Interactive Metronome® Pediatric Specialist Coaching Module 1: Overview and Foundations By Mary Jones, OTR/L, DipCOT Sensational Kids, LLC Brain Focus International, Inc. Program Outline • Module 1: Pediatric Overview and Foundations • Module 2: Modifying IM to Pediatric Populations • Module 3: Motivational Strategies • Module 4: Teaching Auditory Association Skills • Module 5: Building relationships – Allowing control, switch choices and access. • Module 6: Interpreting Data • Module 7: Setting up Individualized Pediatric Treatment Plans with IM: Case Examples. • Module 8: Special Considerations – IM training plans with infant-toddlers or clients with decreased cognitive capabilities. • Module 9: Use of IM Systems in Group and Social Settings • Module 10: Moving Forward – Incorporating IM-Home into your pediatric best practices. Outcome Goals for Module 1 • • • • • • Developing the art of ‘thinking outside the box’ with IM Overview of IM use within the diversity of pediatrics Getting started – Setting up of equipment/ environments The Key to IM success – Learning to Modify! Positioning that can be used with IM – Review of Examples Review of Module 1 Learning Outcomes. Thinking ‘outside of the box’ • Use of professional judgment and creativity to modify IM programming – we are a diverse group! • Developing the flexibility skills to effectively utilize IM as a treatment/training tool • Becoming comfortable thinking ‘outside of the box’ • Taking the principles of the Interactive Metronome® System and consider them for all aspects of pediatric services and performance programs. Why IM in Peds? • Timing is critical for the discrimination of sensory stimuli (Shannon et al., 1995; Buonomano and Karmarkar, 2002; Ivry and Spencer, 2004; Buhusi and Meck, 2005) • Timing is critical for the generation of coordinated motor responses (Mauk and Ruiz, 1992; Ivry, 1996; Meegan et al., 2000; Medina et al., 2005). • The nervous system processes temporal information over a wide range, from microseconds to circadian rhythms (Carr, 1993; Mauk and Buonomano, 2004; Buhusi and Meck, 2005). Applying IM to the diversity of Pediatrics • • • • • • • Educational Therapeutic Peak Performance Recreational Extra-curricular Lifestyle Wellness Educational • • • • • • • • • Low Self Esteem Struggling with academics Anxiety Reactive Poor motor planning Difficulty finding their own ‘Rhythm’ or ‘Still point’ Eager to please Difficulty ‘tuning in’ Difficulty keeping track of time • • • • • • • Survival reactions Chronic adrenal stress Disorganized Clumsy Difficulty ‘connecting the dots’ Poor listening skills ‘Quick to quit’ Therapeutic • Attention Deficit Disorder (314.0; 314.01) • Unspecified Disorders of the Central Nervous System (349.9) • Asperger’s Syndrome (299.0) • Ataxia (438.84; 334.3; 331.89) • Hemiplegia (342; 343.1) • Autism (299.0) • Pervasive Developmental Delay (299.9) • Developmental Delays (315.9) • • Dyspraxia (315.4) Developmental Coordination Disorder (315.4) • Dyslexia (315.02) • Abnormal Posture (781.92) • Lack of Coordination (781.3) • Loss of Limb (755.4) • Speech and Language delays (315.3) • Abnormality of Gait (781.2) • Auditory Processing Disorders (388.45; 315.32) • Difficulty in Walking (719.7) • Orthotic Training (V57.41) • Feeding Difficulties (783.3; 307.59; 779.3; 783.41) • Dysphagia (787.42) • Articulation (315.39; 524.27) • Muscle Weakness (728.87; 780.79) • Tourette’s Disorder (307.23; 333.3) • Anxiety (300.0) Peak Performance • Speed - focuses on developing starting speed and maximizing top end speed. Utilization of plyometrics and speed training techniques to maximize performance. • Agility – focuses on developing coordination, foot speed, reactive ability, and quickness. Utilization of sport specific movement pattern drills, plyometrics, and various mobility training equipment. • Conditioning – focuses on developing sport specific fitness by combining creative training methods with traditional conditioning equipment. • Strength – focuses on teaching proper resistance training techniques for a variety of sport specific exercises with emphasis on core. Recreational • • • • • • Effective use of free time Personal development of ‘self’ Socially acceptable activities PLAY! Keeping up with peers Ability to engage, socialize, plan, follow-through