FRENCHAY DYSARTHRIA ASSESMENT

PAMELA M ENDERBY

INTRODUCTION

The term dysarthria is used to describe speech abnormalities caused by

neuromuscular disorders. While dysarthria is the most commonly acquired
speech disorder, little progress in its clinical management has been achieved.
Despite the sophisticated technological methods of assessing neuromotor
activity, no clinical tool that can be replicated in the treatment setting has been
advanced. The Dysarthria Assessment developed at Frenchay Hospital is a
standardized test that can be used by speech pathologists to categorically
diagnose dysarthria. More than 200 speech therapists have administered this
test to over 600 patients. Its validity in diagnosis and reliability in administration
is presented in this manual.

The protocol required for a test of dysarthria includes:

The test results should be easily applicable to therapy. Dysarthria often presents
speech that is perceptually confusing to the speech therapist. It is essential,
therefore, that the areas of speech that are unaffected as well as those that are
affected are described in relationship to each other so an appropriate treatment
plan can be devised.

The test results should be sensitive to change.

To determine the relevance of a treatment procedure and its impact on a
Disorder, it is desirable to be able to record changes in the pattern of speech
behaviour. Even though recorded samples are of great assistance, audio tapes
have serious limitations in interpreting dysarthric speech.

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The test should be efficient and easy to use.
It is essential that a test format be so clear and practical that the therapists will
not be tempted to change the procedures to reduce the time to administer the
test. Additionally, a test of dysarthria must take into consideration those patients
who have poor stamina.

The test should be standardized.

A standardized administration of any test ensures certain strengths. These
include test-retest and intra/inter-judge reliabilities. In addition, the standardized
test can be used to acquire normative data and data ascribed to specific
abnormal groups for comparison. This enables diagnosticians to describe and
compare patients, and conduct clinical studies with greater specificity. Although
there may be other dysarthria assessment methods available, these would best
be described as clinical checklists because of the lack of standardization, which
limits their value.

Training should be minimal to achieve high reliability. Special attention should be

given to the test procedure and the scoring system to ensure that training
required for a speech pathologist to use this assessment is minimal or does not
detract from its universal appeal. If lengthy, expensive training is needed to use a
test, there may be a basic design fault with the test. This can cause trainees to
loose their reliability in the administration and scoring of the test.

The test results should be easy to communicate.

The results of an assessment should be presented in a manner inclusive of other
professions, especially if the speech pathologist is a part of a clinical team.
Furthermore, the patients of dysarthric symptomatology can be of assistance in
identifying or confirming a medical diagnosis.

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 SPEECH CHARACTERISTICS ASSOCIATED WITH NEUROLOGICAL
ETIOLOGY

Specific dysarthria types such as upper motor neuron, mixed upper and lower
motor neuron, and extra pyramidal lesions may be clearly distinguished on the
basis of mean and standard deviation values associated with each group. The
mean scores can be misleading; however, therefore, careful examination of the
standard deviations is necessary to understand the characteristics of each group.

Group 1 – Upper Neuron Lesions, 30 patients

The striking characteristics of this group can be seen in fig.7. It appears that
these patients have more problems with swallowing and dribbling/drooling than
the other groups. The progressive reduction of mean scores within each section
along the horizontal axis indicates the items that require non-speech oral motor
movements are superior to those involving motor movements in speech. This is
further reflected by the very low speech rate (mean=4.73), in addition to low
intelligibility. Further examination of fig.7 shows disability affecting all areas
similarly except the appearance of the musculature at rest , in which a more
normal mean score in Respiration (1) , Jaw(1) , Palate (1) and Tongue(1) is
achieved. The severity of the dysarthria of these 30 patients as represented by
means and standard deviation is more than two on the 9-point scale for the
majority of items.

