Transcript Voice 7 Neurogenic Voice disorders 1

NEUROGENIC VOICE DISORDERS 1
TOPICS
Anatomy and function of the Nervous
System for Speech
 Common Types of neurogenic voice
disorders

ANATOMICAL DIVISION OF THE
NERVOUS SYSTEM
o
Central Nervous System (within bone):中枢神经系统
* Cerebrum大脑
* Cerebellum小脑
* Brainstem脑干
* Spinal Cord脊髓
o
Peripheral Nervous System 周围神经系统
(outside bone):
* 12 pairs of Cranial Nerves12对脑神经
* 31 pairs of Spinal Nerves 31对脊神经
* Sensory Receptors 感受器
MOTOR SYSTEM运动系统

Efferent connections of cortex frontal lobe
大脑皮层传出结构
Basal ganglia 基底神经节
 Cerebellum 小脑

额叶
MOTOR SYSTEM运动系统
Descending pathways to motor nuclei of cranial
and spinal nerve 脑及脊神经运动核的下行通路
 Efferent fibers within cranial and spinal nerves

脑及脊神经内的传出纤维

Striated muscle
横纹肌
SPEECH MOTOR SYSTEM
Final common pathway 终端通路
 Direct activation pathway 直接运动通路
 Indirect activation pathway 间接运动通路
 Control circuits 控制回路

FINAL COMMON PATHWAY AND SPEECH

Paired cranial nerves supplying muscles
involved in phonation, resonance, articulation
and prosody.


12对脑神经控制发声、共鸣、构音和音律方面的肌肉
Paired spinal nerves involved in respiratory
activities.

31对脊神经参与呼吸方面的运动
DIRECT ACTIVATION PATHWAY AND SPEECH

Upper motor neuron system 上运动神经元系统
 Corticobulbar
tract: influence activities of cranial
nerves

皮质延髓束：影响脑神经的活动
 Corticospinal
tract : influence activities of spinal
nerves

皮层脊髓束：影响脊神经的活动
CORTICOSPINAL TRACT 皮层脊髓束
part of the Pyramidal Pathways
 goes from the cortex to the spinal cord
 provides innervation for skeletal muscles
 made up of over 1 million fibers which arise
from the cerebral cortex and other motor
areas of the brain

CORTICOSPINAL TRACT CONTINUED
also responsible for inhibition of reflexes
 Lesions on this tract would cause

 Muscle
weakness
 Loss of voluntary use of muscles
 Loss of muscle tone

Babinski Reflex
 Natural
reflexes that we have as infants that go
away with time
CORTICOBULBAR TRACT皮质延髓束
is NOT a tract of the spinal cord
 very important for speech production
 arises from the premotor and somesthetic
(body sense) regions of the parietal lobe of
the cortex
 enters the brainstem
 provides innervation to many muscles of the
face, neck, pharynx and larynx

INDIRECT ACTIVATION PATHWAY AND SPEECH

Reticular formation（网状结构）：




Vestibular nuclei（前庭神经核）：



Mediate consciousness,
some portions excite extensor(伸肌) motoneurons and inhibit
flexor(屈肌) motoneurons
other portions inhibit extensor motoneurons and excite flexors.
Corticoreticular tract
modulate the activities of the eye and neck muscles.
Vestibulospinal tract facilitate reflex activity and control muscle tone.
Red nuclei（红核）：

Corticorubral tract and rubrospinal tract, influence flexor muscle
groups on the limbs.
INDIRECT ACTIVATION PATHWAY AND SPEECH

Function:


Effects of damage:




regular reflexes and posture, tone, and associated activities that
provide a framework on which the direct activation pathway can
accomplish skills, discrete actions.
Lesions above the midbrain and red nucleus produce increased
extensor tone in the legs and increased flexor tone in the arms.
lesions below red nucleus produce a generalized increase in
extensor tone.
Lesion below medulla produce generalized flaccidity in muscles.
UMN lesions include direct and indirect activation pathway.
CONTROL CIRCUITS

Do not have direct contact with LMN.
 Basal
ganglia control circuit
 Cerebellar
 Influence
control circuit
movement through cerebral cortex
BASAL GANGLIA CONTROL CIRCUITS AND
SPEECH

Basal ganglia:



caudate nucleus（尾状核）, putamen（豆状核） and globus
pallidus（苍白球） , also substantia nigra（黑质） and subthalamus
nucleus（丘脑底核） .
The balance between acetylcholine（乙酰胆碱） and dopamine（多
巴胺） is important in motor control. Inhibitory neurotransmitter in BG
is GABA.
Function:






