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Praxis Speech Communication study materials
Praxis Speech Communication study resources

Praxis Speech Communication: Voice, Fluency, and Swallowing Disorders

Praxis Speech Communication · Work through your exam, one topic at a time.

All guide sections

Voice, Fluency, and Swallowing Disorders

Voice, Fluency, and Swallowing Disorders tests evaluation and management of dysphonia, stuttering/cluttering, and dysphagia. Questions often ask you to distinguish structural, neurologic, functional, and developmental patterns.

Core rules

  • Voice evaluation includes case history, perceptual ratings (CAPE-V: overall severity, roughness, breathiness, strain, pitch, loudness), laryngeal imaging (videostroboscopy), and acoustic/aerodynamic measures.
  • Vocal fold nodules are typically bilateral at the point of maximum vibration and related to phonotrauma; polyps are often unilateral. Spasmodic dysphonia is neurologic: adductor type causes strained-strangled breaks; abductor type causes breathy breaks. Botulinum toxin is a common treatment.
  • Stuttering core behaviors are repetitions, prolongations, and blocks; secondary behaviors include avoidance and physical tension. Normal developmental disfluency often lacks tension and negative reaction.
  • Fluency treatment includes fluency shaping (easy onset, light articulatory contacts, prolonged speech) and stuttering modification (preparatory sets, pull-outs, cancellations).
  • Dysphagia assessment may use MBSS or FEES; signs include coughing, wet voice, pocketing, weight loss, and aspiration. IDDSI liquid levels are 0-4 and food levels are 3-7.

Worked example

A 7-year-old has part-word repetitions, eye blinks, and avoids ordering in restaurants. This is stuttering, not normal disfluency, because core behaviors plus secondary behaviors and avoidance are present. Treatment should address both fluency and negative affect; a pure "speak slower" instruction would miss the avoidance.

Traps

  • Calling all childhood repetitions stuttering; many preschool disfluencies resolve.
  • Diagnosing nodules without laryngeal imaging.
  • Thickening liquids before instrumental assessment when aspiration risk is unclear.
  • Confusing adductor spasmodic dysphonia with muscle tension dysphonia; the latter often improves with voice therapy and lacks neurologic breaks.