TalkTools® Oral-Motor Skills for Feeding and Speech:

Assessment and Treatment Form

Oral-Motor Skills for Feeding and Speech: Assessment and Treatment Form

Before using this form, please read these important notes:

1. This assessment should be used as an adjunct to traditional articulation and language evaluations. As part of a full evalua-
tion the therapist will be able to identify co-occurring muscle-based deficits that may be affecting speech clarity, or rule out
muscle-based deficits, thereby allowing the therapist to proceed with a traditional speech and language program targeting
speech sound production.

2. This form will be used to record information you identify during the assessment of your client’s oral-motor skills in the areas
of sensory, feeding, and oral-motor exercises. It is intended for use in conjunction with Sara Rosenfeld-Johnson’s muscle-
based sensory, feeding, and speech therapy program, and is designed for users who are familiar with this program. It is
not intended to teach the program. It was developed to assist speech and language pathologists in assessing muscle
function in relation to speech production. Once this assessment has been completed the SLP will be able to develop a
complete oral-motor program using Sara R. Johnson’s approach to normalizing muscle skills for feeding safety and speech
clarity.

3. In order to use this form in its entirety, it is critical that you have a complete understanding of the techniques and exercises
found in Oral-Motor Exercises for Speech Clarity, and Assessment and Treatment of the Jaw: Putting it all together: Senso-
ry, Feeding and Speech, both written by Sara Rosenfeld-Johnson. The following courses are also recommended for those
who wish to receive maximum benefit from these techniques: “A Three Part Treatment Plan for Oral-Motor (Muscle-Based)
Therapy,” “Advanced: Diagnosis and Program Planning For Clients With Muscle-Based Communication Disorders,” and
“Feeding Therapy: A Sensory Motor Approach,” all of which are available as live courses and on video. The step-by-step
instructions used in this assessment are covered thoroughly in these texts and courses.

4. The particular source(s) detailing an exercise is designated as follows, and noted at the bottom of Page 2 of the assess-
ment form:

All exercises are taught extensively in “Level 1: Oral-Motor Exercises for Speech Clarity,” available on DVD or as a live work-
shop through ITI/TalkTools®.

* Denotes exercises found in Oral-Motor Exercises for Speech Clarity

** Denotes exercises found in Assessment and Treatment of the Jaw: Putting it all together: Sensory, Feeding and Speech

^ Denotes exercises which are included with the corresponding tool when purchased through ITI/TalkTools®.

Suggestions to consider when performing this assessment:

1. If these techniques have not yet been included as part of your therapy program, you should first perform the assessment
on a typically developing individual. This will help you understand how individuals with normal muscle skills perform each
activity; once you understand what can be expected of a typically developing individual of the same chronological age,
you will be better prepared to identify what is abnormal. Example: If your therapy practice primarily consists of 7-year-old
children with multiple articulation disorders, you will first want to perform this assessment on a typically developing 7-year-
old with normal speech.

2. This form can be used as part of an initial evaluation, for intermittent re-evaluations and probes to note progress, or as part
of a discharge summary. These options are found at the top of the form (Client Status). When used every 3 to 6 months
for re-assessment, not only will you be able to develop a complete program plan based on the client’s individual skills, but
also chart progress as skills improve. Measurable progress is necessary to ensure the client is making steady progress
and should continue the program (thus justifying continued services) and also for insurance reimbursement.

3. It is important that the client is assessed in the best posture possible. Seating recommendations include using a chair
that supports the client and allows them to maintain a 90-degree angle in the chin, pelvis, knees and ankles throughout
the evaluation. Their feet should be placed on a firm surface at all times. Using a chair with a tray or table (on which the
hands can rest at midline) reduces the ability to compensate using the body rather than the oral musculature. Monitor to
ensure that this posture is maintained throughout the assessment.

Note: If you do not feel comfortable recommending therapeutic seating for your client, consultation with an
occupational therapist is recommended.

4. The therapist must be able to sit in front of the client, working face-to-face.

5. It is highly recommended that you videotape one or more of your initial assessments. At first it may be difficult to identify
all normal and abnormal movements while performing your evaluation and simultaneously transferring the information to

3420 N. Dodge Blvd., Suite 148 MDSS

Tucson, AZ 85716
Phone: 888-529-2879/Local: 520-795-8544
EC REP Burckhardtstr. 1
Fax: 520-795-8559 info@talktools.net 30163 Hannover, Germany
www.talktools.net
WARNING: Therapy tools should not be used without therapist or parent supervision.
Copyright ©2007 TalkTools® / Innovative Therapists International
TalkTools® Oral-Motor Skills for Feeding and Speech: Assessment and Treatment Form Page 2 of 4
this form. The ability to rewind and review the video gives you additional time to become familiar with the format, and also
allows you take more time observing the client before entering the results on the form. As your familiarity with the form
increases, this will no longer be necessary.

