Guidelines for Conducting an Oral Peripheral Exam

(1)

Guidelines for Conducting an

Oral Peripheral Examination



Why an Oral Motor Exam? (PBH)



Research shows that some articulation

disorders may be directly related to abnormal

structure and function of the orofacial

complex



i.e. Open Bite=frontal lisp

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Guidelines for Conducting an

Oral Peripheral Examination



Why an Oral Motor Exam? (PBH)



Helps determine if a speech sound disorder is

functional (cause not determined) or organic

(w/ underlining structural, sensory or

neurological cause—cleft palate) in nature



Helps determine if static and dynamic

articulators are adequate for speech

production

(3)

Guidelines for Conducting an

Oral Peripheral Examination



Tools needed:



Gloves



Tongue depressor

(place on a disposable surface, put a mark on the grasp

end- e.g. for children under 4 can put a happy face)



Penlight



Stopwatch or clock with a second hand



Mirror



Food or drink (optional)

(4)

The Oral Peripheral

Examination

Esther Phillips-Embden, MA,CCC/SLP/L

Cynthia Lewis, MS, CCC/SLP/L

CSD 516

Advanced Practicum

Fall 2009

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Guidelines for Conducting an

Oral Peripheral Examination



Procedure:



Make sure all equipment is sterile that is to be

used in the mouth



Wash hands/sterilize BEFORE and AFTER

exam



Wear gloves and remove PROMPTLY post oral

exam



Did I say “Wash hands?”—again after

removing gloves.

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Guidelines for Conducting an

Oral Peripheral Examination



How to

_(Hedge):_(Hedge):



Position the client so their face is at eye level



Observe the following:



(1) Facial Characteristics



Overall expression and appearance, size, shape and

symmetry of the head and facial structures



Is there drooping of one eye, cheek or corner of the

mouth? Mouth breathing or drooling? May indicate

neurologic involvement, unilateral facial paresis or

paralysis

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Guidelines for Conducting an

Oral Peripheral Examination



How to

_:_:



Facial Characteristics (con’t)



“

Normal” face is “five eyes wide”



“

Normal” esthetic line: tip of nose, lips and chin

should fall along the same line.



Can be divided into three relatively equal thirds

horizontally



Top 3

rdrd

(top of head to eyebrows)



Middle 3

rdrd

(eyebrows to bottom of nose)

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Guidelines for Conducting an

Oral Peripheral Examination



Fetal Alcohol Syndrome Characteristics



Facial Characteristics



Facial asymmetry noted



Microcephaly-small head



Thin upper lip



Long smooth philtrum



Short, upturned nose

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Guidelines for Conducting an

Oral Peripheral Examination



How to:



(2) Observe Breathing



Clavicular breathing



May be associated with excess tension in the neck and

shoulders and may contribute to hyperfunction in the larynx

and consequent voice problems



Irregular breathing patterns or inadequate respiration



May effect speech prosody or have a negative effect on vocal

quality



Mouth breathing



Often associated with open mouth posture and forward tongue

carriage



If nasal breathing is absent or difficulty refer for a medical

exam to determine why

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Guidelines for Conducting an

Oral Peripheral Examination



How to

_(Hedge):_(Hedge):



(3) Observe Lips and ROM on the following:



Round/pucker the lips



Elongate the lips (smile, showing teeth)



Alternate pucker-smile-pucker-smile (“oo-ee, oo-ee”)



Open lips wide



Close lips tightly and puff up cheeks (sustaining

intraoral pressure)

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Guidelines for Conducting an

Oral Peripheral Examination



How to

_(Hedge):_(Hedge):



(3) Observe Lips and ROM (Cont’d)

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Implications

 Labial weakness as indicated by difficulty to round/pucker the lips, Labial weakness as indicated by difficulty to round/pucker the lips, elongate the lips symmetrically or close the lips tightly to sustain

elongate the lips symmetrically or close the lips tightly to sustain

intraoral air pressure, may be indicative of a neurologic involvement.

