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Download SPHS 4050, Neurological bases, PP 01
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SPHS 4050 Neurological Bases of Speech and Hearing Sciences Scope of practice in speech-language pathology and audiology • Communication…of any and all types! • Swallowing The role of the neurological system in communication and swallowing • Carries motor, efferent signals in the direction away from the brain (rostral CNS to distal PNS) • Carries sensory, afferent signals in the direction toward the brain (distal PNS to rostral CNS) The process of communication depends on the neurological system Expressive communication uses efferent neurological pathways Receptive communication uses afferent neurological pathways Neurological system supports variety of communicative functions Efferent modality + afferent modality Efferent (motor) neural pathways for expressive communication BRAIN PLANS AND INITIATES Afferent (sensory) neural pathways for receptive communication BRAIN RECEIVES AND INTERPRETS Verbal + auditory (talking + listening) Spoken language (system of sounds/words/syntax/discourse); speech (articulation); prosody (pitch, timing, loudness) Hearing and interpretation: sounds and sound localization, words, word order, discourse, prosody, metaphor Writing + reading Production of written language, symbols, pictures (manual or digital) Reception and interpretation of written language, symbols or pictures ** Motor + tactile e.g. move to touch person e.g. making a braille message e.g. handing person an object e.g. feel touch of others e.g. feel braille bumps ** e.g. feel shape of object ** Motor + visual e.g. movement for posturing, gesturing, sign language, facial expression e.g. vision**: visual scanning, and interpretation of the posture, gesture sign, facial expression ** Note that the message receiver has to MOVE (eyes or hands) to successfully receive message; both afferent and efferent systems involved Neurological system also supports the pragmatics of communication, no matter what the modality….. • Expressive: – Planning and using the “right” communication for the given context • e.g. changing one’s talking style for a close friend vs. one’s boss • e.g.deciding when and where to use certain gestures • Receptive: – Figuring out appropriateness and “deeper meaning” of communication, for the given context • e.g. We could figure out what he really meant by that comment… He wasn’t really complimenting her…. • e.g. Why did he/she use that intonation in his/her “Oh” ? Pragmatics applies across all the efferent and afferent modalities Pragmatics applies to all the modalities, both efferent and afferent. How so? Efferent modality + afferent modality Efferent (motor) neural pathways for expressive communication BRAIN PLANS AND INITIATES Afferent (sensory) neural pathways for receptive communication BRAIN RECEIVES AND INTERPRETS Verbal + auditory (talking + listening) Spoken language (system of sounds/words/syntax/discourse);spe ech (articulation); prosody (pitch, timing, loudness) Hearing and interpretation: sounds and sound localization, words, word order, discourse, prosody, metaphor Writing + reading Production of written language, Reception and interpretation of symbols, pictures (manual or digital) written language, symbols or pictures Motor + tactile e.g. move to touch person e.g. making a braille message e.g. handing person an object e.g. feel touch of others e.g. feel braille bumps e.g. feel shape of object Motor + visual e.g. movement for posturing, gesturing, sign language, facial expression e.g. vision, visual scanning, and interpretation of posture, gesture, sign, facial expression Pragmatics Planning and use of the “right” communication content in a given context Figuring out appropriateness and “deeper meaning” of the communication in a given context The process of swallowing depends on the neurological system Swallowing uses both efferent and afferent neurological pathways • Movement (efferent) • Sensation (afferent) NOTE: Smell and taste are integral for eating, too! Phases of swallow require the use of both: • Efferent • (motor) neural pathways Afferent (sensory) neural pathways Why Neurosciences for Specialists in Communication and Swallowing (like Speech-Language Pathologists and Audiologists)? Well, sometimes a client has loss of a communicative function (clinical sign or symptom), which is related to disease or damage in the neurological system (neuropathology) Efferent modality + afferent modality Efferent (motor) neural pathways for expressive communication BRAIN PLANS AND INITIATES Afferent (sensory) neural pathways for receptive communication BRAIN RECEIVES AND INTERPRETS Verbal + auditory (talking and listening) Language (system of sounds/ words/syntax/discourse); speech (articulation); prosody (pitch, timing, loudness) Hearing and interpretation: sounds and sound localization, words, word order, discourse, prosody, metaphor Can’t hear Acoustic in one ear neuroma Can’t hear high freq. Damage to high freq. hair cells in cochlea Can’t interpret prosody (receptive aprosodia) Damage to right hemisphere of brain • Clinicopathologic method Can’t interpret prosody (receptive aprosodia) Damage to right hemisphere of brain – Relation between: • the behavioral functions that are lost or modified (as seen in the clinic), and • the site of a lesion (neurological damage, pathology) – Tools: • Careful documentation of client’s abilities PLUS • Neurodiagnostic techniques (as in Chapter 20) • Clinicopathologic method is used in the field of behavioral neurology: “Study of how client’s behaviors/abilities are related to or supported by the neurological system” • Examples from the fields of speech-language pathology and audiology, that we’ll encounter in this class Dysarthria (speech motor disorder) Damage to brain stem or cranial