tag:blogger.com,1999:blog-65528692069562966352024-03-13T08:53:58.378-07:00Brain Tune-UpsTeresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-6552869206956296635.post-16517392725608607882009-09-13T14:38:00.001-07:002009-09-13T14:38:52.292-07:00Timing Literature Review SourceImproved brain timing is at the heart of most of the big breakthroughs for clients in my practice. I've tried to keep up with the literature, but it is vast and complex. Now Kevin McGrew and Amy Vega have put together a review of theory, diagnosis and treatment research. It is available <a href="http://www.iapsych.com/im/iaprr9.pdf">here</a> in PDF format. There are additional appendices for those who wish to delve deep into the literature. The appendices can be accessed via <a href="http://ticktockbraintalk.blogspot.com/2009/08/brain-rhythm-treatment-efficacy-can-we.html">Kevin McGrew's August 14th blog</a>. In that blog, he gives an interesting introduction to the paper. Check it out.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-67058182037175848872009-01-28T07:05:00.000-08:002009-01-28T11:10:42.644-08:00Emotions as an Input Sense - Part III'm wandering into the psychologist's territory armed with my occupational therapy (OT) sensory integration framework. I'm married to a psychotherapist, and so I suppose that I'm not only armed but dangerous. But come with me on a short look at emotions as a source of sensory input from an OT's perspective. I will use the sensory integration framework to talk about emotions as an input sense, much like other senses.<br /><br />OTs treat clients with PTSD, TBI, autism, dementia, stroke and many other diagnoses in which the emotional system may be fragile. As an OT working with a child or adult in a therapy setting, I need to have tools available to help keep my client emotionally organized and well-modulated so that the interventions are better accepted.<br /><br />From the sensory integration viewpoint, we can (to keep it simple) speak of three aspects of emotional skill: registration, seeking/aversion behaviors, and modulation.<br /><ul><li>Registration of emotions refers to whether or not we sense them, and to what degree we sense them.<br /></li><li>If we excessively seek or excessively avoid emotional experiences then we have seeking or aversive behaviors.<br /></li><li>The degree to which we are affected by emotions and react to them are aspects of modulation.</li></ul> <span style="font-weight: bold;">Registering Emotion</span><br />We speak of "palpable emotions" - you walk into a room and you can feel the excitement, fear, sadness or joy of a person or a group. I think of this as "sensing emotion", in the same way that we "sense" taste or vision. I believe that we all are able to sense emotion to some degree. There are three categories of emotional sensitivity: typically sensitive, hypo-sensitive, and hypersensitive. A person with hypo-sensitive emotions will have difficulty registering emotional content and may not understand why others are affected in certain emotional situations. A person with hypersensitive emotions senses emotional content more intensely than others. He or she may even be bombarded by it.<br /><br /><span style="font-weight: bold;">Seeking/Avoiding Emotions</span><br />Some of us seek positive or negative emotional experiences, or both. We may seek emotions because we are hypo-sensitive and our brains are trying to get the sensation. We may seek emotional experiences because we are hyper-sensitive and enjoy the sensation and want more. We may avoid emotional experiences for a variety or reasons. We may be hyper-sensitive and easily overwhelmed by emotional experiences. We may be hypo-sensitive and find the experience boring or confusing.<br /><br /><span style="font-weight: bold;">Handling Emotions (Modulation)</span><br />We can split emotional modulation into two aspects: receptive and expressive. We need to be able to modulate both our reception of emotions and our reactions to emotional experience. A well-modulated person moves in and out of sensory experience with ease. An <span style="font-style: italic;">emotionally</span> well-modulated individual moves in and out of emotional experiences with ease.<br /><br />The topic of emotions is incredibly complex. Briefly, from the eyes of an OT, here are some simple examples of poor receptive emotional modulation: inability to understand cultural differences, inability to see someone else's plight, inability to process complex emotional situations. At the other extreme are people who "feel too deeply" and who perhaps read too much into a situation they are witnessing.<br /><br />Some examples of poor modulation of expressive emotions include tantrums and rages, social phobia, and heavy emoting. At the other extreme is the lack of expression of emotion.<br /><br /><span style="font-weight: bold;">The OT Viewpoint</span><br />As a sensory-based OT, I am concerned with the physiological aspect of sensing and reacting to emotions. My interventions incorporate recorded music, social situations, excitement level in the environment, sensory input and special tools such as sound therapy to shape the mood and induce the appropriate reaction. I work in the same village as the behaviorist or cognitive therapist, but do not offer the same practices nor do I necessarily look for the same results.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-67455324072699751162009-01-25T08:04:00.000-08:002009-03-16T08:49:47.925-07:00Winter Depression and Low Dose Melatonin<span style="font-weight: bold; color: rgb(0, 204, 204);">Over the Counter Treatment for Seasonal Affective Disorder</span><br /><br /><span style="font-weight: bold;">The short story:</span> Low daily doses of liquid melatonin taken every day for 4 weeks once SAD has set in, can lift the mood. A low dose of melatonin - .3 mg - can be obtained by using small amounts of liquid melatonin. The time of day it is taken is important. For most people it is in the afternoon. For some (30%) it should be taken in the morning. (Per research (2) cited below.)