1 / 73

Accelerate Outcomes. Exceed Expectations.

Accelerate Outcomes. Exceed Expectations. Introduction to Interactive Metronome: Professional Application in Hospitals, Clinics, and Schools. Amy Vega, MS, CCC-SLP Interactive Metronome Clinical Education Director. Demonstration of the Interactive Metronome.

xander
Download Presentation

Accelerate Outcomes. Exceed Expectations.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

  3. Demonstration of the Interactive Metronome • Movie: Interactive Metronome Demo

  4. Neural Synchronization

  5. 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

  6. Interactive Metronome Training Goals • Improve neural timing & decrease neural timing variability (jitter) that impacts speech, language, cognitive, motor, & academic performance

  7. Interactive Metronome Training Goals 2. Build more efficient & synchronized connections between neural networks

  8. Interactive Metronome Training Goals 3. Increase the brain’s efficiency & performance & ability to benefit more from other rehabilitation & academic interventions

  9. Interactive Metronome Components • Master Control Unit with USB cord • Headphones • Button Switch • Tap Mat • In-Motion Insole Triggers (IM Pro only)

  10. Interactive Metronome Software • Objectively evaluates & trains timing & neural synchronization • Auditory-visual-motor exercises & games that are effective & engaging • Virtually all of the training settings are adjustable to meet individual needs

  11. Basic IM Training Exercises 13 BASIC IM EXERCISES • Clap both hands • Tap right hand • Tap left hand • Alternate tapping both toes • Tap right toe • Tap left toe • Alternate tapping both heels • Tap right heel • Tap left heel • Alternate tapping right hand & left toe • Alternate tapping left hand & right toe • Balance on right foot, tap left toe • Balance on left foot, tap right toe

  12. Custom Training Exercises Video: Examples of customized IM training exercises

  13. IM-Home & eClinic

  14. Interactive MetronomeDifferent 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

  15. Auditory-Motor Synchronization Impacts Auditory Processing, Language & Motor Skills www.brainvolts.northwestern.edu

  16. AUTISM Speech & Language Skills Wan, C.Y. & Schlaug, G. (2010). Neural pathways for language in autism: the potential for music-based treatments. Future Neurol. 2010 November; 5(6): 797–805 • 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. Nelson et al., 2013 • Preliminary analysis of electrocortical data following 15 sessions of Interactive Metronome (IM) training in a randomized, controlled study showed that IM training produced re-mylenation & re-establishment of critical white matter tracts, including the arcuatefasiculus in subjects who experienced significant demylenation from TBI.

  17. AUTISMAbnormal Neural Synchronization • Autism has been hypothesized to arise from the development of abnormal neural networks that exhibit irregular synaptic connectivity and abnormal neural synchronization. Dinstein, I., Pierce, K., Eyler, L., Solso, S., Malach, R., Behrmann, M., & Courchesne, E. (2011). Disrupted Neural Synchronization in Toddlers with Autism. Neuron, 70, 1218-1225. • 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.

  18. AUTISMPoor Simultaneous Auditory-Visual Synchronization Stevenson, R.A., Siemann, J.K., Schneider, B.C., Eberly, H.E., Woynaroski, T.G., Camarata, S.M., & Wallace, M.T. (2014). Multisensory Temporal Integration in Autism Spectrum Disorders. The Journal of Neuroscience, 34(3), 691-697. • Trouble integrating simultaneous auditory & visual sensory information • Brain has difficulty associating visual and auditory events that happen within a temporal window, including paired audiovisual speech stimuli • Confusion between the senses – hands over ears may be strategy to block out one sense to help process via one sense at a time • This timing deficit hampers development of social, communication & language skills.

  19. AUTISMObserved Changes Following Interactive Metronome Training • Increased ability to tolerate unexpected changes in environment and routine • Decreased perseverative behaviors, ticks, fidgets & compulsive behaviors • Improved classroom behaviors and academic achievement – more in sync with activities and environment around them • Parents describe their child as being 'more comfortable in their own skin’ • Increased timing and coordination of motor control (decreasedclumsiness, improved posture and symmetry) • Increased volitional eye-contact & social engagement • Increased perception of social cues • Increased attention & ability to follow directions • Decreased anxiety & improved ability to self-regulate • Decreased startle response • Improved sensory-processing including ability to give and receive hugs, decreased oral hypersensitivity • Increased fluency and content of speech

  20. SENSORY PROCESSINGOral Motor & Feeding • Movie: Sawyer BEFORE Interactive Metronome training

  21. SENSORY PROCESSINGOral Motor & Feeding • Movie: Sawyer AFTER Interactive Metronome training

  22. CONGENITAL & DEVELOPMENTAL DISORDERS • Emma, 18 months • Aicardi Syndrome • Agenesis of the Corpus Callosum (complete) • Seizure Disorder • Cerebral Palsy • Failure to Thrive • Global Developmental Delays

  23. CONGENITAL & DEVELOPMENTAL DISORDERS Emma • Movie: Emma

  24. 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 • Elementaryn = 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

  25. 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)

  26. 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.”

