Conductive education (CE) is a system of learning developed by the Hungarian doctor András Petö and is sometimes known as the Petö system or method. CE is used by people with movement disorders resulting from neurological illness or injury to help them to lead independent and fulfilling lives.
Petö’s work was revolutionary: it combined medical knowledge with teaching methods to provide an integrated system of education and rehabilitation, which challenged conventional medical approaches. Petö believed that, through teaching and learning, people with Parkinson’s and other neurological conditions can regain conscious, cognitive control of their movement and therefore overcome the movement symptoms relating to their condition. There is a growing evidence base around neuroplasticity which includes teaching and learning to create new brain pathways as one way of overcoming challenges caused by Parkinson’s.
Unlike most complementary treatments CE is not a therapy, but an educational process that becomes the way a person ‘thinks’ about their movements rather than a set of exercises which are repeated each day. By creating an increased awareness of ‘how’ the person moves and how to optimise this, CE offers a chance to apply this learning into everyday activities. Simply, CE becomes a way to think and act all of the time, thus maximsing the movements present and creating a new level of control over daily activities.
CE cannot cure Parkinson’s or any other neurological disabilities. But it can offer a means to control the physical symptoms, improve motor function and increase independent living, by providing practical techniques and the motivation to achieve goals. With sustained effort over a period of time, CE can help overcome individual difficulties.
There are five important elements in CE. These are:
- The conductor – this is the professional who delivers the programme of learning. He or she is qualified to degree level and specialises in neurological conditions. It is essential that there is a mutual trust created between the individual and the conductor by establishing of an active learning environment.
- Daily routine – this covers all activities from waking to sleeping, including self-care, education, work, hobbies and interests.
- Task series – tasks, which are developed to meet group and individual needs, are broken into elements with appropriate goals. Tasks take place in a lying, sitting and standing position and aim to teach the person how to control all the movements required for problem-solving in their daily life.
- Intention / rhythmical intention – CE links speech, thought and movement through the conductor verbalising the task and providing a count in which to complete the movement. Participants actively count while performing the movements as this helps to reduce the time between intending and carrying out the movement. In order to teach the person with Parkinson’s to initiate a movement effectively, tasks are performed on the count of one and held until five. This helps to focus on the movement and teaches how to overcome symptoms and so complete the movement more easily and successfully. Linking speech with thought and then movement also helps to provide a strategy to perform the movement in everyday situations away from the session.
- The group – the group is usually made up of individuals with a similar condition as goals are likely to be common. Groups are frequently matched according to age, life style or specific needs of each person.
CE’s key aims are to:
- teach the person how to gain conscious control over their movements and communication as one step towards improving quality of life
- construct a different and new method of problem solving everyday activities
- encourage personality development, making the individual active rather than passive, and formulating solutions to any difficulties in motor, functional and behavioural communication
- enhance confidence, self-esteem and motivation
- teach family members and carers how to enable the person to remain active within their own environment.
How can conductive education help in Parkinson’s?
Conductive education (CE) in Parkinson’s works at two levels: it addresses existing problems and aims to prevent new ones. It does not replace medication but works alongside it, looking also at the effects and side effects of medications. It encourages the individual to be active at all times, not just when medications are most effective.
CE can help overcome or alleviate everyday problems arising from some of the most common motor symptoms in Parkinson’s - such as tremor, rigidity, slowness of movement, freezing, lack of facial expression and micrographia (small handwriting) – as it provides an opportunity to learn practical techniques to overcome these difficulties. CE techniques may be helpful for the following:
- maintaining a central body position and improving posture, balance, and both range and control of movement
- using rhythm to change the timing of movements needed when performing fine motor activities such as buttoning clothes or tying shoelaces
- improving the initiation of movement when voluntary movement is reduced or during freezing, and increasing the rhythm and speed of movements
- learning how to transfer weight when stepping
- improving arm swing, increasing length of stride and fluency in walking
- overcoming obstacles and changing direction
- improving concentration to achieve co-ordinated movement
- improving breathing techniques to assist with volume, articulation and intonation of speech
- improving facial expression
- improving handwriting, to keep it consistent and a legible size
- motivation to overcome difficulties encountered in everyday life and nurture a belief that one’s goals can be achieved.
Techniques are generally taught within structured group sessions and may be adapted and used to suit individual needs. CE strategies can help you complete daily activities and learn new ones with increased confidence, and many have reported improved motivation and general wellbeing.
Carers may also find it useful to attend CE sessions as they can then help the person they care for to put into practice what they have both learned.
What should I expect at a CE session?
After the initial consultation, you will probably have a session each week, usually lasting between one and a half to two hours. Sessions are generally in small groups as group work is an essential part of the Conductive education (CE) philosophy, providing an opportunity for individuals to share solutions and learn from each other. Learning in a group provides a positive learning environment, promotes interactivity and fun, and helps to motivate each individual.
The group will carry out movement-based tasks of varying complexity and difficulty. Movements are carried out in all positions including lying down, sitting and where possible standing and walking. The conductor will ensure that each person is active and participates to the best of their ability. They will guide you towards finding a solution to carrying out a movement rather than carrying it out for you. It is a partnership, with the conductor passing to you the skills required to achieve tasks so that you can perform them on your own. It is sometimes said to be an apprenticeship in which skills are transferred and available then for use as you require.
CE uses only simple but good quality, purpose designed furniture and equipment.
How do I find a CE group?
To find where conductors work please visit the E-Conduction website.
The Parkinson’s organisation in your country may be able to provide information based on members’ experiences – see Our members and Other Parkinson’s organisations.
Acknowledgement
We would like to thank Dr Melanie Brown (CEO & Senior Conductor, NICE Centre for Movement Disorders, Birmingham, UK( for her help in reviewing this information.