Group 2- Mixed Upper and Lower Motor Neuron Lesions, 13 Patients

There is great disparity of scores as represented by the mean and standard
deviation of this group shown in fig.8. The highest mean score is for palatal

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movement in swallowing and sensory testing (7.30). The lowest mean scores are
for all the laryngeal and tongue tasks (2.46 to 3.23). The means for these
sections and the latter three coordinated Lip tasks are significantly lower than
found in any of the other groups. The standard deviations for all sections are
smaller than those seen for group 1.

Group 3- Extra pyramidal Disorder, 18 Patients

The means and standard deviations for this group shown in fig.9 have similarities
to Group1 (fig 7). Generally in Group 3 the mean scores are higher for nonspeech
functions when compared with the speech function. This is specialy true for the
Lips, Jaw, Palate and Tongue. The mean scores and the variable standard
deviations in each subtest indicate the heterogeneity of this group when
compared to the previous groups.

Group 4- Lower Motor Neuron, 10 Patients

The striking feature of this group of dysarthric patients showed in fig 11is the
normality of the respiration and rate sections. Intelligibility is less severely
affected in this group compared with the previous four groups. None of these
patients exhibited velopharyngeal insufficiency in drinking, nor did they report
such dysfunction when eating. The individual cases in this group demonstrate
isolated areas of involvement, depending on the lower motor neuron involved. For
example, one patient with left facial lesion scored well on all tasks except those
in section 3 (lips). Similarly, a patient with a right hypoglossal nerve lesion
showed marked reduction in ability on section 7 (Tongue)

This group presented a few problems with regard to analysis. First,

no patient with polyneuropathy was induced. Second, the group was
heterogeneous etiologically, which resulted in less meaningful means and
standard deviations for diagnostic purposes. However, the pattern of each of

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these patients shows the particular characteristic of greatly reduced scores in
specific areas, with good compensation in other areas.

TEST EQUIPMENT

1. Test manual
2. Scoring graph
3. Tongue depressor
4. Stop watch
5. Tape recorder
6. Glass of water
7. Word cards

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ADMINISTRATION

The test is divided into 8 major sections: Reflex, Respiration, Lips, Jaw, Palate,
Laryngeal, Tongue, Intelligibility, and Influencing factors of learning, Sight, Teeth,
Language, Mood, and Posture, plus Rate and Sensation. Major sections contain
subtests. It is suggested that each section be tested in order on the graph, but
this is not essential. Test each subtest within the section in the order outlined.
Follow procedure and identify which grade best describes the patient’s behavior.
Familiarity with the test makes it possible to conduct the assessment in a
relaxed interview manner.

The definitions of some grades include several different behaviors. It is not

necessary that the patient exhibit all behaviors to achieve that grade. For
example, “Has difficulty with choking, or food sometimes going down the wrong
way- states some care must be taken”. A patient complaining of taking longer to
eat because of fear of coughing, although the patient does not cough, would be
scored on this grade, as would a patient who occasionally chokes but is unaware
or who does not pay heed to this problem.

If the patient’s behavior does not precisely fit into a grade, you may score on the

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“in between” lines in the direction that indicates the degree of difficulty. For
example, if the patient’s behavior on an item is slightly worse than one grade, but
slightly better than the grade below, mark the line between these two grades.

The test requires that the therapist analyze the behavior of each component in
isolation to examine relative abilities and disabilities. As speech is essentially a
unitary system and impairment of one aspect often influences the behavior of
another, this can be difficult for the assessor to remember. However, the tester
must endeavor to be single-minded and concentrate on each area separately,
trying not to be confused by abnormalities in other areas. Adherence to the test
procedure will facilitate concentration.

Please note that the tester should ascribe a score based on the behavior
demonstrated on the second attempt of the specified tasks. The tester should
not be influenced by the first attempt, which always for practice purposes, and if
the patient wishes to attempt the task a third time, this should not be used for
scoring purposes.

Once the score has been determined, use a ball point pen to draw a bold line on
top of the printed one in that position on the graph. Matching on the graph need
not be completed until the assessment is finished (see fig 12).

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 I. REFLEX

Section1. Reflex

Ask the patient, relative, or staff (as appropriate and wherever possible) to
observe to gauge whether there is difficulty or a degree of difficulty with the
cough reflex, swallowing, dribbling/drooling.

