What is Cuevas Medek Exercises?

CME, the acronym for Cuevas Medek Exercises, is a physical therapy approach for infants suffering abnormal developmental motor evolution caused by a known or unknown non-degenerative syndrome affecting the Central Nervous System, including Cerebral Palsy, Spina Bifida, Hydrocephalus, Down Syndrome, Ataxia, among others.

The goal of CME is to produce functional motor control in young children with motor delay so that they might attain the highest level of independence in sitting, standing, and walking. Among the most difficult challenges, facing children with motor delay are lack of independence, and secondary contractures leading to structural trunk and limb deformities that often require multiple corrective surgeries. Unfortunately, due to the underlying abnormal muscle tone, the deformities eventually recur and repeated surgeries are required for these patients. CME therapy has prevented the need for these major surgical procedures by improving the child’s muscle tone and by increasing flexibility and mobility.

The natural reaction of the “recovery potential” alone, cannot lead the compromised child out of the abnormal motor developmental situation. Therefore it is crucial to begin motor therapy at the same time the first signs of delayed motor function appear.

CME exercises gradually expose the child to anti-gravity motor-postural challenges that facilitate the learning of new anti-gravity control reactions. The focus on facilitating the patient’s self-produced actions to environmental challenges likely leads to neural connection rearrangement in the child’s brain as long as the neurons in the brain retain some form of neural plasticity. This degree of concentration on self-produced motor actions to anti-gravity stimulation, a main feature of CME therapy, is rare among interventions that target motor function but is a common feature of successful ones.

By integrating the components of antigravity posture, range of motion, weight bearing, and stretching in the functional exercises, Ramon Cuevas has been able to improve the agility, flexibility, balance, and coordination of the children he treats. Early intervention is important, as muscles weaken from lack of use, making treatment more difficult as time goes on. Also important for success is the participation of the parents or caregiver, who, after careful instruction, continues with the child’s treatment exercises at home.

This therapy can be applied to children from the age of 3 months until they achieve and control independent walking. Because the CME practitioner needs to expose the infant to the influence of gravity, by providing progressive distal support, the use of this therapy may be limited by the child’s size and weight.

The final level of motor independence achieved by the child will depend on the following:

1) The early recognition of the motor developmental abnormality.

2) The existence of brain’s recovery potential.

3) The timely application of a reliable approach of motor therapy.

4) The constant execution of appropriate exercise until achieve total motor control.

Cuevas Medek Exercises history

Cuevas Medek Exercises approach was created and developed by Ramon Cuevas, Chilean physical therapist, since 1972 in Caracas, Venezuela.

Ramon Cuevas received his PT degree, Summa Cum Laude, from the University of Chile, in November 1969 and moved to Venezuela in April 1970. There, he came in contact with the world of infant rehabilitation, as the person responsible for re-organizing the Physical Therapy Department of the private institute AVEPANE (Venezuelan Association of Parent and Friends of Exceptional Children). The population treated in the Institute, was mainly children between the ages of 8 and 13 years affected by Cerebral Palsy or Down’s syndrome. At the time, the concepts of “high risk” condition and “early stimulation” were not well known.

After two years of full time work, using an eclectic combination of exercises from the conventional approaches of physical therapy, the author recognized two important issues: First, they were not producing noticeable motor improvement in the children as result of the intervention; rather they were only helping the children to “repeat” the motor functions which they had already acquired, and second, he understood that to demand “cooperation” and “motivation” from the child, was unfair and illusory requisites to perform the exercise program. Trying to find some answers to this self-critical analysis, Ramon Cuevas developed the premise that at early ages, the only hope to improve the evolution of the motor delayed child is to “provoke” the activation of the underlying recovery potential through the use of “specific dynamic exercises”.

At the beginning of 1972, Ramon Cuevas established the basic goal of his professional endeavor as a physical therapist: to create a method of exercises that would “provoke absent developmental postural-functional reactions regardless of the symptoms of damage and the level of awareness of the child”. This premise was based on the observed biomechanical fact that in the sitting and standing exercises, “as furthest support is applied by the therapist, stronger functional antigravity reactions are provoked”.

The sequence of pictures shows Ramon Cuevas, doing the CME called Supine sitting by hips to a Down syndrome child of 6 ½ months old, in Caracas in 1972. The purpose of the exercises was to create an alternative way to provoke the sitting reaction instead of the classical maneuver of pulling the child up to sitting by holding both hands and I or pulling the child up to sitting by one hand while the other hand is contained against the table. These two maneuvers were part of the standard repertoire of conventional therapy to help the child to sit up. The new idea was to provoke the sitting reaction by distal input without indicating to the child’s brain that the sitting begins by hand traction.

Fundamentals of CME

Fundamentals of CME®

Psychomotor Therapy Approach

1. CME® aims to provoke in children’s brain the automatic responses of postural and functional motor control.

2. CME® exposes body segments to gravity force influence.

Method 3

3. CME® promotes the use of the maximum possible distal grasp on children’s body.

4. CME® challenges the children’s neuro-muscular system in order to force the appearance of non-obvious motor functions.

Method 3

5. CME® integrates range of motion exercises into the global functional maneuver.

6. High tone conditions is not a limitation to use CME® therapy.

Method 3

7. During the CME® session, children´s emotional irritability is a total acceptable reaction and should not be a negative factor for the goals of the therapy. For CME® therapy the child`s intellectual disabilities are not a limitation to use the exercises program.