SPEECH EVALUATION PROTOCOL (González R. and Toledo L.

, 2000)

Required materials: Flashlight, Recorder, Stopwatch, Glatzel's Mirror, Language Guide, Word List, “Grandpa” Text.

1 2 3 4 5
Normal Mild Deficiency Moderate Deficiency Moderate to Severe Severe deficiency
Deficiency
Y PMB
O
.
1.1. Produce an /s/.
The user is asked to make the phoneme /s/ and the duration is measured with a stopwatch, where it can be classified:
1. BREATH
1 2 3 4 5
20-30 seconds 15-19 seconds 10-14 seconds 1-9 seconds 0 seconds

Maximum duration /S/ (Eckel & Boone, 1981) X= 17.7 (7.6) sec.
Range: 5 - 38 sec. (both genders)

The characteristics of breathing are observed:

Normal Inspiration-forced expiration Audible inspiration. 1

Breathing type:
High cost n Diaphragmatic cost Abdominal 1

Mode:
Nasal n Oral 1 Mixed
1
Correction Guide Table: Score assigned to each aspect according to degree of implication on respiratory function. They
are listed from 1 to 4, from the least to the most influential in the proper respiratory process.

Aspects evaluated Score

Characteristics of respiration (CRE) 1
Produce an /s/ (PRO) 2
Respiratory type (TRE) 3
Respiratory mode (MRE) 4

Below are the characteristics that can be observed in each of the aforementioned aspects. The score assigned in this
case ranges from number 1 to 3, which means that number 1 indicates normality, number 2 indicates alteration (forced
inspiration-expiration) or pattern (type and respiratory mode) and number 3 indicates inefficient respiratory mode. in
breathing.

CRE= Normal (1) Inspiration – forced expiration (2)

PRO= It is measured in seconds (quantitative) through a stopwatch (see annex 5) and the score is given according to
the result, which is marked on the guideline.
TRE= abdominal (1) Cost-diaphragmatic (1) Costal-high (2)
MRE= Nasal (1) Mixed (2) Buccal (3)

1
The procedure to obtain the final score with the scores described above is as follows:
1. Obtain the result of the evaluation by assigning the relevant score to each aspect of breathing (1,2,3,4) and do
the same with the characteristic observed in the corresponding case.
2. The scores for each aspect of breathing are then multiplied with the corresponding characteristic that was
observed.
3. Next, the scores obtained from the multiplication are added.
4. The amount of score is observed in the performance evaluation table and the grade is established.

Performance rating
Degree Scores and Ranks
Normal 9 points
Mild 10 – 15 points
Moderate 16 – 21 points
Moderate – Severe 22 – 27 points
Severe 28 – 33 points

Example of the procedure to obtain degrees of respiratory alteration

Point 1 Point 2 Point 3 Point 4
Breathing with normal CAR = 1 x 1 = 1 1 + 6 + 6 + 8 = 21 points The result (21 points) is
characteristic (1) PRO = 2 x 3 = 6 observed in the table and it is
Production of an /s/ with moderate TRE = 3 x 2 = 6 determined that
difficulty (3) MRE = 4 x 1 = 8 corresponds to the moderate
High costal respiratory type (2) range of the
Mixed breathing mode (2) breathing.

2. PHONATION
2.1. The patient is asked to make the phoneme /a/ and is classified from 1 to 5.

2.2. TMF /a/

It corresponds to the greatest amount of time in which the sustained emission of a sound can be made after taking a
deep breath . Its assessment allows us to study both the efficiency of glottic closure and the efficiency of the respiratory
system in general.

In the case of the Rafael González and Toledo pattern, the authors consider that a maximum adequate phonation time
for the emission of the letter /a/ is 15 to 25 seconds.

2.3. Produce intense /a/:

The patient is asked to perform an intense /a/ and is classified from 1 to 5.

Features of phonation
Quality Normal Forced- strangled blown Wet Shaking
Tone Normal tonal breaks Low High
Intensity Normal Weak Increased

Score guide table assigned to each aspect according to the degree of implication in the phonatory function. Scores 1
and 2 are recorded, with 1 being the least influential and 2 being the most influential in the proper phonatory process.

