Learn about the Interactive Metronome & Earn 0.1 CEU FREE (ASHA, AOTA, BOC)

This webinar welcomes OT/COTAs, SLP/SLPAs, PT/PTAs, ATCs, Educators, Licensed Rehabilitation, Medical, and Mental Health Professionals, Psychiatrists, Neurologists, Psychologists, and Chiropractic Care Professionals. No prior knowledge of IM is required.

Introduction to the Interactive Metronome: History & Research
This presentation will review the clinical research supporting the role of rhythm and timing on a wide array of human function. In addition, this session will provide an overview of the use of rhythm and timing exercises (specifically the Interactive Metronome) that have been shown to improve cognitive and motor function in pediatric and adult rehabilitation. We will give examples of IM’s use in speech therapy, occupational therapy and physical therapy.

*Contact hours are offered pending successful completion of a written exam at the end of the course.

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Q: Does IM work for TBI Patients?

Answered by Clinical Education Director: Amy Vega

See the IM Timing Research Packet & Info below on IM and TBI. 

With regard to the research in the link above, let me first point you to an IM research study (item #2 in table of contents of the attached packet) that proposes IM is influencing 2 levels of temporal processing and describes cognitive domains being addressed by IM and how.  This is a white paper...it was published (in part) in 2007 (item #1 in table of contents).  I find the white paper to be more detailed than the published one and therefore it is included in this packet.

Secondly, I'd like to point you to a temporal processing study completed by neuroscientific scholars who are experts in Scalar Timing Theory, etc (item #4 in the table of contents).  This paper explains the critical role temporal processing plays in all of our abilities from sensory processing to visual saccades to motor coordination to language processing...It helps you understand what you are accomplishing when you work with IM. 

IM for TBI

Taken from:  A Randomized, Controlled, Preliminary Trial of Interactive Metronome® Technology for Remediation of Cognitive Difficulties Following Traumatic Brain Injury

Principal Investigator and Key Staff: 

Lonnie A. Nelson, Ph.D. (Principal Investigator)
Education Coordinator and Research Psychologist

Shane Mcnamee, M.D. (Co-Investigator)
Medical Director
Polytrauma Rehabilitation Center 

Michelle G. Nichols, MSN, RN (Study Coordinator)
Clinical Research Coordinator
McGuire Research Institute

The Interactive Metronome® (IM) is a neurotechnology medical device that uses the principles of neuroplasticity to encourage recovery of function and cortical integration.  In a randomized, controlled study examining the effects of IM training on boys with attention deficit disorder, the control group (who received IM treatment) improved on a host of measures, including attention, motor control, language processing, reading, and parental reports of improvements in regulation of aggressive behavior.  These symptoms are commonly seen in individuals surviving TBI. 

Neuroplastic processes are regulated by several factors.  These include: attentional modulation, patterning of sensory activation, timing of sensory inputs, duration of experience, pairing with neuromodulatory influences, the neurochemical environment, and correlation of sensory inputs.  Traditional therapy interventions in rehabilitation address some of these key elements (i.e., prescription of a stimulant medication during TBI rehabilitation, which alters the neurochemical environment and assists with attentional modulation.)However, other key aspects of the neuroplastic process (i.e., patterning of sensory activation, timing of inputs, and correlation of sensory inputs with motor outputs) are vastly more difficult to standardize in traditional speech, occupational, and physical therapies. 

IM technology integrates these key elements into a singular set of tasks that are designed to work with the mechanisms behind neuroplasticity to encourage integrated neuroplastic activity under cognitively challenging circumstances, resulting in optimal treatment outcomes.  The  instantaneous computerized feedback provides a rich cognitive and sensory environment in which simultaneous auditory and/or visual guidance is delivered following a motor response, while encouraging cognitive and motor preparation for the next response.  Most notably, this critical feedback is directly correlated with the patient's motor output to the millisecond level and is consistent, timely, and reliable.  With a default tempo set at 54 beats per minute, all of this feedback processing and adjustment of behavioral responses must occur approximately every one second (1.1111 seconds to be exact), placing considerable temporal demand upon the attentional, integration, decision making, inhibitory, and motor output operators of the cortex, thereby increasing processing speed and cognitive and motor efficiency over the course of treatment.  

While we await this specific study, there is presently very good anectodal information regarding treatment outcomes with IM and peer-reviewed research supporting the use of IM in adult neuro rehab.

Current theory is that IM is influencing critical neural timing pathways (AKA temporal processing) in the brain involved in speech generation, speech perception/processing, cognitive speed, working memory, executive functions, motor control/praxis, and sensory processing. 

Some of the key brain structures involved in temporal processing include:

• FRONTAL LOBES: The frontal lobes are responsible for action (Hale & Fiorrello, 2004; Duncan et al., 1995; Duncan et al., 1996).  Research has implicated the frontal lobes as the possible location of a “mental time-keeper” (Meck, 1983; Meck et al., 1984; Papagno et al., 2004).  The prefrontal cortex has a high degree of interconnectivity (with other parts of the brain).  This allows the prefrontal cortex to integrate input from many sources in order to implement more abstract behaviors. 
• DORSOLATERAL PREFRONTAL CORTEX:The dorsolateral prefrontal cortex is the highest cortical area responsible for motor planning, organization, and regulation (Hale & Fiorello, 2004).  It has rich connections with the basal ganglia and limbic system. The prefrontal cortex is uniquely oriented to time. (Huey et al., 2006)
• BASAL GANGLIA: The basal ganglia is involved in the generation of goal-directed voluntary movement (VandenBos, 2006).  It is also involved in motor function (posture, tone, motor activity, response coordination, sequencing, control of ongoing movement).  (Cassidy et al., 2002; Hale & Fiorello, 2004; Middleton & Strick, 2000).  The basal ganglia has rich connections to the cerebellum  and is significantly involved in motor planning, sensory performance, and sensorimotor integration (Diamond, 2003).  Evidence is implicating the role of the basal ganglia in mental-timing functions (Janata & Grafton, 2003; Nobre & O'Reilly, 2004; Peretz & Zatorre, 2005).
• CEREBELLUM: The cerebellum is associated with sense of body position (balance, posture, eye movement) (Hale & Fiorello, 2004).  It is also involved in coordinated motor acquisition (Debaere et al., 2001).  And it seems to be involved in timing (Ivry, 1993; Janata & Grafton, 2003; Nobre & O'Reilly, 2004; Peretz & Zatorre, 2005; Rapoport et al., 2000).  
• ANTERIOR CINGULATE GYRUS: The anterior cingulate cortex (ACC), part of the cingulate gyrus, can be divided anatomically based on attributed functions into executive (anterior), evaluative (posterior), cognitive (dorsal), and emotional (ventral) components (Bush et al., 2000). The ACC is connected with the prefrontal cortex and parietal cortex as well as the motor system and the frontal eye fields (Posner & DiGirolamo, 1998) making it a central station for processing top-down and bottom-up stimuli and assigning appropriate control to other areas in the brain. The ACC seems to be especially involved when effort is needed to carry out a task such as in early learning and problem solving (Allman et al., 2001). Many studies attribute functions such as error detection, anticipation of tasks, motivation, and modulation of emotional responses to the ACC (Bush et al., 2000; Nieuwenhuis et al., 2001; Posner & DiGirolamo, 1998).

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