Elise Peltier MS CCC SLP Jeanine Geisler MS CCC SLP Oral Motor Exam Elise Peltier MS CCC SLP Jeanine Geisler MS CCC SLP

What is an Oral Motor Exam Determine the structural and functional adequacy of the oral mechanisms A variety of medical professionals may complete dentists, doctors and speech language pathologists.

Alternative terminology Oral Motor Exam Oral Peripheral Exam Oral Mechanism Exam (Oral Mech) Speech Mechanism

Why do an Oral Motor Exam ? Stroke ( CVA) Feeding and Swallowing Aritculation Disorder Motor Speech Disorder Dysarthria Apraxia

Tools Gloves Tongue Depressor Pen Light Small hand held mirror Watch ( stop watch) Other helpful tools : sucker, cotton guaze

What structures do we look at ? Face Lips Teeth Tongue Jaw ( mandible) Hard/Soft Palate Cheeks

How do we illicit desired results Adult clients Give direct verbal instructions Model

Target: Facial Symmetry Have subject look straight at you Are facial features symmetrical?

Target: Tongue Elicitation Observations Stick straight out, left then right, left right quickly, elevation, retraction, protrusion and lateral movement against resistance ( cheek or tongue blade) Observations Look for symmetry and range of motion, size and evidence of fasiculations. https://www.youtube.com/watch?v=xuwdvBXcr30 Assess ability to exert force against resistance Assess coordination of fast movements

Target: Lips Elicitation Smile Pucker Open Close Tight Puff up cheeks, hold against resistance Observations- Look for symmetrical movements, extent of movements, ability to close completely and hold against resistance

Target: Oral Cavity and Velum Elicitation Open Wide Say “ah” or “E-E-E-” Observation Look at conditions of teeth, any dentures or partials? Watch for extent and symmetry of velar elevation and pharyngeal constriction

Target: Voice/Airway Protection Elicitation Maximum phonation duration S:Z ratio, pitch glides Volitional cough and Throat clearing Observations Listen for intensity, pitch and quality Listen for breathy, horas/harsh, strained, wet/gurgly Listen for hyper or hyponasality

Special considerations for adults Hearing loss or auditory comprehension - check for hearing aids, write instructions, model Adults with Apraxia Blow a kiss, smile Give a spoon or straw

How can we describe/ measure We can describe muscle and function and movement using STARRS MUSCLE STRENGTH MUSCLE TONE ACCURACY OF MOVEMENT RANGE OF MOVEMENT SPEED OF MOVEMENT STEADINESS OF MOVEMENT

Get your ped to participate! Ped friendly language Glove considerations Extra-Oral -> Intra-Oral Use of lollipop or pudding Flavored tongue depressors Flashlight with lights off Take turns looking into each others mouth “Simon Says” game Assess during meal or “snack”

Anatomy Age 5 is when anatomy + physiology (for feeding/swallowing) is like that of an adult Structures and their relationship are previously designed to provide stability, control, and airway protection

Structural Considerations Cleft palate or lip

Structural Considerations cont. Tongue tie (ankyloglossia) or Lip tie

Hypotonic Facial Characteristics

Drooling Assess why - Postural Control - Oral sensory responses - Oral-motor skills - Swallowing ability - Cognitive level - Structural Problems - Dental/Occlusion problems - Medications - Diet

Teeth Normal Occlusion Class II Malocclusion (Overbite) Class III Malocclusion (Underbite)

Teeth cont. Cross Bite Open Bite Tooth Decay

Assessing for Apraxia of Speech Diadochokinetic Rate - Repeat “papapapa” - Repeat “tatatata” - Repeat “kakaka” Alternate Motion Rate - Repeat “pataka” Nonspeech tasks (assess for oral apraxia)