Journal: “Adaptivnaya fizicheskaya kultura” 2000, № 1-2.
TAN-DO: PROFESSION—TRAINING EQUIPMENT
S. P. Evseev, V. I. Illarionov, and V. V. Pevchenkov, the P. F. Lesgaft St. Petersburg State Academy of Physical Culture, All-Style Federation of Martial Arts.
In the 21st century, a person can take the place of training equipment for teaching motor skills development to children with cerebral palsy and slow cognitive development.
If we look at statistics, we will see than in a long list of human illnesses cerebral palsy is far from occupying the first positions, lagging significantly behind AIDS, cancer, and others. Cerebral palsy has also never been proclaimed the illness of the century or the plague of the 20th century. On the other hand, it is difficult not to admit that no other disorder can be compared with cerebral palsy in terms of its obvious symptoms. This is because these symptoms are muscular disorders and a lack of ordinary skills. For this reason, the main goal that people working with children with cerebral palsy are trying to achieve is to teach these children how to move normally and to take care of their own needs.
Usually, normal healthy children are capable of acquiring these skills in a natural way: watching older children or their more developed peers, they try to imitate them, adjusting their own movements. The basic concept of common skills can be acquired very quickly; the rapidness and accuracy are attained over time. This method of learning is sometimes called the method of trial and error (or putting it less bluntly, the method of exercise) (1, p.9).
Cerebral palsy puts obvious obstacles before this method of self-development. This is because children with poor motor coordination are often depressed, self-conscious about their condition, and have a limited circle of acquaintances. It is difficult for them to correct themselves: how can they possibly make their legs move in the right manner if their muscles are weak, due to their mostly motionless mode of life, or themascular tonus is anomalous? And if this is also accompanied with slow cognitive development and impaired vision? How can we explain to such children what is right and what is wrong? Thus, we can only perform actions with them, moving their arms and legs, and continuing to do so until their muscles begin working. This is a method of passive movement, or as it is sometimes called, a method of rigid supervision (1, p. 21).
This is, for example, how a child is taught to crawl: “The mother holds a child horizontally, and the masseur and the doctor move his legs and arms in turn, simulating the crawling movements of a normally developing child. A series of five 30-minute exercises should be done every day, until the child begins crawling independently (2, p. 24).”
Another example demonstrates how to teach a child to take care his own needs independently, in particular feeding himself: “If he is unable to perform actions necessary for feeding, we can stand behind him, take his hand in our hand, and perform all the necessary motions together. We will have to repeat them several times until we can feel that his hand lo longer resists... follows our hand... and begins moving independently” (3, p. 113). To improve such teaching technique, a special glove was developed for simultaneous training of movements of the hand and fingers (4, p. 153). An adult puts the glove on one of his hands. Then the child’s hand is fastened to the inner part of the glove by means of special straps in such a manner that each finger of the child’s hand is attached to the corresponding finger of the hand of the trainer. This equipment allowed the child to clasp and unclasp his fingers, take any object, and draw pictures. At the same time, he can feel all the nuances of the movements.
As you can see from these examples, acquiring motor skills is realized through creating artificial conditions, which naturally prevents erroneous behavior. The child immediately learns the right way of doing things. But these are not the most complex actions. What about teaching him how to walk properly? This is the major point of teaching. Prior to answering this question, let us make a list of conditions affecting correct walking mannerisms (as well as any other actions).
Condition number one: a clear concept of all nuances of a particular body movement. If there is no such concept, the brain is unable to control the muscles properly. I. P. Pavlov wrote: “If you are thinking about a certain movement … you are performing it involuntary, without being aware of it” (5, p. 98). If we repeatedly imagine a perfect variant of a movement, it will improve the performance of this movement on the physical level, making the muscles work with increased accuracy.
The second condition is having a well-prepared joint-muscular system. Having watched many action movies, a child might develop a very good concept of how to kick, but he will be unable to perform this movement. If the hip joint is not trained and the muscles and ligaments of legs are not flexible enough, the movement will be a parody of the concept.
