Monday, 28 June 2010

ICF and Conductive Education

Promised posting

At the Plenary Round Table of the XX. Anniversary Conference of Tsad Kadima, Tel Aviv, December 2007, Peter Rosenbaum asked –

Today, the ICF is 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. 

This is a transcript of my impromptu reply –

Conductive Education has remained largely untouched by the International Classification of Functioning, Heath and Disability. Internally at least, Conductive Education has not needed this, as it has already implicitly moved on to the next stage, which involves mechanisms for change not just classification.

Conductive Education represents a systemic view of human mental development – whether that be a matter of normal or disordered development. From such a viewpoint, the human biological entity exists and acts upon a social world that acts reciprocally back upon the individual, out of which active reciprocity culture is transmitted to each new member of society, emotional bonds are shaped, concepts are formed and our individual psychological worlds created. This is cumbersome to express, but it something that most of us already 'know' from the experience of our own lives. But what happens when some vital biological mechanism is affected (perhaps a child cannot hear, or cannot see) that is vital that is to establishing and maintaining effective, reciprocal transactions with a child's material and especially social worlds? Then we get what Vygotskii (1983, pp. 67ff.) called a 'social dislocation' (English reference translation: Vygotskii, 1993, pp. 76ff.), akin to the physical dislocation of, say, an arm. In the case of a physical dislocation the structure is out of joint, it does not function properly, and it is painful to try.

So too with a dislocation of the process of development If social interaction is out of joint then the reciprocal processes of learning may proceed in a deformed or dysfunctional manner (note the word 'dysfunctional'). This in turn affects the formation of the child's psychological qualities, and the quality of the parents' upbringing of their child, feeding back to the social or even to the biological level, establishing a vicious circle of non-productive learning and development. It is perhaps surprising that developmental psychologists, for all their enormous interest in children who are blind or deaf, have almost wholly ignored the development of children with motor disorders.

When development is dislocated by motor disorder, what is the conductors' task (rather, what is the task of Conductive Education because parents' upbringing should play as important a role here as does conductors' pedagogy)? It is to ensure that all parties involved seek actively to find ways to correct the negative systemic cycle, the chain of consequences that leads from the biological through the social to the psychological, and replace it with a self-reinforcing, benign cycle of learning and development (in the language or Conductive Education, to replace dysfunction with orthofunction).

In a way the International Classification of Functioning already covers this, and so it does but at a descriptive level.

So there you have the dimension, the stage upon which Conductive Education plays its role, whether implemented by conductors or conductive parents, not at the level of the underlying condition but in its systemic sequelae in the social and psychological spheres, where problems arising through learning are met by solutions brought about through pedagogy and upbringing.

If the ICF makes it respectable to mention such levels of effect, then so much the better for the plausibility of Conductive Education, and perhaps Conductive Education has till now missed a chance by not speaking more in the language of the ICF. But the practice of Conductive Education is based upon a rather more dynamic understanding.

A shortened version of this text has recently been published in the Israeli Journal of Occupational Therapy, as part of a report of the whole Round Table. My thanks to Michal De La Vega, Chair of the Israeli Society of Occupational Therapy for confirming that my publishing this original here does not trespass upon ISOT's rights, and to Rony Schenker for mediating.

The reason for publishing this transcript here in full is partly to establish intellectual rights and partly to indicate what was really being argued. The previous posting on this matter refers:

Sutton, A. (2010) CE and ICF, Conductive World, 21 June

Full report of the Round Table:

Schenker, R., Capelovitch, S., Sutton, A., Rosenbaum, P. (2010) Conductive Education and NDT-Bobath: experts' discussion on history, development and current practice, Israeli Journal of Occupational Therapy, vol. 19, no 2, pp. E31-53
(URL still awaited)

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