Swallowing- Case Study
Sarah Miller is a 48 yo female who admitted to the ED with righthemiparesis, dysarthria and a reflexive cough while taking smallsips of water. MRI of the brain confirmed an MCA distributionstroke. A bedside swallow evaluation was ordered which revealed thefollowing: R facial droop with moderately dysarthric speech. Tonguedeviates to the right on protrusion. Lips strength is moderatelyimpaired. Palpation of larynx/hyoid during a dry swallow revealedmildly reduced laryngeal elevation/excursion. Vocal quality is softand breathy. Unable to complete diakochokinetic rate due to poorapproximation and coordination of movements.
1.  Name 3 cranial nerves you think could be damaged andexplain why?
2.  What indications (ie symptoms) do yousubjectively consider based on the patient?s presentation (prior toinitiating the exam) just based off of what you see, hear and haveread about the medical history?
3.  What does the inability to complete thediadochokinetic rate tell you about the patient?s speech/swallowdeficits?
