PROMPT for Speech Therapy: Expert Analysis and Insights from an SLP

Amy Yacoub
CCC-SLP
May 13, 2024

The PROMPT method is a hands-on approach used in speech therapy to improve speech sound production. 

PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) involves the use of specific tactile cues provided by the Speech-Language Pathologist (SLP). The unique technique is frequently used with children who have apraxia, though it can also be used with individuals of all ages diagnosed with speech disorders.

In this comprehensive review, we delve into the methodology of PROMPT for speech therapy, the purpose, who it can benefit, and other essential information about the technique. We’ll also present an expert insight on PROMPT therapy from a Speech-Language Pathologist. 

What is PROMPT Therapy?

PROMPT is a holistic, multisensory approach to improving speech production that combines principles of motor learning and neurodevelopmental theory. The PROMPT method was developed by the Speech-Language Pathologist Deborah Hayden in the late 1970s. 

Purpose

The purpose of PROMPT therapy is to facilitate speech production for individuals with motor speech disorders, articulation disorders, or who are non-verbal. The goal of PROMPT is to integrate input from various sensory systems (tactile, kinesthetic, visual, auditory) in order to improve motor control and coordination. 

How it Works

1. The PROMPT method starts with an assessment (typically 1-2 hours long) that evaluates how the individual functions across three domains (social-emotional, cognitive-linguistic, and physical-sensory). Input from caregivers is also obtained from the SLP. 

2. An assessment tool called the System Analysis Observation (SAO) is used by the PROMPT trained SLP to determine where the motor breakdown occurs during speech production. The SLP uses information from the SAO and client observations to complete a Motor Speech Hierarchy (MSH). The MSH helps the speech therapist develop an individualized treatment plan which includes specific stages that have been identified as priorities to target. 

3. Typical PROMPT sessions for speech therapy last between 30 to 60 minutes, and may be scheduled 1-2 times per week. The frequency of sessions varies depending on the client’s need and the setting where therapy is provided. 

The PROMPT method differs from other prompting speech therapy techniques that speech therapists commonly use in sessions (such as verbal and visual prompting to produce certain speech sounds), as it consists of specific, unique techniques. 

Key Components 

Key Components of a PROMPT speech therapy session include: 

• Attractor State: This refers to the way that the individual prefers to move when attempting speech. By identifying the child’s attractor state, the SLP can better understand the level at which he or she becomes “stuck” when communicating. 

• Motor Speech Priorities: Motor speech priorities include specific movements that can help the individual produce words, phrases, and sentences more accurately. The SLP determines the motor speech priorities to target in therapy, collaborating with the client and family to ensure that the goals are functional and relevant to their communication in daily life. 

• Motor Phoneme Warm-Up: The client is given several practice opportunities in which the SLP helps them focus their attention on moving the articulators (jaw, lips, and tongue) accurately during speech. This might consist of producing specific words, phrases, and sentences. During the phoneme warm-up, the client may repeat the target between 3 to 5 times. 

• Mapping: This PROMPT technique involves the PROMPT-trained SLP using his or her hands to provide touch cues on the client’s face and mouth, shaping correct articulatory positions for speech sounds. Unique touch cues are given for specific sounds, aiming to link motor movements to the understanding and use of words. The client is not expected to say the concepts out loud during mapping. 

• Reciprocal Turn-Taking: The SLP takes turns completing the same actions the child is expected to do during sessions. This includes saying the same words and engaging in the same activities. 

• “On-line” Shaping: This critical component of PROMPT speech therapy involves the SLP using their hands to help a child say a word or phrase by correcting or reinforcing a physical movement of the articulators. On-line shaping occurs throughout a PROMPT session to consistently help the client become successful in improving his or her motor movements during speech production. 

Target Audience

PROMPT therapy can be used for individuals of all ages who experience speech production difficulties. PROMPT is frequently used with children who have the motor planning disorder Childhood Apraxia of Speech. 

Individuals with neurological disorders, including children with Cerebral Palsy and adults recovering from a stroke may also benefit from the use of PROMPT in speech therapy. 

Benefits

According to growing research on PROMPT, the technique can improve communication skills, including: 

• Improved Speech Sound Production: PROMPT can help individuals with motor planning disorders such as Apraxia increase their phonetic inventory (learn to produce more sounds, and improve sound sequence productions within words and connected speech.

• Clearer Articulation: PROMPT can help children with articulation disorders articulate specific sounds more accurately and clearly by guiding the placement of oral musculature to form the sounds. 

• Enhanced Speech Intelligibility: By addressing speech sound difficulties, PROMPT can lead to clearer speech that is easier for others to understand.

• Increased Social-Emotional Functioning: Studies show that children with Apraxia of Speech can have negative attitudes and frustration related to communication. PROMPT can help children communicate more effectively, potentially improving their ability to interact with others. 

