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Jonathan McKee, OTR/L  "TITLE: The Interactive Metronome and Autism
Tuesday, August 27th at 7 p.m. (Eastern), Note portions of the text have been edited for spelling and grammatical errors, while other text with errors was left in tact in the context of the chat.

Jonathan {enters}
Bborsuk {enters}
Moderator {public msg} hi Jonathan
Moderator {public msg} hi Bborsuk
Ron {public msg} hi folks
Rebecca {announces} Starting soon in the talkAutism Room! Please join us for The Interactive MetRonome and Autism - with Jonathan McKee, OTR/L
Rebecca {public msg} Hello and welcome Jonathan
Jonathan {public msg} Thank You.
Rebecca {public msg} Yes you are Bborsuk
Bborsuk {public msg} thank you - never did this before
Rebecca {public msg} Hello and Welcome to our talkAutism Specialty Chat . If you have a question for our Host. Just type a ? in the room. The names will be taken in order received. Please hold your questions until ready to post, when you are cued. Thanks!
Ron {public msg} sounds good, Rebecca
Rebecca {public msg} Jonathan, your welcome to begin when your ready. Perhaps a brief intro about yourself ?
Rebecca {action}  says Welcome to Parenthood Place !!!.
Rebecca {action}  smiles.
Jonathan {public msg} I am an Occupational Therapist in the Atlanta area and work in the pediatric field. I serve children in the school system, clinics and do home based therapies.
Ron {public msg} ?
Jonathan {public msg} I became interested in sound based therapies like The Listening Program, Tomatis, and the Interactive MetRonome and have been using these in my practice. The Interactive MetRonome (IM) was Developed by Jim Cassily to improve timing among musicians during recording. As the musicians reported how it affected them in other ways it was tried as a modality on special needs children and has now been researched and developed for this purpose. It is used for children and adults to improve motor and speech disorders, apraxia, linguistic processing, problem solving and especially attention span.
Jonathan {public msg} Ron please go ahead with any questions.
Ron {public msg} Why did you start using therapies like Interactive MetRonome with autistic kids?
Jonathan {public msg} Due to the neurological nature of autism and the ability of the IM to improve coordination, attention and the underlying timing issues.
Ron {public msg} Will this help children with very little to no language?
Jonathan {public msg} If the underlying problem is in the motor planning of speech, like apraxia or dyspraxia.
Mommyo {enters}
Moderator {public msg} hi Mommyo, welcome
Mommyo {public msg} ?
Ron {public msg} how do you detect timing issues in our kids?
Jonathan {public msg} The timing mechanism in the brain from the research on the brain the timing is in the basal ganglia and the cerebellum. As the timing and planning of motor actions, like speech or bilateral activities, are planned in the brain if the initial plan is improved the outcome -the speech can be improved.
Jonathan {public msg} To detect the timing issues I begin with the Bruininks Osertsky Test of motor skills. I look at the bilateral coordination specifically. This demonstrates how the two sides of the brain are communicating. Then I look at the timing related skills like catching a ball or throwing a ball at a target. We have to time when to open and close our hand to catch. The IM has a pre and post test for timing which is also used. This test has been shown timing to relate to academic placement. The better a child's timing as recorded on the IM the better they were doing in school. All of these tests and research articles can be found on the Interactive MetRonome website for more information.

Mommyo {public msg} How long have you been doing this, and what amount of time does it take to see improvement of the person
Jonathan {public msg} I have been working with sound based therapies for 2 years. Specifically with the IM for over a year now.
Jonathan {public msg} Improvement depends on the child, of course.
Jonathan {public msg} A good prescreening is necessary since the IM program is very intense.
Mommyo {public msg} How many times a week do you usually recommend
Jonathan {public msg} I usually see improvements in attention to task by the fourth session.

Mommyo {public msg} Is this therapy expensive
Jonathan {public msg} Let me give a brief overview of the program.
Mommyo {public msg} Thanks
Jonathan {public msg} The program consists of 15 one-hour (or more) sessions over 3-5 weeks. Headphones are used to deliver the metronome beep. Either a foot or hand switch is used for the participant to respond to what they hear.
Rebecca {action} . o O ( very interesting )
Bborsuk {public msg} ?
Jonathan {public msg} They then receive immediate auditory feedback as to whether they were early, late or right on the beep.
The IM will give me a readout on the computer as to how close the child was to being right on the beat. This readout is in milliseconds and the closer to zero the better.

