A Revolution in Neurological and Motor 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, MD Chairman, 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 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 Fluency1.66 GE Gain in Math Fluency Academic Fluency Study 2.21 GE gain, n=718, Woodcock Johnson, 3 rd Ed.1.66 GE gain, n=703, Woodcock Johnson, 3 rd Ed.

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 / FOCUS 1 MOTOR CONTROL / COORDINATION 2 BALANCE & GAIT 3 LANGUAGE PROCESSING 4 CONTROL OF AGGRESSION / IMPULSIVITY 5

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 PLANNINGSEQUENCINGTIMING

1 second = 1,000 milliseconds – 15ms. Perfect 16 – 22 Superior 23 – 29 Exceptional 30 – 40 Above Average 41 – 69 Average Assessment

The Second Link - Cheryl Miller HealthSouth Regional Director Clinical Services Sunrise, 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 minutes without getting externally distracted  Decreased stamina and endurance Unable to stand for more than 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

DXICD-9 CODE ADD ADHD AUTISM299.0X AKAV49.76 BKAV49.75 DYSLEXIA TBI854.XX DXICD-9 CODE CVA, APRAXIA XX Late Effects CVA438.XX Spinal Cord952.XX Parkinson’s332.0 Gait Disorder781.2 Speech Delay Reimbursement: Billing & Coding

PTCPT Codes Therapeutic Activities97530 Therapeutic Procedures97110 Evaluation97001 Sensory Integration Neuro-muscular Re-education97112 OT CPT Codes Therapeutic Activities97530 Therapeutic Procedures97110 Evaluation97003 Sensory Integration Neuro-muscular Re-education ST CPT Codes Speech Therapy92507 Evaluation92506 Reimbursement: Billing & Coding