speech oral motor assessment checklist

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0.15  ASHA CEUs

Oral mechanism / cranial nerve examination: what every slp needs to know #e72.

Presenter: Kellyn Dailey Hall, PhD, CCC-SLP

Description

Step-by-step instructions for performing and interpreting an oral mechanism and cranial nerve exam..

– S.S., prior course participant

Read more comments about this course!

An oral mechanism examination, an essential part of every speech/language and swallowing assessment, contributes information for the medical evaluation of every client. It is designed to assess the physical condition and function of the mouth and related structures. When performed as part of a cranial nerve exam, it can be used to diagnose the causes of many different kinds of speech/language and swallowing disorders and drive therapeutic interventions.

This course provides participants with step-by-step instructions for performing and interpreting a quick, yet thorough, oral mechanism and cranial nerve exam across all ages. Includes specific guidelines and examples for interpreting and reporting results.

Course is offered for 0.15 ASHA CEUs – 1.5 Contact Hours.

Course Overview & Run Time

Course Overview – Run Time: 1:30:09

• Step-by-step instructions for performing and interpreting a quick, yet thorough, oral mechanism and cranial nerve exam.
• Specific guidelines and examples for interpreting.
• Reporting results.

– E.D., prior course participant

Content Disclosures

The content of this online CE course does not focus exclusively on any specific proprietary product or service. Presenter financial and non-financial disclosures may be found in the Presenter & Disclosures area.

Course Format

Video PowerPoint presentation with author narration & downloadable handout. Stop and re-start the course at any point. Learners retain access to course content after completion for ongoing reference and review.

Comments From Prior Course Participants

"Beneficial information on cranial nerves and how to test for impairment. The course was very clear and easy to understand. I really liked the speaker!" M.L. (Mar. 2024)

"This course was a great refresher to what I knew and added additional knowledge to what I could look for during OME." N.E. (Feb. 2024)

"Adding in the cranial nerve involvement was beneficial. The course was straight to the point and had useful information." J.M. (Feb. 2024)

"The oral mech exam information was beneficial. It was easy to learn from this course." K.B. (Jan. 2024)

"All of the content was relevant. The visual along with the verbal explanations; very helpful in supporting learning." A.P. (Jan. 2024)

"The oral motor exam was helpful. I liked the illustrations." R.P. (Dec. 2023)

"Continued review of oral motor function and CN involvement is always helpful. I liked that the course was easy to access and the cost." A.F. (Dec. 2023)

"Discussing the elements of the cranial nerve exam was helpful. The presenter was very interesting." E.A. (Dec. 2023)

"Good refresher for CN functionality. Loved the whole course. Good use of pictures and video." D.C. (Dec. 2023)

"Activities to assess. Used real life examples." K.W. (Dec. 2023)

"I liked the review of OME and the ease of use of the course." C.H. (Dec. 2023)

"The review of cranial nerves and how to perform oral mechanism exam was beneficial. All of the photos and diagrams really helped assist in understanding the material. The presentation was very well put together. The presenter explained things in a very clear and understandable way." A.C. (Nov. 2023)

"Specific examples of how to assess CN functions made it very easy to apply what was learned. Practical examples Handout was helpful." K.W. (Nov. 2023)

"I liked the video examples of how to complete each step of the exam and what to look for. The review of each of the cranial nerves and their function was beneficial." A.D. (Nov. 2023)

"The detailed descriptions of every task/test done during the exam were helpful. I liked the comprehensive and detailed description of the OME." R.L. (Nov. 2023)

"Learning how to perform a cranial nerve examination was beneficial." P.J. (Oct. 2023)

"Clear information. I liked the refresher of all the cranial nerves." M.M. (Oct. 2023)

"Cranial nerves review and the manifested deficits." C.C. (Sep. 2023)

"The review of cranial nerve functions and how to assess was beneficial. I liked the specific examples." C.F. (Sep. 2023)

"I liked the thorough review of the oral mechanism examination and I will now expand my examination to include more of the tongue assessment by isolating the jaw movement, testing of facial sensation, and taste assessment." T.L. (Sep. 2023)

"I liked the examples and visuals, as well as the handouts." A.R. (Aug. 2023)

"I liked revisiting which parts of the OME are testing for each/group of CN. I found the review, handouts, and OME document to be very beneficial." A.G. (Jun. 2023)

"Discussion of cranial nerves impact on different aspects of the body was beneficial. I liked the example of an oral mechanism exam with a template of how to write up results." D.S. (Jun. 2023)

