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Saturday 7 August 2010

Every moment is living and learning!

"All that glisters is not gold", by Susie Mallett, July 2010

On Thursday 5th August there was a posting on Conductive World that referred to a clinic in Germany where Conductive Education is one of many different services on offer to the young patients.

Andrew Sutton and Norman Perrin discussed the title of this posting, "Every moment is medicine", with Norman preferring to say "Every moment is learning". The use of the term Petötherapie in the list of “therapies" available was also considered.

As I know this clinic (our annual German Conductor Association conference was held there a few years ago) and I also know the system of rehabilitation in Germany, I decided to investigate the site and pass on the information that I found. This resulted in a dialogue on Andrew’s posting. I thought it a pity that so much information should remain hidden down in the comments at the bottom of the page in Conductive World so, with Conductive World’s permission I publish some of it again here.

I hope to be able to follow this up later in the week with some more information as, coincidently, on Monday, I shall be working for the first time with a family who have just returned from the self-same clinic.

As often happens these days Blogger was playing up and Andrew had already posted the piece that I had found and wanted to comment upon even before my comment appeared. Particularly, I had found a paragraph there that we both agreed really would have won the approval of András Petö, therapy or not!

András Petö worked in many such clinics before he returned to Hungary and set up his own institute, he knew how these places worked.

August 5th 2010
Susie Mallett writes

Andrew, sorry about this repeat of information. This comment was written before I sent you the email showing you what I had found but it did not appear on your comments board so I am having another try…

I do not wish that I had said “Jeder Moment ist Medizin” ( Every moment is medicine) I would rather say…..

Every moment is living and learning!

Yes Andrew, I too think that András Petö really would have approved of the Helios clinic in Hohenstücken.

On my comment I have included the therapy concept for the clinic. It reads like something that AP could have written in one of his books about medicine and the art of healing.

András Petö worked in just such clinics in his time, private concerns trying to find a niche in the market. I suspect he also would have understood the reason for the name given to CE amongst the following list of therapies.

CE has been practised in Hohenstüchen for many years now. Just because it is called “therapy” does not indicate that conductive pedagogy and upbringing are not taking place there.

I think that in this case we could say “What's in a name? CE by any other name would smell as sweet”! From what I have seen and heard, they are doing well in Hohenstücken.

The clinic is offering its young patients a package, a combination of therapies and activities from its list, and the health insurance companies foot the bill.

If CE were called education or upbringing it would probably not be included in the list or – would not be paid for if it were. This clinic is one of few places where conductive education is still paid for by someone other than the parents. We cannot know whether András Petö came across similar obstructions in his day and found ways to work around them, perhaps not then with the health insurance companies, but with other authorities footing the bills!

Below is the list of the therapies on offer at the clinic followed by their therapy concept and its translation into English.

Ärztlich-therapeutische Maßnahmen

Aktivierende Pflege (active care)
Hippotherapie/ Tiergestützte Therapie
Neurophysiologie / Psychotherapie
Berufliche Rehabilitation (rehabititation for work)
Sozialmedizinische Beratung durch Sozialarbeiter oder sozialem Dienst (social/ medical advice, contact with social workers or social services)

„Oberstes Ziel der Therapie ist die vollständige und altersgerechte Wiederherstellung der geistigen, körperlichen und seelischen Fähigkeiten. Kann dieses Ziel auf Grund des Schädigungsmusters nicht erreicht werden, soll der Patient in die Lage versetzt werden, die verbliebenen Funktionen optimal zu nutzen. Ganz wesentliches Augenmerk ist auf die Wiederherstellung des Lernpotentials der Patienten zu richten. Hierbei kommt der Motivation des Patienten sowie der Entwicklung adäquater Lernstrategien und der Vermeidung von ungünstigen Umgehungsstrategien eine zentrale Bedeutung zu. Besonders wichtig in diesem Zusammenhang ist, dass diese Strategien in Zusammenarbeit mit den Eltern erarbeitet werden, um eine langfristige Wirkung zu erreichen.”

My own translation, without Google:

The main aim of the therapy is the complete and age-appropriate rehabilitation of the mental, physical (bodily) and spiritual abilities of its patients. If due to the injury and symptoms this is not possible then optimal use is made of the remaining abilities. An essential part of the rehabilitation is the re-development of the potential for learning. An important part of this process is the motivation of the patient and the development of new learning strategies and also the avoidance of negative learning, unwanted compensatory strategies, is also central to the work. Especially important in this context is that in developing these strategies a close working relationship with the parents is developed, so that the long term aims can be reached.”

