Jam-packed therapy

Here is a story about using Interactive Metronome (IM) and Therapeutic Listening (TL) simultaneously. AND, mom and dad put on the headphones, too.

"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.

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.

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.

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.

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.

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.

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.

Core:Tx and Interactive Metronome

Mark
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.

Intervention
Given the range of problems Mark faced, it was decided that a course of Interactive Metronome (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.

Progress with IM
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.

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.”

Core:Tx
Core:Tx 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.

A few Links

I've added a few links to other blogs, etc. You will find them along the right side.

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.


Also check out McNattLearningCenter for information about Interactive Metronome and Tourette's Syndrome/tics.

More to come....

Pioneering Technological Interventions

With 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.

Involuntary Momevent

I 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.

We had talked about sound therapy and Interactive Metronome (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.

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 really complicate things.

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.