McNatt Learning Center, Inc.

Interactive Metronome (IM) is a PC-based interactive version of the traditional music metronome that has been shown to improve attention, coordination, and time management in children and adults with a wide range of cognitive and physical difficulties including Attention Deficit Hyperactivity Disorder (AD/HD). The Interactive Metronome's steady beat (called the "reference tone") is played through stereo headphones, while guide sounds are played in each ear to prompt a student to respond closer to the central beat. The guide sounds direct a student's responses toward the central beat much like the bumpers in bumper bowling direct a bowling ball toward the pins at the end of the alley.

As a student's responses grow closer to the beat, the Interactive Metronome tightens the controls on the guide sounds—the electronic equivalent to moving the bumpers in a bowling alley closer and closer together. This never happens in a bowling alley, of course: eventually, the ball would have nowhere to go but the headpin! But with Interactive Metronome, a student's responses can be guided closer and closer to the central beat, helping the student develop timing more efficiently than ever before. A human coach simply can't provide the consistently accurate and encouraging feedback designed into the Interactive Metronome.

Students who struggle with staying on task, have difficulty getting or staying organized, have trouble "multitasking," seem unaware of date or time, or are frequently tardy usually have poor timing skills. Other students with poor timing may tend to "zone out," read choppily, lose the line while reading, become agitated when doing math, have difficulty remembering when patterns aren't apparent, fail to complete tasks, and/or become easily distracted.

Timing—the ability to synchronize rhythms—is a foundational skill indispensable to maintaining an awareness of the passage of time. With good timing and good "temporal awareness," learners can often remember events in the order they happened, without causal connections, simply because their minds "logged" the events that way.

Without timing and temporal awareness, however, learners' ability to remember must usually depend on their awareness of context. Hence, gifted learners who nevertheless struggle with timing often spend so much effort trying to understand how the particulars of people or situations relate that they seem indecisive and may miss opportunities to act on their conclusions. Lacking gestalt, they may spend so much time and energy "thinking things through" that to others they seem aloof or disinterested. Paradoxically, though these learners with timing deficits are focused on connections among particulars when learning, they may forget on tests whatever particulars were not important in forming their ultimate view of the whole.

Other learners who struggle with temporal awareness, particularly when they also struggle with other cognitive delays, may tend to give up too easily on some activities while perseverating on others. Even in instances in which such students can read phonetically fine, their attention to sequence and flow may be so impaired that they can demonstrate little comprehension of a passage upon completing it.

Individuals with poor timing may have good rhythm, especially if they have been involved in aerobics or dance when young. Rhythm is the ability to "feel" a beat and produce a consistent cadence. Marching requires good rhythm; seeing the whole picture—quickly and easily—requires good timing.

Obviously, the skills of timing and rhythm are highly related: as one improves rhythm (the ability to maintain a consistent beat), timing generally improves, too—and vice versa. However, working on rhythm alone is insufficient to overcome problems with timing: not only must an individual with poor timing learn to "feel" an external beat, as he might in moving rhythmically to a regular metronome, he must also receive precise feedback about how many milliseconds his rhythmic movements fall before or after the beat. A standard metronome alone cannot provide this feedback. The Interactive Metronome, which uses a computer, sensors, and headphones to measure and report the milliseconds a user moves before or after the beat, can.

According to Jim Cassily, inventor of the Interactive Metronome, the Interactive Metronome "provides users with tonally and spatially changing guide sounds that tell them exactly when in time their actions are occurring, as they are occurring." For the first time since metronomes were invented in 1692, timing can be thoroughly trained, thereby increasing students' attention, organization and punctuality, awareness of date and time, and ability to finally do more than one thing at a time.

Moreover, even students who have fewer struggles may benefit from Interactive Metronome. Because what they do requires such precise timing, star athletes, dancers, and musicians may also be interested in using IM to improve their timing and performance. Though not a panacea for every learning difficulty, IM is a giant leap forward in training timing, a foundational learning ability and bedrock of gestalt perception.

