Robert Wood Johnson Hospital Hamilton, N.J.

Hearing Health Associates, P.A., Yardley, PA

My Brain Wellness Center, Yardley, PA

Dr. Lorraine Sgarlato Inducci, Au.D.Audiologist

Topics to be CoveredLocalizationism Early studies on brain

plasticity Early Neuroscientists – brain

plasticityNeuronsWorking Memory Internal Clock Auditory Processing DisorderManagement of A.P.D.Fast ForWord ProgramBrain Fitness Program Interactive Metronome

ProgramQuestion and Answer

Brain Function One of the most

extraordinary discoveries of the twentieth century.

According to the theory ofneuroplasticity; thinking,learning, and acting , actuallychange both the brain's

physicalstructure (anatomy) andfunctional organization(physiology) from top to

bottom.

What is the Neuroplasticity Factor?

Up till about 10 years ago scientists thought our brain was hardwired and can’t be changed.

Breakthroughs in science now tell us that the brain can remodel (rewire) itself

Brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery.

Changes occur in the brain's functional and physical anatomy as a result of experience.

Our brains can not only create new neurons (neurogenesis) but also can change their structure throughout our lifetime.

Neuroplasticity – the origin

“Neuro" for neuron and "plastic" in the sense of adaptable, changeable, malleable.

The adult human brain, can not only change itself but works by changing itself.

Neuroplasticity is the property of the brain that allows it to change its structure and

function in response to what it senses, what it does and even what it thinks and imagines.

Mental Stimulation and Active LifestylesEinstein’s brain – 15%

larger and had more connections

Salk Institute found enriched environments led to neurogenesis

London cab drivers have larger hippocampus – must learn complex maze of streets

Studies on Bilingual people

Nun Study

LocalisationismMost of the 19th

and part of the 20th century –

Brain is a complex machine - each part performing a

single mental function

Theory of Localisationism

Brain’s are hardwired

Each person is born with a genetic template –

Formed and finalized in

childhood.

Localisationism“Mechanistic biology” - William Harvey René Descartes - brain and nervous system were similar,

with currents running up and down the nerves. In 1861 Paul Broca showed that people process speech

with their left frontal lobes. Localizationists began speaking of the brain’s circuits as

“hard-wired,” according to a genetic template and that these circuits were formed, and finalized, in childhood.

Problems with LocalizationismAs early as 1868 Jules Cotard had

shown that children with a diseased left frontal lobe could speak quite well without it.

Cases where someone is born with half a brain — only a right hemisphere. yet speaks normally, holds a job and has a normal life.

These findings amount to the discovery that the adult human brain, rather than being fixed or “hard-wired,” can not only change itself but works by changing itself

Dr. Wilder PenfieldNeurosurgeon at the Montreal

Neurological Institute1930’s Penfield spent years mapping the

brain’s motor and sensory system

He did this while performing brain surgery on cancer and epilepsy patients who could be conscious during the operation.

He found he could make the patient feel different parts of his hand by stimulating an area using an electric probe.

One of his great discoveries - sensory and motor brain maps are topographical; areas adjacent to each other on the body’s surface are also adjacent to each other in the brain

Dr. PenfieldLocalizationists discovered –

Frontal lobes were the brain’s motor system – initiating and coordinates movement of our muscles

Thee lobes behind the frontal lobes comprise the brain’s sensory system – temporal, parietal, occipital – processing signals sent to the brain from our eyes, ears, touch receptors etc.

Dr. Vernon Mountcastle - MicromappingMountcastle – neuroscientist from John

Hopkins, In the 1950’s he began using a new

technique - micromapping with pin-shaped microelectrodes.

Electrodes so small and sensitive that they can be inserted inside or beside a single neuron and can detect when an individual neuron fires off its electrical signal to other neuron.

Micromapping - MountcastleThe invention of micromapping allowed

neuroscientists to decode the communication of neurons.

Scientists can listen in on one of several neurons at a time as they communicated with one another.

Micromapping is a thousand times more precise than current brain scans

Dr. Hubel – Dr. WieselHubel and Wiesel were

micromapping the visual cortex of kittens to learn how vision is processed.

Discovered a critical period from third to eighth week of life when the kitten’s had to receive visual stimulation in order to develop normally.

When the eye was sewn shut they found that the visual areas in the brain map failed to develop, leaving the kitten blind in that eye for life. –

Their brains were plastic!! – their structure literally shaped by experience.

Dr. Hubel – Dr. Wiesel

This work won them the Nobel Prize.

Plasticity in infancy Remained localizationists

defending the idea that the adult brain is hardwired by the end of the infancy to perform functions in fixed locations.

This theory of “critical period” became one of the most famous in biology in the second half of the twentieth century.

“Critical Period Plasticity”Critical period plasticity

– changed medical practice

Corrective surgeries were being performed soon after birth during the critical periods.

