Case study 2 The following four questions (+bonus question a…

Case study 2 The following four questions (+bonus question at the end of the exam) will refer to this case information.  — A 65-year-old woman was admitted to the hospital after her son noticed a sudden onset of “slurred” speech while they were having lunch. Neurologic examination in the ER noted right-sided weakness in the hand, a hyperactive biceps reflex in the right arm, and a droop in the right side of the lower face. The neurologist noted speech difficulty, including mildly decreased intelligibility, and requested SLP consult.  You speak with the patient when she first arrives at your office. She says it feels like his tongue is thick and she can’t speak like she needs to for her job as an auctioneer. She also tells you that about a year ago, she suddenly developed some difficulty speaking clearly and with swallowing, as well as clumsiness in her right fingers, but all of those issues went away in about a week. She says it feels like her speech is worse this time. During this conversation, you note a slightly hoarse voice throughout as well as intermittent articulatory imprecision. You also note that sometimes it sounds like she says her son’s name, “Ned”, more like “Nen”.  During oral mechanism examination, you note the following:  Reduced range of movement one the right side of her mouth during smile and pucker Reduced range of movement in tongue lateralization to the right During DDK tasks, you note the following:  Typical rate with occasional mild slowdowns Occasional imprecise articulation for ta and ka

Case study 1 The following five questions (+bonus at the bot…

Case study 1 The following five questions (+bonus at the bottom of the exam) will refer to this case information. — A 60-year-old man presented with a 9-month history of problems speaking clearly. During your intake conversation, he said that he tried very hard to speak clearly but everything just came out wrong. He said he had started noticing occasional problems with his pronunciation about 9 months ago, but it had gotten worse since then.  Examination of the oral mechanism: Symmetrical face, with clear nasolabial fold No difficulty resisting finger pressure against puffed cheeks No difficulty achieving full pucker or smile Symmetrical, full protrusion of tongue beyond lower teeth Adequate strength holding tongue against the inside of the cheek Adequate tone and muscling in the tongue No fasciculations on the tongue  No fasciculations of the chin No difficulty holding jaw closed against pressure Strong glottal coup Sustained phonation:  Modal voicing, approximately 20 seconds of voicing DDK tasks:  Normal rate and accuracy for papapa, tatata, and kakaka Slower pataka, sometimes producing “papaka” or “pakata” instead.  Grandfather passage:  Frequent but inconsistent imprecise articulation Segmented speech Occasional pausing before long words  Monopitch