8/5/2019
Apraxia Kids Webinar What is PROMPT? April 2019
Instructor Disclosures • Amy Clark, M.S.-CCC, PI is a speech-language pathologist and Director of Clinical Education for the PROMPT Institute, which entails conducting PROMPT courses, developing workshops, constructing online courses, training instructors and addressing general learning program needs. She has over 25 years of pediatric clinical experience. • She receives compensation from Apraxia Kids for presenting this course. • No relevant non-financial relationship exists
Instructor Disclosures • Alice Stroutsos, M.S.-CCC, PI is an independent contractor of the PROMPT Institute. • Alice is a 2012 graduate of the Intensive Childhood Apraxia of Speech Training Institute sponsored by Apraxia Kids. She is recognized by Apraxia Kids for Advanced Training & Clinical Expertise in Childhood Apraxia of Speech. • She receives compensation from Apraxia Kids for presenting this course. • No relevant non-financial relationship exists
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Learning Objectives As a result of this webinar, the participant will be able to: • Discuss the PROMPT Conceptual Framework • Describe key components of PROMPT assessment and treatment • Apply the PROMPT Conceptual Framework to their client or child
The PROMPT Institute Vision
The PROMPT Institute Vision is to have PROMPT readily available to every person, in every country, who has potential to benefit from it.
PROMPT Institute Mission We are a non-profit organization with the following primary objectives: • Provide education for SLPs, parents, general public • Develop, participate in and fund research • Provide workshop scholarships for underserved populations • Provide treatment grants for those unable to pay
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PROMPT Stands For
Prompts for Restructuring Oral Muscular Phonetic Targets
PROMPT is used with Children and Adults Published Papers
Speech Sound Disorders
Developmental Delays Motor Speech Disorders • Dysarthria • Childhood Apraxia of Speech
Hearing Impairment Autism Spectrum Disorders
Fluency Disorders Foreign Accent Modification
PROMPT is: •
•
•
•
A Philosophy * tenets An Approach * organizing principles of assessment A System * development of intervention plans, communication focus, goals, objectives, activities etc. A Technique * purpose and use of PROMPT technique
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PROMPT Conceptual Framework Environment External Cultural Physical Social
Cognitive Linguistic Perception sensation discrimination recognition Concept Formation
interpersonal
Physical Sensory SensoryMotor
Skeletal Structure Neuromuscular Integrity Sensation
Communication
Client
intrapersonal
Behavioral Outcomes
Internal
Social Emotional Interpersonal Interaction Trust
Hayden 02
Three Uses of PROMPT 1. To Develop An Interactive Awareness / Focus For Oral Communication • Social-Emotional Domain 2. To Develop Integrated Multi-Sensory Associative Mapping For Cognitive Or Linguistic Concepts • Cognitive-Linguistic Domain 3. To Develop, Re-balance, Or Re-structure Speech Subsystems At The Sound, Word, Or Phrase Level • Physical-Sensory Domain
Social-Emotional Domain Environment External Cultural Physical Social
Cognitive Linguistic
interpersonal
Perception sensation discrimination recognition Concept Formation
Physical Sensory SensoryMotor
Skeletal Structure Neuromuscular Integrity Sensation
Communication
Client
intrapersonal Behavioral Outcomes
Social Emotional
Internal
Interpersonal Interaction Trust
Hayden 02
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Cognitive-Linguistic Domain Environment External Cultural Physical Social
Cognitive Linguistic Perception sensation discrimination recognition Concept Formation
interpersonal
Physical Sensory
SensoryMotor
Skeletal Structure Neuromuscular Integrity Sensation
Communication
Client
intrapersonal Behavioral Outcomes
Internal
Social Emotional Interpersonal Interaction Trust
Hayden 02
13
Physical–Sensory Domain Environment External Cultural Physical Social
Cognitive Linguistic
interpersonal
Perception sensation discrimination recognition Concept Formation
Physical Sensory SensoryMotor
Skeletal Structure Neuromuscular Integrity Sensation
Communication
Client
intrapersonal Behavioral Outcomes
Social Emotional
Internal
Interpersonal Interaction Trust
Hayden 02
Insert Videos Demonstrating each use • Each use will be discussed prior to the video playing…CL, PS and SE will be shown
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Children with Childhood Apraxia of Speech Often: • Exhibit strengths in the cognitive-linguistic domain – receptive language • Exhibit relative strengths in the social-emotional domain • Expressive language is not supported by the motor speech system, therefore is impaired • Exhibit weaknesses in the physical-sensory domain
Physical–Sensory Domain Environment External Cultural Physical Social
Cognitive Linguistic
interpersonal
Perception sensation discrimination recognition Concept Formation
Physical Sensory SensoryMotor
Skeletal Structure Neuromuscular Integrity Sensation
Communication
Client
intrapersonal Behavioral Outcomes
Social Emotional
Internal
Interpersonal Interaction Trust
Hayden 02
PROMPT Assessment
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Systems Analysis Observation (SAO) Structural - Skeletal YES
A. STRUCTURAL - Skeletal (view at rest)
1.
