ASHA NOMS for Motor Speech - Weebly



Motor Speech Assessment PacketAssembled by: Piper Doering (2013)Includes:After a full review of the patient’s chart:History ComponentsPatient Interview: to collect information first-hand from the patient about the nature and course of impairment. This information pertains to the specific body functions and structures that are impaired. Patient-perceptions on functional limitations and perceived disabilities are also included. This information pertains to the activities the patient is involved in and the participation limitations experienced as a result of the patient’s impairments. In addition, personal factors are emphasized to determine the emotional impact of the current impairment.Partner Interview: to collect information on partner perceptions related to the patient’s impairment and how the impairment impacts daily life. This information pertains to the specific body functions and structures that are impaired in addition to their functional impact on activities and participation. Information on family resources is also included. Knowing and incorporating the strengths and social circles of the family will promote successful intervention.Physical ExaminationOral Mechanism Examination: to assess each component of the speech system separately and to define and classify notable changes by cranial nerves (V, VII, IX, X, XII). The face, lips, jaw, tongue, and palate are all assessed for the following: strength, speech, range of motion, tone, and coordination. Pertinent questions related to patient history are included throughout to supplement the physical examination findings. A test for apraxia of speech is included, but should only be used if groping is present during the evaluation.Motor Speech EvaluationOral Mechanism Examination: an overview of RPRAP components are also included within the oral mechanism examination to screen for changes in respiration, phonation, resonance, articulation, and prosody. This includes the “acoustic motor speech evaluation” and “combined systems” sections. This is a perceptual examination of the patient’s speech at the sound, syllable, and connected speech levels.ASHA NOMS: this rating scale is to be used in conjunction with the connected speech sample from the oral mechanism examination. This rating helps to classify how easily the patient can be understood by others and provides more concrete data on an individual’s speech for reporting purposes.The Frenchay Intelligibility Test: this portion of the Frenchay Dysarthria Assessment is included to assess intelligibility at the word and sentence level. Intelligibility examines the clarity of the patient’s acoustic signal to an unfamiliar listener within a clinical context.PACE Rating Scale: to assess comprehensibility in consideration to environmental and activity/participation components. This assessment allows for observation of the conversational roles of the patient (patient as sender & receiver); in addition to the roles of the patient’s partner (clinician/partner as sender & receiver). This rating provides information on how effectively the patient can share new information. The patient can use any communicative modalities to convey information. This assessment provides useful information to be applied to intervention in relation to co-constructed conversations and communication success within functional social contexts.Interview Questions for PatientDuffy, 2005; Yorkston 1999Patient Name: Date of Birth:Referring Physician: Date of Evaluation: Onset and CourseWhat difficulty do you have with your speech?What comments have others made about your speech?When did your speech problems begin? Suddenly or gradually? Have other problems developed in addition to your speech difficulties?How has your speech changed compared to 6 months ago or a year ago?Has your speech ever returned to normal? If so, when and for how long?Are you taking any medications that affect your speech positively or negatively? What else influences your speech (time of day, rest, who you’re talking to, etc.)Associated DeficitsHave you had any difficulties with chewing or swallowing? Describe. Is it difficult to move food in your mouth or move food back to get the swallow started?Is it more difficult to swallow solids versus liquids? Do you have any coughing or choking sensations at meals?Any difficulty managing your own secretions or drooling?Have you had any change in your emotional expression? Do you cry or laugh more easily or less easily than in the past?Patient’s Perception of DeficitDescribe your current speech difficulty. If your speech was 100% before this all began, what would you rate your speech now?Consequences of the DisorderDo people have trouble understanding you? If so when and what happens during these instances?Have you altered your work or social activities because of your speech? In what way? Does your speech keep you from doing things you would like to do?How do you feel when you have difficulty being understood?How do others react when you have difficulty being understood?5. How has your speech difficulties affected your interactions with your family?ManagementWhat have you done to compensate for your difficulty?Do you think you need help with your speech now?Awareness of Diagnosis and PrognosisWhat have you been told is the cause of this problem?What does the diagnosis mean is going to happen?Interview Questions for PartnersBased on Lubinski, 1991 in Yorkston, 