  27. Timing In Child DevelopmentKuhlman, 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

  28. 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

  29. ADHD • 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%) • 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

  30. Brian 27 IM Sessions (3 months) 7 year old male Short attention span, hyperactive behavior and repetitive habits such as chewing Unable to attend in class, disruptive, slow to follow directions School is focusing more on behavior management than academics Difficulty with language processing Frequent meltdowns!!

  31. Test of Auditory Processing Skills (TAPS)

  32. Test of Everyday Attention in Children

  33. Social Emotional Evaluation (SEE)

  34. Parent/Teacher Observations • Teachers • Improved behavior, interaction, attention, and work completion • More interested in writing, better sustained attention to writing tasks, improved legibility • Improved reading comprehension • Parents • More cooperative with siblings/peers • Easier to calm and better able to self-regulate before his emotions escalate out of control • Improved eye/hand coordination

  35. 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.

  36. Nelson, L. A., MacDonald, M., Stall, C., & Pazdan, R. (2013, September 23). Effects of Interactive Metronome Therapy on Cognitive Functioning After Blast-Related Brain Injury: ARandomized Controlled Pilot Trial. Neuropsychology. Advance online publication. Doi: 10.1037/a0034117 Cohen’s d= .804 “Large” effect 21/26 tests favor IM over TAU in direction of change at post treatment

  37. Nelson, L. A., MacDonald, M., Stall, C., & Pazdan, R. (2013, September 23). Effects of Interactive Metronome Therapy on Cognitive Functioning After Blast-Related Brain Injury: ARandomized Controlled Pilot Trial. Neuropsychology. Advance online publication. Doi: 10.1037/a0034117 Cohen’s d= 0.768  “Large” effect Cohen’s d= .511 “medium” effect

  38. Nelson, L. A., MacDonald, M., Stall, C., & Pazdan, R. (2013, September 23). Effects of Interactive Metronome Therapy on Cognitive Functioning After Blast-Related Brain Injury: ARandomized Controlled Pilot Trial. Neuropsychology. Advance online publication. Doi: 10.1037/a0034117 Cohen’s d= .349 “Small-medium” effect Cohen’s d= .478 “Medium” effect

  39. Nelson, L. A., MacDonald, M., Stall, C., & Pazdan, R. (2013, September 23). Effects of Interactive Metronome Therapy on Cognitive Functioning After Blast-Related Brain Injury: ARandomized Controlled Pilot Trial. Neuropsychology. Advance online publication. Doi: 10.1037/a0034117 Cohen’s d= .588 “Medium” effect Cohen’s d= .630 “Medium-large” effect

  40. Nelson, L. A., MacDonald, M., Stall, C., & Pazdan, R. (2013, September 23). Effects of Interactive Metronome Therapy on Cognitive Functioning After Blast-Related Brain Injury: ARandomized Controlled Pilot Trial. Neuropsychology. Advance online publication. Doi: 10.1037/a0034117 Cohen’s d= .626 “Medium” effect Cohen’s d= .790 “Large” effect

  41. Electrocortical Assessment Special thanks to Mark Sebes, Physical Therapy Assistant • 64 channels of EEG • Capturing resting state and event- related activity • Event-related potentials only captured when the brain is firing synchronously

  42. Kelly

  43. Kelly • Movie: Kelly Speaking

  44. APHASIA Stefanatos, GA, Braitman, LE, & Madigan, S. (2007). Fine grain temporal analysis in aphasia: evidence from auditory gap detection. Neuropsychologia, 45(5), 1127-1133. • Examined auditory temporal processing in individuals with acquired aphasia • Individuals with aphasia produced fewer correct responses than age-matched neurologically intact controls • They did even worse in the presence of background noise • The difficulties with gap detection observed in the aphasic group suggest the existence of fundamental problems in processing the temporal form or microstructure of sounds characterized by rapidly changing onset dynamics.

  45. APHASIA Sidiropoulos, K, Ackermann, H, Wannke, M, & Hertrich, I. (2010). Temporal processing capabilities in repetition conduction aphasia. Brain & Cognition, Aug (73) 3, 194-202. • Looked at temporal resolution capacities of the central-auditory system in a case of conduction aphasia • Concluded that auditory timing deficits may account, at least partially, for impairments in speech processing.

  46. APHASIA Robson, H, Grube, M, Lambon Ralph, MA, Griffiths, TD, and Sage, K. (2013). Fundamental deficits of auditory perception in Wernicke's aphasia. Cortex, 49(7), 1808-1822. • Investigated the nature of the comprehension impairment in Wernicke's aphasia by examining the relationship between deficits in auditory processing of fundamental, non-verbal acoustic stimuli and auditory comprehension. • Results showed there is 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.

  47. Interactive Metronome & Motor Learning • Four factors of motor learning addressed by Interactive Metronome are: • Early cognitive engagement • Repetitive practice • Practice of specific functional motor skills • Feedback for millisecond timing to facilitate motor learning

  48. 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.

  49. Repetitive ^Practice functional 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.

  50. Feedback • 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 Knowledge of Results

More Related