Cough

Suggested Questions:
1. Do you cough or choke when you are eating or drinking?
2. Do you have difficulty clearing your throat?

Grade:

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 a- No difficulty
b- Occasional difficulty with choking, or food sometimes going down the
wrong way- states that some care must be taken.
c- Patient has to take particular care, chokes once or twice during the day.
May have difficulty clearing phlegm from throat.
d- Patient chokes frequently on food or drink or faces danger of inhaling
substances. Chokes at times other than mealtimes, such as on saliva.
e- No cough reflex. Patient on nasogastric tube or continual choking on
food, drink, and saliva.

Swallow

Task:

If possible, observe the patient drinking ¼ pint of cold water and eating a
cookie (biscuit). Ask that this should be done as quickly as possible. In addition,
ask the patient if there is any difficulty with swallowing, and enquire about the
speed of eating, as well as diet.

Score bearing in mind the range of normality for drinking this quantity of water is
between 4 and 15 seconds with an average of 8 seconds. Anytime of more than
15 seconds is abnormally slow.

Grade:

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 a- No abnormality.
b- Patient reports having some difficulty, notices that eating/ drinking is
slower. Pauses more than usual when drinking.
c- Eating is markedly slow. Some foods and or liquids avoided.
d- Patient able to swallow special diet only; such as pureed or minced
foods.
e- Patients unable to swallow- on nasogastric tube

Dribble/ Drool

Ask the patient if there is any difficulty in this area. Observe during the interview.

Grade
a- No difficulty
b- Occasional dampness at the corners of the mouth. Patient may report
that pillow is damp at night (Only note this if there has been a change
of status- some normals have slight dribbling/drooling at night.)
c- Dribbles/ drools when leaning forward or not concentrating – some
degree of control.
d- Very obvious dribbling/drooling when at rest, but not continual.

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 e- Continual excessive dribbling/drooling which is not controlled.

II. RESPIRATION

At rest

Gauge according to your observation of the patient when sitting and not
attempting to speak. As this section is difficult to rate, it may be
necessary to ask the patient to do the following:

Task:

Ask the patient to take a deep breath in through the mouth and let out as audibly

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and slowly as possible. Demonstrate then score second attempt. Remember,
normally air can be expelled smoothly and evenly over a period of 5 seconds.

Grade:
a- No difficulty
b- Inhalation or exhalation not smooth or is shallow.
c- Marked interruptions of inhalation or exhalation, or difficulty in inhaling
deeply.
d- Little control over rate of inspiration or expiration- may appear short of
breath. More consistently impaired than c.
e- Patient unable to attempt task. No control.

In Speech

Engage patient in conversation and observe respiration. Ask patient

whether he or she has noticed running out of breath when speaking and
so forth. The following task may be used to aid assessment.

Task

Ask the patient to count to 20 as quickly as possible on one breath.

Assure that you are unconcerned about the articulation. Just note the

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 number of breaths necessary to complete the task. Remember, that
normally this task can be performed in one breath. However, people with
velopharyngeal incompetence may be mistaken for patients with poor
respiratory control. You might ask the patient to hold his or her nose to
discriminate between the two.

Grade:
a- No abnormality
b- Very occasional breaks in fluency due to poor respiratory
control. The patient may state that he or she is conscious of
having to stop to take in a deep breath on occasions. An extra
breath may be required to complete the task.
c- Patient has to speak quickly because of poor respiratory control
-voice may fade. Patient may fade. Patient may require up to 4
breaths to complete the task.
d- Patient speaks on inhalation or exhalation or breath is so
shallow that only a few words are managed.
e- Poor coordination and marked variability. Patient may require
seven breaths to complete the task.
f- Speech grossly distorted by lack of control over respiration-
may only manage one word on each breath.

III. LIPS

At Rest

Observe the position of the lips when the patient is making an attempt to
speak.

