Association of Developmental Techniques in the Re-education of the Dyslexic

Communication presented at the 3^rd National Congress of the Association Française d’Audio-Psycho-Phonologie (AFAPP), by Anne-Marie Bauduin*, paediatric nurse (Belgium).*

How to combine three developmental approaches — Tomatis’s audio-psycho-phonology, Carl Delacato’s sensorimotor re-education, and the Visiology of the Lefèvre Institute — in the service of the re-education of dyslexic children.

Introduction

Faced with beings whose life is more or less diminished in its expression, the therapist is often constrained to limit the spontaneous character of vital expression and to set himself very precise objectives and means of action, in order to help the being in difficulty to benefit as much as possible from the conditions necessary for harmonious development. One nevertheless senses the difficulties of human development, since normally “it happens by itself”.

This is the fundamental reason for our sharing today. Progressively, I have become convinced that fundamental experiences are an important key to our approach to the dyslexic. This way of seeing things may seem “subjective”. So much the better! This amounts to considering that I am engaged in the indispensable relationship for living the human with the child.

I certainly know that the means of entering into relation with the dyslexic child must undergo the test of rigorous controls which raise them to the rank of techniques. I also know that one must regularly recentre upon one’s aim: theory appears, at this stage, as indispensable to the organisation of action. But in the face of the multiple expressions of life and the difficulties of adaptation — also in the face of the numerous research methods, of the elaborate techniques and of the various theories which in the human sciences have suddenly emerged but which run the risk of “cutting man into slices” — we feel ever more pressingly the imperious need for a passage to practice.

Most modestly, I should like to share with you a beginning of realisation, in the perspective of this art of living to be reinvented, of a profound intuition confirmed by ever more numerous facts. Since one must limit oneself, I shall explore — in the manner of the two-year-old child, who is at the stage of the explorer and who is beginning to enter life — three modes of approach to development: listening, motor function, vision.

Language informs and envelops the human being; it gives him, in the expressions dear to Professor Tomatis, “the desire to be” and “bodily form”, just as it is the living link between beings.

I have the audacious intention to enhance your audio-psycho-phonological discoveries by confronting them with other synthetic approaches, notably those of Carl Delacato and those of the Institut de Visiologie de France. These three types of methods, which have fortunately evolved in parallel, seem to me singularly close and called to a mutual interpenetration — at once very profound and very supple — because aiming to put “the child in difficulty” in a condition to relive the earlier, poorly integrated stages.

On the other hand, their suppleness constitutes the great difficulty of the work of synthesis, for the therapist must find for each child the elements of re-educational programming that answer to his personal needs. A programming regularly adapted to his pace of evolution, in response to the stimulations given him. A second aspect common to these three methods is the share of collaboration asked of the parents.

Carl Delacato and Visiology

Carl Delacato is an American educator from Philadelphia, a disciple of the neurosurgeon Temple-Fay. The latter may be considered, among other things, as one of the precursors of the treatment of children with cerebral lesions — while another disciple, Glenn Doman, continues the research in this field. Delacato, in the line of his pedagogical formation, has been particularly interested in the therapy of “problems of language and reading”, treating dyslexics by an intensive sensorimotor re-education on the theoretical basis of the “Profile of neurological development” from birth up to 9 years, which broadly takes up the important stages of the ontogenesis of a human being — it being admitted that the evolution of an individual broadly retraces the evolution of the species.

This same theory of evolution is used by Jean-Jacques Lefèvre, of the Institut de Visiologie of Quebec — followed in France by the dynamic team of the Institut de Visiologie de France — in a markedly more oriented perspective: vision is therein the crowning of motor development and the object of much more detailed theoretical elucidations than those of Delacato.

Work of synthesis

The attempt at synthesis that I propose to you has nothing original about it but this very idea: having understood the quality of the work of Professor Tomatis, of Carl Delacato and of J.-J. Lefèvre, I absolutely do not modify anything in any of their techniques, but try on the contrary to imbue myself with the spirit which founds and humanises these techniques.

