International Journal of Orofacial Myology 2012, V38

A ONE-PAGE OROFACIAL MYOFUNCTIONAL

ASSESSMENT FORM: A PROPOSAL

LICIA COCEANI PASKAY, MS, CCC-SLP, COM

ABSTRACT
The author presents her own proposal of a one-page orofacial myofunctional assessment and for
each item on the list a brief rationale is provided. The protocol is an easy but comprehensive form
that can be faxed or emailed to referral sources as needed. As science provides more objective
assessment and evaluation tools, this one-page form can be easily modified.

KEYWORDS: One-page, assessment, orofacial myofunctional

INTROUCTION

Although our professional world is increasingly International Association of Orofacial Myology

computer driven, there are certain advantages (IAOM).
to paper and pen assessments. The proposed
form tries to capture the most common The assessment protocol, in its present form,
aspects of a patient assessment without was inspired by the Interdisciplinary Orofacial
excessive details that can be left to the overall Examination Protocol for Children and
intake conversation, and it’s also simple Adolescents (Donato, Lapitz & Grandi, 2009;
enough to allow constant revision and Echarri et al, 2009) form used by Diana Grandi
incorporations of new items. This one-page and her team at the College for Speech-
assessment form is meant to hold quick and Language Therapists of Catalonia, Barcelona,
short notes, such as: within normal limits Spain and by the MGBR Protocol (Genaro et
(WNL), within functional limits (WFL), al, 2009) used at CEFAC in São Paulo, Brazil,
dysfunctional or disordered (D), range of by Irene Q. Marchesan, PhD and by her team
motion (ROM), strength of motion (SOM), of multidisciplinary professionals.
accuracy of motion (AOM), increased (INC),
decreased (DEC) and whatever else is ASSESSMENT PROTOCOL
needed. When the assessment requires DISCUSSION
further explanation an asterisk is placed in the
corresponding box and a separate note is The assessment protocol begins with the
made. general observation of the patient walking,
sitting in a chair and standing. In a normal
Although this assessment protocol (Appendix head posture position the ears should be lined
A) is meant for orofacial myologists with a up with the middle of the shoulders. This is
speech-language pathology background, it important because the life-long complications
can be easily modified to assist dental of a forward head posture at rest and while
professionals, cranio-osteopathic physicians, walking are well documented (Korbmacher,
occupational therapists and others. However, Koch & Kahl-Nieke, 2005; Okuro, Morcillo,
every state (or nation) and every professional Oliveira Ribeiro, Sakano, Margosian Conti,
and licensing board has different requirements Ribeiro, 2011). Slouching in the chair and a
and restrictions with regards to the various lack of any regular physical activity should
sections of the evaluation. This specific also be noted on the chart, because correcting
assessment form was prepared in compliance the orofacial myofunctional disorders (OMD) in
with the laws of the State of California and in a patient might not be successful without
compliance with the American Association of placing those disorders in a much larger
Speech-Language and Hearing (ASHA) context of proper posture (Miles, 2007;
(ASHA, 1991 & 1993) and the standards of the Mathur, Mortimore, Jan, Duglas 1995).

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 International Journal of Orofacial Myology 2012, V38

