Name __________________________________ Score _________/125
 

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

_____/10 You have (finally!) received your CCC and have taken a job in a relatively new regional hospital. To your chagrin, no system is currently in place for identification or instrumental assessment of swallowing function (i.e., no dysphagia team, no MBS's, no FEES). You approach the hospital administration to present a case for the development of a dysphagia team and the acquisition of materials/equipment for instrumental assessment. However, as the conversation progresses, the administrator interrupts you, remarking, " Wait a minute, what is 'dysphagia'?"
 

In appropriate language, write exactly how you would explain to the administrator what dysphagia is and why it should be important to the administration that the problem is addressed.

_____/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.

____/10 Develop a diagram to depict the impact of the presence of tongue weakness on swallowing function.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

____/10 Describe the potential swallowing impairments associated with laryngectomy.
 
 
 

Type of laryngectomy	Anatomical changes	Impact on swallowing
hemilaryngectomy
supraglottic laryngectomy
total laryngectomy

 
 
 
 
 

_____/25 In the first column, indicate whether each of the following interventions is a compensatory technique (C), therapeutic technique (T), or both (B). In the second column, write the number of the technique(s) appropriate for the listed impairment.
 

_____ 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

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

_____/10 Select five of the impairments from column two. Provide the rationale for why a treatment strategy you selected will be effective.
 

Impairment from Column Two	Technique from Column One (one of those you provided in column two)	Rationale for why the technique will work
1.
2.
3.
4.
5.

 

______/10 Discuss the swallowing deficits most commonly associated with Parkinson's Disease.