Oral Mech, Oral Facial Exams Tethered to Oral Tissues Non-Speech Oral Motor Exercises Flashcards
purpose of the oral mech
rule out structural or functional abnormalities that may be related to the child’s SSD
- identify need for referral
- small percentage
general observation
minimum information reported if child is unwilling/unable to participate in full oral mech
general observation
- facial symmetry
- tone: mouth posture, oral postural control
- dentition
- voice, resonance, respiratory support necessary for phonation
- changes in volume
- impression of visible articulators
tone, oral postural control
presence of salivary secretions
functional classificatoin of ankyloglossia based on tongue range of motion ratio (TRMR)
class/grade 1-4
TRMR: class/grade 1
- 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
TRMR: class/grade 2
ties are a little further behind the tip of the tongue
TRMR: class/grade 3
ties are closer to the base of the tongue
classes 1-3 of TRMR are also known as
anterior ties
TRMR: class/grade 4
- 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
class 4 TRMR are also known as
posterior ties
classification of ankyloglossia based on “free tongue” legnth
- 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
TOTs
- 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
so…is revising the tongue tie even worth it?
- 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)
can tonuge tie revision make a difference to anything other than maternal pain?
- 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!
non-speech oral motor exercises (NSOMES)
- 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
- is strength necessary for speaking? if so, how much?
- articulatory strength needs are very low for speech
- agility and fine articulatory movements are required for speech production
articulatory strength needs are very low for speech
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”
agilitiy and fine articulatory movements are required for speech production
NSOMEs usually require gross, exaggerated ROM
- are the articulators actually strengthened by using NSOME?
- muscle strengthening requires multiple reps, resistance
- evidence of muscle strengthening related to swallowing: tongue for oral phase
- no evidence of strengthening improving speech production
- how do SLPs objectively document weakness of articulators and objectively document supposed increases in strength after NSOME?
- measurements of strength are usually subjective
- objective: Iowa Oral Performance Instrument (IOPI)
measurements of strength are usually subjective
- feeling force of tongue pushing against tongue depressor/against cheek
- observing weakness
Iowa Oral Performance Instrument (IOPI)
no standard across related professions
- do children with speech sound disorders have weak articulators?
- nope
- Sudbery et al., 2006: preschool children with SSDs may have stronger tongues than TD peers
