In Memory of Dr Carl H. Delacato Ed. D 1923 - 2007
The Treatment of Neurologically Impaired Children Using Patterning
Movement Therapy
In view of the news of the untimely death of Dr Carl Delacato, who along with the Doman’s proposed the basis for Neurological Reorganisation based on the concepts of Human Movement proposed by Fay, is it now the opportunity for the AAP to reconsider its position on the work of the Doman-Delacato team ultimately re-engineered in later years by Delacato alone to arrive at a programme to assist neurological dysfunctional individuals currently practised worldwide by so many different organisations. These organisations proclaiming and recognising the part played by Delacato in developing the basis of the techniques they currently employ.
Should the AAP stand alone in the World continuing alone to criticise proceedures existing since more than 50 years to the benefit of thousands of individuals having and had help from those proceedures?
Arguably two questions dominate this issue; why 15 years of silence between 1953, the first pronouncement of the group of its intentions and 1968, the first criticism of the group’s work and why only publish in its in- house Journal "Pediatrics".
Could it have been as Neman et al suggested in Experimental Evaluation of Sensorimotor Patterning used with Mentally Retarded Children; American Journal of Mental Deficiency 1974, Vol.79, No.4 372-384 that "The rapid rise to prominence of the Doman-Delacato regimes, the zeal of their followers, and stories appearing in the popular press telling of remarkable "cures" all served to bring the wrath of the "establishment" to bear upon the Institutes for the Achievement of Human Potential and its methods". A case in point being the paper by Freeman, R.D. in Journal of the American Medical Association, 1967, 202, 365-388.
The Neman article along with the results of a two-year Sensori-motor Training project published by the National Association for Retarded Children in Mental Retardation News Vol. 22, No. 3, June 1973 reported "Findings indicate that the programmes involved were of significant benefit" and in the 1974 document "The question raised in the present study- does sensorimotor patterning have a measurable effect in any behavioural domain -has been answered affirmatively".
Both of these articles are ignored by the AAP, in truth, the whole statement by the AAP, first published in 1968 is based principally on the criticism of the original practice of the 50’s and 60’s having in their updated statement of 1982 and 1999 made no reference to Delacato publications and practices after 1970. These early criticisms having been wholeheartedly refuted by the 1973 NARC study.
The number of Movement Therapy organisations currently practising worldwide, many in state educational establishments in Europe, North America, South America, South Africa, Asia, Australasia, as well as many individual professional therapists, in spite of the pronouncements of the AAP, is testament to the Delacato legacy, the AAP should acknowledge Delacato’s place in history.
The submission by the AAP, that, "treatment programmes that offer patterning remain unfounded" needs to be considered thus; the basis of today’s physical therapy movement programmes, is built entirely on the premise, that movement by a therapist, of any part of the human anatomy, on a regular daily basis is in effect "patterning". This movement therapy, practised daily by fully trained, qualified, physiotherapy, and occupational therapists, to rehabilitate stroke victims is accepted worldwide in private, and state medical regimes. The team originally put together by Fay was done so to rehabilitate stroke victims and recipients of traumatic brain injury through accidents.
In effect the AAP critique undermines today’s physio and occupational therapy practitioners those practitioners that the AAP refers to in their web site. www.medicalhomeinfo.org/health/Downloads/EIBrochureF.pdf. to which autistic children should be referred to for therapy as the basis for Early Intervention.
In May 2006 the American Academy of Pediatrics republished its Policy statement originally published in its journal Pediatrics Vol. 104 no.5 November 1999, pp.1149-1151, http://aappolicy.aappublications.org/cgi/content/full/pediatrics; 104/5/1149, referring to the use of patterning.
This in turn was a reiteration of the original statement of 1968 and 1982. The May 2006 statement affirms that "Current information does not support the claims of proponents that this treatment is efficacious, and its use continues to be unwarranted". However nowhere in the References appendage is cited any peer reviewed, journal published work after 1999 which refers to the above mentioned subject matter, to which the article refers, either in support of the argument of the subject matter, or against the subject matter.
Another failure of the AAP, which, is considered to be necessary in balanced scientific commentary, is to ensure that the content of the argumentative discourse at the time of publication contains references to the latest published information from authors of the discussion material pertaining to the subject matter.
To this point, the omission of references to published works of Delacato in 1970, and 1974, "A new start for the child with reading problems" and "The ultimate stranger the autistic child" is to be questioned, as patterning, as defined by the AAP is not referred to in either book.