Training & Certification 

PROMPT is a trademarked approach by the PROMPT Institute. Therapists must undergo specialized training and certification in order to become a PROMPT practitioner. 

Speech therapists can receive PROMPT training by participating in the worldwide workshops offered by the PROMPT institute. Some workshops are in-person and others are available online through Zoom. 

In order to become PROMPT Certified, clinicians are required to complete the following 4 steps: 

1. Introduction to PROMPT 3-day workshop (in person or online)
2. PROMPT Technique Practicum Project
3. Bridging PROMPT Technique to Intervention 3-day workshop  (in person or online)
4. PROMPT Certification Project (a self-study project)

PROMPT for Speech Therapy: An SLP’s Review

I will use my clinical expertise and experience as a Speech-Language Pathologist (SLP) here to provide a thorough review of the PROMPT technique. Within this detailed analysis, I will also include documented reviews from others and explore the methodology, specialized strategies, impact, cost, and support involved in the therapy technique. 

Methodology & Process 

In my opinion, PROMPT is a unique, effective treatment option for SLPs to use for improving motor planning and speech production skills in individuals with speech disorders. I believe it can be particularly effective for children with apraxia:

• Based on principles of motor learning.  

• Involves multisensory integration. According to the American Speech-Language Hearing Association (ASHA), external cues through sensory input can facilitate speech production by providing additional feedback to the individual, who may not be receiving sufficient intrinsic sensory feedback. 

• Tactical-kinesthetic input can effectively guide clients in producing sounds, words, and sentences. 

Teaching Strategies

PROMPT therapy is highly individualized. This allows flexibility in its approach to meet the unique needs of each client. 

In my opinion, the PROMPT assessment can effectively help clinicians identify specific areas of difficulty within the client’s speech sound production disorder. Through this, I believe the PROMPT program guides clinicians in the treatment planning process, assisting them with developing appropriate goals while creating an individualized treatment plan. 

I believe that the use of immediate, constructive feedback throughout PROMPT speech therapy sessions encourages clients to actively participate and self-monitor speech productions during exercises. 

Impact

Through my research of the PROMPT method, I have found several studies showing that PROMPT intervention is associated with improved speech motor control, articulation, and intelligibility of words. 

I see the PROMPT techniques as having the ability to yield long-lasting effects on clients. In my experience as an SLP working with individuals with apraxia, visual and tactile cues can improve a client’s motor planning skills during speech production over time. 

Additionally, research has shown that PROMPT treatment may lead to neural changes in the areas of the brain that have been linked to speech disorders. Due to the plasticity of the brain, PROMPT may then effectively yield detectable changes in an individual’s speech-motor learning and control.  

Cost

The cost of speech therapy sessions with clinicians who are trained or certified in the PROMPT method can vary depending on factors such as location. Sessions may range from approximately $100 to $200 per session. In my experience, many parents feel that this investment is justified by the significant improvements that may be seen in their child’s speech and communication skills. 

Support

A benefit of becoming a PROMPT trained or certified clinician is that the PROMPT institute offers extensive, quality support. Clinicians are typically provided extensive guidance for both the clients and families. 

PROMPT offers opportunities for peer interaction, including group sessions. This can help foster a sense of community among clients and families. Many clinicians also encourage families to attend sessions so they can provide suggestions for home carryover of activities and skills.  

User Reviews

The overall feedback I have found from researching first hand reviews on the PROMPT technique is positive. Many families report satisfaction in their child’s speech clarity and confidence. 

Families frequently highlight the interactive and supportive nature of PROMPT speech therapy. Parent testimonials say that the PROMPT technique has helped their child speak in sentences, improve the intelligibility (clarity) of their speech, and allow them to independently communicate with others. Parents seem to enjoy that PROMPT is a unique approach that yields observable results, and that clinicians typically assign enjoyable home exercises. 

One potential drawback of PROMPT mentioned in some user reviews is that some children do not tolerate or cooperate with the therapist using their hands on the child’s face or lips while providing prompts. 

Strengths of the Prompting Speech Therapy 

In my clinical opinion, the PROMPT technique stands apart from traditional speech therapy due to its integration of motor, sensory, and cognitive aspects of speech production. 

I believe that the tactile cues and prompts, which are used as part of a personalized treatment approach, can be highly engaging for the child and can effectively guide the individual to produce more accurate movements during speech production. 

Areas for Improvement

Obtaining PROMPT certification may be challenging and time-consuming for many clinicians, as the process is extensive and thorough. Additionally, limited access to a PROMPT certified SLP is a potential challenge for some individuals and families interested in the program.  

The tactile prompts given by the PROMPT therapist are an essential component of the program. However, a child’s level of tolerance and cooperation for this type of tactile input, and any sensory aversions that the child may have, should be considered when determining whether to introduce the PROMPT method. 

