Introduction to Interactive Metronome®: Professional Application in Hospitals, Clinics and Schools
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The document introduces the Interactive Metronome (IM), a tool used in hospitals, clinics, and schools to enhance cognitive and motor skills through rhythm-based training. IM is beneficial for individuals with various disorders, including ADHD, autism, and those recovering from brain injuries. It aims to improve neural timing, synchronize brain networks, and enhance overall performance in academic and rehabilitation settings.
Introduction to Interactive Metronome®: Professional Application in Hospitals, Clinics and Schools
- 1. Slide 1 Accelerate Outcomes. Exceed Expectations.
- 2. Introduction to Interactive Metronome: Professional Application in Hospitals, Clinics, and Schools Amy Vega, MS, CCC-SLP Interactive Metronome Clinical Education Director Slide 2
- 3. Demonstration of the Interactive Metronome Slide 3 Video
- 4. Who Benefits from IM? Attention Deficit/Hyperactivity Disorder Language-Learning Disorders Dyslexia and Other Reading Disorders Executive Function Disorder Auditory Processing Disorder Sensory Processing Disorder Autism Spectrum Disorders Stroke Traumatic Brain Injury Concussion/mTBI Brain Tumor Parkinson’s Multiple Sclerosis Sports & Performance Enhancement Slide 4
- 6. Poor timing & synchronization… at the center of it all Attention Information processing Working memory Speech & language Reading & learning Self-regulation & other executive functions Sensory processing Handwriting Motor coordination Balance Slide 6Slide 6
- 7. Interactive Metronome Training Goals 1. Improve neural timing & decrease neural timing variability (jitter) that impacts speech, language, cognitive, motor, & academic performance Slide 7Slide 7
- 8. Interactive Metronome Training Goals 2. Build more efficient & synchronized connections between neural networks Slide 8
- 9. Interactive Metronome Training Goals 3. Increase the brain’s efficiency & performance & ability to benefit more from other rehabilitation & academic interventions Slide 9
- 10. Interactive Metronome Hardware Master Control Unit with USB cord Headphones Button Switch Tap Mat In-Motion Insole Triggers (IM Pro only) Slide 10
- 11. IM Universe Software Objective assessment & training tool Engaging & fun Reports & graphs Adjustable settings Slide 11 Video
- 13. Interactive Metronome Different from a Metronome, Music, & Pacing FEEDBACK to improve “internal” timing & rhythm Adjustable settings (tempo, feedback parameters, volume, visual displays/cues…) Steady, rhythmical beat Intensity of training & repetition Cognitively engaging & rewarding experience Slide 13
- 14. Auditory-Motor Synchronization Impacts Auditory Processing, Language & Motor Skills Slide 14 www.brainvolts.northwestern.edu Slide 14
- 15. Timing In Child Development Kuhlman, K. & Schweinhart, L.J. (1999) n = 585 (ages 4-11) Significant correlation between IM timing and academic performance Reading, Mathematics Oral/written language Attention Motor coordination and performance Timing was better: As children age If achieving academically (California Achievement Test) If taking dance & musical instrument training If attentive in class Timing was deficient: If required special education If not attentive in class Slide 15
- 16. AUTISM Slide 16 Dinstein et al. (2011) Autism has been hypothesized to arise from the development of abnormal neural networks that exhibit irregular synaptic connectivity and abnormal neural synchronization. Toddlers with autism exhibited significantly weaker interhemispheric synchronization (i.e., weak ‘‘functional connectivity’’ across the two hemispheres) Disrupted cortical synchronization appears to be a notable characteristic of autism neurophysiology that is evident at very early stages of autism development. Wan & Schlaug (2010) White matter tracts involved in •language and speech processing •integration of auditory and motor function Arcuate fasciculus connects the frontal motor coordinating and planning centers with the posterior temporal comprehension and auditory feedback regions. Stevenson et al. (2014) Trouble integrating simultaneous auditory & visual sensory information This timing deficit hampers development of social, communication & language skills.
