conductive education (ce) in neurology rehabilitation · conductive education (ce) in neurology...

CONDUCTIVE EDUCATION (CE) IN NEUROLOGY REHABILITATION

Ivan Yuen-wang SU Corporate Programme Coordinator SAHK 18 Jan 2012

Overview

Contemporary Management of Chronic Conditions

Paradox: we are still practicing acute care medicine in a world of chronic disease

Robert L. Kane (1940 - )

(Kane, Priester, & Totten, 2oo5)

(Kane, 2011)

� SShared responsibility

� Shared decision making

� Ongoing communication

From Professional Care to Self-management

Psy

PT P&O

ST OT

P&O

Psy

PT OT

ST Professional Staff

Supporting Staff

Downward Delegation

awareness & acceptance of

RReal-self

controlled free will & choice in establishing

Ideal-self

Subjective Perception of Well-being

Good QOL (WHO, 2004)

DDISABILITY PRIDE

• validate our own experience & establish a culture of our own;

• create a counterculture that teaches new values and beliefs & acknowledges the dignity and worth of all human beings;

• expect more from ourselves and those within the community;

• be committed to building an inclusive community that recognizes the dignity, humanity and worth of all people.”

“…take for granted with opportunities to:

Edward Deming (1900 - 1993) Contemporary Trends in Neurorehab.

• Enhance negative symptoms (e.g., strength, range, endurance, coordination, balance, equilibrium, etc)

• Promote motor learning: (skill acquisition � skill retention � skill transfer)

• Minimise the gap: between capacity & participation

• Holistic approach: an integration of biological, contextual & personal factors

• Reduce positive symptoms (e.g., spasticity, etc)

A 3-pronged approach:

� Biological

� Contextual

� Personal

The ICF Functional Model of Disability

The International Classification of Functioning, Disability, and Health (ICF, WHO)

Contemporary Trends in Neurorehab.

Edward Deming (1900 - 1993) Contemporary Trends in Psychotherapy

• Enhance positive character strengths (e.g., gratitude, optimism, acceptance, self-efficacy, creativity, positive reframing, etc)

• Promote PREMA well-being: (Pleasant life + Relational Life + Engaged life + Meaningful life + Achieving life) (Seligman, 2002, 2010)

• Holistic strength-based approach: an integration of experiential, behavioural, interpersonal, & spiritual strengths

• Reduce negative psychological states (e.g., depression, anxiety, etc)

Flourishing as the goal with the following constructs: (Huppert and So, 2009)

Core Features Additional Features

Positive Emotions (pleasant) Engagement (interest) Meaning (purpose)

Self-esteem Optimism Resilience Vitality Self-determination Positive relationships

Contemporary Trends in Psychotherapy

Overview


Deconstruction of CE

Conductive Education (CE)

CE Furniture e.g., slatted

plinth, ladder back chair, etc

Group & Rhythmical

Intention e.g., task series,

daily routine training, etc

Motor Impairment e.g., manual facilitations, basic motor patterns, etc

Pedagogy

Upbringing

Human Principles

Dislocation of Development

Problems of Learning

Compensatory Links

Orthofunction

Motivation & Will

Person centered

Conductor

Conductive Process

Least Necessary Help

Intended Active Learning

Socialization

Training in group

Daily Routine follow-up

Daily Schedule

Experiencing Success

Philosophical Operational

The Jargons of CE

Intervention Strategies

Task Series, Rhythmical Intention, Manual Facilitation, Slatted Furniture

Strong Assimilating Power with other Interventions

Across Life-span

Universal to all Neurological Conditions

Assimilating Power er Interventions

Life-span

al to all Neurological ons

Core Values of CE

Overview



The New Face of CE in SAHK

Principles of Service Design

•Lifespan process

•Lifelong learning

•Optimal learning environment

•Independence & willpower

•Education & rehabilitation

Framework of Service Delivery

•Whole day structuring

•Activities reinforcing one other

•Trans- disciplinary team work

•Holistic manner

•Experiencing Success

Service Underpinnings

•Unite body & mind

•Connect whole person with environment

•Maximise participation

•Satisfying & independent live

Service Vision

•Self-reliant

•Resilient

•Experience of overcoming mental, motor & psycho-social challenges

•Take charge of own live

•Enlarge prospects

The 4 Pillars of CE in SAHK

Life Span Process

Disability threshold

Life-long Learning

Self Reliance & Problem Solving

Sustainability

Optimal Learning Environment

Mainstream

Contexts

H

ighly Adaptive

Contexts

Chronological Age-appropriateness

� CE is a combined education and rehabilitation system. It is designed to create the OPTIMAL LEARNING ENVIRONMENT for persons with special needs. It involves a LIFE SPAN teaching and learning process, which helps the persons to move towards functional INDEPENDENCE, to establish their own WILLPOWER and to equip them with skills to go about their daily living as well as to face challenges in life.

