关于模式方法的国外评价 Psychomotor Patterning Steven Novella, MD

Psychomotor Patterning
Steven Novella, MD
In the 1960s, psychomotor patterning was proposed as a new treatment modality for people with mental retardation, brain injury, learning disabilities, and other cognitive maladies. The method was subjected to controlled trials and found to be of no value. It was debated in the scientific literature up until the early 1970s, when the scientific medical community arrived at the consensus that is should be discarded as a false concept with no therapeutic role. Its use, however, has not stopped.

The concept of patterning was invented by Glenn Doman and C. Delacato and is therefore often referred to as the Doman-Delacato technique [1]. Their theories are primarily an extension of the outdated concept that ontogeny (the stages through which organisms develop from single cell to maturity) recapitulates phylogeny (the evolutionary history of the species). Thus the neurodevelopmental stages of crawling, creeping, crude walking, and mature walking through which normal children develop is directly related to the amphibian, reptilian, and mammalian evolutionary human ancestors [2].

Doman and Delacato postulated that mental retardation represents a failure of the individual to develop through the proper phylogenetic stages. Their treatment modality supposedly stimulates proper development of these stages, each of which must be mastered before progress can be made to the next stage. This stimulation is done through what they call "patterning," in which the patient moves repeatedly in the manner of the current stage. In the "homolateral crawling" stage, for instance, patients crawl by turning their head to one side while flexing the arm and leg of that side and extending the arm and leg of the opposite side. Patients who are unable to execute this exercise by themselves are passively moved in this manner by 4-5 adults, alternating back and forth in a smooth manner. This must be repeated for at least 5 minutes, 4 times per day. This exercise is intended to impose the proper "pattern" onto the central nervous system. In the full treatment program, the exercises are combined with sensory stimulation, breathing exercises intended to increase oxygen flow to the brain, and a program of restriction and facilitation intended to promote hemispheric dominance [3]. Advocates claim that patterning enables mentally retarded and brain injured children to achieve improved, and even normal, development in the areas of visuo-spatial tasks, motor coordination, social skills, and intellect. They also claim to promote superior development in a normal child [4].