By Stefanaki Evgenia
As a PROMPT© Bridging trained speech and language pathologist I would like to address how Prompt© therapy help children with Apraxia. The PROMPT© therapy is simply a deep understanding of how human motor, cognitive, social and language systems work within a human being and the ability of the clinician to translate that understanding to the client.
Read More: What is Apraxia?
Childhood Apraxia of Speech (CAS)
Apraxia is a term that is frequently used too broadly to describe children with severe speech production difficulties. It is an area that still requires further research and is not fully understood. “In its purest form, DAS is an exclusionary disorder”. “Diagnosis by exclusion implies that a conclusion about the disorder is reached by excluding other known conditions.” To clearly identify CAS one must exclude sensory disorders, cognitive disorders, receptive language disorders, emotional and/or pragmatic language disorders, deviations of muscle tone and imbalance, and global neurological involvement. “Developmental Apraxia of Speech is a disorder of the ability to translate phonemic and linguistic codes to differing planes of movement over time.” The problem is primarily with the organization of movements in time and space. The child has difficulty with the organization of muscle movements specifically for the production of speech. However, muscle tone which affects strength and range of the articulators (i.e. speech muscles) is normal. Sounds may be produced correctly in isolation but as the sequence of sounds grows, the organization of muscle movements becomes more difficult and intelligibility decreases. The problem seems to exist between the transition of movements. The more complex the transitions, the more difficulty the child is likely to have. Frequently, children who are diagnosed with CAS may have both a mild motor control and a sequencing problem.
What is the PROMPT Technique?
The PROMPT© System stands for “Prompts for Restructuring Oral Muscular Phonetic Targets”. It is a dynamic tactile method of treatment for motor speech disorders which is based on touch pressure, kinesthetic and proprioceptive cues. It helps to reshape individual and connected articulatory phonemes and sequences (coarticulation). The clinician helps to manually guide articulators to produce specific sounds or words that seem to be problematic. This is a hands-on approach and thus the clinician uses his/her hands to cue and stimulate articulatory movement, at the same time helping the child to limit unnecessary movements. “The PROMPT© System imposes control on the articulators by providing tactile and kinesthetic (closed-loop) feedback, while guiding the structures toward sequential feed-forward (open-loop) programming.” Generally, this reduces inappropriate feedback and shows the correct sequence of movements to achieve “normal” articulation.
However, it would be most accurate to describe PROMPT© as a philosophy of treatment that strives to (re)connect and integrate the motor, cognitive-linguistic and social-emotional aspects of communication.PROMPT© may be described as a system of treatment that helps clients gain voluntary control of motor-speech systems and links the necessary motor movements to linguistic (word, phrase) equivalents for use in functional communication.
The PROMPT© is a philosophy, a system, an approach and a technique. What most clinicians, teachers and parents see is the technique of prompting, the application of the tactile-kinesthetic cues. However, the entire philosophy and approach that PROMPT© embodies is what guides the selection of those cues and gives the therapist a way to both evaluate and decide on what goals are appropriate. The clinician must always choose goals that will help the client achieve functional language and intelligible speech so that social, emotional and academic interactions with the world are possible. PROMPT© has evolved over time. It began as a way to help children and adults use tactile-kinesthetic information to help guide their articulators and produce more appropriate and intelligible speech; now it is much more and involves not only speech but a bridge to language and interaction.
How PROMPT© System help to treat children who are apraxic?
Childhood Apraxia of Speech (CAS) is a neurological disorder characterized by the inability to carry out skilled or planned movements and gestures, specifically those movements having to do with speech production. Though doctors are uncertain what causes this disorder, they do know that while your child may have the intention to communicate, the desired message gets disrupted on its way to articulation.
Using the PROMPT© the clinician will assess all areas of speech support, evaluate the child’s use of individual articulators and the ability of the child to integrate the movement of these articulators for smooth control and transition. The clinician will also take into consideration the age of the child, the cognitive level of the child, the communication style of the child and the general behavior of the child. Once all of these areas have been assessed the clinician will decide where to place the primary focus of the intervention. The child with developmental apraxia will need help in organizing and sequencing the movements but should not need help to control the various muscle groups through the movements. With this type of problem, the clinician using prompts will need to do much less controlling and should be able to focus on whole words or phrases.
What should parents do at home?
Parents are as critical to the success of PROMPT© treatment as is the clinician-child relationship or the technique of PROMPTing itself. Parents are not encouraged to prompt their child and most do not feel comfortable doing so. They realize that the clinician has had years of experience and also realize that PROMPTing incorrectly may cause their child more frustration. However, they do want to help and be part of the therapy process. This is encouraged and reinforced by supporting the nature of communication between a parent and child. Parenting and loving a child, sharing experiences and talking about daily events, is what good communication is about. Clinicians trained in PROMPT© encourage parents to ask about what the child did in the session, show them the crafts they made, the words they worked on, read the stories that were used to elicit sounds or words, play games that include well rehearsed words or phrases and finally, use the words or phrases the child has learned in other fun and natural environments. Good communication between the parent/caregiver and the clinician is also essential and should be part of every session. Parents are encouraged to observe sessions as often as possible. When parents/caregivers observe in this way it provides a basis for discussion of the child’s successes, difficulties and activities that promote the best speech and language opportunities.
Effectiveness of PROMPT
When clients are treated by a skilled PROMPT© therapist, the changes will reflect the maximum potential possible for that client. With each person, depending on their motor system’s potential, environment, etc., they will gain more functional use of their speech. Some clients have gone from almost no speech to almost normal communication ability; others have only been able to achieve simple words or phrases. Each client has felt proud of their accomplishments and has been enabled in their broader communication environments. Their sense of self has always increased as has their awareness of “what is possible” versus ” what may not be possible”. The PROMPT© is simply a deep understanding of how human motor, cognitive, social and language systems work within a human being and the ability of the clinician to translate that understanding to the client.
Evgenia Stefanaki, SLP, OM, has the private practice "All for Speech Center" and is a nationally certified and licensed Speech & Language Pathologist. She is also PROMPT© Bridging trained and holds specialization in orofacial myofunctional therapy. She writes on the blog about speech & language disorders and orofacial disorders.
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