The Complete Guide to Adult Speech Therapy Assessments

Welcome to the complete guide to adult speech therapy assessments!

This guide lays out exactly what you should assess, based on your patient’s disorder. It covers how to assess swallowing, expressive and receptive language, cognition, visual neglect, motor speech, voice, apraxia, resonance, AAC, and fluency.

To make your life even easier, we link to every assessment, screening, and resource we recommend so that you don’t have to hunt them down.

We often reference our Speech Therapy Evaluation Pack. These are print-and-go templates we created to give you back your time—so you can focus on your patients instead.

* Fyi, we use ‘assessment’ and ‘evaluation’ interchangeably throughout this guide.

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Speech Therapy Evaluations for Adults

Table of Contents

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Handouts, worksheets, therapist treatment guides, evaluation templates, documentation guides, goal banks, references charts, and MUCH more.

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How to Complete a Case History

The case history is a brief overview of a patient’s relevant background information. You should gather a case history during every assessment. How thorough it needs to be will depend on your particular setting.

ASHA offers a free Demographics and History Form.

Your case history may include

  • Patient’s name, date of birth, and contact information
  • Age, gender, race/ethnicity
  • Medications
  • Allergies
  • Primary language and any secondary languages
  • Referring doctor
    • Contact information and reason for referral
  • Medical diagnoses
  • Communication/swallowing diagnoses

  • Speech-Language history
    • Include current/previous occupational therapy, physical therapy, other services

  • Patient’s concerns and goals for speech therapy

  • Relevant medical history
    • Heart disease, stroke, GERD, tracheostomy, etc.
    • Surgeries
    • Hearing (hearing aids?)
    • Vision (glasses/contacts?)
    • Dentition (dentures?)
    • Respiration
    • Assistive devices (wheelchair, walker, etc.)

  • Social History
    • Relationship status (married, long-term partner, etc.)
    • Children, caregivers
    • Living situation (where, with whom, etc.)

  • Education and Employment
    • Employed, unemployed, retired, occupation

Assessing Swallowing

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Worksheets, handouts, and therapist treatment guides

Jump to swallowing assessment.

Swallowing Assessments and Questionnaires

How to Assess Swallowing

A sample page from our Swallowing Evaluation Template

First, complete a case history.

  • Current diet

  • Personal Interview. Ask the patient about their swallowing. Ask about:
    • When their swallowing problems began
    • If and where they feel pain
    • If they have trouble eating certain foods
    • Recent weight gain or loss
    • If and where food feels stuck in their throat or mouth
    • Food/liquid avoidance
    • What they do that helps their swallowing.

  • Oral Mechanism Examination. A printable oral mechanism examination guide. Observe strength, range of motion, and symmetry of the following structures:
    • Mandible (CN V): at rest, open (pressure), close (pressure), lateralization, protrusion, retraction
    • Lips (CN VIII): at rest, protrusion, retraction, repetitive protrude/retract, puff cheeks, strength, sensitivity (CN IX)
    • Tongue (CN XIII): at rest, protrusion (strength), stick up (strength), stick down (strength), lateralization (strength), retraction (CN V, XII), strength, lick teeth, lick lips
    • Velum: at rest (CN IX), prolonged “ah” (CN X), repetitive “ah” (CN X)
    • Reflexes (CN IX, X): gag, faucial arches

  • Additional observations: dentition, oral mucosa, raise eyebrows (CN VII), dysarthria, breath support, vocal quality, resonance, volitional cough, volitional throat clearing, phonation time)

    PO Trials: Liquids and Solids.

    For each trial, measure and record the amount, cup/spoon/straw use, response, strategies, and duration. Printable guide.
  • Findings. Note any unusual findings or observations.
    • Liquids: labial closure, lingual function, oral transit time, residue, multiple swallows/piecemeal, anterior leakage swallow initiation, laryngeal elevation, coughing/throat clearing, wet vocal quality, respiration changes, fatigue
    • Solids: mastication, labial closure, lingual function, oral transit time, multiple swallows/piecemeal, anterior leakage, swallow initiation, laryngeal elevation, coughing/throat clearing, wet vocal quality, respiration changes, fatigue

  • Recommendations.
    • Diagnosis and severity
    • Treatment frequency/duration
    • Diet texture recommendations (liquids and solids)
    • Referrals
    • Prognosis

More Swallowing Resources


Assessing Expressive & Receptive Language

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Jump to the Expressive Language or Receptive Language assessment.

