Assessment of the Oral-Peripheral Speech Mechanism

The oral-peripheral examination (also termed oral facial examination or speech mechanism examination; Johnson-Root, 2015) is an assessment of the anatomical and functional integrity of the structures that support speech and swallowing, and it is an essential part of a complete speech, language, and swallowing evaluation. This part of the diagnostic assessment is administered to clients of all ages, from infancy through adulthood. It is important to note that the oral-peripheral examination is usually performed after obtaining case history information about the client (e.g., the client’s medical history). The clinician can obtain information about the client’s ability to follow directions and communicate his or her wants and needs. Sometimes, the clinician is the person to first become aware of any possible neurological deficits based on the results of the oral-peripheral examination. If so, the speech-language pathologist (SLP) is responsible for making appropriate referrals after the evaluation. The purposes of examining the speech mechanism are to observe the efficiency of the client’s sensory and motor functions of the cranial nerves for speech and swallowing, and to identify structural and functional anomalies that may contribute to a speech or swallowing disorder. Some examples of published tests and materials that contain oral-peripheral assessment protocols are the Clinical Assessment of Oropharyngeal Motor Development in Young Children (Robbins & Klee, 1987), the Structural/Functional Battery of Oral-Motor Tasks (Wertz, 1985), the Dysarthria Profile (Robertson, 1982), the Dysarthria Examination Battery (Drummond, 1993); the Frenchay Dysarthria Assessment (Enderby, 1983), Orofacial Myofunctional Evaluation With Scores (Felício & Ferreira, 2008), Robbins-Klee Oral Speech Motor Protocol (Robbins & Klee, 1987), and the Dworkin-Culatta Oral Mechanism Examination and Treatment System (Dworkin & Culatta, 1980). Hegde and Freed (2013), Hegde and Promoville (2017), Shipley and McAfee (2015), and this chapter have sample oral-peripheral examination forms. Additionally, when performing evaluations on clients suspected of having a motor speech disorder or dysphagia, the SLPs will assess the cranial nerves for speech and swallowing. Hence, motor speech disorder evaluations and clinical bedside examination forms contain the necessary information for an oral-peripheral examination. For example, there is a motor speech disorder evaluation template and clinical swallowing evaluation on the American Speech-Language-Hearing Association (ASHA) Portal, which contains all of the necessary elements for an oral-peripheral examination (https://www.asha.org/Practice-Portal/Templates). In addition, Swigert (2010) provides information about the various types of dysarthria, site of lesion, impact of functioning, and assessment forms using the International Classification of Functioning, Disability and Health (World Health Organization, 2001) as a comprehensive framework for assessing dysarthria. Refer to the references section at the end of this chapter for additional resources. SLPs may choose to create their own oral-peripheral form based on the population they are assessing (e.g., child vs. adult), setting of employment (e.g., university clinic vs. outpatient rehabilitation center), and of course, their knowledge of the anatomy and physiology of the speech and swallowing mechanism.