As you well know, many of our speech therapy patients have neurological disorders. And your speech therapy training makes you a neuro expert—hands down.
But…sometimes some small details may escape your memory. What does the basal ganglia do again? How about Cranial Nerve V?
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Brain Structures & Functions
Includes Broca’s area, primary motor cortex, prefrontal cortex.
Function: attention, problem-solving, language, memory.
Damage: higher-level cognitive processing difficulties, contralateral motor deficits, expressive aphasia (left hemisphere), personality changes.
Includes Wernicke’s area, primary auditory cortex, language association area (left hemisphere).
Damage: aphasia, memory difficulties, visual agnosia, hearing difficulties.
Function: sensory information processing and integration, number computation, movement, spatial orientation processing.
Damage: receptive aphasia, apraxia, sensory loss, tactile discrimination difficulties, visual inattention.
Includes the primary and association visual cortices.
Function: vision and visual processing.
Damage: blindness in the opposite visual field, visual agnosia, alexia, visual memory difficulties, inability to recognize colors.
Includes the substantia nigra.
Function: vision, hearing, motor control, sleep, arousal, temperature regulation.
Damage: body coordination difficulties.
Includes the midbrain, pons, medulla, nerves for the face and neck.
Damage: swallowing, breathing, heart rate difficulties.
Function: perception, motor control, homeostasis, emotional regulation.
Damage: aphasia, sensory perception difficulties, emotional regulation difficulties.
Function: motor coordination, motor precision, the timing of motor movements, motor learning.
Damage: motor control difficulties, ataxia.
Function: emotions, moods, and feelings, survival instincts (e.g., fight or flight, seeking food and sex), memory, learning.
Damage: difficulty with inhibition, memory, and emotional control.
Includes two lateral ventricles, third and fourth ventricles, foramen (through which cerebrospinal fluid flows into the spinal canal).
Damage: hydrocephalus can cause difficulties with balance, coordination, bladder control, memory.
Includes the dura mater, arachnoid, pia mater.
Function: protects the central nervous system.
Damage: meningitis can cause seizures, difficulties with memory, coordination, hearing.
CN V – Trigeminal
Innervation: Temporalis, Masseter, Medial and Lateral Pterygoid, Anterior
Digastric, Mylohyoid, Tensor Veli Palatini.
Motor: jaw opening, jaw lateralization.
Sensory: lower face, sensation in anterior 2/3 tongue.
Damage can lead to: reduced mastication & bolus preparation, reduced awareness of leakage and oral residue, reduced superior hyolaryngeal movements leading to reduced epiglottis inversion, vallecular residue, and increased number of swallows
CN VII – Facial
Innervation: Buccinator, Posterior Digastric, Stylohyoid, Orbicularis Oris.
Motor: smile, pucker, lateralize lips, puff cheeks.
Damage can lead to: lateral sulci residue, reduced bolus formation secondary to reduced saliva production, reduced hyolaryngeal elevation, and increased number of swallow
CN IX – Glossopharyngeal
Motor: larynx and pharynx elevation.
Sensory: taste in posterior 1/3 of tongue, palatine tonsils, oropharynx.
Damage can lead to: delayed initiation, loss of gag reflex, reduced bolus formation
CN X – Vagus
Innervation: laryngeal muscles, Palatoglossus
Motor: volitional cough, vocal quality
Sensory: reflexive cough, larynx, pharynx
Damage can lead to: reduced vocal fold closure increasing risk of aspiration, silent aspiration, no attempt to clear residue due to reduced sensation, breathy voice
CN IX and X – Pharyngeal Plexus
Innervation: all pharyngeal muscles except Stylopharyngeus.
Motor: velar movement, swallowing.
Sensory: oropharynx and laryngopharynx.
Damage can lead to: reduced bolus containment leading to pre-swallow pooling, nasal regurgitation, reduced pharyngeal shortening leading to diffuse residue, reduced upper esophageal sphincter opening leading to pyriform sinus residue, reduced base of tongue to posterior pharyngeal wall movement leading to vallecular residue, no attempt to clear residue secondary to reduced sensation, nasal vocal quality
CN XII – Hypoglossal
Innervation: lingual muscles except Palatoglossus.
Motor: lingual protrusion, retraction, and lateralization.
Damage can lead to: reduced bolus manipulation, preparation and transfer leading to pre-swallow pooling; reduced base of tongue to posterior pharyngeal wall movement leading to vallecular reside
C1 via CN XII
Innervation: Geniohyoid, Thyrohyoid.
