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Choosing Between MOVE© and Conductive Education
By Ginny Paleg, MSPT

Conductive Education and MOVE (Mobility Opportunities via Education) are two functional-based approaches for children and adults with gross motor dysfunction. Both approaches look at function as the focus and seek to push individuals to their full potential by practicing real-life skills as often as possible. While the differences exist and will be discussed, it is important to realize that neither approach has been supported by scientific studies. The few non-randomized non- controlled studies show that they both result in progress in the skills taught, but that these results may also be obtained by traditional programs. Further studies are currently underway and may provide more insight into which approach works best for different populations.

 

MOVE was first developed in the early 1980's by a special educator, Linda Bidabe, in Bakersfield, California. It is designed for individuals who are not yet independently ambulating, including those who have no active movement, absent head control, and are unable to sit. MOVE is an activity based program that is really a curriculum. The manual (available in many languages for $80-$100 from MOVE International) includes an assessment test and specific strategies to teach each skill within the classroom.

Anyone can implement MOVE: parents, teachers, assistants, therapists, care givers. The curriculum describes ways to incorporate functional skills (sitting, standing, walking, using the toilet, eating and communicating) into the daily routine. Individuals using MOVE spend little time in wheelchairs. They are constantly moving from classroom chairs, to standers, to gait trainers. These individuals are taught to walk with hands held (over 3-5 years) and assist with transfers. Individuals who are appropriate for MOVE have moderate to severe gross motor dysfunction. Diagnoses may include cerebral palsy, traumatic brain injury, spina bifida, muscular dystrophy, etc.

The philosophy that sets MOVE apart from mainstream therapy and teaching strategies is the "Top-Down" approach. The traditional "developmental model" believes that a child, regardless of the disability, must progress through a pre-disposed sequence; an individual must learn to roll before crawl, crawl before walk and certainly have head control before learning to sit. MOVE folks believe that since individuals with brain damage may learn slowly, why not teach something really important. They determine which skills are going to make the biggest difference to that person right now, and in 20 years.

Most teams decide to work on sitting, standing and walking as well as toilet training, eating and communicating. Anecdotal reports indicate that 20% of full time MOVE participants graduate from the curriculum (become independent at sitting, standing and walking). Most other children are able to gain at least one full level in 3-5 years. This might mean (and further studies are necessary) that most children, with even the most severe gross motor dysfunction, can learn to take steps in a gait trainer, assist with transfers, and tolerate upright sitting.

Equipment

To implement the MOVE curriculum, you don't need any equipment, however, the gait trainer, dynamic stander, and advancement chair are commonly used. This makes expanding a program to many children with few staff, much easier.

The gait trainer is a device that consists of a wide based steel frame with four casters and four optional quick-release tracking wheels. The triple-strap trunk support adjusts to the contours of the user's body while at the same time, controlling trunk angle. This allows users with little or no trunk control to be positioned to maintain correct balance and posture for walking. The unique forward leaning position encourages walking, while the trunk and pelvic supports free the instructor (parent, teacher, friend) to teach the user to take reciprocal steps. Forearm prompts or the grab bar and tray can be used to increase upper extremity weight bearing to support functional reaching. The abduction straps can be used to control scissoring at the foot, ankle, knee or hip. When used appropriately, these prompts are combined with a motor-learning approach and systematically removed over time. Individuals can experience the joy of independent movement and weight bearing no matter what their level of ability.

The dynamic stander is not a wheelchair. It is a stander with large wheels attached to it. It is a stander that offers the person the opportunity of independent mobility and upper extremity strengthening, while impacting on bone density, cardiopulmonary conditioning, digestive tract health and muscle length. The user stands supported in a slightly forward leaning position which frees the arms for use. The comfortable strapping system and contoured body support encourages longer periods of standing.

The advancement chair comes with a padded seat which adjusts in height, back depth and tilt angle. A typical child will not outgrow this chair for 5-7 years. The interchangeable padded backs, angled at 90 degrees to the seat, provides back support for those who are unable to hold themselves upright for periods of time. The adjustable headrest and arm prompts help in proper positioning and allow for forearm weight bearing. Forearm weight bearing may help a child in gaining volitional arm movement and reaching. The trunk support adjusts in width and height, both forward and back. There are two seat belts; a straight lap seat belt and a center mounted seat belt that can be used to either help position the pelvis in the chair or used over the shoulder to help encourage a more natural sitting posture. To help maintain proper leg positioning while sitting, leg prompts for abduction are positioned behind the knees, and ankle straps keep feet in line below the knees.

