Tuesday, April 26, 2011

Apraxia Therapy: Gestural Prompts

What are Gestural Prompts?

Gestural prompts (sometimes referred to as hand signals or visual cues) are hand signals made by the adult or child as cues to help the child try to make certain target sounds. Using these prompts or cues paired with specific speech sounds has been very successful at helping children with Childhood Apraxia of Speech learn and use the target sounds. Every professional book I have read about Childhood Apraxia of Speech has a section on this technique. Every Speech-Language Pathologist I know who works with children with Childhood Apraxia of Speech uses gestural prompts.

How do I use Gestural Prompts?

Using gestural prompts is a straightforward technique. Make sure your child is watching you (otherwise they will not see the prompt). Use the signal as you make the sound. If you are trying to cue a sound in a word, make the hand signal when you say the target sound. So if you are cueing a /p/ at the end of a word, make the /p/ prompt when you say the /p/ at the end of the word.

For example, let's say you're working on the /t/ sound. The gestural prompt for /t/ is tapping your index finger on your upper lip right under your nose. If your child says "ha" instead of "hat", ask him/her to look at you. Then repeat the word "hat" and make the /t/ gestural prompt as you emphasize the /t/ sound at the end of the word. You can also use the cue to emphasize a sound in the middle of a word. Let's say your child leaves the middle /p/ out of the word "puppy." You can pair the gestural prompt for /p/ (close your fist and then pop it open) paired with emphasizing the /p/ sound in the middle of the word "puppy".

Why do Gestural Prompts work?

Children with Childhood Apraxia of Speech respond well to being cued in multiple ways. Emphasizing the /t/ sound is an auditory cue. Using the /t/ gestural prompt is a visual cue. If they mimic the gestural prompt, it is also a movement or tactile cue as well. It grabs their attention and stimulates multiple pathways in the brain at the same time. This is what makes the technique so effective.

What are some common Gestural Prompts?

These are some commonly used gestures. You can use a different hand signal, it just needs to be consistent.

  • T - tap the index finger on the upper lip right under the nose
  • D - tap the index finger on the lower lip above the middle of the chin
  • P - close your fist and pop it open (into a "5" position)
  • B - use the ASL sign for /b/ and tap the hand gently against the side of your chin
  • M - gently pretend to pinch both lips closed together with your index finger and thumb
  • N - push index finger against one side of your nose as if you're trying to close one nostril
  • SH - finger across your lips like you're shushing a child

There are more. You can find a hand signal (or make one up) for any sound you might be working on. Here is a link to a great video of a woman demonstrating a hand signal for almost every sound. Some of her signals are different from what I described above and that’s fine. You can use any signal you’re comfortable with as long as that symbol is consistent. Also, don't feel like you need to learn all of these at once. Pick one or two to start with and if that goes well you can always learn more. Be sure to choose a sound that your child is currently working on and check with your SLP. She or he may already be using a hand signal for that sound. You would want to use the same gestural prompt in order to be consistent.

Other than tapping, this is one of the techniques I find to be most effective.

Note: You may have found this web page searching for information on PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) therapy. PROMPT is a formal therapy technique conducted by PROMPT certified Speech-Language Pathologists that uses tactile cues (the therapist places his/her hands on the child in specific ways to try to stimulate sound production). If you're looking for more information on PROMPT, start here.

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