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.

HANDLE® Screening or Assessment

In addition to the pretests mentioned above, before a learner's first Interactive Metronome training session at the McNatt Learning Center, Inc., (s)he will usually have completed HANDLE® Screening or Assessment, which provide helpful cues to his or her sensory-motor functioning, including vestibular awareness, gross-motor discrimination, kinesthetic response, and auditory processing skills. We believe a HANDLE® Screening or Assessment is important in part because Interactive Metronome is an extremely powerful tool. Sometimes, due to its power, we believe it is best used in conjunction with complementary modalities—or best delayed until a client has completed some prerequisites.

Autonomic Nervous System Imbalance

If a HANDLE® Screening or Assessment suggests that a learner is frequently in a "high stess state," especially if this is confirmed by scores on the IVA+ Plus and Interactive Metronome LFA, complementary training with Stress Eraser or Freeze Framer to promote consistent variation in heart beat may be recommended. Either of these interventions can help learners relax during Interactive Metronome training and maintain the broad, relaxed focus required in many scholastic and social settings.

Vestibular Function—Avoiding Burnout

If a HANDLE® Screening or Assessment suggests a learner's sense of inertia and balance is impaired, Interactive Metronome may best be delayed until the learner has had several months to work with HANDLE® vestibular activities. (Interactive Metronome training can be overwhelming to individuals with functional vestibular impairments, since it requires a trainee to distinguish between tones of different location (left vs. right ear), pitch (high, medium, low), and timbre (guide sounds vs. reference sounds)—a feat that can be disorienting to individuals with vestibular impairments for two reasons:

•   Vestibular Demand: Localizing sounds requires vestibular contribution to a spatial awareness not facilitated by touch.

•   Vestibular Disturbance: The sound waves from Interactive Metronome's tones can create waves in the fluid in the semicircular canals of the vestibular system, generating unpredictable vestibular input.

As vestibular function improves and Interactive Metronome training is begun, IM students at the McNatt Learning Center, Inc., often do some IM activities on a Belgau Balance Board which, when placed on a hard surface (not carpet), provides prompt feedback if vestibular awareness shifts. This can be especially helpful for individuals who experience dyslexic disorientations.

Kinesthesia—Maximizing Efficiency

If a HANDLE® Screening or Assessment suggests a learner's kinesthesia is impaired, Interactive Metronome may not be overwhelming, but it may be inefficient, since there are far less costly ways—in dollars and in stress—to enhance basic gross-motor rhythm, gross-motor discrimination, and basic neurodevelopmental movement patterns like cross-pattern crawling. General ways to develop these kineshetic abilities include

•   Gross-Motor Rhythm: Have fun playing with Superflight Crystal Stix; skipping or marching (no equipment needed!); spinning Hula Hoops, Poi, or Rhythm Flags (large or small); or tossing bean bags and bouncing racquetballs rhythmically. Equipment for each of these activities is available at the learning center or through the links above.

•   Gross-Motor Discrimination: Practice moving both arms independently of the legs, both legs independely of the arms, each arm and leg independently of the others, the arm and leg on one side of the body independently of the arm and leg on the other side, and the arm and leg on opposite sides of the body independently of the other arm and leg. Practice lying down, sitting, and standing.

•   Cross-Pattern Crawling: Crawl around the floor. Or, as an alternative, try HANDLE®'s Seated Clapping Game. Start by sitting in a chair across from your partner. Then place both feet on the floor and hands together, as if praying.

1. Extend your right hand and raise your left knee as your partner extends her left hand and raises her right knee (a mirror image of you). Slap your partner's hand and your raised knee.

2. Keeping your right foot on the floor, clap your hands together at the same time your left foot hits the floor.

3. Extend your left hand and raise your right knee as your partner extends her right hand and raises her left knee (again, a mirror image of you). Slap your partner's hand and your raised knee.

4. Keeping your left foot on the floor, clap your hands together at the same time your right foot hits the floor.

5. Repeat the above four movements rhythmically in time to "Twinkle, Twinkle, Little Star" or another song with a steady beat.

