Research on Interactive Metronome

Mental Timing
Did you know that your brain has an “internal clock” that keeps time? And that it does so at various intervals: microseconds, milliseconds, seconds, minutes, and hours? Timing in the brain (or what scientists call “temporal processing”) is responsible for detecting where a sound is coming from as sound hits one hear microseconds before the other, for waking up and putting to sleep our brain every 12 hours or so, and for focusing attention, reading comprehension, remembering information, processing speech and motor coordination (millisecond timing). This information comes from a paper titled The Neural Basis of Temporal Processing by Mauk & Buonomano (2004), probably my favorite paper on human timing. Having used Interactive Metronome (IM) in a rehabilitation setting for individuals with traumatic brain injury, stroke, and other neurological disorders for several years and now in the capacity as the Clinical Education Director for Interactive Metronome where I speak to other IM providers regularly, I often see the tremendous impact of IM training on persons with a variety of developmental and acquired disorders. This study really helps us to understand why timing in the brain is so important to all of the skills we address in our therapies (speech, language, cognition, behavior, vision, motor skills, and sensory processing). I strongly encourage you to read it. It will help you understand that timing is at the heart of virtually all we do.

Mauk, M.D. & Buonomano, D.V. (2004). The neural basis of temporal processing. Annual Review of Neuroscience, 27, 307-340.

  • There is a definite trend we see among individuals who undergo Interactive Metronome (IM) training, a program that improves timing in the brain or what is known as “temporal processing.” They typically demonstrate improved motor coordination and ability to focus. Most also experience other benefits like improved reading comprehension and fluency, less aggression and better self-control, more legible handwriting, etc. This study may help us understand why we typically see improvement in BOTH cognitive and motor skills once timing skills are improved. Rubia & Smith (2004) show with fMRI that both motor timing and the timing associated with cognitive abilities are controlled by the same regions of the brain, “suggesting that both functions are probably inseparable and mediated by common neural networks.” This is a good read for anyone interested in learning more about the specific brain structures and “networks” involved in human timing and their relation to cognitive and motor skills. In many conditions, like ADHD, Autism, Dyslexia, Parkinson’s, Traumatic Brain Injury, Stroke, …we see that the person’s ability to achieve and be more independent is impacted by deficits in BOTH cognitive and motor skills. Interactive Metronome, a patented treatment modality commonly used in therapy for these conditions, is the only program that addresses both of these skills simultaneously.

Rubia, K. & Smith, A. (2004). The neural correlates of cognitive time management: A review. Acta Neurobiologiae Experimentalis, 64, 329-340.

  • These statements were made by Lewis & Walsh (2005), prominent neuroscientists who study timing in the brain. “Our brains measure time continuously. We are aware of how long we have been doing a particular thing, how long it has been since we last slept, and how long it will be until lunch or dinner. We are ready, at any moment, to make complex movements requiring muscle coordination with microsecond accuracy, or to decode temporally complex auditory signals in the form of speech or music. Our timing abilities are impressive, diverse and worthy of investigation. But they are not very well understood.” In this paper entitled, Time Perception: Components of the Brain’s Clock, they briefly outline the problems with identifying the exact mechanism for human time estimation. “Regardless of their diversity, the models [or theories about timing in the brain] all agree that temporal information is processed in many ways: it is remembered, compared to other temporal information, combined with sensory information, and used in the production of motor outputs.” While we wait for neuroscientists to refine their methodology and identify the holy grail of mental timing, we don’t have to wait before we introduce the concept of timing into habilitation & rehabilitation programs for individuals with developmental disorders, acquired brain injury from TBI or stroke, or certain degenerative diseases. There exists a growing body of literature describing the neural timing deficits in ADHD, Dyslexia, Autism, Reading Disorders, Auditory Processing Disorder, Parkinson’s, and Huntington’s. By addressing timing in the brain with Interactive Metronome (IM) alongside functional therapy interventions you are not only addressing areas of ability that impact achievement and independence but also the heart of the problem, that of deficient timing. This can only lead to more efficient treatment and better overall outcome.

