UNIT 1

ANATOMY AND PHYSIOLOGY OF NERVOUS SYSTEM

1)GENERAL INTRODUCTION TO BASIC NEUROLOGICAL CONCEPTS

The nervous system is the source of all communication in human beings. Only human beings can express
novel utterances to each other through oral or gestural language. Our highly advanced system of oral
and gestural language identifies us as unique in the animal kingdom. This facility is the result of an
aggregate of intricate nervous system mechanisms that have developed in the human brain through a
series of dramatic evolutionary changes. Neurology is the study of these structures and their functions in
detail.

In speech and hearing sciences, the importance of this field is mostly due to the
relation of cranial nerves and their innervations and also due to their importance in the coordination of
movements. These are so prominent that a separate branch of disorders called Neuro-language
disorders.

2)ORGANIZATION OF THE NEURAL SYSTEM:

The nervous system is composed of two parts: Central Nervous System (CNS) and Peripheral Nervous
System (PNS). CNS contains the brain and the spinal cord whereas the PNS contains the motor and
sensory nerves of various organs and also the Autonomic Nervous System (ANS) which is divided as the
sympathetic nerves and the parasympathetic nerves and the Somatic Nervous System. Now, let us look
at the nerve in detail.
3)CENTRAL, PERIPHERAL AND AUTONOMIC NEURAL SYSTEM

CENTRAL NERVOUS SYSTEM:

The brain is gray, shaped like an oval, and slightly soft to the touch. The average brain weighs
approximately 1350 g, or roughly 3 pounds. The brain is housed in the part of the bony skull called the
cranium. A synonym for brain is encephalon. The largest mass of brain tissue is identified as the
cerebrum. The human cerebrum has evolved to include three parts: the cerebral hemispheres, limbic
system (in earlier terminology, rhinencephalon), and basal nuclei (aka, basal ganglia). The cerebral
hemispheres are the two readily discernible large halves of the brain. The cerebral hemispheres are
connected by a mass of white matter called the corpus callosum. During development the cerebral
hemispheres become enormously enlarged and overhang the structures deep in the brain called the
diencephalon and brainstem. The cerebral hemispheres are crucial for communication, particularly the
left hemisphere, where the major neurologic mechanisms of speech and language are found.

Further, the brain is divided into four parts or cerebral lobes:

Frontal Lobe:

The frontal lobe is bounded anteriorly by the lateral sulcus, or sylvian fissure, and posteriorly by the
central sulcus, or rolandic fissure. The frontal lobe accounts for approximately one third of the surface of
the hemisphere. In the frontal lobe is a long gyrus immediately anterior to the central sulcus. This
prominent gyrus is called the precentral gyrus, and it comprises the majority of what is known as the
primary motor cortex (area 4). The term motor strip is also used for this area. Nerve fibers composing a
large motor pathway called the pyramidal tract descend into the brain and spinal cord from starting
points in the primary motor area. The cells in this area are responsible for voluntary control of skeletal
muscles on the opposite, or contralateral, side of the body

Immediately anterior to the primary motor area are the premotor cortex
and another area with motor assignment, the supplementary motor area. These ancillary motor areas
(area 6) are important in motor learning and in the performance of routine and less practiced motor
sequences. In the frontal lobe of the left hemisphere is an important region known as Broca’s area
(areas 44 and 45). Located in the inferior (third) frontal gyrus of the lobe (2, 3, and 4), Broca’s area in
most people appears to be important for the production of fluent, well-articulated speech. The left
hemisphere is the dominant hemisphere in most persons, meaning that this hemisphere controls
language functions. Approximately 90% of the population is right handed with left hemisphere
dominance for language. Even the majority of persons who are left handed show left dominance for
language. If damage to Broca’s area occurs in adults who are left hemisphere– dominant for language, a
characteristic breakdown usually occurs in the normally fluent production of verbal language; if the
damage is limited to Broca’s area specifically, this breakdown is usually transient. If the damage
results from a larger lesion that includes Broca’s area but also surrounding cortical tissue in what is
known as the perisylvian zone, a classic syndrome of acquired language disorders or aphasia, called
Broca’s aphasia, may be diagnosed.
The rest of the frontal lobe is composed of association cortex, a different type of cortical tissue with less
defined functional assignment. This frontal area is often referred to as the prefrontal cortex (areas 9, 10,
11, 46, and 47) and contains the frontal association areas.

Parietal Lobe:

The parietal lobe is bounded anteriorly by the central sulcus, inferiorly by the posterior end of the lateral
sulcus, and posteriorly by an imaginary borderline. The primary sensory, also known as somatosensory
or somesthetic, cortex is found in the parietal lobe (areas 1, 2, and 3), the major portion of which is the
postcentral gyrus. It is also known as the sensory strip, but it is helpful to use the term somatosensory to
help remember that bodily sensations, as opposed to visual and auditory sensations, are processed
here. This gyrus lies directly posterior to the central sulcus, or rolandic fissure.

Two gyri in the parietal lobe are important to locate and become familiar with in
regard to language. The first is the supramarginal gyrus (area 40), which curves around the posterior end
of the lateral sylvian fissure. The second, the angular gyrus (area 39), lies directly posterior to the
supramarginal gyrus. It curves around the end of a prominent sulcus in the temporal lobe, the superior
temporal sulcus. Damage in the area of the angular gyrus in the dominant left hemisphere may cause
word-finding problems (anomia), reading and writing deficits (alexia with agraphia), as well as left-right
disorientation, finger agnosia (inability to identify the fingers), and difficulty with arithmetic (acalculia).

Language functions tend to be concentrated in the left parietal lobe around the gyri just discussed. In
the nondominant hemisphere, the parietal lobe association cortex primarily processes spatial
information and related selective attention. Damage here may result in difficulty attending to or a
complete neglect of the contralateral side of space. Visuospatial and constructional deficits (such as in
drawing, building small models, and so on) may be found on testing the patient with right hemisphere
parietal lobe damage.