With any of the above activities, stop if you feel dizzy, confused, or suddenly uncoordinated. Stop if your ears turn red, your eyes get wattery, or when you make your third error in the session. (These are called "State Changes" in HANDLE®; they're signs of stress—and signs to stop the activity.) The idea is to do an activity for a few minutes at most, then to come back to it later—generally the next day. A little practice, stopping when you get overwhelmed, goes a long way.

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 such products as the Lateral Thigh Trainer™ or 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.

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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The McNatt Learning Center, Inc., doesn't work directly with complex rhythmic stimulation, though some individuals with autism-spectrum conditions have found such stimulation very helpful. You may want to experiment:

Lucky Media's Quadranome is an interesting 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 sells pre-made and custom CDs that, like the Quadranome, are meant to be played in the background.

Neither the Quadranome nor the REI Institute's CDs are classified as "listening therapies." Neither is based on Tomatis's or Berard's work, as most listening therapies are. The Quadranome and REI Institute's CDs provide complex rhythms, rather than the complex frequency variations provided by most listening therapies: their goals, physiological responses, and real-life outcomes are very different from most listening therapies.

The McNatt Learning Center, Inc., does provide one of the premier listening therapies, 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, often as a prerequisite to the Interactive Metronome.

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

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's 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's syndrome:

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's syndrome using these interventions. Given the role of the thalamus in mediating arousal, stress response, and closure, Newsum Bio-Kinetics Health Restoration System, along with complementary interventions for high or irregular muscle tone or spasticity (see "Providers' Corner," below) may also be recommended in conjunction with Interactive Metronome training.

What follows is fairly detailed and is included here primarily as a resource for other Interactive Metronome providers. If you're interested in receiving Interactive Metronome training through the McNatt Learning Center, Inc., you may be comforted to know that we're checking more than your timing before your IM training ever begins. We're thorough. If you'd like to read about some of what we check, and why, or if you're another Interactive Metronome provider exploring complementary interventions to the powerful training you already provide, read on:

During Interactive Metronome training, a learner focuses primarily on auditory and, occasionally, visual stimuli. The auditory discrimination, rapid cognitive processing, and sustained attention required by Interactive Metronome help ensure that the movement patterns a learner practices during Interactive Metronome training become quickly habituated. It is difficult—some would say high-nigh impossible—to maintain awareness of particulars of each movement pattern, the auditory reference tone, the auditory feedback tones, and recurrent initiations of slight accelerations or deccelerations of generalized movement patterns. Because of this, the body automates the simplest aspects of the Interactive Metronome tasks so it can focus on the more complex aspects. Generally, this means the brain habituates movement patterns to enable focus on timing. Given that movement patterns are likely to be quickly habituated in training, it is important for movements to be practiced with good form—and good posture.

Thus, it is important for individuals whose posture has been compromised by impaired stress-reflex responses (either the tonic stretch reflex, as is frequently the case in Tourette's syndrome, autism-spectrum conditions, scoliosis, and Parkinson's disease, or the phasic stretch reflex, which results in muscle spasticity) to receive appropriate therapeutic interventions in tandem with Interactive Metronome training (which itself is an educational intervention). Complementary therapeutic interventions include

•   Postural feedback during Interactive Metronome (IM) sessions to enable a learner to perform IM movement patterns with good posture: This feedback is especially important during initial IM sessions, when IM's movement patterns are first being learned. Since it takes time for a learner to internalize postural cues and begin to self-correct whenever (s)he resumes previous postural habits during training, initial progress with timing can be slow. The payoff of quickly internalized postural patterns, however, can be tremendous!

