Oral Mech, Oral Facial Exams Tethered to Oral Tissues Non-Speech Oral Motor Exercises

Question 1

purpose of the oral mech

Answer 1

rule out structural or functional abnormalities that may be related to the child’s SSD
- identify need for referral
- small percentage

Question 2

general observation

Answer 2

minimum information reported if child is unwilling/unable to participate in full oral mech

Question 3

general observation

Answer 3

• facial symmetry
• tone: mouth posture, oral postural control
• dentition
• voice, resonance, respiratory support necessary for phonation
• changes in volume
• impression of visible articulators

Question 4

tone, oral postural control

Answer 4

presence of salivary secretions

Question 5

functional classificatoin of ankyloglossia based on tongue range of motion ratio (TRMR)

Answer 5

class/grade 1-4

Question 6

TRMR: class/grade 1

Answer 6

• ties are attached on the very tip of the tongue
• these are the ones that most people think of when they talk about tongue ties

Question 7

TRMR: class/grade 2

Answer 7

ties are a little further behind the tip of the tongue

Question 8

TRMR: class/grade 3

Answer 8

ties are closer to the base of the tongue

Question 9

classes 1-3 of TRMR are also known as

Answer 9

anterior ties

Question 10

TRMR: class/grade 4

Answer 10

• ties may be submucosal
• ex: underneath the mucous membrane covering, so they must be felt to be diagnosed
• babies with this kind of tie are often misdiagnosed as having a short tongue

Question 11

class 4 TRMR are also known as

Answer 11

posterior ties

Question 12

classification of ankyloglossia based on “free tongue” legnth

Answer 12

• clinically acceptable, normal range of free tongue = > 16 mm
• class 1: mild ankyloglossia = 12-16 mm
• class 2: moderate ankyloglossia = 8-11 mm
• class 3: severe ankyloglossia = 3-7 mm
• class 4: complete ankyloglossia = < 3 mm

Question 13

TOTs

Answer 13

• no availabe assessment tools have adequate psychometric properties for assessing TOTs, but 1 study found children have better outcomes when working with a speech pathologist after laser frenulectomy
• the link between tongue tie and articulation remains weak, and while frenotomy can improve some aspects of breastfeeding, a function-focused team approach is recommended

Question 14

so…is revising the tongue tie even worth it?

Answer 14

• as we’ve been reporting for a while now, in some cases, yes
• in this study, researchers did a meta-analysis on the various benefits of revision and they basically said the same thing: revision can help breastfeeding pain (but not always), and the Hazelbaker Assessment Tool for Lingual Frenulum Function Score (HATLFF) assessment was found to be the most functional assessment for breastfeeding infants
• they recommended surgery before 4 months of age, at which point the surgery becomes more dangerous as general anesthesia is needed (vs. just a topical anesthesia for younger babies)

Question 15

can tonuge tie revision make a difference to anything other than maternal pain?

Answer 15

• well…maybe?
• in this article, researchers found a statistically significant improvement in scores on not only the Breastfeednig Self-Efficacy Scale-Short Form (BSES-SF) and the Visual Analog Scale (VAS) pain scores, but also the Infant Gastroesophageal Reflux Questionnaire–Revised (I-GERQ-R), suggesting the revision may improve GERD symptoms
• no definitive answers, but we’ll continue to update you as we get more information!

Question 16

non-speech oral motor exercises (NSOMES)

Answer 16

• motor acts performed by various parts of the speech musculature to accomplish specific movement or postural goals
• any techniques that doesn’t require the child to produce a speech sound but is used to influence the development of speaking abilities
• collection of nonspeech methods and procedures that aim to influence tongue, lip, jaw resting postures, increase strength, improve tone, facilitate ROM, develop muscle control
• muscle exercise, stretching, passive exercise, sensory stimulation
• NOT the same as phonetic placement cues and models

Question 17

1. is strength necessary for speaking? if so, how much?

Answer 17

• articulatory strength needs are very low for speech
• agility and fine articulatory movements are required for speech production

Question 18

articulatory strength needs are very low for speech

Answer 18

speaking strength needs do not come anywhere close to maximum strength abilities of the articulators:
- lips muscle force: 10%-20% of maximum capabilities
- jaw: 11%-15%
- tongue: “fraction”

Question 19

agilitiy and fine articulatory movements are required for speech production

Answer 19

NSOMEs usually require gross, exaggerated ROM

Question 20

2. are the articulators actually strengthened by using NSOME?

Answer 20

• muscle strengthening requires multiple reps, resistance
• evidence of muscle strengthening related to swallowing: tongue for oral phase
• no evidence of strengthening improving speech production

Question 21

3. how do SLPs objectively document weakness of articulators and objectively document supposed increases in strength after NSOME?

Answer 21

• measurements of strength are usually subjective
• objective: Iowa Oral Performance Instrument (IOPI)

Question 22

measurements of strength are usually subjective

Answer 22

• feeling force of tongue pushing against tongue depressor/against cheek
• observing weakness

Question 23

Iowa Oral Performance Instrument (IOPI)

Answer 23

no standard across related professions

Question 24

4. do children with speech sound disorders have weak articulators?

Answer 24

• nope
• Sudbery et al., 2006: preschool children with SSDs may have stronger tongues than TD peers

Question 25

food for thought

Answer 25

• most NSOME disintegrate the highly integrated task of speaking
• the same structures are used for speaking and non-speech tasks, but the structures function differently

Question 26

most NSOME disintegrate the highly integrated task of speaking

Answer 26

• learning and improving speaking ability must be practice in the context of speaking
• isolated movements of the articulators are not the actual gestures used for the production of any sound in English

Question 27

the same structures are used for speaking and non-speech tasks, but the structures function differently

Answer 27

• mediated by different parts of the brain
• organization of movements in the nervous system is different