Tag Archives: dyslexia

Interactive metronome treatment for ADHD/ADD; swing your arms about, cure your brain

Ian Dury. Because… any excuse.

One of the best things about starting this blog was several e-mails I got from like-minded people saying nice things, and often, pointing me towards interesting bits of neurobollocks that I wasn’t aware of. Such was a series of e-mails from Deborah Budding and Michael Thaut (who must be one of only a few people in the world who holds posts as Professor of Music, and Professor of Neuroscience – cool) about the ‘interactive metronome’ technique. Michael’s research (unsurprisingly) focuses on the interplay between the brain and music, and in particular, the processing of temporal information as it relates to rhythmicity, so it’s probably fair to say he certainly knows his way around a metronome.

But what’s this interactive metronome business? Well, as you can see in this video on the hypochondriac’s website of choice (WebMD), it’s basically waving your arms about and moving your feet in time to a regular beat. So, it’s basically dancing then, but much more boring.

Surprisingly, given it appears to be such a simple technique, some people are claiming that it can have profound effects, and assist with various disorders such as ADHD, Parkinson’s, MS and even post-brain injury and stroke. The usual bunch of jokers with slickly-designed websites have sprung up offering treatment for all these things and more. The ‘How it works’ section of that website claims that the underlying deficit in a variety of disorders, claiming that the underlying dysfunction in ADHD, autism, dyslexia, Parkinson’s and others is just a ‘neural timing deficit’. The exercises used in IM correct the timing deficit, and therefore (supposedly) treat the disorder.

To say this is startlingly simplistic would be a massive understatement; it’s just plain wrong. The precise neurological issues in many of these disorders are difficult to pin down and are the subject of active investigation but, to take a simple example, we know exactly what the problem is in Parkinson’s; neuronal depletion in the substantia nigra. To claim that it’s some vague neural ‘timing’ issue goes well beyond disingenuousness and into the realm of outright deception.

There’s even a home-based version of IM therapy, that can be run on any computer – however the basic equipment (wiresless button boxes, tap mats for the feet etc.) and the software licence cost $800.

A PubMed search for ‘interactive metronome adhd’ actually produces five hits! However, on closer inspection, all five articles are seriously compromised in some way – studies with no control group, or with very low numbers. Interestingly, one of the papers that pops up is one I’ve discussed before in reference to Brain Balance Centers. So, IM appears to form a cornerstone of what the Brain Balance guys (chiropractic, with a thin layer of neuro-woo laid on top) are pushing too. The IM guys have gone to a lot of trouble to make their approach appear scientific – there’s a well-populated ‘Science’ section on the website, that contains links to lots of articles, however, many of them are ‘white papers’ of uncertain provenance, and the rest are articles from obscure journals, or on barely relevant topics.

Another problem with IM is that it gets conflated with serious interventions. There’s a large field of study focussed on the use and effectiveness of musical-type interventions for a variety of neurological disorders (broadly, called Neurologic Music Therapy, or NMT) that has some solid research behind it. The slick marketing of IM seeks to conflate their approach with much more high-standard music-based therapy approaches.

In Prof. Thaut’s words (my emphases added):

First, where is the research? Studies that back up the clinical effect of IM directly, are very rare or nonexistent. A small study from 2001 is one that comes up repeatedly. One small study does not build clinical evidence. IM seems in general a well marketed but unresearched application. From a research point I see no evidence for the therapeutic benefit of IM.

Second, brain mechanisms in therapy work differently. Possibly to fill the research void IM generously includes ‘borrowed’ research that has nothing to do with their device. Since I am one of the authors they use I have to clearly  state that my brain research in music and rhythm does not address IM and our results do not support IM applications, neither with patients nor physiologically in explanatory brain mechanisms. The only forms of therapy in brain rehabilitation that work are active and specific exercises based on functional learning and training paradigms, not machine tapping. 

