CDO 402 Oral Mech Exam

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shanamd2011
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202006
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CDO 402 Oral Mech Exam
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2013-02-20 10:00:28
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oral mech exam
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  1. Oral- facial Examination
    • The oral-facial peripheral examination is an important component of a complete speech assessment.
    • Rule out structural or Functional factors that relate to a communication disorder.
  2. Oral Exam Interpretation
    • Reliable & Valid interpretation require understanding of bases of oral structure:
    • anatomic
    • physiologic
    • Neurologic
  3. General Guidelines
    • Sterilize all equipment that is used in the mouth
    • Wash hands before and after contact
    • Wear gloves if there will be contact with bodily fluids, mucous membranes, or broken
    • skin
    • Remove gloves promptly, without touching the outside of them
    • Turn them inside out when removing
    • Safely dispose of them
    • Wash hands after removing gloves
    • Wear eye and mouth protection if any body fluids are likely to splash or spray
    • Wear a gown and shoe covering if clothing is likely to come in contact with body
    • fluids
    • Change your clothing if another person’s blood or body fluid gets onto your clothes
    • Never use single-use equipment (e.g., gloves, tongue depressor, toothette, etc.) more than once
    • Follow facility or campus infection control policies regarding procedures for disinfecting and cleaning various surfaces and instruments
  4. Common Tools
    • Flashlight
    • Tongue Depressor
    • Cotton gauze
    • Gloves
    • Hand antiseptic
    • Mirror
    • Foods for those who are reluctant to participate
  5. Components of Oral-Facial Exam:
    • Observe structures at rest & during function
    • Face
    • Jaw
    • Teeth
    • Lips
    • Tongue
    • Pharynx
    • Hard Palate
    • Soft Palate
  6. Assessing Diadochokinetic Rates
    • A function of motor control
    • Judge the ability of the articulators to perform speech movements
    • -Speed
    • -Accuracy
  7. General Considerations
    • Actual size, shape etc. is not as important as the relationship among them
    • It is difficult to predict the cumulative effects of speech that more than one small deviation will have.
    • Generally speaking if a speaker can say a sound in any context, structural deviations  are not significant.
  8. Face/Head
    Structure
    • Asymmetry-droop on right or left side
    • Disproportion
    • Deviant resting postures
    • Discoloration
    • Scarring
    • Nasal vs. oral breathing
    • Facial expression
    • Hypo/hypertonicity 
    • Drooling may signal inadequate
    • Swallowing mechanism
  9. Face/Head
    Function
    • Abnormal Movements
    • -Are there any grimaces or spasms of the face?
    • Nasal vs Oral Breathing
    • -Does the client breathe predominately through his or her mouth?
  10. Evaluation of Jaw
    Ask client to open and close mouth
    • Range of motion- Can the client open his or her mouth and how wide?
    • Symmetry- Is there noticeable deviation to the right or the left?
    • Movement- Is the movement normal/smooth or are movement s jerky, groping, slow, asymmetrical?
    • TMJ- Can you hear grinding or popping sounds when the client opens his or her mouth?
  11. Lips
    • Highly mobile 
    • Important role in appearance
    • Structure at rest--need a bilateral seal
    • -Compare upper with lower
    • -Symmetrical
    • -Drooping
    • Protrusion/retraction
    • Labial diadochokinesis ‘puh’
  12. Evaluation of Lips
    Ask client pucker lips
    • Range of motion- Is there reduced ability to pucker lips
    • Symmetry- Is there a bilateral droop or droop to left or right?
    • Strength- Ask client to press tongue blade against lips. Is the client able to keep lips closed? If not, note weak lip function.
  13. Evaluation of Lips
    Tell Client to smile
    • Rangeof motion- Is there reduced ability to retract lips?
    • Symmetry- Is there a bilateral droop or droop to left or right?
  14. Evaluation of Lips
    Tell client to puff cheeks and hold air
    • Lip Strength-Can the client maintain labial seal?
    • Nasal emission- Does air escape through the nose?
  15. Mandible Maxilla
    • Range/symmetry of depression and elevation of mandible.
    • Relation of mandible to maxilla.
    • -Dental Occlusions
  16. Evaluation of Teeth
    Observe Dentition (Ask client to open mouth)
    • Teeth- Are all teeth present?
    • Arrangement- Are the teeth jumbled, spaced abnormally, or misaligned?
    • Hygiene- Is there obvious evidence of some degree of oral care? Is hygiene effecting the integrity of teeth and their ability to function properly?
  17. Occlusion Molar Relationship
    • Class I
    • Class II
    • Class III
  18. Occlusion Incisor Relationship
    • Normal
    • Overbite
    • Underbite
    • Crossbite
  19. Hard Palate
    • Arch form (e.g. high vaulted etc.)
    • Color should be pink-white; a bluish tint may be indication of submucous cleft
    • Juncture with soft palate should be slightly scalloped and continuous; a definite notch may be an indication of submucous cleft.
    • Oronasal fistulae (hole)
  20. Observe hard and soft palates- Ask client to open mouth
    • Color- Is there a normal pink color?
    • Rugae- Are the bumps on the roof of mouth normal or very prominent?
    • Arch height- Is the arch abnormally high or low?
    • Arch width- Is the arch abnormally wide or narrow?
    • Growths- Are there any abnormal growths present?
    • Fistula- Is a fistula absent or present?
    • Cleft- Is there clefting present?
    • Symmetry at rest- Does one side rest lower than the other?
    • Gag reflex- Is there normal, absent, hyperactive, or hypoactive?
  21. Ask client to phonate using /a/ (“ahhh”) with mouth open
    • Symmetry of movement- Is there deviation to right or the left?
    • Posterior movement- Is movement of the articulators posteriorly normal, absent, or reduced?
    • Lateral movement- Is movement of the articulators posteriorly normal, absent, or reduced?
    • Uvula- Is it normal, bifid, or deviating to the left/right?
    • Nasality- Is hypernasality present?
  22. Velum
    • Can’t determine the adequacy of the velopharyngeal port just by looking
    • Speech resonance characteristics can help pinpoint the need for instrumental evaluation.
    • Nasoendoscopy
    • Aerodynamics
  23. Evaluation of Pharynx
    Ask client to open mouth and view back wall of oral cavity (pharynx location)-
    • Color- Is the pharynx pink in color?
    • Tonsils- Are they absent, normal, or enlarged?
  24. Velum--Function
    • Stop/plosive load:
    • -Dick took Patty.
    • -Peter has a puppy.
    • Fricative/affricate load:
    • -Sissy sees the sky.
    • -Should I wash the dishes?
    • Nasal environments:
    • -Nancy is a nurse.
    • -Mama makes lemon jam.
  25. Tongue
    • Most important articulator
    • Size in relation to oral cavity
    • Fasiculations