 If If lips lips pull to one side during elongation, then they will pull to the pull to one side during elongation, then they will pull to the

strong

strong side, thus the opposite side is week. side, thus the opposite side is week.

 If a child is unable to sustain intraoral air pressure because air escapes If a child is unable to sustain intraoral air pressure because air escapes through the lips—labial weakness is indicated

through the lips—labial weakness is indicated

 If air escapes through the nose along with hypernaslity or nasal If air escapes through the nose along with hypernaslity or nasal emission--velopharyngeal insufficiency or incompetence is indicated.

emission--velopharyngeal insufficiency or incompetence is indicated.

 If sequencing or motor programming is difficult as indicated by groping If sequencing or motor programming is difficult as indicated by groping behaviors, difficulty alternating the pucker-smile, or difficulty

behaviors, difficulty alternating the pucker-smile, or difficulty

coordinating the movements needed to puff up the cheeks-- apraxia is

indicated

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Guidelines for Conducting an

Oral Peripheral Examination

Figure 20.12: A facial nerve palsy on the left produces

weakness of the muscles innervated by the facial nerve

on the left. This individual displays classic signs of facial

weakness, including absence of forehead wrinkles on

the left. The left eye is abnormally wide open, and the

mouth is pulled to the strong side.

(Oatis, Kinesiology: The Mechanics and Pathomechanics

of Human Movement, 2004)

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Guidelines for Conducting an

Oral Peripheral Examination



How to

_(Hedge):_(Hedge):



(4) Observe Lingual Appearance and Strength



Observe surface appearance of the client’s tongue.



Note any irregularities, scars or discolorations.



Ask client to:

 Protrude tongue: stick the tongue out as far as possibleProtrude tongue: stick the tongue out as far as possible  Push against the tongue blade to assess strengthPush against the tongue blade to assess strength

 Elevate the tongue tip as if trying to touch your noseElevate the tongue tip as if trying to touch your nose  Tongue tip down, as if trying to touch the chinTongue tip down, as if trying to touch the chin

 Tongue tip left then rightTongue tip left then right

 Alternate tongue to left and right sides (for lateralization-look for speed Alternate tongue to left and right sides (for lateralization-look for speed and coordination)

and coordination)

 Put tongue inside cheek on right/left sides and push cheek outPut tongue inside cheek on right/left sides and push cheek out

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Guidelines for Conducting an

Oral Peripheral Examination



How to

_(Hedge):_(Hedge):



(4) Observe Lingual Appearance and Strength



Implications

 An inability to protrude the tongue or push against the tongue blade, An inability to protrude the tongue or push against the tongue blade, difficulty elevating or lowering the tongue tip, moving tongue from side

difficulty elevating or lowering the tongue tip, moving tongue from side

to side, pushing against cheek is indicative of lingual weakness.

 If weakness is unilateral, then the tongue will deviate to the If weakness is unilateral, then the tongue will deviate to the weakweak side side upon protrusion because it is unable to match the

upon protrusion because it is unable to match the extensionextension of the of the stronger side

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Guidelines for Conducting an

Oral Peripheral Examination



How to

_(Hedge):_(Hedge):



(4) Observe Lingual Appearance and Strength



Implications (Cont’d)

 Inability to protrude the tongue beyond the lips and a heart-shaped Inability to protrude the tongue beyond the lips and a heart-shaped tongue when protruded indicate a short lingual frenulum

tongue when protruded indicate a short lingual frenulum

(ankyloglossia)

 May or may not affect articulationMay or may not affect articulation

 Have client produce several speech sounds requiring tongue Have client produce several speech sounds requiring tongue

elevation (/t/, /d/, /n/). If the client cannot contact the palate to

produce these sounds, then he/she may need to have the

frenulum clipped by a physician.