There are several formal batteries specific to aphasia. Many cognitive-linguistic evaluations also have sections that cover language expression, comprehension, reading, and writing.

Keep in mind that formal batteries tend to be more time-consuming and expensive than informal evals. Some settings require a formal battery and provide test kits and paper forms to their therapists—while others will expect you to find and print your own assessments.

Know your setting’s expectations and your patient’s needs and insurance constraints when choosing assessments.

Language Assessments and Questionnaires

Informal Cognitive-Linguistic Evaluations

Formal Batteries

How to Assess Expressive Language

Sample page from our Cognitive-Linguistic Evaluation

First, complete a case history.

  • Basic Orientation
    • What is your name?
    • What year is it?
    • What month is it?
    • What day of the week is it?
    • Where are you right now?
    • Why were you in the hospital? (or, Why did your doctor refer you for therapy?)
    • How long ago were you in the hospital? (or, when did you last see your doctor?)

  • Automatic Series. Record accuracy and incorrect responses.
    • Count from 1 to 10
    • Sing Happy Birthday
    • Say the days of the week
    • Say the months of the year

  • Confrontational Naming Task. Use a set of picture cards or point to different items around the room. Complete at least 10 trials. Record accuracy.

  • Object description and function. “What do you use (a) ____ for?
    • Towel
    • Money
    • Chair

  • Fluency. “Name as many items as you can in 1 minute from the following categories”
    • Animals
    • Stores
    • Clothing items

  • Apraxia Screening
    • “Smile”
    • “Pretend that you’re blowing out a candle”
    • “Pucker your lips like you’re about to whistle”
    • “Pretend that you’re brushing your teeth”
    • “Pretend that you’re combing your hair”
    • “Stick out your tongue”
  • “Repeat after me:”
    • act, action, activity
    • hip, hippo, hypocrite
    • miss, missile, Mississippi
    • happy, afford, pleasant
    • overcome, attraction, cucumber
    • refrigerator, metropolitan, practicality
    • grocery store, doctor office, vacation home
    • home of the brave
    • land of the free
    • United States of America
    • I pledge allegiance to the flag

  • Picture description. Print out a visual scene (e.g. the Cookie Theft picture) and ask the patient to describe it. “Make up a story about what you see in this picture.”

  • Responsive Naming. Record their responses.
    • yes and ___
    • up and ___
    • left and ___
    • before and ___
    • hot and ___
    • I bought a new set of table and ___
    • The mother cat birthed a litter of ___
    • The burger came with fries and a ___
    • I went to the store to buy some ___
    • Please pass the ___

  • Writing. Provide a writing surface and writing utensil. Give the following prompts. Record writing legibility, spelling, and word-finding accuracy.
    • Write your name
    • Write your address
    • Write a sentence about your family

More Expressive Language Resources

How to Assess Receptive Language

First, complete a case history.

  • Basic Orientation
    • What is your name?
    • What year is it?
    • What month is it?
    • What day of the week is it?
    • Where are you right now?
    • Why were you in the hospital? (or, Why did your doctor refer you for therapy?)
    • How long ago were you in the hospital? (or, when did you see last your doctor?)

  • Identify body parts. “Point to your…”
    • stomach, nose, ear, forehead, knee, toes

  • Identify objects by name. “Point to the…”
    • chair, window, floor, ceiling, TV, bed

  • Identify objects by function. Present the physical objects:
    • “Point to the one you eat with. The fork or the remote?”
    • “Point to the one you make calls on. The phone or the clock?”
    • “Point to the one that gives off light. The lamp or the book?”

  • Comprehension of conversation: Participate in a conversation with the patient. Ask them to speak in detail about likes/dislikes, hobbies, previous career, family, etc.

