Cerebral motor disabilities and the Electronic Ear

Inaugural communication of the 2nd International Congress of Audio-Psycho-Phonology (Paris, 11-14 May 1972), given by Bertrand Dubard, physiotherapist at the Centre d’Audio-Psycho-Phonologie of Nice. After twelve years devoted to the re-education of children with cerebral motor disability according to the classical methods (Tardieu, Kabat, Phelps, Bobath), the author testifies to the decisive contribution of the Electronic Ear in these patients whom he had ended up seeing “plateau”. He sets out its effects on the physical plane (relaxation, balance, body schema, laterality, associated visual and auditory disorders) as well as on the psychic plane (relief of anxiety through the maternal voice, sonic birth, exit from a possible psychotic state masked by the motor disorders). There follows the discussion chaired by Professor Tomatis, in which Mr Maeyaert (Antwerp), Dr Sarkissoff (Geneva), Mme Chambéry (Amiens), Dr Spirig (Nieuwpoort) and Mme Sarkissoff (Geneva) take part in turn — each coming to specify an aspect of the work described, before Prof. Tomatis insists on the dimension of humanisation contained in this “new foetal life, this time peaceful” that Dubard proposes to these children.

Cerebral motor disabilities and the Electronic Ear

by Mr Bertrand Dubard
Centre d’Audio-Psycho-Phonologie of Nice

These motor disabilities, whose origin comes from a cerebral injury, most often arise on the occasion of a birth accident.

These disabilities are predominantly motor — that is to say that they exclude, in principle, any impairment of the intellectual faculties, and they are not, ever, progressive.

Professor Guy Tardieu classifies them thus:

Spastics: whose stiffness predominantly affects the lower limbs, giving Little’s syndrome that makes all walking impossible.

Ataxics: in whom the impairment of the cerebellum perturbs balance and thereby compromises walking.

The Athetoids and Choreics, whose movements — slow, spasmed in athetosis, and abrupt and uncoordinated in chorea — are the sign of a dramatic lack of control.

Lastly, Hemiplegia in the child or the adult, which appears to be the consequence of a vascular accident and is most often, in its deep causes, of psychological origin.

Until now

These children were re-educated by various methods:

Classical re-education, which consists in the endless repetition of the same gestures in the hope that these repetitions will impress habits in the non-specific neurons and thereby supply the deficient or wholly inoperative conductions.

The American Kabat method, which, through proprioceptive stimulations along the most physiological neuro-muscular pathways, facilitates and regenerates the nervous conductions.

The American Phelps, much concentrated on spasticity, fights with orthopaedic devices the retractions, the bête noire of those who deal with these children. For the muscle bridled by contractions of cerebral origin does not follow the lengthening of the bone in its growth, which as a rule brings about a worsening of the deformations with age.

The English Bobath method (Mr and Mrs Bobath) consists in inhibiting archaic reflexes in order to promote more evolved patterns, starting from the global gestures of the baby and going back up the whole motor evolution of the child to his complete autonomy on this plane. The Bobaths substitute “patterns” of increasing complexity for the archaic reflexes by a moving method.

Professor Tardieu has had the merit of devoting himself to these disabled children, hitherto neglected, of classifying them, of devising a precise examination of their disorders, of bringing together in re-education centres the various methods mentioned above, of improving them by adding other techniques such as ergotherapy. Moreover, his research on the nerve fibre, undertaken long ago, will certainly enable progress in this field.

These children, with such various disabilities, nevertheless have points that are common and constant to them:

Lack of balance.
Perturbed body image.
Associated visual, auditory, sensory disorders.
Disorders of laterality and of language.
Psychological disorders due on the one hand to having lived through a dramatic birth, and on the other to a very particular relation between the child and his mother, who will react towards her handicapped child either with an attitude of over-protection or of rejection.

In this regard, the consultation of an athetoid child of 9 years, of superior intelligence, comes back to my memory. Dr Tomatis, precisely to help us perceive this very particular relation, had first had this child sit on a chair and, asking him his name, engaged him in dialogue. All went well. Then the Doctor had the mother come in, who took her son on her knees; the dialogue continued, and in the conversation the Doctor asked the child his name again — and this time his head turned to his mother as if drawn by a magnet with which he made one, into which he melted; losing all identity, he became incapable of naming himself.

