A reader of this blog wrote and asked about getting IM Training. Here is some info for those who are thinking about getting started.
There are 2 modes of training: Interactive (alone) and Workshop (in a group). As usual, there are tradeoffs.
If you have access to the IM equipment, then doing the interactive training is a great option. For $225 (or so), you are sent an excellent training manual with 12 lessons, each 30-90 minutes in length, of hands-on training. Most people complete the training in 4-6 weeks. The beauty of doing this is that you will experience the effects of using the product 2-3 times per week for several weeks. The OTs in my clinic found that doing our own course of IM helped us to get our own gears in sync and allowed us to move forward with projects. (For me, it was my blog.)
The workshop is very vaulable for the instructor contact. (I'm sure I missed a lot by not attending the workshop!) and you learn how to facilitate IM in just 48 hours. (And of course, you can then do your own hands-on training later).
Be aware that the IM equipment costs over $3,000. For that price you get hardware (that hooks to your computer), software, headphones, and hand and foot triggers. In addition to the initial equipment cost, the company charges about $6-8/hr for use of the system. You buy blocks of time from IM so that you can treat your clients. In fact, the real cost for a client's session is much less than $6-8, because the IM clock runs only during active clapping.
By the way, the trainees who purchase the Interactive course are given enough minutes to complete the course.
Monday, April 21, 2008
Friday, April 18, 2008
More about Listening & Rhythm
I continue to be pleasantly surprised at the results of Therapeutic Listening (TL) in my practice. The kids get calmer, attention improves, meltdowns decrease and with that, comes real growth. One boy used the headphones for just 4 weeks, and then Interactive Metronome (IM) for another several weeks. Mom reports that he is calm (TL) and has confidence in himself (IM). I've noticed increaed postural control and motor planning, too. Unfortunately, not all children can use TL. Some children do not tolerate headphones or the music through them at all - whether this is due to actual hearing problems such as tinnitus (ringing in the ear) or perhaps a severe tactile issue isn't always clear with some of our non-verbal population.
Therapeutic Listening and Interactive Metronome have overlapping territory in the area of motor planning - although each product works in a unique way. There is rhythmic feedback with IM in which the person actively attempts to increase their rhythmic precision. (See my entry about this, or check out the IM site.) TL is a passive system in which the person receives modulated auditory stimulation through rhythm and music. The therapist can add active components to TL therapy in the form of sensory stimulation, play or exercise.
A third program I have checked into is Samonas. I'll devote a blog to this at some future date. It comes from Germany and is a very high quality listening program that would appeal to adults as well as to children. There are 5 levels of CDs offered. Levels 1-4 require direction from a trained therapist. An introductory set of CDs is available to the general public. The recorded music and nature sounds are gorgeous. I tried a level 1 CD for 15 minutes and felt some powerful broad effects that included auditory refinement, emotional release and energy. I was pleased with it. Samonas offers a series of Listening Programs for the general public specifically aimed at areas including emotional, social, communication, organization, motor planning, etc. The Samonas web site can be very confusing. You can find web-based training programs for professionals at this location. They will be offering live training classes in the fall in New York and Florida. I'll write more when I get the details.
Therapeutic Listening and Interactive Metronome have overlapping territory in the area of motor planning - although each product works in a unique way. There is rhythmic feedback with IM in which the person actively attempts to increase their rhythmic precision. (See my entry about this, or check out the IM site.) TL is a passive system in which the person receives modulated auditory stimulation through rhythm and music. The therapist can add active components to TL therapy in the form of sensory stimulation, play or exercise.
A third program I have checked into is Samonas. I'll devote a blog to this at some future date. It comes from Germany and is a very high quality listening program that would appeal to adults as well as to children. There are 5 levels of CDs offered. Levels 1-4 require direction from a trained therapist. An introductory set of CDs is available to the general public. The recorded music and nature sounds are gorgeous. I tried a level 1 CD for 15 minutes and felt some powerful broad effects that included auditory refinement, emotional release and energy. I was pleased with it. Samonas offers a series of Listening Programs for the general public specifically aimed at areas including emotional, social, communication, organization, motor planning, etc. The Samonas web site can be very confusing. You can find web-based training programs for professionals at this location. They will be offering live training classes in the fall in New York and Florida. I'll write more when I get the details.
