Kids With Cerebral Palsy May Benefit From Intense Therapy

From the WebMD Archives

Aug. 21, 2000 -- When her daughter Olivia was 4 months old, Kathy Krindl knew there was a problem. At 6 months, she found out what it was: cerebral palsy. The pediatrician, Krindl remembers, "didn't come right out and say her prognosis wasn't great. But the tone of voice, it was easy to interpret."

Cerebral palsy is a problem with motor movements and coordination due to damage to the brain -- of which the cause is not always known. Neither is the best way to help these children lead fulfilling lives, because the condition has no cure. The traditional standard has been physical therapy. But now, a growing number of parents are stepping outside the mainstream and getting their children involved in something called conductive education.

Conductive education is not so much a therapy as a multidisciplinary educational program focused on the child's emotional and cognitive growth as well as motor function, supporters say.

While learning to do everyday tasks, children learn motor skills. And in the process, children are hopefully taught to see themselves as active and self-reliant participants in the world. Because these lessons are learned in a group setting, amid songs and games, proponents say children find them fun.

Traditional physical therapy places the focus on building muscle strength and coordination. Those sessions typically take place in 45-minute sessions, twice a week. Conductive education, however, is a five-hour-a-day, five-day-a-week program.

Krindl learned early on that Olivia has spastic cerebral palsy, the most common form of the disorder. Doctors told Krindl that Olivia was "never going to walk, never going to talk," and "we're not sure if she had [thinking] abilities or not. ... It was bleak, but I tend to be a hopeful person. I was skeptical. Maybe he [the doctor] doesn't know everything."

Right away, Krindl took Olivia to speech, physical, and occupational therapists. "She hated them, Krindl tells WebMD. "She screamed ... she was never encouraged to do anything on her own. I know my daughter has a ton of intelligence, the will to do something on her own. Why not give her the opportunity to achieve some sense of independence? Conductive education gives her a reality that's based on her. It allows her to be good at who she is."

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Today, Krindl and her mother, Judy Gillespie, run the Midwest Centre for Conductive Education in Glenview, Ill., outside of Chicago. The conductive educators in their school were trained in Hungary, where the program was developed in 1945.

Debra Gaebler, MD, a pediatric physiatrist at the Rehabilitation Institute of Chicago, tells WebMD that she has referred a number of children to Krindl's center. The sessions she has observed are "very rote, very rhythmic, very pleasing. It's translated into the first person, so the child is taking responsibility for his or her own actions. It's very functionally oriented. Some kids come back toilet trained. It has a more practical application than some other ways we do therapy."

For certain children, she says, "it is very good, but I don't think it's for every kid. I've referred many people to it who don't think it's right for their child. The child has to be motivated by the group. You can't have a child who is not able to follow direction or is so emotionally or medically fragile that they need a lot of support."

The goal is "integrate children into a normal classroom," says Anita Keresztury, a Hungarian-trained conductor who teaches at Krindl's school. "As soon as they are able to move or sit independently, they can be in normal schools. Just because they cannot walk a long distance does not mean they have to be in a special class."

Whether they are involved in "potty time," "circle time," or lunchtime, kids are expected to try to walk into the room. "They can use a walker, but they have to take some steps. Of course, most of them need help, but they have to try. ... I don't think everybody will walk and we don't promise anything, but they have to keep trying," Keresztury tells WebMD.

Children are also expected to try sitting up on their own; special chairs come equipped with ladders or side handles to provide support. At lunch, children must eat with a spoon or drink from a cup -- not use a bottle, as do many children with cerebral palsy. All during the day, as each child makes small successes, the other kids offer lots of approval. There's also "lots of singing, all day long," says Keresztury. "It's very motivational for them."

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Fifty conductive education groups exist today in North America, and four more are in the making, says Patrick Riley, president of the Inter-American Conductive Education Association. "We have made great headway." And in Grand Rapids, Mich., Aquinas College is opening a four-year course to train conductors. The college has launched the first conductive education program to be held in a public school.

"We want to mainstream these kids," Riley says. "Some kids make more improvement than others, but we don't want to turn anyone away. For the mother who sees her child pick up a spoon, that's a miracle in itself. So is a child with cerebral palsy who is going to the potty by himself. I saw the progress day after day in my granddaughter. Every hour, they're learning new things."

Krindl couldn't agree more. "In physical therapy, they would keep her sedentary in any kind of chair, strapped in. They stood her up one minute to bowl, not implying this was something she could do in the future. They were ... enabling her to become dependent, not trying to get her to stand up by herself."

One example of Olivia's progress: Today, at age 5, she can sit by herself on the couch. "She gets down off it, turns around, can walk along the edge. It may not seem like much, it's as much as a normal 1-year-old can do, but she didn't have any sense of walking before, even the concept of movement," Krindl says.

Conductive education is a "total immersion" philosophy that seems to work largely because it envelops the child's daily existence, Murray Goldstein, MD, medical director of United Cerebral Palsy's Research and Educational Foundation, tells WebMD. However, the results are temporary, and children require constant retraining, he says.

Outside of one small study, scientific research is not available on conductive education, says Goldstein. "Even though we have pushed these organizations very hard to conduct research, they have not. ... We have asked, do they have any specific information about special characteristics of children who can be helped, how long the effect will last. I suspect it doesn't last long because children keep going back for classes. It's a very, very, very intense program."

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The one study, which took place last year in the Australian school system, separated children with cerebral palsy into two groups, one receiving conductive education, the other receiving standard physiotherapy. Both groups had therapy the same number of hours a week: five to six hours a day, five days a week.

"So the only thing different was the actual therapy. And they found no difference [in the children's progress]," Goldstein tells WebMD. "It wasn't the most complete experiment in the world, but it reinforces the hypothesis that the biggest benefit is the immersion technique and the strong motivational reward system."

"I've seen good things with conductive education," says Donna Nimec, MD, MS, director of pediatric physical medicine and rehabilitation at Boston Children's Hospital and Spaulding Rehabilitation Hospital. "It's a very therapeutic environment. Children do make really nice gains, but I think it's important to understand the ultimate goals."

"I believe that conductive education combined with other therapies may be most beneficial," she says. "Conductive educators get their training in all the therapies -- speech therapy, occupational therapy, physical therapy -- but those are each specialty areas. One person can't learn all those therapies in just a few year's training."

As in building a bridge, traditional physical therapy seeks to build "supports before you build the actual roadway," Nimec tells WebMD. And that may frustrate some parents.

"If I can't control my head," Nimec explains, "if I can't control my trunk, therapists may start out working to strengthen muscles. If I can't sit on the floor, how will I be able to stand, when gravity has so much greater effect on me when I'm up higher? In a parent's perception, this may seem like the therapists are just not moving fast enough."

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