Balance, Coordination & Motor Planning Balance, Coordination & Motor Planning are interwoven and are critical components in neurodevelopment. It is painful to watch a child that is 'uncoordinated' try to play in gym class, only to be ridiculed by his classmates. The good news is that we can evaluate for and enhance the function of these areas! Balance is the dynamic ability to maintain your center of gravity with minimal postural sway. Keeping balance requires the integration of inputs from three main sensory systems; the vestibular system, the visual and the perception of pressure and proprioception from the somatosensory system. The motor (musculoskeletal) system is responsible for muscular actions to react to each of these inputs. In a healthy balance system, the senses must continually detect the change of the body's position with respect to the ground or base. Motor coordination is essentially the complex set of interactions between neural processes involved in moving a limb or the entire body and the actual movement itself. It is dependent on the integration of sensory and motor systems to achieve the virtually effortless smoothness of motion that we enjoy. Motor Planning is also called praxis. It is a three step process starting with an idea about what you want to do, the organization a program of action (both consciously and subconsciously) and the performance of that action. A problem in this area is called Dyspraxia. Dyspraxia is difficulty getting the body to do what you want when you want to do it. For example, the ability to touch your finger to your nose after seeing someone else do it. The Science Brain research has outlined the function of the vestibular system and its role in the 'sense' of balance and how it affects brain processing and sensory integration.  It is this system that is a main contributor to brain development and can have a significant effect on visual processing, reading, and learning efficiency and academic performance. Our sensory systems 'construct our reality' as a result of inputs from our receptors. The objects and images we see in the space around us are created in the brain using a complex system of neural networks. Neural networks are the mechanism the brain uses to process information. The vestibular system is the primary movement and gravitational sense. It is able to pick up any and all movements of the head. It accomplishes this by using information received from two separate motion sensors in the inner ear, the semicircular canals and the otoliths. The first sensory system to develop and provide the brain with meaningful information is the vestibular system or balance sense. The motor system and other brain systems that control body, limb, finger, tongue, lip, jaw, and eye position, and which are responsible for gross and fine motor skill, also sense movement and position in space utilizing gravitational and inertial information. These senses, as well as the auditory and visual systems, are built on, integrated with, and highly dependent upon the inertial and gravitational foundations provided by the vestibular system. The three dimensional frame of reference provided by the vestibular system drives the brain to develop structures to create language, to think and create linguistically, and to read and write. The coordination of all of the processes of brain timing is provided by the vestibular system. To put it simply, the individual's ability to balance is indicative of the efficiency of his or her brain processes. ** Since so much of development of the brain is dependent on sensory-motor coordination, it is critical to hone the skills that can further advance the efficiency of this input. The Training When a person engages in balance exercises that include motor activities involving many different sensory systems, the brain utilizes neural networks to organize and execute the activities effectively. As the difficulty of a task increases, the number of neurons the network requires to perform the task increases. Our goal is to incrementally increase the demand on the system to force it to grow or expand by changing around the exercises the child does. Depending on the age of the child, their physical abilities and their level of interaction, we use a variety of balance and coordination games and exercises. Everything from the most basic, standing straight with eyes closed for a period of time, to the intermediate - the Wii Fit System, to the most advanced - The Interactive Metronome System is employed! What is Interactive Metronome (IM)? Interactive Metronome (IM) is a training system that was designed to enhance brain function through integration of the sensory and motor systems. It is the only therapy tool that improves coordination, motor planning and sequencing by using a series of specific exercises developed to improve the brain's inherent ability to repair or remodel itself through a process called neuroplasticity. It was developed in the early 1990s and it has been used to help children with learning, attentional and developmental disorders. It accomplishes this by recruiting a number of brain areas related to organizing, planning and sequencing that are foundational to the ability to attend and learn.  The abilities of motor planning and sequencing are central to human activity. From the coordinated movements needed to walk or ordering words in a sentence, planning and sequencing are critical to efficient human function. Why does Interactive Metronome (IM) work? The brain works on precisely timed cyclic or rhythmic patterns.  Properly tuned natural timing or rhythmicity allows the human brain to: 1. Plan and sequence thoughts and actions 2. Recognize that patterns exist in their environment as they occur 3. Connect actions and thought patterns with their consequences as they occur 4.Perform complex problem solving activities such as copying shapes, writing words language, social behavior, and other academics 5. Learn from one's experiences and mistakes The object of the IM training is to help individuals improve their ability to selectively plan and sequence, without interruption by internal thoughts or external distractions, over extended periods of time. Simple limb motion exercises are used as systematic timing 'trainers' of an underlying mental control improvement process. Interactive Metronome Training improves one's ability to: 1. Recognize that rhythmic patterns or cycles exist in our surrounding 2. Focus attention long enough to recognize individual patterns exist within groups of simultaneously occurring patterns in the surroundings 3. Create patterns (our actions and thoughts) that are in sync with other patterns (entrainment) 4. Improve the ability to learn from experiences INTERACTIVE METRONOME "...a unique drug-free treatment that has shown great promise in kids with Attention Deficit Disorder." - CBS Early Show "HealthWatch" The Need The Interactive Metronome has been shown to improve attention and focus, control of aggression and impulsivity, reading, language and processing, and coordination. It also improves key cognitive abilities: motor planning, timing and sequencing. The truth is that the ability to plan and sequence motor actions with correct timing and rhythm is a critical component of adaptive skills in everyday living. This capacity is an aspect of coordination as well as basic thinking, organizing, and planning, (e.g., the ability to sequence actions, information, and ideas). For children, this may mean sequencing the act of getting dressed or brushing their teeth. How does it work? While wearing a set of stereo headphones, the user hears a rhythmic sound and responds by moving specific parts of their body, keeping time with the beat. Guide sounds alert the user whether they are early, late, or right on the beat and their brain quickly learns how to find its own rhythm. Over a series of 12 to 15 sessions, the brain learns rhythm and timing, much like the way feedback from training wheels helps someone to learn how to balance on a bicycle. As timing improves, so do motor control & coordination, focus, concentration & attention span, self-control, and school, sports, & social performance. The Research Intervention Study In this study, titled "Effect of Interactive Metronome Rhythmicity Training on Children with ADHD", the IM trained group was compared with a control group receiving no intervention, and a second control group receiving a placebo computer based intervention. The IM group showed statistically significant improvements over both control groups in areas of attention, motor control, language processing, reading and in the ability to regulate their aggression. This peer reviewed research appears in the American Journal of Occupational Therapy March/April 2001 volume. Motor Skills Study In this study, widely used tests for fine and gross motor skills were administered to 38 students in special education in the Kentwood, MI school district. The results, presented at the annual meeting of the American Educational Research Association showed significant improvements for the IM group in areas of visual motor control and coordination. Assessment and Achievement Study 585 students aged four to eleven years of age in an Effingham, IL school district were part of a study to assess the reliability and validity of the IM as a measure of motor timing and planning capacity. The results, published by the High/Scope Foundation, a prestigious non-profit educational research institution since 1970, showed significant correlations between IM performance and factors of age, motor coordination, attention, academic achievement and other areas. Scheduling The Interactive Metronome training program includes a minimum of 15 one-hour private sessions or 30 1/2 hour sessions with a Certified IM Practitioner. Some individuals will need more if they have unusually impaired rhythm and timing skills. We strongly urge that appointments be scheduled at no greater than 4 day intervals in order to produce the maximum benefit from the program.