No, I’m not teaching the children to tell fibs and no it’s not nap time. It is much easier to say what it is not though, than to say what it is.
I must admit I have been planning to write this for quite some time, but have been daunted by the task. There is just no easy way to explain what my classmates and I do each day in placement, especially in written word. But even if you came with me on Monday and watched a programme, you would not know half of what goes into it. I didn’t, and I’ve been involved in conductive education for 6 years! So bear with me as I try to clear things up a bit.
Each day in school group (my current placement, 6-11 year old children) the children keep to a specific schedule of programmes. Some are academic, some are movement based. The movement based programmes include the lying, standing, individual, and speech and manipulation programmes. I currently am learning to lead the lying programme, the first programme of the day. It lasts about 45 minutes and involves 6-10 children depending on the day.
It is the first programme of the day because it prepares the children for the following programmes. The lying position is the easiest and safest position to perform the movements. It also helps the children to relax and stretch their muscles, which will help throughout the day (this is especially important for the children with high muscle tone). All of the subsequent programmes will build from the lying programme.
In the lying task series, children don’t simply learn specific movements directly, they learn strategies for movement. We purposefully do not call the tasks ‘exercises,’ as they are actively engaged in the task, not repeating something without thought. It is important that the children learn to problem solve rather than just learn a specific functional movement. If this type of learning does not take place, they may be wonderfully successful in a small area of functioning, but as soon as they leave that area they will struggle. It is not being able to step over a purposefully placed obstacle in the classroom that is important; it is being able to work out how to get past that branch on the playground. It is about transferring learnt skills, and the increased capacity to problem solve, to everyday life. This is essentially the basis of everything done in the conductive classroom.
During the lying programme children will change positions constantly, standing to crouching, crouching to kneeling, kneeling to lying, lying to sitting, etc. They will turn and roll and bend and stretch legs and arms. Though the instruction (‘verbal intention’, which I will discuss later) is the same each day, the way the child completes the task will change. The programme helps the children develop their proprioception- the body’s recognition of where it is. We take for granted our body knowing where our arms and legs are, many of these children must actively learn this. It also helps them begin to create pathways in their brains for functional movement, to replace the dysfunctional movement that occurs because of their condition.
All programmes involve:
The group (rather than individual instruction, as is common for PT, OT, etc)
Aims and differentiation
Prevention and feedback
The lying programme begins with the children in a line, either sitting on a stool (no back or sides) or sitting cross-legged on a mat, depending on their needs and aims. Each child has a mat, similar to a yoga mat. Shoes, socks, braces, etc are taken off and the children wear jumpers and joggers (AmEnglish- sweatshirts and sweatpants). Programmes are done in groups for many reasons; peer support, visual feedback, motivation, a dynamic environment, and more. If I am leading I’ll ask them about their weekend to get them engaged and talking and then I will introduce the theme. Last week I used the book “A Fish out of Water” by Helen Palmer as a theme, because they are getting a goldfish for the classroom soon. I told them about the book and read a few pages to get them interested. Then I gave them their individual aims for the programme. Each child has 2 aims, one of which is given to them so that they will have a specific goal for that programme. I give *Sarah* the “special job” of keeping her toes up toward the ceiling when she is on her back- because she has high muscles tone and needs to practice pulling her toes up. I ask *Jen* to keep her right arm down by her side- because her right side is more affected than her left and her arm tends to bend at the elbow. These aims are continually referred to throughout the programme to remind the children and facilitators that that is their focus.
Once they have their aims I begin the programme by saying “I sit tall.” The children repeat “I sit tall” and then everyone counts together, 1 to 5. I check that they are sitting correctly, give praise or correction and then move on to “I slide forwards on my stool” to which they respond “I slide forward” and then shuffle forward in preparation for standing. I’ve not made these up on the spot; each instruction is part of a specific task series for a specific group. They are written down and memorized by those who are leading. The children are used to it, and know what to repeat and what count to use (1 to 5 or “1 and 2, 1 and 2”) This is how the programme progresses from here on out, I will give the instruction and they will repeat it and then do the movement. This is called rhythmic intention. Once they are lying down I will read a bit more of the story and maybe ask some questions about it.
