Profound Effects of Interactive Metronome and Brain Balance Exercises on a Subset of Children with Attention Deficit Hyperactivity Disorder

Martin H Teicher, PhD, MD

White paper: Developmental Biopsychiatry Research Program, McClean Hospital, Harvard Medical School

RESULTS:
Preliminary results from this ongoing study showed that 5 of 14 children (36%) diagnosed with ADHD demonstrated 40% or greater improvement on standardized neuropsychological measures of hyperactivity and spatial working memory (the executive function most notably impaired in ADHD) following completion of a combined Interactive Metronome (IM) and Brain Balance (BB) training protocol. According to Dr Teicher, “this is a degree of improvement that we have not previously observed in children with ADHD unless they were receiving medications, and then only if they were receiving the correct medication at optimal dose.”

Neuroimaging of brain regions strongly implicated in the neurobiology of ADHD helped to parse out the influence of each training program and the effect of combining them. Specifically, scans showed that BB training was associated with increased connectivity between prefrontal cortex and the frontal pole, temporal pole, cerebellum, precentral gyrus and supramarginal gyrus with extensive effects on connectivity of the amygdala and hippocampus, which are involved in implicit and explicit memory as well as stress response.

Increased connectivity of the amygdala with supramarginal gyrus, cingulate gyrus, anterior cingulate, angular gyrus, frontal pole and precuneus were associated with combined IM and BB training. Greater connectivity between the amygdala and cingulate allows for better emotional self-regulation and impulse-control.

IM training was associated with increased connectivity between the hippocampus and the angular gyrus, precuneus, middle temporal gyrus, lateral occipital cortex, supramarginal gyrus, cingulate gyrus and frontal pole, areas responsible for language processing, memory retrieval, handwriting, mathematical calculations, and L/R discrimination. A closer examination of the impact on the cerebellum revealed that IM training was associated with increased resting state functional connectivity between: cerebellum I and middle frontal gyrus; cerebellum II and inferior temporal gyrus/fusiform gyrus; cerebellum IV-V and parahippocampal gyrus and inferior temporal gyrus/fusiform gyrus; cerebellum VII and lateral occipital cortex; cerebellum VIII and superior frontal gyrus and cerebellum IX and lingual gyrus and postcentral gyrus. IM training was also associated with decreased resting state functional connectivity between cerebellum III and
anterior cingulate gyrus and cerebellum VI and lateral occipital gyrus.

“These appear to be potent changes. Our findings of symptomatic improvement and enhanced connectivity of the supramarginal gyri with the amygdala, hippocampus, and prefrontal cortex is consistent with a recent report showing that reduced connectivity of the left and right supramarginal gyri was associated with increased symptom severity in ADHD24. Given the role these regions appear to play in timing makes these observations particularly compelling.” Research is ongoing and will continue to investigate and further define the host of neurobiological changes associated with IM and BB training as well as their relationship to clinical outcome for individuals with ADHD.

DETAILS:

  • n=14 (8-14 years of age) confirmed to have ADHD through structured diagnostic interview (K-SADS-PL)
  • intervention: 15 weeks of combined Interactive Metronome and Brain Balance training (up to 75 sessions) were completed remotely via online access
    • standardized exercises with no individualization
    • not directly supervised by an experienced administrator (carried out by families at home)
  • clinical outcome measures:
    • ADHD Quotient System. “This test is highly responsive to the effects of medication, correlates with blood levels of methylphenidate but is not responsive to placebo. Indeed, we reported in N=30 children receiving placebo that only 7% showed a greater than 25% improvement and none had a 40% or greater improvement in Quotient scaled scores.”
    • Cambridge Neuropsychological Test Automated Battery (CANTAB) to evaluate spatial working memory
    • Neuroimaging with diffusion MRI optimized to evaluate the brain’s structural connections (part of the Human Connectome Project)

How Rhythmic Skills Relate and Develop in School-Age

Silvia Bonacina, Jennifer Krizman, Travis White-Schwoch, Trent Nicol, and Nina Kraus

Published in GLOBAL PEDIATRIC HEALTH

RESULTS:
Simply drumming to a isochronous beat had no impact on recall of rhythmic patterns. Children who performed better at drumming to the beat of music were better at both drumming to a beat and remembering rhythmic patterns. However, children who were able to clap in time with a steady beat with the least amount of variability in their synchronization (due to real time millisecond feedback from Interactive Metronome) demonstrated better ability to drum to a beat, recall rhythmic patterns & drum to the beat of music. According to Dr Nina Kraus, rhythm is complicated, there are several rhythm intelligences, & Interactive Metronome, by itself, impacts all of these vital rhythms that are so important to the development of language and literacy. “Several clinical populations exhibit timing deficits that co-occur with to language deficits; for example, individuals with reading impairment often struggle to tap along to an isochronous beat. It is conceivable that clapping in time to feedback could be a viable intervention for populations with distinct rhythmic deficits (such as one group who struggles to synchronize to a beat and another who struggles to remember rhythmic patterns).” The authors hypothesize that the perception & production of rhythm begins as a global skill early and becomes more specialized later in life. This is in line with previous IM research and the IM Indicator Table data.