If the uncommitted reader is to draw a judgement from the argument by the presenters then the reader has to have been given the opportunity to consider a balanced view of the critique.
The reader would then have discovered that the so-called Doman –Delacato therapy was first proposed by Dr Temple Fay MD a neurosurgeon working in Philadelphia, who incidentally, was responsible for the introduction of brain cooling protocol prior to neurosurgery, whose original operational cooling equipment was exhibited at the Smithsonian.
Fay’s paper "The origin of Human Movement" was published in Amer.J. Psychiatry 111: 644-652, 1955.
Further more the uninformed reader would have discovered that Delacato and Doman had gone their separate ways by 1972 and Delacato continued his work to develop a new therapy which relied less heavily on the "patterning" concept first laid down by Fay.
The submission by the authors for a need for several persons to perform exercises to the head and extremities for several hours a day, no longer applies to today’s Delacato Therapy, except on individuals with no movement ability, and then only for very short periods.
The omission of these pertinent points by the AAP, is a serious misjudgment by the AAP to construct a valid balanced argument, necessary to have credence in the cause of scientific discourse, which makes their published critique appear to be more of personal issue, rather than a scientific one. This can be argued due to the fact that other individuals such as Orton were working on the same principles as the Doman’s and Delacato, Kephart (1975), Cratty (1972,1973) and only the Doman-Delacato work is primarily referred to in text and References. In 1969, according to Maguire, Brain Gym; Humanising Language Teaching Year 4; Issue 3; May 02, Paul E. Dennison, Ph.D established his first clinic. According to Maguire "Noted authorities such as Orton, Doman, Delacato, Kephart and Barsch have used similar movements successfully in their learning programmes. Dr Dennison drew from his knowledge of such programmes". No direct criticism of Dennison is noted by the AAP.
In 1970, Carl Delacato proposed a new revolutionary concept together with a new curative therapy, outlined in his book, " A New Start for the Child with Reading Problems".
In his book Delacato describes his work as being hard in as much as it presented a new approach to reading problems; reading problems were the result of lack of development of the nervous system, especially in the development of complete one-sidedness.
Delacato notes that the previous book relating reading to brain function was written in 1923 by Dr Samuel Orton, and now he was to resurrect and add fuel to that old fire in educational circles.
Dr Orton, a clinician and prominent dyslexia researcher, hypothesised that normally developing readers suppress the visual images reported by the right hemisphere of the brain because these images could potentially interfere with input from the left.
Using functional magnetic resonance imaging to study brain activity in children, researchers led by Dr Guinevere Eden at Georgetown University Medical Center confirmed part of an eighty year old theory on the neurobiological basis of reading disability, and shed new light on brain regions that change as children become accomplished readers. Advanced technology allowed the researchers to discover that children do in fact turn off the right side of their visual parts of the brain, as they become accomplished readers. This confirms an aspect of Ortons’ work - borne out of observations of individuals with reading disability - is correct.
To put this theory into its simplest terms, systems of reading and language difficulty, show up where there is conflict between one side of the brain and the other to gain language dominance.
In the human brain the language area is usually located in either, the left, or right side of the brain. Likewise, man is usually left- handed or right- handed.
Normally, dominance in the brain begins as soon as baby learns to speak, total dominance achieved around 7 to 8 years of age. Theoretically, a missing of any stage of development between crawling, creeping, walking, seeing, talking and writing creates problems in reading.
In November 2003 researchers led by Dr Mark Wallace , report that Dyslexia may stem from how the brain processes sight and sound together rather than simply a problem decoding the written word. They go on to suggest "For the first time, there is evidence that dyslexia is a multi- sensory disorder. It is not solely a problem with visual processing or with language"," our study suggests that it is actually a problem combining visual information with auditory information. "Early reading involves matching what you see with what you hear. The sights and sounds of words are inappropriately matched. So, while the average person very quickly matches the written word "dog" with the sound "dog", a child with dyslexia may have much more difficulty".
Turning again to the text of the body of the critique, there is a precis of the theory of neurological organisation underpinning patterning. "According to this theory" the authors consider that, "the majority of cases of mental retardation, learning problems, and behaviour disorders are caused by brain damage or improper neurologic organisation. Current information does not support these contentions".
On this issue alone has the AAP ignored or completely missed the plethora of peer reviewed, journal published, investigative research papers, suggesting, by brain scanning autistic subjects, with the latest high definition MRI, CAT, and PET scanners, and identifying lesions in various parts of the autism forming brain.
