ALS

Question 1

What does it mean if an ALS patient’s speech rate falls below 125 WPM or 90% intelligibility.

Answer 1

A sharp decline in the patient’s condition is imminent

Question 2

At what stage of ALS should the patient complete voice banking?

Answer 2

early

Question 3

Which presentation of ALS Impacts the cranial nerves first?

Answer 3

bulbar

Question 4

Premature spillage and delayed swallow onset indicate what kind of impairment

Answer 4

Sensory

Question 5

During an OME the clinician instructs the patient to stick their tongue out, in, up, down, and side to side against resistance. Which cranial nerve is being assessed?

Answer 5

XII

Question 6

Which compensatory swallowing strategies would you implement with a middle stage ALS patient?

Answer 6

thicken liquids, soften foods, chin tuck, semi-reclined position

Question 7

Your ALS patient presents with generalized weakness that is more notable on the right side for facial asymmetry at rest and in movement, lingual weakness against resistance, and labial weakness against resistance. This right sided facial weakness of the orbicularis oris and buccal muscles indicates a likely impairment in the oral phase of the swallow. What might you expect to see in bolus trials?

Answer 7

Difficulty with rotary chew, lingual residue, escape of bolus to lateral cavities

Question 8

What does the observation of lingual residue indicate

Answer 8

Weakness of the tongue

Question 9

In the summary report, the clinician who completed the instrumental assessment wrote, “premature spillage in the pharyngeal cavity, with a several second delay before the swallow onset.”
This indicates interruption in the central pattern generator, which involves CNs

Answer 9

V sensory, VII sensory, IX sensory, X sensory

Question 10

What are likely contributing factors to swallowing impairment in ALS?

Answer 10

UMN, LMN, Motor, Sensory

Question 11

Nasal regurgitation indicates

Answer 11

Velopharyngeal mechanism failure

Question 12

During an OME the clinician instructs the patient to cough and say “ah ah ah” to assess velum closure. Which cranial nerve is being assessed?

Answer 12

X

Question 13

Lingual residue after the swallow indicates an impairment in what stage of the swallow?

Answer 13

Oral transit

Question 14

Which compensatory swallowing strategies would you implement with an early stage ALS patient?

Answer 14

take smaller bites, double swallow

Question 15

During an OME the Clinician applies a cold/sour bolus to the back of the tongue. Which cranial nerve is being assessed

Answer 15

IX

Question 16

Which compensatory swallowing strategies would you implement with a late stage ALS patient?

Answer 16

feeding tube, manage secretions with bib or suction or medications

Question 17

All of the following are shared characteristics of spastic and flaccid dysarthria except:
Hypernasality
Weak cough
Imprecise consonants
Slow AMR and speech rate

Answer 17

Weak cough

Question 18

During an OME the clinician touches the top, middle, and bottom of the face and tests jaw movement. Which cranial nerve is being assessed

Answer 18

V

Question 19

What impaired system would contribute to lingual residue following a solid bolus trial in ALS?

Answer 19

LMN, CN XII

Question 20

During an OME the clinician assesses facial symmetry and movement, and applies a cold/sour bolus to the front of the tongue. Which cranial nerve is being assessed?

Answer 20

VII

Question 21

Which of the following is not characteristic of spastic dysarthria?
Pseudobulbar affect
Pathologic oral reflexes (babinski, rooting, etc)
Hyperactive gag reflex
Fasciculations

Answer 21

Fasciculations

Question 22

What is the most likely reason for nasal regurgitation to occur in ALS?

Answer 22

Velopharyngeal weakness