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The Importance of Touch
by Barbara Gerber, The New Mexican, 09/30/2002
For more articles on disabilities and special ed visit
www.bridges4kids.org.
Say the word "neat" and notice what happens:
Your tongue rests briefly on the back of your front teeth, a
column of air begins to flow from your lungs, a slightly nasal
"n" sound is produced, your jaw drops slightly, your lips draw
apart to release the "e" and your tongue stops the sound with
a touch of a "t." In a fraction of a second, you have
coordinated a vast collection of muscles to produce an
intelligible sound.
You also responded to a request, accessed the meaning of the
word, and likely experienced some sort of emotion. In short,
you spoke, and in speaking you used physical, mental and
emotional aspects of yourself.
Deborah Hayden, a speech-language pathologist and executive
director of The PROMPT Institute in Santa Fe, has created a
method and philosophy of speech therapy that helps
speech-impaired individuals do just that. PROMPT is an acronym
for Prompts for Restructuring Oral Muscular Phonetic Targets,
a system Hayden has been developing for nearly 30 years.
"With PROMPT, we're really trying to work with the whole
individual," Hayden said. "We build an entire program around
all of these domains and make sure it is relevant to a
client's life."
PROMPT can be used to correct speech problems that might be
caused by developmental delays, autism, mild cerebral palsy,
Down syndrome, hearing impairment and stroke. It is also
effective in correcting mild stuttering and general
articulation disorders, Hayden said.
Touch is key
A large part of what distinguishes PROMPT from conventional
speech- language therapy is touch. Hayden and other certified
PROMPT clinicians touch the face, head and neck of a client as
he or she works to produce words. These gentle, well-timed
touches stimulate specific muscles to contract for the time
needed to produce certain sounds.
For example, if a PROMPT client were having a hard time
uttering the word "neat," Hayden would first gently touch the
nose to cue for the nasal "n." Then, using her thumb and
forefinger, she would put pressure on the corners of the mouth
to draw the lips back for the "e." She would make sure the jaw
didn't drop too far down, and she'd touch beneath the chin to
signal the tongue to contract for the "t."
"PROMPT takes them through the motor control aspects," Hayden
said. She explained that often a speech-impaired child or
adult will overuse certain muscles, which causes other muscles
to develop less fully. PROMPT seeks to correct that.
"Speech is all about contraction of muscle groups in certain
ways to produce acoustic results," Hayden said. "The muscles
have to work independently yet also together, like different
instruments in a symphony.
"Touch is critical as a way to guide and shape," Hayden
explained. "Using tactile information helps to organize and
'glue' sensory information into concepts."
The difference
In conventional speech-language therapy, Hayden said,
pathologists rarely touch the client. Instead, they model how
sounds are produced and encourage the client to mimic those
facial movements.
Hayden also said that conventional therapy focuses a great
deal on verbally labeling items, perhaps having a client utter
phrases such as, "this is a cat" and "this is a ball." By
contrast, she explained, PROMPT sessions feature interaction,
with responses engendered by questions such as, "Would you
like some tea?" and "How are you?" In addition, the words that
get worked on are those the client needs for his or her daily
interactions.
Kathleen Castle, a Santa Fe speech-language pathologist, said
she admires the PROMPT method. "It's good technique," she
said. "I wish I had it in my bag of tricks.
"It's a wonderful resource to have in the community," Castle
continued. "There are children and adults who specifically
need this, and I think they can progress much more quickly
with it."
However, Castle said, she believes that PROMPT is not
necessary for all speech-impaired individuals. "The treatment
is very specialized," she said. "Not every kid who has an
articulation problem needs PROMPT."
No longer alone
When Wyatt Gordon celebrated his third birthday, he was not
yet speaking. His mother, Katja Gordon, said that this caused
a great deal of difficulty for her son and their family.
"He was unable to speak at all," Gordon said. "He was really
frustrated because he couldn't communicate. He would throw
tantrums, shake his head no, and wouldn't cooperate. He didn't
want to do anything or be with other kids, because the other
kids were already talking."
Gordon took Wyatt to The PROMPT Institute for treatment. After
nine months of weekly sessions with Hayden, she said, he was
speaking "perfectly."
"He talks up a storm now," Gordon said. "All the behavior
problems are totally gone. Now," she added with a laugh,
"sometimes I wish that he would just shut up."
On a videotape of past clients, an older woman who had
suffered a stroke struggled with making single sounds. After
11 months of treatment, she was speaking in full sentences.
Although thousands of people have improved their speech with
PROMPT, Hayden acknowledges that the treatment has its
limitations. "You can't go in and fix everything," she said.
"There will be some people I can't help - sometimes the muscle
problems are just too severe. When you know what you can and
can't do, then a parent (or a client) can be proud of the
gains.
"Communication is such a big part of our lives," Hayden said.
"Without it, you're locked away, you're alone. It's one of the
worst things that can happen to a person."
PROMPT Institute
Hayden, 57, began developing the PROMPT method in the 1970s,
as director of the Speech Foundation of Ontario, at the
Toronto Children's Centre. By the mid-1980s she published a
technique manual and began conducting workshops to train other
speech-language pathologists.
Today, she said, there are 22 PROMPT instructors worldwide and
approximately 2,000 clinicians using the method in the United
States. The manuals are available in four languages.
"It's been a process of refinement and expansion over 25
years," she said, adding that the institute is a 501(c)3
nonprofit.
Hayden moved to Santa Fe in 1995, and at first operated The
PROMPT Institute from her home. She recently moved the clinic
to Office Court Drive, behind Villa Linda Mall, where she
treats clients and conducts research. She and two employees
coordinate approximately 45 training workshops a year, in an
effort to firmly establish the method in the field of
speech-language pathology.
"It's pretty powerful," Hayden said of PROMPT. "I want it to
live on."
For more information, call 466-7710, or go to check the Web.
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