- 17. ADHD Shaffer, R.J., Jacokes, L.E., Cassily, J.F., Greenspan, S.I., Tuchman, R.F., & Stemmer Jr., P.J. (2001). Effect of Interactive Metronome rhythmicity training on children with ADHD. Americal Journal of Occupational Therapy, 55(2), 155-162. n = 56 (boys, 6-12 yrs) Randomly assigned to: Control (n=18) – recess Placebo control (n=19) – videogames Experimental (n=19) – 15 1-hour IM sessions Slide 17Slide 17
- 18. ADHD Improvements Attention to task Processing speed & response time Attaching meaning to language Decoding for reading comprehension Sensory processing (auditory, tactile, social, emotional) Reduced impulsive & aggressive behavior 58 tests/subtests Attention & concentration Clinical functioning Sensory & motor functioning Academic & cognitive skills Interactive Metronome group Statistically significant improvements on 53 of 58 tests (p ≤ 0.0001%) Slide 18
- 19. Brian TEST OF AUDITORY PROCESSING SKILLS PRE POST OVERALL SCORES Phonological Skills 55th 86th Memory 50th 63rd Cohesion 47th 70th TEST OF EVERYDAY ATTENTION IN CHILDREN PRE POST Sustained-Divided Attention > 0.2nd 96.7 – 98.5th Selective-Focused Attention 12.2 – 20.2nd 56.6 – 69.2nd Sustained Attention 0.2 – 0.6th 30.9 – 43.4th SOCIAL EMOTIONAL EVALUATION PRE POST RECEPTIVE SCORES Identifying Emotional Reactions 20 26 Understanding Social Gaffes 2 20 Understanding Conflicting Messages 6 10 RECEPTIVE PERCENTILE CHANGE 5th 90th EXPRESSIVE SCORES Identifying Emotional Reactions 20 28 Understanding Social Gaffes 2 20 Understanding Conflicting Messages 6 10 EXPRESSIVE PERCENTILE CHANGE 10th 95th Slide 19
- 20. READING McGrew, KS, Taub, G & Keith, TZ (2007). Improvements in interval time tracking and effects on reading achievement. Psychology in the Schools, 44(8), 849-863. Controlled studies Elementary n = 86 High School n = 283 18 Interactive Metronome training sessions (4 weeks) Elementary: ~ 2SD ↑ in timing Most gains seen in those who had very poor timing to begin with 18-20% growth in critical pre- reading skills (phonics, phonological awareness, & fluency) High School: 7-10% growth in reading (rate, fluency, comprehension) Achievement growth beyond typical for age group Slide 20
- 21. Slide 21 READING Based upon numerous peer reviewed studies examining the role of timing & rhythm and cognitive performance, the authors concluded Interactive Metronome must be increasing: Efficiency of working memory Cognitive processing speed & efficiency Executive functions, especially executive- controlled attention (FOCUS) & ability to tune-out distractions Self-monitoring & self- regulation (META- COGNITION) Video
- 22. Slide 22 READING Ritter, M., Colson, K.A., & Park, J. (2012). Reading Intervention Using Interactive Metronome in Children With Language and Reading Impairment: A Preliminary Investigation. Communication Disorders Quarterly, Published online September 28, 2012. Controlled study n = 49 (7 – 11 yrs) Concurrent oral & written language impairments Reading disability Lower to middle class SES Control - 16 IM sessions over 4 weeks, 15 min duration per session Experimental - IM training in addition to reading instruction While both groups demonstrated improvement, gains in the IM group were more substantial (to a level of statistical significance). “The findings of this study are relevant to others who are working to improve the oral and written language skills and academic achievement of children, regardless of their clinical diagnosis.”
- 24. CONGENITAL & DEVELOPMENTAL DISORDERS Emma, 18 months Aicardi Syndrome Agenesis of the Corpus Callosum (complete) Seizure Disorder Cerebral Palsy Failure to Thrive Global Developmental Delays Slide 24Slide 24
- 25. CONGENITAL & DEVELOPMENTAL DISORDERS Slide 25Slide 25 Video
- 26. TRAUMATIC BRAIN INJURY Blind randomized, controlled study n=46 active duty soldiers with mild-moderate blast-related TBI Control: Treatment as Usual (OT, PT, ST) Experimental: Treatment as Usual (OT, PT, ST) plus 15 sessions of Interactive Metronome treatment @ frequency of 3 sessions per week. Slide 26Slide 26
- 27. Slide 27 ASSESSMENT SKILLS MEASURED OUTCOME DKEFS: Color Word Interference Attention, response inhibition Cohen’s d= .804 LARGE p=.0001 RBANS Attention Index Auditory attention, auditory memory & processing speed Cohen’s d= .511 LARGE p=.004 RBANS Immediate Memory Index Auditory attention, auditory memory & processing speed Cohen’s d= .768 LARGE p=.0001 RBANS Language Index Confrontation naming, verbal fluency, & processing speed Cohen’s d= .349 MED p=.0001 WAIS-IV Symbol Search Processing speed, short-term visual memory, visual-motor coordination, cognitive flexibility, visual discrimination, speed of mental operations, & psychomotor speed Cohen’s d= 0.478 MED p=.0001 WAIS-IV Coding Visual attention, processing speed, short- term visual memory, visual perception, visual scanning, visual – motor coordination, working memory, & encoding Cohen’s d= ..630 LARGE p=.0001 WAIS-IV Digits Sequencing Auditory attention, working memory, cognitive flexibility, rote memory & learning, Cohen’s d= .588 LARGE p=.021 DKEFS Trails: Motor Speed Motor speed, executive functions Cohen’s d= .790 LARGE p=.015 DKEFS Trails: Letter Sequencing Processing speed, working memory, and executive functions Cohen’s d= .626 LARGE p=.0001 Group that received IM + TAU outperformed the control group that received only TAU on 21 of 26 assessments (p=.0001) TRAUMATICBRAININJURY PUBLISHEDRESULTS
