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Deborah Hayden first began to develop PROMPT (PROMPTs for Restructuring Oral Muscular Phonetic Targets) in the late 1970's. Since then, PROMPT has continued to evolve. In the 1970's, the systematic manipulation of tactual-kinesthetic-proprioceptive input to oro-motor structures for changing speech targets was begun with children who presented severe motor impairment. These children did not respond to traditional treatment approaches that rely predominantly on auditory and visual input. The development of PROMPT treatment for them was grounded in theoretical and clinical perspectives that cross several disciplines concerned with physical, mental and social development.

The focused use of tactile-kinesthetic input was influenced by the early work of scholars and practitioners who explored the tactile system in the neurological organization of normal and diseased brains and embraced its use in the clinical treatment of motor disorders including speech articulation. As PROMPT evolved over time, it was influenced more broadly by scholarly work that included the neurobiological, the cognitive-linguistic and the social aspects.

Taken together, these multiple theoretical perspectives stimulated questions about: 1. how motor systems typically develop; 2. how dynamic interaction and equilibrium among whole body systems affect speech, language, and social interaction; and 3. how damage to the neuromotor pathways can unbalance the motor speech system and affect physical, mental and social functioning either directly or indirectly. Answers to these questions have led to much broader conceptualization of the speech production process than is typically described in the literature. PROMPT's multidimensional approach to speech production disorders has come to embrace not only the well known physical-sensory aspects of motor performance, but also its cognitive-linguistic and social-emotional aspects.

During the 1980's, the first empirical studies of PROMPT's treatment efficacy were done. These studies led to the development of the first manual describing the technique of PROMPTing. In 1984, the first publication describing PROMPT appeared (Chumpelik (Hayden), 1984). It described the technique and use of "surface" tactile PROMPTs. They provide input about place of articulation, the amount and type of muscular contraction, movement transition and timing needed to produce speech sounds. At the same time, the issue of how a 3 - dimensional "intraoral" target movement system might affect co-articulatory reality began to be explored. This exploration focused on how phonatory, mandibular, labial-facial and lingual movements worked interactively in speech production and on how these subsystems could be re-balanced using tactile input to develop clear speech.

Also in the 1980's, collaborative research began with Paula Square whose research at the University of Toronto focused on acquired speech dyspraxia in adults. In the 1990's, standardized assessment protocols were developed, and PROMPT treatment refined. VMPAC showed that development of the speech subsystems (i.e., mandibular, labial-facial, and lingual control and sequencing) was consistent with the hierarchical, interactive model of the Motor Speech Hierarchy. Children with normal and disordered speech developed motor control, flexibility and integration of the motor subsystems as age increased, although the disordered group was slower to develop than was the normal group.

With respect to PROMPT treatment in the 1990's, emphasis began to be placed on the concept of "planes of movement" (vertical, horizontal, anterior-posterior) used in co-articulated speech, and on how these movement planes become coordinated in normal speech. Attention was given to how much motor control was needed to produce words (i.e., a lexicon) in either one or more movement planes. PROMPT treatment was refined with respect to selecting speech, language, and social interaction goals. The empirical validation of PROMPT as a clinical approach continues into the current century.

In the 2000's PROMPT's main focus has been to integrate all of our previous research, experience, and writings into a cohesive model. The PROMPT model coming from a dynamic systems theoretical position utilizes tactual sensory information (in addition to auditory and visual), to support and develop speech-motor functioning leading to improved communication functioning across all domains. The model now provides for assessment across all domains and in depth analysis of the motor speech subsystems. It also discusses how to choose the best focus for intervention, how to plan and organize treatment and how to select and use the most appropriate level or levels of PROMPTs.

Also of importance, has been the refinement of many aspects of operations. For example, management, materials upgrading, instructor mentoring and training have all changed significantly in the last few years. Since there are more than 35 instructors, on 4 continents, it is critical to provide consistent, well-organized information. Because PROMPT is committed to teaching excellence an Instructor Coordinator position was added in 2005, to keep all instructors up-to-date and involved in on-going training. We have also worked to upgrade our web page and data base capacities for clinician referrals.

We have established a PROMPT Clinic in Santa Fe, New Mexico, at our headquarters. Research efforts continue in the areas of autism, apraxia, cerebral palsy and other motor speech disorders. In the near future we hope to look at a multi-site study with different speech production disorder populations in order to make better predictions about the way PROMPT treatment should be delivered to different populations and the amount of change that may be expected using PROMPT.


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