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CONDUCTIVE EDUCATION (CE) IN NEUROLOGY REHABILITATION
Ivan Yuen-wang SU Corporate Programme Coordinator SAHK 18 Jan 2012
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
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
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
Contemporary Management of Chronic Conditions
Deconstruction of CE
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
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
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
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)
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
� 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
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
Companionship for Life’s Journey
Human Attributes
SPEECH
Fundamental Human Actions
MIND
Basic Motor Patterns
� 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
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
� 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
Principles of Service Design
• longitudinal view
• lifelong learning
• upward mobility
Framework of Service Delivery
• 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
The 4 Pillars of CE in SAHK
Orthofunction
• Age-appropriate
• Culture-compatible
• Connected
• Enthusiasm
• Self-determination
• Self-actualization
Well-being
• Pleasant
• Engagement
• Relationships
• Meaningful
• Achievement
Overview
Contemporary Management of Chronic Conditions
Deconstruction of CE
The New Face of CE in SAHK
History of CE on a Global Stage
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.”
Overview
Contemporary Management of Chronic Conditions
Deconstruction of CE
The New Face of CE in SAHK
History of CE on a Global Stage
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
Overview
Contemporary Management of Chronic Conditions
Deconstruction of CE
The New Face of CE in SAHK
History of CE on a Global Stage
Conductor vs Transdisciplinary Team
CE for Developmental Neurological Conditions
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
Overview
Contemporary Management of Chronic Conditions
Deconstruction of CE
The New Face of CE in SAHK
History of CE on a Global Stage
Conductor vs Transdisciplinary Team
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.