Aspects evaluated Score

Start an /a/ (INI) 2
Maximum speaking time (MTF) 1
Produce an intense /a/ (PRO) 2
Speech quality (CAL) 1
Tone (TON) 2
Intensity (INT) 2

2
 CAL = Normal(1) Forced-Strangled-Blown-Rough and Trembling (2)
TON = Normal(1) Tonal Breaks, low and high (2)
INT = Normal(1) Weak and Increased (2)

The procedure to obtain the final score is the same as that presented in the Respiration item.
Performance rating
Degree Scores and Ranks
Normal 10 points
Mild 11 – 15 points
Moderate 16 – 21 points
Moderate – Severe 26 – 30 points
Severe 31 – 35 points

3. RESONANCE
3.1. The veil is observed at rest , where it is designated if it is found:
Yo Normal -YO Unilateral paralysis DI Unilateral paralysis I bilateral
paralysis
3.2. . Movement of the veil when producing an /a/:
It is classified from 1 to 5

3.3. Produce word pairs

/mata- bata/ 1 /bad- bullet/ 1 /moto-boto/ 1

Resonance characteristics:
Normal 1 Hypernasal ] Hyponasal 1 Nasal emission 1 Short utterances 1

Guide table correction score assigned to each aspect according to degree of implication in the resonance. E records
scores 1,2,3,4, from the least to the most influential in Resonance.

Aspects evaluated Score

Veil at rest (REP) 1
Velar movement in an /a/ (MOV) 3
Produce word pairs (PRO) 2
Characteristics of Resonance (CAR) 4

REP = Normal (1) PU = Unilateral Paralysis (2) PB = Bilateral Paralysis (3)

MOV = Only numbers from 1 to 5, depending on the degree of difficulty.
PRO = Only numbers from 1 to 5, depending on the degree of difficulty.
CAR = Hypernasal or Hyponasal (2)

The procedure to obtain the final score is the same as that presented in the breathing item.
Performance rating
Degree Scores and Ranks
Normal 10 points
Mild 11 – 17 points
Moderate 18 – 24 points
Moderate – Severe 25 – 31 points
Severe 32 – 36 points
4. Oral Motor Control and Articulation
• Oral movements:
The evaluation of oral movements allows us to obtain relevant information in relation to speech production, because it
provides a global vision of the functioning of the OFA, responsible for the execution of the sounds that compose it.
Another advantage of this type of evaluation procedure is that it makes it possible to observe oral motor functioning in
specific actions, free of “linguistic restrictions”, an important element if one thinks that the above can facilitate the

