Assessment

 


A standard screening for tongue thrust involves observation of positive indicators for the tongue thrust swallow pattern involving the following structures:  

Lips: 
              Symmetry, shape, strength, posture.

Palate: 
             height of arch and mobility of soft palate 

 Tonsils and adenoids:
             enlarged?
Jaw: 
             type of occlusion
Tongue
             size in relation to oral cavity; back of tongue strength, sides of tongue strength, tone (flaccid?), mobility, length of frenulum, resting posture, position


Breathing
             Nose/mouth

Swallowing:
             Contraction of mentalis, forward or lateral lingual protrusion, tensing of obicularis oris muscle to produce lip seal, extraneous movement of face or head, little or no contraction of masseter muscle.

Teeth: 
             Malocclusion; anterior open bite ?

Speech:

             Speech sound errors

                          (Richardson, 2003)
 

Presently, there is no validated instrument for evaluating  the orofacial myofunctional condition of children so that  the examiner can actually quantify the characteristics of a tongue thruster.

Felicio  and Ferreira (2007) have developed a validated protocol to measure  the degree of myofunctional  deviation without the need for special equipment. Parameters evaluated are:  appearance and posture, mobility of lips, tongue, jaw and cheeks, as well as breathing and deglutition.

See appendix A to view a copy of this OMES (orofacial myofunctional evaluation with scores) protocol.               
   Dagenais et al 1994 suggests that electropalatography might be useful initially as an assessment tool as well as in  monitoring the progress of myofunctional treatment. It involves visual and oral sensory feedback associated with “linguapalatal contact patterns.”         

 


  Clark (1993) summarized various subjective and objective techniques to measure oral motor strength and which can be adapted for assessing  the strength of individual muscles comprising the oral facial musculature.

 

Subjective measures:

Muscle strength can be assessed based on the force of resistance provided by the examiner when :

(a) the client pushes tongue against tongue blade in various directions 

(b)  Client attempts to help lips together while the examiner attempts to pull them apart, and

(c)  Client holds air in the cheeks while the examiner provides pressure.

 

For example, the Dworkin-Culatta Oral Mechanism Examination (D-COME) assesses resistance of passively moving articulators (cited by Clark, 2002).

 

Objective measures:

Strength is assessed based on instrumentally transduced forces or pressures.

 

 

  Examples: Iowa Oral Performance Instrument (IOPI) http://www.iopi.info/