•   Rolfing® or KMI to enable the learner to adopt a new posture: Without fascial release and reorganization, pain may prevent individuals with irregular or high tone from adopting a new posture, even with expert postural cues during IM training. Without fascial reorganization, the unfamiliarity of new postural positions may also confuse individuals with poor reflex integration, especially those with Tourette's syndrome. This is especially evident during or after sessions with cognitive demands (like alternating between four counts of moving both hands and four counts of moving both feet) sufficient to disallow the top-down movement planning these individuals are often accustomed to. Sometimes, this challenge results in a temporary reduction in motor control. Resumption of IM training, however, is sufficient to facilitate a return of motor control—actually more than a "return," since the resulting motor control is often surprisingly, wonderfully effortless. To enable postural change, the McNatt Learning Center, Inc., recommends Rolfing® or KMI prior to Interactive Metronome for all of its clients with Tourette Syndrome and about 30 to 40% of its Interactive Metronome clients in general.

•   Myofascial release to decrease muscle hypertonicity in clients with elevated or irregular muscle tone: Elevated or irregular tone can hinder relaxation, proprioceptive awareness (body in space), and eventual internalization of movement patterns trained through IM, so it's important to address. Using NeuroSoma, a limited pressure, cross-fiber or percussive touch that avoids engaging the phasic stretch reflex, is one way to address elevated or irregular tone without compounding the problem by initiating anaerobic activity or engaging the stretch reflex. HANDLE® Peacemaker Massage may also be recommended to help with muscle tone distribution. (Regrettably, many forms of massage and trigger point therapy activate the stretch reflex by pressing into the muscle, and even indirect interventions that involve waiting for a release can quickly become anerobic, leaving behind lactic acid, an irritant to already sensitive muscle fibers.)

•   Isokinetic exercise to decrease muscle spasticity in clients with spastic muscles: Muscle spasticity can hinder kinesthesia (perception of movement), proprioceptive awareness (body in space), and motor planning (intentionality in executing the movement patterns trained through IM), so it's important to address. Isokinetic exercise uses an isometric stretch followed by isotonic pressure in the same direction as the initial stretch. The isometric stretch causes chain fibers in many muscle spindles to shorten. (The stretch reflex of the bag fibers is not automatically engaged.) When the part of the body that had been holding the stretch begins to move, the lengthening reflex (via the golgi tendon organ) is initiated. This enables the chain fibers to relax (i.e., to temporarily cease spasticity) while the muscle contracts through an often improved range of motion. Perhaps best of all, proprioceptive awareness often increases during this "release through movement," enabling an individual to better "feel" the movement patterns of IM.

We currently provide postural feedback, Rolfing®, and assistance with The Trainer (an isokinetic exercise machine) in conjunction with Interactive Metronome. If we believe a client may benefit from more precise help with muscle spasticity or muscle strengthening, we may refer a client for one of the following interventions:

•   Techniques for muscle release: The historic Jones' Strain-Counterstrain or more recent adaptation such as D'Ambrogio's Positional Release Therapy, Dreaver's Somatic Technique, Hanna Somatics, or Mattes' Active Isolated Stretching. In addition to muscle release, Dreaver's Somatic Technique aims to awaken a client's awareness of his/her unconscious movement patterns. Hanna Somatics likewise aims to awaken awareness yet also includes training in pandiculation—a sensory-motor "reset" pattern evident throughout the vertebrate kingdom that a client can practice every morning. Mattes' AIS aims to make brief, targeted stretching and strengthening a regular part of every athlete's training.

In general, these release techniques are considered "indirect": instead of trying to force a part of the body to move a particular way (as do most manual therapies), the practitioner places the body in a position or takes the body through a movement pattern in anticipation of the body's response. These techniques are also, in general, considered "directional": instead of trusting the body to utilize kind, gentle, but nonspecific touch in the best ways possible (as do many energy medicine approaches), the practitioner depends on a thorough knowledge of anatomy and physiology to guide the intervention.

•   Techniques for muscle strengthening: Mattes' Active Isolated Strengthening, Pneumex, and/or Protonics. Mattes' Active Isolated Strengthening builds on his Active Isolated Stretching. Pneumex's and Protonics' approaches both feature their products, which facilitate muscle isolation in the context of integrated, strengthening movement.

•   Techniques for movement integration (generally post-Interactive Metronome): Hanna Somatics, Feldenkrais, or Gyrotonic (Gyrotonic, not Gyrokinesis, with feedback from a qualified practitioner—not self-directed from a video).