Monday, 31 December 2007

Round Table – NDT (Bobath) and Conductive Education

Practical arrangements

The ‘Round Table’ at Tsad Kadima’s recent conference comprised Sarah Capelovich, President of the European Bobath Tutors’ Association, and myself, with Peter Rosenbaum, Professor of Pediatrics at McMaster University, London, Ontario, serving as ‘Moderator’.

Sarah Capelovitch’s role was to represent NDT (Bobath), mine to represent Conductive Education. Peter Rosenbaum held the ring and made sure that a lot of ground was covered within the space of a single hour event. The event was held in the plenary hall of the conference centre, with some two hundred people or so attending.

A series of six questions for discussion had been formulated with the help and reflections of Peter Rosenbaum, Orpa Fucs-Bar and Naama Shahar, and pre-circulated to Sarah Capelovitch and myself for our prior consideration. Following a brief introduction by Peter Rosenbaum we were asked to make our responses to each question in turn. Peter Rosenbaum ruthlessly checked the duration of our responses, gave a terse linking commentary and jiggled the running order to suit the emerging theme.

All in all a tough assignment! First, before I even went to Israel, I had found it hard to match what I understand about the nature and circumstances of Conductive Education to some of the content of some of the questions. It was not that the questions themselves were unreasonable: far from it. Rather, the problem was Conductive Education itself, which, as is not uncommon, just did not fit. As a result, try as I might, I managed no sensible preparation before I left for Israel, promising myself that what I experienced of the mood of the conference would help me formulate my responses once I was there. In the event I still mounted the podium knowing that I should have to wing it. Nothing new there, then. Secondly, a more immediate problem. Sitting facing a darkened auditorium, with banks of lights shining into my eyes, I couldn’t see the audience. Worse, with the auditorium’s loudspeakers facing away from me and into the audience, I could not hear what was coming out of them. I could hear what Peter said, because he was sitting directly next to me, But Sarah, seated on his other side, might as well have been in the next room for all that I could make out of what she said (I am a little deaf).

So I responded to each question within my own dark, almost silent self-contained bubble, myself, the microphone on the desk in front of me and my pencil-scribbled notes jotted down on my question sheet as we went along. This in brief is what recall of what I said (the questions being presented in italics).


Questions and answers

Every system of treatment or therapy is grounded in a particular set of historical forces, such as people’s contemporary perception of diseases, prevailing social and religious philosophies, economic realities etc. Please give us a brief ‘context’ of the approach with which you are connected – how it emerged and what you think were the most importance influences on its development and adoption by practitioners at the time it was developed.

The easy answer about the historical roots of Conductive Education is that it is ‘Hungarian’. I had certainly began my own study of this question years ago by enquiring along this line – and I was wrong. My present historical analysis is that the system has developed in periods or stages, each one leaving its mark upon what we presently know as Conductive Education and how we understand it. In considering its earlier origins, that is before we outside Hungary knew it, we have first to go back to András Pető before the Second World War and the likely influence upon him of German-Jewish liberal thinking of the time. Also from that period we have to account the particular nature of András Pető’s medical training and his notion of healing, especially the ‘healing of the soul’ (seelische Heilung) that, I now recognize, permeates Conductive Education through and through. That was, I think, András Pető’s great contribution. But secondly we also have to consider the context of the Hungarian People’s Republic within which Conductive Education as we now know it developed after the war, and especially Mária Hári’s contribution to its development. Following 1962, in order to survive under a Soviet Bloc Ministry of Education, Conductive Education – its practice and the training of its practitioners – had to accommodate to the psycho-pedagogy and associated knowledge systems of the Soviet intellectual hegemony. An example of this would be Conductive Education’s particular take on ‘potential’. This entered into an extraordinary marriage with the direct heritage of András Pető – and achieving a practical synthesis was Mária Hári’s major achievement. It was this synthesis that so impressed the pioneers who first worked to bring Conductive Education out of Hungary some twenty or so years ago. So, after twenty years of working with Conductive Education I see the original history of the idea as being a coming together of German-Jewish and Soviet understandings, with little (nothing perhaps) substantively Hungarian in the mix.

How has the system evolved, and what factors have been central to its evolution? (Please discuss any combination of developments in neurobiology, psychology, social sciences, child development and research findings based on this approach.)

Frankly, the world of Conductive Education has been somewhat autistic with respect to the sort of things in the question. But, I suggest, the system is still evolving and developing, and it now readier to look outside itself than ever before. Many of us here in this room have contributed actively to the new major historical force that has helped shape Conductive Education’s development over the last twenty years or so – the influence of parents, the importance of families. I do not think that this was a domain central to the concerns of either András Pető or Mária Hári. It has certainly been central to the internationalisation, perhaps the very survival of Conductive Education in the modern world. The mix that is now Conductive Education has therefore been further enriched through leaving Hungary, not just by bringing family life more centrally into the practice and analysis, but through consideration of new ethical imperatives such as inclusion and rights – not just of parents but, as Conductive Education for adults gains greater focus, the question of the rights and aspirations, the ‘voice’, of those who use conductive services. And as Conductive Education has entered the modern world it has had to confront and adapt to pressing contemporary influences such as were the topic of this question, its relationship with existing fields of professional-academic knowledge and the own evidence-base for its own practice.

What are the major contributions and the most meaningful achievements of the approach? (Please reflect on paradigm shifts, revised definitions, new 'entry points' in intervention, parents’ involvement etc.)