Grade

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 a- No abnormality
b- Lips slightly drooping apart or asymmetrical- only noticeable to
a skilled observer.
c- Lips drooping, but patient occasionally attempts to reposition.
Some variability of position.
d- Lips asymmetrical or distorted- noticeable to any observer.
e- Severe asymmetry or bilaterally severely affected, little change
in position.

Spread

Task:

Ask the patient to give an exaggerated smile. Demonstrate and encourage

the patient to exaggerate to attempt further and note the second attempt.
Observe elevation and lateral movement.

Grade
a- No abnormality
b- Slight asymmetry- noticed by skilled observer.
c- Severely distorted smile showing elevation on one side only.
d- Patient attempts to start the task, but both spread and elevation are
minimal.
e- Patient unable to elevate lips on either side. No spread of lips observed.

Seal

Ask the patient to undertake one or both of the following tasks to help establish
the degree of lip seal that can be attained.

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Task 1:

Ask the patient to blow air into cheeks and maintain for 15 seconds.
Demonstrate and note second attempt. Note time and whether any air leaks from
lips- do not penalize for nasal emission in this section. Therapist should pinch
the patient’s nose between thumb and forefinger if there is nasal emission.

Task 2:

Ask the patient to say /p/ /p/ crisply and clearly 10 times. Demonstrate and
encourage the patient to exaggerate the plosion. Note the second attempt and
observe the consistency of seal for the position of /p/.

Grade
a- Good lip seal. Retains pressure for 15 seconds or repeats /p/ /p/ with
even seal.
b- Occasional air leakage, break in lip seal, lip seal not consistent for
plosion on each sound.
c- Patient able to retain pressure for 7 to 10 seconds. Lip seal observed on
sound, but auditorily weak.
d- Very poor lip seal, pressure lost from one segment of lips. Patient able
to attempt closure but unable to maintain. Not auditorily
represented.
e- Patient unable to maintain any pressure. Patient unable to visually or
auditorily represent sound.

Alternate
Task:

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Ask the patient to repeat “oo ee” 10 times. Demonstrate by producing 10
segments in 10 seconds. Ask patient to exaggerate movement and to try to copy
the speech demonstrated. Note second attempt. Do not say in unison. It is not
necessary for the patient to use voice.

Grade:
a- Patient able to articulate both movements in 10 seconds
rhythmically. Shows good rounding and spread of lips.
b- Patient able to articulate both movements in 15 seconds. May
have faltering rhythm or variability in rounding or spreading of
lips.
c- Patient attempts both movements, but labored. One movement
may be within normal limits, but other movement severely
distorted.
d- Shapes recognizable as being different. Or one shape managed
three times.
e- Patient unable to make any movement recognizable as
representing either shape.

In Speech

Observe the movement of lips in conversation. It is important to notice shape of

lips associated with all sounds, not just bilabials.

Grade:
a- Lip movements within normal limits
b- Some weakness or briskness. Variable with occasional omissions.
c- Consistently poor movement acoustically represented as weak or
explosive. Many omissions of labial shaping.
d- Patient produces some lip movement- not represented acoustically.
e- No observable production of bilabials or movement of lips in speech
attempt.

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 IV. JAW

Section 4. Jaw

At Rest

Observe position of jaw when patient is not attempting speech.

Grade:
a- Jaw relaxed in normal position.
b- Jaw occasionally drooping, or there is occasional brisk closure.
c- Jaw hanging loosely open, but there are occasional attempts to close
and or frequent repositioning of jaw.
d- Jaw loosely open majority of time and or slow involuntary movements
noted.
e- Jaw hanging widely open or clamped extremely tightly. Very severely
affected. No attempt to reposition.

In Speech:

Observe the position of the jaw when patient is conversing. Remember, in normal
speech there are small and very continuous changes in the distance between the
jaws as the person speaks.

Grade:
a- No abnormality
b- Minimal deviation when fatigued.
c- Jaw in fairly fixed position or jaw jerks apparent, but is under
voluntary control.