"I liked the evaluation of VII, the examples and videos." C.G. (May 2023)

"Succinct course. I liked the review of cranial nerves for speech and swallowing as well as going step-by-step through the exam." K.K. (Mar. 2023)

"Very specific course. Liked the cranial nerve exam." F.B. (Feb. 2023)

"This course was well organized and a good refresher for me. The videos and pictures were very illustrative and helpful. Liked everything regarding the tongue, a very important structure. The exam/eval (questions to ask, what to make the patient do) was very interesting." N.T. (Feb. 2023)

"The review of cranial nerves was beneficial. I liked the thoroughness of content." A.S. (Jan. 2023)

"Very in-depth course. Good review of cranial nerves and how to test their function." E.G. (Dec. 2022)

"The presenter was engaging and explained things well. Learning different exercises for the oral mech eval was beneficial." E.S. (Dec. 2022)

"Good review of specifics of motor vs sensory." D.R. (Dec. 2022)

"Clear and concise course with good visuals. Going through all of the components of the OME during the second half of the course was helpful." C.S. (Nov. 2022)

"I felt the review of the cranial nerves with relation to the oral mech exam was highly beneficial. The video examples were also extremely helpful." M.R. (Nov. 2022)

"This course was thorough with the CN. Learning approaches during oral mech exam was helpful." T.P. (Nov. 2022)

"Helpful review. I liked the examples of patients." W.H. (Nov. 2022)

"Great review of cranial nerve function and oral mechanism exam. The presenter is clear and easy to understand. Kellyn is also enjoyable to listen to." D.B. (Nov. 2022)

"The speaker was thorough detailing the cranial nerve information as it pertains to the oral motor exam." L.K. (Nov. 2022)

"I liked the description of the specific techniques the speaker uses to complete her exam with minimal tools to make it feasible in a work situation. The pace and direct application of how the OME can help with daily therapy knowledge were good." T.C. (Nov. 2022)

"Very clear descriptions with interpretations. A great review and pleasant presentation style of the clinically necessary info." M.Z. (Oct. 2022)

"Very thorough review of cranial nerves and testing during oral mech. Excellent lecture and support materials - examples and visuals - excellent handout with included oral mech examination form and sample verbiage for reporting." M.E. (Oct. 2022)

"I liked the examples, photos, and clear delineation of each CN. The course is thorough and clear." L.C. (Oct. 2022)

"I thought the course was excellent. The discussion on cranial nerve assessment was beneficial." D.Z. (Sept. 2022)

"Although it was much more detailed than I expected, I appreciated the additional facts and information." H.E. (Aug. 2022)

"It was a great review, and her handout was incredibly useful." R.L. (Jul. 2022)

"The speaker was easy to listen to and follow. I appreciated the review of the cranial nerves and their functions." K.B. (Jul. 2022)

"Very clear, concise, and practical information." H.H. (Jul. 2022)

"Liked review of the cranial nerves and ways to test their integrity." K.B. (Jul. 2022)

"I liked all of it. Determining which CN was involved in the observations found will be helpful." J.M. (Jun. 2022)

"I most appreciated the various patient demonstrations. Knowledge of neuroanatomy and differentiation of upper vs. lower motor neuron involvement increase confidence in assessing patients with certain diagnoses." S.S. (Jun. 2022)

"All of the information was valuable and beneficial. The presenter was very knowledgeable."   M.M. (Jun. 2022)

"I found the walk-through of the cranial nerve exam very useful. This was one of the most well-presented courses I have taken on NSS. Everything was clear and concise. The explanation of the cranial nerves and how to test their functions were well explained." M.H. (May 2022)

"Pace of the instructor was good. It was a great review of important information for me. I liked the oral exam suggestions." B.C. (May 2022)

"Clear, well-explained information without excessive detail. Beneficial to learn cranial nerves and their function." A.M. (May 2022)

"Incorporating CN knowledge into OME was beneficial." A.D. (May 2022)

"I liked the tools and process of testing the oral mechanism – the videos were very helpful." M.P. (Apr. 2022)

"The knowledge of the speaker and how information is presented was good. Valuable course! Highly recommended for SLPs." B.M. (Mar. 2022)

"Clear examples. Good review of what things I see in my exam could mean." D.D. (Mar. 2022)