The 1st Pillar: Principles of Service Design


•Lifespan process









•Holistic manner







Service Vision

•Self-reliant

•Resilient





Conductive Bringing/pulling together all the systemic aspects of development

Conductive bringing together different specialists out of their therapy room and to work in common causes for the best interests of their patients

Shared Goals

at a time for

Individual Clients

PT, OT, ST, N, SW

Common Philosophy: CE

P/O/ST, N, SW

Philosophy Service Design Service Delivery

Education & Habilitation

Daily Life

Activities Reinforcing one other

Transdisciplinary Team

Well-being

� 40% of individual differences in well-being can be accounted for by one’s activities and perception of life circumstances

(Lyubomirsky, Sheldon, & Schkade, 2005)

Whole Day Structuring

Daily R

hythm

D

aily Time Table

safety & security

image & hygiene

taking meals

going out

meeting others

Process Owner: Supporting staff

Enabler: Professionals

nursing care

OT session

PT session

ST session

Education

Lesson

Compartmental System (Specialist-based)

Whole Day Process (Client-based)

Downward Delegation

Learned Helplessness

Handicap

Disability

Neurological Impairment

Experiencing Success

� In a CE system, a CLEAR STRUCTURE for the ENTIRE DAY is established. Within this framework, the persons together with all the staff involved, follow an integrated routine of educational/vocational, rehabilitation and recreational ACTIVITIES that CONSTANTLY REINFORCE each other. It allows staff of various disciplines to work together cohesively and in a holistic manner to help the persons learn through well-planned processes to EXPERIENCE SUCCESSES in real-life situations.

The 2nd Pillar: Framework of Service Delivery


•Lifespan process









•Holistic manner







Service Vision

•Self-reliant

•Resilient





Companionship for Life’s Journey

Human Attributes

SPEECH

Fundamental Human Actions

MIND

Basic Motor Patterns

Unite Body & Mind

Intention

Motor Speech

Connect with Environment

Successful & Personally Satisfying

Social Material

Satisfying & Independent Live

Real-self Ideal-self

Subjective Perception

of Well-being

� CE finds ways to UNITE the BODY and MIND of the persons, to CONNECT the WHOLE PERSON with his/her ENVIRONMENT and foster active learning via environmental interactions. Its goal is to provide a programme for both learning and living which will MAXIMISE their PARTICIPATION to achieve a flourishing life.

The 3rd Pillar: Underpinning Beliefs


•Lifespan process









•Holistic manner







Service Vision

•Self-reliant

•Resilient





Self-reliant & Resilient Personality

Enlarged Prospects

AGE-APPROPRIATENESS Client

Self-care Study/Work Recreation

� The ultimate aim is to cultivate SELF-RELIANT and RESILIENT PERSONALITIES, whose confidence in themselves is developed through DAILY EXPERIENCE of how the challenges of mental, physical and psycho-social impairments can be overcome. It enlarges the prospects for PERSONAL FREEDOM by enabling the persons to TAKE CHARGE OF THEIR LIVES.

The 4th Pillar: Service Vision


• longitudinal view

• lifelong learning

• upward mobility


• transverse view

• lifewide learning

• coherency

Underpinning Beliefs

• whole person

• well-connected

• flourishing life

Service Vision

• self-directive

• freedom & will

• +ve personality

Upbringing Pedagogy Conductive Ortho- function


Orthofunction

• Age-appropriate

• Culture-compatible

• Connected

• Enthusiasm

• Self-determination

• Self-actualization

Well-being

• Pleasant

• Engagement

• Relationships

• Meaningful

• Achievement

Overview




History of CE on a Global Stage

Hungarian Period 40’s – 70’s

Prof. Andras Peto

International Period 80’s – 00’s

1st Wave


2nd Wave 3rd Wave 4th Wave

Emerging of CE in Mainland China


Great Impact on CE World: What is the Essence of CE?