  • 1-step commands
    • “Touch your head”
    • “Give a thumbs up”
    • “Point to me”

  • 2-step commands
    • “Smile then point to the window”
    • “Blink twice the shrug your shoulders”
    • “Point to both knees, then raise your left hand”

  • 3-step commands
    • “Touch your stomach, make a fist, then say ‘ah'”
    • “Before you point to me, point to the chair and your nose”
    • “Clap your hands twice, shrug your shoulders, then raise both hands”

  • Simple Yes/No questions
    • “Are you sitting down?”
    • “Do you have socks on?
    • “Is it nighttime right now?”
    • “Do you live in California?”
    • “Are these floors carpeted?”

  • Moderate Yes/No questions
    • “Does spring come before summer?”
    • “Does Friday come after Tuesday?”
    • “Is the chair bigger than this pen?”
    • “Are there 6 days in each week?”
    • “Do two dimes equal a quarter?”
    • “Do you swallow before you take a sip?”

  • Auditory paragraph comprehension. Read a simple paragraph to your patient and ask yes/no questions.

    For example: “I am going to read a paragraph then ask you some questions about it. Please answer each question with ‘yes’ or ‘no’.”

    Example: Daniel was very tired after a long day working at the hospital. He couldn’t wait to get home and sleep. However, it was so late that none of the buses were still running. He decided to catch a taxi and was home before midnight.

  • Reading Comprehension
    • Letter identification
    • Word identification
    • Phrase comprehension
    • Short paragraph comprehension
    • Paragraph comprehension

More Receptive Language Resources


Assessing Cognition

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Handouts, worksheets, and therapist treatment guides

Jump to the Cognition Assessment.

You have many options for assessing cognition. In addition to formal batteries, there are quite a few free, standardized cognitive screens and assessments to choose from.

Consider what’s best for you, your patient, and your specific setting when deciding whether to invest the time and money required to complete a formal battery. Consider using screens, parts of formal cognitive evaluations, and/or informal cognitive-linguistic evaluations.

Know your setting’s expectations and your patient’s needs and insurance constraints when choosing assessments.

Cognitive Assessments and Screens

Cognitive Screens

Formal Batteries

How to Assess Cognition

Sample page from our Cognitive-Linguistic Evaluation

First, complete a case history.

  • Basic Orientation
    • What is your name?
    • What year is it?
    • What month is it?
    • What day of the week is it?
    • Where are you right now?
    • Why were you in the hospital? (or, Why did your doctor refer you for therapy?)
    • How long ago were you in the hospital? (or, when did you last see your doctor?)

  • Long-term memory
    • Where were you born?
    • What is your address?
    • What is your phone number?
    • How old are you?
    • When is your birthday?
    • What is/was your occupation?
    • Who is the president of the United States?
    • Why were you in the hospital?
    • What symptoms are you experiencing?
    • What are your goals for therapy?

  • Short-term memory. “Repeat after me…”
    • 8 5 2
    • 9 8 1 1 0
    • 979-3214
    • hat, socks, necklace
    • flower, bucket, train
    • soap, towel, lotion, toothpaste
    • radio, bread, bank, infant

  • Delayed recall. “Remember these words a few minutes from now…”
    • radio, bread, bank, infant

  • Paragraph level recall. “I am going to read you a story/paragraph, then I will ask you some questions about what I just read”.

  • Delayed recall. “What were the words I asked you to remember a few minutes ago?”
    • radio, bread, bank, infant

  • Attention
    • Count backward from 100
    • Start at one and count by threes: 1, 4, 7, 10, 13, 16, 19, 22, 25, 28, 31
    • Start at 70 and subtract by threes: 70, 67, 64, 61, 58, 55, 52, 49, 46, 43, 40

Organization and sequencing

  • “What category do these items belong to?”
    • red, orange, purple, blue
    • van, car, truck, train
    • pig, cow, horse, cat
  • “How are these items the same and how are they different?”
    • piano and guitar
    • necklace and scarf
    • chair and sofa
  • “What are the steps to…”
    • brushing your teeth
    • doing the laundry
    • making a sandwich
  • “Put these words into some kind of order…Why did you put them in that order?”
    • country, state, city, continent
    • grandson, father, grandfather, son
    • large, small, extra-small, medium

  • Problem-solving for safety
    • What number do you call if you have an emergency?
    • What would you do if you forgot to take your morning medications?
    • What would you do if you were running low on groceries?

