PROMPT Therapy
LLA Therapy, Speech Language Pathologist, Teal Simmons, M.A., CF-SLP, discusses the benefits of PROMPT therapy and why she is getting certified
What is PROMPT?:
The word ‘prompt’ is often associated with a method of eliciting a specific response/behavior when attempting to teach a skill. For example, “I prompted her to get her coat off the hook and put it on.” However, PROMPT therapy takes on a very different meaning. PROMPT is an acronym for ‘Prompts for Restructuring Oral Muscular Phonetic Targets.’ This method of speech therapy was originally created to target individuals with severe motor impairments. PROMPT provides support in a multi-sensory (with focus on tactile-kinesthetic) and dynamic way to support growth and development of speech and communication function across all domains.
This method is supportive of the areas of social interactions and communication, in addition to the development of motor speech movement/sounds. It sets therapy up to focus on all aspects, including the systems for social-emotional, cognitive-linguistic, and physical-sensory(motor), and how these systems work when interacting within the environment. PROMPT uses a functional lexicon (a set of words) that correlates with the child’s motor speech ability to support overall speech/language development. This allows the child to learn sounds/words that will be useful when they are mastered to support their communication and social interactions as a whole – not just being able to correctly make the sound or word. Using the targeted set of words during everyday situations (to later target production) also allows for the child to have exposure to the words, engage in simple routine activities, incorporate turn taking with the routine, and provide opportunities for the child to “see the word” being verbalized correctly, hear the word, and tie meaning to the word.
This process supports the motor piece of PROMPT when a child is ready to receive the kinesthetic-tactile input for learning how to produce speech sounds. It helps the child correctly and simply connect the meaning words and activities used and provides exposure to help tie how a speech sound/word looks and sounds with how it feels when given the prompted motor input. The purpose of working on a child-based holistic assessment of how all systems are functioning is to ensure that there is a limited amount of stress or strain on all other systems (i.e., cognitive/linguistic, social/emotional) so that the child’s sensory/motor system can be the primary focus without stressing out other systems. Motor input is exhausting!
Clients that may benefit from PROMPT:
A wide range of clients, beginning as early as six months old, could potentially benefit from this method of speech therapy. Most commonly, client’s treated with PROMPT therapy present with some type of motor speech disorder, articulation problem, or are considered to be “late talkers.” This method is a way to reduce a client’s workload for attempting to correctly place their articulators to produce true speech sounds and sound sequences. Clients are given tactile-kinesthetic supports, or prompts, to shape the sound while they feel it, see it, hear it, and make the prompted sound production. Other clients that have been found to benefit from this method of therapy include those with apraxia/dyspraxia, dysarthria, aphasia, cerebral palsy, autism spectrum disorder, pervasive development disorders, aphasia, and other communication disorders. PROMPT takes the focus off of solely speech-sound production, and instead aims to focus on improving motor skills for functional use throughout language development to support social interactions.
Why PROMPT makes sense:
PROMPT aims to facilitate a client’s ability to produce speech sounds, to modify motor patterns already created for speech sounds, and to integrate motor, social-emotional, and cognitive-linguistic functions for the development of effective communication.
PROMPT differs from the typical developmental hierarchy of speech sounds and ‘scrambles it up’, so to speak. It ventures to address where a developing motor system needs support to strengthen and grow, rather than determining therapy targets based on what sounds should be present in a typically developing child (and motor system) at a specific age on a developmental scale. This makes sense to me because some of the earlier developing sounds are, in fact, some of the most motorically complex. (i.e., a /t/ sound, that is often one of the first sounds to be targeted takes a large amount of motor skill to move the tongue independently from everything else). A child whose system presents with a delay may not be “wired” or “set up” for functioning to produce more complex sounds that are known to come earlier in more typical developing speech systems.
All of an individual’s systems (e.g., social emotional, cognitive linguistic, physical-sensory), as well as the child’s environment, are considered when using this approach to therapy to ensure that a client’s primary needs are targeted during therapy. The PROMPT method focuses on a child’s specific needs for communication based on an assessment of all of their systems functioning together as a whole unit. If one system requires more support than the motor system, the focus for therapy should be on that system. This also makes sense because if the child is receiving motor input and has too much stress/strain on other systems, therapy won’t be beneficial for the child. If the other systems are being too “stressed out” or taxed at the same time of motor information input, the motor system will likely not be able to effectively process/use the information being provided.
My personal journey to PROMPT:
In my experience with therapy and working with children with broad ranges of skill levels and developmental disabilities, I have become a firm believer in the idea that there is not a “one size fits all” approach for therapy. I feel that every client is unique and should be assessed and treated on an entirely individualized basis. As a speech therapist, I have had experience providing services at a board of developmental disabilities, a head start program, a neurological center, through telepractice, at private clinics, and at a school for autism. I have had the opportun
ity to see, experience, and utilize a wide range of approaches to treatment. Some examples include The Son-Rise Program, Floor Time, The Early Start Denver Model, and Applied Behavioral Analysis (ABA), among other approaches. I do not utilize a favorite or a “standard” method. I am constantly evaluating, re-evaluating, and changing my approach in therapy based on what I believe would benefit the client and the client’s family.
ity to see, experience, and utilize a wide range of approaches to treatment. Some examples include The Son-Rise Program, Floor Time, The Early Start Denver Model, and Applied Behavioral Analysis (ABA), among other approaches. I do not utilize a favorite or a “standard” method. I am constantly evaluating, re-evaluating, and changing my approach in therapy based on what I believe would benefit the client and the client’s family.
I first learned of PROMPT during my time as a graduate student. I volunteered with a family to help facilitate The Son-Rise Program for their son who had been diagnosed with autism and apraxia of speech. The child’s parents continuously searched for a way to help him learn how to talk. All of their searching lead them to PROMPT. Their son was eight years old when the family began traveling almost four hours for PROMPT therapy once a month. In a very short time, he was beginning to produce sounds that he had never been able to say before taking a chance with this intervention. I had the privilege of being a part of their PROMPT journey: learning about what PROMPT means, learning how PROMPT is effectively implemented, and seeing progress that PROMPT made possible.
Why I wanted to become a PROMPT trained clinician:
PROMPT is a method to approach communication and speech sound production therapy in a way that is holistic and considers all aspects of a child, their environment, and all of the child’s system. Therapy focuses on all systems fluidly rather than only targeting the motor speech production piece of communication. It is a method that allows flexibility and constant evaluation, re-evaluation, and fluid movement through different phases of treatment to target and put a spotlight on whatever the child’s needs are during a particular time in their development or even during one therapy session. This method aligns well with my belief that therapy is ever changing and that “one size” truly does not fit all. It also supports the idea that one method of therapy for a specific child may need to be changed and altered constantly to fit their individual needs as they change.
So, I asked to become “PROMPT trained,” and I traveled to New York in September, 2015 for an intensive training. My goal is to become fully PROMPT certified in the future. I am very passionate about this method to approach communication development, and I am excited to be using it in practice and to be seeing results (in just a short time) with my clients!
Questions?:
Feel free to send me an e-mail with questions: tsimmons@llatherapy.org
Also, you can find out more at the PROMPT Institute’s Website: http://promptinstitute.com/