However, diagnosing and treating postural addition, conditions such as cancer (current
problems is not in the scope of practice of US- and past chemo and radiation therapy) are
based orofacial myologists. Fortunately, in also noted, since each disorder may require
many countries the posturologist is an intrinsic modifications to the therapy style, tools and
member of the orofacial management team, procedures.
along with the orthodontist, the
otolaryngologist (ENT) and the orofacial Special attention is given to known allergies
myologist. In the US, if the forward head but also to tale-tell signs such as: “allergic
posture is significant, a consultation with shiners” or dark areas under the eyes, “allergic
and/or a referral to a physical therapist may be salute” or wiping the nose with the hand, stuffy
helpful. nose, runny nose, red eyes. Identifying
allergies is relevant to the evaluation process
Next, the type of breathing is assessed by as flare-ups may impact therapy and orofacial
direct observation, to determine if the posture habituation. If medications are already
breathing is primarily either “clavicular” or being taken by the patient, but strong
“abdominal” (often referred to as symptoms still persist, then questions about
“diaphragmatic”). Upon inquiry, some patients compliance, diet modification or environmental
may report breathing signs like sighing or modifications should be asked. However,
shortness of breath during or after eating or because consulting on a hypo-allergenic diet
during speech. The nostrils aperture is noted is not within the scope of practice of US-based
(liminal valve) as per the Multidisciplinary SLPs, patients are usually referred for all their
Protocol (Donato, Lapitz & Grandi, 2009; additional needs back to the referring
Echarri, Carrasco, Vila, Bottini, 2009) and physician and for additional information to
three tests are performed if needed: the science-based educational websites such as
Rosenthal breathing test for minimum mayoclinic.com, webmd.com, health.gov,
breathing endurance, the Gudin test (or the health.harvard.edu and others.
“sniff” test) for flaring of the nostrils and the
nasal mirror test for patency of the nasal This specific assessment form notes any past
cavities (Garretto, 2003 and 2005). accidents, mostly those related to injuries of
the head and face but also to the legs and
When the nasal passages seem to be back to identify possible starting points of
somewhat restricted or compromised, an compensatory postures or behaviors.
inquiry into sleep disorders is warranted, as Significant surgeries are mostly those to the
sleep disorders are potential life threatening head and face or oral cavity (like avulsion of
conditions (Barsh 1998, Bonuck, Freeman, wisdom teeth or tonsillectomies) but also
Chervin, Xu, 2012). Apart from known signs surgeries that could impact orofacial or
and symptoms of sleep disorders such as: breathing functions, like abdominal surgeries
Mallampati score 1 or 2, hypertrophic tonsils resulting in scars affecting the breathing
and/or adenoids, scalloped tongue, increased pattern or significant back surgery as they
body-mass index (BMI), neck circumference, affect posture and trigger compensatory
or retrognathic mandible, (Guimarães, Drager, positions and functions.
Genta, Marcondes, Lorenzi-Filho, 2009;
Coceani, 2003; Li, Wong, Kew, Hui, Fok 2002; Next, a specific box allows for a quick inquiry
Weiss, Atanasov & Calhoun, 2005), the into any orofacial habits, such as thumb and
positive findings in the Epworth Sleepiness finger sucking, chewing habits, leaning on
scale (available through www.stanford.edu) one’s hand (Miyake, Ohkubo, Takehara,
and individual reports are added to the overall Morita, 2004), lip licking, tongue sucking or
assessment in order to decide if the patient cheek biting. The current frequency, duration
needs to be referred back to his treating and possibly intensity of the habits are also
physician or dentist, to determine whether or noted, along with an approximate starting date
not a sleep study is warranted. in years or months for that habit.

In the box reserved for general health, notes In cases of suspected or medically diagnosed
are made about chronic conditions (not disorders such as Parkinson’s or Multiple
allergies, which have their own box) such as Sclerosis or Cerebral Palsy, a note is made if
diabetes, Crohn’s disease, or autism. In the disorder is affecting jaw stability, chewing,

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 International Journal of Orofacial Myology 2012, V38

