Sensory Challenges

A 9 year old girl with a diagnosis of hypotonia was referred for Interactive Metronome to help with strength and coordination. After working with her for one session, we began to discover some sensory issues that had not been addressed before that were impacting the development of her skills. Another therapist asked me if we should stop IM because we wouldn’t be able to handle her sensory issues during our sessions. I reassured her, that we’d be able to adapt the activities and work with her to help her sensory system.

There is still controversy over whether Autism Spectrum Disorders result from some interaction with environment after birth (i.e., toxic exposures, immune-modulation post-vaccination, etc) or whether they result from genetic defect(s). Some would argue both are contributing factors, that certain individuals are born with a genetic predisposition and that exposure(s) in the environment turn on or off certain genes that may contribute to the development of Autism Spectrum Disorders. In this study, researchers provide a strong argument for a genetic defect in the “clock genes,” genes that control our perception of time and with genes for a process called “methylation” that controls the turning on and off of our genes or how they are expressed (ultimately how they control our abilities). Individuals on the Autism Spectrum demonstrate numerous symptoms resulting from an impaired perception of time from circadian rhythm (sleep/wake/appetite) to millisecond timing required for speech-language, social/behavioral, cognitive, motor, and visual skills. The Interactive Metronome (IM) is a training program that is administered under the guidance of a certified professional. It is designed to improve the basic timing skills necessary for development of speech, language, cognitive, and motor skills. Many parents and professionals also report decrease in aggressive behavior, improved social skills, and better sensory processing following IM training.
Wimpory, D. (2002). Social timing clock genes and autism: A new hypothesis. Journal of Intellectual Disability Research, 46(4), 352-358.

The important of timing in Speed Skating and the use of the Interactive Metronome

Researchers at Korea University College of Medicine (Park et al, 2012) recently conducted a neural imaging study of elite speed skaters to investigate whether training of complex motor skills resulted in structural changes to the cerebellum. The cerebellum responds to intense, repetitive training with increased brain mass in areas critical for skilled motor movement, in this case for control of balance, precisely coordinated movement, and visually guided movement. The authors compared the cerebellums of professional speed skaters to individuals who did not engage in regular exercise. They found that the specific skills required for speed skating that were trained repetitively resulted in structural changes to the brain that enhanced balance and coordination. They also found that the particular side of the cerebellum that was exercised repeatedly was affected (i.e., the right side due to maintaining balance on the right foot during turns). Of note, the cerebellum is also a central part of the brain’s internal timing network. The timing and synchronization of neural signals ultimately controls balance and coordination...

The front portion of the brain, or frontal lobes, are particularly vulnerable to damage during accidents. Individuals with traumatic brain injury frequently have what is called a “frontal lobe injury.” This is significant because this area of the brain is responsible for so many important skills for successful community reintegration: our personality and mood, our ability to plan and organize events, to manage and monitor time, to focus our attention and problem-solve, to sequence and coordinate motor movements, and the list goes on and on...

Have you ever heard that ADHD is genetic? Ever notice that children with ADHD seem out of sync? Here is a research study by Nanda et al (2007) that supports this view and does so by showing that not only is timing in the brain disrupted in children with ADHD, but that it IS ALSO slightly disrupted in their siblings who do not have ADHD (when compared to children from families with no diagnosis of ADHD). From this and other studies, evidence shows that the more the brain’s timing skills are off, the more symptoms like impulsivity, hyperactivity, inattention, lack of organization, poor time-management, or difficulty with reading and other academic work are evident. The Interactive Metronome is a relatively easy, non-medical treatment program for ADHD that improves the brain’s critical timing skills and is tailored to each child’s specific needs.

Nanda, N.J., Rommelse, M.S., Oosterlaan, J., Buitelaar, J., Faraone, S.V., and Sergeant, J.A. (2007). Time reproduction in children with ADHD and their nonaffected siblings. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 5.

IM and Transverse Myelitis – a tool to recovery

Transverse Myelitis can be very scary. Its onset is fairly quick, and its symptoms can be long lasting. It can be very treatable though, and typically when patients are medically stable, they can benefit from some type of rehabilitation therapy...

ADHD as a brain network dysfunction—IM as a tool to “fine tune” and control this network.

The explosion of research on large scale brain networks, and the “resting state” or “default mode or default network” in particular, has been dizzying.  I previously reviewedkey brain network research describing the interaction between the default, salience (attention) and executive controlled networks.  The most important conclusion, which was reinforced by my personal experiencewith Interactive Metronome (IM), is that problems with controlled attention (focus) may be responsible for a number of the behavioral symptoms of ADHD—and this is due to the poor ability to suppress the random self-talk “background noise” of the default brain network.  [Click herefor related IM-HOME ADHD posts; click herefor ADHD- related Brain Clock.]