3
differential diagnosis between cases compromised at the programming level. speech motor and those linked to
Bilabial
ou
execution.
4 3.5 Produce /pal 1 2 3 4
U
4.3.6 Produce series /pa/: 1 2 3 4
The estimation of the strength,
4 3.7 produce/dad/ /pipe/: speed,
1 regularity, accuracy
2 and range3 of this type of4 movements, as
U well as the
U
observation of muscle
4 3.8 Produce wrongtone, both in1its voluntary performance
2 and in the3 maintenance of static
4 postures, correspond
U to
4 3.9 Produce series /bad: 1 2 3 4
determining characteristics
4 3.10 Prod /mom//mima/: in the diagnosis
1 of the pathology,
2 hence its importance
3 in clinical
4 evaluation. This
ou is because
m
possible4variations in the mentioned components
3.11 Prod A statement: /my momrepresent
spoils me/ a sensitive indicator of the presence of motor U disorders;
1 2 3
This is how, for example,
4 3.12 Produce /ba/: variations 1 in tone can be observed
2 in those pathologies
3 that compromise
44 different
u
U
levels of
motor processing,
4.3.13 produce both
seriescentrally
/bal and
1 peripherally, involving
2 structures3such as the neuromotor 4 plate, motor
on neurons,
4.3.14 Produce /bobo/ /drink/ 1 2 3 4 ou of severity,
nerve fibers and muscle fibers. These alterations can compromise speech function in different degrees oU
manifesting in increases
4 315 Produce/fa/ or decreases
1 in tone, as occurs
2 in some types 3 of dysarthria. From4 this perspective,
U the need
U
arises to have standardized measures in relation to the aforementioned components, which reflect the Ureality of the
4 316 Produce series /fa/ 1 2 3 4
4.3.17
population produce
studied. /fofo/ /fifa/:
Although 1
the present study does 2not intend to provide 3 4
qualitative information on theinvariations of
in
these and4 4other components, it is worth highlighting the influence of these variables on the quantitative aspects
Language: in
of the
4 41 Protrude (Dev. GAVE ): 1 2 3
evaluation of oral motor skills, since they can impact the number of movements that an individual is capable 4 in of doing in
a certain4 time.
4.2 Retract:
The above corresponds 1 to an aspect worth 2 considering, 3since the speed of4oral movementsin in
corresponds
4 4.3 Move right: 1 2 3 4
to a fundamental trait
4 4 4 Move left: at the articulatory
1 level, with2 special repercussions
3 at the level4 of fluency. This
in measure is
in
determined
4 4.5in a special way by the 1amplitude of movements,
Above: 2 tone and 3muscle strength, which 4 is why it represents
in
one
4 4 6 Below:
of the elements most susceptible to1 being affected in2the pathology, due 3 to the confluence 4 of factors thatin intervene in
In 5 seconds:
its manifestation. The observation of this parameter and its specific quantification in relation in
to the movements of the
4 4.7 Protrude and retract: 1 (18-25) 2(14-17) 3 (8-13) 4 (1-7) in
different4 perioral organs
4 8 Right and Left: therefore deserves
1 (18-25) special consideration.
2(14-17) Once again,
3 (8-13) there is a need
4 (1-7) to standardize
in these
in
parameters
4 4.9inUprelation
and down: to the population
1 (18-25)studied, in 2(14-17)
order to establish3 limits
(8-13) of normality that can be used
4 (1-7) in in clinical
practice.Upper Postdentals: 4 4.10 in
Produce/da/ 1 2 3 4 in
4 4.11 Produce series/da/: 1 2 3 4 in
4.1.4 4.12
Expensive.
Produce/given//doubt/1 2 3 4 in
in
4.1.1.
4 4.13Resting:
Produce Hat 1 2 3 4 in
Yo 4 4.14 Produce series /ta/
Normal 1
-YO Unilateral weakness2 DI Unilateral weakness
3 4
II Bilateral weakness I in
4 4.15 Produce /tata//tito/ 1 2 3 4 in
Lower Postdental: in
4.1.2.
4 4.16Smile:
Produce/sa/: 1 2 3 4 in
in
Yo Normal
4 4.17 -YO Raises
Produce series /sa/: 1 die DI only Raises
2 side II only Does
3 not raise both 4sides I
in
4 4.18 Produce /susi/ /seso/ 1 2 3 4 in
Alveolar:
4.2.4 4.19
JawProduce/na/: 1 2 3 4
4.2.1.
4 4.20Open:
ProduceScored
series from
/na/ 1 to 1 5 2 3 4
4 4.21Close.
4.2.2. Produce/lullaby//baby/1
It is scored from 1 to 5 2 3 4
4 4.22 Produce /la/: 1 2 3 4
4 4.23 Produce series /la/: 1 2 3 4
4.3.4 4.24
Lips:Produce /lolo/ /lila/ 1 2 3 4
4.3.1.
4 4.25Protrude:
Produce /ra/Scored from1 1 to 5 2 3 4
4 4.26Retract:
4.3.2. Produce series
Scored/ra/from 11 to 5 2 3 4
4 4.27 Produce /rare/ / rorro/ 1
4.3.3. Close for 5 seconds: Scored from 1 to 5 2 3 4
4.3.4.
palatalOpen and close for 5 seconds:
4 4.28 Produce /ya/: 1 2 3 4
4 4.29 Produce series /ya/: 2
Performance rating 3 4
4 4.30 Produce /yaya/ /yoyo/ 1 2 3 4
4 4.31 Produce/na/: 1 Degree 2 3 Scores and Ranks4
4 4.32 Produce series Normal /ña/: 1 2 3 15 -20 points 4
4 4.33 Produce/ñaña//ñoño/:
Mild 1 2 3 10 – 14 points4
4 4.34 Produce /cha/: 1 2 3 4
Moderate
4 4.35 Produce series /cha/. 1 2 3 5 - 9 points 4
Moderate – Severe
4 4.36 Prod /chicha//checho/:1 2 3 1 - 4 points 4
Velars Severe 5 points
4 4 37 Produce fjal: 1 2 3 4
4 4.38 Produce series /ja/: 1 2 3 4
4 4.39 Produce /haha/ 1 2 3 4
4 4.40 Produce ika/: 1 2 3 4
4 4.41 Produce series/ka/: 1 2 3 4
4 4.42 Prod /cake/ /cuckoo/: 1 2 3 4
4 4 43 Produce/gal: 1 2 3 4
4 4 44 Produce series /ga/: 1 2 3 4
4 4.45 Produce /guagua/: 1 2 3 4