  • Mathematical reasoning
    • Your friend’s birthday is one week away. You guy her a gift and pay extra for 3-day shipping. How many days before her birthday does her gift arrive?

      Find more examples in our print-and-go evaluation template

  • Inferencing
    • The floor sways under you, but you keep a firm grip on your seat. It’s windy, and water splashes on your face as you check the net. Where are you?

  • Medication label comprehension and simple math

  • Assess for visual neglect, if appropriate. Jump to our visual neglect assessment guide.

More Cognition Resources


Assessing Visual Neglect

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The Catherine Bergego Scale (below) is well-regarded for detecting even mild visual neglect. Beyond that, there are some cognitive screens and formal batteries that have a visuospatial component.

Consider what’s best for you, your patient, and your specific setting when deciding whether to invest the time and money required to complete a formal battery. Consider using screens, parts of formal cognitive evaluations, and/or informal cognitive-linguistic evaluations.

Know your setting’s expectations and your patient’s needs and insurance constraints when choosing assessments.

Visual Neglect Assessments

Functional Scales and Cognitive Screens

  • The Catherine Bergego Scale (CBS) is sensitive enough to detect mild visual neglect. Here’s the PDF and a supporting article.
  • The MoCA, MMSE, and SLUMS have visuospatial sections
  • Informal evaluations often include cancellations tasks, reading aloud, scanning a picture, reading clocks, and copying written information

Formal Batteries

More Visual Neglect Resources


Assessing Motor Speech

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Jump to the motor speech assessment.

A motor speech assessment consist of a case history, oral mechanism examination, connected speech and reading sample, assessment of diadochokinetic rate, repetition of words and phrases, naming, picture description, and tests for limb and oral apraxia.

Motor Speech Assessments

Informal Assessments

Formal Batteries

How to Assess Motor Speech

Sample page from our Evaluation Pack

First, complete a case history.

  • Oral Mechanism Examination. Observe strength, range of motion, and symmetry
    • Mandible (CN V): at rest, open (pressure), close (pressure), lateralization, protrusion, retraction
    • Lips (CN VII): at rest, protrusion, retraction, repetitive protrude/retract, puff cheeks, strength, sensitivity (CN IX)
    • Tongue (CN XII): at rest, protrusion (strength), stick up (strength), stick down (strength), lateralization (strength), retraction (CN V, XII), strength, lick teeth, lick lips
    • Velum: at rest (CN IX), prolonged “ah” (CN X), repetitive “ah” (CN X)
    • Reflexes (CN IX, X): gag, faucial arches

  • Diadochokinetic Rate (Complete three trials of each of the following): “puh puh puh” (CN VII), “kuh kuh kuh” (CN XII), “tuh tuh tuh (CN XII), “puh tuh kuh”

  • Additional observations: dentition, oral mucosa, raise eyebrows (CN VII), dysarthria, breath support, vocal quality, resonance, volitional cough, volitional throat clearing, phonation time)

  • Connected speech and reading sample: Have the patient read the Rainbow Passage.

  • Repetition of Words. “Repeat after me…”
    • act, action, activity
    • hip, hippo, hypocrite
    • miss, missile, Mississippi

  • Repetition of Phrases

  • Picture Naming.
    Present 10 pictures to the patient (download our photo-naming list). “What is this? Please repeat what you just said two more times.”

    Record latency time, naming accuracy, and phonetically transcribe responses as needed.
  • Picture description

  • Test for Limb and oral apraxia
    • “Smile”
    • “Pretend that you’re blowing out a candle”
    • “Pucker your lips like you’re about to whistle”
    • “Pretend that you’re brushing your teeth”
    • Pretend that you’re combing your hair”
    • “Stick out your tongue”
    • “Blow a kiss”
    • “Give me a thumbs up”
    • “Snap your fingers”

  • Complete the Communicative Effectiveness Survey. The patient rates their own communication effectiveness in different situations.