Temporal Lobe:

The temporal lobe is the seat of auditory processing in the brain. It is bounded superiorly by the sylvian
fissure and posteriorly by an imaginary line that forms the anterior border of the occipital lobe. Two gyri
of the temporal lobe are prominent on the lateral surface of the brain: the superior and middle
temporal gyri. The third important gyrus, the inferior gyrus, can be seen on the lateral surface but
continues onto the interior surface of the lobe as well. Less visible on the lateral surface are the
transverse temporal gyri (areas 41 and 42), which can be found on the upper edge of the temporal lobe,
extending deep in the medial surface of the brain. The transverse gyrus of Heschl (most commonly
called Heschl’s gyrus), area 41, forms the primary auditory cortex, representing the cortical center for
hearing in each hemisphere. There is bilateral representation of the auditory signal though more fibers
terminate in the gyrus of the contralateral hemisphere than will terminate on the ipsilateral side of the
brain. The ability to detect the presence of sound is a function of the peripheral hearing mechanism and
the auditory nerves. The cortical area is the site of conscious processing of those impulses as “sound,”
allowing us to perceive these signals as sound and do what we call “hear.”
Area 42 is adjacent to Heschl’s gyrus and is an auditory association area, although it is frequently
presented as part of the primary cortical area of hearing. It has been found to participate in the
processing of harmonic and rhythmic patterns.

The posterior part of the superior temporal gyrus in the left temporal lobe is the auditory association
area, best known as Wernicke’s area (area 22), which is important to the development and use of
language. Damage to Wernicke’s area may result in a particular classification of acquired language
disorder called Wernicke’s aphasia. If the two borders of the lateral (Sylvian) fissure are pulled apart, a
cortical structure called the insula, or the island of Reil, may be seen hidden under the area where the
temporal, parietal, and frontal lobes come together. It includes some of the oldest cortical tissue in the
brain.

On the medial aspect of the temporal lobes, near the sagittal plane between the two hemispheres one
can locate several important deep brain areas important to memory. These include the hippocampal
region and the parahippocampal gyrus. On the parahippocampal gyrus can be found subcortical areas
known as the perirhinal, parahippocampal and entorhinal cortices

Occipiatal Lobe:

The occipital lobe occupies the small area behind the parietal lobe and is marked on the lateral surface
by imaginary lines rather than prominent sulci. Two sulci that can be found on the medial surface of the
brain that help locate the occipital lobe are the parietal-occipital sulcus and the calcarine sulcus. The
occipital lobe is concerned with vision, with the primary visual area (area 17) located in gyri that border
the calcarine sulcus.

Limbic System:

The limbic system or limbic lobe was named by Pierre Paul Broca, who thought of it as the fifth lobe of
the brain. It is occasionally referred to as Broca’s lobe because of this. The “lobe” is on the medial
surfaces of the two hemispheres. An archlike pattern of cortex surrounding the nonconvoluted central
portions of the brain can be observed on the medial surfaces of the hemispheres with the brainstem
removed. This internal circular arch is called the limbic lobe (or limbic system or formation). The limbic
system includes the oldest or most primitive cortex, the rhinencephalon, also called the “smell brain.”
The prefix rhino means “nose”; the functions of the old animal brain dealt primarily with the sense of
olfaction, or smell. Because smell is a much more crucial sense for animals in their adaptation to the
environment than it is to human beings, the old brain is relatively large in animals, and the cerebral
hemispheres are less well developed.

Basal Ganglia:

The basal ganglia, or basal nuclei as some texts use, are large masses of gray matter deep within the
cerebrum, below its outer surface or cerebral cortex. The division of the structures known as basal
ganglia has been confusing in the literature because various anatomists have categorized the structures
differently. A review of current literature indicates that most neuroanatomists include the following
structures as basal ganglia (or basal nuclei):

• Caudate nucleus

• Putamen

• Globus pallidus

• Substantia nigra

• Subthalamic nucleus

The putamen and globus pallidus are sometimes grouped and called the lentiform or
lenticular nucleus. The caudate and the putamen grouped together are called the striatum (or
neostriatum in some texts). These three main parts—caudate, putamen, and globus pallidus—when
grouped together are referred to as the corpus striatum.

Cerebellum:

The word cerebellum means “little brain,” and the cerebellum is indeed a much smaller structure than
the cerebrum, weighing approximately one eighth as much. The cerebellum is located at the rear of the
brain, below and at the base of the cerebrum. It resembles a small orange wedged in the juncture of the
attachment of the spinal cord to the melon-shaped cerebrum. The cerebellum as it is understood is a
relatively recent evolutionary addition to the nervous system. Initially it was found in fish and was
almost solely related to vestibular functioning. As movement on four legs evolved, the cerebellum
developed a rich mass of connections to the spinal cord. As upright posture developed and human
beings continued to learn new physical skills, the cerebellum, particularly the posterior lobes, developed
many linkages with the cerebrum. Similar to the cerebrum, the cerebellum consists of two hemispheres.
Each is primarily concerned with coordination of movements ipsilaterally, providing fine coordination of
movement. The cerebellum plays an important role in postural stability and fixation, as well as in
learning a novel motor act.

Damage may result in a particular type of motor speech disorder, one of the classic dysarthria types
called ataxic dysarthria. The cerebellum may also have a role in cognitive processing with linkages found
with the lateral prefrontal cortex.

Brainstem:

The brainstem and its subdivisions cannot be directly viewed unless the cerebral hemispheres are cut
away to reveal the internal structures of the brain. The brainstem appears as a series of structures that
seem to be an upward extension of the spinal cord, thrust upward into the brain between the cerebral
hemispheres. Often the parts of the brainstem are depicted as extending as vertical segments one above
the other, but the parts of the brainstem actually do not sit in a vertical plane. The upper structures are
crowded together to fit within the cranium. In some texts and, in fact, previous editions of this text, the
diencephalon is included as part of the brainstem. Contemporary neuroanatomy teaching separates the
diencephalon and includes only three structures. Moving from the rostral (head) to the caudal (tail)
segments, the three brainstem structures are as follows

• Mesencephalon (midbrain)

• Pons

• Medulla oblongata

IMPORTANT AREAS OF THE BRAIN (BROADMANN’S AREA):

NUMBER 4: Primary Motor Cortex

NUMBER 6: Supplementary Motor Cirtexs

NUMBER 44: Inferior Frontal Gyrus

NUMBER 8: Orbito-frontal Cortex

NUMBER 1,2,3: Pre-frontal Cortex

NUMBER 8,4,6: Motor Strip (Somato-sensory area)

