Rhythm and Synchronicity
- 1. Rhythm and Synchronicity Metronome as a Modality By Asha Moonjely, OTS
- 2. What is the metronome? • Any device that produces regular, metrical ticks • The brain uses the interval of rhythm to synchronize the execution time of motor movement required (Thaut, 2002). • Rhythm functions as a sensory cue to enhance the temporal organization of motor control in the nervous system(Thaut,2002)
- 3. Role of Neural Synchronization • The execution of purposeful motor tasks requires timing and coordination. • Timing refers to the production of intrinsically timed motor actions involving complex spatiotemporal patterns of muscle action. • The ability to synchronize motor movements with a steady auditory beat is a measure of neural efficiency or neural synchronization.
- 4. Timing Affects Function – Attention – Information processing – Working memory – Speech & language – Reading & learning – Self-regulation & other executive functions – Sensory processing – Handwriting – Motor coordination – Balance
- 5. TIMING IN THE BRAIN • Dorsolateral pre-frontal cortex (timing, motor planning, speech) • Basal ganglia (timing, voluntary motor coordination) • Cingulate gyrus (timing, executive functioning, modulation emotions) • Cerebellum (timing, sense of body position, production of speech) • Listening to rhythm activates premotor cortices.
- 6. TIMING IN THE BRAIN • temporal resolution • white matter tract processing between B/L parietal frontal regions • efficiency of attentional control system • observable results
- 7. SUPPORTING RESEARCH • Motor Relearning is influenced by several key elements: intensity, task-specificity, active-initiations, motivation and feedback. (Birgit, 2010) • Improvements seen in fine motor skills, elbow and shoulder ROM, functional use in patients with strokes. • Used to improve gait, balance, coordination in stroke patients and those with PD • Colfesh & Conway(2007) found evidence for what is called the “controlled attention theory of working memory”, which can be improved by addressing underlying deficiencies in neural timing.
- 8. Who can benefit? • Adult patients with: – Attention and memory deficits, Stroke, TBI, Parkinson’s & other neurodegnerative disorders, Apraxia – Anyone with mpaired coordination, balance, gait, posture, functional mobility, handwriting skills, motor planning and sequencing
- 9. APPLICATION
- 10. ACTIVITIES –Weight bearing and reaching –Clapping –Tapping on vertical/horizontal surface –Reaching/tapping with cognitive demands –Utilizing tap lights for upgrade challenge –Increase proprioception to affected UE –Supination/pronation –Pushing/pulling –Visual integration to improve balance
- 11. General Facilitation – Verbal cues to “speed up, slow down, focus” – Hands on assistance to internalize sense of timing – Whole body movement vs isolated body part – Adjust tempo – Use visual pendulum as an aid – Repetition is critical (i.e 3 x a week ) – Performance was dictated by the individual’s internal clock rate (Baudouin, 2006). • For Hemiplegia: – Learn with the active hand first before progressing toward affected hand – Try to bring affected hand to midline when clapping – Self assist – Gravity assisted movement
- 12. Billing • It is a treatment modality. • Customary charges as: – Cognitive development – Neuromuscular reeducation – Therapeutic exercise
- 13. Case Study Age: 44 y/o Gender: Female PMHx: L MCA Infarct with Right Hemiparesis (admitted from TBI); HTN Social History: Mother, Living with family in apartment and 2-3 steps with wide BHR PLOF: Independent in all ADLs and ambulation Values/Beliefs: spiritual, states gratitude to God, extremely motivated to return to PLOF Leisure: music, reading, socializing with friends outside Focus of Intervention: Improve independence in self care and mobility, improve RUE motor control
- 14. Case Study –Areas of Occupation 3/5/2015 5/3/2015 Sitting Balance S/D G/F+ N/G+ Standing Balance S/D F-/P+ G+/G Bed Mobility S<->S; sup<->sit Min. A Mod I. Transfer chair<->bed Min. A Mod I req. SC Toilet transfer Min. A Mod. I Tub transfer Min/Mod. A supervision Grooming Mod. A Mod. I LBD Mod/Max. A Mod. I UBD Min/Mod. A Mod. I PROM WFL for BUE WFL for BUE AROM RUE no active, LUE WFL 20-110 elbow flexion RUE
- 15. Project – Repetition ( to automate skill) is key (1000s of repetitions) – More repetitions than encouraged in traditional OT due to engagement and focus – Cueing may distract from fatigue due to engagement – Functional reaching to improve S/D sitting or standing balance • Combine with cognitive demands or perform in isolation such as: –Number tasks for sequencing –Categorization with shapes or colors –Letter tasks for STM or working memory (i.e ask to spell word)
- 16. Bibliography • Baudouin, A., Vanneste, S., Isingrini, M., and Pouthas, V. (2006) Differential involvement of internal clock and working memory in the production and reproduction of duration: A study on older adults. Acta Psychologica, 121, 285-296. • 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. • Bengtsson, S., Ullén, F., Ehrsson, H., Hashimoto, T., Kito, T., Naito, E., . . . Sadato, N. (2008). Listening to rhythms activates motor and premotor cortices. Cortex, 45, 62-71. • Colflesh, J.H &C Conway, R.A (2007). Individual differences in working memory capacity and divided attention in dichotic listening. Bulletin & Review, 14(4), 699-703. • Hill, V., Dunn, L., Dunning, K., & Page, S. J. (2011). A Pilot Study of Rhythm and Timing Training as a Supplement to Occupational Therapy in Stroke Rehabilitation. Topics In Stroke Rehabilitation, 18(6), 728- 737. • Malcolm, M., Massie, C., & Thaut, M. (2009). Rhythmic auditory-motor entertainment improves hemiparetic arm kinematics during reaching movements: a pilot study. Topics In Stroke Rehabilitation, 16(1), 69-79. • Thaut, M. C, G.C.McIntost, R.R.Rice (1997). Rhythmic facilitation of gait training in hemiparetic stroke rehabilitation Journal of Neurological Sciences, 151, 207-212 • Thaut, M., Kenyon, G., Hurt, C., McIntosh, G., & Hoemburg, V. (2002). Kinematic optimization of spatiotemporal patterns in paretic arm training with stroke patients. Neuropsychologia, 40(7), 1073- 1081. • Whitall,J., Waller, S., Silver, K., & Macko, R. (2000). Repetitive Bilateral Arm Training With Rhythmic Auditory Cueing Improves Motor Function in Chronic Hemiparetic Stroke. Stroke, 2390-2395.