DETAILS:

  • n=68 typically developing children between 5 – 8 years of age
  • n=46 children were re-assessed 1 year after conclusion of the study to monitor development of rhythmic skills
  • first study of its kind to provide evidence of the interconnections among rhythmic skills in school-age children
  • assessed via 4 different rhythmic tasks:
    • 3 tasks used a conga drum, with a trigger to register drum hits:
      1. Drumming to an Isochronous Beat: listen and drum to an isochronous pacing beat presented through in-ear headphones
      2. Remembering and Repeating Rhythmic Patterns: listen to 3 repetitions of a rhythmic sequence without drumming and then drum out the sequence during a pause, producing the sequence exactly when it would have occurred had it repeated a fourth time
      3. Drumming to the Beat of Music: listen to a musical excerpt through speakers and tap to the perceived beat
    • 1 task involved clapping in time and was completed using Interactive Metronome (IM)

Influences of Synchronized Metronome Training on Soccer Players’ Timing Ability, Performance Accuracy, and Lower-Limb Kinematics

Louise Rönnqvist, Rachel McDonald and Marius Sommer

Published in FRONTIERS IN PSYCHOLOGY

The purpose of this study was to evaluate the effect of Interactive Metronome (IM) training on athlete’s sensorimotor timing ability and whether timing and rhythm training is a valuable adjunct to soccer training for performance enhancement. Twenty-four female sub-elite and elite outfield soccer players ages 16.2 to 25.8 were randomly assigned to an experimental group that received 45-50 min sessions of Interactive Metronome (IM) training 3x/week in addition to regular pre-season soccer practices (for a total of 12 IM sessions over 4 weeks) or a control group that just participated in the same pre-season soccer practices. Millisecond timing and rhythm were measured via Interactive Metronome. Both groups also participated in pre and post examination of performance on a complex, high cognitive-load stepping task, recorded in 2D and 3D for each participant via an optoelectronic motion capture system, for kinematic analysis.

RESULTS:
The experimental (IM) group demonstrated significant improvement in millisecond timing, compared to the control group, as a result of IM training. Additionally, the group that received IM training demonstrated greater speed and accuracy on the high cognitive-load, complex stepping task. IM training appeared to positively impact executive-controlled attention and working memory in the experimental group leading to improved performance in motor coordination, precision and speed when compared to the control group. Of interest, those athletes who demonstrated the MOST improvement in timing scores on Interactive Metronome also demonstrated the GREATEST gains in speed and accuracy on the complex stepping task. Correlations were found between the participants’ performance on the stepping task and kinematic parameters, likely associated with inter-individual variations in higher-order cognitive processing ability. Recent studies have confirmed that executive functions are imperative for high performance in soccer and hockey. The more elite the player, the higher they tend to perform on tests of executive functioning. “…the findings from the present study provide support for the explanation that SMT [Interactive Metronome training] may strengthen the neural pathways within the spatiotemporal network, and thereby improve motor planning ability.”

“To conclude, even if physical strength and mental ability are of high importance in all sport performance, sensorimotor timing ability may be the key factor. The present study emphasizes the importance of improving the cognitive-motor planning ability and sensorimotor timing skills, especially in team sport such as soccer where the players have to rely on accurately timed actions on milliseconds level. It is clear from the results that synchronized sensorimotor timing abilities should be acknowledged as a critical factor for soccer player’s performance. Additionally, that SMT [Interactive Metronome training] also may be beneficial for both general motor planning and in other sports performance and situations of complex, high cognitive-motor demanded tasks, and dynamic contexts.”

Training effects of Interactive Metronome® on golf performance and brain activity in professional woman golf players

Jin Hyun Kim, Joung Kyue Han, & Doug Hyun Han

Published in HUMAN MOVEMENT SCIENCE

Prior research utilizing kinematic analysis & functional MRI have shown  that Interactive Metronome (IM) training facilitates measureable and statistically significant improvements in golf shot accuracy (distance to the pin) and substantial improvement in performance consistency (Sommer &  Rönnqvist, 2009;  Sommer et al., 2014).  In the present study, 20 professional female golfers from the KLPGA participated in a randomized, controlled study comparing the effect of IM training (35-40 min, twice weekly for 6 weeks) to spending more time playing the game of golf (increasing golf playing time by an additional 35-40 min twice weekly for 6 weeks).

The purpose of the study was to determine the impact of IM on swing speed during putting, which was specifically executed at a distance of 2-5m, which has been previously determined to set apart elite golfers who achieve a par or birdie compared to those that demonstrate only about a 10% success rate (Pelz, 2000). Golf putting movements and brain activity were analyzed using Kinovea Software and resting state functional MRI (fMRI). Performance variability (or consistency) was measured as the standard deviation of mean swing speed (SSD) during 3 sections of the swing: backswing, backswing-impact, and impact-finish.

Upon completion of the 6 week study, professional golfers who received IM training demonstrated improved timing between the back swing and impact for both the 2m putt and 5m putt compared to the control group. A comparison of brain activity under fMRI between the IM group and the control showed increased functional connectivity from the superior cerebellar vermis to the right medial frontal gyrus, left superior temporal gyrus, right middle occipital gyrus, right middle temporal gyrus, right cingulate gyrus, and right supramarginal gyrus (uncorrected p < 0.001, voxels > 40).

“These findings suggest that IM training in professional female golf players may improve consistency in putt timing. In addition, IM training may increase brain connectivity from the cerebellum to the frontal cortex, which plays an important role in motor control and timing.”

