CERTIFICATION & COACHING: IM PEDIATRIC BEST PRACTICES MODULE 8: SPECIAL CONSIDERATIONS – IM TRAINING PLANS WITH INFANTS- TODDLERS OR CLIENTS WITH DECREASED COGNITIVE CAPABILITIES By Mary Jones, OTR/L, DipCOT Sensational Kids, LLC Brain Focus International, Inc

Outcome Goals for Module 8 Homework assignment and post-test review from Module 7. Age considerations for use of IM. Review of case examples: Emma; Reyna; Betsy Considerations from a parents perspective The importance of modifying IM with this client group. Review of levels of training needed when working with children with low cognitive capacity. Case example: Katie Review of Session 8 Assignment/Homework

Review of Post-Test from Module 7 1. True or False: It is not necessary to consider IM testing data when formulating a treatment plan, only use discipline specific testing. Answer: False

Review of Post-Test from Module 7 2. True or False: The key to success with IM training is to always have a plan laid out for a student to participate in and stick to that plan throughout the training session. Answer: False

Review of Post-Test from Module 7 3. True or False: It is not important to increase repetitions, just as long as your IM student is enjoying their sessions with you. Answer: False

Review of Post-Test from Module 7 4. True or False: You do not need to own expensive therapeutic equipment to modify IM interventions. Answer: True

Review of Post-Test from Module 7 5. True or False: It is important to consider preparing short articles and case studies to support your interventions with Interactive Metronome ® and to keep up with current research. Answer: True

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

Age Considerations “At what age can I effectively introduce Interactive Metronome ® activities into my treatment programs?” Slide # 10

My inspiration … Emma … A presentation at the IM Professional Conference 2007 My thanks to Lucy Barlow, MED, SLP-CCC From The Language Learning Center, Kingsland, Georgia. Movie: 11.Lucy beginning.mp4

Interview from Emma’s Mom Movie: 12.after IM.mp4

IM Modifications with Emma and Lucy Barlow (SLP) Movie: 13.IM teq qith Lucy.mp4

Why IM for Emma? This provider’s prior observations of the success of IM with cross- hemisphere difficulties Neuro-rehabilitative aspects of IM Prospect of stimulating hemispheric communications Motivation to achieve best possible outcome for patient

Clapping to Music Movie: 15.clapping to music.mp4

Using Video Feedback Movie: slide16-usingvideofeedback.mp4

Wonderful Reyna Movie: _0731MISCSORT0070.mp4

Slide # 19

Slide # 20

Examples of infant modifications: Using a folded sheet or large towel, swaddle the infant ‘hammock style’ with their face looking towards their mother or caregiver. Starting low and slow, gently swing to the right and then to the left, providing soft ‘end points’ to mark the beat. Movements may also include up and down, with cushions or a mattress beneath the infant. Tempo should be no higher than 54 bpm, and if the infant shows signs of distress, skip to every other beat for consistency. Follow the infant’s tolerance and lead. A soft song or lullaby can be sung in sync to the beat.

Secure rhythmic engagement to the metronome beat

Example of a net hammock used on the beat

Key systems influenced by regulating to a beat Breathing Engagement Autonomic nervous system responses Vagus nerve Audition

Which in turn can help with: Down regulation Up regulation Respiration Digestion – reflux (GERD) Feeding – colic Sleep – sleep apnea Alert state and regulation of primary functions.

Wearing a hat to decrease sensitivity to headphones

Contained sitting to increase attention

Combine with favorite and ‘safe’ places to increase frequency and duration

Allow manipulation of headphones – also consider using speakers…

Provide positive support and hand over hand assist

If a child wants to use celery as a drumstick….

Then let them!

Introduce headphones as part of play and sensory diet

Include passive metronome beats and rhythms to daily activities such as:

And ultimately…

Case study: Katie

Areas commonly identified for treatment in children with low cognitive and neurological capacity NEUROLOGICAL: Developmental delays – genetic Developmental delays – environmental Developmental delays – acquired

Use of media to record initial performance and timing tendencies Movie: slide43-usingmedia.mp4

Considerations… Long repetitions to increase tolerance to hearing the beat in the environment High energy prompting and hand over hand assist to generate pockets of engagement.

Feeling the beat together Hand over hand assist Containment and postural support Movie: slide45-feelbeattogether.mp4

Considerations… Hand over hand assist Containment and postural support Headphones vs speakers

Independent in supported sitting Movie: slide47-supportedsitting.mp4

Considerations… Adapt environment to support attention; posture; switch access.

Keeping the beat at the right pace Movie: slide49-keepingthebeat.mp4

Considerations… Match tempo to child in the moment. Continue to apply rhythm to handling; games; movement activities.

Review of Module 8 Learning Outcomes Age considerations for use of IM Review of case examples: Emma; Reyna; Betsy Considerations from a parents perspective The importance of modifying IM with this client group Review of levels of training needed when working with children with low cognitive capacity. Case example: Katie

Module 8 Homework 1. Complete Post-Test for Module 8 2. Select one of the following IM webinars to consolidate learning in this area: – “Using IM for Moderately Dependent, Low-Level Inpatients” – “The Use of Interactive Metronome in Infancy” 2.Complete webinar Post-Test