Cuevas Medek Exercise....anyone ever heard of this before?

[Guest guest]

http://www.cnsfoundation.org/site/News2?page=NewsArticle & id=6699 & security=1 & news_iv_ctrl=0

CME:

Cuevas

Medek

Exercise

By Ramon Cuevas, PT, CME Founder

This

motor therapy for infant rehabilitation was created by Ramon Cuevas PT, in Caracas, Venezuela,

between 1971 and 1973. The main motivation for Ramon was to find the way “to provoke active-automatic motor

responses” in young developmental motor delayed

children, regardless of the child’s “cooperation and motivation” factors.

The therapy was originally named MEDEM

(Spanish acronym for dynamic method for motor stimulation), then in 1980 was

changed to MEDEK

(“M” for Motor, “K” for Kinetic). Finally the

current name CME was established by Ramon in 1998. CME is acronym for

Cuevas-Medek-Exercise.

The basic

assumption of Cuevas-Medek-Exercise therapy is that motor control originates

from genetic sources induced and manifested as consequences of gravitational

influences and the aging process. Aging processes produce maturity and

the maturity allows the child to take gradual control of his or her postures

and movements. Antigravity motor functions are triggered from the moment

of birth and reach their pinnacle with independent gait around the average age

of 12 to 14 months. Early walkers can achieve walking as early as 10

months and later walkers at 14-16, or even 18 months.

CME

theoretical frame is based on a primary premise: “the brain’s recovery potential produces

better responses when the child is gradually exposed to motor-postural

challenges regardless of the condition of his/her musculoskeletal

system”. The core idea of CME therapy:

“is to provoke the central nervous system to produce new antigravity

postural control reactions, with little to no external support”.

The rational behind this postulate, is that the laws of standard developmental

processes do not apply for developmentally delayed children. The special

child can not be expected to evolve in the same sequence of standards, because

when the brain is affected, it can only express the ?aging maturity” in a

random way and is shaped with the dominant muscle tone abnormality. CME

therapy can be used with children starting at the age of 3 months and

continuing for the necessary time until achieving independent walking, and only

if the child shows significant motor progress during the first 8 weeks of CME therapy.

Limitations of using this therapy are determined by the size and weight of the

child, and the CME practitioner’s skills to expose the child to

gravitational force influences while providing only progressive distal support.

For instance holding the child in a standing position by the waist is

“proximal support”: Holding the child below the hips, at the

thighs, below knees and/or finally by ankles, means “progressive distal

support”. The reason why CME cannot be applied to adult motor

impaired population is precisely because of the “progressive distal

support techniques”

CME

specific characteristics are:

1. Provokes the appearance of absent automatic motor functions:

The appropriate exercise is the one that induces the child to actively respond

with a motor reaction which is not currently under his/her spontaneous control.

2. The

child’s cooperation and motivation are not a requisite in CME: We

cannot use the argument: “the therapy is not working properly today

because the child is uncooperative and not motivated”. By contrast, the

CME principle says, it is the therapist’s responsibility to find the

appropriate postural exercises that will evoke a motor response within the

child during the session.

3. Expose

the child to gravity force influence with gradual progression from proximal to

distal support: After the child is able to react positively to any given

exercise, a new exercise, using more distal support should be tried.

4. Stretching

maneuvers are integrated in the CME program: The necessary stretching

maneuvers can be integrated into the functional exercise. As a consequence, the

child’s brain will receive better proprioceptive information because of

the combination of 3 components: range of motion, functional antigravity

posture and weight bearing.

5. High

muscle tone conditions in the lower extremities are not obstacles to

stimulating standing position control: CME sustains and applies the

conditions of early stimulation for standing regardless of high tone. For

instance, prompting standing in delayed children older than seven months

develops vertical trunk control which is the basis of any further motor

function.

6. A

Trial period is proposed to verify short term results of CME: After an

initial motor assessment with direct parent participation, 2 or 3 basic absent

motor functions, (for instance to keep a self supported sitting position for 30

seconds, or to keep standing posture supported by ankles), are chosen as

primary goals to be achieved within the first 8 weeks of application of CME therapy.

