A Revolution in Neurological andMotor 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

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

“Motor planning and sequencing is a critical component of the deficit in a variety of developmental and learning disorders.”

Science Overview

Motor Planning Processes of Organizing and Sequencing are a

core function of the brain

- Stanley I. Greenspan, M.D.

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

Large-Scale Correlation Study

Timing and Child Development Study Published• Conducted in Illinois by High/Scope

Foundation• 585 students, 6-10 years old

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

AJOT Published Clinical Study

Language Processing Test Similarities

Pre and Post Test Differences

2.666

9.316

-1

-2

0

2

4

6

8

10

Control Placebo IM

Sim

ilari

ties

(Sta

ndard

Sco

re)

Interaction Effect = 0.005

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

2.21 GE Gain in Reading Fluency 1.66 GE Gain in Math Fluency

Academic Fluency Study

12.46

10.25

0

2

4

6

8

10

12

14

Pre IM Post IM

Gra

de E

quiv

ale

ncy

2.21 GE gain, n=718, Woodcock Johnson, 3rd Ed. 1.66 GE gain, n=703, Woodcock Johnson, 3rd Ed.

12.39

10.73

9.5

10

10.5

11

11.5

12

12.5

13

Pre IM Post IM

Gra

de E

quiv

ale

ncy

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

Athletic Performance Study

20% Overall Gain in Shot Accuracy

35% Increase for advanced golfers who had consistent swing mechanics

Results from Early Clinical Trials

MEDIAL BRAINSTEM

Neuro-motor pipeline

BASAL GANGLIA

Integrates thought and movement

CINGULATE GYRUS

Allows shifting of attention

Cognitive flexibility

Results from a pilot fMRI (brain scan) study show IM directly activates

multiple parts of the “neuronetwork”

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

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.”

What are the Benefits?

ATTENTION / FOCUS1MOTOR CONTROL / COORDINATION2

BALANCE & GAIT3

LANGUAGE PROCESSING4

CONTROL OF AGGRESSION / IMPULSIVITY5

Interactive Metronome for Rehabilitation Training

Jimmy Eggleston was the First

Rehab Case

Invention of Interactive Metronome

After 3 weeks walking without assistive device

Interactive Metronome Today

Currently provided by thousands of therapists in

hospitals, clinics, schools and

rehab centers

Who Can Benefit?

Loss of Motor Control

Loss of Speech/Cognition

Loss of Balance and Gait

ADD/ADHD

Asperger's Syndrome

Sensory Integration

Language Processing

Motor Control and Coordination

Impulsive/Aggressive

Enhanced Coordination

Improved Focus and Attention

Improved Academic Performance

PERFORMANCE NEURO-SCHOLASTIC

REHABILITATION

PLANNINGPLANNINGSEQUENCINGSEQUENCING

TIMINGTIMING

1 second = 1,000 milliseconds

200 69

40 15

0

15 40

69 200

0 – 15ms. Perfect 16 – 22 Superior23 – 29 Exceptional30 – 40 Above Average41 – 69 Average

Assessment

The Second Link

- Cheryl MillerHealthSouth Regional Director Clinical ServicesSunrise, Florida

“ IM impacts the neurological population in the same way it helps the developmental population.”

Key Diagnoses

CVA and Brain Injury

Amputees

Parkinson’s

General Rehabilitation

ADHD

Cognitive / Developmental Disorders

Academic / Sports Performance

Address Cognitive Deficits

Attention and Concentration

Motor Planning and Sequencing

Language Processing

Behavior (Aggression and Impulsivity)

Executive Functioning

Address Physical Deficits

Balance and Gait

Endurance

Strength

Fine/Gross Motor Skills

Coordination

Case Study 1: Jake

16 year old male - TBI from MVA

Severe impairments:

Sustained attention & concentration

Poor memory

Left-right discrimination

Gross and fine motor coordination

Balance

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

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

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

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

Case Study 3: Brenda

Disney Marathon

FINISH LINE!

January 2004

Benefits of IM

Non-invasive

Non-pharmaceutical(not exclusive of Rx)

Complements existing therapy

Short-term (length of treatment)

Measurable outcomes

Functional cross-over

Questions and Answers

DX ICD-9 CODE

ADD 314.00

ADHD 314.01

AUTISM 299.0X

AKA V49.76

BKA V49.75

DYSLEXIA 784.61

TBI 854.XX

DX ICD-9 CODE

CVA, APRAXIA

997.02

430-434.9

674.XXLate Effects CVA

438.XX

Spinal Cord 952.XXParkinson’s 332.0Gait Disorder

781.2

Speech Delay

315.39

Reimbursement: Billing & Coding

PT CPT CodesTherapeutic Activities 97530

Therapeutic Procedures 97110

Evaluation 97001

Sensory Integration  97533

Neuro-muscular Re-education 97112

OT  CPT CodesTherapeutic Activities 97530

Therapeutic Procedures 97110

Evaluation 97003

Sensory Integration  97533

Neuro-muscular Re-education   97112

ST  CPT CodesSpeech Therapy 92507

Evaluation 92506

Reimbursement: Billing & Coding