The Anat Baniel Method (ABM) is a type of physiotherapy that Ali and I came across while sharing experiences with other families that have children with CP. The ABM approach to therapy is unique and drastically different then the dominant conventional therapies out there. We initially approached this therapy with hesitation and doubt. But after some research and deliberation we decided to give it a go because of its success with CP and spasticity. We tried a few introductory sessions and quickly began opening up to its method.
Judy working with James
One of the main differences is that conventional therapies largely focus on muscle strengthening and development, while ABM focuses primarily on brain development and awakening neuropathways. Both are integral to development and they correlate to one another. However, the methods of invoking these changes of development are very different. ABM puts forth what it calls the 9 essentials for the healthy development of children with special needs.
Each of these principles are fascinating in their own right because they reveal how children and parents will learn to improve the developmental delays that they experience due to the presence of a disability or disorder. Anat Baniel describes each at length in her book "Kids Beyond Limits". The main idea is that parents and children need to move their focus away from fixing the problems, and move towards connecting through the Nine Essentials and incredible gains will happen as a result.
Conventional therapies for children with CP tend to focus on learning the positions and experiences of sitting, standing, and walking through training, exercising and repetition. To learn the positions of sitting, standing and eventually walking for James involves forcing him to do movements that are not natural for him, and that increase the tone, or spasticity, in his muscles in order to do so. The thought in conventional therapy is that through practice, strengthening and pushing through the pain the child will gain the resiliency, discipline and an ability over time to eventually become independent in their movements.
Every one of these milestones (sitting, standing, walking) is so incredibly important for a child to develop if they have the ability to do so. Sitting, standing and walking opens up endless possibilities for a child to explore, to gain independence, to interact with their world with excitement all the while growing, making connections and developing at very rapid pace. These skills build off of one another, and it is as if a new world is opened to them with each skill learned. For most people, these skills are learned and become automatic as the neuropathways used to accomplish these ends become more "grooved in" with time. Accomplishing these skills can also act as gateways for other types of development such as speech, eating and cognition. As the core gains strength and mobility to sit, stand and walk, the brain can choose to focus on other stimulation instead of fighting to maintain a specific position in spasticity in order to explore other things.
Which therapy to choose?
When researching about ABM, we quickly ran into conflicting messages about how to bring about the most effective development for James. ABM puts forth some contrary ideas to conventional therapy. It suggests that going too fast too quickly can actually have detrimental effects on the child and may lead to habits that children need to "unlearn". Since humans learn through the experience and not what the intended goal is, you always have to ask the question "what information is the brain being taught?" If James is being positioned to stand by holding onto something and having an adult hold him up he automatically engages the muscles in his legs creating stiffness. So, what is he learning? ABM would suggest that he is learning that it hurts to stand, and that spasticity is encouraged because of the repetitive nature of doing the same thing over again. Even though the intention is that he is learning to stand, ABM would say that he is primarily learning that standing is frustrating and is uncomfortable. Doing this before he is ready will limit his motivation.
The ABM method attempts at addressing development at the origin of the disability - the brain, not the muscles. When the correct neuropathways are established and awakened, the muscles will begin to do what they are supposed to do. If he could, he would - is one of the reasoning tools used to explain the importance of a focus on the brain. In other words, if James could sit independently, he would. So, if he is not, ABM would state that we need to awaken James' awareness of his legs, core strength and a capacity to learn and grow into sitting.
ABM also suggests other principles that are contradictory to conventional therapy such as what to do when he cries, and how soon to begin practicing milestones.
Crying: Conventional therapy might have a child learn to work through the pain (within obvious thresholds) and learn to become more perseverant and learn the skill through effective practice. ABM would respond to crying in a different way. They might pull back and continue working on skills the child is mastering already because the crying indicates he is not ready for this yet.
Milestones: Conventional therapy sees the importance of training the child to develop the skills needed to sit, stand, walk as early as possible. ABM encourages the child to take their time, approach new skills when they have mastered previous ones. If you go too quick too soon, you will lose the chance to develop important brain pathways needed for future tasks.
Now, Ali and I are not experts by any means on brain and motor development. So we decided to talk to a lot of people in the medical world and weigh their thoughts against the experiences that families have had with ABM. After a lot of thought we decided to try ABM for three months and reassess afterwards. One thought was that the time for creating new neuropathways is now. And it would make sense to allow ABM to work unhindered. If we did a bunch of conventional therapy and then tried ABM, James would have more to "unlearn".
The Fixing Paradigm:
One of the concepts in ABM that is an alternative perspective in physiotherapy is what Anat calls the "fixing paradigm". I find this idea fascinating in many respects because I think it hints at a larger ingrained human behaviour that we tend to apply to our relationships, our expectations of ourselves and even our own spirituality. The idea is that whenever you see a problem or limitation, you tend to try to fix it. Now, It's only natural for us all to fix problems that arise in our lives. And this inclination is, most of the time, very helpful. For example, if a car is not working properly, you take it to the mechanic; when we experience pain or hurt, the easiest thing to do is to look for reassurance and a time in the future when it will feel better.
However, when problems arise that are beyond our reach of fixing we still tend to naturally treat these problems as if they are fixable. Our mind and emotions initially go into the default mode of repairing, restoring, fixing. After all, we are taught that the highest level of thinking is to "problem solve". But what do you do with a problem that can'tbe solved? What do you do with a brain injury that is permanent? This is where the fixing paradigm begins to have a negative effect. Anat suggests in her book that when encountering a child with special needs the fixing paradigm can in fact lead to further complications. "We need to back off from trying to makethe child do what he can't do... we are 100 percent dependent on the child's brain to make the necessary changes".
The easiest thing - avoiding the problem and pretending it doesn't exist - is a horrible response as it disconnects you from reality. Of course, having the problem go away is what everyone wants, but, unfortunately that is not one of the available paths. It is much harder to face the hardship or uncertainty of the unknown of the problem. Attempting to be honest about it often makes people feel uncomfortable because we are not used to conversations outside of a polite veneer. The honesty is unscripted, reveals struggle and emotion, and lack the resolution that we are all so used to. One suggestion from Anat in her book is that you try not to embrace the "fixing paradigm" that looks at a situation through the lens of its limitation, its problem. Instead, try to look at the situation from the realm of connection. Allow your expectations to shift and to see what your child isdoing. James has demonstrated some really exciting small gains in the first two weeks of trying the ABM method. He has begun to roll over reaching for an object more frequently and he has also demonstrated a flexibility that we haven't seen up to this point. Those are really exciting gains, and are the building blocks of further gains to come. ABM has taught Ali and I to value the discipline of "slow". It is so important not to rush, to overwhelm, to try and gain milestones that typically developing children achieve. If you do this, you loose the process of refining small movements along the way (such as head control, arm, shoulder and back strengthening) that are far better for his longterm ability then simply achieving a milestone like sitting independently quickly.
The path that ABM suggests for us to follow is to learn how to reframe what the word "problem" means as well as reframing what the word "solving" means. The Nine Essentials support a framework for approaching your child and participating alongside him in his day to day. Although hesitant at the start, Ali and I have agreed to try ABM for three months to see how James responds. Our journey in ABM begins with connecting with James using a heightened awareness of him and helping him begin to create his own unique solutions to his environment. Way to go little man!