The Motor Speech Hierarchy

The Motor Speech Hierarchy

The Motor Speech Hierarchy

The Motor Speech Hierarchy (MSH) a central element of PROMPT therapy is a 7️⃣-stage guide that helps SLPs analyze speech through the lens of MOVEMENT. (For more about PROMPT visit their web-site at )


Why I ❤️ it:


⭐️ The MSH corresponds neatly to developmental progression of speech sounds. In slide 3, I’ve juxtaposed it to the consonant norms outlined in 2018 by McCleod & Crowe (poster from The Speak Boutique store) and vowel norms from Dr. Namasivayam et al’s 2020 paper: Speech Sound Disorders: An AP Perspective.


⭐️ By addressing sounds according to MOVEMENT, S-LPs can address several sounds at once. E.g. when working on lip closure, we can address P, B and M at the same time. When working on back tongue control, we can target K and G together.


⭐️ It is a MYTH that you need to address sound errors in the sequence of the MSH. PROMPT trained SLPs to analyze the subsystems of speech breakdown & prioritize/customize according to the specific child’s abilities and needs. #clinicaljudgement


The MSH in a nutshell:



1️⃣ and 2️⃣:

✅ 💪🏼 tone/posture

✅ basic phonatory control

⭐️ both = related to 💨 BREATH control.

‼️important bc/ speech = shaping of air through the vocal tract 🫁 👄.



✅🦈 JAW movement.

✅ vertical ↕ movement

✅ mostly VOWELS

✅👀ing for central & stable 🦈 mvmt.



✅ LIP 👄 movement

✅horizontal ↔️ movement.

✅ lips stretch: “ee”, or are ⭕️: “o”.

✅lower 👄 to 🦷 contact for F/V

✅ 👀 at if 👄s are closing fully and symmetrically.



✅TONGUE 👅 movement

✅ anterior/posterior ✈️.

✅is 👅 moving independently from jaw.



✅sequenced movement - changes in voicing & 💨 control (valving) and integration of multiple planes of movement.

✅ 💡Compare “mom” (↕️movement/all voiced) vs. “squirrel” which requires variation of voicing, control of jaw, lip and tongue movement. ↕️↔️👅)



✅ Prosody: the melody 🎶 of speech. 💭re: ⏱ time and volume/emphasis.

✅ Stage 7️⃣ is connected to Stage 3️⃣. We consider prosodic elements throughout a child’s intervention.

‼️ very important for kids with CAS.

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