Condition number three is the ability to keep balance during walking. Dr. P. Bragg wrote: “The vital necessity of maintaining balance becomes obvious when examining the process of walking. We constantly need to keep our balance, first standing on one foot, then on the other, shifting the weight of our body forward, from the left to the right, and from the right to the left. Indeed, these movements require perfect balance, taking into account the fact that the weight of the human body is supported merely by such a small foundation as a foot… The correct manner of walking is the art of keeping balance on unstable legs” (6, p. 61).
Finally, condition number four: the ability to correct our own movements, adjusting the ideal variant to the conditions that are prerequisites of its performance. There is a saying among physiologists that goes: “The brain knows how a movement begins, but knows nothing about how it will end.” “A movement is modeled and can be changed, adjusting to changes in the environment, or depending on various conditions in the process of performing the movement” (7, p. 61).
Now, let us go back to the issue of teaching how to walk properly. How is it realized in practice? Here is an example: a trainer stands in front of a child, facing him, and holds him by his shoulders; two other trainers sitting on the floor move his legs with their hands—one moves his left leg, the other his right hand (8, p. 158). Another example: a child stands between two suspended ropes, holding them; two trainers squatting on the floor move his legs with their hands, imitating walking movements (8, p. 160). Not particularly good variants. Moving legs with hands is almost like moving hands with legs. Would it not be easier to move the child’s legs with trainer’s legs? They are twice as strong, not to mention the fact that this would be much more comfortable.
Such methods also exist. When a child is held by the bars, a trainer stands behind the child, holding him by his shoulders, and “…uses his legs to control the amplitude and force of each leg of the patient, making walking movements together with the child” (9, p. 159). Far from being perfect, indeed. What if we somehow fasten the child’s and trainer’s lower limbs to each other by means of some device? There were successful attempts to do so with hands; why not try it with legs?
This attempt has also been undertaken. “Skis” were used as a means of training: “ …two 12 by 75 cm planks (the length was determined by the child’s height). A stick reaching the child’s head was inserted in a hole ten centimeters away from the frond edge of either plank. In the middle of either plank there was a reliable foot binder” (10, p. 136). Below is the training method: “According to our program,’ the mother of an impaired girls says, ‘we were supposed to do skiing twice a day. … The total length …of exercises then amounted to up to four hours a day, and skiing was the most difficult part of it. We put Karen’s feet into the binders, she would grab the sticks, and then we would stand behind her on the skis and trained her walking pushing them forward in turn. Karen was little, but not too light, and together with the corset it was quite heavy. … We generously spread corn flower on the floor to reduce the friction of wood against wood” (10, p.147). What follows is a description of the corset, which “ was wrapped around the whole body,” and a system of straps that secured the foot in a physiologically correct position. Well, such a method can be used of course, but what it trains one to do is to make skiing movements. As a result, the child will walk shuffling his feet.
All the abovementioned methods of training to walk leave one with contradictory thoughts. On the one hand, trainers are working hard, teaching a child how to walk, spending a great deal of time in uncomfortable, unnatural positions. On the other hand, these are still far from correct walking movements. There are other disadvantages, as well: turns are difficult to make, and the mobility is low. No, this is a dead end.
There is another way of solving this problem, however—technology. We all know about blood circulation apparatuses, breathing apparatuses, kidney substitution apparatuses, etc. Why not design an apparatus that would aid in walking? What kind of machine should it be? It should have “arms” to control the child’s arms, and “legs” to move the child’s legs; thus it should resemble the human being. As a minimum, it should be able to perform a sequence of movements: lie down, sit up, stand up, walk; to reproduce all necessary movements of the limbs, within one’s physiological abilities; plus it should perform actions with the necessary muscular effort... There is no need to continue this list, since it is already obvious that this should be a very complicated piece of machinery.
