A Revolution in Neurological andMotor Rehabilitation
Overview
History & Research
Clinical adoption & areas of use
Cases Studies
Billing & Coding
History of Interactive Metronome
Began formal clinical research in 1994
First used with Pediatric patients
Stanley I. Greenspan, MDChairman, IM Scientific Advisory
Board
Clinical Professor Psychiatry, George Washington Medical School
Contributor to over 100 articles and 27 books, including Building Healthy Minds, and The Child with Special Needs
Child Development Expert Featured in The Washington Post, Newsweek, Time Magazine, ABC’s Nightline, NBC, and CBS
“Motor planning and sequencing is a critical component of the deficit in a variety of developmental and learning disorders.”
Science Overview
Motor Planning Processes of Organizing and Sequencing are a
core function of the brain
- Stanley I. Greenspan, M.D.
Early Studies:Motor Skills Study
Special education students
Improved fine and gross motor and visual motor skills
Results presented to the American Educational Research Association
Large-Scale Correlation Study
Timing and Child Development Study Published• Conducted in Illinois by High/Scope
Foundation• 585 students, 6-10 years old
AJOT Published Clinical Study
3 groups of ADHD boys separated by: Control / Placebo / IM-trained
Statistically significant improvement in:• Attention• Motor Control and
Coordination• Language Processing• Reading• Control of Aggression
and Impulsivity
AJOT Published Clinical Study
Language Processing Test Similarities
Pre and Post Test Differences
2.666
9.316
-1
-2
0
2
4
6
8
10
Control Placebo IM
Sim
ilari
ties
(Sta
ndard
Sco
re)
Interaction Effect = 0.005
Academic Fluency Study
Over 700 middle and high school students
Pre and post subtest on nationally standardized Woodcock-Johnson III test
Results showed significant increases in grade equivalent (GE) performances in IM Group
2.21 GE Gain in Reading Fluency 1.66 GE Gain in Math Fluency
Academic Fluency Study
12.46
10.25
0
2
4
6
8
10
12
14
Pre IM Post IM
Gra
de E
quiv
ale
ncy
2.21 GE gain, n=718, Woodcock Johnson, 3rd Ed. 1.66 GE gain, n=703, Woodcock Johnson, 3rd Ed.
12.39
10.73
9.5
10
10.5
11
11.5
12
12.5
13
Pre IM Post IM
Gra
de E
quiv
ale
ncy
Athletic Performance Study
Comparison of IM trained golfers to a control group
Produced significant improvements in golf shot accuracy
An average of 20-40% improvement in shot accuracy obtained by the IM group
Control group saw no gain
Athletic Performance Study
20% Overall Gain in Shot Accuracy
35% Increase for advanced golfers who had consistent swing mechanics
Results from Early Clinical Trials
MEDIAL BRAINSTEM
Neuro-motor pipeline
BASAL GANGLIA
Integrates thought and movement
CINGULATE GYRUS
Allows shifting of attention
Cognitive flexibility
Results from a pilot fMRI (brain scan) study show IM directly activates
multiple parts of the “neuronetwork”
Parkinson’s Study
“In this controlled study computer directed rhythmic movement training was found to improve the motor signs of parkinsonism .”
Daniel Togasaki, MD, Parkinson’s Institute
Neal Alpiner,Rehab Medical Director William Beaumont Hospital…
“IM Neuro therapies have been shown to be efficacious in:
Phase I (Acute Inpatient Rehab)
Phase 2 (Outpatient)
Phase 3 (Eminence) stages of client neuro-recovery.”
What are the Benefits?
ATTENTION / FOCUS1MOTOR CONTROL / COORDINATION2
BALANCE & GAIT3
LANGUAGE PROCESSING4
CONTROL OF AGGRESSION / IMPULSIVITY5
Interactive Metronome for Rehabilitation Training
Jimmy Eggleston was the First
Rehab Case
Invention of Interactive Metronome
After 3 weeks walking without assistive device
Interactive Metronome Today
Currently provided by thousands of therapists in
hospitals, clinics, schools and
rehab centers
Who Can Benefit?