"I appreciated the discussion of the actual tools/implements that Dr. Hall practically uses for all populations in an assessment. It was very well organized, structured and sequenced for optimal learning of the nerves, structure/function, and implementation. She is an excellent instructor, very concise and efficient in her methods." A.D. (Feb. 2022)

"I found the photos and live videos most helpful for applying content to clinical work." K.B. (Jan. 2022)

" The step-by-step breakdown of cranial nerves assessed through each oral motor task was helpful for my daily practice.  I liked the course format." S.S. (Oct. 2021)

" So much information, although it will have limited use for me with my caseload of general education and Mild-moderate special ed kids." J.C. (Sept. 2021)

" Esophageal dysphagia, Managing trach/vent patients with dysphagia & dysphagia in neurodegenerative diseases, Aspiration pneumonia, oropharyngeal strengthening & hydration management.  I feel like many aspects were covered & research I've never heard about in the section New Devices to Manage Sensory Loss." K.L. (Sept. 2021)

" It is so interesting to learn how the brain works to help move our muscles, swallow, eat, etc. I have always had a hard time learning all the cranial nerves and what each one innervates, so this was a wonderful refresher course for me. It was enjoyable to listen to and easy to follow. It was most interesting to learn about how to complete a thorough oral mechanism exam. Usually, the oral mechanism part of an evaluation is something I gloss over, but since taking this course, I see a greater importance for it.  Thank you!" A.H. (Sept. 2021)

" Practical application of a CN exam in written form was beneficial for my daily practice." K.S. (Aug. 2021)

" I appreciated the review of cranial nerves with the pictures of different patients/clients.  I liked the variety of pictures and videos the presenter used to get her points across. It greatly helped my application of the knowledge to have lots of examples." E.L. (Aug. 2021)

"The cranial nerve examination was beneficial for my practice, and the presenter gave lots of examples." B.S. (Jun. 2021)

" The actual testing of the nerves.  The speaker was thorough and simplified it. I was thinking back to graduate school and wished I had a professor like her who makes learning the CNs functional.  I wished there was a video clip of true tongue fasciculations.  More pictures and examples." B.U. (Jun. 2021)

" I thought this course was great!" D.S. (Jun. 2021)

" The example of the OPE exam/ checklist and the corresponding CN involvement." K.V. (Jun. 2021)

" Tongue movement. Very organized and easy to understand ." M.A.H. (Jun. 2021)

" Separating each cranial nerve and talking about function and testing" T.J. (Jun. 2021)

"Actual videos demonstrations of OME and how to assess resonance with no tech/ low tech procedures. I was able to sustain attention throughout the entire course. Speaker kept me engaged" K.P. (Jun. 2021)

“I found the examination form and the report samples to be very helpful!” T.M. (Mar. 2021)

“I loved the detailed explanations and visuals.”  B.A. (Feb. 2021)

Course Objectives

• Understand the neurology and neuroanatomy underlying speech, language and swallowing disorders in children and adults.
• Conduct a quick and thorough oral mechanism/cranial nerve examination across all ages.
• Interpret the results of the exam.
• Translate the results of the exam into a written report.

Presenter & Disclosures

Kellyn Dailey Hall, PhD, CCC-SLP, has worked over 30 years as a clinician, clinical specialist, and clinical manager in medical settings. Currently, she is an Associate Professor at North Carolina Central University in Durham, NC where she teaches courses in Medical Speech-Language Pathology. She is a member of the North Carolina Speech-Language-Hearing Association’s Professional Affairs Subcommittee on Healthcare and has presented at state and national conventions on Medicare documentation and ethics. Her current research focuses on the development and implementation of dining culture change practices for SLPs working in SNFs.

Speaker Disclosures:

Financial — Kellyn Hall receives salary from North Carolina Central University.  Dr. Hall also receives royalties from Northern Speech Services and Carolina Speech Pathology for the development of various continuing education courses.

Nonfinancial — Kellyn Hall is a member of ASHA, a member and serves as President of NCSHLA, and member of NBASLH.

Intended Audience / Accreditation

This program is offered for 0.15 ASHA CEUs (Intermediate Level; Professional Area).

Intended Audience

• Speech-Language Pathologists

ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.

ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:

• Current ASHA Member
• ASHA Certificate of Clinical Competence (CCC) Holder
• Licensed by a state or provincial regulatory agency to practice speech-language pathology (SLP) or audiology
• Credentialed by a state regulatory agency to practice SLP or audiology
• Credentialed by a national regulatory agency to practice SLP or audiology
• Engaged in a Clinical Fellowship under the supervision of an individual with their ASHA CCC
• Currently enrolled in a master's or doctoral program in SLP or audiology

If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site .

Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.

Additional accrediting agencies by which Northern Speech is an approved CE provider:

• California: NSS is approved as a provider of continuing education by the California Speech-Language Pathology & Audiology Board. Provider #PDP4. Online CEU limits may apply; please contact SLPAHADB for current online CEU acceptance policies.
• Iowa: NSS is approved as a provider of continuing education by the Iowa Board of Speech Pathology and Audiology Examiners. Provider #169.
• Kansas: NSS is approved as a provider of continuing education by the Kansas Department of Health and Environment. Provider #LTS-S0005.

Frequently Asked Questions

Online course faq — click here, customer support: please phone 888.337.3866 or email [email protected] ..

Course Completion Timeframe:

You have unlimited time to complete our online courses. You may log off and log on as often as you’d like to in order to complete all sections of a course.

However, completion dates are based on Eastern Standard Time. Therefore, if you need your CEUs by a certain date, be sure to complete the course test before 11:59pm EST on that date. For example, if you need CEUs before January 1st, you will need to complete the course test before 11:59pm EST on December 31st.

Content Access:

Access to course materials and content does not expire, even after completing the post test. You may continue to review course material by logging into your NSS account, clicking the My Online Courses tab, and then viewing your desired course.

Certificate of Completion:

On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.

ASHA CE Registry Submission:

During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

Purchase Orders:

Purchase orders are currently not accepted for online orders, if you wish to submit a purchase order please do so at [email protected]  or fax to 888-696-9655.

What is an Online Course?

Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your NorthernSpeech.com online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.

Receiving CEUs:

Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online. Please note that courses offered for university students are not applicable for CEUs.

Registering for an online course:

You may browse all online courses by clicking the Continuing Education tab above, then Online Courses. Once you find a course, click Enroll Now, and you will be asked to either log into your existing Northern Speech account or create a new online account. Once you’ve entered your account information and provided your credit card payment, your course will be immediately available to you.

Accessing your purchased course or returning to a purchased course:

You will be able to access your online course by logging into your Northern Speech account and then clicking the My Online Courses tab on your profile screen. Click the course you would like to start or to resume. From there, proceed through the course sections until you are ready to complete the post test. You do not have to complete your course all at once. You may log on and off as you wish.

Testing requirements:

Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.

Number of CEUs offered:

We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.

State licensing boards and online CEUs:

NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.

Course formats:

Our course formats include: text, audio, video, and PowerPoint with author narration. Each course will note the format on the course description page. Most courses include closed captioning.

Course handouts:

Most of our online courses provide a link to download the accompanying handout as a PDF file. 

Group discounts:

Groups of 3 or more are eligible for a 20% discount on each registration on most of our online courses. To receive this discount, registrations need to be processed together via the "Group Rates" tab on the Online Course of your choice.

Computer requirements:

For our online courses to function best, we recommend that you update your computer to include the newest version of your Internet browser (Safari, Chrome, Firefox, Edge, Internet Explorer, etc.) and newest version of your computer's operating system. Also a high-speed Internet connection is recommended (cable or DSL). Speakers or headphones will be required for many of our courses as many contain audio components.

Course Cancellation Policy:

A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded. 

Special Needs:

Please click here for any special needs requests, and we will do our best to accommodate them. 

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This advice-column-style blog for SLPs was authored by Pam  Marshalla  from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.

Standardized Oral Motor (OM) Tests

By Pam Marshalla

Q: I need information on evaluating oral-motor skills in school age articulation/phonological cases as well as appropriate oral-motor exercises/goals for educational IEP’s/settings.

The only test I know of that will give you a standard score for oral motor skills is my test called the MOST —  The Marshalla Oral-Sensorimotor Test . It is  available through SuperDuper Publications .

The MOST was normed on kids 4;0 – 7;11. It will give you individual scores for jaw, lips, tongue, velum, respiration, phonation, and oscillating oral movements.

All other tests that I am aware of are simple checklists.

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• Debbie's Blog

What Do I Look for in an Oral Motor / Feeding Assessment?

Posted by Debra C. Lowsky, MS, CCC-SLP on 15th Jun 2018

What do I look for when I’m doing an oral motor / feeding assessment?   It's never a cookie-cutter check list.  It always depends on the individual and their skills and goals and where the evaluation, medical history, family history, etc. lead me.  But, there are some general skills that I look for and “tests" that I do:

Is there  tongue lateralization ? Is the tongue moving from side to side, or is it just pumping up and down?

