Adults may undergo speech and language evaluations for a variety of reasons, including, but not limited to, difficulty pronouncing sounds or words, speaking clearly, retrieving and using familiar words, understanding words they hear, speaking fluently, remembering peoples/places/events, and swallowing. Adult speech and language evaluations may be performed differently depending on the speech-language pathologist (SLP), the setting of the evaluation and/or the reason for the referral. To help you and your loved one prepare for a speech and language evaluation, below you will find detailed descriptions of what you can expect during a typical evaluation.
The purpose of the intake interview is to gather information about you. This is the most important aspect of any speech and language evaluation as it helps the SLP understand why you are seeking the evaluation, how your current communication difficulties are impacting your daily life and what you hope to get out of the evaluation and/or therapy. During the intake interview, the SLP will ask you about your medical history, education and employment, cultural and linguistic background, and current and past evaluations and therapies.
Oral Mechanism Examination
The purpose of an oral mechanism examination is to assess the structure and function of your oral mechanism (e.g., lips, tongue, teeth, hard/soft palate) to support speech and/or swallowing. Examples of tasks you may be asked to do during this portion of the evaluation include moving your tongue from side-to-side, opening your mouth and saying “ah,” and raising your tongue to try and reach your nose.
Articulation is the manner in which sounds are produced using the oral mechanism and phonology is the manner in which we organize sounds to form words. Assessment of articulation and phonology is important if you are difficult to understand. The purpose of this assessment is to determine what sounds you have difficulty saying and if there is a pattern to your difficulties. In addition to general pronunciation concerns, this type of assessment is important if there is suspected apraxia and/or dysarthria. General assessment of articulation and phonology typically includes obtaining and analyzing a speech sample (this is exactly how it sounds – a sampling of your speech) obtained during conversation with the SLP, as well as administration of a standardized test (e.g., Goldman Fristoe Test of Articulation, Arizona Articulation Proficiency Scale, Hodson Assessment of Phonological Patterns, Apraxia Battery for Adults, Frenchay Dysarthria Assessment). During standardized testing, you will be asked to look at and name various pictures and/or objects, repeat a variety of words and phrases of varying lengths and complexities, and/or perform different actions with your mouth. The evaluator will transcribe what you say during the assessments for later analysis.
Assessment of Voice
Voice refers to the quality, loudness, pitch, resonance and prosody of one’s speech. A person typically undergoes a voice assessment due to vocal concerns as the result of a neurological condition (e.g., Parkinson’s Disease), a vocal pathology (e.g., nodules, cyst), or dysarthria. A thorough voice assessment cannot be completed without prior evaluation from an otolaryngologist (ENT) to determine the potential etiology of the vocal concerns. After a patient has been seen by an ENT, a voice assessment can be completed by an SLP and components of the assessment may include a discussion of how you use your voice and your feelings about the current status of your voice, use of computerized software to analyze your speech compared to other adults of similar ages, and/or use of laryngeal imaging.
Assessment of Fluency
Fluency refers to fluidity of one’s speech. Assessment of fluency is crucial if you have concerns that you stutter. A fluency assessment typically involves engaging in conversation with the SLP on topics of interest so she can obtain a speech sample for later analysis, as well as discussing your feelings about your stuttering administering a standardized fluency test (e.g., Stuttering Severity Instrument). During the standardized test, you will likely be asked open-ended questions, instructed to read passages and describe pictured scenes, and/or tell a story.
Assessment of Language and Cognition
Language refers to receptive and expressive language. Receptive language is an individual’s ability to understand language; where as expressive language is an individual’s ability to use language. Language goes beyond the spoken word and also encompasses written words, gestures, and facial expressions. Cognition describes a person’s memory, attention, problem solving, executive function, reasoning, organization, perception, and judgment. Assessment of language and cognition is typically completed when there is a suspicion of aphasia and/or a noted neurological decline, which may be the result of a traumatic brain injury, stroke, or neurological condition (e.g., Alzheimer’s, Parkinson’s). Assessment of language and cognition includes obtaining a language sample, as well as administering standardized tests (e.g., Western Aphasia Battery, Boston Diagnostic Aphasia Examination, Montreal Cognitive Assessment, Cognitive Linguistic Quick Test). The tasks you would be asked to do would depend on the test(s) administered; however, like with most standardized tests, you are likely to be asked questions about different pictures, words, objects, stories, and concepts. For example, you may be asked to find a letter or word named by the SLP.
Assessment of Swallowing
The purpose of a swallowing assessment is to determine what, if any, difficulties you have swallowing, at what stage the difficulties occur, and what types of food and liquid consistencies are safe for you to consume. Swallowing assessments can be done with and without instruments. Non-instrumental swallowing assessments involve the SLP watching you as you eat different foods and taking notes on what happens as you eat (e.g., do you cough after swallowing?). Instrumental swallowing assessments (e.g., videofluoroscopic swallowing study, fiberoptic endoscopic evaluation of swallowing) involve using medical equipment to watch your swallow internally.
Discussion of the Results
At the conclusion of the evaluation, the SLP should discuss the results with you. The discussion should include information related to her findings (diagnoses, observations) and recommendations (e.g., if additional testing by an SLP or related professional is recommended or required and/or if speech/language therapy is warranted). You should also be given the opportunity to ask any questions you may have.