DYSARTHRIA PROFILE (REVISED) - SCORING FORM. Date of Name: D.of B. Medical Diagnosis Testing TASK (See norms sheet) Descriptive Information (underline where relevant RESPIRATION 1. Ability to sustain 6 exhalation also /7 Q) 2. Ability to "erescendo" on / or/7 3. Ability to “diminuendo onl or/7 4: Ability wo repeat eres of or/7 5 Abily to synchronise respiration with phonation IL PHONATION Abit inate eT 2. Ability wo sustain ad “AB way TT Vy Toualy “Ability wo exescendo” on f= (teint owen (b) Speed of respiration at rest is: normal, rapid, slow. (c) Respiration during speech is: normal, shallow, Siren ate tenet ep ea an Sia (O) Respiration occurs: without stridor, with strider. ‘5. Ability to diminuendo ona fe! > 6. Ability to repeat series ofa: 7-Ability to raise pitch on fa! pitches) ‘Ability wo Tower pic on ad @ pitches) ‘9. Ability wo glide upscale on fad (octave) 10. Ability 1ogide down sale on fa: (octave) TH Abilify to maisiain adequate volume fa wpeech . (@) Pitch of voice for speech is soem v0 toe low. “en (2) Ph break: donot oceur, do occu. (© Intonation for speech normal, monotonous, Anepproprint. (2 Tooe of voici: normal, hypernasa Speman (© Voice quay is: normal, horse, breathy, weak, Sean erate YD Page 1DYSARTHRIA PROFILE (REVISED) - SCORING FORM 1 TASK. Descriptive Information (undertine where relevant) IIT FACIAL MUSCULATURE 1. Change expression oa smile 2. Change expression to 4 frown 3. Open and close mouth 4: Pare ips 00" hel 5 Stretch lips "ee" A Maina ip closure (bold spatula against vecitance) 7 Proinde tone Reva nga ‘9: Lateral tongue movement (agar spatula resistance) 10. Pass tongue over ath 11, Tongue tip into Right cheek (agains spatula resistance) 12, Tongue tip into Left check (against sptuia resistance) 13. Rao tongue tpt the alveolar ridge 14, Blevmte sot palate a! 15 Elevate soft palate ona scis of) 16. Coughs strongly as possible Jef side, moves tnvoluntarly. Dicng nile ce drooe on right Seopred ih kat mevertovmaaanye (©) Tone of ips eppears: normal, increased, decreased. IL. (@ Atrest face: droops on right edo, droops on ly. (@) Atrest tongue appears: normal, larg, small, (f) Atrest soft palate is: normal, deviates to right, deviates to left (@ During phonation sof palates: normal, deviates o right, deviates tole. Page?1V. DIADOCHOKINESIS. DYSARTHRIA PROFILE (REVISED) - SCORING FORM (N) +See Norms Sheet TASK Descriptive Information 1. Abily repent 00-0" rapidly (N) W. iE 2 Abily repent pa” rapialy ©) 1.0006 fal id 3: Abily to repeat "laa ail ON) 2p el 4 Abt repeat "aa apy) 3" ad 5: Aili repent "p= 1-1 reply ™) 47k" eps t-k iptkl PagesDYSARTHRIA PROFILE (REVISED) - SCORING FORM TASK, 3 1. Ability to epeat inital consonants = paw os 7 Accuracy of vowel unde 2 = [epee a = 5 4: Abit to repent polyaylabie words = as amination Tr Rend Swords (1 fom ac is) fox fw sotto 3 Rel pas (fond = ei [rom | — =— es B “Ability to malian appropiate rie @) 700 co la Ayo malntaa appropriate tonation oe oral bis ‘6. Abiity to maintain propriate yin (3) "Abily wo nite sess pater Page 4 gle Ria ral [40] () Rete of spech is normal too slow too fast, Sestnate, sows dawn. (© Ray of pooch is normal, ylablestacat, nth prlonpndons, ith nwaticent engDYSARTHRIA PROFILE (REVISED) - SCORING FORM (QUESTIONS (For self sereening) 1. Does your partner / carer close ends have dificult understanding you? 2. Do strangers have dificalty understanding you? 3. De you have dficly speaking and for being underiood by a group of people? “4 Do you have dificult speaking being undersiod i here is background noise (the television, music or machinery)? 5 Do you bavedificulty speaking / being understood when you are onthe telephone ? ‘Eating and Drinking 1. Do you bave dificuty geting food or drink to your mouth? 2. De you have difficulty chewing the food in your mouth 7 3.Do you have dificly swallowing food ? SWALLOWING. 4:Do you have dficalty swallowing liquids? ‘5. De you find that you cough or choke durig or jut alter you eat or drink ?