Pervasive Developmental Delay

I have had the opportunity of working with many children who are diagnosed with PDD. The diagnosis in general seems to have a very wide range of abilities and areas that are affected. I have found in my area (Northeastern part of the country), that these children seem to fall somewhere between those who are diagnosed with Autism, and those diagnosed with Aspergers Syndrome. So their responses to using the Interactive Metronome have been very similar, with great progress in a shorter amount of time...

Temporal processing (or the timing of neural oscillations/transmissions) plays a critical role in coordinated motor movement. In this paper published in Science, the authors distinguish between “continuous” motor tasks, which involves moving steadily and smoothly at a certain pace, versus “discontinuous” motor tasks, which involve a succession of stops and starts as a person accomplishes each step of an overall goal (i.e., picking up a plate, walking it over to the table, and setting it down). They discuss the role of the cerebellum in each of these types of motor tasks and how the timing control for each differs in terms of the brain structures used, arguing that the cerebellum is involved only early on in setting the timing goal for continuous, smooth movements, but that the cerebellum is involved throughout the movement when it is discontinuous or involves several starts and stops by setting several, successive timing goals. Timing in the brain may be disrupted due to developmental disorder, trauma, or illness resulting in uncoordinated movement and/or cognitive impairment. The Interactive Metronome is a treatment program that measures and improves temporal processing, or timing in the brain, that is critical for movement and thinking.

Spencer, R.M.C., Zelaznik, H.N., Diedrichsen, J., and Ivry, R.B. (2003). Disrupted timing of discontinuous but not continuous movements by cerebellar lesions. Science, 300(5624), 1437-1442. 

Here is an interesting study by Gilden and Marusich (2009) published in Neuropsychology that looked at the ability of adults with ADHD to maintain a rhythm with either a faster tempo (less demand on focus, self-control, and working memory) or a slower tempo (more demand on focus, self-control, and working memory). Persons with ADHD had MUCH more difficulty when the tempo was slower, requiring them to estimate a longer time interval between beats, maintain the time interval in their memory, and restrain themselves from hitting too soon. This study, like many others, points to the direct relationship between timing in the brain and its command center “working memory.” Researchers theorize that Interactive Metronome is affecting this critical “control center” for timing in the brain and thereby improving many of the time-related symptoms of ADHD.

Gilden, D.L. and Marusich, L.R. (2009). Contraction of Time in Attention-Deficit Hyperactivity Disorder. Neuropsychology, 23(2), 265-269.

Why Can’t I use a Regular Metronome?

Some parents have asked me if they could just use a regular musical metronome and get the same results as Interactive Metronome at home or IM-Home. A standard metronome is typically used by musicians to help them practice the tempo of music. They have also been used in traditional therapy to help patients with their timing and rhythm, however there is one piece that is missing. – FEEDBACK!

Dr. Stanley Greenspan, a noted expert in autism and child development/disorders, and his team of researchers conducted a study to see whether Interactive Metronome (IM) was a beneficial treatment for children with ADHD. They compared boys who received IM to boys who received either no treatment at all or boys who only played video games to try to improve their ability to focus. They found that those children with ADHD who received IM did far better than those that did not, with significant improvement in the areas of attention, motor skills, language processing, reading, and self-control (i.e., less aggressive behavior).

Shaffer R.J., Jacokes L.E., Cassily J.F., Greenspan S.I., Tuchman R.F., Stemmer P.J. Jr. (2001). Effect of
Interactive Metronome on children with ADHD. American Journal of Occupational Therapy, 55, 155–162 

Timing skills play a pivotal role in the development of speech production and perception, or the ability to speak and understand the speech and/or intent of others (Kello, 2003). Not only must a child rapidly decipher the timing characteristics of each individual sound, syllable, word, and phrase in the speech stream, but for successful communication to occur there must be precisely timed coordination between centers of the brain for language and cognitive processing or thinking skills and the muscles and structures of the mouth and throat (or voice box). On top of that, a child must process and understand other information associated with what is said, such as demeanor of the person (Is he happy? Angry? Sad? ) or humor (Was he serious? Or was he joking?) Many children on the Autism Spectrum either don’t understand what you said, or don’t understand the unspoken social aspects of speech. All of this depends upon timing in the brain!!! That’s a bit like patting your head and rubbing your tummy at the same time! However, in normal development the brain’s “internal clock” functions very precisely so that children learn to speak intelligibly and understand you when you speak to them, including your mood and intent. Interactive Metronome (IM) training impacts the very critical timing centers of the brain necessary for effective communication & social skills.