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 d- Some voluntary control apparent, nut grossly deviant.
e- No apparent movement of jaw in attempt to speak.

V. SOFT PALATE

Fluids

Patient is observed and asked whether food or drink comes down nose.

Grade:
a- No difficulty.
b- Occasionally difficulty- patient reports having noticed this once or
twice. Occurs occasionally when coughing.
c- Moderate problem, with patient noticing occurrence several times a
week.
d- Patient notices this difficulty at least once every mealtime.
e- Patient has continual difficulty with fluid or food.

Maintenance

Ask the patient to say “AH-AH-AH” five times. Ensure that there is a good pause
between each “AH”, so that the palate has time to lower. Demonstrate this task
to the patient and observe the palatal movement on the patient’s second attempt

Grade:
a- Smooth, symmetrical movement of palate fully maintained.

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 b- Slightly asymmetrical but maintains movement.
c- Inability to elevate palate for all sounds, or severe asymmetry.
d- Some minimal movement of the palate observable.
e- Palate shows no spreading or elevation.

In Speech

Note nasal resonance and nasal emission in spontaneous conversation. To help

to rate this section you may use the following:

Task:

Ask the patient to say /may pay/ /nay bay/ while you listen to the change of
quality.

Grade:
a- Normal resonance. No nasal emission.
b- Slight hyper nasality and or imbalanced nasal resonance or occasional
slight nasal emission.
c- Moderate hyper nasality or imbalanced nasal resonance, some nasal
emission.
d- Moderate to gross hyper nasality or imbalanced nasal resonance and
or noticeable nasal emission.
e- Speech completely masked by gross hyper nasality or nasal emission.

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 VI. LARYNGEAL

Section 6. Laryngeal

Time

Task:

Ask the patient to say “AH” as long as possible. Demonstrate and note the
second attempt. Only time, voice that is clear.

Grade:
a- Patient can say “AH” for 15 seconds.
b- Patient can say “AH” for 10 seconds.
c- Patient can say “AH” for 5 to 10 seconds-intermittent huskiness or
breaks in phonation.
d- Patient can say “AH” for 3 to 5 seconds clearly, or can say “AH” for 5 to
10 seconds, but noticeably husky.
e- Patient unable to maintain a clear phonation on “AH” for 3 seconds.

Pitch

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Task:
Ask the patient to sing a scale (at least six notes). Demonstrate and make
assessment on second attempt.

Grade:
a- No abnormality.
b- Good, but patient shows some difficulty- pitch breaks or laboring.
c- Patient able to represent four distinct pitch changes. Uneven
progression.
d- Minimal change in pitch- shows difference between high and low.
e- No change in pitch.

Volume

Task:

Ask the patient to count to five, increasing volume, each number. Start in a
whisper and end up with a very loud voice. Demonstrate and note second
attempt.

Grade:
a- Patient able to change volume in controlled manner.
b- Minimal difficulty- occasional numbers sounding similar.
c- Changes in volume but noticeably uneven progression.
d- Only limited change in volume, or all excessively quiet or loud.

In Speech

Note whether the patient uses clear phonation, appropriate volume and pitch in
conversational speech.

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Grade:
a- No abnormality.
b- Slight huskiness or occasional inappropriate use of volume or pitch.
Only noticeable to the trained ear.
c- Voice deteriorates with the length of passage. Frequent modulation,
phonation, or pitch difficulties.
d- Voice quality persistently shows change, with difficulty in maintaining
clear phonation, appropriate volume or pitch. If any one of these are
consistently impaired, the patient should be scored on this grade.
e- Severely deviant voice which may show two or all of the following
features; continual inappropriate use of pitch and volume.

VII. TONGUE

At Rest

Ask the patient to open mouth, observe the tongue at rest for a period of not less
than 1 minute. Remember that the tongue may not be completely at rest
immediately after the mouth has opened; therefore, a period of time should
elapse before observation of the “at rest” position is made. Use a spatula on its
edge between the side teeth if a patient has difficulty keeping mouth open.

