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ADULT HEAD AND NECK CANCER SPEECH/SWALLOWING HISTORY Forename: ___ Date of Birth: ___Reason for this evaluation: PreTreatment Evaluation Swallowing Communication Previous Speech/Swallow Evaluation:

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How to fill out speech and swallowing rehabilitation

01

Consult with a speech-language pathologist to determine the specific needs and goals for the rehabilitation process.

02

Attend regular therapy sessions to work on exercises and techniques designed to improve speech and swallowing abilities.

03

Practice daily exercises at home to reinforce the skills learned during therapy sessions.

04

Maintain open communication with the speech-language pathologist to track progress and make adjustments to the treatment plan as needed.

Who needs speech and swallowing rehabilitation?

01

Individuals who have experienced a stroke or traumatic brain injury that has affected their ability to speak or swallow.

02

Patients with degenerative neurological conditions, such as Parkinson's disease or multiple sclerosis, that have led to speech and swallowing difficulties.

03

People with vocal cord disorders or head and neck cancer that have impacted their ability to communicate effectively or swallow safely.

04

Anyone with developmental delays or cognitive impairments that have resulted in speech and swallowing challenges.

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What is speech and swallowing rehabilitation?

Speech and swallowing rehabilitation is a therapy program designed to help individuals improve their ability to communicate and swallow effectively.

Who is required to file speech and swallowing rehabilitation?

Speech and swallowing rehabilitation may be recommended by a healthcare professional, such as a speech-language pathologist or an otolaryngologist.

How to fill out speech and swallowing rehabilitation?

Speech and swallowing rehabilitation may be filled out by the referring healthcare professional or a licensed therapist providing the therapy.

What is the purpose of speech and swallowing rehabilitation?

The purpose of speech and swallowing rehabilitation is to improve communication skills and swallowing function in individuals with speech and swallowing disorders.

What information must be reported on speech and swallowing rehabilitation?

Information reported on speech and swallowing rehabilitation may include the patient's medical history, evaluation results, treatment goals, and progress notes.

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