rOMP

T
prompts for restructuring oral
muscular phonetic target
 PROMPT is a motor speech approach,
reported to be used with both adults
and children that is unique in that it
utilizes tactile input to facilitate
speech production in addition to the
auditory and visual cues frequently
relied upon other treatment
approaches. Therapists begin by
helping patients produce certain
phonemes. The system uses a
different prompt for each phoneme
(Square et al., 2000)
 muscle
contractions/retractions

Each
phoneme placement/movement of

requires
the jaw

different

lips, tongue, -voicing

-nasality
 All of these things have to
happen with the proper timing
and sequence to produce one
phoneme correctly. The
therapist attempts to “teach”
the patient’s muscles to
produce a phoneme correctly
by stimulating all of these
through touch. With the timing
and movement of more than
100 muscles involved, you can
see why the training is so
intense. (Hayden &Square,
1994).
 Especially crucial to the system
is the timing of each prompt
imposed by the clinician on the
patient. This becomes especially
important when moving form more
static segment productions to
transitional and coarticulation
processes in phrases and
sentences. Duration of the prompts,
pressure on specific muscle groups,
and tension placed on those muscle
groups help to develop afference for
the development of appropriate
programming (Chumplik, 1984).
PROMPT presupposes that
one of the most
important organization
factors in human
development, affecting all
domains, is active touch
which refers to both
surface contact and co-
occurrence of tactual,
proprioceptive and
kinesthetic information
(Cholewisk & Collins,
1991).
 Thus touch may be viewed as
the underlying glue that holds all
other sensory systems (e.g. visual,
auditory and tactual information)
together. Touch also promotes the
amalgation of focus, the
development of cognitive- linguistic
association and greatly enhances
the development of speech
 auditory

Multisensory
movement
Visual input

tactile
MOOTOR SPEECH HIERARACHY
 facial Jaw height Myelohyoi d Nasal laryngeal Mouth contact timing Pressure
(tension)
/b/ First and 1 9 1.2 hold firm
second fingers
hold lips closed
/p/ First and 1 1,2 fast moderate
second fingers
hold lips
closed/ pull out
/t/ 1 A 9 9,5 fast Slight

/d/ 1 A 9 9,5 hold Firm

/k/ 3 D 12-8 Fast Slight

/g/ 3 D 12-8 Hold Firm

/l/ 2 Move C to A 11-10- 9-5 Moderate

/r/ 1-2 if myeloh 1 D crooked 12,8 Hold firm

yoid prompt s finger
doesn't work
/f/ 5 1 2,3 Hold Slight

/v/ 5 1 9 2,3 Hold Slight

 facial Jaw height Myelohyoi d Nasal laryngeal Mouth contact timing Pressure
(tension)

/Ѳ/ 1,2 2 B 9,3-4 Hold slight

/ð/ 1,2 2 B 9 9,3-4 Hold moderate

/s/ 6,7 press in 1 A 3-4,9-4 Hold moderate

forward
/z/ 6,7 press in 1 A 9 3-4,9-4 Hold moderate
forward
/ʃ 6,7 press in 1 A-C 10,6…. 7 Hold moderate
forward
/ʒ/ 6,7 press in 1 A-C 9 10,6…. 7 Hold moderate
forward
/m/ 8 hold lips 1 8 Hold firm
togethe r
/n/ 8 1 A 8 9,5

/ŋ/ 8 1 D 8 12,8,8+

/h/ Low air on each 2

other's hands
1)Muscle tone and bone
structure

Low muscle tone

-High muscle tone
-Orthodontics
2)Control of airflow
and voice

Non voiced sounds for . /p/. /t/

-Voiced sounds for/b/, /d/
-Nasal (nose) sounds for /n/ and
/m/
 3)Jaw movement and control
For all vowels and some consonants,
closure reflects the degree of jaw
openness "height" needed for
primarily target movement. The
PROMPT system concerns itself with
four different jaw positions:
1- Neutral resting. In this position the
teeth are just touching and the jaw is
loose. Most consonant productions
are made in this position, especially
in the running speech.
2- Part open: in this position the jaw is
just slightly lowered, in a lax or very
relaxed stat.
 3- Half open: the jaw is
lowered slightly below
the number two
position.
 4- Full open: this
position is used only in
teaching some isolated
phonemes, for
differentiating vowels,
or aiding in the
production of
linguovelar sounds /g/,
/k/. Vowels that require
this position are /æ/
and / (Chumplik, 1984).
 Poor differentiation between open jaw
middle jaw and closed jaw movement can
result in sound
Distortion, Omission and substitution

(Chumplik, 1984). Figure 8 illustrates the jaw

position for
vowel production.
 4)Lip and facial
control
Lips together /p/, /b/, /m/
Rounded lips /u/
Smiling lips /i/
Button lips /f/,/v)
Top lips move evenly
4)Lip and facial control
 Muscles used in specific phoneme production:

The system continually uses the muscles

and muscle groups to effect a given target
position. For example, the facial prompts
are given on specific location positions
around the orbicularis oris, buccinators,
and zygomatic muscles. For the mylohyoid
prompts, attention is paid to the difference
in muscle tension and combined
movements of the various tongue muscles.
(Chumplik, 1984).
 8
3
4
6
7
1
2
5
9

Figure 9: Facial prompts. (Chumplik, 1984).