Globalization Period 21st Century

Prof. Ildiko Kozma (President, International Petö Association)

“ …HK plays an important, leading role in the development of CE.”

“Many dignified persons holding no conductors qualification have been …promoted to the establishment of CE.”

Prof. Franz Schaffhauser (Rector, András Petö Institute)

“…imperative to acknowledge every professional accomplishing an efficient transmission for the local development of systemic CE.”

The 7th World Congress on CE East Meets West: Adaptation and Development

Other Feedback: from VIP

� Dr E. Balogh (IPA, Hungary):

“ …raised the standard of the Congress”

“… making steps to secure CE professionalism”

� Dr A. Sutton (Conduction, UK):

“…enabled me to shift my understanding of CE …to a degree that older people do not often achieve.”

Other Feedback: from VIP

� Ms Susie Mallett (Hungarian-trained British Conductor currently working in Germany)

“There is something missing in the world of CE…” “…I am sure that AP was on the same wave length in creating Konductiv Nevelés as you are in HK.”

Last Year in Hong Kong (Sutton, A., 2011)

Overview





Conductor vs Transdisciplinary Team

The 3 Waves of our Civilization

1st Wave: Agricultural Revolution

2nd Wave: Industrial Revolution Capitalism (1776) – Adam Smith Scientific Management (1913) – Henry Ford Human Relations (1940) – Abraham Maslow Management Science (1951) – ORG Quality Revolution (1980) – Deming Process Reengineering (1990) – Hammer Six Sigma (1995) – Jack Welch

3rd Wave: Information Revolution

Michael Hammer (1948 - )

Service Process: a series of activities that create a value to the customer

András Petö (1893 - 1967) András Petö (1893 - 1967)

Founder of CE: : a German speaking

Jewish native Hungarian studied medicine in Vienna

Rehabilitation Personnel

P&O

Clin Psy

PT

OT

ST

CP

Conductive Education

OT

PT

ST

P&O Clin Psy

Teacher

Conductor Generalist

Transdisciplinary Team (CE as common philosophy)

Overview






CE for Developmental Neurological Conditions

Targeted Clients

Persons with Neurological Impairments

Acquired Developmental

Infanthood Adulthood

Cerebral Palsy

Life-long Challenge

Long-term Upbringing

Preschool Adult Service Service

Infanthoodd AAduulthoodGrowth

Through-Train Service

Adult Service (age � 15)

Special Education (age 6 - 16�2)

Special Child Care (age 2 - 6)

Early Education & Training (age < 6)

Normal Schooling

Large Hostel

Supported Employment

Sheltered Workshop

Day Activity Centre

Compassionate Rehousing Open Employment

Through-Train Service

Adult Service (age >16)

Semi-independent Hostel

Independent Home

Care & Attention Home

Independent Home

Semi-independent Hostel

Large Hostel

Supported Employment

Sheltered Workshop

Day Activity Centre

Community Inclusion

Adult Service (age >16)

Special Education (age 6 - 16�2)

Special Child Care (age 2 - 6)

Early Education & Training (age < 2)

Compassionate Rehousing Open Employment Normal Schooling

SAHK Ambassadors

outstanding clients and their proud achievements

Overview






CE for Developmental Neurological Conditions

CE for Acquired Neurological Conditions

22 Feb 2008

Community Support - NGOs SWD-Elder: C&A, DCC, EHCS/IHC teams

SWD-Rehab: CRN

Community Rehabilitation

Hospital Care - HA Hospital (acute, convalescent, day), OPD

Innovation in Community Rehabilitation

Wellness Ageing Continuum Illness

HA: NTEC hospitals Community Support: Chronic Illness

Primary prevention Secondary prevention Tertiary prevention

Hospital Setting: Acute Care

A Life-span Approach

Salvation Army: Elderly Centers SAHK: Community Rehabilitation

Community Services: Healthy Elders

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MMedical-Social Model

(clinical pathway)

26 Nov 2007

Task Series Training

Electrotherapy

Hand & Perceptual Training

Circuit Training

Domestic Training

Community Living Training

Muscle Re-education

Level & Stair Ambulation Training

Fall Prevention & Balance Training

Daily Routine Training

Virtual Reality Training

PT OT

Training on: •household safety; •cooking & washing tasks; •laundry & cleaning tasks; with: •model kitchen & laundry; •height-adjustable furniture; •adapted tools.

