PROMPT Therapy

I recently gave a presentation on a therapy of my choice to my cohorts. I chose PROMPT therapy which I had the opportunity to see at my current internship, as my supervisor has been properly trained.

What is PROMPT Therapy you may ask?

PROMPT: Prompts for Restructuring Oral Muscular Phonetic Targets was developed by Deborah Hayden. She began manipulating the oro-motor structures to help adults and children with varying speech disorders to produce sounds that could be shaped for verbal interaction with others. Hayden, along with multiple neuromotor theorists was interested in how normal systems developed from birth. She explored how the dynamic interaction and equilibrium among all motor systems directly affected speech-motor systems. PROMPT was first published in 1984. PROMPT therapy is a physical-sensory approach that integrates all domains and systems toward positive communication outcome. Children or adults with various disabilities such as: developmental delays, phonological impairments, dysarthria, apraxia of speech, speech disorders,Broca’s aphasia, Autistic Spectrum Disorders (ASD), hearing impairment, dysfluencies, and accent reduction can benefit from PROMPT therapy. PROMPT may be used on all speech production disorders from approximately 6 months of age and onward. Intensity and focus will vary depending on the client’s age and severity. It should not be used mainly to produce individual sounds/phonemes, to facilitate oral-motor skills, or as an articulation program, but instead as a program to develop motor skills in development of language for interaction. It has an emphasis on vowels, consonants and diphthongs through tactile cueing.

PROMPT may be used to assist the progress of production, revise or change the production, or to integrate motor production with cognitive-linguistic function. Clinicians will receive a more organized way to assess all domains for the most effective and functional treatment program.

Speech-Language Pathologists (SLP) needs to be fully trained in order to provide PROMPT therapy. PROMPT training consists of four steps and the SLP must complete each step in order to fully comprehend the therapy and apply it appropriately to clients. The four steps are as followed: 1. Introduction to PROMPT: Technique, 2. Bridging PROMPT Technique to Intervention, 3. The PROMPT Technique Self Study Project, 4.PROMPT Certification: A Self Study Project. Training is primarily a “hands on” approach.

Step 1 consists of a 3-day workshop that concentrates on teaching the technique of PROMPT. It is a hands-on training workshop emphasizing the need to integrate into a holistic therapy approach. It should be noted the SLPs do not have long fingernails when training or applying therapy. Step 2 focuses on setting goals and objectives that are appropriate for the client within the PROMPT framework. SLP’s are trained to enable therapy to be incorporated across a range of setting including the home, while maintaining a focus on the key needs. Step 3 supports the SLP’s learning of PROMPT and provides direct suggestions about assessing; selecting targets and executing a PROMPT treatment plan with a particular client. This project can be completed any time up to certification. In step 4, the SLP is asked to provide a detailed assessment of the client’s abilities across all domains and develop a holistic therapy plan. It needs to include the selection of priorities on the Motor Speech Hierarchy to develop motor-phonemes and words for use within functional, interactive contexts. The SLP is also expected tocreate parent/caregiver goals and strategies.

The basic principles of PROMPT focus on head/hand positions, mandibular positions and finger placement positions. Prompts for finger placement positions will either be on the mylohyoid(all should be placed mid-line along the mylohyoid), or facial prompts which should be placed equal distant, and symmetrical from the midline. Only finger pads should be used with facial prompts. Pressure is always lighter on the face where skin connects directly to muscle, than on mylohyoid where several layers of muscle lay between the skin and tongue.

There are many advantages to use PROMPT therapy. PROMPT therapy is appropriate for a wide variety of individuals with speech disorders such as autism, apraxia, aphasia, phonological disorders, childhood motor speech disorders, childhood apraxia of speech (CAS), and so forth. PROMPT therapy isindividualized and considerate for each client. The clinician does not need additional materials for the PROMPT, just herself and adequate training. PROMPT is different from traditional treatment approaches in that it does not rely predominantly on auditory and visual input. It is a multidimensional approach and relies on the motor performance. PROMPT also contains a System Analysis Observation checklist which is used as an assessment tool for the neuromotor speech system and turned into a hierarchy for therapy. The checklist helps the SLP tosystematically evaluate a child’s motor speech system as well as helps the SLP identify the level or stage where problems occur.There are numerous ongoing efficacy studies in terms of research for PROMPT therapy. There is a high degree of satisfaction from the clients who have used PROMPT. Clients learn to self-monitor and self-correct for generalization. Co-articulation is always considered, and PROMPT can be used with clients with cognitive impairments.

A disadvantage for PROMPT is that it requires trained professionals to implement the interventions in order for them to be effective. PROMPT requires the SLP to touch the client’s face, neck, lips, head and sometimes shoulders. If the SLP is not comfortable, the client will not be comfortable and there will be no trust. PROMPT is a motor skill, and the clinician requires extensive practice and training.

To become certified, workshops for PROMPT therapy can be purchased and scheduled online at www.promptinstitute.com,and varies in price from $650 to $700 depending on your location.

References

Hayden, D.A. (1994).Differential diagnosis of motor speech dysfunction in children.

Developmental apraxia of speech: Assessment. Clinics in Communication Disorders, 4(2), 118–147, 162–174.

Hayden, D.A. (2004).PROMPT: A tactually grounded treatment approach to speech production

disorders. In I. Stockman (Ed.), Movement and action in learning and development: Clinical implications forpervasive developmental disorders (pp. 255–297). San Diego, CA: Elsevier–Academic Press.

Hayden, D. A. (2006).The PROMPT model: Use and application for children with mixed

phonological-motor impairment. Advances in Speech-Language Pathology, 8(3), 265–281.

Hayden, D., Eigen, J., Walker, A., Olsen, L. (2010).PROMPT:A tactually grounded model. In

Williams, L, McLeod, S. & McCauley, R.(Eds.)Interventions for Speech Sound Disorders in Children. Baltimore,

Maryland; Brookes Publishing. Square-Storer, P., & Hayden, D. A. (1989). PROMPT treatment.

One thought on “PROMPT Therapy

  1. Congratulations on finishing your masters! I happily stumbled across your blog. I will complete my CF within the next few months, and then will begin my PROMPT certification! I completed both Intro and Bridging during my CF year, and wanted to encourage you to do the same. I feel that being so young I was able to make the shift with ease, and I am NEVER looking back. I love it. I wanted to provide new PROMPTers with resources. Please come visit if you decide to take your own PROMPT journey: http://ipaiduplay.blogspot.com/.

    Best of luck to you!

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