Conductive Education
Etienne’s story
Etienne was evaluated at the Center for Independence through Conductive Education in 2021 and joined us for the 4 weeks individualized motor learning summer intensive program. He enjoyed time with his peers, and after summer, life happened. He had major hip surgery and moved houses, which meant he had to stop coming to the Center.
In 2023, Etienne ‘s mom decided to try the Center’s summer intensive again and Etienne was placed in a group with his similarly abled peers for 3 days a week, 6 hours a day.
He drove in his power chair on the first day of summer camp using a special joystick to drive, with a big, shy smile!
The students in his group were a bit older than him, but they all relate to the feeling of coming in and seeing the therapy rooms after a long time!
Like everyone else, Etienne started using elbow supports, in addition to his Benik hand brace, and after the initial tears, it started to feel better! He began reaching with his arms forward. Etienne wanted to sit with his peers at the plinth table for games, art and fun!
He got so very brave sitting on a stool with a walker behind him for safety around his trunk. Once the game started, he was part of the group with his voice and his smile. The fear of sitting with less support and more independence was gone!
By the end of the Center’s summer intensive program:
- Etienne was sitting on a Rifton toilet seat every day he came. He even asked to be left alone to get some privacy!
- He sat at the plinth with his peers for 45 minutes without any complaint about wearing his elbow supports
- He ambulated inside/outside with the Rifton Gait trainer for 150 feet daily with assistance and a smile! He has not been in a walker for over 2 years due to his previous hip surgery!
- His mom now uses the same Rifton toilet seat at home for showers.
- Etienne is now using his home bike, after practicing at the Center with his peers outside in the parking lot.
The Center is looking forward to discovering more of Etienne’s skills when he continues attending the program on a regular basis!
Story by Gabi Molnar, Conductive Education Teacher
Alleviating Stressors for Caregivers
Being a parent or caregiver to an individual with motor impairments can be a challenging journey, requiring immense dedication, love, and support. This parenting and caregiving journey can become overwhelming, often accompanied by emotional and physical strain. The Center strives to alleviate these hardships by both empowering and supporting both individuals with disabilities AND their caregivers.
The demands of caregiving, medical appointments, therapy sessions, and the uncertainties of a child’s future can significantly impact parents’ physical, emotional, and financial well-being, relationships, and overall quality of life. Recognizing and addressing this burden is crucial for creating a supportive environment for both the individual with a disability and their family.
The Intensive Motor Therapy approach used at the Center, is a comprehensive and transdisciplinary treatment approach that focuses on enhancing motor skills and maximizing functional independence. Unlike traditional outpatient therapy, which typically involves shorter and less frequent sessions, our intensive therapy programming offers high frequency and high intensity therapy optimizing the participant’s motor development. Our research based intensive therapy programming is grounded in multi-sensory peer driven learning and principles of Neuroplasticity to make neurological and functional changes for individuals with physical disabilities.
Benefits of the Center’s Intensive Motor Therapy for Parents!
- Expert Guidance and Support: Our therapeutic programs are led by skilled physical and occupational therapists and conductive education teachers who provide specialized care and guidance. Parents/Caregivers can benefit from the expertise and knowledge of these professionals, gaining a deeper understanding of their child’s condition and receiving personalized recommendations to support their child’s progress.
- Empowerment and Skill Acquisition: Through our intensive therapy programs, parents/caregivers are actively involved in their child’s therapy and developing their care plan. Parents and participants are involved in setting their goals and developing their therapy plans of care. The skills learned in therapy can then be incorporated into daily routines to maximize independence.
- Emotional Support and Networking: Participating in Center’s intensive therapy programs provides parents and participants with opportunities to connect with others facing similar challenges. Sharing experiences, challenges, and triumphs can offer emotional support, encouragement, and a sense of community, reducing feelings of isolation that may stem from caring for a person or growing up as a person with special needs.
