Kids With Cerebral Palsy May Benefit From Intense Therapy
(By Jeanie
Lerche Davis WebMD Medical News Archive)
Aug. 21, 2000 -- When her daughter Olivia was 4 months old, Kathy
Krindl knew there was a problem. At 6 months, she found out what
it was: cerebral palsy. The pediatrician, Krindl remembers, "didn't
come right out and say her prognosis wasn't great. But the tone
of voice, it was easy to interpret."
Cerebral palsy is a problem with motor movements and coordination
due to damage to the brain -- of which the cause is not always
known. Neither is the best way to help these children lead fulfilling
lives, because the condition has no cure. The traditional standard
has been physical therapy. But now, a growing number of parents
are stepping outside the mainstream and getting their children
involved in something called conductive education.
Conductive education is not so much a therapy as a multidisciplinary
educational program focused on the child's emotional and cognitive
growth as well as motor function, supporters say.
While learning to do everyday tasks, children learn motor skills.
And in the process, children are hopefully taught to see themselves
as active and self-reliant participants in the world. Because
these lessons are learned in a group setting, amid songs and games,
proponents say children find them fun.
Traditional physical therapy places the focus on building muscle
strength and coordination. Those sessions typically take place
in 45-minute sessions, twice a week. Conductive education, however,
is a five-hour-a-day, five-day-a-week program.
Krindl learned early on that Olivia has spastic cerebral palsy,
the most common form of the disorder. Doctors told Krindl that
Olivia was "never going to walk, never going to talk,"
and "we're not sure if she had [thinking] abilities or not.
... It was bleak, but I tend to be a hopeful person. I was skeptical.
Maybe he [the doctor] doesn't know everything."
Right away, Krindl took Olivia to speech, physical, and occupational
therapists. "She hated them, Krindl tells WebMD. "She
screamed ... she was never encouraged to do anything on her own.
I know my daughter has a ton of intelligence, the will to do something
on her own. Why not give her the opportunity to achieve some sense
of independence? Conductive education gives her a reality that's
based on her. It allows her to be good at who she is."
Today, Krindl and her mother, Judy Gillespie, run the Midwest
Centre for Conductive Education in Glenview, Ill., outside of
Chicago. The conductive educators in their school were trained
in Hungary, where the program was developed in 1945.
Debra Gaebler, MD, a pediatric physiatrist at the Rehabilitation
Institute of Chicago, tells WebMD that she has referred a number
of children to Krindl's center. The sessions she has observed
are "very rote, very rhythmic, very pleasing. It's translated
into the first person, so the child is taking responsibility for
his or her own actions. It's very functionally oriented. Some
kids come back toilet trained. It has a more practical application
than some other ways we do therapy."
For certain children, she says, "it is very good, but I
don't think it's for every kid. I've referred many people to it
who don't think it's right for their child. The child has to be
motivated by the group. You can't have a child who is not able
to follow direction or is so emotionally or medically fragile
that they need a lot of support.
" The goal is "integrate children into a normal classroom,"
says Anita Keresztury, a Hungarian-trained conductor who teaches
at Krindl's school. "As soon as they are able to move or
sit independently, they can be in normal schools. Just because
they cannot walk a long distance does not mean they have to be
in a special class."
Whether they are involved in "potty time," "circle
time," or lunchtime, kids are expected to try to walk into
the room. "They can use a walker, but they have to take some
steps. Of course, most of them need help, but they have to try.
... I don't think everybody will walk and we don't promise anything,
but they have to keep trying," Keresztury tells WebMD.
Children are also expected to try sitting up on their own; special
chairs come equipped with ladders or side handles to provide support.
At lunch, children must eat with a spoon or drink from a cup --
not use a bottle, as do many children with cerebral palsy. All
during the day, as each child makes small successes, the other
kids offer lots of approval. There's also "lots of singing,
all day long," says Keresztury. "It's very motivational
for them." Fifty conductive education groups exist today
in North America, and four more are in the making, says Patrick
Riley, president of the Inter-American Conductive Education Association.
"We have made great headway." And in Grand Rapids, Mich.,
Aquinas College is opening a four-year course to train conductors.
The college has launched the first conductive education program
to be held in a public school.
"We want to mainstream these kids," Riley says. "Some
kids make more improvement than others, but we don't want to turn
anyone away. For the mother who sees her child pick up a spoon,
that's a miracle in itself. So is a child with cerebral palsy
who is going to the potty by himself. I saw the progress day after
day in my granddaughter. Every hour, they're learning new things."
Krindl couldn't agree more. "In physical therapy, they would
keep her sedentary in any kind of chair, strapped in. They stood
her up one minute to bowl, not implying this was something she
could do in the future. They were ... enabling her to become dependent,
not trying to get her to stand up by herself."
One example of Olivia's progress: Today, at age 5, she can sit
by herself on the couch. "She gets down off it, turns around,
can walk along the edge. It may not seem like much, it's as much
as a normal 1-year-old can do, but she didn't have any sense of
walking before, even the concept of movement," Krindl says.
Conductive education is a "total immersion" philosophy
that seems to work largely because it envelops the child's daily
existence, Murray Goldstein, MD, medical director of United Cerebral
Palsy's Research and Educational Foundation, tells WebMD. However,
the results are temporary, and children require constant retraining,
he says.
Outside of one small study, scientific research is not available
on conductive education, says Goldstein. "Even though we
have pushed these organizations very hard to conduct research,
they have not. ... We have asked, do they have any specific information
about special characteristics of children who can be helped, how
long the effect will last. I suspect it doesn't last long because
children keep going back for classes. It's a very, very, very
intense program."
The one study, which took place last year in the Australian school
system, separated children with cerebral palsy into two groups,
one receiving conductive education, the other receiving standard
physiotherapy. Both groups had therapy the same number of hours
a week: five to six hours a day, five days a week.
"So the only thing different was the actual therapy. And
they found no difference [in the children's progress]," Goldstein
tells WebMD. "It wasn't the most complete experiment in the
world, but it reinforces the hypothesis that the biggest benefit
is the immersion technique and the strong motivational reward
system."
"I've seen good things with conductive education,"
says Donna Nimec, MD, MS, director of pediatric physical medicine
and rehabilitation at Boston Children's Hospital and Spaulding
Rehabilitation Hospital. "It's a very therapeutic environment.
Children do make really nice gains, but I think it's important
to understand the ultimate goals."
