Friday, December 4, 2009

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.


5 comments: said...

Hi Amy,

I've been reading your blog for a while but haven't commented yet. I just wanted to talk a little bit about CME. I brought my son to Chile to work with Ramon, the inventor of CME, and it's been an amazing experience. Nathan is a tough tough tough case so his improvement has been very slow, but it's the first therapy where he's actually had results! When I saw Elena doing the exercises I thought of a little boy from Argentina that worked with Ramon for 2 weeks. When he started, he could only walk with crutches and was quite unstable. Every day I could see him getting straighter and more stable, and after a few days his mom took his canes away. Towards the end of the 2 weeks, the little boy was walking without canes and without using the wall for assistance. It was amazing to watch. I also have a friend who took her son to Ramon, who could walk but could not stand up on his own, and after just 1 month he can now stand up on his own.
Nathan is a different case but we stopped all other therapies and I don't regret it for a second. Ramon has invented over 600 exercises so it never gets boring for Nathan - he's always dong different exercises.
I am a super advocate of CME, I've seen miracles since I've been around this therapy.
I've written a few posts on CME:

And here's a blog of a child who does CME in Canada who is a lot more like E than my son, Nathan:

Let me know if you have any questions or if there's anything I can help you with!!!


Justine, Romy's Mama said...

Hey there! Just wanted to let you know that I'll be mailing off Elenas letter within the next day or two. Love the video's by the way! She's doing so awsome!

Jen said...

Hi Amy,

We're considering a week session in Toronto at Simona's clinic for CME, for our 14 month old daughter (chromosome deletion). But there's not a lot of info on personal experiences out there. I'm glad I found your site. Thanks for sharing your experience. We're still a bit scared to go, just because it's a huge amount of money and time to invest, and we're not sure how our daughter will react.
It sounds like, in the end, you would do this (CME) again and would recommend it?

(jenrx99 at replace "at" with @!

月月鳥 said...

Hi all,

I have been reading about CME and my physio tried CME on my dsykinetic cp son for few weeks. She was a CME level 1 therapist. I think CME makes a lot of sense but my son got a serious sleeping problem after doing that. Did your kids also suffer a prieod of sleepless right after the treatment?


cristina said...


I am interested about CME therapy for my daugther who is now 4.5 years old. She has flaccid paralysis, is not able to stand or walk;
I would like to know how can we schedule in Chile for therapy with Ramon.
And how much will the therapy costs?