An evaluation of the effectiveness of PROMPT therapy in improving speech production accuracy in six children with cerebral palsy

Figures & data

Table I. Participant characteristics.

Characteristic	P1	P2	P3	P4	P5	P6
Age	11;9	8;5	5;4	5;2	3;0	3;6
Sex	F	F	F	M	M	M
Type of CP	Dyskinetic	RH	Quad	LH	RH	LH
GMFCS	3	3	2	2	2	1
Vision	NAD	Corrected	NAD	NAD	NAD	Reduced in left eye
Hearing	NAD	NAD	NAD	NAD	NAD	NAD
Epilepsy	NAD	Controlled	NAD	NAD	NAD	Controlled
IQ Estimatea	79	70	85	73	95	121
Attention and Memorya	93	90	73	81	—	100
Receptive Languageb	−1 SD	+ 1 SD	−1 SD	−2 SD	−1 SD	+ 1 SD
Intelligibilityc	54%	54%	36%	20%	34%	30%
Arizona-3	−2 SD	−2 SD	−1.5 SD	−1.5 SD	−1.5 SD	−1.5 SD
Total Score	67.5	79	69	68.5	60.5	54.4
PPC	2.5%	12.6%	8%	13.5%	6.5%	5.6%
VMPACd
Global Motor	25%	65%	50%	60%	60%	70%
Focal Oromotor	37%	53%	26%	57%	29%	43%
Sequencing	91%	65%	83%	24%	0%	34%
Connected Speech/Language	58%	78%	58%	51%	35%	46%
Speech Characteristics	14%	57%	14%	57%	28%	57%

Note. CP, cerebral palsy; RH, spastic right hemiparesis; LH, spastic left hemiparesis; Quad, spastic quadriparesis; NAD, no abnormality detected; GMFCS, Gross Motor Function Classification System; Arizona-3, Standard deviation and total score obtained on The Arizona Proficiency Scale, Third Revision (Fudala, 2000); PPC, percentage phonemes correct.

aBased on the Leiter-R International Performance Scale – Revised (Roid & Miller, 1997).

bObtained on the Clinical Evaluation of Language Fundamentals–Pre-school (Wiig et al., 1992) or Clinical Evaluation of Language Fundamentals-4 (Semel et al., 2003).

cObtained on the Children's Speech Intelligibility Measure (Wilcox & Morris, 1999).

dVerbal Motor Production Assessment for Children (Hayden & Square, 1999).

Table II. Participant intervention priorities.

Participant	Intervention Priority One: Phase B	Intervention Priority Two: Phase C	Intervention Priority Three: Control
1	Reduce jaw open distance in words containing high vowels. Lip-to-lip contact during bilabial productions.	Anterior elevation of the tongue within the mouth and independent of the jaw (tongue movements external and laterally rotated).	Sequenced movements (e.g., CCVC).
2	Facilitate jaw grading and distance between low vowels. Decrease anterior thrust of jaw (evident with increased jaw open distance).	Decrease jaw open distance on high vowels. Facilitate appropriate neutral, rounded, and retracted lip movements.	Anterior tongue movements independent of jaw.
3	Reduce path distance travelled on low vowels. Promote controlled open-to-closed jaw actions (ballistic action pushing lower lip superior to upper lip and excessive retraction used to stabilize jaw).	Independent lip movements—rounded movements for rounded vowels. Lip-to-lip contact during bilabial contact.	Anterior tongue movements independent of jaw.
4	Facilitate jaw grading in words containing low and high vowel positions. Facilitate rounding and retraction.	Anterior tongue control independent of jaw.	Sequenced movements.
5	Increase jaw grading between the jaw height positions. Maintain mid-line stability on low vowels.	Facilitate appropriate neutral and rounded lip movements (excessive retraction).	Anterior tongue movements independent of jaw.
6	Increase jaw open distance on low vowels with return to closure on CVC words.	Facilitate appropriate neutral and rounded lip movements (excessive retraction).	Anterior tongue movements independent of jaw.

C, consonant; V, vowel.

Figure 1. Accuracy of performance on the speech probes as scored for motor speech movement patterns (MSMP) and perceptual accuracy (PA) across the intervention priorities and study phases for P1.

Figure 2. Accuracy of performance on the speech probes as scored for motor speech movement patterns (MSMP) and perceptual accuracy (PA) across the intervention priorities and study phases for P2.