Last, rhythm has its own life. The claim that tapping to a metronome improves timing in patients which in turn transfers to all kinds of cognitive and motor improvements is not only unsupported by research but seems based on a misunderstanding. Rhythmic synchronization is a very complex process that fluctuates continuously on a millisecond level and is inherently unstable and variable. This time flexibility is the actual hallmark of functional entrainment. Therefore the IM definitions and measurements of what constitutes rhythmic improvement seem physiologically and functionally meaningless.

So, there you have it. If you’re concerned about your child’s sense of rhythm (for some reason?) you’d probably be much better off signing them up for dance classes, or piano lessons. It’ll almost certainly be cheaper, and they’ll likely have a lot more fun too.

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Brain Balance Centers: total and utter neurobollocks

Masthead from the Brain Balance Center's website. "clinically proven"!

Masthead from the Brain Balance Center’s website. “Clinically proven”, and oooh… “holistic”. Marvellous.

Brain Balance Centers are a network (actually, to be precise, a network of franchises) of treatment centers spread across the United States, currently operating in 54 locations; most of the major US cities. They offer a treatment called the ‘Brain Balance Program’ that claims to be able to improve:

1. Academic performance
2. Social abilities
3. Cognitive function
4. Sensory and motor skills
5. Visual-spatial organizational skills
6. Immunity and nutritional health

They also claim to effectively treat pretty much any developmental disorder under the sun, including autism, ADHD, Asperger’s, Tourette’s and dyslexia, without the use of any drugs. This is because all these disorders are (apparently) caused by an “underlying functional imbalance or under-connectivity of electrical (brain) activity within and between the right and left sides of the brain.”

Any alarm bells ringing yet? They should be. Whenever someone comes along with a miracle-cure for a range of unrelated conditions, and has come up with the equivalent of a Unified Field Theory of neurodevelopmental disorders, something must be a bit fishy. So it appears in this case. There have already been a couple of excellent take-downs of the claims that Brain Balance Centers make. The first is by the really-very-wonderful Emily Willingham, and you can find it here. Emily expertly refutes a number of the key claims, and proceeds to drill down on the list of evidence and references provided on the website. Her conclusion is that the claims are an “enormous steaming pile of bullshit”.

Another great piece on these guys is by Harriet Hall of SkepDoc, and can be found here. This examines in detail a study published in the International Journal of Adolescent Medicine and Health (which at least appears to be a ‘proper’, if obscure, journal). Harriet notes that despite all the waffle about functional disconnection and hemispheric imbalance of the brain, the exercises performed by the kids in the study were relatively simple (such as synchronising movements to a metronome) and the conceptual link between the treatments and correction of the underlying ‘hemispheric disconnection’ is vanishingly tenuous. Most damningly, the study didn’t include a control group, meaning it’s possible (likely?) that any improvement seen was simply a placebo effect (or more precisely, a Hawthorne effect).

The last author on that paper is a guy named FR Carrick, and all the authors’ affiliations are listed as the “The FR Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience”; and this is where it gets really interesting. Dr Carrick is a specialist in ‘Chiropractic Neurology’. Chiropractic is a branch of alternative medicine with a fairly wacky history (founded in 1895 by a magnetic healer named DD Palmer), and essentially aims to treat health issues by manipulation of the spine. Debunking chiropractic is well beyond the scope of this piece, but let’s just note that there is a paucity of evidence for effectiveness in any condition other than low-back pain, and even there, evidence is pretty mixed. ‘Chiropractic neurology’ as a discipline then, is highly suspect.

It turns out the FR Carrick Institute of whatever whatever has a very glossy and slick webpage, that on closer inspection, really doesn’t contain a whole lot of content. The Wikipedia page for the institute gushes on at some length about the incredible research happening at the Institute, and the “faculty of world class scientists and clinical researchers” employed there (clearly in need of some de-biasing, Wikipedia) but the only personnel mentioned on the website are in the ‘Management’ section: Dr Gerry Leisman and Dr Robert Melillo. Gerry Leisman seems to have had a somewhat chequered career at several universities in the US and UK. Interestingly, in 1994 he was sanctioned by the NIH office of research integrity for falsely claiming to have a MD degree from the University of Manchester (amongst other things).