6. It is not necessary to perform your assessment in the precise order outlined on this form. Instead, use the form as a refer-
ence for which exercises may be included in a complete oral-motor assessment as well as a place to record your findings.

7. Note that some of the exercises in the Oral-Motor Exercise category require that a prerequisite is met before they can be
implemented.

A. Exercises designated No Prerequisite should be included in your initial assessment.

TalkTools® Bubble No Prerequisite:

Blowing Hierarchy*^: Yes___ No ______ Step:_____ Reps:______ Step # 8, 10 times
Comments:

B. Exercises that do include a Prerequisite can only be introduced once the prerequisite has been mastered.
Example: If the client has mastered Bite Block Jaw Height #2 and 3, “Tongue Depressor for Lip Closure” would be in-
cluded. If the client failed at Bite Block Jaw Height #2 or 3, the exercise would not be included because the prerequisite
has not been met.

Tongue Depressor Prerequisite: Completion of all Bite Block Exercises for Jaw Heights #2 and 3:
for Lip Closure*: Yes___ No___
Level 1: Single Tongue Depressor:____ Seconds: _____Reps:______
Level 2: Single Tongue Depressor with Pennies: ___ # of Pennies:____Seconds: ____Reps:____
Comments:

8. The Criteria For Success is listed to the right of each exercise and describes the requirements for completion of a given
exercise. Note: The Criteria For Success for each individual step of an exercise can be found in the texts and courses
discussed previously.
Criteria for Success
Slow No Prerequisite:
Feed**: Yes__ No___ # of chews: Left ___ Right ___ (Unit: Left__ Right__ or Bilat ___) Reps:____ 10 chews
per side

9. Two additional assessment forms have been included with this set to assist you in performing a jaw assessment. Follow-
ing the assessment and completion of these forms you will be able to transfer the “Highest level before failure” onto the
Oral-Motor form for concise record keeping.

o TALKTOOLS® JAW ASSESSMENT AND TREATMENT PROTOCOL FORM: This form further outlines the steps
for performing a complete jaw assessment and will assist you in transferring the results into a treatment plan.
o TALKTOOLS® JAW GRADING BITE BLOCK ASSESSMENT AND TREATMENT FORM: This form further out
lines the steps for performing the Jaw Grading Bite Block assessment.

Both forms are also taught in, and included as part of, Sara Rosenfeld-Johnson’s Assessment and Treatment of the
Jaw: Putting it all Together, Sensory, Feeding and Speech.

10. If the client reaches the Criteria for Success for any exercise during the assessment it will not be necessary to
include that exercise in their program plan. They already have the skills required to perform that task.

11. Other Exercises Less Commonly Used: This category (found toward the bottom of page 2 of the Assessment Form)
lists supplemental exercises that may be included as part of a therapy plan. If you find that these exercises may be ben-
eficial for your client, check “yes √ ”. Any findings can be recorded in the Notes/Observations section below the box.

Filling Out the Form:

1. SENSORY: In the Sensory category under the diagnostic terms are a list of therapeutic techniques that you may choose
to use to make your sensory diagnosis. Put a check mark next to the tool or tools that you plan to use in your therapy.
Once you perform your sensory assessment, check the appropriate box for the client’s sensory diagnosis.

o Example: Client diagnosis: Hypersensitive. In the diagnositic the client was able to tolerate Touch w/ Hands,
Sensory Bean Bags, and begin to use the Z-Vibe Green Round Tip with no vibration. The chart would be
completed as follows:

3420 N. Dodge Blvd., Suite 148 MDSS

Tucson, AZ 85716
Phone: 888-529-2879/Local: 520-795-8544
EC REP Burckhardtstr. 1
Fax: 520-795-8559 info@talktools.net 30163 Hannover, Germany
www.talktools.net
WARNING: Therapy tools should not be used without therapist or parent supervision.
Copyright ©2007 TalkTools® / Innovative Therapists International
TalkTools® Oral-Motor Skills for Feeding and Speech: Assessment and Treatment Form Page 3 of 4

SENSORY: Hyposensitive___ Hypersensitive √ Mixed___ Fluctuating___ Tactile Defensive ____ Normal ____
Touch w/ Hands^ √ Sensory Bean Bags^ √ Z-Vibe: Green Round Tip^ √ (on___off √ ) Yellow Tip^____ (on___off___) Toothette^_
Toothette w/ Vibrator^____ Bubble Hierarchy Step #1*^____ Casper Jiggler^_____ Gator Jiggler^_____ Ellie Jiggler^_____
Comments:

2. FEEDING: This category is included to allow the therapist to identifiy any feeding issues related to speech movements
as part of Sara Rosenfeld-Johnson’s therapy program. Each food texture (Purees, Solids, Liquids) includes levels of
exercise that facilitate movements used for both feeding and speech sound production. Lip closure, for example, is neces-
sary for spoon feeding as well as production of the bilabials /m/, /p/, and /b/. You will need to observe the client feeding
themselves first to identify how they use their muscles for feeding with each food consistency. A check mark will be placed
in one of the following boxes for each consistency:

A. Attempted ___: Indicates the client was observed eating the identified consistency during the evaluation and a thera-
peutic technique was attempted.
B. Not Attempted ___ : The client was not observed eating the identified consistency, refused to try the food, or did not
allow the therapist to attempt a therapeutic technique during the evaluation.
C. Normal Skill (no intervention needed)___: The client was observed eating the identified consistency during the
evaluation using normal skills, so no therapeutic technique was necessary.
D. No Purees, No Solids, or No Liquids Approved ___: The client’s diet does not permit him/her to eat the identified
consistency, or the client is not yet at the developmental stage for that food choice.
E. Completed ____: The client has completed all of the therapeutic techniques identified with that consistency. This will
never be checked during an initial assessment; it is included for use during a probe or discharge summary.

o Example: Purees: While observing the parent feeding the client, it was noted that a scraping motion toward the
upper lip was used to remove the puree from the spoon and the client’s tongue protruded for the swallow. When the
therapist placed the spoon on the lips laterally while giving jaw support (a therapeutic technique), the client pulled
his upper lip down to remove the puree. When the therapist supported the lower lip through the swallow (another
therapeutic technique), no tongue protrusion was observed. The client was able to perform this task 4 times
correctly; on the 5th attempt his upper lip would not move down and his tongue protruded despite therapist
intervention. This would be recorded by placement of check marks for Attempted and Level #1 (Side Placement)
and the number 4 would be noted under Reps as indicated below. This client would then be required to eat
spoonfuls at the beginning of each meal in the therapeutic manner. As skills are mastered, the client will be
required to increase this number in 1 repetition increments until the Criteria for Success has been met.

Purees: Attempted √ Did Not Attempt____ Normal Skill (no intervention needed) _____ lip closure/lip
No Purees Approved____ Completed _____ protrusion with
tongue retraction
Level #1 (Side Placement) √ Level #2 (Front Placement) ___ Level #3 (Spoon Slurp) ____ Reps:
4 habitually

o Example: Solids: The client is observed to have a preference for chewing on the left side of the mouth at the mid
point between the central incisors and back molars. When the therapist places a cubed solid on the right side back
molars (a therapeutic technique), the client is able to chew 2 pieces successfully before shifting the piece to the
stronger side on the 3rd attempt. On the form the therapist will check Attempted and Level #2 (Side Placement)
for the therapy technique. Because asymmetric jaw skill was identified, the Unit would be 2X Right (weaker side),
1X Left (stronger side) as indicated below. This client would then be required to eat 3 cubes in this therapeutic
manner at the beginning of each meal. As skills are mastered he will increase by 3 additional pieces per meal until
the Criteria for Success has been met.

Solids**: Attempted √ Did Not Attempt____ Normal Skill (no intervention needed) _____ Chews on back
No Solids Approved _____ Completed _____ molars on
Level #1 (Teach Chew) ___ Level #2 (Side Placement) √ Level #3 (Independent Placement) ___ alternating
(Unit: Left 1 Right 2 ) Reps: 1X sides habitually

o Example: Liquids: When talking with the parent it was identified that the 18 month old client only drank from a
Sippy Cup at home and was unable to drink from a straw. When the therapist introduced the Honey Bear the
client was able to close the lips and tolerate the therapist squeezing a small amount of liquid into the mouth while
giving jaw support with their non-dominant hand (therapeutic technique). The client was able to tolerate this
technique 4 times before liquid was observed leaking from the side of the mouth (failure). The therapist did not
observe cup drinking. On the form the therapist will check Not Observed under Bottle or Breast because neither
is being used. The therapist will check Attempted under Straw Drinking and place a check after Honey Bear
for the therapy technique targeted. Because the client was able to perform this task 4 times before failure, you will
enter the number 4 after Reps. Did Not Attempt would be checked under Cup Drinking.

