1. Improving Visual Attention & Processing with Visual-Only IM
Presented by Amy Vega, MS, CCC-SLP, IM Clinical Education Director

2. Course Objectives
Identify patients who will benefit from use of visual-only IM to rehabilitate visual processing skills;
Demonstrate evidenced-based practice through appropriate use of objective assessments to measure visual-only IM treatment outcomes;
And demonstrate use of an appropriate IM treatment hierarchy to remediate visual processing skills.

3. In Search of a Remedy to Improve Outcomes
Highly specialized outpatient brain injury rehabilitation
Variable outcomes in visual attention & processing with IM as compared to auditory attention & processing
After IM treatment via combined auditory – visual modalities, impairments persisted in:
Visual attention
Cognitive speed during visual tasks
Executive functioning

4. Example of Auditory-Visual Performance Discrepancy after IM

5. Auditory: Pre & Post Test Comparison
PRE-TEST
Sustained attention
10th percentile
Attention – switching
<1st percentile
Selective attention
Divided attention
POST-TEST
Sustained attention
75th percentile
Attention – switching
50th percentile
Selective attention
Divided attention
35th percentile

6. Visual: Pre & Post Test Comparison
PRE-TEST
Sustained attention
5th percentile
Attention – switching
<1st percentile
Selective attention
Divided attention
POST-TEST
Sustained attention
9th percentile
Attention – switching
<1st percentile
Selective attention
Divided attention

7. Contributing Factors?
Reliance on stronger modality during IM (auditory)?
Not really engaging visual attention and processing?
Visual modality is more passive during IM in some patients?

8. A solution?
Improve timing & rhythm in better/preferred modality first (auditory)?
Then “force” use of visual modality by turning off the sound?
Measure outcomes to see if approach works.

9. Expected Outcomes Reading Safety Functional independence
Visual attention
Visual processing
Visual memory
Executive functioning

10. Supporting Research

11. Neuroplasticity Schwartz and Begley (2002)
The Mind and the Brain: Neuroplasticity and
the Power of Mental Force.
“A consistent factor in laboratory and clinical studies of neuroplasticity is that to obtain reorganization of the neural system, cognitive input must be present and many repetitions are required.

12. Role of Attention in Visual Processing
Vuilleumier & Driver (2007)
Modulation of visual processing by attention and emotion: windows on causal interactions between human brain regions.
Visual processing is not determined solely by retinal inputs.
The internal attentional state of the individual can
alter visual processing of the same stimuli. This can
influence visual cortex, boosting neural responses
to an attended stimulus.

13. Role of Attention in Visual Processing
Vision therapies focus on:
Perception
Tracking
Focus
Eye teaming

14. Role of Visual Attention in Reading
Solan, Larson, Shelley-Tremblay, Ficarra, & Silverman (2001)
Role of visual attention in cognitive control of oculomotor readiness in students with reading disabilities.
Eye movement therapy improved eye movements and also resulted in gains in reading comprehension. The results support the notion of a cognitive link among visual attention, oculomotor readiness, and reading comprehension.

15. Role of Visual Attention in Fall Prevention
Hyndman & Ashburn (2003) People with stroke living in the community: Attention deficits, balance, ADL ability and falls. Sustained and divided attention deficits correlated with functional impairments and falls, highlighting that attention deficits might contribute to accident prone behaviour and falling.

16. Candidacy for Visual-Only IM
DEFICITS MAY BE PRESENT IN:
Visual attention
Visual memory
Spatial orientation
Processing speed
Concentration
Executive functioning
DEFICITS MAY IMPACT:
Reading
Writing
Driving
Safety
Etc

17. Guidelines for Visual-Only IM First, combine auditory & visual modes
Guidelines for Visual-Only IM First, combine auditory & visual modes. Achieve best performance possible.
Patient hears the IM
…And patient sees the IM

18. Assessing Outcomes of Visual-Only IM
Woodcock-Johnson Tests of Cognitive Ability III
Test of Everyday Attention
Visual Object and Space Perception Battery
Bender® Visual-Motor Gestalt Test
Behavioral Inattention Test
Stroop Color & Word Test
Symbol Digit Modalities Test

19. Assessing Outcomes of Visual-Only IM
Trail Making Test – Parts A & B
Rey Complex Figure Test
Gray Oral Reading Test
Gray Silent Reading Test
Woodcock-Johnson Tests of Achievement
Boston Diagnostic Aphasia Exam – 3rd Edition
Nelson-Denny Reading Test

20. Critical Elements of IM
Timing stimulus (reference tone or center flash, a visually-based metronome stimulus)
Timed movements (IM exercises, other activities based on your creativity)
Feedback (guide sounds, visual mode, a visually- based guidance system)
Intensity (repetition, repetition, repetition)

21. And so much more…
Check out the full presentation for more great tips on using IM training for visual attention and processing.
Also included:
Extended Research
Sample Exercises
Case Studies
Parent testimonial

22. Check us out online.
If you are looking for CEUs, look no further than Interactive Metronome®.
We have an extensive catalog of over 100 webinars with topics on everything from autism to motor deficits to ensuring clinical profitability and success with IM.
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