swallowing, breath control or speech. In asymmetry in facial movements can be

selected patients (those who have or might evaluated by having the patient smile or frown.
have a neuromuscular disorder or are stroke
survivors) a quick assessment of the cranial The lips are assessed next and the shape of
nerves and their symmetry is done: asking each lip is noted to see if either one deviates
about the sense of smell (CN I), ability to react from the “norm”; which is racially determined.
to light (CN II), track a finger or a light point in The rationale for this note is that lips can be
all directions (CNs III, IV, VI), face sensitivity modified by growth and development (Vig &
and biting (CN V), facial expressions (CN VII), Cohen, 1979), therapy (Meyer, 2000) and also
finger rubbing test (CN VIII), soft palate by atypical breathing conditions (mouth
movement (CN IX), voice (CN X), shoulder breathing) or surgeries (cleft lip or lip injury).
shrug (CN XI) and tongue waggle (CN XII). The loss of integrity of the orbicularis oris
This protocol can be easily found in neurology should be noted as it may affect the therapy
books or websites. results (Carvajal, Miralles, Cauvi, Berger,
Carvajal, Bull, 1992). The range of motion
In patients who present perceptual asymmetry (ROM), strength of motion (SOM) and
of the face, especially in those with habitual accuracy of motion (AOM) can be listed here.
mouth open/mouth breathing (Bresolin, Within Functional Limits (WFL) indicates lip
Shapiro, Shapiro, Dassel, Furukawa, Pierson, movements that, although not “normal” or
Chapko, Bierman, 1984), it is useful to optimal, still accomplish the task nonetheless.
quantify such a finding, by taking a full frontal For instance, although the patient might not be
picture or a freeze frame from a video to able to properly pucker or frown his or her lips
analyze the two halves of the face (such as in on command or in imitation, they do not lose
the case of habitual unilateral chewing) and to liquids or food as they eat, so their lips are still
measure the line linking the corners of the functioning although not at an optimal level.
eyes versus the line linking the corners of the
mouth. Such lines should be parallel and often The presence or absence of labial seal is
in OMDs, these lines are not. However, noted and when a gap between lips is present,
therapy can positively influence these its dimension is also noted. This measure is
measures. A quick measurement of the 3 very important to orofacial myologists because
thirds of the face can also be useful, as lip seal can be achieved through therapy
therapy might influence the dimension of the (Satomi, 2001). Lifting the upper lip reveals
lower one third. The measurements are taken the length and thickness of the labial frenum
between menton and nasion, nasion and and if it’s too thick it may not only contribute to
glabella and glabella and trichion. For further the presence of a diastema but also prevent a
details, please refer to Paskay, 2006; proper lip seal. Dry lips are documented
Scarborough, Ghali & Smith, 1997; Quintal, because they can suggest a generalized
Tessitore, Rizzoato Paschoal, Nizam dehydration, which itself can cause
Pfeilsticker, 2004; Proffit & Fields, 1986; drowsiness and confusion in children and
Ferrario, Sforza, Poggio, Tartaglia, 1994. elderly patients, but dry lips also stimulate bad
oral habits like lip licking, thumb sucking, lip
The assessment should include a general sucking or lip wedging (lower lip between
overview of the facial muscles, including the upper and lower teeth in a severe overjet).
eyes (semi-closed or wide open) and the
forehead (furrowed at the glabella, wrinkled) A note is made as to the quantity and quality
as possible signs of stress, pain or of saliva. If the saliva pools white and foamy at
compensatory use of facial muscles to support the sides of the mouth then there is an
and stabilize the mandible. If the freeway obvious change in both the quality and
space is clearly excessive or reduced, the quantity of saliva. Mavash Navazesh, PhD
space can be measured (Mason, 2005) and wrote in several articles for the Journal of
listed in this box. The ability of “blowing one’s American Dental Association (JADA) that the
cheeks” should be an indication of the term “xerostomia” indicates qualitative and
functionality of the buccinators and the perioral quantitative changes to the saliva. In this
muscles in general, while the mentalis should assessment chart, presence of excessive
be relaxed and not “bunched up”. Droops and salivation (scialorrhea or drooling) is noted, as

