The following article was written by PROMPT Instructors Jennifer Moore, MS-CCC- SLP and Natalia Eva Mir MS-CCC-SLP for the PROMPT Institute Parent’s blog.
PROMPT can be an effective tool for teaching verbal communication to individuals who are nonverbal. The key to making the transition to verbal communication is assessing the strengths and weaknesses in each of the communicative domains (cognitive-linguistic, physical-sensory, and social-emotional) and then developing a treatment plan which addresses the needs in each area. Examples of contributing factors in the physical-sensory domain can be motor planning difficulty/apraxia or high/low muscle tone or spasticity. In the cognitive-linguistic domain, poor receptive language skills (understanding of language/concepts) and low IQ can contribute to limitations in verbal language. Poor understanding of the use of language to communicate is a factor in the social-emotional domain. For example, many children with autism will vocalize/engage in vocal “stim”, but they are not using the vocalizations for communicative purposes. Once the weaknesses in each domain are identified, the therapist can focus treatment on developing those skills in each domain.
An individual’s readiness for verbal communication is evidenced by their intent to communicate. The turning point toward verbal communication is when the individual begins to show intent to communicate (prelinguistic behaviors) and is able to vocalize on command or with tactile cues. Prelinguistic behaviors include gestures such as pointing, reaching, grabbing, and eye contact. Many individuals who are nonverbal do not have the understanding that their voice has meaning and can be used to communicate.
When working with a nonverbal individual, the therapist should address the weaknesses in each of the domains in order to build the skills necessary for verbal communication. For the physical-sensory domain, the PROMPT therapist will use mostly Parameter Prompts (broad, organizing prompts which target larger muscle groups) and surface prompts (prompts which target timing, pressure, and transitioning between sounds). For example, the therapist may use a prompt to cue voicing and then another to lower the jaw for “ah”. Motor control needs to be achieved at the lower subsystems (basis for speech production: phonation and jaw) and work its way up to the more complex systems (lips, tongue, sequencing).
The therapist will then tie in the cognitive linguistic domain by linking “ah” to the word “on”. The individual says “ah” and then the movie is turned “on”. The link is further established by the therapist using surface prompts to “map in” a concept. The individual may produce “ah” and the therapist then provides the full word “on” by using surface prompts. We use the term “mapping in” for linking cognitive-linguistic concepts with verbal motor movements. The individual may not be ready to produce the full word form of “on”, but can feel the entire word with the use of surface prompts. This begins the process to set the neuropathway for the full word.
In PROMPT therapy, the words (lexicon) are practiced during meaningful, interactive routines. The meaningful, interactive routines tie in the social-emotional domain. The individual will use the word “on” to request the movie being turned “on”. Communication requires a successful balance of all 3 domains working together. The individual must have some balance in all 3 domains to transition to verbal language. The key is linking all three domains within the communicative exchange in order to set the neuropathway. For example, to use the word “on”, the individual must be able to produce the verbal movements for an approximation/word (physical sensory; voicing, jaw open-close, ah-n), have an understanding of the word (cognitive-linguistic; “on” means the movie will play), and use the word appropriately and meaningfully (social-emotional; say “on” to the caregiver who can play the movie).
PROMPT can be used with nonverbal individuals in the aforementioned manner. Overall, communicative intent and activation of the 3 domains are needed for successful, verbal communication.