The following is a query received off list-serve with response.

Hi Debra-

A colleague and I were discussing how to score lip and cheek strength
and we came across a question for you. First of all, we work with
children-usually between the ages of 2 and 4. When you are testing
for either of these and are giving verbal cues for the child to
activate that muscle by saying something or having them "get your
finger", how do you account for if you did not feel the contraction
because they did not understand the direction? We know that this
contraction should be felt if the person is not cognitive or
conscious on a reflexive basis, but does this also apply to the young
child? Can you feel the contraction in a child who is awake even if
you do not ask them to respond as listed above?

DEBRA BECKMAN'S RESPONSE
I am so glad you are completing baselines for your caseload.
The child does not have to be able understand commands, the response
then becomes reflexive. However, if the child does understand
commands, and you think they are not responding just to vex you, I
would score it the way you feel it - 0/5 for cheek strength or 0/6
for the lip strength. You can always update the baseline and I would
rather underestimate than over estimate. Some 2 and 3 years olds can
and do follow commands. Many understand the command, but have
specific oral motor weakness at these small levels of activation that
make it impossible for them to activate, just like the older lady on
the case study we showed in class. Muscle range and strength are not
cognitive, they are mechanical properties of the muscle. The
response is active if the person is cognitive, and reflexive if they
are not cognitive. It is possible to be cognitive and have poor
range or strength, which would result in failure for the muscle to
activate for these small tasks on the Beckman Oral Motor Protocol.
I hope this helps with your testing.
Debra
Debra Beckman, MS, CCC-SLP
Beckman & Associates, Inc.
1211 Palmetto Ave
Winter Park, FL 32789
407-647-4740
FAX 407-647-6415
www.beckmanoralmotor.com