Lewis, P.A. & Walsh, V. (2005). Time perception: Components of the brain’s clock. Current Biology, 15(10), R389-R391.
I like this description about timing in the brain by Dr. Penny Lewis (2006). “Time measurement [in the brain] is fundamental to almost everything we do: music and speech, for instance, are just time-coded variations in sound, and movements are carefully timed contractions of muscles. We perceive our lives as a flow of events in time, and plan our futures in the same way. If our timing system gets damaged, as it does in patients with Parkinson’s Disease, Schizophrenia, and certain types of brain injury, all of these abilities can be impaired.” Did you realize that mental timing was so important? Why do we still conduct therapies without incorporating timing and rhythm? Certainly, after review of the ever-growing body of research demonstrating its importance, we now know how important timing is to speech, language, cognition, and motor skills. Surely, we will begin to incorporate the foundational skill of timing more and more into our interventions for children and adults who are seeking greater achievement, independence, and quality of life. Interactive Metronome (IM) is a patented treatment tool for doing just that. It has been successfully used with individuals of all ages, from early intervention with infants to treat hemiplegia, sensory, communication/language, and cognitive skills to geriatric patients with aphasia, decreased independence with self-care and basic ADLs, cognitive impairments that affect safety judgment, and increased fall risk.

Lewis, P.A. (2006). Emotion, memory, and the perception of time. The University of Liverpool. Unpublished white paper.

  • Scientists agree that our brain contains a “clock,” or at least one, maybe more than one. What they can’t precisely agree on, but generally seem to understand each other’s viewpoints on, is the central location of the ticker… Is it in the basal ganglia, the striatum, the dorsolateral prefrontal cortex, the cerebellum??? There are good arguments for each location, … perhaps they are all involved and work in a “network” of sorts or perhaps they are all individual clocks that keep time in our brain for various different functions … processing speech or music, coordinating movements, paying attention, etc. Dr. Penny Lewis, in this 2002 article titled Finding the Timer, discusses new and important research by Constantinidis et al. (2002) that may help shed more light on the location and mechanism for mental timing. Of course, more research has been published since then, but are we any closer to knowing?? Fortunately, we don’t have to know the exact location of the ticker to know how important it is or that we professionals absolutely must assess and treat timing in the brain just as we do the various skills that are controlled by timing in the brain!! Interactive Metronome is an assessment and treatment tool that measures timing in the brain and improves it. It is flexible and is ideally administered alongside other functional interventions to build and strengthen abilities.

Lewis, P.A. (2002). Finding the timer. Trends in Cognitive Sciences, 6(5), 195-196.

  • Here is another study, one of MANY, that show a clear relationship between working memory and timing in the brain (Fortin et al., 2007). Essentially, if timing in the brain is disrupted, then working memory does not work very efficiently or effectively leading to a host of problems at home, school, work, and play. If you’ve been searching the Internet for a program or treatment to address school performance, a developmental delay or disorder, or overall brain fitness, then you’ve surely seen all the buzz about the importance of working memory for cognitive performance. Given the importance of timing in the brain for working memory, and thus cognitive performance, it is critical to assess timing in the brain to see if that is the root of the problem. Interactive Metronome is a patented program that both assesses and improves timing in the brain, providing measurable scores each step of the way. Persons may then derive more benefit from the various cognitive fitness programs available once his/her brain is focusing, processing information, and utilizing cognitive resources like working memory more efficiently and effectively.

Fortin, C., Champagnea, J, and Poirier, M. (2007). Temporal order in memory and interval timing: An interference analysis. Acta Psychologica, 126(1), 18-33.

  • Here is another favorite of mine when it comes to papers describing the human clock system, How Do We Tell Time? (Buonomano & Karmarker, 2002). It is easy to read, a huge bonus (you know what I mean if you have been following this stuff!!!), and goes into detail about the various levels of timing in the brain: microseconds, milliseconds, seconds, circadian rhythms… The authors also discuss the various theories that abound such as whether we have a distributed network of clocks or whether there is one central clock that does it all. All??? Right, the brain clock is intimately involved in our abilities to do the following: understand and produce intelligible speech (articulation, phonological processing disorders), read and write, organize our thoughts and communicate our ideas clearly and concisely (like I am doing!), attend to task, switch attention from one thing to another, multitask (mothers, you know what this one is!), sequence the steps to perform everyday tasks, listen to a class lecture and take notes, remember and learn new information, reach for a glass of water without knocking it over, walk with good speed, symmetry, and balance, and on and on… You might be asking by now, “What is wrong with my clock, with my child’s clock, with my significant other’s clock??” as you or they may be displaying difficulty with some of the skills I just described. The brain’s clock can be disrupted (and the synchronicity of it can be out of whack) when there is a problem with childhood development (ADHD, Autism, Dyslexia…), injury to the brain (Traumatic Brain Injury, Stroke, Aneurysm…), or disease (Schizophrenia, Parkinson’s, Huntington’s…). The Interactive Metronome is a patented, flexible program that improves timing and synchronization in the brain. Professionals can easily incorporate IM training into treatment for speech, language, cognition, and motor skills (i.e., professionals in Speech & Language Therapy, Cognitive Rehabilitation, Physical Therapy, Occupational Therapy, Psychology Services, etc).

