MMBGR protocol – diagnostic accuracy of clinical examination in infants

Matos, Anna Luiza dos Santos; Berretin-Felix, Giédre; Barreto, Íkaro Daniel de Carvalho; Gurgel, Ricardo Queiroz; Medeiros, Andréa Monteiro Correia

doi:10.1590/2317-1782/e20240315pt

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Original Article • CoDAS 37 (6) • 2025 • https://doi.org/10.1590/2317-1782/e20240315en linkcopy

MMBGR protocol – diagnostic accuracy of clinical examination in infants

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose To present the diagnostic accuracy of the clinical examination with scores, the Orofacial Myofunctional Evaluation Protocol MMBGR for Infants and Preschoolers, for the age group of six to 23 months.

Methods Diagnostic accuracy validation using a convenience sample. Images from 76 participants were analyzed by groups of three speech-language pathologists, who individually and separately assessed the images, with agreement between two of them considered valid. An electronic form was used to assess the domains of the orofacial myofunctional evaluation, Orofacial Myofunctional Disorder (OMD), and the need for referrals. The responses of speech-language pathologists who provided opinions based on clinical experience, without using the protocol (gold standard), were compared with those provided by speech-language pathologists who used the protocol (index test). The Receiver Operating Characteristic Curve (ROC) method was employed, and cut-off points were assigned using the R Core Team (2022) software, yielding sensitivity and specificity values.

Results For infants aged six to 11 months, diagnostic accuracy was not ideal for orofacial structures, orofacial functions, and Orofacial Myofunctional Disorder (OMD), but reasonable for tone (70%). For infants aged 12 to 23 months, accuracy was reasonable for most domains— orofacial structures, orofacial functions, tone—and ideal for OMD (88.9%). The OMD cut-off point is 9 (for ages 6 to 11 months) and 14 (for ages 12 to 23 months). Accuracy was reasonable for multidisciplinary referrals but not ideal for speech-language pathology referrals.

Conclusion The Orofacial Myofunctional Evaluation Protocol MMBGR for Infants and Preschoolers, when analyzed through photos and videos, is accurate for assessing infants aged six to 11 months only in terms of tone; and for infants aged 12 to 23 months, it is accurate across all exam domains, being ideal for diagnosing OMD. The instrument is reasonable for determining the need for multidisciplinary referrals in infants.

Keywords:
Speech, Language and Hearing Sciences; Infant; Clinical Diagnosis; Validation Study; Sensitivity and Specificity; Myofunctional Therapy; Stomatognathic System

Age Group	Items Evaluated
06-11 months	✔ Orofacial Structures (intraoral and extraoral)
	✔ Tonus
	⮚ Breathing
	⮚ Sucking/Swallowing (bottle or breast)
	⮚ Swallowing of semi-solid food (porridge, purée, or mashed food)
12-23 months	✔ Orofacial Structures (intraoral and extraoral)
	✔ Tone
	⮚ Breathing
	⮚ Sucking (bottle or breast)
	⮚ Chewing: solid/semi-solid
	⮚ Swallowing: semi-solid (porridge, purée, mashed food); solid or semi-solid (food cut into very small, soft pieces or shredded); and liquid

Age Group	% (n)
31 to 40 years	37.5 (3)
41 to 50 years	50.0 (4)
51 to 60 years	12.5 (1)
Region of professional practice
North	12.5 (1)
Northeast	37.5 (3)
Middle-West	25.0 (2)
Southeast	25.0 (2)
Degree
Postdoctoral	12.5 (1)
Doctorate	25.0 (2)
Master	37.5 (3)
Specialist	25.0 (2)
Teaching (time in practice)
Less than 5 years	25 (2)
Between 5 and 10 years	37.5 (3)
Between 11 and 15 years	12.5 (1)
Between 21 and 25 years	12.5 (1)
Not Teaching	12.5 (1)
Years of experience in Speech-Language Pathology in orofacial motricity
Between 05 and 10 years	37.5 (3)
Between 16 and 20 years	25.0 (2)
Between 21 and 25 years	25.0 (2)
More than 25 years	12.5 (1)
Years of practice in Orofacial Motricity with infants
Less than 5 years	12.5 (1)
Between 5 and 10 years	25.0 (2)
Between 11 and 15 years	12.5 (1)
Between 16 and 20 years	25.0 (2)
Between 21 and 25 years	12.5 (1)
More than 25 years	12.5 (1)