Clapping in time parallels literacy and calls upon overlapping neural mechanisms in early readers

Silvia Bonacina, Jennifer Krizman, Travis White-Schwoch, and Nina Kraus

Published in ANNALS OF THE NEW YORK ACADEMY OF SCIENCES

The ability to synchronize motor movements with a steady auditory beat is dependent upon a shared network between sensory and motor systems that also engages auditory and cognitive processes involved in reading. The purpose of this study was to investigate whether links, that have been previously demonstrated in older children, exist between synchronization ability and literacy skills in 64 typically developing children. Results indicated that children who can synchronize most consistently with the least variability in timing & rhythm demonstrate more advanced neurophysiological responses linked with language skills. Significantly, performing the auditory-motor synchronization with visual feedback for millisecond timing (Interactive Metronome) was linked with several literacy skills, including processing speed, phonological processing, word reading, spelling, morphology, and syntax. “These results suggest that rhythm skills and literacy call on overlapping neural mechanisms, supporting the idea that rhythm training may boost literacy in part by engaging sensory-motor systems.”

The Effectiveness of Interactive Metronome® as a Restorative Modality to Improve Cognition and Motor Performance in Healthy Older Adults In Eastern North Carolina

Leonard G. Trujillo

Published in Journal of Neurology and Neuroscience

The purpose of this study was to measure the effectiveness of the Interactive Metronome (IM) in improving cognitive and motor performance in healthy older adults. As the aging adult population continues to rise, it is important to explore tools which can support this population to live as independently as possible for as long as possible. Literature indicates there is a natural decline in cognition with aging, and that cognitive decline may be related to decline in functional performance. fifteen healthy older adults completed 18 sessions of IM protocol and researchers gathered data from IM assessments, d2 Test of Attention and Nine Hole Peg Test across four points of measure; a total of 30 participants completed 12 intervention sessions and 3 points of evaluation. Results indicated a significant increase in change from the baseline measure to the final point of measure on each of the three assessments as well as the final assessment after the shorter round of interventions. Researchers concluded the participants’ improved scores on cognitive and fine motor dexterity measures might indicate IM could be beneficial in enhancing or maintaining individuals for this population Future research should explore if increased performance on assessment scores might contribute to increased functional performance.

Effects of Interactive Metronome training on upper extremity function, ADL and QOL in stroke patients

Ga-Hui Yu, Jae-Shin Lee, Su-Kyoung Kim, & Tae-Hyun Cha

Published in NeuroRehabilitation

Thirty (30) stroke patients, verified for homogeneity & at least 6 months post-stroke, were divided equally into experimental and control groups to evaluate the effect of IM training on motor function, ADLs & quality of life. While the experimental group received only IM training 3x/week for 12 sessions, the control group completed bilateral arm self-exercises for the same period of time. A comparison of outcomes between the groups revealed that the stroke patients who received IM training demonstrated greater improvement in finger control and overall motor function compared to the control group (p<0.05). The IM group also demonstrated greater overall improvement in their ability to perform self-care ADLs (p<0.05), including feeding, toileting, dressing & transfers. The IM group especially outperformed the control group in the area of dressing. Quality of Life measures indicated greater performance & satisfaction for the IM group in the domain of Self-Help, which is in line with the outcome of previous IM research on stroke patients with hemiplegia.

Incorporation of Feedback during Beat Synchronization is an Index of Neural Maturation and Reading Skills

Kali Woodruff Carr, Ahren B. Fitzroy, Adam Tierney, Travis White-Schwoch, Nina Kraus

Published in Brain & Language

Speech communication involves integration and coordination of sensory perception and motor production, requiring precise temporal coupling. Beat synchronization, the coordination of movement with a pacing sound, can be used as an index of this sensorimotor timing. We assessed adolescents’ synchronization and capacity to correct asynchronies when given online visual feedback. Variability of synchronization while receiving feedback predicted phonological memory and reading sub-skills, as well as maturation of cortical auditory processing; less variable synchronization during the presence of feedback tracked with maturation of cortical processing of sound onsets and resting gamma activity. We suggest the ability to incorporate feedback during synchronization is an index of intentional, multimodal timing based integration in the maturing adolescent brain. Precision of temporal coding across modalities is important for speech processing and literacy skills that rely on dynamic interactions with sound. Synchronization employing feedback may prove useful as a remedial strategy for individuals who struggle with timing-based language learning impairments.

The Effects of Interactive Metronome on, Cognitive and Upper Extremity function, balance for Parkinson’s disease

A-Reum Kim

White Paper

The purpose of this study was to investigate the effects of Interactive Metronome (IM) on the cognitive and upper extremity function and balance for Parkinson’s disease. For this study, a single-subject experimental research was conducted using ABA design. We observe the two Parkinson’s patients for around 30 to 40 minutes, with a total of 25 sessions. After IM training, the participant showed an increase in cognitive and upper extremity function and balance. The result of this study suggests that IM training has a positive effect on cognition, upper extremity function as well as balance. In addition, IM training can be used as basic data for Parkinson’s patient clinicians in the area of Occupational Therapy.

Effects of Interactive Metronome (IM) training on motor timing, EEG, and putting performance in golf: A neuropsychological approach