Children born with cataracts no longer were children faced blindness.

Mike MerzenichWorld’s leading researcher in the field of

neuroplasticity today.Pioneered the idea of shifting

brain maps.Merzenich found that sensory

and motor brain maps are not universal or immutable within a single brain. They vary in their borders and size from person to person.

Merzenich et al. In the 1960’s Merzenich and his

colleagues set out to uncover why large peripheral nerves when cut sometimes in the process of regeneration the wires get crossed.

Scientists believed this occurred because the regeneration process shuffled the nerves sending the signal from the index finger to the brain map for the thumb.

MerzenichThis breakthrough changedmainstream neuroscience. If the brain map could normalize

itsstructure in response to abnormalinput, the prevailing view that weare born with a hardwired systemhad to be wrong.

The brain had to be plastic!!

Merzenich – Cochlear Implant1971 – Merzenich - Professor at the

University of California at San Francisco - Department of otolaryngology and physiology.

He did research on diseases of the ear. He spent much of the 70’s mapping the

auditory cortex of different species of animals.

Using micro mapping Merzenich discovered that in the auditory cortex, sound frequencies are mapped tonotopically.

He set up to find if the brain which decodes thousands of complex signals coming from the cochlear now decode only a couple of thousand from a far simpler device? If it could it would mean that the cochlear is plastic – capable of modifying itself and responding to artificial inputs .

He co-invented the cochlear implant.

Plasticity of the Nervous System

We now know that the central nervous system (brain and spinal cord) are both plastic.

Brain with Blurry Borders The brain is indeed a

bordered organ, subdivided into zones and functions. But the lines are blurrier than we ever imagined.

Lose your vision, and the lobe that processed light may re-purpose itself for other senses.

Suffer a stroke in the area that controls your right arm, and another area may take over at least some of the job.

Competitive Plasticity – Use it or Lose it The brain is constantly assessing

how important it is to allocate space to certain skills and functions.

The greater the demand of a certain skill (like playing the piano) the more space and brain power it gets.

The less we use a certain function or skill, the more it loses its brain real estate to other functions (use it or lose it).

Driving NeuroplasticityWe now know that brain plasticity exists

from the cradle to the graveRadical improvements in cognitive

functioning are possible even in the elderly.

Brain exercises may be just as useful as drugs to treat attention deficit disorder, learning disabilities, cognitive impairments, auditory processing disorder, language impairments and diseases as severe as depression and schizophrenia

Neurons that Fire Together Wire Together Neurons that fire at the same time

repeatedly wire together through chemical changes that occur in both to create a bond making them connect more strongly.

Neurons that fire apart wire apart Neurons out of sync fail to link Brain maps work by spatially

grouping together events that happen together

Brain maps will grow as the skill is being learned.

After many repetitions the skill is learned

It takes less neurons within the area to perform the task.

The neurons became faster and more efficient requiring less to keep the skill functioning.

Fast Neurons – Clearer Signal As neurons are trained and

become more efficient, they can process faster.

Thinking is itself plastic. Speed of thought is essential

to our survival and a crucial component of intelligence.

Faster neurons ultimately lead to faster thought.

Faster neurons become better team players – wiring together more and forming groups of neurons that give off clearer and more powerful signals.

A powerful signal has a greater impact on the brain.

Brain representations can only be as clear as its original signal

Neurotrophin In 1986 by Rita Levi-Montalcini and Stanley Cohen received the Nobel prize for

identifying a set of proteins called nerve growth factor or NGF for short A neurotrophin is a type of protein that promotes the survival of neurons. One type of neurotrophin, known as a "neurotrophic factor", is a growth factor

that affects neurons in particular. A growth factor is a protein that signals certain types of cells to survive,

differentiate, or grow.

BDNF (Brain Derived Neurotrophic Factor) was the second neurotrophic factor to be characterized after nerve growth factor (NGF). BDNF itself is important for long-term memory

BDNF acts on certain neurons of the central nervous system and the peripheral nervous system, helping to support the survival of existing neurons and encourage the growth and differentiation of new neurons and synapses.

In the brain, it is active in the hippocampus, cortex, and basal forebrain—areas vital to learning, memory, and higher thinking

.

The young Brain - BDNF During the critical period of childhood

learning, a child’s brain secretes large quantities of BDNF (brain-derived neurotrophic factor).

BDNF also promotes the growth of thick fatty coats around every neuron that speeds up the transmission of electrical signals.

This process triggers the nucleus basalis (the brain’s attention governor), keeping the brain constantly ready to absorb new memories and skills.

Once turned on the nucleus basalis helps us not only pay attention but remember what we are experiencing.

The nucleus basalis when turned on puts the brain in an extremely plastic state.

BDNF and the Critical PeriodChildren build up a vocabulary of tens of

thousands of words over a very short period of time.

But once we reach our late teens our bodies begin to produce a lot more BDNF, a trigger which turns off the nucleus basalis.