Obviously, engineers are not afraid of these obstacles, since similar devices do exist. One of such machines was described by Kevin Warwick, a leading specialist in the area of robotics, in one of his books: “It is a hydraulically driven machine that has hip joints and knee joints. Originally, a healthy adult climbs into it, and then stands, turns, walks, climbs up and down the stairs, and so on. The machine ‘learns’ from him, and later when an invalid takes the place of the healthy person, it repeats these actions” (11, p. 44). But even this extremely complicated device can hardly be called a two-legged robot. This is what professor of cybernetics Kevin Warwick, a man to whom many refer as the “prophet of the Robot Age,” says about difficulties of creating machines resembling human: “Many problems arise when attempting to create a human-resembling robot. Even if we had managed to design a good pair of ‘arms,’ controlling them to achieve the necessary coordination, flexibility, and so on is rather a complicated task. And even if we had managed to do so, it is highly unlikely that we would have been able to program the necessary sensitivity in the fingers. Further, we could probably, with a great difficulty create a body with a powerful power supply inside, attach legs to it and even make it sit. But to make it stand without falling would be extremely difficult, and totally impossible to make it walk right. In other words, at the present moment we are as far from creating such a robot as we were before.” (11, p. 45).
Conclusion: today robots have all the symptoms of cerebral palsy—they sit poorly, they stand unstably. It is necessary to say, however, that we mean human-like, two-legged robots. Only these robots can perform movements closest to similar human movements. Four-legged and six-legged machines moved better and are better balanced, but their movements are so inhuman. Then again, to keep such a monster in an apartment…
So, what should we do now? To hope for the creation of a cyborg trainer, and in the meantime, as professor I. Skvortsov once said, to adapt “… a child to its disability, so that he would better walk on his poor legs, or better move his crooked arms” (12)? Maybe we made a mistake somewhere in our reasoning?
A man teaches a robot to walk, and later the robot teaches an invalid to walk. Why can’t a man teach an invalid directly? Can we do without this cybernetic intermediary? Sometimes a broken finger can be firmly attached by means of an adhesive tape to a neighboring healthy finger, so that the latter will involve the former in performing movements. (7, p. 152). Remember the glove and the skis.
Maybe we should use the same principle but on a large scale? To unite a child unable to walk and his trainer in a tandem—arms with arms, legs with legs, all at the same time. This is not as easy as with two fingers and a piece of adhesive, but still technically possible. Skis, however should be replaced with something more comfortable—boots for example. They just need to have a common sole. The trainer would do different body movements: stand, turn, go up and down the stairs (all the movements that the robot professor Warwick was telling us about), and the child would passively reproduce these movements. He would then feel what and how should be done with every cell of his body.
Looks very logical, even technically possible. So, have we found the final solution yet? No, not really. We have come back to where we started. The weakest element in our reasoning is the human factor. Limited physical abilities of the human being will not allow him to do all we have discussed earlier. Really, if it were so simple, it would have been done long ago. Now we have boots instead of skis. The skis had sticks, at least. What can you get a grip on when in boots? The shoelaces?
So, another dead end? Maybe a person is really to inferior for playing the role of training equipment? What if we look at it from the point of view of Djigoro Kano, a master of martial arts, a wonderful philosopher, and the founder of contemporary Judo?
Judo and cerebral palsy. How can two such different things interconnect? In addition to creating a complex of Judo fighting lessons, Kano has developed a theory according to which brute force does not play a crucial role in fighting. It is not the physical abilities of the fighter that are important, but his ability to manage them correctly. This is approximately the concept of Kano’s theses “on the most rational application of force” and “on the most efficient use of the body and spirit.” Let us see how efficiently we use our body, and how rationally we apply our strength when teaching a child how to walk.
When making a step with the right foot together with the child, the trainer is bound to complete two tasks: to perform the movement (to move the right foot and left arm forward, and to move the right hand backward), and to hold the child (not to let him crumble down under the weight of his own body or to swing aside). The latter is the most vital task both in terms of importance and, what is more, in terms of the effort it requires. While holding the child, the arms are making a continuous effort, and thus get tired very quickly. For this reason, the trainer, not relying on his own strength, uses additional equipment for supporting himself, such as ropes, bars, crutches, etc. Strangely enough, adults can easily walk having a child in their arms or on their shoulders, but seem to be unable to move putting a child on his weak legs in front of them. Why?