Likewise, I in no way substitute myself for the therapeutic role which seems to me to fall naturally to the parents. Therapy being to my mind only a particular form of education, I am convinced that it is through the parents that it will best be lived by the child. Thus, how can I define my role, if not by this simple word: “orienter”?

The work of synthesis will thus, in practice, be established at two levels: diagnosis and re-education.

I — Diagnosis

The diagnosis of the dyslexic child is established by a general assessment of his aptitudes and deficiencies, which I call, following Delacato, the initial evaluation. It is regularly modified according to the child’s progress by periodic evaluations, which are at once status reports on the work performed and new bases for the subsequent stage of re-education.

The dyslexic’s journey before the re-educator

The dyslexic child is “discovered” at school. Before being brought to the specialist re-educator, he will have lived through quite a few peripeteia. First, he finds himself before a teacher who no longer understands him because she considered him a “normal” child. Now, the child confuses letters; perhaps he does not see well? From then on, the long journey begins.

His contact with the psychologist will give a tableau of his intellectual capacities, his possibilities of perception and reasoning, his mastery of vocabulary and his affective conflicts. The teacher observes the child’s behaviour in the group, his dispositions and difficulties in the face of the school task. The school physician, in general, will teach us nothing — though the functions which underlie the effects observed by the teacher and the psychologist should be capable of being explored by him in view of the school task. It is often at this moment that I am brought to see the child.

The initial evaluation will try to find the causes of this situation as a whole, hardly satisfactory for the child. On the theoretical plane, the psychologists tell us a great deal; they explain that the spatial structuring is deficient, that the child has oculo-manual difficulties or of fine motor function — but in general, they limit themselves to a record of deficiencies. One must resolutely go back in time, to the intra-uterine life of the child, if this proves useful, to be able truly to understand what the dyslexic child is. At this stage, for many reasons, the essential meeting between mother and child may have been more or less missed. This is one of the possible affective causes which can influence the child’s development.

a) Examination of vision

The functional examination of vision retraces the stages of visuomotor development and of luminous integration at the various neurological centralising levels:

At the level of the spinal cord — monocular test of the pupillary reflex, normally corresponding to birth.
At the level of the brain stem — monocular acuity at distance and at near, detection of astigmatism, monitoring of elementary visuomotor coordination, monitoring of the release of the nape with respect to the shoulders, eye-hand coordination in lying, dorsal and standing positions. Acquired between 1 and 5 months.
At the level of the midbrain — fusion of images by coupling of the eyes: investigation of strabismus, observation of the alignment of the eyes, temporary masking of an eye, biocular pursuit, prism test. Acquired between 4 and 13 months.

Simple perception of depth (8 to 26 months) — visual field, convergence, peripheral stereoscopic vision (fly test, fusion by the Delacato method).
Stage of recognition (13 to 45 months) — reproduction of simple visual symbols, central stereoscopic vision (Wirt dots card).
Correct visual perception (22 to 67 months) — base of the learning of reading: visuomotor test by Laura Berder, visual perception test by Marianne Frostig, visuo-spatial perception test.
Ocular lateralisation in binocular vision (Inizan tests, Reversal tests).

b) Examination of audition and language

The discovery of the work of Professor Tomatis and of audio-psycho-phonology has wholly modified my approach to the problems of auditory reception and verbal expression of the dyslexic child. It seems interesting to share with you on this subject the results of a systematic research in a population of children with mild mental disability and characteriological disorders, conducted in the course of the school year 1974-75 in 4 schools of the same pedagogical level of basic learning.

As regards audition, the results at the listening test are as follows:

Category	Number of children
Children examined	49
Untestable	3
Moderately deaf	4
Weak or disturbed auditory perception	18
Sufficient auditory perception	17 only
Good auditory perception	7

As regards selectivity, it was totally closed for 41 children out of 49, that is, 83%. And partially open, in the low frequencies, for the others.

