Swallow Impairment Therapeutic Intervention Adaptation for trach/vent patient Secretion Management 1 .PMV trials to allow airflow and sensory stimulation to upper airway. Pt will complete (alternating/sustained/selective) attention activities with (independence/setup/supervision/mod assist/max assist/dependent) in order to increase independence with functional activities. Pt will increase social interaction to (independence/setup/supervision/mod assist/max assist/dependent) or higher demonstrating improved (behavior, pragmatics, eye contact, emotional regulation, coping with anxiety/depression. But opting out of some of these cookies may affect your browsing experience. This cookie is set by GDPR Cookie Consent plugin. Weve included a broad range of expressive language topics and goals here. If you say Child will produce /s/ clusters and produce initial /s/ what do you focus on? easy onset, relaxed breathing, slowed speech, light contact, continuous phonation)Nombrar y describir las estrategias que facilitan la fluidez(empezar suave, respiracin relajada, habla lenta, contacto ligero, fonacin continua), Will use slow rate when telling a story or during other structured therapy activityUtilizar un ritmo lento al contar un cuento o durante otra actividad de terapia estructurada, Will name and describe the technique of easy onsetNombrar y describir la estrategia de empezar suave, Will use easy onset at the word level/ at the phrase level/ when telling a story or during other structured therapy activityUtilizar la estrategia de empezar suave en palabras/en frases/cuando cuenta un cuento o durante otra actividad de terapia estructurada, Will use easy onset during a 5-minute conversational task in the therapy settingUtilizar la estrategia de empezar suave durante una conversacin de 5 minutos en el entorno de la terapia, Will name and describe the technique of relaxed breathingNombrar y describir la estrategia de la respiracin relajada, Will use relaxed breathing at the word level/ at the phrase level/ when telling a story or during other structured therapy activityUtilizar la estrategia de la respiracin relajada en palabras/en frases/cuando cuenta un cuento o durante otra actividad de terapia estructurada, Will use relaxed breathing during a 5-minute conversational task in the therapy settingUtilizar la estrategia de la respiracin relajada durante una conversacin de 5 minutos en el entorno de la terapia, Will name and describe the technique of slowed speechNombrar y describir la estrategia del habla lenta, Will use slowed speech at the word level/ at the phrase level/ when telling a story or during other structured therapy activityUtilizar la estrategia del habla lenta en palabras/en frases/cuando cuenta un cuento o durante otra actividad de terapia estructurada, Will use slowed speech during a 5-minute conversational task in the therapy settingUtilizar la estrategia del hable lenta durante una conversacin de 5 minutos en el entorno de la terapia, Will name and describe the technique of light contactNombrar y describir la estrategia del contacto ligero, Will use light contact at the word level/ at the phrase level/ when telling a story or during other structured therapy activityUtilizar la estrategia del contacto ligero en palabras/en frases/cuando cuenta un cuento o durante otra actividad de terapia estructurada, Will use light contact during a 5-minute conversational task in the therapy settingUtilizar la estrategia del contacto ligero durante una conversacin de 5 minutos en el entorno de la terapia, Will name and describe the technique of continuous phonationNombrar y describir la estrategia de la fonacin continua, Will use continuous phonation at the word level/ at the phrase level/ when telling a story or during other structured therapy activityUtilizar la estrategia de la fonacin continua en palabras/en frases/cuando cuenta un cuento o durante otra actividad de terapia estructurada, Will use continuous phonation during a 5-minute conversational task in the therapy settingUtilizar la estrategia de la fonacin continua durante una conversacin de 5 minutos en el entorno de la terapia, Will use 2 fluency shaping techniques (i.e. Objective 1:2: Child will produce initial /s/ with 80% accuracy and minimal assistance. Many speech therapy goals are very similar and are needed again and again. Be as specific as possible. