Oral Mechanism Examination

Name______________________________________ Date of Examination_____________

Age_____________________ Examiner________________________________________

Lips Alevolar Ridge / Hard Palate

_____ structure at rest _____ structure

_____ labial mobility /u/, /i/ _____ cleft
_____ retain pressure behind lips _____ length / width /depth
_____ purse lips _____ teeth in palate
_____ labial sounds /b/, /p/, /m/ _____ other_________________________
_____ cleft lip/other ____________________

Tongue Soft Palate / Velum

_____ structure at rest _____ structure at rest

_____ protrusion/retraction _____ cleft
_____ mobility: side to side _____ mobility /a/, /a-a-a/
_____ mobility: lift up & down _____ VPC: /k/, /s,z/, /t/
_____ mobility: lick lips _____ tonsils_______________________
_____ lingual frenum
_____ lingual strength: push stick Mandible
_____ lingual sounds: /l/, /t/, /k/, /kl/
_____ other___________________________ _____ structure at rest
_____ occlusion______________________
_____ jaw stability: bite stick
Teeth _____ mouth breathing
_____ open mouth/hold 10-15 sec
_____ Occlusion ____________________ _____ close and hold 10-15 sec
_____ Condition ____________________ _____ other________________________
_____ Spacing _____________________
_____ Other ______________________

Apraxia The structure and function of the

oral mechanism are:
_____ lick lips, pucker lips
_____ puff cheeks, tongue protrusion _____ Adequate for Speaking
_____ increasing word complexity: _____ Inadequate for Speaking
sit / city / citizen / citizenship _____ Degree of Impairment:
jab / jabber / jabbering Mild / Moderate / Severe
Kalamazoo _____Impairment of Structure
_____ AMR: /p/ or buttercup _____Impairment of Function
or mommy-daddy-baby

Developed by Brenda Addington, MA, CCC-SLP. www.speechfriends.com