 Kim, Pil Jung

White Paper

The purpose of this study is to examine the effect of IM training on the motor timing, EEG, and putting performances of golfers. Participants were 34 elite golfers and they were assigned to either the experimental group (i.e., IM training group, n=18) or control group (n=16). The golfers in the experimental group received a series of IM training (total of 12 sessions) and those in the control group conducted putting practice while the experimental group participated in IM training. The conclusions of this study are: IM training is effective in improving the motor timing among golfers. All motor timing errors among the IM training group are significantly decreased. Based on this result, it is concluded that the function of the brain area related to timing has improved and affected the motor timing function. Second, theta wave of the left and right prefrontal lobe of the experimental group showed a significant decrease and all SMR wave, Mid-Beta wave, High-Beta wave of the right prefrontal lobe showed a significant increase. Through this result, it can be contended that IM training is effective in decreasing the theta wave and affects the right brain activities while golfers are putting. Third, the improvements in attentiveness were identified among the IM training group. This suggests that IM training may improve the communicative efficiency between the brain areas of white matter tract and information process. At the same time, the functions of attentional system are improved. Fourth, IM training group showed an improvement in putting timing. This result was shown as the increased motor timing ability was transferred to golf putting timing. Fifth, IM training enhanced the field golf performance ability. The activation of the right brain function, attentiveness, motor timing ability and putting timing improvement of golfers identified in this study seem to have had a positive effect on the putting field performance. In conclusion, IM training had a positive influence on basic motor ability and motor skills and brought about positive neuropsychological changes. In particular, strengthening of motor coordination, timing ability and selective attention is considered to be shown in the process of synchronizing the external environment and internal movement during training. Besides, right brain activities can be interpreted to have had a positive impact on the space perception for hole cup or target and the ability to control temporal movement speed of the putter head in the golf putting situation. Therefore, as a single training protocol, IM training is expected to improve kinematic, neurological, and psychological functions all together among the elite golfers.

Effect of Interactive Metronome Training on Timing, Attention and Motor Function of Children With ADHD: Case Report

Namgung, Young, M.S., O.T., Son, Da-In, B.S., O.T., Kim, Kyeong-Mi, Ph.D., O.T.

White Paper

To report the effects of a specific intervention, the Interactive Metronome (IM), on timing, attention and motor function of a children with ADHD. The study is case reports about two boys with ADHD. One boy who is born 2008 is attending general elementary school as a first year student (case 1), and another boy who is born 2001 is attending general elementary school as a second year student (case 2). For each case subject, IM training was provided during 3 weeks, from January 2015 to February 2015. Evaluations were performed pre- and post-intervention in order to exam timing, attention and motor skills. The measurements uses in this study are Long Form Assessment (LFA) for the timing, RehaCom screening module for the attention, and Bruininks-Oseretsky Test of Morot Proficiency, second version (BOT-2) for the motor function. The timing function was improved in both cases since both showed reduced response time for all motor tasks of LFA. In terms of attention, case 1 showed improvement of visual attention division, neglect and response Inhibition, and case 2 showed improvement of sustained attention. Lastly, in the BOT-2, case 1 showed improved the percentile rank of short (from 42%ile to 96%ile), and case 2 also showed similar improvement (from 21%ile to 66%ile). This study provides positive evidence that the Interactive Metronome training has positive power to facilitate several body functions such as timing, attention and motor control of children with ADHD, through two case studies.

The Effects of Interactive Metronome on Timing, Attention, Bilateral Coordination and Balance for Adult with Intellectual Disabilities: Single Subject Design

Kyeong Mi Kim, Mi Su Kim & Soo Min Lee

Published in Journal of Special Education & Rehabilitation Science

The purpose of this study was to investigate the effects of Interactive Metronome (IM) on timing, attention, bilateral coordination and balance for adults with intellectual disabilities. The subject of study was a 26 years old woman with intellectual disabilities. This study is a single subject AB design. The procedure consisted of 5 sessions of baseline phase (A) and 12 sessions of intervention phase (B). The baseline phase involved no intervention, but during the intervention phase, IM intervention was conducted. Timing was measured by task average in short form test of IM and attention was measured by SRO% in short form test of IM. Bilateral coordination and balance were measured by bilateral coordination, balance items in the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. The results of this study are as follows; first, timing was decreased in the intervention phase than in the baseline phase. Second, attention was improved in the intervention phase than in the baseline phase. Third, bilateral coordination was improved in the intervention phase than in the baseline phase. Fourth, balance was increased in the intervention phase than in the baseline phase. This study showed that the IM intervention provided positive effects on attention, bilateral coordination and balance of the adult with intellectual disabilities.

Validity of Long Form Assessment in Interactive Metronome® As a Measure of Children’s Praxis

Kyeong-Mi Kim, Ph.D., O.T., Seo-Yoon Heo, M.P.H., O.T., Mi-Su Kim, D.S., O.T., Soo-Min Lee, D.S., O.T.

Published in The Journal Korean Academy of Sensory Integration

The aim of this study is to verify validity of Long Form Assessment, which is an Interactive Metronome measure (LFA-IM), as a measurement of praxis of children. The study was implemented from March 2015 to July 2015. Twenty-five children with Attention Deficit Hyperactivity Disorder (ADHD) and those without ADHD (age of 6∼11) were selected from a local university hospital and community in Gyeoung-Nam province and Busan for this study. In order to examine discriminative validity of LFA-IM, Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2) was used to compare the difference of results with LFA-IM for both children with- and without ADHD. For concurrent validity, correlation between LFA-IM and BOT-2 was investigated using spearman correlation coefficients. For the comparison between children with ADHD and children without ADHD, there were significant differences in the total scores of LFA-IM (p<. 05). Regarding the concurrent validity, there was a strong negative correlation between the total scores of LFA-IM and BOT-2 (p<. 05). In addition, there was high correlation between LFA-IM and BOT-2 for the area of hand control (rs=-.532), and high negative correlation for the area of fine-motor accuracy (rs=-.447), hand dexterity (rs=-.532), and balance control (rs=-.623) (p<. 05). This study identified validities of LFA-IM as an assessment of praxis of children. The results showed that it is appropriate to evaluate praxis of children with the total score of LFA-IM and, thus, it is believed that LFA-IM has a potential clinical utility. However, there should be more researches with large number of subjects.

