Video Case 2. A 59 year old male (RL) who carries a medical diagnosis of multiple system atrophy-cerebellar (MSA-C) presents to your outpatient clinic for progressive changes to speech and swallowing function. More specifically, he reports “slurred” speech and a “raspy/breathy” vocal quality. He notes that listeners frequently have difficulty understanding him, especially on the telephone. He and his wife note occasional coughing/choking during meals. d) Based on the MBS, please select any of the following signs/symptoms of dysphagia that you observe. (2 points) Oral Phase (Word Bank):                                                                                ” Pre-swallow spill (Specify to the: valleculae or pyriform)               ” Delayed initiation of bolus transit                                              ”  ” Difficulty with bolus formation                                                    ”  ” Slow oral transit                                                                               ” Fast oral transit                                             ” Oral residue

7. Convert:

Video Case 2. A 59 year old male (RL) who carries a medical diagnosis of multiple system atrophy-cerebellar (MSA-C) presents to your outpatient clinic for progressive changes to speech and swallowing function. More specifically, he reports “slurred” speech and a “raspy/breathy” vocal quality. He notes that listeners frequently have difficulty understanding him, especially on the telephone. He and his wife note occasional coughing/choking during meals. 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:

10. Cerebellar dysfunction is most commonly associated with ataxic dysarthria.

21. You receive a consult to perform speech, swallowing, and cognitive-linguistic evaluations for a 66 year-old male who is believed to have a Parkinsonian disorder. His medical history is also significant for GERD. The patient and his wife report 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? (1 point)

21. You receive a consult to perform speech, swallowing, and cognitive-linguistic evaluations for a 66 year-old male who is believed to have a Parkinsonian disorder. His medical history is also significant for GERD. The patient and his wife report 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 item (b), tell me some key ways to disentangle these disorders (think speech and motor symptoms)? (2 points)

Video Case 1. Please answer the following questions based on the audio sample from Case 1. A 65 year-old female (JG) with probable ALS presents to your outpatient clinic for evaluation of speech-language and swallowing function as part of her multi-disciplinary neurological visit. According to the patient’s son, symptoms began 1 year ago, and her speech and swallowing function has progressively declined since then. Regarding speech function, she reports that she sounds “slurred, nasally, and slow.” In terms of swallowing function, she reports occasionally coughing during and after mealtimes, and eating more slowly (approximately 45 minutes to finish a meal). The patient crushes or cuts her pills in half in order to swallow them, and cuts her food into smaller pieces and takes smaller bites of food to compensate. She denies reflux or any pneumonia. h) Based on the MBS you observed in Video Case 1, select the severity of dysphagia you observed.

21. You receive a consult to perform speech, swallowing, and cognitive-linguistic evaluations for a 66 year-old male who is believed to have a Parkinsonian disorder. His medical history is also significant for GERD. The patient and his wife report 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? Is this patient a good candidate for DBS? What are some important things that you would educate the patient on regarding his candidacy and impact to corticobulbar functions?  (3 points).

Video Case 2. A 59 year old male (RL) who carries a medical diagnosis of multiple system atrophy-cerebellar (MSA-C) presents to your outpatient clinic for progressive changes to speech and swallowing function. More specifically, he reports “slurred” speech and a “raspy/breathy” vocal quality. He notes that listeners frequently have difficulty understanding him, especially on the telephone. He and his wife note occasional coughing/choking during meals. g) Based on the MBS you observed in Video Case 1, select the severity of dysphagia you observed.

8. A LMN lesion of CN XII will cause the tongue to deviate ipsilateral to the side of the lesion; whereas an UMN lesion of CN XII will cause the tongue to deviate to the contralateral side of the lesion.