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well as “dry mouth” by the patient’s own assessment of the ROM and SOM of the jaw
admission and by pressing a wooden tongue offers an insight into the integrity of the TMJs
depressor against the internal surface of the (Goncalves Bianchini, 2000; Rodrigues Correa
cheek. If the tongue depressor sticks then the & Berzin, 2004; De Felicio, Melchior & Da
salivary output is already 50% or less of what Silva, 2010). The ROM is tested by asking the
it should be (Navazesh, 2003). A positive patient to move the jaw in antero-posterior,
tongue depressor test, especially in adults, right-left and vertical (mouth opening)
should be followed by an inquiry into directions. Questions about biting apples,
medications that might cause a reduction in hamburgers or simply eating soup with a
salivation. The rationale to investigate, in spoon may gain some insight into the
greater detail, the production of saliva is adequacy of the mouth opening during
because saliva affects speech (and/or oral feeding. It is important to note if the patient
health), chewing, and swallowing which are can move the mandible without a teeth assist,
within the myofunctional purview. Also, noting with a teeth assist or with a tongue depressor
changes in saliva triggers inquiries into sleep assist. The strength of motion is considered at
habits and sleep disorders. According to a least WFL if the patient is able to chew most
2012 article by Joseph Shames, DMD (in foods. If the patient reports significant
press), oral saliva is part of a liquid film that impairment in the chewing ability then a
extends from the oronasal cavities to our referral to the treating orthodontist or TMJ
stomach and beyond and a dry mouth seems specialist is warranted. However, some
to be linked to sleep disorders by increasing patients might be sent to orofacial myologists
the surfactant tension of the oral soft by surgeons after maxillofacial surgery, or by
structures that collapse and stick together TMJ pain management specialists, in cases
during sleep. where the TMJs have already been assessed,
to be treated in a multidisciplinary fashion and
The maximal aperture of the mouth should be the plan of care has been discussed and
measured with a caliper or a ruler and noted approved by the TMJ specialist. In this case a
on the chart, always using the same teeth as gentle passive opposition to the opening of the
references. When the opening is between 35 mandible, the lateral movement and antero-
mm and 50 mm it’s defined as WNL, if it is posterior movement along a tongue depressor
less but the patient is still able to eat fairly may indicate the SOM of the mandible. The
well, it is WFL. An aperture greater than 50 ability to chew increasingly “tough” foods is
mm may indicate an articular laxity, which also an indication of the SOM of the TMJ.
does not affect the work of an orofacial
myologist but should nevertheless be noted on Since not every patient is referred to the
the chart. A second measurement is taken orofacial myologist by an orthodontist or a
with the tip of the tongue on the retro-incisal dentist, asking a patient to gently open the
papilla to measure the functional mouth as wide as possible (but without pain or
measurement of the lingual frenum. According discomfort) allows the clinician to note the
to the Marchesan protocols (Marchesan, 2004, presence of a lateral, ‘S’ shaped shift of the
2005 and 2010) for lingual frena (tongue-tie), if mandible, suggesting problems with the TMJ
the second measurement is less than 50% of meniscus that might warrant a consultation
the first measurement, then surgical “release” with a dentist, orthodontist or a TMJ specialist.
of the frenum should be considered. If the Signs and symptoms of TMJ disorders should
second measurement is between 51% and be noted and a consultation or a referral
59% of the full mouth opening, then the case needs to follow. Signs and symptoms
is “borderline” and some stretching exercises (according to mayoclinic.com and
could be considered to repattern the tongue. webmd.com) are: popping or grinding noises,
Anything above 60% is considered WNL. A impaired functions (mouth open or closed),
lingual frenum attached to the tip of the tongue pain, discomfort, headache, neck ache,
is considered a true ankyloglossia for which a shoulder ache. A stethoscope could be used
surgical consultation is warranted. to listen to noises coming from the TMJ and,
by gently pressing a finger against the
Because of all the connections between patient’s external ear, it’s possible to feel the
tempomandibular joints (TMJ) and breathing, asymmetric movement of the TMJs.
chewing, swallowing, and speech, a gentle

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Unlike the facial muscles, the masseters have more common occurrence in speech and
an important role in the stability of the dental practice. Additional genetic anomalies
mandible because they have a stretch reflex should be noted, like skin tags or auricular
(Scutter & Turker 2001; Miles, Flavel & fissures, as they are part of a larger issue that
Nordstrom, 2004; Goulet, Clark & Flack, might impact therapy. The mobility of the soft
1993). Therefore assessing their tone and palate should be noted as well by pretending
activation timing (they should activate almost to gag with the mouth wide open or by saying
simultaneously), gives an indirect indication of “ah”.
the condition of posterior occlusion, therefore
chewing capabilities. The activation of the The shape and appearance of the palate
anterior vs. the posterior portion indicates the should be noted, either subjectively or by
specific extent or absence of an adequate measuring the space between the lingual
occlusion. The infrahyioid muscles (below the cusps of the first upper premolars. It could be
hyoid bone, antagonistic of the chewing inadequate for orthodontic needs but WFL for
muscles) are tested by opening the mouth tongue suction and tongue placement. Any
wide. The temporalis are also palpated while exostosis, torus palatinus and mandibular tori
the pterygoids are not directly assessed should be noted. They are bony growths that
because of their location, but indirectly can impact tongue rest posture, chewing and
assessed by the lateral excursion of the swallowing. Because tori are often linked to
mandible. Tension to the head stabilizing bruxing and clenching (and genetic
muscles (the posterior neck muscles, predisposition), an inquiry can be made about
especially when coupled with a forward head these habits, if they are not already mentioned
posture) is an indicator of possible in the patient’s dental report.
compensatory positions, strain and muscle
pain which may complicate therapy. The Although tonsils and their evaluation should be
tongue at rest is in different positions when the left to the ENT, in order to properly document
head is not properly aligned and the neck a referral or justify a delay in myofunctional
muscles are tense. For additional information therapy a rough tonsil grading is appropriate
on muscle testing please refer to Camargo (for grading of tonsils please refer to Harley,
Tanigute, 2005; Hanson & Mason 2003; 2002). Again, it’s a mere description of the
Queiroz Marchesan 2005. visible tonsils on assessment day. Also, any
type of oral lesion whatsoever is referred,
The Mallampati score is useful in identifying since serious medical issues may arise and a
patients more likely to have a tongue thrust diagnosis must be made by the appropriate
and sleep disorders (Guimaraes et al. 2009). medical or dental professional, as this
Although the traditional Mallampati is assessment form is mostly designed for SLPs.
assessed with the mouth fully open and the The general oral hygiene of the patient is
tongue sticking out, several “modifiers” have merely an indication of the compliance of the
been added in the last few years, such as the patient and is not meant to replace the
tongue sticking out with/without maximum evaluation of a dental professional, but also
extension, with/without phonation (aahh) suggests issues with chewing and oral
(Mallampati, Gatt, Gugino, Desai, Waraksa, clearance due to muscles working at a less
Freiberger, Liu, 1985; Samsoon & Young, than optimal level.
1987).
A note may be made regarding past, present
Speech-language pathologists should note and scheduled orthodontic conditions, both in
any type of cleft, repaired or not, including terms of fixed appliances and removable
fistulas, their position and their extent. The appliances, including palatal expanders (rapid
type and severity of velopharyngeal and slow) sleep-dental appliances, night
incompetence, insufficiency or inadequacy guards, oral hygiene appliances, habit trainers
(VPI) should be noted (Peterson-Falzone, or functional appliances. Oral appliances
Harding-Jones & Karnell, 2009). If possible, impact not only teeth and bone but also
this information should be coupled with muscles and oral functions (Jonas, Mann,
objective data and reports from referring Munker, Junker, Schumann, 1978; Kucukkeles
doctors or care team members. A VPI can be & Ceylanoglu, 2003; Halazonetis, Katsavrias &
the temporary result of adenotonsillectomy, a Spyropulos, 1994).

