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Conductive education (Interventions & Therapies)

Last update: 19 Dec 2016

► Children with cerebral palsy may benefit from Conductive Education, a model of learning which provides fun, playful opportunities to increase life skills and independence1-4
► Children are encouraged to set their own achievable goals and practice their new skills at school, home and in the community

Who is it for?

Conductive Education is suitable for children and adolescents with cerebral palsy who are able to follow instructions and engage with others in a group setting.

Participants undertake a structured program of age-appropriate activities designed to improve their fine motor, mobility and play skills. They also practice self-care tasks like dressing, eating and toileting.

This supportive, group approach to learning has the potential to increase a child’s self-esteem, motivation and activity levels. It can help someone persist in their efforts to overcome barriers and nurture in them new social and communication skills1-3.

This page focuses on the benefits and uses for children and adolescents who have these characteristics:

Age: Infants and Toddlers, Preschoolers, School-aged, Adolescents
Type of cerebral palsy : Bilateral cerebral palsy, Diplegia, Hemiplegia, Quadriplegia, Triplegia, Unilateral cerebral palsy

More information about cerebral palsy is contained in the What is CP? section.

Mobility : GMFCS I, GMFCS II, GMFCS III, GMFCS IV, GMFCS V

Gross Motor Function Classification System (GMFCS) – classifies severity of mobility difficulties of children and adolescents with CP.

GMFCS Level I
Walks without limitations in the home and community, climbs stairs and can run and jump, difficulties with speed and coordination.

GMFCS Level II
Walks with limitations, difficulties with long distances and uneven surfaces, uses a railing for climbing stairs, limited running and jumping.

GMFCS Level III
Walks using a hand-held mobility device such as crutches or walking frame, may use wheeled mobility for long distances.

GMFCS Level IV
Usually relies on wheeled mobility with assistance, may use powered mobility, usually needs special seating and assistance with transfers.

GMFCS Level V
Usually transported in a manual wheelchair, requires specialised seating and full assistance for transfers.

Arm ability : MACS I, MACS II, MACS III, MACS IV, MACS V

Manual Ability Classification System (MACS) – classifies severity of upper limb impairment: how children with cerebral palsy use their hands to handle objects in daily activities in the home, school, and community settings.

MACS Level I
Handles objects easily and successfully.

MACS Level II
Handles most objects but with somewhat reduced quality and/or speed of achievement.

MACS Level III
Handles objects with difficulty; needs help to prepare and/or modify activities.

MACS Level IV
Handles a limited selection of easily managed objects in adapted situations.

MACS Level V
Does not handle objects and has severely limited ability to perform even simple actions.

Communication ability : CFCS I, CFCS II, CFCS III, CFCS IV, CFCS V

Communication Function Classification System (CFCS) – classifies severity of everyday communication of people with cerebral palsy.

CFCS Level I
Effective Sender and Receiver with unfamiliar and familiar partners.

CFCS Level II
Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.

CFCS Level III
Effective Sender and Receiver with familiar partners.

CFCS Level IV
Inconsistent Sender and/or Receiver with familiar partners.

CFCS Level V
Seldom effective Sender and Receiver even with familiar partners.

Movement disorder : Ataxia, Athetosis, Dystonia, Spasticity

More information about movement disorders can be found on our websites.

Intellectual ability : No intellectual disability, Mild intellectual disability, Moderate intellectual disability

A person’s thinking skills – ability to understand ideas, learn and solve problems. People with intellectual disability have difficulty with intellectual functioning which may influence learning, communication, social and daily living skills. Intellectual disability may be mild to very severe.

More about Conductive Education

Conductive Education was developed in Hungary in the 1940s1-3. As it has expanded into other countries this model has been adapted to suit local needs. All Conductive Education programs, however, have some common features:

  • Task series – when needed, tasks are broken down into smaller steps which children practice to help them build towards achieving their goals1-3.
  • Rhythmic intention –Conductors guide the child using a self-talk method that includes rhyme and singing. Rhythmic intention helps a child to problem solve their own movement tasks at an individualised level, which assists with their learning1-3
  • Special equipment – items including wooden slatted plinths (exercise benches) and ladder-back chairs are used to assist hand and arm movements and to build skills like sit-to-stand, standing and walking1, 3.

Assessments

There are two types of assessment required when undertaking Conductive Education:

To guide intervention

At the initial consultation with the family, the child undertakes a fun, interactive assessment to help the Conductor understand their motor, communication, cognitive and social abilities, and identify if a group environment is suited to them. The Conductor will then work with the family to develop goals to pursue during this intervention.

To measure the outcome of the intervention

The second type of assessment measures the outcome of Conductive Education to ensure it has been effective. The Conductor, together with the child and their family, meet once a year to review the child’s progress, determine if the family’s goals are being met and set new goals.

The typical assessment and outcome measure for this intervention is the Canadian Occupational Performance Measure.

Best available research evidence

Where did we search?

We searched the allied health, medical and educational literature to find research evaluating the effects of Conductive Education for children with cerebral palsy aged 2 years to 18 years old.

What were we looking for?

We aimed to find the best available evidence about whether Conductive Education improves a range of outcomes including social skills, independence in daily activities, communication, learning, and gross and fine motor skills.

What did we find?

The best available evidence was a systematic review3 of Conductive Education for children with cerebral palsy. The review comprised 15 studies (published up to 2001) including one randomised controlled trial (RCT) and other lower-level study designs. The best available evidence published since this systematic review was in five lower-level studies (three Level 3 studies5-8 and two Level 4 studies9,10).

