+

+ Course Objectives

Identify patients who will benefit from use of visual-only IM to

rehabilitate visual processing skills;

Demonstrate evidenced-based practice through appropriate

use of objective assessments to measure visual-only IM

treatment outcomes;

And demonstrate use of an appropriate IM treatment

hierarchy to remediate visual processing skills.

+ In Search of a Remedy to Improve

Outcomes

Highly specialized outpatient brain injury rehabilitation

Variable outcomes in visual attention & processing with IM as compared to auditory attention & processing

After IM treatment via combined auditory – visual modalities, impairments persisted in:

Visual attention

Cognitive speed during visual tasks

Executive functioning

+Example of

Auditory-Visual

Performance

Discrepancy

after IM

+ Auditory: Pre & Post Test Comparison

PRE-TEST

Sustained attention

10th percentile

Attention – switching

<1st percentile

Selective attention

<1st percentile

Divided attention

<1st percentile

POST-TEST

Sustained attention

75th percentile

Attention – switching

50th percentile

Selective attention

75th percentile

Divided attention

35th percentile

+ Visual: Pre & Post Test Comparison

PRE-TEST

Sustained attention

5th percentile

Attention – switching

<1st percentile

Selective attention

<1st percentile

Divided attention

<1st percentile

POST-TEST

Sustained attention

9th percentile

Attention – switching

<1st percentile

Selective attention

<1st percentile

Divided attention

<1st percentile

+Contributing Factors?

Reliance on stronger modality

during IM (auditory)?

Not really engaging visual

attention and processing?

Visual modality is more passive

during IM in some patients?

+ A solution?

Improve timing & rhythm in better/preferred modality first (auditory)?

Then “force” use of visual modality by turning off the sound?

Measure outcomes to see if approach works.

+Expected Outcomes

Reading

Safety

Functional

independence

Visual attention

Visual processing

Visual memory

Executive functioning

+Supporting

Research

+ Neuroplasticity

Schwartz and Begley (2002)

The Mind and the Brain: Neuroplasticity and

the Power of Mental Force.

“A consistent factor in laboratory and clinical studies of neuroplasticity is that to obtain reorganization of the neural system, cognitive input must be present and many repetitions are

required.

+ Role of Attention in Visual

Processing

Vuilleumier & Driver (2007)

Modulation of visual processing by attention and emotion: windows on causal interactions between human brain regions.

Visual processing is not determined solely by retinal inputs.

The internal attentional state of the individual can

alter visual processing of the same stimuli. This can

influence visual cortex, boosting neural responses

to an attended stimulus.

+ Role of Attention in Visual

Processing

Vision therapies focus on:

Perception

Tracking

Focus

Eye teaming

+ Role of Visual Attention in Reading

Solan, Larson, Shelley-Tremblay, Ficarra, & Silverman (2001)

Role of visual attention in cognitive control of oculomotor readiness in students with reading disabilities.

Eye movement therapy improved eye movements and also resulted in gains in reading comprehension. The results support the notion of a

cognitive link among visual attention, oculomotor readiness, and reading comprehension.

+ Role of Visual Attention in Fall

Prevention

Hyndman & Ashburn (2003)

People with stroke living in the community: Attention deficits, balance,

ADL ability and falls.

Sustained and divided attention deficits correlated

with functional impairments and falls, highlighting

that attention deficits might contribute to accident

prone behaviour and falling.

+ Candidacy for Visual-Only IM

DEFICITS MAY BE PRESENT IN:

Visual attention

Visual memory

Spatial orientation

Processing speed

Concentration

Executive functioning

DEFICITS MAY IMPACT:

Reading

Writing

Driving

Safety

Etc

+ Guidelines for Visual-Only IMFirst, combine auditory & visual modes.

Achieve best performance possible.

Patient hears the IM

…And patient sees the IM

+ Assessing Outcomes of Visual-Only

IM

Woodcock-Johnson Tests of Cognitive Ability III

Test of Everyday Attention

Visual Object and Space Perception Battery

Bender® Visual-Motor Gestalt Test

Behavioral Inattention Test

Stroop Color & Word Test

Symbol Digit Modalities Test

+ Assessing Outcomes of Visual-Only

IM

Trail Making Test – Parts A & B

Rey Complex Figure Test

Gray Oral Reading Test

Gray Silent Reading Test

Woodcock-Johnson Tests of Achievement

Boston Diagnostic Aphasia Exam – 3rd Edition

Nelson-Denny Reading Test

+ Critical Elements of IM

Timing stimulus (reference tone or center flash, a visually-based metronome stimulus)

Timed movements (IM exercises, other activities based on your creativity)

Feedback (guide sounds, visual mode, a visually-based guidance system)

Intensity (repetition, repetition, repetition)

+ And so much more…

Check out the full presentation for more great tips on

using IM training for visual attention and processing.

Also included:

Extended Research

Sample Exercises

Case Studies

Parent testimonial

+ Check us out online.

If you are looking for CEUs, look no

further than Interactive Metronome®.

We have an extensive catalog of over 100

webinars with topics on everything from

autism to motor deficits to ensuring

clinical profitability and success with IM.

And our new badging system makes it

easy to identify the information that is

tailored to your practice. No more

wasting time looking for CEUs! It is time

to take your clients’ training to the next

level!

+

Thank you.

For more information:

visit

www.interactivemetronome.com

or call (877) 994-6776 (*US Only)

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call (954) 385-4660