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CERTIFICATION & COACHING: IM PEDIATRIC BEST PRACTICES MODULE 8: Special Considerations – IM Training Plans with Infants-Toddlers or clients with decreased cognitive capabilities. By Mary Jones, OTR/L, DipCOT Sensational Kids, LLC Brain Focus International, Inc.

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CERTIFICATION & COACHING: IM PEDIATRIC BEST PRACTICES MODULE 8: Special Considerations – IM Training Plans with Infants-Toddlers or clients with decreased cognitive capabilities

By Mary Jones, OTR/L, DipCOT

Sensational Kids, LLC

Brain Focus International, Inc


Outcome Goals for Module 8

  • Homework assignment and post-test review from Module 7.

  • Age considerations for use of IM.

  • Review of case examples: Emma; Reyna; Betsy

  • Considerations from a parents perspective

  • The importance of modifying IM

  • with this client group.

  • Review of levels of training

  • needed when working with

  • children with low cognitive

  • capacity.

  • Case example: Katie

  • Review of Session 8

  • Assignment/Homework


Review of Post-Test from Module 7

1. True or False: It is not necessary to consider IM testing data when formulating a treatment plan, only use discipline specific testing.

  • Answer: False


Review of Post-Test from Module 7

2. True or False: The key to success with IM training is to always have a plan laid out for a student to participate in and stick to that plan throughout the training session.

  • Answer: False


Review of Post-Test from Module 7

3. True or False: It is not important to increase repetitions, just as long as your IM student is enjoying their sessions with you.

  • Answer: False


Review of Post-Test from Module 7

4. True or False: You do not need to own expensive therapeutic equipment to modify IM interventions.

  • Answer: True


Review of Post-Test from Module 7

5. True or False: It is important to consider preparing short articles and case studies to support your interventions with Interactive Metronome® and to keep up with current research.

Answer: True


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


Age Considerations

  • “At what age can I effectively introduce Interactive Metronome® activities into my treatment programs?”


My inspiration … Emma …

Movie: 11.Lucy beginning.mp4

A presentation at the IM Professional Conference 2007

My thanks to Lucy Barlow, MED, SLP-CCC

From The Language Learning Center, Kingsland, Georgia.


Interview from Emma’s Mom

Movie: 12.after IM.mp4


IM Modifications with Emma and Lucy Barlow (SLP)

Movie: 13.IM teqqith Lucy.mp4


Why IM for Emma?

This provider’s prior observations of the success of IM with cross-hemisphere difficulties

Neuro-rehabilitative aspects of IM

Prospect of stimulating hemispheric communications

Motivation to achieve best possible outcome for patient


Clapping to Music

Movie: 15.clapping to music.mp4


Using Video Feedback

Movie: slide16-usingvideofeedback.mp4


Wonderful Reyna

Movie: 17.2008_0731MISCSORT0070.mp4


Examples of infant modifications:

Using a folded sheet or large towel, swaddle the infant ‘hammock style’ with their face looking towards their mother or caregiver. Starting low and slow, gently swing to the right and then to the left, providing soft ‘end points’ to mark the beat. Movements may also include up and down, with cushions or a mattress beneath the infant. Tempo should be no higher than 54 bpm, and if the infant shows signs of distress, skip to every other beat for consistency. Follow the infant’s tolerance and lead. A soft song or lullaby can be sung in sync to the beat.


Secure rhythmic engagement to the metronome beat


Example of a net hammock used on the beat


Key systems influenced by regulating to a beat

  • Breathing

  • Engagement

  • Autonomic nervous system responses

  • Vagus nerve

  • Audition


Which in turn can help with:

Down regulation

Up regulation

Respiration

Digestion – reflux (GERD)

Feeding – colic

Sleep – sleep apnea

Alert state and regulation of primary functions.


Wearing a hat to decrease sensitivity to headphones


Contained sitting to increase attention


Combine with favorite and ‘safe’ places to increase frequency and duration


Allow manipulation of headphones – also consider using speakers…


Provide positive support and hand over hand assist


If a child wants to use celery as a drumstick….


Then let them!


Introduce headphones as part of play and sensory diet


Include passive metronome beats and rhythms to daily activities such as:


And ultimately…


Case study: Katie


Areas commonly identified for treatment in children with low cognitive and neurological capacity

NEUROLOGICAL:

  • Developmental delays – genetic

  • Developmental delays – environmental

  • Developmental delays – acquired


Use of media to record initial performance and timing tendencies

Movie: slide43-usingmedia.mp4


Considerations…

  • Long repetitions to increase tolerance to hearing the beat in the environment

  • High energy prompting and hand over hand assist to generate pockets of engagement.


Feeling the beat together

  • Hand over hand assist

  • Containment and postural support

Movie: slide45-feelbeattogether.mp4


Considerations…

  • Hand over hand assist

  • Containment and postural support

  • Headphones vs speakers


Independent in supported sitting

Movie: slide47-supportedsitting.mp4


Considerations…

  • Adapt environment to support attention; posture; switch access.


Keeping the beat at the right pace

Movie: slide49-keepingthebeat.mp4


Considerations…

  • Match tempo to child in the moment.

  • Continue to apply rhythm to handling; games; movement activities.


Review of Module 8 Learning Outcomes

Age considerations for use of IM

Review of case examples: Emma; Reyna; Betsy

Considerations from a parents perspective

The importance of modifying IM with this client group

Review of levels of training

needed when working with

children with low cognitive

capacity.

Case example: Katie


Module 8 Homework

  • Complete Post-Test for Module 8

  • Select one of the following IM webinars to consolidate learning in this area:

    • “Using IM for Moderately Dependent, Low-Level Inpatients”

    • “The Use of Interactive Metronome in Infancy”

      2.Complete webinar Post-Test


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