Tuesday, 21 April 2009

Cerebral palsy: research results compatible with developmental disorder

'Activity limitations not a mirror of motor impairments'

People concrned with Conductive Education for children and their families should be interested in a just-published study from the Netherlands, compatible with Conductive Education’s implicit understanding of cerebral palsy as a dynamic, systemic, developmental disorder, representing the interactive product of learning.

Here is the formal Abstract of the published paper:

Wichers, M., Hilberink, S., Roebroeck, M. E., van Nieuwenhuizen, O., Stam, H. J.

Motor impairments and activity limitations in children with spastic cerebral palsy: a Dutch population-based study, J. Rehabil. Med. 2009 Apr. 41(5), 367-74.

OBJECTIVE: To determine the prevalence of motor impairments and activity limitations and their inter-relationships in Dutch children with spastic cerebral palsy.

PATIENTS AND METHODS: In a population-based survey 119 children, age range 6-19 years, with spastic cerebral palsy were examined. Anthropometry, muscle tone, abnormal posture, joint range of motion, major orthopaedic impairments and gross motor functioning and manual ability were assessed or classified, in addition to limitations in mobility and self-care activities. Spearman's correlation coefficients, bivariate post hoc analyses and univariate and multivariate logistic regression analyses were used.

RESULTS: Children with spastic cerebral palsy had a lower body height and weight compared with typically developing peers. Forty percent had no range of motion deficits. Hip dislocations were rarely encountered. Motor impairments were associated with gross motor functioning and manual ability levels. Close to sixty-five percent walked independently. Children with diplegia and tetraplegia differed in activity limitations. Motor impairments and limitations in mobility and self-care activities were only modestly related in multivariate analyses.

CONCLUSION: Distribution of cerebral palsy-related characteristics is consistent with that found in representative studies of other countries. The distinction between diplegia and tetraplegia is relevant from an activity point of view. The child's activity limitations are not a mirror of the motor impairments, which suggests multifactorial influences. An activity-oriented rehabilitation approach goes beyond treating specific impairments.

Facts, Zeitgeist and paradigm shift

The full paper offers some interesting facts of interest to anyone involved with cerebral palsy and its treatment, ‘consistent with [those] found in representative studies in other countries‘.

For Conductive Education, however, this study also offers important empirical assurance on a fundamental question:

Activity limitations are determined only partly by the mere presence of motor impairments, which confirms the findings of other studies… Individual goal setting in rehabilitation should identify all factors relevant to the child, including environmental factors. An activity-oriented rehabilitation approach goes beyond the treatment of motor impairments that are present.

In other words, what children with cerebral palsy can and cannot do is not simply a direct effect of the degree of their underlying physiological deficit. It is mediated by something else.

Nothing new here for the fields of deaf and blind education, or to otologists and ophthalmologists. Everyone working with those developmental disorders has long known this to be so, recognising the essentially psychosocial mechanisms involved in bringing this about (‘multifactorial influences’ indeed!), and actively welcoming the pedagogic and other processes that serve to enhance such ‘dislocation of development'. In the field of motor disorder, however, this long-established and self-evident-human truth remains a stranger to the Zeitgeist, be this in educational or medical areas.

All the same, these multi-factorial influences can be gathered together, focussed and integrated (’conducted’, as we say), and consciously directed, to enhance the process and outcome of development (that is where pedagogy and upbringing come in). Not a lot of people seem to know that, even now.

Meanwhile, as this paper from Holland exemplifies, information is there from medical research to support such a position. All that is needed is minor adjustment in the way of understanding such information. A paradigm shift.

Open access

This report is published in the April issue of the Journal of Rehabilitative Medicine, on-line and open-access. This mean that this journal article is available, free of charge, and in its entirety, to read on the Internet, or to download if you require a paper copy.

Hats off to the Journal of Rehabilitative Medicine:



  1. How great to have such a result of a study. Thanks to turn our attention to this. But as usual, raising a question: will this generate any changing towards common, better understanding CE?

  2. No, of course not, not on its own.

    People in Conductive Education have to use such information in suport of their position, arguing it here, there and everywhere.

    If they do not or they can not argue such findings on behalf of CE, then no one else will see or articulate their significance.