Tuesday, 5 May 2009

Study stuck in old way of thinking

But interesting, indicative findings nevertheless

A couple of weeks back it was suggested on Conductive World that, instead of seeking some magic research bullet to 'prove' Conductive Education, through specially mounted comparative outcome trials, the evidential case for Conductive Education might be found and argued from amongst accumulating research evidence with findings compatible with the position of CE (Sutton, 2009)

Here is the formal abstract of another, recently published example (coincidentally, like the last one, also from Holland).

Holsbeeke L., Ketelaar, M., Schoemaker, M.M., Gorter, J.W. (2009) Capacity, capability, and performance: different constructs or three of a kind? Archives of Physical and Medical Rehabilitation, vol. 90, no 5. pp. 849-855.

OBJECTIVES: The present study focused on motor activities of young children with cerebral palsy (CP) and examined the relation between motor capacity (what a person can do in a standardized, controlled environment), motor capability (what a person can do in his/her daily environment), and motor performance (what a person actually does do in his/her daily environment).

DESIGN: The relations between motor capacity, motor capability, and motor performance were calculated by using Pearson correlations and visualized by scatterplots.

SETTING: A cross-sectional study of a hospital-based population of children with CP.

PARTICIPANTS: Subjects were children with CP (N=85) aged 30 months (Gross Motor Function Classification System levels I-V).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Motor capacity, motor capability, and motor performance were assessed with the Gross Motor Function Measure and 2 scales of the Pediatric Evaluation of Disability Inventory, respectively.

RESULTS: Correlations between motor capacity, motor capability, and motor performance were high, between 0.84 and 0.92, and significant (P< .001). But when comparing children with the same level of motor capacity or motor capability, large ranges at the level of motor performance were found.

CONCLUSIONS: Results imply that motor performance levels are only partly reflected by the motor capacity and motor capability levels in young children with CP. Contextual factors (physical and social environment) and personal factors (such as motivation) influence the relations between capacity, capability, and performance. This information is essential in making decisions about the focus of therapy to maximize a child's independent functioning in daily life.

This abstract makes interesting reading. The complete article would be even more so but unfortunately the Archives is only open-source to a degree and twenty-four hours’ access to this particular article would cost me $31.50. Sorry, but checking on what I say here and maybe taking such critical analysis further is a matter for those many institutions that call for ‘research evidence’ on Conductive Education..

I shall continue noting them as they appear. I very much hope that others are doing so too. I shall of course be also on the look-out for studies bearing the contrary implication.

There is no need to restrict this approach to cerebral palsies ot to childhood conditions.

An accumulation of such studies might not so much ‘prove’ Conductive Education. They might, however, make it harder to accept that other approaches are really feasible!

What it says

Bear in mind the proviso that what follows is based solely upon the published Abstract reproduced above.

Underlying constructs
  • motor capacity (what a person can do in a standardized, controlled environment)
  • motor capability (what a person can do in his/her daily environment)
  • motor performance (what a person actually does do in his/her daily environment).
Had not these authors heard of the zone of next development (a rhetorical question of course, this, since I cannot access their reference list)? Have people no concept of the potential level of development and its relationship to adult intervention (equally rhetorical of course, for the same reason)? On the face of it the underlying constructs for this study seem fixed in a time-warp paradigm that people, disabled children anyway, are ‘as is’. No particular fault of these researchers of course: a lot of other researchers and practitioners seem to assume very much the same.

Findings
  • Results imply that motor performance levels are only partly reflected by the motor capacity and motor capability levels in young children with CP.
  • Contextual factors (physical and social environment) and personal factors (such as motivation) influence the relations between capacity, capability, and performance.
  • This information is essential in making decisions about the focus of therapy to maximize a child's independent functioning in daily life.

Whatever the value and meaning of these constructs, however, certain factors are identified here as being associated with at least some degree of change in children’s lives: their physical and social environment (my emphasis) and their motivation.

Ring a bell? I’m not sure where ‘therapy’ comes in (though it would do no harm for therapists to be aware of such vital factors) but something utilizing social environment and emotion, to enhance what people actually do in their daily environments… now there's an approach to look out for.

References

Holsbeeke L.. Ketelaar, M., Schoemaker, M.M., Gorter, J.W. (2009) Capacity, capability, and performance: different constructs or three of a kind? Archives of Physical and Medical Rehabilitation, vol. 90, no 5. pp. 849-855.
http://www.archives-pmr.org/article/S0003-9993(09)00125-7/abstract

Sutton, A. (2009) Cerebral palsy: research results compatible with developmental disorder, Conductive World, 21 April
http://www.conductive-world.info/2009/04/cerebral-palsy-research-results.html

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