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...
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.
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.
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...
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.
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.
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....
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.
Bonus: You can purchase either device in an SLP Bundle along with my Oral-Facial Exam at a special price for SLPs.
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.