Grade:
a- No abnormality.
b- Tongue shows occasional involuntary movements, or deviation.
c- Tongue noticeably deviated to one side or involuntary movements
apparent.
d- Tongue noticeably shrunken on one side- fasciculation apparent.

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 e- Tongue appears grossly abnormal; that is, it is small, furrowed,
shrunken, or excessively large.

Protrusion

Task:

Ask the patient to stick tongue out completely and retract five times.
Demonstrate at the speed of five complete movements in 4 seconds. Note the
second attempt.

Grade:
a- Movement conducted smoothly and clearly within normal limits.
b- Task is slow (between 4 to 6 seconds), otherwise normal.
c- Patient varies in ability, irregular or accompanied by facial
grimace, accompanied by noticeable tremor, or takes between 6
to 8 seconds.
d- Patient able to protrude tongue to lip only or unable to manage
more than two movements. Task takes more than 8 seconds.
e- Patient unable to attempt task, tongue does not protrude to lip.

Elevation

Task

Ask patient to point tongue towards nose and then towards the chin, in sequence,
five times. Encourage the patient to keep the mouth open while doing this task.
Demonstrate at the speed of five cycles in 6 seconds. Note second attempt.

Grade
a- No abnormality.
b- Moves well but slow (within 8 seconds).

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 c- Moves well both ways, but laborious or incomplete.
d- Moves in one direction only, or movements are gross.
e- Patient unable to attempt task, no elevation or depression.
Lateral

Task:

Ask the patient to move tongue (outside lips) from one side to another five times.
Demonstrate the task within 4 seconds. Note the second attempt.
Grade:
a) No abnormality.
b) Moves well but slow – takes 5 to 6 seconds.
c) Moves both ways, but laborious or incomplete. May take 6 to 8 seconds.
d) Moves to one side only, or unable to maintain. Takes 8 to 10 seconds.
e) Patient unable to make either movement, or takes longer than 10 seconds.

Alternate

Task:

Ask the patient to say “ka la” 10 times as quickly as possible. Demonstrate 10
units in 5 seconds.

Grade:
a- No difficulty observed.
b- Some difficulty observed- slight in coordination, slightly slow, task
takes 5 to 7 seconds to complete.
c- One sound well articulated, other poorly presented, or task deteriorates;
task takes 10 seconds to complete.
d- Tongue changes position, different sounds can be identified.

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 e- No change in position.

In Speech

Note the tongue movements in conversation.

Grade:
a- No abnormality observed.
b- Tongue movement slightly inaccurate; occasional mispronunciation.
c- Correct articulation points on whole, but slow alternating movements
makes speech laborious. Several omissions of consonants.
d- Grossly distorted movement, only articulation with one point of tongue
or severe changes in tongue potential. Vowels distorted and
consonants frequently omitted.
e- No apparent movement of the tongue.

VIII. INTELIGIBILTY
This section owes much to work by J. Black and C. Hagen (1963) and K.
Yorkston and D. Beukelman (1980) but has been revised and restandardized for
inclusion here.

Words/ Repetition

The following words should be written on individual cards. It is suggested that

bold ¼ high prints on 6”-by- 4” cards be used.

Farm Jagged Here Pay Sergeant

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Warm Glow Error Briar Brought
Swarm Go Air Prior Thought
Storm Grow Single Area Brawn
Spark Goat Jungle Floor Thorn
Park Bubble Cycle Galore Spain
Dark Stubble Sprinkle Explore Loyal
Dagger Trouble Sway Though Lair
Gadget Double Slay Know Vat
Jacket Car Play Urgent Fat

Task:

Shuffle the cards and place face down, select 12 cards at random, taking care
not to look at the cards. Expose the face of each card to the patient. The patient
should read the card and the therapist should write down what the word is
understood to be. The first two of the 12 cards are practice cards and the other
10 are test cards. When the patient has attempted all the cards, take and check
the card against the words written down. Add the number of words correctly
interpreted and score using the following grades.

