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, resonance, AAC, and fluency.

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

To save even more time, check out our bestselling Adult Speech Therapy Starter Pack!

Popular Articles

• Speech Therapy Goal Bank
• How to Write An Evaluation Report
• Voice Therapy Exercises

Assessing Swallowing

Swallowing Assessments

1. Clinical Swallowing Exam Template (ASHA)
   
   
2. The Adult Speech Therapy Evaluation Pack
   
   
3. Mann Assessment of Swallowing Ability (MASA). A useful tool for quantifying information collected during a bedside swallowing evaluation. MASA scoring sheet.
   
   
4. Yale Swallow Protocol. A standardized swallowing screen that includes the 3-ounce water test.
   • See our article Yale Swallow Protocol for a free PDF template.
   • Yale Swallow Protocol book or ebook
     
     
5. Eating Assessment Tool (EAT-10). A patient-reported outcome with excellent consistency and validity.
   • ASHA EAT-10 assessment PDF
   • Read our article for more details
     
     
6. Instrumental Evaluations. Many patients will benefit from completing at least one instrumental evaluation. The results can help you choose the best goals, exercises, and strategies for your patients.
   • Modified Barium Swallow Study
   • Flexible Endoscopic Evaluation of Swallowing (Endoscopy)

How to Assess Swallowing

A sample page from The Adult Speech Therapy Evaluation Pack

• 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: at rest, open (pressure), close (pressure), lateralization, protrusion, retraction
  • Lips: at rest, protrusion, retraction, repetitive protrude/retract, puff cheeks, strength, sensitivity
  • Tongue: at rest, protrusion (strength), stick up (strength), stick down (strength), lateralization (strength), retraction, lick teeth, lick lips
  • Velum: at rest, prolonged “ah” (CN X), repetitive “ah”
  • Reflexes: gag, faucial arches
    
    
• Additional observations: dentition, oral mucosa, raise eyebrows, 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, vocal quality, respiration changes, fatigue
  • Solids: mastication, labial closure, lingual function, oral transit time, residue, multiple swallows/piecemeal, anterior leakage, swallow initiation, laryngeal elevation, coughing/throat clearing, vocal quality, respiration changes, fatigue
    
    
• Recommendations.
  • Diagnosis and severity
  • Treatment frequency/duration
  • Diet texture recommendations (liquids and solids)
  • Referrals
  • Prognosis
    

More Swallowing Resources

• Dysphagia Treatment Options
• Laryngeal Palpation of a Swallow
• Oral Mechanism Examination

Assessing Expressive & Receptive Language

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

Informal Cognitive-Linguistic Evaluations

• Adult Language/Cognitive-Communication Evaluation Template (ASHA)
• The Adult Speech Therapy Evaluation Pack

Formal Batteries

• Assessment of Language-Related Functional Activities
• Western Aphasia Battery
• Boston Diagnostic Aphasia Examination

How to Assess Expressive Language

Sample page from The Adult Speech Therapy Evaluation Pack

• First, complete a case history
  
  
• 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.
  
  
• 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 ___
    
    
• 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
  • Minnie and Mickey Mouse
  • What a beautiful day
  • I would like some water
    
• 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.”
  
  
• 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

• 55 Aphasia Treatment Activities
• 23 Expressive Language and Writing Tasks
• Aphasia Treatment Approaches: A step-by-step guide

How to Assess Receptive Language

• First, complete a case history
  
  
• 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?”‘
    f
    
• Simple Yes/No questions“Are you sitting down?”
  • “Do you have socks on?
  • “Is it nighttime right now?”
  • “Do you live in California?”
  • “Are the floors carpeted?”
    
    
• 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”
    
    
• 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.
  
  
  • Was Daniel leaving work?
  • Did he miss his bus?
  • Was he home before midnight?
  • Was he going to work?
    
    
• Comprehension of conversation: Participate in a conversation with the patient. Ask them to speak in detail about likes/dislikes, hobbies, previous career, family, etc.
  
  
• Reading Comprehension
  • Letter identification
  • Word identification
  • Phrase comprehension
  • Short paragraph comprehension
  • Paragraph comprehension
    

More Receptive Language Resources

• 55 Aphasia Treatment Activities
• 14 Receptive Language Activities

Assessing Cognition

Handouts, worksheets, and therapist treatment guides

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

Cognitive Screens

• The Adult Speech Therapy Evaluation Pack
• Montreal Cognitive Assessment (MoCA). PDF download, an article with scoring instructions, and the MoCA test page
• Mini-Mental State Examination (MMSE)
• Addenbrooke’s Cognitive Examination (ACE). The University of Sydney offers many translations of the ACE—plus options for those who are hard of hearing.
• Mini-Cog. Their site includes administering and scoring instructions.
• Saint Louis University Mental Status (SLUMS). SLUMS training video below:

Formal Batteries

• Memory: Ross Information Processing Assessment. There is also a geriatric version for patients aged 55 years+
• Delis-Kaplan Executive Function Systems
• Parts of the Wechsler Adult Intelligence Scale
• Rey-Osterrieth Complex Figure Test
• Dysexecutive Questionnaire (DEX). The DEX is packaged with a formal battery called the BADS—but you can purchase the DEX forms separately.

