Thursday, November 20, 2008

IM + Core:Tx Interventions

Mark is a 12 year old boy with high functioning autism who returned to occupational therapy after a break of several years. Although Mark was doing well in school, he was unable to fully dress himself or bathe himself. In terms of neuromuscular control, Mark had poor overall tone, poor postural control, and significant motor planning issues. He walked with a very wide gait (total deviation of 80 degrees), had poor handwriting, and lacked the ability to plan and execute movements with his arms and hands that would allow him to reach the top of his head and flex his fingers to wash his hair. In addition, he chewed his food in the front of his mouth and for this reason preferred a soft foods diet. Mark’s social skills were quite limited. He rarely looked at others while speaking and limited his conversations to single words.

Given the range of problems Mark faced, it was decided that a course of Interactive Metronome (IM) would reduce the time in therapy. Mark did IM twice per week for 30 minute sessions. He started each session with a few minutes in the ball pit to help him relax and self-organize. He then did 10 minutes of IM, took a short break on a swing or trampoline and then a final 10 minutes of IM. As his skills improved (and he moved to phase 4 of the IM program), he did 20 minutes of IM and then practiced dressing skills or handwriting.

Progress with IM
The program of IM had profound effects on Mark. He developed a self-awareness and motivation that led to greater independence. First, he figured out how to regulate the shower temperature. Next, he tried to wash his hair on his own, although he still lacked the correct motor-planning for that task. He took an interest in outside activities and began to talk about what he did. He displayed a good sense of humor. He saw gains in motor planning and postural control. He learned to dress himself entirely with the exception of buttoning pants at the waist and tying shoes. He learned to chew with his whole mouth. His wide stance improved, so that his feet were better aligned by 5-10 degrees.

After 19,000 repetitions, therapy took a new direction. It was time for Mark to learn a variety of new skills through exercise and repetition. Mark was aware and motivated, but with his new sense of humor, he was also very playful. It was difficult to keep him on task to perform the more difficult work of exercising his body to make additional gains. For example, when asked to lay over a therapy ball to work on posture, he would fall off the ball and roll on the floor and giggle. When asked to pretend to wash his hair by moving his hands together on top of his head, he would pat the sides of his head with extended fingers, as if to say, “there, all done.”

Core:Tx proved to be the solution for getting him to perform exercises correctly. Its game-like nature engaged him, and he paid attention to the instructions rather than acting-out with silly behaviors. On the first day he performed scaption (shoulder/rotator cuff) exercises. As he attempted to keep Core:Tx’s red ball within the square, he made smooth movements with his arms to the top of his head, using full range of motion, for the first time. He was proud of himself and after two sessions, he developed the motor planning to successfully wash his hair independently. He currently uses Core:Tx in both physical therapy and occupational therapy to address postural control, lower extremity motor planning and gait issues.

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