Foundations & Professional Practice
33%of exam
Screening, Assessment & Diagnosis
33%of exam
Treatment Planning & Implementation
33%of exam
Quick Facts
- Exam Code
- 5331
- Credential
- CCC-SLP (ASHA)
- Questions
- 132
- Time
- 150 min
- Passing Score
- 162
- Format
- Selected-response
- Fee
- $146
- Level
- Graduate/entry-level SLP
Cranial Nerves for Swallow
V chews, VII smiles, X swallows most
V: jawVII: face/lipsIX: pharynx/tasteX: palate/larynxXII: tongue
Nodules vs Polyps (Voice)
Vocal Nodules
- Bilateral
- Callus-like
- Phonotrauma overuse
Vocal Polyps
- Usually unilateral
- Fluid-filled
- Single vocal trauma
Bilateral vs unilateral
Typical Development Milestones
- First words
- Emerge around 12 months
- 50-word vocabulary
- Reached near 18 months
- Two-word combinations
- Begin 18 to 24mo
- Early-8 sounds
- m,b,y,n,w,d,p,h early
- Middle-8 sounds
- t,ng,k,g,f,v,ch,j by 5
- Late-8 sounds
- sh,s,z,th,voiced-th,l,r,zh by 7-8
Domain Weight Rule
Three domains, each exactly one-third
Foundations: 33%Assessment: 33%Treatment: 33%
Conductive vs Sensorineural Loss
Conductive Loss
- Outer/middle ear
- Often medically treatable
- Air-bone gap present
Sensorineural Loss
- Inner ear/nerve
- Usually permanent
- No air-bone gap
Mechanical vs nerve
Cranial Nerves for Speech
- CN V (trigeminal)
- Jaw closure, sensation
- CN VII (facial)
- Lips, facial expression
- CN IX (glossopharyngeal)
- Pharynx, posterior tongue taste
- CN X (vagus)
- Palate, pharynx, larynx
- CN XII (hypoglossal)
- Tongue movement, protrusion
- Vagus damage
- Biggest swallow/voice risk
Etiology Categories
- Genetic
- Inherited syndromes, chromosomal
- Developmental
- Delayed skill acquisition
- Disease processes
- Acquired medical conditions
- Auditory
- Hearing loss impact
- Neurological
- CNS/PNS damage
- Structural/functional
- Cleft, velopharyngeal insufficiency
- Psychogenic
- Stress-based, no organic cause
Ethics & Scope of Practice
- ASHA Code of Ethics
- 4 core principles
- Principle I
- Welfare of clients
- Principle II
- Professional competence, credentials
- Principle III
- Honesty to public
- Principle IV
- Respect colleagues, professionals
- Scope of practice
- Defines SLP role boundaries
- Informed consent
- Client understands, agrees
Cultural & Linguistic Practice
- Bilingual difference
- Not automatically a disorder
- Dialect (e.g. AAE)
- Rule-governed, not disordered
- Trained interpreter
- Required, not family member
- Non-biased assessment
- Multiple measures and contexts
- Standardized test bias
- Norms may not fit
Big Nine Areas
9 areas span speech to swallowing
Speech soundFluencyVoice/resonanceLanguagePragmaticsCognitionAACHearingSwallowing
Apraxia vs Dysarthria
Apraxia of Speech
- Planning deficit
- Inconsistent errors
- Groping behaviors
Dysarthria
- Execution deficit
- Consistent errors
- Weak/slow movement
Plan vs execute
Which Clinical Step Next
- New referral arrives→Screen first(Pass/fail decision)
- Screening fails→Full assessment(Comprehensive battery)
- Assessment complete→Write goals(Treatment planning)
- Treatment underway→Monitor progress(Adjust as needed)
- Goals met→Plan dismissal(Generalization check)
Screening & Referral
- Screening goal
- Pass/fail, refer decision
- Not screening
- Diagnosis or severity rating
- Vision/hearing check
- Rule out sensory cause
- Referral sources
- Teachers, physicians, parents
Aphasia Fluency Rule
Anterior nonfluent, posterior fluent aphasia
Broca: anterior, nonfluentWernicke: posterior, fluentGlobal: both, nonfluentConduction: fluent, poor repetition
Aspiration vs Penetration
Aspiration
- Below vocal folds
- Airway violation
- May be silent
Penetration
- Enters larynx only
- Above vocal folds
- Less severe
Below vs above folds
Which Assessment Tool
- Articulation/phonology concern→GFTA-3(Single-word artic)
- School-age language concern→CELF-5(Norm-referenced)
- Infant/preschool language→PLS-5(Birth to 7)
- Voice quality concern→CAPE-V(Perceptual rating)
- Stuttering severity→SSI-4(Frequency + duration)
- Swallow safety concern→MBSS or FEES(Instrumental exam)
Case History & Approach
- Case history
- Prior history, current concerns
- Standardized test
- Norm-referenced, standard scores
- Criterion-referenced test
- Mastery of specific skills
- Dynamic assessment
- Measures learning potential
Broca's vs Wernicke's Aphasia
Broca's
- Nonfluent output
- Comprehension relatively spared
- Poor repetition
Wernicke's
- Fluent but empty
- Poor comprehension
- Poor repetition
Output vs comprehension
Assessment Tools by Area
- GFTA-3
- Articulation/phonology test
- CELF-5
- Language test, school-age
- PLS-5
- Language test, birth-7
- CAPE-V
- Voice quality rating
- SSI-4