<br /><br />Melatonin is available over the counter, but one should consult a doctor regarding usage.<br /><br /><span style="font-weight: bold;">Long Story:</span><br /><br />A running theory of the cause of seasonal affective disorder (SAD) or winter depression, is that a person's circadian rhythms are out of sync. NIHM defines this: "A person's rhythms are synchronized when the interval between the time the pineal gland begins secreting melatonin and the middle of sleep is about 6 hours. (1)" There are a number of therapies aimed at correcting the problem including lights, exercise, anti-depressants and melatonin. (See the <a href="http://en.wikipedia.org/wiki/Seasonal_affective_disorder">Wikipedia entry.</a>)<br /><br />The synchronization can be off in two ways: - a longer-than or a shorter-than 6 hour interval. A study by Lewy, et al (2), showed that subjects who took low dosages of melatonin every day for 4 weeks found an improvement in mood. The dosage was as follows: for those who's interval is less than 6 hours, .3 mg in the afternoon. For those with a longer than 6 hour interval, .3 mg in the morning. If you have to guess which you are, the odds from the study favor the short interval (71% to 29%). The study gave 2 small doses adding up to .3 mg in 2 hours.<br /><br />Melatonin is available over the counter, but generally in high dose formulations. The study used capsule formulation. There are liquid forms of melatonin available in some health food stores. (Again, I found Natrol 1 mg, and adjusted the amount.)<br /><br />Both articles cited are available on line.<br /><br /><span style="font-weight: bold;">References</span><br />1. April 2006 article from the National Institute of Mental Health,<span style="font-size:85%;"> "<a href="http://www.nimh.nih.gov/science-news/2006/properly-timed-light-melatonin-lift-winter-depression-by-syncing-rhythms.shtml">Properly Timed Light, Melatonin Lift Winter Depression by Syncing Rhythms</a>"</span>.<br /><br />2. Lewy AJ, Lefler BJ, Emens JS, Bauer VK. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16648247">The circadian basis of winter depression.</a> <em>Proc Natl Acad Sci U S A</em>. 2006 Apr 28.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com1tag:blogger.com,1999:blog-6552869206956296635.post-61286419516048109422009-01-16T07:47:00.000-08:002009-01-26T07:56:39.780-08:00Jam-packed therapyHere is a story about using Interactive Metronome (IM) and Therapeutic Listening (TL) simultaneously. AND, mom and dad put on the headphones, too.<br /><br />"Gary" is a very sweet 12 year old who suffered severe deprivation in early life. His parents are now able to provide him with a safe, loving environment, but he still has tons of stuff to work through (sensory seeking, emotional neediness, act-out behaviors, plus some motor planning problems), and it is hard on the entire family.<br /><br />He was referred to me for Interactive Metronome (IM), and that made sense as an initial approach. Four to six weeks of IM can provide breakthroughs in a range of body-brain areas and make therapy go faster. However, it turns out that Gary is bullying other kids at school and has act-out behaviors at home, too. He needed some self-regulation. IM provides that, but it takes a few weeks to kick in. In the meantime, it can ramp-up personal intensity. In the end, that is a positive effect, but I was worried that it might increase the outbursts at school and home in the short term.<br /><br />And so I thought of Therapeutic Listening or Samonas. Sound therapy programs focus first on self-regulation. But they too, have a drawback. They work more slowly and a person can go through weeks of emotional passivity while the brain reorganizes. The other side of a bully is an insecure human being. I didn't want Gary to flip-flop. I also wanted to make faster progress. With sound therapy, Gary might invest several months before getting to the heart of many issues.<br /><br />In the end, Gary's family opted to do both therapies simultaneously. And so began some jam-packed therapy sessions in which Gary would independently do his IM program while mom, dad and I discussed strategies for home and in the community. During Gary's breaks, he would play on the sensory equipment, try out sound therapy disks or join us for some discussions about behavior. Within a couple of weeks, mom and dad asked if they might benefit from listening to the sound therapy CDs, too. Why, yes. Of course. It had been a long road for them, as well as for Gary, and the music would help to remove some of the built up trauma that they had undergone.<br /><br />Last week, Gary finished his IM program. He will continue to listen to Therapeutic Listening and Samonas CDs for another 6-10 weeks, depending. His dad gave me an update. "The changes are subtle, but they are deep." He was very pleased. He was seeing cooperation and motivation to change where there was none before. Parents sometimes miss these changes in their children. But they are profound and grow with time.<br /><br />Gary told me that everything in his life felt a little easier. I measured Gary's performance on motor-skills tasks, and he gained 18-24 months in fine motor skills and upper body movement and coordination. The results for cognitive and sensory gains are not in yet.<br /><br />Gary's parents seem to have relaxed several magnitudes since I first met them. In early sessions, they spoke through clenched teeth. Now there are smiles.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-32482607791879150912009-01-14T11:49:00.000-08:002009-01-14T11:53:19.589-08:00Core:Tx and Interactive Metronome<strong><span style="color: rgb(0, 204, 204);">Mark</span></strong><br />Mark is a 12 year old boy with high functioning autism who returned to occupational therapy after a break of several years. Although Mark was doing well in school, he was unable to fully dress himself or bathe himself. In terms of neuromuscular control, Mark had poor overall tone, poor postural control, and significant motor planning issues. He walked with a very wide gait (total deviation of 80 degrees), had poor handwriting, and lacked the ability to plan and execute movements with his arms and hands that would allow him to reach the top of his head and flex his fingers to wash his hair. In addition, he chewed his food in the front of his mouth and for this reason preferred a soft foods diet. Mark’s social skills were quite limited. He rarely looked at others while speaking and limited his conversations to single words.