    • Function:
    • Protrusion/elevation range, strength, symmetry, rhythm
    • Normal side will push to the weaker side upon protrusion.
    • Diadochokinetic rates
    • Lingual frenum
  26. Observe Tongue (ask client to open mouth)
    • Surface color- Is the tongue normal pink color?
    • Movements- Are the jerks, spasms, writhing, or fasciculation present? Is tongue movement absent?
    • Size- Is the tongue normal, small, or large sized?
    • Frenulum- Is the frenulum normal or short in length?
  27. Ask client to protrude tongue
    • Excursion- Is there deviation to the right or left?
    • Range of Motion- Is range of movement reduced?
    • Speed of Motion- Is movement slower than normal?
    • Strength- Apply pressure against the tongue blade while it is protruded. Is there reduced strength?
  28. Ask client to retract tongue
    • Excursion- Is there deviation to the right or left?
    • Range of Motion- Is range of movement reduced?
    • Speed of Motion- Is movement slower than normal?
  29. Ask client to move  tongue tip up and then down
    • Movement- Are there groping movements present?
    • Range of motion- Is range of motion reduced?
    • *Note these observations separately for movement upward and movement downward
  30. Observe rapid side to side movements (Ask client to quickly move tongue tip from one corner of the lips to the other)
    • Rate- Is movement slowed, or does it slow progressively?
    • Range of Motion- Is there reduced motion on the right or left?
  31. Laryngeal Mechanism
    • Quality (weak and whispery to harsh and hoarse)
    • Pitch
    • Loudness
    • Cough
    • Maximum phonation time
  32. Summary for Core Speech Mechanism Examination
    • Symmetry of face, lips, velum, tongue
    • Strength and coordination of tongue and jaw
    • Irregularities in motor movement patterns
    • signs of progressive problems
    • good medical history
    • sensory information is important
    • Multiple samples of motor activities

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