Overall, we found that the evidence for Conductive Education was of low quality and there was substantial variability in the results of the studies, meaning that the results need to be interpreted with caution. The evidence does suggest, however, that Conductive Education may be of benefit for children with cerebral palsy, and equally as beneficial as the other types of intensive interventions included in the review above. This means that if Conductive Education with qualified Conductors is not available, families may be able to achieve similar outcomes undertaking a different type of intensive intervention. Factors such as cost, feasibility for families, and the preferences of the family for the types of experiences they wish their child to have, will have an important impact on their decisions to pursue Conductive Education.

Conductive Education compared with another intervention

Several of the studies compared outcomes from Conductive Education with another intervention such as special education programs or physiotherapy.

The systematic review3 concluded that there was an equal number of improvements attributed to Conductive Education as to traditional therapy, physiotherapy and special education. This means that any of these interventions may be appropriate for children with cerebral palsy.

The five low-level studies5-10 published since the systematic review3 and their findings are summarised below:

Activities of daily living - two studies6,9 concluded that Conductive Education contributed to an improved ability to complete daily living activities more than the Bobath approach to rehabilitation, parent education and special education. An additional two studies showed that children with cerebral palsy made equal and small improvements with Conductive Education, intensive traditional therapy and special education5,7.

Goal achievement - one study8 found Conductive Education and an intensive mobility training program resulted in similar rates of goal achievement (mostly mobility goals).

Gross motor ability - two level three studies used the Gross Motor Function Measure to measure gross motor outcomes. One study reported that Conductive Education and a special education group did not improve in gross motor skills whereas gains were made in a group who participated in intensive therapy including physiotherapy5. The other study reported equal amounts of improvement between Conductive Education and an intensive mobility training program7.

Fine motor skills - two studies measured fine motor ability. One study9 reported improvement and the other reported no change in fine motor ability5.

Conductive Education before and after intervention

Another group of studies evaluated Conductive Education before and after intervention (and did not include a comparison intervention in the study design).

The systematic review3 concluded that these studies tended to show improvement across a range of outcomes. One additional study10 published since the systematic review reported goals (mostly mobility goals) were generally achieved. The authors of the systematic review advised that these studies were low level, generally low quality and at greater risk of bias. They recommended that the results be applied cautiously.

Social skills and communication, which are considered important outcomes of Conductive Education, were not evaluated in any of the eligible studies.

Overall, the evidence that exists to guide decision making about the effectiveness of Conductive Education is lower-level and low quality. The evidence is designated as low quality because the studies are mostly small, of lower level (Levels 3 and 4) and many have weaknesses in their design and reporting. A great deal of variability exists in most aspects of the studies such as type of comparison interventions, the assessments that were used to measure outcomes, and the age, types and severity of cerebral palsy and cognitive ability of participants. There is also substantial variability of the Conductive Education programs themselves - intensity and duration of interventions (that is, the number of hours that children were engaged in the program), the background and training of instructors overseeing and implementing the programs, and the actual content of the Conductive Education programs. This variability means it is difficult to generalise the results obtained to all children with cerebral palsy.

Date of literature searches: March 2016

  1. Bourke-Taylor, H., O’Shea, R., & Gaebler-Spira, D. (2007). Conductive education: a functional skills program for children with cerebral palsy. Physical & Occupational Therapy in Pediatrics, 27(1), 45-62
  2. Tuersley-Dixon, L., & Frederickson, N. (2010). Conductive education: appraising the evidence. Educational Psychology in Practice, 26(4), 353-373. See abstract
  3. Darrah, J., Watkins, B., Chen, L., & Bonin, C. (2004). Conductive education intervention for children with cerebral palsy: An AACPDM evidence report. Developmental Medicine and Child Neurology, 46(3), 187-203
  4. Conductive Education Learning Centre at Cerebral Palsy Alliance. Available here. Accessed 7th August 2016.
  5. Stiller, C., Marcoux, B. C., & Olson, R. E. (2003). The effect of Conductive Education, intensive therapy, and special education services on motor skills in children with cerebral palsy. Physical & Occupational Therapy in Pediatrics, 23(3), 31-50. See abstract
  6. Dalvand, H., Dehghan, L., Feizy, A., Amirsalai, S., & Bagheri, H. (2009). Effect of the Bobath technique, Conductive Education and education to parents in activities of daily living in children with cerebral palsy in Iran. Hong Kong Journal of Occupational Therapy, 19(1), 14-19
  7. Odman, P., & Oberg, B. (2005). Effectiveness of intensive training for children with cerebral palsy – A comparison between child and youth rehabilitation and Conductive Education. Journal of Rehabilitation Medicine, 37(4), 263-270. See abstract
  8. Odman, P. E., & Oberg, B. E. (2006). Effectiveness and expectations of intensive training: A comparison between child and youth rehabilitation and Conductive Education. Disability and Rehabilitation, 28(9), 561-570. See abstract
  9. Blank, R., von Kries, R., Hesse, S., & von Voss, H. (2008). Conductive education for children with cerebral palsy: effects on hand motor functions relevant to activities of daily living. Archives of Physical Medicine & Rehabilitation, 89(2), 251-259.
  10. Effgen, S. K., & Chan, L. (2010). Occurrence of gross motor behaviors and attainment of motor objectives in children with cerebral palsy participating in Conductive Education. Physiotherapy theory and practice, 26(1), 22-39. See abstract
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