ORAL
- MOTOR PATTERNS
Oral
- motor functioning is the area of assessment which looks at normal and
abnormal patterns of the lips, tongue, jaw, and cheeks for eating, drinking,
facial expression and speech to determine which functional skills a client has
to build on, and which abnormal patterns need to be inhibited or for which
compensation is needed.
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Normal Lip Patterns
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Three normal lip patterns are lip
rounding, lip spreading, and lip closure.
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Lip rounding - The lips form a circular shape maintaining muscular
tonal balance. This position is attained through easy, nonforceful movement.
The amount of rounding can be varied as needed to obtain and maintain a seal
around a feeding utensil, or to build up or maintain intra-oral pressure.
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Lip spreading - The lips form an expanded horizontal line from the rest
position, maintaining normal muscle tone. The position is attained through
easy, non-forceful movement. The amount of spreading can be varied as needed
to control substances in the front of the mouth, or to aid in drawing
substances into the mouth.
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Lip closure - The lips meet and touch to seal off the contents of the
mouth from the outside. The position is attained through easy, non-forceful
movement. The amount of contact and the area of contact can be varied as
needed to retain substances in the mouth.
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Note: Each of these patterns may be reduced in efficiency by
weakness of the lip muscles. For example, the lips may close, but food/fluid
escapes due to weak lip seal.
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Abnormal Lip Patterns
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In addition to recognizing normal
patterns, you should also evaluate for abnormal patterns, including lip
retraction, and lip purse-string, hypotonicity and asymmetrical lip movement.
Each of these patterns interferes with lip closure, mouth opening and with
forming a seal around a feeding utensil (bottle, straw, cup, spoon, etc.). It
also affects one's ability to obtain and/or maintain intra-oral pressure.
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Lip tremor - Rapid, small movements of the lips during purposeful
activity, such as lip seal. A mildly abnormal pattern indicating fatigue. Lip
retraction - This is an abnormal pattern in which increased abnormal tone
pulls the corners of the lips up and back. It may be observed to affect upper
lip movement more than lower lip movement. The person with this pattern may
be described as "always smiling". The anterior cheek area usually
shows a retracted pattern also.
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Lip purse-string - This is an abnormal pattern in which the corners of the
lips are pulled back as the rest of the lip pulls to midline, with an
increase in abnormal tone. Increased tone may extend from below the nose to
the chin and into the cheeks.
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Asymmetrical lip movement - This is an abnormal pattern in which one side of the
lip moves with less control than the other side. Abnormal patterns and muscle
tone are noted on the affected side.
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Hypotonic lips - This is an abnormal pattern in which the lips appear
flaccid, with little or no active movement. The lips may look puffy. The
lower lip may appear more involved than the upper lip.
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Dystonic lip movement - An abnormal pattern characterized by rhythmical,
nonfunctional movement of either or both lips, associated with Parkinson's or
Parkinson's like symptoms. The ability to interrupt the movement is related
to the severity of the disease. With less severe involvement, the pattern can
be interrupted during functional activities such as eating and speech, and
will not be observed during sleep.
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Lip Fasciculations - An abnormal pattern of nonrhythmical, unorganized contraction of individual muscle fibers across the lips. May be observed when the lips are at rest, or following direct stimulation of the lips. May also be observed during generalized hypotonicity affecting the whole body.
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