1999DemandsWhat significant events were occurring in your family prior to the onset of your family member’s communication difficulties?How have these events changed since the onset of the physical and communication problems?Is your family member independent in caring for himself or do they depend on someone for all or some of their cares?How as the communication difficulties affected your family member’s social life?How has the communication difficulties affected your family member’s caregiver(s)?How as the primary caregiver and your family member’s daily life changed since the start of the communication difficulties?What are the financial implications of the communication difficulties?How did the family change immediately at the onset of the problem? How has it changed since?ResourcesHow would you describe your family’s strengths?How willing is your family member to seek help from friends, counselors, religious institutions, social services, others.Who are the primary communication partners of your family member and will they be able to participate in the therapy program?Definition of the ProblemWhat do you perceive as the major problem facing your family at the present time?What do you think can be done about this problem?If there are other issues going on in your family and family member’s life, how do they compare to the current communication difficulties your family member is experiencing?Oral Mechanism ExaminationAdapted from Freed, 2012 and Enderby, 1983Patient’s Name:Date of Examination:Patient’s Age:Neurological Diagnosis:Relevant Personal Information:Medical History:Instructions: Answer each item yes or no and indicate the degree of impairment as follows:0 = no impairment1 = mild impairment2 = moderate impairment3 = severe impairmentAlso be sure to answer all other questions in the space indicatedIf any groping is present, an additional test for nonverbal oral apraxia must be completed.Facial musculature at rest: CN VIIYesNoDegreeIs the mouth symmetrical?Can patient resist examiner’s attempt to force lips open?Are eyes open?Are eyes partially closed?Is the face rigid or masked?Is there wrinkling of forehead when asked to look up?Is nose symmetrical (look at nasolabial fold)?Facial musculature during movement: CN VIIYesNoDegreeIs the smile symmetrical?Is groping present?Can patient pucker lips?Is groping present?Can patient puff out cheeks and maintain lip seal when pressure is applied?Mandibular musculature at rest: CN VYesNoDegreeDoes mandible hang lower than normal?Is there even bulk of mandibular musculature on each side of the face?Mandibular musculature during movement: CN VYesNoDegreeWhen mouth is open as widely as possible, is there deviation to one side? Is groping present?Can patient move mandible voluntarily to the right or left?Can the patient resist the examiner’s attempt to lower the jaw when the teeth are clenched?Can the patient keep mouth wide open as the examiner attempts to force it closed?Any pain with movement?General Observations of the Oral CavityObserve teeth: cavities, missing teeth, overall hygieneDoes the patient have dentures?Observe oral cavity: moisture, color, bite marks on cheeksTongue musculature at rest: CN XIIYesNoDegreeIs tongue normal in size (normal bulk, no atrophy)? Is tongue moist?Does the tongue lie midline?Is the tongue symmetrical in shape?With tongue resting atop edges of lower incisor teeth, is fasciculation observable?Tongue musculature during movement: CN XIIYesNoDegreeCan patient protrude tongue completely? Is groping present?With tongue protruded, can patient resist examiner’s attempt to force tongue to the other side?With tip of tongue, can patient touch the upper lip and alveolar ridge?With tongue in cheek, can patient resist examiner’s effort to force tongue inward?Can the patient move the tongue from side to side?Velum and Pharynx at rest and during movement: CN XYesNoDegreeIs the velum symmetrical at rest? Does the velum rise symmetrically each time the patient sustains /a/?Does the velum rise symmetrically each time the patient says /a, a, a/?Is the uvula symmetrical?Is there a gag reflex when the back wall of the pharynx is touched?Is the patient able to produce a sharp cough?Can the patient produce a sharp glottal stop?Is inhalatory stridor present?Questions for PatientDo you cough or choke when eating or drinking? - reflexDo you have difficulty clearing your throat? - reflexDo you have difficulty swallowing? - reflexDo you ever notice dribbling or drooling from your mouth? - reflexDo you notice running out of breath when you speak? - respirationDoes food or drink ever come down your nose? - soft palateTesting for Nonverbal oral ApraxiaThis is to be used only if groping is present during the oral mechanism examinationDirections to patient: “Now I want you to do some things. Listen closely and do everything as completely and as well as you can. Are you ready?”ResponseTest ItemGraded Response Scale1. Stick out your tongueAccurate and immediate response with no hesitationAccurate after trial-and-error searching movement on commandCrude, defective in amplitude, accurate, or speed on commandPartial response (an important part missing) on commandSame as (1) after demonstrationSame as (2) after demonstrationSame as (3) after demonstrationSame as (4) after demonstrationPerseverative responseIrrelevant responseNo oral performance2. Show me how you blow out a match3. Show me your teeth4. Round your lips5. Touch your nose with the