感谢网友linyd0804提供的这篇文章，本来试图翻译一下，但水平实在有限，翻的太差，大家还是自己看吧。
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.
精神运动模式
在20世纪60年代，精神运动模式被提议作为一种新的治疗方法用于有智力缺陷、脑损伤、学习障碍和其他认知病的患者的治疗。 该方法接受了受控试验，被发现是没有价值的。在科学文献中关于这种方法的辩论一直持续到70年代早期，当时医学科学界达成了共识，认为该方法是一个应该被放弃的错误概念，没有治疗作用。然而这种方法的使用并未停止。
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 Their theories are primarily an extension of the outdated concept that ontogeny (the stages through which organisms develop from single cell to maturity) recapitulates phylogeny (the evolutionary history of the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 neuron developmental 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].
模式的概念是由Glenn Doman和C. Delacato发明的，因此经常被称作Doman-Delacato技术[1]。 他们的理论是对一个不再流行的概念――个体发生学――的一个扩展，（个体发生学研究有机体从单细胞发展到成熟物种所经过的各个时期，既种系演变历史中各阶段的概括）。这样正常小孩发育过程中的腹爬、立爬、未成熟的行走到成熟行走，其神经元的发展阶段直接对应于两栖动物、爬行动物、哺乳动物和人类的祖先的进化[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].
Doman和Delacato假定神经发育延迟代表个体在发育中通过某个阶段的失败。他们的治疗方式按照他们的想象可以激励这些阶段的发育，这些阶段必须在完全掌握后发育才会进化到下一阶段。 这种刺激是通过被他们成为“模式”的方法完成的，在模式训练中，患者重复当前阶段的移动模式。 比如，在“同侧爬行”阶段，患者通过转动他们的头到一边，同时弯曲这一侧的胳膊和腿，伸展另一侧的胳膊和腿。 无法独自进行这种锻炼的患者被动地由4-5个成人进行如此移动，以顺畅的方式反复交替。 这项运动必须持续至少5分钟，每天进行4次。 这种训练意在强加适当的运动“模式” 在中枢神经系统上。 在全套的治疗项目中，模式训练与感觉刺激，呼吸训练（意在增加大脑的氧流量），和一个意在限制和帮助促进半球优势的项目结合一起进行[3]。 倡导者声称模式可以使智力迟滞者和脑子受损害的孩子得到改善、甚至正常，在视觉空间任务、运动协调、甚而社会技能和智力方面得到发展。 他们也声称这种方法可以促进一个正常孩子的超常发展[4]。
The theoretical basis of psychomotor patterning is therefore based on two primary principles, the recapitulationist theory of ontogeny and phylogeny, and the belief that passive movements can influence the development and structure of the brain. As Delacato stated in 1963:
Man has evolved phylogenetically in a known pattern. The ontogenetic development of normal humans in general recapitulates that phylogenetic process. We have been able to take children who deviate from normal development (severe brain injured) and through the extrinsic imposition of normal patterns of movement and behavior have been able to neurologically organize them sufficiently so that they can be placed within a human developmental pattern of crawling, creeping, and walking [3].
Medical treatments are evaluated on two criteria, their theoretical basis and their empirical value. The scientific community has rejected patterning on both counts. By the 1960s, it became clear that recapitulation it is based on an incorrect linear concept of evolution. Evolutionary lines continuously branch and deviate, forming a complex bush of relationships, not a linear ladder of descent. Embryological development does not reflect the mature stages of other distant branches of this evolutionary bush. Studying the embryology of the developing fetus also does not reveal any evidence of successive stages reflecting past evolutionary ancestors.
医学治疗方法通过两个标准来评估：既他们的理论依据和他们的经验值。在这两方面科学界都拒绝模式。 在20世纪60年代，事情变得清晰，个体发生学是基于一种不正确的线性进化概念。 事实上进化进程中连续地出现分支和偏离，形成关系复杂的进化丛，它不是一个线性的世系阶梯。 胚胎学的发展也没有反映出进化丛中在远亲分支中存在这种成熟阶段。对发育中胎儿的胚胎学研究同样也没有揭示出任何证据，能反映过去祖先进化的渐进阶段的。
There is also no theoretical basis for the belief that patterns can be impressed upon the developing cortex. Brain development is genetically driven and involves a complex sequence of cell growth, migration, organization, and even programmed cell death. Abnormalities in this process can be caused by genetic flaws, toxic insults, infection, or biochemical abnormalities. There is no model by which any of these disparate causes can be influenced by passive, or even active, movement of the neck and limbs. Thirty years of subsequent neurological, embryological, and medical progress have failed to lend any theoretical or clinical support for Doman and Delacato's principles.