- 28. Electrocortical Assessment 64 channels of EEG Capturing resting state and event- related activity Event-related potentials only captured when the brain is firing synchronously Slide 28 Special thanks to Mark Sebes, Physical Therapy Assistant
- 29. APHASIA “…fundamental problems in processing the temporal form or microstructure of sounds characterized by rapidly changing onset dynamics.” Stefanatos et al (2007) “…auditory timing deficits may account, at least partially, for impairments in speech processing.” Sidiropoulos et al (2010) “…co-occurrence of a deficit in fundamental auditory processing of temporal and spectro-temporal non-verbal stimuli in Wernicke’s Aphasia that may contribute to the auditory language comprehension impairment.” Robson et al (2013) Slide 29
- 30. Kelly Slide 30
- 31. HEMIPLEGIA Beckelhimer, S.C., Dalton, A.E., Richter, C.A., Hermann, V., & Page, S.J. (2011) Computer-based rhythm and timing training in severe, stroke- induced arm hemiparesis. American Journal of Occupational Therapy, 65, 96-100. Pilot study: n=2 Ischemic stroke with R hemiplegia x 23 yrs prior Ischemic stroke with L hemiplegia x 2 yrs prior Substantial results: ↑ ability to grasp, pronate, and supinate arm & hand ↑ ability to perform ADLs ↑ self-efficacy ↑ self-report of quality of life Slide 31
- 32. BALANCE & GAIT IM In-Motion The smooth transition between phases of the gait cycle is an integrated activity that is difficult to learn through practice of individual parts. The only true way to practice walking is to walk. Goals for gait training with IM in-motion trigger: improve biomechanics alter gait speed increase stride length… Slide 32 Video
- 33. PARKINSON’S Daniel Togasaki, MD, PhD n=36 individuals with mild-moderate Parkinson’s Control Group: rhythmic movement and clapping to music, metronome, or playing videogames Experimental: Interactive Metronome training x 20 hours (rhythmic movement + feedback for timing) “In this controlled study computer directed rhythmic movement training was found to improve the motor signs of parkinsonism.” Slide 33 Video
- 34. Interactive Metronome & Motor Learning Four factors of motor learning addressed by Interactive Metronome are: 1. Early cognitive engagement 2. Repetitive practice 3. Practice of specific functional motor skills 4. Feedback for millisecond timing to facilitate motor learning Slide 34Slide 34
- 35. Cognitive Engagement Early stages of motor learning during Interactive Metronome training are mainly cognitive. Motor learning at this stage involves the conscious thought process of figuring out how, when, and what movements are needed to facilitate action. Slide 35Slide 35
- 36. Repetitive ^ Practice Motor Learning… Cannot be achieved without repetitive practice As learning occurs, the motor skill becomes more automated and the cognitive demand is decreased The individual will perform 10’s of 1,000’s more repetitions during Interactive Metronome than he would during traditional OT or PT therapies. Interactive Metronome exercises can be tailored to address specific, functional movement patterns. Slide 36
- 37. Feedback Slide 37 Knowledge of Results Specific scores are provided at the end of each exercise & can be compared to previous scores Millisecond average Millisecond variability Bursts (perfect consecutive hits) IAR (highest number of perfect consecutive hits) Scores enable the person to monitor progress toward movement goals over time
- 38. Feedback Feedback provided in real- time (for each trigger hit) about the timing, rhythm & quality of movement Auditory and/or visual guides provide immediate feedback so that the person can make online corrections for attention and motor planning & sequencing The challenge with providing KNOWLEDGE OF PERFORMANCE feedback is speed! Typically, by the time a therapist has said something, the motor plan has passed. Slide 38 Knowledge of Performance
- 40. Interactive Metronome & Domain-General Learning Mechanisms Slide 40
- 41. Full report available at: www.interactivemetronome.com Click on SCIENCE Slide 41
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- 43. FREQUENCY & DOSAGE Slide 43Slide 43 FREQUENCY: Inpatient rehab: daily Outpatient rehab, clinics & schools: 3x/week DOSAGE: Inpatient rehab: 15-20 min/day Outpatient rehab, clinics & schools: 15-60 min/day DURATION: Inpatient rehab: 2-4 wks, continued as outpatient Outpatient rehab, clinics & schools: 8 – 12 wks (15+ training sessions)
- 44. Insurance Reimbursement for Allied Health Professionals IM is a treatment modality & does not have its own CPT code Prescription & insurance authorization for evaluation and treatment Bill customary charges: Speech and language therapy Cognitive development Therapeutic activities Therapeutic exercise Gait training Neuromuscular re-education Individual psychotherapy… Slide 44Slide 44
- 46. IM Education Certification Specialization Tracks Coaching Programs 100+ OnDemand Course Library Badges to promote & market your education accomplishments Slide 46
- 47. Interactive Metronome, Inc 13798 NW 4th St., Suite 300 Sunrise, FL 33325 Toll free: 877-994-6776 www.interactivemetronome.com Education Department 877-994-6776 Option 3 support@interactivemetronome.com imcourses@interactivemetronome.com