tip of your tongue6. Bite your lower lip7. Show me how you whistle8. Lick your lips all around9. Clear your throat10. Move your tongue in and out11. Click your teeth together once12. Show me how you smile13. Click your tongue14. Chatter your teeth as if you were cold15. Touch your chin with the tip of your tongue16. Show me how you cough17. Puff out your cheeks18. Wiggle your tongue from side to side19. Pucker your lips20. Alternately pucker and smileTesting for Apraxia of Speech (Oral Verbal Apraxia)This is to be used only if groping is present during the oral mechanism examinationDirections to patient: “Say these words for me.” If patient is unable to repeat to verbal stimuli, present words as printed on cards. As patient reads or repeats the following, tape record and transcribe errors.slowpoke _______________________________________________________________conference ______________________________________________________________Tahiti __________________________________________________________________dressmaker ______________________________________________________________Annapolis _______________________________________________________________kindergarten _____________________________________________________________condominium ____________________________________________________________industrial revolution _______________________________________________________Winnie-the-Pooh and Tigger too _____________________________________________________________________________________________________________________stiff-stiffer-stiffening ______________________________________________________________________________________________________________________________base-baseball-baseball cap __________________________________________________________________________________________________________________________fan-fancy-fantastic ________________________________________________________________________________________________________________________________glow-glowing-glistening-glamorously _________________________________________________________________________________________________________________rid-riddle-ridicule-ridiculous ________________________________________________________________________________________________________________________“Now these.”The beautiful girl was dancing. ______________________________________________________________________________________________________________________Open this birthday present first. ______________________________________________________________________________________________________________________The stranger walked into the store. ___________________________________________________________________________________________________________________The birdwatcher saw a Norwegian Blue parrot. _________________________________________________________________________________________________________Test for Apraxia of Speech continued“Count from 1 to 20.” Indicate pauses for breath by a slash (/) after the appropriate number.1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.16.17.18.19.20.“Now count backward from 20 to 1.”20.19.18.17.16.15.14.13.12.11.10.9.8.7.6.5.4.3.2.1.“Tell me what is happening in this picture.” Use the Boston’s “Cookie Theft” picture to evoke at least 1 minute of ongoing speech. If necessary, point out neglected features of the picture by asking, “What’s happening here?”-85725096520Testing for Apraxia of Speech continuedWrite down four sentences that the patient says. If the patient provides an insufficient speech sample here, use any four sentences produced at any point in the evaluation.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________“Say these sentences after me.” Use the sentences just written above. Write down (and if necessary phonetically transcribe) the patient’s imitations.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Connected Speech SampleHave the patient read “My Grandfather” or another standard reading passage and rate the following questions:YesNoDegreeAre vowels and consonants produced clearly? Is the patient’s rate of speech too slow?Is the patient’s rate of speech too fast?Does the patient show inappropriate silent intervals between words?Does the patient show hypernasality?Is nasal emission present?Does the patient vary loudness normally?If not, is there evidence of monoloudness?Is there evidence of tremor in the patient’s voice?Does the patient show abnormal pitch variations?Does the patient’s voice have a harsh vocal quality?Does the patient’s voice have a strained-strangled voice quality?Does the patient’s voice have a breathy vocal quality?Does the patient speak in abnormally short phrases?Are there moments of involuntary inhalation or exhalation?Is inhalatory stridor present?Does the patient use normal stress on the appropriate syllables or words?If not, is there a reduction in normal stress?Or is there excess and equal stress?Grandfather PassageYou wished to know all about my grandfather. Well, he is nearly ninety-three years old. He dresses himself in an ancient black frock coat, usually minus several buttons; yet he still thinks as swiftly as ever. A long, flowing beard clings to his chin, giving those who observe him a pronounced feeling of the utmost respect. When he speaks his voice is just a bit cracked and quivers a trifle. Twice each day he plays skillfully and with zest upon our small organ. Except in the winter when the ooze or snow or ice prevents, he