Fabus et al 2011

Assessment of the Oral-Peripheral Speech Mechanism

Chapter Overview

The assessment of the oral-peripheral speech mechanism is crucial for evaluating the anatomical and functional integrity of the structures involved in speech and swallowing. This assessment is applicable to clients across all age groups and plays a vital role in comprehensive speech, language, and swallowing evaluations. Understanding these mechanisms is essential for diagnosing speech and swallowing disorders effectively.

Assessment Purpose

The primary objectives of the oral-peripheral assessment include:

  • Observing the client’s sensory and motor functions to gauge overall oral and speech health.

  • Identifying any structural and functional anomalies, such as malformations or muscle weakness, that could contribute to speech and swallowing disorders. Accurate observations can lead to targeted interventions and improved outcomes for the client.

Protocols

Several notable oral assessment protocols utilized by Speech-Language Pathologists (SLPs) include:

  • Clinical Assessment of Oropharyngeal Motor Development in Young Children (Robbins & Klee, 1987): Focuses on developmental milestones and motor control relevant to young children.

  • Structural/Functional Battery of Oral-Motor Tasks (Wertz, 1985): Comprehensive tool for evaluating oral structures and their functionality.

  • Dysarthria Profile (Robertson, 1982): Assesses the presence and severity of dysarthria, a motor speech disorder.

  • Frenchay Dysarthria Assessment (Enderby, 1983): A tool for evaluating dysarthric symptoms and their impact on speech.

  • Dworkin-Culatta Oral Mechanism Examination and Treatment System (1980): Provides an assessment framework for clinical intervention.

Examination Materials

For effective assessments, the following materials are typically necessary:

  • Sterile gloves, pen light, tongue depressor, mirror, stopwatch, glass of water, lollipops, bubbles, and sterile cotton swabs.

  • Adherence to infection control practices, such as washing hands before and after using gloves, is paramount to prevent cross-contamination and ensure client safety.

Anatomy and Physiology

A thorough understanding of facial and neck anatomy is crucial for the accurate assessment of speech mechanisms. Notable variations in structural and functional aspects are often observed and are usually typical; such variations do not necessarily indicate the presence of a disorder.

Cranial Nerves Overview

The cranial nerves play vital roles in speech production and swallowing, a brief overview includes:

  • CN V (Trigeminal): Provides sensory innervation to the face and motor control to muscles involved in mastication.

  • CN VII (Facial): Responsible for sensory function (taste from the anterior 2/3 of the tongue) and motor control for facial expressions.

  • CN IX (Glossopharyngeal): Supplies bilateral sensory input to the oropharynx and motor control to the pharyngeal constrictors.

  • CN X (Vagus): Involved in bilateral sensory innervation of the larynx and pharynx; motor control includes innervation of the soft palate and vocal cords.

  • CN XI (Spinal Accessory): Primarily motor, innervating muscles of the neck.

  • CN XII (Hypoglossal): Responsible for motor control of both intrinsic and extrinsic muscles of the tongue, crucial for speech articulation and swallowing.

Oral Reflexes in Infants

In infants, several oral reflexes are significant for development:

  • Bite Reflex: Characterized by rhythmic jaw opening and is integrated typically by 9-12 months.

  • Rooting Reflex: Initiated by stroking the cheek; the infant will turn their head toward the stimulus, integrating by 6 months.

  • Gag Reflex: Persists throughout an individual’s life, serving as a protective mechanism that includes mouth opening and tongue protrusion to avoid choking.

Examination Steps

The examination should be systematic, beginning with the assessment of external structures (like the face) before moving to internal structures (such as the velum). Key steps include:

  • Observing symmetry, function, and observing any structural integrity issues.

  • Noting atypical presentations, such as drooping lips or lack of facial movement, which can indicate underlying disorders.

Components of Oral Examination

  • Facial Motor Integrity: Evaluate the resting position and movement capabilities of facial muscles. Standard tasks include asking the client to smile, frown, puff cheeks, and close their eyes tightly to assess functionality.

  • Labial and Lingual Integrity: Observations should focus on structural integrity and the adequacy of movements; check the range of motion (ROM) and strength to ensure effective speech articulation.

  • Dentition & Occlusion: Assess for malocclusions (Class I, Class II, Class III) since missing teeth can have a significant impact on speech clarity and articulation.

  • Hard Palate Inspection: Carefully check for clefts, fistulas, scars, and other anomalies that could affect articulation.

  • Velopharyngeal Function Assessment: Assess closure by pinching the nares and asking the client to produce non-nasal sounds to confirm the effectiveness of velopharyngeal function.

  • Speech Rate Assessment: Utilizing diadochokinesis (D/K rate), assess the speed and accuracy of articulation by comparing client performance with established age norms.

Behavioral Considerations with Young Children

For young children, specific strategies can enhance compliance and engagement, such as:

  • Using games and familiar phrases during assessments to create a comfortable testing environment.

  • Engaging with the child using visual and tactile cues to elicit more accurate responses and reduce anxiety during evaluation.

Findings Requiring Referral

If noteworthy anomalies are detected, such as facial asymmetry, ptosis, or symptoms of dysphagia, consider:

  • Referring the client to specialists, including neurologists or otolaryngologists (ENTs), to address observed concerns comprehensively.

Conclusion

Conducting oral-peripheral exams is essential for gathering critical information regarding structural and functional speech integrity. Recognizing individual variations in anatomy is vital in discerning what constitutes normal versus pathological findings, ultimately guiding the treatment and intervention strategies for clients with speech or swallowing disorders.