同样没有理论根据能让人相信模式可以对大脑皮层的发育产生影响。大脑发育是基因驱动的、包括一个复杂序列：细胞生长、迁移、组合、甚至细胞死亡，这个过程中异常可以由基因缺陷、中毒性侵害、传染、或者生物化学的畸变造成。 在这些异常原因中没有任何模型能说明通过被动的、或者主动的脖子和肢体运动可以影响脑发育。随后三十年中神经学，胚胎学和医学进展也没能为Doman和Delacato的方法提供理论或临床上支持。
Their use of breathing exercises to promote oxygen delivery to the brain also lacks an acceptable theoretical basis. The brain and the cardiovascular system are designed to give highest priority to oxygen flow to the brain cells. Elaborate and powerful feedback mechanisms ensure adequate delivery. It is true that carbon dioxide retention, in this case achieved through breathing techniques, does increase blood flow to the brain. There is absolutely no reason to believe, however, that this helps the developing brain.
他们使用的呼吸锻炼用来促进氧气传输到脑子的方法也缺乏一个可接受的理论依据。大脑和心血管系统被设计为优先为脑细胞供氧。精心制作的和强大的反馈机制保证充分的传送。二氧化碳的残留是真实的，在这种情况下通过呼吸技术来实现增加对大脑的供血。然而，没有绝对的理由相信这些能帮助大脑的发育。
In 1982, the American Academy of Pediatrics issued a position statement concluding that "patterning" has no special merit, that its proponents' claims are unproven, and that the demands on families are so great that in some cases there may be actual harm in its use. The National Down Syndrome Congress has endorsed this statement and published it on its Web site [5].
1982年美国小儿科学会发表了一个看法声明，结论是模式没有什么特别价值，它的拥护者的主张是无法证明的，
Of course, if clinical evidence could demonstrate that patterning improves neurological development, it would be still accepted and used. Many mainstream interventions lack a fully understood theoretical basis. Physicians are, at their heart, practical individuals, and if something works, it works. They require proof, however, that an intervention does indeed work and is safe.
On this score, patterning has just not delivered. Duringf approximately ten years in the late 60s and early 70s, dozens of clinical trials compared groups of developmentally delayed children given patterning treatment to comparable who received no treatment but similar amounts of attention [2,6-8]. None confirmed the claims of Doman and Delacato. Some found modest improvements in motor or visuo-spatial skills, but none showed improved intellectual development. The few positive studies were neither impressive nor reproducible. Eventually, such clinical trials stopped and the scientific community abandoned the technique as a blind alley.
The tragedy of this story does not stem from the fact that patterning is a failed theory. It is regrettable that patterning did not deliver as promised, for any legitimate treatment for brain injured and retarded children would be most welcome. The real tragedy began, however, when Doman and Delacato released their claims for a new dramatic treatment before their theories had been scientifically validated. This behavior, similar to the "cold fusion" fiasco, is more than just professionally irresponsible. In physics, such behavior is merely bad form; when dealing with the desperate parents of brain injured children, it should be considered cruel. Doman and Delacato were widely criticized for publicizing their unsubstantiated claims and giving false hope to vulnerable parents and their afflicted children.
The saga, however, did not end with the scientific death of patterning. Doman, Delacato, and their associates began incorporating the patterning technique into their Institutes for the Achievement of Human Potential (IAHP), which was established in Philadelphia in the 1950s and still operates today. A second facility, the National Academy of Child Development (NACD) in Huntsville, Utah, that offers patterning as part of their treatment program. The NACD is run by Robert Doman, the nephew of Glenn Doman, although both institutions state that there is no association between the two.
On August 8, 1996, NBC aired a program titled "Miracle Babies," hosted by Kathy Lee Gifford. The program included a segment portraying an apparent "miracle cure" of a child suffering from moderate mental retardation. As is typical of the lay media, Kathy Lee provided an emotionally appealing view of patterning without even a hint of skepticism. The segment did bring out the desperateness of the parents. They were clearly devastated, as any parents would be, by the need to finally accept that their child was not developing normally. In their desperation, they sought any possible hope, and it was offered to them by the IAHP. The hope that they purchased, however, came at a heavy price, both financial and emotional.
