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Conductive Education
Evidence reviewed as of before
01-01-2021 Author(s): Ogourtsova, T. (PhD OT); Steven, E. (MSc App OT); Iliopoulos, G. (MSc App OT); Deleva, V. (MSc App OT) & Majnemer, A. (PhD, OT, FCAHS)Share this
intervention:
Conductive education (CE) was founded in Hungary in the 1940s. It is a structured program built on the assumption that motor disorders (e.g. cerebral palsy) are learning disabilities which can be overcome by using specialized learning strategies. The program is provided in a group and its goal is to maximize a child’s independence in daily activities. Since the 1940s, CE has been used around the world and its format can differ significantly depending on the country. However, there are some common elements to all CE programs:
Task-oriented structured learning – tasks are broken down into smaller steps (task series) which the children practice; tasks start within the children’s ability level and then increase in difficulty until they reach a functional goal.
Group setting – where the children work together and encourage each other in order to increase participation. The program is led by an experienced “conductor” who is trained in special education.
Rhythmic intention – a technique using rhyme and song to provide verbal instructions to the task series.
Special equipment – wooden slatted beds and ladder-back chairs are used by the children to assist their movements and build skills.
Conductive education (CE) is an educational approach for children with cerebral palsy (CP) and other neuro-motor disorders. It is a structured program consisting of age-appropriate activities designed to maximize a child’s independence in daily tasks (including mobility, self-care tasks such as dressing and eating, and play skills). CE is provided in a group in order to promote active participation and social interaction. The program is led by a trained “conductor” who tailors it to the general ability level of the group and each child. The children are encouraged to set their own goals and to be problem-solvers.
Conductive education is intended to increase the functional independence and quality of life of children with CP or other motor disorders. It teaches children how to complete daily tasks such as eating, dressing, sitting, walking, etc. It emphasizes problem-solving and encourages children to practice their new skills in many different settings with the ultimate goal of creating a self-reliant, independent personality.
CE has been used in many countries since the 1940s and the program is often adapted to suit the local needs. Different aspects of it, including where it takes place, who provides the treatment, the age and physical abilities of children eligible for it, as well as the length of the program, can vary greatly. There are some common features to all CE programs, however. These include a group setting, the use of special equipment, rhythmic intention, and task-oriented learning.
Only one recent study has examined the effectiveness of CE for young children with CP. This high quality study from Norway did not find any improvement in functional skills and quality of life of children with CP or their parents when receiving CE compared to conventional functional training (e.g. targeted walking, eating, etc.). However, children in the CE group made greater gains in gross motor function and the parents of kids in the CE group reported receiving more specific information about their children as the program offers many opportunities for meetings and discussions with the CE conductor.
In the reviewed study from Norway, the CE program was provided in groups of 4-6 children (aged 3-6 years old) split into walkers and non-walkers. The course contained a daily training program targeting standing, sitting, walking, arts and crafts, as well as self-care tasks such as dressing, toileting, drinking and eating. Each course had a topic selected by the children and also contained specific child-parent-conductor set goals.
CE is provided by health professionals known as “conductors” (or conductive educators). Conductors typically have a college degree with an emphasis on special education. They are responsible for the design, monitoring, and facilitation of the program.
No specific side effects or risks were reported in the study. However, if you have concerns, we suggest that you discuss these with the treatment provider.
Conductive education is best suited for children with CP who are able to follow directions and participate in a group. Different CE programs may also vary in their requirements for eligibility, such as type or severity of CP.
The examined study included children with unilateral, bilateral, ataxic and dyskinetic CP and all levels of severity (GMFCS level I through V). Conductive education was found to be more effective than conventional functional training in improving gross motor function in this population. However, it was not shown to improve functional skills or quality of life of children with CP or their parents.
Information on this website is provided for informational purposes only and is not a substitute for professional medical advice.
