21. You are a clinician in an acute inpatient hospital. You receive a consult for a 66 year-old male who presented to the ED due to a fall. His medical history is also significant for HTN, urinary incontinence, excessive sweating, and HLD.  Upon entry into the room the patient reports that he is falling much more frequently over the past 8 months, and has noticed significant decline of his speech function with listeners frequently asking him to repeat himself because of reduced loudness and consonant imprecision. He also acknowledges coughing/choking with thin liquids at home approximately once per meal. a). What tasks/evaluative techniques would you use to evaluate this patient? (2 points)

22. You are consulted to see a patient in an outpatient multi-disciplinary clinic and have no information on the patient’s medical history. You observe an OME WFL. A motor speech evaluation reveals a hyperkinetic dysarthria characterized by what is perceptually deemed vocal breaks or vocal tremor, a perceptually markedly strained vocal quality, slight respiratory dyscoordination, and a slow rate. b). How are you going to evaluate this patient? (1 point)

21. You are a clinician in an acute inpatient hospital. You receive a consult for a 66 year-old male who presented to the ED due to a fall. His medical history is also significant for HTN, urinary incontinence, excessive sweating, and HLD.  Upon entry into the room the patient reports that he is falling much more frequently over the past 8 months, and has noticed significant decline of his speech function with listeners frequently asking him to repeat himself because of reduced loudness and consonant imprecision. He also acknowledges coughing/choking with thin liquids at home approximately once per meal. d). Following your evaluation, you learn that this patient is interested in deep brain stimulation. What makes a patient a good candidate for DBS? (1 point). Is this patient a good candidate for DBS? (1 point). What are some important things that you would educate the patient on regarding his candidacy and impact to corticobulbar functions? (2 points).

What are 2 movement disorders that commonly present in pediatric populations? Please briefly describe what type of dysarthria you would expect in these populations and how you might intervene to improve signs/symptoms. (2 points).

4. The basal ganglia are comprised of nuclei including the caudate, putamen, and vermis which are responsible for the initiation of voluntary movement.

A 37 year-old male presents to your multi-disciplinary clinic with clumsiness and intermittent jerking/writhing of all the limbs. He exhibits variable loudness and rate. He has a history of psychiatric paranoia and hallucinations. Family history is significant for dementia at young ages. What is this patient’s most likely diagnosis?

Video Case 1. Please answer the following questions based on the audio sample from Case 1. A 67 year-old female with a 3 year history of parkinsonism presents to your outpatient clinic for a routine evaluation of speech-language and swallowing function as part of her multi-disciplinary neurological visit. Regarding speech function, she notes significant changes over the last 2 years with an increased need to repeat herself to listeners; however, she denies any cognitive changes. In terms of swallowing function, she received an MBS 2 years ago which identified intermittent penetration above the level of the vocal folds and mild residue in the pyriform sinuses. She admits to coughing/choking everyday during meals; however, she denies pneumonia, pain, and weight loss. The patient also reports a history of reflux which she manages with daily oral medication. b). Based on the above perceptual motor speech evaluation, please state what type(s) of dysarthria you think this patient has? (2 points).

21. You are a clinician in an acute inpatient hospital. You receive a consult for a 66 year-old male who presented to the ED due to a fall. His medical history is also significant for HTN, urinary incontinence, excessive sweating, and HLD.  Upon entry into the room the patient reports that he is falling much more frequently over the past 8 months, and has noticed significant decline of his speech function with listeners frequently asking him to repeat himself because of reduced loudness and consonant imprecision. He also acknowledges coughing/choking with thin liquids at home approximately once per meal. c). Based on your response to part (b) of question 21, tell me some key ways to disentangle these disorders (think speech and motor symptoms)? (2 points)

2. Video Case 2. A 28 year old female who carries a medical diagnosis of Friedrich’s ataxia presents to your outpatient clinic for reported changes to speech, language and voice function. In terms of speech and voice function she reports “slurred” speech and a “raspy/breathy” vocal quality. She also admits to mild anomia, difficulty maintaining attention, experiencing a globus sensation with solid foods, and smoking 1 pack of cigarettes per day. She is non-ambulatory and utilizes a motorized wheelchair. a). Motor Speech Evaluation: Perceptual speech evaluation is rated on a 0-7 point scale, with 0 indicating normal function and 7 indicating profound dysfunction. Please rate each subsystem and characteristic that you hear (6 points). Respiratory mechanism is involved with a severity rating of: Maximum phonation duration:      Maximum loudness:                Normal           Adequate          Inadequate                                      Loudness in conversation:      Normal           Adequate          Inadequate Laryngeal mechanism is involved with a severity rating of: Vocal quality:      Normal                Hoarse              Breathy (continuous)                               Breathy (transient)           Strained-strangled           Harsh              Rough Pitch range:         Normal            Adequate          InadequateVocal tremor:      Yes                      No Velopharyngeal mechanism is involved with a severity rating of:                               Resonance:          Normal            Hypernasal            HyponasalNasal emission:        Yes                        No                                                                                  Nasal assimilation:   Yes                        No Orofacial mechanism is involved with a severity rating of:                                    Conversation:           Precise               Imprecise                                                        Diadochokinesis:     Precise               Imprecise Rate is involved with a severity rating of:                                                                                            Speed:            Normal              Fast                  Slow                                                                        Pace:              Consistent        VariableDDK rate:      Normal             Fast                     Slow Prosody is involved with a severity rating of:                                                                    Intonation in conversation:           Normal            Variable            Monotonous                  Stress in conversation:                  Normal            Equal and excess                                                                                                                      Reduced stress               Excess loudness variation Fluency is involved with a severity rating of: Neurogenic stuttering:     Yes             No Palilalia:                             Yes              No Naturalness is involved with a severity rating of (0-7): Intelligibility in connected speech is:

The main role of the tonsils is to __________.