3420 N. Dodge Blvd., Suite 148 MDSS

Tucson, AZ 85716
Phone: 888-529-2879/Local: 520-795-8544
EC REP Burckhardtstr. 1
Fax: 520-795-8559 info@talktools.net 30163 Hannover, Germany
www.talktools.net
WARNING: Therapy tools should not be used without therapist or parent supervision.
Copyright ©2007 TalkTools® / Innovative Therapists International
TalkTools® Oral-Motor Skills for Feeding and Speech: Assessment and Treatment Form Page 4 of 4

Liquids: Bottle ____ Breast _____ Not Observed √ Normal Skill _____ No Liquids Approved _____ Straw #8
Straw Drinking: Attempted √ Did Not Attempt____ Normal Skill (no intervention needed) _____ lip protrusion
No Liquids by Straw Approved _____Completed _____ with
Honey Bear^ √ Reps: 4 tongue retrac-
tion habitually
TalkTools® Straw Hierarchy*^: Straw # ____ Straw Cut:____ (#1 or #4) Reps: _____
Thickened Liquids*^: Straw A:___ Consistency:______ Straw B: ___ Straw C: ___ Straw D: ___

Cup Drinking: Attempted ___ Did Not Attempt √ Normal Skill (no intervention needed) ___
No Liquids Approved _____ Completed _____
Level #1 (Single Sip) ____ Level #2 (Repetitive Sip) ____ Level #3 (Independent) ____ Independent
Cup Drinking

3. ORAL-MOTOR EXERCISE: For each exercise you will be asked to place check marks or numbers in the appropriate
location. Refer to the example following item D for additional clarification.

A. Yes___ No____: Check Yes if the exercise will be included in the program plan. Check No if it will not.

B. Results of Evaluation: The requirements of this entry will vary from exercise to exercise depending on the technique
and the muscle being targeted. For each exercise you will indicate the highest level before failure by including the
number of repetitions the client successfully achieved.

C. Unit: In some exercises the client will be performing an exercise on only one side of their mouth, or on both sides but
with differing numbers of required repetitions. The following scenarios may be observed:

1. The client performs the exercise equally well on both the left and right sides of the mouth, but neither side is per
forming to norm. The Unit would then be (Unit: Left 1 Right 1 ).
2. The client performs the exercise more effectively on the right side than the left. The Unit would then be
(Unit: Left 2 Right 1 ), as the client’s skills are asymmetrical.
3. The client performs the exercise more effectively on the left side than the right. The Unit would then be
(Unit: Left 1 Right 2 ), again because the client’s skills are assymetrical.
4. The client performs the exercise with normal skill on the left side but demonstrates weakness on the right. The
Unit would then be (Unit: Left 0 Right 1 ), as the client’s skills are assymetrical with one side at norm.
5. The client performs the exercise with normal skill on the right side but demonstrates weakness on the left. The
Unit would then be (Unit: Left 1 Right 0 ), as skills are again asymmetrical with one side at norm.
If the client presents with normal skill on both sides the therapist would check “No___,” as the client has already
reached the Criteria for Success. In this case the therapy technique would not be included in the program plan.

D. Reps: Note the highest number of successful repetitions the client was able to perform without evidence of
compensatory posturing.
Example: The client has completed all three exercises using Jaw Grading Bite Blocks #2- 5. Because the prerequisite
for working on tongue tip lateralization has been met, the Tongue Tip Lateralization Tool can now be used for further
assessment, during which the client performed Step B with greater skill on the left side of the tongue than the right.
The exercise was performed successfully 3 times (twice to the left, once to the right) before the client was unsuccess-
ful on the right side. This indicates an asymmetry of skill, with the right side weaker than the left. On the form the
therapist would check “No” for the Tongue Tip Lateralization exercise and “Yes” for Tongue Tip Lateralization Tool
(indicating the exercise should be included in therapy). The therapist will then insert a “2” for Step. The Unit would
then be (Unit: Left 2 Right 1 ). The number of Reps would be noted as “3,” as that was the highest level before
failure:

Prerequisite: Completion of all Bite Block Exercises for Jaw Heights #2 through #5: Lateralization
Tongue Tip
of tongue tip
Lateralization: Tongue Tip Lateralization*: Yes____ No √
Midline to Either Side: Left ___ Right ___ (Unit: Left__ Right__ ) Reps:___ across midline
Across Midline: Reps:_____ left and right,
10 times
Tongue Tip Lateralization Tool^: Yes √ No____ Step #: 2 (Unit: Left 2 Right 1 )
Reps: 3
Comments:

E. Continue to use this system of checks and numbers to fill out all appropriate exercises as recommended in your client’s
program plan.

Remember that this is only a means to document the results of an assessment; it is not designed to teach you
how to perform the assessment. Additional information about performing a proper oral-motor assessment can
be found in the texts and videos described earlier.

3420 N. Dodge Blvd., Suite 148 MDSS

Tucson, AZ 85716
Phone: 888-529-2879/Local: 520-795-8544
EC REP Burckhardtstr. 1
Fax: 520-795-8559 info@talktools.net 30163 Hannover, Germany
www.talktools.net
WARNING: Therapy tools should not be used without therapist or parent supervision.
Copyright ©2007 TalkTools® / Innovative Therapists International