PROMPT TherapyPROMPT TherapyA Procedural DescriptionA Procedural Description

Presentation by:Presentation by:Christeen Z. ScarpaChristeen Z. Scarpa

June 18, 2008June 18, 2008Caldwell CollegeCaldwell College

Overview of PresentationOverview of Presentation

Search DescriptionsDefinition of termsBrief HistoryDescription of proceduresConceptual analysisReferences

Search DescriptionSearch Description PsycINFO: PsycINFO: Typed: PROMPTTyped: PROMPT Results: NONEResults: NONE Typed: PROMPT TherapyTyped: PROMPT Therapy Results: NONEResults: NONE Typed: “PROMPT Therapy”Typed: “PROMPT Therapy” Results: 3 peer reviewed journal articlesResults: 3 peer reviewed journal articles Key words: “PROMPT therapy”, “PROMPT intervention”, or Key words: “PROMPT therapy”, “PROMPT intervention”, or

“PROMPT strategies”“PROMPT strategies” Google: Google: Typed: PROMPT Therapy and autismTyped: PROMPT Therapy and autism Results: NONEResults: NONE Typed: PROMPT Therapy:Typed: PROMPT Therapy: Results: Several results including: http: Results: Several results including: http:

//www.promptinstitute.com/ & http://houghton-//www.promptinstitute.com/ & http://houghton-meg.tripod.com/id3.htmlmeg.tripod.com/id3.html

Definition of PROMPT TherapyDefinition of PROMPT Therapy

Tactile based treatment strategy for Tactile based treatment strategy for reshaping the individual’s articulatory reshaping the individual’s articulatory phonemes (sounds) and sequences. phonemes (sounds) and sequences.

PROMPT uses a different prompt for PROMPT uses a different prompt for each individual phoneme. each individual phoneme.

Method applies external tactile-sensory Method applies external tactile-sensory information in order to create new and information in order to create new and more “together” motor sounds & pathsmore “together” motor sounds & paths

Why Focus On Speech?Why Focus On Speech?

Speech is a crucial tool for learning, self-advocacy, social relationships, and participation in community.

(Rogers et. al. 2006)

Brief History Of PROMPTBrief History Of PROMPT

Developed by Deborah Hayden, MA, CCC-SLPDeveloped by Deborah Hayden, MA, CCC-SLP 1970’s1970’s Explored PROMPT’s for Restructuring Oral Explored PROMPT’s for Restructuring Oral

Muscular Phonetic Targets Muscular Phonetic Targets Explored how the interaction and balance or Explored how the interaction and balance or

symmetry among all motor systems direction symmetry among all motor systems direction affect speech-motor systems controlaffect speech-motor systems control

Explored how effects of damage or disruption Explored how effects of damage or disruption to motor paths could unbalance motor speech to motor paths could unbalance motor speech system developmentsystem development

Brief History of PROMPT Brief History of PROMPT (Cont’d)(Cont’d)

1980: 11980: 1stst Empirical research of Empirical research of Prompt efficacy was conductedPrompt efficacy was conducted

Leading to 1Leading to 1stst Manual of techniques for Manual of techniques for conducting and implementing PROMPTconducting and implementing PROMPT

Research attempts continue focusing Research attempts continue focusing on autism and motor speech on autism and motor speech disordersdisorders

Why use PROMPT Therapy?Why use PROMPT Therapy?

Methods used for many speech Methods used for many speech disorders:disorders: Non verbal children with autismNon verbal children with autism stuttering, stuttering, language formulation, language formulation, syntax, syntax, auditory processing disordersauditory processing disorders Global DelaysGlobal Delays Apraxia Apraxia

Description of ProceduresDescription of Procedures

Technique where the therapists fingers are Technique where the therapists fingers are placed:placed:

face, face, jaw, jaw, under the chin under the chin Cues Given: Cues Given: finger placement,finger placement, finger movement,finger movement, pressure from fingers pressure from fingers duration of finger placement on individual. duration of finger placement on individual.