<br /><br /><strong><span style="color: rgb(0, 204, 204);">Intervention</span></strong><br />Given the range of problems Mark faced, it was decided that a course of <a href="http://www.interactivemetronome.com/">Interactive Metronome </a>(IM) would reduce the time in therapy. Mark did IM twice per week for 30 minute sessions. He started each session with a few minutes in the ball pit to help him relax and self-organize. He then did 10 minutes of IM, took a short break on a swing or trampoline and then a final 10 minutes of IM. As his skills improved (and he moved to phase 4 of the IM program), he did 20 minutes of IM and then practiced dressing skills or handwriting.<br /><br /><strong><span style="color: rgb(0, 204, 204);">Progress with IM</span></strong><br />The program of IM had profound effects on Mark. He developed a self-awareness and motivation that led to greater independence. First, he figured out how to regulate the shower temperature. Next, he tried to wash his hair on his own, although he still lacked the correct motor-planning for that task. He took an interest in outside activities and began to talk about what he did. He displayed a good sense of humor. He saw gains in motor planning and postural control. He learned to dress himself entirely with the exception of buttoning pants at the waist and tying shoes. He learned to chew with his whole mouth. His wide stance improved, so that his feet were better aligned by 5-10 degrees.<br /><br />After 19,000 repetitions, therapy took a new direction. It was time for Mark to learn a variety of new skills through exercise and repetition. Mark was aware and motivated, but with his new sense of humor, he was also very playful. It was difficult to keep him on task to perform the more difficult work of exercising his body to make additional gains. For example, when asked to lay over a therapy ball to work on posture, he would fall off the ball and roll on the floor and giggle. When asked to pretend to wash his hair by moving his hands together on top of his head, he would pat the sides of his head with extended fingers, as if to say, “there, all done.”<br /><br /><span style="color: rgb(0, 204, 204);"><strong>Core:Tx</strong></span><br /><a href="http://www.performancehealth.com/our-products/coretx-pro/">Core:Tx</a> proved to be the solution for getting him to perform exercises correctly. Its game-like nature engaged him, and he paid attention to the instructions rather than acting-out with silly behaviors. On the first day he performed scaption (shoulder/rotator cuff) exercises. As he attempted to keep Core:Tx’s red ball within the square, he made smooth movements with his arms to the top of his head, using full range of motion, for the first time. He was proud of himself and after two sessions, he developed the motor planning to successfully wash his hair independently. He currently uses Core:Tx in both physical therapy and occupational therapy to address postural control, lower extremity motor planning and gait issues.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-91061995656337134842009-01-12T08:02:00.000-08:002009-01-28T11:22:01.403-08:00Personal Genome Project: Nature & NurtureYesterday's New York Times Magazine (1/11/09) had an interesting cover story by cognitive scientist, Steven Pinker, who is a participant in the Personal Genome Project. The genome project will create technology and practices allowing individuals to access and interpret their personal genetic information.<br /><br />The identification of a person's traits (personal genomics) using DNA is in its infancy. We can identify risks for some diseases, and map some physical attributes such as hair color and skin tone, but not always accurately. We can identify ancestral lineages (- which is very cool!).<br /><br />What I found most interesting in Dr. Pinker's article is that personality and behavioral traits such as extroversion, intelligence, religiosity, neuroticism, mental illnes can be mapped to our genes to some degree. And giving nurture (as opposed to nature) <span style="font-style: italic;">its</span> due, our differences from each other can be also attributed to culture, shared environments (homes, work and schools), and unshared environments. However, gentic studies are finding that the older we get, the more our behaviors appear to revert to our genetic traits. That is, we move away (perhaps literally) from the cultural and environmental factors as we grow and mature and back to the original DNA expression of ourselves.<br /><br />Hmm... this will surely impact psychotherapy, spiritual development and a slew of other areas. The nature vs. nurture debate should explode in the near future.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-6470469200079073142009-01-09T14:36:00.000-08:002009-01-12T08:01:56.305-08:00Your Brain on MusicJust finished reading the 2006 book, <span style="font-style: italic;">This is Your Brain on Music, The Science of a Human Obsession</span> by Daniel J. Levitin. No surprise that it was a finalist for the LA Times' Book Prize.<br /><br />This wonderful book looks at music and the brain from a-to-z. In doing so, it demonstrates how music and modulated music travel about the brain in a way that influences our ability to trust, self-regulate, identify sounds in space, motor plan, communicate, organize, discriminate sounds, multi-task and relax. In other words, the book provides insight into how sound therapy works -- but without ever mentioning the term sound therapy.