How to Assess Cognition

Sample page from The Adult Speech Therapy Evaluation Pack

• 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?
    
    
• 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

More Cognition Resources

• The Adult Speech Therapy Starter Pack
• How to Make a Memory Book
• Cognitive Speech Therapy Activities

Assessing Visual Neglect

The Catherine Bergego Scale and Albert’s Test (below) are 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.
• Albert’s Test is an quick, effective screen
• 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

• Parts of the Test of Everyday Attention
• Parts of the Delis-Kaplan Executive Function Systems
• Parts of the Wechsler Adult Intelligence Scale

More Visual Neglect Resources

• How to Treat Visual Neglect
• 2 Quick Visual Neglect Screens

Assessing Motor Speech

A motor speech assessment consists 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

• The Adult Speech Therapy Evaluation Pack
• Word Intelligibility Test. Scroll down to pages 11-12 and 18-19 for the lists

Formal Batteries

• Assessment of Intelligibility in Dysarthric Speech
• Apraxia Battery for Adults

See Apraxia Assessments below for more

How to Assess Motor Speech

Sample from The Adult Speech Therapy 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 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.

Informal Assessments

• The Adult Speech Therapy Evaluation Pack
• Measure Vocal Quality: Consensus Auditory-Perceptual Evaluation of Voice (ASHA)
• Acoustic Analysis: Free Praat software
• Communicative Effectiveness Survey. The patient rates their own communication effectiveness

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.

• 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:

Assessing Fluency

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.

Fluency Assessments

Questionnaire and Informal Assessments

• Locus of Control Behaviour Scale (see page 28)
• Adult Speech Therapy Evaluation Pack

Norm-Referenced Evaluation

• Stuttering severity instrument

How to Assess Fluency

First, start with a case history.

RECORD THE PATIENT SPEAKING

Obtain signed permission, as appropriate.

• 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 The Adult Speech Therapy Evaluation Pack

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

• The Adult Speech Therapy Starter Pack
• Stuttering Therapy Activities for Adults

List of Speech and Language Assessments

Here’s a list of adult speech and language assessments.

Swallowing

• ASHA’s Clinical Swallowing Exam Template
• Adult Speech Therapy Evaluation Pack
• Mann Assessment of Swallowing Ability (MASA)
• Yale Swallow Protocol
• Eating Assessment Tool (EAT-10)
• Videoflouroscopic Swallowing Study/Modified Barium Swallow Study
• Endoscopic Evaluation of Swallowing

Cognitive-Linguistic

• ASHA’s Adult Language/Cognitive-Communication Evaluation Template
• Adult Speech Therapy Evaluation Pack
• Assessment of Language-Related Functional Activitives
• Western Aphasia Battery
• Boston Diagnostic Aphasia Examination

Cognition

• Montreal Cognitive Assessment (MoCA)
• Mini-Mental State Examination (MMSE)
• Addenbrooke’s Cognitive Examination (ACE)
• Mini-Cog
• Saint Louis University Mental Status (SLUMS)
• Ross Information Processing Assessment
• Delis-Kaplan Executive Function Systems
• Parts of the Wechsler Adult Intelligence Scale
• Rey-Osterrieth Complex Figure Test
• Dysexecutive Questionnaire (DEX)

Visual Neglect

• The Catherine Bergego Scale (CBS)
• Albert’s Test
• The MoCA, MMSE, and SLUMS have visuospatial sections
• Parts of the Test of Everyday Attention
• Parts of the Delis-Kaplan Executive Function System
• Parts of the Wechsler Adult Intelligence Scale

Motor Speech

• Adult Speech Therapy Evaluation Pack
• Word Intelligibility Test
• Assessment of Intelligibility in Dysarthric Speech
• Apraxia Battery for Adults
• Apraxia of Speech Rating Scale (ASRS)
• Differential Diagnosis Chart

Voice & Resonance

• Adult Speech Therapy Evaluation Pack
• Consensus Auditory-Perceptual Evaluation of Voice (ASHA)
• Acoustic Analysis: Free Praat software
• Communicative Effectiveness Survey

Fluency

• Locus of Control Behaviour Scale
• Adult Speech Therapy Evaluation Pack
• Stuttering severity instrument

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