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Higher Brain Functions: Physiology of Speech, Language & Speech disorders

Reference: chapter 57, Guyton 11th Ed.


Dr. Samina Malik

Centers for Speech


Mechanisms related to language (understanding the spoken & printed words) are mainly localized to NEOCORTEX. Speech & other intellectual functions are well developed in humans.

Areas with language function in the dominant / categorical hemisphere:

Language & Speech related cerebral areas:

Motor & Sensory Speech areas:

Areas for language comprehension (Wernickes area) & speech production (Brocas area):

Physiology of Speech:
Speech Involves: Respiratory system Specific speech nervous control systems in cerebral cortex Respiratory control centers of brain Articulation & resonance structures of mouth & nasal cavities.

Mechanical functions of SPEECH:


1) Phonation 2) Articulation 3) Resonance

Phonation:
Larynx is adapted to act as a vibrator. Vibrating parts are the vocal cords / folds. They protrude from lateral walls of larynx towards the center of glottis They are stretched & positioned by specific laryngeal muscles.

Vocal cords during normal breathing Vs phonation:


Normal breathing: Vocal cords are wide open to allow easy passage of air. Phonation: Vocal cords move together so that passage of air between them will cause phonation.

Determination of PITCH of vibration:


Determined by: Degree of stretch of cords. How tightly the cords are approximated to one another. The mass of the edges of the cords.

Phonation: Function of larynx. Vocal cords as seen by laryngoscope when looking into the glottis:

How vocal cords are stretched?


By either: Forward rotation of thyroid cartilage.

Or: Posterior rotation of arytenoid cartilages.

Role of muscles in forward & posterior rotation of thyroid & arytenoid cartilages:
Muscles stretch from thyroid & arytenoid cartilages to cricoid cartilage. Thro-arytenoid muscles located within the vocal cords lateral to vocal ligaments pull the arytenoid cartilages towards the thyroid cartilage loosen the vocal cords. Slips of muscles within the vocal cords change the shapes & masses of vocal cord edges sharpening of vocal cord edges emission of high pitched sounds or blunting of vocal cord edges emission of more bass / low pitched / heavy / deep sounds. Small laryngeal muscles lie between arytenoid & cricoid cartilages rotate these cartilages inwards or outwards or pull their bases together or apart (abduct or adduct) to give various configurations of vocal cords.

Articulation:
It means formation of words from sounds produced in larynx. Major organs of articulation: Lips Tongue Soft palate Teeth

Articulation:
Consonants of speech are related to certain anatomical sites. When we want to speek p & b, they are labial (from the lips). D & t are dental (top of tongue is approximated behind the teeth). N is nasal (in nasal obstruction, n cannot be pronounced).

Abnormal Articulation in:


In hair-lip defect In local defect in muscles of articulation Cleft palate

Resonance:
Related to quality or timbre / character of sound. Resonance depends on resonating chambers. Resonators include: Nasal cavity Paranasal sinuses Pharynx mouth Chest cavity (vocal resonance in chest examination) Hollow cavities (musical instruments) resonance. Nasal twang: change in character of sound in nasal obstruction.

Written speech:
Involves coordinated contraction of small muscles of hand. In dominant cerebral hemisphere there are certain speech areas.

In right handed, speech areas are in left cerebral cortex.

Brocas area / motor speech area /Brodmans area 44:


Location: Inferior frontal gyrus, anterior to face representation area in primary motor area.

Brocas area / motor speech area /Brodmans area 44:


Function: Detailed pattern for contraction of muscles of phonation & articulation is formed here. Then impulses are sent to motor cortex to initiate these contractions. It receives impulses from Wernikes area through arcuate fasiculus.

Wernikes area / sensory speech area / Brodmans area 22:


Location: Posterior part of superior temporal gyrus. Posteriorly continues with angular gyrus.

Wernikes area / sensory speech area / Brodmans area 22:


Function: Highly intellectual function. All spoken or written words are completely understood here. Thoughts are formed & words are chosen to express these thoughts. Sentences are made & then impulses from this area go to motor speech area through Arcuate fasiculus.

Angular gyrus / Brodmans area 39:


Location: Lower part of parietal lobe, posterior to Wernikes area. Posteriorly it becomes continuous with secondary visual area. Function: Interpretation of visual information.

