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Blog

Oral-Facial Exams… the missing piece to your assessment puzzle

12/31/2021

5 Comments

 
Oral-Facial Exams: The missing piece to your assessment puzzle
We‘ve all had those kids on our caseloads that just don’t progress very quickly in speech therapy…. it’s a puzzle, right?!  
I get questions nearly every day from SLPS with these “puzzles” and frequently my first question is, “what did the oral-facial exam reveal?”.  More often than not, the answer is that one was never conducted. But, for kids with speech sound disorders, assessing the oral-facial mechanism is one of the most important, though frequently neglected, parts of a speech assessment.  In fact, as outlined in ASHA’s Practice Portal regarding Speech Sound Disorders, an oral-facial examination (i.e., oral mechanism exam, oral peripheral exam, oral motor exam, etc.) is a key component of a comprehensive speech evaluation. 

​Completing a thorough oral-facial exam (OFE) helps us as SLPs determine if the structure and/or function of the speech mechanism could be impacting speech production and frequently helps us identify that missing piece to those proverbial puzzles...
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Sometimes it’s that child who you think is “just artic” but has this one sound they can’t seem to generalize into conversational speech. They may have a structural difference for which effortful compensations make it too difficult for carryover to take place.

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Or that child who does fine on an articulation test but whose intelligibility is really reduced in connected speech and you just can’t put your finger on why. They may have motor planning deficits that a thorough OFE could help identify, such as how they perform on diadochokinetic tasks or volitional non-speech tasks.

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Or maybe you just have a gut feeling that there’s “more going on” with a preschooler’s speech than a straight-forward phonological delay. They may also have some red-flags for myofunctional deficits, such as a high/narrow palate, mouth breathing, or a malocclusion, to which your OFE can alert you.

A thorough OFE can help you uncover such contributors by looking at 2 aspects...
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1. Structure 
Physical abnormalities may impact speech production, such as 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 referrals to particular specialists (e.g., ENT, craniofacial team, neurologist, dentist, etc.) may be appropriate and therapy may need to focus on compensatory strategies.

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2. Function
OFEs can also uncover functional deficits by observing how each articulator performs on motor tasks to assess strength, range of motion, speed of movement, and whether or not extraneous movements or groping are observed during volitional motor tasks. These observations are key in helping us differentially diagnose dysarthrias and oral apraxia, as well as determining if targeted assessments are warranted, such as myofunctional or motor speech evaluations.

Oral-Facial Exam
If you're a little intimidated by all the information you’re supposed to gather and interpret with an OFE, you’re not alone. It's why I spent so long developing my Oral-Facial Exam form... an easy to use 3-page exam form that includes additional pages of detailed instruction, guidelines, and diagrams to help any SLP feel confident administering and interpreting findings.

But, if you feel like you need a little more guidance, check out my RESOURCES page where I've linked free webinars, podcast interviews, and video tutorials....
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You may notice in all those courses and videos that I'm using my favorite OFE tools from Holland Healthcare... the Throat Scope and Telescope. They make administration SO. MUCH. EASIER. These light-up tongue depressors illuminate the oral cavity and help you see alllllll the things. The newer TelScope even allows you to capture intraoral images and videos for patient files and specialist referrals.  And I haven't met a child that doesn't think it's a lightsaber or fairy wand.
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Bonus: You can purchase either device in an SLP Bundle along with my Oral-Facial Exam at a special price for SLPs.
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So, I hope I've managed to outline some of the benefits of administering a thorough OFE. If we haven’t identified or ruled-out underlying structural or functional issues, then we may be missing key information to help us make accurate diagnoses or make appropriate referrals to specialists, which means that we could also be wasting valuable time by using the wrong approach in therapy. ​Don’t let another child with a speech sound disorder be added to your caseload without doing an OFE… you never know how it may improve their trajectory in therapy.
5 Comments

Using Boom Cards to Implement the Cycles Approach!

7/20/2021

1 Comment

 
Graham speech Therapy Boom Cards Cycles Approach
If you're new to Boom Cards, they're digital task cards accessed on the Boom Learning website.  I learned about them when I had to switch to virtual therapy for all my clients following the pandemic and needed some engaging speech-specific activities to use over the computer. But, I quickly learned that this fun platform is great for in-person therapy, as well!

One thing I found lacking, however, were activities that were intervention specific, when it came to my kids with phonological deficits. If you treat kids with speech sound disorders, you know that articulation resources are often not appropriate for phonological intervention (that's another post for another day!). So, I decided to make some "CYCLES" specific boom decks.
Graham Speech Therapy Boom Learning Decks Cards Cycles Phonology
What's great about these Cycles Boom Cards, is they actually make implementing cycles so much easier! Each deck includes all the components of a complete cycles session:

  1. Auditory bombardment cards with audio playback
  2. Target words in phonetically appropriate contexts
  3. Cards for familiarization and elicitation of LOTS of trials per card
  4. Ability to send links for home practice!

Here's a little video preview of one of my decks....
So, if you still don't feel super confident implementing the cycles approach, these Boom Cards can be a great resource. There are currently 5 decks addressing primary and secondary patterns, in alignment with cycles... with new decks being added regularly.  You can find them on Boom Learning and Teachers Pay Teachers.

Want to know more about cycles? Watch this video I posted explaining it!
1 Comment

Why Articulation Norms Don't Matter That Much...

