PROMPT: A Different Approach to Treating Speech Disorders

There are many different approaches that Speech Pathologists use to treat speech delays and disorders in children. For example there are phonetic approaches (articulation therapy) that target the ability to accurately make speech sounds, phonemic approaches (phonological therapy) that target the organisation of speech sounds, phonotactic approaches that target word and syllable shapes, core vocabulary therapy which improves the consistency of sounds in everyday words, and orofacial myology therapy which targets underlying structural causes (see article).

These are just a few examples among a wide variety, and it is important to remember that not all approaches suit every child – depending on the nature of a child’s speech difficulties and the impact of cognitive, physical, social and emotional factors, a Speech Pathologist may use one or more different techniques to best suit a child’s needs at a particular point in time.

However, many speech difficulties are not as straightforward as some may think and therefore traditional therapy approaches may not be suitable. This is particularly the case when children have difficulties with motor speech programming, causing impaired movements of the muscles used for speech production – such as in cases of Dysarthria and Childhood Apraxia of Speech. Traditional therapy approaches typically follow a top-down, linear model that place high cognitive demands on the child and rarely consider bottom-up influences such as sensory aspects of motor control which play a crucial part in motor programming.

What is PROMPT?

PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is a therapy approach that uses a bottom-up model in speech therapy for children and adults. It addresses difficulties in motor programming by focusing on the sensory aspects of motor speech control. The Speech Pathologist uses touch cues on a client’s face to support correct movement of structures used to produce speech sounds (jaw, lips, tongue), as well as guiding them into appropriate transitions for syllables, words and phrases.

PROMPT not only aids in developing control of the motor speech system (rather than producing inaccurate or unnecessary movements for speech) but also provides valuable kinesthetic feedback (information about the position and movement of muscles). With repetition, kinesthetic feedback helps the brain to remember correct target positions and recall the motor programs for future speech productions.

Unlike some therapy approaches, PROMPT considers all internal factors that have an impact on a client’s communication, across three domains:

• Physical-Sensory Domain – This includes includes factors that impact the client’s ability to physically produce speech. For example, skeletal structure, muscular development, muscle tone, neurological damage and sensory difficulties such as hearing or vision impairment.
• Cognitive-Linguistic Domain – This includes factors that impact how the client processes information and interacts with the environment in order to learn. For example, perception of visual information, auditory discrimination, language skills and attention difficulties.
• Social-Emotional Domain – This includes factors that impact the client’s ability to express their needs and wants and engage in social interaction. For example, emotional states and behaviours, trusting clinician/client relationships and the client’s intent to communicate.

Through evaluating all three domains, Speech Pathologists approach speech difficulties holistically. As such, PROMPT not only focuses directly on improving a client’s motor speech control but also provides opportunities to develop their intent to communicate, engage in verbal turn-taking, improve attention, and improve functional communication in daily routines.

While PROMPT is most commonly used with children who have motor speech disorders, articulation difficulties or who are non-verbal, it is also used in speech therapy for adults with aphasia, dysarthria, apraxia, acquired brain injuries, cerebral palsy, and more.

For more information on how PROMPT works, please visit the PROMPT website.

Peninsula Speech Plus has several PROMPT trained clinicians.