Post on 25-Oct-2015
description
PROFORMA FOR FLUENCY DISORDERS
Name: Client.No: Date:
Age/Gender: Student clinician: Informant:
Mother tongue:
Presenting complaint:
Onset/Nature of the problem:
Family history:
Reaction to the problem:
Variation in stuttering:
Sound/ word/ language specificity:
Situation specificity:
Individual specificity:
Word position specificity:
Consistency in errors:
Anticipatory behaviour:
Avoidance behaviour:
Coping mechanism (if any):
OSME:
Language skills:
Secondary language skills:
Speech skills:
Respiration:
Phonation:
Articulation:
Prosody:
Rate of speech:
Intelligibility of speech:
Components of stuttering:
Core behaviors: Reading/conversation:
Secondary behaviors:
Feelings and attitudes:
Naturalness of speech:
Tests administered:
Results:
Severity of the problem:
Previous history of treatment:
Provisional Diagnosis:
Recommendations:
Signature of the Staff:
KUNNAMPALLIL GEJO JOHN