Use of Interactive Metronome Interventions within the diverse population of pediatrics.

1. Use of Interactive Metronome Interventions within the diverse population of pediatrics.

2. CONGRATULATIONS! • You have completed the IM Certification process. • You have gained an understanding of how IM can help a diverse population. • Get ready to learn more advanced applications of IM.

3. Applying Interactive Metronome to the World of Pediatrics diverse unpredictable unforgiving energetic creative stubborn variety novel defiant irrational aggressive ritualistic stimulating clumsy disorganized

4. Common Q&A Leading up to the Development of PBP • At what age can I begin to implement IM with a child? • What can I do to motivate a child to do IM? • How long should IM sessions be with a child? • Can I use Listening Therapy at the same time as IM? • What should I do if a child begins to cry as he doesn’t like IM?

5. Common Q&A Leading up to the Development of PBP • Will IM help my child get off ADHD medications? • How can I get my child to sit still for long enough to do IM? • Can a child with a cochlear implant use IM? • How can I use IM to improve ocular-motor stability? • Can I use IM in a group setting?

6. And thus, the concept of getting IM training ‘IN SYNCH’ with the needs of pediatric providers was born…

7. Brainstorm 1: Who, What & Where do you IM? • What is the youngest child you have ever used IM with? • Where do you typically treat your IM clients? • What key problems do your clients present with? Give 3 examples • _________________________________ • _________________________________ • _________________________________ • List any secondary problems that you have identified while using IM. • What clients have NOT benefited from IM? Why do you think this was the case?

8. Areas Commonly Identified for Treatment PHYSICAL • Tone • Range of movement • Endurance • Gross motor coordination • Fine motor coordination • Reflex integration • Posture • Environmental limitations • Vision impaired • Hearing impaired • Sensory-motor impairments

9. Areas Commonly Identified for Treatment COGNITIVE LINGUISTIC • Learning disabilities • Delayed processing • Auditory processing delays • Language processing delays • Memory impairments • Attention to task • Organizational skills • Poor insight/judgment • Decision-making skills • Following directions • Delayed working memory • Poor sequencing • Ability to comprehend technology

10. Areas Commonly Identified for Treatment EMOTIONAL • Anxiety • Self-esteem • Sense of self • Depression • Lability • Irrational fears • Attitude

11. Areas Commonly Identified for Treatment BEHAVIORAL • Passive • Defiant • Aggressive • Controlling • Agitation • Self-obsessed • Ritualistic • Self-stimulating • Inability to attain/sustain eye contact

12. Areas Commonly Identified for Treatment SENSORY • Sensory-seeking • Sensory-avoiding • Visual sensitivities • Tactile sensitivities • Auditory sensitivities • Olfactory sensitivities • Gustatory sensitivities • Vestibular sensitivities • Body-in-space awareness • Internal drive • Impaired modulation skills • Impaired behavioral regulation • Inability to attain/sustain a ‘ready alert state’

13. Areas Commonly Identified for Treatment NEUROLOGICAL • Developmental delays – genetic • Developmental delays – environmental • Developmental delays – acquired

14. Maximum Weightage with IM (child led!)Use of an X-RayVest & Pinto Beans to Give Deep Pressure Input

15. IM Cave Providing Safe Environment

16. Blending Oral Motor Sequencing Task with Bilateral Upper Extremity Control on a Hand Trigger

17. Head & Neck ROM to the Beat

18. Oral Motor - Tongue ROM

19. Chewing In Sync to the Trigger & Beat

20. Strategies to Modify IM IM student squishing bugs to a consistent interactive beat. As your learning foundations develop - start thinking about modifications to IM that will facilitate activity application to specific patients.

21. Brainstorm 2 – How are you using your IM? • List 3 activities that you feel blend well with IM treatment activities. • What professional attributes do you bring to your IM sessions that help enhance activities? • List 3 items that are useful to have on hand when applying IM to the pediatric population. • What is your best advice to a co-worker when using IM with the pediatric population? • What areas do you find most challenging when using IM with the pediatric population?

22. Modifications – Environmental As you set up your treatment area for each individual, consider : • Size of room/space • Seating options • Lighting options • Available wall space • Available floor space • Storage for small/large items

23. Sample Pictures of IM Room with Desktop Computer (Clinic Setting)

24. Desktop IM Set-up in aHome Setting

25. Portable IM Unit with Use of Rolling Carts

26. Portable IM Unit with Use of a Rolling Computer Bag

27. Modifications – Applying IM to Your Treatment Environment Emily • Emily is an 8 year old child with a diagnosis of “handwriting difficulties.” • She comes in for her regularly scheduled one-hour OT session. • She is working on • proximal stability (trunk control) • bilateral coordination • fine motor skills • visual attention to task

28. Treatment Sessions May Include These Activities:

29. Modifications – Applying IM to Your treatment Environment JOHN • John is a 3 year old boy with a diagnosis of developmental delays. • Scheduled PT session of 30 minutes duration. • Fleeting attention, quick to quit. • Goals include being able to: - climb a flight of 5 stairs - attain half-kneeling stance - being able to pick up items from the floor with stand-to-squat stance - kick a ball with his right foot

30. Treatment Sessions May Include These Activities: • *As proficiency and tolerance to IM improves, start to increase the minutes of IM used in each session. • Get in as many IM repetitions as you can while presenting the just-right challenge.

