Oral Mech Exam Flashcards
What is the purpose of the oral mech exam?
Identify or rule out structural or functional factors that relate to a communicative disorder or dysphagia
What are we looking at with an oral mech exam?
Structural adequacy for speech and swallowing
Functional adequacy for speech and swallowing
Contributing factors to swallowing and/or communication issues
Direct treatment and/or assessment
When is an OME done?
Evaluation
New client
Concerns presented by client or caregiver
What may SLPs see when conducting an OME
Cleft lip/palate
Palatal insufficiency
Tumor
Shortened frenulum
Velopharyngeal insufficiency (VPI)
Medical conditions
What are the must-have tools for an OME?
Gloves
Tongue depressor
Small flashlight
Tools of the OME that are nice to have
Throatscope
Toothette
Stopwatch or app for DDK
Long cotton swabs
Gauze
Small tabletop mirror
Bubbles
Balloon
Cotton Balls
For an OME, children 4-14 will do best if you ….
Model (I do, you do)
Very young children might not be compliant during OME but you can ….
Guardian can assist
Assess with food/drink
Be creative and silly
Make it a game
Make directions kid-friendly
If you cannot get a good OME, you can rely on …
Caregiver report
What are some important pediatric reflexes?
Sucking reflex: automatic sucking when lip area stroked, resolved by 4 months
Rooting reflex: when cheek is stroked, turn head towards stroke, resolved by 3 weeks
Biting reflex: clenching of jaw when jaw/teeth/gums are touched, resolved by 6 months
Vocal quality can be described as
Weak, breathy, hoarse strained
What structures of the face are examined during an OME?
Face, eyes, jaw, nose, neck, cheeks
What structures of the oral cavity are examined during an OME?
Lips, tongue, hard palate, soft palate, teeth, inner cheeks, tonsils, uvula, frenulum
What are we looking for during an OME?
Difference vs disorder
Structural disorders: changes in physiological structures
Functional disorders: reduced ROM, strength, or sensation
When looking at the facial structures look for ….
Asymmetry of face, resting position
When assessing teeth during the OME, ask the client to
Smile with and without showing teeth
What are we looking for when assessing teeth?
Checking bite, teeth missing,
What is crowding/overcrowding of teeth?
Teeth are crooked and overlapped due to lack of space in the mouth
What is overjet of teeth?
How far forward top teeth are over lower teeth in the horizontal plane
Problems with speech and eating
What is an overbite?
How much top teeth overlap bottom teeth
Can cause speech problems depending on how the teeth and tongue are affected
All bite differences can cause speech and/or feeding problems depending on impact to ___ and ___
Teeth and tongue
What is spacing?
Too much space between each tooth
Missing teeth, small teeth, tongue thrust, thumb sucking
Assessment of the palate/VP closure involves the following steps:
- Check palate shape and intact (pink with visible ridges and arch gradually increasing to thumb width peak)
- Look at alveolar ridge, intact uvula, tonsils
- Instruct client to open mouth and say “ah”
- Check tonsils and VP movement (have client swallow)
When assessing movement of different areas, what 3 aspects are we looking at?
- Range of motion (ROM)
- Strength (symmetry, check using resistance)
- Look for dyskinesia (involuntary repetitive movements of the mouth/face)
What are the movement structures?
Lips, velum, jaw, tongue, masseter, facial muscles, eyes, glottis
What should be done during an OME when looking at coordination and tone?
Coordination: look at rate, coordination and accuracy of movement
Tone: observe at rest and with movement, assess for primitive reflexes
What does looking at control of movement during an OME involve?
How well does the patient respond to your instructions?
Can they modify their movement?
Better movement modulation = better therapy prognosis
What does looking at sensation during an OME involve?
Looking at taste, touch, proprioception
What are the cranial nerves that we are looking at?
Trigeminal, Facial, Glossopharyngeal, Vagus, Spinal acessory, Hypoglossal
All the cranial nerves has ____ innervation
Bilateral, except the lower facial nerve has contralateral innervation
Trigeminal nerve V carries M, S, or both?
Motor: muscles of mastication
Sensory: pain and touch to face and anterior 2/3 of tongue
Assessing trigeminal nerve:
Touch forehead, cheek, jaw, anterior 2/3 of tongue
Range of motion of jaw (open and close mouth, move jaw side to side)
Look for sucking reflex (touch/stroke hard palate) and rooting reflex (stroke cheek)
Red flags during trigeminal nerve assessment
Absent jaw movement and jaw drop
Mandible deviate towards one side
Reduced/no pain sensation in area supplied
Slow rate of speech and imprecise articulation
Fasciculations of temporalis and masseter muscles
Facial nerve carries S, M or both?
Motor to muscles of facial expression
Sensory (taste) to anterior 2/3 of tongue
When looking at facial nerve function, what areas are we looking at?
Face at rest
ROM and strength of each group of facial muscles: orbital, nasal, oral
What reflexes do you check when looking at the facial nerve?
Snout reflex
Touch lips while closed at rest, abnormal response would be pursing or protruding lips
Red flags when assessing the facial nerve?
Orbital: cannot shut eye, droopy lower eyelid
Nasal: cannot flair nostrils, scrunch nose, furrow eyebrows
Oral: asymmetry of lower face/tongue, flaccidity of entire face, difficulty producing labial/labiodental articulation
Glossopharyngeal carries S, M or Both?
Motor to stylopharyngeus to elevate larynx/pharynx and dilate pharynx during swallow
Sensory to palate, posterior 1/3 of tongue, oral pharynx, taste to posterior 1/3 of tongue
When looking at glossopharyngeal nerve function, what areas are we looking at?
ROM: soft palate movement
Resonance
Gag reflex
Red flags when assessing the glossopharyngeal nerve?
Palate and uvula deviate toward one side
No movement of palate or uvula on either side
Vagus nerve carries S, M or Both?
Motor to larynx, pharynx, soft palate
Sensory to pharynx and larynx, taste from epiglottis and pharynx
When looking at vagus nerve function, what areas are we looking at?
Volitional cough, glottal coup (hard “uh”), maximum phonation time (hold “ah”), pitch glides
Red flags when assessing the vagus nerve?
Unilateral or bilateral vocal fold, palatal or pharyngeal weakness
Hyperactive gag reflex with no voluntary movement of the palate
Absent gag reflex with no voluntary movement of the palate
Hypernasality, nasal emissions, abnormal vocal quality
Spinal accessory nerves carries S, M or both?
Motor to strap muscles of the neck
Indirectly influences position of the larynx
When looking at the spinal accessory nerve, what are areas are we assessing?
ROM: turning head
Strength while turning head
Red flags when assessing the spinal accessory nerve?
Weakness, atrophy and or fasciculations
Hypoglossal nerve carries S, M or both?
Motor to tongue (except the palatoglossus CN X Vagus)
When looking at hypoglossal nerve function, what areas are we assessing?
ROM of tongue
Strength of the tongue
Red flags when assessing the hypoglossal nerve?
Tongue deviates to one side
Rounded tongue tip
Tongue does not move independently from the jaw
Increased tone or atrophy
Fasciculations
Difficulty with lingual sounds
How is oral agility assessed during an OME?
Diadochokinetic rates: ability to make rapid alternating speech movements
DDK assessment involves what sounds
puh, tuh, kuh
Separately and together
Count # of syllables in # of seconds