Sunday, April 6, 2008
Parents of kids with Autism
I mentioned in an earlier blog that I am engaged in a small research project. There are 10 parents doing a course of Interactive Metronome. At the start of the study, we gave the parents 2 assessments: The Parental Stress Inventory (PSI) and the Sensory Profile for Adults. I recently scored the PSI and was surprised to see just how high the stress levels are. All of the scores were high and some were literally off the scoring charts. Our clinical director, a psychologist, has analyzed the PSIs and she said that she was gratified to see that in spite of the high stress, there was equally high parent-child attachment levels.
As for the Sensory Profile, most were typical. But 2-3 showed sensory issues.
As for the Sensory Profile, most were typical. But 2-3 showed sensory issues.
Calming Rhythms
I have begun to work with a product called "Calming Rhythms" from REI Institute. Calming Rhythms is a CD with three 20-minute pieces of music/alpha-rhythms that are played for a calming affect. Jeff Strong, the head of REI, has tested the product on children with autism and found it to be quite effective, but with a few occasional side-effects - acting out behaviors in some children.
To get a feel for the therapy, I tried it out on myself. I tried it under 3 conditions:
1. At night before bed for 2-3 nights. This is per the instructions from the REI site. I slept deeply, awoke with deep calm and felt like I could handle anything.
2: During the day, during very stressful occasions. I didn't notice anything while it was playing, but within 30 minutes, I was very cranky, and snapped at someone. Later, I became even more irritable. Was it the music or the stressful situation? I am typically very easy-going and handle stress well. The next morning, I was calm and happy.
3. Several times for a few minutes throughout the day under stress-free conditions (on a Friday while treating children in the clinic) . Seemed fine at the time, and all weekend I've had a wonderful sense of calm and perspective as I deal with another stressful situation.
My conclusions: use it when the client is in a good mental state for just a few minutes at a time or at bedtime.
One of my clients,, Tommy, has what appears to be an undiagnosed case of ADHD. I am doing 15-20 minutes of Interactive Metronome (IM) with him once a week as part of his OT session. Since the IM can be very arousing, I thought to counter it with the Calming Rhythms. Jeff Strong told me that other therapists are using this same approach. I gave Tommy's mom the CD and instructions and suggested she try it at night over the weekend. I warned her to watch out for acting-out behaviors. Can't wait to hear how he did.
I think that this will be a good option for my hyperactive kids. By the way, if you want to try it, Jeff Strong offers a free demo download at his site.
4/18/08 Update: 3 parents tried the Calming Rhythms CD for 10 minutes just before bedtime for a few nights. One boy made noticeable decrease in hyperactivity. A second mom reported no change. The third boy, Tommy, liked the rhythms, however, his mom reported that he got up in bed and danced to them ... not exactly what we were hoping for ... but she planned to try it for another night or two and report back.
To get a feel for the therapy, I tried it out on myself. I tried it under 3 conditions:
1. At night before bed for 2-3 nights. This is per the instructions from the REI site. I slept deeply, awoke with deep calm and felt like I could handle anything.
2: During the day, during very stressful occasions. I didn't notice anything while it was playing, but within 30 minutes, I was very cranky, and snapped at someone. Later, I became even more irritable. Was it the music or the stressful situation? I am typically very easy-going and handle stress well. The next morning, I was calm and happy.
3. Several times for a few minutes throughout the day under stress-free conditions (on a Friday while treating children in the clinic) . Seemed fine at the time, and all weekend I've had a wonderful sense of calm and perspective as I deal with another stressful situation.
My conclusions: use it when the client is in a good mental state for just a few minutes at a time or at bedtime.
One of my clients,, Tommy, has what appears to be an undiagnosed case of ADHD. I am doing 15-20 minutes of Interactive Metronome (IM) with him once a week as part of his OT session. Since the IM can be very arousing, I thought to counter it with the Calming Rhythms. Jeff Strong told me that other therapists are using this same approach. I gave Tommy's mom the CD and instructions and suggested she try it at night over the weekend. I warned her to watch out for acting-out behaviors. Can't wait to hear how he did.
I think that this will be a good option for my hyperactive kids. By the way, if you want to try it, Jeff Strong offers a free demo download at his site.
4/18/08 Update: 3 parents tried the Calming Rhythms CD for 10 minutes just before bedtime for a few nights. One boy made noticeable decrease in hyperactivity. A second mom reported no change. The third boy, Tommy, liked the rhythms, however, his mom reported that he got up in bed and danced to them ... not exactly what we were hoping for ... but she planned to try it for another night or two and report back.
