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Monica is a 48-year-old mother of two teenaged girls who has been referred to you for assessment of swallowing difficulties described as “choking on water and even my own saliva.” The following are selected findings from your clinical examination: • Hyperactive gag reflex • Perceived hypernasal resonance with nasal air emission • Strained voice quality • Slow lingual movement • Reduced speed on all alternate movement rate (AMR) tasks (diadochokinetics) • Visible fasciculations in the tongue • Slight atrophy of the tongue on lateral boarders Based on these observations, which of the following would be the most accurate statement regarding a clinical assessment? A. The findings are consistent with mixed upper and lower motor neuron pathology. B. The findings are consistent with upper motor neuron pathology. C. The findings are consistent with lower motor neuron pathology. D. The findings are highly unreliable and do not fit any predictable pattern of pathology.

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