Sunday, February 24, 2008

Interactive Metronome Research

I wrote earlier of being "blown away" by the capabilities of the Interactive Metronome™ (IM) product. The literature shows that IM increases mental fluency which in turn increases the efficiency (and skill level) of many brain and body functions including motor planning. (See the TickTockBrainTalk blog and the IM site, for much more on this!)

There has been substantial research done on IM for children. (The article cited below finds that IM "appears to facilitate a number of capacities, including attention, motor control, and selected academic skills in boys with ADHD.) There are a few studies on the effects of IM on adults in rehabilitation recovering from varied disabilities such as stroke, TBI and loss of limb. None of the studies I've seen address softer issues such as stress, organization, or well-being.

I have launched a small research project studying the effects of the IM protocol on parents of children with special needs. It's a convenience study being done at Building Bridges therapy Center, where I work. I am asking the question: Does IM help parents of children with special needs become better organized such that they are better able to accomplish their goals. And does this is turn help reduce their stress levels? These parents operate at a very high level of challege and stress (lots 0f OT journal articles have documented this).

I may also look at another factor -- SI. Since many of the children at my clinic have autism and sensory integration issues, as a result, I may assess parents for sensory integration issues using the Adult/Adolescent Sensory Profile. If indeed they do, I wonder if any symptoms lessen at the end of the study....and if not, perhaps, I could re-enlist them in another short study with a different intervention. H-m-mm.


Shaffer, R. J., Jacokes, L. E., Cassily, J. E., Greenspan, S. L., Tuchman, R. E., & Stemmer, P. J., Jr. (2001). Effects of Interactive Metronome™ training on children with ADHD. American Journal of Occupational Therapy, 55, 155-162.


(This was copied from the IM site)
The purpose of this study was to determine the effects of a specific intervention, the Interactive MetronomeÒ, on selected aspects of motor and cognitive skills in a group of children diagnosed with attention-deficit/hyperactivity disorder (ADHD).

The study included 56 boys, age 6 to 12 years, pre-diagnosed as having ADHD who were pre-tested and randomly assigned to one of three matched groups. The 19 children receiving 15 hours of Interactive MetronomeÒ rhythmicity training exercises were compared with a group receiving no intervention and a group receiving training on selected computer video games.

A statistically significant pattern of improvement across 53 of 58 variables favoring the Interactive Metronomeâ treatment was found. Additionally, several statistically significant differences were found among 12 factors on performance in areas of attention, motor control, language processing, reading, and parental reports of improvements in regulation of aggressive behavior.

Friday, February 22, 2008

Sensory Profile Factors


Ermer, J. & Dunn, W. (1998). The sensory profile: a discriminant analysis of children with and without disabilities. American Journal of Occupational Therapy, 52, 283-290.

Here is an older study done in Kansas that looks at the factors (1-9) in the Sensory Profile for positive correlations to autism and ADHD. (The authors note that this process can be done for other disabilities, as well. I vote for Fetal Alcohol Syndrome!)

ADHD can be distinguished by high scores in Factors 1 and 5, sensory seeking and inattention/distractibilty and low scores in factors 4 and 9, oral sensitivity and fine motor perceptual.

Autism can be distinguished by high scores in Factors 4, 5 and 9, sensory seeking, inattention/distractibilty and oral sensitivity and low scores in factor 4, fine motor perceptual.

The study results had a statistical error, the assumption of homogeneity of variance was violated for the control group, and so these results must be used conservatively.

Questions for research:
1. Will these results pass muster on a larger population?
2. What does the factor profile look like for FAS, ODD, CD, etc.?

Friday, February 8, 2008

Modulation Case Study

Article Review

Roberts, J.E., King-Thomas, L., & Boccia, M. L. (2007). Behavior indexes of the efficacy of sensory integration therapy. American Journal of Occupational Therapy, 61, 555-562.

The authors performed a single-case study on a boy age 3 years and 5 months with sensory modulation disorder (as diagnosed by the Sensory Profile which noted tactile and auditory processing issues and sensory seeking behaviors) and delayed communication skills. He had been given a reduction in school hours due to classroom behaviors of phycial and verbal aggressive, throwing objects, mouthing objects and touching others within a classroom setting. Treatment was given in an ABAB format: 2 weeks of no treatment, 5 weeks of intense SI therapy (3 times per week), 2 weeks of no treatment, and 2 weeks of treatment. Success was gaged by teacher report of observed behaviors. The SI treatment was provided by a therapist trained by Jean Ayers.

At the end of the study all aggression and mouthing behaviors had diminished. There was a 50% decrease in teacher intensity needed to manage the child's behavior and he was engaged in classroom activities for 70% of the time, a 40% increase from the start of the study.

The child continued with once per week OT which was reduced to once per month over a 3 year period. At the age of 6 he was diagnosed with ADHD.

My Thoughts

This is a nice look at the early stages of a boy with ADHD and the affect of intense early intervention.

See also the article by Ermer & Dunn regarding the using the Sensory Profile to differentiate typically developing children, children with ADHD, autism, and other disabilities.

Ermer, J. & Dunn, W. (1998). The sensory profile: a discriminant analysis of children with and without disabilities. American Journal of Occupational Therapy, 52, 283-290.

