Support Isn’t Cheating: The Real Double Standard in Communication Therapy
We Trust PROMPT. So Why Do We Question Spelling to Communicate?
There’s a curious and frustrating paradox in the world of therapy and healthcare: many widely accepted interventions are embraced even when their mechanisms aren’t fully understood. PROMPT therapy is a perfect example. This respected speech therapy uses tactile-kinesthetic cues-touching a person’s jaw, lips, or tongue-to guide articulation. Therapists swear by it. Families see real progress. And yet? The exact neurological mechanisms behind its success remain murky.
Still, no one questions whether the person is speaking independently.
Now let’s talk about Spelling to Communicate (S2C), Rapid Prompting Method (RPM), and other motor-based communication methods used by cognitive communicators (cognitive communicators are individuals whose thinking is intact, but whose bodies can’t reliably express that thinking through speech or typical motor responses). These approaches also help individuals access their voices-just through different motor pathways. But here’s the double standard: the moment a cognitive communicator points to a letterboard with support, skeptics line up to ask, “How do we know it’s really them?”
We don’t demand this of other therapies.
So why here?
The Real Issue: Motor Planning, Not Competence
To understand spelling-based communication, you have to understand motor planning. It’s not about intelligence-it’s about execution. Many cognitive communicators have apraxia or other motor disorders that make it incredibly difficult to control their bodies, even though their thoughts are fully intact. Imagine having something urgent to say-but your mouth doesn’t obey. Or your hand won’t move to type. Or you can’t initiate a movement without a stabilizing anchor. That’s the daily reality for many cognitive communicators.
Spelling gives them a way through.
It’s not easy. Pointing to letters on a board or screen takes immense concentration, regulation, and coordination. In the early stages, a communication partner may hold the board, help stabilize the body, or offer emotional grounding. Over time, the goal is always to fade prompts, just like any effective therapy. Even during supported stages, the ideas are real. The communication is authentic.
Critics treat any support as a red flag - when in truth, it’s standard practice across all therapies.
Other Therapies Involve Support Too-We Just Don’t Question It
If we applied the same hyper-skeptical lens to other therapies, we’d have to discredit half the field of rehabilitation.
PROMPT therapy uses touch to guide muscle movement for speech. No one claims the therapist is “puppeting” the speech.
Melodic Intonation Therapy (MIT) uses singing to activate different brain regions and help people with aphasia regain speech-its precise mechanism is still being studied, yet it’s embraced.
Hippotherapy (horseback riding therapy) improves balance and sensory integration through the motion of the horse. We don’t fully understand how, but we’ve seen the results.
Physical therapy regularly involves a practitioner guiding a person’s limbs until they can move independently.
So why do we hold spelling to a harsher standard?
Reframing the Debate: Communication Is a Right, Not a Prize
At the core of the skepticism is a failure to presume competence.
We assume the individual doesn’t have original thoughts to share, so we assume someone else must be influencing the message. But this assumption has it backward. It’s not that the ideas aren’t there-it’s that the body struggles to express them. The communication partner isn’t controlling the message. They’re holding the door open long enough for the speaker to walk through it.
If a person uses a wheelchair to move, we don’t say, “Well, they’re not really walking.” We say, “This is how they move through the world.”
Spelling is no different. It’s a tool that bridges a gap-not a sign of incompetence.
Helpful Analogies to Shift the Mindset
Sometimes it takes the right metaphor to break through bias:
Training Wheels: Just as training wheels support balance until a child is ready to ride solo, a communication partner helps stabilize motor intent until independence emerges. The support fades-but the learning remains.
A Conductor and a Symphony: The conductor doesn’t write the music. The musicians already know it. The conductor guides timing, presence, and coordination. Spelling support is the same-the ideas are fully formed. The partner just helps them flow.
PT Analogy: In physical therapy, early movements are often heavily supported. Over time, the patient takes more control. We don’t call those early steps “fake.” We call them progress.
Research and Real Voices Are Catching Up
Skeptics often hide behind the phrase “lack of evidence.” But the reality? The evidence is growing.
Recent studies using eye-tracking and hand movement analysis show that cognitive communicators look at letters before they point-demonstrating intentionality. Some are now participating in MRI studies that further explore the motor and cognitive coordination involved in spelling.
And then there are the stories. Hundreds of cognitive communicators-many who were once presumed incapable-are now writing poetry, taking high school and college courses, advocating publicly, and mentoring others. Some have even described their own experiences of being misjudged or locked away-fully aware, but trapped without a voice.
These are not isolated miracles.
They are part of a movement.
What This Means for All of Us
We need to stop moving the goalposts for cognitive communicators. We don’t question PROMPT, MIT, or wheelchairs-because we trust the people who use them. It’s time to offer cognitive communicators that same trust.
The movement toward inclusion isn’t just about communication. It’s about liberation. It’s about acknowledging that a person’s voice may take a different path-but it is no less true, no less real, no less theirs.
This isn’t a fringe idea anymore. It’s a revolution.
And the voices rising through spelling aren’t asking for permission.
They’re asking to be heard.
If this message resonates, please share it. And if you’ve ever doubted a nonspeaker-take a second look. They might just change everything you thought you knew about communication.