- Stuttering severity instrument
- MBSS/VFSS
- Videofluoroscopic swallow study
- FEES
- Endoscopic swallow evaluation
- Pure-tone audiometry
- Hearing threshold screening
Screening vs Assessment
Screening
- Pass/fail decision
- Quick, brief tools
- No diagnosis
Assessment
- In-depth evaluation
- Standardized + informal
- Yields diagnosis
Refer vs diagnose
The Big Nine Practice Areas
- Speech sound production
- Articulation, phonology
- Fluency
- Stuttering, cluttering
- Voice/resonance/motor speech
- Quality, nasality, dysarthria/apraxia
- Language (receptive/expressive)
- Comprehension, production skills
- Pragmatics
- Social communication use
- Cognition
- Attention, memory, executive function
- AAC
- Augmentative/alternative communication
- Hearing
- Auditory function, rehabilitation
- Feeding/swallowing
- Dysphagia across lifespan
Aphasia Type Differential
- Broca's aphasia
- Nonfluent, comprehension ok, repetition poor
- Wernicke's aphasia
- Fluent, comprehension poor, repetition poor
- Global aphasia
- Nonfluent, all poor
- Conduction aphasia
- Fluent, repetition poor only
- Anomic aphasia
- Fluent, word-finding deficit only
Motor Speech Disorders
- Apraxia of speech
- Planning deficit, inconsistent errors
- Dysarthria
- Execution deficit, consistent errors
- Flaccid dysarthria
- LMN damage, hypernasal, breathy
- Spastic dysarthria
- Bilateral UMN, strained-strangled
- Ataxic dysarthria
- Cerebellar, scanning speech
- Hypokinetic dysarthria
- Parkinson's, reduced range
Dysphagia Safety Signs
- Aspiration
- Food/liquid below vocal folds
- Penetration
- Enters larynx, above folds
- Silent aspiration
- No cough, no symptoms
- Wet vocal quality
- Residue on vocal folds
- Thickened liquids
- Slows bolus, reduces risk
Compensatory vs Rehabilitative Strategies
Compensatory
- Immediate safety fix
- Posture, diet change
- No lasting change
Rehabilitative
- Builds swallow strength
- Exercises, maneuvers
- Lasting physiologic change
Now vs long-term
Which Dysphagia Strategy
- Thin liquid aspiration→Thicken liquids(Slows bolus)
- Delayed swallow trigger→Chin tuck(Protects airway)
- Reduced laryngeal closure→Effortful swallow(Rehabilitative)
- Reduced tongue-base retraction→Mendelsohn maneuver(Extends closure)
- Unilateral pharyngeal weakness→Head turn(Toward weak side)
Treatment Planning Essentials
- SMART goals
- Specific, measurable, achievable, relevant, time-bound
- Prognosis factors
- Severity, motivation, support, comorbidities
- Baseline data
- Establishes pre-treatment performance level
- Short-term objectives
- Steps toward long-term goal
- Stimulability
- Sound produced with cues
- Treatment hierarchy
- Isolation to conversation level
Which Treatment Approach
- Multiple phonological errors→Cycles approach(Rotate patterns)
- Few sound contrasts missing→Minimal pairs(Meaning-based contrast)
- Core stuttering behaviors→Stuttering modification(Ease the moment)
- Building overall fluency→Fluency shaping(Rate, breath control)
- Limited functional speech→AAC evaluation(Aided or unaided)
- Parkinson's hypophonia→LSVT LOUD(Increase vocal loudness)
EBP Treatment Approaches
- Minimal pairs
- Contrast therapy, phonology
- Cycles approach
- Phonological patterns, rotating targets
- Stuttering modification
- Reduce struggle, ease moments
- Fluency shaping
- Rebuild fluent speech patterns
- Milieu teaching
- Naturalistic language intervention
- PECS
- Picture exchange communication system
Outcomes & Dismissal
- Generalization
- Skill transfers, new contexts
- Maintenance
- Skill holds without support
- Dismissal criteria
- Goals met, plateau reached
- Progress monitoring
- Ongoing data, adjust plan
Common Traps
Screening vs Diagnosis
Screening refers only ≠ Assessment yields diagnosis
Bilingual vs Disordered
Difference is not disorder ≠ Compare both languages
Aspiration vs Penetration
Aspiration goes below folds ≠ Penetration stays above folds
Apraxia vs Dysarthria
Apraxia plans wrong ≠ Dysarthria executes weak
Compensation vs Rehabilitation
Compensation is immediate fix ≠ Rehab builds strength
Interpreter vs Family Member
Use trained interpreters ≠ Avoid child interpreting
Documentation vs Effort Notes
Skilled notes show data ≠ Effort alone is insufficient
Last Minute
- 1.132 questions, 150 minutes total
- 2.Domains split evenly 33/33/33
- 3.ASHA requires score of 162
- 4.Screen first, then assess fully
- 5.Bilingual difference is not disorder
- 6.Aspiration goes below vocal folds
- 7.Apraxia plans wrong, dysarthria executes weak
- 8.Use trained interpreters, not family
- 9.Vagus nerve drives most swallowing
- 10.Goals need measurable, observable data
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