Consultants in Dysphagia Evaluation and Management
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Created by : Ronda Polansky M.S. CCC-SLP
Oral Motor Management
An examination of the patients anatomy is done during an Bedside Swallow Eval (BSE)
This usually begins with lip seal and tongue movement
Of importance is evaluation of oromandibular movement during mastication, with SLP noting symmetry of motion, labial closure, control of saliva during fixed expression and chewing.
Oral – motor functioning is the area of assessment which looks at normal and abnormal patterns of the lips, tongue, jaw, and cheeks for eating, drinking, facial expression and speech to determine which functional skills a client has to build on, and which abnormal patterns need to be inhibited or for which compensation is needed. Oral-motor disorders are diagnosed by the SLP directly observing the patient, doing what is called an “Oral-Motor Exam”. In this exam, the therapist asks the patient to do a variety of tasks (such as pursing lips, blowing, elevating tongue, etc), looks inside the mouth, observes the patient eating and listens to them talk. The therapist will also listen for the patient’s ability to produce rapid oral movements.
- Low muscle tone in the face (i.e. “droopy face”)
- Open mouth posture/Trouble keeping lips closed
- Tongue hangs forward
- Speech sounds are unclear/Makes speech sound errors
- Leaves food in cheeks after eating or does not chew it up well
- Teeth grinding
- Oral defensiveness (i.e. Will not let you touch their face or doesn’t like food on it)
- Oral Hyposensitivity (i.e. crave sensory input so will mouth non-edible objects such as toys and clothes, etc. to increase awareness in the mouth)
- Difficulty moving tongue side to side, up and down, or point it outside of the mouth
- Head does not move with tongue movement (i.e. when move tongue side to side the head goes with it)
- Bites on fork/spoon/straw when eating/may bite on a horn while blowing
- Feeding problems
Facial asymmetry can be produced by structural abnormalities or by unilateral or asymmetrical weakness of the muscles of the face. Structural abnormalities are due to musculoskeletal deformations, soft tissue masses, and tumors
- Facial weakness or paralysis can be a result of a stoke or Bell’s palsy effecting the 7th cranial nerve.
All types of Dysarthria affect articulation of consonants, causing slurring of speech.
- It is a motor speech disorder that effect the muscles of the mouth, face and respiratory system. Type and severity of dysarthria depend on what area of the nervous system is affected
- Dysarthria errors result from a disruption of muscular control due to lesions of either the central or peripheral nervous system. It is classified as a neuromotor disorder.
- Dysarthria is different from Apraxia. Apraxia results from an impaired ability to generate motor programs for speech movement rather than from a disordered transmission of controlling messages to the speech musculature. Apraxia is a planning/programming problem, not a movement problem like Dysarthria
Ideas for more interesting O-M exercises for adults and children that can be done at home:
This may seem a bit immature, but it is a great exercise for breath control as well as pursing the lips.
In our own experience the clients that we’ve worked with have all enjoyed this activity. Remember, you’re never too old to have some fun!
Blow a Harmonica
Here is another great oral motor exercise for breath control and lip pursing, but with this one you get to make some noise!
If breath control is weak then your goal might be to get “louder” sounds from the harmonica.
If your lip strength is weak you might focus on trying to play just one note at a time.
Harmonica’s are inexpensive (you can even use a plastic one), and all in all it’s another fun activity.
Peanut Butter on the Lips
Rub some peanut butter on your lips and do your best to lick it all off. Make sure you apply the peanut butter from one corner of the mouth to the other.
This will force the tongue to reach from side-to-side to lick that tasty spread. This should go without saying by now, but never use this with anyone experiencing feeding or swallowing difficulties.
Putting ice on the lips will certainly help “wake up” those muscles. You can use a plain ice cube for this exercise, but ice pops are easier to use and add some flavor as well. Run the ice from the middle of the lips outward to the corner. Do this on both sides and then ask the patient to smile. Repeat the icing movements and the smiling attempts several times.
Using a toothbrush, brush the upper and lower lips. You can purchase toothbrushes with different levels of stiffness. Try to use different levels ranging from very soft to stiff (never use anything that may cause pain). You can also use the brushing technique on the muscles surrounding the mouth (including the jaw).
Using a Straw
Practicing with a straw will obviously work on sucking skills, however it also involves pursing those lips again.
“Thin” liquids like water or apple juice are good starters.
As you progress you might want to try a “thicker” liquid like a milk shake.
Do not use this exercise if your patient has feeding or swallowing difficulties.
References: Speechtherapyonvideo.com, Beckman Oral Motor patterns