PROMPT Therapy

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What is PROMPT therapy?

Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) is a tactually grounded sensori-motor and cognitive-linguistic approach and technique for treating motor speech and language disorders in children and adults. It can only be completed by a trained and/or certified therapist due to the specific process that must be followed for evaluation and treatment planning and the intricacies that are required for implementation.

How is PROMPT therapy different from traditional articulation or phonological therapy approaches?

During a traditional speech sound evaluation, sound errors are identified through standardized assessments and conversational speech samples. Therapy targets are then selected based upon developmental norms for the typical emergence and mastery of speech sounds. Patients are instructed how to modify their speech errors with visual support, models, and perhaps some surface level tactile cues for individual targets.

The PROMPT philosophy revolutionizes the methodology for evaluation and treatment planning. PROMPT uses a Systems Analysis Observation (SAO) to systematically evaluate the full motor speech system and a Motor Speech Assessment (MSA) to identify the levels and stages where problems occur. The MSA considers tone (body and facial), breath support, jaw control, control of the lips and cheeks, precision of tongue movements, coordination of the entire speech mechanism, and prosody (timing/fluidity). The three primary areas of need are identified from the MSA. Based upon the areas of need, sounds are selected to address the motor goals, and the motor speech targets are used to generate target syllables and words to correct the disordered motor speech patterns. In therapy, the PROMPT therapist provides active tactile-kinesthetic-proprioceptive input to the patient’s articulators across all sounds in a word and/or phrase to increase the accuracy of speech sequencing. Up to four different types of PROMPTS are completed on the face, jaw, and mylohyoid muscle (running under the chin toward the neck) to provide cues related to the most salient information of a sound. On-line shaping of the motor system can be utilized within the 4 different levels of PROMPT to provide more support and input as needed.

Bridging Speech & Language Needs:

Although PROMPT is often thought of as a treatment technique for motor speech disorders, it truly looks at the whole individual. The evaluation and therapy will address the two greatest areas of need for a patient, to include expressive/receptive language, social-emotional skills, and/or motor speech production. A client’s needs are frequently reassessed (every 4-6 months) to determine if the two areas of greatest need should be revised to support growth in other domains.

PROMPT uses a play-based/functional therapy approach. If a patient has a need in the motor speech area, target words are formulated to match the client’s cognitive age and are integrated into therapy sessions in a functional context, which allows for patients to develop vocabulary and concepts while simultaneously reprogramming the motor speech system. If a client has a need in the area of receptive and/or expressive language, activities will be selected to help advance those skills, and if a patient has needs in the area of social-emotional development, the PROMPT program will include goals to address social skills including turn taking, eye contact, initiating interactions, etc. Some client’s greatest needs may fall in the areas of language and social skills, and in those cases, PROMPTs are used for mapping in concepts to help with storage of conceptual targets.

Who is appropriate for PROMPT therapy?

The only precursor to initiating a PROMPT program is that the individual has the intent to communicate. PROMPT has been used with patients with a wide range of diagnoses including apraxia of speech, Cerebral Palsy, autism spectrum disorders, hearing impairment, repaired cleft lip and palate, aphasia, dysarthria, and motor speech disorders. PROMPT can be used with a wide range of skill sets from patients who are non-verbal and may be using augmentative and alternative communication systems to individuals with mild articulation delays. PROMPT allows for treatment at the single phoneme (sound) level through words, phrases, and sentences.

Therapy Frequency and Duration:

The course of treatment will vary depending on each individual. PROMPT may be needed for as short as a 3 month period or for multiple years. As with any treatment, the more intensive the frequency, the greater the gains, so therapy is recommended at least 1x/week but ideally twice a week if feasible, especially since PROMPT can only be performed by a trained therapist. Home programs will be provided as appropriate, but the actual PROMPTing can only be carried out by a trained professional.

For more information on PROMPT, visit the PROMPT Institute website at http://www.promptinstitute.com or contact Melissa Rightor at NCEENT. Melissa is the only PROMPT certified speech/language pathologist in the Triangle and one of two certified PROMPT providers in North Carolina.