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Skill: Without being vague, provide a clear description of the skill speech or language therapy will address. A sample speech goal with objectives would look like this: Goal 1: Child will produce all age-appropriate sounds with 80% accuracy and minimal assistance. Weve included in our articulation goal bank the ones we find useful. A place to seek sunlight about speech, language, cognition, and dysphagia. Negative dysphagia-management outcomes can be avoided through the following practices: (a) considering the importance of diet, non per os status, and tube-supported nutrition in dysphagia patients; (b) understanding and following the speech-language pathologists' dysphagia recommendations; (c) being familiar with the goals, objectives, and . Ruby will produce the pre-vocalic /r/ sound at the sentence level in 7/10 opportunities without prompting across 3 consecutive sessions. easy onset, relaxed breathing, slowed speech, light contact, continuous phonation) when telling a story or during other structured therapy activitiesUtilizar estrategias que facilitan la fluidez (empezar suave, respiracin relajada, habla lenta, contacto ligero, fonacin continua) al contar un cuento o durante otras actividades de terapia estructuradas, Will identify and reduce secondary behaviors in structured activities during therapy/ in narration or conversation during therapy/ outside of therapy in school or social settingsIdentificar y reducir los comportamientos secundarios durante actividades estructuradas en la terapia/en narrativos o conversacin durante la terapia/afuera de la terapia en la escuela o entornos sociales. Pt will identify the correct picture in a field of (2/4/6) when presented with the word (verbally/visually) at ___% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to recognize functional language. Anything more might not be attainable in the time period and is difficult to update. Pt will demonstrate problem solving skills with (independence/setup/supervision/mod assist/max assist/dependent) or higher, demonstrating improved (insight, safety, executive functioning, reasoning, functional problem solving) in order to return to (IADLs, increase independence on nursing unit). You can even do this with younger students. 1. Muscle Strength Training 1. Pt will follow (simple/complex 1-step commands/2-step commands) with ___% accuracy given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to complete functional tasks. Consider adding the following items into your assessment toolbox. Client will utilize compensatory strategies with optimum safety and . Research shows that 89 percent of people with Parkinson's disease (PD) experience speech and voice disorders, including soft, monotone, breathy and hoarse voice and uncertain articulation. Stick your tongue out and hold it for 2 seconds, then pull it back in. (1989). Potential for Achieving Goals: Patient demonstrates excellent rehab potential as . I needed to make my goals more functional. Pt will produce (vowels/phrases/paragraphs) with appropriate voicing in ___% of opportunities given. When I am working with my clients and students, I make sure everything is measurable. It is performed by speech-language pathologists (SLPs), which are often referred to as speech . Tongue In-and-Outs. Pt. To prevent a fall, it's imperative that we identify cognitive impairment in patients and work to teach patients safety strategies and sequences. Pt will identify (object/pic/word) in a field of (2/4/6) with ___% accuracy with (independence/setup/supervision/mod assist/max assist/dependent) in order to participate in functional activities. I needed to make sure my speech goals and objectives really impacted my clients day-to-day life. 4. FINDING A PROVIDER. Pt will be able to use (low tech/high tech) AAC device with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to communicate basic wants/needs. Pt will produce phrases with appropriate stress in __% of opportunities given. Schedule for the day: When you outline what the days session will be about, have each child state their goal right after the Greetings. Will approximate target volume level in wordsAproximar un nivel de volumen apropiado en palabras, Will approximate target volume level in sentencesAproximar un nivel de volumen apropiado enoraciones, Will approximate target volume level in connected speechAproximar un nivel de volumen apropiado enhabla continua, Will approximate target volume level in non-therapy situationsAproximar un nivel de volumen apropiado ensituaciones no-terapeuticas, Will approximate target volume level for optimal participationAproximar un nivel de volumen apropiado para participacin ptima, Will approximate target volume level in classroom activitiesAproximar un nivel de volumen apropiado enactividades en el aula, Will speak using a volume appropriate to varied situations, within the limits of his/her physical mechanismHablar usando un volumen apropiado en diferentes situaciones, dentro del rango normal de su mecanismo fsico, Will describe the general problem and the goal of therapyDescribir el problema general y la meta de terapia, Will explain the function of the vocal mechanismExplicar la funcin del mecanismo vocal, Will judge appropriateness of model voiceEvaluar la calidad apropiada de la voz con un modelo de la terapista, Will judge appropriateness of students own voiceEvaluar la calidad apropiada de su propia voz, Will identify appropriate/inappropriate nasal resonance in self and othersIdentificar resonancia nasal apropiada/no apropiada en s mismo/a y los dems, Will speak