slowly takes a short walk in the open air each day. We have often urged him to walk more and smoke less, but he always answers, “Banana Oil!” Grandfather likes to be modern in his language.Rainbow PassageWhen the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long, rough arch, with its path high above, its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People look, but no one ever finds it. When a man looks for something beyond reach, his friends say he is looking for the pot of gold at the end of the rainbow.Acoustic Motor Speech ExaminationDirections to patient: “Take a deep breath and say /a/ as long, steadily, and clearly as you can.”Duration: the average is 15 seconds for adults and 10 seconds for school-age childrenTrial 1:Trial 2:Trial 3:Average:Latency: Is there a latency period between signal to say /a/ and initiation of phonation?QualitySteady and evenSmooth and clearHypernasalityBreathinessHarshnessDiplophoniaPitchToo highToo lowNormalTremorPitch breaksLoudnessExcessive loudnessInadequate loudnessNormal loudnessDescribe Abnormalities: __________________________________________________________________________________________________________________________________________________________________________________________________Combined Systems (Phonatory, Respiratory, Resonatory, and Articulatory)Alternate Motion Rate (AMR)Directions to patient: “Take in a deep breath and say (e.g., puh, puh, puh) as long, as fast, and as evenly as you can.”YesNoDegreeIs AMR slow? Is AMR excessively fast?Is AMR dysrhythmic?Is AMR uneven in loudness?Is AMR uneven in pitch?Is there a tremor?Is there equal spacing between syllables?Is there blurring between syllables?Is there hypernasality?Is there nasal emission?Is there restriction in amplitude of motion of lips and jaw?Are there imprecise or distorted consonants?Indicate rate per 5-second intervals on this table. The average rate for “puh” and “tuh” is about 30 to 35 repetitions for 5 seconds; “kuh” is somewhat slower.puhtuhkuhpuh, tuh, kuhTrial 1Trial 2Trial 3AverageSequential Motion RateDirections to patient: “Now I want you to make those three sounds, ‘puh,’ ‘tuh,’ and ‘kuh’ together as long, as fast, and as evenly as you can.YesNoDegreeIs the patient able to move smoothly from syllable to syllable? Are sounds blocked, transposed, or omitted?Stress Testing of the Motor Speech MechanismDirections: Instruct the patient to count rapidly (approximately two numbers per second) at least up through 100. Demonstrate 1 – 10.YesNoDegreeIs there audible deterioration of phonation or articulation? Respiration TaskDirections: Ask the patient to count to 20 as quickly as possible on one breath. Assure that you are unconcerned about articulation. Just note the number of breaths necessary to complete the task. Normally, this task can be performed in one breath. People with velopharyngeal incompetence may be mistaken for patients with poor respiratory control. You may ask the patient to hold his or her nose to discriminate between the two.Check the most applicable optionNo abnormalityVery occasional breaks in fluency due to poor respiratory control. The patient may state that he or she is conscious of having to stop to take deep breaths on occasions. An extra breath may be required to complete the task.Patient has to speak quickly because of poor respiratory control. The voice may fade. Patient may require up to four breaths to complete the task.Patient speaks on inhalation or exhalation, or breath is so shallow that only a few words are managed. Poor coordination and marked variability. Patient may require seven breaths to complete the task.Speech is grossly distorted by lack of control over respiration. May only manage one word on each breath.ConversationDirections: Engage the patient in conversation (e.g., “Tell me about your morning” or “Tell me about your speech problems”), taking note of relevant speech characteristics. After observing for each component of RPRAP, rate the patient’s speech using ASHA NOMS.RespirationPhonationResonanceArticulationProsodyASHA NOMS for Motor SpeechNote: Individuals who exhibit deficits in speech production may exhibit underlying deficits in respiration, phonation, articulation, prosody, and resonance. In some instances it may be beneficial to utilize additional FCMs focusing on voice if disordered phonation is a large component. Level 1: The individual attempts to speak, but speech cannot be understood by familiar or unfamiliar listeners at any time.Level 2: The individual attempts to speak. The communication partner must assume responsibility for interpreting the message, and with consistent and maximal cues, the patient can produce short consonant-vowel combinations or automatic words that are rarely intelligible in context.Level 3: The communication partner must assume primary responsibility for interpreting the communication exchange, however, the individual is able to produce short consonant-vowel combinations or automatic words intelligibly. With consistent and moderate cueing, the individual can produce simple words and phrases intelligibly, although accuracy may vary.Level 4: In simple structured conversation with familiar communication partners, the individual can produce simple words and phrases intelligibly. The individual usually requires moderate cueing in order to produce simple sentences intelligibly, although accuracy may vary.Level 5: The individual is able to speak intelligibly using