Stoke Pt's and their eyes

G
The only thing I would disagree with (and it's a meaningless distinction for those providing emergency care) is about Broca's area. It probably shouldn't be considered a motor disorder as Broca's is responsible for sequencing and syntax, the final speech is produced by muscles controlled by motor cortex adjacent to broca's area, not broca's itself.

-B

'Fraid I'm going to have to disagree with that. While it is true that relatively recent evidence has implicated Broca's area in the comprehension of syntactical relationships, it is also certainly involved in the motor output of speech. My take is that Broca's area probably encompasses multiple "areas" which are architecturally indistinguishable (the traditional way of delineating areas of the brain) but functionally distinct. The lack of fluency in Broca's patients cannot be explained by grammar problems, but demonstrates an inability of the brain to generate and carry out the complex stereotyped motor programs necessary to produce speech.

The primary motor strip is far from the only structure in the nervous system involved in motor output. There is remarkable complex interaction between the (I'm probably forgetting some) cerebellum (coordination feedback to make sure the body is actually performing the action it wanted to), basal ganglia (initiation of movement, among other roles), primary, supplementary, and premotor areas, the visual system including primary and secondary visual areas of cortex (visually guided actions, mapping of environment) as well as subcortical tectum (important for orienting reflex actions) and even the spinal cord which stores many complex motor patterns on its own in spinal pattern generators (the way this was demonstrated is pretty neat: cats with transected spinal cords, when supported above a treadmill, walk with their hind legs).


While the primary motor cortex is responsible for the direct output to the motor neurons (or spinal central pattern generators), Broca's area is required in order for the pattern of complex and coordinated oropharyngeal movements required to speak to be produced (it's like the programmer...the motor strip follows the program written by broca's area). Similar to how the supplementary motor area coordinates complex and bilateral hand movements and sends the output to the primary motor strip to be executed.

It's interesting that Broca's area also seems to have mirror neurons in it...just as the supplementary motor area does. Mirror neurons are neurons which fire as if they are coordinating a specific action when that action is seen. E.G. I see you raise your hand, the mirror neurons in my supp. motor. area will fire in the exact same way they would if I were to acutally raise my hand in imitation. It's a sort of practice execution of the program, without acutally telling the motor strip to "GO." Broca's does the same thing (which I think is also used as evidence that it is involved in speech comprehension).

Overall the research here is pretty complex, and a lot of it has been focusing on parceling out parts of the brain into smaller and smaller "subareas" each responsible for a different function (thank you occasionally mediocre fMRI studies for that), but as long as we talk about Broca's area as the area laid out by Broca (or Broadmanns 44 and 45), it will encompass an area of cortex which is important for motor output. It's called non-fluent or expressive aphasia for a reason...while there is now appreciated to be a receptive aspect to the language dysfunction, the classical idea of Broca's as a motor problem is still valid, based on any evidence I've ever seen.

Fun discussion. Like you said...largely irrelivent to the practice of EMS, but super interesting nonetheless.
 
Fun discussion. Like you said...largely irrelivent to the practice of EMS, but super interesting nonetheless.

Not really, Advanced Stroke Life Support Course goes into very depth discussion of this, as they presume that all Paramedics should know that this as a minimum. Again, an in-depth knowledge of evaluating the nervous system should be a required minimal requirement.

R/r 911
 
Gonna have to read up on this! apparently more has been found since I last studied it.

Great discussion

-B
 
Not really, Advanced Stroke Life Support Course goes into very depth discussion of this, as they presume that all Paramedics should know that this as a minimum. Again, an in-depth knowledge of evaluating the nervous system should be a required minimal requirement.

R/r 911

Huh...I had no idea. One of these days I'll have to finagle my schedule to sit in on that class. If its really in depth I'm impressed...I imagined a very superficial course with maybe some discussion of how to administer more tests...like those seen in NIH stroke scale perhaps, but without too much neuro A&P. I'm happy to be told I"m wrong.

That said, I wasn't really referring to the difference between Broca's and Wernicke's aphasia as "not relevent to EMS," but the more nitty gritty details of the exact nature of the processing done in Broca's area and its relationship to the SMA etc. I'd be very impressed if, for instance, mirror neurons were mentioned in the course. they may well be, I don't know. Unfortunately, from what I've seen, even paramedics tend to hit expressive vs. receptive aphasia and that's about it. Basics..(in general) forget about it. If the course at least give you some basic functional neuroanatomy I'd be very enthused.

As I see it, in the prehospital arena recognition of suspicious symptoms is the most important thing...neurologist specialists will (hopefully) be making the definitive diagnosis and doing specific interpretation of symptoms.

In the same vein, depth is relative. I've spent almost three years on this stuff, and I've just scratched the surface compared to the experts in the field. Heck the whole field has just scratched the surface of the brain..I don't know that any human can clam they have an in depth understanding of more than one or two subfields when dealing with the CNS...the field is just moving too fast to keep up at more than a somewhat superficial level. I guarantee that something I said in my post above is outdated...and if it isn't today, by next month it will be. To me that's what this stuff so intriguing.
 
Gonna have to read up on this! apparently more has been found since I last studied it.

Great discussion

-B

Ha...more is always being discovered..and fast! More has been discovered since I posted that, I'd be willing to bet.

I will say that I've always heard of Broca's as traditionally being thought of as a primarily motor disorder. The identification of its role in syntax and processing is historically a more new idea. I'm far from up on the new ideas, and acutally I can imagine that there could be new evidence that Broca's acutally plays little direct role in motor programming. However, from what I remember, there is evidence of a topographic organization in the area which maps onto the muscles needed to produce speech...or something like that. I remember being pretty convinced that Broca's was more similar than different to the supp. motor area.

I'd be interested if you find out that I'm completely wrong. Sure wouldn't be the first time..
 
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