NUMBER 40: Supramarginal Gyrus

NUMBER 39: Angular Gyrus

NUMBER 37: Fusiform Gyrus

NUMBER 21,22: Wernicke’s Area

NUMBER 18: Secondary Auditory Cortex

NUMBER 17: Primary Auditory Cortex

NUMBER 52: Insular Lobe ( Island of Reil)

PERIPHERAL NERVOUS SYSTEM:

The peripheral nervous system (PNS) includes (1) the cranial nerves with their roots and rami (branches),
(2) the peripheral (spinal) nerves, and (3) the peripheral parts of the autonomic nervous system. The
peripheral ganglia are groups of nerve cell bodies located outside the CNS forming an enlargement on a
nerve or on two or more nerves at their junction. They are primarily sensory in nature, although motor
ganglia are found particularly in the autonomic nervous system. The cranial nerves exit from the
neuraxis at various levels of the brainstem and the uppermost part of the spinal cord. When we use the
term peripheral nerves, we are typically referring to the spinal nerves plus their branches.
 Cranial nerves V (the trigeminal nerve), VII (the facial nerve), IX (the glossopharyngeal nerve), and X (the
vagus nerve) have dedicated sensory ganglia originating from the neural crest during embryonic
development. They contain pseudounipolar cell bodies.

These sensory ganglia are classified as the trigeminal or semilunar ganglion (cranial nerve V). The
geniculate ganglion of cranial nerve VII.The superior and inferior ganglia of cranial nerve IX, or the
glossopharyngeal nerve; and the jugular and nodose ganglia of cranial nerve X, or the vagus nerve.

The jugular and nodose ganglia are often referred to as the superior and inferior ganglia of the vagus
nerve. Cranial nerve VIII, the vestibulocochlear nerve, primarily arises from the otic placodes.

AUTONOMIC NERVOUS SYSTEM:

The innervation of involuntary structures such as the heart, smooth muscles, and glands is accomplished
through the autonomic nervous system. Although this system has primarily indirect effects on speech,
language, and hearing, the speech-language pathology and audiology student must be familiar with its
contribution to total body function to understand how involuntary but vital functions such as hormonal
secretions, visual reflexes, and blood pressure are controlled within the nervous system.

The autonomic nervous system is distributed throughout both the CNS and the PNS. The enteric nervous
system, which is formed by neuronal plexus in the gastrointestinal tract, is considered a division of the
autonomic nervous system. Enteric functioning has a direct effect on the deglutition and digestion of
food.

Aside from the enteric system that deals directly with swallowing and
digestion, the major divisions of the autonomic nervous system are the sympathetic and
parasympathetic divisions, which have almost antagonistic functions. The sympathetic system is the
body’s alerting system, sometimes referred to as the fight-or-flight system. This part of the autonomic
nervous system is responsible for such preparatory measures as accelerating the heart rate, causing
constriction of the peripheral blood vessels, raising the blood pressure, and redistributing the blood so
that it leaves the skin and intestines to be used in the brain, heart, and skeletal muscles if needed. It
serves to raise the eyelids and dilate the pupils. The sympathetic part also decreases peristalsis (the
propelling contractions of the intestine) and closes the sphincters. The parasympathetic part of the
autonomic nervous system has an almost opposite calming effect on bodily function. It serves to
conserve and restore energy by slowing the heart rate, increasing intestinal peristalsis, and opening the
sphincters. As a result of parasympathetic action, other functions, such as increased salivation and
increased secretion of the glands of the gastrointestinal tract, may take place.

The autonomic nervous system is composed of both efferent (conducting away from the CNS) and
afferent (conducting toward the CNS) nerve fibers. Several similarities and differences exist between the
neural control of skeletal muscle and visceral effectors such as smooth muscle.

Rarely is autonomic activity solely sympathetic or parasympathetic. Both parts work together in the
autonomic nervous system along with the endocrine system to maintain the stability of the body’s
internal environment or homeostasis. The endocrine system is a group of glands and other structures
that release internal secretions called hormones into the circulatory system. These hormones influence
metabolism and other body processes. The endocrine system includes such organs as the pancreas,
pineal gland, pituitary gland, gonads, thyroid, and adrenal glands. These work more slowly than the
autonomic nervous system.

Spinal Nerves:

Spinal peripheral nerves are described as mixed nerves, meaning they carry both sensory and motor
fibers. Each spinal nerve is connected to the spinal cord by two roots: the anterior root and the posterior
root. The anterior root of the spinal nerve consists of bundles of nerve fibers that transmit nerve
impulses away from the CNS. These nerve fibers are called efferent fibers.

Efferent fibers that go to the muscles and make them contract are also called motor fibers. The motor
fibers of the spinal nerves originate from a group of cells or motor nuclei in the spinal cord called the
anterior (ventral) horn cells. The anterior horn cells are the point of synapse, or connection, with the
spinal nerves as they leave the neuraxis. When nerve impulses have left the neuraxis, they have reached
what the great British neurophysiologist Charles Sherrington (1857-1952) called the final common
pathway, or the terminal route of all neural impulses acting on the muscles. The posterior root of the
spinal nerve consists of afferent fibers that carry information about the sensations of touch, pain,
temperature, and vibration into the CNS via the spinal cord. They are also called sensory fibers. The cell
bodies of the sensory fibers are a swelling on the posterior root of the spinal nerve called the posterior
root ganglion.

4)NEURAL STRUCTURES - APPLIED ANATOMY AND PHYSIOLOGY

Each nerve fiber is made up of a surrounding thin layer called epineurium and inside this is, there are
multiple perinerium which is a fascicle containing many neurons which is the smallest unit. Each neuron
is connected to each other by endoneurium which contains the neurons and their interconnecting fluids
and loose connective tissues. Now, we will move on to the anatomy of neuron.
AXON:

The smallest part of the nervous system is called as neuron. A neuron contains a cell body and an
axon with the synapses at the end. The cell body contains the nucleus which coordinates the activities of
the neurons and this is also connected to certain branches called dendrites which provide the impulses
to the neurons. The cell body also contains the Nissil’s body which is the rough endoplasmic reticulum in
the neurons. This is connected to an axon which provides communication and helps in transmission of
impulses. It is long and cylindrical process which is covered by protective cells called as Glial cells. At the
end of the axon, it terminates into synapses which are connected to the dendrites of the other neuron.
The synapse and the dendrites are immersed in a pool of chemical called neurotransmitter which passes
the impulses. Further, neurons are divided as myelinated and unmyelinated neurons in which
myelinated contains myelin sheath and unmyelinated does not. This gives a characteristic white color to
the myelinated neurons and grey color to the unmyelinated neurons. In addition, the gap between the
myelin sheath is called Nodes of Ranvier which is only present in the myelinated neurons. The axon also
contains axoplasm which is the fluid in the axon.