31. Modifications – Sensory Considerations • Lighting • Space • Sounds • Surfaces • Scents

32. Modification Kit • Colored Tape • Self-adhesive Velcro strips • Non-slip matting • Various textured/sized balls • Visual timer • Balloons • Bubbles • Stickers • Washable tattoos • Munchies • Chewables • Suckables • Variety of switches/triggers • Cable splitters • Portable speakers • Variety of headphones • Soft squishy bug toys • Selection of small kids toys • Silk scarves • Ball on a string • Flashlights • Word/Letter/Picture flash cards • Soft knit gloves • Sanitizing hand wipes!

33. Larger Items to Consider • Hopper or rebounder trampoline • Bosu • Balance disc • Therapy ball • Aeromat or large foam cushions • Weighted balls (3-5#) • Mop handles • Weighted items (i.e., vest, blanket, bean bags) • Portable sports equipment (i.e., baseball bat, hockey stick, etc.) • Portable floor mat

34. JAKE - Sample Goal Analysis • “OT and Speech Therapy to address difficulties with handwriting and reading” • Change to “Occupational Therapy evaluation and treat, Speech Therapy evaluation and treat, diagnoses: lack of coordination and developmental language delays.” • 7 years of age, struggling with academics, an active child, below peer level developmentally.

35. Difference in Learning Style • Attention to task • Reading / writing skills • Disruptive influence on classmates • Gross and fine motor skills • Balance • Visual motor skills • Reflex integration • Language delays • Sensory-motor integration skills Treatment Plan: OT and ST two times per week PT referral Developmental Optometry referral

36. Jake’s Goals Within six months (5/08), Jake will: • hold a pencil with a right-handed modified tripod grasp (85% of written tasks). • trace infinity pattern independently with consecutive intersections for 20 reps. • throw overhand 5ʼ at target with right upper extremity 5/8 times. • demonstrate shoulder girdle strength sufficient to wheelbarrow walk 30 with support at lower legs. • read 10 basic site words fluently. • follow 2-step verbal directions timely and accurately.

37. Brainstorm 3 – Consider Each of the Six goals Brainstorm the following aspects of each goal: • What skills are required for goal attainment? • What activities/exercises could you use to work toward achieving these goals? • List three modifications of the use of IM to achieve goal attainment. • How could you set up these activities to mask the challenge of the activity?

38. Goal #1 • Attention to task • Bilateral integration (praxis) • Gross and fine motor skills • Body-in-space awareness (proprioception) • Kinesthesia (movement/motor planning) • Sensory-processing skills (visual/auditory/vestibular/kinesthesia/proprioception) • Phonological awareness • Expressive/receptive language Maneuvering colored balls inside infinity loop to the rhythm of the metronome beat Use of giant knitting needle to practice tripod grasp onto trigger.

39. Goal #2 • Handwriting training • Postural alignment and strengthening • Sensory integration training • Visual-motor training • Reflex integration training • Gross and fine motor skills training Use of office footrest as a slant board to increase anterior pelvic tilt and postural control Suspended hand trigger placement working on grasp/ release and visual control

40. Goal #3 • Use of hoop to address boundary for movement with overhand reach • Use of large/novel items to reinforce modified tripod grip • Visual motor applications during IM • Balance applications during IM Use of hoop to define Motor plan for overhand throw Tracing infinity loop with trigger placed at center to mark the beat

41. Goal #4 • Use of child-specific interest (i.e., sports) • Use of turn-taking games to increase attention to task • Allow child to set up components of the activity Overhead swing with bat to trigger, within the context of sport, to increase motivation to challenge Turn taking to increase focused attention to task

42. Reference Point • Now, for your own reference, jot down 3 sample goals that you may have for an individual using IM. • Consider how IM can fit in with “the whole picture” when planning discipline specific treatment. Calming down after IM session

43. Infinity Loop with IM

44. The Ultimate Balance Challenge

45. Going Backward to Come Forwards

46. Assessing the Right Pace • Strategies to customize your approach with the pacing of IM activities include: - Adjusting the tempo - Adjusting the duration of IM tasks - Adjusting the frequency of IM tasks - Supplementing IM tasks with age-appropriate incentives - Monitoring IM participant for signs of distress or fatigue

47. Signs of Distress/Fatigue/Overload • Oral motor overflow • Sweating • Changes in skin color • Marked increases/decreases in postural control • Aversion to sensory input • Increases in motoric output • Changes in respiratory rates • Increased fidgeting behaviors • Increased vocal distress • Increased verbal distress • Decreased attention/engagement

48. IM Activity with Comfort Accommodations

49. IM Activities with Graded Force Pressure Accommodations

50. Riley Completing Step-up with IM