It is very important to become aware that, if it is already difficult for a normal child to accept at a certain moment to grow up, it is much more so for the C.M.D. child, who can envisage his becoming only through a painful universe and who will often, for this reason, wish to remain a baby. This refusal to live often goes as far as undetected psychosis.

What the Electronic Ear can bring to the C.M.D. child

These patients having been for twelve years the principal object of my activity as a physiotherapist, I was struck by the considerable contribution the Electronic Ear could constitute for them.

Indeed, I had the impression of going round in circles, running up on the one hand into these errors of command stemming from the electronic apparatus that the brain in continual short-circuit constitutes, and on the other into this very mechanistic view whose whole perspective was limited to an excessive focus on the obtaining of walking at any cost.

The enormous progress achieved by the Electronic Ear treatments after years of re-education on children who had reached a plateau allowed me to call into question both the functioning of the brain and the orientations to be given to the process of re-education and readaptation of the C.M.D. child.

On the cerebral plane, while the birth accident causes the anoxia of nerve cells and their death after 3 minutes of non-irrigation — an irreversible but in fact limited deficit — there is a considerable mass of cells that find themselves dumbfounded, as if in a state of shock, and that must be awakened, somewhat as if it were a matter of reassuring and getting the occupants of a building, in which people had cried “thief, thief!” and who had barricaded themselves inside, to open their doors again.

Now, while some doors have certainly been broken and a few tenants knocked out if necessary, all the others must be reassured, invited to loosen their bolts and to resume their activities.

The Electronic Ear, through the relaxation and the euphoria it brings, through the stimulations it provides, will awaken a part of these dumbfounded cells. Notably in the spastic, the contractures will diminish. In the choreo-athetoid, coordination will be better, thanks to the cerebral stimulation that will allow increased control of the cortex over the rest of the nervous system.

The ataxic will see his precarious balance improved by the fact that one touches the inner ear, the centre of balance.

Alongside this help that the Electronic Ear brings on the purely physical plane, a clear improvement is observed in the various disorders we have just spoken of. We see the child enter his body, inhabit it; his gestures are more harmonious; the perception of his body schema is sharpened; his spatialisation becomes more sure.

The associated disorders amend themselves: audition obviously, vision also since you know that the ocular nerve is a branch of the auditory nerve itself; therefore, the fact of acting on the auditory nerve makes the ocular nerve work. One thus manages to straighten slight strabismus.

Laterality begins to emerge and then strengthens, orienting the elaboration of a language that installs itself, and through the dynamic it establishes, allows it to be structured.

On the psychological plane, the Electronic Ear here plays an essential, primordial, irreplaceable role, of which only the main lines will be retained.

The maternal voice frees the child from anxiety; the sonic birth allows him to relive without shock a birth that could only have been traumatising, since it is the cause of his present disability.

Filtered music allows him to feel his body, which until then was in large part foreign to him: his sensations were diffuse, his command unskilful, often treacherous, sometimes impossible.

He will re-enter his body, his skin; he will make acquaintance with himself and will become cooperative in all sorts of help that until then had been brought to him in vain, because it ran up against an indifference consequent on a lack of inner dynamism.

The awakening given to the auditory nerve will bring speech, then straightening, verticality: a posture that directly prepares for verbalisation, the last stage of his humanisation.

The trainings, the sibilants and the reading aloud will incite him to express himself and will thus bring him to a greater acceptance of himself, and it is only in this acceptance that he will be able to energise himself.

A new foetal life, this time peaceful, a birth without shocks, an opening to life through the perception of sounds that make its most essential warp, will bring him to realise himself to the maximum of his possibilities.

Bertrand Dubard

Discussion on Mr Dubard’s paper (Nice)

on
“Cerebral motor disabilities and the Electronic Ear”

Debate chaired by Professor Tomatis

Mr Maeyaert (Antwerp)

I should like to know whether, alongside re-education with the Electronic Ear, you practise other forms of re-education.

