By Amy Vega - January 15, 2015
Can regulatory tempo(54bpm) be adjusted according to medical indications? Please let us know clinically adoptable tempos if tempo can be adjustable, especially for sports areas such as golf, baseball and so on.
Adagio is a term in music that means “slowly and gracefully. ” A tempo of 54 allows you to remain at ease (almost meditatively so) while moving slowly and rhythmically to the beat. Practice is more neurologically impactful when it is repeated over and over with proper form (in the case of IM, it must be rhythmical), and each time the movement is repeated, it is repeated … S L O W L Y. A great resource to learn more about the amazing impact of training slowly and repeatedly is The Talent Code: Greatness Isn’t Born. It’s Grown. Here’s How by Daniel Coyle.
With that said, there are clinical rationales for modifying the tempo and results have been consistently reported, although many of the approaches have not undergone rigorous study. While modifying tempo is at the discretion of the IM Provider, based upon his/her best professional judgment, here are a few reasons for adjusting tempo:
1. If your client exhibits impaired motor planning & sequencing (praxis) and movements are linear, choppy, awkward or otherwise lack good coordination then a change in tempo is indicated (a person with good coordination can make circular, rhythmical, smooth movements with the hands when clapping or tapping the leg without effort ). In this instance, it is best to reduce the tempo slightly (by trial and error you will find the correct tempo — somewhere between 48-52 bpm). You may also need to provide hand-over-hand assistance to this client, weaning from your direct assistance to providing a visual/simultaneous model; then, weaning from your cues entirely as your client learns to effortlessly make rhythmical movement. If your client presents with this impairment, it is also imperative that you do not turn the guide sounds on until your client is able to make effortless, rhythmical movement at the slightly slower tempo. You will gradually increase the tempo toward 54 bpm (by increments of 1-2 bpm), pairing exercises over the course of a session or several sessions (i.e., for example Both Hands at 50 bpm until competent, then Both Hands at 52 bpm … continue until competent and then move to 54 bpm). Once back at 54 bpm and competent with making rhythmical movement, turn on the guide sounds with Difficulty setting 300, working toward Difficulty setting of 100 over time as timing and rhythm continue to improve.
2. If working with a client who displays gait or balance problems, and you are working on the foot exercises, you may need to reduce the tempo to allow your client enough time to alternate the feet and hit the trigger timely. For example, a neurologically impaired client who displays a hip hike when ambulating or alternating feet will require increased time to reach the trigger. The tempo may need to be reduced to as low as 30 bpm in this case. Adapting the tempo in this instance, as with all cases, is by trial and error. As the IM Provider gains more experience with IM training with a variety of client types, (s)he will become adept at intuitively knowing what tempo is best.*
3. If working with a hemiplegic client who displays spasticity, the IM Provider will need to pay special attention to the affected arm. Typically, a slower tempo is indicated so that … 1) the client can make more smooth, circular, rhythmical movements with the affected arm/hand (54 bpm is way too fast in this instance), and 2) the client does not experience significant increase in muscle tone during the exercise.*
4. When working with individuals who display significant impulsivity (i.e., from developmental disorders like autism or ADHD or from acquired brain injury such as stroke, TBI or Parkinson’s disease), it may be necessary to start IM training with a faster tempo — meeting them where they are. As they begin to understand the concept, that they are supposed to try to synchronize with the beat, you can begin to gradually adjust the tempo back toward 54 bpm. If taking this approach, it is helpful to initially keep the guide sound volume turned off. It may be helpful to provide visual feedback by selecting the visual display that has the scores without the center flash (using a default background or plain white, black or blue background to minimize distractions). So, in essence, your client will hear the auditory reference tone at the faster tempo (anywhere from 60-90 bpm) and will receive feedback for timing via the computer screen to decrease the demand on auditory processing. The Difficulty setting should initially be at 300 and should be adjusted as your client is able to make use of the feedback to improve timing.
5. It has long been observed, and has recently been documented in research, that IM impacts cognitive processing speed. Clinically, there are times when you want your client to learn to slow down to be more in sync with what is happening in the environment. A client who has gained competence at 54 bpm should work at slower tempos to improve executive functions, namely inhibitory control. Gaining competence at a variety of slower tempos is helpful. A client who is very impulsive and having trouble synchronizing with the beat (and who is not responding to the faster tempo described in #4) may benefit from a temporarily reduced tempo of 30 bpm with the instruction “do not clap your hands until you hear the beat.” In this way, you are working on the executive skill of inhibition. There is good carryover from this repeated exercise, with substantial improvement in subsequent LFA measures. Increasing the tempo can also have an impact on cognitive speed. Once the client with a known problem with cognitive speed displays competence at 54 bpm, it is helpful to gradually increase the tempo (with the guide sounds turned on) to improve auditory processing speed. There is a separate protocol for addressing visual processing and speed with IM (send an email to firstname.lastname@example.org and ask for “visual IM protocol” if you would like more information).
6. Based upon the work by Jodi Fulwood and others who work with amateur and elite athletes, it is recognized that working initially at 54 bpm to learn to synchronize as perfectly with the beat as possible (with guide sounds on), then increasing the tempo as high as 100 bpm is beneficial to improving the cognitive and motor skills necessary for peak performance in athletics, whether it be soccer, baseball, tennis, golf or some other sport. Not only is the tempo adjusted for athletes, but specific exercises have been created by Jodi and others to work on specific skills, depending upon sport and position the athlete plays. Here are a list of on-demand webinars that would be worth viewing if you plan to work on peak performance with athletes:
*It is typical for the IM provider to also provide other therapy modalities in conjunction with IM training based upon their area of expertise to treat the condition.
Amy Vega, MS, CCC-SLP
Interactive Metronome, Inc
Clinical Education Director
Clinical Advisory Board Director
Clinical Education Administrator