Training on: •static & dynamic balance; •fall prevention & landing; •fast twitch muscle; with: •low-frequency vibration; •c. g. feedback system; •wobble board & rocker; •interactive video games.

Training on: •money management;•shopping; •road safety; •transportation; with •model shop;•simulated facilities; •related training packages.

Training on: •symmetry; •weight-shift & gait; •step & stairs negotiation; with: •suspended ambulation; •slow-start treadmill; •FES (surface electrodes); •mobility aids prescription.

•pain management; •reduce swelling; •promote healing;•breakdown adhesion.

Training on: •reality orientation; •short-term memory; •concentration span; •mental imagery; with: •memory aid; •interactive software; •cognitive training packages

Training on: •dexterity; •eye-hand coordination; •visual perception; •step sequencing; with: •perceptual training kits; •fine motor apparatus; •adaptive input devices.

Training on: •selective attention; •skills transfer; •spatial & temporal relation; •response time; with: •interactive motor & cognitive games.

Training on: •speed, endurance; •balance & equilibrium; •bilateral coordination; with: •simulated escalator; •stepper & ergometer; •wall-mounted exercisers; •path with obstacles.

Training on: •personal self-care tasks; •skills transfer; •psycho-social adjustment; •work adjustment; •recreation & leisure; with: •adapted tools; •real-life environment.

Training on: •muscle strength; •muscle endurance; •active range & control; with •neuromuscular stimulation; •EMG biofeedback syst; •O/B pulley system.

Training on: •fixation & body transfer; •problem solving skills; •organisation skills; •executive functioning; with: •slatted furniture & tools; •goal-directed tasks; •age-appropriate themes.

Orientation & Cognitive Training

Consolidation, Retention & Transfer

PT, OT and integrated programs

Seamless Integration of PT & OT Programs

References Batini, N., Callen, T., & McKibbin W. (2006). The global impact of demographic change, IMF Working

Paper: International Monetary Fund.

Clare, E. (1999). Exile and Pride: Disability, Queerness and Liberation. South End Press.

Hammer, M. & Champy, J. (1995). Reengineering the Corporation: A Manifesto for Business Revolution. N. Y.: HarperCollins.

Hammer, M. & Stanton, S. A. (2000). The Reengineering Revolution: A Handbook. N. Y.: HarperCollins.

Huppert, F. A. & So, T. T. C. (2009). What percentage of people in Europe are flourishing and what characterises them? OECD/ISQOLS Meeting “Measuring subjective well-being: an opportunity for NSOs?”, Florence, Italy, July, 2009.

Kalache, A. & Kickbusch, I. (1997). A global strategy for health aging. World Health, 50:4, July-August, 4-5.

Kane, R. L., Priester, R., & Totten, A. M. (2005). Meeting the Challenge of Chronic Illness. Baltimore: The Johns Hopkins University Press.

Kane, R. L. (2011). The Good Caregiver: A One-of-the-Kind Compassionate Resource for Anyone Caring for an Aging Loved One. Avery Publishing Group.

Lyubomirsky, S., Sheldon, K. M., & Schkade, D. (2005). Pursuing happiness: The architecture of sustainable change. Review of General Psychology, 9:2, 111-131.

References Mallett, S. (2010). Susie Mallett’s Conductive Upbringing and Lifestyle: Let Me Tell You a Story.

Nurnberg: Conductor Nurnberg.

Maguire, G. & Sutton, A. (Eds.). (2004). Mária Hári on Conductive Pedagogy. Birmingham: The Foundation for Conductive Education.

Maguire, G. & Sutton, A. (Eds.). (2005). Looking Back and Looking Forwards: Development in Conductive Education. Birmingham: The Foundation for Conductive Education.

Morris, J. (1991). Pride against Prejudice: A Personal Politics of Disability. Women’s Press.

Hári, M. & Akos, K., & Smith, N. H. (1988). Conductive Education. (N. H. Smith & J. Stevens, Trans.). London: Taylor & Francis Ltd.

Seligman, M. E. P. (2002). Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfillment. NY: Free Press.

Seligman, M. (2011). Flourish: A new understanding of happiness and well-being – and how to achieve them. London: Nicholas Brealey Publishing.

Sutton, A. (2011). Last Year in Hong Kong. (G., Maguire, Ed.) Birmingham: Conductive Education Press.

World Health Organization (2004). The World Health Organization Quality of Life (WHOQOL) – BREF. WHO.

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