These frightening figures deserve our attention all the more in that the technically possible therapeutic solutions are, alas, often “reserved” for a few beneficiaries, despite our struggle and our fierce efforts.

c) Examination of tactile sensitivity

It comprises the recognition of the parts of the body by touch (eyes closed), the perception of differences of temperature, the fineness of perception in the tactile comparison of objects “that seem flat” such as the pages of a book (Delacato). The best test seems to me, however, the description, eyes closed, of small objects, with observation of the preferential hand.

d) Examination of mobility

There exist excellent psycho-motor tests, very precise… but also very long! I use preferentially the “Psycho-Motor Assessment” by Bellugon, which in less than 10 minutes provides information on static and dynamic balance, coordination and laterality. Then I add in any case the monitoring of rolling, of creeping, of quadrupedy, borrowed from Delacato — for they allow me to know the level of neurological organisation that has been poorly lived by the child in the course of his evolution.

In summary

To the APP assessment, I add a complete examination of vision, mobility and tactile sensitivity, while recognising the narrow limits of investigation in this last domain.

II — Synthetic re-education

In a general way, the therapeutic programming must take account of:

the actual level of neurological organisation of the dyslexic and his possible gaps in a particular sensorimotor domain;
the state of his conscious and less conscious relations with his parents;
the affective, material and financial possibilities of these latter.

Daily realism being an important factor of success, it must preside over any proposal of re-education made to the child and his parents.

Listening cure

Following the proven methods of audio-psycho-phonology, I propose above all to begin with the phase of the listening cure of filtered music, of maternal voice and of sonic birth, which helps the child acquire his autonomy.

The cure under maternal voice is a sonic return to the foetal stage corresponding to the state of life of the fish — with all the affective and neurological differences that we know. When the parent-child relationship is restored, it is appropriate not to move too quickly to auditory lateralisation, but to continue to have the child relive the intermediate stages between birth and lateralisation.

Two stages of re-education

a) Certain exercises are facilitated when they are performed under music. The impact of filtered music upon the vitality of the vagus nerve is a matter of common experience for us all. A sensory branch of this nerve ends at the external face of the tympanum and we can therefore “energise” the nervous system by this pathway. In sessions which constitute “strong moments”, I have motor and visual exercises performed under filtered music, so as to obtain a joint action of the nervous system.

b) At home, the parents and the child perform complementary sensorimotor exercises — the child often succeeding much better if he feels reassured and motivated by his family.

Passing again through earlier stages

According to the guiding thread that for us is the theory of evolution, we shall sometimes start again from very low: that is, the stage of monolateral organisation. It is fundamental, at this period of re-education, that the child reorganise and automatise all the sensorimotor functions prior to the differential corticalisation that is lateralisation.

The child will therefore pass again through the stage in which the crocodile lives. This “setting on the floor” can be very short for dyslexic children, and for them, I rarely use the rolling stage, which is prior to it.

The ramping is very important: it has happened that I have re-educated dyslexics by the execution of this movement 20 minutes a day for 3 to 4 months. By the setting on the floor, the body is put in contact with a hard plane, and by the rhythmed stimulation of tactile sensitivity, the child will take much greater consciousness of his body. At the same stage, it is important — depending on the case — to develop or reinforce the muscular tone, and by exercises similar to ramping, to automatise definitively the monocular organisation.

Muscular tone is a slight permanent tension provoked by the balance of a muscle with its antagonist; it is indispensable to muscular movement, to respiration, to the maintenance of posture, and plays an important role in thermal regulation. It depends, like indeed all neurological organisation, on the state of vitality of the inner ear.

From ramping to quadrupedy

At the level of the midbrain is effected duo-lateral organisation. During this phase — during which the child will make enormous progress because he recognises his mother’s face — the two cerebral hemispheres function in parallel and simultaneously. In this period, the two eyes converge towards the midline, just as the two ears, the two arms and the two legs respond to the gesture of the mother approaching her child.