Outcomes

The original pilot study (Bidabe and Lollar) looked at 15 children who were non-ambulatory. After three years, 14 took steps for five feet with hands held or in a gait trainer, two could walk independently for 20 feet, seven could stand independently for one minute, all 14 sat independently in regular classroom chairs, and 12 could sit on stools for five minutes. This data represents all the new skills gained (i.e. kids couldn't do these prior to their participation in the program). A follow-up study (Paleg) found that after just five days of training in 19 subjects, 95% of the children learned to take steps in a gait trainer, 58% learned to sit in a chair and hold their heads up for 30 seconds, and 47% of the children learned to stand with hands held only for ten seconds. Functional outcomes are measured through the use of the Top-Down Motor Milestone Test. This booklet measures levels of function (I, II, III and graduate) for 21 skills. When completed by a trained provider, IEP goals and a team plan for implementation of these goals will result.

 

Conductive Education was developed in the late 1940's by Dr. Andras Peto in Budapest, Hungary. Children in this communist country who were not toilet trained and could not walk independently were not allowed to attend public schools. The Peto Institute originally enrolled only minimally and moderately involved children who could follow directions. These children were given one on one instruction by "conductors". The groups performed motor skills in a routine which combined music and repetitive phrases or songs with functional motor tasks. This concept of "rhythmical intention" is very popular today. The basis is that by incorporating music and rhythm, the brain bypasses the motor centers which are damaged and uses deeper centers which may be intact. This may be why you can remember songs from the radio from when you were in elementary school but can't, as an adult, remember your anniversary.

The focus in conductive education is on just that; education (rather than exercises or training). The goal in using this approach is not only to improve motor skills and functions, but also to improve the overall development of a child, including emotional and intellectual aspects.

Each session consists of "units." Each unit is a skill that involves it's own "song" and is a routine that results in a functional task being completed. The beginning of the day may start as getting out of the wheelchair and onto a "plinth" or "slatted" table. The child must then pull themselves up to the sitting position. The conductor will keep the child safe and facilitate the movement, but will not do the movement for the child. The routine is repeated daily and includes dressing, eating, using the toilet and writing.

At home, some parents buy the furniture (table, chair, and potty) and do the routines in a modified way. These are adaptations made mostly in the UK, Canada, and the USA by parents and therapists, rather than Hungarian conductors themselves. In fact, in the Peto model, the children are only with the parents one day a week, whereas in the newer models, the family is much more involved and responsible for implementing the program.

The children enrolled in the traditional conductive education programs are reported to gain the skills practiced. Conductive education is used mainly for children with minimal to moderate cerebral palsy, spina bifida, head injury and multiple sclerosis. In recent years, children with more severe involvement have been included as well. Conductive education may also be helpful in individuals with weakness, tonal problems (hypo or hypertonia), or movement disorders (including ataxia).

Equipment

Slatted furniture is used to allow the child to push and pull themselves into the required position. Slatted benches, ladder-back chairs and poles are used. Often a child will begin walking by pushing the ladder-backed chair across the floor. Traditional equipment may be used as well, however, conductors aim to decrease the amount of support given to children so that over time, the children become more independent.

Outcomes

There have been a handful of studies published in the UK and USA. The results were mixed from no difference between conductive education and traditional approaches, to minimal differences. Because the approach is so labor intensive, few school systems can afford to adopt this approach (it must be provided by a trained conductor rather than your child's therapist) and even fewer seem to be able to adapt conductive education to an inclusion environment.

 

Summary

Conductive Education and MOVE began in very different environments and were designed for very different kinds of children (MOVE serving the more involved child, conductive education serving the child who is able to follow commands). Over time they have become more similar. Their basic philosophy is shared; every child, regardless of their level of involvement, must "do" to learn. No child ever learned head control by spending most of the day reclined in a wheelchair with their head fully supported. The only way the child can progress is to practice a particular motor skill integrated into a functional task. The big difference in the US is that most public school districts cannot afford to support the needed infrastructure to implement conductive education. MOVE, on the other hand, may be easier to implement since it uses the structure of the regular school team. MOVE may also be easier to implement as part of total inclusion, while allowing the child to remain immersed in the regular school routine. Children who are ambulating with aids and have little or no communication problems may thrive in a conductive education environment. More involved non-ambulatory children who rely on augmentative communication may benefit more from the MOVE approach. Both methods have strengths, both lack scientific credibility. Hopefully, as more and more studies are conducted and published, we will have a better understanding of which approach is best for each individual child.

For more information on MOVE and Conductive Education, visit their web sites at:

 

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