Henceforth the nucleus can be activated only when Something is important, Surprising, or novel occurs,If we make the effort to pay close attention.

BDNF - Having adequate BDNF is essential for nerve

and brain related health. 

If your supplies run low then you cannot tolerate stress properly, you are more likely to be or become depressed, your brain is prone to excess inflammation, and you are set on a path of decline. 

Conversely, adequate BDNF helps you keep up with the demands in your life. 

BDNF - Merzenich honed in on brain-derived

neurotrophic factor or BDNF.

Mice born without the ability to make BDNF suffer developmental defects in the brain and sensory nervous system, and usually die soon after birth, suggesting that BDNF plays an important role in normal neural development

Merzenich – studies on AutismTheory – during the critical period some

situations overexcite the neurons in children who have genes that predispose them to autism - leading to the massive, premature release of BDNF.

Instead of important connections being reinforced, all connections are – so much BDNF is released that it turns off the critical period prematurely, sealing all these connections in place and leaving the child left with undifferentiated brain maps

Pervasive developmental disorder. Their brains are hyper-excitable and

hypersensitive. An autistic child will hear a sound/frequency and it sets off the whole auditory cortex.

Katz (1994), “It is what the brain does with what the ear hears

The Ear-Brain Connection Auditory system is the only sensory system to be fully

functioning in utero

By its order in our development the auditory system demonstrates its importance to the growth and maintenance of the brain and body

The ear is physiologically and neurophysiologically connected to nearly every organ in the human body as well as the auditory and language centers in the brain

A well developed and fully functioning auditory system serves as a critical foundation for balance, coordination and movement, communication, relationships, language, self regulation, attention and thinking

The auditory system should be the first system addressed when issues are present

What is an APD?APD is a condition in which one has difficulty processing or

interpreting auditory information when presented in a less than optimal listening environment.

It is the brain’s function to assign meaning to auditory stimuli and at the same time, block or suppress undesirable stimuli.

Cannot be attributed to higher-order language, cognitive, or related confounds

May lead to or be associated with difficulties in higher-order language, learning and communication function

May co-exist with, but is not the result of, dysfunction in other modalities.

1996 ASHA Concensus Statement of APDWhat are auditory processing skills?

Sensation – the ability to identify the presence of sound Localization – The ability to determine the location of the signal. Auditory attention – the ability to direct attention to relevant

acoustic signals and sustain that attention for the age appropriate amount of time.

Auditory figure-ground – the ability to identify the primary linguistic or non-linguistic sound source from background noise.

Auditory discrimination – the skill necessary to discriminate among words and sounds that are acoustically similar. (i.e. bad/bath – deaf/death)

Auditory closure – the ability to understand the whole word or message when a part is missing.

Auditory synthesis – the ability to merge or blend isolated phonemes into words which is critical to the reading process (c – a – t….Cat)

1996 ASHA Concensus Statement of APD (continued)

Auditory analysis – the ability to identify phonemes embedded in words. This is important for distinguishing verb tenses (worked vs. words) and other morphological markers that may be acoustically distorted or masked by background noise.

Auditory association – to identify the signal and associate it with its source or label a linguistic or non-linguistic sound or experience. This is a fundamental skills for developing auditory memory.

Auditory Memory – the recall of acoustic signal after it has been labeled, stored, and then recalled. This skill also requires remembering and recalling various acoustic stimuli of different length or number. Short-term memory is the ability to retain auditory information as immediately presented, and auditory sequential memory is the ability to recall the order of a series of details.

Developmental dyslexia. Specific reading disability, A.D.D., Autistic spectrum disorder, Specific language impairment, Pervasive developmental disorder, Developmental delay

Auditory processing - in the pediatric population

Diseased or injured central auditory nervous system <5%

Maturational delay 25-30%

Disorganized auditory processing system 65-70%

Prevalence – 2-5% of school age

population2:1 ratio of boys to girls Chermak & Musiek,

1997

Risk Factors for APD Neonatal:

Prematurity, Low Birth Weight, Bilirubinemia, Asphyxia

Extrinsic Brain Damage Meningitis, Encephalitis,

Lyme’s Disease, Head Trauma, Heavy Metal Exposure

Prenatal Drug Exposure

Postnatal Anoxia

Cerebrovascular Disorders (i.e. stroke)

Metabolic Disorders

Epilepsy

Identification - ClinicalBehavioral tests that

include a number of different types of stimuli : low redundancy, filtered speech, time-compressed speech, speech in noise, binaural fusion, dichotic tasks, temporal ordering and sequencing.

Advanced technology – objective electrophysiological measures of the central auditory nervous system i.e. ABR using middle latencies , late latency, and event-related responses (P300). Functional MRI’s.