More Motor Speech Resources


Assessing Apraxia

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Hundreds of worksheets, handouts, and therapist treatment guides

Jump to Apraxia Assessment.

Apraxia evaluations consist of a case history, connected speech and reading sample, assessment of diadochokinetic rate, repetition of words and phrases, naming, picture description, and tests for limb and oral apraxia.

Apraxia Assessments

Informal Assessments

Formal Batteries

How to Assess Apraxia

First, complete a case history.

  • Diadochokinetic Rate (Complete three trials of each of the following): “puh puh puh” (CN VII), “kuh kuh kuh” (CN XII), “tuh tuh tuh (CN XII), “puh tuh kuh”

  • Repetition of Words. “Repeat after me…”
    • act, action, activity
    • hip, hippo, hypocrite
    • miss, missile, Mississippi

  • Repetition of Phrases

  • Limb and oral apraxia
    • “Smile”
    • “Pretend that you’re blowing out a candle”
    • “Pucker your lips like you’re about to whistle”
    • “Pretend that you’re brushing your teeth”
    • Pretend that you’re combing your hair”
    • “Stick out your tongue”
    • “Blow a kiss”
    • “Give me a thumbs up”
    • “Snap your fingers”

  • Picture Naming.
    Present 10 pictures to the patient (download our photo-naming list). “What is this? Please repeat what you just said two more times.”

    Record latency time, naming accuracy, and phonetically transcribe responses as needed.

  • Note any speech errors and your observations during the following tasks:

More Apraxia Resources


Assessing Voice

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Worksheets, handouts, and therapist treatment guides.

Jump to Voice Assessment.

To assess voice, complete an oral mechanism evaluation and collect a connected speech sample and reading sample. Measure vocal quality. Complete an acoustic analysis.

Informal Assessments

How to Assess Voice

First, complete a case history.

  • Oral Motor Evaluation. Observe strength, range of motion, and symmetry
    • Mandible (CN V): at rest, open (pressure), close (pressure), lateralization, protrusion, retraction
    • Lips (CN VII): at rest, protrusion, retraction, repetitive protrude/retract, puff cheeks, strength, sensitivity (CN IX)
    • Tongue (CN XII): at rest, protrusion (strength), stick up (strength), stick down (strength), lateralization (strength), retraction (CN V, XII), strength, lick teeth, lick lips
    • Velum: at rest (CN IX), prolonged “ah” (CN X), repetitive “ah” (CN X)
    • Reflexes (CN IX, X): gag, faucial arches
      
  • Diadochokinetic Rate (Complete three trials of each of the following): “puh puh puh” (CN VII), “kuh kuh kuh” (CN XII), “tuh tuh tuh (CN XII), “puh tuh kuh”
    
  • Additional observations: dentition, oral mucosa, raise eyebrows (CN VII), dysarthria, breath support, vocal quality, resonance, volitional cough, volitional throat clearing, phonation time)

Record the patient speaking

Obtain signed permission, as appropriate—check with your setting to understand the rules regarding voice recording.

  • Provide the following prompts. Write down your observations.
    • “Tell me about your speech. Tell me about your speech concerns.”
    • “What are your speech strengths? Weaknesses?”

  • Measure vocal quality during picture descriptions. In general, is the vocal quality breathy, harsh, hoarse, etc?

  • Connected speech sample. Have the patient read the Rainbow Passage:
The Rainbow Passage (pdf download)

When the sunlight strikes raindrops in the air, they act as a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People look, but no one ever finds it. When a man looks for something beyond his reach, his friends say he is looking for the pot of gold at the end of the rainbow. Throughout the centuries people have explained the rainbow in various ways. Some have accepted it as a miracle without physical explanation. To the Hebrews it was a token that there would be no more universal floods. The Greeks used to imagine that it was a sign from the gods to foretell war or heavy rain. The Norsemen considered the rainbow as a bridge over which the gods passed from earth to their home in the sky. Others have tried to explain the phenomenon physically. Aristotle thought that the rainbow was caused by reflection of the sun’s rays by the rain. Since then physicists have found that it is not reflection, but refraction by the raindrops which causes the rainbows. Many complicated ideas about the rainbow have been formed. The difference in the rainbow depends considerably upon the size of the drops, and the width of the colored band increases as the size of the drops increases. The actual primary rainbow observed is said to be the effect of superimposition of a number of bows. If the red of the second bow falls upon the green of the first, the result is to give a bow with an abnormally wide yellow band, since red and green light when mixed form yellow. This is a very common type of bow, one showing mainly red and yellow, with little or no green or blue.