Effects of the Interactive Metronome® on Memory Process and Balance with Aging Adults 60+ population

Leonard G. Trujillo

White paper presented at ISNR 2015

Nine adults, ages 60 – 80, completed 12 sessions of Interactive Metronome training over two months with a six week break period followed by the remaining six sessions for a total of 18 sessions. Session length was 30 – 45 minutes, never exceeding 275 repetitions per task. All participants were seated during training for safety precautions. Gains on all outcome measures were achieved. The most notable gain (88 % improvement*) was accomplished on the Four Step Square Test, which implicates improvement in balance, speed, and confidence with independent ambulation. This has significant meaning for adults who are at risk of falling and is a substantial outcome considering all participants were seated and only performed upper extremity tasks during training.

The Validation of the Interactive Metronome: A Pilot Study Prior to Implementation for Post Deployment Service Members

Leonard G. Trujillo & Jane Painter-Patton

Published in Journal of Neurology and Neuroscience

The purpose of this study was to validate the protocols created for the Interactive Metronome TM (IM) used in conjunction with the TRX® System for returning post-deployment service members diagnosed with mild traumatic brain and/or Post-Traumatic Stress Disorder. This was done using a pilot population similar in age and physical status as active duty military but within a college setting. The pre-established protocols were pilot tested on two male and two female participants. Changes were observed and recorded using a variety of instruments. The Canadian Occupational Performance Measure, Test of Everyday Attention, IM Long Form assessment, and the Nine-Hole Peg Test were administered during pre- and post-test evaluations. The results collected demonstrated positive results. These results are highly notable especially given the premorbid normal status of the participants who then made measurable positive changes. Participants reported that they found the IM reassuring; especially at the end of the academic day. Anecdotally, the participants reported that it was a “happy place to go to” during their final exams and relieved some of the sense of stress.

Effects of Improvements in Interval Timing on the Mathematics Achievement of Elementary School Students

Gordon E. Taub, Kevin S. McGrew & Timothy Z. Keith

Published in Journal of Research in Childhood Education

A total of 86 students ranging in age from 7-10 years of age from 1st through 5th grade classrooms at an inner-city charter school participated in a randomized, controlled study to examine the effect of IM training on mathematics achievement. Students in the experimental group participated in 18 daily sessions of IM training (50 minutes each) over a period of 4 weeks. Students in the control group participated in recess. All study participants participated in pre & post testing with The Woodcock-Johnson III Tests of Achievement to evaluate mathematics achievement. As shown in several other IM studies, there was again an observed cross domain effect from sensorimotor synchronization training with IM (i.e., previous studies have shown IM training for timing/rhythmicity generalizes to significant gains in cognitive, motor and academic skills). Students that received 18 daily sessions of IM training demonstrated significantly higher scores for mathematics achievement when compared to students who participated in recess. The authors provide an in-depth analysis for these findings, including “an integration of psychometric theory and contemporary information processing theory to provide a context from which to develop preliminary hypotheses to explain how a nonacademic intervention designed to improve timing/rhythmicity can demonstrate a statistically significant effect on students’ mathematics achievement scores.”

A Retrospective Outcomes Study Examining the Effect of Interactive Metronome on Hand Function

Tracy M. Shank & Wendy Harron

Published in Journal of Hand Therapy

This retrospective study examined the efficacy of IM training on improving timing skills, hand function, and parental report of self-regulatory behaviors. Forty eight children with mixed motor and cognitive diagnoses completed an average of 14 one-hour training sessions over an average of 8.5 weeks in an outpatient setting. Each child was assessed before and after training with the Interactive Metronome Long Form Assessment, the Jebsen Taylor Test of Hand Function, and a parent questionnaire. All three measures improved with statistical significance despite participants having no direct skill training. These results suggest an intimate relationship between cognition and motor skills that has potential therapeutic value. According to the study’s authors, “Philosophically, the use of intervention tools from a variety of domains makes sense using dynamic systems theory. Interactive Metronome is unique in that it gives immediate unbiased, nonjudgmental visual and auditory feedback on a participant’s motor performance over thousands of repetitions. Most participants find it challenging, like a game, as opposed to critical, like feedback from a parent or therapist. As therapists we believe that the child’s internal motivation, parental support, environment, and the therapist’s unique skills in creating a positive rehabilitation experience are all key ingredients to the success of this program. Scientifically, these results are consistent with two particular studies recently published in neurorehabilitation journals. Yozbatiran et al. published a single case study describing the effects of robotic training on arm function after spinal cord injury. Interestingly improvements were only found in the non-dominant arm and hand.28 Similarly Boggio et al. studied the effects of transcranial direct current stimulation on hand function. They reported significant results were only found in the nondominant hand. They hypothesized that there could be greater neuroplasticity related to the underuse of the non-dominant hand.25This study offers a consistent profile of results across each item of the JTTHF with the non-dominant hand. The opportunities for research following this lead are wide open.”