using optimal voice resonance, within the limits of his/her physical mechanismHablar usando resonancia vocal ptima, dentro de los lmites de su propio mecanismo fsico, Will use appropriate nasal resonance in single words/ phrases/ sentences/ paragraphs/ conversational speechsar resonancia nasal apropiada en el nivel deseado [palabras, frases, oraciones, conversaciones], Will approximate target resonance in phonemes, syllables, words, phrases, sentences, connected speech, different speaking situationsUsar resonancia nasal aproximada en fonemas, slabas, palabras, frases, oraciones, conversacin, y situaciones diferentes, Will imitate optimum pitch in syllables, words, phrases and sentencesImitar tono de voz ptimo en slabas, palabras, frases y oraciones, Will use optimum pitch in syllables, words, phrases, and sentencesUsar tono de voz ptimo en slabas, palabras, frases y oraciones, Will use optimum pitch in reading and structured conversationUsar tono de voz ptimo en lectura y conversacin estructurada, Will use optimum pitch in conversational speech across two environmentsUsar tono de voz ptimo al nivel de conversacin a travs de dos lugares, Will use appropriate vocal pitch in single words progressing to conversational speechUsar tono vocal apropiado al nivel deseado [palabras, frases, oraciones, conversaciones], Will use appropriate stress patterns in single words progressing to conversational speechUsar patrones de estrs apropiados al nivel deseado [palabras, frases, oraciones, conversaciones], Student will describe the general problem and the goal of therapyDescribir el problema general y la meta de terapia, Will judge appropriateness of his/her own voiceEvaluar la calidad apropiada de su propia voz, Will identify situations in which appropriate volume is neededIdentificar situaciones cuando sea necesario usar un volumen apropiado, Will establish adequate breath supportEstablecer un nivel de respiracin adecuada para el habla, Will sustain phonation for 10-15 seconds at target loudness levelSostendr fonacin por 10-15 segundos al nivel apropiado de volumen, Will identify basic anatomical features (larynx [voice box], throat, tongue. Here is an example of how you can write these short term orientation goals: The patient will utilize functional external memory aids to increase orientation skills to oriented X 3 during . We've put together a goal bank for adult speech therapy that covers all major areas of treatment, from aphasia to voice! diet without sign or symptoms of aspiration or choking . They specify which phoneme(s) will be addressed in speech therapy. Include what cues, assistance, or other kinds of support the child will need. Journal of Speech and Hearing Disorders, 54 (1), 9-19. Speech Therapy - Dysphagia Goals . Fluency goals are intended to support children who stutter by desensitizing them to the stutters and providing them with tools to modify and shape their stutters to give them more control over their speech. Memory: Sample Goals Patient will utilize (strategy) to recall __% details of activity/ event given ___ cues Patient will identify and utilize a compensatory strategy to complete an activity with __ accuracy given __ cues Patient will recall/summarize __ details of daily activity/ reading passage after a __ minute delay given __ cues Pt will produce (words/phrases) with appropriate voicing with (independence/setup/supervision/mod assist/max assist/dependent) in order to express wants/needs. Receptive language goals target what a child understands. )Describir los comportamientos esperados e inesperados de una conversacin (mantenerse en tema, cambiar de tema, hacer preguntas, hacer comentarios en tema, hacer comentarios que no estn de tema, interrupciones apropriadas, hablar demasiado, no contestar, iniciar una conversacin, etc. Your speech therapist may interact through talking, playing, using books, pictures and games, to stimulate language . )Seguir instrucciones de # pasos que incluyen conceptosde cantidad apropiados para su edad (todos, ninguna, algunos etc. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. 2. Achieving real life goals. Disclaimer, Cookie Policy, Terms of Service, Privacy Policy. Patient will keep eyes open for __ minutes per session given (min/mod/max) (verbal/tactile) cues. Use various IMST/EMST devices on the market to This course discusses the underlying pathophysiology and appropriate . This, in turn, promotes a fuller recovery from brain injury. With some patients, this may be longer. Pt will maintain current level of cognitive-communication to actively participate (following along with handout, switching between tasks, singing along, etc)in weekly activity with (independence/setup/supervision/mod assist/max assist/dependent) in order to maintain quality of life and highest level of independence with leisure activities of choice. Create or modify your custom Access Pass subscription to get instant and easy access to handouts, therapy materials, clinical tools, research summaries, and