2.  Normal range of structure and function of the speech mechanism is very broad and varied  Structural deviations do not necessarily equal speech production difficulties  Looking for RED FLAGS during the oral exam  Tremors, voice quality, nasal sounds, breath support, structures,

3.  Observe at least 10 typical people’s mouths  Listen to their voices  Let’s practice

4.  Universal precautions  Protect others  Protect yourself  Tools?  Rubber gloves  Pen flashlight  Tongue depressor  Stopwatch  Facial tissue  Dental mirror (?)  Disinfectant

5.  Broad to specific assessment  Symmetry of the face  Client’s breathing  Open mouth posture  Adequate breath support  Voice quality  Connected speech (control of saliva)  Some of your most valuable dx info can be from functional situations !!!

6.  Facial structure – first sign of a syndrome  Symmetry  Muscle control  Presence of tremors, spasms, or tics  Abnormal tension or lax in the face at rest  Breathing  Mouth or nasal breathing

7.  Mouth  Lip closure  Cleft?  Smile symmetry  Eyes  Eyebrows?  Shape and ‘alertness’ of the eyes

8.  Sensations of upper and lower lip, cheeks by closing eyes (soft vs hard touch)  Hot/cold senses  Respiration  In through nose, out through mouth  Air flow during speech  Abdominal breathing/shallow breathing  Stridor or hoarseness in voice  Straw for kids, hold their nose, blow bubbles as long as they can (5 seconds – okay)

9.  Nose  Look up in the nose for possible obstruction  Lips  Important articulator and anatomical structure  Eating, drinking, facial expression, speech  Natural smile,  Fill cheeks with air and hold for 10 seconds  Retract, protrude, /pa/ /ba/ (lip/jaw movement)  Pucker/smile (for adults) ‘baby’ or ‘mama’ (for kids)  O-e (over and over)

10.  Open mouth ( for kids = ‘let’s see what you had for lunch  Color of oral cavity  Hard/soft palate  Normal arch to hard palate  Healthy color – no growths  Fistula  Uvula  Tonsils  ‘ahhh’ soft palate elevation quick ‘ahhs’  Gag reflex

11.  Dentition  Tongue (feeding and speaking)  Size, color, symmetry  Tongue at rest (color), atrophy  Tongue mobility (lollipop for kids)  Stability of head and jaw during tongue movmnts

12.  Timed for 20 pahs, then tahs, then kahs  Then asked to say pahtahkah 10 times

13.  (more specialized area)  Observe eating 2 or 3 textures  Drinking liquids by cup and straw  Food introduced by spoon and hand  History is important here

14.  Why do an oral mech exam?  Why is it important to look at the function as well as the structure when assessing?  What are some factors influencing speech intelligibility besides structure and function?  What are some important precautions to take before you perform an exam