Cerebral Palsy, Conductive Education and Controversy MADAM - May we express our delight with the CSP statement on conductive education (Physiotherapy, May, page 2361. We have really had to wait a long time for someone to write such a concise and considered statement with regard to the Pet0 approach to treatment.

Whether one is for or against it, it seems to us, who have been in the forefront of developing ideas about the treatment of cerebral palsy over the last forty years, that it is sad there has been no reply to the repeated assertion that nothing has been done for these children in this country, until this statement.

May we congratulate the Chartered Society on this realistic and helpful assess- ment of the situation.

KAREL K BOBATH MD DPM FRCPsych BERTA BOBATH MBE FCSP APTAIHon) London NW3

MADAM - It is e strange paradox when a system which has generated so much interest and so much enthusiasm, simultan- eously ignites a controversy. More so when the parties in conflict are in agreement about the benefits of that system for the cerebral palsied child and his family.

I think that the controversy surrounding the subject of conductive education has developed out of ignorance. The ignorance is wide ranging: from the understanding of cerebral palsy; of alternative treatment methods; and of the principles of conductive education to its practice in Britain and elsewhere.

Specific codes of conduct are laid down to which all therapists are expected to adhere One forbids negative criticism of the practice of another. Never before have I encountered a situation where a practice has been publicly criticised on such scant information and almost no observation by an uninformed non-professional body whose sole objective is to concentrate on one method only. The aim of that body is to introduce a system of education into Britain which claims to educate the dysfunctional child or adult to function in society and to evaluate it. This is undoubtedly a noble aim requiring considerable time, effort and money. That this is an ambitious and credit- able scheme cannot be denied and should be welcomed.

However, until a particular method is learnt, practised and polished there is little to evaluate. Moreover, advantages or disadvantages are unlikely to be elicited unless compared with the polished perform- ance of another method. Therefore, I would claim that the current controversy is unnecessary, non-productive and at worst could result in discrediting a system which is promising, before it has time to gain the respect it deserves.

Cerebral palsy is a complex syndrome with many permutations. Not all cerebral palsied

children are suitable candidates for conduc- tive education. Conductive education is not another treatment method. It is an educa- tional system; a way of life; founded on neuropsychological principles. Treatment methods, of which there are at least six known to paediatric therapists, are neuro- developmental in character. Because conductive education has education as its fundamental tenet, it is claimed that only a special teacher or conductor has the skill to implement or practise it.

Close examination of a therapist's basic training will reveal numerous areas where the ability to teach is crucial to achieving objectives. Therapists treat, teach and motivate both individuals and groups to reach functional goals. They are special educators and as such are versatile and progressive; forever examining practice, seeking out new avenues which improve their performance and the quality of life for their patients. With these fundamental qualities it cannot be claimed that such an individual is incapable of participating in an education system and learning new skills. Likewise, therapists could not claim that the class teacher is incapable of successfully managing the cerebral palsied child given appropriate tuition.

How did it come about in the mid-Sixties that an experienced paediatric physiother- apist became one of the first pioneers to recognise the advantages of conductive education? She was merely observing a practice, eliciting crucial elements which she recognised as unique and untried. An exercise which could not be realistically pursued without a vast amount of practical experience using other methods together with knowledge of cerebral palsy.

How did it come about that The Conductive Education Association was founded in Britain in 1980, instigated by physiotherapists with a membership of 250, the majority being physiotherapists?

I was a founder member of this very active Association, and it was quite apparent at the time that physiotherapists were quick to recognise the advantages of education as opposed to treatment in this situation. All had practised individual treatment methods and had had varying degrees of success. However, generalisation of skills was expected but in practice was sorely lacking because treatment and lifestyle were compartmentalised. Therefore, it is not surprising in the light of this experience that a global system which encompasses all the aims of the therapist was seized upon by therapists as an answer to their frustrations.

There is no myth about conductive educa- tion. It is a special teaching system with readily defined principles. The system is not appropriate for every cerebral palsied child. The specific practice alone is not in itself sufficient to guarantee maximum success; it requires an appropriate cultural and social system to support it, which is what occurs in Hungary.

In Britain, this much more important issue has still to be addressed. Continuing debate centred on practice merely masks this funda- mental aspect.

If there is to be any debate at all it should be aimed at improving existing services, utilising resources and providing a concen- trated and consistent service for all cerebral palsied children from the day of diagnosis.

OLIVE B SURTEES MCSP Vice-chairman The Conductive Education Association Newcastle upon Tyne

The Chartered Society of Physiotherapy welcomes this statement and helpful comment on the current debata-Editor

Tumbledown Travesty MADAM - Having watched the television play 'Tumbledown' I am prompted to ask whether the time has come for the Chartered Society (and for that matter the Royal College of Nursing too) to request a direct line to the BBC and ITV so that when physiotherapists at work are portrayed on the screen the director of the programme can be given on-the-spot professional advice.

The travesty of interpretation of our methods as shown, is fully belied by the fine rehabilitation of this badly wounded young man, and even one or two instances of constructive treatment would have painted a more accurate picture.

SHRLEY PURVES MCSP Exeter

Stuart Skyte, director of public relations, says:

This is a good idea but unrealistic in practice. TV producers do seek our advice on clinical issues from time to time. On this occasion they did not, but clearly received help from other sources.

Come to IFOMT MADAM - May I draw attention to the international congress, hosted by the Manipulation Association of Chartered Physiotherapists, to be held in Cambridge, September 4-9 this year.

'IFOMT '88 (for details see Physiotherapy, April 1988, page 179) will be of particular interest to all physiotherapists involved in the management of musculoskeletal problems. The programme reflects the very high level of expertise which has been developed in this core specialism by physiotherapists around the world.

Booking is going well and I would urge all physiotherapists thinking of attending either for part or the whole of the week to book soon.

PETER E WELLS BA MCSP DipTP Chairman of the Convening Committee IFOMT '88 London SW10

328 f i P b m y , July 1988, vd 74. no 7