Voice

CAPE-V: What It Measures

Consensus Auditory-Perceptual Evaluation of Voice

Quick answer

The CAPE-V measures the auditory-perceptual quality of a voice. A clinician listens to sustained vowels, standard sentences, and conversational speech, then rates overall severity, roughness, breathiness, strain, pitch, and loudness on 100 mm visual analog scales, producing a standardized description of dysphonia that can be compared across clinicians and over time.

Voice quality is inherently perceptual, and the CAPE-V is the profession's attempt to make that perception reliable. It standardizes the tasks, the attributes, and the rating scale so that 'moderately breathy' means something similar in two different clinics.

CAPE-V at a glance

Full name: Consensus Auditory-Perceptual Evaluation of Voice
Publisher: ASHA (Division 3 consensus protocol)
Domain: Voice
Age range: Adolescents and adults (adaptable to children)
Administration time: About 10–15 minutes
Format: Auditory-perceptual rating protocol using 100 mm visual analog scales
Score types: Visual analog scale ratings (0–100 mm) per attribute, Consistency ratings (consistent vs. intermittent)

What the CAPE-V measures

Overall severity of dysphonia
Roughness — perceived irregularity in the voicing source
Breathiness — audible air escape during phonation
Strain — perceived effort or hyperfunction
Pitch — deviation from expected pitch for age and sex
Loudness — deviation from expected loudness

Subtests and sections

Sustained vowels: /a/ and /i/ held 3–5 seconds each, repeated three times, to hear the source signal without articulation.
Six standard sentences: Phonetically loaded sentences targeting all voiced content, hard glottal attacks, nasals, and voiceless consonants.
Running speech: At least 20 seconds of conversational speech about a neutral topic.
Visual analog rating: Each attribute marked on a 100 mm line and reported as a number out of 100 with a consistency notation.

CAPE-V vs. GRBAS

GRBAS rates grade, roughness, breathiness, asthenia, and strain on a four-point ordinal scale (0–3). It is quick and internationally used, but the coarse scale limits sensitivity to small changes. The CAPE-V uses continuous 100 mm visual analog scales, adds pitch and loudness, and specifies the elicitation tasks, which makes it more sensitive for outcome measurement.

If a question asks which tool best documents subtle improvement after six weeks of voice therapy, the continuous scale is the better answer.

Building a complete voice evaluation

A defensible voice evaluation layers four kinds of data: perceptual (CAPE-V), acoustic (fundamental frequency, cepstral peak prominence, perturbation measures), aerodynamic (maximum phonation time, s/z ratio, airflow), and patient-reported outcome (Voice Handicap Index or V-RQOL). Laryngeal imaging from ENT sits underneath all of it as the diagnostic foundation.

No single layer is sufficient. Exam items often present a plan missing one layer and ask what the SLP should add.

Strengths

Standardized tasks and scales improve inter-rater reliability over free description.
Free to use and widely adopted, so results transfer across settings.
Sensitive enough to document change from voice therapy or surgery.
Captures dimensions that acoustic and aerodynamic measures alone do not.

Limitations

Perceptual judgment still varies with rater training and experience.
Not a diagnosis — it describes quality but says nothing about laryngeal pathology.
Must be paired with laryngeal imaging before initiating voice therapy for an undiagnosed dysphonia.
No normative cut scores; interpretation is descriptive and comparative.

When clinicians use it

Baseline and outcome documentation across a voice therapy episode.
Communicating voice quality precisely to otolaryngology colleagues.
Complementing acoustic (jitter, shimmer, CPPS) and aerodynamic (MPT, subglottal pressure) measures.
Training students in reliable perceptual judgment.

What the Praxis 5331 asks about the CAPE-V

Know that laryngeal examination by an ENT is required before voice therapy for an undiagnosed voice disorder — a very common keyed answer.
Match attributes to pathophysiology: breathiness with glottal incompetence, strain with hyperfunction, roughness with irregular vibration.
Distinguish perceptual (CAPE-V, GRBAS), acoustic, aerodynamic, and imaging measures.

Practice assessment questions with rationales

Praxis Path pairs this reference material with scenario questions, spaced-repetition flashcards, and a timed 132-question mock exam.

See what's included Try a free practice test

FAQ

What does the CAPE-V measure?

Auditory-perceptual voice quality across six attributes: overall severity, roughness, breathiness, strain, pitch, and loudness, rated on 100 mm visual analog scales.

What tasks are used in the CAPE-V?

Sustained vowels /a/ and /i/, six standardized sentences, and at least 20 seconds of running conversational speech.

What is the difference between CAPE-V and GRBAS?

GRBAS uses a four-point ordinal scale with five attributes; the CAPE-V uses continuous visual analog scales, adds pitch and loudness, and standardizes the elicitation tasks.

Can an SLP start voice therapy based on a CAPE-V alone?

No. A laryngeal examination by an otolaryngologist is required to rule out pathology before initiating voice therapy for an undiagnosed dysphonia.