobes, and the
inferior areas of the temporal lobes, as well as supplying
blood to the thalamus and other subcortical structures
posterior
commissure:
one of the three major groups
of commissural fibers
posterior
communicating arteries:
arteries that arise from the
internal carotid arteries; they join the middle cerebral
arteries to the posterior cerebral arteries
posterior
lesions:
problems with meaning are associated with posterior lesions
post-ganglionic
cells:
neurons of the autonomic
nervous system that are located in its target organs and
muscles
post Rolandic
area:
lesions in this area result in
fluent aphasia, these are posterior lesions and result in
problems with meaning
precentral gyrus
(primary motor area, motor strip):
a gyrus in the frontal
lobe which controls the voluntary movements of skeletal
muscles; it is located immediately anterior to the
central sulcus and has a lateral and medial aspect; the
cell bodies of the pyramidal tract are found here
pre-ganglionic
cells:
neurons of the autonomic
nervous system that are located in some of the cranial
nerves of the brain stem and in some spinal nerves; they
project to the ganglionic chains of the autonomic nervous
system
premotor areas
(supplemental motor areas):
Brodmann's Area 6, areas
located immediately anterior to the motor strip; this
portion of the frontal lobe is responsible for the
programming of motor movements (except speech)
presensory areas
(secondary sensory areas or sensory association
areas):
areas located posterior
to the postcentral gyrus; these areas are capable of more
detailed discrimination and analysis than the primary
sensory areas
press of
speech:
phenomenon characterizes
Wernicke's aphasics. Patients may speak very rapidly,
interrupting others. It may seem as though the patient is
striving for a sense of closure or a sense that he has
actually communicated what he intended to say (Goodglass
and Kaplan, 1983).
primary auditory
cortex:
Brodmann's areas 41 and
42
primary visual
area:
an area located within
the occipital lobe; it receives input from the optic
tract; damage to this area may cause blind spots in the
visual field or total blindness
pragmatic
approaches:
use social interaction
to improve the communicating abilities of aphasic
patients.
programmed
stimulation:
LaPointe (1990),
approach to aphasia therapy combines behavioral and
cognitive methods. He advocated the use of a hierarchy of
therapy tasks based on level of difficulty employed by
behaviorists, but uses the kinds of stimuli employed by
therapists with a cognitive orientation. Several types of
programmed
stimulation for
aphasics have been developed by other therapists. Among
these are melodic
intonation therapy (Sparks & Holland, in Chapey, 1994) and
visual action therapy VAT (Fitzpatrick & Baresi,
1982).
progressivestrokes:
still evolving, meaning
that the patient's condition is continuing to
deteriorate. Progressive strokes can last for over a
week. This condition is usually the result of a severe
hemorrhage.Particular caution should be used when
evaluating the swallowing status of such a patient. Also,
progressive strokes tend to happen to people who have
very poor cerebral vascular health and are therefore at
risk for having another stroke very soon.
developed by G. Albyn
Davis, based on the pragmatic rule of
reciprocity; the therapist and the patient participate
in a conversation as equals, each taking turns sending
and receiving messages. According to Davis and Wilcox
(1981)PACE is based on the following four principles, The
Exchange of New Information, Free Choice of Communicative
Channels, Equal Participation, Functional Feedback
proprioception:
sensory information
about pressure, movement, vibration, position, muscle
pain, and equilibrium that is received by the brain
(especially the cerebellum) from the muscles, joints, and
tendons
prosopagnosia:
inability to recognize
faces
pseudobulbar
palsy:
the paralysis that
results from bilateral upper motor neuron lesions of the
pyramidal tract; it produces a paralysis very similar to
that seen with bulbar palsy
putamen:
the more lateral part of
the lenticular nucleus
Purkinje cells:
radish-shaped cells
located in the cerebellar cortex that regulate and
inhibit the firing of the deep nuclei, thus controlling
the output of the cerebellum
pyramidal tract:
a fiber tract that
carries messages for voluntary motor movement to the
lower motor neurons in the brain stem and spinal cord;
the pyramidal tract is direct and monosynaptic, pyramidal
tract, which is the most important of the upper motor
neuron tracts, transmits messages directing voluntary
motor movements. It is primarily facilitory (Duffy,
1995).
pyramids:
landmarks in the medulla
which mark the decussation of the pyramidal tract; they
lie on either side of the medial fissure