Editor's Notes
- #3: Sounds like this: (play metronome beat) Musicians use to keep a steady tempo Helps regulate internal sense of timing For example: Reaching for cup of coffee- signals generated and transmitted in CNS to perform contractions in arm, hand, and fingers to grasp that coffee and bring to lips – brain is connected to UE via timing. When this timing is disrupted, you get disorders of attention, concentration, gait, articulation, PD…
- #4: Rhythm and movement are intuitively connected as demonstrated through the widespread inclination to spontaneously move to music.
- #5: Auditory input can raise spinal motor neuron excitability to increase motor readiness before input occurs & auditory rhythm rapidly creates stable perceptual traces as anticipatory time schema (Thaut, 2002). Timing is one of the most critical factors in human performance. It is essential for all neurological functions. Our ability to focus and process information efficiently and accurately is all a matter of timing whether at home, school, work or play/leisure for focus, executive function, process of information, speed and accuracy, motor coordination Quick and synchronous timing Improves neural efficiency..rate of neurons firing On a wave..firing at the peak..as it goes down refreshing/recharge or AP and then fire again
- #6: The metronome improves the processing abilities that affect attention, motor planning, and sequencing. This, in turn strengthens motor skills including mobility and gross motor function
- #7: The metronome improves the processing abilities that affect attention, motor planning, and sequencing. This, in turn strengthens motor skills including mobility and gross motor function Increased temporal resolution which means faster clock speed-faster rate of oscillations of the brain block which improves neural efficiency LEADS to improved brain network communication via increased white matter track processing particularly between bilateral parietal frontal regions which LEADS TO improved focus via increased efficiency of the attentional control system that maintains goal related info active in working memory LEADS TO improved efficiency of executive functions and you see better cognitive and motor performance
- #8: Rhythm and movement are intuitively connected as demonstrated through the widespread inclination to spontaneously move to music. Relatively new so further research continues to be conducted. 1.Bilateral arm training for 20 min 3 x a week lead to significant improvements in motor performance and ROM sustained 8 weeks after training 2. Although we don’t usually address in OT, also used for gait training, after 6 weeks 10 stroke patients showed stat. significant improvement in velocity, stride length 3.Target arrays in sagital plane with RAS lead to decrease in compensatory trunk movement and increased shoulder flexion 4. 30 min OT plus 30 min traditional OT lead to improved grasp, pron/sup/ and functional use after 4 weeks 5.Reaching movements sig. improved in RAS group vs non-RAS 6. In PD, IM group showed more improvement but not statistically. In Conclusion, rhythmic cuing has been shown to lead to significant improvements or equally effective as traditional OT. The plus is that it is engaging, adds variety as a different modality, offers chance to increase intensity
- #10: Search “metronome” in App store. Choose the Market wall App. Free!
- #12: Performance was dictated by the individual’s internal clock rate (Baudouin, 2006). Some had faster clock rates; they tended to produce shorter time intervals (shorter than the amount of time they were asked to present). For ex, due to stroke or Parkinson’s some subjects could not slow down and tended to be inattentive, impulsive, exhibiting memory and cognitive problems. By starting at their own internal clock at a higher tempo, you can modulate them gradually down to a slower tempo where they could function better and more safely.
- #14: Rhythm and movement are intuitively connected as demonstrated through the widespread inclination to spontaneously move to music.
- #15: Leisure: able to ambulate with SC or pushing wheelchair independently to travel within hospital
- #16: The goal is to improve temporal processing which affects many other physiological, including motor and cognitive, systems. Clients become more goal oriented. RAS engages various brain networks to collaborate. Planning and sequencing required for motor learning with higher cognitive processing.
- #17: The End.