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A Revolution in Neurological and Motor Rehabilitation

A Revolution in Neurological and Motor Rehabilitation. Overview. History & Research Clinical adoption & areas of use Cases Studies Billing & Coding. History of Interactive Metronome. Began formal clinical research in 1994 First used with Pediatric patients.

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A Revolution in Neurological and Motor Rehabilitation

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  1. A Revolution in Neurological andMotor Rehabilitation

  2. Overview • History & Research • Clinical adoption & areas of use • Cases Studies • Billing & Coding

  3. History of Interactive Metronome • Began formal clinical research in 1994 • First used with Pediatric patients

  4. Stanley I. Greenspan, MDChairman, IM Scientific Advisory Board • Clinical Professor Psychiatry, George Washington Medical School • Contributor to over 100 articles and 27 books, including Building Healthy Minds, and The Child with Special Needs • Child Development Expert Featured in The Washington Post, Newsweek, Time Magazine, ABC’s Nightline, NBC, and CBS

  5. Science Overview Motor Planning Processes of Organizing and Sequencing are a core function of the brain “Motor planning and sequencing is a critical component of the deficit in a variety of developmental and learning disorders.” • - Stanley I. Greenspan, M.D.

  6. Early Studies:Motor Skills Study • Special education students • Improved fine and gross motor and visual motor skills • Results presented to the American Educational Research Association

  7. Large-Scale Correlation Study • Timing and Child Development Study Published • Conducted in Illinois by High/Scope Foundation • 585 students, 6-10 years old

  8. AJOT Published Clinical Study • 3 groups of ADHD boys separated by: Control / Placebo / IM-trained • Statistically significant improvement in: • Attention • Motor Control and Coordination • Language Processing • Reading • Control of Aggression and Impulsivity

  9. AJOT Published Clinical Study Interaction Effect = 0.005

  10. Academic Fluency Study • Over 700 middle and high school students • Pre and post subtest on nationally standardized Woodcock-Johnson III test • Results showed significant increases in grade equivalent (GE) performances in IM Group

  11. Academic Fluency Study 2.21 GE Gain in Reading Fluency 1.66 GE Gain in Math Fluency 2.21 GE gain, n=718, Woodcock Johnson, 3rd Ed. 1.66 GE gain, n=703, Woodcock Johnson, 3rd Ed.

  12. Athletic Performance Study • Comparison of IM trained golfers to a control group • Produced significant improvements in golf shot accuracy • An average of 20-40% improvement in shot accuracy obtained by the IM group • Control group saw no gain

  13. Athletic Performance Study • 20% Overall Gain in Shot Accuracy • 35% Increase for advanced golfers who had consistent swing mechanics

  14. Results from Early Clinical Trials Results from a pilot fMRI (brain scan) study show IM directly activates multiple parts of the “neuronetwork” CINGULATE GYRUS Allows shifting of attention Cognitive flexibility BASAL GANGLIA Integrates thought and movement MEDIAL BRAINSTEM Neuro-motor pipeline

  15. Parkinson’s Study • “In this controlled study computer directed rhythmic movement training was found to improve the motor signs of parkinsonism .” Daniel Togasaki, MD, Parkinson’s Institute

  16. Neal Alpiner,Rehab Medical Director William Beaumont Hospital… “IM Neuro therapies have been shown to be efficacious in: • Phase I (Acute Inpatient Rehab) • Phase 2 (Outpatient) • Phase 3 (Eminence) stages of client neuro-recovery.”

  17. What are the Benefits? 1 ATTENTION / FOCUS 2 MOTOR CONTROL / COORDINATION 3 BALANCE & GAIT 4 LANGUAGE PROCESSING 5 CONTROL OF AGGRESSION / IMPULSIVITY

  18. Interactive Metronome for Rehabilitation Training Jimmy Eggleston was the First Rehab Case

  19. Invention of Interactive Metronome After 3 weeks walking without assistive device

  20. Interactive Metronome Today Currently provided by thousands of therapists in hospitals, clinics, schools and rehab centers

  21. Who Can Benefit? REHABILITATION Loss of Motor Control Loss of Speech/Cognition Loss of Balance and Gait PLANNING SEQUENCING TIMING NEURO-SCHOLASTIC PERFORMANCE ADD/ADHD Asperger's Syndrome Sensory Integration Language Processing Motor Control and Coordination Impulsive/Aggressive Enhanced Coordination Improved Focus and Attention Improved Academic Performance

  22. Assessment 15 40 15 40 0 200 69 200 69 1 second = 1,000 milliseconds 0 – 15ms. Perfect 16 –22 Superior 23 – 29 Exceptional 30 –40 Above Average 41 –69 Average

  23. The Second Link “ IM impacts the neurological population in the same way it helps the developmental population.” - Cheryl Miller HealthSouth Regional Director Clinical Services Sunrise, Florida

  24. CVA and Brain Injury Amputees Parkinson’s General Rehabilitation ADHD Cognitive / Developmental Disorders Academic / Sports Performance Key Diagnoses

  25. Address Cognitive Deficits • Attention and Concentration • Motor Planning and Sequencing • Language Processing • Behavior (Aggression and Impulsivity) • Executive Functioning

  26. Address Physical Deficits • Balance and Gait • Endurance • Strength • Fine/Gross Motor Skills • Coordination

  27. Case Study 1: Jake 16 year old male - TBI from MVA Severe impairments: • Sustainedattention & concentration • Poor memory • Left-right discrimination • Gross and fine motor coordination • Balance

  28. Case Study 1: Jake After 6 weeks of IM Training: • Able to attend to paper/pencil tasks for up to 50mins in preparation for school • Reported that he could hold conversations for longer periods of time and now able to “day dream” • After IM, only needed minimal cues for L-R discrimination

  29. Case Study 2: Veronica 37 year old female - CVA Deficits addressed: • Poor attention & concentration • Unable to attend to tasks for more than 10-15 minutes without getting externally distracted • Decreased stamina and endurance • Unable to stand for more than 15-20 minutes

  30. Case Study 2: Veronica Following 8 weeks of IM training: • Able to complete simulated work activity for at least 60 minutes without becoming distracted • Able to stand and complete household activities for at least 45 minutes

  31. Case Study 3: Brenda • 6 months of traditional therapy with poor outcome • Thousands of IM reps particularly using her feet • Significant improvements in motor sequencing • Improved gait & balance

  32. Case Study 3: Brenda Disney Marathon FINISH LINE! January 2004

  33. Non-invasive Non-pharmaceutical(not exclusive of Rx) Complements existing therapy Short-term (length of treatment) Measurable outcomes Functional cross-over Benefits of IM

  34. Questions and Answers

  35. Reimbursement: Billing & Coding

  36. Reimbursement: Billing & Coding

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