Effect of timing training in golf and soccer players: skill, movement organisation, and brain activity

Marius Sommer

Doctoral Thesis

This paper is an in-depth analysis of the effect of IM training for sensorimotor synchronization on peak athletic performance based upon 3 studies conducted at Umeå University, Umeå, Sweden. The following studies are discussed: Sommer, M. & Rönnqvist, L. (2009). Journal of Sports Science and Medicine, 8, 648-656. This study investigated the impact of IM training on golf shot accuracy and variability. Sommer, M., Häger, C. & Rönnqvist, L. (2014). Sports Biomechanics, 13, 1-16. This study further investigated the impact of sensorimotor synchronization training (via IM training) on the kinematic properties of the golf swing, specifically spatiotemporal movement organization and dynamics. Sommer, M., Häger, C., Olsson, C. J., & Rönnqvist, L. (2014). Manuscript in progress. This study investigated the effect of IM training on cross-pass soccer kick accuracy in elite and sub-elite female soccer players. Underlying brain activity was studied via fMRI. In summary, these randomized, controlled studies revealed that sensorimotor synchronization training with IM significantly improved several aspects of athlete performance, including:

  1. Improved motor timing ability
  2. Improve golf shot and soccer kick accuracy
  3. Decreased variability in performance outcome [more consistent]
  4. Decreased activation within bilateral cerebellum, fusiform gyrus and superior temporal gyrus on fMRI, demonstrating a more efficient pattern of neural recruitment after IM training [automaticity]

The Evaluation of the Effectiveness of Interactive Metronome® Training in Older Adults, as a potential modality for Enhancing Skills Necessary for Driving

Leonard G. Trujillo, Lindsay Alspaugh, Sandy Gant & Amanda Garner

White Paper

Twelve participants ranging in age from 55-68 demonstrated statistically significant improvement in finger dexterity after completing 8 sessions of IM training. Dexterity was measured with one of the most common and accepted assessments available, the Nine Hole Peg Test, and provide an accurate baseline. Finger dexterity is an important skill for many daily activities, like driving, grooming, and feeding.

Efficacy of the Interactive Metronome® for Improving Attention in Veterans Returning to School Settings: A Pilot Study

Karla Baker & Leonard Trujillo

White paper presented at national AOTA conference 2014

This study showed the effectiveness of the Interactive Metronome® specific to improving attention in veterans. Findings concluded that all participants rated their satisfaction with attention in school or work higher than before they started the IM. All participants were able to process more information in their post-test d2 Test of Attention and improved in the Concentration Performance measure.

Synchronized metronome training induces changes in kinematic properties of the golf swing

Marius Sommer, Charlotte Hager & Louise Rönnqvist

Published in Sports Biomechanics

This study is a follow-up to that published by the same team in 2009. The purpose of this research was to explore more deeply the effect of Interactive Metronome® on golf-swing performance. The authors concluded that Interactive Metronome®influences temporal synchronicity & domain-general abilities that underlie brain-based motor control strategies for the coordinated movement pattern of golf-swing performance.

Effects of Interactive Metronome® Therapy on Cognitive Functioning After Blast-Related Brain Injury: A Randomized Controlled Pilot Trial

Lonnie A. Nelson, Margaret MacDonald, Christina Stall & Renee Pazdan

Published in Neuropsychology

Preliminary findings of a randomized, controlled study concerning the efficacy of IM for remediation of cognitive deficits in active duty soldiers following blast-related mild-to-moderate TBI. Compared outcomes of standard rehabilitation care alone (OT, PT, SLP) to the same standard rehabilitation care + 15 IM treatment sessions. The group that received IM in addition to standard care outperformed the group who received standard rehabilitation care alone on several neuropsychological measures with medium to large effect sizes. Future publications based upon this study will reveal the results of 6-month follow-up testing (still in process) and analysis of electrocortical (EEG) data.

Chiropractic management using a brain-based model of care for a 15-year-old adolescent boy with migraine headaches and behavioral and learning difficulties: a case report

Kurt W. Kuhn & Jerrilyn Cambro

Published in Journal of Chiropractic Medicine

This case study highlights the treatment of a 15-year-old boy who had over 10 years of migraine headaches and learning difficulties, including ADHD, Tourette syndrome and obsessive-compulsive disorder. Before the program, the subject scored below his grade average in all achievement test. After training, his achievement test scores showed an improvement of 90% in vocabulary, 110% in math and an incredible 134% in concepts and application. Additionally, after the course of the program, he reported his headaches had diminished, his vision was improved, his asthma had eased and he didn’t feel sick all of the time. Further study is required to fully prove the efficacy of the treatment plan, as it was only one patient; however, results are very promising for the application of brain-based training methods in chiropractic management.

A Collective Review of Completed Research Projects Evaluating the Effectiveness of the Interactive Metronome® as an Occupational Therapy Intervention

Leonard G. Trujillo

White paper presented at national AOTA conference 2013

The purpose of this project was to compile the different pilot studies that have been conducted of the last 5 years in regard to using the Interactive Metronome® and identify the strengths and weakness of the outcomes and feasibility of using the Interactive Metronome® as a viable treatment modality in the clinic.

  • Study 1 looked at normal individuals over the age of 55 and compared pre and post-test IM scores and those of the NHPT. Notable improvements ave. 24% and above were achieved.
  • Study 2 compared those clients following standard of care Active ROM exercise program compared to those who received the IM for 8 sessions. The percentage of change was 24%for the IM participants as compared to 10% following the in-home ROM
  • Study 3 looked at 2 CVA cases – Both making notable changes with 30 days longevity retest and 2nd series of IM provided demonstrated performance improvement
  • Study 4 showed compared 22 individuals both Post CVA and Healthy Individual groups. There were no significant differences in percentage of improvement between groups, which indicates IM may be just as effective with individuals who are post-CVA as in healthy aging individuals

Reading Intervention Using Interactive Metronome® in Children with Language and Reading Impairment: A Preliminary Investigation

Michaela Ritter, Karen A. Colson & Jungjun Park

Published in Communication Disorders Quarterly

This study shows that after only 4 hours of IM training, larger gains were made in most areas of reading achievement over the control group. In a 4 week time period, the IM group did 15 minutes of training before a traditional reading intervention while the control group just did the traditional reading intervention. The improvements over the control group are listed below.