nerves, as might happen with M.S. Aphasia (acquired language disorder) Damage to left hemisphere of cerebrum Cognitive-communicative disorders associated with memory and attention problems Traumatic brain injury (diffuse injury to brain) Meniere’s disease Meniere’s disease (associated with damage to hair cells in the cochlea) Dysphagia (swallowing disorder) Damage to specific cranial nerves Cortical blindness Damage to vision centers of brain Anosmia (inability to smell) Damage to nerve receptor endings in nasal epithelium Some examples from the book (Table 1-2) of clinical signs symptoms associated with various neurological diseases/pathology. This again illustrates clinicopathologic method. Need for this knowledge/understanding of behavioral neurology • Variety of work settings – – – – Schools Hospitals Medical centers University and private clinics • Increasingly interdisciplinary work settings need workers with specialized knowledge, who can also interpret work of other disciplines • e.g. IMT (interdisciplinary management team) • e.g., multidisciplinary school IEP meetings Basic Principles of the Organization of the Nervous System Basic Principles: Why Study These? • They give us clue about how the nervous system is organized – Our understanding of these principles affects how we study and investigate the brain – These principles are based on clinicopathologic evidence of how the brain works #1: Interconnectivity in the Brain • All functionally discrete/separate regions of the brain are connected, either – Directly – Indirectly • Multiple areas interact, e.g., for language, memory, attention See pp. 73-77 for discussion of the three types of connecting fibers! #2: Centrality of Central Nervous System (CNS) • Role of Central nervous system (brain and spinal cord) – Integrate impulses: Bring information in and make sense of it – Generate impulses: Typically accomplished through movement • CNS “Collaborates” with peripheral • nervous system PNS (outside of brain and spinal cord) Info entering and leaving the CNS are carried by different pathways – Information going (up) to the CNS from the PNS is sensory or afferent. – Information coming (down) from the CNS to the PNS is motor or efferent. #3a Hierarchy of Neuraxial organization: Lower to Higher • Lower levels perform more basic • functions, higher levels perform more complex functions For example (going from simple/basic to more complex) − Spinal cord responsible for reflexes (no cognitive involvement) − Brain stem responsible for more complex tasks such as body functions (breathing, heart beat) − Brain’s cortex is responsible for complex integration and higher mental functions, like language, memory, and attention #3b Hierarchy of Organization: Inside to Outside • Structures at deeper level of brain: More basic/primal/older – e.g. limbic system (in color): Basic emotions such as fear, as linked to memory • Structures closer to surface: “Newer” structures develop on top of older structures – E.g., neocortex (in brown) is laid on top of the (older) limbic system, and allows us to “think about,” interpret, analyze, plan, based on memories and emotions associated with them #4a Bilateral Anatomic Symmetry (throughout NS) • Both sides of CNS essentially structural mirror images of each other • This principle is used in medical diagnosis #4b Unilateral functional asymmetry • Generally thought that the both sides of the nervous system are functionally the same at birth • Experience allows for some functions to become associated with one side of the brain or the other – Language associated with left cerebral hemisphere – Pragmatics associated with right cerebral hemisphere Careful: This does not mean that we don’t use right hemisphere when we’re using language. The two hemisphere do communicate. #4c Contralateral Sensorimotor Control (esp. for body sensation and mvmnt) • Most sensory (afferent) and motor • • (efferent) fibers decussate (cross) the midline of the body – A touch at the right hand crosses midline over to the left – Movement of right is controlled by the left Some information (i.e. hearing) may cross midline more than once Some systems (e.g., speech motor system) have both ipsilateral and contralateral control #5a Structure/Function Relationship • If two NS structures have differing morphologies (different shapes), then they probably also have different functions (Fx) – Different morphologies reflect different processing times and processing abilities • e.g., long nerve cells with thick insulation are designed to carry nerve impulses long distances, as opposed to short cells with little insulation, designed for short distance • E.g., different areas of the cortex covering the brain surface have different cellular composition and perform different functions #5b Functional networking • Many different locations are networked together to fill complex functions – E.g. reading aloud – E.g. Thinking about what someone said and responding appropriately – E.g. someone taps you on the shoulder, and you respond to it #6 Topographical Organization of Function • Functions can be strongly associated with certain anatomical locations • E.g. Motor homunculus (“little man”) in primary motor cortex NOTE: EACH side of the brain has BOTH a sensory and a motor homunculus. (Motor is in front of the sensory on each side.) #7 Plasticity in the Brain • Brain is able to reorganize functions if needed – Particularly true in younger children – Seem to lose some of this ability as we age • PNS may better able to reorganize than CNS • after trauma, but our understanding of CNS recovery is improving Plasticity – Learning – Recovery following trauma, through rehabilitation #8 Culturally neutral brain • Brain potential-independent of gender, color, or cultural variations • Notable variations in brain size, shape, or weight –Functionally unimportant normal variations