FastForward

Q: Which is more effective for reading, FastForward or IM?

A: It is more effective to first improve timing and phonological awareness via IM, then proceed with intensive reading instruction, like FastForward.

Frequency

Q: What is the optimal frequency? Can gains be seen if patient only receives 1-2 sessions per week?

A: Frequency and intensity of therapy dictates pace of therapy and how quickly outcomes are realized. The more frequent and the more
intense (i.e., more repetitions each session), the faster and more complete the outcomes. Obviously, if less is provided, then outcomes will take longer to realize and if frequency is too low, full outcomes may not be realized. Each individual’s needs vary, so determine the frequency and intensity based upon the individual. One time per week, while certainly helpful and better than nothing, may not be enough for many patients.

In adult outpatient rehab settings that accept Medicare, the maximum frequency allowed is 3x/week. Inpatient rehab is 5-7x/week. Pediatric rehab may be 3-5x/week in outpatient, 5-7x/week in inpatient.

Duration of sessions vary depending upon setting (inpatient versus outpatient, age, and individual patient characteristics) Short sessions of 15-30 min 3x/week have been reported to be effective for some patients.

Funk Period During Reorganization

Q: Do patients go through a period of regression during IM as neurological reorganization is taking place?

A: This frequently happens. Regression can occur in speech fluency, language, fine/gross motor, social/emotional, and behavioral skills. This is temporary and IM should continue. Also: Always monitor the frequency and intensity of treatment to make sure it is not too much for the patient.

G

Gait Switch

Q: What is the IM Gait Switch?

A: Plastic shoe insert with wireless IM trigger in the heel. One goes in each shoe. As the patient walks, he receives feedback regarding symmetry, timing, and rhythm of gait.

Grant Writing

Q: Does IM provide assistance or a template for grant-writing?

A: Contact Joe Miller (West Coast), Al Guerra (Midwest), or Brad Cohen (East Coast) at IM for a template and assistance.

H

Hands-On Assist

Q: How does IM work if you are providing all hands-on assist?

A: As the provider, you provide hands-on feedback for timing to your patients as needed. Some patients, particularly young ones, will need complete hands-on assist. It is important for your timing to be in the 20’s or lower if at all possible before you provide hands-on assist to patients. Not sure exactly how it works, anecdotal reports indicate that pediatric patients who receive total hands-on assist make substantial gains in sensory, motor, cognitive, and language skills.

Headphones

Q: Can you use other types of headphones with IM?

A: Yes you can use headphones such as ipod ear buds, open systems, audiology headphones that fit snugly, etc.

Hearing Impaired

Q: How do you adjust the volume for hearing impaired patients?

A: If no hearing aids, use headphones & raise Master Volume a notch at a time & check to see if patient can hear the individual sounds. Note: When clicking on each sound tab, that sound will play in only one of the ears. To check the other ear, turn the headphones around so other ear can hear the sounds. Raise Master Volume to as high as 11 if needed. Do not go much higher than that as it gets very loud and may damage hearing.

If hearing aids are worn, use speakers instead of headphones and raise Master Volume as high as needed. Place speakers so they are at head level and patient is facing them in order to localize if sound is coming from the left or right side. Placement of speakers on a medical bedside table that can be raised or lowered is optimal so that speakers are at head/chest level when patient is seated or standing. Tip: Velcro speakers to the table to prevent them from falling off.

I

IM Settings

Q: How do you know when you need to modify IM settings?

A: Observe the patient. Here are some examples:

You will see that the tempo is either too fast for the patient and he can’t keep up. Or you will see that the patient is too fast and cannot slow down to get into sync with 54 beats per minute. In one case, you will reduce the tempo and in the other you may opt to increase the tempo to facilitate success with the program initially.

Before turning on the guide sounds, you may notice that that patient is scoring 256ms. You may reason that if you have the Difficulty set at 100, the patient will hear the buzzer constantly and get frustrated. So you will adjust the difficulty to an easier setting, like 300.

Once the guide sounds are learned, you may notice the patient stays within a certain ms range now, but seems to plateau. He can only get his score to 55ms. You now have the Difficulty back to 100. The patient may need you to nudge him in the direction of Super-Right-On, so you adjust the Difficulty to 80.

