CME (Cuevas MEDEK Exercise)

General overview

The Medek Method was created by Ramon Cuevas, a physiotherapist in Santiago, Chile. It is used to develop motor skills in infants and young children with motor impairment. 
This method aims to bring about a functional improvement as quickly as possible, by providing intensive and multiple stimulation that puts the child in a position to perform movements that he or she could not perform alone.
It is one of the complementary methods most practiced in France by families with children with cerebral palsy in particular.

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Main objectives of the method

The objectives of this method (as defined by R. Cuevas) :

  • To make automatic postural responses emerge (which are absent due to brain damage) via the subject's exposure to the influence of gravity.

  • Stimulate the neuromuscular system to force the appearance of absent motor commands, through very frequent repetition of exercises. 

Specificities of the method

It is a method that does not depend on the child's motivation or cooperation, so it can be used from a very young age and even if the child does not respond to instructions or has difficulties such as vision or communication difficulties, does not respond to instructions....

The method is practiced both in the form of intensive therapy sessions with a practitioner and with the parents on a daily basis at home. 
Following an evaluation which allows the definition of short-term objectives, an intensive program is defined (with generally 8 to 9 exercises to be repeated for 20 to 45 minutes each day for 2 months). 

Each exercise corresponds to the child's level of motor development and waits for the child's "active response" to provoke the appearance of automatic motor functions absent from the brain:
The child is constantly active. Each exercise consists of a solicitation from the therapist that generates an active motor response from the child.
The method uses very precise equipment and the therapist uses it to provoke a very active maintenance during the session.
The therapist seeks to stimulate postural abilities and movement control.
He repeats the exercises until the brain's reaction becomes automatic.
The child is exposed to the natural influence of gravity:
The therapist seeks to induce absent anti-gravity control by holding the child as low as possible on his body. The child is gradually exposed to gravity. The goal is to compensate for the absence of motor reactions that are normally automatic.
The method does not necessarily respect the developmental stages of the child (e.g., putting the child on his or her feet even if he or she cannot do it alone).
Therapy is not based on learning by oral instruction. 
The therapist never gives specific instructions to the child such as "sit up straight", "push your leg". Children are placed in a position where their natural recovery instincts are put into effect and the child can then complete an action in his or her own way. 
Particularly relevant for some children: e.g. intellectually disabled, visually impaired, not interested in play...

This method requires a very strong involvement of the parents. The latter are trained with their child during training courses, so that they can repeat the exercises at home: series of exercises are to be carried out daily, even twice a day, which represents 20 to 45 minutes/day. There are also weeks of intensive courses. Usually the follow-up lasts at least 2 to 3 years.

The method is unusual: while most methods recommend respecting the natural stages of the child's development, the Medek method places the child in postures that he cannot perform and in which he feels gravity, in order to force the appearance of motor commands (see video). 

Who is this method for ?

The method is intended for all children with severe motor deficits, including children who have had a stroke in utero, have hemiplegia, hemiparesis, cerebral palsy.... 
They recommend starting as early as possible, as early as 8 or 9 months and it is difficult to start after 4 years.
Whatever the level of participation (reaction to instructions, solicitations, play), Medek can work, as it does not require children to understand or speak (no "instructions" are used), nor to be interested in participating in a game.

What parents say about it

It is one of the most popular complementary methods practiced by families: it is one of the most practiced in France, despite the small number of practitioners. This can be explained by the good results of the method and the greater involvement of the parents, who feel less powerless in the face of their child's disability.
"The exercises are not violent but intense. To do them well, you have to do two 45-minute sessions a day, six days a week. It is the repetition that allows the child to create brain connections, improving motor development. I decided to try this method for Youna, because I would like to test everything that exists to help her learn to walk. After the assessment, the physiotherapist tells us that she has the motor development of a 5.5-month-old child. For 2 months, we did the ten exercises planned and we went back to see the specialist in April. Youna now has 7.75 months of motor development." Youna's mom
A very technical method:
"Force the child to become aware of his body", "make the child feel gravity when he doesn't perceive it". 
"The child is put in a situation to get motor responses."
"The material is designed for very specific goals and very specific but affordable gestures for parents to learn."
"There is a lack of explanation and pedagogy, the Medek therapists are specialised in neuromotor disability and have given me a lot of explanations and advice"

An intensive method, which pushes the child: 
"We were told all the time: 'You have to go slowly' 'at your own pace' 'don't skip steps' but we were convinced that he could do much more."
"In the classical method, if the child is reluctant, we stop, with Medek he is put in a difficult situation but not a failure"
"We need to stop talking about our children's "fatigability" and look at what they're capable of doing as individuals."

"Apprehension to try but progress was apparent from the first days and despite the difficulties my daughter was eager to return."
"Sometimes difficult, the child may cry, but the child is usually demanding."
"Filipino girl was not receptive to physical therapy solicitation, not interested in what she was being offered."
"Whatever the child's level of involvement, response to instruction, response to challenge, response to play, Medek will work."
"I have a tetraparesis BMI child and my son has been practicing MEDEK for a year with excellent results. It's a fantastic method!!!" (forum: http://imc-kinesi.blogspot.com/2010/05/methode-cuevas.html)
The results obtained with this method can be impressive, as shown by the example of Martin, who had had a fetal stroke: at 9 months, he could not sit upright and could only turn around on his back. At 27 months, he was riding a 3-wheeled scooter and climbing stairs unaided, with support.

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This work is based on a collaborative approach to sharing research and family experience.

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