Before a learner's first Interactive Metronome training session at the McNatt Learning Center, Inc., (s)he will have taken an IVA+ Plus test, which measures ability to achieve, sustain, and switch between visual and auditory focus, and the Interactive Metronome Long Form Assessment (LFA), which measures how close to a metronome beat (s)he can consistently respond.

A learner's IVA+ Plus test may indicate that Play Attention and/or The Listening Program would be beneficial to pursue before Interactive Metronome training. Support implementing both is available through the McNatt Learning Center, Inc.

If a learner's IVA+ Plus scores suggest (s)he can succeed at a round of Interactive Metronome training, we will look for three tendencies on the Interactive Metronome LFA:

1. Responses on the LFA that average more than 70 milliseconds (ms) off beat, suggesting difficulties with timing.

2. Responses on the LFA that are outside of a 70/30 early/late ratio, suggesting a learner has to remain stressfully vigilant, guessing when something will occur next, in order to keep pace with peers who relax and handle things as they come.

3. Rhythm scores (adjusted variability average) at least 30% lower than timing scores (adjusted task average). This tendency suggests that a learner's good rhythm may be masking very real difficulties with timing; i.e., difficulties with timing may still impair a learner's everyday life, even if his/her timing scores on the LFA are within normal parameters.

The more of the above tendencies we see, the greater the positive impact we expect Interactive Metronome to make in a learner's life. The corollary is that the more tendencies we see, the more commitment to follow-up training we anticipate an adult learner will need to break old habits and to realize what profound skills (s)he has developed with Interactive Metronome.

Usually, a learner's LFA post-test will show none of the three tendencies in "Pre- and Post-Testing," above. The absence of these tendencies indicates that Interactive Metronome is no longer needed: completing Interactive Metronome training has significantly improved the learner's timing. Since daily stresses can inhibit a learner's newfound timing from flourishing, however, continuing practice of any complementary, stress-reducing interventions begun in tandem with Interactive Metronome generally proves helpful.

Many learners also find regular participation in rhythmic, bilateral movement helps to diversify the areas of their lives affected by their increased timing abilities. Simply by dancing, taking an aerobics class, or using a Trikke, the gains that Interactive Metronome effected in timing can become increasingly evident in coordinating schedules for the family, timing meal preparation in the kitchen, and relating with others at the office. Applying timing skills to intense tasks that require simultaneous attention (multi-tasking) and selective attention (directed focus)—tasks like those found in PACE or BrainSkills—can also help students’ ability to stay "in time" become even more automatic, so that "dwelling in the moment" can begin to feel more natural.

Throughout this period, the continued support of a student’s family and peers is helpful, if not essential. Especially for adults with years of habits working around timing deficits, freedom to change and grow is crucial. After years of internal struggle with an episodic grasp of reality and tendency to miss important pieces of conceptual puzzles, they may default to others’ views of situations—and even of themselves. It is, thus, important that family and friends acknowledge the changes in those who undertake Interactive Metronome training as those changes become evident. Occasionally, abilities beginning to be evident as an adult finishes Interactive Metronome stagnate without the nourishment of broadened application, continued practice, and family and peer support. In contrast, nascent abilities usually become obvious—and celebrated—as those abilities grow and develop in a supportive environment.

For reflections on the science behind Interactive Metronome and similar interventions, see Tick Tock Brain Talk.

To download a recent research article on Interactive Metronome, which explains how Interactive Metronome training has been demonstrated to help timing, click Interactive Metronome Research Study.

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To try complex rhythmic stimulation, which some individuals with autism-spectrum conditions have found helpful, you may be interested in:

Lucky Media's Quadranome: This is a computer program that plays up to four metronome beats simultaneously, creating a background soundscape sufficiently complex to engage the timing centers of a listener's brain without overwhelming most listeners, since the patterns of overlain beats are nearly impossible to "figure out." Quadranome doesn't provide user feedback like Interactive Metronome, nor does it require special hardware or guidance through an individualized program: it just plays metronome beats, which some learners with timing issues and auditory hypersensitivities find soothing to play in the background while doing homework or tinkering around the house. A trial version is available from the link above.

