Describe different approaches to facilitation of speech/communication.
In Autism, Speech is one mode of communication. There are others, such as AAC , gesturing and sign language. No matter what the mode of communication may be, what is most important is that the system is internalized by the child with Autism who then feels more “in control”, and feels confident that the system works, and his or her needs are better met when the system works.
Facilitation of communication is the primary role of a speech and language pathologist, although most of us, O.T., teacher, parent must follow along and support the SLP in the method being trialed/used.
Some of the facilitation techniques are: PROMPT and NSOME.
PROMPT
The picture above demonstrates a therapist using PROMPT method to increase the oral-motor skills of a child with speech production disorder.
PROMPT (Prompts for restructuring oral musculature phonetic targets is a tactile-kinesthetic system, a philosophy that tries to integrate all aspects of communication; motor, cognitive-linguistic and social-emotional.
It can be useful in sevral speech disorders and conditions including disarthria, apraxia, hearing impaired, even non-verbal children with hearing loss.
Since children with autism respond to tactile, proprioceptive input, it can be derived that PROMPT methods are useful since they incorporate touch pressure kinesthetic tactile and proprioceptive cues and manual guidance of the clinician of the articulators.
Prompts are provided externally by touching muscles of face, under chin, mandible, nose and other structures that are involved in speech production.
The goal of the mothod is for the client to achieve intelligible speech and functional language. Check the following links for more detailed discussion on PROMPT.
NSOME
Any oral motor treatment not involving speech output is typically considered to be N-SOME.
Research on NSOME was indicative of biased view existence, where those who study phonology and professors that teach speech and sound disorders seem to find NSOME ineffective, while clinicians and those giving continuing education courses have maintained that in practice they believe NSOMEs help through strengthening of oral motor musculature.
There is significant debate whether this is appropriate argument since there is much difference between the oral musculature and limb muscle system.
Following are some interesting articles that point to such unsettled dynamic that exists today for NSOMEs. All articles below are available full text at the Misericordia e-Library.
1: Watson, Maggie M.; Lof, Gregory L. Language, A survey of university professors teaching speech sound disorders: Non speech oral motor exercises and other topics,
Speech & Hearing Services in Schools, Jul2009, Vol. 40 Issue 3, p256-270
2: Forrest, Karen; Iuzzini, Jenya. A comparison of oral motor and production training for children with speech sound disorders, Seminars in Speech & Language, Nov2008, Vol. 29 Issue 4, p304-311.
3: Lof, Gregory L.; Watson, Maggie M. Language, A nationwide survey of Non speech oral motor exercise use: Implications for evidence based practice, Speech & Hearing Services in Schools, Jul2008, Vol. 39 Issue 3, p392-407.
4: Kamhi, Alan G., A Meme’s-Eye view of Non speech oral-motor exercises, Seminars in Speech & Language, Nov2008, Vol. 29 Issue 4, p331-338.
Both strategies are very interesting. It seems like PROMPTS requires alot of hands on and is intense.
ReplyDeleteAudra
Deepali, What does N-some stand for?
ReplyDeleteJen
Deepali, just wondering if PROMPTS is as effective in the ASD population since they learn better and carry over more when it is a functional task. One will not be physically giving input to the child outside of the clinic. Nicely done! Kevin
ReplyDeleteJenn,
ReplyDeleteNSOMEs literally means: Non-speech oral motor exercises.
Kevin,
Thats what I had thought when I was researching information on PROMPT that would it work in social functional realms, apparantly it is helpful because it gives the "proprioceptive" cues, probably in the begining in clinic level until mastery of that sound comes...then fade away cues. I see your point though.