- Holistic Development: Our intensive therapy programs focus on the overall development of the child, not just their motor skills. As parents witness progress in their child’s physical abilities, they often observe improvements in other areas, such as cognition, communication, and social interactions. This holistic development can alleviate parental concerns about their child’s future and enhance their overall well-being.
- Time Management and Convenience: While our programming does require a more intensive commitment during the therapy period, it can be more time-efficient for parents in the long run. By receiving care from our transdisciplinary staff, participants receive physical and occupational therapy in the same session, decreasing the burden of scheduling separate sessions with multiple practitioners. This decreases mental load of scheduling, transportation, and communication with various practitioners! Caregivers and parents can dedicate more time for work, personal activities, or spending quality time with their families.
CONCLUSION
The Center’s intensive motor therapy programs offer a range of benefits for individuals with motor impairments and their parents/caregivers. By actively involving caregivers in the individual’s therapy journey, the Center helps alleviate parental stressors by providing expert guidance, emotional support, skill acquisition, and fostering a sense of empowerment. As the individual progresses in their motor skills, caregivers witness growth in multiple domains, enhancing overall well-being and optimism for the future. The Center strives to support individuals with physical disabilities in addition to their families to maximize independence throughout the lifespan!
What’s CFI Been Up To?
When the COVID-19 coronavirus health crisis closed the doors of Center for Independence our dedicated physical and occupational therapists, conductive education teachers and social worker opened their laptops, charged their smartphones and sprang into action! Our professional staff were ready to provide innovative, telehealth therapy services using social media outlets and video chat platforms!
Our hardworking staff immediately began (and continues!) to provide telehealth therapy services to more than 100 children and young adults with physical disabilities while our building is closed. To support the families during this pandemic, our therapy staff also developed home exercise programs and organized equipment lending for all families. We will continue providing telehealth therapy and social work services until Governor Pritzker declares it is safe for our doors to reopen.
Check out a short 90-second video of the talented Center staff delivering virtual PT, OT and CET services to children with physical disabilities:
During this time of crisis, people with cerebral palsy need access to vital healthcare services to breathe every breath, and step every step. The Center is using remote communication technologies to provide skilled healthcare intervention for those most at risk, so children and young adults with cerebral palsy stay active, remain healthy, and feel safe!
The Center fully understands the emotional and financial burden this crisis is having on our families. Our top priority is making sure that children and young adults with disabilities remain healthy and active. To help make that possible, the Center will not be charging families for telehealth therapy throughout the COVID-19 crisis.
The Center estimates that we will provide over $350,000 in charitable care teletherapy services to children and young adults with disabilities throughout the duration of our closure due to the pandemic.
How Can You Help?
You can change the lives of so many hardworking children and young adults with physical disabilities by making a donation. In this time of the unknown, you can make a difference in a way that works for you. If you donate now through June 1, 2020, your gift will be MATCHED by The Coleman Foundation up to $25,000!
Thank you for supporting the Center for Independence and the dedicated children and young adults we serve.
10 Principles of Neuroplasticity: Part 3
Keep reading for part three, the final installment of the neuroplasticity series. Check out parts one and two if you haven’t read them yet! As a reminder, everything I write about here is found in the article, “Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage.”1
6. Time matters
Different forms of change (plasticity) in the brain happen at different times during training.
The authors highlight how rehabilitation has different levels of efficacy at different points following a brain injury. Specifically, they discussed a study that found that rehabilitation provided 30 days after adults had strokes was far less effective, both functionally and neurologically than rehabilitation provided 5 days after the injury.
So what does this mean for children with CP? First of all, it means that therapy should be started as SOON as possible for babies with a suspected brain injury. Your child should be getting physical and occupational therapy while they are still in the NICU, and this should be continued when they are discharged home. Note that I say “suspected” injury intentionally: sometimes, it takes a while for a baby to be diagnosed with a neuromuscular disorder. This does not mean that the child doesn’t need therapy until they are diagnosed! The sooner therapy is started, the better their outcomes will be.
Secondly, puberty is also an important time to capitalize on neuroplasticity. Check out my previous article on CFI’s blog to read more about critical times for children with CP.