<br /><br />Music operates independent from language. Some aspects of music, like pitch, are hard-wired into brain areas. They have their own neural centers on the right side of the brain. For example, a neuro-surgeon can pinpoint the note, C#, in the open brain. Other aspects of music: musical syntax, timbre, rhythm, etc., are processed simultaneously in their own specialized regions across the brain. Music can be an intellectual, regulatory, emotional and/or social experience. We admire the construction of a song, work to the beat of a driving rhythm, allow ourselves to move with musically expressed emotions, and make music a part of our social events and rituals.<br /><br />The brain has two main pathways for music. The first moves from the inner ear into the auditory processing areas where it then moves to other high-functioning cortical regions including executive functioning and memory. The second pathway moves directly from the inner ear to the primitive cerebellum where motor planning and our fight-or-flight is centered. The cerebellum is also the seat of the brain's timing and rhythm, and has important emotional function. Both pathways are bi-connected to each other and to a variety of emotional centers in the brain including those responsible for pleasure and reward.<br /><br />Why did music evolve into animals? Darwin linked music to sexual selection by virtue of music's seductive powers. Others have noted that it was (and continues to be) an important aspect of social bonding and cohesion. This would make it important to the evolution of social beings like ourselves.<br /><br />The book is full of deep information as well as interesting tidbits.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-89497057262306984782008-12-30T07:21:00.000-08:002008-12-30T09:14:07.621-08:00Emotion as a sensory needWhen I step back and look at emotions from a cognitive rather than anatomical viewpoint, it appears to me that emotions act like a sense, and that we can discuss them in the same way we discuss other senses. That is, emotions can be well-regulated or poorly regulated and that a person can have emotional sensory seeking, emotional sensory aversion, low or high emotional registration and emotional modulation-driven behaviors -- just the same as they can for the anatomical senses: touch, taste, smell, hearing, seeing, movement and body sense (proprioception).<br /><br />I see a boy who has pretty typical sensory processing skills with one exception. He is a seeker of sensory input. Not any special kind of input, just all sensory input. He is easily excited and has emotional outbursts. He is eight and mostly non-verbal, but he can say, "I want" and put a name top all of the things that he wants. And he wants a lot, and wants it now.<br /><br />On the Sensory Profile, he scores as "definitely different" from peers in modualtion: social/emotional and sensory seeking. Were you to meet him, you would think of him as emotionally intense. We all know people that we consider to be drama queens and drama kings. In his own way, he is probably one.<br /><br />I wonder what his need is. Is his emotion-seeking due to to low emotional registration? (I am suggesting a brain-level sensory need similar to tactile seeking.) Or does his brain for some other reason (perhaps chemical), have a greater need than most -- here I am thinking of our pleasure-seeking drives? (Or does chemical need and brain-level sensory need mean the same thing in the emotional arena?) Is he not seeking emotion but just demonstrating what appears to be emotional seeking behaviors as a by-product of poor modulation of emotion?Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-26943313897183211312008-12-26T06:51:00.000-08:002008-12-26T10:43:03.639-08:00Walking the Walk with Sound TherapySound therapy can be pretty complex stuff. A 1 or 2 day class is a good start in learning the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">regimen</span>, but it doesn't teach a therapist how to veer from the prescribed path and provide a more customized program for clients.<br /><br />I make an effort to try all the therapies that I provide for my clients so that I can gain a deeper knowledge of what's happening. In doing so, I've gotten any number of personal benefits. Practices such as improving the ergonomics of my computer station give me a fast return for my effort. Some of the deeper therapies, such as sound therapy, have longer healing cycles, and one has to be patient to reap the rewards. I find that it is necessary to listen slowly and steadily to each CD, noting the feelings that come up and the changes that seem to occur. There are small miracles that can occur from the listening.<br /><br />I have been told that adults (and some children) can be highly sensitive to sound therapy. And for 3 of the 5 adults I've worked with, including myself, this was true (until we altered the regimen). What we noticed was feelings of heavy emotions including depression that arose a few hours after therapy and lasted for the better part of a day. And worse, it happened after each listening session. What I noticed was that after having endured that, I felt as if some difficult thing(s) in my past had been purged and that social interactions with difficult people were easier.<br /><br />Now, small changes like that are nice, but no one is going to put up with going through days of depression for some small social gains. However, it turns out that being sensitive has an up-side. One can decrease the listening time to very small increments and still get large gains. I decreased the time to 1 minute per day to start with and then added 30 seconds each day. I did this for both Samonas and Therapeutic Listening. It worked for me and for two clients. In addition to decreasing time, right after the therapy, I listened to emotionally evocative music such as blues, rock, or passionate classical as a way of releasing the emotions from the listening.