Table 2.

Clinical features of oral motor and swallowing assessment (Case 2).

Oral-motor clinical assessment
Lip closure	Abnormal – parted lips at rest and reduced muscle strength
Tongue movement	Abnormal – reduced strength and mobility
Palatal elevation	Normal
Gag reflex	Normal
Voice quality (GRBAS-I)	Abnormal – (G1R0B0A1S0-I1) – vocal instability
Speech-motor control (speech intelligibility, prosody and articulatory precision)	Abnormal – reduced speech precision and intelligibility, decreased intonation pattern, irregular DDK

Nonverbal apraxia
Protruding the tongue	3
Blowing	3
Biting lower lip	3
Puckering lips	2
Coughing	2
Puffing out cheeks	1
Blowing a kiss	3
Alternating between puckering lips and smiling	2
Clicking the tongue	3

Swallowing clinical assessment
Tested for all food consistencies	Clinical signs: food retention in oral cavity; slower oral transit time; multiple swallowing - signs for solid and liquid; poor bolus ejection; altered cervical auscultation after swallowing and respiratory distress (liquid and puree). Observations: incoordination and difficulty in controlling the sips of water taken from the cup. Comments: food spillage from the mouth for all consistencies except solids
Swallowing functional Level	ASHA NOMS Level 5

Videofluoroscopic assessment of swallowing
Presence of penetration/aspiration (Figure 2)	Score 4