Voice Assessment For Adult Speech Therapy (2024)

What are the components of a voice assessment? And what can you do if you don’t have access to a specialized voice lab?

In this post, you’ll find practical tips for how to complete an informal voice assessment—plus helpful links to free PDFs and software.

For bestselling assessment templates and patient handouts and worksheets, check out The Evaluation Pack and Voice & Resonance Pack!

More Voice Articles

• Voice Disorders: How to Treat
• Vocal Function Exercises
• LSVT Loud vs SPEAK OUT!

How to Assess Voice

1. Case History

Gather information about the patient’s current medical status (medical diagnosis and onset date, medications, pain, etc.) and medical history (surgeries, chronic disorders, etc.)

Voice Questionnaire

• Do you have reflux? Is it being treated?
• Do you smoke (cigarettes, marijuana, etc.) If yes, how often?
• Are you often around people who smoke?
• Are you often in environments with smoke, chemicals, or allergens?
• Please describe your voice problem. What are the symptoms of your voice problem? When did it first begin?
• Have you been treated for your voice problem before? What was the treatment? What was the outcome of the treatment?
• Does your voice problem impact your ability to communicate in everyday life? How?
• How many cups of water do you drink every day?
• How many cups of caffeine do you drink every week?
• How many servings of alcohol do you drink every week?
• On an average day, how much demand do you put on your voice?
  • Rarely talk for long periods/raise voice
  • Sometimes talk for long periods/raise voice
  • Consistently talk for long periods/raise voice

2. Assess Oral Mechanism & Diadochokinetic Rate

Oral Mechanism Examination

Observe strength, range of motion, speed, and symmetry of the following:

• Mandible(CN V):
  • At rest
  • Open
  • Open with resistance
  • Close
  • Close with resistance
  • Lateralize
  • Protrude
  • Retraction
  • Sensation
• Lips(CN VII):
  • At rest
  • Protrude
  • Retract
  • Repetitive protrude/retract
  • Puff cheeks
  • Puff cheeks against resistance
  • Sensitivity to touch
  • Sensation
• Tongue(CN XII):
  • At rest
  • Protrude out
  • Protrud out with resistance
  • Protrude up
  • Protrude up with resistance
  • Protrude down
  • Protrude down with resistance
  • Lateralize
  • Lateralize with resistance
  • Retract
  • Lick teeth
  • Lick lips
  • Sensation
• Velum:
  • At rest (CN IX)
  • Prolonged “ah” (CN X)
  • Repetitive “ah” (CN X)
  • Sensation
• Reflexes(CN IX, X):
  • Gag
  • Faucial arches
• Other Observations
  • Dentition
  • Raise eyebrows (CN VII)
  • Breath support
  • Oral mucosa
  • Cough on command
  • Throat clear on command

Diadochokinetic Rate

Prompt the patient to say the following sounds as quickly and clearly as they can for 15 seconds each. They will repeat each 3 times.

“puh puh puh”

“tuh tuh tuh”

“kuh kuh kuh”

“puh tuh kuh”

You can compare their DDK rate with norms.

3. Assess Respiration

Breathing Patterns

Record your observations about the patient’s breathing patterns.

For example: “quick inhale”, “slow controlled exhale”, “clavicular vs abdominal breathing”, “holds breath,” etc.

Maximum Phonation Time (MPT)

• Prompt the patient to say ‘ah’ for as long as they can. They should use their normal loudness. Record their time in seconds
• Have them repeat this 3 times. Their MPT is the longest of the 3 trials
• You can compare their MPT with norms

S/Z Ratio

1. Have the patient say ‘sss’ for as long as they can, recording their time in seconds
2. Have them repeat this 3 times. Note their longest trial
3. Next, have the patient say ‘zzz’ for as long as they can, recording their time in seconds
4. Repeat this 3 times, noting their longest trial
5. Divide their longest /s/ trial over their longest /z/ trial for their s/z ratio
6. You can compare their s/z ratio with norms

Shimmer, Jitter, & Noise-To-Harmonics Ratio

Record a voice sample. Obtain the appropriate permissions before recording the patient.

Ask your patient to say “eee” for 4 seconds using their typical pitch and loudness. Record pitch (Hz) and repeat for a total of 15 trials. Analyze the voice recordings using voice software (i.e. Praat).

You can compare their results with norms.

Habitual Pitch

• Record your patient’s voice
• Ask the patient to repeat after you (see sentences below)
• Measure pitch using a device or software (digital orchestral tuner, Visipitch, pitch pipe, etc.)
  • Modal pitch
  • Lowest pitch
  • Highest pitch
  • Average pitch

Does anyone know how many calories are in a bag of popcorn?

My mom meant well but made wrong turns while driving.

4. Assess Voice Quality

For this portion of the assessment, record another voice sample. Transcribe the patient’s responses, as appropriate, and note your observations

• Word list (either repetition or have the patient read a prepared list aloud)
• Sentences: “Tell me about your speech. Tell me about your voice. What are your speech strengths? Weaknesses?”
• Read paragraph: Ask the patient to read a paragraph aloud (i.e. Rainbow Passage)
• Monologue: Ask the patient about their career, hobbies, family, etc. Or to describe a visual scene (i.e. Cookie Theft Picture)

Voice Quality: What To Measure

• Overall Severity: Your overall impression of the voice problem
• Roughness: Vocal irregularity
• Breathiness: Audible air escape in voice
• Strain: Excessive vocal effort
• Pitch: Deviance from a patient’s normal pitch, given their gender, age, and cultures
• Loudness: Deviance from a patient’s normal loudness given their gender, age, and cultures. Including whether too soft or loud.
• Additional Features: such as diplophonia, aphonia, pitch instability, tremor, vocal fry, falsetto, and wet/gurgly quality

Use ASHA’s Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) to measure voice quality.

5. Assess Resonance

Ask your patient to read aloud or repeat words that do not contain nasal sounds (see examples below).

• Hypernasality: your patient may have hypernasality if you hear nasal sounds during these trials
• Hyponasality: ask your patient to complete the trials twice, once while plugging their nose and once without. They may have hyponasality if you hear a difference between the two trials
• Nasal air emission: place a dental mirror under your patient’s nostril during the trials. They may have nasal air emissions if the mirror fogs up.

Say, “oooo”

Say, “eeee”

Say, “papa bear blows bubbles”

Say, “give us the goods or get out!”

Free! Voice Assessment Resources

• Praat Software
• CAPE-V
• Voice assessment norms
• Max phonation time norms
• DDK rates norms
• ASHA’s Voice Evaluation Template
• Rainbow Passage

More Voice Resources

References

• _{American Speech-Language-Hearing Association (2009). Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). https://www.asha.org/siteassets/uploadedfiles/asha/sig/03/cape-v-procedures-and-form.pdf}
• _{American Speech-Language-Hearing Association. (n.d.). Voice Evaluation Template. https://www.asha.org/siteassets/practice-portal/aatvoiceevaluation.pdf}
• _{American Speech-Language-Hearing Association. (n.d.).Voice Disorders[Practice portal].https://www.asha.org/practice-portal/clinical-topics/voice-disorders.Rerieved May 24, 2023.}
• _{Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.}
• _{University of Washington Department of Speech and Hearing Sciences. (n.d.). Voice Intake Form. https://sphsc.washington.edu/sites/default/files/documents/Voice%20Intake%20Form_Questionnaires_Fillable_101119.pdf}