Mommyo {public msg} Can anyone do this type of therapy
Jonathan {public msg} The person needs to be 6 years old physically and emotionally to handle the intensive program

Ron {public msg} do some kids not take to it well?
Jonathan {public msg} To answer an earlier question: Typically the cost is between $2000 to $3000  for the 15 day program.

Jonathan {public msg} Some children do have difficulty with either the sounds or the intensity of the program. Understand to train the brain lots of repetitions are needed. Some days the child is clapping his hands in a circular motion for close to 40 minutes. This is to build new synapse connections in the brain to retrain or train it for the first time. A good pre evaluation is needed to make sure the child or adult is ready. And I have often introduced children to it slowly to build them up.

Ron {public msg} insurance covering this at all?
Jonathan {public msg} Insurance is not yet covering this specifically. Though when used as part of occupational or other therapy some of the cost is covered.
Jonathan {public msg} The improvements I see in the 3-5 weeks has been in the range of a jump in timing and motor skills of 6 months to over a year in a half. This is why I like these therapies, because of the jumps in abilities they can provide.

Moderator {public msg} Bborsuk has a question, go ahead Bborsuk
Bborsuk {public msg} thank you.  this sounds similar to auditory integration therapy (tomatis or berard methods).  Is it along that line or would it be a problem if the child has already had that therapy?
Jonathan {public msg} Further therapy is needed to refine the specific skills learned.
Jonathan {public msg} It is similar in that it uses sounds to initiate the process.
Jonathan {public msg} If I have a client in need of Tomatis or similar therapy I suggest they do that first. This is to clear up initial and more primary listening issues.
Ron {public msg} ?
Jonathan {public msg} This method is much more participant involved and physical.
Bborsuk {public msg} ?
Jonathan {public msg} There are 13 different movements the child will have to do over the 15 sessions. Sometimes precessions or post sessions are necessary to reach certain levels of timing. These levels are based on the initial test and the expected abilities of the child.

Moderator {public msg} Ron, you have a question, go ahead
Ron {public msg} Is this anything like neurofeedback?  They also train the brain with repetitive interaction and sound.
Nicolehotchick2 {enters}
Jonathan {public msg} It is similar in that the client is having to react to the stimuli but different in the areas of the brain being stimulated.
Jonathan {public msg} I am researching that question since I have been getting it allot.
Ron {public msg} Is the success permanent, once achieved
Jonathan {public msg} The success is permanent based on the studies and what I have experienced in the clinic with follow up evaluations.

Moderator {public msg} Bborsuk, you have a question, go ahead
Jonathan {public msg} The client also continues from the new level reached to achieve greater motor skills now that one of the primary and very important aspects has been corrected namely the timing aspect.
Mommyo {public msg} ?
Jonathan {public msg} We use timing to catch a ball, enter into a conversation in a chat room etc.
Caulie {enters}
Jonathan {public msg} Clinical study findings indicate that improving the ability to plan and sequence motor actions can favorably influence important learning, cognitive, and social skills.

Mommyo {public msg} What type of credentials does the therapist need to do this.  And where can they be trained?
Jonathan {public msg} Without the ability to properly plan and sequence, it is also very difficult for children to modulate aggression and set limits on themselves because this ability is necessary for understanding consequences.
Mommyo {public msg} I am sorry for going out of turn, but my computer doesn't seem to be working properly.  I am not getting the whole chat.
Jonathan {public msg} The Interactive MetRonome website is the place to start.
Rebecca {action} . o O ( the full transcript of the chat will be available within a week following the Chat. For those that missed the presentation. )
Ron {public msg} , I believe
Jonathan {public msg} It will give the information about the program, cost and specific credentials.

Bborsuk {public msg} would it be difficult to notice improvement in a child with high-functioning autism and good speech?
Rebecca {action: Mommyo}  smiles at Mommyo.
Jonathan {public msg} Speech Therapists, Physical Therapists, and many other medical and even sports therapists are using this therapy.
Jonathan {public msg} Bborsuk, if the child has poor coordination or in need of improving attention span I would say you would notice a difference.
Jonathan {public msg} An evaluation of gross motor coordination and bilateral skills and the initial IM test would show the need.
Ron {public msg} ?
Jonathan {public msg} Parameters for the initial test are part of the training and if a child falls into the typical range for their age then the timing is not an issue for them.

