Addressing Hemispheric Imbalances with Interactive Metronome This course

Addressing Hemispheric Imbalances with Interactive Metronome This course introduces the certified Interactive Metronome provider to the concept of Hemispheric Imbalances in children and adults and how to address these imbalances using the Interactive Metronome. By Heather Cross, OTR/L

What is Hemispheric Imbalance?

Dr. Robert Melillo wrote a book called: “Disconnected Kids: The Groundbreaking Brain Balance Program for Children” According to his book, hemispheric imbalance or functional disconnection is “an imbalance in the connections and function between and within the hemispheres of your child’s brain…”

What are the responsibilities of each hemisphere?

Your Right Brain Ø Gives you the big picture Ø Non-verbal communication Ø Large muscle control Ø Comprehension Ø Math reasoning Ø Interpreting information Ø Unconscious actions Ø Ø Negative emotions Low frequency sound High frequency light Interpreting auditory input Ø Understanding abstract concepts Ø Cautious and safe actions

Your Left Brain Ø Ø Ø Ø Small picture Verbal communications Small muscle control IQ Word reading Math Calculations Processing information Ø Ø Ø Conscious actions Positive emotions High frequency sound Low frequency light Receiving auditory input Ø Linear and logical thinking Ø Curious and impulsive actions

What are the symptoms or behaviors exhibited when there is a weakness in one hemisphere?

Examples of behavior for right side weakness Ø Poor muscle tone Ø Odd gait Ø Poor balance, rhythm, and coordination Ø May trip and fall for no reason Ø Odd in social situations Ø Impulsive and anxious Ø Making inappropriate comments and not understanding why they are inappropriate Ø Picky eater Ø Good reading skills, but poor interpretation skills Ø Decreased attention, compulsive Ø Auto immune disorders(allergies/asth ma)

Examples of behavior for left side weakness Ø Ø Shy or withdrawn Sullen/Sad Difficulty with speech Difficulty with handwriting Ø Prone to chronic infections such as ear infections Ø Arrhythemia Ø Possible learning disabilities Ø Difficulty with organization

What measures can you use to check for imbalances?

Melillo Brain Checklist Dr. Melillo developed a check list for parents or adults to fill out to help identify hemisphere weaknesses. This check list can be found in his book as well. The Melillo Brain Checklist is a master checklist that contains 200 characteristics – 100 signify a right brain deficit and 100 signify a left brain deficit. The checklist helps a therapist know if there is “Functional Disconnect” in the sides of the brain and which side of the brain is causing it. The greater the number of checkmarks, the more severe the brain imbalance. The total number of checkmarks give an indication of the severity of the problem as a whole: 0 -50 checks = Mild; 50 -100 checks = Moderate; 100 or above = Severe Imbalance. The checklist is filled out by one or both parents, and helps therapist tailor the plan of care to specifically address the weaker side of the brain. The checklist is subjective and answers are based on typically developing children of the same age. The total with the highest score is the side that is weaker. When answering these questions, answers should be based on a comparison with typically developing children of the same age. Also, if your child is on medication, answer based on how the child would compare when not on the medication.

Motor Characteristics (A) Ø Clumsiness and an odd posture Ø Poor coordination Ø Not athletically inclined and has no interest in popular childhood participation sports Ø Low muscle tone – muscles seem kind of floppy Ø Poor gross motor skills, such as difficulty learning to ride a bike and/or runs and/or walks oddly Ø Repetitive/stereotyped motor mannerisms (spins in circles, flaps arms) Ø Fidgets excessively Ø Poor eye contact Ø Walks or walked on toes when younger (B) Ø Fine motor problems (poor or slow handwriting) Ø Difficulty with fine motor skills, such as buttoning a shirt Ø Tends to write very large for age or grade level Ø Stumbles over words when fatigued Ø Exhibited delay in crawling, standing, and/or walking Ø Loves sports and is good at them Ø Good muscle tone Ø Poor drawing skills Ø Difficulty learning to play music Ø Likes to fix things with the hands and is interested in anything mechanical Ø Difficulty planning and coordinating body movements

