Name __________________________  Score ______/100

Section I: Foundations

1. Match each of the following impairments with its probable site of lesion: (5)

_____    unilateral facial droop _____    tongue weakness _____    numbness on one side of the face _____    inability to make pitch adjustments _____    unilateral vocal cord paralysis _____    impaired sense of taste on the front of the tongue _____    jaw paralysis _____    deafness _____    reduced velar elevation _____    numbness and lack of taste on posterior portion of tongue

a.    CN V (unilateral) b.    CN X (recurrent laryngeal branch) c.    CN XII d.    CN V (bilateral) e.    CN VII (unilateral) f.    CN XI g.    CN VIII h.    CN VII (bilateral) i.    CN X (superior laryngeal branch) j.    CN IX

2. Name the branch of the internal carotid or vertebral arteries that supplies the areas of the brain most important for speech and language. (2)

3. Describe the communication characteristics of someone from your hometown, specifically indicating how a speech language pathologist or other professional “not from around those parts” might misinterpret a particular “normally diverse” behavior as pathological. (3)

Section II: Disorders and Etiologies

4. Compare and contrast the following disorders/etiologies:

• conduction aphasia and transcortical sensory aphasia (5)
• ataxic and spastic dysarthria (5)
• apraxia of speech and spastic dysarthria (5)
• ALS & Parkinson's disease (5)
  

It is recommended that students use the following format to respond to these items

Ways that the two disorders are the same	Disorder 1 is like this	But disorder 2 is like this
Factor 1 (e.g., both affect language) Factor 2 (e.g., both cause slow rate) etc	Factor 3 (e.g., causes hypotonia)	Factor 4 (e.g., causes hypertonia)

5. List the types of motor speech disorders that have the greatest impact on vocal functioning, describing the voice characteristics associated with each motor speech disorder listed. (5)

6. Name, define, and give examples of five behaviors exhibited by individuals with aphasia (5)

7. For each patient listed below, identify the following

• if not provided, a likely medical diagnosis
• expected deficits in cognition
• expected deficits in language content, form & use
• expected underlying motor impairments
• expected deficits in respiration, phonation, articulation, resonance, & prosody
• expected progression (e.g., deficits should get better, get worse, stay the same)

Cases:

• 47 year old male with gradual onset of tremor, stooped posture, and mumbled speech (10)
• 68 year old female with sudden onset of right hemiparesis and garbled speech (10)

Section III: Assessment

Mrs. Jones is 54 years old and is 5 days s/p a left hemisphere stroke. She has just been admitted to an inpatient rehabilitation facility where you are the SLP on the stroke team. The discharge summary from the acute care hospital indicates that the patient initially had “garbled speech” and that a swallowing evaluation had revealed normal swallowing function.  This is the only information provided related to communication/swallowing.

8. Based on this information, indicate how you will plan to assess the patient (put a check in the appropriate boxes) (6)

Area	Assess Carefully	Screen	Will Not Assess
Orientation
Oral Motor
Receptive Language
Expressive Language
Speech Production
Swallowing

9. For each of the areas above you will be screening, give examples of ways you will elicit behaviors to judge whether additional assessment is needed. (3)

10. For each of the areas in question one you will be assessing carefully, give examples of formal instruments you might use, and samples of subtests that are included in those instruments. (4)

11. Mrs. Jones exhibits mild impairments in auditory comprehension.  Her spontaneous speech is fluent but characterized by sound substitutions, which are more prevalent during repetition.  These behaviors are most consistent with what diagnosis? (2)

Section IV: Treatment

Mr. Richards is a 38 year old police officer who sustained a gun shot wound to the head resulting in nonfluent aphasia and moderate apraxia of speech. His auditory comprehension and reading are only mildly impaired but expression in written and spoken modes remains largely dysfunctional. He has just returned home following six weeks of inpatient rehabilitation and will be receiving outpatient speech pathology services.

12. Develop treatment goals for Mr. Richards. The goals should target impairment, activity, and participation. (10). Note: students may develop their own assumptions about Mr. Richards' personal and professional needs when developing goals, to the extent that they are not inconsistent with information provided .

13. Develop a 60-minute lesson plan addressing the identified goals (10).

14. Develop a brief progress note (e.g., soap note) for the treatment session described above (5).