A human being is a very complicated vibratory system. The arm is a pendulum, for example. This pendulum consists of a number of smaller pendulums. All of them, including a phalanx of the little finger, perform vibratory movements in different planes. The same can be said about any part of the body. These movements occur even when our muscles are completely relaxed: when we sleep, or under narcosis… This happens constantly from the moment of birth to death (this phenomenon of microvibrations of the human body was discovered by Rochracher, an Austrian neuropathologist) (5, p. 98). A natural conclusion would be: in our body, everything and everywhere constantly vibrates.
The method of rigid supervision can be described as follows: one vibratory system is to try to control another vibratory system. They have different periods of vibration, frequencies, and amplitudes. Whereas the trainer performs so-called harmonic oscillations (i.e. constantly trying to return to a stable vertical position), the vibrations of a child with cerebral palsy are chaotic, for the most part. These chaotic vibrations knock the child and the person holding him out of the balanced position. The trainer tries to hold the child being in an unstable position. In addition, he needs to straighten his own position. If at some time, the frequencies of their vibrations match, i.e. both systems are in resonance and the amplitude of oscillations increases sharply, the child and the trainer can even fall. The trainer cannot help himself keep his balance with his arms because they are holding the child. Summarizing the above we can point out the major problem of holding: the trainer is unable to balance the child, because the child prevents the training from keeping his own balance.
Is there a way to make the oscillations of the child and trainer to agree with each other? Yes, there is. As we have mentioned earlier, we should combine them in a tandem. Since these vibratory systems consist of many smaller vibratory systems, it is necessary to match each of the trainer’s mini-systems with corresponding mini-systems of the child. In order to do so, we should raise the pelvis of the child to the level of the trainer’s pelvis (thus, moving together their centers of mass, which are located in the pelvis). We can now attach the torso of the one to the abdomen of the other. The vibrations of these most massive and large parts of the body were causing most trouble. Additionally, this will allow their arms to agree with each other—fingers with fingers, hands with hands, upper arms with upper arms—to perform various motions. How to fasten the legs of the child? Now, his calves and knees are much higher than the corresponding joints of the trainer. We need to think of some mechanical fastening system. We are not saying this is impossible. Remember Archimedes who realized the possibilities of the lever and threatened to move the Earth if he had a place to stand and a lever long enough. There are numerous “places to stand” in a human body.
What is the result of this fastening system? Now, the child’s body is secured tightly to the trainer’s body.
It is totally dependent on the oscillations of the body of the trainer, who can perform any compensatory movements to keep his balance: waving his hands, bending his body, stepping aside… The child feels these movements and remembers them subconsciously without making efforts to concentrate his attention on it. There is no need for additional equipment.
Let us see how this method correlates with the conditions that we defined as essential in the beginning of the article. In this tandem position, the child gets a clear notion of any body movement or action. We can work out his joint-muscular system by doing any stretching exercise and performing any movements in any joint. We have already covered the balance part. As for the adaptation to external conditions, in this tandem position the child is learning how to react to various emergencies, such as pushes, tripping, etc.
What will the structure look like in particular?
For the lower limbs a double orthesis can be used; let us call it a tandesis. The upper limbs can be fastened to each other by means of a special glove or pieces of adhesive. The abdomens of the adult and the child can be fastened with a double corset or a system of straps. We are simplifying it, naturally; but if the basic principle is clear, it is not very hard to actually design this system. One only needs to deliberate on this problem: how to apply force rationally, and use the body and spirit efficiently.
By the way, Djigoro Kano wrote: “The principle of the most efficient use of the body and spirit is the basic principle defining the technique of Judo. It, however, is something even greater than that. The same principle can be used in fixing defects and perfecting the human body…” (italics ours) (13, p. 297). What was the implication of this sentence? Maybe something similar to what we say in this article. We’ll never know…
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