PROMPT TherapyPROMPT Therapy

Example of finger placementExample of finger placement

PROMPT TherapyPROMPT Therapy

www.youtube.comwww.youtube.com

11stst time session, time session,

22 months old22 months old

Description of Procedures Description of Procedures (Cont’d)(Cont’d)

**Claims to help facilitate **Claims to help facilitate articulatory postures**articulatory postures**

Oral tactile kinesthetic cues given:Oral tactile kinesthetic cues given:Signals varieties of movementSignals varieties of movement Includes: Includes: place of contact; place of contact; closure closure manner manner

PROMPT’S PHILOSOPHYPROMPT’S PHILOSOPHY

Philosophy excepted in treatments:Philosophy excepted in treatments: Humans are externally & internally Humans are externally & internally

motivated by mental, physical, and motivated by mental, physical, and emotional domainsemotional domains

Those 3 domains are fully integrated in Those 3 domains are fully integrated in most “typical” developing humansmost “typical” developing humans

Communication represents important form Communication represents important form of integration involving these domainsof integration involving these domains

Humans need to connect with each other, Humans need to connect with each other, either mentally, physically, and emotionallyeither mentally, physically, and emotionally

PROMPT’S PHILOSOPHY PROMPT’S PHILOSOPHY (Cont’d)(Cont’d)

Communication may be disrupted by Communication may be disrupted by interruption of any or all of these domainsinterruption of any or all of these domains

To strengthen weakest domain all domains To strengthen weakest domain all domains must be reincorporate systematicallymust be reincorporate systematically

Restructuring should alternate focus among Restructuring should alternate focus among all domains- must be individualizedall domains- must be individualized

No communication intervention can produce No communication intervention can produce permanent change without involving all permanent change without involving all domainsdomains

Motor Speech Treatment Motor Speech Treatment HierarchyHierarchy

Information used to determine target Information used to determine target treatment’s for individuals with treatment’s for individuals with speech disordersspeech disorders

Stage 1: Stage 1: Body Tone:Body Tone: How is postural How is postural support for speech?, how is neck & head support for speech?, how is neck & head control?control?Stage 2: Stage 2: Breath, Phonation, VoiceBreath, Phonation, Voice: : How is Breath support, how valving & How is Breath support, how valving & phonation control to support speech?phonation control to support speech?Stage 3: Stage 3: Jaw:Jaw: how is control of jaw how is control of jaw movementmovement

Motor Speech Treatment Motor Speech Treatment Hierarchy (Cont’d)Hierarchy (Cont’d)

Stage 4: Stage 4: Face & Lips:Face & Lips: How is control of How is control of the face? How is lip movememt?the face? How is lip movememt?

Stage 5: Stage 5: Tongue:Tongue: How is control of How is control of tongue movement?tongue movement?

Stage 6: Stage 6: Sequencing:Sequencing: Precise motor Precise motor phonmene targetsphonmene targets

Stage 7: Stage 7: ProsodyProsody: temporal aspects of : temporal aspects of speech production (e.g., rate & speech production (e.g., rate & intonation/tone) intonation/tone)

Can PROMPT Therapy Prove Can PROMPT Therapy Prove Effective When Implemented Effective When Implemented

Alone?Alone?

PROMPT simply as a technique PROMPT simply as a technique to elicit phonemes will not to elicit phonemes will not achieve the best outcomes.achieve the best outcomes.

(Houghton, Meg)(Houghton, Meg)

Conceptual AnalysisConceptual Analysis

Higher Order Conditioned Stimulis Higher Order Conditioned Stimulis →→

Discriminative Stimuli/Motivating Operations→

Response Response →

ConsequenceConsequence

Conceptual AnalysisConceptual Analysis

Surrounding Environment (e.g., home or classroom Surrounding Environment (e.g., home or classroom (teacher present); a visible, non reachable bag filled (teacher present); a visible, non reachable bag filled

with desirable “gold fish” crackerswith desirable “gold fish” crackers

→→

Direction of task (e.g., “say, fhhh”)/ Child is Direction of task (e.g., “say, fhhh”)/ Child is hungry/or craves “gold fish” crackershungry/or craves “gold fish” crackers

→→

Target behavior occurs (e.g., child says “fhhh”)Target behavior occurs (e.g., child says “fhhh”)

→→

Reinforcement (e.g., child receives “gold fish” Reinforcement (e.g., child receives “gold fish” crackers)crackers)

Is PROMPT Therapy Effective?Is PROMPT Therapy Effective?