Area for naming of objects:


Location: Posterior temporal lobe.

Naming mainly involves auditory input.

Facial recognition area:


Prosophenosia: Inability to recognize faces. Lesion: extensive damage on medial undersides of both occipital lobes (continuous with visual cortex) & along medioventral surfaces of temporal lobes (associated with limbic system that deals with emotions, behavior response to environment & brain activation).

Additional parts with role in speech:


Motor cortex. Basal ganglia. Cerebellum. Respiratory center.

Feedbacks to brain:
To check if we are expressing our thoughts correctly, there are feedbacks to brain.

Feedbacks for Spoken Vs Written speech


Spoken speech feedback: Auditory feedback: When we speak, we hear feedback goes to brain to check. Proprioceptive feedback: Phonation & articulation involve muscles stimulation of proprioceptors brain Written speech feedback: Visual feedback: When we write, we see & check. Proprioceptive feedback: Writing involves small muscles of hand proprioceptors brain

Pathway for speaking out heard words Vs pathway for speaking out written words:
Speaking out heard words: Q: What is your name? Received in ears Impulses along auditory pathway Auditory cortex Wernickes area (understood & answer decided) along arcuate fasiculus Brocas area motor cortex muscles of phonation & articulation question is answered. Speaking out written words: Q: What is your name? We read the question Written words are received in primary visual area initial interpretation of these words in secondary visual area further interpretation in angular gyrus Wernikes area (understood & answer decided) along arcuate fasiculus Brocas area motor cortex muscles of phonation & articulation question is answered.

Speech Pathways:

Disorders of speech: APHASIA


Motor / non-fluent aphasia: Patients feel difficulty in uttering words. Speech is very slow. In severe cases, speech is limited to few words. Sometimes, words spoken are those that were spoken at the time of trauma / C.V.A which led to aphasia. Lesion: Brocas area / motor speech area. Sensory / fluent aphasia: Patients speech is fluent. Speech appears to be normal. Patient may talk excessively but talk carries little sense. Thoughts are not expressed correctly. Words chosen are not adequate. Sentences are not correctly made. Lesion: Wernikes area / sensory speech area.

APHASIAS:

Disorders of speech: DYSLEXIA / VISUAL RECEPTIVE APHASIA / WORD BLINDNESS Patient can see but is unable to understand the written words / seen words. Writing & reading is not normal. Lesion: Angular gyrus or Visual Association Area.

Disorders of speech: GLOBAL APHASIA


Severe type of Aphasia. Patient is completely demented. May talk irrelevant. Lesion: wide-spread, involving Wernikes area, Angular gyrus, part of temporal lobe & Sylvian fissure.

Disorders of speech: DYSARTHRIA


Disordered articulation. Incoordination of muscles of articulation. CAUSE: Cleft palate Hair-lip Loosely fitting dentures Poliomyelitis Myasthenia gravis Motor neuron Cerebellar disease Tongue tie

Disorders of speech: DYSPHONIA / HOARSENESS OF VOICE


CAUSE: Chronic laryngitis Papilloma of vocal cords Damage to recurrent laryngeal nerve Hysteria (psycho-neurosis) Myxoedema (hypothyroidism)

Disorders of speech: STAMMERING / STUTTERING


Speech is not fluent. Speech rhythm is interrupted by: Arrest Repetition Prolongation of certain words / syllables / phrases

Stammering attracts the attention of others. May occur in normal people during emotional stress.

Risk Factors for Stammering:


Very strong familial tendency Incomplete cerebral dominance (some areas controlling speech are not developed) Environmental factors (very strict discipline) Aggravated by rapid speech, answering questions, talking to superiors & during emotional states / anxiety / nervousness.

Mechanism of Normal Vs Stammering speech


NORMAL SPEECH: STAMMERING SPEECH Laryngeal reflexes In people who stammer, there (adduction of vocal cords) is no stammering during & voluntary action of singing or recitation, because speech (forceful in singing & recitation, there expiration) are is coordination. coordinated or laryngeal reflexes are pre-set just before voluntary action of speech. Any defect in this coordination results into stammering.

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