Cranial Nerve Ax

Question 1

What are the 5 cranial nerves?

Answer 1

V (5) trigeminal
VII (7) facial
IX (9) glossopharyngeal
X (10) vagus
XII (12) hypoglossal

Question 2

How would you assess the function of the trigeminal nerve (v)

Answer 2

Motor:
open/close jaw
Bite down (palpate masseter)
Open jaw to resistance (2 fingers pushing jaw up)

Sensory:
Stroke above eyebrow
Stroke lip to cheek
Stroke lip to chin
Sensation to anterior tongue
Sensation to medial tongue

Ax on both sides of the face

Question 3

How would you assess the function of the facial nerve (VII)

Answer 3

Motor:
Close eyes
Wrinkle and raise eyebrows
Shut eyes tightly
Smile
Pucker lips
Puff out cheeks

Sensory:
Facial symmetry at rest

Question 4

How would you assess the function of the vagus nerve (X)

Answer 4

Motor:
Say [a:] Voice quality
Volitional cough
Say [a:] look for palatial elevation and depression
Dry swallow

Sensory:
Reflexive cough

Question 5

How would you assess the function of the hypoglossal nerve (XII)

Answer 5

Motor ONLY:
Tongue at rest
Stick tongue out
Tongue laterally side to side
Tongue up and down
Lick lips
Tongue in cheek and push against fingers
DDK (diadochokinetic) rates [t] [d] [i] [j] [k] [g]

Ax on both sides of the face

Question 6

Implications of Trigeminal (V) difficulties

Answer 6

Decreased bolus recognition and awareness
Difficulties with bolus breakdown and formation
Decreased anterior hyoid movement causing:
Decreased upper oesophageal sphincter opening CAUSING pyriform sinus pooling and post- swallow aspiration

Question 7

Implications of facial (VII) difficulties

Answer 7

Decreased lip seal- Premature spillage
Decreased hyoid elevation increasing risk of aspiration
Decreased displacement of tongue, hyoid, larynx CAUSING:
Pre- swallow pooling
And implications for oral containment of bolus

Question 8

Implications of Vagus (X) difficulties

Answer 8

Decreased capacity for laryngeal adduction (causing aspiration)
Decreased effectiveness of clearing coughs
!!! Silent aspiration
? Upper Oesophageal sphincter impairment CAUSING:
Post swallow residue/pooling
Post- swallow aspiration

Question 9

Implications of hypoglossal (XII) difficulties

Answer 9

Decreased ability to manipulate bolus
Which affects bolus manipulation, preparation and transfer
Lack of cohesive bolus which may lead to
Post swallow residue

Question 10

Implications of glosso-pharyngeal (IX) difficulties

Answer 10

Reduced pharyngeal mobility
Reduced supraglottic compression
CAUSING:
Decreased bolus awareness
Aspiration