What is PROMPT Therapy
Deborah Hayden first began to develop PROMPT (PROMPTs for Restructuring Oral Muscular Phonetic Targets) in the late 1970's. Since then, PROMPT has continued to evolve. In the 1970's , the systematic manipulation of tactual-kinesthetic-proprioceptive input to oro-motor structures for changing speech targets was begun with children who presented with severe motor impairment. These children did not respond to traditional treatment approaches that rely predominantly on auditory and visual input. The development of PROMPT treatment for them was grounded in theoretical and clinical perspectives that cross several disciplines concerned with physical, mental and social development. Its focused use of tactile-kinesthetic input was influenced by the early work of scholars and practitioners who explored the tactile system in the neurological organization of normal and diseased brains and embraced its use in the clinical treatment of motor disorders including speech articulation. As PROMPT evolved over time, it was influenced more broadly by scholarly work that included the neurobiological, the cognitive-linguistic and the social aspects.
Taken together, these multiple theoretical perspectives stimulated questions about:
- how motor systems typically develop;
- how dynamic interaction and equilibrium among whole body systems affect speech, language, and social interaction; and
- how damage to the neuromotor pathways can unbalance the motor speech system and affect physical, mental and social functioning either directly or indirectly. Answers to these questions have led to much broader conceptualization of the speech production process than is described typically in the literature.
PROMPT's multidimensional approach to speech production disorders has come to embrace not only the well known physical-sensory aspects of motor performance, but also its cognitive-linguistic and social-emotional aspects.
During the 1980's, the first empirical studies of PROMPT's treatment efficacy were done. These studies led to the development of the first manual describing the technique of PROMPTing. In 1984, the first publication describing PROMPT appeared (Chumpelik (Hayden), 1984). It described the technique and use of "surface" tactile PROMPTs. They provide input about place of articulation, the amount and type of muscular contraction, movement transition and timing needed to produce speech sounds. At the same time, the issue of how a 3-dimensional "intraoral" target movement system might affect co-articulatory reality began to be explored. This exploration focused on how phonatory, mandibular, labial-facial and lingual movements worked interactively in speech production and on how these subsystems could be re-balanced using tactile input to develop clear speech. Also in the 1980's, collaborative research began with Paula Square whose research at the University of Toronto focused on acquired speech dyspraxia in adults.
In the 1990's, standardized assessment protocols were developed, and PROMPT treatment refined. VMPAC protocol showed that development of the speech subsystems (i.e., mandibular, labial-facial, and lingual control and sequencing) was consistent with the hierarchical, interactive model of the Motor Speech Hierarchy. Children with normal and disordered speech developed motor control, flexibility and integration of the motor subsystems as age increased, although the disordered group was slower to develop than was the normal group.
With respect to PROMPT treatment in the 1990's, emphasis began to be placed on the concept of "planes of movement" (vertical, horizontal, anterior-posterior) used in co-articulated speech, and on how these movement planes become coordinated in normal speech. Attention was given to how much motor control was needed to produce words (i.e., a lexicon) in either one or more movement planes. PROMPT treatment was refined with respect to selecting speech, language, and social interaction goals.
The empirical validation of PROMPT as a clinical approach continues into the current century.
Hope Fernicola, M.A. CCC-SLP is a trained Level II, PROMPT clinician who has extensive experience using the PROMPT method with a varied caseload of children with motor speech disorders.