Region

Static Assessment Procedures

Dynamic Assessment Procedures

Jaw

Practitioner Stands in front of client:

1 Palpate TMJ region for pain/asymmetry of condyles.

2. Run fingers along anterior border of masseters. Feel for tension; tenderness.

3. Look for signs of clenching, teeth grinding.

Practitioner Stands in front of client:

1. Look for mouth opening: 3 1/2 fingers wide, symmetry, zigzag, asymmetry (pulling to one side) 2. Check range of movement for protraction; retraction; lateral movements; tongue tension.

Floor of mouth (Anterior

Supra-hyoid region)

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck:

1. Palpate region under chin between hyoid bone and mandibular arch. Feel for bulging; tight/tender muscles; distance of hyoid body from anterior portion of mandibular arch.

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck:

1. Palpate action of floor of mouth muscles while client swallows. Palpate for upward and forward hyoid-laryngeal movement.

2. Apply slight pressure to hyoid body to

assess strength of swallowing action.

Hyoid Bone

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck:

1. Palpate level of hyoid relative to submandibular line.

2. Shift hyoid from side to side to check muscle tension and symmetry in the movement.

3. Check position of hyoid body relative to thyroid cartilage.

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck:

1. Palpate the hyoid bone while client swallows;

yawns; ascends pitch; descends pitch.

2. Palpate hyoid bone while client drops jaw.

Differentially diagnose “held” from tight larynx.

3. Palpate for laryngeal click.

Middle Constrictor and Base

of Tongue

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck:

1. Palpate for tension and tenderness.

2. Note client’s emotional reaction.

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck:

1. Move hyoid bone from side to side. Palpate for quality of movement.

Thyro-Hyoid mechanism

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck:

1. Palpate size of gap between thyroid and hyoid cartilages.

2. Palpate along thyro-hyoid muscles for tenderness. 3. Note relationship between hyoid body relative to thyroid prominence: anterior, flush or

posterior

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck:

1. Palpate while client drops jaw; yawns, to determine amount of laryngeal descent and whether there is a dynamic change in thyro-hyoid gap. Differentially diagnose “held” from tight larynx.

2. Palpate while client yawns; sighs; ascends

pitch, to study dynamic quality of thyro-hyoid mechanism.

Base of tongue

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck

1.palpate superior surface of the hyoid by-laterally

2. Find base of tongue

3. Note one might need to release the area to do this

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck

1.Palpate action of tongue movements

2. Assess what happens when tongue is pushed out

Thyroid cartilage

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck

1.Palpate posterior margins

2.Compare ease of access on both sides

3. difficulty to access the posterior margin unilaterally possible Lx rotation to that side

4.Bilaterally inability to palpate margins might mean back larynx against cervical fascia

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck/

1. Dynamically ask patient to swallow

2. Observe backing movement.

3. Observe strength of onset of swallowing

4. Observe a twist or rotation to one side when the larynx ascends

Crico-thyroid mechanism

Palpate with the pulp of the 3rd finger in the midline, the

gap between thyroid cartilage and cricoid cartilage/

1. Note size of gap open /close

2. Look for anterior / posterior position of cricoid in relationship to thyroid

3. Palpate for tenderness around crico-thyroid muscle

1. Ask the patient to produce a sound and go

through a loop of hi / lo notes

2. Palpate for changes in the size of the gap

3. Note for anterior / posterior relative shift of cricoid against thyroid

Arytenoid function

It is possible to access the arytenoids by palpating

behind the larynx

This procedure requires in good palpatory experience and is beyond the scope of this protocol

Inferior strap muscles

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck:

1.Palpate level of cricoid arch relative to sternal notch

2.cricoid hidden in thoracic inlet /high sternum

Practitioner stands at the side of client, one hand

stabilizing client’s head-neck

1.Ask patient to swallow / high notes assess dynamic movement of the larynx

Breathing apparatus

1. Rib cage

1.

2.

3.

4.

Observe level of sternum

Observe upper chest movement exhale /

inhale

Palpate sternum while patient exhale

Palpate sternum on exhale

Vertical / horizontal

Upper chest movement noticeable / minimal Sternum doesn’t descend / sternum moves down Assess extent of exhale phase in seconds. 15 sec is good

2. Diaphragmatic

1.

2.

3.

Observe diaphragmatic expansion

Palpate diaphragmatic movement

Palpate diaphragmatic action on onset

On inhale abdomen protrudes

On exhale abdomen retracts

Onset causing a stop on diaphragmatic flow Paradoxical diaphragmatic movement Freeze of movement

Posture related laryngeal

function

Observe laryngeal position in the midline

Observe of laryngeal deviation is cause by posture or

Local muscle tension

Deviated laryngeal position check for spinal curves

Palpate laryngeal movement on swallowing look for a twist in rotation

Rotate torso on fixed pelvis observe laryngeal swing

Relative to midline