If one places the child on the floor on his belly, one can observe that he will go through several stages: like the frog, he will progressively detach the trunk from the ground; then in this quadrupedy position, become mobile by displacing — like the bear — the right hand and right knee at the same time, while the two eyes converge towards the advancing hand. Then mobility becomes crossed, in the manner of the horse’s trot.

Verticalisation and lateralisation

The child, little of man, will express himself more in the following stages: verticalisation and lateralisation. The bilateral approach is a complex cortical work which favours a better coordination of the two sides of the body. The alignment of the two eyes becomes precise and the child capable of identification. Audition is refined and the comprehension of language asserts itself. The child stands up and begins to walk, the arms serving him as counterweights, and language develops as does manipulation.

In the re-educational work of this stage, the crossed walking sums up many elements of neurological organisation at the level of the cortex: the child walks by pointing the left foot with the right hand and vice versa. Games with a large ball, cycling, the integration of current language, the manipulations requiring the complementary action of the two hands, the refinement of tactile sensitivity, the deepening of the recognition of objects far and near, constitute very diverse but also very precise objectives, which will help the dyslexic child to reconquer a solid bilaterality, investing the concerted action of the two cerebral hemispheres — the indispensable base for lateralisation.

The child having “relived” for a period of 2 to 3 months the first three stages of development, he approaches unilaterality, or the lateralisation stage. In practice, according to the sensorimotor evolution, the balance of sounds will have been modified through the electronic ear, and this phase of lateralisation — influenced at the level of the ear — can also be influenced at the level of general motor function through various children’s sports, and at the oculo-manual level through drawing or writing exercises with the partial obliteration of the left eye by a red-coloured patch.

In this way, the child who uses a marker of the same colour as the patch can see the lines only with the right eye; the two eyes see, moreover, the whole frame of the drawing. The reinforcement of right oculo-manual activity is much more rapid during sessions of filtered music at balance 1.

Stereo-ocularity and visual identification are also dependent on the improvement of touch: the child manipulates numerous rounded, pointed and flat objects. Then, thanks to a better control of finger motor function, manipulation becomes more precise, specialises in small objects: the child plays with crumbs of bread, grains of sand; he pours liquids, rummages, touches everything. He thus develops his sensitivity to details and to relief. He begins to acquire the notions of constancy, of “invariant” (Piaget).

Spatialisation: the journey ends

The dyslexic child, fixed in his body, can now feel comfortable in it and use it to know space and time, and to go towards others.

“He appreciates space, first by the objects to be found in it, but he also learns to situate the elements relative to one another, situating himself in the whole. By the play of the displacement of objects and of his own locomotion, he constructs the principal directions of space: vertical, horizontal, oblique. He gives them a meaning: upwards, downwards, to the right, to the left, forwards, backwards. These orientations are essential to differentiate d from b, p from q, 12 from 21.”

Between foetal life and lateralisation — which are the poles of audio-psycho-phonology applied to the dyslexic — the child develops an art of seeing, a way of feeling, a joy of creating and of reducing distances, a taking-possession of space and time, a softness of touch and gesture, which spring from the desire to communicate. These gifts are the necessary expressions taken up in language, which sums everything up, raises everything, links in a continuous song matter and spirit.

“The evolutionary finality — Professor Tomatis affirms — is to transform an oculo-cephalo-gyric being into a listening being.” It seems obvious, in this perspective, that man must first be oculo-cephalo-gyric. This is one of the tasks to which I devote my care.

May time permit us to see the realisation of this dream: the therapists of development and those of listening at last united to help the dyslexic let himself go to Language. May we all let ourselves go to a “common hope in the expectation of the redemption of our body” (Epistle to the Romans, VIII, 23).

Bibliography

A. A. Tomatis, Éducation et dyslexie, ESF, 1972.
Institut de Visiologie de France, Introduction à la Visiologie (collective work), 1974.
Carl H. Delacato, A New Start for the Child with Reading Problems, 1970.

— Anne-Marie Bauduin, paediatric nurse, Belgium. Communication to the 3^rd National Congress of the AFAPP.