Mr Dubard

Yes, certainly. It is moreover after having practised for many years the methods of re-education I have just told you about that I was led to use the Electronic Ear in children who, in addition to their motor difficulties, presented language disorders. What was very interesting for me was to observe that these children, who had progressed by the various usual forms of re-education, had reached at a certain moment a plateau. I then put some of them under Electronic Ear, and I had to wait still long months before seeing them get going again. But I then noticed that, by performing an auditory gymnastics under Electronic Ear, these children had made very, very clear progress on the psycho-motor plane. I was able to observe such surprising things as the loosening of a lower limb or the straightening of the spinal column — that is, elements bearing on purely physical domains (at least apparently).

In face of these results, I took the decision to put systematically and from the outset under Electronic Ear the children whose psycho-motor re-education I was undertaking. I henceforth never do the one without the other.

On the psychological plane, the results have also been very perceptible. I have perhaps not insisted enough on the modifications, the transformations that have taken place, after the sessions under Ear, in these children who are all, without any doubt, psychotic. I am now wholly convinced of it. They are first of all psychotic and accessorily and consequently, I might say, motor disabled.

Dr Sarkissoff (Geneva)

When you spoke just now of modifications at the thalamic level, it reminded me that one long thought that the human being was the only animal that came into the world crying.

Mr Dubard

We now have the possibility of soaking the body in sounds in its entirety, that is to say through all the pores of the skin. I am personally working at present on problems of sound vibrations and I think we are about to find something interesting.

A listener

Do you see a difference between athetoid children and spastic children?

Mr Dubard

I should like you to specify what you are asking me, in order not to reply beside the point. What do you call a difference?

The listener

Is there only athetosis, that is with many kinaesthetic signs, or hemiplegia? Does one see more progress in a hemiplegic than in an athetoid, or do you not see a difference?

Mr Dubard

The children have such personal impairments that it is difficult to reply to you exactly. It depends on the cases. They all progress, but I really cannot say in what proportion. What is certain is that athetoids are generally very intelligent people.

Dr Sarkissoff

I must say that I am still under the impression of what I am learning today. All this is very new to me. I should simply like to ask you what is the duration of the treatment you apply.

Mr Dubard

That is almost a trick question for me, because it is so variable! Are you accustomed to treating this kind of children?

Dr Sarkissoff

No.

Mr Dubard

It is so variable according to their impairment that I cannot answer you. I hesitated to make this communication without the aid of projections, because I realised that the one who does not know this kind of children risks finding himself completely disoriented. It is a little as if he were landing on Mars, for these are children very, very impaired in their bodies. They are certainly among those one can find most affected on the motor plane. On the intellectual plane, they do not seem affected in the same way, and I increasingly wonder whether the intellectual disorders we encounter are not in fact a kind of mask for an enormous psychosis.

It must be said that in the end many of them present, because of birth troubles or of early childhood or of foetal life, disorders in their schooling or in their behaviour. Imagine, in addition to that, that they were affected in their body and their flesh to the point of remaining disabled; it is true that these are children who have psychological traumas; the contrary would be impossible. And one often has the impression, when one makes these psychological disorders regress, that the physical disorders are brought to a much smaller proportion compared with what they were at the start.

From the point of view of the time to devote to them, one must nevertheless say that it lasts at least 2 or 3 years longer; only the difference is that they are children who are sometimes kept in Re-education Centres without progressing, while if we take them in hand in psychomotricity and under Electronic Ear — which is not always the case — they make perceptible progress. There is therefore a notable difference all the same.

Mme Chambéry (Amiens)

Is it the same for polios?

Mr Dubard

No, for a polio it is nevertheless different, for in its case there is no a priori psychological impairment, unless of course it is a matter of psychological disorders proper to him. Polio, unless it strikes from birth, involves less nervous trauma. That is moreover what it represents most often, either at the origin of the disorders of the motor-disabled children sent to us. These are children who, from birth, have suffered an enormous trauma.

Dr Spirig (Nieuwpoort)

Do spastic disorders diminish in a very perceptible way with these techniques compared with other re-education systems? I think you suppose so, to have an evolution.