simple sentences in daily routine activities with both familiar and unfamiliar communication partners. The individual occasionally requires minimal cueing to produce more complex sentences/messages in routine activities, although accuracy may vary and the individual may occasionally use compensatory strategies.Level 6: The individual is successfully able to communicate intelligibly in most activities, but some limitations in intelligibility are still apparent in vocational, avocational, and social activities. The individual rarely requires minimal cueing to produce complex sentences/messages intelligibly. The individual usually uses compensatory strategies when encountering difficulty.Level 7: The individual's ability to successfully and independently participate in vocational, avocational, or social activities is not limited by speech production. Independent functioning may occasionally include the use of compensatory techniques.IntelligibilityAdapted from the Frenchay Dysarthria Assessment (Enderby, 1983)Words/RepetitionThe following words should be written on individual cards. It is suggested that bold ?” high print on 6”x4” cards be used.FarmJaggedHerePaySergeantWarmGlowErrorBriarBroughtSwarmGoAirPriorThoughtStormGrowSingleAreaBrawnSparkGoatJungleFloorThornParkBubbleCycleGaloreSpainDarkStubbleSprinkleExploreLoyalDraggerTroubleSwayThoughLairGadgetDoubleSlayKnowVatJacketCarPlayUrgentFatTask: Shuffle cards and place face down. Select 12 cards at random, taking care not to look at the cards. Expose the face of each card to the patient. The patient should read the card and the therapist should write down what the word is understood to be. The first two of the 12 cards are practice cards and the other 10 are test cards. When the patient has attempted all the cards, take and check the cards against the words written down. Add the number of words correctly interpreted and score using the following grades.Check the most applicable optionTen words correctly interpreted by the therapist, with speech easily intelligible.Ten words correctly interpreted by the speech therapist, but therapist had to use particular care in listening and interpreting what was heard.Seven to nine words interpreted correctly.Five words interpreted correctly.Two or less words interpreted correctly.Sentences/DescriptionClearly write the following sentences on cards. “The man is ____________.”clockingrepeatingteachingpitchingbendingplottingrecedingtaggingnumbingbringingleapingcateringtickingthumbingbitingcreepingtinkeringlaggingpinningdancingcashingdamningairingfindingfencingpatchingsendingblockingreceivingtuggingcomingprovingblottingnamingtuckingsummingfightingsleepingdrinkingpickingspinningspittingreapingstinkinggaggingsinningprancingcatchingstandinghearingTask: Use the sentence cards in the same manner as you did for the word-level intelligibility task. Add the number of sentences correctly interpreted and score using the following grades.Check the most applicable optionTen sentences correctly interpreted by the therapist, with speech easily intelligible.Ten sentences correctly interpreted by the speech therapist, but therapist had to use particular care in listening and interpreting what was heard.Seven to nine sentences interpreted correctly.Five sentences interpreted correctly.Two or less sentences interpreted correctly.Rating Scale for PACE Interaction(Davis, 1980)Score 5Message conveyed on first attempt. There are two definitions of best performance: (1) message is conveyed by client with combined active participation of the client’s sending behavior and the clinician’s ability to make an appropriate interpretation from information given by the client, acknowledging the usual contribution of the receiver in any conversation or (2) a specified required completeness of the client’s sending behavior in terms of number of concepts conveyed, minimizing the clinician’s filling in of missing parts and placing a greater burden on the client for the communication.Score 4Message conveyed as above (either 1 or 2) after general feedback from the clinician indicating the first attempt had not been completely understood. This includes the clinician’s repeating the client’s attempt in a questioning fashion.Score 3Message conveyed as above (either 1 or 2) after specific feedback. This feedback reflects the clinician’s assuming an active role as receiver in determining the client’s message, either by proposing hypotheses about the messages (topic, semantic relations) or by suggesting an additional channel be used (“Show me” “Tell me anything about it”). Clinicians sometimes risk pursuing this level of feedback too long, especially having ignored that the message was conveyed. Because of the varied types and amounts of feedback possible, this category might be differentiated into a greater number of scale points in order to make the scale more sensitive to efficiency.Score 2Message partially conveyed by the client, only after general (point 4) and specific (point 3) feedback have been attempted.Score 1Message not conveyed appropriately despite efforts by the patient and clinician reflected in points 4 and 3.Score 0Client does not attempt to convey the message.Score “U”Unscorable response, usually because one or more of the principles of PACE were violated in the interaction. PACE InstructionsBasic OverviewThe patient and partner take turns exchanging new information, as in a natural conversational context. Conversations should