"It must be considered as a basic principal that, when a lesion exists within the confines of the brain, treatment to be successful must be directed at the brain, wherein lies the cause, rather than to that portion of the periphery where the symptoms are reflected. Whether the symptoms exist in an almost undetectable subtlety in human communication or in an overwhelming paralysis, this principal must not be violated by those who seek success with the brain-injured patient", 1953, Delacato, Doman et al, presentation, New York Institute of Physical Medicine and Rehabilitation.
Today, we accept without question, the presence of abnormalities affecting the Central Nervous System (CNS) of individuals exhibiting behavioural, learning and mobility problems, after a mild diffuse brain injury.
For an in depth explaination of the effect of lesions that affect the different parts of the cortex and thus have an influence on speech, language, vision, reading and writing ability, a presentation entitled Higher Cortical Function, Language, and Cerebral Lateralisation is published on a web site emanating from the University of San Francisco via its web site http://Keck.ucsf/physio/courses/p122hcf.htm.
In 2001 The American Academy of Neurology (AAN) published in its Journal " Neurology" October 9th issue, a study undertaken by the PET Center at Children’s Hospital of Michigan in Detroit on 26 children with tuberous sclerosis complex (TSC). Researchers used MRI and PET examinations to study how brain lesions resulted in common behaviours of autism, including difficulties in social interaction and communication and narrow and repetitive stereotyped behaviour. They found that more than one area of the
brain was responsible for autistic behaviour in children with brain lesions, and that autism results from a complex combination of events in different parts of the brain, rather from one single source.
In Feb 2002 the AAN published a report of a study carried out at the Medical College of Georgia, using computerized imaging in the frontal, and temporal lobes of autistic patients, and observed minicolumnar abnormalities. A minicolumn is a basic organizational unit of brain cells and connective wiring, allowing an individual to take in information process it and respond. Thus any changes in size shape or location of the minicolumn will have an effect on the processing capacity of the brain.
The principals of the relationships between the senses, hearing, seeing, touching, which are referred to as the ‘in" channels which have a direct effect on brain development and the "out" channels of mobility, speech and hand use, which depended on the "in" channels have been established. It has been shown that a lack of opportunity for development for any of those channels, had an effect upon the development of the others, and as such showed the way in which integration of the senses into a therapy, that overcame the brain injury and lack of development opportunity.
Increased interaction produces increased development and decreased interaction results in decreased development. This interaction, which is prerequisite to development, is also a prerequisite to learning.
The brain interacts with its environment through a cybernetic loop, which begins in the environment, follows afferent or sensory pathways to the brain and then efferent or motor pathways from the brain back to the environment. Thus the environment as it reaches the brain through the sensory pathways, is the primary prerequisite for the development of the CNS, and consequently for learning. Any changes that occur which have a direct effect of the CNS to function effectively with the environment, have a profound effect on the ability of the CNS to experience the environment, and effectively learn from that experience.

The basis of a movement therapy programme, Sensory Integration Therapy for Neurological Rehabilitation being used in school environments dedicated to the education of special needs children has been established within the Westminster Governments’ Department for Education and Skills.
In their document "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html they offer the following guidance;
Physical education; Opportunities at Key Stage 1
Much of the programme of study at Key Stage 1 is relevant to pupils with learning difficulties. With modification, it can provide stimulating and challenging learning opportunities. All pupils can contribute in group work with others at their own level of ability.
The document suggests pupils explore basic body movements and actions using different parts of their bodies. To acquire and develope skills, suggesting, crawling, sliding, rolling, moving backwards and forwards. To select and apply skills, tactics and compositional ideas, be helped to follow and respond to simple instructions for example stop and start.
At Key stage 2, the document suggests listening and responding to action words, for example, walking, marching on the spot. Suggesting, as part of games activities, ball games, catching, throwing, on the floor foot skills of passing, dribbling. Throwing and catching bean bags, all as part of hand eye coordination programme, to develop binocular vision.
The Welsh Assembly Government, in their recently published guidance document "Routes for learning", Crown copyright 2006, reference AC/GM/0612, April 2006, affirms that, "This guidance document, written to support the use of the Routes for Learning materials, offers an overview of the main theories and background information, underpinning the effective teaching and assessment of learners with profound, and Multiple Learning Difficulties". In the Additional Guidance section, the document suggests that therapies, including movement therapy, and occupational therapy to address sensory impairment, could be included in the curriculum design. The rationale for this is explained in the premise that inhibiting factors in the student’s ability to learn is irrefutably connected to sensory impairments exhibited by students with learning delay. The document outlines the reasons for the sensory impairments linked to retained inhibitive reflexes. Addressing these inhibitive reflexes being the key to improved learning ability.