  • 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)

  • Shimmer, jitter, and noise to harmonic ratio.


    Record pitch in Hertz and analyze voice using the free Praat software available online (acoustic analysis).
    • “Say ‘eee’ for four seconds using your typical pitch and loudness. Repeat fifteen times.”

  • Habitual pitch. Use a digital orchestra tuner, Visipitch, pitch pipe, or a pitch app on your phone to determine pitch. Document modal pitch, lowest pitch, highest pitch, and average modal pitch. “Repeat after me”
    • “Does anyone know how many calories are in a bag of popcorn?”
    • “My mom meant well, but made wrong turns while driving.”

  • S/Z Ratio. Record number of seconds. s/z ratio = (longest s )/ (longest z), Complete 3 trials:
    • “Say ‘sss’ for as long as your can
    • “Say ‘zzz’ for as long as your can

  • Complete the Communicative Effectiveness Survey. The patient rates their own communication effectiveness in different situations.

More Voice Resources


Assessing Resonance

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Worksheets, handouts, and therapist treatment guides.

Jump to Resonance Assessment.

Assess resonance with nasal-loaded sentences, nose pinch while reading non-nasal sentences, and the modified tongue anchor test. Complete an aerodynamic assessment, including maximum phonation time, subglottal pressure, and airflow. Include an oral mechanism evaluation and measure diadochokinetic rate.

Informal Assessments

How to Assess Resonance

  • Oral Motor Evaluation. Observe strength, range of motion, and symmetry
    • Mandible (CN V): at rest, open (pressure), close (pressure), lateralization, protrusion, retraction
    • Lips (CN VII): at rest, protrusion, retraction, repetitive protrude/retract, puff cheeks, strength, sensitivity (CN IX)
    • Tongue (CN XII): at rest, protrusion (strength), stick up (strength), stick down (strength), lateralization (strength), retraction (CN V, XII), strength, lick teeth, lick lips
    • Velum: at rest (CN IX), prolonged “ah” (CN X), repetitive “ah” (CN X)
    • Reflexes (CN IX, X): gag, faucial arches

  • Diadochokinetic Rate (Complete three trials of each of the following): “puh puh puh” (CN VII), “kuh kuh kuh” (CN XII), “tuh tuh tuh (CN XII), “puh tuh kuh”

  • Additional observations: dentition, oral mucosa, raise eyebrows (CN VII), dysarthria, breath support, vocal quality, resonance, volitional cough, volitional throat clearing, phonation time)

  • Hypernasality. If the patient has hypernasality, you will hear nasal sounds in their repetitions. “Repeat after me…”

    • ooo
    • eee
    • sss
    • shh
    • Papa Bear blows bubbles.
    • Give Gary a gift of cookies and cookie.
    • Please pay in part for Bob’s burger.

  • Nose pinch. If the patient has hypernasality, you will hear a change in their productions whenever you pinch their nose while phonating.

    “Repeat after me again, but this time I am going to pinch your nose while you speak.”

    • ooo
    • eee
    • sss
    • shh
    • Papa Bear blows bubbles.
    • Give Gary a gift of cookies and coffee.
    • Please pay in part for Bob’s burger.

  • Hyponasality. If the patient is hyponasal, then the nasal consonants will sound non-nasal. “Repeat after me…”

    • May my mom come in?
    • Nina’s new Nikes never came.
    • The mooing in the morning.

  • Nasal air emission. Place a tissue or dental mirror under the patient’s nose. If the patient has emissions, the tissue will move or the dental mirror will fog up. “Repeat after me.”