One high quality cross-over RCT (Myrhaug et al., 2018) investigated the effects of a conductive education (CE) program on caregivers’ perspectives about health services among parents of children with CP (all types, GMFCS level I-V). In this high quality cross-over RCT, children were randomized to receive CE or to be on a waitlist; both groups received conventional therapy. At 4 months, the control group crossed over to receive CE. The caregivers’ perspective about health services was assessed using the Measure of Processes of Care (MPOC-20: Enabling & partnership; Providing general information; Providing specific information about the child; Coordinated & comprehensive care; Respectful & supportive care) at post-treatment (4 months). Significant between-group differences were found in 2 measures (MPOC-20: Enabling & partnership; Coordinated & comprehensive care), favoring CE vs. waitlist.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that conductive education is not more effective than a comparison intervention (waitlist) in improving the overall experience of services among parents of children with CP.
One high quality cross-over RCT Myrhaug et al., 2018 & Myrhaug et al., 2019) investigated the effects of a conductive education (CE) program on functional skills among children with CP (all types, GMFCS level I-V). In this high quality cross-over RCT, children were randomized to receive either CE or to be on a waitlist (Myrhaug et al., 2018); both groups received conventional therapy. At 4 months, the control group crossed over to receive CE. Functional skills were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) at post-treatment (4 months) and at follow-up (12 months). No significant between-group differences were found at any time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that conductive education is not more effective than a comparison intervention (waitlist) in improving functional skills in children with CP.
One high quality cross-over RCT (Myrhaug et al., 2018 & Myrhaug et al., 2019) investigated the effects of a conductive education (CE) program on motor function among children with CP (all types, GMFCS level I-V). In this high quality cross-over RCT, children were randomized to receive either CE or to be on a waitlist (Myrhaug et al., 2018); both groups received conventional therapy. At 4 months, the control group crossed over to receive CE. Motor function was assessed using the Gross Motor Function Measure-66 (GMFM-66) at post-treatment (4 months) and at follow-up (12 months). A significant between-group difference was found at follow-up, favoring CE vs. waitlist.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that conductive education is more effective than a comparison intervention (waitlist) in improving gross motor function in children with CP.
One high quality cross-over RCT (Myrhaug et al., 2018 & Myrhaug et al., 2019) investigated the effects of a conductive education (CE) program on quality of life among children with CP (all types, GMFCS level I-V). In this high quality cross-over RCT, children were randomized to receive CE or to be on a waitlist (Myrhaug et al., 2018); both groups received conventional practice. At 4 months, the control group crossed over to receive CE. Quality of life was assessed using the Peadiatric Quality of Life Inventory (PedsQL: Physical functioning; Emotional functioning; Social functioning; Functioning in daycare) at post-treatment (4 months) and follow-up (12 months), and Quality of Life Scale at post-treatment only. A significant between-group difference was found at follow-up on one measure of quality of life (PedsQL: Social functioning), favoring CE vs. waitlist.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that conductive education is not more effective than a comparison intervention (waitlist) in improving quality of life in children with CP (all types, GMFCS level I-V).
References
Myrhaug, H. T., Odgaard-Jensen, J., Østensjø, S., Vøllestad, N. K., & Jahnsen, R. (2018). Effects of a conductive education course in young children with cerebral palsy:A randomized controlled trial. Developmental neurorehabilitation, 21(8), 481–489. https://doi.org/10.1080/17518423.2017.1360961
Myrhaug, H. T., Odgaard-Jensen, J., & Jahnsen, R. (2019). The long-term effects of conductive education courses in young children with cerebral palsy: a randomized controlled trial. Developmental neurorehabilitation, 22(2), 111–119. https://doi.org/10.1080/17518423.2018.1460771
A group of lifelong disorders affecting a person’s movement, coordination, and muscle tone and which are the result of damage to the brain before, during, or shortly after birth.
Gross Motor Functional Classification System. It is a tool used to categorize the gross motor skills of children with cerebral palsy into 5 different levels across 5 age bands. It evaluates the child’s abilities in sitting, walking and wheeled mobility as well as the type of assistive devices needed for mobility. The levels are assigned based on the severity of the limitations, ranging from mild (level I) to severe (level V).