Dr Robert Melillo (and congratulations for making it, if you wondered where I was going with this digression…) as well as being the executive director of the FR Carrick Institute for advanced alternative navel-gazing is also the founder of… you guessed it! The Brain Balance Centers! Let’s look at his list of eminent-sounding qualifications listed on the site shall, we?

“…adjunct professor of functional neuroanatomy for the graduate doctoral neuropsychology program at Touro College, NY and Leeds Metropolitan University, England.”

Well, they sound like academic appointments at genuine, if hardly wildly-prestigious institutions. Unfortunately,  a search of the Leeds Metropolitan University website produces no hits for “melillo”. A search of the Touro college site also comes up blank (except for a Nicholas P. Melillo – oooh, so close!).

“He is also an associate professor of clinical neurology and childhood behavioral disorders at The Carrick Institute, in FL.”

This Carrick Institute in Florida (not to be confused with the one mentioned above, in New York state!) appears to be a teaching school concerned with chiropractic neurology, and has a loooong list of associate/assistant professors.

“He holds a master’s degree in Neuroscience and is currently completing his PhD in Clinical Rehabilitation Neuropsychology.”

No indication of where he obtained his Masters degree, or where he’s working on his PhD. I’m betting that it might be in one of the FR Carrick Institutes… Incidentally, if he doesn’t have a PhD, or any medical qualifications, why is he calling himself ‘Dr’?

“He is board certified in Chiropractic Neurology and is the former chairman of the American Board of Chiropractic Neurology.”

Meh.

“He is also President of the Foundation for Cognitive Neuroscience.”

The what, now? I can’t find anything online about a Foundation for Cognitive Neuroscience, in fact a google search for “Foundation for cognitive neuroscience” +melillo returns precisely zero results.

My point in all this is not to expose this guy as some kind of fraud, fun though that might be. I find it interesting that Dr (?) Melillo’s background is obviously in chiropractic treatment, and he’s found a gosh-darn-whizzo way of spinning this out into a national network of treatment centers for children. Interestingly, chiropractic isn’t mentioned anywhere on the Brain Balance Center site at all, and it’s not clear if the treatments are derived from chiropractic theory/practice. This paper from 2008 notes that chiropractic has something of an image problem, and is declining in popularity – re-packaging it as ‘hemispheric integration therapy’ for developmental disorders is a good wheeze – it allows a complete break with the previous practices, and allows you to pander to the fears of time-poor, cash-rich parents (a course of treatment is reported to cost around $6000).

So, will your child benefit from treatment at a Brain Balance Center? Possibly they will; regular sessions of individual attention and structured exercises of almost any kind are probably good for children. Will they benefit more than if you just took them to the park to ride their bike every weekend? Most likely not.  The neuro-inspired claims that the Brain Balance Center makes are an incoherent muddle of utterly fly-blown bullshit, built on the foundation of an alternative therapy (chiropractic) which itself is highly suspect. Don’t waste your hard-earned money people – it’s an out-and-out scam.

What this means, is that the Brain Balance Centers receive the highest honour it’s possible for this humble blog to bestow – a mighty 10 out of 10 on the NeuroBollocks rating scale!

Finally, just to leave you in a good mood, here’s Eddie Izzard with a brief bit on chiropractors:

**Update**

I’ve just been sent a link to another piece I wasn’t aware of by Jon Brock. Jon is a developmental disorders researcher in Australia, and became aware of a video discussing one of his papers by a chiropractor called David Sullivan, who it turns out, is connected to the various Carrick institutes, and Robert Melillo, and runs Keystone Chiropractic Neurology. The article is well worth a read, and there’s a lot of good discussion in the comments section too.