If these goals are achieved the parents are advised to continue with the CME

program, otherwise, they are encouraged to search for other options of physical

therapy.

CME

assessment:

The current version of the CME evaluation format is a revised version

of the original test developed in 1972. From 1976 to 1980, the assessment

was under experimental scrutiny as a curricular component of the research

project ARYET (Spanish acronym for High Risk and Early Stimulation). The

ARYET project was sponsored by THE NEUMANN FOUNDATION and the Clinic Hospital

of the Central University of Venezuela. The result of the project was published

in Caracas in

1982 in a 3 volume edition, plus one volume specially dedicated to the CME

assessment protocol. The first version of the motor test had 86 items and

has since been gradually simplified in the spirit of saving time during the

examination without loosing accuracy. The current CME assessment consists

of 41 items that cover the neonatal period through independent walking.

CME therapy is currently composed by nearly 600 different exercises. Ramon

prepared a manual of 99 selected exercises for general public, compilation

which will be available in English by end of summer 2006.

CME

model of intervention:

After the initial evaluation, motor outcomes will guide the

therapist in setting up the short terms goals that need to be achieved within

the first 8 weeks of treatment. The therapist should teach parents how to

do the home program exercises, including the amount of exercises and the

duration of each session. Within these 8 weeks the therapy program will be

applied twice daily, 6 days a week. If the chosen goals are satisfactorily

achieved during the first 8 weeks of treatment it signifies that CME therapy

can help the child reach high levels of motor progress. If results are

not seen the parents are encouraged to search for other motor-therapy

approaches that may be more beneficial to their child’s needs. This is a

highly ethical CME characteristic.

Example of successful results through CME therapy:

Patient: Teya R.

Diagnosis: Severe cerebellar hypoplasia, deafness,

Official prognosis: wheel chair or walker frame dependant,

Chronological age at start of standard motor therapy: 5 years,

Motor functional status at that time: no standing, no walking, the mother

carried her straddled on hip.

“So why have you not heard about CME

therapy? Ramon only teaches small groups at a time, as the technique takes

time and practice to learn. Currently, he also does all the teaching himself.

He wants the exercises taught properly so that the correct response is

achieved with each child and the technique does not loose its impact. He

has little spare time to promote or advertise

CME, because he is busy helping many children.

Ramon is trying to complete a book

illustrating all his exercises so that he can educate many about CME, and

give many more an understanding about this technique. You will not see big

colorful advertisements to promote CME, as many other therapies and

institutes are able to use. However, this therapy should not be overlooked

because of this. The results are far superior to most techniques available

for children with motor delay. CME’s advertising is in its

results.”

Jo-Anne Weltman PT, CME III certified

practitioner

In 2000

Ramon established the current Cuevas-Medek-Exercises Continuing Education

Program (CMECEP), a unique entity dedicated to the promotion and offering of

CME Therapy world wide, through seminars and formal courses which provide

state-of-the-art information about CME Therapy. Courses are divided in 4

levels: CME ONE: Introduction, CME TWO: Intermediate, CME THREE: Advanced and

CME IV: Instructor Certification Course. Currently there are many CME I and CME

II certified practitioners and 9 CME III certified practitioners. CME III

certified practitioner Simona DeMarchi, from Toronto is in the process of becoming the

first CME IV certified instructor. To inquire about CMECEP certified therapist,

send email to feedback@...

DISCLAIMER

There are no world wide approved branches of MEDEK CENTERS, other than the

Chilean Home office of Cuevas-MEDEK-Exercise

There are no approved Cuevas-MEDEK-Exercise courses other than the ones offered

by Ramon Cuevas through the CME Continuous Education Program, which are awarded

with the registered official CMECEP diploma

There are no authorized world-wide CME instructors approved to run CME courses

without Ramon Cuevas participation.

MEDEK and CME are intellectual registered property by R. Cuevas

For

information regarding CME therapy provided directly by Ramon Cuevas, CME materials,

publications, seminars and CME courses, send an email to: cme@...

or medektherapy@...