Rhythmic intention (RI) is very important in conductive education. It links thought, language/speech, and conscious movement. It helps create a fluent, voluntary movement. Intention is the decision to do a movement at the neurological level. Saying out loud the movement that they are about to perform actually stimulates the pathways needed for that movement. It also aids in speech development. Language and thought are tightly linked; RI uses this link to produce more functional movement. Rhythm helps link the intention to the action. In typical, functional movement there is fluidity. This is lacking in the movement of people with movement disorders such as cerebral palsy. The speed and intonation of the count helps the individual produce a more fluent, skilled movement. In sum, RI links the inner thought processes with action- an important step in education of the brain and body. RI is also used in the form of songs and rhymes.
Skipping to the middle of the programme- the kids are now on their backs. The next task is to put their right foot flat. Before I give the verbal intention, I give prevention and differentiation and after the movement I give feedback. Prevention is essentially correcting the mistakes that are likely to happen before they happen- this gives the children a better chance at performing the task in a functional manner. For example, I remind Jen to keep her arm down when she bends her leg, because I know she finds it difficult to move just one body part at a time. I will remind the whole group which side is their right side, and ask them all to help me with the RI. I give differentiation to Jack- asking him to stretch his leg out to the side while the other children bend theirs, because of the tightness in his hips. I then say “I put my right foot flat” and the children repeat “right foot flat 1, 2, 3, 4, 5,” then attempt to do the movement. After the movement is completed I give feedback, praising and correcting them. I notice Alex kept up, starting and finishing his movement within the count- his individual aim. I praise him for doing this well. I notice many in the group have forgotten to flex their left foot. I remind Sarah, because it is her aim, but in such a way that the whole group hears and also adjust themselves. Constant and careful observation takes place during the programme. I am using 3 kinds of conductive observation while leading this programme: operative (what the child is doing here and now), progressive (what the child has changed from previous attempts), and comparative (which children need differentiation from the group for certain movements). This observation enables me to give good prevention and feedback, and determines what facilitation I use.
Throughout the programme three kinds of facilitation will be employed: educational, psychological, and physiological. Physiological is easily recognized. The other conductors/students and I will give manual facilitation at times. For example, the next task is “I put my left heel onto my right knee.” For this task, Anton will need aid to place his heel in the correct position, because he has difficulties with targeting his movements. Simultaneously, educational and psychological facilitation will be employed. I will use one mode of educational facilitation by giving him prevention, explain to him that he needs to keep his opposite foot flat and lift his left knee high to get his heel onto his right knee. I will also use psychological facilitation in the form of motivation, “Wow Anton! You are so strong!” or “Yikes! Smelly feet! How high can you put your smelly feet?” Each child needs different educational, psychological, and physiological facilitation based on their personality and needs.
In the task of putting their right foot flat and their left heel onto their right knee the children are learning many things simultaneously. They are learning to use the correct muscles to lift their legs or learning, they are practicing targeting of movement (placing heel onto knee), they are stretching their legs and hip flexors, they are getting feedback about where their body is on the mat and in relation to itself, they are maintaining stretched arms, and they are actively flexing their feet- an important preparation for walking. It is not an exercise they simply repeat. They can use what they have learnt through this task to step up a curb because of the ability to lift their foot and knee, to sit more comfortably because of the stretching that was involved, or to step on that ant on their porch (maybe not the best use for targeting, but kids will be kids!). It’s that the kids will be able to take the learning into their everyday lives that is the goal of each programme.
The programme will carry on with similar tasks including things such as rolling onto their tummies, stretching their arms forward and bending their knees, pushing up into a kneeling position, lifting their leg behind them, crawling over to their stools, and lastly sitting up onto their stools with feet flat and hands on their laps. Throughout the programme we will have had natural stops where I read more of the book. At the end I will finish it up and have a bit of a chat about it. Then I will ask them how they thought it went, did they remember their jobs, did they work hard, etc. I will talk for a few moments with each about it, “Jen you kept your arm by your side often, well done! Next time, can you try to keep it down with fewer reminders?” After it’s all wrapped up they will put their braces, socks, and shoes on and get ready for their next programme!
I hope this as given you a better idea of what it is when I say I am planning for a programme or leading one. I am learning to put each of the many aspects into the programmes. At first it was enough to think about just trying to remember the verbal intention! I am slowly putting the pieces together and am really enjoying it! There is plenty to work on, but each programme seems to be getting a bit better. I have my practical exam in 2 weeks, wish me luck! Thanks for reading, let me know what you think!
Keep an eye out for pics from Cardiff!