A.P.D. Tests Appropriate for Younger ChildrenPI-PB Function with PBKsSCAN-CPediatric Speech Intelligibility (PSI) TestDichotic DigitsGIN (Gaps-In-Noise)SSW

Early indications of A.P.D. in children

Infancy and early childhood

Tune out – quiet, easy baby.

Not readily alert to voices.

Hypersensitive to sounds

Delayed speech/language

Preschool – Early Indications They enjoy nursery rhymes and

music but appear to have difficulty learning the words.

They have difficulty sitting for story time.

Require repetition of oral directions

Need tactile or visual cues to attend when spoken to. Can be over-focused on other visual activities (i.e. television)

Describes as “daydreamer” or as a “selective listener”.

Hypersensitive to sound and cover their ears often during play ground activities, fire drills, sport events, or birthday parties.

Difficulty expressing themselves – does not use appropriate language – wrong words, or mixes up the words in the sentence.

Early Indications - CAPDKindergartenDifficulty remembering letter

names.Difficulty distinguishing

between similar sounding phonemes ie. /p/ and /b/.

Difficulty with pre-reading skills – identifying the beginning, middle, and ending sounds of words i.e. “cat”../k/ /a/ /t/

Difficulty following longer and more linguistically complex oral directions.

Grade SchoolDifficulty hearing or

understanding announcements over the loud speakers, tape recorder, or telephones.

Misinterpret oral directions.Fail to master sound-symbol

relationships.Difficulty learning to readFrustration, lowering self

esteem. Inability to appreciate tonal

qualities and therefore often think people are mad, angry or don’t like them.

High School and BeyondTrouble hearing clearly when

it’s noisySometimes make silly

mistakes or careless errors. Miss important sounds or

signals that others hear easilyGet important messages

wrong.Forget instructionsHave difficulty knowing

“what to say when”Only get part of more

complex directions or lengthy explanation?

Remediation of A.P.D. Preferential seating so the child

can see the teacher as he or she speaks, see the board easily, and have some distance from distracting noises.

Reduction of noise, when possible, by use of acoustic ceiling tile, sot furniture, wall panels, and so on.

Assistive Listening Devices – amplification systems that amply the teacher’s voice over ambient noise levels in the room.

Auditory therapy – Fast ForWord, Brain Fitness, and others. The key to the program is that it must be “research based, systematic, challenge the system, and progress in difficulty”.

Speech/language therapy – Expressive/receptive language deficits – impacting on their ability to process speech.

Multisensory reading programs – Orton Gillingham, Wilson, Lindamood-Bell

Management of A.P.D. Management techniques are classified into

three categories: Compensatory strategies Optimal changes in the listening environment, Specific training of auditory skills

Chermak, Musiek, Hall (2000) have writtenextensively on various techniques and procedure forclinical modifications for children diagnosed withA.P.D.

General Principles of A.P.D. ManagementInterdisciplinary – neurologists, psychologists,

developmental pediatricians, nutritionists, speech pathologists, occupational therapists, physical therapists

Management should not be generalized – “appropriate for all children” analyze the appropriateness of each suggestion for the specific child in question.

A comprehensive approach to management should include auditory stimulations designed to bring about functional changes within the nervous system.

Auditory Therapies Auditory training dates back to 6th century and was

initially used in cases of hearing loss. It was found not to improve pure-tone thresholds,

but instead improve speech perception. Modern auditory training is based on brain

plasticity. Research has provided evidence that AT can

enhance various auditory processes by reorganizing auditory neural substrates.

This theory has been supported by documentation of electrophysiologic changes in the brain following auditory therapy.

Auditory therapies must be challenging to the auditory system so as to trigger appropriate changes in structure and function. Tasks that are too easy or too difficult will not yield the type of improvement that can result from tasks of moderate difficulty that progress over time.

How to measure success Input from various specialists

Psychologists, Speech pathologists, Occupational therapists, Learning support specialists Parents

Measuring the patient’s auditory deficits and how that deficit relates to functional difficulties and behavioral outcomes, helps to see the “bigger picture” before and after therapy.

Testing should include Standardized testing Questionnaires PET Scans ABR’s Functional MRI’s

Snap Shot of APD

Slower Processing

Working Memory Deficits

Cocktail Party Effect

Short term working memory

How do we use working memory? › Socially› Academically› Professionally

Living with poor working memory is like running many software programs simultaneously on a computer with little random access memory (RAM) it would be slow, frustrating, and very inefficient.

Brain Exercises – Can they really help?

Stanford University School of Medicine Associate Professor and expert on longevity and robust aging - - Dr. Walter Bortz II

"There is research that justifies the belief that games can aid the brain's health”

10 Questions to Choose the Right Brain Fitness Program

Based upon Scientific Research?

1. Are there scientists and a scientific advisory board behind the program?

2. Are there published peer-reviewed scientific papers written by those scientists? How many?

www.ncbi.nlm.nih.gov/entrez is a service of the U.S. National Library of Medicine that includes millions of citations science journals. If a scientist has not published a paper that appears in that database, he or she cannot make scientific claims.