Regulate muscle tone,
Regulate movements associated with goal-directed activities,
Regulate automatic activities,
Regulate postural adjustments during skilled movements,
Regulate the relationship of required movement to the environment
Regulate the learning of new movements.
BASAL GANGLIA CONTROL CIRCUITS AND
SPEECH

Effects of damage:

Disease of substantia nigra cause
Hypokinesia
 Increased muscle tone
 Increased resistance to passive movements
 Reduced range of movement (rigidity)
 Affectively expressionless.


Hyperkinesia result from excessive activity in
dopaminergic nerve fibers cause involuntary movements.
CEREBELLAR CONTROL CIRCUIT AND SPEECH

Cerebellar hemispheres: control movement of
ipsilateral side of body.

Flocculonodular lobe（绒球小结叶）: modulate
equilibrium and orientation of head and eyes.

Anterior lobe（小脑前叶）: regulating posture, gait, and
truncal tone.

Posterior lobe（小脑后叶）: coordinate skilled, voluntary
muscle activity and muscle tone.
CEREBELLAR CONTROL CIRCUIT AND SPEECH

Reciprocal connections（交互连接） with cerebral cortex;

Auditory feedback and proprioceptive（本体感受） input
from speech muscles, tendons and joints;

Reciprocal connections with brainstem components of the
indirect activation pathways, and cooperative activity with
the basal ganglia control circuit
VAGUS NERVE迷走神经

Two important branches:

Superior laryngeal nerve(SLN)喉上神经



internal and external laryngeal nerve
Recurrent laryngeal nerve (RLN)喉返神经
Function:


Innervation of striated muscles of the soft palate, pharynx,
and larynx 支配软腭咽喉的横纹肌
Sensation from soft palate, pharynx and larynx 接受软腭、咽
腔和喉腔的感觉
VAGUS NERVE迷走神经

Unilateral LMN lesion单侧下运动神经元:


affect phonation
Bilateral LMN lesion双侧下运动神经元受损:


affect resonance, phonation, prosody and clarity of
articulation构音清晰度, and swallowing吞咽.
Produce weakness of soft palate, pharynx, and larynx.
CLASSIFICATION OF NEUROLOGICAL DISORDERS
OF VOICE
Hypoadduction
 Paralysis
 Hyperadduction
 Ataxic Disorders
 Mixed Disorders

HYPOADDUCTION 关闭不严

Myasthenia Gravis重症肌无力
 breathiness

Parkinsonism 帕金森症
 monopitch

and reduced loudness
Laryngeal paralysis 喉麻痹
 breathiness
PARALYSIS麻痹 – SUPERIOR LARYNGEAL
NERVE喉上神经

Unilateral paralysis单侧声带麻痹
 may
see elevation of affected fold or shortening of
VF 可看到受损声带位置抬高或声带变短

Bilateral paralysis 双侧声带麻痹
 limp

flaccid appearance bowed and short
麻痹部位松弛、弓形变短
PARALYSIS 麻痹– RECURRENT LARYNGEAL
NERVE喉返神经

Unilateral or bilateral 单侧或双侧
 VF/s

appear flaccid and floppy声带变得无力、松软
Adduction position
 complete完全中位,

paramedian旁中位, or bilateral外展位
Abduction position
 complete,
paramedian, or bilateral
HYPERADDUCTION关闭太紧
Spasmodic Dysphonia 痉挛性发音障碍
 Essential tremor 特发性震颤
 Huntington’s Chorea舞蹈症

SPASMODIC DYSPHONIC痉挛性发音障碍

laryngeal dystonia 喉肌张力障碍
 Adductor
(ADSD) 内收性
 strained
strangled quality 发音紧张
 Spasms triggered by vowels 发元音易痉挛
 Abductor
(ABSD)外展性
 Interspersed
breathy spasms 全程气息音
 Difficulty transitioning from voiced to voiceless 从浊音难过
渡到清音
ESSENTIAL TREMOR特发性震颤
Not considered a dystonia不认为是肌张力异常
 Regular involuntary movement规律的不自主运动

ATAXIC DISORDERS

Cerebellar ataxia小脑运动失调
MIXED DISORDERS


Multiple sclerosis多发性硬化
Traumatic brain injury
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