Elsevier

Journal of Hand Therapy

Volume 28, Issue 4, October–December 2015, Pages 396-402
Journal of Hand Therapy

Scientific/Clinical Article
A retrospective outcomes study examining the effect of interactive metronome on hand function

https://doi.org/10.1016/j.jht.2015.06.003Get rights and content

Abstract

Introduction

Interactive Metronome (IM, The Interactive Metronome Company, Sunrise, Florida, USA) is a computer-based modality marketed to rehabilitation professionals who want to improve outcomes in areas of coordination, motor skills, self-regulation behaviors, and cognitive skills.

Purpose

This retrospective study examined the efficacy of IM training on improving timing skills, hand function, and parental report of self-regulatory behaviors.

Methods

Forty eight children with mixed motor and cognitive diagnoses completed an average of 14 one-hour training sessions over an average of 8.5 weeks in an outpatient setting. Each child was assessed before and after training with the Interactive Metronome Long Form Assessment, the Jebsen Taylor Test of Hand Function, and a parent questionnaire.

Results

All three measures improved with statistical significance despite participants having no direct skill training.

Conclusion

These results suggest an intimate relationship between cognition and motor skills that has potential therapeutic value.

Level of evidence

Level 4, Retrospective Case Series

Section snippets

Background

Therapists have examined the impacts of numerous factors,1, 2, 3 such as age, traumatic injury, and restricted range of motion, on hand function. The vast majority of published hand therapy research has examined the effects of conventional techniques on function, including early active motion protocols, total end range time, orthotic intervention, tendon gliding, and scar massage.4, 5, 6 This research has begun to identify the physical measures that contribute to loss of hand function and

Purpose

We sought to determine: the extent to which IM training impacts functional hand skills, to which parents report an observable difference in behavior after IM training, and to which timing scores improve after IM training. This study was conducted as part of a continuous improvement project in a large outpatient rehabilitation center at a children's hospital.

Design

This retrospective case series study compared pre- and post-test data from three measures: 1) timing as measured by the IM Long Form Assessment (LFA),15 2) hand function as measured by the Jebsen Taylor Test of Hand Function (JTTHF),20 and 3) behavior as measured by performance on an IM parent questionnaire.15

Data collection

Data were collected via chart review of children receiving these services between January 1, 2012 and December 31, 2013. As standard of care, all therapists using this modality kept

Timing scores

The average adjusted LFA pre-test score in this population was 212 ms (median, 225; range, 53–403). The average adjusted LFA post-test score was 76 ms (median, 57; range, 22–293). This is a 64% improvement in timing scores (SE, 3%). A paired two-sample Student t-test demonstrated that the pre/post-test change on average IM timing scores was statistically significant (P < 0.0001).

The IM company provides the norms chart shown in Table 1 to describe what the scores mean. Using the norms provided,

Discussion

The results of this outcomes study suggest the following: 1) a short regimen of therapist-led IM training is likely to significantly, positively change functional hand skill in a pediatric population as measured by the JTTHF; 2) a short regimen is likely to significantly, positively change a participant's internal timing abilities; and 3) parents report statistically significant changes in a variety of their children's behaviors after IM training. To validate the results, this study should be

Conclusion

This study supports the notion that a cognitively based modality such as Interactive Metronome can produce significant changes in the quality of motor skills of the hand. In the sample of 48 children we examined, the average JTTHF score significantly improved after IM training. Both the dominant hand and the non-dominant hand improved. Although the improvement percentage was greater in the dominant hand, improvements were more equitable across tasks with the non-dominant hand. These patterns of

Acknowledgments

I would like to thank Wendy Haron, OTR/L first and foremost as she worked for so long creating this program and making such a difference in the lives of all the children she treated. She was the vision behind this study. Thank you to Patty Hove, Amy Jackson, Martina Brennan, Isabel Meuller, and Alyssa Paranto for their wonderful clinical skills and dedication to this program. I would also like to thank Sherlly Xie and the Department of Biomedical Research who assisted me in data analysis and

Quiz: #391

Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.

  • #1.

    The study design was

    • a.

      prospective

    • b.

      retrospective

    • c.

      RCTs

    • d.

      single case study

  • #2.

    IM training was directed toward improving

    • a.

      timing skills

    • b.

      self-regulation behavior

    • c.

      hand function

    • d.

      all the above

  • #3.

    The authors use the term “top down” to refer to

    • a.

      from physician, to therapist, to patient

    • b.

      parent to child

    • c.

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