PROMPT may be used to facilitate PROMPT may be used to facilitate production, revise or change production, revise or change

production or to integrate motor production or to integrate motor production with cognitive-linguistic production with cognitive-linguistic

function.function.

(Prompt Institute) (Prompt Institute)

HOWEVER….HOWEVER….

Some studies concluded:Some studies concluded:None of the children benefited from None of the children benefited from

PROMPT treatment PROMPT treatment (Dodd, B. & Bradford, A. ,2000).(Dodd, B. & Bradford, A. ,2000).

PROMPT TherapyPROMPT Therapy

ComparisonComparisonChild in 10Child in 10thth session session

www.google.comwww.google.comDeborah Haydon and youtubeDeborah Haydon and youtube

ReferencesReferences Bose, A., Square, Paula. A., Schlosser, R., & van Lieshout, P. (2001). Effects of PROMPT therapy on speech motor Bose, A., Square, Paula. A., Schlosser, R., & van Lieshout, P. (2001). Effects of PROMPT therapy on speech motor

function in a person with aphasia and apraxia of speech. Aphasiology, 15(8), 767-785function in a person with aphasia and apraxia of speech. Aphasiology, 15(8), 767-785 Davis, Anna F., Rosenthal, Ted L., Kelley, John E. (1981) Actual fear cues, prompt therapy, and rationale enhance Davis, Anna F., Rosenthal, Ted L., Kelley, John E. (1981) Actual fear cues, prompt therapy, and rationale enhance

participant modeling with adolescents; Behavior Therapy, Vo 12(4), pp. 536-542participant modeling with adolescents; Behavior Therapy, Vo 12(4), pp. 536-542 Dodd, B. & Bradford, A. (2000). A comparison of three therapy methods for children with different types of Dodd, B. & Bradford, A. (2000). A comparison of three therapy methods for children with different types of

developmental phonological disorder. developmental phonological disorder. International Journal of Language and Communication Disorders, 35, International Journal of Language and Communication Disorders, 35, 189-189-209.209.

Hayden, D.A. (2004). PROMPT: A tactually grounded treatment approach to speech production disorders. In I. 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 for pervasive Stockman (Ed.), Movement and action in learning and development: Clinical implications for pervasive developmental disorders (pp. 255–297). San Diego, CA: Elsevier–Academic Press. 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 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. impairment. Advances in Speech-Language Pathology, 8(3), 265–281.

Rogers, Sally J., Hayden, Deborah., Hepburn, Susan., Smith, Renee C., Hall, Terry., Hayes, Athena. (2006). A Pilot Study of the Denver Model and PROMPT Interventions, J Autism Developmental Disorder 36:1007–1024

Houghton, Meg (2008) Online. Internet. Reviewed June 16, 2008, from Houghton, Meg (2008) Online. Internet. Reviewed June 16, 2008, from http://houghton-meg.tripod.com/id3.htmlhttp://houghton-meg.tripod.com/id3.html Mars, Isa SLP, Speech and Language (2008). Online. Internet reviewed June 16, 2008 from Mars, Isa SLP, Speech and Language (2008). Online. Internet reviewed June 16, 2008 from

www.speechlanguagefeedings.comwww.speechlanguagefeedings.com The PROMPT Institute (2008). Online. Internet reviewed June 16, 2008, from The PROMPT Institute (2008). Online. Internet reviewed June 16, 2008, from www.promtpinstitute.comwww.promtpinstitute.com Youtube (2008). PROMPT Therapy sample. Retrieved June 16, 2008 from Youtube (2008). PROMPT Therapy sample. Retrieved June 16, 2008 from www.youtube.comwww.youtube.com Speech, Language, and Learning pathways (2008). Online. Internet. Reviewed, June 17, 2008 from Speech, Language, and Learning pathways (2008). Online. Internet. Reviewed, June 17, 2008 from

www.mypathways.orgwww.mypathways.org