<br /><br />So how is it going now? Great! I've gone through a few <span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">CDs</span></span> - in the order prescribed by <span class="blsp-spelling-error" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">Samonas</span></span> and Therapeutic Listening, and am able to feel each <span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">CD's</span></span> therapeutic effects on my brain, senses and body. I've noticed lots of small changes and a few big ones, too, including auditory processing, handwriting and modulation. I was surprised by changes in motor areas such as improved handwriting (even though I'd seen it in my kids at the clinic) and my increased ability to handle spicy foods. It is also true that I have slowed down and am attending to things with greater <span class="blsp-spelling-corrected" id="SPELLING_ERROR_5">diligence</span>. (I guess I have listed about half of the areas in which we hope for change for our kiddos from a sound therapy program.) I just notice little improvements every few days, and they keep adding up.<br /><br />I still have a number of <span class="blsp-spelling-error" id="SPELLING_ERROR_6"><span class="blsp-spelling-error" id="SPELLING_ERROR_5">CDs</span></span> to listen to. I'll report on any increased tolerance for the music as evidenced by being able to listen for longer periods of time without ill effect.<br /><span style="color: rgb(0, 204, 204); font-weight: bold;"></span>Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-11120671038828254722008-12-10T11:26:00.000-08:002008-12-10T11:37:25.743-08:00A few LinksI've added a few links to other blogs, etc. You will find them along the right side.<br /><br />Take special note of Tic Toc Talk - an excellent source of information about the brain and intelligence. Kevin McGrew's blog has pointers to many other excellent sites.<br /><br /><br />Also check out <a href="http://www.mcnattlearningcenter.com/services/im/im.html/">McNattLearningCenter</a> for information about Interactive Metronome and Tourette's Syndrome/tics.<br /><br />More to come....Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-85035476437627713862008-12-04T13:14:00.000-08:002008-12-06T14:01:22.104-08:00Sounds and Rhythms<strong><span style="color:#00cccc;">Rhythms and the Vestibular System</span></strong><br />I am reading tons about sound and rhythm, and their affect on the auditory and vestibular systems. Currently, I am reading the 2001 version of Listening with the Whole Body by Sheila Frick and Colleen Hacker. (The new version is due in January!)<br /><br />I didn't realize that the vestibular system (as opposed to the auditory system) picks up and utilizes sound frequencies in the 16-50 Hz. These low sounds are primal and input to the autonomic system as input to our fight/flight motor algorithms. Why? The sounds might come from thunder or from a predator and we may need to run.<br /><br />Of course, this is not always the case, since low sounds can come from percussive instruments which the body can enjoy. The sensation of structured rhythm can be very organizing and calming. It is a useful tool in sensory-based interventions. My favorite rhythm CD for use with clients is Sacred Earth Drums by David and Steve Gordon.<br /><br />A little more from the book: low sounds are multi-directional. They permeate the background. It's hard to tell where they come from (like thunder, for example). High sounds are uni-directional. They move to the foreground with very specific information about where they are. The auditory system can locate low sounds in the range of 500 to 1500 Hz, as well as mid-range and high frequency sounds.<br /><br /><br />1. <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Frick</span>, S. M., and Hacker, C. (2001). Listening with the Whole Body. Vital Links, Madison, WI.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-31244279985289844072008-12-03T09:57:00.000-08:002008-12-03T10:10:26.900-08:00Pioneering Technological InterventionsWith a 20+ year background in computer hardware, software and artificial intelligence, I enjoy using, reviewing and giving feedback on OT interventions that make use of technology. The process can be quite frustrating when products have unexpected quirks: software that doesn't work, technical manuals that are poorly written, and bugs that affect my clients. But overall, the process is a good one. Products like Interactive Metronome, Neuro Core:Tx, Samonas and Therapeutic Listening help my clients make speedier progress on their goals. My challenge is finding the "just the right challenge" for them. I want them to go slow enough that they can integrate the growth. Going too fast can produce side-effects such as sore muscles, act-out behaviors, headaches and emotional melt-downs. Going at the right speed can help them make gains over their entire being as the senses, brain and body all process the changes together.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-25962454062259247442008-11-20T13:28:00.000-08:002009-03-16T08:51:05.642-07:00SamonasThis is a repeat of a posting from my pediatric blog, <a href="http://otselfregulation.blogspot.com/">OT, Self Regulation and Autism</a>.<br /><br />I've been using Therapeutic Listening with clients for about a year now. I recently got Samonas sound therapy training, and I have been reading everything in site about Samonas, Therapeutic Listening and other sound programs. I want to know about the technology and how the programs differ from each other.<br /><br /><strong><span style="color: rgb(0, 204, 204);">Over Speakers</span></strong><br />One thing that Samonas has that others do not, is a series of disks (<a href="http://www.soundfoundations.biz/clqucq1.html">the CQ series</a>) that can be played over stereo speakers. One of my colleagues uses them in the school setting with her kids once per week and sees gains.