— (Omnis evaLuxTion © pe-evauarion Method(s) of Administration © direct Assessment (© ‘etormal Observation (O Review of Records Functional Communication Profile - Revised” Z0 pe MN 71 —Auhise, ‘Dacwoss (Gears eae wormar © S° suo montRATE > SEVERE PROFOUND wes Sensory ob bo a g oO Motor o Q o a 0 Behavior a g o a G Attentiveness a fe oO Q Oo Receptive Language o o a oa a Expressive Language = o A o mol Pragmatic/Social a o a oO o Speech a “oO o or o Voice o. bao o 0 o Oral o +.0 a o Oo Fluency a -o 0 Q Ona ‘ UnauiSystems ee _ a Coppi © 200 Lingus ems,Srnec (Hearing normal Cte toss, 1D moderate oss severe loss D protound loss (D uncertain CD may hear yet not react notes; __ —___— O Auditory Localization 7 adequate D tir inconsistent D poor O none O selective to a certain source O Vision © tunetional i possioie iss) medical condtion() blindness impairs coven or ype —_ — Tenses preserved “wom ”.£ ot wem C) lenses not prescribed Oye Contact adequate Di efits air © poor 1D best wiobjects CO best wipersons CD avoids none 1D nla duo 0 bincnoss O Visual Tracking Weseaate O ter 1D treonsstent poor Gi bestwicbjects best wipersons 1 none O Visually inspects Objects Weep G inconsistent D poor OD none O Grasp 7 ecequate O tar momentary Oi passive O randomiytosses 0 unable 1D motor impied, but possible O SeltHelp sks C independent —CLrneeds.assit——_O ependent O mines O Head & Trunk Positioning communication/ewallowing implications: 0 Grose Motor /snessoy CO peorcoortnatonC powrbauree 0 roranly © Accepts Being Physically Guided yes Om D parity D else tal dete 0 mete wetictone © Motor itation Wereoncad Cl wipes Cl ements oad 1 ma tacks vision C2 movement restricted (gross but net fine motor O inappropriate Behavior © sterotyped repetive motor mannerisms ‘stimulus fascination (igh, smels, eta.) 1 ols py eomaet 1 cma onrenety preters objects to persons D poor sensory integration 1 satnagaeon 1 emahal pech 1 verbal egpesson © utd inwessewtte 1 muting nee ctectebody pats frequent des chanong / soca tolationthawal 1 poor socal boundaries | G adheres to nonfunctional routines CO poor safety awareness | © poco met pt 7 amepaaa ge ' | tre Th etota recs change 0 food tang Cleartaeell Ul ene Clesedacenaiccaee 1 prepay desiucton swearng 1 imatonal fear hypereivy 0 Pea D oheriL O Attention span D adequate O mid defeits oar O poor O fatigues O varies wimood CD object preoccupation 0) none © Distractibte O atvostrever 2 cccasionaly moderately frequently © eonstanty not observed depends on task or ne OAteriness O adequate moderate O tw O tenargic D non-responsive selective OResponse nate aeroplane == Wma Cl moderate delays 0 severe delays. no response D mixed (__ best receptively __ best expressively) O Awareness of Others W7adeqiate O tar Gi poor 1D ronexstont 1 seeks oters (3 dsregardsoters. maintain interaction O Awareness of Environmental Events usualy $f moderately © eccatonaty rarely D never sensory impaired C3 physical status resets O Cooperation ae D wisome prompts) winumerous prompts © resists (O Native Language eee eee Otanguages Understood —ENGNiSla | Soen@ Poiisly . Coral Comprehension words wo prrases Aoentences O rove 2 ome Dow aot Oy na conversations comvereatons requests requests 0 tera but not nia cu 0 0 uses sgn fiuave heating loss language O Understands Basic Concepts 1 tunctonal O titations D poor © rene Check Concepts Understood: Weoiors Ppoay pans Howe S spape ‘money object uncton —Opreposiions tego O samefaterent ©) merafess © oppostes/synonyms (how many A emotions C physical property 0) time © quantity OResponds to Name on request D wisn 1D wigostre sensor oes © noresponse O wiphysical prompt C) may tune out others O Responds to * ‘Atetlon Commands on request 1 wegn 1B