Review

1
Review
2
Physiology of respiration Diaphragm

• most important respiratory muscle
• dome-shaped, originates from the lumbar spine,
  the sternum and lower ribs
• separates thorax and abdomen
• descends by 3-6 cm during deep inspiration

3
Physiology of respiration Intercostal muscles

• external intercostal muscles connecting the
  osseous parts of the ribs
• internal intercostal muscles connecting osseous
  and cartilaginous parts
• external and parts of the internal intercostal
  muscles elevate the ribs

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Physiology of respiration Musculature
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Physiology of respiration In- / exspiration

• contraction of the diaphragm and the intercostal
  muscles leads to increased pulmonary volume
• increased volume leads to lower pulmonary air
  pressure
• lower pressure leads to air flow into the lungs

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Physiology of respiration Pleura

• pleural linkage through adhesion between costal
  and pulmonary pleura
• an injury of the costal pleura can disrupt the
  pleural linkage pneumothrax
• can we survive with only one lung?

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Physiology of respiration Lung volumes

• vital capacity (VC) maximal in- and expiration,
  about 5 l
• tidal volume normal in- and expiration, about
  500 ml

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Speech Science

• Respiration Nervous Control and Disorders

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Brain anatomy

• Cerebral hemispheres
• voluntary actions
• basal ganglia
• regulate extent and direction of voluntary
  actions
• cerebellum
• coordinates the activity of voluntary muscles
  (agonist / antagonist)
• brainstem
• spinal cord

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Cerebral hemisphere

• Frontal lobe
• motor
• higher cognitive functions
• Parietal lobe
• sensory
• Temporal lobe
• auditory
• Occipital lobe
• visual

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Cerebral hemisphere

• Frontal lobe
• motor
• higher cognitive functions
• Parietal lobe
• sensory
• Temporal lobe
• auditory
• Occipital lobe
• visual

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Basal ganglia

• Basal ganglia
• Caudate nucleus
• Globus pallidus
• Putamen
• Thalamus
• sensory filter

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Cerebellum

• strong connections to the cerebral hemispheres
  and the spinal cord
• is involved in various movements, e.g. speech
  production
• one function sequential movements

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Brainstem 1

• Trigeminal nerve (V)
• sensory orofacial
• motor closing of the jaw
• Facial nerve (VII)
• motor muscles of expression
• Vestibulocochlear nerve (VIII)
• hearing

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Brainstem 2

• Glossopharyngeal nerve (IX)
• sensory taste and somatosensation of the
  posterior part of the tongue
• Vagus (X)
• motor larynx
• sensory larynx
• Hypoglossal nerve (XII)
• motor tongue

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Motor System

• primary motor cortex
• pyramidal tract
• cerebellum

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Motor System

• primary motor cortex
• pyramidal tract
• cerebellum
• basal ganglia

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Pyramidal tract

• first motor neuron motor cortex
• second motor neuron brainstem / spinal cord
• motor pathways cross to the contralateral side

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Homunculus

• somatotopic organization of the primary motor and
  somatosensor cortex
• discovered by intraoperative stimulation of the
  cortex

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Spinal Nerves

• 8 cervical spinal nerves
• 12 thoracic
• 5 lumbar
• 5 sacral

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Spinal nerves

• anterior root motor
• posterior root sensory
• axons of the pyramidal tract are connected with
  the second motor neuron

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Phrenic Nerve

• innervates the diaphragm
• is formed by the 3rd to 5th spinal nerve (C3 - C5)

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Nervous control

• inspiratory neurons in the brain stem
• receptors in the lung and in respiratory muscles
  send feedback via the vagus nerve
• expiratory neurons are activated
• chemical regulation receptors in the aorta, the
  carotid arteries, and the brain stem
• additional regulation emotion, body temperature

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Disorders
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Spinal cord injury
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Spinal cord injury

• thoracic injury
• most frequent, due to rigid rib cage
• paralysis of the legs
• paralysis of intercostal muscles
• lower cervical injury
• paralysis of legs and arms
• paralysis of intercostal and accessory
  respiratory muscles
• upper cervical injury
• plus paralysis of the diaphragm

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ALS

• amyothrophic lateral sclerosis
• US Lou Gehrigs disease
• a motor neuron disease chronic progressive
  degeneration of the first and / or second motor
  neuron
• bulbar onset (affecting the brainstem)
  dysarthria, dysphagia, respiratory insufficiency
• limb onset muscle weakness in the limbs
• to compensate respiratory failure intermittend
  ventilation via a mask or continous ventilation
  via a tracheostoma
• many patients die because of respiratory failure
  or pneumonia

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ALS

• most patients have no significant cognitive
  deficits
• patients may profit from alternative
  communication devices
• a cursor moves on a computer screen
• letters and words can be selected by a switch
• sentences are sent to a speech synthesizer

Stephen Hawking