Timing in the brain is an involved and invaluable process necessary for speech, coordination and the learning of intricate physical and cognitive tasks. The Interactive Metronome (IM) programme provides a platform for students to focus attention and develop mental control.
Timing in the brain is quite an intricate process. Mostly located in the temporal lobe of the brain, its origins start in more primitive functions of the brainstem and cerebellum. Research has stated that temporal lobe timing in the brain supports the formation of language, as much as it supports motor coordination and creating and adaptive anticipatory response to stimuli in our environment.
Occupational therapists in the pediatric field frequently apply sensory integration principles in their work with children and are concerned with the ability of the child to process information through the different senses. This is a wonderful work that is celebrated and culminates in the ability of the child to participate in the occupational function of play and being a school student. It is great to see that the child is able to do a jumping jack now, or is able to handwrite. But can this same child go back into the classroom and participate in these functions at the same time as his peers? Can this child keep pace with his peers? This is where working on timing frequently ‘clinches the deal’.
THE IM ORIGINS
The Interactive Metronome (IM) was first developed in 1992 by a man named James Cassily. His formal education is in child psychology. He has spent over 20 years in record production, engineering and recording studio equipment design, and manufacturing. His personal interest in audiology helped him pioneer physcho-acoustic audio signal processing in the recording, sound reinforcement, and broadcast fields.
HOW THE IM FUNCTIONS
The IM program ‘trains the brain’ to plan, sequence and process information more effectively through repetition of interactive exercises. During the IM training a trainee wears stereo headphones and listens to special sounds that the IM computer software program generates to guide the training process. Motion sensing triggers, connected to the computer via cables, relay information about the trainee’s performance to the computer during training. One trigger is worn like glove on either hand. It senses exactly when the hand makes contact when tapped during training. The other trigger is placed on the floor, and senses exactly when the trainee taps either a toe or heel upon it.
Thirteen different hand and foot exercises are performed while auditory guide tones direct the individual to match the metronome beat. The IM program analyses the accuracy of each tap as it happens and instantaneously creates a sound that the trainee hears in the headphones. They learn to focus all their attention on the steady metronome beat sound in their headphones, without being interrupted by thoughts or actions around them. IM trainees experience maintaining precise focus for longer and longer periods of time. The ability to maintain focus becomes automated. The mental control learned through repetitively successful planning and sequencing experiences is rarely forgotten. Upon completion of IM training (following approximately a total of 35, 000 repetitions) most trainees find it significantly easier to learn new complex cognitive and physical tasks.
TIMING AND THE WORKING MEMORY
In order for us to sustain focus and attention, we have to use many executive skills, but one in particular is working memory. Longterm memory is a cognitive skill and pertains to what happened a long time ago. Short term memory is new information from a short while ago. Working memory is multi-tasking memory that enables us to take in large chunks of information at a given time and scaffold this new information on information we had already learnt. It is a complex process and requires active work from our visual-spatial stream of processing as well as our verbal function. If the student can look at what the teacher is demonstrating and is able to hear clearly the language she is using in describing her demonstration, we have good working memory. Trouble is that these two streams of information have to work together in the same timing and be in synch with each other for maximum working memory potential. The timing between the systems matters. If there is a delayed processing in either system, impacting on the timing system, it causes a diminished capacity for working memory, the student is overloaded and overwhelmed, starts becoming distracted, fidget, move around and generally loses attention to the task.
Some students still try to use one stream information to the utmost and they will look away from the teacher in order to hear her better, but this behaviour is frequently misinterpreted as an ‘attention difficulty’and the student is requested to ‘look’ at the teacher. Once the student’s eyes are on the teacher again, he forfeits the ability of the auditory system to focus. We need both functions to pay effective and sustained attention at the same time and the IM program is therefore helpful for students who struggle with learning/reading disorders, ADHD/ADD, motor disorders, speech disorders and of course students who struggle with sensory processing.
The March/April 2001 issue of the American Journal of Occupational Therapy identified five core areas of statistically significant improvements gained through the IM training program:
Attention and Focus, Motor Control and Coordination, Language Processing, Reading and Math Fluency, Ability to Regulate Aggression/Impulsivity.
The program is flexible in its application. We prefer working in an intensive format with a minimum of three sessions per week, up to five sessions per week. In the first two phases of intervention, while the student is still getting used to the program, we may introduce the program in our weekly sessions until the student is ready for an intensive session. Most intensive sessions last for one hour each time while activities are planned to create an increase in the ability to sustain attention to task over time. Intensives could be as long as 15 sessions (three weeks) or shorter at 10 days (two weeks). It can be quite rigorous for some and not all students are thrilled with clapping and tapping for an hour, but therapists do try to put fun into it, working out reward activities and such. The student learns to compete with himself; to improve himself and is not being asked to compete against others. The intrinsic motivation grows as the student can see his scores change on a daily basis. The amount of intensives needed would depend on the individual profile and we frequently prepare the auditory system first through a combination of sound therapy and Sensory Integration therapy. The student has to be able to register the information first, then process and time it together.
We do not think that any one program can ‘do it all’, but we have found a strong need to include the IM program in our intervention plan for most of our cases.
Maude Le Roux. OTR/L,