A Presentation by Shawna St. John and Amy Kuck

What occurs during normal speech development?

Children must be able to process sensory feedback, including auditory, tactile, and kinesthetic elements, for early word production to develop.

Leads to the development of internalized plans of action and programs for the timing and spatial aspects of speech.

Automaticity

As children mature, speech movements are refined.

Ultimate goal:Precisely timed, flexible, and coordinated movements that meet a speech output goal Use sensory feedback to make online adjustments while speaking.

What happens when there is a breakdown?Childhood Apraxia of Speech (CAS)

Motor speech planning and programming disorder

Inability to “translate phonemic and linguistic codes to differing planes of movement overtime” (Hayden, Strand & Velleman, 2004).

Inability to use motor plans and programs for automatic speech movements

What can be done to address that breakdown?Tactile-Kinesthetic Approaches

‘‘Map in’’ spatial and temporal parameters of movement Highlight sensory feedbackDevelopment of schemas/motor plans that have not developed naturally

(Caruso & Strand, 1999)

Theoretical basis: Feeling speech is critical for speech production, treatment approaches that enhance feeling should work!

Prompts for Restructuring Oral Musculature Phonetic Targets (PROMPT)

Conceptualization of Communication

(Hayden, 2007)

VII: Stages are combined on multiple planes using precise control to create intonation, stress, juncture and prosody in speech.

VI: Stages are sequenced, controlled, and precisely timed on multiple planes of movement.

V: Integrate front-to-back tongue movements.

IV: Adding additional planes of movement. Integrate face and lip control with breath support and phonation and jaw movements.

III: Single movement to combined movement on a single plane. Control of jaw movements; reduction of side to side and front-to-back jaw sliding

II: Breath support and phonation control to support speech

I: Postural support for speech; trunk, head and neck control; suppression of abnormal oral-motor reflexes

(Hayden, 2007)

(Hayden, 2007)

Treatment PlanningPinpoints how the child is using their communication and where the breakdowns are occurring based on the motor speech hierarchy.

Treatment Phase 1Motor Control Of:

Stage II (phonation and voice)III (jaw) IV (lip and face)

Motor Speech Goaldevelop motor speech control in one plane of movement

Language and Interaction Goal use sounds and syllables for oral communication in highly structured activities and routines

(Hayden, Strand & Velleman, 2004)

Treatment Phase 2Motor Control Of:

Stage III (jaw)IV (lip and face)V (tongue)

Motor-Speech Goal build on phase one by combining two planes of movement in a speech sound sequence and to refine movement

Language and Interaction Goal Develop a lexicon, include semantic-syntactic relations in language, use short phrases for turn taking and interaction routines

(Hayden, Strand & Velleman, 2004)

Treatment Phase 3Motor- Speech Goal

Refining speech motor control by producing words and phrases involving three planes of movement (vertical, horizontal, anterior-posterior)

Language and Interaction GoalUse more complex phrase structures and generalize the learned motor-speech control to less structured activities with less support from the clinician

(Hayden, Strand & Velleman, 2004)

Prompts for PROMPTDifferent prompt for each English Phoneme that are given externallyTiming, duration, pressure, tension very important!

Place of contactplace of articulation

ClosureDegree of jaw closure necessary

Manner voicing, duration, continuancy (open oral or nasal cavities), movement (of articulators), fusion (co-articulation), lateralization (air around the tongue), labialization (secondary lip closure by lip rounding)For prompts – specific features of phonemes are highlighted

/k/ - duration, place, jaw heightMuscles used

Facial prompts given to on certain muscles Tension

Vowels – tense/ laxConsonants – time required to produce

/g/ needs more tension than /k/ because of voicing

(Chumpelik (Hayden), 1984)

Prompts for Consonants

(Chumpelik (Hayden), 1984)

Place of Contact

(Chumpelik (Hayden), 1984)

Jaw Height

(Chumpelik (Hayden), 1984)

Prompts for PROMPT Cont. Tactile-kinesthetic information across phonemes in connected speech

Transition from phoneme in isolation, to short phrases, to connected speechIn phrases, prompts are given to target phonemes

/ b g b l/

Incorporate suprasegmental aspects of speechStress

Lengthening the duration of a prompt to a vowel Timing in speech

Altering the duration of prompts, speed of combined prompts used(Chumpelik (Hayden), 1984)

What is the research showing?

Efficacy of PROMPT for Children with CASChumpelik (1980)

8 year old non-verbal maleautism & cognitive impairment4 months of PROMPT, he acquired 40 words

Chumpelik & Sherman (1983)Auditory-Visual tx and PROMPT tx for CAS4 males with normal cognitive and gross motor abilities4 males with moderate cognitive deficits with motor impairmentAll participants had severely impaired speechAll children significantly changed the production of target wordsTypically developing males had a larger change with the PROMPT Children with motor impairment only improved with PROMPT treatment.

What is the research showing?

Square, Goshulak, Bose, and Hayden (2000)6 males, 4;2-4;6Speech- motor deficits Not responding to traditional treatmentsPre and post standardized tests of phonological, motor, language, and social skillsImproved intelligibility of target words, intelligibility generalized to untrained words, and significant improvements in other domains

Rogers et al. (2000)10 Children, 24-57 MonthsAutismComparison of Denver Model and PROMPTDenver Model relies on imitationIn each group one child with significant gains, three with good gains, one with no gains80% of children developed spontaneous speech

Works CitedChumpelik (Hayden), D. A. (1984). The PROMPT system of therapy: Theoretical framework and applications for developmental apraxia of speech. Seminars in Speech and Language, 5, 139–156.Chumpelik [Hayden], D. & Sherman, J. (1980). Using a tactile approach in the acquisition of functional oral communication in a non-verbal, eight year old autistic child: a case study. Unpublished research.Chumpelik (Hayden), D., & Sherman, J. (1983). Treatment comparisons for developmental apraxia of speech. Unpublished research, Thistletown Regional Centre, Toronto, ON.Hayden, D. (2007). PROMPT: Prompts for Restructuring Oral Muscular Phonetic Targets. Introduction to Technique: Manual. Santa Fe, NM. Hayden, D. A. Strand, E., & Velleman, S. (2004, November). Comparison of three treatment approaches for childhood apraxia of speech. Short course presented at the American Speech-Language-Hearing Conference, Philadelphia, PA.Rogers, S. J., Hayden, D. Hepburn, S., Charlifue-Smith, R., Hall, T., & Hayes, A. (2006). Teaching young nonverbal children with autism useful speech: A pilot study of the Denver Model and PROMPT interventions. Journal of Autism and Developmental Disorders, 36(8), 1007–1024.Square, P.A., Goshulak, D., Bose, A., & Hayden, D. (2000, February). The effects of articulatory subsystem treatment for developmental neuromotor speech disorders. Paper presented at the Tenth Biennial conference on Motor Speech Disorders and Speech Motor Control, San Antonio, TX.The PROMPT Institute. (2005). Retrieved April 22, 2008 from http://www.promptinstitute.com/aboutus.html.