Grace is a 70 year-old female technical support specialist who was referred by her neurologist for neuropsychological services. A neuropsychological evaluation was conducted, followed by treatment with the Interactive Metronome® (IM), which is a brain-based rehabilitation assessment and training program developed to directly improve the processing abilities that affect attention, motor planning, and sequencing. This, in turn, strengthens motor skills, including mobility, gross motor function, and many fundamental cognitive capacities such as planning, organizing and language.
Grace’s medical history includes triple aortic repair after which she noted multiple cognitive changes. Her most prominent issues noted during neuropsychological testing were a pervasive mental fog, which presented as residual short-term memory difficulty, word finding problems, and a slight deficit of processing speed connecting thoughts into actions. An MRI scan of the brain showed mild cortical involution and chronic microvascular gliosis involving the frontal, parietal, and periventricular white matter. She had been working from home as well as collecting short term disability. She had previously discussed recent cognitive issues with her supervisor, stating that she was concerned with her loss of focus and concentration affecting her ability to perform job-related tasks. She was motivated to return to work to avoid losing her employment.
Her cognitive fatigue transpired to low physical and mental energy, impairing her ability to complete job related tasks within given time constraints as well as affecting daily living. She complained of a recent onset of sleep difficulty involving waking early in the morning hours regardless of what time she went to bed. She also noted difficulty in multitasking, such as conversing with a client over the phone while typing information into the computer. At home her lifestyle had become much more sedentary, which increased her physical malaise. She displayed mild emotional and social anxiety following her diagnosis, which also impeded her daily routine and interpersonal functioning. Her goals were to improve her overall cognitive functioning, return to pre-diagnosis job performance, and decrease her emotional/anxiety stressors.
During her initial IM assessment, she was very receptive to treatment and showed motivation for change. Her pre-LFA total unadjusted score was 115 ms (below average); 73% of hits were early and 27% were late. Total number of IAR bursts was 2. She displayed marked difficulty particularly with exercises involving the lower extremities. Scores for both heels stood at 303 ms (extreme deficiency). Bilateral exercise scores were 188 ms (right hand/left toe; severe deficiency) and 142 ms (left hand/right toe; below average). She had difficulty in maintaining cognitive/physical stamina and displayed some struggle in learning the exercise movements. Exercises involving balance were also of specific concern. Balancing on her right and left foot both produced below average results (86 ms and 88 ms, respectively).
Clinical techniques were then modified to slowly increase stamina in each session. This included adjustment of repetitions and tempo. Tempo was slowed to 45-50 BPM for exercises with the lower extremities. This allowed for increased concentration on movement as well as lessening the instance of physical fatigue. Alternating exercises from sitting to standing and slowly increasing repetitions also aided in the gradual improvement of stamina. Occasionally changing the sensor trigger motion to better fit her current range of motion (tapping on a buzzer, clapping, balancing, marching) also helped to produce beneficial results. Once she started to display objective improvement, visual aids such as interactive games were also used successfully to increase focus and engagement. Difficulty began at 200 ms and was gradually raised to 100 ms. She would occasionally display frustration, but continued each session of increasing difficulty with steady improvement. She was particularly fond of the soccer ball game, continually trying to top her personal score in each session. In later sessions, scores continued to improve to the above average range. For example, scores in week 8 sessions were 34 ms right heel, 38 ms left heel, 34 ms both heels, and 35 ms left hand/right toe. Week 9 sessions even produced exceptional results in the upper extremities. Exercises with both hands were between 22-26 ms. By the end of treatment (10 weeks), all scores had improved dramatically, particularly those involving the lower extremities. Overall scores from first to last session showed a considerable increase in all spheres of motor coordination. First session hands ms avg. began at 53 ms (average) and ended at 36 ms (above average). First session feet ms avg. began at 126 (below average) and ended at 38 ms (above average). Overall ms avg. began at 110 ms (below average) and ended at 40 ms (above average). Physical stamina and gait improved greatly, as she could now make it through a rigorous IM session with little to no rest. Post-LFA scores solidified the evidence of her improvement, with all scores indicative of average to above average performance at minimum. Total results were 35.8 ms (above average) for hand exercises, 37.9 ms (above average) for feet exercises, and 60 ms (average) for bilateral exercises. Total unadjusted score was 40 ms (above average). Her number of total IAR bursts also increased significantly from 2 (pre) to 8 (post). In the days and weeks following her IM therapy, Grace’s level of attention to task and processing rose, motor coordination improved, and her cognitive fog began to lift. She expressed a substantial increase in cognitive functioning and clarity, particularly at her job and in personal conversations. Work was now being completed with greater ease and her emotional state had improved. She no longer felt as plagued by anxiety from home/work as her cognitive fatigue continued to decrease. She also reported a slight ease in gait directly following the end of her treatment. Grace’s benefit from Interactive Metronome® treatment has been both observable and reflective in her scores. She is now pursuing more active and involved responsibilities congruent with what she had been working towards.
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