Term
| Problems with the mouth and its structures may be the cause of or contributed to communication problems |
|
Definition
| The mouth, its oral structures, comes in a variety of shapes and sizes |
|
|
Term
|
Definition
| SLPs must be skillful in determining when oral structures and function are within normal and detecting problems in oral motor structure and function |
|
|
Term
| SLPS evaluate the following structures |
|
Definition
Face
Lips
Tongue
Teeth
Hard palate
Soft palate
Pharynx |
|
|
Term
|
Definition
-Structural adequacy-normalcy of the structures and their relationship to each other-appearance
-Functional adequacy- quality of movement of the structure during speech production
-Structural difficulties may (not) adversely impact function
-Congenital abnormalities-present from birth
-Acquired abnormalities- caused by accident, injury, illness, disease, surgery |
|
|
Term
| Assessing function is more difficult than assess structure |
|
Definition
| Functional difficulties may exist when no known cause can be determined or when structure appears as they should |
|
|
Term
|
Definition
| How frequently is target movement achieved? |
|
|
Term
|
Definition
| How fluidly is target movement achieved? |
|
|
Term
| The exam relies on observation, estimates and clinical judgments |
|
Definition
Direct measurements may include measuring the dimensions of a cleft palate or dental occlusions
Norm-reference tasks
Diadochokinetic rate-ability to assess client at other times in order to obtain client-referenced data |
|
|
Term
|
Definition
Flashlight-observe structures and movements
Tongue depressor- manipulate structures
Stopwatch-time functional movement
Small mirror- observe structures
Gloves- protection |
|
|
Term
|
Definition
Goal- evaluate functional adquency
How- client engages in rapid repetition of speech and nonspeech tasks
Task places stress on speech mechanism by requiring that it perform beyond its typical or usual function |
|
|
Term
| Assess individual and group function- 2 methods |
|
Definition
Client produces task for specific period and repeats task for 3 or more trials
- average # of productions per second is calculated
Client produces a specific # of productions or movements and is tines to determine how much time it took to complete task |
|
|
Term
| Norms available are used with caution due to limited standardized samples |
|
Definition
| DDK increased with age, starting at 2;6 |
|
|
Term
| Speech and nonspeech tasks |
|
Definition
| Used to determine if there is a problem with the mechanism and if problem exists what type of problem |
|
|
Term
| Speech and nonspeech tasks examine |
|
Definition
Range of movement- how far structure can move
Duration of movement- how long a single movement can be maintained
Strength of movement- how well a structure can achieve and maintain a position when an external force is applied |
|
|
Term
|
Definition
Establish rappor with the client before conducting the oral mech
Briefly explain what will be done and why it is important to the total evaluation |
|
|
Term
Face
Plays an important role in nonverbal communication |
|
Definition
Provides clues about muscle weakness and possible problems with the nerve intervention of the face and mouth
Look at general symmetry of face |
|
|
Term
| Procedures to assess structural adequacy of face |
|
Definition
Open the mouth as far as possible-range
Raise both eyebrows- strength
Close both eyes tightly |
|
|
Term
|
Definition
Lips are important in the production of speech
Lips impound air for plosives: /b/ /p/
Restrict air for fricative: /f/ /v/
Shape the oral cavity for the production of vowels
Lip seal is important in swallowing |
|
|
Term
|
Definition
Look for symmetry, general contour, shape or mucocutaneous ridge and condition of lips
Observe any presence of inflammation, infection, growths or scars
Observe presence of cleft lip
Lack of symmetry may reveal neurological problems |
|
|
Term
| Procedures to assess structural adequacy of lips |
|
Definition
Observe lips at rest for symmetry, contour, condition and amount of tissue
Observe presence of scar tissue |
|
|
Term
|
Definition
Non speech tasks used to assess functional adequacy of lips
Unilateral retraction of the lips to each side of the face
Bilateral retraction of lips
Series of pucker-smile movements
Series of upper and lower lip approximations |
|
|
Term
Speech movements
Functional adequacy |
|
Definition
DDK in nature- /u/ /i/ /uiuiuiu/ and /puh/
There are no known norms for this speech task
Observe accuracy, smoothes, and rate during task |
|
|
Term
|
Definition
Strength of seal
Request patient to puff cheeks, push against each and both |
|
|
Term
|
Definition
Teeth channel the airstream in the production of consonant sounds: labiodentals (/f/ /v/) linguadentals (/th/) fricatives (/s/ /z/ /dg/)