Loss of Motor Control
Loss of Speech/Cognition
Loss of Balance and Gait
ADD/ADHD
Asperger's Syndrome
Sensory Integration
Language Processing
Motor Control and Coordination
Impulsive/Aggressive
Enhanced Coordination
Improved Focus and Attention
Improved Academic Performance
PERFORMANCE NEURO-SCHOLASTIC
REHABILITATION
PLANNINGPLANNINGSEQUENCINGSEQUENCING
TIMINGTIMING
1 second = 1,000 milliseconds
200 69
40 15
0
15 40
69 200
0 – 15ms. Perfect 16 – 22 Superior23 – 29 Exceptional30 – 40 Above Average41 – 69 Average
Assessment
The Second Link
- Cheryl MillerHealthSouth Regional Director Clinical ServicesSunrise, Florida
“ IM impacts the neurological population in the same way it helps the developmental population.”
Key Diagnoses
CVA and Brain Injury
Amputees
Parkinson’s
General Rehabilitation
ADHD
Cognitive / Developmental Disorders
Academic / Sports Performance
Address Cognitive Deficits
Attention and Concentration
Motor Planning and Sequencing
Language Processing
Behavior (Aggression and Impulsivity)
Executive Functioning
Address Physical Deficits
Balance and Gait
Endurance
Strength
Fine/Gross Motor Skills
Coordination
Case Study 1: Jake
16 year old male - TBI from MVA
Severe impairments:
Sustained attention & concentration
Poor memory
Left-right discrimination
Gross and fine motor coordination
Balance
Case Study 1: Jake
After 6 weeks of IM Training:
Able to attend to paper/pencil tasks for up to 50mins in preparation for school
Reported that he could hold conversations for longer periods of time and now able to “day dream”
After IM, only needed minimal cues for L-R discrimination
Case Study 2: Veronica
37 year old female - CVA
Deficits addressed:
Poor attention & concentration • Unable to attend to tasks
for more than 10-15 minutes without getting externally distracted
Decreased stamina and endurance• Unable to stand for more
than 15-20 minutes
Case Study 2: Veronica
Following 8 weeks of IM training:
Able to complete simulated work activity for at least 60 minutes without becoming distracted
Able to stand and complete household activities for at least 45 minutes
Case Study 3: Brenda
6 months of traditional therapy with poor outcome
Thousands of IM reps particularly using her feet
Significant improvements in motor sequencing
Improved gait & balance
Case Study 3: Brenda
Disney Marathon
FINISH LINE!
January 2004
Benefits of IM
Non-invasive
Non-pharmaceutical(not exclusive of Rx)
Complements existing therapy
Short-term (length of treatment)
Measurable outcomes
Functional cross-over
Questions and Answers
DX ICD-9 CODE
ADD 314.00
ADHD 314.01
AUTISM 299.0X
AKA V49.76
BKA V49.75
DYSLEXIA 784.61
TBI 854.XX
DX ICD-9 CODE
CVA, APRAXIA
997.02
430-434.9
674.XXLate Effects CVA
438.XX
Spinal Cord 952.XXParkinson’s 332.0Gait Disorder
781.2
Speech Delay
315.39
Reimbursement: Billing & Coding
PT CPT CodesTherapeutic Activities 97530
Therapeutic Procedures 97110
Evaluation 97001
Sensory Integration 97533
Neuro-muscular Re-education 97112
OT CPT CodesTherapeutic Activities 97530
Therapeutic Procedures 97110
Evaluation 97003
Sensory Integration 97533
Neuro-muscular Re-education 97112
ST CPT CodesSpeech Therapy 92507
Evaluation 92506
Reimbursement: Billing & Coding