Domain	Age Group (months)	AUC (95% IC)	Cutoff	Maximum Score	SE	SP	ACC	TP	FN	FP	TN	PPV	NPV
Orofacial Structures	6-11	0.609 (0.396-0.822)	7	62	83.3	28.6	45.0	10	2	20	8	33.3	80
Orofacial Structures	12-23	0.587 (0.360-0.815)	8	62	78.6	37.5	69.4	22	6	5	3	81.5	33.3
Tone	6-11	0.634 (0.454-0.815)	1	6	66.7	71.0	70	6	3	9	22	40	88
Tone	12-23	0.672 (0.467-0.877)	1	6	71.4	50	66.7	20	8	4	4	83.3	33.3
Orofacial Functions	6-11	0.645 (0.369-0.920)	5	46	83.3	35.3	42.5	5	1	22	12	18.5	92.3
Orofacial Functions	12-23	0.586 (0.368-0.805)	5	92	96.3	0	72.2	26	1	9	0	74.3	0.0
Orofacial Motricity (OM disorders)	6-11	0.496 (0.298-0.694)	9	114	81.2	8.3	37.5	13	3	22	2	37.0	40.0
Orofacial Motricity (OM disorders)	12-23	0.602 (0.317-0.886)	14	160	96.9	25	88.9	31	1	3	1	91.2	50.0

Age (months)	6-11	12-23
EXTRAORAL EXAM (best result = 0 and worst = 20)
Face (best result = 0 and worst = 10)	[ ]	[ ]
Lips (best result = 0 and worst = 9)	[ ]	[ ]
Mandible (best result = 0 and worst = 1)	[ ]	[ ]
INTRAORAL EXAM (best result = 0 and worst = 42/56)
Lips (best result = 0 and worst = 5)	[ ]	[ ]
Cheeks (best result = 0 and worst = 6/8)	[ ]	[ ]
Tongue (best result = 0 and worst = 13/16)	[ ]	[ ]
Palate (best result = 0 and worst = 10)	[ ]	[ ]
Palatine tonsils (best result = 0 and worst = 4)	[ ]	[ ]
Teeth and occlusion (best result = 0 and worst = 4/13)	[ ]	[ ]
RESULT OF EXTRAORAL + INTRAORAL EXAMINATION	[ ]	[ ]
CUTOFF POINT: EXTRAORAL + INTRAORAL EXAMINATION	7	8
TONE (best result = 0 and worst = 6)
Lips (upper+lower) (best result = 0 and worst = 2)	[ ]	[ ]
Mental (best result = 0 and worst = 1)	[ ]	[ ]
Tongue (best result = 0 and worst = 1)	[ ]	[ ]
Cheeks (right+left) (best result = 0 and worst = 2)	[ ]	[ ]
RESULT OF TONE	[ ]	[ ]
CUTOFF POINT: TONE	1	1
OROFACIAL FUNCTIONS (best result = 0 and worst = 46/92/53/68)
Breathing (best result = 0 and worst = 2)	[ ]	[ ]
Suction/Swallowing (best result = 0 and worst = 22)	[ ]	[ ]
Chewing (best result = 0 and worst = 13)	___	[ ]
Swallowing semi-solid/solid (best result = 0 and worst = 17)	___	[ ]
Swallowing pasty (best result = 0 and worst = 22)	[ ]	[ ]
Swallowing liquid (best result = 0 and worst = 15)	___	[ ]
RESULTS OF OROFACIAL FUNCTIONS	[ ]	[ ]
CUTOFF POINT: OROFACIAL FUNCTIONS	5	5
TOTAL SCORE (Orofacial Myofunctional Clinical Examination)	[ ]	[ ]
CUTOFF POINT: Orofacial Myofunctional Disorder (OMD)	9	14

Domain	Age Group (months)	SE	SP	ACC	TP	FN	FP	TN	PPV	NPV
Referral to Speech-Language Pathology	6-11	13.3	84.0	57.5	2	13	4	21	33.3	61.8
Referral to Speech-Language Pathology	12-23	18.2	100	50.0	4	18	0	14	100	43.7
Other multidisciplinary referrals	6-11	44.4	87.1	77.5	4	5	4	27	50	84.4
Other multidisciplinary referrals	12-23	50	78.6	61.1	11	11	3	11	78.6	50

Domain	%Accuracy/Concept 06 to 11 months	%Accuracy/Concept 12 to 23 months
Orofacial Structures	45.0 - Not ideal	69.4 - Reasonable
Tone	70.0 – Reasonable	66.7 - Reasonable
Orofacial Functions	42.5 - Not ideal	72.2 - Reasonable
Orofacial Motricity (OMD)	37.5 - Not ideal	88.9 – Ideal
Referral to Speech-Language Pathology	57.5 - Not ideal	50.0 - Not ideal
Other Referrals (Multidisciplinary)	77.5 – Reasonable	61.1 - Reasonable

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[1] Caption: % = Percent; n = Nº of observations