Interactive Metronome is a treatment that aims to improve timing, accuracy and motor skills. It was originally developed for musicians but is now used to help those with developmental delays, ADHD, brain injuries and more. Several studies found IM improved motor skills, attention, behavior and academics for conditions like ADHD, sensory processing disorders and more. Case studies describe individuals who showed benefits like improved concentration, coordination and independence after IM training.

1. A Rehab Revolution

2. Introducing Interactive Metronome evaluation and training for athletes, students who wish to improve their timing, accuracy and academics. Appointments available with Dr. Doreo and staff (805)777-7184

3. History of Interactive Metronome Originally developed to assist musicians with studio recording Used later to help developmentally delayed students with music training Formal clinical research began in 1994

4. 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

5. 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

6. Science Overview Motor Planning and Sequencing are core functions of the brain. “ Motor Planning and Sequencing is a critical component of the deficit in a variety of developmental and learning disorders.” - Stanley I. Greenspan, M.D.

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

8. 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

9. AJOT Published Clinical Study Interaction Effect = 0.005

10. 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

11. 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, 3 rd Ed. 1.66 GE gain, n=703, Woodcock Johnson, 3 rd Ed.

12. 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”

13. Key Diagnoses CVA and Brain Injury Amputees Parkinson’s General Rehabilitation ADHD Cognitive / Developmental Disorders Academic / Sports Performance

14. 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 PLANNING SEQUENCING

15. What are the Benefits? ATTENTION / FOCUS 1 MOTOR CONTROL / COORDINATION 3 BALANCE & GAIT 4 LANGUAGE PROCESSING 5 CONTROL OF AGGRESSION / IMPULSIVITY 6 MENTAL / COGNITIVE PROCESSING 2

16. Performance on IM directly correlates with performance in: Attention and Concentration Mental Processing Motor Planning and Sequencing Language Processing Behavior (Aggression and Impulsivity) Executive Functioning

17. Performance on IM directly correlates with performance in: Balance and Gait Endurance Strength Fine/Gross Motor Skills Coordination

18. Jake: TBI 16 year old male - TBI from MVA Severe impairments: Sustained attention & concentration Poor memory Left-right discrimination Gross and fine motor coordination Balance

19. Jake: TBI After 6 weeks of IM Training: Able to attend to paper/pencil tasks for up to 50mins in preparation for school Only needed minimal cues for L-R discrimination Reported that he could hold conversations for longer periods of time and now able to “day dream”

20. Alexandria: Sensory Integration Disorder 9 year old female – Sensory Integration Disorder Impairments: Poor fine motor coordination Balance Multiple Tantrums Each Day D Average in Math

21. Alexandria: Sensory Integration Disorder After 5 weeks of IM Training: Able to ride her bicycle without training wheels for the 1 st time Her attention increased dramatically Earned and A and B on her next two math tests Drastic decrease in frequency and duration of emotional outbursts

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

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

24. Benefits of IM Non-invasive Non-pharmaceutical (not exclusive of Rx) Complements existing therapy Short-term Measurable outcomes Functional cross-over Clinical differentiator

25. Demonstration

26. Assessment 1 second = 1,000 milliseconds 0 - 15 ms Perfect 16 - 40 ms Above Average 41 - 100 ms Average 200 100 40 15 0 15 40 100 200

27. Questions and Answers

28. Other Case Studies Stroke TBI Amputee

29. Lizette: Stroke Initial Therapy: Met all IP and OP functional goals Discharged to home Returned with cognitive shifting deficits IM training initiated Patient returned to work with improvement in concentration, speech, balance, and motor coordination.

30. Edward: TBI Improved Auditory Sequencing Improved Concentration Motor improvements particularly in his lower body After only his third session he demonstrated improvements in his ability to attend for much longer periods of time without stopping or talking 14 years old

31. Veronica: Stroke 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

32. Case Study 2: Stroke 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

33. Brenda: Amputee 6 months of traditional therapy with poor outcome Thousands of IM reps particularly using her feet Significant improvements in motor sequencing Improved gait & balance

34. Brenda: Amputee Disney Marathon FINISH LINE! January 2004

35. Interactive Metronome evaluation and training available by appointment with Dr. Doreo and her staff (805)777-7184 Thousand Oaks, CA www.drdoreo.com