1,2 at lips corners (intersection between zygomatic maior and
arbicularis oris)
3,4 above lip corners (between levator anguli oris and zygomatic
major)
5 beyond lip corners: point of contact for /f/ and /v/ (intersection
between buccinators and zygomatic major)
6,7 beyond lip corners (intersection between buccinators and
zygomatic major)
8. point of contact for nasal prompt 9. point of contact for voiced
prompt
 5)Tongue control
and targetness

 Place of contact specially denotes

the primary target movement or
end product to be reached.
Perhaps it should be stated that
"targetness" denotes a movement
towards an end point that will
result in an acoustically
acceptable production of the
phoneme selected by the speaker.
If this is the case, then place of
contact will likely vary to some
degree, depending on the
contextual constrains and
structural deviations of the
individual.
 The PROMPT system gives locations
or end points to be reached by the
articulators and in this sense
specifies place orientation (Chumplik,
1984). next Figure illustrates the
place of contact of most of
phonemes
 The mouth by numbers:
1. Upper lip 2. Lower lip 3. Upper central incisors
4. Lower central incisors 5. Alveolar ridge 6. Front hard palate
7. Mid hard palate 8. Soft palate/velum 9. Tongue tip
10. Apex 11. Blade front 12. Dorsum
13. Larynx 14. Nasal
Figure 7: place of contact for target position (Chumplik,
1984).
6)Overall coordination,
sequencing and tension
Tension is a well-established term in
describing vowel characteristics. For
example, /i/ is described as tense
unrounded, high-front vowel. The
phoneme/o/ is described as tense,
rounded, high , mid-back, and /u/ as lax,
rounded, low-high, back. Tense vowels are
described as longer in duration and
involving a greater degree of muscular
tension.
 In consonants, tension is
normally not an ascribed feature.
Instead, they are described with
such terms as high, low, back,
rounded. In PROMPT system,
tension of muscle groups is
noted in the timing required by
the contact to produce the target
position. Tension and timing are
variables that significantly affect
target phoneme production
(Chumplik, 1984)
Transitive movement of phonemes in
connected speech
 The PROMPT system is unique in
that it allows the clinician to cue
or prompt each target or target
series at a syllable, word, or
phrase level. Prompts may be
strung together to produce an
overall pattern that closely
duplicates that of the
articulatory movements to be
matched or to move the patient
through the series at the time of
production.
 In other words, the clinician may
prompt for a two-phoneme
combination, such as /to/, or a
three-phoneme combination such
as /æple apple. At a phrase level,
the clinician may prompt all, or key
targets to be reached. The ability
of the system to provide for
transitive movement is
especially important in such
disorder as AOS in which
sequencing of phonemes is seen
as the most salient problem
(Chumplik, 1984
 Box 1: new speech action
(phoneme or syllable)

Box2: Previously established action

routines (phoneme or syllable)

Box3: Integration of established action routines into

larger units (phoneme or syllables into words)

Box4: Patterned contextual units

(programmed words or phrases)
 Timing for transitive
movement:
 Timing is closely tied to transitive
movement and stress.
 Timing is critical to a well-produced,
sequential phoneme
production at the multiple syllabic word and
phrase levels.
 The clinician using the PROMPT system can
alter timing
by the duration of the prompt, the overall
speed of the
combined prompts and by the specific
selection of some
 key prompts over others in a sequence
(Chumplik, 1984).
7)Prosedy
:
Prosody is the natural
melody and rhythm of
speech: Stress Pitch
Intensity and timing
 Stress, as a general
definition, refers to the
degree of effort,
prominence, or importance
given to a part of phrase or
sentence. Stress is usually
discussed with respect to
syllables because of its
influences that extend
beyond the initial phoneme
target
 In PROMPT system,
stressing for
suprasegmentals is possible
because the clinician may
emphasize vowel durational
or intensity differences by
marking or choosing to
intervene with a prompt at a
certain place within the
phrase. Speed of utterances
as well as various stress
markers can be controlled
(Chumplik, 1984).
Organization of the system:

 The headings in table refer to

various aspects of the
components just mentioned,
such as the jaw height or
closure, and to such specifics
as finger placement for facial
prompts. The myelohyoid
category shows the
myelohyoid prompt position
for each phoneme, when one
is used, and mouth contact
refers to place of contact.
 Prompts for all phonemes are discussed using
the following
 characteristics as they appear most salient.
 1- Facial prompts (according to figure 2)
 2- Jaw height (according to figure 1)
 3- Myelohyoid prompt (according to figure 3)
 4- Resonance factor "nasality" (according to
figure 4)
 5- Mouth contact (according to figure 5)
 6- Timing "speed" of contact
 7- Tension required in specific muscle and
specific muscle groups
 These stages are inter-dependent;
that is, each stage interacts with the
stage above and below it, and each
stage is considered with the content of
the entire system. The clinician must
have thoroughly assessed the patient's
level of motor control at each stage.
This ensures that the intervention will
begin at the correct level.
 .
The system has been used to
treat a number of disorders
including phonological,
developmentally delayed,
dysarthric, apraxic, fluency, and
hearing impaired. Children and
adults have been treated both
individually and in group
sessions.
Chumpelik, D. (1984). The PROMPT
system of therapy: Theoretical
framework and applications for
developmental apraxia of speech.
Seminars in Speech and Language, 5,
139–156
Hayden, D. (2002). Introduction to
PROMPT: Technique Manual revised.
Sante Fe, New Mexico: The PROMPT
Institute

Hayden, D., & Squqre, P. (1994). Motor speech

treatment hierarchy: A system approach. Clinics in
Communication Disorders,
4, 162-174