wigestire 0 retuses — unable. C wiphysical prompt . OLooks at Pictures WY winerest 1 midy atentve "Cl tacks interest «= no Cony wphotcs tems, not scenes Ol na (Copies © 2003 Linguyecay, ne,O Accepts Objects ww Presented ‘oy request O woesture C wiphysical prompt 0) wiotal assistance © motoricaty unable C1) rejects CO no response 1D spontaneously O Gives Objects to Speaker %/y request O wigesture 1D wiphysical prompt 0 refuses Cl whota assistance 2) no response 2) motoicaly unable only exchanging O Routine Commands ‘V=wiverbal comments T = wiotal assistance 'S=wisigning instruction M = winotorimpaiments ‘Types of Commands: 3 read vp 1D evalow A ustiput D oxen win Suen ono Wpands down 0 smile a wa ena are Seo Cepmiteeeneuh CD tanutete aap O Environmental Commands followed on request 7 wirepeated command 1 wipestural rome 1 whi promot 1 mut-step commands whiten instruction tal assitance required 1 may understand buts motocaly rested es Cl needs situational cues “wipicture cues: follows routine Oe response G setuses or uncooperative O Nonverbal Comprehension of cosures pronation cranges 1 pateésm Oia expressions “cher foings & thoughts 0 soc cues 1 boay language vein atc of speaker 0D context 111 nt sonsory os O Object identtication 7 verbal request 0 wioestue wphysical prompt wisign 1 bytuncton 1 witle exploration whimted tems none O Two-Dimensional Recognition A ohotos “Zine cravings colordrawings 0 symbols vious dofcts CO entetysigns CZ communtylogee C1 requ large pltures unable of Presentation: en vebal request 0 signed 0 win, OC partonime © pointing prompt ==) PECS e ' i © Languages Expressed _ EA Q\\S\n a ae ‘ O Verbat Status nonverbal eroa! Cl noneral °C total communication communtestor —-commmunialor-—«=Sscommuntatot—=~-scommmuneetor © Expressive Level 0 one unit 1D single words vases D sentences, (Check highest level) © conversation OnaO Methods of ‘Communication O Sett-Expression © duality ot Setf-Expression O Object interaction © Appropriate Object Use © Operates Cause & Effect Item O Descriptive Language 1 sounds (peech 1D spoting fecal expressions © gestwes 0 actions D manipulates others (photo sevbooklet (O word bookletboard CI computertaptop we 0 1 signing 1 wting Cl eye gaze 1D head nod O pointing 1 word cards 1 picture bookletboard ) PECS. 1D object manipulation C) object symbols O fecitates 1 romaxal 1 ectty schedule 0 none cemmuricaton communication device rane O/rasicneeds O preterences © routines 1 physical eoings social EMG echolalia 1 interests 1 emotions Di experiences concems 1D opinions aspirations C1 tumor orjoke share ideas C1 news events 1 fetious unable 1 mone expressed O specie D generat agua 1 mustbe ered variable ee A maiaine asp Costes © active reach ypomertt om ronpmomtd ae 0 omen 1 sue ‘operates or random for 1 uses adaptive switch cause 6 effect Settstinutaon Most Common Prompting; © independent guid assist phys © gest Overt O eesiets Cl roresponsé 0 unable A adequate 1 wimetorimtatons 1 preter inappropriate tems excessive proooepaton shares or show others 1D tor sybote playretona 1D wairited items 0 ree 1 insists on sameness lacks interest or rejects D onyysoltary 1D unabietnone & unpromptes © prysicaty nab 1 wipysia prompt rept in naire Dt bsorved wiverbal request D wigestura prompt 1D no interest 1D tited tems only 2 wladaptive equipment Wot naming eft con 1D inograted actions aston sequence narrates widalogue defines central theme (the ig picture?) comments on thoughts or feoings 1D wa —visualy impaired 1D targets insigniticant facts 1D contains delayed echotaia projects sett nto scene purely tterat supplements vérbal wigestures 1D deduces conclusion © contains delayed echolalia © nonvertatQ Basic Communication Expression (Check