Appendix

Survey Questions

1.  How many years have you been practicing in the field of speech pathology?

a.  0 - 5

b.  5 – 10

c.  More than 11

2.  What percentage of all your patients are head & neck cancer patients?

a.  10 %

b.  10-25 %

c.  More than 25 %

3.  Do you consider Tongue Strength as one of several predictors of speech and swallow functioning in oral and oropharyngeal cancer patients after treatment?

a.  Yes

b.  No

Comment: ______

4.  Do you assess tongue strength?

a.  Yes

b.  No

Comment: ______

5.  How do you assess tongue strength?

a.  IOPI

b.  Kay Pentax swallow signals tongue bulbs

c.  Tongue depressors (Clinical Judgment)

d.  Both a & b

e.  Both a & c

f.  All of the above ( a, b & c )

g.  Other

h.  Does not apply

If other, then specify: ______

6.  If you do use a tool to assess tongue strength then at what cut off score would you typically recommend tongue strengthening exercises to improve speech and swallowing in patients after oral and oropharyngeal cancer treatment?

a.  Less than 30 kPa (225 mmHg)

b.  More than 30 kPa (225 mmHg) but less than 50 kPa (375 mmHg)

c.  Always recommend exercises , irrespective of tongue strength

d.  Decision to administer tongue exercise is solely based on clinical judgment using a tongue depressor (i.e Independent of tongue strength score )

e.  Does not apply

Comments: ______

7.  Do you consider Tongue Range of Motion as one of several predictors of speech and swallow functioning in oral and oropharyngeal cancer patients after treatment?

a.  Yes

b.  No

Comments:______

8.  Do you assess tongue range of motion?

a.  Yes

b.  No

Comment:______

9.  How do you assess tongue range of motion?

a.  Ruler (mm)

b.  Just eyeball / guesstimate

c.  Other

d.  Does not apply

If other, please specify:______

10.  Do you assess tongue range of motion in terms of

a.  Tongue protrusion beyond upper lip margin/central incisors

b.  Tongue lateralization to corners of the mouth

c.  Tongue tip elevation to upper alveolar ridge (with minimal mouth opening)

d.  Does not apply

11.  Do you agree with this proposed severity rating on tongue ROM for protrusion

Tongue ROM / Agree / Disagree / I do not know
Protrusion
Normal / Tongue protrudes >= 15mm past upper lip margin
Mild- Moderately impaired / Tongue protrudes > 1mm but <15 mm past upper lip margin
Severely impaired / Some tongue movement but fails to reach upper lip margin
Totally impaired / No tongue movement

12.  Do you agree with this proposed severity rating on tongue ROM for protrusion

Tongue ROM / Agree / Disagree / I do not know
Lateralization
Normal / Tongue touches corner of mouth
Mild- Moderately impaired / < 50% reduction in tongue movement from corner of the mouth in either direction
Severely impaired / > 50% reduction in tongue movement from corner of the mouth in either direction
Totally impaired / No tongue movement in either direction

13.  Do you agree with this proposed severity rating scale on tongue ROM for tongue tip elevation ( with mouth partly open )

Tongue ROM / Agree / Disagree / I do not know
Elevation
Normal / Tongue tip contact with upper alveolar ridge
Moderately impaired / Tongue tip elevation but no contact with upper alveolar ridge
Severely impaired / No visible tongue tip elevation

14.  In your opinion, what is an acceptable compliance level with swallow exercises during treatment to ensure optimum functioning post treatment?

a.  100 % ( 7times/week)

b.  43 – 86 % ( 3 – 6 times/week)

c.  14 – 29 % ( 1 – 2 times/week)

d.  I do not know

15.  Please identify which of the following variables may have an effect in determining an overall prognosis of speech and swallow functioning in oral and oropharyngeal cancer patients after treatment

Variables / Significant effect on Speech / Significant effect on Swallowing / Sign. effect on both Speech & Swallowing / No effect on Speech or Swallowing / I do not know
Age of patient
Socio-economic status
Occupation
Weight of the patient
Stage of disease
Recurrent disease
Multiple treatments for recurrent disease
Jaw opening
Saliva production
Oral Competence/Drooling
% Oral Intake
Dental Status (presence of opposing dentition)
Intelligibility Score
% Correct phonemes
% Nasalance
Bite force
Chewing efficiency
(% bolus residue in oral cavity )
MBS study
FEES evaluation
Patient motivation
Depressive symptoms prior to treatment
Swallow exercises

16.  General comments / Other important variables in determining the overall prognosis of functioning after treatment of Oral/Oropharyngeal cancer

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