Thursday, February 7, 2008

Therapeutic Listening


Hall, L. & Case-Smith, J. (2007). The effect of sound-based intervention on children with sensory processing disorders and visual-motor delays. American Journal of Occupational Therapy, 61, 209-215.

Leah Hall conducted a study with 10 children ages 5y 8m - 10y 11m who were diagnosed with sensory processing disorder (they were rated "Definitely different" in 3 or more areas of the Sensory Profile). Children were given home programs of four weeks with a sensory diet followed by 8 weeks of continued sensory diet with Therapeutic Listening. Significant results were found at the end of the first 4 weeks and at the end of the 12 weeks. Children gained an average of 71 points on the Sensory Profile with the biggest gains in the area of auditory processing and behaviors associated with sensory processing. Children with specific issues (such as auditory hyper-sensitivities, tantrums and hyperactivity made significant gains in some of those areas, as well). In addition, significant gains were made in handwriting (as assessed by the Etch program, and visual processing (as assessed by the VMI). Parents noticed large changes in overall behavior included improved attention, social interactions, self awareness, communication and sleep patterns. One child on medication for ADHD was given a reduction in dosage.

Wednesday, February 6, 2008

Parameters of Modulation

I recently read the March/April, 2007, Sensory Integration issue of AJOT. Lots of great articles. I was especially interested in the lead in article that describes the push for three SI diagnosies in the DSM. They are Sensory Modulation Disorder, Sensory-Based Motor Disorder and Sensory Discriminiation Disorder. With this breakdown (and some sub-categories underneath them) we come closer to being able to perform meaningful research in the area of modulation. Although we have diagnostic and therapeutic tools for motor and discrimination, these are not in place for modulation.

For example, we have developmental scales and excellent assessments for a child's motor skills. They are quite specific, and provide a therapist working with a child with motor delays with a measure of the disability as well as indicate an enumerated set of goals to reach.

Similar OT-based tools for modulation will tell us what modulation behaviors are typical for children at various ages. This in turn will allow us to create assessment tools for children with sensory disorders (including autism) and will allow us to estimate the degree of problem a child has, as well as where they are on the developmental scale. Good assessments will give us milestones for our treatment, and allow us to determine if indeed our treatment is effective. On a larger scale, these tools will allow us to perform quantitative research interventions on large populations. (This topic is also addressed in depth in other articles within the same issue of AJOT).

We need to know precisely the qualities of modulation and their developmentaly characteristics. According to Williamson and Anzalone, the qualities of modulation for infants and toddlers include arousal, attention, affect, and attention. Can we quantify these, assess them in clinical (and other) contexts? For example, can we talk about joint attention, object manipulation, object play, etc.? I am guessing that there are many subtleties here. I hope that we can find specific assessable qualities that are general enough to give us a picture of the child (as the motor assessments do). A resource I have not yet looked at is the zero-to-three foundation's publications (with the exception of the book cited below).

1. Miller, L.J., Anzolone, M. E., Lane, S. J., Cermak, S. A., & Olsten, E. T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. American Journal of Occupational Therapy, 61, 135-140.

2. Williamson, G. G., & Anzalone, M. E. (2001). Sensory integration and self regulation in infants and toddlers: helping very young children interact with their environment. ZERO-TO-THREE: National Center for Infants, Toddlers and Families.

Monday, February 4, 2008

Things I learned while looking up something else...

1. It takes 8 - 10 tries for an older child to accept a new food. (I'm assuming that that number is for typically developing children.)

2. A study found that babies are more inclined to eat veggies (green bean, for example) if the green beans are followed by a treat such as peaches. This is just proof of what every mother knows works.

3. Raisins are good for the teeth ... BUT ... they can be made into a yeast starter (and so feed yeast and yeast infections!). I continue to find sugar(s), fructose and glucose a mystery. Not to mention honey!

Food aversion story

Food aversion therapy is by no means an easy thing to do. Children don't want to eat the foods they don't like (go figure!). So, we trick them, soothe them, cajole them, reward them and somehow many of them try and then eat heartily foods that wouldn't touch previously.

Here is a recent success. Three mornings a week, I do food therapy during snacktime with two 8-9 year old boys in the school attached to our clinic. Billy eats very few fruits, but he likes crunchy foods. So every day, I bring in an apple or pear cut 2 slices and then deliberately crunch on one slice while I put the other near his mouth. He can't resist. He still grimaces at the apple, so I don't make him eat it, just crunch on it. He loves to do that. And once in a while, he will chew and swallow a bite (with surprise).

A month ago, I brought in tangerines. I put a slice on my tray and had the boys practice cutting the orange. To my surprise, Billy started mashing the orange with his finger playfully. I did so, too. We made a mess and giggled. Then I encouraged him to lick his finger. We played with oranges a few times that week and then went back to apples.

Last week, Billy's mom caught me in the hallway, "I just have to tell you what happened! I was on the phone in the kitchen, when Billy came in. He took an orange from a bowl of fruit, peeled it and then ate the whole thing! THEN, he went back, got another one and ate part of that, too."

Success with oranges is very sweet!