Bottom Line

PROMPT is a unique, effective treatment approach for improving speech production, articulation, and intelligibility in individuals with apraxia, articulation disorders, and neurological disorders causing speech impairments. 

Our Methodology: How We Reviewed the PROMPT for Speech Therapy

I completed a comprehensive review of the PROMPT method for speech therapy by utilizing a multifaceted approach. I have integrated a range of perspectives from a diverse set of sources to present an unbiased, thorough analysis of the effectiveness of PROMPT. I used the following methodology in my assessment of the value and effectiveness of the PROMPT approach:

• Evaluation Criteria: My review was guided by clearly defined criteria focusing on key areas, including:
  • Usability
  • Accessibility for diverse users
  • Level of support and resources provided
  • Functional application

• Evidence-Based Approach: My review included a comprehensive examination of how PROMPT treatment can improve speech production skills and overall communication skills for individuals experiencing motor planning difficulties resulting in reduced speech intelligibility. I developed an analysis through research from reputable sources such as research journals and publications. 

• User Feedback: I located direct feedback from individuals who have first hand experience using the PROMPT approach with their children. This feedback enabled a comprehensive assessment of the technique’s impact. 

• Unbiased Opinion: It is essential to note that this review is independent and free from any financial affiliations with tools or resources related to the PROMPT method. The insights I have presented here are based solely on my professional experience and expertise with the approach. 

• Expert Analysis: I synthesized my professional experience as a Speech-Language Pathologist trained in the PROMPT technique, working with children with Apraxia and articulation disorders with the opinions of other professionals in the field. This helped ensure a well-rounded and informed evaluation. 

Forbrain and PROMPT as Complementary Speech Therapy Methods

Forbrain and PROMPT are complementary speech therapy methods that offer a comprehensive approach to improving speech when used together. 

Forbrain utilizes bone conduction technology to transmit sound vibrations through specialized headphones and enhance auditory feedback. This can help individuals to better perceive their voice when articulating speech sounds. 

When used together, PROMPT and Forbrain may offer significant benefits. PROMPT focuses on improving motor planning and coordination involved in speech production through tactile kinesthetic prompts. Forbrain’s technology can complement PROMPT exercises by helping individuals better monitor and adjust their speech. 

Integrating Forbrain with PROMPT may improve motor planning, articulation, and overall speech intelligibility to allow individuals to effectively communicate and enhance their quality of life. 

Comparison of PROMPT Therapy and Forbrain

Final Words

PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is an effective approach used by Speech-Language Pathologists for improving motor planning and articulation in individuals with Apraxia and other speech sound disorders. 

The PROMPT technique is based on principles of motor learning, and PROMPT trained clinicians utilize specific tactile prompts to enhance motor planning, coordination, and execution of speech movements. The method’s effectiveness is supported by research, and users report positive feedback with the outcomes from the technique. 

Potential drawbacks of PROMPT include limited access to a PROMPT certified clinician. However, positive research and outcomes supporting the method may outweigh this. 

Speech-language pathologists, clients, and family members can consider using the auditory stimulation headset Forbrain to complement PROMPT speech therapy exercises. This holistic approach can potentially enhance the effectiveness of PROMPT therapy and improve an individual’s ability to produce clear, intelligible speech. 

References

Fiori, S., Pannek, K., Podda, I., Cipriani, P., Lorenzoni, V., Franchi, B., … & Chilosi, A. (2021). Neural changes induced by a speech motor treatment in childhood apraxia of speech: a case series. Journal of Child Neurology, 36(11), 958-967. DOI: https://doi.org/10.1177/08830738211015800 

Furlong, L. M., Morris, M. E., Serry, T. A., & Erickson, S. (2021). Treating childhood speech sound disorders: Current approaches to management by Australian speech-language pathologists. Language, speech, and hearing services in schools, 52(2), 581-596. DOI: https://doi.org/10.1044/2020_LSHSS-20-00092

Keller, S., & Maas, E. (2023). Self-reported communication attitudes of children with childhood apraxia of speech: An exploratory study. American Journal of Speech-Language Pathology, 32(4S), 1806-1824. https://doi.org/10.1044/2022_AJSLP-22-00163 

Namasivayam, A. K., Huynh, A., Granata, F., Law, V., & van Lieshout, P. (2021). PROMPT intervention for children with severe speech motor delay: a randomized control trial. Pediatric research, 89(3), 613-621. DOI: https://doi.org/10.1038/s41390-020-0924-4 

Amy Yacoub

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Amy Yacoub, MS, CCC-SLP is a Speech-Language Pathologist. She has over 12 years of experience working with children who have a variety of diagnoses and disorders, including speech and language delays, Childhood Apraxia of Speech, and Autism. She is trained in the PROMPT technique and Hanen Program. She is also an experienced consultant within the field

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