Psychomotor Patterning: A Critical Look

Steven Novella, M.D.
February 9, 2008

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.

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 Their theories are primarily an extension of the outdated concept that ontogeny (the stages through which organisms develop from single cell to maturity) recapitulates phylogeny (the evolutionary history of the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 neurodevelopmental 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].

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].

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.

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.

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.

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