<br /><br /><span style="color: rgb(0, 204, 204);"><strong>Web-Based Monitoring</strong></span><br />Another feature I like is even more important. The Samonas people will tell you all about the high quality music recorded in pristine settings by joyful musicians.... that's important, but even more so is the feature of web-based monitoring. After clients get their listening CD, they log into a web site every day or so and provide a rating of how it's going. Based on that day's feedback, they are told how many minutes to listen the next day.<br /><br />To understand why this is important one needs to know that with some other programs, therapists give the one-size-fits-all instruction: 30 minutes, twice per day. There is no room for nuance here. It belies the fact that these therapies truly are powerful, and for people who are sensitive (typically, the people who need them), they can have powerful effects. I have seen adults and children have unwanted emotional reactions at inoportune times.<br /><br />One can use the Samonas disks without the web log-in. I like the fact, that therapists are being instructed in how to grade auditory therapy ... just as they currently grade their other therapies. <strong><span style="color: rgb(0, 204, 204);"></span></strong><br /><strong><span style="color: rgb(0, 204, 204);"></span></strong><br /><strong><span style="color: rgb(0, 204, 204);">Levels of Intensity</span></strong><br />Finally, there are many levels of intensity in the Samonas program. A therapist finds out what level to start a client at by giving them the intro (A.R.T.) CD and monitoring the effects using web-based reporting. Once the client is matched to an intensity level, listening disks are chosen.<br /><br />There are a myriad of other features, and more to come. I am impressed with the program, and confident that it will serve my clients well.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-42268526128135174392008-11-20T10:14:00.000-08:002008-12-03T10:16:14.658-08:00Involuntary MomeventI am seeing a client who has a tic that starts at her mid-section and thrusts her head and shoulders outward a few inches. In addition, she constantly touches things, is emotionally volatile and obsesses over having her way. Did I say that these symptoms were compounded by teenage hormones? Not an easy state for a pretty girl.<br /><br />We had talked about sound therapy and <a href="http://www.interactivemetronome.com/">Interactive Metronome</a> (IM). I knew that IM would help with the sensory issues and eventually decrease a lot of the associated anxiety. I know of an IM provider who has Tourettes Syndrome who regularly keeps his symptoms at bay with IM. I wanted to try this approach with my client, but I was worried that the intensity of IM would cause an increase in her obsessive behaviors.<br /><br />So why not use sound therapy... it would improve overall self-regulation and help her find calm. However, I've seen some amount of passive behaviors with sound therapy. I didn't want her self-esteem to take a nose dive, and <em>really</em> complicate things.<br /><br />Finally, I suggested to the parents that we do both. And they agreed. Within a couple of weeks, the body tic has substantially diminished. Her overall home behaviors have improved and both parents are beaming. We completed the IM program, and still have a 6 weeks remaining on the sound therapy. My plan is to give her a quick shot of IM every 2 weeks to bolster the initial gains. I'll update more on this later.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-18021552720271079482008-11-12T08:12:00.000-08:002008-11-20T13:41:40.161-08:00Musical EmotionsI just read about a number of dual sensory experiences in the book, Musicophilia, by Oliver Sacks. His examples include people who hear colors. He can add this one to the list: a woman who feels in musical notes.<br /><br />My good friend, Amanda, called me this morning in a state of excitement. Amanda has minor bouts of mania and minor bouts of depression. Another friend of hers once called her the most intense person she ever know. That was before my time with Amanda. She's pretty mellow these days. Although, I guess she has her moments.<br /><br />And today was evidently one of them. It's been a rough November for her. External events had brought up some emotions, and combined with the dreary Michigan November she succombed to a bit of depression. As a friend, I was keeping a very careful eye on her.<br /><br />During her call she said, "Last night I listened to some sublime choral music on my stereo. It filled my whole body with feeling. Finally, I couldn't handle any more and turned it off. This morning when I was in the shower, I felt a little funny. Instead of feeling a single emotion or feeling, I had...", -- and here she paused trying to find the words -- "...a whole harmonic range of emotions, arranged just like notes stacked one on top of the other". Then she explained that it was just like the rich choral music she had been listening to.<br /><br />I got her to slow down long enough to explain it.<br /><br />She told me that she had seen a visual image (in her inner eye) of about 12 emotions. The feeling of each emotion was represented by a musical note on a staff. The 12 feelings or notes were stacked in a single beat on the staff. She felt the emotions within herself like a rich chord of music -- all at once. Pretty bizarre and very beautiful.<br /><br />"How did it feel?", I asked, afraid of the answer.<br />"Just fine.", she said. "Amazing and fine."<br />"What emotions were there?"<br />"The deeper notes were fear, sexual feelings, longing, up through greed, compassion, a need to express myself, and on and on. The highest note was joy."<br />"How do you feel now?"<br />"Very connected and in harmony with myself. Everything is just perfect."<br /><br />I talked to her later. It was a momentary experience. It came with a high and then a low, but she did fine. That brain of ours is filled with <em>all kinds</em> of mysteries!Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-42012023040373909952008-11-08T11:09:00.000-08:002009-01-09T15:41:58.471-08:00Physics and the brain<span style="color: rgb(51, 255, 51);">**Meandering-Entry Alert**<br /></span>This entry talks about replacing depressed thoughts and associations with pleasant ones, creating new associations and memories in the brain that can be the basis for a more pleasant life. It builds off of brain theory (neural networks from a lecture from U. of Mich.) and psychotherapy.