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Interactive Metronome IM


Significant improvement in arm's reaching motions ... Interactive exercises. Objective data. Used as part of therapy or private pay basis ... – PowerPoint PPT presentation

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Title: Interactive Metronome IM

Interactive Metronome (IM)
April 2009 LeeAnn Mateffy-Horn, MS, OTR/L, CBIS
What is Interactive Metronome - IM?
  • IM is a brain based rehabilitation program
    developed to improve the processing abilities
    that affect attention, motor planning and
  • This in turn strengthens motor skills such as
    mobility and gross motor function and many
    cognitive skills such as planning, organizing and

Who can benefit from IM?
  • Adult and pediatric patients who have benefited
    from IM include those with
  • 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

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

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 training…I 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.

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.

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
  • Speech and language
  • Cognition
  • Behavior
  • Sensory processing and integration

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

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)

Academic Performance Study Timing in Child
Development. High/Scope Educational Research
  • 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.

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

Motor Studies
  • Hemiplegia Study Thaut et al. (2002) Published in
  • Investigated the effect of rhythm on control of
    stroke affected upper extremity in 21 stroke
  • 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

IM Activates the Brain
  • Prefrontal Cortex
  • Basal Ganglia
  • Cerebellum

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
  • (Schimer, 2004)
  • Connections to the basal ganglia
  • (Hale Florello, 2004)

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)

IM Activates the Brain - Cerebellum
  • Balance
  • Coordination
  • Timing
  • Skilled motor activity
  • Posture
  • Eye movement
  • Muscle tone

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

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….

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).

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
  • 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.

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)

Executive Function (The essential brain injury
  • 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

  • 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)

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

The IM Effect Executive Controlled
Attention Working Memory Model (Taub McGrew
  • Differences in individual task performance is
    related to controlled attention (executive
  • 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.

  • 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

Getting Started in Therapy
  • Use standardized and/or functional assessments
  • Determine candidacy deficits and resulting goal
  • Cognitive skills (plan execute tasks with
    greater independence)
  • Behavioral skills (decrease aggression)
  • Sensory skills (focus on tasks without fidgeting)
  • Language skills (comprehend multi-step
  • Motor skills (maintain balance during ambulation
  • 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.

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

IM treatment hierarchy
  • 6 phases could remain in one phase the entire
  • 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)

Case studies and example
  • OT
  • Pediatric
  • Adult
  • PT
  • Pediatric
  • Adult
  • ST
  • Pediatric
  • Adult

Interactive Metronome (IM) www.interactivemetrono