Speech Therapy Assessments For Parkinson's Disease

What should you assess when your patient has Parkinson’s disease?

In this post, you’ll find a step-by-step guide to speech therapy assessments for Parkinson’s disease—plus helpful links to assessment forms and norms.

For print-and-go assessment templates, check out our bestselling Adult Speech Therapy Starter Pack!

Visit Our Shop!

More Articles

Swallowing Assessments for Parkinson’s Disease

When deciding whether to do a swallowing screen or a full swallowing assessment, start with a chart review.

If the patient has a swallowing eval order or their chart review has dysphagia red flags (i.e. pneumonia secondary to aspiration), complete a full bedside swallowing assessment.

If not, complete a 3-ounce water test plus an oral motor examination.

If appropriate, also recommend an instrumental swallowing assessment.

Clinical Bedside Swallowing Assessment: Step-by-Step

_{Sample page from The Evaluation Pack.}

1. Current diet

2. Personal Interview

Ask the patient about their swallowing:

Any recent changes in their swallowing
When their swallowing problems began
If and where they feel pain
If they have trouble eating certain foods
If and where food feels stuck in their throat or mouth
Food/liquid avoidance
Recent weight gain or loss
What they do that helps their swallowing

3. Oral Motor Examination

Observe strength, range of motion, speed, and symmetry of the following:

Mandible (CN V):
- At rest
- Open
- Open with resistance
- Close
- Close with resistance
- Lateralize
- Protrude
- Retraction
- Sensation
Lips (CN VII):
- At rest
- Protrude
- Retract
- Repetitive protrude/retract
- Puff cheeks
- Puff cheeks against resistance
- Sensitivity to touch
- Sensation
Tongue (CN XII):
- At rest
- Protrude out
- Protrud out with resistance
- Protrude up
- Protrude up with resistance
- Protrude down
- Protrude down with resistance
- Lateralize
- Lateralize with resistance
- Retract
- Lick teeth
- Lick lips
- Sensation
Velum:
- At rest (CN IX)
- Prolonged “ah” (CN X)
- Repetitive “ah” (CN X)
- Sensation
Reflexes (CN IX, X):
- Gag
- Faucial arches
Other Observations
- Dentition
- Raise eyebrows (CN VII)
- Breath support
- Oral mucosa
- Cough on command
- Throat clear on command

Read How To Do An Oral Moral Exam for more details.

4. PO Trials: Liquids and Solids

For each trial, measure and record the amount, cup/spoon/straw use, response, strategies, and duration.

5. Findings

Note any unusual findings or observations.

Mastication time and amount
Labial closure completeness
Oral residue amount and location
Multiple/suspect piecemeal swallows
Anterior spillage
Drooling
Swallow initiation timeliness
Laryngeal elevation amount
Coughing/throat-clearing
Vocal quality changes
Respiration changes
Fatigue

The Mann Assessment of Swallowing Ability (MASA) is a useful tool for quantifying information collected during a bedside swallowing evaluation. Here’s the MASA scoring sheet.

Swallowing Screens for Parkinson’s Disease

The 3-ounce Water Test

The Yale Swallow Protocol is a standardized swallowing screen that includes the 3-ounce water test.

See Yale Swallow Protocol for a free PDF template.

Eating Assessment Tool (EAT-10)

The EAT-10 is a patient-reported outcome (aka questionnaire) that’s recommended by ASHA and has excellent consistency and validity.

Download ASHA’s free EAT-10 PDF template.

Learn more about EAT-10.

Oral Motor Exam

The Motor Speech & Voice Assessment includes an oral motor exam.

To make your own, read How To Do An Oral Motor Exam.

Speech & Communication Assessments for Parkinson’s Disease

speech and communication assessments for parkinson's disease

If the chart review showed speech or communication red flags, complete the Motor Speech & Voice Assessment, which is available in our shop.

If you’d rather put together your own informal assessment, here’s a step-by-step guide to assessing speech and communication in patients with Parkinson’s disease.

1. Maximum Phonation Time

Prompt the patient to say ‘ah’ for as long as they can. They should use their normal loudness. Record their time in seconds
Have them repeat this 3 times. Their MPT is the longest of the 3 trials
You can compare their MPT with norms

2. Diadochokinetic Rate

Prompt the patient to say the following sounds as quickly and clearly as they can for 15 seconds each. They will repeat each 3 times.

“puh puh puh”

“tuh tuh tuh”

“kuh kuh kuh”

“puh tuh kuh”

You can compare their DDK rate with norms.

3. S/Z Ratio

Have the patient say ‘sss’ for as long as they can, recording their time in seconds
Have them repeat this 3 times. Note their longest trial
Next, have the patient say ‘zzz’ for as long as they can, recording their time in seconds
Repeat this 3 times, noting their longest trial
Divide their longest /s/ trial over their longest /z/ trial for their s/z ratio
You can compare their s/z ratio with norms

4. Habitual Pitch

_{Sample page from the Motor Speech & Voice Assessment}

Record your patient’s voice
Ask the patient to repeat after you (see sentences below)
Measure pitch using a device or software (digital orchestral tuner, Visipitch, pitch pipe, etc.)
- Modal pitch
- Lowest pitch
- Highest pitch
- Average pitch

“Does anyone know how many calories are in a bag of popcorn?”

“My mom meant well but made wrong turns while driving.”