Based on the shape, neurons are divided as:

1) Bipolar Neurons: It contains two dendrites branching from the cell body.
2) Multipolar Neurons: It contains multiple dendrites branching from the cell body.
3) Pseudo Bipolar Neurons: It contains two axons out of which one branches out and gives rise to
dendrites.

GLIAL CELLS:

Composing the majority of cells in the nervous system are the glial, or neuroglial, cells. The CNS contains
four types of neuroglial cells: astrocytes, oligodendrocytes (called Schwann cells in the PNS), microglia,
and ependyma. Glial cells do not propagate neural impulses but provide extremely important supportive
and facilitative functions to the nervous system. Although we spend a majority of our study looking at
signals generated by the neurons and the ensuing activations (or lack thereof), you must understand
that the neuroglia make it possible for neurons to function optimally.

A summary of gilal cells can be provided as:

• Provide supportive functions in the nervous system

• Do not propagate neural impulses

• Serve in early development of CNS, guiding developing neurons to their correct locations

Astrocytes:

• Provide structural matrix for cell bodies in the CNS

• Cause capillary walls to form tight endothelial junctions to ensure that most solutes must pass through
endothelial cells

• Help maintain appropriate environment for neuronal function

• Allow for neural plasticity and help brain adapt to injury

Oligodendrocytes/ Schwann Cells:

• Form and maintain myelin Microglia

• Perform scavenger functions such as cleaning out debris after neural cell damage and forming brain
macrophages

• Mediate immune response after injury or infection to the brain Ependyma

• Line ventricles in the brain and spinal cord

• Specialized types form choroid plexus, which manufactures cerebrospinal fluid

Satellite Cells:

• Found in CNS and PNS

• Surround neuron bodies but function unknown

Physiology:

The main function of the nervous system is the transmission of the impulses from one end to the other.
Neurons do the work of the nervous system by transmitting electrical signals or neural impulses to
glands, muscles, and other neurons. Basically, the purpose of the neuron is to communicate, to send a
“neural message.” In the peripheral nervous system (PNS) many neuromuscular (i.e., neuron to muscle
fiber) transmissions take place. In the brain itself, most of the neurons conduct neural impulses to other
neurons, which are clustered quite close together, providing a high neuronal density in the cerebrum.
This high density creates an almost unlimited capacity for complex neuronal activity The synapse is
usually the point of contact between one neuron (typically the axon of that neuron) with another
neuron’s cell body, dendrites, dendritic spines, or axon. Axonal transport occurs either slowly or fast. If
the transport occurs from the cell body toward the axon terminal, it is known as anterograde. Transport
up the axon from the terminal toward the cell is also possible and is called retrograde.

SODIUM-POTASSIUM PUMP:
The sodium-potassium pump is the most important to the neuron, helping maintain the steep
gradient of sodium to potassium and providing energy to a cell by increasing sodium transport into
the cell. Like the channels, the pumps in the membrane are water-filled proteins, but unlike the
channels, which are completely open passages, the pump will open only on one side of the
membrane at a time.
The energy fueling this pump is adenosine triphosphate or ATP. The
interaction of the ATP results in a phosphate ion group binding with the transport channel protein.
This phosphorylation changes the shape of the transport channel (the pump channel), driving out
three sodium ions. That change in shape results in the transport channel now attracting potassium
ions in the extracellular fluid. Two potassium ions then bind with the newly inviting channel and are
pumped through the opening to the intracellular fluid. It is always a “3 sodium out, 2 potassium in”
mechanism involved.
Thereby, the excess of sodium in the extracellular fluid is maintained. The concentration of sodium to
potassium will also play an important part in the generation of chemical and electrical signals in the
nervous system. This results in the changing of the resting potential which changes the gradient and
results in the transmission of the impulse.
This type of transmission is only present in the unmylienated neurons. For mylienated
neurons, there is another type of transmission involved. This is due to the fact that myelin in the cells
act as insulators and this does not allow proper passage of impulses.

SALTATORY TRANSMISSION:
Layers of myelin are incorporated in the cells that produce myelin—oligodendrocytes in the CNS and
Schwann cells in the PNS. Myelin is white, contrasting these nerves sharply with the gray
unmyelinated nerves, and the myelin sheet is thick. It can be revealed by a special myelin stain.
The thick insulation of myelin is interrupted at intervals by structures called
the nodes of Ranvier. Because of how the myelin sheaths are designed, these nodes enhance rapid
propagation of the electrical impulse along the nerve fiber. The APs necessary to propagate a signal
down a myelinated axon develop only at these nodes. The impulse is vastly increased in speed by
hopping from node to node on a myelinated axon without any active contribution from the long
internodal spaces. This mode of transmission is extremely efficient compared with the slow gliding
along of the nerve impulses on unmyelinated fibers. The type of transmission in myelinated fibers is
called saltatory transmission.

The efficiency of saltatory transmission is achieved because of :

 The insulation that prevents current flow between nodes.
  Little leakage of current from the fibers occurs.
 The conduction velocity of a myelinated fiber is directly proportional to the diameter of the
fiber, whereas in an unmyelinated fiber the velocity is approximately proportional to the
square root of the diameter.
On average, transmission along a myelinated fiber is roughly 50 times as
fast as one along an unmyelinated fiber. The rapid muscular movements underlying speech would
require the fastest mode of transmission of neural impulses.

