Compelling Case Studies & Research: PROMPT in Action

GSHA 2019 -- February 15, 2019

Disclosure Statement I have the following relevant relationship in the services described and reviewed in this presentation:

PROMPT Institute•  Contract employee which entails

conducting PROMPT courses and PROMPT Instructor responsibilities.

After GSHA 1977

Learning Objectives•  Identify Movement patterns as they apply

to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH)

•  Identify Priorities as they apply to the Motor Speech Hierarchy (MSH) and Conceptual Framework (CF)

•  List and explain Key Features of PROMPT Treatment

What is the PROMPT Institute?

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PROMPT INSTITUTE

SANTA FE, NEW MEXICO www.prompt.org

•  A Non-Profit Organization dedicated to improving verbal communication and interactions for children and adults.

•  Research•  Treatment grants•  50 instructors worldwide •  Trained 40,000 SLP worldwide•  PROMPT in different languages

Who can offer PROMPT treatment?

•  Only speech-language pathologists are trained by the PROMPT Institute

•  Four levels of PROMPT education§  PROMPT Trained

o PROMPT: Introduction to Techniqueo Bridging PROMPT to Intervention

§  PROMPT Certified Clinician§  PROMPT Certified Instructor

Sample of PROMPT Therapy

What makes “PROMPT” PROMPT?

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TKP input Motor Speech

Assessment

Conceptual Framework

Treatment Activities

What is the PROMPT Technique?

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TKP input

WHAT IS PROMPT?

•  Prompts for•  Restructuring•  Oral•  Muscular•  Phonetic•  Targets

–  A tactile-kinesthetic-proprioceptive (touch-movement) based treatment method

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Surface Parameter Syllable

Complex

Levels of PROMPTing

Physiological (muscular)

Neurological (motor)

Refined, stable motor speech control

What is the Tactile-Kinesthetic-Proprioceptive input doing to the brain?

What is the Tactile-Kinesthetic-Proprioceptive input doing to the brain?

Clinician acts as external programmer by giving TKP input…

to develop/restructure connections…

which then changes the output!

PROMPT the entire word •  to form holistic construct for the motor plan •  highlight transitions from and to target

phonemes

Current PROMPT Research

Cite: Namasivayam, A. K., Granata, F., Huynh, A., & Van Lieshout, P.H.H.M. (2018). Randomized Control Trial of PROMPT Intervention for Children With Severe Speech Sound Disorders. Presentation at the American Speech-Language-Hearing Association Convention, Boston, USA (November 15–17).

What is the PROMPT Approach?

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TKP input Motor Speech

Assessment

MotorSpeechHierarchySpeechSubsystems

SystemsAnalysisObservation

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TONE

Increased/decreased tone Neurological concerns Postural support

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PHONATORY CONTROL

Airflow Breath support Phonation/valving

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MANDIBULAR CONTROL

Jaw stability Jaw grading Up/down movements

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LABIAL-FACIALCONTROL

Medial 1/3 Lip contact Lip-jaw dissociation Independent lower lip Retracting Rounding

SampleVideo

•  RyanandLilly

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LINGUAL CONTROL

Anterior Mid Mid-back Posterior

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SampleVideo

•  Will

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SEQUENCED MOVEMENTS

Vocal timing Smooth, coordinated transitions Optimal functioning of all speech subsystems

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PROSODY

Integration of breath support, phrasing, stress, rate, loudness

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•  Systems are inter-connected

•  Analyze the

system, find the point of breakdown(s)

•  Examine as a

whole system!

•  Select 3 subsystems for treatment

LookatMovementNOTspecificsounds

•  Phonemesaremultidimensional-•  Phonation•  Jaw•  Lips•  Tongue

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ClinicalImplication

•  ConsonantandVowelCombinations•  Needtothinkbeyondthesyllableshape.