Buonomano, D.V. & Karmarker, U.R. (2002). How do we tell time? Neuroscientist, 8(42), 42-51.

  • In this 2004 issue of Trends in Cognitive Sciences, Nobre & O’Reilly comment on an important research study by Coull et al. (2004) that showed involvement of the fronto-striatal loop in mental timing-related cognitive and motor functions. This area of the brain has been implicated in the skills of sequencing, attention-shifting and decision-making, particularly under time-pressure, as well as the planning and sequencing of motor movements. Here is yet another connection between thinking and motor skills…they appear to share at least some of the same neural circuitry. Perhaps this, at least in part, explains why the overwhelming majority of individuals who complete Interactive Metronome (IM) training typically demonstrate improvement in BOTH cognitive and motor skills. IM training involves synchronizing the body to move to a steady beat. Immediate feedback is provided (audio, visual, or both) to help the individual improve their overall mental and physical timing skills that form the basis for speech, language, thinking, behavior, and coordinated movement.

Nobre, A.C. & O’Reilly, J. (2004). Time is of the essence. Trends in Cognitive Sciences, 8(9), 387-389.
Here is a novel research idea. Rao et al. (2001) examined the various areas of the brain known to be involved in mental timing under fMRI during a time-perception task to see how timing in the brain unfolded in a sequential way. For example, they noticed that the basal ganglia lit up first and that it was uniquely associated with encoding time intervals. Also engaged early in the process were other parts of the neural timing network responsible for attention and temporary maintenance (or recall if you will) of time intervals in memory. Later in the process, as the brain compared current timing information to that from memory (is this the same, more, or less amount of time?), the right dorsolateral prefrontal cortex was activated. Also, late to activate was the cerebellum. “Our results illustrate a dynamic network of cortical-subcortical activation associated with different components of temporal information processing.” What does this mean? Areas of the brain known to be involved in attention, memory/learning, and motor skills are part of this brain network for timing. Timing in the brain, in turn, determines how well a person can focus, learn, and move. Interactive Metronome is a patented training program that improves timing in the brain through a series of mind-body exercises that require a person to move to a steady beat. Most critically, immediate feedback is provided after each movement to help a person know how far off the beat (s)he is and make corrections to improve timing & rhythm. Improvement in focus, memory, reading, and motor skills occurs as a result of improved mental timing skills.

Rao, S.M., Mayer, A.R., and Harrington, D.L. (2001). The evolution of brain activation during temporal processing. Nature Neuroscience, 4(3), 317-323.

Motor Skills

  • Temporal processing (or the timing of neural oscillations/transmissions) plays a critical role in coordinated motor movement. In this paper published in Science, the authors distinguish between “continuous” motor tasks, which involves moving steadily and smoothly at a certain pace, versus “discontinuous” motor tasks, which involve a succession of stops and starts as a person accomplishes each step of an overall goal (i.e., picking up a plate, walking it over to the table, and setting it down). They discuss the role of the cerebellum in each of these types of motor tasks and how the timing control for each differs in terms of the brain structures used, arguing that the cerebellum is involved only early on in setting the timing goal for continuous, smooth movements, but that the cerebellum is involved throughout the movement when it is discontinuous or involves several starts and stops by setting several, successive timing goals. Timing in the brain may be disrupted due to developmental disorder, trauma, or illness resulting in uncoordinated movement and/or cognitive impairment. The Interactive Metronome is a treatment program that measures and improves temporal processing, or timing in the brain, that is critical for movement and thinking.

