Conductive education ... complicatus eliminatus!

Surely we can all recall Dr. Seuss's beloved book, The Cat In The Hat, as he sings absolute chaos into a previously mild-mannered suburban home. It is a simple story about two children tired of doing the same old thing, waiting around for something to happen, when a walking, talking cat changes their world with his seemingly zany, yet important, lesson-filled antics. Whose advice should we believe? It was the ever stern, anxiety filled, change-weary, seemingly logical voice of reason of the curmudgeon-goldfish, Carlos K. Krinklebine, who oversaw their world from his big glass bowl and was constantly warning the children that any deviation from their "normal and predictable" activities was too messy, a waste of their time, and actually dangerous for them and should, therefore, not be attempted. He would have us think that life is too complicated and serious to be "fooling around" with something unknown, untried, and possibly untrue. On the other hand, The Cat In The Hat taught us to develop a thicker skin for such criticism and to "go with the flow" following simple, very basic logic, while also finding humor and frivolity in the face of seemingly dire circumstances. In doing so, we could actually get more out of life than what we were currently experiencing.

It is in that same fun-filled, brilliantly simple--yet undeniably profound--purely positive--yet slightly rebellious--spirit that an amazing program, called conductive education (CE), stands firmly planted in countless countries throughout the world. It shines as a bright spotlight on the very realistic, stunning possibilities that exist for true physical independence for many people with motor/movement disorders, such as cerebral palsy, spina bifida, stroke, multiple sclerosis, Parkinson's disease, and various traumatic brain injuries, all of which result in neuromuscular impairment affecting and interfering with physical movement. Here in the U.S., however, CE is quite unknown and is often met with the same kinds of misunderstood, misinformed, conservative tone (from the medical, insurance, and even some educational communities) as the critical voice of Krinklebine, who continues to only see the world from his point of view, in the glass bowl.

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Dealing with the various "establishments" and "institutions" can be beyond frustrating. Our children are constantly referred to by their disabilities; defined by various statistics, ICD-9 & CPT codes; identified as the subjects of their IEPs, and/or as dependents of policyholders. These precious children are relegated to lives of doctor visits, specialists, second and third opinions, a wide variety of therapies, painful (often unavoidable and sometimes even debilitating) surgeries, and a lifetime of people in society pointing out everything they CANNOT do for themselves as a result of their disabilities. Oftentimes, unless assisted by complex, expensive, and bulky adaptive equipment that separates them from everything in their world, these children grow up dependent upon and limited by access issues and by the availability of a personal aid to help them perform everything from the most basic of personal hygiene tasks to the more complex daily living skills like ambulating, dressing, eating, etc. But for many, there is hope--THERE IS ANOTHER WAY!

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Conductive education is NOT a medical treatment, not a therapy, or even a school (in the traditional sense of pure academics). It is something that we do NOT have a definition for in this country because we separate learning and physical development as if they occur absent of one another. In the U.S., one is a purely medical need, requiring "correction," and the other is an educational one, requiring "instruction." CE believes that both fall under "Human Development" and therefore must be simultaneously addressed, just like real life learning and development. And THAT is what makes CE so different from traditional practices. There is nothing wrong with what we currently practice in the United States, per say. It is just that we've been doing the SAME THING since the 1950s, and many believe that our children (and even adults) need MORE than what our current system is set up to provide!

CE is more accurately described, when seen through the eyes of those who experience it, as "a type of learning" and "a way of living" because CE is not something one does to a person, nor is it something one receives. Rather, it is something that one experiences. Humans learn by experience--not by exercise. This experience is delivered and facilitated on the part of a highly trained professional called a conductor, who seeks to awaken genuine intent on the part of the person with physical challenges, making them want to move. This innate intent is the basis for everything in CE. It is the same intent that drives an infant to want to move for the first time from a seated position into crawling to get hold of the object of their desire--a bright red ball that lies just out of reach. Most babies with motor disorders quickly learn to forget all about intent, mostly due to the frustration of their uncooperative bodies, but also because their caregivers continue to do everything for them. And this is often long after typically developing children are held accountable for doing it on their own. Children with motor disorders are unconsciously taught that they are not expected to do it for themselves so intention takes another form; it becomes frustration first, then complacency. The conductor uses various forms of rhythm, repetition, and a distinctively different first-person voice and then seeks to motivate and facilitate the individuals to do for themselves. They are to do so in every possible aspect of their daily existence with as minimal outside assistance as possible so that they may later avoid the need for extraneous, expensive, medical devices, and/or a full time personal aid. Ideally, a slight touch or a simple verbal prompt or reminder will suffice, but the turn-key that makes this ideal a reality is early intervention--as early as possible (six months for children exhibiting high and/or low tone and immediately following a debilitating stroke or certain signs of impaired movement due to MS or Parkinson's in adults).

Contrary to some indications, CE relies upon some very distinct, straightforward, research-driven, and clinically evidenced elements:

* Environment/Equipment

Very much like Montessori education, CE takes place in a very specific planned environment, typically bright and stimulating, that looks more like a classroom in a school than a rehabilitation facility or therapy room. Most of the "equipment" is very basic and plainly crafted wooden furniture, and almost everything is multi-purpose. In true keeping with CE philosophies, the furniture is designed to give the minimal assistance and adaptations necessary and meets very cost effective solutions to daily living problems (as opposed to thousands of dollars of various external assistive devices whose absence leaves the user completely at a loss for participation in activities and access to their environment).

