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Oral- facial Examination
- The oral-facial peripheral examination is an important component of a complete speech assessment.
- Rule out structural or Functional factors that relate to a communication disorder.
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Oral Exam Interpretation
- Reliable & Valid interpretation require understanding of bases of oral structure:
- anatomic
- physiologic
- Neurologic
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General Guidelines
- Sterilize all equipment that is used in the mouth
- Wash hands before and after contact
- Wear gloves if there will be contact with bodily fluids, mucous membranes, or broken
- skin
- Remove gloves promptly, without touching the outside of them
- Turn them inside out when removing
- Safely dispose of them
- Wash hands after removing gloves
- Wear eye and mouth protection if any body fluids are likely to splash or spray
- Wear a gown and shoe covering if clothing is likely to come in contact with body
- fluids
- Change your clothing if another person’s blood or body fluid gets onto your clothes
- Never use single-use equipment (e.g., gloves, tongue depressor, toothette, etc.) more than once
- Follow facility or campus infection control policies regarding procedures for disinfecting and cleaning various surfaces and instruments
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Common Tools
- Flashlight
- Tongue Depressor
- Cotton gauze
- Gloves
- Hand antiseptic
- Mirror
- Foods for those who are reluctant to participate
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Components of Oral-Facial Exam:
- Observe structures at rest & during function
- Face
- Jaw
- Teeth
- Lips
- Tongue
- Pharynx
- Hard Palate
- Soft Palate
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Assessing Diadochokinetic Rates
- A function of motor control
- Judge the ability of the articulators to perform speech movements
- -Speed
- -Accuracy
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General Considerations
- Actual size, shape etc. is not as important as the relationship among them
- It is difficult to predict the cumulative effects of speech that more than one small deviation will have.
- Generally speaking if a speaker can say a sound in any context, structural deviations are not significant.
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Face/Head
Structure
- Asymmetry-droop on right or left side
- Disproportion
- Deviant resting postures
- Discoloration
- Scarring
- Nasal vs. oral breathing
- Facial expression
- Hypo/hypertonicity
- Drooling may signal inadequate
- Swallowing mechanism
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Face/Head
Function
- Abnormal Movements
- -Are there any grimaces or spasms of the face?
- Nasal vs Oral Breathing
- -Does the client breathe predominately through his or her mouth?
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Evaluation of Jaw
Ask client to open and close mouth
- Range of motion- Can the client open his or her mouth and how wide?
- Symmetry- Is there noticeable deviation to the right or the left?
- Movement- Is the movement normal/smooth or are movement s jerky, groping, slow, asymmetrical?
- TMJ- Can you hear grinding or popping sounds when the client opens his or her mouth?
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Lips
- Highly mobile
- Important role in appearance
- Structure at rest--need a bilateral seal
- -Compare upper with lower
- -Symmetrical
- -Drooping
- Protrusion/retraction
- Labial diadochokinesis ‘puh’
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Evaluation of Lips
Ask client pucker lips
- Range of motion- Is there reduced ability to pucker lips
- Symmetry- Is there a bilateral droop or droop to left or right?
- Strength- Ask client to press tongue blade against lips. Is the client able to keep lips closed? If not, note weak lip function.
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Evaluation of Lips
Tell Client to smile
- Rangeof motion- Is there reduced ability to retract lips?
- Symmetry- Is there a bilateral droop or droop to left or right?
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Evaluation of Lips
Tell client to puff cheeks and hold air
- Lip Strength-Can the client maintain labial seal?
- Nasal emission- Does air escape through the nose?
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Mandible Maxilla
- Range/symmetry of depression and elevation of mandible.
- Relation of mandible to maxilla.
- -Dental Occlusions
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Evaluation of Teeth
Observe Dentition (Ask client to open mouth)
- Teeth- Are all teeth present?
- Arrangement- Are the teeth jumbled, spaced abnormally, or misaligned?
- Hygiene- Is there obvious evidence of some degree of oral care? Is hygiene effecting the integrity of teeth and their ability to function properly?