5)CRANIAL NERVES AND THOSE IMPORTANT FOR SPEECH, LANGUAGE, HEARING AND BALANCE

The cranial nerves, in contrast to the spinal nerves, are of more significance to the speech pathologist
because most of the cranial nerves have some relation to the speech, language, and hearing process and
seven of the 12 nerves are directly related to speech production and hearing. On dissection, the 12 pairs
of cranial nerves look like thin, gray-white cords. They consist of nerve fiber bundles surrounded by
connective tissue. Like the spinal nerves, they are relatively unprotected and may be damaged by
trauma. The cranial nerves leave the brain and pass through foramina of the skull to reach the sense
organs or muscles of the head and neck with which they are associated. Some are associated with
special senses such as vision, olfaction, and hearing. Cranial nerves innervate the muscles of the jaw,
face, pharynx, larynx, tongue, and neck. They are further discussed afterwards.

The nuclei of the cranial nerves are of three different types. The motor nuclei are distinguished by the
embryologic origin of the muscles they innervate. In the development of the embryo, the branchial (gill)
arches are responsible for the structure, muscles, and nerves of the face and neck. Cranial nerves V, VII,
IX, X, and XI are thus known as the branchial set. Cranial nerves III, IV, VI, and XII are derived from this
somatic segmentation and thus are called the somatomotor, or somitic, set. The elaboration of the
longitudinal tubes gives rise to three cranial nerves (I, II, and VIII) known as the solely special sensory
set. Some branchial and somitic cranial nerves have a visceral component: III, VII, IX, and X. Cranial
nerves V, VII, IX, and X also have a general sensory component (i.e., they participate in sensation of pain,
pressure touch, vibration, and proprioception).

Here, we will be dealing in detail about the cranial nerves that are related to speech and hearing.

Cranial nerve V ( Trigeminal Nerve):

Both the motor and sensory roots of the trigeminal nerve are attached to the lateral edges of the pons.
The motor nuclei are restricted to the pons, but the sensory nuclei extend from the mesencephalon to
the spinal cord.

The motor part of the trigeminal nerve innervates the following muscles: masseter, temporalis, lateral
and medial pterygoids, tensor tympani, tensor veli palatini, mylohyoid, and the anterior belly of the
digastric muscle. The sensory fibers have three main branches:

1. The ophthalmic nerve, which is sensory to the forehead, eyes, and nose
 2. The maxillary nerve, which is sensory to the upper lip mucosa, maxilla, upper teeth, cheeks, palate,
and maxillary sinus

3. The mandibular nerve, which is sensory to the anterior two thirds of the tongue, mandible, lower
teeth, lower lip, part of the cheek, and part of the external ear

Cranial nerve V is primarily responsible for mastication and for sensation to the face, teeth, gums, and
anterior two thirds of the tongue. Innervating the tensor velar palatini, cranial nerve V is partially
responsible for flattening and tensing the soft palate and for opening the eustachian tube. Innervating
an extrinsic laryngeal muscle (the anterior belly of the digastric), it also assists in the upward and
anterior movement of the larynx. Innervating the mylohyoid and part of the digastric, this nerve
contributes to retraction of the tongue. Also innervated by CN V, the tensor tympani in the middle ear
works with the stapedius muscle to dampen oscillation of the eardrum in the presence of loud noise.

Cranial Nerves VII (Facial Nerve):

The facial nerve is a complex nerve carrying two motor and two sensory components. It involves several
different nuclei, all within the pons near the reticular formation. The special sensory component of the
facial nerve involves the taste fibers for the tongue and palate. These fibers have their primary sensory
neurons in the geniculate ganglion. They enter the brainstem in the sensory root of the facial nerve,
called the nervus intermedius. They run in a bundle, or fasciculus, called the tractus solitarius and are
joined in that bundle by the taste fibers from cranial nerves IX and X. The taste fibers split off from the
facial nerve in the middle ear as the chorda tympani. This joins the lingual branch of cranial nerve V.

The general sensory component of VII is a small cutaneous component whose nerve cells are found in
the geniculate ganglion in the temporal bone. Impulses travel in the nervus intermedius, descending in
the spinal tract of the trigeminal nerve and synapsing in the spinal nucleus of the trigeminal nerve
located in the upper medulla. This sensory component may supplement the mandibular portion of
cranial nerve V, providing sensation from the wall of the acoustic meatus and the surface of the
tympanic membrane.

The visceral motor component of cranial nerve VII is composed of cell bodies that
are preganglionic autonomic motor neurons. These cell bodies are collectively called the superior
salivatory nucleus and the lacrimal nucleus. The fibers from the nucleus travel in the nervus intermedius
and divide in the facial canal, becoming the greater petrosal nerve and the chorda tympani. The petrosal
nerve fibers follow a complicated path and join fibers of the trigeminal to reach the lacrimal and
mucosal glands of the nasal and oral cavities, where they stimulate secretion.

The branchial motor component of the facial nerve is of critical

importance to the speech-language pathologist. The fibers of the motor nucleus extend to the floor of
the ventricle, curve around the nucleus of the abducens (cranial nerve VI), and exit the brainstem near
the inferior margin of the pons. These fibers then join those from the nucleus of the tractus solitarius
and the autonomic or parasympathetic nuclei and enter the internal auditory meatus as they extend
through the facial canal of the petrosal bone. They leave the skull through the stylomastoid foramen.
While coursing through the facial canal, the facial nerve travels through the tympanic cavity, innervating
the stapedius muscle. The facial nerve can therefore be involved in pathologic conditions related to the
ear as well as the oral musculature. Surgeons removing acoustic tumors must be mindful of the location
of the facial nerve. The dorsal motor nucleus of cranial nerve VII innervates the lower part of the face
and receives most of its corticonuclear fibers from the opposite hemisphere; thus innervation to these
structures is primarily contralateral. The ventral motor nucleus that supplies the upper part of the face
receives fibers from both cerebral hemispheres (i.e., receives crossed and uncrossed fibers), and
innervation is bilateral.

