CH 9 Motor Speech Disorders and Dysphagia

1.A clinician in a hospital setting is asked to evaluate a 64-year-old patient who appears to have dysarthria as a result of a TBI from falling and hitting the back lower portion of his head. A detailed motor speech evaluation shows that the patient presents with slurred speech, imprecise consonants, distorted vowels, slow rate of speech, and excess and even stress. The patient's motor movements are described by the nursing staff as "clumsy" and "uncoordinated." Based on the given information, the clinician would most likely classify the patient's dysarthria as

1. Hyperkinetic dysarthria.

2. Hypokinetic dysarthria.

3. Ataxic dysarthria.

4. Flaccid dysarthria.

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2.Which of the following dysarthria is associated with Parkinson's disease?

1. Spastic dysarthria

2. Flaccid dysarthria

3. Hypokinetic dysarthria

4. Hyperkinetic dysarthria

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3.Amyotrophic lateral sclerosis results in which kind of mixed dysarthria?

1. Spastic-ataxic dysarthria

2. Flaccid-spastic dysarthria

3. Hypokinetic-spastic dysarthria

4. Flaccid-ataxic dysarthria

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4.Which of the following is characteristic of apraxia of speech but not dysarthria?

1. Consistent errors regardless of length and complexity of utterance

2. Difficulty performing both non-speech and speech motor tasks

3. Predictable errors

4. Normal strength, tone, and range of movement of oral and pharyngeal muscles

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5.Purposeless, random, involuntary movements of body parts associated with hyperkinetic dysarthria in

1. myoclonus

2. chorea.

3. tics.

4. tremors

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6.Which of the following is not a disorder of the pharyngeal phase of the swallow?

1. Decreased laryngeal elevation

2. Reduced tongue base retraction

3. Decreased upper esophageal sphincter (UES) opening

4. Premature spillage over the base of the tongue

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7.For which of the following disorders of swallowing would it be inappropriate to recommend tilting the head towards the strong side?

1. Unilateral weak pharyngeal constriction

2. Decreased laryngeal elevation

3. Decreased upper esophageal sphincter
   (UES) opening

4. Incomplete epiglottic inversion

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8.Apraxia of speech is often associated with

1. lesions in Broca's area

2. lesions in Wernicke's area.

3. lesions in subcortical structures

4. lesions in the occipital area

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9.Dysarthria is

1. a speech disorder in the absence of muscle weakness or paralysis.

2. a speech disorder never associated with aphasia.

3. a single disorder with a unitary etiology

4. a speech disorder associated with muscle weakness or paralysis.

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10.Of the following symptoms, the one associated with dysarthria is

1. even and consistent breakdowns in articulation.

2. impaired syntactic structures

3. forced inspirations and expirations that interrupt speech

4. an invariably slower rate of speech.

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11.A clinician in a skilled nursing facility (SNF) receives a note that Dick, a new 80-year-old patient, has been transferred to her facility. The note states that Dick was assessed by the clinician in the previous SNF, but there is no diagnosis in the papers that have been sent from the previous clinician. However, the previous clinician reported that Dick manifested the following symptoms: general awareness of his speech problems, significant articulation problems, problems with volitional speech with relatively intact automatic speech, more difficulty with consonants than vowels, intonation and fluency problems, and trial-and-error groping and struggling associated with speech attempts. Therapy was recommended. Dick post likely has

1. hyperkinetic dysarthria.

2. unilateral upper motor neuron dysarthria.

3. right-hemisphere syndrome.

4. apraxia of speech.

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12.Lucien, a 22-year-old male, is hospitalized after sustaining traumatic brain injury from a motor vehicle accident. There is no injury to the cerebellum, brainstem, or peripheral nerves. When assessing Lucien, the clinician might expect to find

1. dysarthria, confused language (e.g., confabulation), auditory comprehension problems, confrontation naming problems, perseveration of verbal responses, pragmatic language problems, and reading and writing difficulties.

2. dysarthria, confused language (e.g., confabulation), auditory comprehension problems, no confrontation naming problems, and agrammatic or telegraphic speech.

3. confrontation naming problems, perseveration of verbal responses, pragmatic language problems, intact reading and writing skills, and echolalia.

4. severely impaired fluency, severe echolalia, agrammatic and telegraphic speech, and intact auditory comprehension skills.

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13. Which of the following is considered an exercise for patients with dysphagia and should not be performed with food?

1. Masako maneuver

2. Supraglottic swallow

3. Mendelsohn maneuver

4. Effortful swallow

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14. Which of the following would be inappropriate to recommend for a patient with dysphagia due to poor base-of-tongue retraction?

1. Use of the chin tuck strategy

2. Swallowing multiple times for one bolus

3. Lingual sweep of lateral sulci

4. Effortful swallow

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15.A clinician is asked to give a workshop to graduate students about evaluation of patients with swallowing dis-orders. She discusses evaluation in depth. Which one of the following facts in the clinician's workshop would be inaccurate?

1. An ultrasound examination can measure oral tongue movement and hyoid movement.

2. A manometric assessment can assess the preparatory phase of the swallow using posterior and lateral plane examinations.

3. An electromyographic assessment can be conducted by attaching electrodes on structures of nterest (e.g., oral, laryngeal, or pharyngeal muscles)

4. A laryngeal examination can be conducted with indirect laryngoscopy or endoscopi examination to inspect the base of the tongue, vallecula, epiglottis, pyriform sinuses, vocal folds, and ventricular folds.

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