<br /><br /><span style="color: rgb(0, 204, 204);">Self Sabotage</span><br />My husband, Peter, a psychotherapist, has written a book on self-sabotaging behavior. He says that we subconsciously try to repeat negative experiences - usually left over from earlier times or childhood. It is hard to change our ways. For example, if we are depressed, we will seek out behaviors to reinforce our depression. He says that we have to catch ourselves in the act, and then purposefully change what we do.<br /><br /><span style="color: rgb(0, 204, 204);">The Novelty of Pleasant Associations</span><br />I would like to propose that when we feel depression stir, we step back from it, see it for an emotion (that is, don't identify with it, just look at it) for about 10 seconds. It will fade. When it comes back (even in a few seconds), repeat the process. At this point, we should be in a less-depressed state. Now try to find gladness, and look for things to associate it with: a potted plant, art, a person we enjoy. This new memory is novel. It will be taken into the brain, and if it sits there for a few minutes without depression, may stick. Thus we will have associated something in our environment (the plant) with gladness, and with repeated sessions over several days, can take hold in our being.<br /><br />This method creates a novel experience, a novel association between pleasantness and situations that might have been associated with depression. For example, Michigan is gray in the winter. Without sun, people here tend to get seasonal affective disorder (and the poor economy is no help!). So, what happens, for example, if you go away from Michigan for 5 years? A psychiatrist friend of mine once explained that without the associations of winter events with no sun, seasonal depression will fade. In place of gray skies, different memories will exist and they will override the gloomy ones.<br /><br />Can one get the sad memories to fade without leaving the gloomy weather? I think so. Read on.<br /><br /><span style="color: rgb(0, 204, 204);">Lecure on Memory</span><br />The beauty of living in a (great) college town is the availability of stimulating lectures. Today, Professor Michal <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Zochowski of the University of Michigan</span> Biophysics department lectured on "Physics and Brain Function". Professor Zochowski creates neural networks in petri dishes. A neural network is a very complex structure that can be "taught" to learn things. That is, information can be input to the network and then retrieved later. The format of the neural network's information is so complex, that you can't figure out what it is doing. For example, if I look on my computer for information I have stored, I can find it. I can see the folders and find the folder it is stored in, open a file in the folder and then find the informaiton. However, this is not possible for information stored in a neural network.<br /><br />If you try compare the brain's memory and function to a (PC or Mac) computer, the comparison breaks down very quickly. Computers are far to simplistic. However, it is possible (at this point), to use a neural network to model brain function and gain some insight.<br /><br />Professor Zochowski uses his neural networks to simulate the brain's hippocampus and cortex. The hippocampus is thought of as a "device" that 1) finds interesting (and novel) associated bits of information and 2) keeps alive a memory of the bits and their association so that the cortex can (very slowly) put this into long term memory as a newly learned fact. The cortex acts as a mechanism for creating and storing long-term memories. Together, they take novel information, keep an impression of it alive and then after a while (if the information is interesting enough to be still alive), store it in long term memory and create rich connections so that it is easily found. To test these assumptions of how the brain's memory works, Professor Zochowski programmed his neural networks to mimmick the hippocampus and cortex as stated above. The model duplicated know brain wave formation and function, and so the neural network is a good model for now.<br /><br />Back to Michigan gloom, memories and making new associations. What does the neural network experiment tell us? Does it support our thesis of replacing sad memories with happier ones? I think so.<br /><br />The model suggests that by creating a new set of associations and holding them steady for a few minutes, a new memory is made. We need to pay keen attention to the stimulus (the pleasant association) so that it appears to be a novel event. If it is done repeatedly, it will strenghthen and override the old one. With disuse, one hopes that the old memory will fade.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-21183802935163903602008-11-02T08:14:00.000-08:002008-11-12T10:40:10.339-08:00IM & Depression - Single Case<strong>BACKGROUND<br /></strong>Carrie is a 35 year old woman who put aside her career several years ago to care for her two children. ages 3 and 6. Her six year old son has autism. Carrie took part in a 10-person study focusing on Interactive Metronome (IM) as an intervention for reducing stress in parents of children with autism. She, like others in the study, spends a great deal of time in doctor’s offices, therapy clinics and in school meetings. Carrie had little time for herself due to the rigors of caring for and supervising her son, which includes moderate assistance with bathing and grooming, hours in the kitchen preparing special foods, and constant supervision for his safety.