Insurance

Q: Is IM reimbursed by insurance?

A: IM is typically reimbursed by insurance if it is provided by an allied health professional, physician, chiropractor or psychologist/neuropsychologist who is on the insurance companies panel of providers (for this, you must apply to each individual insurance panel), and it is billed using the appropriate CPT code (i.e., for OT: therapeutic activities, therapeutic exercises, neuromuscular reeducation, cognitive development, etc).

IM does not have it's own CPT code, so you should never ask for authorization for "IM Treatment" or "Interactive Metronome Therapy" from the insurance company. To be reimbursed by insurance, you will need a prescription from a physician for "OT/ST/PT eval and treat," that includes the treatment frequency and duration, and that the treatment is medically necessary.

To maximize reimbursement, you must also be sure the appropriate diagnosis code is used, perform appropriate pre and post objective and functional assessments, document sound rationale for the treatment (how it will improve the patient's function), document functional and measurable goals, and functional outcomes of treatment. You are better off using terminology that describes OT/ST/PT eval and treat, rather than IM. IM will simply be part of your treatment approach and may be combined with other approaches to achieve therapeutic outcomes. This will help prevent insurance companies from labeling your treatment as experimental.

Your documentation (initial evaluation, progress reports, and discharge summary) will also facilitate reimbursement as long as it includes the following information:

• Patient demographics (Name, DOB, Age)
• Dates of service
• Medical reason for needing OT (insurance will only pay for treatment that is medically necessary)
• Medical diagnosis and code
• Treatment diagnosis and code
• Medical history (date of onset, previous therapies, medical complications, etc)If patient has had OT before and his returning to OT to receive IM, then state that a therapeutic approach shown to improve ________ was not available to the patient previously, so patient is returning to receive this therapy in order to improve ______.
• Objective assessments administered, results, and interpretation
• Functional (clinical) observations and assessments
• Measurable and functional short & long-term goals
• Estimated treatment frequency and duration (that is reasonable and in line with customary OT services)
• Treatment approach (i.e., therapeutic exercises, Interactive Metronome, neuromuscular reeducation)
• Therapists name, credentials, license #, and signature

If you are not on an insurance panel, patients who submit your report and required paperwork to their insurance company for reimbursement, must usually get pre-approval for therapy from the insurance company for an "out-of-network provider." Many insurance companies require their insured to stay within their provider network. Often, if there is a provider within the insurance network that can provide the same therapy for the patient, the insurance company will deny out-of-network benefits and refer them to a therapist in network. You may need to make the case, then, that you are providing a service that the in-network therapists cannot provide, namely Interactive Metronome.

For this, you will need to draft a letter to the insurance company (probably with more meat than you are currently doing) to convince the insurance company to pay for your services. Contact Amy Vega, IM Clinical Education Director for research that you can cite (there is MUCH more research & information supporting he efficacy of IM than previously).

Many insurance companies do not cover disorders that are considered “developmental,” regardless of the intervention. This may include learning disabilities, dyslexia, Sensory Processing Disorder, ADHD, Autism, etc.

Integrating IM into Practice

Q: How do you integrate IM into a treatment plan?

A: IM is only part of a more comprehensive treatment plan. Depending upon the patient, IM may be the only treatment received initially followed by reassessment and other therapies as needed. i.e., TBI patient does IM to improve attention, processing, executive functioning, working memory, behavioral self-regulation, and reading. Reassessment reveals continued memory deficit. Therapy transitions to training of compensation device for memory such as blackberry.

Other patients may begin their therapy session with short IM tasks to improve alertness/arousal, then therapy proceeds with other tasks. i.e., man with stroke in inpatient rehab setting who is lethargic and has difficulty with active participation in therapy. IM is done for 10-15 min followed by dysphagia therapy

A child with sensory processing disorder may begin the treatment session with vestibular and proprioceptive activities, followed by brushing, then IM for 15 min with sensory moderators as needed for sensory defensiveness. The IM machine will be brought to the sensory gym if not too distracting for the child, rather than taking the child away to a quite, sterile room.

Look for more FAQs of the
alphabet in the April eNews