4
5
4 5 Diphones
Consonants 1 2 3 4 5
4.5.1 Produce: /blouse/ /nail/ /skinny/ /balloon/ /plate/ /atlas/ /arm/ /cream/ /front/ /grain/
/prisoner/ /train/ /dragon/
Vowels 1 2 3 4 5
4 5 2 Produce /piano/ /lay/ /foot/ /king/ /city/ /beret/ /quota/ /louse/ /rheumatism/
I went/ /gentle/ /pattern/ /new/

Oral Motor Control and Articulation: All points are added to obtain a total. Diadochokinesias are also included.
Performance rating
Degree Scores and Ranks
Normal 10 points
Mild 11 – 17 points
Moderate 18 – 24 points
Moderate – Severe 25 – 31 points
Severe 32 – 36 points
4.8 Reading: 1 2 3 4 5
4.8.1 read the reading “The Grandfather”:
“You want to know about my grandfather. Well, he is nearly ninety-three years old and still thinks as lucidly as ever. He dresses
himself, and puts on his old black jacket that usually has several fewer buttons.
A long beard hangs from his face, inspiring those who observe him with a deep feeling of respect. When he speaks and his voice
seems a little broken and shaky.
Twice a day, he enjoys skillfully playing a small organ.
Every day, Grandpa takes a short walk, except in the winter when rain or cold prevents him from doing so.

Reading time: ____________________ sec.

Speaking speed in reading per minute: X= 6,060 / _____________ reading time in sec. / ___________ words per minute

For the reading evaluation: the therapist must have the text of the grandfather's reading printed in large print, where
the time it will take the patient to read the text must be measured with a stopwatch.
In order to calculate the speed of speech in reading: The number of words per minute that the patient was able to utter
while reading the text “The Grandfather” is obtained. This number is obtained by multiplying the total time spent
reading the text, measured in seconds, by a constant c = 6060, which represents the transformation of the measurement
in seconds to minutes, calculated by multiplying the total number of words contained in the text (101 words) for 60sec.
According to Kent, the normal reading speed is 100 words per minute, which was determined in English speaking.

Number of words = 101 words per minute

Approximately, the time it takes for normal speakers to read this text aloud is 31 to 40 seconds.

