Wednesday, 6 November 2013

THE MILLS OF GOD GRIND SLOWLY

Yet they grind exceeding small

Developmental Medicine and Child Neurology is a leading English-language medical journal. Earlier in this year it published a review article on effectiveness of interventions for cerebral palsy, by Iona Novak and others in Sydney, New South Wales:


This included mention of Conductive Education. Evaluations of the effectiveness of Conductive Education is no longer an active matter of academic interest but what has already been published remains on the published record. This record – for those in Conductive Education who still do not know – does not bear out the expectations and claims of those who use, provide and advocate Conductive Education. In line with which this, the recent review concluded that Conductive Education falls below the 'worth-it line', and advised practitioners and parents: 'Probably don't do it'.

This authoritatively stated conclusion marks no advance upon received paediatric wisdom in the early 1980s when I was first involved with Conductive Education.

What to do?

I have to admit that in recent years I have let the erosive waves of research reviews of CE evaluations just pass me by. After all, I no longer make a living from Conductive Education, but there are plenty who do and presumably therefore have a stake in doing something in response to help secure their own long-term positions. I have therefore largely ignored the occasional dreary rehashes of the same old stuff that appears in second-line journals. Unfortunately perhaps, so did Conductive Education.

Most deplorably, having had the recommendations of Ilona Novak and her associates drawn to my attention, first by Lisa Gombinsky when they appeared in Australia in an informal presentation, and then a little later when Rony Schenker directed me to the internationally published version in DMCN, my initial established inclination was that I could not be bothered. I am pleased to say that Rony shamed and bullied me out of this attitude. Given the place of publication, this one matters, and will itself lie upon the scientific record as a truth.

Rony and I then jointly wrote a brief letter to the journal for publication, headed 'Researching Conductive Education?'not an easy task since we were working to a short deadline (hard) and within a tight word limit (horrendously hard).

We have just heard that the letter has been to referees and has now been accepted for publication. It will now be edited to fit with the jourmnal's internal requirements, and go to Novak & co. to see whether they might wish to reply in turn (more refereeing required?). It can then be published.

It would be much quicker to do all this on Facebook but horses for courses and the question of what constitutes valid and relevant research in Conductive Education – as a basis for appropriate advice to users and policy-makers – is sufficiently important to merit a response that can be regarded as more authoritative.

What now?

Our letter will appear in the Correspondence pages of DMCN when there is a slot for it. Maybe others will have also responded, we shall have to see. Maybe even then there will be reason or opportunity to follow up with further correspondence. After all, there is no private club in operation here, and others may have something of relevance and note to say. You who read these words here, for example.

Most people (myself included) do not regularly read DMCN. Conductive World will continue to update on this little saga.

As for myself, I have quite enjoyed this experience – and it might not be all over yet. Moreover, it has rekindled a taste. There may well be further ill-judged, 'evidenced-based' statements on the effectiveness of Conductive Education. Bring them on.

References

Novak, I., McIntyre, S., Morgan, C., Campbell, L., Dark, L. Morton, N., Stumbles, E., Wilson, S.-A., Goldsmith, S. (2013) A systematic review of interventions for children with cerebral palsy: state of the evidence, Developmental Medicine and Child Neurology, vol. 55, no 9

Sutton, A. (2013) Evidence-based Conductive Education, Conductive World, 27 August

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* The sentiment goes back to Classical times. The best wording in English is Longfellow's aphorism –

   Though the mills of God grind slowly,
   Yet they grind exceeding small;
   Though with patience he stands waiting,
   With exactness grinds he all.

   H. W. Longfellow, 'Retribution', 1845

Longfellow's words of course rather Christianise the thought, but can still be used to characterise mechanisms of the law, academe, science, bureaucracy and analogous social institutions. Conductive Education has not yet evolved systematised structures for dealing with its problems, internal or external.

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