PROFORMA FOR ORAL SPEECH MECHANISM EXAMINATION
Name: Age/Gender: No:
Date:
|
ARTICULATOR
|
STRUCTURE
|
FUNCTION
|
|
Face
|
·
Drooping
·
Eyelid closure
(partially/completely)
·
Abnormal
movements (grimaces, spasms, etc)
·
Drooling
·
Mouth breathing
|
·
Deviation to
anyone side
·
Rising of
eyebrows
·
Closing of eyes
|
|
Lips
|
·
Normal
·
Cleft (repaired/
unrepaired)
·
Drooling
·
Drooping
·
Deviation
·
Lip closure
·
Symmetrical/
Assymmetrical
|
·
Retraction
·
Puckering
·
Rounding
·
Pursing
·
Lateral
movements
·
Lip strength
against resistance
·
Range of motion
|
|
Teeth
|
·
Normal
·
Missing teeth
·
Alignment
·
Malocclusion
Þ
Open bite
Þ
Close bite
Þ
Under bite
Þ
Over jet
Þ
Cross bite
|
|
|
Tongue
|
·
Normal (if
abnormal, specify)
·
Tongue tie
·
Macroglossia/
Microglossia
·
Bifid tongue
·
Tremors
·
Tongue thrust
·
Tongue
coloration
|
·
Elevation
·
Retraction
·
Protrusion
·
Lateral
movements
·
Range of motion
|
|
Hard Palate
|
·
Normal
·
High arched /
Narrow
·
Cleft (
repaired/ unrepaired)
·
Fistula
·
Discoloration
·
Prosthesis
|
|
|
Soft Palate
|
·
Normal
·
Cleft (repaired/
unrepaired)
·
Fistula
·
Bifid uvula
·
Discoloration
·
Prosthesis
·
Symmetrical/
asymmetrical
|
·
Movement
(elevation / depression)
·
Hyponasality/Hypernasality/
Nasal emission
|
|
Jaw
|
·
Normal
·
Alignment
·
Drooping
|
·
Opening / Closing
·
Lateral
Movements
·
Chewing
|
1.
Intra Oral Breath Pressure :
2.
Diadochokinetic rate :
·
Alternate Motion Rate
(AMR):
·
Sequential Motion
Rate (SMR):
3.
Velopharyngeal Incompetency / Insufficiency / Inadequacy :
Signature of staff:
KUNNAMPALLIL GEJO JOHN
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