The client’s face is symmetrical in shape.
2.
The mandible and maxilla are in proper alignment, height, shape and size.
3.
Dental occlusion is within normal limits. e.g., there is no open bite, Class II or Class III malocclusion
4.
The palatal arch and oral/dental structures are within normal limits.
NO
COMMENT
SAO – Stage III B. FUNCTION - Neuromotor, continued (view in movement) STAGE III: Mandibular Control (from this point on, view in connected speech) YES 10.
NO
COMMENT
Jaw movement shows: Good range and control e.g., open-close; close-open; close-open-close
No lateral or anterior sliding
TOTAL
/2
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100
100
100
3
100
2
100
1
50
33
PROMPT as a System
Complete SAO
Transfer to MSH
3 Motor Speech Priorities
Motor Phoneme Links • Phonemes: another word for sounds • Phonemes are linked into functional words/phrases • Each phoneme has motor requirements for: • Jaw • Lips • Tongue Example: /m/ Example: /o/ Example: /d/
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Vowel Chart
Levels of PROMPT
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4 Levels of PROMPTing Parameter – provides broad organizing base support (e.g., jaw stability) Surface - provides specific information in only one plane of movement (e.g., lip rounding) Complex - provides information over 2 planes of movement (e.g., tongue placement and lip rounding) Syllable- combination of Surface and Parameter prompts for CV productions
Parameter PROMPTs
Parameter PROMPTs are provided for one subsystem (or stage or parameter) at a time. We never mix Parameter PROMPTs (e.g., support jaw and then rounding)
Parameter PROMPT Video
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Complex PROMPTs Provide information over 2 planes of movement. Example: point/width of lingual contraction and lip rounding. Complex PROMPTs are ONLY for motor phoneme links in isolation.
Complex PROMPT Video
Levels of PROMPT: the BIG idea • PROMPT is NOT a touch cue system • 4 levels of PROMPT are used for specific reasons • They are used to address motor breakdowns identified on the SAO & MSH • There is a systematic reason we use each level of PROMPT
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Treatment Planning
Treatment Planning • Establish motor speech goals based on results of the SAO and MSH • Choose 10-11 motor phoneme links that address the identified motor breakdowns based on the SAO • Put these phonemes together to create functional words and phrases • Embed functional words/phrases into interactive activities
Motor Phoneme Warm-Up PROMPT is based on the principals of motor learning. The purpose of the warm-up is to: 1. Help child focus attention to the act of motor control 2. Set the appropriate boundaries for the involved muscular actions 3. Provide multiple practice opportunities 35 repetitions for a single target (mass practice) so motor schemas/plans can be recalled and more readily accessed in activities (distributed practice) 4. Provide specific verbal feedback regarding knowledge of performance and knowledge of results
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Motor Phoneme Warm-Up • Another key aspect of PROMPT treatment is…feedback • Clients require specific feedback to change • Knowledge of Performance • Specific information about motor actions • “Use your round lips”, “No wiggly jaw” • Knowledge of Results • Information about whether the production was correct or incorrect • “That was it”, “No- that wasn’t right”
Cognitive-Linguistic Domain Environment External Cultural Physical Social
Cognitive Linguistic Perception sensation discrimination recognition Concept Formation
interpersonal
Physical Sensory SensoryMotor
Skeletal Structure Neuromuscular Integrity Sensation
Communication
Client
intrapersonal Behavioral Outcomes
Internal
Social Emotional Interpersonal Interaction Trust
Hayden 02