5. Assess Voice Quality

For this portion of the assessment, record another voice sample. Transcribe the patient’s responses, as appropriate, and note your observations

Word list (either repetition or have the patient read a prepared list aloud)
Sentences: “Tell me about your speech. Tell me about your voice. What are your speech strengths? Weaknesses?”
Read paragraph: Ask the patient to read a paragraph aloud (i.e. Rainbow Passage)
Monologue: Ask the patient about their career, hobbies, family, etc. or to describe a visual scene (i.e. Cookie Theft Picture)

Voice Quality: What To Measure

Overall Severity: Your overall impression of the voice problem
Roughness: Vocal irregularity
Breathiness: Audible air escape in voice
Strain: Excessive vocal effort
Pitch: Deviance from a patient’s normal pitch, given their gender, age, and cultures
Loudness: Deviance from a patient’s normal loudness given their gender, age, and cultures. Including whether too soft or too loud
Additional Features: such as diplophonia, aphonia, pitch instability, tremor, vocal fry, falsetto, and wet/gurgly quality

Use ASHA’s Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) to measure voice quality.

6. Other Observations During Conversational Speech

Prosody
Speech rate (# words per minute during connected speech)
Breathing pattern (e.g., quick inhale, slow controlled exhale)
# of words in each breath
Pitch breaks
Aphonia
Phonatory onset of vowels
Glottal fry
Vocal tremor
Resonance
Intelligibility (% words understood)
Loudness (using a sound level meter)

Simple rating scale
0= very severely impaired
1= clearly impaired
2= slightly impaired or uncertain
3= within normal limits

7. Complete A Qualitative Questionnaire

The Communicative Effectiveness Index asks caregivers to rate their loved one’s communication effectiveness. Download the free PDF.

Getting caregiver feedback is especially helpful as people with Parkinson’s disease are often unaware of the extent of their communication (and other) issues.

Drooling Assessment for Parkinson’s Disease

The Radboud Oral Motor Inventory for Parkinson’s disease (ROMP) was developed specifically for Parkinson’s disease. The ROMP is a patient-rated assessment with a ‘Saliva’ subsection. Research has found it to be reliable and valid (Kalf, J. G. et al., 2011).

The ROMP is available for clinicians to use with their patients. You can access it in the Guidelines for Speech-Language Therapy in Parkinson’s Disease (scroll down the document to the Appendix).

Free! Parkinson’s Disease Assessment Forms & Tools

Complete Follow-Up Assessments (As Needed)

Complete a follow-up assessment if you notice red flags in your patient’s communication or cognition that impact their quality of life, independence, safety, and/or ability to communicate easily and effectively.

For example, if they struggle with word-finding or starting and maintaining a conversation, you may do a full cognitive-linguistic assessment during their first speech therapy session.

Use the Cognitive-Linguistic Assessment available in our shop.

For more assessment help, read The Complete Guide To Adult Speech Therapy Assessments.

Referrals

If your patient with Parkinson’s disease has issues outside of your scope of practice, take advantage of your talented healthcare team members!

Neurology: Progression of Parkinson’s disease, medication doesn’t seem to be working
Otolaryngology: If vocal fold pathology is suspected (not due to Parkinson’s disease)
Occupational therapy: Slow eating is due to upper extremity issues, needs help with ADLs
Physical therapy: Postural instability and weakness, wheelchair modifications
Neuro-ophthalmology: Visual problems related to the nervous system (not caused by the eyes themselves)
Hand therapy: Tendonitis caused by repetitive movements

Read When & Where To Refer Out Speech Therapy Patients for more ideas.

More Speech Therapy Resources

See The Starter Pack!

References

American Speech-Language-Hearing Association. (n.d.). Voice Evaluation Template. https://www.asha.org/siteassets/practice-portal/aatvoiceevaluation.pdf
Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
Goy, H., Fernandes, D.M., Pichora-Fuller, K., & van Lieshout, P. (2013). Normative Voice Data for Younger and Older Adults. Journal of Voice, 27(5), 545-555.
Kalf, J. G. et al. (2011). Guidelines for Speech-Language Therapy in Parkinson’s Disease. ParkinsonNet. Retrieved September 6, 2023, from https://www.parkinsonnet.nl/app/uploads/sites/3/2019/11/dutch_slp_guidelines-final.pdf
Maslan, J., Leng, X., Rees, C., Blalock, D., & Butler, S. G. (2011). Maximum phonation time in healthy older adults. Journal of voice : official journal of the Voice Foundation, 25(6), 709–713. https://doi.org/10.1016/j.jvoice.2010.10.002
Nascimento, D. et al. (2021). Drooling rating scales in Parkinson’s disease: A systematic review. Parkinsonism & Related Disorders, 91, 173-180. https://doi.org/10.1016/j.parkreldis.2021.09.012
Picheny, M. A., Durlach, N. I., & Braida, L. D. (1986). Speaking clearly for the hard of hearing. II: Acoustic characteristics of clear and conversational speech. Journal of speech and hearing research, 29(4), 434–446. https://doi.org/10.1044/jshr.2904.434
WEVOSYS Medical Technology. (2013). Voice Protocol norms. https://mmsp.com.au/mmsp/wp content/uploads/2019/08/lingWAVES_Voice_Protocol_Norms_2017_09_25.pdf

Featured on

Speech Therapy Assessments for Parkinson’s Disease