Most important to the SLP is that the facial nerve is responsible for all movements of facial expression.
All facial apertures are guarded by muscles innervated by the facial nerve: the eyes, the nose, the
mouth, and the external auditory canal. Cranial nerve VII enables the actions of wrinkling the forehead,
closing the eyes tightly, closing the lips tightly, pulling back the corners of the lips, pulling down the
corners of the lips and tensing the anterior neck muscles. It provides motor innervation to the sublingual
and submaxillary salivary glands, and it guards the middle ear by innervating the stapedius muscle,
which, with the tensor tympani muscle, dampens excessive movement of the ossicles in the presence of
a loud noise. Finally, the facial nerve also is partially responsible for taste

Cranial Nerve VIII(Acoustic Vestibulocochlear)

As can be ascertained from its name, the acoustic-vestibular, or vestibulocochlear, nerve consists of two
distinct parts: the vestibular nerve and the cochlear, or acoustic, nerve. Both take afferent information
from the internal ear to the nervous system, but as their names imply, they carry different types of
information. The vestibular nerve consists of nerve cells and their fibers, which are located in Scarpa’s
ganglion located in the internal acoustic meatus. The fibers enter the brainstem in a groove between the
lower border of the pons and the upper medulla oblongata in a sulcus called the cerebellopontine angle.
This location is the site of one of the most common brain tumors, a vestibular schwannoma, also known
as an acoustic neuroma.

The cochlear nerve consists of nerve cells and fibers located in the spiral
ganglion located around the modiolus of the cochlea. Nerve fibers wrap around each other in the
modiolus, with a layering effect. Fibers from the apex, carrying low-frequency information, are found on
the innermost part of the core, whereas fibers from the basal part of the cochlea, carrying high-
frequency information, are found on the outermost layers. The nerve fibers from these cell bodies enter
the brainstem at the lower border of the pons on the lateral side of the facial nerve. They are separated
from the facial nerve fibers by the vestibular nerve.

When the cochlear fibers enter the pons, they divide into two branches. One branch enters the dorsal
cochlear nucleus (high frequencies), and the other enters the ventral cochlear nucleus (low frequencies).
Both nuclei are situated adjacent to the inferior cerebral peduncle.

Both portions of the vestibulocochlear nerve are primarily sensory in nature.

The vestibular nerve receives afferent information from the utricle, saccule, and semicircular canal of
the inner ear and from the cerebellum. The vestibular nerve also sends out efferent fibers that pass to
the cerebellum through the inferior cerebellar peduncles and also to the spinal cord, forming the
vestibulospinal tract. Efferent fibers are also sent to the nuclei of cranial nerves III (oculomotor), IV
(trochlear), and VI (abducens) through the medial longitudinal fasciculus. As previously outlined, the
cochlear nerve carries afferent fibers from the cochlea to the auditory cortex.

Cranial nerve VIII takes afferent information from the internal ear to the nervous system. It is
responsible for sound sensitivity and innervates the utricle and the saccule of the inner ear, which are
sensitive to static changes in equilibrium. In addition, innervation of the semicircular canals takes place
through this nerve, controlling sensitivity to dynamic changes in equilibrium.

Cranial Nerve IX (Glossopharygeal Nerve):

The glossopharyngeal nerve carries two motor components and three sensory components. It can be
found emerging from the medulla between the olive and the inferior cerebellar peduncle. The main
trunk of the nerve exits the skull through the jugular foramen. Three nuclei in the brainstem are
concerned with the functions of the glossopharyngeal nerve: the nucleus ambiguus, the inferior
salivatory nucleus, and the nucleus solitarius.

The nucleus ambiguus receives corticonuclear fibers of cranial nerve IX

from both hemispheres and supplies the efferent innervation to the stylopharyngeus muscle, which
contributes to the elevation of the pharynx and larynx. The inferior salivatory nucleus receives afferent
information concerning taste from the hypothalamus, olfactory system, and mouth cavity.

Efferent fibers supply the otic ganglion of the ear and the parotid salivary gland. The nucleus solitarius
receives fibers arising from the inferior ganglia. Peripherally these visceral afferent fibers of cranial
nerve IX mediate general sensation to the pharynx, soft palate, posterior third of the tongue, fauces,
tonsils, ear canal, and tympanic cavity. The fibers decussate and travel upward to the opposite thalamic
and some hypothalamic nuclei. From here the axons pass through the internal capsule and carry this
sensory information to termination points in the lower postcentral gyrus.

Cranial nerve IX is efferent to one muscle only—the stylopharyngeus. This muscle

dilates the pharynx laterally and contributes to the elevation of the pharynx and larynx. It thereby serves
to help clear the pharynx and larynx for swallowing. Secretomotor fibers are efferent fibers provided for
the parotid gland’s production of saliva. Sensory fibers carry taste information from the posterior third
of the tongue.

Cranial Nerve X (Vagus Nerve):

Like the glossopharyngeal nerve, the vagus nerve also has three associated nuclei: the nucleus
ambiguus, the dorsal nucleus, and the nucleus solitarius, also located in the medulla. Axons from vagal
cell bodies in the nucleus ambiguus have two major branches: a pharyngeal branch and a laryngeal
branch. The laryngeal branch will branch again into the recurrent laryngeal nerve and the superior
laryngeal nerve. The superior laryngeal nerve further splits into two branches, the internal laryngeal and
the external laryngeal.
 The recurrent laryngeal nerve does not divide again. It arises
considerably below the larynx and ascends to terminate at the larynx.

The nucleus ambiguus receives an approximately equal number of corticonuclear fibers of cranial nerve
X from both hemispheres; these fibers are efferent to the constrictor muscles of the pharynx and the
intrinsic muscles of the larynx. The efferent fibers of the dorsal or parasympathetic nucleus are
associated with autonomic functions and innervate the involuntary muscles of the bronchi, esophagus,
heart, stomach, small intestine, and a portion of the large intestine. The afferent fibers from the nucleus
of the tractus solitarius follow much the same path as those of the glossopharyngeal nerve and
terminate in the postcentral gyrus.

Vagus means wanderer, an apt name considering the many functions of the vagus nerve. It is motor to
the viscera (heart, respiratory system, and most of the digestive system). It supplies primary efferent
innervation to the palatal muscles (except for innervation of the tensor palatini by the trigeminal nerve).
The vagus is also the primary efferent for the pharyngeal constrictors. On its own, the vagus innervates
all of the intrinsic muscles of the larynx, primarily through the recurrent laryngeal branch. The
cricothyroid, however, is innervated by the external laryngeal branch of the superior laryngeal nerve.
This can be an important difference to remember during clinical examinations for speech or swallowing.

Cranial Nerve XI (Spinal Acessory):

The spinal accessory nerve consists of a cranial and a spinal root. The nucleus of the cranial root is found
in the nucleus ambiguus of the medulla. It receives corticonuclear fibers from both cerebral
hemispheres. These fibers then join the glossopharyngeal, vagus, and spinal accessory nerves.