2/3/2020

9 Comments

 
Why Articulation Norms Don't Matter That Much
Yup... I said it.  Given all the buzz from that McCleod & Crowe article last year, it should be no secret that we've totally been misinterpreting those articulation norms. But, for a lot of SLPs it still begs the question... "then at what age should we be addressing particular sounds in speech therapy?"

Some of the most common questions I hear from SLPs sound something like this:

"When should I start treating kids for /r/ errors?"
... or ...
"Aren't /s/ sound errors still age appropriate for preschoolers?"

Those are the WRONG QUESTIONS.

If we base eligibility criteria and/or target selection primarily on arbitrary "cut-off" ages for acquisition of sounds, then we're missing the whole point. There are so many other variables that should be considered in addition to what particular sounds a child has at a particular age...


  • Intelligibility... if a child isn't at least 75% intelligible to unfamiliar listeners by the age of 3 (and 100% by age 4), then it's time to address speech, regardless of what the charts say.
  • Presence of phonological processes... all sound errors are not created equal. Maybe a child has all their "age appropriate" sounds, but they're still deleting final consonants at the age of 3.  Time to treat and remediate that phonological process! #phonologyisnotarticulation
  • Underlying structural or functional deficits... if things like VPI, tongue thrust, etc. are present, making referrals or getting a jump on speech intervention can be hugely beneficial. This also highlights the importance of ALWAYS administering an oral facial exam whenever possible. It can help you uncover or rule out issues that could be contributing to speech sound errors and help you make necessary referrals to other professionals.
  • Presence of multiple errors... even if all those errors are "developmentally appropriate", if there's a bunch of them and they're significantly reducing speech intelligibility, don't wait!
  • Family history of speech difficulties or learning disabilities...  this is a big one!  If you know there is a history of speech/learning disorders in the family, that's definitely something to consider when recommending services. So make sure you're doing your best to get a super thorough case history!
  • Difficulty learning to read and/or write... we know that children with speech sound disorders are at higher risk for having literacy related deficits, especially in the areas of  phonological awareness, decoding, and spelling.  So much more about that from Dr. Kelly Farquharson here.
  • Social/emotional impact... if a child is self-conscious about their speech difficulties, if it's inhibiting participation in their school or community, or if they're avoiding speaking in certain situations, please don't wait to treat.
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I like a good bar graph as much as the next guy... but I have to remind myself its just one piece of a bigger puzzle.

Let's take the /s/ sound, for example. Here are some factors I take into consideration when I decide whether or not to recommend speech therapy:


  1. How much do the child's speech errors impact intelligibility? Usually a simple frontal lisp doesn't impact intelligibility too much, but if they’re 4 years or older and strangers can’t understand them close to 100% of the time, then it’s time to treat.
  2. Are they omitting, substituting, or distorting the /s/? I may consider treating earlier or later depending on whether they are reducing consonant clusters or stopping vs lisping. Again, phonology is not articulation.
  3. Are there any other speech errors? If you’re already treating this child, for the love of speech sound disorders, please start treating /s/... even at 3! We already know they have trouble acquiring speech, so get a jump on it!
  4. Are there red flags for a myofunctional disorder? This deserves a post in itself... But, if there’s a tongue thrust, low tongue resting position, mouth breathing, high/narrow palate (I could go on and on), by all means don’t wait! Treat the underlying myofunctional deficit or refer to an SLP who can.
  5. Is it a lateral lisp? TREAT NOW. That’s not a developmental error and kids don’t “grow out” of it. I developed the Bjorem Speech Sound Cues for Lateralization for this particular speech sound disorder, which I've found to be so helpful with little ones who have such a hard time understanding correct placement.

​Now, I completely understand that many school-based SLPs are all too often bound by black-and-white eligibility guidelines put in place by administrators with little to no understanding of the nuances of SSDs.  And believe me, I can totally empathize with the concerns over gigantic caseloads in light of all these considerations (I was a school-based SLP for many years, myself). Unfortunately, I have no easy answers.  I just know that we do our kids and their families a disservice when we solely rely on speech acquisition norms as an arbitrary threshold for eligibility criteria.

With everything we’re learning about complexity theory, how we’ve been misinterpreting those speech acquisition charts, and how speech delays/disorders can impact literacy... it becomes pretty clear that there really is no “magic age” at which we should begin providing intervention for kids with errors of particular sounds. It’s much more complicated than that. 
9 Comments
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    Amy Graham, MA, CCC-SLP
    Amy is a licensed/certified Speech Language Pathologist in Colorado Springs and owner of Graham Speech Therapy, LLC.

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Graham Speech Therapy
  • Home
  • About
  • Services
    • Professional Development >
      • Recorded Courses
      • Book a Live Event
      • Live Webinars
      • Amy's Speaking Schedule
    • Consultation Request
    • Assessments & Therapy >
      • Therapy Calendar
      • Inclement Weather Policy
      • Testimonials
      • FAQ
  • SHOP
    • Downloads
  • Resources
    • Lateral Lisps
    • Oral-Mech Exams
    • R Sound Resources
    • Cycles
    • Complexity Approach
    • Multiple Oppositions
    • Minimal Pairs
    • Apraxia
    • Parent Resources
    • Freebies
    • Therapy Videos
    • Podcasts
    • Affiliate Links
  • Blog
  • Contact