Mr Dubard

That is to say there remains the problem of distinguishing retraction from spasticity. For a triceps cruralis story for instance, it is not very clear; one nevertheless observes a slight softening. It is true also that some time after birth one can have these children reach something that resembles directly the muscle, in order to inhibit sound through the pores of the skin. However, what is certain is that these children straighten up during Electronic Ear sessions — a result of very great importance in my view.

But there is also the problem of other domains: independently of the progress these children may make on the physical plane thanks to these new methods, progress that is considerable compared with all other re-education systems, it is useful to point out that these children unfetter themselves and blossom. This is very important in my view. It must not be forgotten that the classical techniques of psycho-motor re-education are localised to the extreme on walking, in a certain way at any cost. When a subject no longer has the desire to live, to become, the underlying bodily machine, whatever it is, even if it is good, is not used in the right directions — all the more so if it is rejected by the individual himself. Would you all here live in the skin of a paralysed person? That is the problem.

I should like to specify here something concerning the re-education of these cerebral-motor malformations, namely what Mr Dubard has said — the opportunity of examining and treating on several occasions athetoids. I thought at the outset that it was necessary to say very quickly to help them more. Now, that is partly true, but it must be known that these perceptible modifications in all domains, I had done twice the results of the following our sensory auditions for day. Now I had one of my two times the results of the following who wished thus to speak do not treat their body. They have had enough perhaps. Now, by speaking too much of dynamism to a being, I energise all his miseries, and I saw one who attempted twice to kill himself, once very seriously since he ended up in hospital; but, an interesting detail, that cured him. He made his coming-to-consciousness; he finally accepted to be what he was; on the day he accepted it, this man who was on my ambulance began to release his contractures and now he walks without crutches. He has not of course become a great runner, but he has nevertheless been able to pass his examinations. As he was brilliant, he completed part of his legal studies (at present he has a doctorate in law), did a degree in psychology and prepared Sciences-Po. Now, he is a very well-rated employee of the Magistracy. This rehabilitation process required several years of work under Electronic Ear, so that this man could assume his disability and project himself into the future. What can be read in him, for instance, is his aggressiveness, and he still bears on his face the trace of the surgeon’s scalpel inflicted on him when the uterus was opened; the face was opened; the sabre is still some time after birth. All his rejection is one thing; it is what she has been obliged at times to try to distinguish, this time indeed, that I am infected. He comes to see me from time to time to find out whether I have nothing new to propose to him to go further.

I thank Mr Dubard once again for having insisted on several occasions on the psychic universe of these motor-disabled children and for having opened a therapeutic way full of hope. It does not apply itself enough to humanising these children who bore, who have so much need to live, you wish to multiply tenfold the action we have on them. If you have the good fortune of being able to give a child, through a physical activity, the right to believe that he exists, you must consider yourself satisfied, for if, in addition, you give him the true meaning of life through a harmonisation of his being (which is not his body), you do a task that is yet more beautiful, more accomplished.

Thank you again to Mr Dubard for his very interesting communication.

Mr Dubard

I should like to add something. When the parents are very affected psychically by their child’s disability, we put them automatically under Electronic Ear in Filtered Music, of stupefying duration, and put them on the same wavelength as their child; thus taking up, to bring them back to the thing. They are put once, twice, three times; provided that they come more willingly.

We have made an observation in parents who come weeping for the first time and say: “Everything has cracked, nothing helps; if you can do the slightest thing, do it, and we shall work with you yourselves.” But as soon as they see their child too much, they take him away, for they are themselves disconnected. So that now, we put them as much as possible under Electronic Ear so that they evolve at the same time as their child.

Source: Actes du II^e Congrès International d’Audio-Psycho-Phonologie, Paris, 11-14 May 1972, pp. 6-19. Communication by Mr Bertrand Dubard (Nice Centre) given on Friday 11 May 1972, followed by the discussion chaired by Professor Alfred Tomatis. Text transcribed as close as possible to the original typescript; some technical passages of the final discussion present obvious defects of OCR or of typing (notably on pages 16-19) which have been preserved as such out of fidelity to the source document. Document digitised from the personal archives of Alfred Tomatis.