The IAHP and the NACD both rely heavily on the family as the primary deliverers of the patterning treatment. In order to even reach the stage where their child can be enrolled into the aggressive treatment program, they must first complete a training and evaluation course that begin with purchasing and listening to a set of audiotapes. The IAHP states in their literature that only the most dedicated and capable parents will make it to the final stage of treatment. The NACD appears less demanding, but follows the same principle. The program requires families to alter their lives to institute a daily program of patterning exercises, breathing exercises, and sensory stimulation. The mother interviewed by Kathy Lee stated that the program was so demanding that it dominated her life, resulting in emotional and physical exhaustion.
The program also illuminated another important feature of the patterning phenomenon, the difference between anecdotal and scientific evaluation of its effectiveness. Most children, even severely mentally retarded children, still grow and develop, although more slowly than average. Therefore, any child admitted into any treatment program will make some progress as an inevitable consequence of time and their natural development, even if that treatment program is completely worthless. Without adequate controls, it is therefore impossible to evaluate any such treatment. Of course, Kathy Lee and the parents of the child on the program reported remarkable progress. Whether or not the treatments played any role, however, cannot be known. The viewers, however, were encouraged to believe that they had witnessed a miracle cure.
NACD and IAHP literature both caution that individual results will vary. It also implies that if the patient fails to make significant progress, the parents are to blame. The NACD also embraces other scientifically questionable practices. Its Web site offers the following screening test for "food sensitivieis":
Check the following list. If three or more apply to your child, food sensitivity may be a problem:
Sometimes congested
History of ear infections
Behavior: frequent ups and downs
Poor attention span at times
Night or morning coughing spells
Variable hearing, sometimes good, sometimes poor
Post-nasal drip
Headaches
Periods of restlessness
Although the problems listed above undoubtedly have a number of possible causes, food sensitivities must be considered as one of the most likely [9].
Food sensitivies have no proven relationship to behavior, and most of the above symptoms are not related to food sensitivity. The NACD also offers a consultation with an "orthomolecular physician." Such practitioners are clearly outside of the scientific mainstream.
Conclusion
The Doman-Delacato patterning technique is premised on a bankrupt and discarded theory and has failed when tested under controlled conditions. Its promotion with unsubstantiated claims can cause significant financial and emotional damage. Such claims can instill false hope in many people who are already plagued by guilt and depression, setting them up for a futher disappointment, guilt, and feelings of inadequacy. The process can also waste their time, energy, emotion, and money. These resources may be taken away from their children. Parents can also be distracted from dealing with the situation in other practical ways and coping psychologically as a family with the reality of having a brain-injured or mentally retarded child. Parents are encouraged, in fact, to remain in a state of denial while they are pursuing a false cure.
References:
Doman RJ, Spitz EB, Zucman E, Delacato CH, Doman G. Children with severe brain injuries: Neurologic organization in terms of mobility. JAMA 174:257, 1960.
Cohen HJ, Birch HG, Taft LT. Some considerations for evaluating the Doman-Delacato "Patterning" method. Pediatrics 45:302- 14, 1970.
Delacato CH. The Diagnosis and Treatment of Speech and Reading Problems. Springfield, Illinois: Charles C Thomas, 1963.
Doman G, Delacato CH. Train your baby to be a genius. McCall's magazine, March 1965, p 65.
American Academy of Pediatrics. Policy statement: The Doman-Delacato treatment of neurologically handicapped children. Pediatrics 70:810-812, 1982.
Neman R and others. Experimental experimental evaluation of sensorimotor patterning used with mentally retarded children. American Journal of Mental Deficiency 79:372-84, 1975.
Ziegler E, Victoria S. On "An experimental evaluation of sensorimotor patterning": A Critique. American Journal of Mental Deficiency 79:483-92, 1975.
Freeman RD. Controversy over "patterning" as a treatment for brain damage in children. JAMA 202:83-86, 1967.
Doman G. Food sensitivities: The hidden problems
______________________________
Dr. Novella, a member of Quackwatch's advisory board, is Assistant Professor of Neurology at Yale University School of Medicine and president of the The New England Skeptical Society. This article is adapted from an article in The Connecticut Skeptic, Vol. 1 Issue 4, Fall 1996.
先到这里，以后有时间再翻，或者哪位网友愿意继续翻译？谢谢 |
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发表于 2008-3-13 16:12:47
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