Moderator {public msg} Ron, you had a question, go ahead
Jonathan {public msg} The parents of the children I have trained have reported the differences they have noticed. Like not tripping as much, more attentive, more self initiating. This also improves self esteem if they are functioning better at the motor skills, or games with their peers.
Ron {public msg} If the child has excellent balance beyond normal kids, but has ineffective language does this have any link with their timing?
Rebecca {public msg} ?
Jonathan {public msg} Balance is part strength and only a little timing. A better test would be can they coordinate skipping.
Jonathan {public msg} Can they keep the beet with which you present to them clapping your hands?
Ron {public msg} Our son has great balance but no he can't skip
Rebecca {action} . o O ( never mind my ? you just answered my question :o) )
Jonathan {public msg} Can they track a ball with their eyes, move their hand to catch the ball, but then fail to open and close quickly enough to actually catch the ball? These would be better timing tests.
Ron {public msg} The more you explain the more I realize that he does have timing issues
Jonathan {public msg} Can he keep the beat with music or clapping?
Ron {public msg} He loves music, but doesn't keep a beat
Jonathan {public msg} Have him march in place and then tap the knee with his hand on the same side, when the knee is in the air.
Ron {public msg} Why?
Bborsuk {public msg} ?
Jonathan {public msg} Then have him tap his knee while it is in the air with the opposite hand (left hand to right foot).
Jonathan {public msg} These are the timing and coordination methods I use to get a child ready for the Interactive MetRonome.
Ron {public msg} thanks!
Jonathan {public msg} As this skill improves his ability to time and plan and coordinate the two sides of his body are improving. For more information in home programs for coordination look up Brain Gym.

Moderator {public msg} Bborsuk, go ahead with your question
Bborsuk {public msg} what about a child on medication for attention.  Would that affect this therapy?
Bborsuk {public msg} ?
Jonathan {public msg} Bborsuk: The children in the study either were able to decrease their medication or not begin taking it for those that were about to go on it.
Rebecca {public msg} please go ahead Bborsuk, you have the floor
Rebecca {action}  smiles.
Bborsuk {public msg} are there a certain percentage of children who do not improve at all?
Jonathan {public msg} I have taken several children with ADHD through the program. One child in particular I actually had to tape a square on the floor and tell him to stand in it. He was very active and getting into everything. By the fourth day he was calm enough to remove the square.
Jonathan {public msg} As for clients not improving I have not had any yet who have not improved either their motor skills or attention span. Though I will say some children do not make the gains I had hoped but that also happens in traditional occupational therapy. That is why a proper screening is necessary.
Ron {public msg} I wanted to mention that there is a great 'Demo' presentation on the website to illustrate the equipment, the software, the practitioners etc.
Bborsuk {public msg} ?
Rebecca {public msg} One last question :)
Rebecca {public msg} This ok with you Jonathan?
Jonathan {public msg} Yes thank you Ron. The website is an excellent resource and they are very willing to answer questions by email or phone.

Bborsuk {public msg} my son did AIT a few years ago and we didn't notice any improvement.  that makes us reluctant to try something similar that's so expensive.
Jonathan {public msg} Sure another question is fine and if anyone wants they are welcome to email me if that is ok with you Ron?
Ron {public msg} yes, by all means
Rebecca {public msg} please continue Jonathan
Jonathan {public msg} I understand and with AIT the pre and post test is often subjective. I think it is a good therapy. The Interactive MetRonome has a very objective pretest.
Jonathan {public msg} Thank you for having me I enjoyed it. My email is
Bborsuk {public msg} thank you
Ron {public msg} thanks so much Jonathan, and for others with good questions.
Mommyo {public msg} Thank you Jonathan.  I learned allot
Rebecca {public msg} Jonathan, Contact Ron and you are always welcome to return. It was nice having you
Ron {public msg} good night.
Rebecca {public msg} And...thanks Ron for everything you do for others. ;o)
Jonathan {public msg} Goodnight
Bborsuk {leaves}
Rebecca {public msg} good night all
Ron {leaves}
Rebecca {public msg} You are all welcome to come chat here anytime! The rooms are open 24/7
Mommyo {leaves}
Rebecca {public msg} thanks for coming!
Rebecca {leaves}
Caulie {public msg} "thank you'
Jonathan {public msg} your are welcome, have a good night
Jonathan {leaves}

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