Is there tongue elevation ( tongue tip , mid-blade, and  back of tongue )?

Is there  lip closure ?

How is the individual manipulating food?  Is there  rotary chewing ?  The tongue should be moving food from side to side before forming it into a bolus (ball of food).  The bolus should then be positioned between the palate and the middle of the tongue, and then passed to the back of the tongue, triggering an automatic swallow?

How many times does the individual chew a bite of food?   This will vary a lot depending on the kind of food.  For example, a banana slice will be a lot easier to chew and will require fewer chews than a piece of carrot.  I’ll try the food myself to see how many it should take - that’s really key.  Personally, I sometimes have to chew things up to 20-30 times, which takes strength and endurance.  

When the individual is chewing, I’ll feel the masseter bulge and the temporalis to see if they’re working.

Is there oral tone?   Drooping,  drooling , the  tongue positioned low and forward , open mouth posture, flaccid not toned cheeks, food loss, etc. may be signs of low oral tone.

Is the individual swallowing everything?  After the individual swallows, I’ll ask him/her to open the mouth so I can see if there are food particles left on the tongue and/or scattered throughout the oral cavity.  Can the individual do a lingual sweep to collect any leftover food particles? Is there awareness of food left on the lip, tongue, cheek, palate, or gum area?  Does he/she swallow on their own, or do they need to be cued/prompted to swallow? 

How is the oral resting posture?   The tongue should be not be making contact with either the bottom or top teeth, but retracted inside the oral cavity with the tongue tip resting on the alveolar ridge.   The jaw should be maintained in a high but not completely closed (upper and lower teeth almost touching each other, but not touching).

I’ll watch the individual drink from a straw, looking for lip closure, lip tension, cheek tension, tongue retraction, spillage, etc.  I’ll also check the length of the straw to make sure they’re not putting too much of the straw inside the mouth.   You can see how I do this at about 1:11 into the video below - As he takes a sip, I put my fingers where the straw meets the lips, then remove the straw to see how much of the straw he had in his mouth.  Using a  Lip Blok can help here.  Ideally I only want 1/4" of the straw inside the mouth ( click here to learn why ).

Is there a  tongue thrust ?  One thing I’ll have the individual take a small sip of water and hold it in his/her mouth.  Very lightly I’ll rest my hand under the chin, tell the individual to swallow, and “follow the swallow” with my hand.  If my hand moves forward during the swallow, this is one of several indications that there may be a tongue thrust.  The hand should not move.

As the individual drinks, I’ll also listen for gulping and gurgling sounds, which could mean there's too much air in the swallow, and/or that the swallow isn’t coordinated.

Check the food diary - I’ll have the parents keep a food diary to gather more information.  Everything the child eats for three days, including notes on how easy or hard it was for him/her to eat each food.

I’ll also check the individual’s medical history, especially GI - everything must be ruled out and/or addressed first - ENT, GI, esophagus, swallow study, MBSS, FEES, etc.

I’ll look at the parent’s history, too.  The parents might have a tongue thrust too for example.  Or the parents might dislike certain foods and may have passed those preferences on to their kids (my own kids won’t go near mushrooms because of me for example - I think they’re gross).  And so forth.

Are there any signs of  sensory issues / aversions ?  I’ll watch facial expressions and body language.  Grimacing, gagging, pulling away, turning the head - those are the easy/obvious ones.  I also look at facial expressions and read the eyes as well, looking for signs of dislike, fear, concern, like, delight, etc., especially if the individual is nonverbal.

This list is by no means all-inclusive, but I hope you find it helpful!

To any parents reading this - If you are at all concerned about your child's oral motor / feeding skills, please do consult with a feeding therapist so they can assess things in person, put together a personalized treatment plan if needed, and guide you through it.    

Debra C. Lowsky, MS, CCC-SLP

• #feeding-therapy
• #lip-closure
• #oral-motor
• #tongue-elevation
• #tongue-lateralization
• #tongue-retraction

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The Case for an Oral-Mech Exam

by Emily | Jun 20, 2019 | Guest Blogger

Oral mechanism exam, oral motor exam, oral-facial exam, oral peripheral exam, oral-mech exam… whatever you call it, it’s one of the most important , but frequently neglected , components of an initial assessment for any child with a suspected speech sound disorder. In fact, as outlined in ASHA’s Practice Portal regarding Speech Sound Disorders, an oral mechanism examination is a key component of a comprehensive speech evaluation.  Completing a thorough Oral Mechanism Exam (OME) helps us as SLPs determine if the structure and/or function of the speech mechanism is even adequate for speech production .

