The Use of IM in Infancy

By: Lucy Barlow, CCC-SLP

Emma’s Study

Emma

• Born 6.22.05• Agenesis of the

Corpus Callosum• Failure to Thrive• Seizure Disorder • Global Developmental

Delays• Probable Cerebral Palsy

The Corpus Callosum

• is a band of over 200 million nerve fibers connecting the two sides (hemispheres) of the brain

• provides the main route for the transfer and integration of information between the two hemispheres of the brain

• Agenesis of the corpus callosum (ACC) is a birth defect in which the structure that connects the two hemispheres of the brain (the corpus callosum) is partially or completely absent

www.TheFetus.net

The sagittal section of a normal brain. The corpus callosum is represented in gray.

The coronal section of a normal brain. The corpus callosum is observed as a bundle of fibers crossing the midline (represented in gray).

A transverse section of a normal brain. The corpus callosum is observed as a bundle of fibers crossing the midline (represented in gray).

Corpus Callosum

living brain as seen

via MRI scan

Normal

Corpus Callosum

Parts of the Human Corpus Callosum

• In Emma’s case this entire structure is absent

Functional DeficitsPhysical Deficits-Initial Evaluation

• No core/trunk tone, unable to sit unsupported• No prone positioning• No step reflex• No protective balance reflex• Unable to weight bear on upper extremities• Limited reach/grasp behaviors/No pincher grasp• No crossing of midline• Presents in the 5th percentile on growth chart

Functional DeficitsSensory Deficits- Initial Evaluation

• Hypersensitive/Defensive to touch on face, hands or feet

• Severe gag reflex, with non-tolerance to a sippy cup or textured food

• Frequent rocking and head banging• Limited Visual Tracking/No eye contact • Visual fixation on geometric shapes• Severe startle reflex-easily upset/over stimulated in

crowds

Functional DeficitsCognitive/Language Deficits- initial

evaluation

• Excessive sleeping (18-20 hours per day) with limited arousal time

• Limited use of pragmatics• Limited oral movements for sound

production• Limited localizations to her name• Limited cause-effect behaviors• Limited & infrequent sound productions with

low volume (whispers)

The Beginning

• Results of REEL-2 indicate an age equivalency of 4 months in receptive language and 2 months in expressive language

• Traditional pre-linguistic therapy yielded minimal improvement (6 month gain after 18 months of therapy)

Why IM?

• This provider’s prior observations of the success of IM with cross-hemisphere difficulties

• Neuro rehabilitative aspects of IM• Prospect of stimulating hemispheric

communications• Motivation to achieve best possible outcome

for patient

Taking IM out of the box

• Develop Emma specific IM goals

• How to adapt IM exercises for a 22 month old developmentally delayed child?

• “stakeholder” discussion with parents

The Results-Physical

• Sitting unsupported• Moderate righting/balance reflex• Weight bearing of Upper extremities• Getting on knees & crawling• Grasping objects, banging objects together• Using pincher grasp• Crossing midline, reaching across midline

The Results-Cognitive/Language• After 3 sessions Mother reported marked increase in

babbling and volume• Consistent localization to name• Identifying familiar people by localizing head• Direct imitation of speech sounds• Rapid increase in babbling & jargoning sound

variety• Mouthing “Momma” and “bye-bye”• More affective behavior noted-laughing, smiling,

obviously understanding tone of speaker’s emotion

The Results-Sensory

• Frequently makes & maintains eye contact• Less visually defensive when objects

approach face/ startle reflex greatly reduced• Consistently eats textured foods without

gagging. Using pincher grasp to feed herself• Allows/enjoys use of Z-Vibe for oral

stimulation• Non-defensive when touching feet, hands or

face

“How to” guide?

• No 2 patients, regardless of age are going to be alike

• Think “out-of-the-box” and find what works• IM can lead to amazing improvements, even

if the treatment requires total “hand-over-hand” assistance

The Results…

Questions