al that apply) O Uses Common Gestures (© Grammar Skills O Vocabulary © Average Phrase Length attempts speech speaks imitates speech ‘sign language fingerspels alphabet set writes types picture eystom” PECS word system eye gaze ‘communicaion device ‘ecihaton vocalzes poinisigestures facial expression Takes object of choice body movernenis ‘shows ID tag orcard ‘ol expressed ‘ther spontaneous zene prompt C) wiphysical prompt C] none 1 adequate D tar poor means: D excotent © none bites One places 1 tuture-tense action quantity 1 plurals Yyesino time concepts i iiomatc expression C physical & (cotoquial) ‘emotional states O sweating 5 wos * 1 printed message O extensive of basichunctonal ‘Check All Types Used: Gf crjecs A person 1 presenttenes acton D pasttense action Gi social rms © stang pronouns 1 Jocation/retion 1 action quality W/ objoct quality (adverts) (adjectives) eis, metaphors, puns 2B words Incigate Means: fopoxon D signed 1D communication device Ova 1 categories ‘possession Imitation Span i picturefsymbot 0 other:oe CO PRAGMATIC/SOCIAL LANGUAGE: © Communicative intent CYrequest tenvacon. CYallsummmon CO compimertpraise deny O gain atenton 2 action O grate 0 iestuct C/orotestresst «ewok approval ©) make plans D deceive 1D groottake leave CI intemptohars Cl make tends remina 1 command 0 socaze Dassen sot D eatioze Ci reqestassst I oferassitwam CO aferempatty CI persuade norm about eC comment 1 informed consent’ inst O Inform about others Cag © repair conversation CI apologize . 1D provide information ( argue or disagree C1 request clarticaton © controt show intrest in othersacty 1 oanty meaningeslan 1 toply wth others 1 har inerosislbjcts wotners 1 inqure 1 none domonstated Cotter: Otnitates Communication © aperopiatey ned Wt askesirompted 0 rarely Ci eccasonaly «CL excessively onlyogocentic none CO Answers who, What, \a/onsistenty ——, C Inconsistenly 0) minmally 1D rotabie ‘8 Where Questions CO Answers When, Why, conestenty ——« inmesterty Yara D notable & How Questions Oanswers Yeanio ——/eanstenty CO romtnty——O miinaty i notable Questions randomly (recriminat) only concerning needs or dais O Asks Questions ” ‘simple forms Gi complex forms Cl uses changes in Vocal inflection Ci via gestures 1D none elcted/emitied (reported but not observed 1D interviews istener (0 only concoming sel C) unable O Conversational Skills appropriate | needs improvement WZ limited Cl none G nonverbal O Communication Partners. /iamiy Lema rcomnan Wankedger .* 0 henna 1D community member © job coactsupervisor C) poor interes in relationships D none Come Coconversational Topics 0 pfmuualnerest /seltcentred C1 approprately abou so ‘neleverttangenisl C persoversive about uae Oi noreirieed = na O Twrn-Taking 1D appropriate roeds cves needs cuos neces eves cecosonaly eerily frequently fats oatend «Cl dominates oC) unintrestedin unable toittenors conversation nner Ona oe "pe © Topic inition independent woszasonal only wih assistance ©/rone stance oreo, 1D wva—no means C1 excessive for odd (crcumseribed\unusua! topios Cop © 2003 LingiSyrems, le.‘Pragmate/ Sod argvog, conioas © Topic Maintenance O Topic Elaboration (O Cause-Ettect Reasoning O Shares Personal Data O Appropriateness ‘of Communication CO Discusses News Events O Reading/Literacy © wniting/Spetting O memory Co O intenigibitity (O Understood By D adequate prompted of rina C1 unsuocesstul 1D rapialy sits G tacks interestmotivation Ona oe eS umber of diferent statements: | a 1 independently CI indirect verbal cues NY sirect verbal promots 1 wigraphic cues Clionly for fixations] not stimulable nonverbal appropriate response or explanation © routinet response or explanation air response or explanation i only it prompted or drected M