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Interactive Metronome Pediatric Specialist Coaching Module 1: Overview and Foundations By Mary Jones, OTR/L, DipCOT Sensational Kids, LLC Brain Focus International, Inc. Slide 2 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. Slide 3 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. Slide 4 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. Slide 5 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). Slide 6 Slide 7 Applying IM to the diversity of Pediatrics Educational Therapeutic Peak Performance Recreational Extra-curricular Lifestyle Wellness Slide 8 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 Slide 9 Therapeutic Attention Deficit Disorder (314.0; 314.01) Aspergers Syndrome (299.0) Ataxia (438.84; 334.3; 331.89) Autism (299.0) Developmental Delays (315.9) Dyspraxia (315.4) Dyslexia (315.02) Lack of Coordination (781.3) Speech and Language delays (315.3) Auditory Processing Disorders (388.45; 315.32) Unspecified Disorders of the Central Nervous System (349.9) Hemiplegia (342; 343.1) Pervasive Developmental Delay (299.9) Developmental Coordination Disorder (315.4) Abnormal Posture (781.92) Loss of Limb (755.4) Abnormality of Gait (781.2) 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) Tourettes Disorder (307.23; 333.3) Anxiety (300.0) Slide 10 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. Slide 11 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 Slide 12 Lifestyle Choices Opportunities Exposure Tolerance Slide 13 Extra-Curricular Sports Drama Music Voice Dance Clubs Societies Cultural Slide 14 Wellness Mental Endurance Mental Attitude Stress Management Focused Attention Sleep Slide 15 The Key to IM Success: Modify for Engagement! Be Spontaneous for Novelty! Increase Repetition for Synaptic Growth! Slide 16 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 Slide 17 Set Up - Equipment Slide 18 Slide 19 Positioning: Upright Stance UPRIGHT STANCE: Extensor tone; balance; visual orientation; praxis. Modify with variance of surface/texture/height/size of base/footwear. Slide 20 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 Slide 21 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 Slide 22 Round Sitting ROUND SITTING : Pelvic and shoulder girdle alignment Posture and positional awareness (grounded) Upper body strengthening Pelvic shift and core balance Diaphragmatic breathing Slide 23 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 Slide 24 Supine/Lying Down SUPINE TIME: Facilitates proprioceptive awareness (firm surface) Decreases demands on motor planning Work up against gravity Reflex integration: Supine flexion Slide 25 Prone/Tummy Time Modifications: Floor (good for sensory feedback Floor mat/different textures Inverted/under/over Modifications: Floor (good for sensory feedback Floor mat/different textures Inverted/under/over PRONE/TUMMY TIME: Strengthening shoulder girdle Hip flexor stretch Facilitate co-contraction to flexor/extensor core stability Visual-motor integration Reflex integration Slide 26 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! Slide 27 Slide 28 Module 1 Homework 1.Complete Module 1 Post-Test 2.Complete Module 1 Worksheet 3.Review ready reference/resource sheet for Module 1 Slide 29 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, 19972008. 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, 4251 Carr, C.E. (1993). Processing of temporal information in the brain.Annu. Rev. Neurosci. 16, 223243. Slide 30 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, 225232 Mauk, M.D., and Buonomano, D.V. (2004). The neural basis of temporal processing. Annu. Rev. Neurosci. 27, 304340 Mauk, M.D., and Ruiz, B.P. (1992). Learning-dependent timing of Pavlovian eyelid responses: differential conditioning using multiple interstimulus intervals. Behav. Neurosci. 106, 666681 Slide 31 References 3 Medina, J.F., Carey, M.R., and Lisberger, S.G. (2005). The representation of time for motor learning. Neuron 45, 157167. Meegan, D.V., Aslin, R.N., and Jacobs, R.A. (2000). Motor timinglearned without motor training. Nat. Neurosci. 3, 860862. Shannon, R.V., Zeng, F.G., Kamath, V., Wygonski, J., and Ekelid, M. (1995). Speech recognition with primarily temporal cues. Science 270, 303304. Slide 32 Useful Resources Sensory Processing Disorder: www.spdfoundation.net www.sensory-processing- disorder.com www.sensory-processing- disorder.com www.sensorysmarts.com www.spdsupport.org Dyspraxia: www.dyspraxiausa.org www.dyspraxia.info www.alifewithdyspraxia. webs.com www.alifewithdyspraxia. webs.com Autism: www.autismspeaks.org www.aspergersyndrome. org www.aspergersyndrome. org www.autismspot.org Slide 33 Recommended Webinars Introduction to IM Pediatric Best Practices - Self-Study