Interactive Metronome IM

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Interactive Metronome (IM)
April 2009LeeAnn Mateffy-Horn, MS, OTR/L, CBIS
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What is Interactive Metronome - IM?

• IM is a brain based rehabilitation program
  developed to improve the processing abilities
  that affect attention, motor planning and
  sequencing.
• This in turn strengthens motor skills such as
  mobility and gross motor function and many
  cognitive skills such as planning, organizing and
  language.

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Who can benefit from IM?

• Adult and pediatric patients who have benefited
  from IM include those with
• ADD/ADHD
• Asperger Syndrome
• Autism Spectrum Disorder (ASD)
• Balance Disorders
• Cerebral Palsy (CP)
• Cerebral Vascular Accident (CVA)
• Developmental Disorders (DD)
• Incomplete Spinal Cord Injury
• Multiple Sclerosis (MS)
• Traumatic Brain Injury (TBI)
• Sensory Integration Disorder

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Benefits of IM

• Gains in motor planning, rhythm, timing and
  sequencing lead to improvements in
• Attention and concentration
• Language processing
• Behavior (aggression impulsivity)
• Fine/Gross motor skills
• Balance and gait
• Strength
• Coordination
• Endurance
• Academic performance

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IM - Exercising the Brain

• What research has shown is that cognition, or
  what we call thinking and performance, is really
  a set of skills that we can train systematically.
  And that computer based cognitive trainers or
  cognitive simulations are the most effective
  and efficient way to do so.
• We have shown that working memory can be
  improved by trainingI think that we are seeing
  the beginning of a new era of computerized
  training for a wide range of applications.
• Sharp Minds Eleven Neuroscientists Debunk a
  Common Myth About Brain Training.

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IM - Exercising the Brain

• Training is very important attention control
  is one of the last cognitive abilities to develop
  in normal brain development.
• Learning is physical. Learning means the
  modification, growth, and pruning of our neurons,
  connections called synapses-and neuronal
  networks, through experience. When we do so, we
  are cultivating our own neuronal networks. We
  become our own gardeners.
• Sharp Minds Eleven Neuroscientists Debunk a
  Common Myth About Brain Training.

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How does IM work?

• IM provides a structured, goal-oriented training
  process that challenges a person to precisely
  match a computer generated beat or cow bell
  with repetitive motor actions such as hand
  clapping or foot tapping while wearing a palm
  trigger or touching a floor sensor mat. The
  client receives immediate audio and/or visual
  feedback which is measured in milliseconds. The
  resulting score indicates timing accuracy.
• IM impacts timing centers in the brain that
  control
• Speech and language
• Cognition
• Behavior
• Sensory processing and integration

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Timing

• Microsecond processing
• Sound location
• Millisecond processing (IM)
• Speech generation
• Cognition
• Motion detection
• Motor coordination
• Second processing
• Conscious time estimation
• Circadian Rhythm
• Appetite
• Sleep/wake

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History of IM

• Inventor of IM Jim Cassilly
• 1994 first private research
• Children with Autism demonstrated improvements in
  coordination (fine/gross/visual-motor)
• Stanley Greenspan, MD learned of these results
  and became involved in IM as the Chairman, IM
  Scientific Advisory Board
• Resulting research followed 2 parallel paths
• Cognitive (attention, concentration, language
  processing and academic fluency)
• Motor (fine and gross control, balance and gait)

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Academic Performance StudyTiming in Child
Development.High/Scope Educational Research
Foundation

• Kuhlman, K. Schweinhart, L.J. (1999)
• Found significant correlation between IM timing
  and academic performance in 585 students aged
  4-11 years in
• Reading
• Math
• Language
• Science
• Social studies
• Study skills
• Significant difference in timing rhythm between
  children in special education classes and
  children in dance and musical instrument training
• Strong relationship between attentiveness in
  class and better rhythm and timing.

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Academic Correlation StudyTiming Rhythmicity
Cognitive-Academic Performance

• Greenspan et al., (2002) studied 5 groups of
  children (kindergarten, elementary students, ADHD
  boys, special educ. students, high school
  dropouts)
• Significant relation ship between IM performance
  and the following
• Reading
• Math
• Oral/written language
• Writing
• Attention
• Motor coordination and performance

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Motor Studies

• Hemiplegia Study Thaut et al. (2002)Published in
  Neuropsychologia
• Investigated the effect of rhythm on control of
  stroke affected upper extremity in 21 stroke
  patients
• Significant improvement in arms reaching motions
• Parkinson Study pending publication in Neurology
• Computer directed rhythmic movement training
  improved the motor signs of Parkinsonism
• Golf Study The Journal of General Psychology
• IM training resulted in significant improvements
  in golf shot accuracy when IM trained golfers
  compared to a control group

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IM Activates the Brain

• Prefrontal Cortex
• Basal Ganglia
• Cerebellum

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IM Activates the Brain - Prefrontal Cortex

• Uniquely oriented to time
• (Huey et al., 2006)
• Responsible for motor planning and emotions
• Implicated repeatedly in the temporal aspects of
  speech, such as rapidly changing acoustic
  information
• (Schimer, 2004)
• Connections to the basal ganglia
• (Hale Florello, 2004)

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IM Activates the Brain - Basal Ganglia

• Four nerve clusters involved in physical
  movements by sending information from the
  cerebral cortex to the cerebellum and brain stem
• Involved in the generation of goal-directed
  voluntary movement
• (VandenBos, 2006)
• Involved in posture, tone, motor activity,
  response coordination, sequencing, control of
  ongoing movement
• (Cassidy et al., 2002 Hale Fiorelio, 2004
  Middleton Strick, 2000)
• Significantly involved in motor planning, sensory
  performance and sensorimotor integration
• (Diamond, 2003)
• Evidence in implicating the role of the basal
  ganglia in mental-timing functions
• (Janata Grafton, 2003 Nobre OReilly, 2004
  Peretz Zatorre, 2205)

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IM Activates the Brain - Cerebellum

• Balance
• Coordination
• Timing
• Skilled motor activity
• Posture
• Eye movement
• Muscle tone

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So what?

