A Brain's Timing

A new computer-based therapy offers hope to patients with developmental challenges, stroke and other conditions.

A Brain's Timing

With guidance from Rehab & Wellness therapist
Sara Peterson, Landon Skluzacek works
with the Interactive Metronome.

By Kay Marner

You wouldn’t immediately think that a kindergartner and a stroke survivor would have much in common.

But, both of these people have been helped by a new occupational therapy (OT) program at Mary Greeley Medical Center. The therapy, called Interactive Metronome (IM), is a versatile computer-based treatment designed to improve temporal processing, or timing in the brain. The user performs a motor task and a cognitive task at the same time, in a video game-like format.

IM works on the premise that timing in the brain is vital to many brain functions, including attention, comprehension, memory, processing speech, and motor coordination. People with attention deficit hyperactivity disorder (ADHD), dyslexia and other learning disabilities, autism spectrum disorders, Parkinson’s disease, and several other conditions are believed to have deficits in temporal processing. Traumatic brain injury and stroke are also believed to disrupt the brain’s timing. IM fine-tunes neural timing, taking advantage of the brain’s ability to adapt and change over time.

Mary Greeley is one of only four hospitals in Iowa offering IM.

Landon’s Diagnosis

Six-year-old Landon Skluzacek was one of the first patients to benefit from IM therapy at Mary Greeley. A kindergartener at Edwards Elementary School in Ames, Landon has received OT at Mary Greeley since June 2012, but the path that led the youngster here started several years earlier.

Landon did fine as a preschooler, but had trouble with things like writing his name. He was also easily over-stimulated, and had trouble going from activity to activity. “I didn’t want him to hate school because it was so hard,” his mom Beth says.

As kindergarten approached, Beth worried about the transition Landon would have to make. “He would have a whole different level of support. There would be one teacher and a lot of kids, instead of a teacher and several aides and a smaller number of kids,” she says.

At an appointment for an unrelated medical issue, Landon complained that he didn’t like the feeling of his socks. After asking Beth a few questions, the doctor suggested she have Landon evaluated for Sensory Processing Disorder (SPD) by an occupational therapist.

SPD is a condition where sensory input—sight, hearing, touch, taste, smell, and motion—isn’t processed accurately by the brain. In some cases, the brain under-responds to stimulation. A child might, for example, burn his hand in water that’s too hot, without realizing it or feeling pain. Or, the brain over-responds to stimulation, like interpreting the sensation of a tag in a T-shirt, that others would find merely scratchy, as causing pain. Kids with SPD are described as sensoryseekers, sensory-avoiders, or both. SPD is diagnosed using the Sensory Integration and Praxis Test (SIPT), administered by a qualified OT.

The doctor’s advice led Beth to look beyond school-based services, to Mary Greeley’s OT department, where a thorough evaluation revealed that Landon had SPD, as well as issues with fine motor skills and balance. Landon began weekly therapy sessions.

Impressive Progress

Mary Greeley began offering IM in December after purchasing the software and hardware, and after two therapists —Sara Peterson and Katie Martinek—completed training and earned certification. The IM purchase was funded by the Mary Greeley Medical Center Foundation.

According to Peterson, Mary Greeley invested in IM therapy because of the program’s unparalleled versatility, and the vast amount of research supporting its efficacy. The program contains 13 basic programs that can be customized for each patient. It can be used by people of all ages, with wide-ranging conditions.

Landon now spends 15 minutes of each hour-long therapy session using IM. During his weekly sessions, Landon appears to be playing a video game. He strives to clap (a motor task) in time with a rhythmic series of beeps, which he hears through headphones. At the same time, he watches a computer screen, which, in his case, features a graphic of a horse and rider. A green signal flashes on the screen when Landon claps at exactly the right time, as measured by a sensor strapped to the palm of his left hand. Landon uses that feedback (a cognitive task) to adjust his timing.

With continued practice and increasingly challenging tasks, Landon is seeing more green on the computer screen. Peterson, a licensed occupational therapy assistant, says that after six weeks of IM therapy, Landon’s accuracy rate went from above 200 to about 50, with the goal being zero. Perhaps more impressive is the fact that Landon is also progressing more quickly in his other OT goals since starting the program.

Help after Stroke

Therapist Katie Martinek provides encouragement for stroke survivor

Therapist Katie Martinek provides
encouragement for stroke survivor
Michelle Morgan.

Another of IM’s early users was Michelle Morgan, of Sioux City. In September 2012, Morgan, a competitive volleyball player and veteran club volleyball coach, had a blood clot in her brain stem, which caused a stroke. The stroke paralyzed her right arm, leg and facial muscles. Morgan spent a month in an Omaha hospital, followed by two weeks at a rehabilitation center in Sioux City. Following her discharge, Morgan’s desire to continue to improve her speech and movement led her to move in with her parents in Story City, and in November 2012, begin physical, occupational and speech therapy at Mary Greeley. IM was added to Morgan’s occupational therapy regimen in January 2013.

Morgan’s work with IM was quite different from Landon’s. Rather than wearing a sensor on her hand, and clapping, Morgan was challenged to reach her right arm above her head and touch a sensor attached to the wall, move from side to side and touch a sensor placed low on the wall, or perform a walking motion and touch a foot pedal—always in time with the beep heard through headphones.

“It was a good challenge,” Morgan said. “My right arm and leg worked differently than before the stroke. I had to really concentrate to do the exercises—to cause my brain to fire and make the muscles move, and move better.”

Although jogging and running are still problematic, if you saw Morgan walk today, you wouldn’t be able to tell she’d had a stroke. And, her speech has improved to the point where she’s comfortable talking on the phone again. She’s concluded therapies at Mary Greeley and is back in Sioux City now. “It’s good to be home. My daughter is especially glad to have me home,” Morgan said.

Learn More:

To learn more about Interactive Metronome therapy or traditional physical, occupational, or speech therapy services, contact MGMC’s Rehab & Wellness Department at 515-239-2600.