CD 5671 Neurogenic Disorders
Summer 2000
Exam IV

Name __________________________________ Score _________/100
 

_____/15 Describe the innervation for the normal swallow. Include the specific aspect of the swallow (anatomical structure & function) to which each cranial nerve contributes.


_____/15 For each of the following sets of radiological signs, provide the most parsimonious physical impairment(s) that would explain the sign(s). Then provide one therapeutic technique and one compensatory strategy you would suggest to address the impairment(s). 
 
Radiological Sign Physiologic Impairment(s) Therapeutic Technique Compensatory strategy
retention in the right lateral sulcus
inadequate mastication		 . . .
pyriform retention
aspiration after the swallow		 . . .
vallecular retention in isolation . . .
pooling in the valleculae after the oral phase but before the pharyngeal phase . . .

regurgitation of liquid into the nasopharynx		 . . .
failure to produce serial swallows in response to pharyngeal retention . NOT APPLICABLE .

____ / 20 Column one lists the complaints described by the patient during the interview. In column two, list the impairment(s) you suspect are contributing to the complaint, then indicate by a check () which of the assessment tools would allow you to test your hypotheses (i.e., assess that aspect of the swallow). Remember that some symptoms (complaints) may result from more than one impairment. I have provided a "suggested" number of impairments that you would want to consider.
 
Complaint Suspected impairment(s) Bedside Clinical Evaluation MBS FEES Other
Coughing with liquids
 
 

 

 1.

2.

3.

 . . . .
Can't get swallow started 1.

2.
 

 . . . .
Food sticks in my throat 1.

2.

3.
 

 . . . .
Food comes back up after I swallow 1.

2.

 . . . .

_____/15 Indicate whether each of the following interventions is a compensatory technique (C), therapeutic technique (T), or both (B). 

_____ 1. chin tuck
_____ 2. thickened liquids
_____ 3. thermal stimulation
_____ 4. Masako maneuver
_____ 5. Mendelsohn maneuver
_____ 6. head tilt
_____ 7. puree diet
_____ 8. oral motor exercises
_____ 9. artificial saliva
_____ 10. supraglottic swallow
_____ 11. head lifting exercises
_____ 12. alternating solids and liquids
_____ 13. laryngeal adduction exercises
_____ 14. hard swallow
_____ 15. head turn

______/10    From the list above, write the number of the technique(s) appropriate for the listed impairment.

__________ 1. Delayed swallow reflex
__________ 2. Reduced tongue strength
__________ 3. Reduced laryngeal elevation
__________ 4. Unilateral pharyngeal paresis
__________ 5. Xerostomia
__________ 6. Aspiration during the swallow
__________ 7. Reduced UES dilation
__________ 8. Premature delivery
__________ 9. Anterior spillage
__________ 10. Aspiration after the swallow
 

_____/10 Select five of the impairments from the list above. Provide the rationale for why a treatment strategy you selected will be effective.
 
Impairment from List Two Technique from List One
(one of those you provided in list two)		 Rationale for why the technique will work
1. . .
2. . .
3. . .
4. . .
5. . .

______/10 Discuss the relationships among dysphagia, dysarthria, and dementia.

______/5   Discuss the relationship between dysphagia and aspiration pneumonia..