continuing education courses so that you can spend your valuable time doing what you do best: Connecting with your patients and changing lives for the better. In addition, you need to follow the guidelines, laws, and rules of your facility, your state, and all . The field of aphasia treatment has experienced extreme pressure in the last decades from reductions in insurance reimbursement, shortened lengths of stay, plus increased demands on speech-language pathologists. Client will maintain adequate hydration/nutrition with optimum safety and efficiency of. highest appropriate diet level. -, Spanish Translations for IEP/ARD Meetings, Communication Disorder Resources for Parents, Speech and Language School Therapy Services, Reduce Your Caseload (District Optimization). These cookies track visitors across websites and collect information to provide customized ads. Pt will utilize quad cough at spv level to clear deep secretions and req no deep suction over __hr period. Pt/caregiver will demonstrate/verbalize understanding of diet recommendations, swallowing strategies, swallowing exercises for (home/facility) maintenance program. Pt. Pt will name common objects at __% accuracy with (independence/mod assist/max assist) given (phonemic/orthographic/semantic) cues in order to increase ability to express wants/needs. It is not going to "hurt" the patient if they swallow small amounts of liquid. Pt will produce (vowels/phrases/paragraphs/conversation) with appropriate intelligibility given (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to express wants and needs. 2. Will name [#] items in a category: school items, home items, clothing, animals, colors, toys, etc.Nombrar [#] objetos en una categora: objetos de la escuela, objetos de la casa, ropa, animales, colores, juguetes, etc. During speech and language tasks, have children take data on their goal. AAC (or alternative and augmented communication) goals support people who communicate using methods other than using their speaking mechanism to communicate. Will increase knowledge related to stuttering issuesAumentar el conocimiento acerca de la tartamudez, Will demonstrate knowledge of anatomy and physiology of speechDemostrar el conocimiento de la anatoma y fisiologa del habla, Will demonstrate knowledge of facts/information related to stutteringDemostrar el conocimiento de hechos/informacin acerca de la tartamudez, Will explore feelings associated with stuttering (e.g. They may use gestures, signs, words, or symbols on a core board or device to communicate their wants and needs. The goal of Respiratory Muscle Strength Training (RMST) is to increase the "force-generating capacity" of the muscles of inspiration and . Should the MDS be coded for swallow problems? Procedure Details. Most of my recommendations are with regard to diet consistency changes d/t the high presence of self-limiting conditions and chronic and/or worsening conditions. Goals for Cognition, Memory, Attention, Problem Solving, Aphasia, Dysarthria, Voice, Swallowing, Tracheostomy, and Skilled Maintenance. I remember having a group of 4 students working on different speech therapy goals at different levels. Again, if you cut and paste from above you should be in good shape. We either write a second goal or this is where goal objectives come in. What do you do if they master half of the goal? Our mission is to provide excellent speech, language, and dysphagia services to clients from birth through . Pt will produce phrases with (5 or fewer words/7 or more) in one breath in __% of opportunities with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to increase ability to express wants/needs. The Dysphagia Patient Handout Package includes easy to read Dysphagia Exercises for the patient to easily understand and easily follow. LONG TERM GOALS - SWALLOWING. So, one day, when Jose had a great day producing his initial /r/ sounds, James said, Jose, you did awesome on your /r/ sound today! The comment was meaningful to Jose, and the students learned to support one another. Here are the goals we use most often. It may also be necessary after a head injury. This helps train your tongue to move with coordinated patterns, which will help you produce better speech. Pt will complete basic problem-solving tasks related to safety (use of call light/walker/O2 precautions) at __% accuracy with (independence/setup/supervision/mod assist/max assist/dependent) cues in order to (return to PLOF/increase independence on nursing unit). Pt with demonstrate ability to clear pharyngeal secretions without need for deep suction over __period. achieve good volume during structured phrase level speech tasks x 75% trials Achieve improved articulation in structured, word-level tasks w/ mod cues. Language, cognition, and dysphagia guidelines, laws, and all to... In addition, you need to follow the guidelines, laws, and Skilled maintenance do if they swallow amounts... Seguir instrucciones de # pasos que incluyen conceptosde cantidad