7. Salience matters
The training experience must be meaningful to the person in order to cause change (plasticity).
In every human brain, there’s a mechanism for remembering important things and forgetting less important things. Your brain isn’t able to contain photographic memories of every single experience you have in life, so it filters out which memories are more important to retain, and which ones you can live without.
This concept is true in rehabilitation as well: the experience needs to be meaningful to the child for neuroplasticity to be maximized. Kids need to have sufficient motivation and attention to the task at hand, and higher emotions and excitement help solidify motor learning. This is where conductive education truly excels because of the social context of therapy.
A great example is a popular activity sometimes used in class here called Body Bowling, which is the brainchild of our OT Josephine Boggs. In this activity, rolling is the main motor skill practiced, as kids compete to roll to knock over their bowling pins the fastest. This is a great therapeutic activity because it works on strengthening abdominal muscles, coordinating body parts to complete the movement, stretching shoulders, and so on. Kids don’t care about that, though. They care about winning the competition! It is amazing how much faster they roll during Body Bowling rather than alone as a warm-up activity. Making the activity fun and meaningful, or salient, to the child, not only increases their participation and enjoyment of the activity, but it makes stronger changes in the brain, too.
8. Age matters
Training-induced change (plasticity) occurs more readily in younger brains.
You may remember from part one of this series that I highlighted some good news about neuroplasticity: brains can change at any age! Well, here’s the bad news. While it’s absolutely true that brains at any age can undergo neuroplastic changes, it’s also true that changes are more robust at younger ages. This just serves to underscore the importance of beginning therapy as young as possible, and continuing throughout childhood and adolescence.
9. Transference
Change in function as a result of one training experience can even lead to learning other similar skills.
Researchers have found in a study of neuroplasticity, that after a group of people underwent training for a skill that involved the use of just one finger, neural pathways for use of the whole hand were strengthened. This finding indicates that it’s possible for one kind of training experience to enhance neural connections for other motor skills or body parts.
10. Interference
Brain changes (plasticity) that result in bad habits can interfere with learning good habits.
Neuroplasticity is usually used as a positive term, but not all neuroplastic changes are desirable. The authors of the article describe it well: “brain damage survivors may develop compensatory strategies that are easier to perform (“bad habits”) than more difficult but ultimately more effective strategies acquired through rehabilitation.” Learning those bad habits can make it harder for your brain to learn the “good habits” or better, more efficient, or safer movement patterns. The specifics of what are “good” or “bad” habits for kids with CP is highly specific and individualized to each child, so this is a good thing to ask your child’s therapist or CE teacher about.
As I did in part two, I want to pause for a moment to highlight what all of this has to do with conductive education. The truth is, any kind of experience or therapy will yield some sort of change in the brain, so for any therapist, doctor or clinic to claim to have a monopoly on neuroplasticity is just not true. However, based on the principles we just learned about, there are things you can do to really maximize on neuroplasticity to make those changes bigger and more meaningful. While conductive education indeed does address all ten principles, where I believe conductive education really stands out is with principles four, five and seven (repetition matters, intensity matters, and salience matters). You will be hard-pressed to find a commercially available therapy that provides greater repetition or intensity on a long-term basis than what is provided at the Center for Independence. In addition, the social context provides a rich environment ripe with opportunities to make movement meaningful to children, which provides the much-needed salience that was discussed above.
Congratulations on making it through the ten principles of neuroplasticity! I hope this leaves you with a better understanding of what neuroplasticity even is, and some of the most important factors in how to maximize neuroplasticity. Please leave any comments or questions on our Facebook page!
- Kleim, JA, Jones, TA. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, 51, S225-S239.
10 Principles of Neuroplasticity: Part 2
Let’s dive right into the first five principles of neuroplasticity. Everything I write about here is found in the article, “Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage.”1
1. Use it or lose it
Failure to drive specific brain functions can lead to loss of abilities.
