Friday, November 2, 2012

Defining Apraxia & PROMPT© therapy

Childhood Apraxia of Speech (CAS) “is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements for speech are impaired." CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin, or as an idiopathic neurogenic speech sound disorder.

Childhood Apraxia of Speech (CAS) is a complex and variable motor based speech disorder which emerges in early childhood, marked by inconsistent and imprecise motor executions.

Although there are not any formal guidelines for diagnosing CAS, as it is a variable disorder and features change over time, there are three key features that SLP’s look for to identify such a disruption in a child’s motor planning:

Inconsistent Speech Sound errors in repeated productions of syllables and words
Disrupted and/or lengthened co-articulatory transitions between sounds and syllables, as well as impaired prosody (or rhythm of speech)
Inconsistent errors in repetition of the same target. (This is the strongest indicator of CAS)

Children with CAS tend to also have impairments in non-speech motor movements. They also tend to present with vowel and sound ordering errors, while experiencing groping.

A diagnosis of CAS is reached via an assessment in observation of the child’s speech production skills, prosody, and expressive language and non-speech skills. Such an assessment may include:

A sound discrimination task (have children listen to, and discriminate phonemes)
Syllable repetition and alternating production task (such as asking the child to repeat: “pu-tuh-kuh” several times)
Sound imitation task: Children with CAS have significant difficulty imitate sounds.Obtain a speech sample of utterances of greater length and complexity.
Administer a standardized Articulation Test, such as the GFTA (Goldman Fristoe Test of Articulation) to evaluate all sounds in varying word positions. 

Chatterboxes’ SLP’s are trained in a specialized form of ‘hands on’ speech therapy, known as PROMPT© therapy. The PROMPT© System stands for ‘Prompts for Restructuring Oral Muscular Phonetic Targets’.

WHAT:          PROMPT© is a dynamic tactile method of treatment for motor speech disorders which is based on touch pressure, kinesthetic and proprioceptive cues.

WHY:            PROMPT© helps to reshape individual and connected articulatory phonemes and sequences (coarticulation).

WHO:            During this approach, the clinician helps to manually guide articulators to produce specific sounds or words that seem to be problematic.

HOW:            This is a hands-on approach. The SLP uses her hands to cue and stimulate articulatory movement, at the same time helping the child to limit unnecessary movements

The below series of photographs demonstrate the touch cues that may be applied during a typical PROMPT© therapy session by the Speech-Language Pathologist. Please note: such kinesthetic cues may be provided by the SLP to aid the child in eliciting a single sound, such as “ah.” In addition, combinations of tactile cues may be used to aid in elicitation of sound combination, single words, short phrases, and even sentences.  More information about PROMPT can be obtained via  

The PROMPT photograph demonstration is as follows: