Paper presented at 4th World Congress on Conductive Education

12 – 14 September 2001, London


An appropriate strategy:
Introducing the Principles of Conductive Education to


Clare Cheng, SAHK


With over 60 million people with disabilities in China, the task of providing rehabilitation is an enormous challenge.  However, during the past two decades, services have been initiated with inspiring developments. These include a law to protect the rights of the disabled people (1999), and targets set at national level to establish services for people with specific disabilities.  Children with cerebral palsy and multiple disabilities, however, present the greatest challenge for the service providers.

While the policy level is supportive the general public has little awareness of disability and even less of the rehabilitation concept, and most crucial of all the severe lack of trained personnel to address the problem across the full spectrum of children’s disability. 

Few children with cerebral palsy attend school.  Indeed, the majority of disabled children are abandoned in orphanages or lying at home with no help.  In the orphanages while there is care and attention, there is no knowledge and understanding of disability problems, or training on how to help the disabled children.  The two Chinese words “殘疾” meaning “withered and sick” ascribed to these children bear the strong connotation of “no cure, no hope”.

The change in attitude happened with the introduction of a one-year certificate course in rehabilitation for Chinese doctors organized by the Hong Kong Society for Rehabilitation in its capacity as WHO Collaborating Centre Hong Kong Office.  From 1989 to 1997, ten courses at national level were run in two medical universities in Central China and the courses were endorsed by the Ministry of Civil Affairs and the China Disabled Person’s Federation.  The aim was to train one thousand rehabilitation specialists by the end of twentieth century.  The courses included a module on childhood disability.  It soon became clear to the organizers that there were almost no rehabilitation facilities of any kind for children with cerebral palsy and multiple disabilities, whether in hospital, community or orphanage.

Faced with this challenge and scarce resources, the service providers were compelled to find an effective model to meet the challenge.  Encouraged by the success of the trans-disciplinary team experience based on the principles of conductive education being practiced in Hong Kong, it was decided to expand this model to the mainland, and an introduction to CE principles was included in the childhood disability module of the certificate course curriculum.  Hong Kong being part of China with the same cultural background and language had the technical expertise and resources to support this initiative.

Graduates from the certificate courses were identified as suitable target personnel to initiate the adoption of CE principles in their respective orphanages.  While doctors on the whole were responsible for the overall program, nurses as frontline people were the principal deliverers. The Jockey Club Conductive Learning Centre of the Spastics Association of Hong Kong and the Hong Kong Society for Rehabilitation worked closely together in training these personnel.  The training format consisted of introductory courses together with on site teaching combining theory and practice, in short, an apprenticeship style of learning.  In the developing situation such as China this is seen as by far the best method to ensure quality as well as sustainability.  Selected trainees also had an opportunity to participate in intensive courses in the Conductive Learning Centre in Hong Kong.

This teaching and monitoring for more than 10 years has helped building up a core group of practitioners who are committed to developing the practice using CE principles.  In truth, one can say, not only have the children improved, but also the staff have undergone a transformation in the way they look at disabled children.  The humanistic aspect of Conductive Education has enabled the staff to appreciate the quality of the children beyond their pathological signs and symptoms.  Working together with the children in all aspects of living, “from sitting on the pot to learning ABC”, the staff have fostered a genuine loving relationship with the children. The trust built up is expressed in a manner in which they challenge the children in a spiral of demanding tasks, like climbing down a long flight of stairs from the dormitories to the dinning hall for lunch.

This change in attitude is also evidenced in some administrators of orphanages.  They begin to appreciate the service given to the children is not a matter of charity but the right of these children whom they now see as human beings.  They further recognize there is more than basic care they can offer.  Recently, the director of an orphanage who now runs a successful program under the principles of CE admitted to us that it was the early nineties before she learnt disabled children could benefit from training.

To underscore this change of attitude, one orphanage has taken the bold step of including mild and moderately disabled children in the recently established foster program initiated by the government.  The pioneering foster project seeks to place children from the orphanage in suitable homes in the farming community in the countryside.  The director aims at placing two or three children with one disabled in any one family. The staff of the orphanage visit the families and conduct parent workshops to demonstrate the basic skills in helping their fostered disabled children.  Their experience in teaching the children in the orphanage has given them the courage and confidence to implement this outreach program.  This effort will undoubtedly have far reaching effects on attitude towards the disabled in the wider community.

To sum up, for ten years now, seeds for implementing the system of CE have been sown in orphanages and rehabilitation centres in many parts of China, from the far north to the border provinces with Vietnam, and from Urumqi in the desert regions of the northwest to Ningbo on the South China Sea. In some places, there is concerted effort on the part of the frontline staff and the administrators to constantly strive for a better quality of programs geared to their socio-economic background.  In other places, there is still struggle with the basic concept of CE and the quality of implementation. Nevertheless, the introduction of CE principles is found to be appropriate to the urgent need for rehabilitating and educating the large number of children with disability in China. Sue Mackey writing on “Childhood Disability: a model of training for developing countries” published in the British Journal of Therapy and Rehabilitation November 1999 issue (Vol. 6, No. 11) has the following to say about the situation “During my subsequent experience in China, where a cross-over of skills is taught and is a feature and necessity of childhood disability, the approach works well in meeting the needs of a population of children that would otherwise have no services at all.”