Measurable Claims and Benefits?

3. What are the specific benefits claimed for using this program?

4. Does the program tell me what part of the brain or which cognitive skill I am exercising and is there an independent assessment to measure progress?

5. Is it a structured program with guidance on how many hours per week and days per week to use it?

10 Questions to Choose the Right Brain Fitness Program for youEnsures Cross-Training6. Do the exercises vary and teach

something new?Is it Exercise or Entertainment? 7. Does the program challenge and motivate the person, or does it feel like it would become easy once learned?Good Fit for Me? 8. Does the program fit the person’s personal goals?

9. Does the program fit their lifestyle

10. Is the person ready and willing to do the program or would it be too stressful?

Why Computers?Easy to administer – Little computer knowledge

necessary (point and click)Delivers stimuli accuratelyTracks performance gainsAdjusts task difficulty in

accordance with each user’s progress

Structured exercises which increase in complexity - challenge and motivate the brain to create neurologic changes.

Computer Treatment Options with Good Promise

COGMED Fast ForWord

Language Brain Fitness In-Sight Interactive

Metronome

Important Factors of Brain ExerciseMust motivate and engage – focused

attentionChallenge and adaptMust be intensiveMust cross train – involve multiple regions of

the brain driving multiple cognitive functions.

What happens in the brain?When the brain is presented with novel

stimuli - Requires greater mental effort, Increase in focus and thought - Brain cells gradually increase their activity. New connections are created Cells generate more Nerve Growth FactorsIncrease in brain alertness and performance.

Symptoms of normal brain agingDifficulty recalling a word

or nameTrouble understanding the

“jabbering” of a child or the “mumbled” conversation of a friend when in background noise.

Difficulty remembering verbal instructions

Slower mental processingKeeping up with quick

firing speech

Growing Older The growing prevalence of Alzheimer's has

also heightened anxiety about mental acuteness.

According to researchers at the Johns Hopkins Bloomberg School of Public Health in Maryland, one in 85 people worldwide will have Alzheimer's by 2050.

The Aging BrainCognitive abilities - processing speed, memory

and reasoning start to decline in our late 20’s. The brain’s white matter begins to degrade

around age 50.After the age of 60 your brain shrinks - .5 percent

to 1 percent of its volume each year As we age we get better at dealing with the

familiar, but worse at dealing with the new.Find yourself more forgetful It becomes more difficult to process and respond

to information You have more difficulty reasoning your way

through a problem.

Older BrainsLack of exercise Gradual neglect and atrophy

of the brain’s attentional system and nucleus basalis.

Atrophy leads to poor representation of oral speech (words sound fuzzy).

Muddy in muddy outDifficulty hearing,

remembering an finding words

Less engaged in learning and acquiring new skills and abilities

We rarely engage in tasks which require the same focus and attention as we did when we were students

Re-Stimulating plasticity in AdultsConditions for

Neural Plasticity in Adults: The first condition

is highly focused attention.

The second is reward or satisfaction, which can come from novelty, pleasure, or a sense of achievement.

Brain Fitness Program Mayo Clinic - 487 healthy

adults over 65 Published in The Journal of the

American Geriatrics Society. The largest study ever on aging

and cognitive training done using a commercial product

Participants who used the Brain Fitness Program, on average, more than doubled their processing speed, improved their memory and attention by about 10 years, and noticed significant changes in their every day lives

Impact Study – Posit Science 40 hours over the course of eight

weeks improved their memory and attention

by about 10 years— improvements in remembering names

they heard spoken and understanding conversations in noisy settings.

Half the volunteers did the six Brain Fitness exercises, which involve listening for finer and finer auditory distinctions, and half watched an educational DVD.

exercises based on neuroplasticity (the brain’s power to alter its structure and function in response to certain inputs) can produce lasting mental benefits.

volunteers improved on mental skills that the exercises did not specifically target, namely memory and attention

Paula Tallal5 – 10% of preschool children

have a language disability that makes it difficult for them to read, write or follow instructions.

Research - children with language disabilities have auditory processing problems with the fast components of speech (consonant-vowel pa/ba).

Difficulty hearing/processing these sounds results in difficulty reproducing them accurately (“Muddy in – Muddy out)

Merzenich and TallalTallal’s research - Children with language disabilities have

auditory processing problems – Difficulty understanding the fast parts of speech. Merzenich believed these children had neurons in their

auditory cortex which were firing too slowly. Normally neurons after they have processed a sound are ready to fire again after about a 30 millisecond rest.

Neuron firing patterns were examined - they weren’t firing rapidly enough – their signals weren’t clear.

Muddy in, muddy out!

Merzenich and TallalDifficulties in processing leads to weaknesses in all

language tasks: vocabulary, comprehension, speech, reading and writing.