Thursday, March 13, 2008
White Matter
This month's Scientific American (March 2008) has an article called, "White Matter", by R. Douglas Fields about myelination in the brain and how that process affects development. As you know, myelin is white matter - the sheathing around neural axons that protects signals and speeds them up. Turns out that myelin has other properties/functions, too, of which I will just briefly describe.
In order to be effective, myelin must have exactly the right amount of sheathing around its neuron's axis. Too much or too little and the signal's timing gets messed up. Pretty critical! It turns out that neurons have a constant ratio (.6) for the thickness of an axon to the thickness of myelin sheathing wrapped around it. Somehow the developing brain cells are able to place the myelin down to the exact prescribed thickness. Except, of course, when they get it wrong, which they do with various developmental disorders, cerebral palsy, ADHD, language disorders, autism, bi-polar disease, schizophrenia and so on, including pathological lying(!).
The brain puts the myelin in place slowly over the years starting in the back (shirt collar) at an early age to the front (temples) by age 28-30. The brain forms and prunes itself until the sheathing is done, and then things are pretty well set - barring the phenomena of plasticity, which is a much subtler process. By the time a child turns 4, the myelin has been fully wrapped around the neurons in the visual cortex (so that is the optimal time to have vision therapy complete - but we rarely note problems by then!)
The author explains that the lack of sheathing on the pre-frontal cortex - executive function - is what prevents teenagers from making mature decisions -- that area is still developing and the lack of myelin means that the timing in the area is just not working yet.
The implication for practice with children is that there are critical times for completing therapies. Just as a person learning a second language after age 11 will retain an accent whereas a 10 year old child will not, there are developmental (and other) issues that can be repaired, adapted, etc. if caught before the final myelination takes place. Intensive practice in certain ways (Fields uses learning a musical instrument as a child for the example) will increase myelin thickness (probably because the axon grows wider, too), and this may allow for an impacted area to correct itself.
We can see why early intervention is critical. The author did not identify the critical age for various regions in the brain other than those given above. We will be waiting with baited breath for more particulars!
Fields also discussed the role of insufficient myelination in the pre-frontal cortex (during the teenage years) on the onset of bi-polar disease and schizophrenia. He described the failed process and the role of mutated genes.
Good article - can't wait for greater detail.
In order to be effective, myelin must have exactly the right amount of sheathing around its neuron's axis. Too much or too little and the signal's timing gets messed up. Pretty critical! It turns out that neurons have a constant ratio (.6) for the thickness of an axon to the thickness of myelin sheathing wrapped around it. Somehow the developing brain cells are able to place the myelin down to the exact prescribed thickness. Except, of course, when they get it wrong, which they do with various developmental disorders, cerebral palsy, ADHD, language disorders, autism, bi-polar disease, schizophrenia and so on, including pathological lying(!).
The brain puts the myelin in place slowly over the years starting in the back (shirt collar) at an early age to the front (temples) by age 28-30. The brain forms and prunes itself until the sheathing is done, and then things are pretty well set - barring the phenomena of plasticity, which is a much subtler process. By the time a child turns 4, the myelin has been fully wrapped around the neurons in the visual cortex (so that is the optimal time to have vision therapy complete - but we rarely note problems by then!)
The author explains that the lack of sheathing on the pre-frontal cortex - executive function - is what prevents teenagers from making mature decisions -- that area is still developing and the lack of myelin means that the timing in the area is just not working yet.
The implication for practice with children is that there are critical times for completing therapies. Just as a person learning a second language after age 11 will retain an accent whereas a 10 year old child will not, there are developmental (and other) issues that can be repaired, adapted, etc. if caught before the final myelination takes place. Intensive practice in certain ways (Fields uses learning a musical instrument as a child for the example) will increase myelin thickness (probably because the axon grows wider, too), and this may allow for an impacted area to correct itself.
We can see why early intervention is critical. The author did not identify the critical age for various regions in the brain other than those given above. We will be waiting with baited breath for more particulars!
Fields also discussed the role of insufficient myelination in the pre-frontal cortex (during the teenage years) on the onset of bi-polar disease and schizophrenia. He described the failed process and the role of mutated genes.
Good article - can't wait for greater detail.
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.
Article
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.
Abstract
(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.
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.
Article
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.
Abstract
(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
Article
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.?
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.?
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