•  CVo  Moo,Ma,Me

•  VCo  On,Eat

•  CVCo  Bop,Beep

•  CVCVo  Dada,Mommy,Puppy,Bye-bye

•  VCVo  Anna,oboe,Ido

TrajectoryofWords

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•  Vowels•  Shiftawayfromtraditionalarticulationfromconsonants

Lookatthissystem!

•  Lana,4years,10months•  Whatsoundsdidyouhear?•  Nowlet’stakealookatmotor!

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AdditionalPROMPTAssessmentComponents

GlobalDomainAnalysis•  Physical-Sensory•  Cognitive-Linguistic•  Social-Emotional

KnowledgeofexternalenvironmentDeterminesupportstrategies

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Physical Sensory DomainAreas to observe General Assessment

Questions

Skeletal Structure How does the client’s skeletal structure and muscular development impact movement?

Sensation What is the status of the neuromuscular system?How well do the sensory organs function?

Neuromuscular Integrity What factors impact global motor and speech motor control?

Cognitive Linguistic DomainAreas to observe General Assessment

QuestionsPerception; sensation, discrimination, recognition

How does the client process information and interact with the environment to learn?

Concept Formation How does the environment need to be structured for learning?

What modifications are necessary for the client to learn?

Social Emotional DomainAreas to observe General Assessment

Questions

Interpersonal Interactions How does the client express their needs and wants?

Trust What communicative functions does the client exhibit?

How does the client use significant others to aid in the acquisition of knowledge

What is the PROMPT Philosophy?

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TKP input Motor Speech

Assessment

Conceptual Framework

The PROMPT Philosophy

HolisticPROMPT

Conceptual Framework

PROMPT Tenets

EnvironmentExternal

PROMPTConceptualFramework

Client

Internal

Hayden02

CulturalPhysicalSocial

intrapersonal

interpersonal

PhysicalSensorySkeletalStructureNeuromuscularIntegritySensation

CognitiveLinguisticPerceptionsensationdiscriminationrecognitionConceptFormation

SocialEmotionalInterpersonalInteractionTrust

Sensory-Motor

Communication

BehavioralOutcomes

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EnvironmentExternal

PROMPT Conceptual Framework

Client

Internal

Hayden02

CulturalPhysicalSocial

intrapersonal

interpersonal

PhysicalSensorySkeletalStructureNeuromuscularIntegritySensation

CognitiveLinguisticPerceptionsensationdiscriminationrecognitionConceptFormation

SocialEmotionalInterpersonalInteractionTrust

Sensory-Motor

Communication

BehavioralOutcomes

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PROMPTisusedwithChildrenandAdults

PublishedPapers

SpeechSoundDisorders ü

DevelopmentalDelays

MotorSpeechDisorders•  Dysarthria•  ApraxiaofSpeech

üü

HearingImpairment

AutismSpectrumDisorders üFluencyDisorders

ForeignAccentModification

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What is the PROMPT System?

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TKP input Motor Speech

Assessment

Conceptual Framework

Treatment Activities

PROMPT as a Systemfor organizing and executing a treatment plan

Use data from Domains

Evaluation

Use SAO & MSH to select Motor

Speech Priorities

Develop Goals & Objectives,

Motor-Phoneme Targets, Lexicon,

Activities

Sessions

•  Motor goals•  Select target motor-

phoneme links•  Create meaningful and

functional lexicon •  Embed lexicon into

functional, interactive routines/activities

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Treatment videos

Considerations: Traditional Therapy and PROMPT

What makes “PROMPT” PROMPT?

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TKP input Motor Speech

Assessment

Conceptual Framework

Treatment Activities

Online Courses/ Mentoring

Technique Practicum

PROMPT Pathway to Certification

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Introduction to

Technique

Certification Project

Bridging – Technique

to Intervention

OnlineCourses/Mentoring

TechniquePracticum

PROMPTPathwaytoCertification

X

IntroductiontoTechnique

CertificationProject

Bridging–TechniquetoIntervention

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Questions?

THANK YOU!

You are welcome to contact meGayle Merrefield

gaylem@promptinstitute.com

For additional information please visit

www.prompt.org