Naming CE has always been a difficult problem to solve in Germany with its system of health insurance for medical services, that even include riding, and with the local authorities then taking over for anything else that hints at education. In my experience it has been easier for parents to convince the health insurances to pay than it has been so far to convince the local authorities. In some instances, especially after von Voss's research report, distinctions are made with so many percent of the cost being the responsibility of one department and the rest the other's. It is often decided for costing purposes that CE is 40% therapy and 60% education!!!

In Hohenstücken, with CE as part of the overall package, no one has to convince anyone to pay. This has already been done by Helios, by putting it into the package for the mental, physical and spiritual rehabilitation and development of the young patients..

No, AP would not have minded too much!

August 6th 2010
Andrew Sutton writes

Susie, Thanks for that, not least for the somewhat superior translation!

Most of all, however, for the reminder that translation problems are never simply linguistic, they are contextual and cultural too.

There used to be so much Iron Curtain talk about how different Hungary was (from us in the UK) because it was 'communist' .

Yes, it was different, but once the Cold War was over and done it was time to realise that this difference was/is in no small part due to Hungary's being part of Central Europe. EU or no EU, this is another country, and Hungary, Germany, Austria are still very 'different' (from us in the UK), not least in their understandings of health and what should be done to maintain or restore it.

We Brits (and peoples like us) should be more aware of this factor when we struggle to grasp what CE might have meant, not only to its founder but also to those who came after – and what it might mean now to those who struggle, work and train in that part of the world for what we English-speakers now call Conductive Education.

Thanks for reminding us. Maybe you could add a little specific explanation around three specific examples on the list. What are 'Aktivierende Pflege' . 'Krankengymnastik' and 'Tiergestützte Therapie'? Linguistically, no problem: active care, illness gymnastics and wild beast therapy.

But in practice what on Earth do these mean?

August 7th 2010
Susie Mallett writes:

Yes, sometimes I have to sit back and tell myself that I am very lucky to be living and working in a country where the understanding of health, and restoring it, follows a more holistic approach than it seems to do in the UK and other many countries. CE often fits the bill even if it has to be called Petötherapie to get the financing.

I will be able to tell you more soon about the types of therapy on offer at the Helios Clinic. I shall be beginning conductive upbringing with a two year old and her mother on Monday. They have recently returned from Hohenstüchen where they experienced some of the therapies on offer, but unfortunately not CE.

In answer to your questions:

Aktivierende Pfelge is active, stimulating care. It means not just washing and dressing and passively caring for someone but encouraging active participation and encouraging particular movements or speech.

In the clinic it has a central roll in the all the therapies on offer. It is important to the development of independence, the process of rehabilitation, and most importantly to the psychological strength of the client. The correct way must be found for the individual. A deciding factor is finding a synthesis between giving a sense of security and being cared for but also providing enough freedom for independence so that the patient becomes motivated and believes in himself. The clinic’s concept says that this is the basis for the success of all the other therapies that it offers its clients.

Krankengymnastik is what we would call physiotherapy. With the introduction in Germany of the B.A. degree in physiotherapy more and more Krankengymnastic practices are changing their names to physiotherapy.

At Hohenstücken this area includes the usual therapies on offer in Germany: Voyta, Bobath, PNF (practised by Kabat, Sherrington,Voss, Knott, All names from Dr Hári's lectures)

and also a few that are less usual but used a lot in Germany by children with physical disabilities:

Pfaffenrot - manual therapy, (I have worked with this doctor and I have been treated by him).

Peter-Hanke-konzept -

Padovantherapie -

Taubsches Therapy or "Forced-use therapy" -

I have written about this on my blog.

Tiergestützte Therapie - this has actually nothing to do with wild animals as you suggest, it is therapy with the aid of animals, often with the use of dogs but in this case horses. The clinic says that as well as the benefits therapeutically of the movements of the horse through the body of the patient there are also the Heilpedagogik aspects that play an important roll. Heilpedagogik: healing education??

I hope this all goes some way to answering your questions.

This clinic would certainly be my first choice if I had a child with disabilities being offered several months of rehabilitation following an accident or as a regular yearly provision. I look forward to hearing what the mother can tell me next week about her stay there with her two year old daughter who became disabled at 18 months of age after severe epileptic seizures.

I realised as I went through the website of this clinic how important it is that I carry on publishing snippets from András Petö`s writings here on this blog, so that others can read about the numerous therapies of the sort that he perhaps experienced when working in clinics in Central Europe or learnt about from other sources.

As Andrew said, it is important to remember that the approach to maintaining and restoring health in Germany, Austria and Hungary is different to the approach in the UK and perhaps other countries.

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