Review: Cuevas Medek Exercise (CME)

This week has been pretty crazy! Simona DeMarchi came to teach a CME Level 1 Course in my town. The course was for therapists, but Elena was used as a model throughout the course.

I can't tell you much about the instruction. I do know that they use dolls for much of their course, and then they had volunteer kids as models. After observing what they do with real people, I can't imagine trying to get certified using mainly dolls...using real models are SO much different.

A sample modeling portion would go as follows: Simona would discuss an exercise in the CME manual. She would describe the usual patient for said exercise, and then how she would go about it. There were a number of models in the room--four different kids, of different sizes, ages, tone, and diagnoses (for instance)--and Simona would then demonstrate that exercise with each child, highlighting their differences and the difficulty along the way. For the kids, it was a lot of waiting and being patient before being asked to do an exercise. I think it was a lot to ask of these kids, to sit/behave/be quiet for so long--but absolutely necessary to really convey how CME can be used for all sorts of patients. I'm happy we got to be a part of someone's education, and E was a champ the whole time.

CME, from what I was observing, is all about "provoking" movement patterns. The therapist doesn't try to tell the child what to do--the idea is the desired movement should happen naturally and hopefully evolve to a normal response. The exercise to provoke a certain movement or balance response may seem extreme (which is why you need a skilled, certified therapist), but I guess when you have a child with tone issues you need an extreme provocation to jump-start the emerging movement pattern.

Another BIG thing about CME is orthoses and assistive devices are not permitted. Children wear shoes for safety, but not AFOs, crutches, walkers, etc. Most exercises revolve around simple materials--blocks, boards, traction material.

What do I think? In a nutshell, I'm pretty impressed. Simona is confident, knowledgeable, patient, and personable. Elena liked her (and the other therapists in the room). I think E could benefit tremendously from this method--but, I'm not ready to exchange all our current therapies for CME. Two big obstacles are TIME and resources, as CME providers/time slots are very limited. I'd love to start a CME regimen, as it is extremely challenging for E--and it's great to keep therapy fresh, so E doesn't get bored. I am very interested in what it can do for her.

So, how did E do?

Before Simona suggested exercises for E, she needed to be evaluated. There is a battery of test exercises to determine her ability level, based on protective responses, righting responses, and movement. Gross motor-wise, most people reach their definitive movement patterns by 18 months of age (walking, running, jumping, falling, sitting, lying down, rolling, and transitions). Elena's test results put her gross motor skills equivalent to that of a 14 month old.

There are a LOT of exercises applicable to Elena. Some are appropriate for the level taught in this week's course, some are not. I'm not sure which ones--but you can bet, if the exercise looks advanced, IT IS. I have a few film clips shown here--the rest of them will be on The Doodle.











Overall, I was surprised how E "crouched" over sometimes while challenged. I don't see this at home often--then again, she's wearing her AFOs and she's not trying to walk on a balance beam, or an unstable surface, or moving without a handhold close by. I'll be very interested to see when and if this balance compensation/posture changes.

BRING IT ON.