It is essential to recognise that the physical exercise components of the DfES document, and movement therapy in the Welsh Document are the core elements of Delacato Therapy, evolved from the ideas of neurologist Dr Temple Fay and propounded in his paper The Origin of Human Movement, presented to the Fourth Annual Institute in Psychiatry and Neurology April 1954 and published in Amer. J. Psychiatry 111:644-652,1955.
In the published work "Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, Teacher Education, University of South Africa, Pretoria, Republic of South Africa, describe the outcomes of a rigorous experimental programme to associate the benefits of physical exercise movement to cognitive learning and academic skills and investigate the efficacy of a movement programme on the academic skills of early learners
In their opinion " The results of the pre-testing and post-testing indicate that the learners of the experimental group showed a significant improvement in spatial development as well as in reading and mathematical skills, compared to the learners in the control group, free-play group and educational toys group".
In support of the rationale behind their experimental programme, the authors cite Summerford, C. (2001). What is the impact of exercise on brain function for academic learning? Teaching Elementary Physical Education, 12(3): 6-8." that physical education is often seen as a frill, and has been discontinued in many South African schools, which might be a misguided kind of thinking "
The authors, drawing on the works of Kephart, (1975). The slow learner in the classroom. Columbus, OH: Merrill, Ayres, (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services. Delacato, (1959). The treatment and prevention of reading problems. Springfield, IL: Charles C. Thomas. . (1974). The ultimate stranger, the autistic child. Novato, CA: Academic Therapy, and the recent works, brain research of Pica, (1998). Movement and the brain: moving and learning in early childhood. Teaching Elementary Physical Education, 9(6): 18-19, De Jager, (2001). Breingim. Kaapstad: Human & Rousseau, and others suggest, "in effect, that the body, as a sensory-motor response system, causes the brain to learn and thus to organise itself ".
The premise that movement (physical education programmes) is the sole mechanism for effective remedial action has to be viewed with caution. Feigley, (1990), Should schools eliminate mandating physical education classes? School Administrator, 47(2): 15, 17, 20.proposes that physical education programmes need to more than mere physical fitness regimes. Likewise according Fredericks et al, Corrie and Barratt-Pugh, (1997). Perceptual-motor programs do not facilitate development: why not play? Australian Journal of Early Childhood, 22(1): 30-36, report on studies showing that certain perceptual motor training was not an effective intervention technique for academic cognitive or perceptual-motor variables. The results show little effect in any developmental domain, even on children's gross motor skills. Furthermore, the programmes made little difference to the reading, arithmetic, language or spelling of children with learning difficulties or of normally developing children. However, even though it may initially seem that Corrie and Barratt-Pugh) do not accept the theory that movement leads to learning, they do state that it is not the importance of perceptual-motor development that is disputed, but the way of supporting and facilitating that development that is critical.
According to the authors Fredericks et, al a sensori-motor movement programme should be aimed at the root cause of learning difficulties. On the basis that vestibular, proprioceptive, tactile visual and or auditory systems are dysfunctional, the child will fail in its attempts at academic work. Kokot,S.J. (2003a). Diagnosing and treating learning disabilities in gifted children: a neurodevelopmental perspective. Gifted Education International 17(1): 42-54.
To read full article "The treatment of neurologically impaired children using patterning" from which this extract is taken visit The Autism Centre web site www.theautismcentre.co.uk go to" Related Links" then "Learning Connections".
For further reading go to article "Brain Research supports learning" written by Kay Hamilton published in the same web site in the "Blog " section, also in Research Articles my December 2003 again in The Autism Centre.
Finally, the submission by the AAP, that "treatment programmes that offer patterning remain unfounded" needs to be considered thus; the basis of today’s physical therapy movement programmes, is built entirely on the premise that movement by a therapist, of any part of the human anatomy, on a regular daily basis is in effect "patterning". This movement therapy, practised daily by fully trained, qualified, physiotherapy, and occupational therapists, to rehabilitate stroke victims is accepted worldwide in private, and state medical regimes. The team originally put together by Fay was done so to rehabilitate stroke victims and recipients of traumatic brain injury through accidents.
In effect the AAP critique undermines today’s physio and occupational therapy practitioners.

Robin Burn
The Autism Centre
April 2007