Oro-Motor Examination – based on Cichero and Murdoch (2006)


Inspection of the oral cavity and oropharynx: Comprehensive examination may be limited by the individual’s diminished cognitive capacity. An attempt should be made to check for:

•Any tongue abnormalities and it’s general condition
•Evidence of thrush (white areas or a complete cover of the tongue)
•Evidence of biting their tongue and the insides of their cheeks
•Any atrophy
•Lack of saliva
•Poor dentition
•Poorly fitting dentures
Tooth pain may be a cause of poor oral intake due to low tolerance of chewing (Cichero and Murdoch, 2006). See 'Intervention' for risk of aspiration pneumonia related to poor oral hygiene Decreasing the Risk of Aspiration
Saliva management: This is difficult to manage in this population however reminders to swallow intermittently can help.
Cranial Nerve Assessment
This assessment will be challenging and the difficulty carrying it out will increase with the severity of the dementia. The assessment may be inappropriate due to reduced cognition and subsequent distress.
The following gives examples of how to test each cranial nerve involved in mastication and deglutition.
Trigeminal (V): bite teeth together, SLT can palpate the temporalis and masseter muscles. Open jaw against resistance of therapists hand on chin.
Facial (VII): Motor - Lip seal can be visually assessed during oral trials. Strength may be difficult to assess. Attempt to get the client to pout and give a wide smile. Observe frowning and opening and closing the eyes.
Sensory: Use various taste dropped on tongue. According to Easterling and Robbins (2008) individuals with dementia have reduced taste, therefore suggest using food with stronger tastes in oral trials.
Glossopharyngeal (IX) and Vagus (X): Try and get them to say ‘ah’ for velum symmetry assessment. The assessment may be terminated by trying to elicit a gag response, so this is a good one to do last. Attempt to get a voluntary cough.
Hypoglossal (XII): Observe tongue at rest if possible. Ask client to poke tongue out and move it left and right, attempt up and down but success is unlikely due to cognitive difficulties. Is their speech intelligible?
Ability to protect the airway: Ask them to hold their breath for 2 seconds.
Attempt the assessment as best you can however this client group is difficult to assess (see link for further discussion Dysphagia and Dementia, ASHA).

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