In 1996 Merzenich, Tallal, Jenkins and Miller formed a company called Scientific Learning – devoted to using neuroplastic research to help people rewire their brains.

Fast ForWord – training program developed for language-impaired and learning disabled children. The program exercises every basic brain function involved in language from decoding sounds up to comprehension (cerebral cross training).

Neural deficits in children with dyslexia ameliorated by behavioral remediation: Evidence from functional MRI: Proceedings of the National Academy of Sciences, USA, 100 (5): 2860 -65

Fast ForWord StudiesFirst study – published in

Science in January 1996 –FFW group made significant progress on speech, language auditory processing and followed 6 weeks later gains remained.

Study followed 500 children at 35 different sites.

Gains of 1.8 years of language development

in six weeks.

Results of StudyExperimental group trained for 1 hour 40 minutes/day, 5

days/week, and participated an average of 39 days. Before participation, language comprehension performance for

both groups of students was at approximately the 12th percentile.

At the end of the treatment period, Control group’s performance was at the 21st percentile,

Training group’s performance was at the 49th percentile. The number of children performing at or above the median in

age-corrected language comprehension improved Trained group from 11.3% to 39.3% Control group - 11.9% to 14.8%

The above changes were found to be statistically significant, and greater for the Fast ForWord group than the control group.

Fast ForWord SoftwareImproves memoryImproves attentionStrengthens processing rateDevelops sequencing

How New Technology HelpsWhen the acoustic differences of these two consonants are stretched to 80 msec., children with language problems begin to perceive the difference.

0 2500

1000

2000

3000

4000

0Time (milliseconds)

/ba/

8080

/da/

250

Animated Exercises…Develop the brain through

Frequency (20-40 instructional sessions)Intensity (30-90 minutes a day)Adaptivity (adjusting to every key stroke)Motivation (a token economy)

Improved Language Scores – P.D.D.Children diagnosed with

Pervasive Developmental Disorders (PDD) made significant gains in their oral language skills after using the Fast ForWord Language product. One-third of the children were diagnosed with Pervasive Developmental Disorder- autism, two-thirds were diagnosed with Pervasive Developmental Disorder- not otherwise specified. The improvements seen for the two diagnoses were similar

Brain Imaging- Dyslexic Brains – Improved Fluency Stanford University, CA Brain imaging scans of

children with dyslexia who used the Fast ForWord Language product showed normalization of activity in critical areas of the brain used for reading. Furthermore, this group of students showed significant improvements in reading and oral language skills on a number of assessments.

Interactive Metronome Overview

Stanley Greenspan, M.D. - Chairman of the Interactive Metronome Multidisciplinary Scientific Advisory Board.

Greenspan is the first prominent scientist to recognize and acknowledge the broad scale potential of IM.

He led the company to implement highly credible research processes to scientifically understand, develop and validate the Interactive Metronome's intervention capabilities.

Studies show correlation between motor timing and improved reading, attention, motor coordination, language processing, and control of aggression/impulsivity.

Exercises Auditory Motor Processing – complex task involving many structures of the brain

Interactive Metronome

Evidence-basedObjectiveFlexibleEngaging

Slide 87

IM FeaturesReference toneGuide soundsVisual guidanceInteractive exercisesObjective millisecond

data

Slide 88

IM Assessment Analysis

Compare IM scores to Indicator Chart Timing tendencyPerformance breakdowns

Sensory Motor Behavioral Cognitive Stamina

Slide 89

:TIMING IS THE FOUNDATION TO LEARNING

IM…

Slide 90

IM…

Scalar Timing Theory ; Mauk & Buonomano (2004)

Our brains measure time continuously! – Circadian Rhythms – 24 hour oscillationsSecond processing – conscious thoughts on what to do next Millisecond level – do it without thinking Microsecond processing – speech processing and motor coordination -

IM Impacts Mental/Interval Timing Structures of the Brain

Dorso-Lateral Pre-Frontal CortexBasal GangliaCingulate GyrusCerebellum

Slide 91

Neuro-imaging StudyPresented at 65th Annual American PM&R Conference

Slide 92

MEDIAL BRAINSTEM

Neuro-Motor Pipeline

BASAL GANGLIA

Integrates Thought and Movement

CINGULATE GYRUS

Allows Shifting of Attention

Cognitive Flexibility

Alpiner (2004). Results from this pilot fMRI study show IM directly activates multiple parts of the

“neuro-network.”

Cross Training of the Brain “You cannot have

plasticity in isolation…it’s an absolute impossibility.

