INTRODUCTION: Interactive Metronome (IM, The Interactive Metronome Company, Sunrise, Florida, USA) is a computer-based modality marketed to rehabilitation professionals who want to improve outcomes in areas of coordination, motor skills, self-regulation behaviors, and cognitive skills. PURPOSE: This retrospective study examined the efficacy of IM training on improving timing skills, hand function, and parental report of self-regulatory behaviors. METHODS: Forty eight children with mixed motor and cognitive diagnoses completed an average of 14 one-hour training sessions over an average of 8.5 weeks in an outpatient setting. Each child was assessed before and after training with the Interactive Metronome Long Form Assessment, the Jebsen Taylor Test of Hand Function, and a parent questionnaire. RESULTS: All three measures improved with statistical significance despite participants having no direct skill training. CONCLUSION: These results suggest an intimate relationship between cognition and motor skills that has potential therapeutic value. LEVEL OF EVIDENCE: Level 4, Retrospective Case Series.