Lifestyle • • • • Choices Opportunities Exposure Tolerance Extra-Curricular • • • • • • • • Sports Drama Music Voice Dance Clubs Societies Cultural Wellness • • • • • Mental Endurance Mental Attitude Stress Management Focused Attention Sleep 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 Set Up - Equipment Positioning: Upright Stance UPRIGHT STANCE: Extensor tone; balance; visual orientation; praxis. • Modify with variance of surface/texture/height/size of base/footwear. Half Kneeling HALF KNEELING • Core strengthening • Pelvic segmentation • Upper body/lower body integration • Proprioceptive body-in-space awareness • Reflex integration • Bilateral integration (praxis) MODIFY: • Surfaces/textures/heights/ stability/alternate knees Modify Base of Support • • Alter points of stability and mobility Upper extremities: Clap High-Clap Low • • • Adapt lower extremity movement sequence Side step and clap on the beat Match tempo of music piece or sing to the beat Round Sitting ROUND SITTING: • Pelvic and shoulder girdle alignment • Posture and positional awareness (grounded) • Upper body strengthening • Pelvic shift and core balance • Diaphragmatic breathing Dynamic Postures DYNAMIC POSTURES: • Proprioceptive awareness • Core stability and shift • Visual orientation • Strengthening • Praxis EXAMPLES: • Ball sit • Stool sit • Bench sit • Bolster sit (astride) • Cube sit • Rocking chair Supine/Lying Down SUPINE TIME: • Facilitates proprioceptive awareness (firm surface) • Decreases demands on motor planning • Work up against gravity • Reflex integration: Supine flexion Prone/Tummy Time PRONE/TUMMY TIME: • Strengthening shoulder girdle • Hip flexor stretch • Facilitate co-contraction to flexor/extensor core stability • Visual-motor integration • Reflex integration Modifications: • Floor (good for sensory feedback • Floor mat/different textures • Inverted/under/over Review of Module 1 Learning Objectives • IM is used as a training tool across multiple domains and disciplines within pediatrics. • Professional judgment and creativity are required to provide optimum outcomes in pediatric IM programs. • Modification is key to provide a customized approach to each individual. • Pediatrics is diverse – so too is the application of IM to this population! Module 1 Homework 1. Complete Module 1 Post-Test 2. Complete Module 1 Worksheet 3. Review ready reference/resource sheet for Module 1 References • Boyle CA, Boulet S, Schieve L, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan MD. Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008. Pediatrics. 2011 • Buhusi, C.V., and Meck, W.H. (2005). What makes us tick? Functional and neural mechanisms of interval timing. Nat. Rev. Neurosci. 6, 755– 765. • Buonomano, D.V., and Karmarkar, U.R. (2002). How do we tell time? Neuroscientist 8, 42–51 • Carr, C.E. (1993). Processing of temporal information in the brain.Annu. Rev. Neurosci. 16, 223–243. References 2 • Ivry, R. (1996). The representation of temporal information in perception and motor control. Curr. Opin. Neurobiol. 6, 851– 857 • Ivry, R.B., and Spencer, R.M.C. (2004). The neural representation of time. Curr. Opin. Neurobiol. 14, 225–232 • Mauk, M.D., and Buonomano, D.V. (2004). The neural basis of temporal processing. Annu. Rev. Neurosci. 27, 304–340 • Mauk, M.D., and Ruiz, B.P. (1992). Learning-dependent timing of Pavlovian eyelid responses: differential conditioning using multiple interstimulus intervals. Behav. Neurosci. 106, 666–681 References 3 • Medina, J.F., Carey, M.R., and Lisberger, S.G. (2005). The representation of time for motor learning. Neuron 45, 157–167. • Meegan, D.V., Aslin, R.N., and Jacobs, R.A. (2000). Motor timinglearned without motor training. Nat. Neurosci. 3, 860–862. • Shannon, R.V., Zeng, F.G., Kamath, V., Wygonski, J., and Ekelid, M. (1995). Speech recognition with primarily temporal cues. Science 270, 303–304. Useful Resources Sensory Processing Disorder: • www.spdfoundation.net • www.sensory-processingdisorder.com • www.sensorysmarts.com • www.spdsupport.org Dyspraxia: • www.dyspraxiausa.org • www.dyspraxia.info • www.alifewithdyspraxia. webs.com Autism: • www.autismspeaks.org • www.aspergersyndrome. org • www.autismspot.org Recommended Webinars • Introduction to IM Pediatric Best Practices Self-Study