 Difficulties noted in sequencing or motor programming as Difficulties noted in sequencing or motor programming as

indicated by searching and groping behaviors, alternating tongue

movements and coordinating the movements (i.e. putting the

tongue in the cheek or drawing it back along the hard palate may

indicate the presence of apraxia

(16)

Guidelines for Conducting an

Oral Peripheral Examination



How to (

_{Shipley & McAfe):}_{Shipley & McAfe):}



(5) Observe Palatal Appearance and Function

 Observe surface appearance of the client’s hard and soft palate.Observe surface appearance of the client’s hard and soft palate.  Note any irregularities, discolorations, or growths.Note any irregularities, discolorations, or growths.

 Note any abnormalities or enlargement of the tonsilsNote any abnormalities or enlargement of the tonsils  Note the shape and width of the palatal archNote the shape and width of the palatal arch

 Note the presence of pronounced rugaeNote the presence of pronounced rugae

 Note the presence of a weak, asymmetrical or absent gag reflex (when Note the presence of a weak, asymmetrical or absent gag reflex (when

concerned with swallowing and /or neurological involvement)

 To check velar efficiency, ask client to phonate” /a/” (the velum should To check velar efficiency, ask client to phonate” /a/” (the velum should

move upward )and note symmetry or deviation of movement

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Guidelines for Conducting an

Oral Peripheral Examination



How to

_{(Shipley & McAfe e):}_{(Shipley & McAfe e):}



(5) Observe Palatal Appearance and Function

 Implications:Implications:

 A grayish color of the palate may be associated with muscular paresis or paralysis, A grayish color of the palate may be associated with muscular paresis or paralysis, a bluish tint may be the result of excessive vascularity or bleeding, and a whitish

a bluish tint may be the result of excessive vascularity or bleeding, and a whitish

color along the border of the soft and hard palate may indicate a submucosal cleft

color along the border of the soft and hard palate may indicate a submucosal cleft  An abnormally dark or translucent color on the hard palate may indicate a palatal An abnormally dark or translucent color on the hard palate may indicate a palatal

fissure or cleft

 A narrow, vaulted palate may result in nasality of middle consonants due to A narrow, vaulted palate may result in nasality of middle consonants due to restricted tongue movement

restricted tongue movement

 Dark spots may indicate oral cancerDark spots may indicate oral cancer

 Enlarged tonsils typically do not adversely affect speech production, however, Enlarged tonsils typically do not adversely affect speech production, however, they may interfere with resonance and hearing acuity (if the eustachian tubes are

they may interfere with resonance and hearing acuity (if the eustachian tubes are

blocked) as well as general health

(18)

Guidelines for Conducting an

Oral Peripheral Examination



How to

_{(Shipley & McAfee):}_{(Shipley & McAfee):}



(5) Observe Palatal Appearance and Function



Implications (Cont’d):

 An especially wide or high arch may interfere with palatal-lingual sound An especially wide or high arch may interfere with palatal-lingual sound

production ( /t̬ʃ , /dʒ/ , and /ʒ/)

 Prominent rugae may indicate an abnormally low or narrow palate (or both) Prominent rugae may indicate an abnormally low or narrow palate (or both)

or an abnormally large tongue in relation to the palate. Pronounced rugae

may also be associated with tongue thrust.

 Deviation of the uvula to the left or right may indicate neurological Deviation of the uvula to the left or right may indicate neurological

involvement. On phonation, the uvula may deviate to the

(19)

Guidelines for Conducting an

Oral Peripheral Examination



How to

_{(Hedge; Shipley & McAfee):}_{(Hedge; Shipley & McAfee):}



(5) Observe Appearance and Function of the Jaw and Teeth

 Have the client open and close their mouthHave the client open and close their mouth

 Not e any abnormalities in symmetry or movement of the jawNot e any abnormalities in symmetry or movement of the jaw

 Observe dentition- note any abnormalities in occlusion or alignment, missing Observe dentition- note any abnormalities in occlusion or alignment, missing

teeth or the presence of dentures



Implications

 Weakness of the jaw, lips or tongue may indicate neurological impairment Weakness of the jaw, lips or tongue may indicate neurological impairment

(aphasia, dysarthria, or both)

 Depending on which teeth are missing, articulation may be impaired. Depending on which teeth are missing, articulation may be impaired.