Figure 3. Accuracy of performance on the speech probes as scored for motor speech movement patterns (MSMP) and perceptual accuracy (PA) across the intervention priorities and study phases for P3.

Figure 4. Accuracy of performance on the speech probes as scored for motor speech movement patterns (MSMP) and perceptual accuracy (PA) across the intervention priorities and study phases for P4.

Figure 5. Accuracy of performance on the speech probes as scored for motor speech movement patterns (MSMP) and perceptual accuracy (PA) across the intervention priorities and study phases for P5.

Figure 6. Accuracy of performance on the speech probes as scored for motor speech movement patterns (MSMP) and perceptual accuracy (PA) across the intervention priorities and study phases for P6.

Table III. Summary of the two-standard deviation band analysis on the speech probes across the study phases for each of the participants.

P	Phase	Intervention Priority 1				Intervention Priority 2				IP 3 Control
		TR		UT		TR		UT
		MSMP	PA	MSMP	PA	MSMP	PA	MSMP	PA	MSMP	PA
1	A1→B	*S	*S	*S	*S	I	I	I	I	I	I
	A1→C	*S	*S	*S	*S	*S	*S	*S	*S	I	I
	B→C	I	I	I	*S	*S	*S	I	*S	I	I
	A1→A2	*S	*S	*S	*S	*S	*S	*S	*S	I	I
2	A1→B	*S	*S	*S	I	I	*S	I	*S	I	I
	A→C	*S	*S	*S	*S	*S	*S	*S	*S	*S	I
	B→C	C	I	I	C	*S	I	*S	C	I	I
	A1→A2	*S	*S	*S	*S	*S	*S	*S	*S	I	I
3	A1→B	*S	*S	*S	*S	I	*S	I	*S	I	I
	A1→C	*S	I	*S	I	*S	*S	*S	*S	I	I
	B→C	I	I	I	I	*S	I	*S	I	I	I
	A1→A2	*S	*S	*S	*S	*S	*S	*S	*S	I	I
4	A1→B	*S	I	*S	I	*S	*S	I	I	I	I
	A1→C	*S	*S	*S	*S	I	*S	I	I	I	I
	B→C	I	I	I	I	I	I	I	I	I	I
	A1→A2	*S	*S	*S	*S	*S	*S	*S	*S	I	I
5	A1→B	*S	I	*S	‡S	*S	I	*S	I	I	I
	A1→C	*S	*S	*S	*S	*S	*S	*S	I	I	*S
	B→C	I	I	I	I	*S	I	*S	I	I	I
	A1→A2	—	—	—	—	—	—	—	—	—	—
6	A1→B	*S	*S	*S	*S	I	*S	*S	I	I	I
	A1→C	*S	*S	*S	*S	*S	I	*S	I	I	I
	B→C	I	I	I	I	I	I	I	I	I	I
	A1→A2	*S	*S	*S	*S	*S	*S	*S	*S	I	I

*S, significant; I, insignificant; P, Participant; IP, Intervention Priority; TR, trained; UT, untrained; MSMP, motor-speech-movement pattern; PA, perceptual accuracy; A1→B, baseline (phase A) to intervention block 1 (phase B); A1→C, baseline (phase A) to intervention block 2 (phase C); B→C, intervention block 1 (phase B) to intervention block 2 (phase C); —, no data, ‡, baseline data-point six removed from the analysis; C, unable to calculate due to ceiling effect.

Table IV. Summary of the split-middle and binomial test on the speech probes across the study phases for each of the participants

P	Phase	Intervention Priority 1				Intervention Priority 2				IP3 Control
		TR		UT		TR		UT
		MSMP	PA	MSMP	PA	MSMP	PA	MSMP	PA	MSMP	PA
1	A1→B	*S	*S	*S	*S	I	I	I	I	I	I
	A1→C	*S	*S	*S	*S	*S	*S	*S	*S	I	I
	B→C	I	I	I	I	*S	*S	I	I	I	I
2	A1→B	*S	*S	*S	I	*S	I	I	I	I	I
	A1→C	*S	*S	*S	*S	*S	*S	*S	*S	I	I
	B→C	I	I	I	I	I	I	I	*S	I	I
3	A1→B	*S	*S	*S	*S	I	*S	I	I	I	I
	A1→C	*S	*S	*S	*S	*S	*S	*S	*S	I	I
	B→C	I	I	I	I	*S	I	*S	I	I	I
4	A1→B	*S	*S	*S	*S	I	I	I	I	I	I
	A1→C	*S	*S	*S	*S	I	*S	I	*S	I	I
	B→C	I	I	I	I	I	I	I	I	I	I
5	A1→B	*S	I	*S	I	*S	*S	*S	*S	I	I
	A1→C	*S	*S	*S	*S	*S	*S	*S	*S	I	I
	B→C	I	I	I	I	I	I	I	I	I	I
6	A1→B	*S	*S	*S	*S	I	*S	*S	*S	I	I
	A1→C	*S	*S	*S	*S	*S	*S	*S	*S	I	I
	B→C	I	I	I	I	*S	I	I	I	I	I