Grade
a- Ten words correctly interpreted by the therapist, with speech
easily intelligible.
b- Ten words correctly interpreted by the speech therapist, but
therapist had to use particular care in listening and interpreting
what was heard.
c- Seven to nine words interpreted correctly.
d- Five words interpreted correctly.
e- Two or less words interpreted correctly.

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Sentences/ Description
Clearly write the sentences on cards.

The man is clocking. The man is blocking.

The man is plotting. The man is blotting.
The man is leaping. The man is sleeping.
The man is creeping. The man is reaping.
The man is cashing. The man is catching.
The man is patching. The man is pitching.
The man is coming. The man is numbing.
The man is summing. The man is thumbing.
The man is spinning. The man is pinning.
The man is sinning. The man is finding.
The man is repeating. The man is receiving.
The man is receding. The man is naming.
The man is catering. The man is drinking.
The man is tinkering. The man is stinking.
The man is damning. The man is standing.
The man is sending. The man is bending.
The man is proving. The man is bringing.
The man is fighting. The man is biting.
The man is spitting. The man is dancing.
The man is prancing. The man is fencing.
The man is teaching. The man is tugging.
The man is tagging. The man is tucking.
The man is ticking. The man is picking.
The man is lagging. The man is nagging.
The man is airing. The man is hearing.

Task/ Grade:

Use these cards in the same manner as you did for the previous section. Use

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same rating scale as in previous section.

Conversation

Engage the patient in conversation for about 5 minutes. Ask about jobs, hobbies,
relatives, and so on.

Grade:
a- No abnormality.
b- Speech abnormal but intelligible- patient occasionally has to repeat.
c- Speech severely distorted, can be understood half the time. Very often
has to repeat.
d- Occasional words decipherable.
e- Patient totally unintelligible.

INFLUENCING FACTORS
Make a note about whether you feel the listed features are abnormal or normal. If
you feel that any of the influencing factors are affecting or contributing to the
patient’s overall performance, indicate with a cross in the column beside.

HEARING
Ask the patient whether there is any problem in hearing. Judge from patient

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responses in your interview if the hearing is adequate. Enter your comments or
results of audiometric assessment in the space provided.

SIGHT
Ask the patient whether there is any problem with eyesight. Ask if glasses are
worn and when they were prescribed. Enter comments in the appropriate space.

TEETH
Examine teeth and or dentures. Notice condition of teeth and gums and fit of
dentures. Ask how regularly dentures are worn and when they were issued. Enter
comments in appropriate space.

LANGUAGE
Note whether there is any expressive or receptive language involvement. Note
whether additional testing is required.

MOOD
Comment on whether the patient has insight into the difficulty, whether the
patient is cooperative, motivated, and the emotional state of the patient.

POSTURE
Observe the patient’s posture in the interview. Comment on the symmetry of the
client and head, notice whether the head and shoulders are tense or slumped,
and notice the patient’s head control when speaking.

RATE
From the tape recording of the “conversation” subtest, judge the speed of the
patient’s speech. Enter the number of words per minute in the appropriate area
on the form. Remember, that the normal speed varies between 5 and 8 syllables
per second, or 150 to 200 words per minute.

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SENSATION
There has been considerable discussion in the literature with regard to the role of
sensory feedback in speech. This study conducted several trials including
mandibular proprioreception tasks, oral form discrimination, and two-point
testing. None was found to be satisfactory from a standardization point of view.
Problems with normal data, reliability, validity, or discrimination were noted. The
following simple task will identify patients with gross sensory loss and, therefore,
may be of value.

Using the standard calipers instruct the patient that you want an indication if he
or she feels one or two points when touched. Demonstrate and practice on the
patient’s hand. You will test the right and the left side of the upper lip and the
tongue tip (slightly protruded). Ask the patient to close eyes while being tested.
Use the widths 4mm, 5mm, and 1cm. randomly alternate using one or both
points. Test each area with each width at least three times. Remember that
normals make an occasional error.

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