The structural-functional evaluation is an important component of a complete speech assessment. Its purpose is to identify or rule out structural or functional factors that relate to a communicative disorder. Minimally, you will need:
a small flashlight
You may also need
a bite block (to disassociate tongue and jaw movements)
cotton gauze (to hold the tongue in place)
an applicator stick (to assess velopharngeal movement)
A complete oral examination includes an assessment of diadochokinetic rates, which measures a client's ability to produce rapidly alternating articulatory movements.
Interpreting the Structural-Functional Examination
Valid interpretation of findings from an oral-facial examination requires an understanding of the anatomic, physiologic, and neurologic bases of the oral-facial structures and their functions, combined with experience in performing oral-facial examinations and assessing the relationship between oral-facial integrity and communicative function. Sophistication in administering these examinations takes time and a good deal of experience to develop.
Several common observations from an oral-facial examination and possible clinical implications are described below. Recognize that this is not an all-inclusive list, nor does it exhaust the potential implications of each finding. Beginning clinician will need to rely on class notes and anatomy, physiology, and neurology textbooks as well as the chapters on oral examinations in diagnostic textbooks.
Abnormal color of the tongue, palate, or pharynx: There are several abnormal colors you may observe. A grayish color is normally associated with muscular paresis or paralysis. A bluish tint may results from excessive vascularity or bleeding. A whitish color present along the border of the hard and soft palate is a symptom of a submucosal cleft. An abnormally dark or a translucent color on the hard palate may be an indication of a palatal fistula or a cleft. Dark spots may indicate oral cancer.
Abnormal height or width of the palatal arch: The shape of the palatal arch may bary considerably from client to client. If the arch is especially wide or high, the client may experience difficulties with palatal-lingual sounds. An abnormally low or narrow arch in the presence of a large tongue may results in consonant distortions.
Deviation of the tongue and/or uvula to the left or right: This may indicate neurological involvement. If so, the tongue may deviate to the weaker side because the weaker half of the tongue is unable to match the extension of the stronger half. On phonation, the uvula may deviate to the weaker side because the weaker half of the tongue is unable to match the extension of the stronger half. On phonation, the uvula may deviate to the stronger side as the palatal muscles on that strong side pull the uvula farther toward the velopharyngeal opening. Facial asymmetry is also likely to be present. The client may exhibit concomitant aphasia and/or dysarthria.
Enlarged tonsils: Many children have large tonsils with no adverse affect on speech production. In some cases, however, enlarged tonsils interfere with general health, normal resonance, and/or hearing acuity (if the eustachian tubes are blocked). A forward carriage fo the tongue may also persist, resulting in abnormal articulation.
Missing teeth: Depending on which teeth are missing, articulation may be impaired. It is important to determine whether the missing teeth are the primary cause of, or a contributor to, the communicative disorder. In most cases, especially in children, missing teeth do not seriously affect articulation.
Mouth breathing: The client may have a restricted passageway to the nasal cavity. If this is a persistent problem and the client also exhibits hyponasal (denasal) speech, a referral to a physician is warranted. Mouth breathing may also be associate with anterior posturing of the tongue at rest.
Poor intraoral pressure: Poor maintenance of air in the cheeks is a sign of labial weakness and/or velophryngeal inadequacy-more specifically, velophayngeal insufficiency (a structural problem) or velopharyngeal incompetence (a functional problem). Check for nasal emission or air escaping from the lips. This client may also have dysarthria and/or hypernasality.
Short lingual frenum: This may result in an articulation disorder. If the client is unable to place the tongue against the alveolar ridge or the teeth to produce sounds such as /t/, /d/, /n/, /ch/, and /j/, the frenum may need to be clipped by a physician.
Weak or absent gag reflex: This often indicates muscular weakness in the velopharyngeal area. Neurological impairment may be present. A warning thorugh - do not make this conclusion without considering other factors. Some clients have a very high tolerance for gagging and will not gag even if muscular integrity is normal.
Weakness of the lips, tongue, and/or jaw: This is common among clients with neurological impairments. Aphasia annnd/or dysarthria may be present.