1. A Revolution in Learning and Developmental Rehabilitation

2. Overview Research Clinical adoption & areas of use Cases Studies
Billing & Coding

3. 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

4. Science Overview
“Motor planning and sequencing is a critical component of the deficit in a variety of developmental and learning disorders.”
- Stanley I. Greenspan, M.D.
The Motor Planning Processes of Organizing and Sequencing are a core function of the brain

5. 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

6. Large-Scale Correlation Study
Timing and Child Development Study Published
Conducted in Illinois by High/Scope Foundation
585 students, 6-10 years old

7. 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

8. AJOT Published Clinical Study
Interaction Effect = 0.005

9. 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

10. Academic Fluency Study
2.21 GE Gain in Reading Fluency
1.66 GE Gain in Math Fluency
2.21 GE gain, n=718, Woodcock Johnson, 3rd Ed.
1.66 GE gain, n=703, Woodcock Johnson, 3rd Ed.

11. 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

12. Athletic Performance Study
20% Overall gain in shot accuracy
35% Increase for advanced golfers who had consistent swing mechanics

13. Learning & the Brain Conference 2005
“The Impact of Synchronized Metronome Tapping Treatments on School Achievement:  A Report of Two Preliminary Investigations”
Presented at Harvard University
Gordon Taub, Ph.D., University of Central Florida
Kevin McGrew, Ph.D., Institute for Applied Psychometrics

14. Learning & the Brain Conference 2005
2 separate studies (high school & elementary)
50% greater performance levels in timing and rhythmicity
3-4 weeks of IM resulted in 7-20% growth in reading/math achievement
Effect sizes were typically larger in elementary age students

15. Results from Early Clinical Trials
Results from a pilot fMRI (brain scan) study show IM directly activates multiple parts of the “neuronetwork”
CINGULATE GYRUS
Allows shifting of attention
Cognitive flexibility
BASAL GANGLIA
Integrates thought and movement
MEDIAL BRAINSTEM
Neuro-motor pipeline

16. MOTOR CONTROL / COORDINATION CONTROL OF AGGRESSION / IMPULSIVITY
What are the Benefits?
ATTENTION / FOCUS 1
MOTOR CONTROL / COORDINATION 2
BALANCE & GAIT 3
LANGUAGE PROCESSING 4
CONTROL OF AGGRESSION / IMPULSIVITY 5

17. Interactive Metronome for Rehabilitation Training
Jimmy Eggleston was the First Physical & Developmental Patient

18. Invention of Interactive Metronome
After 3 weeks walking without assistive device

19. Interactive Metronome Today
Currently provided by thousands of therapists in hospitals, clinics, schools and rehab centers

20. Who Can Benefit? PLANNING SEQUENCING TIMING REHABILITATION PERFORMANCE
Loss of Motor Control
Loss of Speech/Cognition
Loss of Balance and Gait
PLANNING
SEQUENCING
TIMING
PERFORMANCE
NEURO-SCHOLASTIC
ADD/ADHD
Asperger's Syndrome
Sensory Integration
Language Processing
Motor Control and Coordination
Impulsive/Aggressive
Enhanced Coordination
Improved Focus and Attention
Improved Academic Performance

21. Assessment 1 second = 1,000 milliseconds 200 69 40 15
0 – 15ms. Perfect
16 – 22 Superior
23 – 29 Exceptional
30 – 40 Above Average
41 – 69 Average

22. Key Diagnoses Sensory Integration Disorder Cerebral Palsy
ADD/ADHD
Asperger's Syndrome
Cerebral Palsy
Autism Spectrum Disorder
Amputees

23. Address Cognitive Deficits
Attention and Concentration
Motor Planning and Sequencing
Language Processing
Behavior (Aggression and Impulsivity)

24. Address Physical Deficits
Balance and Gait
Endurance
Strength
Fine/Gross Motor Skills
Coordination

25. Case Study 1: Alex 9 year old male – Sensory Integration Disorder
Impairments:
Poor fine motor coordination
Balance
Multiple tantrums each day
D average in math

26. Case Study 1: Alex After 5 weeks of IM Training:
Able to ride his bicycle without training wheels for the 1st time
His attention increased dramatically
Earned and A and B on her next two math tests
Drastic decrease in frequency and duration of emotional outbursts

27. Case Study 2: Diane ADHD and Severe Learning Disabilities
Enrolled in the IM program at age 8
Deficits addressed:
Poor Attention & Concentration
Great difficulty processing multiple instructions

28. Case Study 2: Diane
Her therapist reported that she was “bouncing off the walls” and even tried to stand on her head in her chair during her 1st visit
Following 2 weeks of training:
Sat and read her mom a book
Able to sit quietly for up to 20 minutes

29. Case Study 3: Max Asperger Syndrome-8 year old male
Difficulty completing tasks
Following directions
Cooperating in a group environment
Often displayed tantrums

30. Case Study 3: Max After IM: Improved transitioning
Greater Independence
Decreased frustration
Reduced tantrums (both in number and intensity)

31. Benefits of IM Short-term (length of treatment) Non-invasive
Non-pharmaceutical (not exclusive of Rx)
Complements existing therapy
Short-term (length of treatment)
Measurable outcomes
Functional cross-over

32. Questions and Answers

33. Reimbursement: Billing & CodingDX
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
674.XX
Late Effects CVA
438.XX
Spinal Cord
952.XX
Parkinson’s
332.0
Gait Disorder
781.2
Speech Delay
315.39

34. Reimbursement: Billing & CodingPT
CPT Codes
Therapeutic Activities
97530
Therapeutic Procedures
97110
Evaluation
97001
Sensory Integration
 97533
Neuro-muscular Re-education
97112 OT
 CPT Codes
97003
  97112 ST
Speech Therapy
92507
92506