The cranial root joins the vagus to innervate the uvula and the levator palatini. As previously
mentioned, the spinal root innervates the sternocleidomastoid and trapezius muscles.

The spinal accessory nerve’s primary function is as a motor to the muscles (including the
sternocleidomastoid) that help turn, tilt, and thrust the head forward or raise the sternum and clavicle if
the head is in a fixed position. It provides innervation also to the trapezius muscle, which is responsible
for shrugging the shoulders.

Cranial Nerve XII ( Hypoglossal Nerve ):

The hypoglossal nerve runs under the tongue and controls tongue movements. The nucleus, called the
hypoglossal nucleus, is located in the medulla beneath the lower part of the fourth ventricle. It receives
fibers from both cerebral hemispheres, with one exception. The cells serving the genioglossus muscle
receive only contralateral fibers. The nerve fibers pass through the medulla and emerge in the groove
between the pyramid and the olive.

The hypoglossal nerve innervates the intrinsic muscles of the tongue. It also
innervates four extrinsic tongue muscles: the genioglossus, hyoglossus, chondroglossus, and
styloglossus. With the branches from the ansa cervicalis, cranial nerve XII contributes to the innervation
of the sternothyroid, sternohyoid, and omohyoid muscles, thus contributing to the elevation and
depression of the larynx.

The hypoglossal nerve innervates the muscles responsible for tongue movement. The four intrinsic
muscles of the tongue control tongue shortening, concaving (turning the tip and lateral margins
upward), narrowing, elongating, and flattening. The extrinsic muscles innervated account for tongue
protrusion (genioglossus), drawing the tongue upward and backward (styloglossus), and retraction and
depression of the tongue (hyoglossus). The hyoglossus also acts with the chondroglossus to elevate the
hyoid bone, thus participating in phonation.

6)CEREBRAL BLOOD SUPPLY, NOURISHMENT AND PROTECTION OF THE BRAIN

The brain uses about 20 percent of the blood of the body at any one time and requires approximately 25
percent of the oxygen of the body to function maximally. Initially, blood is delivered to the brain through
four main arteries. There are two large internal carotid arteries, one on either side of the neck. These
are a result of bifurcation, or splitting, of the common carotid artery from the heart. The other two main
arteries supplying the brain are the vertebral arteries.

Internal Carotid Artery and its Branches:

The internal carotid arteries ascend in the neck and pass through the base of the skull at the carotid
canal of the temporal bone. The ophthalmic artery supplies the eye, the frontal area of the scalp, the
dorsum of the nose, and the ethmoid and frontal sinuses. The posterior communicating artery runs
posteriorly above the occulomotor nerve and joins the posterior cerebral artery, forming part of the
circle of Willis. The anterior communicating artery joins the two anterior cerebral arteries together in
the circle of Willis.

Through these cortical branches, the internal carotid artery provides the blood supply
to a very large portion of the cerebral hemisphere. The anterior cerebral artery supplies all the medial
surface of the cortex as far back as the parieto-temporal-occipital sulcus. It also supplies the so-called
leg areas of the motor strip. Branches of this artery supply a small portion of the caudate nucleus,
lentiform nucleus, and internal capsule. The middle cerebral artery is the largest branch of the internal
carotid. Its branches supply the entire lateral surface of the hemisphere except for the small area of the
motor strip supplied by the anterior cerebral artery, the occipital pole, and the inferolateral surface of
the hemisphere, which are supplied by the posterior cerebral artery. The middle cerebral artery's central
branches also provide the primary blood supply to the lentiform and caudate nuclei and the internal
capsule.

Vertebral Artery and its Branches:

The vertebral artery passes through the foramina in the upper six cervical vertebrae and enters the skull
through the foramen magnum. It passes upward and forward along the medulla and at the lower border
of the pons and joins the vertebral artery from the opposite side to form the basilar artery. Prior to the
formulation of the basilar artery, several branches are given off, including:
1. The meningeal branches, which supply the bone and dura of the posterior cranial fossa

2. The posterior spinal artery, which supplies the posterior third of the spinal cord

3. The anterior spinal artery, supplying the anterior two-thirds of the spinal cord

4. The posterior inferior cerebellar artery, which supplies part of the cerebellum, the medulla, and the
choroid plexus of the fourth ventricle

5. The medullary arteries, which are distributed to the medulla

After the basilar artery is formed by the union of the opposite vertebral arteries, it ascends and then
divides at the upper border of the pons into the two posterior cerebral arteries . These arteries supply
the inferolateral surface of the temporal lobe, and the lateral and medial surfaces of the occipital lobe
(that is, the visual cortex). They also supply parts of the thalamus and other internal structures. Other
branches of the basilar artery include:

1. The pontine arteries, which enter the pons

2. The labyrinthine artery, which supplies the internal ear

3. The anterior inferior cerebellar artery, supplying the anterior and inferior parts of the cerebellum

4. The superior cerebellar artery, which supplies the superior portion of the cerebellum

Circle of Wills:

The circle of Willis, or the circulus arteriosus, is formed by the anastomosis of the two internal carotid
arteries with the two vertebral arteries. The anterior communicating, anterior cerebral, internal carotid,
posterior communicating, posterior cerebral, and basilar arteries are all a part of the circle of Willis. This
formation of arteries allows distribution of the blood entering from the internal carotid artery or
vertebral artery to any part of both hemispheres. Cortical and central branches arise from the circle and
further supply the brain.