Kello, C.T. (2003). Patterns of timing in the acquisition, perception, and production of speech. Journal of Phonetics, 31, 619-626.
 

Guidance shows improvement in children with Pervasive Developmental Delay

I have had the opportunity of working with many children who are diagnosed with PDD. The diagnosis in general seems to have a very wide range of abilities and areas that are affected. I have found in my area (Northeastern part of the country), that these children seem to fall somewhere between those who are diagnosed with Autism, and those diagnosed with Aspergers Syndrome. So their responses to using the Interactive Metronome have been very similar, with great progress in a shorter amount of time.
 

Infants, before than can speak, are exposed to rhythmic sounds in the form of music and song. This research by Bergeson and Trehub (2006) shows that their little tiny ears and developing brains are already tuned just like an adult’s to hear the slightest changes in tempo, tone, and rhythm. They discuss the importance of the brain’s “internal clock” as it relates to how infants respond and move their bodies to music and other rhythms. IM providers who specialize in infant care and early intervention are reporting very good results when using the Interactive Metronome in the treatment of infants and young children who have developmental delays or disorders with improvements in the areas of: sensory processing, pre-speech/cognitive development, and motor skills. Case studies can be found at www.interactivemetronome.com

Bergeson, T.R. and Trehub, S.E. (2006). Infants’ perception of rhythmic patterns. Music Perception, 23(4), 345-360.

Humans perceive time. We use this ability to predict what is coming, to think about how we will react, and then to respond in a timely fashion. It is well-documented that children with ADHD have an impaired sense of time. Areas of the brain that control our perception of time are affected in children with ADHD (i.e., working memory). In an article published in the Journal of Child Psychology and Psychiatry, researchers found that children with ADHD who also have a Reading Disorder have even more difficulty with timing skills. Research has shown that Interactive Metronome, a training program that addresses the underlying problem with timing in the brain, improves symptoms of ADHD and reading.

Toplak, M.E., Rucklidge, J.J., Hetherington, R., John, S.C.F., and Tannock, R. (2003). Time perception
deficits in attention deficit/hyperactivity disorder and comorbid reading difficulties in child and adolescent samples. Journal of Child Psychology and Psychiatry, 44(6), 888-903.

Some of my patients are very sports oriented. When we start IM, I tell them all about how professional sports teams such as the Miami Dolphins or the golf pro ViJay Singh use IM as part of their training to improve and enhance their performance. Every once in a while, I get a patient who just really “gets on a roll” and makes improvements very quickly earning lots of “bursts” (so many consecutive super right on the beat hits).

Bill was one of those kids. He just loved beating his scores during every visit. He got the idea in his head, that he wanted to reach 1000 bursts before he completed his sessions. Every visit, Bill would request to perform various exercise that he knew he was good at, just to increase his number of bursts so he could reach his goal. Now a kiddo (who happened to have Asperger’s syndrome and ADHD) who has set his mind to something is very difficult to stop!...

Have you ever heard the saying “timing is everything?” Our brain keeps time – in microseconds, milliseconds, seconds, minutes, hours. This time-keeping function is critical for all of our human abilities and thinking skills. According to research, persons with musical training tend to consistently demonstrate better timing and rhythm than those who are not musically oriented. Children who play an instrument or are otherwise musically trained tend to also perform better in school, are focused, and complete projects on time. Here, Eck & Scott (2005) discuss the critical timing skills involved in the perception and creation of music. It is not surprising that musicians have better timing skills, and thus are more equipped to handle academic hurdles. Do you see the connection? If a child is struggling with school work, to focus or stay on task, has behavioral outbursts, is impulsive, or has trouble staying organized or managing time … the brain’s clock may be out of sync and areas of the brain may not be communicating efficiently or effectively, therefore the child may also be out of sync with other people and events in his/her environment. Interactive Metronome is the only treatment program that provides training and feedback in order to improve timing skills that are so critical to academic and social success.

Eck, D. and Scott, S.K. (2005). New research in rhythm perception and production. Music Perception, 22(3), 365-369.

Nonverbal Learning Disorder (NLD), also called Nonverbal Learning Disability, is a developmental disability which all too often goes undiagnosed. Individuals with this potentially debilitating disorder generally suffer in silence...

Has your child ever had trouble concentrating on daily tasks? Although Mason Roach, a 6-year-old boy, was not diagnosed with ADHD, he still showed similar symptoms. Mason had trouble following through with simple tasks, such as taking a shower and brushing his teeth. His Mom came to Lisa Poe, OTR/L for help...