Motor: superior and anterior hyolaryngeal movement, laryngeal elevation.
Innervation: Geniohyoid, Thyrohyoid.
Damage can lead to: reduced anterior and superior hyolaryngeal movement leading to reduced epiglottic inversion, reduced upper esophageal sphincter opening, post-swallow residue
Cerebral Blood Supply
Internal Carotid: Supplies the anterior, medial, and lateral surfaces of the brain.
Posterior Vertebral Arteries: Forms the basilar artery which supplies the cerebellum and the inferior and posterior surfaces of the brain.
Anterior Cerebral Artery: Supplies the medial surfaces of the right and left hemispheres.
Middle Cerebral Artery: Supplies the Sylvian fissure and lateral surfaces of the right and left hemispheres.
Posterior Cerebral Artery: Supplies the occipital, inferior temporal lobes, and thalamus.
Communicating Arteries: Includes anterior and posterior branches. Supplies small segments of the circle of Willis.
Common Neurological Disorders & Impairments
Dementia is an umbrella term for a group of symptoms. It is memory loss plus difficulties in one (or more) of the following: judgment, abstract reasoning, visuospatial, executive functioning, and/or language.
The most common form of dementia. It is caused by beta-amyloid plaque buildup and tau protein tangles that lead to brain cell death. This usually starts in the hippocampus, the memory center of the brain.
Lewy Body Dementia
The second most common form of dementia. It is caused by abnormal plaque buildup in the brain, called Lewy bodies.
Cerebrovascular Accident (CVA, Stroke)
Caused by a blockage of blood flow to the brain or a ruptured blood vessel in the brain. Both lead to brain cell death. Intensive therapy can help create new brain cell pathways. This improves function, especially in the first 6 months after the stroke
Traumatic Brain Injury
Caused by a sudden and violent blow to the brain, such as a fall, car accident, gunshot wound, or blunt force trauma.
Primarily affects brain cells that produce dopamine, which is a chemical messenger. The main symptoms are tremors, bradykinesia (slow movements), limb rigidity, and walking and balance problems. It’s progressive with no cure, although medications, surgeries, and therapy may help improve functioning and reduce symptoms.
Most people with Parkinson’s Disease will develop speech, voice, and/or swallowing impairments. Speech therapy can help treat dysarthria (weak speech muscles), dysphagia (difficulty swallowing), and cognitive impairments.
An umbrella term for any dysfunction of the brain.
Tumors can cause neurological changes, including memory impairments. The changes depend on the location and size of the tumors.
A language disorder caused by brain damage that can result in difficulty understanding language, producing language, reading, and/or writing. It does not affect intelligence.
Also known as “receptive aphasia.” Difficulty with understanding language. Patients who present with less jargon at first tend to make better progress.
Also known as “expressive aphasia.” Difficulty with producing language. People with Broca’s aphasia typically make fair progress, with the quickest recovery happening during the first three months after the brain injury.
Also known as “receptive and expressive aphasia.” Difficulty with both understanding and producing language. Progress is typically less than the other types of aphasia especially if there is no notable progress made in the first few weeks post-stroke. However, some patients experience a leap in progress about six months post-stroke.
Apraxia of Speech
A speech disorder caused by damage to the part of the brain that coordinates the movements of speech. A person with apraxia has difficulty coordinating what they want to say clearly and consistently.
A speech disorder caused by weakness of the muscles that help us speak. This weakness comes from an underlying neurological disorder (e.g., stroke, ALS, Parkinson’s Disease). Speech may sound unclear, mumbled, or slurred.
Mild Cognitive Impairment
Difficulties with memory, language, and thinking abilities that are more severe than can be explained by normal aging but less severe than dementia.
Executive Functioning Impairment
Executive functions help you plan, organize, problem solve, and correct errors. An impairment can make it harder to complete everyday tasks, learn new things, and solve problems. Speech therapy can help by directly working on the specific cognitive difficulty.
A disorder that causes inattention to one side of the visual field (either left or right side, although most commonly left). It is caused by damage to the brain. Although the person can ‘see’, their brain fails to pay attention to that side. Therapy can help increase visual attention.
Visual Field Cuts
A vision disorder that causes “true” blindness (when the brain doesn’t process visual information) to part of the visual field. It is caused by damage to the brain. Talk to your therapist and doctor if a visual field cut is suspected. There are specialists who can help.