Praxis Speech Communication cheat sheet

ASHA certification requires a graduate degree, supervised clinical practicum (minimum 400 clock hours), passing the Praxis exam, and completion of the Clinical Fellowship (CF).

The ASHA Code of Ethics has four principles: responsibility to persons served, responsibility for professional competence, responsibility to the public, and responsibility for professional relationships.

Scope of practice for SLPs includes screening, assessment, diagnosis, treatment, prevention, counseling, and collaboration; audiologists' scope covers prevention, identification, assessment, and rehabilitation of hearing and balance disorders.

Informed consent requires disclosure of nature of services, risks, benefits, alternatives, and the right to refuse; it must be documented before treatment begins.

Confidentiality is governed by FERPA in schools and HIPAA in health care settings; disclosure without consent is permitted only for imminent harm, abuse reporting, or legal mandate.

Evidence-based practice integrates three components: best available research evidence, clinical expertise, and client values and preferences.

Supervision ratios and requirements: the CF requires 36 weeks of full-time equivalent experience with at least 30% direct supervision and 6 hours of on-site observation.

Reimbursement concepts: CPT codes describe procedures, ICD-10 codes describe diagnoses; medical necessity documentation must link assessment findings to treatment goals.

Normal hearing thresholds are 0-25 dB HL in adults (0-15 dB HL in children); mild 26-40, moderate 41-55, moderately severe 56-70, severe 71-90, profound >90 dB HL.

Conductive hearing loss shows air-bone gaps with normal bone conduction; sensorineural loss shows no air-bone gap; mixed loss shows both elevated bone thresholds and an air-bone gap.

Pure-tone average (PTA) is typically the average of thresholds at 500, 1000, and 2000 Hz; used to classify degree of loss and predict speech recognition.

Tympanometry types: Type A normal peak, Type B flat (effusion or perforation), Type C negative pressure (Eustachian tube dysfunction); Type As shallow, Type Ad deep.

Otoacoustic emissions (OAEs) reflect outer hair cell function and are absent with loss greater than about 25-30 dB HL; ABR estimates hearing in infants and difficult-to-test populations.

Speech recognition testing should be performed at a comfortable level (typically 40 dB SL re: SRT); rollover (decline at high presentation levels) suggests retrocochlear pathology.

Hearing aid fitting uses prescriptive targets (e.g., NAL-NL2, DSL) verified by real-ear measurement; real-ear-to-coupler difference (RECD) is essential for pediatric fittings.

Cochlear implant candidacy in adults generally requires moderate-to-profound bilateral sensorineural loss and limited benefit from amplification; children require a trial with hearing aids first.

Speech sound acquisition milestones: /p, b, m, h, w/ by age 3; /k, g, f, t, d, n/ by age 4; /s, z, l, r, v/ by age 6-8; blends and /th/ later.

Language milestones: first words around 12 months, 50-word vocabulary and two-word combinations by 18-24 months, 200+ words and simple sentences by age 2-3.

Brown's morphemes are acquired in a predictable order: present progressive -ing, plural -s, irregular past, possessive -s, articles, regular past -ed, third-person -s, auxiliary verbs.

A language disorder may be receptive, expressive, or mixed; a language difference (e.g., dialect, bilingualism) is not a disorder and requires assessment in both languages.

Phonological processes that persist past age 3-4 (e.g., final consonant deletion, cluster reduction, fronting) are candidates for intervention; processes like reduplication and velar fronting are typically suppressed earlier.

Childhood apraxia of speech shows inconsistent errors, disrupted transitions, and prosodic impairment; treatment emphasizes motor planning and intensive practice, not just articulation drills.

Autism spectrum disorder assessment includes social communication, restricted/repetitive behavior, and early screening (e.g., M-CHAT); SLPs address pragmatic language and social skills.

Specific language impairment (developmental language disorder) is diagnosed when language deficits are not explained by hearing loss, intellectual disability, or other conditions and persist into school age.

Voice assessment includes perceptual evaluation (GRBAS), acoustic measures (jitter, shimmer, harmonics-to-noise ratio), and aerodynamic measures (maximum phonation time, s/z ratio).

Normal maximum phonation time is approximately 15-25 seconds in adults; an s/z ratio greater than 1.4 suggests glottal incompetence or vocal fold pathology.

Vocal fold nodules are bilateral, typically at the anterior-middle third junction, associated with phonotrauma; treatment is behavioral voice therapy first, surgery only if therapy fails.

Spasmodic dysphonia: adductor type causes strained-strangled voice breaks on voiced sounds; abductor type causes breathy breaks on voiceless sounds; treated with botulinum toxin injections.

Fluency disorders: stuttering is characterized by repetitions, prolongations, and blocks; secondary behaviors include escape and avoidance; onset typically 2-5 years.

Stuttering risk factors include family history, male sex, late onset, and persistence beyond 6 months; the Lidcombe Program uses operant conditioning with parent-delivered feedback.

Dysphagia assessment includes clinical/bedside swallow evaluation and instrumental exams (VFSS and FEES); VFSS visualizes all phases with barium, FEES directly views the pharynx and larynx.

Penetration is material entering the laryngeal vestibule without passing the vocal folds; aspiration is material passing below the vocal folds; both are rated on the Penetration-Aspiration Scale (1-8).

Dysphagia diets follow the IDDSI framework with levels for foods and liquids; thickened liquids slow bolus flow but do not eliminate aspiration risk.