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Although ONLY a dentist can diagnose any 1985). Also, although orofacial myologists in
dental issue, including Angles Class, if and general should be able to document speech
when it is appropriate a note should be made misarticulations by having the patient repeat
of the various spatial relationships between easy sentences, often the misarticulations are
dental arches, as they indicate where there is multiple and complex, warranting a referral to
a functional disorder or less than optimal a speech language pathologist, if the treating
function. An anterior open bite is often orofacial myologist is not already an SLP.
accompanied by an anterior tongue thrust, an Misarticulations affecting the /s/ and /z/ are
excessive overjet may stimulate “lip-wedging” more common in OMDs followed by the
against the upper teeth, also a crossbite may misarticulation of the /r/ as the tongue is not
be an indication of a unilateral tongue thrust or able to properly elevate its sides.
a significant asymmetry of the tongue.
Because this assessment tool includes
The tongue is assessed in its overall aspect, functions of interest to a speech language
which most of the time is WNL but in certain pathologist, information about the general
cases it may look either flaccid or “stiff”. For aspect of voice and hearing is also listed.
additional information about assessment While some speech pathologists might have
strategies please refer to Solomon, 2004; access to digital tools and software to identify
Solomon & Munson, 2004; Lazarus, 2005; voice disorders, this tool only lists perceptual
Clark, 2012; Clark & Solomon, 2012. Often characteristics of the voice, like its volume
measuring the actual protrusion of the tongue (intensity) pitch (frequency) and nasality
can be useful to document the need for a (resonance). Also the quality of the voice is
referral for a lingual frenum release. The noted: hoarseness, dyplophonia, wetness. A
measurement can be done easily with the note about prosody can be added when
tongue extending on top of the tongue appropriate. If everything is normal the note
depressor and by measuring the length on the written is WNL (within normal limit).
tongue depressor itself, anchored against the
lower incisors (Marchesan, 2005). A functional In addition to information collected from the
way to assess the tongue movement is to patient or the parents, the finger rub test for
determine if the patient can clean the buccal hearing acuity is used. This is a very simple
surfaces of the lower and upper molars. As screening test well documented in medical
mentioned before, when talking about signs literature. Clearly it requires a quiet office
and symptoms of sleep disorders, the environment. An inquiry is also made to the
scalloping of the tongue is noted, with the integrity of the tubaric function, to address
various degrees of severity (Weiss, Atanasov possible disturbances due to allergies and
& Calhoun, 2005). It may denote an obligatory hypertrophic tubal tonsils. Poor functionality of
or a compensatory tongue thrust. A full ROM, the Eustachian tubes is conducive of
SOM and AOM assessment of the tongue is decreased hearing, increased internal noise
also performed. during chewing, and trouble swallowing. (Mew
& Meredith, 1992).
Skills regarding chewing and the quality of the
food chewed are noted, including food The dental professionals might want to skip
avoidance or texture avoidance and the these two sections above or modify them for
reasons why. Chewing with the mouth open or their own needs. They may also be used to
not is also noted. Swallowing is assessed in all document referrals when the voice or the
its types such as: saliva, liquid (holding, speech of the patient is perceptually not
gulping, sipping, chugging), foods and pills. “right”.
Anything of note is recorded, like gagging or
burping. Additional tests done or scheduled can be
added and a narrative about birth,
The diadochokinetic assessment (fast development and life style related to OMDs
repetition of trains of syllables like “buttercup” can be added separately, including any
or puh-tuh-kuh) is useful primarily to speech musical instruments played, reading and
pathologists, as speed is needed mostly in writing skills, or dexterity.
speech performance (Fletcher, 1972 and

