Monday, June 11, 2007

Conductive Education

So, the subject of Conductive Education has come up in several conversations lately.
I am an aide in our local conductive education center. When my last job started feeling shaky, I called Conductive Ed and asked if they'd hire me for the summer. They remembered me from when I used to pick up a student there, so they said sure. Of course, that was before the flare hit, when I had confidence in my ability to do the physical stuff involved, and I thought I'd only work with S. part time and Cond. Ed part time.

So, today was a good day. I saw a boy I used to be waiver staff for but haven't seen in a year. I was so happy to see him that I wanted to cry. It's so hard sometimes to totally love kids and then have nothing to do with them. But I'm proud of the job I did with that family -- I came in, I was their first staff, I let them know that it was okay to have staff and other people looking after their child, and then I moved on when I took the S. job full time.

To see him again though was amazing. And I got to work with him today.

So what is conductive education?

In a nutshell, Conductive Education was developed in Hungary in the 1940s for children with motor disorders -- mostly cerebral palsy. Imagine taking a preschool classroom, having each child have his or her own aide. It's highly structured, incorporating stretching, motor activities, cognitive activities, activities of of daily living, songs, etc. Everything is focused on helping the child become self-sufficient, but not in the traditional way. Alot of the usual adaptive equipment (Standers, gait trainers, wheelchairs, augmentative devices, pecs, etc) just aren't there. Instead, when it's time to walk out at the end of the day, the child might push a wooden chair while an aide stands behind him or her and moves each leg accordingly.


I feel the same way about it that I feel about A.B.A. or any other intense therapy. It works for some kids, but I'm a bit uncomfortable with it. It's not child-centered. It's the opposite of child-centered. It's program-centered. I've heard it explained as that Conductive Ed developed in response to Nazism, so the philosophy is anti-special equipment. Besides the helmets and the walkers on the wall, there's not much equipment that would be out of place in a 1940s gym. The theory is that if "they" are coming after disabled people, then if you raid this place, there will be no disabled people here. No one in wheelchairs, no one that stands out.

Also, according to some sources, the plinths and other equipment are modeled after concentration camp beds -- a "constructive use of pain" according to a CBS story. YIKES!

There's not a lot of great evidence for or against conductive education. UCP concludes that it's at least as effective as traditional therapy. I would think that 5 hours a day of working on physical, occupational, speech, and cognitive needs would have results. And it tends to have good results, just from what I can see. The change in the boy I used to work with with amazing after he went to conductive ed. He moved around a lot more of his own volition.

At what cost though?

I remember a study of children with Down Syndrome that showed babies with D.S. actively manipulated their environments MORE at 6 months than at 9 and still less at 12. That learned helplessness sets in easy. (Note, again, I'll check the source, but since my readership is like nil, I'm not too worried about my scholarship these days. I will check to make sure I got this right though).

I think this was from the book Teaching Reading to Children with Down Syndrome. The author recommended errorless teaching to help build up confidence of kids with Down Syndrome, as they've already learned early that they try and fail, so it's better not to try.

Conductive Ed takes the other approach. You might have learned not to try, but we will make you try, or you will fall on your butt. We aren't going to hold you up.

Again, at what cost?

I know of parents who report that therapy is so aversive to their kids that it's set them back. I think that this could break some kids, that the act of being made to do exercises against their will would cause shut down, just as discrete trial after discrete trial would bore and ultimately alienate some kids.

Yet, I've been involved in so many traditional therapy sessions that sort of vaguely make progress. We do something here... okay, kid's had enough. We'll work on walking a bit until kid cries. Okay, we'll work on it again next week. Maybe. If we remember. Conductive education has goals, has a structure that traditional 1-on-1 therapies seem to lack. The idea that everyone in the class is doing their activities together is a huge motivator. When it's time to walk, everyone walks. Some with canes, some on their own, some with one chair, some with two. When it's time to answer questions, some kids are only expected to vocalize ANYTHING that's close and others are expected to spell the words, according to abilities. Conductive education is inclusive education at its best.

There are some of the same limitations that other highly structured activities have. For instance, if I am walking with a kid who I'm not familiar with, and I'm not doing things exactly right, she might just sort of go limp on me, instead of thinking "Wow. She's not holding my shoulder like the other girl does. What can I do to fix it?" It's the bodily equivalent of the confusion of a kid on ABA therapy shows if I ask "Who are you?" instead of "What is your name?"

But, the more advanced kids physically are working on that. There's a lot of prompting one kid with canes ("My sticks" he calls them in the cutest Southern accent you've ever heard) to look and figure out his environment. And he does. I have no doubt that he would not be walking in a traditional therapy system, but here, he does. And is expected to.

So, I'm not against conductive education. I think a lot of traditional educators could come observe on how to really structure a classroom for kids with diverse needs by it. I just don't think it's right for all kids. But how do you tell?

Again, I don't envy the jobs that parents have.

Will I crush my kid's spirit by trying this or will it give him the best chance to walk independently? How do you make that choice? Do you push? Or do you follow the child's lead?

I think if more traditional supports functioned better, it would be a harder choice. But as of now, it's probably one of the only games in town that offers real, tangible results.

A CBS News Report from 2004: http://www.cbsnews.com/stories/2004/02/24/60II/main601944.shtml

Positive Health: http://www.positivehealth.com/permit/Articles/Bodywork/suton47.htm

from UCP.org: (It's interesting to watch UCP's stance change throughout the years).

Conductive Education 2004: Research Status Report, 6/2004

Comparison of Two Alternatives of Intensive Training for Children with Cerebral Palsy, 3/2002

Effect of Physiotherapy on Children with Cerebral Palsy: Report of a Clinical Trial, 4/2001

Fact Sheet for Educators: Conductive Education: Update, 9/1997

Conductive Education:An Overview 9/1995

2 comments:

Camilla said...

hey, Leslie. That third article from UCP was very interesting...no significant improvement found with regular or intense therapy...not too surprising actually! Chloe does CE because she likes it, most of the time, and it's the only day-care-like setting where I know she'll get to participate. And I think that the exercise is probably good for her, I guess. But honestly I think all her physical progress is from ABR. CE provides lots of motivation, which works well for Chloe, but it can't fix her body.
Camilla

Lesley said...

What I am really appreciating about CE is the education and participation side of it. This is an inclusive setting -- everyone participating, everyone valued, everyone expected to learn.

This is how a special ed class room, or any class room, SHOULD be run. It is assumed that the children understand. And over and over again, I find that I have underestimated every kid at times.

Imagine how kick ass it could be with a little bit of comprimise -- maybe a few PECS cards instead of insisting on vocalizations -- very good adaptive supports for the school work side of it...

It's frustrating at times, but it's good for me to watch.

We just had a staff meeting and I always leave feeling like "yuck, I won't come back." But I will... I guess. :)