be personally-relevant to the patient. The receiver provides natural feedback aimed at problem-solving the sender’s message (i.e., co-constructing the conversation). In other words, the receiver must make educated guesses on the sender’s message that simulates a natural conversation. The turn ends when the sender’s message is conveyed, not when a pre-determined linguistic form is produced (Davis, 2005). In essence, emphasis is placed on the transaction of information.Four Principles of PACEEqual participation: the clinician and patient participate equally as senders and receivers of messages.This is done by taking turns sending messages.When the clinician sends a message, the patient can verbalize in a different role, that of receiver.New information: There is an exchange of new information between the clinician and the patient.This is done by the sender’s keeping his message (picture, printed word) from view of the receiver. Usually, a stack of message stimuli is face-down on the table, and the participants take turns drawing from the stack.It is difficult to maintain genuinely; so, the clinician must minimize familiarity with the message stimuli. When the clinician is the receiver, s/he should give general feedback first in order to avoid responses based on familiarity with the stimuli.Free choice of channels: The patient has a free choice as to which communicative channels (modalities) s/he may use to convey new information.The patient, when sending, may use any single channel or channels in combination.The clinician does not direct the patient to use any particular channel. The clinician, when sending, can model the communicative value of channels which the patient may not be choosing to use.This is a process of self-discovery by the patient as to his or her communicative options.Natural feedback: Feedback is provided by the clinician, when receiving, in response to the patient’s success in conveying a message. The clinician responds first to communicative adequacy.Once the patient realizes the message is conveyed, the clinician may pursue linguistic adequacy for the same message. The clinician may encourage revisions or repairs or may provide standard cues. The latter can be done only because the clinician has understood the patient’s message. Time to pursue linguistic adequacy is taken usually only when the patient wants to improve a verbal attempt.In giving feedback for determining the patient’s message, the clinician proceeds in a sequence from general to specific feedback, corresponding to scale points on a rating scale. Wilcox, M.J., and Davis, G.A., PACE: Promoting Aphasics’ Communicative Effectiveness. Activity IdeasDescriptive picture taskPlace a stack of picture cards face down on the table. The patient and partner take turns picking up a picture card and describing it to the other person. Example picture cards are attached to this document; however please use pictures that are more applicable to the individual client.Conversational cardsThe patient and partner will take turns drawing conversational cards from a stack. The patient and partner take turns discussing the topic on the card, exchanging new information to the other person. Example conversational cards are attached to this document.Story sharingPatient and partner will take turns sharing stories about their childhoods. This task is unstructured, increasing the complexity of the task.-533400-3314703105150-331470-4762501028703105150102870-533400-2362202943225-236220297180027305-5334002730530861004450080-49530044500803105150-331470-495300-331470Find out what television program your partner watched last evening. Extend the conversation by adding two more comments of your own. Find out about what your partner is doing for this upcoming holiday. Extend the conversation by adding two more comments of your own.Find out what vacations or road trips your partner gone on or is planning. Extend the conversation by adding two more comments of your own.Find out where your partner grocery shops. Extend the conversation by talking about where you usually grocery shop and why.Find out what important information your partner heard or watched in the news this week. Extend the conversation add two more comments of your own.Find out about a restaurant at which your partner has eaten. Extend the conversation by asking about the food and environment. Also, share information about a restaurant you like.Find out if your partner has attended or will be attending a wedding this year. Extend the conversation by sharing information about a wedding you have attended.Find out about a home project your partner is working on this summer, either in the house, garage, or yard. Extend the conversation by sharing information about a project on which you are working.Find out about a grandchild, niece, nephew, or other young person with whom your partner is close. Extend the conversation by sharing a story about a young person with whom you are close.Find out your partner’s plans for the weekend. Extend the conversation by sharing your plans for the weekend. Find out if your partner attends any social, church, or other type of group during the week. Extend the conversation by sharing information about a group you have attended.Find out about a special recipe your partner has used in the past. Extend the conversation by describing a recipe with which you have had good luck. ................
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