*S, significant; I, insignificant; P, Participant; IP, Intervention Priority; TR, trained; UT, untrained; MSMP, motor-speech-movement pattern; PA, perceptual accuracy; A1→B, baseline (phase A) to intervention block 1 (phase B); A1→C, baseline (phase A) to intervention block 2 (phase C); B→C, intervention block 1 (phase B) to intervention block 2 (phase C).

Table V. Effect size data on the speech probes across the phases of the study for each participant.

P	Measure	PHASE B					PHASE C
		IP 1		IP 2		IP 3 C	IP 1		IP 2		IP 3 C
		TR	UT	TR	UT		TR	UT	TR	UT
1	MSMP	1.5	2.2	0.7	0.2	U/C	1.6	1.5	1.8	1.2	U/C
	PA	1.9	2.6	0.5	0.0	0.2	1.2	1.3	2.4	2.7	0.2
2	MSMP	3.0	2.5	1.4	1.5	0.9	0.8	1.4	2.3	1.8	0.3
	PA	2.4	0.7	1.5	1.8	1.2	0.7	0.7	0.5	0.7	0.6
3	MSMP	1.7	2.1	0.6	1.3	−0.4	0.4	0.5	2.9	2.1	−0.5
	PA	0.5	0.7	1.0	1.0	0.0	1.0	0.6	1.1	1.1	−1.2
4	MSMP	1.9	2.3	1.0	0.9	U/C	1.1	0.9	1.1	0.5	U/C
	PA	1.2	1.4	1.2	0.6	0.7	0.9	0.7	1.0	0.5	0.4
5	MSMP	1.8	2.5	3.2	3.1	−0.1	0.1	0.5	1.9	1.5	0.3
	PA	1.1	1.7	1.0	1.8	0.8	1.1	0.8	0.8	−0.2	0.3
6	MSMP	2.2	3.1	1.4	3.3	0.5	0.9	0.5	2.0	1.7	−0.5
	PA	2.1	1.8	1.2	1.6	0.3	0.2	0.1	0.1	−0.3	0.2

Note: IP, Intervention Priority; TR, trained; UT, untrained; C, control; U/C, unable to calculate due to data consisting of zero scores; MSMP motor speech movement pattern; PA perceptual accuracy.

Appendix Table I. Example of a speech probe wordlist.

	Mandibular		Labial-Facial		Lingual control
	Trained	Untrained	Trained	Untrained
1	BAA (SHEEP)	MAA (GOAT)	POOH	MOO	SAT
2	ARM	AM	NOW	WOW	CUP
3	ONE	DONE	YOU	DO	COAT
4	BUBBLE (BABAL)	PAPA	WASH	WISH	DUCK
5	UP	HIGH	PUSH	BUSH	SACK
6	MY	BYE	BOAT	BOW	SIP
7	BA (BALL)	MA (MUM)	NO	DOUGH	GOOD
8	PAN	PAT	WATER	OW OW (SORE)	HOUSE
9	HOT	POT	BOW	MOW	NOTE
10	POP	MOP	GO	WHOA	GIRL
11	ONE	DONE	SHOE	SHOW	BIG
12	MINE	MANE	MOON	(S)POON	SIT
13	ON	UNA (UNDER)	BOW	BOA(T)	CHEESE
14	MORE	POUR	BEE	PEA	GOAT
15	MAN	NAN	OH OH	PO(LE)	DOG
16	PUP	BUB	EAR	HERE	SOCK
17	MY	EYE	B(L)UE	DO	SUN
18	DOWN	OU(T)	BIR(D)	PURR (CAT)	PLANE
19	BA(T)	PA(T)	HOME	WORM	CAKE
20	PAN	MAN	BEEP	PEEP	KNOT

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