* Small Group Setting

CE ideally takes place in a small group setting (though private tutorial services are also available, including teaching parents and caregivers to maintain consistency at home and in the community). The group dynamic serves to motivate and encourage each individual to do more and to achieve more because they work together and also in friendly social competition with each other. Just as in any other group environment, it leads to improvement in interpersonal relationships; reduction of fear and increased sense of community and connectedness; development of self esteem and self control; and it allows the individual to see what others can do and, therefore, develop the belief that "if they can do it, I can too!"

* Task Series

Tasks (physical and cognitive activities) that are designed in incremental formats that increase in complexity for the individual as their skills improve are based upon creating tiny opportunities for success for each person so they build their esteem, confidence, and internal desire to accomplish more and more. This increases their self-motivation to achieve. Each task is applied uniformly to each member of the group but is individually tailored to each person's needs by using different types of facilitations, dependent upon ability and function level. Task Series, as they are called, are implemented in a variety of settings within the classroom to simulate the various circumstances in which we live our daily lives. They are broken down into 7 categories:

1) Cognition program (to include addressing concrete and abstract problem solving skills as well as general education requirements for preschool and school age children)

2) Lying program

3) Sitting program

4) Standing program

5) Manipulation program

6) Speech program

7) Individual programs (encouraging "active" implementation of sequential skills as learned from each task series previously execute, like building a modular home, where entire sections are built separately and then finally put together on site to make the various rooms come together to as a "home")

Conductive Education (CE) was born in the early 1940s in Budapest, Hungary and was the revolutionary concept and genius of the now famed, Dr. Andras Peto. The program struggled for recognition and legitimacy in its early years like any new discipline, idea, approach, or practice, but it later found a strong foundation under Peto's tenacity and rose to even more formidable heights under the subsequent leadership of Dr. Maria Hari, Dr. Peto's closest colleague and personally chosen successor. It is she who led the modern day Peto Institute to world fame and recognition with her vision.

CE targets the disability from the person outward--not from the outside symptoms of the disability backwards. It is holistic in approach and does not see any distinction in development between the mind and the body; it believes both must be addressed in tandem. CE believes you can teach the person to overcome the disability by stimulating new neural connections in the brain that literally compensate for the damaged portions, which result in the official diagnosis. CE coins a new term, orthofunction, which refers to the individual's kinetic potential and personal readiness that can be vastly improved upon through conductive education. A natural byproduct of improved physical function is improved cognitive function. Science already knows that cognition is predicated by movement, as evidenced in early life on earth and in current human infant development. Ortho-function is a term you will come to love because it paints a clear picture in terms of the basic "can do" philosophy of CE, versus the "can't" philosophy of a rehabilitative model that points out the abnormalities. Ortho-function, as opposed to "orthopedic impairment," clearly shows the difference in focus--function, potential, and ability vs. impairment and "dis" ability.

CE is not for everyone. It is not a cure, and it is no miracle fix for your child's disability. It is hard work, but there can be very distinct, significant payoffs that profoundly change both the individual and the entire family's lives. Individuals must qualify for the program. They must undergo a comprehensive evaluation to be sure that they fit the criteria of being most likely to benefit from CE. Insurance programs typically will not pay for CE (which is yet another good reason to make sure that you have a reasonable expectation for significant results). For the greater good of the individual with the disability and their overall function and development, it should be mentioned that a genuine atmosphere of cooperation among all the different disciplines as well as a consistent and ever-present open mind to other emerging and supportive ideas and approaches should always be strived for.

Unlike Dr. Seuss's Sam-I-Am character, who expends all his energy trying to get the large, fuzzy guy to simply try green eggs and ham so that he may experience it for himself, it is not in conductive education's nature to chase anyone in order to convince them of anything. It is up to exceptional parents to search and unite for, to research, and to demand more options for our children!

EDITOR'S NOTE: AS PART OF EP'S MISSION TO PROVIDE FORUMS FOR THE DISCUSSION OF ALTERNATIVE AND COMPLEMENTARY THERAPIES, WE ARE PRESENTING THIS ARTICLE ON CONDUCTIVE EDUCATION. IT IS NOT AN ENDORSEMENT OF THIS MODALITY. PARENTS ARE ADVISED TO DISCUSS ALL THERAPEUTIC APPROACHES WITH THEIR HEALTHCARE TEAMS.

Rhoda Waiss is an experienced, private tutor and the founder and Executive Director of a new non-profit center (which includes CE) called "The Banyan Center for Alternative Approaches to Motor Disabilities," which is set to open in the summer of 2008 in Sarasota, FL. She is a wife and mother of two. Her youngest, Liam, who has CP (spastic quadriplegia), PVL, speech dysarthria, and apraxia, started CE at age four in 2005. Ms. Wais can be contacted at [e-mail].

Zsuzsi I. Borcsok, a lead conductor at The Jackson Center for Conductive Education in Indianapolis, IN, is a top graduate (CE and teaching credentials) from the Peto Institute in Budapest. In the last 15 years, she has worked in and helped establish many centers around the world. Believing in constant personal and professional improvement, she holds additional credentials/training that compliment CE and is dedicated to bringing CE into the mainstream in the US. She can be reached at [e-mail].