Motor Speech Treatment Hierarchy: a systems approach.

The Motor Speech Treatment Hierarchy used to guide PROMPT intervention represents a theoretical framework for the application of all bottom-up motor speech treatments. In addition, the hierarchy can be used prior to motor speech treatment to evaluate what aspects of the child's neuromotor system are intact and which elements are operating ineffectively or partially. When consideration is given to the development of the speech motor system and the interaction among the various valves and/or articulators, it becomes apparent that treatment must focus on the integration of all these aspects in order to be successful. The goal of intervention must be the voluntary control of all speech actions. But voluntary control of all speech actions is not possible for all children, and the clinician must realize that compensatory actions, although beneficial in the short term, will limit more complex interactions later. It is for these reasons that more attention should be given to mastery of control at the lower stages of the hierarchy. The clinician should not assume that all actions are intact based upon the perceived quality of speech. For the child with "pure" DAS, intervention usually begins at stage V or VI, whereas for children with developmental dysarthria, intervention begins at lower levels of the hierarchy. The responsibility, as always, lies with the clinician to determine the most appropriate level at which intervention should begin and the steps needed to achieve the best speech production. The clinician's knowledge provides the foundation for changing deviant motor speech patterns and for providing for our clients voluntary control of motor speech function. It has been the aim of this article to provide for clinicians a framework for treatment that will enhance their clinical effectiveness.