Social-Emotional Domain Environment External Cultural Physical Social
Cognitive Linguistic
interpersonal
Perception sensation discrimination recognition Concept Formation
Physical Sensory SensoryMotor
Skeletal Structure Neuromuscular Integrity Sensation
Communication
Client
intrapersonal Behavioral Outcomes
Social Emotional
Internal
Interpersonal Interaction Trust
Hayden 02
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PROMPT Conceptual Framework Environment External Cultural Physical Social
Cognitive Linguistic
interpersonal
Perception sensation discrimination recognition Concept Formation
Physical Sensory SensoryMotor
Skeletal Structure Neuromuscular Integrity Sensation
Communication
Client
intrapersonal
Behavioral Outcomes
Social Emotional
Internal
Interpersonal Interaction Trust
Hayden 02
Support Strategies • Strengths and weaknesses in relation to the Conceptual Framework determine support strategies • Support strategies are any strategy that needs to be in place for a client to be available for learning • Task Selection, task hierarchy, timing/pacing
Support Strategies: Physical-Sensory • Supported seating • PROMPT: 4 levels • Gross/fine motor breaks • Gestures and signs • Sensory strategies • Occupational Therapy • Physical Therapy
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Support Strategies: Cognitive-Linguistic • Clear expectations • Consistent instructions • Consistent feedback • Visual schedules • Augmentative alternative communication • Predictable play routines • Match language model to language age • Cognitively appropriate tasks
Support Strategies: Social-Emotional • Positive reinforcement • Social stories • Clear boundaries • Clear feedback • Verbal praise for specific behaviors • Peer models • Caregiver involvement
What to Expect: Parents/Caregivers • Strengths/weaknesses • System Observation Analysis (SAO) • Motor Speech Hierarchy (MSH) • Conceptual Framework • Tactile support in treatment • Home programming
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What to Expect: SLPs • • • • • • •
Holistic – addressing all of the domains Inclusive – bringing caregivers/families into the treatment process Motor rather than strictly auditory or developmental model “Speech through speech”, no oral-motor Proximity to client and tactile cueing New motor skills All treatment is functional and interactive
Current PROMPT Evidence Pyramid 13+ studies; 135+ subjects; $2+ million Meta-Analysis 2019
To be presented at July 2019 Apraxia Kids Conference
Multi-Center RCT 2018
results presented ASHA 2018; publication anticipated early 2020 Yu et al. 2018-SSD Fiori et al. 2018 - CAS Yu et al., 2014 -SSD Namasivayam et al. 2013 SSD Kadis et al. 2013-CAS Square et al., 2014- SSD Dale & Hayden 2013- CAS Ward et al., 2013 a,b - CP Grigos et al., 2010- SSD Rogers et al., 2006 - Autism Bose et al. 2001- Adult apraxia Freed et al. 1997- Adult apraxia
Random Control Trial – Efficacy Study Results University of Toronto at ASHA Convention 2018
PROMPT intervention is a clinically effective treatment approach for children with severe Speech Sound Disorders:
• Significant change in: • Oro-Motor Control Skills • Articulation • Speech Severity (PCC) • Word-Level Speech Intelligibility • 10 weeks of therapy may be inadequate for • Changes in Sentence level intelligibility (BIT) • Functional communication (FOCUS) • Non-target variables in therapy do not change • Oro-Motor Sequencing • Phonological processes.
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Want to Learn More? • Visit PROMPTinstitute.org • Read evidence-based research • Find a PROMPT Trained Therapist • Register for the Introduction to PROMPT: Technique Course
Thank You! We enjoyed sharing PROMPT with you! Additional questions? You are welcome to contact us:
[email protected] [email protected]
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