4.9. Diadochokinesias : Scored from 1 to 5

4.9.1. Produce /pa- ta-ka/: Scored from 1 to 5
4.9.2. Serial production /pa- ta-ka/: Scored from 1 to 5
4.9.3. Production /pituco/ /petaca/: Scored from 1 to 5

• Oral diadochokinesis: Diadochokinesis corresponds to antagonistic movements carried out in a rapid sequence17,
representing a form of rhythmic movement that consists of a closed to open circuit, that is, the presence of rapid
arbitrary movements that are not retroactively coupled at a sensory level, contrary to what happened in slow
movements. Given its rhythmic nature, both the cerebellum and the basal nuclei participate in its execution. Pereira et
al.13 have highlighted “the importance of phonoarticulatory diadochokinesis as a tool in the evaluation of motor control
in neurological cases.” Currently, research continues to be scarce and most of the studies involved are oriented towards
pathology, because the variations in its production rate correspond to a sensitive indicator that reveals “structural and
physiological changes in the central nervous system and in the peripheral components of oral mechanisms and speech
production”15. In this way, the perceptual analysis of the production of fast syllabic sequences corresponds to a
common diagnostic procedure for motor speech disorders, allowing the study of articulation deficits in particular,
especially through oral diadochokinesis based on combination of plosive sounds with the vowel /a/ through the syllables
/pa-ta-ka/.
According to Lotze, what happens in the particular case of the series /pa-ta-ka/ is that its structure combines in the same

6
direct syllable, aphonic plosive consonant sounds with the voiced vowel sound of /a/, which implies the generation of a
“powerful closure of the air” followed by its subsequent release. Some characteristics described by this author and his
collaborators about the execution of said sequence include difficulties at the level of bilabial movements during the
production of the syllable /pa/, as well as the movement of the lingual apex in /ta/ and the back of the tongue in the
syllable /ka/. Other studies have focused on the search for differences in oral diadochokinetic productions between
various groups of adults, which have provided some evidence about the functioning of this type of movement in normal
subjects. Among these investigations, it is worth mentioning a study carried out by Portnoy and Aronson in 1982,14 who
compared the production of the syllables /pa/, /ta/ and /ka/ between normal adults and patients with spastic and ataxic
dysarthria, in which the results obtained in the group of normal subjects they showed an average of 155.3, 163.9 and
174.4 ms for the syllables /pa/, /ta/ and /ka/, respectively, in a total of 30 subjects. Although the objective of the study
was not to obtain normative values in diadochokinetic production, it corresponds to one of the few references of this
phenomenon found in the literature.
Tiffani (1980) found that in the production of the syllables /pa/, /ta/ and /ka/ adults without speech pathology produced
an average of 7.1; 7.1 and 6.2 syllables per second respectively. That is, 35.5, 35.5 and 31 syllables in 5 seconds.
Furthermore, within the same study, the author found that for the series /pata-ka/ 2.5 syllables per s would be
produced, that is, 12.5 series in 5 s. On the other hand, it seems interesting to highlight the existence of comparative
studies between groups of adults of different ages, which have provided empirical evidence about the production of oral
diadochokinesis and its age-related changes.

Produce /pa/-/ta/-/ka/
Maximum output per second, Kent, Kent and Rosenbeck (1987):
/da/ X = 6.3 (0.7) Min.= 5.0 (0.4) Max= 7.1 (1.2)
/ta/ X = 6.2 (0.8) Min.= 4.8 (0.4) Max= 7.1 (1.2)
/ka/ X = 5.8 (0.8) Min.= 4.4 (0.6) Max= 6.4 (1.1)

Produce series /pa-ta-ka/

/pa-ta-ka/ X = 5.0 (0.7) Min.= 3.6 (0.3) Max= 7.5 (1.3)

4.10. automatic speech

The evaluation of automatic speech is carried out at a clinical level with the purpose of comparing the subject's
performance in this type of production and in those originating from voluntary speech. When the difference in
performance between both types of production is evident, the presence of voluntary automatic dissociation is verified,
which corresponds to a classic sign related to alterations in speech motor programming, as occurs in Apraxia of Speech.
This type of production can be evaluated through the repetition of series, the elaboration of which does not require
voluntary processing; The above occurs when said utterances or sequences, as the case may be, are known by the
subject who produces them, corresponding to information already stored, which implies that the motor engrams are
already previously established at a central level. This makes it possible for access to said content at the time of execution
to be an easier task compared to that required in the case of voluntary executions. The numerical series, days of the
week, months, among others, correspond to some examples of automatic speech.

