Tracey Kellner, M.A.CCC/SLP: PROMPT Institute: Tracey Kellner is an independent contractor and is compensated by the PROMPT Institute for this role. (Ongoing)
Abstract: PROMPT is an acronym for Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT). PROMPT-trained SLPs assess and treat individuals holistically by approaching communication as an interaction of the Physical-Sensory, Cognitive-Linguistic and Social-Emotional Domains within the Conceptual Framework. This presentation will examine how treatment planning and implementation center around these domains. It will also outline the PROMPT goal writing process which helps facilitate functional outcomes with clients. In addition, clinical cases will be shared to demonstrate how PROMPT goals guide therapy.
Summary of Presentation : PROMPTs for Restructuring Oral Muscular Phonetic Targets (PROMPT) is a philosophy, approach, system and technique that helps clients reach their full potential. PROMPT is effective due to the Conceptual Framework (CF), which is comprised of three domains: Physical-Sensory, Cognitive-Linguistic, and Social-Emotional. It approaches communication breakdowns across these domains in order to find ways to utilize the client’s strengths to maximize potential for communication skills.
The CF is globally grounded in Dynamic Systems Theory and within each domain several critical theories have been integrated, further supporting the effectiveness of PROMPT. The Physical-Sensory Domain is comprised of the Neuronal Group Selection (Sporns, O. et al.) (Kaas, J.H.), Functional Synergies (Green, J.R. et al.) and Motor Learning Theory (Maas, E. et al.) (Schmidt, R.A.). The Cognitive Linguistic Domain is grounded in Cognitive Schema (Piaget, J.), Event Knowledge (Nelson, K.) and Competition Model Theory (Bates, E. et al.) (Bloom, L.). The Social-Emotional Domain is supported by Social Development (Vygotsky, L.S.) and Social Pragmatic Theory (Prizant, B. et al.) (Wetherby, A.).
When PROMPT is implemented several procedures are completed. The client’s system is systematically evaluated via the Global Domain Evaluation (GDE), System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH). Therefore, PROMPT not only addresses “speech”, it addresses all aspects of the client, which highlights additional reasons why PROMPT is successful. It helps the clinician plan and organize the direction and type of treatment needed for the specific delay or disorder. In addition, it provides kinesthetic, proprioceptive, auditory and visual feedback to the speech subsystem. Part of the success of PROMPT centers around including caregivers in the therapeutic process. This is accomplished through caregiver coaching and training parents/caregivers to visualize the motor speech breakdown. The caregiver/parent then gives feedback specific to the motor speech breakdown and uses distributed practice of a motor speech-based vocabulary throughout daily routines and activities. Parent training and parent led intervention have been supported with improved child outcomes with a number of interventions (Wetherby, A. et al; Roberts & Kaiser).
Numerous efficacy studies have been conducted, which further supports the effectiveness of PROMPT. PROMPT Intervention for Children with Severe Speech Motor Delay: A Randomized Control Trial (Namasivayam et al.), evidenced that PROMPT intervention is a clinically effective intervention approach for children with speech motor disorders. Notable improvements in speech motor control, speech articulation, and word-level speech intelligibility were identified. Treating Speech Subsystems in CAS with Tactual Input: The PROMPT Approach (Dale et al.), showed that PROMPT assessment and treatment has also demonstrated to be effective amongst children with apraxia. Results of this study indicated that even the children who did not receive tactile input with PROMPT technique, for the full eight weeks, made significant improvements with motor speech control. These results indicate PROMPT is efficacious without tactile input, which supports the use of PROMPT in teletherapy. A study conducted using MRI technology, Cortical Thickness in Children Receiving Intensive Therapy for Apraxia of Speech (Kadis et al.), for example, discovered magnetic resonance images in children with CAS had significantly thicker Left Posterior Superior Temporal Gyrus (LPSTG). After PROMPT Therapy, significant thinning of the LPSTG was evident and intelligibility improvements were noted. This was the first study to show experience related structural plasticity after therapy for speech sound disorders. Kinematic Changes in Jaw and Lip Control of Children with Cerebral Palsy Following Participation in a Motor-Speech (PROMPT) Intervention, suggested movement changes in response to PROMPT therapy. These improvements in movement resulted in significantly improved speech perception (Ward, R. et al.).
Setting goals is a critical element of the assessment and treatment planning process, as goals drive treatment. Goals organize treatment, provide a roadmap of skills for clients to achieve and determine clinical strategies. Developing specific, measurable, attainable, relevant, and timely (SMART) goals is essential to the treatment planning process (Nobriga, C. et al.). Outlining the PROMPT goal writing process helps facilitate functional outcomes with clients.
Working in Speech Language Pathology for over 25 years has given me the opportunity to use evidence-based practice guidelines which direct and guide my assessment and treatment protocols. The past year has emphasized to me how goals guide treatment.
Learning Objectives:
At the completion of this activity, participants should be able to:
1. List and explain PROMPT treatment planning and implementation.
2. Describe the PROMPT Goal Writing Process for selecting functional and realistic targets.