I had an opportunity to check gains in the sensory processing skills of a 7 year old girl who had undergone 6 months of SI. Her clinic-based OT consisted primarily of vestibular & tactile interventions was 1/2 hour weekly sessions with modulated music playing in the backgound. This was followed by 1/2 hour sessions with a music therapist. In addition, she received 6 weeks (so far) of Therapeutic Listening and a very good sensory diet program at her school.
She made significant gains in her parent's eyes and it also registered on the Sensory Profile (SP). She now accepts hugs from her family without tactile defensiveness (talk about huge!). On the SP, She gained 10 points overall (from 497 to 487). Her Touch Processing score moved from definite difference to probable difference and the Sedentary Factor moved from probable difference to typcial.
Friday, May 16, 2008
Thursday, May 8, 2008
Tyler's Case Study
Here is an Interactive Metronome case study that I wrote up for IM. Thought I'd reproduce it here.
Tyler is an 11 year old boy with high functioning autism who attends regular education and special education classes. Before his IM program, he displayed low tone, poor motor planning, and poor attention and organization skills. He also demonstrated poor overall motivation. Tyler could not tie his shoes. He had difficulty playing the typical games of children his age that involved motor planning, rules and social interaction. Tyler had language skills but engaged in very little communication. For example, he did not acknowledge his mother when she asked him what he wanted to eat or requested that he clean up his toys.
His mother’s stated goals for Tyler’s IM program were improved organization and motivation skills. Tyler’s personal goal was to be able to compete with family members when they played Wii. The IM long form pre-test indicated average to severely-below-average scores for Tyler. He was given a four-week, 12-session program with adaptations for low tone in his lower extremity (therapy ball), tempo modification and use of the visual mode. He began with 800 repetitions and by the twelfth session was able to maintain 1800 repetitions that included 30 minutes of continued focus.
Initially, Tyler showed poor motivation and tried to find ways to take frequent breaks. Introduction of a therapy ball during an early session increased his overall compliance. After 3 sessions, he independently taught himself in the space of one day to tie shoes. He also began to learn new gross motor skills in the gym. More important, he began to demonstrate a noticeable sense of pride in his accomplishments and to work diligently in the program. After two weeks, his mother said he was acquiring better focus, as well as improved attention, memory and sense of responsibility. He also beat his brother in a game of Wii. After three weeks, his mother said, “I was blown away. I asked him to pick some things up, and he said, ‘Sure, Mom, I’ll get it in a few minutes.’” She went on to say, “He had never done that before!” Tyler completed the program with above-average scores. Four months later, his gains including his newly-developed reciprocal communication skills remained intact and are growing.
Tyler is an 11 year old boy with high functioning autism who attends regular education and special education classes. Before his IM program, he displayed low tone, poor motor planning, and poor attention and organization skills. He also demonstrated poor overall motivation. Tyler could not tie his shoes. He had difficulty playing the typical games of children his age that involved motor planning, rules and social interaction. Tyler had language skills but engaged in very little communication. For example, he did not acknowledge his mother when she asked him what he wanted to eat or requested that he clean up his toys.
His mother’s stated goals for Tyler’s IM program were improved organization and motivation skills. Tyler’s personal goal was to be able to compete with family members when they played Wii. The IM long form pre-test indicated average to severely-below-average scores for Tyler. He was given a four-week, 12-session program with adaptations for low tone in his lower extremity (therapy ball), tempo modification and use of the visual mode. He began with 800 repetitions and by the twelfth session was able to maintain 1800 repetitions that included 30 minutes of continued focus.
Initially, Tyler showed poor motivation and tried to find ways to take frequent breaks. Introduction of a therapy ball during an early session increased his overall compliance. After 3 sessions, he independently taught himself in the space of one day to tie shoes. He also began to learn new gross motor skills in the gym. More important, he began to demonstrate a noticeable sense of pride in his accomplishments and to work diligently in the program. After two weeks, his mother said he was acquiring better focus, as well as improved attention, memory and sense of responsibility. He also beat his brother in a game of Wii. After three weeks, his mother said, “I was blown away. I asked him to pick some things up, and he said, ‘Sure, Mom, I’ll get it in a few minutes.’” She went on to say, “He had never done that before!” Tyler completed the program with above-average scores. Four months later, his gains including his newly-developed reciprocal communication skills remained intact and are growing.
Monday, April 21, 2008
Getting IM Training
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.
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.
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.
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