If one brain system changes, those systems connected to it change as well

Interactive Metronome improves the brain’s efficiency and performance

By improving: Auditory Processing Short Term Memory Working Memory Processing Speed Cognitive Resources Executive Functions Motor Coordination Sensory Processing

Slide 94

Key DiagnosesDevelopmental

Delay/DisordersLearning DisabilityDyslexiaNonverbal Learning

DisorderApraxia ADD/ADHD Auditory/Language

Processing Disorders

Autism/PDD Sensory Processing

DisordersCerebral PalsyFetal Alcohol SyndromeStroke/Brain InjuryParkinson’sMSLimb AmputationAnd more…

Slide 95

ADHD StudyEffect of Interactive Metronome Training on Children with ADHD.The American Journal Of Occupational Therapy

First study to use IM as a treatment intervention to improve timing -

Schaffer et al., (2001) 56 boys, age 9-12 3 Groups

Treatment – 15 hours of treatment Video Game (Placebo) Control (no treatment)

Slide 96

ADHD StudyEffect of Interactive Metronome Training on Children with ADHD.The American Journal Of Occupational Therapy

Statistically significant improvement across 53 of the 58 variables:Motor control and

coordinationAttentionProcessing speedConsistency of responsesLanguage processing ReadingDecrease in aggressive

behavior

Slide 97

ADHD StudyEffect of Interactive Metronome Training on Children with ADHD.The American Journal Of Occupational Therapy

Language Processing Test Similarities

Pre and Post Test Differences

2.666

9.316

-1

-2

0

2

4

6

8

10

Control Placebo IM

Sim

ilari

ties

(St

anda

rd

Scor

e)

Slide 98

Interaction Effect = 0.005

Academic Fluency StudyJacokes (2004) 1500 middle and high school students 20 different schools Completed 12 sessions of IM Participated in pre & post-testing via WJ-III

Reading fluency Math fluency Cognitive processing speed

Significant increase in grade equivalent performance Overall gain in both reading and math fluency with a

2.5 year improvement in cognitive processing skills.

Slide 99

Academic Fluency Study

12.46

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Slide 100

2.21 GE Gain in Reading Fluency 1.66 GE Gain in Math Fluency

2.21 GE gain, n=718, Woodcock Johnson, 3rd Ed. 1.66 GE gain, n=703, Woodcock Johnson, 3rd Ed.

Slide 101

Taub et al (2007)- Psychology in the Schools

Cognitive improvements after 12 sessions of IM:

Sustained attention over timeAbility to tune out distractions and multi-taskWorking memoryImpulse-control and self-monitoringMental processing speedExecutive functions (meta-cognition)Academic achievement

According to CHC Theory, these improvements likely result from a more efficient mental clock (faster processing) after IM.

Drs. Taub, McGrew and Keith studied the impact of IM on academic achievement. They believe IM is impacting the timing structures of the brain and that IM is currently the ONLY intervention that works on both mental and interval timing.

Cognitive-Behavioral Outcomesof Interactive Metronome

Harvard Learning & The BrainPresented by Taub, McGrew & Keith (2005)

General Findings3-4 weeks of IM treatment 7% to 20% gain in reading/math achievementEffect was larger in the elementary-aged children

(18-20% gain)Developmental Growth Curve

Little academic growth takes place over short periods of time in children averaging 15.5 years of age

Slide 102

Edward TaubEdward Taub has shown that paralysis

caused by strokes, cerebral palsy, multiple sclerosis and brain trauma can be significantly improved using the Interactive Metronome – a brain exercise that reorganizes the brain to work around dead tissue. In some cases, disabilities in place for as long as 50 years can be reversed

Auditory Processing Pilot StudyEtra (2006)Applied Dissertation, Nova Southeastern University

8 children, 15 hours of IM training

SCAN-C 1. Filtered Words2. Auditory Figure-Ground3. Competing Words (dichotic listening)

4. Competing Sentences (dichotic listening)

Statistically significant gains All subtests Greatest Gains subtests 3 & 4

Strongly suggests IM affects auditory processing disorders by influencing neurological organization.

Slide 104

Research Continues & Takes Two Divergent Paths

Cognitive Attention/Concentration Language Processing Academic Fluency

Motor Fine & Gross Motor Skills Balance Gait

Slide 105

Ongoing Research

Drexel University: Durability & GeneralizationUniversity of Rochester: Visual AttentionUniversity of Cincinnati: Hemiplegic ArmMedical College of Georgia: Parkinson’s DiseaseVeterans Administration: Cognitive, Behavioral & Motor Skills

(unimpaired & veterans with blast injuries)Walter Reed Army Medical Center: PTSD, Sleep, Cognition

Slide 106

Internal ClockOn-going ResearchParkinson’s, ADHD, Reading disorders, Dyslexia, Schizophrenia,

Speech and Language Disorders, Autism www.sharpbrains.com

 Tic Toc Talk: The IQ Brain Clock Blog www.ticktockbraintalk.blogspot.com IQ Brain Clock Evolving Web of Knowledge - Map http://www.iapsych.com/iqclock2/map.htm IQ’s Corner: Intelligent Insights on Intelligence Theories & Tests www.intelligencetesting.blogspot.com

Slide 107

Myth 1: It’s all in our genes.Reality: A big component of our lifelong brain health and development depends on what we do with our brains. Environment plays 80% of a role while genes are only 20% responsible. Genes predispose us, not determine our fates.•Individuals who lead mentally stimulating lives, through education, occupation and leisure activities, have reduced risk of developing Alzheimer’s. Studies suggest that they have 35-40% less risk of manifesting the disease” - Dr. Yaakov Stern, Division Leader of the Cognitive Neuroscience Division of the Sergievsky Center at Columbia University.