Now, I know we’ve all had those kids that pop up on our caseloads that look like clear-cut, straightforward “just artic” cases.  A quick Goldman-Fristoe and language sample shows that the only issues seem to be one or two speech sound errors.  Should be a pretty quick fix, right? Then, low and behold, years go by and that child is still in speech therapy working on those same sounds.  Or perhaps you’re treating a child who is so highly unintelligible that you suspect Childhood Apraxia of Speech, but don’t really have a clear picture of his or her speech/oral motor abilities, so making a definitive diagnosis is proving to be tricky.  What about that child who may only present with a couple of speech sound errors, but those errors tend to be hypo- or hypernasality and they just don’t seem to be stimulable for the target sounds at all?  What’s a clinician to do?

I frequently receive queries from other SLPs asking for tricks and tips for treating just such cases. But, before I even address appropriate therapeutic intervention strategies, my first question is almost always, “what did the oral-mech exam show you?” .  If we haven’t found or ruled out underlying structural or functional issues, then we may be using the wrong approach in therapy.

So let’s talk about what a good oral-mech exam (OME) can help you determine:

There may be actual physical abnormalities that impact speech production, such as any significant asymmetries, atypical dentition, the presence of dental appliances, abnormalities of the palate, like clefting or a bifid uvula, enlarged tonsils, or other unusual growths, just to name a few. If the actual structure of the oral mechanism is compromised then a referral to a specialist (ENT, craniofacial team, neurologist, dentist, etc.) may be appropriate and therapy may need to focus more on compensatory strategies.

An OME should also systematically assess how each articulator performs motor tasks , addressing strength, range of motion, speed of movement, whether extraneous movements are noted, and if any groping is observed during volitional motor tasks. These observations are key in helping us differentially diagnose the dysarthrias and oral apraxia, as well as determining if further assessment is warranted, such as myofunctional or motor speech assessments.

I have also come to realize that a good OME can not only help us be more confident in making differential diagnoses and determining what types of therapeutic interventions will be most appropriate, but it can also give us important clues about what types of supports will benefit a particular child.  For example, if you have a child who is extremely averse to touch, has a hyperactive gag reflex, or just doesn’t want you anywhere near their mouth, then tactile prompts may not be a good option.  Relying on visual and verbal prompts may be your best bet, at least initially.  In addition, if a child shows difficulty moving the tongue independently from the jaw, for example, then focusing on jaw/tongue dissociation should also be a consideration in therapy, especially if speech errors involve lingual sounds.

Don’t let another child with a speech sound disorder be added to your caseload without doing an OME… you never know how it may change your entire therapy approach! All you need is the Oral-Facial Exam form, a tongue depressor, a flashlight and you’re ready to go!

I hope I’ve managed to explain some of the benefits of administering a thorough OME with each child you assess for speech sound disorders.  It’s why, several months ago, I went on the hunt for an exhaustive, but easy to use oral-mech exam  form to use at my practice.  Now that I own my own private practice that specializes in speech sound disorders, I wanted to find a checklist-style oral motor assessment form to help me be thorough, yet efficient in its administration.  Since that proved to be difficult to find, I began creating an Oral-Facial Exam for my own use. But, I quickly found that not only were there other SLPs who were looking for something similar, but many didn’t feel like they had the knowledge to know how to interpret the results. So, I spent a little more time, did more research, and added detailed instructions , guidelines , and even diagrams to help any SLP identify and rule out structural/functional deficits, determine if those deficits impact speech production, and decide when to consider appropriate referrals to specialists.

Amy Graham , MS, CCC-SLP has been a speech-language pathologist for 20 years and is the owner of Graham Speech Therapy , a private practice in Colorado Springs specializing in speech sound disorders.  She is listed on the Apraxia Kids Directory of SLPs with expertise in Apraxia and is PROMPT trained. She has worked in a variety of settings, from numerous public/charter schools, acute care/rehabilitation hospitals, an audiology clinic, and now private practice. Amy is committed to raising awareness about Childhood Apraxia of Speech and supporting and equipping SLPs to provide evidence-based therapy through her social media accounts on Instagram and Facebook .

If you are a parent in Austin, TX and looking for support for your child, please contact me to discuss your options.

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