Oral Motor Exam Elise Peltier 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 • 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=xuwdv. BXcr 30 • 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 “papa” - Repeat “tata” - Repeat “kakaka” • Alternate Motion Rate - Repeat “pataka” • Nonspeech tasks (assess for oral apraxia)