Myth 2: The field of Cognitive/ Brain Fitness is too new to be credible. Reality: The field rests on solid foundations dating back decades --- what is new is the number and range of tools that are now starting to be available for healthy individuals.• “Rigorous and targeted cognitive training has been used in clinical practice for many years. Exercising our brains systematically is as important as exercising our bodies.” - Dr. Elkhonon Goldberg, neuropsychologist, clinical professor of neurology at New York University School of Medicine, and disciple of Alexander Luria.• "Today, thanks to fMRI and other neuroimaging techniques, we are starting to understand the impact our actions can have on specific parts of the brain." - Dr. Judith Beck, Director of the Beck Institute for Cognitive Therapy and Research.

Myth 3: Medication is and will remain the only evidence-based intervention for a number of brain-related problems.Reality: Cognitive training programs are starting to show value as complements to drug-based interventions.• “Cognitive training rests on solid premises, and some programs already have very promising research results"- Professor David Rabiner, Senior Research Scientist and Director of Psychology and Neuroscience Undergraduate Studies at Duke University.

Myth 4: We need to buy very expensive stuff to improve our brains. Reality: Every time we learn a new skill, concept or fact, we change the physical composition of our brains. Lifelong learning means lifelong neuroplasticity. • “Learning is physical. Learning means the modification, growth, and pruning of our neurons, connections–called synapses– and neuronal networks, through experience...we are cultivating our own neuronal networks.” - Dr. James Zull, Professor of Biology and Biochemistry at Case Western University,

Myth 5: Schools should just focus on basic skills like Reading and Math. Reality: “Mental muscles,” such as working memory, are fundamental to academic performance and are currently overlooked by the school system.• “I don't see that schools are applying the best knowledge of how minds work. Schools should be the best place for applied neuroscience, taking the latest advances in cognitive research and applying it to the job of educating minds.” - Dr. Arthur Lavin, Associate Clinical Professor of Pediatrics at Case Western School of Medicine.

Myth 6: On-the-job training is the only way to train one's mind. Reality: Computer-based programs can be more effective at training specific cognitive skills.• “What research has shown is that cognition, or what we call thinking and performance, is really a set of skills that we can train systematically. And that computer-based cognitive trainers or “cognitive simulations” are the most effective and efficient way to do so.” - Dr. Daniel Gopher, Professor of Human Factors Engineering at Technion Institute of Science.

Myth 7: Brain exercise is only for seniors. And, only about memory. Reality: People of all ages can benefit from a variety of regular brain exercises. For active professionals, managing stress and emotions is often a good first step.• “It is important to understand the role of emotions: they are not “bad”. They are very useful signals. It is important to become aware of them to avoid being engulfed by them, and learn how to manage them.” - Dr. Steenbarger, Associate Professor of Behavioral Sciences at SUNY Upstate Medical University, and author of the book Enhancing Trader Performance.

Myth 8: This all sounds too soft to be of real value to managers and professionals. Reality: There is nothing soft about the hard science-based training of specific cognitive and emotional skills.• “I can easily see the relevance in highly competitive fields, such as professional sports and military training.” - Dr. Bradley Gibson, Director of the Perception and Attention Lab at University of Notre Dame.

Myth 9: Videogames are always a waste of time. Reality: Scientifically-designed, computer-based programs can be a good vehicle for training specific skills. For example, it has been shown that short term memory can be expanded by such programs.• “We have shown that working memory can be improved by training.” – Dr. Torkel Klingberg, Director of the Developmental Cognitive Neuroscience Lab at Karolinska Institute.

Myth 10: This means kids will spend more time playing videogames. Reality: In Japan – the world’s earliest adopter of brain-related videogames- overall home videogame sales have declined, with children playing less over time. Interestingly, adults in Japan have started to play brain-related video games more, and we are starting to see the same trend with adults in the US and Europe.

Books to Read“The Brain that Changes Itself” – Norman

Doidge“A Stroke of Insight” - Dr. Jill Bolte Taylor “Welcome to Your Brain” by Sandra Aamodt. “Aging with Grace” by David Snowden “The Overflowing Brain” – Torkel Klingberg, “Delivered from Distraction” – Edward

Hallowell, M.D.

Dr. Lorraine Sgarlato Inducci, Au.D.Robert Wood Johnson Hospital,

Hamilton, NJMy Brain Wellness Center, Yardley,

PA