  • Reading Naturally +5.48
  • DIBELS-6 +5.77
  • GORT4-rate +0.96
  • GORT4-fluency +0.32
  • GORT4-comprehension +0.77

Timing abilities among children with developmental coordination disorders (DCD) in comparison to children with typical development

Sara Rosenblum & Noga Regeve

Published in Research in Developmental Disabilities

The aim of the study was to compare timing abilities and temporal aspects of handwriting performance and relationships between these two components among children with Developmental Coordination Disorders (DCD) and a control group. Forty two children, 21 diagnosed as DCD and 21 with typical development, aged 7–12, were matched for age, gender and school performed 14 tasks of the interactive metronome (IM) and three functional handwriting tasks on an electronic tablet that was part of a computerized system (ComPET – computerized penmanship evaluation tool). The IM supplies response time, while on- paper and in-air time per written stroke is received from the ComPET. Results indicated significant differences between the groups for both IM and handwriting tasks (ComPET). Linear regression indicated that the mean IM response time explained 37% of variance of the in-air time per stroke during a paragraph-copying task. Furthermore, based on one discriminate function including two measures reflected timing ability, 81% of all participants were correctly classified into groups. Study results strongly recommend consideration of the IM as an evaluation and intervention tool for children with DCD who are faced with timing deficits in their everyday functioning.

The Effects of Interactive Metronome® on Bilateral Coordination, Balance, and Upper Extremity Function for Children with Hemiplegic Cerebral Palsy: Single-Subject Research

Ji-Hye Jung & Su-Kyoung Kim

Published in Journal of Korean Society of Occupational Therapy

The purpose of this study was to investigate the effects of an Interactive Metronome (IM) on the bilateral coordination, balance, and upper extremity function for children with hemiplegic cerebral palsy. Methods: For this study, single-subject experimental research was conducted using an ABA design. We observed the child for around 40 minutes twice a week for 10 weeks, with a total of 20 sessions. We evaluated the child’s bilateral coordination without intervention in the baseline phase (A) for four sessions. In the intervention phase (twelve sessions), the child received 40 minutes of Interactive Metronome training twice a week. The bilateral coordination of the child was measured after each training. During the second baseline phase, data were collected using the same procedure as the first baseline phase. The child’s balance was assessed before and after treatment. In addition, the child’s hand function was assessed pre-, interim-, and post-treatment. After IM training, the participant showed an increase in bilateral coordination and balance and demonstrated significant improvement. Additionally, the participant showed an increase in hand function, although not at a significant level. The results of this study suggest that IM training has a positive effect on bilateral coordination and balance.

*note: currently only translated into Korean

Evaluation of the Hardy Brain Camp

Hannah Grossman & Mary E. Brenner

White Paper

This was an evaluation of the Hardy Brain Camp, designed for the Boys and Girls Club of America. The theoretical underpinnings of Hardy Brain Training are that learning improves when processing speed, perceptual-motor, sensory, and cognitive skills improve. The Hardy Training is a two-part training system: 1) a movement to a beat-millisecond timing training (MTT) and 2) a movement to a beat plus a cognitive component-ball bounce activity (Ball Training). Interactive Metronome® is the central component of Hardy Brain Training. 62 elementary students between 2nd and 5th grade were randomly assigned to one of three groups: Control, Interactive Metronome®, or Interactive Metronome® plus Ball Training. Before and after a 20 session training period, all participants were given standardized measures of processing speed, reading fluency, and math fluency. The group that received Interactive Metronome plus Ball Training outperformed both of the other groups on measures of processing speed and reading & math fluency.

Short- and long-term effects of synchronized metronome training in children with hemiplegic cerebral palsy: A two case study

Anna-Maria Johansson, Erik Domellof & Louise Ronnqvist

Published in Developmental Neurorehabilitation

The objective of this study was to explore the potential effects of synchronized metronome training (SMT) on movement kinematics in two children diagnosed with spastic hemiplegic CP (HCP). After four weeks of training, significant changes in kinematic outcomes were found for both cases. Findings included smoother and shorter movement trajectories in the bimanual condition, especially for the affected side. In the unimanual condition, Case I also showed increased smoothness of the non-affected side. Although the effects of IM training on kinematics varied among the two children, some improvements in spatio-temporal organization were observed. Future studies, including larger samples of children with different severity level of HCP and also other types of CP are needed to evaluate the generalizability and stability of the present findings.

Academic and Behavioral Improvements in 2nd-8th Grade Students in the hardy Brain Camp Program: Report on the Hardy Brain Camp Pilot Study of the Boys & Girls Clubs of Greater Oxnard and Port Hueneme and the United Boys & Girls Clubs of Santa Barbara County

 Jamshid Damooei

White Paper

The academic and behavioral performance of 54 students (grades 2-8) was measured before and after participation in the Hardy Brain Camp program, the centerpiece of which is Interactive Metronome training. Students were identified for participation in the Hardy Brain Camp because they demonstrated difficulties with learning, attention, organization, behavior, poor grades, listening, following directions, completing schoolwork, reading and/or math weaknesses that significantly interfered with academic performance. The theoretical underpinnings of Hardy Brain Training are that learning improves when processing speed, perceptual-motor, sensory, and cognitive skills improve. The Hardy Brain Training is a two-part training system: 1) a movement to a beat- millisecond timing training (MTT) via Interactive Metronome and 2) a movement to a beat plus a cognitive component- ball bounce activity plus Interactive Metronome (Ball Training).