Spencer, R.M.C., Zelaznik, H.N., Diedrichsen, J., and Ivry, R.B. (2003). Disrupted timing of discontinuous but not continuous movements by cerebellar lesions. Science, 300(5624), 1437-1442.

  • Here is a fascinating study in Cortex that looked at the brain under fMRI while listening to rhythmic auditory sounds. Bengtsson et al (2009) found that areas of the brain involved in motor planning and sequencing (or preparing motor sequences) were activated while listening to rhythmic sound. Interactive Metronome (IM) training improves motor planning and sequencing (and thus motor coordination) through a series of progressive exercises that are synchronized to a steady auditory rhythm. As the person performs each distinct movement, audio and/or visual feedback is provided in milliseconds to improve “temporal processing” for fine and gross motor coordination.

Bengtsson, S.L., Ullen, F., Ehrsson, H.H., Hashimoto, T., Kito, T., Naito, E., Forssberg, H., and Sadato, N. (2009). Listening to rhythms activates motor and premotor cortices. Cortex, 45, 62-71.

  • Most of the motor movements involving our arms and hands are bilateral, meaning they involve using both limbs together in a coordinated fashion. Examples given in this paper are: typing, using a fork and knife, and buttoning a shirt. In this article by Ivry et al (2004), the authors go into significant detail about how the two sides of the brain work together to make this possible. They discuss timing in the brain and show how thinking and movement work in tandem for coordinated motor movement. Interactive Metronome is a unique training tool that challenges thinking and movement simultaneously as the individual synchronizes movements with a steady auditory rhythm. Feedback regarding how close to or how far away from the beat is provided following each individual movement to help the individual refine his/her motor skills. Research has shown that listening to rhythmic sound activates the centers of the brain involved in coordinated motor planning and sequencing.

Ivry, R., Diedrichsen, J., Spencer, R., Hazeltine, E., and Semien, A. (2004). A cognitive neuroscience perspectivce on bimanual coordination and interference. In S.P. Swinnen & J. Duysens (Eds.), Neuro-Behavioral Determinants of Interlimb Coordination: A Multidisciplinary Approach (Chapter 9). New York: Springer Publishing.

  • In this study by Jantzen et al. (2007), the authors identified that timing in the brain for motor coordination relies upon a “network of brain areas engaged to meet the specific sensory, motor and cognitive demands of the associated coordination behavior.” While looking at the brain under fMRI during synchronous movement they were able to tease out regions of the brain involved in interval timing for motor activity and to show that information about timing from the environment (or context) influences internal timing for coordinated movement. Interactive Metronome training promotes synchronization within this neural network for more coordinated movement through a series of progressive exercises that are performed to a steady beat. Millisecond feedback for mental/interval timing is provided following each movement to help refine timing skills and coordination.

Jantzen, K.J., Oullier, O., Marshall, M., Steinberg, F.L., and Kelso, J.A.Ss. (2007). A parametric fMRI investigation of context effects on sensorimotor timing and coordination. Neuropsychologia, 45, 673-684.

  • Movement requires precise timing, especially that of athletes, musicians, and skilled workers. This article by Larue (2005) delves into the timing mechanisms within the brain that govern movement. What I particularly like about this paper is its readability as I am not a neuroscientist but am keenly interested in timing in the brain and the interplay between temporal processing, cognition, and coordinated movement. The author discusses unique versus multiple timing mechanisms, learning timing, the contribution of movement-related feedback to timing, the contribution of attention in the learning of timing, and other important topics relating to how timing in the brain determines the quality of movement. This article should be of particular interest to anyone who is familiar with or uses the Interactive Metronome in the habilitation or rehabilitation of motor skills. Timing & rhythm are essential to movement.

Larue, J. (2005). Initial learning of timing in combined serial movements and a no-movement situation. Music Perception, 22(3), 509-530.

  • This study by Lewis et al. (2004) shows that our brain learns then retains the temporal (or timing) information about particular movement sequences. Once the movement is over-learned (or repeated to the extent we can do it without thinking) we can continue the movement on “autopilot” so to speak. The relevance of the paper here is to point out, once again, that movement is governed by timing in the brain and that the brain can learn the temporal information necessary for coordinated movement. Interactive Metronome can be easily integrated into habilitation/rehabilitation programs to provide this learning opportunity through exercises requiring synchronization of movement with auditory rhythm (and of course, feedback for timing!).