Conductive Education represents a major paradigm shift in the care and well being of children and adults with movement disabilities and their families, in that it moves on beyond the old duality of the ‘medical’ and the ‘social’ models of disability, indeed rather beyond ‘disability’ itself, representing instead a new way of understanding and acting, what might be called the ‘developmental’ or ‘systemic’ model. Within a wider developmental model of how human biology can lead on to human psychology only through the mediation of human social activity, then the systemic effects of biological damage can be readily understood in terms of what Vygotskii called a ‘dislocation’ of the developmental process. Within this context, intervention moves on from treatment to pedagogy, intervention within the psycho-social domain, by psychosocial means and primarily psycho-social outcomes. Once you cross into this other way of thinking, that movement disability is a developmental disorder like any other, then of course you can pick and chose from all sort of psychological frameworks already commonplace in providing for other developmental disorders. You can think behaviourally or in terms of Feurestein’s mediation. You can invoke ecological psychology or transactionalism. You can think about the implications of learned helplessness and learned dependence. There is a whole new world out there just waiting to be applied’ not just to Conductive Education but to the whole field of what people call physical disability. Along with it, potentially comes a whole repertoire of assessment, evaluation and research just waiting to be applied.

What would you say is the most scientifically credible evidence that the approach 'actually' works? How should future research about your approach look, and what should it focus on?

So far there has been no scientifically credible evidence that Conductive Education actually works. This is in itself not necessarily evidence that Conductive Education does not work: an equally plausible plausible explanation is that research into Conductive Education to date has not worked, because it has not been appropriately structured. How should such research look in future? It would have to adopt a paradigm appropriate to the systemic nature of Conductive education and the disabling conditions that it deals with. The very nature of these demands that we redefine a whole mass of associated concepts to suit our own systemic, mediated, conductive understandings and practice. We have conductive pedagogy and conductive upbringing. These have now to be matched by, for example, explicit articulations of a conductive psychology, by a conductive formulation of human development, and by a conductive model of inclusion. These are what I have tried to develop for teaching my student-conductors. With respect to this specific question posed here, researchers should stop trying to shoe-horn Conductive Education into their existing paradigms but collaborate with conductivists to create a conductive research paradigm capable of revealing systemic changes at all levels. As for the future development of research into Conductive Education I would hope I would look forward to the ‘developmental’ understanding of physical disability becoming as well recognised as it is with respect to, say, the education and upbringing of the deaf, with appropriate process-oriented research stemming naturally from this, and with findings and insights from our specialised field spilling over in the same way into understandings of normal development.

The ICF [the International Classification of Functioning, Disability and Health] is today a central framework which should guide our work and thinking, both for clinical and research activities in childhood disability. Please try to ‘place’ the ideas of the approach you represent into the ‘modern’ conceptual framework of the ICF.

Being embroiled in Conductive Education over the last twenty or so years means that the ICF has largely passed me by. I have been primarily involved in education, not functioning, disability or heath. I have the impression that Conductive Education does not really need the ICF classification as we are already a stage beyond it. Yes, the ICF recognises the biological and the psychological and the physical, and it is comforting to know that their relevance is so powerfully acknowledged, but Conductive Education sees them linked, dynamically, in an essential human unity and acts upon them accordingly – and the link and the action are through the mechanisms of human learning.

What do you believe is unique about the system of therapy/treatment with which you are associated? What does it not do?

Peter forewent this question in favour of a new one that he sprang on us without notice. I hope that the opportunity comes to examine Conductive Education’s uniqueness and what it does not do at a later date.


An unexpected question

What we would arrange if asked to prepare a brief item for a television audience to convey the essence of our approach, be it Bobath or Conductive Education?

I would show some establishing shots, children, young people, adults with disabilities learning and living because of Conductive Education, including the voices of learners and their families who always describe and account for this better than do any of the professionals involved. It is important that the audience seen that something massive and hugely beneficial is happening here. Professional comment should be limited to emphasizing that nothing being shown is a ‘miracle or a ‘mystery’ but the material product of hard work and discipline (in the highest sense of the word) from everyone involved. Then I would conclude with a family speaking, saying something that I have heard said spontaneously again and again from people around the world who have experienced Conductive Education: ‘Conductive Education gives us back hope’.

[I was aware from out of the darkness before me that this final point drew a round of applause. Afterwards I was told that quite a few of the audience rose to their feet for this – the ‘hope’ allusion refers, I suspect, to one of Conductive Education’s most powerful and deep-rooting effects, and deserves far greater explicit attention than it has yet been accorded.]


Peter managed to chair this Round Table as a helter-skelter ride, concluding it within the time available. I hope that it will prove possible to publish rather more comprehensive replies to the questions presented to us in the form of a journal paper. This would provide an opportunity to discuss the two approaches in a way that has never yet occurred in writing. I would particularly like to read what I could not hear on the day, how Sarah responded to the questions put to us, and any commentary that Peter cares to make upon the two.

2 comments:

  1. Andrew,

    "Conductive Education gives us back hope"


    1. As a parent I have never belief that there is a cure for Cerebral Palsy.

    2. Being a parent of disable child is a tough job. Unfortunately this job is different from any job…you will never retired.

    3. Peto Method ? (I wish that one day people will stop use the terminology of “Conductive Education”),

    4.I wish to understand better CE 13 years ago. I would not have to go trough all the psychological abuse served so well by both...the parents and professionals.

    5. What about Fredericke or Susan Sweeney?...They both doing Doctorate today !!!

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  2. We have been involved with the Conductive Education concept and believe in it. Our grandson gets a great deal from it. Its convincing the local authority that there way is not best for everyone.

    ReplyDelete