It’s Monday! I’m ready and raring to go with this first series that I’m calling “Back to School Screenings and Evaluations.” When pondering where to begin all these blogs, I let mass screenings be my deciding factor. These first six blogs will all relate to screenings, evaluations, and placement considerations.
I felt the most appropriate place to start would be with a quick refresher of the oral mechanism examination. If your workload is anything like that which I faced, you’ll find yourself rushing through the oral mech or just doing a cursory exam. I found, after doing therapy for many years, that when a child presented as a simple artic disorder my exams tended to consist of a quick look inside the mouth and a few basic tongue movements. Not good. You’ll get into therapy and a few weeks or possibly months later find that this kid has an oral deficit that you didn’t pick up during the oral exam. So you have to back up and start again and that might even involve having to rewrite your IEP goals/benchmarks/objectives, and that means scheduling another meeting. You really don’t want to have to do another meeting do you? Me either! So do a thorough oral exam the first time and avoid creating headaches for yourself later in the year. The time spent now will save you frustrations later.
I can’t recommend one specific exam over another, but I can strongly urge you to do a complete exam. Beyond checking the structure and function of the lips, teeth, tongue, and palate, you need to really look at and note ALL findings. Many times we do note them on the oral mech record sheet but then ignore it as insignificant when considering the child’s overall assessment, or can’t remember what the implication of that would be. The next few blogs will target some of these, but today I’ll simply refresh your memory regarding nasality.
A quick screen for nasality is to simply have the child occlude their nostrils and say “oo”. I always demonstrate the procedure as I give the direction. The sound should be produced completely out the mouth. There should be no sound from the nose. If you hear nasality have the child try it two more times with additional instruction on how to do it correctly. Some children just don’t understand what to do the first time, and can be successful on subsequent attempts. If they are unable to do this correctly after three attempts, then that is a red flag that you should consider referral to an ENT.
Now for a refresher tip: when I am looking in the child’s mouth instead of having them say “ah” I have them say “uh-uh-uh” (three short repetitive sounds) because it lifts the velum higher and more than once, so I can clearly see the movement. Is it lifting up as it should? Is it lifting on one side higher than the other? This is your first indicator of possible neurological involvement (nerve damage) or velopharyngeal incompetency or insufficiency.
NOTE: Velopharyngeal insufficiency and incompetency are NOT interchangeable terms. Velopharyngeal insufficiency is an anatomical defect. It is a physical problem and could warrant surgery. You do not do therapy for that.
Velopharyngeal incompetence is not anatomical. It is an articulation problem and you would address it in therapy.