• Brain areas activated by IM in turn affects
• Auditory processing
• Memory span
• Working memory
• Cognitive processing
• Executive functions
• Speech-Language

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Auditory Processing(Taub McGrew 2006)

• Ability to analyze, comprehend , discriminate,
  manipulate, and synthesize sound patterns and
  group of sounds.
• Relationship between auditory processing and
  timing and rhythm has been exemplified in studies
  of tonal patterns in music.

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Memory Span (MS)Short-Term Auditory Memory(Taub
McGrew 2006)

• Ability to attend to, register, and immediately
  recall (after only one presentation) temporally
  ordered elements and then reproduce the series of
  elements in correct order
• Successful processing of auditory temporal
  information requires individuals to maintain
  perceived stimuli for a certain period of time in
  short-term memory (MS)
• Believed to play an important role in rhythm,
  perception and performance (Franek, in press).

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Working Memory (WM)

• The ability to keep and store information for a
  brief time in order to perform cognitive tasks
  such as controlled attention, problem solving,
  self-evaluation, short term memory and reading
  comprehension.
• Training can improve working memory which
  increases activity in the brain (prefrontal and
  parietal cortexes) and leads to better
  performance of daily tasks requiring increased
  attentiveness and comprehension.

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Cognitive Processing Speed(Taub McGrew 2006)

• The ability to automatically and fluently perform
  relatively easy or over-learned (automatized)
  cognitive tasks, especially when high mental
  efficiency (attention and focused concentration)
  is required
• There is a link between cognitive processing
  speed and working memory. The more complex a
  task the stronger the relationship may be between
  speed and working memory
• (Jensen 1998)
• IM tasks are dependent upon the quickness and
  efficiency of the responding, which eliminates or
  reduces the need for utilization or necessity of
  long term memory
• (Vorberg Fuchs, 2004)

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Executive Function(The essential brain injury
guide)

• Located in the prefrontal lobe and vulnerable to
  injury as it lies just inside the front of the
  skull. Consists of the following processes
• Initiation/Inhibition
• Problem solving
• Judgment
• Planning
• Anticipation
• Self-monitoring
• Motor planning
• Personality
• Emotions
• Organization
• Attention
• Concentration
• Mental flexibility
• Speaking

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Speech-Language

• Motor planning sequencing play a significant
  role in speech production, language, social, and
  emotional development. Language flows from the
  actions and movements of play. Interaction and
  engagement for infants and young children are
  filled with gesture, movement and facial
  expression, all of which require motor planning
  and sequencing. (Greenspan, 1993 Greenspan
  Weider, 1998)
• Children with language disorders require hundreds
  of milliseconds to process auditory information,
  normally developing children require only tens of
  milliseconds to process the same information.
  (Merzennich et al., 1996 Tallal Piercy, 1973)

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The IM Effect

• More efficient working memory
• Increased ability to
• Sustain and selectively divide attention for
  longer periods
• Filter or screen out distractions
• Inhibit impulsive responses
• Self-regulate and monitor mental operations
• Mentally process information faster

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The IM EffectExecutive Controlled
AttentionWorking Memory Model(Taub McGrew
2006)

• Differences in individual task performance is
  related to controlled attention (executive
  function)
• People with higher working memory have better or
  are more efficient in being able to pay attention
  or focus and are more able to resist being
  distracted while trying to problem solve than
  people with lower working memory.
• Being able to maintain information or a thought
  process especially when distracted is consistent
  with training process required by IM.

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IM

• Consists of
• Patented hardware and software
• Reference tone
• Guide sounds
• Interactive exercises
• Objective data
• Used as part of therapy or private pay basis
• Early Hit - sound in left ear
• Buzzer
• Rubber band twang
• Right on Hit sound in both ears
• High pitch rewarding sound
• Late Hit - sound in right ear
• Buzzer
• Rubber band twang

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Getting Started in Therapy

• Use standardized and/or functional assessments
• Determine candidacy deficits and resulting goal
  areas
• Cognitive skills (plan execute tasks with
  greater independence)
• Behavioral skills (decrease aggression)
• Sensory skills (focus on tasks without fidgeting)
• Language skills (comprehend multi-step
  directions)
• Motor skills (maintain balance during ambulation
  ADLs)
• Billing and insurance
• Part of discipline specific treatment plan (lower
  IM score is not the goal)
• Bill usual codes such as gait training, language
  therapy, therapeutic exercises, etc.

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Short and Long Form IM Assessments

• Short Form Test
• 2 tasks, 5 minutes to administer
• Use for screening, warm-up or to measure progress
• Long Form Test
• 14 tasks (upper body and lower body, bilateral
  and balance), 20 minutes to administer
• Used for baseline, interim/progress and discharge

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IM treatment hierarchy

• 6 phases could remain in one phase the entire
  program
• Typically 15 x 1 hour treatments
• Phases 1-3 learn IM
• Reference tone
• Learn the guide sounds
• Develop basic timing skills
• Phases 4-6 improve timing and rhythm
• Generalize timing skills (increase repetitions
  and duration)
• Develop focus skills (increase repetitions,
  duration and difficulty)
• Develop sustained timing focus (discharge when
  client achieves best score for longest duration
  tolerated will have a functional outcome)

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Case studies and example

• OT
• Pediatric
• Adult
• PT
• Pediatric
• Adult
• ST
• Pediatric
• Adult

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Interactive Metronome (IM) www.interactivemetrono
me.com