Wednesday, January 12, 2011

Occupational therapists are beginning to ask questions about Interactive Metronome

The questions about Interactive Metronome have been coming fast and furious the last few months, perhaps associated with their increased marketing - although that is my own speculation. I am also aware of some franchised 'brain therapy' centers that are using the intervention protocol so that might also be driving some of the questions.

Anyway, I recently received this email, which reflects the typical question:
Thank you for your candid thoughts. I loved reading your blog and stayed up until 3 in the morning doing so. I am an OT who has been practicing in pediatrics for 12 years and have never really bought into the whole SI thing; I thought maybe I did not really get it. I have always felt like sensory issues are part of the big picture but have never observed them to be an isolated concern that is fixed by swinging or brushing. I have had some parents ask me about interactive metronome and some therapists I know swear by it. What are your thoughts? Does it have the research to back it up? Thanks for your work to improve our profession and help kids. Happy New Year!
First of all, I don't recommend that anyone stay up that late reading my blog, although I really do appreciate the kind words! :)

Interactive Metronome was introduced several years ago and marketed in perfect timing with an AJOT article that provided some initial evidence about its effectiveness. The basis of the method seems to have some sound science behind it.

In subsequent years, very little research has been done on the method. Most of the more recent 'research' that the IM people refer to is unpublished white papers and conference presentations. Rather than produce research, now all they put out are a bunch of anecdotal case studies - to the point where they now claim that IM helps every condition from soup to nuts. There is a particular case study on Alzheimer's on their website that states "To date there is no published research that clearly shows a link between the use of IM and clinical outcomes in patients diagnosed with Alzheimer’s. But sometimes patients are running out of hope. And sometimes their care providers take chances." What is that supposed to mean? If a desperate family is willing to shell out the dough, am I supposed to do ANYTHING? I just don't like it.

I don't know that IM training is any more or less effective than any other exercise-based therapy approach that focuses on motor planning, timing, and sequencing. At its basic core the concepts seem sound, but I don't think there is enough evidence to state that it is a superior or preferred method in any way - especially since people are charging exorbitant prices for the intervention.

As for their 'certification' process - I am doubtful about anything that 'certifies' anyone after a single day of training. Like many other therapy approaches out there - I think that the 'certification' is more marketing ploy than anything else. It allows someone to say that they are 'IM Certified" and then of course what follows is that people offer "IM Therapy" and of course they charge people a lot of money to receive this "special intervention." For these reasons I tend to dislike the whole premise of one-day crash-course certification so you can hawk someone else's product.

This type of marketing/research conundrum is common in the OT world. Sad to say, but the whole push to have Sensory Processing Disorder included in the DSM-V suffers from the same ill-fate - the people making the argument for inclusion talk about science on one side of their website and they also sell sensory processing disorder t-shirts and offer 'exclusive' sensory processing training on the other side of their website. They don't seem to understand that when they financially benefit it makes the so-called 'research' that they offer somewhat hard to swallow. They don't seem to understand the concept of 'conflict of interest.'

Someday, I am hopeful that people will realize how important it is to separate research and clinical interventions from product sales. For what might have been a program with some merit - the IM people have simply driven themselves down the road of lower credibility, at least from the perspective of people who actually think about these things and don't just drink the marketing Kool-Aid that they put out there for public consumption.


References:

Shaffer, R. J., Jacokes, L. E., Cassily, J. F., Greenspan, S. I., Tuchman, Robert F., Stemmer, Jr., P. J. (2001). Effect of Interactive Metronome Training on Children with ADHD. The American Journal of Occupational Therapy 55 (2); 155-161.

2 comments:

Aubrie said...

I tend to agree with your statement about "certifications" however as a clinician who routinely uses interactive metronome, I can tell you that it works.
I'm not saying that other traditional interventions aren't just as effective, but IM tends to draw kids in and allow them to interact in a different way that they enjoy and can relate to. I have seen outcomes with kiddos who were previously "plateaued" and that those outcomes transition into function.
I understand the hesitation, but until you've used and seen it in action, don't be too quick to judge the merits of this modality.

Chris said...

Thanks for your note Aubrie. I am not judging the basic merits nearly as much as I am questioning the marketing.

Also, given that other traditional interventions may be 'just as effective' and given that therapists aren't charging exorbitant fees for more traditional interventions - is this not something worth discussing?

I can assure you that I am not passing quick judgment. I was excited to see the initial research in 2001 and followed the downward spiral where now it is marketed for conditions where there is no evidence to support it.

Thanks again for your comments. I think it is important that we discuss the merits of the interventions we are providing to people, especially in consideration of the time, energy, and financial resources that people are using in hope that we will be helping them in a meaningful way.