This principle is pretty intuitive: if you don’t actively use a functional component of the brain, that part starts to lose the ability to carry out the function it is responsible for. This is true for everyone: say you take piano lessons when you are young, but you stop taking them and don’t touch a piano for 10 years. When you try to play the piano again, you may be able to remember a little bit at best; certainly, you won’t be able to play as well as you did when you were practicing regularly. You literally lost some of the brain cells, and the connections between cells, responsible for playing the piano. You didn’t use it, so you lost it.
This is even true in the context of injured brain tissue. Researchers have found that when one part of the brain is injured, other parts of the brain can take over the function of the injured part. With rehabilitation, the brain literally reorganizes itself to carry out functional tasks.
What this means for kids with CP, is that it’s important to continue actively completing motor tasks, otherwise their brain will adapt and lose the “muscle memory” of how to complete those tasks. Of course, that’s true not just from a neurologic perspective but from a muscle perspective – keeping your brain strong and your muscles strong go hand in hand here!
2. Use it and improve it
Training that drives a specific brain function can lead to improving abilities.
This principle is also easy to understand: the brain will change in response to specific training. When a certain task is learned, the part of the brain responsible for that task grows new brain cells and forms stronger connections between those brain cells. This goes along with a change in output: the person becomes better at doing that task that is trained. Taken together with the first principle of neuroplasticity, there is a strong case for kids with CP to stay active!
3. Specificity
The nature of the training experience dictates the nature of the change in the brain (plasticity).
In this third principle, we get a little more, well, specific about neuroplasticity. The authors explain how different kinds of training can affect what changes happen in the brain. They highlight two examples.
First, the authors note how the biggest changes that happen to the brain are the result of learning new skills. In animal studies, research has shown that learning new skills yields a bigger change in the brain as compared to repetition of previously acquired motor movements. Please note that this doesn’t mean that working on existing skills is not important – remember the first principle, and look ahead at the fourth too – but rather that incorporating new skills into rehab can help maximize neuroplasticity.
Second, the authors explain that there is regional specificity. This means that if you are training a skill that uses a specific body part, for example using only your right hand, the changes that happen to the brain will be largest in the areas of the brain responsible for that movement. Since your right and left sides of your body are controlled by the opposite side of your brain, that means working on something with your right hand is going to make the biggest changes to the left side of the brain, and vice versa.
4. Repetition matters
Change (plasticity) requires sufficient repetition.
Think back to any time you learned a new skill. It could be writing the alphabet, playing the piano, learning to drive, anything. Did you perfect that skill after practicing it just a few times? Probably not. You had to practice it many times before it felt natural and easy to you. That’s because lasting, meaningful neuroplastic changes only happen with repetition.
The same process is at play when learning motor skills. It is not enough to practice going from sit to stand just a few times and expect to have mastered the skill. In order for a child’s brain to undergo meaningful change, it is critical for the skill to be repeated many times.
5. Intensity matters
Change (plasticity) requires intensive training.
Here’s an interesting fact about neuroplasticity that you can impress your friends with. There was an animal study where researchers studied brain changes following practice of a skilled motor task. They divided the animals into two groups: one group completed the task 400 times per day, and the other group, 60 times per day. They found that the animals in the first group had a measurable increase in connections between brain cells in the part of the brain responsible for that task, whereas animals that completed the task only 60 times per day did not.
The takeaway here is that kids with CP need pretty high intensity in their motor program in order to make meaningful changes in their brain.
Phew. We made it through the first five principles of neuroplasticity!
Before we move on the next five, I’d like to pause and consider how the ideas seen so far connect with what conductive education offers. Kids who come to the Center practice a wide range of motor tasks regularly, in a highly intense fashion, with lots of repetition of many familiar tasks, while also being given opportunities to learn new skills on an individualized basis. From what you’ve just read, I hope it’s apparent that conductive education capitalizes on every single one of the first five principles.
Stay tuned for the last installment of the neuroplasticity series!
1. Kleim, JA, Jones, TA. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, 51, S225-S239.