Sensory Characteristics (A) Ø Ø Ø Ø Poor spatial orientation – bumps into things often Sensitivity to sound Confusion when asked to point to different body parts Poor sense of balance High threshold for pain – doesn’t cry when gets a cut Likes to spin, go on rides, swing, etc. – anything with motion Touches things compulsively A girl uninterested in makeup or jewelry Does not like the feel of clothing on arms or legs; pulls off clothes Doesn’t like being touched and doesn’t like to touch things Incessantly smells everything Prefers bland foods Does notice strong smells, such as burning wood, popcorn, or cookies baking in the oven Avoids food because of the way it looks Hates having to eat and is not even interested in sweets Extremely picky eater

Sensory Characteristics (B) Ø Doesn’t seem to have many sensory issues or problems, such as a sensitivity to sound Ø Has good spatial awareness Ø Has good sense of balance Ø Eats just about anything Ø Has a normal to above-average sense of taste and smell Ø Likes to be hugged and held Ø Does not have any oddities concerning clothing Ø Has auditory processing problems Ø Seems not to hear well, although hearing tests normal Ø Delay in speaking was attributed to ear infections Ø Gets motions sickness and has other motion sickness issues Ø Is not undersensitive or over sensitive to pain

Emotional Characteristics (A) Ø Spontaneously cries and/or laughs and has sudden outbursts of anger or fear Ø Worries a lot and has several phobias Ø Holds on to past “hurts” Ø Has sudden emotional outbursts that appear over-reactive and inappropriate to the situation Ø Experiences panic and/or anxiety attacks Ø Sometimes displays dark or violent thoughts Ø Face lacks expression; doesn’t exhibit much body language Ø Too uptight; cannot seem to loosen up Ø Lacks empathy and feelings for others Ø Lacks emotional reciprocity Ø Often seems fearless and is a risk taker

Emotional Characteristics (B) Ø Ø Ø Overly happy and affectionate; loves to hug and kiss Frequently moody and irritable Loves doing new or different things but gets bored easily Lacks motivation Withdrawn and shy Excessively cautious, pessimistic, or negative Doesn’t seem to get any pleasure out of life Socially withdrawn Cries easily; feelings get hurt easily Seems to be in touch with own feelings Empathetic to other people’s feelings; reads people’s emotions well Ø Gets embarrassed easily Ø Very sensitive to what others think about him or her

Behavioral Characteristics (A) Ø Ø Ø Ø Logical thinker Often misses the gist of a story Always the last to get a joke Gets stuck in set behavior; can’t let it go Lacks social tact and/or is antisocial and/or socially isolated Poor time management; is always late Disorganized Has a problem paying attention Is hyperactive and/or impulsive Has obsessive thoughts or behaviors Argues all the time and is generally uncooperative Exhibits signs of an eating disorder Failed to thrive as an infant ***continue***

Behavioral Characteristics (A) continued Ø Mimics sounds or words repeatedly without really understanding the meaning Ø Appears bored, aloof, and abrupt Ø Considered strange by other children Ø Inability to form friendships Ø Has difficulty sharing enjoyment, interests, or achievements with other people Ø Inappropriately giddy or silly Ø Acts inappropriately in social situations Ø Talks incessantly and asks the same question repetitively Ø Has no or little joint attention, such as the need to point to an object to get your attention Ø Didn’t look at self in mirror as a toddler

Behavioral Characteristics (B) Ø Ø Ø Ø Procrastinates Is extremely shy, especially around strangers Is very good at nonverbal communication Is well liked by other children and teachers Does not have any behavioral problems in school Understands social rules Has poor self esteem Hates doing homework Is very good at social interaction Makes good eye contact Likes to be around people and enjoys social activities, such as going to parties Doesn’t like to go to sleepovers Is not good at following routines Can’t follow multiple-step directions Is in touch with own feelings Jumps to conclusions