cot expressed Ona ‘15D ‘consistent °° 5 inconsistent °°). getestond oe Descriptive Conditions (Check al that appl i considers listeners perspective _yes 1 uses social rules +/—yes __ no D nows where to say it 1 knows what to say 1D impaired topics D knows whontosayt 1D onverbal D specie 1D general 1 vague eee C1 rote repetition wio meaning or rlevance _C) unable to express Wenors Woame umbors ey words 1 sunvalwords C3 pbvases paragraphs store signs 1D prodet abesigos) C) none O toners D oumbers Okey words woame O pases CD conversaton ‘I factated one ‘Short Term: WZ tunctionat 1 fritatons © norecatt not testable tong Term: A iunctional C Iimtationsiseloctive C1 no recall nottesteble D savantike skas or caleulations © asiy understood by ates © unersiod winino ty nro winoderat ty ended wir dlewy CO rot understandable: 1 nonverbal or n/a Protloncy Level: words of pases 0 conversation oorton must how (Jonson O tarestaunns O/meupetiows 0 alten 5 noone (lot may rere wih itigbty ‘Capra © 200) ngayon, neO dlusts Speech to Improve Understanding O Sounds Produced O Error Phonemes © Omitted Phonemes: © Dentition O Articulators © Orai-Motor imitation D inadequate 1 successtul 1D ro change required © sometimes Seacty Smo Gea Se ean aoe Cpomnimassnnnary Weomammen iia eae eras a ss Cocca aA sonasiass! Docent D unremarkable) overbite 1D undertite 1D open bite D overcrowding repaired cleft minimal dentition 0 wears braces 1 removable dentures (I absent 1 poor condition uncooperative O Loudness G adequate D excessive Aariadle ow intensity Ci monotoudness —_Dnonverbenon-oral fades 1D mapproprae to setting 1D reduced breath support © Vocal Quality 1D omat rast 0 tone 0 parsh 0 strained whining stent D breathy whispered 1D explosive vocal ty wet dysartna 1D iplophonia © vocal tremors. spaste dysphonia 0 sing-song 1 nonverbalinonoral C1 cubde-sec resonance a O Piteh © appropnate Gi higher than normal Cl tower range 1G vanabie G monotone C/mmature forage 0 falsoto nonverbal (Cony © 2003 Linguiyrems, ne pitch breaks «mimics other's ph CY inappropiato rising iecon 1D changes for mua! speech or echolaia inappropriate for genderO Mouth Breather D aways Ci mestettte tine some of ne tme (not problem i tracheostomy 1 due to nasal congestion O Dreoting evsent Ci onoccasion OT requenty not ebserved CF nearyavays CO sltmonors——)unmenitored medication pescrbed 1 requires protective measures O Tongue Thrust D atest Di enswalow 0 ding speech eo served © Swallowing & Diet) gasrosiomy use C1 aspatonrsk C1 adequato chow watow DD pureed texture Ci thickened tiquids +O) coughing observed © ground texture © spillage CO rapid eating’stutfing chopped texture C1 food pocketing I uses adaptive equipment O mechanical sot 2 modi heath diet 1 adaptive strategies: O Fiveney — 0 repations 0 books © protongations halting 1D nonverbal regular pauses C1 secondary mannerisms: —_- © Rate of Speech 1 appropriate Gi too rapid Wiaboredision D varabie 1D nonverbat 1 itters for echotata progressively faster CI increases for rtual speech SS O Rhythm & Intonation £8 appropriate tow atfectintent lacks affectintent C1 nonverbal 1 rebotic 1D caricature pattems 0 sing song 1 equal stress 1 protongs vowels C) choppy 1 changes stress re: meaning _ yes _no i other (describe) Se Use of Sign Language tocommunicate — oncommand emerging 1 tates Cl whtysicel prompt not stimuable C1 ot needed 1 wmotoe ints © Meaning of Signs Cl understands expresses none One OLevel of signs 0 sime 1D compex 1 tingerspeting 1 norunetional (O Sample Signs © Two-Dimensional ' | Expression Cindeperdonty emerging skis) wisigning prompt} wPecs | D encommand 2) wigestural prompts) facilitated 1D unsuccessta One C1 wladapive equipment ” ” ~ “Cag 6203 Lnpayeemm he 10