The Second Mobility Revolution

The greatest change that has taken place in The Institutes Program in half a century is not really a change, but instead a true revolution - the second mobility revolution.

The first Mobility Revolution had as its very basis the fact that well children were born with the ability to move their arms and legs, and that by two and a half months of age they began to use those motions to crawl. By seven months of age they began to defy gravity by getting up on hands and knees and creeping. By one year of age they began to walk, and then by six years of age they walked and ran in a perfect cross pattern. The world of mobility was now their oyster.

The first Mobility Revolution, which we had pioneered as a result of Temple Fay's staggering insights, saw this pathway of crawling, creeping, walking, and running not only as supremely important, which indeed it is, but saw these four functions as being the actual cause of the well baby's growth to physical and mobility success and competence.

Using that belief as a basis, we had designed successful programs that had brought thousands of paralyzed children to crawling, or creeping, or walking, or running.

The events that led us to the second Mobility Revolution took years of observations of why we had failed when we had failed; new experiments to solve problems that were successful and endless thought and discussion.

Slowly a new and staggering realization began to take form, which contradicted our absolute faith in what we had always believed and which had served us so well in creating techniques which had worked so successfully in the thousands of children in whom they had worked.

That new understanding in no way diminished the vital importance of those ancient processes of crawling, creeping, walking, and running.

Instead, the second Mobility Revolution, which has brought sweeping changes in treatment, is based on the realization that crawling, creeping, walking, and running are vital results rather than causes.

The revolution had actually started some time earlier, but we had thought of it as an innovation, when we began using the overhead ladder. After that we used the NASA crawling gadget, and then the gravity friendly environment, then the physical problem-solving situations, then the vertical kinesthesia device, and then the Jungle Jefferson, and so on.

We didn't think of it as a revolution, because it did not have its roots in a new philosophy, but was grounded in individual treatment innovations.

That did not become clear until it became obvious that what was needed was a true revolution in thinking. I would like to approach that revolution in thinking of a new philosophy, in a far more orderly way than the way in which it actually happened. Let me begin at the beginning.

To crawl, we must deal with three different factors. We must have the strength necessary to push our body to one side. Secondly, we must have the balance necessary to maintain ourselves in that position. And thirdly, we must have enough control while we are in that position to move another arm and leg forward to the position where we want it so that we can start over.

To creep, there are three factors. We must have the strength required to support ourselves on four points, on two hands, and two knees. And then we must have the balance required to lean on only two of those points. And then we must have the control required to move the other arm and leg into the position necessary to start over.

To walk, we must have three factors. We must have the strength necessary to support ourselves on two feet. Then we must have the balance necessary to shift our weight entirely to one foot. And then we must have the control necessary to put the other foot in a position to start over.

To run, we must have three factors. We must have the strength required to stand on one foot. Then we must have the balance required to leap into the air without falling down. And thirdly, we must have the control to end up with the other foot in a position to start that process over again.

To do the most complex gymnastic routine, we must have three abilities. We must have the strength to do the intricate gymnastic skills required. Let us say, for example, a cartwheel. We must have the balance required to move our support from our legs to our arms and back again. And we must have the control, while we are doing that, to make sure that the hand or leg going onto the ground is where we need it to be to start over again.

To do the most complex ballet routine, we need three factors. We need the strength necessary to support ourselves on the toes of a single foot. We must have the balance required to spin on those toes. And we must have the control required to perform the next step in the ballet.

In short, to do all the things required by human mobility, we need these three factors-strength, balance, and control.

Temple Fay taught us, and quite correctly, the necessity to first move arms and legs, and then to crawl, and then to creep, and then to walk, in that order. He also taught us that if our crawling was incorrect it would follow that our creeping would be incorrect, and that if our creeping were incorrect it would follow that our walking would be incorrect, and so on. This is also true.

For the brain-injured kids the problem of having to handle these three variables of strength, balance, and control simultaneously is a staggering one. We assumed (I assumed) that because they were brain-injured it took them months or even years to do what a well child did in a very short time-to crawl at two and a half months, to creep at seven months, to begin to walk at one year, to begin to run at two and a half years, which would culminate in complete cross-pattern walking and running by six years. I assumed that the well children (we all assumed this) could do this simply because they were well.

I would like to talk about those three things - strength, balance, and control. I would like to call them variables, because surely they are variables. I would like to use the word variable in the mathematical sense, which is to say "a variable is composed of a number of values." It may contain two values; it may contain fifty values.

I assumed, quite incorrectly as it turned out, that well children handle these variables simultaneously because they are well and because they appear to do it with so little effort. But our brain-injured children, being brain-injured, took great lengths of time to deal with them, and sometimes even our brain-injured children did succeed.

What, in point of fact, was wrong in what we have been doing all these years and what we have been saying all these years? First of all, I would like to point out that two variables are not twice as difficult to deal with simultaneously as one variable. They may be a hundred times more difficult to deal with than one variable. I should like to point out that three variables being dealt with simultaneously is not three times as difficult as one variable, but it may be literally a thousand times more difficult.

