Lecture 5 Oral Peripheral Examination

Oral Peripheral Examination

Overview

  • Synonymous Terms:

    • Oral Motor Exam

    • Oral Mechanism Exam

    • Oral Exam

Definition- What Is It?

  • A systematic assessment of anatomical structures and physiological functions crucial for speech production.

  • Involves examining anatomy and physiology.

  • Typically performed as a regular part of diagnostic evaluations.

  • The examination usually takes less than 2 minutes.

  • swallowing disorder eval may include a cranial nerve exam

  • stroke or artic patient may have structural issues

  • we are always looking for the cause and factors that cause it

Purpose

  • To aid in shaping theories related to:

    • Etiology

    • Diagnosis

    • Prognosis

    • Treatment direction

Required Tools

  • Light source (pen light) NOT phone obviously

  • Tongue depressor- can be used to depress tongue and to check gag reflex and to target the tongue to touch it like stick it out as far as you can

  • Gloves

  • Cotton gauze pads- used to assess chewing or to move tongue

  • Candy suckers- used to elicit oral motor movements like in place of tongue depressor for kids

  • Mirror- so they can see their movements

  • Stopwatch- used for diadokokinesis= rapid alternating movements. stick your tongue out as many times as you can in 1 min

Areas to Assess 1/22/25

  • Face and Breathing

    • Examine facial muscles, nasolabial folds, eyelid and facial droop, appearance of features. can suggest diff. syndromes

    • facial droop= bells palsy, paralysis

    • Observe breathing patterns during speech and at rest; assess for mouth breathing and nasal passage obstructions.

  • Lips

    • Assess structure (size, symmetry, scarring) and function (smile, pucker, strength).

    • Tasks include lip closures against resistance and performing "puh" at least once per second.

  • Tongue

    • Evaluate size relative to oral cavity, symmetry (at rest and during movement), scarring, and atrophy.

    • Function tasks include protruding, retracting, and lateral movements.

    • resistance tasks with tongue depressor and moving it around

    • look specifically at the tip and back of tongue

    • Perform "tuh" and "kuh" once per second, this uses tip and back of tongue

  • Diadochokinetic Rate (DDK) Assessment slide 10

    • Evaluates rapid alternating speech movements, rhythm, speed, and coordination.

    • assessment of rapid alternating speech movements, how fast can they do these sounds and can they do multiple things in a row. looks for speed, corrdination and rhythm

    • speed: pupupupu tutututu kukukuku

    • coordination: putuputuputuputu putukuputuku buttercup patty cake

    • always model it before you let them do it, model it pretty fast

    • always use a stopwatch and do 3 trials per stimulus

    • Fletcher count by time method: how many seconds will it take for my client to produce 10 syllables? if they have 10 syllables in 10 seconds, that is 1 syllable per second


buttercup: 13

  • Jaw

    • Check jaw at rest and symmetry; is the position and rest position symmetrical

    • Functional tasks include opening and closing the jaw and checking strength against resistance.

    • check if they can open jaw against your hand as a little bit of resistance

  • Teeth

    • Assess for cavities, alignment (crooked teeth), gaps, and the condition of dental prostheses.

    • we can help refer for dental care

    • look for cavities, crooked teeth, missing teeth, braces

    • look for their bite at rest, overbite, underbite, any weird side bite

    • class 1 malocclusion: upper and lower molars align but teeth are crooked, normal overbite

    • class 2 malocclusion: bad overbite

    • class 3 malocclusion: underbite

  • Hard Palate

    • Evaluate shape (flat, high, arched), width, scarring, and palatine variations.

    • palatal vault: archway

    • a little variation is ok

    • a hard biny growth is normal= torus palatinus

  • Soft Palate and Velopharyngeal Closure (20)

    • Look at structure, size, and movement symmetry; observe lateral movements and perform specific tasks like puffing cheeks.

    • 1/27/25: you can have a cleft lip, cleft palate or full cleft of both

    • listen for nasality, could be a sign that something is functionally wrong

    • also look for variation in color and size relative to depth of pharynx

    • function: look for symmetry of movement, for any deviation, can they puff their cheeks (this tests for labial seal and closure of VP port)

  • Fauces

    • Inspect for scarring, palatine tonsils, and overall condition of the oropharynx.

    • tonsils should be pink, not bright red

    • should not see kissing tonsils where they meet in the middle

    • look at how far apart are they

    • general condition - red, inflamed, or not

Four Options for oral mech protocols

  • OSME-3

  • Screening test for dev. apraxia

  • Frenchay

  • DEAP

Diadochokinetic (DDK) Rate Details

  • Types of Stimuli

    • Speed: "puh-puh-puh", "tuh-tuh-tuh", "kuh-kuh-kuh".

    • Coordination: "puh-tuh", "puh-tuh-kuh", phrases like "pattycake" and "buttercup".

  • Measurement Method

    • Model desired responses and allow for practice.

    • Use a stopwatch to average 3 trials for each stimulus.

    • Count-by-Time Method: Counts syllables produced in a designated timeframe (e.g., 10 seconds).

    • Fletcher Time by Count Method: Measures how long it takes to produce a set number of syllables.

Normative Data for DDK

  • Reference various studies and authors including Canning and Rose (1974), Fletcher (1972), and others for established norms.

Additional Areas to Assess

  • Jaw: Same structure and function assessments as above.

  • Teeth: Investigate occlusion criteria such as Angle's classification.

  • Hard Palate: Assess specific features like scars and shape variations.

  • Soft Palate and Velopharyngeal Mechanism: Review for symmetry and movement capabilities.

Recommended Assessment Protocols

  • Options include:

    • Oral Speech Mechanism Screening Examination (OSMSE-3): ages 5-77, audiocassette training, no guidance on planning treatment. plus or minus scoring system, has lots of tasks to indicate problems or normal function

    • Screening Test for Developmental Apraxia of Speech (STDAS-2): ages 4-8, no guidance for treatment, do not use to diagnose apraxia

    • DEAP Articulation Assessment: ages 3-8:11, tests DDk, isolated movement, sequenced movement

    • Frenchay Dysarthria Assessment (FDA-2): intended for suspected dysarthria, age 12- adult, gives performance profile to determine etiology, very user friendly

Conclusion and Resources

  • Regular screening and assessments are essential in guiding appropriate therapeutic interventions.

  • snoring also can be a sign of abnormal adenoids

  • xerostomia= dry mouth/tongue

  • ankyloglossia= mick, tongue tie, does it impact speech, feeding and/or swallowing? a congenital condition in which the tongues range of motion is affected by a short thick frenulum & it impacts speech and swallowing