Interactive Metronome®

Pediatric Specialist Coaching

Module 1: Overview and FoundationsBy Mary Jones, OTR/L, DipCOT

Sensational Kids, LLCBrain Focus International, Inc.

Program Outline• Module 1: Pediatric Overview and Foundations• Module 2: Modifying IM to Pediatric Populations• Module 3: Motivational Strategies• Module 4: Teaching Auditory Association Skills• Module 5: Building relationships – Allowing control, switch choices and

access. • Module 6: Interpreting Data • Module 7: Setting up Individualized Pediatric Treatment Plans with IM:

Case Examples.• Module 8: Special Considerations – IM training plans with infant-toddlers

or clients with decreased cognitive capabilities.• Module 9: Use of IM Systems in Group and Social Settings • Module 10: Moving Forward – Incorporating IM-Home into your pediatric

best practices.

Outcome Goals for Module 1

• Developing the art of ‘thinking outside the box’ with IM

• Overview of IM use within the diversity of pediatrics

• Getting started – Setting up of equipment/ environments

• The Key to IM success – Learning to Modify!• Positioning that can be used with IM – Review

of Examples• Review of Module 1 Learning Outcomes.

Thinking ‘outside of the box’

• Use of professional judgment and creativity to modify IM programming – we are a diverse group!

• Developing the flexibility skills to effectively utilize IM as a treatment/training tool

• Becoming comfortable thinking ‘outside of the box’ • Taking the principles of the Interactive Metronome®

System and consider them for all aspects of pediatric services and performance programs.

Why IM in Peds?• Timing is critical for the discrimination of sensory stimuli

(Shannon et al., 1995; Buonomano and Karmarkar, 2002; Ivry and Spencer, 2004; Buhusi and Meck, 2005)

• Timing is critical for the generation of coordinated motor responses (Mauk and Ruiz, 1992; Ivry, 1996; Meegan et al., 2000; Medina et al., 2005).

• The nervous system processes temporal information over a wide range, from microseconds to circadian rhythms (Carr, 1993; Mauk and Buonomano, 2004; Buhusi and Meck, 2005).

Applying IM to the diversity of Pediatrics

• Educational• Therapeutic• Peak Performance• Recreational• Extra-curricular• Lifestyle• Wellness

Educational• Low Self Esteem• Struggling with academics• Anxiety• Reactive• Poor motor planning• Difficulty finding their own

‘Rhythm’ or ‘Still point’• Eager to please• Difficulty ‘tuning in’• Difficulty keeping track of

time

• Survival reactions• Chronic adrenal stress• Disorganized• Clumsy• Difficulty ‘connecting the dots’• Poor listening skills• ‘Quick to quit’

Therapeutic • Attention Deficit Disorder

(314.0; 314.01)• Asperger’s Syndrome (299.0)• Ataxia (438.84; 334.3; 331.89)• Autism (299.0)• Developmental Delays (315.9)• Dyspraxia (315.4)• Dyslexia (315.02)• Lack of Coordination (781.3)• Speech and Language delays

(315.3)• Auditory Processing Disorders

(388.45; 315.32)

• Unspecified Disorders of the Central Nervous System (349.9)

• Hemiplegia (342; 343.1)• Pervasive Developmental Delay

(299.9)• Developmental Coordination

Disorder (315.4)• Abnormal Posture (781.92)• Loss of Limb (755.4)• Abnormality of Gait (781.2)• Difficulty in Walking (719.7)• Orthotic Training (V57.41)• Feeding Difficulties (783.3; 307.59;

779.3; 783.41)• Dysphagia (787.42)• Articulation (315.39; 524.27)• Muscle Weakness (728.87; 780.79)• Tourette’s Disorder (307.23;

333.3)• Anxiety (300.0)

Peak Performance• Speed -  focuses on developing starting speed and

maximizing top end speed. Utilization of plyometrics and speed training techniques to maximize performance.

• Agility – focuses on developing coordination, foot speed, reactive ability, and quickness. Utilization of sport specific movement pattern drills, plyometrics, and various mobility training equipment.

• Conditioning – focuses on developing sport specific fitness by combining creative training methods with traditional conditioning equipment.

• Strength – focuses on teaching proper resistance training techniques for a variety of sport specific exercises with emphasis on core.

Recreational• Effective use of free time• Personal development of ‘self’• Socially acceptable activities• PLAY!• Keeping up with peers• Ability to engage, socialize,

plan, follow-through

Lifestyle• Choices• Opportunities• Exposure• Tolerance

Extra-Curricular• Sports• Drama• Music• Voice• Dance• Clubs• Societies• Cultural

Wellness• Mental Endurance• Mental Attitude• Stress Management• Focused Attention• Sleep

The Key to IM Success:

• Modify for Engagement!• Be Spontaneous for

Novelty!• Increase Repetition for

Synaptic Growth!

