Speech therapy for children with PWS

The most prominent linguistic symptom of Prader-Willi Syndrome is dyspraxia. A person with dyspraxia is not in a position to precisely realise individual sounds and/or sound connections. Language movement planning and realisation are only possible for them to an inadequate extent. It is therefore difficult for them to place the movements required for speech productions in their spatial and temporal relationship.

There are various approaches for the treatment of childhood dyspraxia. Roughly speaking, there are two main directions for therapy: association therapy (e.g. according to McGinnis) and therapy, which gives the patient tactile-kinaesthetic hints for pronunciation. The PROMPT® method (Prompts for Restructuring Oral Muscular Phonetic Targets) is particularly worthy of a mention.

In association therapy, the child learns each individual sound in association with an image (meaningfully an image that triggers a mostly positive feeling). The child should be able to remember the sounds better and then retrieve them via the pictorial connection. First the sounds are worked out individually, then sound connections are added: Consonant-vowel: “ba”; consonant-consonant-vowel: “bra”; consonant-vowel consonant: “bab” etc.

In the current literature, however, the structure of the sound system with the help of tactile-kinaesthetic feedback for the sounds makes more sense. PROMPT® is the best known method. Here, too, the target sounds are isolated for the time being, and later practised in sound connections.

 However, the child always receives a tactile-kinaesthetic feedback from the speech therapist by means of movement on the lips, cheeks and base of the tongue. These prompts enable the child to “feel” the sounds directly. The sound is “mapped”, so to speak, and strengthened by tactile-kinaesthetic means. This makes sense because we generally control our speech not only through our hearing, but also through tactile-kinaesthetic feedback mechanisms.

It is important for the therapy with PROMPT® to be carried out at high frequency. One word can then be mapped 40-50 times per therapy unit. The therapy has to be built up step by step from a single sound to a whole sentence. Parents are taught special prompts to help their children continue the therapy at home. The children are also taught tactile signs to support themselves.

In Germany PROMPT® is unfortunately not yet very widespread. But more and more people are becoming trained professionals, who focus on this method (German Federal Association of Academic Speech Therapists – dbs (www.dbs-ev.de)), Prologue (www.prolog-wissen.de).

The second major focus in speech therapy for children with PWS is building grammatical skills such as forming sentences. An important factor that enables a language learner to build sentences is short-term memory. Since this is often impaired in children with PWS, the linguistic structure alone can be difficult for that reason. So you should not expect too much at the beginning of the therapy: