Free Speech Therapy Feeding Evaluation Template
Speech Therapy Feeding Evaluation
[YOUR COMPANY NAME]
Date: [ Insert Date]
Introduction: Feeding challenges, caused by factors such as anatomical issues, sensory sensitivities, and motor coordination or behavioral problems, can affect regular diet, nutritional intake, and social interactions during meals. The Feedback and Improvement Evaluation form serves as a systematic tool for assessing and monitoring feeding skills over time.
Purpose: This Speech Therapy Feeding Evaluation aims to appraise and guide an individual's feeding skills for improvement by focusing on physiological and behavioral factors. It identifies areas of strength and development to shape therapy interventions for enhanced feeding function.
Evaluation Criteria
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Oral Motor Skills: Assess the strength, coordination, and movement patterns of the lips, tongue, and jaw during feeding.
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Sensory Responses: Evaluate the individual's reactions to different textures, temperatures, and tastes of food items.
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Swallowing Function: Determine the efficiency and safety of the swallowing process, including the presence of any signs of dysphagia.
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Mealtime Behavior: Observe behaviors exhibited during mealtime, such as attention span, distractibility, and engagement with food.
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Self-Feeding Skills: Assess the individual's ability to manipulate utensils, grasp food items, and self-feed independently.
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Nutritional Intake: Review dietary preferences, intake patterns, and nutritional adequacy of the individual's diet.
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Parent/Caregiver Feedback: Solicit input from parents or caregivers regarding feeding challenges, strategies used at home, and observations of progress.
Instruction: Select the appropriate score from the rating scale provided based on the observed level of impairment or function.
|
Rating Scale |
Description |
|---|---|
|
1 |
Severe impairment; significant intervention required. |
|
2 |
Moderate impairment; intervention needed. |
|
3 |
Mild impairment; some intervention may be beneficial. |
|
4 |
Minimal impairment; little to no intervention needed. |
|
5 |
Normal function; no impairment observed. |
Evaluation Table
|
Criteria |
Rating(1-5) |
|---|---|
|
Oral Motor Skills |
|
|
Sensory Responses |
|
|
Swallowing Function |
|
|
Mealtime Behavior |
|
|
Self-Feeding Skills |
|
|
Nutritional Intake |
|
|
Parent/Caregiver Feedback |
Additional Comments and Notes
|
Comments |
|---|