The bloodstreams from the internal carotid artery and vertebral artery on both sides come together at a
certain point in the posterior communicating artery. At that point the pressure is equal and they do not
mix. Should, however, the internal carotid artery or the vertebral artery be occluded or blocked, the
blood will pass forward or backward across that point to compensate for the reduced flow. The circle of
Willis also allows blood to flow across the midline of the brain if an artery on one side is occluded. The
circle of Willis thereby serves a safety valve function for the brain, allowing collateral circulation (or flow
of blood through an alternate route) to take place if the flow is reduced to one area.
TRANSMISSION OF INFORMATION IN NEURAL SYSTEM – NERVE FIBERS, SYNAPTIC TRANSMISSION,
ACTION POTENTIAL, CHEMICAL TRANSMISSION, EXCITATORY AND INHIBITORY POTENTIAL &
NEUROMUSCULAR TRANSMISSION:

The neural messages are sent from the cell body or soma to the synapse in ten steps:

1. Neurons contain fluid inside the cell (intracellular) and are bathed in fluid outside (extracellular
fluid). These fluids are made up of water molecules and of chemicals that are ionic in nature,
that is, they carry a positive or negative electrical charge.
2. The membrane surrounding the neuron and its extensions is an “excitable” membrane. When
inactive, or not “firing,” the neuron is at rest. This resting state is a result of the maintenance of
a particular polarity or relative charge across that membrane. This resting polarity is obtained
when the intracellular fluid surrounding the point of the axon hillock (initial segment of the
axon) is approximately 70 mV more negative (–70 mV) than the fluid outside the cell membrane.
Therefore, it can be concluded that the intracellular fluid is negative and extracellular fluid is
positive.
3. Due to this excitable state, the polarity at different points along the membrane is constantly
being changed because there are neural signals being sent throughout your nervous system all
the time. There is a certain threshold of change in polarity that will cause the neuron to “fire” or
generate a neural electrical “spike” called an AP. An AP can be generated only at the axon
hillock. However, most of the singular neural signals that reach the membrane of a neuron are
not strong enough to generate movement around the membrane of the cell to the axon hillock
to generate an AP. These signals do cause a change in polarity at a point on the cell membrane,
resulting in what is called a graded potential. Thus neural firing (an AP) most often results not
from a single transmission but from the summative effect of many signals resulting in a spatial
 and/or a temporal summation of signaling effects on the membrane. This summation will result
in a strong enough change in polarity at the axon hillock to generate an AP.
4. The threshold for an AP is reached through a depolarization causing the intracellular fluid to
become more positive (or less negative) relative to the outside. This occurs through an influx of
sodium (Na+) ions. At the point of the axon hillock, this threshold for depolarization is
approximately –55 mV.
5. Once generated, an AP (in a healthy neuron with a normal axon) is propagated in an “all-or-
nothing” fashion down the axon to the end of it, the terminal bouton (the presynaptic terminal).
6. The AP triggers calcium channels in the presynaptic terminal to open and release calcium. The
calcium influx causes synaptic vesicles in the presynaptic terminal to fuse with the membrane
and release neurotransmitters that have been synthesized and stored in them.
7. The neurotransmitters diffuse out into a small space, the synaptic cleft, between the presynaptic
terminal and the membrane of a postsynaptic terminal (e.g., the membrane of a receiving
dendrite).
8. The postsynaptic membrane usually contains specialized receptor proteins for the
neurotransmitters involved. With channel activation, the transmitter molecules will bind with
the membrane. Binding of the principal neurotransmitters allows an exchange of ions across the
postsynaptic membrane. Ionic transfer will result in either a brief excitatory postsynaptic
potential (EPSP) or an inhibitory postsynaptic potential (IPSP).
9. Other neurotransmitters may be released at the same time and bind with their receptor
proteins but serve as neuromodulators of the effect of the principal chemical. This occurs
through a longer response called a second messenger system. The action that occurs in the
receiving neuron or cell depends on whether the overall summation of the transmissions to it
(the EPSPs, IPSPs, and second messenger action) results in another AP being generated, cell
activity enhancement, or overall inhibition of activity.
10. The excess neurotransmitter substance left in the space of the synaptic cleft will be either taken
up (reuptake) by the presynaptic membrane to be recycled or will be inactivated by enzymes.

Action Potentials are brief electrical transients visible when recorded as intracellular voltages or
extracellular current. If a neural signal is strong enough or the temporal or spatial summation of
electrical signals is strong enough to depolarize the receiving cell at the point called the axon hillock, the
result will be this electrical impulse, or action current (the AP), sent down the axon of that cell.

The transmitter release changes the potential of the receptor membrane to a

receptor potential by opening ionic channels. This receptor potential is called excitatory postsynaptic
potential (EPSP), the neurotransmitter binds to chemical-gated sodium channel receptors. The
conductance of these channels is briefly increased, and sodium is allowed to flow into the cell. This
partially depolarizes the membrane. If a sufficient number of EPSPs arrive at the membrane in a
synchronous fashion, the depolarization is larger in strength. If strong enough, the threshold to open the
voltage-gated sodium channels at the axon hillock is reached and an AP is generated. If the EPSP is not
strong enough and does not summate with others, it decreases and an AP is not generated at that time.
This happens in exhibitory neurotransmitter such as Glutamate.

A neurotransmitter such as gamma-aminobutyric acid (GABA), the primary inhibitory transmitter

substance in the nervous system, has the opposite effect on the postsynaptic membrane. The binding of
GABA with the membrane results in the influx of chloride ions or the efflux of potassium ions, either of
which result in hyperpolarization of the membrane and an inhibitory postsynaptic potential (IPSP). With
this, the receptor neuron becomes somewhat less likely to generate a neural impulse or spike.
CEREBRAL PLASTICITY:

Also known as brain plasticity or neural plasticity is the ability of the brain to change continuously
throughout an individual’s life. The aim of this function is to optimize neural networks during
phylogenesis, ontogeny and physiological learning. Earlier, it was believed that this happens only in
the brains of children but recent studies have reveled that adults also exhibit cerebral plasticity but
it is much slower. The basis of neural plasticity derives from synaptic plasticity. Synaptic plasticity
refers to changes in the strength of neurotransmission induced by activity experienced by the
synapse in the past. The potential for neuroplasticity appears to be greatest at the level of the
cortex, with development being more dependent upon environmental input rather than innate
mechanisms. Neurotrophins, a category of proteins found in both the peripheral and central
nervous system (CNS), are instrumental in plasticity.

It is ability of neurons to change their function, chemical profile or structure. (Woolf

and Salter,2000).
This includes :
1. Habituation: It is the simplest form of plasticity. According to Sherrington, it is the decrease in
synaptic activity between sensory neurons and interneurons. It is the prolonged repetation of
stimuli that causes structural changes i.e. the stimulus is given for a longer time and gradually the
skill is learnt. This was used in associated learning of B.F. Skinner.
2. Learning and Memory: It is a persistent and long lasting changes in strength of synaptic
connections. It is a task that is learnt and by that a small region of brain shows increased activity
and this results in storing of information.