<br /><br /><strong>ASSESSMENTS</strong><br />As part of the study, Carrie was given a small battery of pre- and post- IM assessments. The primary assessment tool was the Parental Stress Index (PSI), a standardized assessment that measures stress in parents with children 12 years and younger. Stress sources on the PSI are broken into two sections: Questions about the child and his/her characteristics and questions about the parent (including parenting itself). <br /><br />Other assessments in the battery included the adult/adolescent version of the Sensory Profile and the 6-item IM Survey.<br /><br />Carrie’s overall pre-score on the PSI demonstrated stress in excess of 4 standard deviations higher than the norm. All components including depression and health demonstrated large contributions to her overall stress levels. She was within 2 standard deviations from the norm in just one area, “isolation” (from peers, family). Previous studies on parents of children with autism indicate “somewhat” higher PSI scores on the child component items. Carrie’s scores are in excess of that.<br /><br />Carrie's IM Survey scores indicate excellent rhythm & timing, good concentration and focus, fair memory recall and organization skills, and poor multi-tasking and coping skills,. She completed the adult Sensory Profile on the pre-test only and scored as “typical” in all areas.<br /><br /><strong>THE IM PROGRAM </strong><br />The IM intervention program was set-up to allow a parent to complete a 25- 40 minute IM session while his/her child was in therapy elsewhere in the clinic. Each parent was expected to do sessions once or twice a week, as schedules permitted, for a total of 15,000 IM claps and taps of the hands, feet and novel combinations of both. It is thought that 15,000 repetitions is enough for the effects of IM to last with time. The program had two characteristics. First, once a parent established competence with IM tasks and had achieved average or better scores ( usually at session 2), he or she was given increasingly larger number of repetitions (up to 1000 repetitions) for both hands. This was usually completed on session 7. Second, starting at session 8, tempos were altered for some or all tasks in each session. A standard tempo is 54 beats/second - just lower than typcial hearbeat (60 beats/second). In session 8, the tempo was lowered to 46 for 200 repetitions and then lowered again to 40 for the remainder of the session. In session 9, the tempo was raised to 64 for 300 repetitions, raised again to 69 for 200 repetitions and then, back to 64, before ending on at a tempo of 54. In session 10, the tempo was lowered to 35 for the entire session. In 11, the tempo was raised to 72 for 400 repetitions, and then lowered to 54.<br /><br />The rationale for higher tempos was to assist with multi-tasking. The life of the parent of a child with special needs is busy to the point of being overwhelming, and so increased multi-tasking would be a plus. Multitasking was directly measured on the IM Survey and indirectly measured as the competence component of the PSI.<br /><br />The rationale for lower tempos was to assist with focus and concentration (measured on the IM Survey). In addition, the study team hoped for increased patience, as measured indirectly by acceptability (of the child) on the PSI. In fact, the lower tempos did try the patience of two of our test subjects to the point that they were allowed to forego those tempos. Carrie on the other hand persevered and completed those tasks.<br /><br />As the program progressed, Carrie visibly relaxed. After 3 sessions, she said that she looked forward to coming, and she arranged for an extra session each week to complete the program faster. After 7 sessions, Carrie observed that she seemed to be “coming out of a fog”. She said that she hadn’t realized that she was depressed and had been so for a number of years. After 7 sessions, she arrived wearing new clothes and said her self-esteem had improved and that she now wanted to look good when in public.<br /><br /><strong>POST-IM ASSESSMENTS </strong><br />At the end of the program, Carries’ scores for stress had decreased by 3.6 standard deviations – an impressive amount. Her stress scores for non-parenting factors is at the 64th percentile, and within the typical range for all parents. Her overall stress scores remain high, but as we discovered in the study, the life of a parent with a special-needs child is necessarily complex. Carrie’s overall score (86th percentile) is now the second lowest (second best) of our 10 parents.<br /><br /><strong>EPILOGUE </strong><br />In an interview six months later, Carrie said that her affect remains positive, her self-esteem is high, and she has good self-confidence. She said that she feels resilient to stress and handles it very well, without moving into bad habits such as binge eating. She said that she now has perspective on her life’s challenges, and she expressed confidence about handling challenges in the future.Teresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0tag:blogger.com,1999:blog-6552869206956296635.post-67423544311962307742008-10-31T08:50:00.000-07:002008-10-31T09:09:53.790-07:00Intro to Brain Tune-Ups<strong>What is a brain tune-up?</strong><br /> It's the use of technology to improve brain performance as it relates to thinking, motivation, motor movement, communication, emotions, social interactions and ability to stay stress-free.<br /><br /><strong>How is it done?</strong><br />Tools such as Interactive Metronome, Samonas, Therapeutic Listening, EMDR, bio-feedback, stress-reducers are used therapeutically to help the brain perform better. The tools may affect brain timing, auditory processing, visual processing, as well as the shape of brain waveforms. This tuning is done precisely and gently by clapping to rhythms with feedback, listening to music, etc.<br /><br /><strong>So what is this blog about?</strong><br />I'll review brain therapy products, pass along the latest research and share my experience using these technologies. I'll also share comments from those who write to me about their experiences.<br /><br />TeresaTeresahttp://www.blogger.com/profile/13396770897787677711noreply@blogger.com0