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CONCLUSIONS
with referrals and parents, if needed.
By no means is this assessment chart Moreover, there is always room for
complete, but it’s quite comprehensive, improvement and new items for the form may
evidence-based and easy to scan and share be added if necessary.

CONTACT AUTHOR:
Licia Coceani Paskay, MS, CCC-SLP, COM
300 Corporate Pointe, Suite 468
Culver City, CA 90230 USA
+1-310-351-4084
[email protected]

Disclaimers: The author has no institutional affiliations and no sources of funding. The author has no
financial interest or other benefits, either direct or indirect, that may represent a conflict of interest.

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APPENDIX A
Assessment Chart for Speech and Swallow

Posture Sitting Breathing type Mirror test Gudin test

Head posture Walking

Breathing signs Liminal valve/nostrils Rosenthal test
Shoulders Sports/activities
Signs/symptoms of General health issues Accidents (car, skiing) Sucking habits Visible neurom. Dis.
sleep disorders
Chewing habits
Allergies Surgeries Cranial nerves assess.
Other habits
Facial symmetry: halves .Lower 1/3 Facial muscles: general Buccinators Droop/asymmetry
aspect
Eyes/lip line symmetry Middle 1/3 Mentalis Smile
Freeway space
Upper 1/3 Perioral Frown
Upper lip aspect Seal Upper lip frenum Excessive saliva Max aperture

Dry mouth (tongue blade Aperture with tongue on

Lower lip aspect Interlabial gap Dry lips: yes no test) the spot

TMJ ROM Deviation in opening Masseters: RT Masseters: LT Temporalis RT

Ant. Portion Ant. Portion

TMJ SOM TMJD signs&sympt. Temporalis LT
Post. portion Post. portion
Infrahyoid muscles Additional notes Mallampati score: VPI Cleft lip
1 full vision
Head stabilizing muscles 2 50% of uvula Cleft hard palate
3 no uvula Soft palate mobility
4 only tongue Cleft soft palate

Shape of palate Tonsil grades: Visible oral lesions Fixed appliance Dental class
0-1 0-25% space
Tori (palate and 2 up to 50% space Palatal expander Open bite
mandible) 3 up to 75%space Dental hygiene:
4 up to 100% space Poor Fair Good Functional appliance Overjet
Bruxing/clenching 4+ touching
Crossbite Tongue aspect Protrusion mm Clean molars with Scalloping
tongue tip? Yes No 0 not present
Missing teeth Tongue tie 1 only at rest
Hypotonic/Hypertonic Suction 2 only in protrusion
Teeth anomalies Ankyloglossia 3 always

Laterality RT Chewing Swallowing: Diadochokinesis Misarticulations:

Laterality LT Fragmented/tough Saliva Puh/tuh/kuh Begin. word
ROM Liquids Tuh/duh/nuh Middle word
SOM Food avoidance Type Fuh/suh/shuh End word
Accuracy Solids Coartic. /r/
Pills Stuttering

Loudness Voice quality Hearing (finger test) Tests previously done Notes

Resonance
Eustachian tube function
Pitch

Name:________________________________Date:__________DOB_________

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