A Revolution in Neurological and
Motor Rehabilitation
Overview
 History & Research
 Clinical adoption & areas of use
 Cases Studies
 Billing & Coding
History of Interactive Metronome
 Began formal clinical
research in 1994
 First used with Pediatric
patients
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
Science Overview
“Motor planning and sequencing is a
critical component of the deficit in a variety
of developmental and learning disorders.”
- Stanley I. Greenspan, M.D.
Motor Planning Processes of Organizing and
Sequencing are a core function of the brain
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
Large-Scale Correlation Study
 Timing and Child Development Study Published
• Conducted in Illinois by High/Scope Foundation
• 585 students, 6-10 years old
AJOT Published Clinical Study
 3 groups of ADHD boys
separated by:
Control / Placebo / IMtrained
 Statistically significant
improvement in:
• Attention
• Motor Control and
Coordination
• Language Processing
• Reading
• Control of Aggression and
Impulsivity
AJOT Published Clinical Study
Similarities (Standard
Score)
Language Processing Test
Similarities
10
8
6
4
2
0
-2
Pre and Post Test Differences
9.316
2.666
-1
Control
Placebo
Interaction Effect = 0.005
IM
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
Academic Fluency Study
2.21 GE Gain in Reading Fluency 1.66 GE Gain in Math Fluency
14
12.39
12.5
10.25
Grade Equivalency
Grade Equivalency
12
13
12.46
10
8
12
11.5
6
4
11
10.73
10.5
2
0
10
9.5
Pre IM
Post IM
2.21 GE gain, n=718, Woodcock Johnson, 3rd Ed.
Pre IM
Post IM
1.66 GE gain, n=703, Woodcock Johnson, 3rd Ed.
Athletic Performance Study
 Comparison of IM trained
golfers to a control group
 Produced significant
improvements in golf shot
accuracy
 An average of 20-40%
improvement in shot accuracy
obtained by the IM group
 Control group saw no gain
Athletic Performance Study
 20% Overall Gain in Shot Accuracy
 35% Increase for advanced golfers who had
consistent swing mechanics
Golf Shot Accuracy Study
28.23%
30%
24.22%
25%
% Improvement
19.85%
20%
15%
14.98%
14.05%
10%
5%
0%
-5%
-10%
9 Iron
7 Iron
IM Group
5 Iron
Driver
Control Group
Overall
Results from Early Clinical Trials
Results from a pilot fMRI (brain scan) study show IM
directly activates multiple parts of the “neuronetwork”
CINGULATE GYRUS
BASAL GANGLIA
Allows shifting of attention Integrates thought and
movement
Cognitive flexibility
MEDIAL BRAINSTEM
Neuro-motor pipeline
Parkinson’s Study
 “In this controlled study computer directed rhythmic
movement training was found to improve the motor signs of
parkinsonism .”
Daniel Togasaki, MD, Parkinson’s Institute
Neal Alpiner,
Rehab Medical Director William Beaumont Hospital…
“IM Neuro therapies have been
shown to be efficacious in:
 Phase I (Acute Inpatient
Rehab)
 Phase 2 (Outpatient)
 Phase 3 (Eminence) stages of
client neuro-recovery.”
What are the Benefits?
1
2
3
4
5
ATTENTION / FOCUS
MOTOR CONTROL / COORDINATION
BALANCE & GAIT
LANGUAGE PROCESSING
CONTROL OF AGGRESSION / IMPULSIVITY
Interactive Metronome for
Rehabilitation Training
Jimmy Eggleston was the
First Rehab Case
Invention of Interactive Metronome
After 3 weeks walking
without assistive device
Interactive Metronome Today
Currently provided by
thousands of therapists
in hospitals, clinics,
schools and rehab
centers
Who Can Benefit?
REHABILITATION
Loss of Motor Control
Loss of Speech/Cognition
Loss of Balance and Gait
PLANNING
SEQUENCING
TIMING
PERFORMANCE
NEURO-SCHOLASTIC
ADD/ADHD
Enhanced Coordination
Improved Focus and Attention
Improved Academic Performance
Asperger's Syndrome
Sensory Integration
Language Processing
Motor Control and Coordination
Impulsive/Aggressive
Assessment
1 second = 1,000 milliseconds
40
200
15
15
40
0
69
0 – 15ms.
16 – 22
23 – 29
30 – 40
41 – 69
Perfect
Superior
Exceptional
Above Average
Average
69
200
The Second Link
“ IM impacts the
neurological population in
the same way it helps the
developmental population.”
- Cheryl Miller
HealthSouth Regional Director Clinical Services
Sunrise, Florida
Key Diagnoses
 CVA and Brain Injury
 ADHD
 Amputees
 Cognitive /
Developmental Disorders
 Parkinson’s
 Academic / Sports
 General Rehabilitation
Performance
Address Cognitive Deficits
 Attention and Concentration
 Motor Planning and Sequencing
 Language Processing
 Behavior (Aggression and Impulsivity)
 Executive Functioning
Address Physical Deficits
 Balance and Gait
 Endurance
 Strength
 Fine/Gross Motor Skills
 Coordination
Case Study 1: Jake
16 year old male - TBI from MVA
Severe impairments:
 Sustained attention & concentration
 Poor memory
 Left-right discrimination
 Gross and fine motor coordination
 Balance
Case Study 1: Jake
After 6 weeks of IM Training:
 Able to attend to paper/pencil
tasks for up to 50mins in
preparation for school
 Reported that he could hold
conversations for longer periods
of time and now able to “day
dream”
 After IM, only needed minimal
cues for L-R discrimination
Case Study 2: Veronica
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 1520 minutes
Case Study 2: Veronica
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
Case Study 3: Brenda
 6 months of traditional
therapy with poor outcome
 Thousands of IM reps
particularly using her feet
 Significant improvements
in motor sequencing
 Improved gait & balance
Case Study 3: Brenda
Disney Marathon
FINISH LINE!
January 2004
Benefits of IM
 Non-invasive
 Non-pharmaceutical
(not exclusive of Rx)
 Complements existing
therapy
 Short-term (length of
treatment)
 Measurable outcomes
 Functional cross-over
Questions and Answers
Reimbursement: Billing & Coding
DX
ICD-9 CODE
ADD
314.00
ADHD
314.01
AUTISM
299.0X
AKA
V49.76
DX
CVA, APRAXIA
ICD-9 CODE
997.02
430-434.9
Late Effects CVA
674.XX
438.XX
Spinal Cord
952.XX
Parkinson’s
332.0
BKA
V49.75
DYSLEXIA
784.61
Gait Disorder
781.2
TBI
854.XX
Speech Delay
315.39
Reimbursement: Billing & Coding
PT
CPT Codes
Therapeutic Activities
97530
Therapeutic Procedures
97110
Evaluation
97001
Sensory Integration
97533
Neuro-muscular Re-education
97112
OT
CPT Codes
Therapeutic Activities
97530
Therapeutic Procedures
97110
Evaluation
97003
Sensory Integration
97533
Neuro-muscular Re-education
97112
ST
CPT Codes
Speech Therapy
92507
Evaluation
92506