Oro-motor Assessment CN V: 1. Ask pt to bite down as hard as possible. Feel if bulk of the Masseter muscle can be felt. 2.

. Strength of jaw closure. Place hand on the tip of the pts mandible as the jaw is held open. Place the other hand on the forehead to prevent neck extension. Ask pt to bite down hard against resistance of the hand. PT should be able to close jaw against a moderate resistance. 3. Open Jaw against resistance of hand to test lateral pterygoid muscles. And also move jaw from side to side. 4. Have pt move the jaw to one side while I try to push to the center. Place other hand in opposite cheekbone so that pt cannot use the neck. 5. For the sensory component testing, ask pt to close their eyes. A cotton swab is used to stroke face at: above the eyebrows, upper lip in an upward movement toward the cheekbone, and between the lower lip and chin. Left and right sides should be done separately.

CN VII: 1. 2. 3. 4. 5. 6. CN IX: 1. Most functions of this cranial nerve cant be separated from those of CN X when testing. However testing of pharyngeal gag does provide information of CN IX. 2. Put cotton tip back against 1 side of the posterior pharyngeal wall, avoiding any contact with the base of the tongue or velum. With gentle pocking, a gag should be elicited. CN X: 1. Observe palate at rest. Look at palatal arches and observe symmetry. Note patients face at rest , and symmetry of face. Pt to wrinkle forehead and look up at ceiling. Pt to close the eyes as tightly as possible. Pt to smile (exaggerating, showing teeth) or pull back the corners of the lips. Pt to pucker lips. Pt to wrinkle skin of the neck.

2. Ask pt to phonate an ah and observe. The soft palate should elevate and move posteriorly and symmetrically. If palate does not raise, do the CN IX gag reflex test.

3. Ask pt to phonate /a/ as long as possible. If pt can do this for 7 or 8 seconds, laryngeal and respiratory control is presumed acceptable. CN XI: 1. Look at size and symmetry of the sternocleidomastoid muscle and touch them.

2. Ask pt to turn head to one side and hold it there while I try and push head back to the middle. Put one hand on pts check and other on shoulder. Observe and touch the sternocleidomastoid on the opposite side of the neck. 3. Pt to thrust head forward while I resist movement with my hand against the forehead. Observe and touch the sternocleidomastoid muscle. 4. Pt to shrug shoulders while I press down on the shoulders. CN XII: 1. Look at tongue at rest. Look for signs of atrophy and fasciculations. Also check for tremors or random movements while tongue is at rest. 2. Pt to stick out tongue to evaluate symmetry. Tongue tip should be at midline.

3. Strength of tongue protrusion tested by pt pushing against a tongue blade held directly in front of lips. 4. Pt to move the tongue from one corner of the mouth to the other. To test for strength, ask pt to push tongue against inside of cheek against the fingers I put outside the cheek. 5. Ask pt to open mouth to a moderate level, and I hold down mandible with finger. Pt to try and touch the top lip and alveolar ridge.

Assessment of swallowing: 1. Taste (CN VII and IX) tested with primary tastes: salt, sweet, bitter, sour. This must be done on both sides of the anterior 2/3 of the tongue and on both sides of the posterior 1/3 of the tongue to include CN VII and IX. 2. General sensation to the posterior 1/3 of the tongue (CN V and IX) tested with the 2 sides compared regarding sensitivity to touch. Pharyngeal gag can be attempted.