Thursday, 7 May 2009

Cerebral palsy on BBC Radio 4

Existing paradigm unassailed

Last week, on his blog Geek Conductor, Ben Foulger mentioned a forthcoming BBC radio broadcast on cerebral palsy, and asked:

…what’s the betting that the words 'Conductive Education' won't feature? (Foulger, 2009)

The programme went on air on Tuesday (and was repeated on Wednesday). Conductive Education was indeed not mentioned, Britain’s three Bobath Centres were.

If you want to listen to this programme, it is available (for the next few days anyway) at:

http://www.bbc.co.uk/iplayer/console/b00k3zzj

Against reductionism, again

This broadcast was part of a series called Case Notes, presented by a physician (Porter, 2009). No real surprise that in this context cerebral palsy was presented in the way that it was, construed unquestioningly within the dominant and therefore usually unstated background assumption that developmental disorder arising out of motor impairment is sufficiently explained as a medical condition.
  • Fair enough, the cerebral palsies are a medical conditions and consideration of these and their possible medical treatment is a necessary component of any analysis of movement disorder as a whole (and of course too such matters are legitimate topics for technical concern in their own right). So far, so good, but only so far and only so good.
  • Medical considerations are not sufficient in themselves for effective understanding of the lives of children and adults and their families affected by cerebral palsy, and what might be done to enhance these.

The basic question here is not the importance of therapies (physio-, Bobath, whatever) or surgical and other medical procedures in the treatment or amelioration of medical conditions involved in cerebral palsy. A priori this seems a reasonable match of problem and solution, certainly one within which I have no expertise with which to come to any judgement. Horses for courses.

The radio programme dealt with the medical conditions, but them alone It defined cerebral palsy as:

  • a persistent problem of movement and posture… a permanent difficulty in either coordinating or making effective movements’.

Its recommendations for action were correspondingly straightorward:

  • The most important thing is physiotherapy
  • Physiotherapy is a cornerstone in the treatment of cerebral palsy.

And what is this thing called physiotherapy? The Head Physio from Bobath Scotland put it like this:

  • It’s a problem-solving approach.

And she put it like that:

  • It’s a hands-on approach.

So where’s the problem?

Developmental, systemic, ecological, social, psychological etc, again

Problems arise when the human situations that stem from cerebral palsy are understood and responded to as though the it is sufficient to do so at the biological level alone, with their discussion exhausted by medical analysis.

It is a question of paradigms, with motor-disorder stuck in some strange conceptual limbo long since escaped by most other disorders of development, now being regarded unquestioningly as product of interactions between children and their world, especially their social worlds.

In the twenty-first century one can hardly conceive of a similar programme’s being broadcast on say visual and auditory disabilities, even nowadays on intellectual disabilities, concentrating upon biological causation, medical intervention and therapies, to the exclusion of learning, specialist teaching and training, education and upbringing, and family life.

Know your level

Despite the easy convenience of saying (and writing) that Conductive Education is relevant to cerebral palsy, like all simplifications this soon runs into trouble if its audience does not know that it expresses less that the whole truth, in this case drastically less. Conductive Education is in fact not directly relevant to the primary impairment at the biological level, but to the systemic effects, secondary or even tertiary, that this generates, to what people involved experience as developmental disorder (conveniently termed a ‘motor disorder’).

The proper arena for Conductive Education is not at the primary, biological level. That is the proper stomping ground of medicine and its associates, and is the level at which the medical conditions of cerebral palsy exist. The proper arena for Conductive Education is within the systemic psycho-social effects that ensue from cerebral palsy conditions, and its task is to seek ways to reset Vygotskii’s ‘dislocation of social development’.

This is no academic abstraction but a philosophical position with implications for the sensible and non-conflictual ordering of professional practices and services.

  • It behoves Conductive Education always to know the biological base for the problems of learning that lead to motor disorders affecting human development, and something at least of the steps available to deal with these at this level.
  • Medical and para-medical personnel are correspondingly beholden to know the psycho-social sequelae that constitute the motor disorders, in the formation of the personalities, family life, education, everything to do with living in its non-biological sense, and something at least of the steps available to del with these at this level.

The two levels are causatively linked, and ultimately inseparable. Providing them ‘professionally’ involves activities that should be distinct, yet mutually aware, integrated and complimentary.

Never forget, that the meaning of the Latin verb conducere is ‘to bring together’. For those who prefer the word ‘holistic’ then here is a place to use it.

The underlying problem with the radio program was not that it mentioned Bobath and not Conductive Education, but the fundamental one, that the dominant understanding of motor disorders remains as something adequately explained by its underlying physical condition (here cerebral palsy)

And to be fair to the BBC…

The Beeb runs a permanent cerebral-palsy information page on the Internet, also medically authors, quite a good one actually. Having run through the medical bases of the condition, it poses the $64,ooo question: ‘What's the treatment?’

It briefly parades the usual suspects (surgery, drugs and therapies) and advocates early intervention. But there is more. Mirabile dictu:

Many children with cerebral palsy benefit from an approach known as conductive education, which helps them to overcome movement problems and gain some control through special education and rehabilitation. Adults can get a lot from it, too. (Macnair and Hicks, 2009).

OK, the exiting paradigm remains unassailed, cerebral palsy, the medical condition, is all the explanation required, and learning and development, upbringing and education might as well not exist. One may also gripe that it rather does look as if the authors are presenting this as part of physiotherapy, but you can’t have everything. At least CE is hanging on in there, it’s on the radar, on somebody’s agenda.

It’s a start.

References

Foulger, B. (2009) Radio 4 programme Case Notes on Cerebral Palsy, 05/05/09, Geek Conductor, 29 April
http://geekconductor.blogspot.com/2009/04/radio-4-programme-case-notes-on.html

Macnair, T., Hicks, R. (2009) Cerebral palsy, BBC Health: conditions (last revised, April)
http://www.bbc.co.uk/health/conditions/cerebralpalsy1.shtml

Porter, M. (2009) Cerebral palsy, Case Notes, BBC Radio 4, 5 May
http://www.bbc.co.uk/iplayer/console/b00k3zzj

2 comments:

  1. Thanks for the summary and commentary Andrew. I chanced upon the programme, driving home from Paces.

    There is no debate on the education and upbringing of children with "a persistent problem of movement and posture… a permanent difficulty in either coordinating or making effective movements’.

    What is truly appalling is that almost no-one in "the children's workforce" regards it as a question worth debating.

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  2. I doubt that there can be many people in the 'children's workforce' with the apparatus criticus to debate either the specific nature of developmental disorder or even. more generally, child devlopment as whole. As for questions of pedagogy and upbringing...

    I admit to saying this on the basis of rather little evidence. I was accidentally roped into the early stages of the creation of the training syllabus for the so-called workforce. I was horrified both at the way this was done, by 'consultants', and the rag-bag of superannuated nonsense that they stirred unquestioningly into the mix.

    Maybe things improved after I left. Maybe they didn't.

    Anyway, the workforce is not employed to debate, but to 'deliver targets' (or some such mantra).

    These are of course empirical considerations. Daunting though these are, I fear, daunting more by far is the simple philosphical block of the notion that cerebral problem is a medical problem. End of story.

    As you say, truly appalling. Like so much else...


    Keep kicking against the pricks,

    Andrew.

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