Techniques for success

• Positioning alternatives• Physical Environment• Sensory Environment• Motivation Strategies• Tempo/Timing variance• Feedback Strategies• Interpreting Data• Pacing of activities and themes• Duration of tasks and sessions• Building Relationships – allowing control• Switch choices and Access

Set Up - Equipment

Positioning: Upright Stance

UPRIGHT STANCE: Extensor tone; balance; visual orientation; praxis. • Modify with variance of surface/texture/height/size of

base/footwear.

Half KneelingHALF KNEELING• Core strengthening• Pelvic segmentation• Upper body/lower body integration• Proprioceptive body-in-space

awareness• Reflex integration• Bilateral integration (praxis)

MODIFY:• Surfaces/textures/heights/

stability/alternate knees

Modify Base of Support

• Alter points of stability and mobility

• Upper extremities: Clap High-Clap Low

• Adapt lower extremity movement sequence • Side step and clap on the beat• Match tempo of music piece or sing to the

beat

Round SittingROUND SITTING:• Pelvic and shoulder girdle

alignment• Posture and positional

awareness (grounded)• Upper body

strengthening• Pelvic shift and core

balance• Diaphragmatic

breathing

Dynamic PosturesDYNAMIC POSTURES:• Proprioceptive awareness• Core stability and shift• Visual orientation• Strengthening• Praxis

EXAMPLES:• Ball sit• Stool sit• Bench sit• Bolster sit (astride)• Cube sit• Rocking chair

Supine/Lying DownSUPINE TIME:• Facilitates proprioceptive

awareness (firm surface)• Decreases demands on motor

planning• Work up against gravity• Reflex integration: Supine flexion

Prone/Tummy Time

Modifications:• Floor (good for

sensory feedback• Floor mat/different

textures• Inverted/under/over

PRONE/TUMMY TIME:• Strengthening shoulder

girdle• Hip flexor stretch• Facilitate co-contraction to

flexor/extensor core stability

• Visual-motor integration• Reflex integration

Review of Module 1 Learning Objectives

• IM is used as a training tool across multiple domains and disciplines within pediatrics.

• Professional judgment and creativity are required to provide optimum outcomes in pediatric IM programs.

• Modification is key to providea customized approach toeach individual.

• Pediatrics is diverse – so too isthe application of IM tothis population!

Module 1 Homework1. Complete Module 1 Post-Test2. Complete Module 1

Worksheet3. Review ready

reference/resource sheet for Module 1

References• Boyle CA, Boulet S, Schieve L, Cohen RA, Blumberg SJ,

Yeargin-Allsopp M, Visser S, Kogan MD. Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008. Pediatrics. 2011

• Buhusi, C.V., and Meck, W.H. (2005). What makes us tick? Functional and neural mechanisms of interval timing. Nat. Rev. Neurosci. 6, 755–765.

• Buonomano, D.V., and Karmarkar, U.R. (2002). How do we tell time? Neuroscientist 8, 42–51

• Carr, C.E. (1993). Processing of temporal information in the brain.Annu. Rev. Neurosci. 16, 223–243.

References 2• Ivry, R. (1996). The representation of temporal information in

perception and motor control. Curr. Opin. Neurobiol. 6, 851–857

• Ivry, R.B., and Spencer, R.M.C. (2004). The neural representation of time. Curr. Opin. Neurobiol. 14, 225–232

• Mauk, M.D., and Buonomano, D.V. (2004). The neural basis of temporal processing. Annu. Rev. Neurosci. 27, 304–340

• Mauk, M.D., and Ruiz, B.P. (1992). Learning-dependent timing of Pavlovian eyelid responses: differential conditioning using multiple interstimulus intervals. Behav. Neurosci. 106, 666–681

References 3

• Medina, J.F., Carey, M.R., and Lisberger, S.G. (2005). The representation of time for motor learning. Neuron 45, 157–167.

• Meegan, D.V., Aslin, R.N., and Jacobs, R.A. (2000). Motor timinglearned without motor training. Nat. Neurosci. 3, 860–862.

• Shannon, R.V., Zeng, F.G., Kamath, V., Wygonski, J., and Ekelid, M. (1995). Speech recognition with primarily temporal cues. Science 270, 303–304.

Useful Resources

Sensory Processing Disorder: • www.spdfoundation

.net

• www.sensory-processing-disorder.com

• www.sensorysmarts.com

• www.spdsupport.org

Dyspraxia: • www.dyspraxiausa.o

rg• www.dyspraxia.info• www.alifewithdyspra

xia.webs.com

Autism:• www.autismspeaks.o

rg

• www.aspergersyndrome.org

• www.autismspot.org

Recommended Webinars

• Introduction to IM Pediatric Best Practices - Self-Study