    • Peppy puppies play ball.
    • People go buy groceries.
    • Curiosity killed the cat.

  • Modified tongue anchor test. Press cheeks lightly. Cheeks will remain puffed given normal velopharyngeal functioning. “Stick your tongue out, then puff out your cheeks around your tongue.”

    * Refer to an otolaryngologist as needed to assess and treat any underlying structural issues.

More Voice Resources


Assessing AAC

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Handouts, templates, and therapist treatment guides.

Choose assessments based on your patient’s disorder or disease.

You may assess language, cognition, motor speech, vision, hearing, and/or overall physical functioning (e.g., ability to write or type on a keyboard). Refer out to specialists as needed.

Basics of an AAC assessment.

  • Complete a case history and support system interview
  • Determine speech rate, intelligibility, language expression and comprehension, and motor abilities
  • Trial AAC devices
  • Identify the patient’s support system (these people often become the AAC facilitators)
  • Identify what vocabulary needs to be added to the device based on the patient’s current needs
  • Add and organize messages on the device and train facilitators
  • Train the patient in other modalities (e.g. eye gaze)

Evaluations by Diagnosis

  • For patients with ALS and Parkinson’s Disease, start with a motor speech evaluation
  • For patients with aphasia, start with a language evaluation
  • Other patients requiring AAC may have long-term intubation, myasthenia gravis, head and neck cancer, Guillain-Barre syndrome, etc. Select the most appropriate assessment for each patient.

More AAC Resources


Assessing Fluency

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Handouts, treatment activities, and therapist treatment guides

Jump to Fluency Assessment

Collect a case history, conversational speech sample, reading sample, and five-minute monologue. Complete a molecular analysis using the five-minute monologue speech sample to determine percent of stuttering dysfluencies versus percent normal dysfluencies. Consider using the norm-referenced assessment and the scale below.

Questionnaire and Informal Assessments

Norm-Referenced Evaluation

How to Assess Fluency

First, start with a case history.

Record the patient speaking

Obtain signed permission, as appropriate—check with your setting to understand the rules regarding voice recording.

  • Conversational speech sample. Converse with your patient. This includes rapport-building time, small talk, discussing recent events, etc.

  • Reading sample. Ask them to read the Rainbow Passage aloud.

  • Interview questions
    • When did your stutter begin?
    • Did it come suddenly or gradually?
    • Has it gotten better/worse/stayed the same?
    • Do you have family members who stutter?
    • Is there anything you do that makes your stutter get better/go away?
    • What physical sensations warn you that you’re about to stutter?
    • In what situations/settings do you stutter more/less?
    • How do people react to your stutter?
    • What are your goals for therapy?

  • Objective data. Use a norm-referenced evaluation such as the Stuttering Severity Instrument.

  • Subjective data. Complete a questionnaire, such as the Locus of Control of Behavior (page 28), to assess the patient’s attitudes and feelings about their stutter.

Collect a five-minute monologue sample. Use a dysfluency grid or molecular analysis (described below) to determine the frequency of each type of dysfluency.

Five-minute monologue. Ask your patient about something they specialize in or are passionate about, such as a career, hobby, or what the grandkids are up to.

  • Option 1: Monologue Dysfluency Grid. Take the middle 300 words from the monologue. Input dysfluent words into a 300-word grid. If the word is fluent, leave that box blank. But if the word is dysfluent, record what type of dysfluency occurred.

Example: During a 20-word sample, only the 5th, 10th, and 12th words were dysfluent. The grid will look like this:

  • Option 2: Molecular Analysis. Count the number of dysfluencies that occur in every 100 meaningful words.

Sample page from our print-and-go Fluency Evaluation.

Percent of stuttering dysfluencies (SD) = total # of SD/# of meaningful words spoken during sample

Percent of normal dysfluencies (ND) = total # of ND/# of meaningful words spoken during sample

More Fluency Resources

More Resources

Complete Digital Adult Speech Therapy Workbook 9 PDF Packs image 7

Complete Digital Workbook
Printable worksheets, handouts, and therapist treatment guides

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