Lewis, P.A., Wing, A.M., Pope, P.A. Praamstra, P., and Miall, R.C. (2004). Brain activity correlates differentially with increasing temporal complexity of rhythms during initialization, synchronization, and continuation phases of paced finger tapping. Neuropsychologia, 42(10), 1301-1312.

Processing Speed
Not only are researchers fascinated with the idea that humans possess an “internal clock” … the fact that it controls and regulates so many of our human abilities like our thinking (or processing) speed … but they are also very interested in seeing if they can manipulate the brain’s clock by speeding it up or slowing it down. Previous research has shown that repetitive stimulation has an effect on a person’s internal timing by either speeding it up or slowing it down, depending upon the goal and type of stimulation provided. This was again demonstrated in a study by Droit-Volet & Wearden (2002) where they provided repetitive stimulation to children of a variety of different ages to “speed up” their internal clock or ability to process information faster. In my experience with Interactive Metronome (IM), I have found that the repetitive auditory/visual stimulation of IM training has a very definite impact on processing speed. This has been repeatedly evident on standardized post-testing. Taub et al (2007) studied the effect of IM training on reading skills in elementary school children and proposed that the improvement seen in reading may be attributed to IM’s effect on “clock speed.” The repetitive stimulation of Interactive Metronome both synchronizes and increases the speed of our internal clock. This is important because current research in the field of “intelligence” and the neurosciences tells us that the faster our “internal clock” operates, the more we are able to reach our potential academically, professionally, socially, athletically…

Droit-Volet, S. & Wearden, J. (2002). Speeding up an internal clock in children? Effects of visual flicker on subjective duration. The Quarterly Journal of Experimental Psychology, 55B(3), 193-211.

  • Researchers have discovered that one way to further prove contemporary theory on human timing (i.e., scalar timing theory; pacemaker-accumulator model), is to manipulate “internal clock speed.” In other words, they seek to make the brain operate faster or slower by asking individuals to complete specific repeated activities that over time have the effect of slowing down the internal clock or speeding it up. Here is yet another study (Penton-Voak et al., 1996) where the authors proved that the pace of our internal clock or what is otherwise known as our ability to think faster can be sped up. The authors mention something important in that to increase our cognitive speed, the stimulation must be repetitive and must engage attention. Interactive Metronome is patented brain training program that provides the right combination to increase mental speed and fitness.

Penton-Voak, I.S., Edwards, H., Percival, A., and Wearden, J.H. (1996). Speeding up and internal clock in humans? Effects of click trains on subjective duration. Journal of Experimental Psychology, 22(3), 307-320.

  • Scalar expectancy theory (SET) is one of the most popular current models of human timing. This article contains one of the simplest explanations of SET that I have seen. Wearden (2008) suggests our brain keeps time via a pacemaker that starts pulsing at regular intervals as the brain receives information from the environment that is timed (i.e., when listening to someone speak). Speech contains many timed elements that must be separately interpreted and then integrated to distinguish between sounds, syllables, words and other information like intent of the speaker (serious? joking?). Each “pulse” is then collected by something called an “accumulator.” The authors discuss how the pacemaker is switched on and off, how the accumulator starts and stops collecting the timed information based on the switching on and off of the pacemaker, and about the reference memories for time (or # of pulses) that are kept in memory and accessed in order to make a final determination (i.e., in the example I gave earlier, the decision would be about what is heard …did he say “burst” or “birth?”). Additionally, Wearden provided further evidence that the pace or speed of the brain’s clock can be manipulated with specific activities that are repetitive and engage attention. The Interactive Metronome is a brain fitness tool that is used in the treatment of many developmental disorders, acquired brain injuries, progressive illnesses, and by those that are feeling the effect of aging or want an academic or athletic advantage. Through repetitive exercises aimed at synchronizing timing in the brain, individuals learn better focus, memory, and coordination.

Wearden, J.H. (2008). Slowing down an internal clock: Implications for accounts of performance on four timing tasks. The Quarterly Journal of Experimental Psychology, 61(2), 263-274.