The REI Institute also sells pre-made and custom CDs that, like the Quadranome, are meant to be played in the background. Their CDs are not based on Tomatis's or Berard's work, as most listening therapies are. They provide complex rhythms, rather than the complex frequency variations provided by most listening therapies. Hence, their goals, physiological responses, and real-life outcomes are different from most listening therapies.

The McNatt Learning Center, Inc., also provides The Listening Program. The Listening Program is one of the most gentle listening interventions, making it well suited for use in tandem with HANDLE and other home-based interventions, sometimes as a prerequisite to the Interactive Metronome.

If our director's story is any indication, individuals with Tourette may find particular benefit from Interactive Metronome (IM). The founder and director of the McNatt Learning Center, Inc., Matthew McNatt, grew up with a moderate case of Tourette syndrome, with moderate to severe dystonic tics but with few vocal tics and no coprolalia. Years ago, at the time he completed Interactive Metronome as a patient, his clinician was told that Matthew was the first test case in the United States for the application of IM to Tourette. Matthew experienced over an 80% reduction in his tics from IM alone, and he delights sharing the intervention with others.

Matthew also temporarily lost the ability to walk while completing IM as a patient: for a disconcerting couple of hours, his brain struggled to choose between the deliberate movements Matthew was accustomed to or the natural movements being trained by IM. More IM training quickly remedied Matthew's loss of motor control, enabling Matthew to move fluidly, gracefully… even to dance. Wow! Matthew's experience with IM left him very convinced of its power, and also of the need for prerequisite and complementary interventions when appropriate.

Individuals with Tourette often struggle with closure: visual, auditory, haptic, and temporal. Since closure is rarely a conscious process, difficulties with closure can be difficult to relate to… and difficult to understand. Let's look at each type of closure in turn:

•   Imagine seeing an object but having your vision partially obscured. Good visual closure would enable your brain to compensate for the obstruction, effectively "filling in" missing pieces to discern what the object is. Individuals with Tourette usually struggle with visual closure.

•   Imagine listening to a teacher in a noisy classroom. Good auditory closure would enable your brain to hear each of the teacher's words distinctly—separable from one another and separable from the background din of the classroom. Individuals with Tourette often hear speech as a string of sounds and then try to separate the sounds into words. Positively, since strings of sound can sometimes be separated into funny statements, individuals with impaired auditory closure may pick up on and enjoy puns more readily. Negatively, since strings of sound can sometimes be separated into words that don't convey what the speaker intended, individuals with impaired auditory closure may frequently mishear what was said, especially in the presence of background noise.

•   Finally, imagine feeling a touch, movement of clothes on the skin, or movement of muscle or joint inside your body. Good haptic closure would enable you to discern the significance of that touch or movement, likely concluding it wasn't a threat to your well being, and usually dismissing it as insignificant. Individuals with Tourette often struggle to discern the significance of such touch or movement, yet they keep trying. Displaying a hallmark of a difficulty achieving closure, they quite literally don't know when to stop gathering information—or when to stop responding to what they perceive.

Moreover, once individuals with Tourette achieve closure, their perceptions are often quite inflexible. Especially when young (before social conventions have taught them to suppress such insistence), they're likely to insist they saw, heard, or felt something in a particular way, even if no one else agrees. Given the tremendous effort an individual with Tourette expends in deciding (s)he finally has enough information to judge a perception complete or action appropriate, it's no wonder that few individuals with Tourette are eager for more information, which may call their judgment into question.

Individuals with schizophrenia, in contrast to those with Tourette, can often achieve closure—but the closure they achieve is impermanent. Their perceptions or responses are fragile, open to intrusion of new information (from the outside or from their own mind) at any time. Though the McNatt Learning Center, Inc., has not yet provided Interactive Metronome training to any individuals with schizophrenia, we're excited about the potential Interactive Metronome may have for the schizophrenic population—for much the same reason we're excited about the potential IM has for individuals with Tourette syndrome: Interactive Metronome trains closure.