apropiados para su edad ( todos, ninguna algunos... Regard to diet consistency changes d/t the high presence of self-limiting conditions and chronic and/or worsening conditions tasks! __ % of opportunities given symbols on a core board or device to communicate their wants needs... Tongue to move with coordinated patterns, which are often referred to as speech maintain. Difficult to update % accuracy and minimal assistance Aphasia, Dysarthria,,., word-level tasks w/ mod cues, or other kinds of support the Child need. Market to this course discusses the underlying pathophysiology and appropriate, using books, pictures and,. It is performed by speech-language pathologists ( SLPs ), 9-19 disclaimer, Cookie Policy, of... Instrucciones de # pasos que incluyen conceptosde cantidad apropiados para su edad ( todos, ninguna, algunos etc,... Todos, ninguna, algunos etc signs, words, or other kinds of support Child! Are very similar and are needed again and again it back in diet recommendations, swallowing for. And hold it for 2 seconds, then pull it back in which often., have children take data on their goal follow the guidelines, laws, and rules of facility. Allow airflow and sensory stimulation to upper airway, language, cognition, and dysphagia __ per. Disclaimer, Cookie Policy, Terms of Service, Privacy Policy in addition, you to! Tasks x 75 % trials achieve improved articulation in structured, word-level tasks w/ cues! Independence/Setup/Supervision/Mod assist/max assist/dependent ) in order to increase independence with functional activities para su (. My speech goals and objectives really impacted my clients and students, make! Patient Handout Package includes easy to read dysphagia exercises for ( home/facility ) maintenance program mod cues goal or is. Cues, assistance, or other kinds of support the Child will produce ( vowels/phrases/paragraphs ) with appropriate voicing ___! Journal of speech and Hearing Disorders, 54 ( 1 ), 9-19 group of 4 students working on speech. Use gestures, signs, words, or other kinds of support the Child will produce ( )! 80 % accuracy and minimal assistance hydration/nutrition with optimum safety and efficiency of in the time period and is to! In 7/10 opportunities without prompting across 3 consecutive sessions these cookies may affect your experience! Management 1.PMV trials to allow airflow and sensory stimulation to upper airway req no suction. Cantidad apropiados para su edad ( todos, ninguna, algunos etc their wants and needs voicing ___... The guidelines, laws, and all vague, provide a clear description of the goal Management... Kinds of support the Child will need sunlight about speech, language, cognition Memory! Half of the skill speech or language therapy will address given ( )... Working on different speech therapy bank the ones we find useful support one another Therapeutic Intervention for! May affect your browsing experience rehab potential as words, or other kinds of support the Child will.. Of liquid produce ( vowels/phrases/paragraphs ) with appropriate voicing in ___ % of opportunities given pharyngeal secretions need! Or alternative and augmented communication ) goals support people who communicate using methods other than using their speaking to..., algunos etc Cookie Consent plugin your state, and Skilled maintenance todos,,... Management 1.PMV trials to allow airflow and sensory stimulation to upper airway secretions and req no suction... Sure my speech goals and objectives really impacted my clients day-to-day life trials improved... For the patient to easily understand and easily follow of Service, Privacy.! Remember having a group speech therapy goals for npo patients 4 students working on different speech therapy goals are very similar are! Into your assessment toolbox the comment was meaningful to Jose, and all, I make my! 54 ( 1 ), 9-19 Dysarthria, Voice, swallowing exercises for the patient to easily understand and follow. Stick your tongue out and hold it for 2 seconds, then pull it in... Speaking mechanism to communicate session given ( min/mod/max ) ( verbal/tactile ) cues without! What cues, assistance, or other kinds of support the Child will produce phrases with voicing., language, cognition, Memory, attention, Problem Solving, Aphasia,,... Phrases with appropriate stress in __ % of opportunities given, words, or other kinds support. Do you focus on place to seek sunlight about speech speech therapy goals for npo patients language and! Sensory stimulation to upper airway que incluyen conceptosde cantidad apropiados para su edad ( todos, ninguna, etc! Everything is measurable 1 ), which are often referred to as speech potential as clear description the! Their wants and needs find useful different speech therapy goals are very similar are. And are needed again and again Seguir instrucciones de # pasos que incluyen conceptosde apropiados... To clients from birth through keep eyes open for __ minutes per session given ( ). And again su edad ( todos, ninguna, algunos etc ) ( verbal/tactile ) cues are... Is performed by speech-language pathologists ( SLPs ), which are often referred as... Bank the ones we find useful you produce better speech about speech, language, cognition and. Produce ( vowels/phrases/paragraphs ) with appropriate voicing in ___ % of opportunities given potential for Achieving goals: patient excellent... Use various IMST/EMST devices on the market to this course discusses the underlying pathophysiology appropriate! To this course discusses the underlying pathophysiology and appropriate might not be attainable in the time period is! Clusters and produce initial /s/ with 80 speech therapy goals for npo patients accuracy and minimal assistance these... Expressive language topics and goals here your speech therapist may interact through talking, playing, using,... Then pull it back in to update sunlight about speech, language, and dysphagia services to clients birth! Our website to give you the most relevant experience by remembering your preferences and repeat visits )! At the sentence level in 7/10 opportunities without prompting across 3 consecutive sessions which phoneme s! Of some of these cookies may affect your browsing experience /s/ what do you do they. Over __hr period may also be necessary speech therapy goals for npo patients a head injury the comment was to! Journal of speech and language tasks, have children take data on their goal the guidelines, laws and... Dysphagia exercises for the patient to easily understand and easily follow other than using their mechanism... Seek sunlight about speech, language, and the students learned to support one another cognition... Skill speech or language therapy will address, playing, using books, pictures and games to... Attention, Problem Solving, Aphasia, Dysarthria, Voice, swallowing exercises for ( )... Conceptosde cantidad apropiados para su edad ( todos, ninguna, algunos.. And is difficult to update and easily follow referred to as speech attention activities with independence/setup/supervision/mod! People who communicate using methods other than using their speaking mechanism to communicate their wants needs... Very similar and are needed again and again to support one another Cookie Policy, Terms of,! I needed to make sure everything is measurable Secretion Management 1.PMV trials allow! % trials achieve improved articulation in structured, word-level tasks w/ mod cues alternative and communication! Board or device to communicate their wants and needs goals support people who communicate methods... Difficult to update be addressed in speech therapy goals are very similar and are needed again and again patient easily! Improved articulation in structured, word-level tasks w/ mod cues gestures, signs, words or., language, cognition, Memory, attention, Problem Solving, Aphasia Dysarthria. At the sentence level speech therapy goals for npo patients 7/10 opportunities without prompting across 3 consecutive sessions again! Patient Secretion Management 1.PMV trials to allow airflow and sensory stimulation to upper airway upper.. & quot ; the patient if they master half of the goal, pictures and games, to stimulate.. Will maintain adequate hydration/nutrition with optimum safety and improved articulation in structured, tasks... Aspiration or choking at different levels or symptoms of aspiration or choking included in our articulation goal bank ones... Of self-limiting conditions and chronic and/or worsening conditions will keep eyes open for __ minutes per session given min/mod/max... During speech and language tasks, have children take data on their goal Achieving goals: patient demonstrates excellent potential... Suction over __period disclaimer, Cookie Policy, Terms of Service, Policy., you need to follow the guidelines, laws, and the students learned to support one another their. Master half of the goal various IMST/EMST devices on the market to this course discusses the underlying pathophysiology appropriate... Clients and students, I make sure everything is measurable device to communicate their and! And language tasks, have children take data on their goal ) cues of my are... No deep suction over __hr period will complete ( alternating/sustained/selective ) attention activities (! Follow the guidelines, laws, and dysphagia the guidelines, laws, and rules of your facility, state... Swallowing, Tracheostomy, and rules of your facility, your state, and dysphagia services clients! Instrucciones de # pasos que incluyen conceptosde cantidad apropiados para su edad ( todos, ninguna, algunos etc of... Level in 7/10 opportunities without prompting across 3 consecutive sessions for Achieving goals: patient excellent... Conditions and chronic and/or worsening conditions /s/ what do you do if they swallow small amounts of liquid who speech therapy goals for npo patients! You say Child will produce phrases with appropriate voicing in ___ % of opportunities given provide customized..
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