Observe dental occlusions
Relationship of upper and lower dental arches and alignment of teeth when jaw is closed |
|
|
Term
| Angle Classification System |
|
Definition
Normal occlusion- very few individuals have an occlusion that is normal in every way
Neutroclusion (Class I)- upper and lower dental aches are in correct occlusion but individual teeth are misaligned
Distoccusion (class II) - lower dental arch or mandible is too far back in relation to the upper dental arch
Mesioccusion (class III)- mandible is too far forward in relation to the maxilla |
|
|
Term
| Additional observation of teeth |
|
Definition
Open bite: lack of contact between upper and lower anterior teeth when first molars are in normal occlusion
Over bite/ close bite: excessive vertical overlapping of the lower anterior teeth by upper anterior teeth
Cross bite- lateral rather than parallel, overlapping of the upper and lower dental arches |
|
|
Term
|
Definition
Dental appliances
Missing teeth
Decorative caps |
|
|
Term
The tongue
Tongue varies in size and shape |
|
Definition
Tongue and mouth should complement each other in size/shape
Tongue is used to channel and obstruct the air stream in the production of phonemes
Tongue influences vowel production and voice resonance (shapes oral cavity)
Tongue is crucial to swallowing |
|
|
Term
| Clinician should observed (tongue) |
|
Definition
Abnormal color of tongue, palate, pharynx
Grayish color: muscular paresis or paralysis
Bluish color: bleeding
Whitish color: sub mucosal cleft
Dark spots: cancer |
|
|
Term
| Asses the structure of the tongue by |
|
Definition
Observing the tongue at rest for shape, completeness and condition
Asking client to protrude tongue
Detect presence of a tongue thrust |
|
|
Term
| Observing the length of the lingual frenum |
|
Definition
Can result in articulation disorder if too short
Client may need medical intervention |
|
|
Term
| Nonspeech tasks to assess functional adequacy of tongue |
|
Definition
Ask client to repeat elevate the tip of the tongue to the alveolar ridge without sound
Wiggle the tongue
Make circular movements with the tongue |
|
|
Term
| Speech tasks to assess functional adequacy of the tongue |
|
Definition
DDK- (p,t,k) puhtuhkuh- buttercup, patty cake
If frenum is restricted- /l/ /n/ /t/ /d/ |
|
|
Term
|
Definition
Ask client to protrude tongue and provide resistance when you apply force with a depressor on the left, right and center of the tongue
Ask client to move the tongue to the inside of the cheek and provide resistance as you apply force |
|
|
Term
Hard/Soft palate
Provide barrier between nasal and oral cavity |
|
Definition
If hard is not intact air may escape the mouth into the nasal cavity and through the nose
Observe (palates)
Abnormal height or width or palatal arch
Arch too high/wide- difficulty achieving lingual contact for palatal lingual sounds
Arch too low- consonant distortions |
|
|
Term
Velopharyngeal Mechanism
Consist of the velum (soft) and pharynx (back and side walls of throat) |
|
Definition
The VP opens and closes the area in the back of the throat allowing safe swallow and normal speech production
Closed during swallowing, plosives, fricatives
Open during nasals
Pay attention to function not structure
Structures may appear to be normal in the presences of abnormal function |
|
|
Term
| Assess structural adequacy (VM) |
|
Definition
Observe soft palate for intactness and symmetry at rest and during productions of prolonged and repeated /a/
Evaluate the width and depth of the oropharynx |
|
|
Term
|
Definition
Deviation of the tongue or uvula to the left/right
May indicate neurogological problems
Tongue may deviate to the weaker side
Uvula may deviate to the stronger side
Facial symmetry may also be present
Patient may also present with aphasia, dysarthria, or both |
|
|
Term
|
Definition
Enlarged tonsils
May not interfere with speech even if enlarged
May affect normal resonance, hearing acuity, and articulation |
|
|
Term
Velopharyngeal function
Not possible to assess function on physical exam |
|
Definition
Can gain important information through use of speech/nonspeech tasks
Instrumental observations are also helpful
Listen to speech to detect nasality
Detect mouth breathing
Use nasal mirror
Watch nares to determine flaring when talking
Are sounds being produced too far back in mouth? |
|
|
Term
| Additional activities to assess functional adequacy |
|
Definition
Have client impound air to blow cotton ball
Poor maintained of air in cheeks is a sign of labial weakness as well as VP inadequacy
Person may also have dsyrathria, hypernasality or both
Elicit gag reflex
Only if detect hyernasality and see little or no movement during prolonged and repeated /a/ |
|
|