Interactive Metronome trains closure.

First, Interactive Metronome trains auditory closure. Every beat, IM calls a trainee's attention back to the task at hand—back to the stimulus, and back to the expected response. If the trainee's attention drifts, there's nothing (s)he can do to make amends, but it really doesn't matter: another opportunity is available within a second. If someone with Tourette tries to wait for more information, surprise: they can't… but here comes the next opportunity to respond in time to the information available. Still don't have enough information to respond? That's okay… but they'd better choose to respond quickly, because another reference tone is on its way! Interactive Metronome's recurrent demand builds closure and, with its requirements of openness to new information, also builds flexibility. Even more flexibility is developed by IM's requirement that brain hemispheres sometimes alternate in initiating movement, helping to effect efficient interhemispheric integration.

With its largely fluid, no-pause movements, Interactive Metronome training also enhances haptic closure.

Unhelpful Awareness

Individuals with Tourette, given their struggles with closure, may be aware of sensations that most people efficiently block from consciousness—specifically, they may actually feel some of the "flow" of energy along their nerves. (Remember, individuals with Tourette continue to perceive information, even when it is not helpful to a gestalt perception or response.) Certainly, reports of "internal energy" being "blocked" and of ticcing to get things "unstuck" or "unblocked" are common among those with Tourette. Such reports are especially common and site-specific (around trigger points) among adults with Tourette who opt not to take dopamine blockers, perhaps due to these adults' increased experience with an unwieldy neuronal sensitivity.

Indecisive Action

Individuals with Tourette, again given their struggles with closure, may also be uncertain what to do with their sensitivities to neuronal energy, especially when a nerve becomes irritated.

Impaired Discrimination

The difficulty individuals with Tourette have in responding to neuronal irritation is frequently compounded by poor neurological discrimination: when most individuals with Tourette Syndrome try to move one part of the body, their brains often send commands to parallel or surrounding parts of the body. When they want to move one arm, for instance, both arms move—though the arm they did not intend to move might twitch only slightly, while the arm they intended to move completes the desired motor pattern. Muscle spasm is easily triggered in the area that moved incompletely and is frequently exacerbated at the original site, since tics do little to resolve neuronal irritation. (The exacerbation at the original site does, however, trigger the release of endorphins, whose pleasant numbing reinforces the tic.)

Typical Explanation

Physiologically, since one would expect extra dopamine to be produced to facilitate indiscriminate movement (movement of both arms, in our example), it is not surprising that excess dopamine is a suspected cause of many Tourette symptoms and a frequent target of pharmacological intervention. For many, Interactive Metronome may be a helpful complement—or even alternative.

A reduction in tics—though a real possibility—is never a central goal in IM training at the McNatt Learning Center, Inc., which provides IM training strictly as an educational intervention. During Interactive Metronome training, individuals with Tourette move fluidly, frequently suppressing tics to execute movements in time to a steady reference tone. Once habituated, the fluidity of these movements (uncharacteristic of most tics) expands the movement repertoire of many individuals with Tourette, whose movements may have beforehand been described as "robotic." Since fluid movement through an expanded range of motion can sometimes indirectly alleviate muscle spasm, hypertonicity, and/or a concomitant lactic acid buildup, this expanded repertoire alone is important: it provides an alternative to the "direct" attempt many individuals with Tourette make to relieve these sensations through tics.

Moreover, Interactive Metronome, along with prerequisite HANDLE Activities, can frequently improve neurological discrimination. Thus, though no reduction in tics can be promised, since each learner incorporates and utilizes improved timing differently, it is doubly not surprising to see a reduction in motor tics among individuals with Tourette syndrome using these interventions. If you'd like to give Interactive Metronome a try, or investigate whether Interactive Metronome training may be appropriate for you, why not give us a call today?