Academic Characteristics (A) Ø Ø Ø Ø Poor math reasoning (word problems, geometry, algebra) Poor reading comprehension and pragmatic skills Misses the big picture Very analytical Likes “slapstick” or obvious physical humor Is very good at finding mistakes (spelling) Takes everything literally Doesn’t always reach a conclusion when speaking Started speaking early Has tested for a high IQ, but scores run the whole spectrum; or IQ is above normal in verbal ability and below average in performance abilities Was an early word reader Is interested in unusual topics Learns in a rote (memorizing) manner Learns extraordinary amounts of specific facts about a subject Is impatient

Academic Characteristics (A) continued Ø Speaks in a monotone; has little voice inflection Ø Is a poor nonverbal communicator Ø Doesn’t like loud noises (like fireworks) Ø Speaks out loud regarding what he or she is thinking Ø Talks “in your face” – is a space invader Ø Good reader but does not enjoy reading Ø Analytical; led by logic Ø Follows rules without questioning them Ø Good at keeping track of time Ø Easily memorizes spelling and mathematical formulas Ø Enjoys observing rather than participating Ø Would rather read an instructions manual before trying something new Ø Math was often the first academic subject that became a problem

Academic Characteristics (B) Ø Ø Ø Ø Very good at big picture skills Is an intuitive thinker and is led by feelings Good at abstract “free” association Poor analytical skills Very visual; loves images and patterns Constantly questions why you’re doing something or why rules exist Has poor sense of time Enjoys touching and feeling actual objects Has trouble prioritizing Is unlikely to read instructions before trying something new Is naturally creative, but needs to work hard to develop full potential Would rather do things instead of observe Uses good voice inflection when speaking Misreads or omits common small words

Academic Characteristics (B) continued Ø Ø Ø Ø Has difficulty saying long words Reads very slowly and laboriously Had difficulty naming colors, objects, and letters as a toddler Needs to hear or see concepts many times to learn them Has shown a downward trend in achievement test scores or school performance Schoolwork is inconsistent Was a late talker Has difficulty pronouncing words (poor with phonics) Had difficulty learning the alphabet, nursery rhymes, or songs when young Has difficulty finishing homework or finishing a conversation Acts before thinking and makes careless mistakes Daydreams a lot Has difficulty sequencing events in the proper order

Academic Characteristics (B) continued Ø Often writes letters backward Ø Is poor at basic math skills Ø Has poor memorization skills Ø Has poor academic ability Ø Has an IQ lower than expected and verbal scores are lower than nonverbal scores Ø Performs poorly on verbal tests Ø Needs to be told to do something several times before acting on it Ø Stutters or stuttered when younger Ø Is a poor speller Ø Doesn’t read directions well

Common Immune Characteristics (A) Ø Has lots of allergies Ø Rarely gets colds and infections Ø Has had or has eczema or asthma Ø Skin has little white bumps, especially on the backs of the arms Ø Displays erratic behavior – good one day, bad the next Ø Craves certain foods, especially dairy and wheat products

Common Immune Characteristics (B) Ø Gets chronic ear infections Ø Prone to benign tumors or cysts Ø Has taken antibiotics more than 10 to 15 times before the age of ten Ø Has had tubes put in the ears Ø Catches colds frequently Ø No allergies

Autonomic Characteristics (A) Ø Problems with bowels, such as constipation and diarrhea Ø Has a rapid heart rate and/or high blood pressure for age Ø Appears bloated, especially after meals, and often complains of stomach pains Ø Has body odor Ø Sweats a lot Ø Hands are always moist and clammy

Autonomic Characteristics (B) Ø Has a bedwetting problem Ø Has or had an irregular heartbeat, such as an arrhythmia or a heart murmur

Scoring The highest number of check marks show which side of the brain is weaker. Ø Total Number (A) ____ Right side Ø Total Number (B) ____ Left side

A weakness has been identified…What now? Therapeutic interventions that have had a positive effect hemispheric imbalance: TLP or other auditory programs Interactive Metronome Brain. Builder Astronaut Program Sensory Integration Home Exercise Programs Ocular Motor Program Handwriting Programs Cognitive Therapy Behavioral Therapy

Specific exercises to stimulate the right hemisphere Ø Use Eucalyptus or Peppermint essential oil 3 -5 times daily to stimulate the right brain. One drop on the tip of the right nostril is all you need. This will also help with pulling his/her sensory system into sync. Ø Listen to Albums 3 -4 on the Listening Program, with only the left ear plugged into the headphones. 15 minutes daily and then increase to 30 minutes as tolerated. If the Listening Program is not available, use music that has a lot of lower frequencies. This gives the right brain auditory input.

Specific exercises to stimulate the right hemisphere Ø Spin in a Clockwise direction while seated for 30 seconds at a time (1 rotation should take 1 -2 seconds). Look at the eyes and see if they are moving involuntarily. If they are not moving, or if they only move for 58 seconds, repeat this exercise only faster and a little longer. The eyes should move back and forth after spinning for 13 -15 seconds. This will target the Right Brain vestibular system. Ø Do activities like balancing, jumping on one foot, throwing, pushing – etc. with the left side of the body – LEFT arm, LEFT foot. This stimulates the Right Motor cortex of the brain. Ø Patch the Right Eye for small tasks (legos, blocks, puzzles, coloring) for 3 -5 minutes at a time. This gives the right brain visual input through his/her left eye.

Specific exercises to stimulate the left hemisphere Ø Use Lavender or Orange essential oil 3 -5 times daily to stimulate the left brain and improve clarity/focus. One drop on the tip of the left nostril is all you need. This will also help with pulling the sensory system into sync. Ø Listen to Albums 7 -10 on the Listening Program, with only the right ear plugged into the headphones. 15 minutes daily and then increase to 30 minutes as tolerated. This gives the left brain auditory input. If the Listening Program is not available, music that has a lot of high frequency tones such as Baroque music will work as well.

Specific exercises to stimulate the left hemisphere Ø Spin in a Counter Clockwise direction while seated for 30 seconds at a time (1 rotation should take 1 -2 seconds). Look at the eyes and see if they are moving involuntarily. If they are not moving, or if they only move for 5 -8 seconds, repeat this exercise only faster and a little longer. The eyes should move back and forth after spinning for 13 -15 seconds. This will target the Right Brain vestibular system. Ø Do activities like balancing, jumping on one foot, throwing, pushing – etc. with the right side of the body – Right arm, Right foot. This stimulates the Right Motor cortex of the brain. Ø Patch the Left Eye for small tasks (legos, blocks, puzzles, coloring) for 3 -5 minutes at a time. This gives the right brain visual input through his/her left eye.

Why Interactive Metronome? Skills targeted through the use of Interactive Metronome: School Performance Visual Perception Impulse Control IM Fine Motor Delay Manual Motor Control Tracking 35

Ideas to incorporate hemisphere stimulation to your IM program: Ø Have the client wear an eye patch on the right eye for right brain stimulation while watching the visual training screen Ø Have the client wear an eye patch on the left eye for left brain stimulation while watching the visual training screen 36

Ideas to incorporate hemisphere stimulation to your IM program: Ø Focus exercises on the left side of the body for right brain stimulation Ø Focus exercises on the right side of the body for left brain stimulation 37

Ideas to incorporate hemisphere stimulation to your IM program: Ø Remove all visual from the clients sight and have the guide sound only in the one ear that is on the opposite side of the hemisphere you are trying to target. Turn off all guide sounds for this exercise. 38

Ideas to incorporate hemisphere stimulation to your IM program: Ø Add rotary motion to your IM exercises, focusing on the direction that will stimulate the hemisphere you are working on. Using a spinning board, platform swing, or a sit and spin are easy ways to achieve rotary motion. 39

Conclusion: Addressing Hemispheric Imbalances in your case load is another tool you can use as a therapist to help your clients achieve their maximum potential. Focusing on stimulating the right or left hemisphere using your Interactive Metronome can enhance your treatment sessions and help achieve desired effects in a shorter time frame. Any Questions? 40