Joint features:
Vowels:
Normal Distortion ] Extension Bankruptcy 1
1
Consonants:
Normal Distortion ] Extension Bankruptcy 1
1

7
Repetition of syllables: Yes/no
Word repetition: Yes/no
Joint features:
Vowels: NormalDistortion Extension Bankruptcy
Consonants: NormalDistortion Extension Bankruptcy
Syllable repetition: Yeah No Word repetition: Yeah No

5. Prosody: 1 2 3 4 5
Monointensity: Yeah No
Monotony: Yeah No
Excessive variations in intensity: Yeah No
Box office: Yeah No
Bradilalia: Yeah No
Brief rushes when speaking: Yeah No
Inappropriate silences: Yeah No
Excessive and uniform accentuation: Yeah No

When the characteristic is absent, the alternative is NO and a value of 1 is given. Meanwhile, when it is present it is Yes
and a value of 2 is assigned. Meanwhile, the values established for each of the aspects range from 1 to 3, in which the
lower number indicates that it is the least influential and thus increases according to the implication in the prosody.

Aspects evaluated Score

Monointensity (MOI) 3
Monointensity 3
Excessive Intensity Variations (EVI) 1
Taquilalia 2
Bradilalia 2
Brief rushes when speaking 1
Inappropriate silences 1
Uniform Excessive Accentuation 1

Performance rating
Degree Scores and Ranks
Normal 14 points
Mild 15 – 17 points
Moderate 18 – 20 points
Moderate – Severe 21 – 22 points
Severe 23 – 24 points

In the case of Taquilalia (TAQ) and Bradilalia (BRA), both cannot be given together in the same person, therefore, only
one of the two is considered to obtain the total score.
Example:
MOT MOI EVI BPH SIL AEU TAQ or BRA
3x2 = 6 3x2 = 6 1x2 = 2 1x2 = 2 1x2 = 2 1x2 = 2 2x2 = 4

TOTAL = 24
This score (24) corresponds to the severe range of Prosody.

6. Intelligibility: 1 2 3 4 5
6.1 Words: 1 2 3 4 5
6.2 Prayers: 1 2 3 4 5
6.3 Paragraph (reading): 1 2 3 4 5
6.4 Conversation: 1 2 3 4 5

7. Oral sensitivity: 1 2 3 4 5

8
 II. Synthesis:
1. Breathing: 1 2 3 4 5
2. Phonation: 1 2 3 4 5
3. Resonance: 1 2 3 4 5
4.C. Mot. Oral and Art.: 1 2 3 4 5
5. Prosody: 1 2 3 4 5
6. Intelligibility: 1 2 3 4 5

Obtaining final scores/Synthesis:

Once the scores are obtained in each of the basic motor processes, the final score of the severity of the Dysarthria is calculated in
each of the cases.

Procedure:
1. The scores obtained in each of the evaluated items are added.
2. An average is taken, considering the five sections (Breath, Phonation, Resonance, Articulation – Oral Motor Control and Prosody).
3. Depending on the result obtained, the severity is assigned as the case may be.

Performance rating
Degree Scores and Ranks
Normal 5 points
Mild 6 – 13 points
Moderate 14 – 16 points
Moderate – Severe 17 – 18 points
Severe 19 – 21 points

Dysarthria: Yeah No Degree l M Yes Guy:

Apraxia of Speech: Yeah No Degree l M Yes
Oral Apraxia: Yeah No Degree l M Yes
Phonatory apraxia: But :

III. Observations:

Phonatory Apraxia: Acquired inability to initiate phonation as a result of brain damage in the absence of a neuromotor
disorder.

Apraxia of Speech: Acquired speech disorder that affects articulation and prosody due to brain damage. The ability to
spatially and temporally program the movements of the speech muscles is altered.

Oral Apraxia: Disorder acquired as a result of brain damage. It can be considered a type of ideomotor apraxia,
characterized by an inability to perform voluntary orolinguofacial movements, with the preservation of automatic and
reflex activities.