Computer-Based Rhythm and Timing Training in Severe, Stroke-Induced Arm Hemiparesis

Sarah C. Beckelhimer, Ann E. Dalton, Charissa A. Richter, Valerie Hermann & Stephen J. Page

Published in American Journal of Occupational Therapy

This study of two stroke patients with hemiparesis shows remarkable functional gains made using IM years after the patients suffered their strokes.

Effects of motor sequence training on attentional performance in ADHD children

Gerry Leisman & Robert Melillo

Published in International Journal on Disability and Human Development

This study addresses the lack of motor coordination in ADHD children and suggests that going through IM training would have a significant effect on improving focus in ADHD children.

Improved motor-timing: effects of synchronized metronome training on golf shot accuracy

Marius Sommer & Louise Rönnqvist

Published in Journal of Sports Science and Medicine

This European study is an independent recreation of earlier IM research studying golfers. This new study showed the same results: working with IM’s timing exercises improves golfers’ control of their swing and improves shot accuracy.

A Preliminary Study of the Effects of Interactive Metronome® Training on the Language Skills of an Adolescent Female With a Language Learning Disorder

Jessica J. Sabado & Donald R. Fuller

Published in Contemporary Issues In Communication Science and Disorders

This published study demonstrated the effect of IM training on expressive and receptive language skills in an adolescent female with a language learning disorder (LLD). The authors suggest that IM training may be a useful tool in the treatment of communication disorders for a wide range of clinical conditions.

Improvements in interval time tracking and effects on reading achievement

Gordon E. Taub, Kevin McGrew & Timothy Z. Keith

Published in Psychology in the Schools

A study published in the journal Psychology in Schools showed that children completing a training program with Interactive Metronome achieved accelerated reading outcomes. A gain of 7 – 20% in reading achievement was shown in the 49 children whose reading and pre-reading skills were pre and post-tested.

The Effect of Interactive Metronome® Training on Children’s SCAN-C Scores

Joel L. Etra

White Paper

This pilot study by Joel Etra, PhD, SLP measured the effects of IM on children diagnosed with Central Auditory Processing Disorder. It showed that IM statistically significantly improved 4 areas of auditory processing in all the children tested. The largest increases occurred in dichotic listening, a measure of selective attention.

Interactive Metronome® training for a 9-year-old boy with attention and motor coordination difficulties

Melinda L. Bartscherer & Robin L. Dole

Published in Physiotherapy Theory and Practice

This case study shows IM’s training results for a 9-year-old boy with attention and motor coordination difficulties being treated by physical therapists.

The role of functional MRI in defining auditory-motor processing networks

Dr. Neal Alpiner

White paper presented at national PM&R conference 2004

A study of 13 patients measured across a broad spectrum of function shows that gains made with IM are still present 6 months after therapy was completed.

Pathways Center Final Statistical Analysis

Lee E. Jacokes

White Paper

A study of 13 patients measured across a broad spectrum of function shows that gains made with IM are still present 6 months after therapy was completed.

Processing speed and motor planning: the scientific background to the skills trained by Interactive Metronome® technology

Susan J. Diamond

White Paper

A study of 585 children found significant correlations between the students’ mental timing as measured by IM and their academic performance in reading, math, language, science, social studies and personal study skills. This study shows that brain timing plays a foundational role in a child’s academic performance.

Learning Problems and the Left Behind

Dr. Cindy Cason

White paper presented at the annual meeting of the National Association of Elementary School Principals

This study of 40 4th and 5th grade “at risk” children showed dramatic gains in reading and math fluency in only 4 weeks. 40 similar students in the control group showed no improvement at all.

Interactive Metronome- Underlying neurocognitive correlates of effectiveness

Dr. Patrick Gorman

White Paper

A white paper by psychologist Dr Patrick Gorman explaining the underlying neuro-cognitive mechanisms of IM training.

Training in timing improves accuracy in golf

Terry M. Libkuman & Hajime Otani

Published in The Journal of General Psychology

This published study demonstrates a connection between IM’s timing exercises and improvements in complex movements as seen in dramatic improvements in golf shot accuracy.

Timing in child development

Kristyn Kuhlman & Lawrence Schweinhart

Published in High/Scope Press

A study of 585 children found significant correlations between the students’ mental timing as measured by IM and their academic performance in reading, math, language, science, social studies and personal study skills. This study shows that brain timing plays a foundational role in a child’s academic performance.

Theoretical and Clinical Perspectives on the Interactive Metronome®: A View From Occupational Therapy Practice

Jane Koomar, Jeannetta D. Burpee, Valerie DeJean, Sheila Frick, Mary J. Kawar & Deborah Murphy Fischer

Published in American Journal of Occupational Therapy

This published white paper includes the perspective of six Occupational Therapists describing IM’s usefulness in addressing school, home and social relationship problems in children.

Effect of Interactive Metronome® Training on Children with ADHD

Robert J. Shaffer, Lee E. Jacokes, James F. Cassily, Stanley I. Greenspan, Robert F. Tuchman & Paul J. Stemmer, Jr.

Published in American Journal of Occupational Therapy

A study of 56 pre-teen boys diagnosed with ADHD found that those using IM showed statistically significant improvement in attention and concentration, motor coordination, language processing, reading and math fluency and the ability to control impulsivity.

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