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Occlusion Molar Relationship
- Class I
- Class II
- Class III
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Occlusion Incisor Relationship
- Normal
- Overbite
- Underbite
- Crossbite
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Hard Palate
- Arch form (e.g. high vaulted etc.)
- Color should be pink-white; a bluish tint may be indication of submucous cleft
- Juncture with soft palate should be slightly scalloped and continuous; a definite notch may be an indication of submucous cleft.
- Oronasal fistulae (hole)
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Observe hard and soft palates- Ask client to open mouth
- Color- Is there a normal pink color?
- Rugae- Are the bumps on the roof of mouth normal or very prominent?
- Arch height- Is the arch abnormally high or low?
- Arch width- Is the arch abnormally wide or narrow?
- Growths- Are there any abnormal growths present?
- Fistula- Is a fistula absent or present?
- Cleft- Is there clefting present?
- Symmetry at rest- Does one side rest lower than the other?
- Gag reflex- Is there normal, absent, hyperactive, or hypoactive?
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Ask client to phonate using /a/ (“ahhh”) with mouth open
- Symmetry of movement- Is there deviation to right or the left?
- Posterior movement- Is movement of the articulators posteriorly normal, absent, or reduced?
- Lateral movement- Is movement of the articulators posteriorly normal, absent, or reduced?
- Uvula- Is it normal, bifid, or deviating to the left/right?
- Nasality- Is hypernasality present?
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Velum
- Can’t determine the adequacy of the velopharyngeal port just by looking
- Speech resonance characteristics can help pinpoint the need for instrumental evaluation.
- Nasoendoscopy
- Aerodynamics
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Evaluation of Pharynx
Ask client to open mouth and view back wall of oral cavity (pharynx location)-
- Color- Is the pharynx pink in color?
- Tonsils- Are they absent, normal, or enlarged?
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Velum--Function
- Stop/plosive load:
- -Dick took Patty.
- -Peter has a puppy.
- Fricative/affricate load:
- -Sissy sees the sky.
- -Should I wash the dishes?
- Nasal environments:
- -Nancy is a nurse.
- -Mama makes lemon jam.
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Tongue
- Most important articulator
- Size in relation to oral cavity
- Fasiculations
- Function:
- Protrusion/elevation range, strength, symmetry, rhythm
- Normal side will push to the weaker side upon protrusion.
- Diadochokinetic rates
- Lingual frenum
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Observe Tongue (ask client to open mouth)
- Surface color- Is the tongue normal pink color?
- Movements- Are the jerks, spasms, writhing, or fasciculation present? Is tongue movement absent?
- Size- Is the tongue normal, small, or large sized?
- Frenulum- Is the frenulum normal or short in length?
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Ask client to protrude tongue
- Excursion- Is there deviation to the right or left?
- Range of Motion- Is range of movement reduced?
- Speed of Motion- Is movement slower than normal?
- Strength- Apply pressure against the tongue blade while it is protruded. Is there reduced strength?
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Ask client to retract tongue
- Excursion- Is there deviation to the right or left?
- Range of Motion- Is range of movement reduced?
- Speed of Motion- Is movement slower than normal?
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Ask client to move tongue tip up and then down
- Movement- Are there groping movements present?
- Range of motion- Is range of motion reduced?
- *Note these observations separately for movement upward and movement downward
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Observe rapid side to side movements (Ask client to quickly move tongue tip from one corner of the lips to the other)
- Rate- Is movement slowed, or does it slow progressively?
- Range of Motion- Is there reduced motion on the right or left?
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Laryngeal Mechanism
- Quality (weak and whispery to harsh and hoarse)
- Pitch
- Loudness
- Cough
- Maximum phonation time
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Summary for Core Speech Mechanism Examination
- Symmetry of face, lips, velum, tongue
- Strength and coordination of tongue and jaw
- Irregularities in motor movement patterns
- signs of progressive problems
- good medical history
- sensory information is important
- Multiple samples of motor activities
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