Infant stroke can’t stop Marcus

Marcus is a five year old who suffered stroke during infancy. All developmental milestones were delayed. Marcus crawled at approximately 18-19 months of age, walked at 2 years and was nonverbal. He demonstrated severe difficulty communicating basic wants and needs. At the time of his evaluation, Marcus’s father reported that he had heard Marcus babble on numerous occasions and his expressive vocabulary consisted of “hi”. His father reported that crying was Marcus’s only way to communicate. He was unable to gesture or point. His parents pureed his food and he was unable to self-feed. Marcus also had visual deficits and engaged primarily in solitary play.

Due to the fact that Marcus was non-verbal and had no way to communicate basic wants and needs, we began the PECS program with color coded, enlarged cards. Sign language was attempted; however, due to Marcus’s decreased finger dexterity he was unable to form hand movements necessary for signing. Therapy also addressed eye contact, joint attention, sound play and oral defensiveness. His play skills had somewhat improved; however, most play was inappropriate. Marcus made therapeutic progress; however, at a much slower rate than we had anticipated. Expressive vocabulary was slowly developing. Melodic intonation was utilized and facilitated some expressive vocabulary development. Eye contact had improved somewhat.

And then we started Interactive Metronome® training. At the time we began using IM, Marcus’s expressive vocabulary consisted of: 27 single words, 4 two-word phrase and 2 three word phrases. Due to scheduling issues, Marcus received IM one time a week. Due to Marcus’s inability to complete the exercises himself; all exercises were completed with hand-over-hand assist. Initially, keeping the headphones on Marcus was a task in and of itself, however, over time, he began to tolerate this and we continued to increase exercise length. A long form assessment was not completed due to the fact that all exercises were competed hand-over-hand. IM protocol was modified to increase Marcus’s participation. Marcus sat on his father’s lap during all exercises, as he was extremely resistant to try new things.

Initially, Marcus achieved scores ranging from 70-100ms with hand-over-hand assist due to his reluctance to participate. IM usually only took place during the first 10-15 minutes of Marcus’s sessions.

After approximately four sessions, we began to see an increase in his overall attention. Expressive vocabulary really started to develop halfway through the program, especially when his training times increased. He also began to take an interest in structured activities. Currently, Marcus is demonstrating an expressive vocabulary of: 51 single words, 17 ““ 2 word phrases, 9 ““ 3 word phrases and 7 – 4 word sentences. His expressive vocabulary is increasing everyday and he is beginning to imitate numerous words and phrases. IM was discontinued after 19 sessions due to scheduling issues. By the end of the 19^th session, his scores were in the 20’s and he was tolerating 30 minutes of IM training!

Initially, Marcus’s father reported that school staff was concerned because Marcus would cry for most of the day, making it difficult to complete any kind of schoolwork. Today, Marcus has begun to interact more with the other children at school. His willingness to participate in school activities has also improved, and he is also playing with his siblings. Crying episodes are almost nonexistent. Marcus’s family is extremely happy with the progress he has made with Interactive Metronome®. His father feels it is because of IM training that Marcus has grown so much in the last few months. His father’s face lights up every time he reports a new addition to Marcus’s vocabulary!