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What Do I Assess First?! A Quick Guide For SLPs

As an adult speech-language pathology professional, you can assess a lot of things! From cranial nerves to vocal quality to attention to sound distortions, your well of knowledge is deep.

And while this means that you’re amazing, it also means that the sheer volume of possibilities can lead to analysis paralysis when deciding what to assess first.

In this post, you’ll find a quick guide for SLPs on how to quickly and confidently choose the right assessments for your adult patients!

For EB handouts, worksheets, assessments, and much more check out The Starter Pack!

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The Assessment Flow Chart

adult speech therapy treatment plan pdf

Sometimes, knowing where to start your assessment is obvious. The doctor literally wrote, “Swallow assessment.” Or the patient was transferred to your facility after intensive stroke rehab and their needs are clear.

But what about all the other times? Does choosing what to assess have to feel like solving an Einsteinian physics problem? You take each diagnosis to the power of the severity plus possible memory loss divided by age…

No, it does not!

Speech therapy assessment has a predictable flow. No matter the disorder, you can follow the same route, from chart review to writing excellent goals.

We call this flow The Adult Speech Therapy Assessment Roadmap. And we created it for adult SLPs because having a route to follow is much more efficient than the alternative—both for you and your patients!

In this post, we’ll cover one part of The Assessment Roadmap. Ready to learn the flow of choosing an assessment? Keep scrolling!

Step 1: Do A Chart Review

assessment guide for SLPs

First, you’ll do a chart review.

Start by scanning the speech therapy discharge and treatment notes, if there are any. These are likely to have the most recent and relevant information for your assessment.

Next, scan the medical notes to find the answer to these three questions:

  1. What happened to the patient?
  2. Why were they referred to speech therapy?
  3. Why now?

Step 2: Are There Swallowing Red Flags?

speech therapy swallowing red flags

In step 2, you’ll analyze the information gathered from the chart review to find the answer to one question:

Are there swallowing red flags?

Look for diagnoses related to the mouth, throat, central nervous system, cranial nerves, respiration, cardiovascular system, and others related to swallowing disorders.

Are there structural issues to the mouth and throat due to radiation treatment? Does the patient have an altered level of consciousness? Did they have COPD or COVID-19? How about a stroke? Or a history of tube-feeding?

If the answer is YES there are swallowing red flags, then you will complete a Clinical Bedside Swallowing Assessment.

If no, continue to Step 3.

Find the steps to swallowing assessment in The Complete Guide To Adult Speech Therapy Assessments.

Step 3. Are There Cognitive-Linguistic Difficulties?

cognitive-linguistic assessment

For patients both with and without swallowing red flags, you can pretty much go ahead and print out a Cognitive-Linguistic Assessment because it covers so much of what we do as SLPs.

We’ll go over some exceptions below, but look for diagnoses related to the central nervous system, the cardiovascular system, the renal system, and other specific issues that point to the need for a Cognitive-Linguistic assessment.

Did the patient have a stroke or have dementia? Did they have a myocardial infarction? How about a history of falls or alcohol abuse?

If the answer is YES there are cog-ling red flags, then you can confidently complete a Cognitive-LInguistic Assessment.

You can find informal assessment templates on our shop

If, during the assessment, you see another issue that’s negatively impacting their ability to communicate, then move on to Step 4.

Step 4: (Maybe) Add Another Assessment

adult speech therapy assessments

Try not to knock yourself (or your patient!) out by assessing everything that could possibly be going on.

But, if you do believe that there’s another issue that’s impacting communication, choose another assessment.

For example, you may hear certain sound distortions that make you suspect apraxia of speech. Or abnormal pitch and loudness that makes you suspect voice issues.

Choose from one of these areas of assessment:

  1. Motor Speech
  2. Voice
  3. Apraxia
  4. Resonance
  5. Fluency

What If I Start With One of These?

If for some reason you will begin with one of these assessments, you can reverse engineer this process a bit by looking out for swallowing and cognitive-linguistic red flags in your assessment and chart review.

It’s still best to screen for these speech therapy heavy hitters!

Step 5: Move On!

slp assessment

Based on your assessment results and professional judgment, does the patient need speech therapy treatment? Great! Recommend treatment and write solid goals.

If they don’t need treatment, make that recommendation.

Either way, move on with your life, knowing that you assessed what you needed to assess.

To recap:

  1. Do they have swallowing red flags? ➡️ Do a Swallowing Assessment
  2. Just about every patient ➡️ Do a Cognitive-Linguistic Assessment
  3. If those 2 didn’t quite cover everything you’re seeing ➡️ Add a Motor Speech, Voice, Apraxia, Resonance, or Fluency Assessment

The Adult Speech Therapy Starter Pack

Interested in having premade assessments, goals banks, and documentation templates? Then check out the bestselling Adult Speech Therapy Starter Pack!

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