Monday, 24 March 2014

INTELLECTUAL CUT AND THRUST

Or the sound of one hand clapping?
Last year, from Sydney, a meta-review of evidence-based practice for children with cerebral palsy was published in the international paediatric journal Developmental Neurology and Child Neurology. Its apparently authoritative judgement on Conductive Education placed CE below a 'worth-it line', along with the apparently research-based advice 'Probably don't do it'.

Rony Schenker and I duly wrote a joint letter to the Editor for publication in the journal. This has now been published as part of wider correspondence stemming from this meta-review. Our letter is republished here in its entirely, with the permission of Peter Baxter, Editor in Chief of Developmental Neurology and Child Neurology –
SIR–The recent review by Novak et al. raises the spectre of conductive education research. Placing conductive education below the ‘worth-it line’, with the advice ‘probably do not do it’, restates a general conclusion of earlier meta-reviews and looks to mark the scientific verdict on research into the benefits of conductive education. Or is there an alternative?
Conductive education’s breakout from Hungary in the late 1980s has captured the attention and the enthusiasm of many families around the world, and brought experience of a developmental-educational paradigm for understanding and working with motor disorders. Conductive education is neither a therapy nor a medical intervention and is not provided by medical practitioners or by allied health professionals. It is an educational process, led mainly by conductors who are teachers (or special education teachers) specializing in conductive education pedagogy (3- or 4-year higher-education courses).
Most evaluation studies have utilized concepts and methods from the medical and allied health professions. Despite the clue inherent in its English name, however, conductive education has rarely been investigated by means familiar in education.
We face a paradox. The general finding has been that conductive education demonstrates little or no measured benefit – yet many users and providers continue to seek and to fund it. How to explain this? One possible explanation is that advocates of conductive education are deluded fools with no respect to the findings of medical science. Another is that medical science has failed to capture the social and personal benefits widely reported by users of this approach. If so, reliance upon medical-style evaluation may have both missed a trick and helped choke off development of a major humane and scientific advance. The absence of evidence is not evidence of absence. It may instead be a function of looking in the wrong place, by the wrong means. If conductive education represents a paradigm, a philosophy, a way of life – in the specific area of childhood a style of childrearing – then medical-style research is but one amongst a number of possible ways to investigate this.
http://onlinelibrary.wiley.com/doi/10.1111/dmcn.12363/full

The review covered the evidence bases for interventions of various kinds, and Rony and I were not the only ones to make a public response. We do not know whether anyone else responded about this review's treatment of Conductive Education – just that ours was the only one letter published published on this specific theme. A number of responses (themselves refereed) have been published together in the latest issue of the journal, in return Novak et al. have responded to their critics. Their response includes brief reference to Conductive Education –
We welcome conductive education and NDT groups (such as Capelovitch, Mayston and Rosenbloom, and Schenker and Sutton) conducting more efficacy research, using rigorous methods, and measuring important and relevant end-points such as participation as Mayston and Rosenbloom propose.
http://onlinelibrary.wiley.com/doi/10.1111/dmcn.12426/full

That's it. For now.

References

Novak, I., McIntyre, S., Morgan, C., Campbell, L., Dark, L. Morton, N., Stumbles, E., Wilson, S.-A., Goldsmith, S. (2013) A systematic review of interventions for children with cerebral palsy: state of the evidence, Developmental Medicine and Child Neurology, vol. 55, no 9

Schenker, R., Sutton, A. (2014 ) Researching conductive education, Developmental Medicine and Child Neurology, vol. 56, no 4, pp. 402-403, March


1 comment:

  1. "We welcome conductive education and NDT groups (such as Capelovitch, Mayston and Rosenbloom, and Schenker and Sutton) conducting more efficacy research, using rigorous methods, and measuring important and relevant end-points such as participation as Mayston and Rosenbloom propose." Presumably they would welcome the same for education and upbringing in general - if only one could work out how to do so in any meaningful way.

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