Indeed, with our new understanding it is impossible to imagine that a well child could possibly deal with these three variables, which surely contain hundreds of values simultaneously. How then do we explain their ability to crawl at two and a half months, to creep at seven months, to walk at a year, to go on to run and to jump and to dive and to swim and to ski and to dance and do all the thousands of other things a well kid does? How do we explain the fact that they do?

The truth is that it is profoundly embarrassing for me to say that I, of all people, of everybody alive, should have known first that not even well children could have dealt with these three variables simultaneously. Indeed, I have been scornful and abrasive about people, educators, psychologists, etc., who underestimate tiny children intellectually. And I have laid about me with a heavy hand in that regard.

Consider, for instance, the irony of our two- and three-year-old brain-injured children reading, while a huge number of well sixteen-year-olds, seventeen-year-olds, and eighteen-year-olds can not read. I have been scornful in pointing out that tiny children, contrary to popular thought, are in truth linguistic geniuses.

How inappropriate then that I, of all people, should have missed the point that tiny children are movement geniuses. What does that mean?

It means that tiny children, far from dealing simultaneously with the three variables involved in learning to crawl, creep, walk, run, jump, ski, and swim-far from doing that-they not only break them down into three variables but they break those three variables down into hundreds of experiments.

I have looked at tiny children in constant motion and said, "O well, they are overflowing with energy, they are all that way." The fact is that tiny children do endless experiments in mobility.

Tiny children are born with an imperative, an absolute command within them, to move. Because not to move is to die. That is literally true-to not move is to die. In the end, immobile people get hypostatic pneumonia, urinary tract infections, and a number of other things, and they die. So children, all tiny children, are born with an absolute imperative to move.

Are you all aware that the most common cause of death in children between birth and five years of age in the United States is physical accident? Not automobile accidents, but physical injuries-physical injuries that they sustain while doing the thousands of experiments which are required to meet that mobility imperative, to learn all of the things they need to learn in order to crawl, to creep, to walk, and to run. So the imperative to move says that you must move even at the risk of dying, even at the risk of killing yourself in endless experiments you must do to learn how to do this.

I began to become more aware of these ideas about five years ago. I had always been aware that a two-month-old baby learning to crawl and a seven-month-old baby learning to creep and a one-year-old learning to walk were performing miracles, but I missed the fact that they were creating the miracles.

But times and knowledge change.

Not even the well kids could perform the miracle of dealing with three variables simultaneously - and they didn't.

Far from it.

Not only did well kids deal with one variable at a time but, in fact, they broke each single variable down into as many sub-steps as they could imagine, and they could imagine many. They dealt with them with frequency, intensity, and duration.

Breaking each variable down into a hundred sub-tasks was closer to reality.

I became aware of it consciously when my grandson Spencer was two years old.

At every opportunity he would climb on our bed while we were reading and jump up and down amidst the jumble of our legs under the covers.

"Hey, Roz! Hey, Doug! Watch this kid! Your son is going to break his neck!" I would shout to his parents.

Spencer would also use the wooden sides of the bed as a tight rope for his super balance routine while I yelled for his parents.

About the time his younger sister, Morgan, was one year old and climbing onto the bed unassisted and again scared the devil out of me. By now Spencer was ending his bed-bouncing routine by doing a forward roll off the bed, and I began to understand what I was seeing. They were obeying their inborn commandment to move at all costs-even at the risk of death.

Of course! And before them had been their older brother, Marlowe, and before Marlowe our own son, Doug, and before them my little sister, Helen, and before her-me.

The point is that well kids, beginning at birth, perform every act of mobility (which is to say strength, balance, and control) of which they are capable in order not to try to accomplish the impossibility of dealing with three variables simultaneously.

It spoke volumes for our program, our parents, and our staff that we had succeeded as splendidly as we had on a program that did not take that into account.

We must now give our hurt kids every single advantage which the well kids give themselves, not in four steps of moving arms and legs, crawling, creeping, and walking, but rather, in hundreds or even thousands of steps.

Mt. Fuji, I am told, is eighteen thousand feet tall. I believe I could not climb that mountain if you broke it down into four steps that you might call:

But I believe I could climb even Mt. Everest if you broke it down into enough steps.

If you broke Mt. Fuji down into 18,000 one-foot steps I am sure I could climb it (although it might take me a long time-maybe months).

That's precisely what we must do for our hurt children.

Instead of facing them with four staggering steps of crawling, creeping, walking, and running, we must break them down into a hundred or two hundred or, if necessary, a thousand steps to make it not as difficult as possible but as easy as possible to deal with the three variables in each vital stage-those of strength, balance, and control.

It is called "THE SINGLE VARIABLE PATHWAY FROM IMMOBILITY TO PHYSICAL VIRTUOSITY" and that's exactly what it means.

When this was first written we were working with the seventh edition, which had 220 steps.

We are now working on the thirteenth edition, which will have more than 467 steps, but let's consider the version with 220 steps.

The child who only needs fifty of the steps will breeze through the other 170.

The child who needs 100 will breeze through the other 120.

The child who only needs 20 will breeze through the other 200.

The single variable strategy to achieve function from immobility to physical virtuosity is not a change in mobility achievement for brain-injured children, it is a mobility revolution.

The first series of steps in the second Mobility Revolution is called the Medullary Reflex Mobility Program.

By Glenn Doman, Founder