THERAPEUTIC EXERCISE III

Temple Fay
The teachings of Temple Fay (creator of a rehabilitation approach of the nervous system (called Neurological Reorganization) described very well the different stages of the neuro-psycho-motor development of the man. It was the precursor for the Doman Method which was established by Glen Doman, a Physiotherapist.

Doman-Delacato treatment
Introduction
The Doman-Delacato treatment (Sensorimotor Patterning), is based on psychomotor patterning exercises designed by physiotherapist, Glen Doman, and educational psychologist, Carl Delacato, in the late 1950s. Proponents of the intervention persist in promoting its use, despite convincing evidence that it is implausible and ineffective.1 The Institute for Applied Human Potential (IAHP), still operate an internet web page (www.iahp.org) offering to train therapists and parents, despite the evidence for its being an ineffectual therapy. The American Academy of Paediatrics issued statements on patterning and its lack of benefits in 1968, 1982, and 1999.1

What is the Doman-Delacato treatment?

The theory behind patterning is based on the belief that children with disabilities fail to progress through the typical developmental stages of movement, and that this leads to neurological disorganisation. Treatment begins with determining the childs current developmental stage of neurological organisation. A team of three to five people, often volunteers, simultaneously move the childs head and limbs through a pattern of movements, such as crawling, that would be typical for that particular developmental stage. The pattern must be repeated for at least five minutes and four times a day.2 Other techniques that may be used along with the patterning include various methods of sensory stimulation, rebreathing expired air through a face mask to increase blood flow to the brain, and limiting the intake of fluids, sugars and salts in an effort to decrease the production of cerebrospinal fluid and to reduce brain irritability. Proponents believe that if the patterning sequence is rigorously applied on a daily basis, undamaged brain cells will be programmed to take over

the function of damaged brain cells, allowing the child to progress to the next developmental stage. Unfortunately, the theory has not been subjected to controlled scientific study, and the method has been harshly criticised by the medical community. Critics also express concern that the programme demands an inordinate amount of time on the part of parents and volunteers, which may prevent them from pursuing other treatment options.2

Studies to evaluate the Doman-Delacato treatment

In 1960, Doman conducted trials of his sensorimotor patterning programmes, (including creeping, crawling and walking exercises), with children having a variety of neurological disabilities caused by traumatic brain injury, between the ages of 1 and 9 years. He reported significant improvements, with some individuals exceeding peer levels of development.3 In 1969, Herbert et al analysed the theories upon which the method is based and the findings which have stemmed from its application. They found that consideration of the statistics of individual case reports suggested that the changes obtained may reflect normal growth and development occurring independently of the method applied, or the inadvertent consequence of social stimulation and environmental change inherent in, or resulting from, the application of almost any method. They also noted evidence that was available that justified questioning the theoretical premises of the method. This team from the Albert Einstein College of Medicine pointed out that sensory and motor function are not affected in a uniform and consistent manner by damage to the central nervous system. Lack of understanding of the fundamental mechanisms which integrate sensory and motor activities continues to make the selection of a therapy most difficult. Until a greater understanding of sensory and motor integrative mechanisms is gained, scientific (statistically corroborated) proof is needed before patterning or any other method may claim sufficient universal applicability to serve as the sole therapeutic approach to one or more disturbances of intellectual and motor function.4 In 1975, Neman et al evaluated the sensorimotor patterning programme using 66 institutionalised, mentally retarded children and adolescents. The subjects were randomly assigned to one of three groups: (a) Experimental1 group, which received a programme of mobility exercises including patterning, creeping, and crawling; visual-motor training; and sensory stimulation exercises; (b) Experimental 2 group, which received a programme of physical activity, personal attention, and the same sensory stimulation programme given to the first group; or (c) Passive Control group, which provided baseline measures but which received no additional programming as part of the study. Experimental 1 group subjects improved more than subjects in the other groups in visual perception, programme-related measures of mobility, and language ability. Intellectual functioning did not appear to be enhanced by the procedures, at least during the active phase of the project. They discussed the results with reference to other researchers who have

failed to support the patterning approach, and some reasons were suggested for the differences between the present and past investigations, such as the amount of one-to one attention received each day, and normal expected development.5 In 1978 Sparrow and Zigler carried out a long-term evaluation of the patterning treatments used by Doman and Delacato. They studied three groups, each with 15 seriously retarded institutionalised children, employed to evaluate the modified sensorimotor patterning treatment developed at the Institutes for the Achievement of Human Potential (IAHP). The treatment group received a programme modelled after the IAHP methods for approximately two hours per day, five days per week, for one year. For the same length of time, a matched motivational control group participated in activities with foster grandparents designed to create positive, success-oriented interactions to improve self-esteem and feelings of efficacy. A no treatment group continued to receive the standard care of the institution, which was enlightened and resident-oriented. At the end of the study, a wide variety of behavioural measures were employed, including the IAHP Developmental Profile, IQ, motor and language development scales, and measures of affective, social, and maladaptive behaviours. On the majority of the measures there were no differences in post-test performance among any of the three groups. In no case did the pattern of change of the treatment group differ from that of its crucial comparison, the motivation group. However, all three groups showed some improvement in performance between the beginning and end of the study. They concluded that the patterning treatment investigated in this study could not be recommended for seriously retarded children.6

Conclusions
A great number of organisations issued cautionary statements in respect of the Doman-Delacato patterning treatments7,8,9 which caused some controversy, and some of the reasons included:

The promotional methods used by IAHP made parents feel inadequate and unmotivated.10 The programmes were lengthy and demanding, causing considerable stress on parents, resulting in the neglect of other family members needs.11 Claims were made for rapid and conclusive diagnosis based on a Developmental Profile, but this had been neither validated nor published.12 Claims were made that normal children could be made superior to hasten the evolutionary process.13

A well-designed study was set up by federal and private agencies and was in the final planning stages when IAHP withdrew from their original agreement to participate.14

Summary
The Doman-Delacato treatments are poorly documented and are neither validated nor published. Much pressure is put upon parents to unswervingly carry out lengthy procedures for up to two hours a day, and they are then blamed for failure, if the techniques are not carried out to the smallest detail. Much of the reported improvements may be accounted for in normal growth and development, no special merit for this treatment, above any others, has been proven.15