Where’s the Evidence? - Challenging Therapists to Stop Legitimizing Dynamic Movement Intervention and Cuevas Medek Exercises

Sep 29, 2026

Uploaded by Mabel

Dynamic Movement Intervention (DMI) and Cuevas Medek Exercises (CME) are promoted as neurorehabilitation options for children with neurological disabilities, but their reflex-hierarchical foundations conflict with modern motor learning principles. A literature review finds CME has only limited support, largely from a few case reports and two small biased comparative studies. DMI, introduced in 2021, has no published empirical evidence beyond a conference abstract. The commentary highlights ethical risks and urges evidence-based, child-led pediatric rehabilitation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Cuevas Medek Exercises

Origins and therapeutic approach

What this adds to the evidence

| | S P E C I A L C O M M U N I C A T I O N | | --- | --- | |
Where’s the Evidence? Challenging Therapists to Stop Legitimizing Dynamic Movement Intervention and Cuevas Medek Exercises
Ginny Paleg, PT, MPT, DScPT; Dayna Pool, PT, PhD; Álvaro Hidalgo-Robles, PT, MSc; David Frumberg, MD; Roslyn Livingstone, OT, MSc(RS); Diane Damiano, PT, PhD
McMaster University, Hamilton, Ontario, Canada (Dr Paleg); School of Health Sciences, University of KwaZulu Natal, Durban, South Africa (Dr Paleg, Ms Livingstone); The Healthy Strides Foundation, Perth, Australia (Dr Pool); School of Allied Health, Curtin University, Perth, Australia (Dr Pool); Facultad de Educación, Universidad Internacional de La Rioja, Logroño, Spain (Mr Hidalgo-Robles); Department of Orthopaedics, Yale, School of Medicine, New Haven, Connecticut (Dr Frumberg); Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada (Ms Livingstone); National Institutes for Health Clinical Center, Bethesda, Maryland (Dr Damiano) . | | | Dynamic Movement Intervention (DMI) and Cuevas Medek Exercises (CME) are promoted as innovative neurorehabilitation methods for children with neurological disabilities, yet both rely on outdated reflex-hierarchical models rather than contemporary motor learning principles. A review of the literature reveals that CME, despite 5 decades of use, is supported only by a few case reports and 2 small, biased comparative studies. DMI, introduced in 2021, has no published empirical evidence beyond a single conference abstract. Thus, both interventions remain at Sackett Level 5—no evidence. The ethical implications are substantial. Families often pay thousands for intensive, noncovered therapies that may displace meaningful participation in education and social life. Therapists have a professional responsibility to avoid legitimizing unproven practices and to prioritize interventions supported by robust evidence. Pediatric rehabilitation should shift toward child-led, functional, and task-specific approaches grounded in modern motor learning science, with professional bodies and insurers withholding endorsement of nonevidence-based methods. (Pediatr Phys Ther 2026;38:138–143) | | 0898-5669/110/0000-0001 Pediatric Physical Therapy Copyright © 2025 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Academy of Pediatric Physical Therapy of the American Physical Therapy Association Correspondence: Ginny Paleg, PT, MPT, DScPT, School of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa ([ginny@paleg.com](ginny@paleg.com)). Dr. Ginny Paleg is a paid educational consultant for a company that manufactures supported standing and stepping devices (Prime Engineering) . She is neither an employee nor shareholder. Dr. Ginny Paleg claims no bias for this publication and received no funding for work on this project. Dr. Dayna Pool is the clinical lead of a not-for-profit charitable organization in Perth (Australia) and Miri (Malaysia) . The Foundation is a clinical research center that focuses on delivering only evidence-based interventions. It is brand agnostic with no corporate shareholders or stakeholders. Dr. Pool is also the co-host of two podcasts: ResearchWorks and Therabytes. Neither the Foundation nor it’s media arms of ResearchWorks and Therabytes have any financial conflicts of interest to disclose. There are no corporate sponsors and advertisers, nor any paid-for-content partnerships. D. Frumberg disclosure: Consulting fees from Orthofix, Orthopediatrics, Kyowa Kirin, Ultragenyx. No other authors have disclaimers, disclosures, or conflicts of interest. This project was unfunded and completed on each author’s own personal time. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBYNC-ND), where it is permissible to download and share

FAQs

What evidence supports CME and DMI for pediatric neurorehabilitation?

CME relies mainly on a few case reports and two small biased comparative studies despite decades of use. DMI has no published empirical evidence beyond a single conference abstract, leaving both interventions without evidence at the cited level.

Why do the authors consider the theoretical foundations of DMI and CME controversial?

Both approaches depend on outdated reflex-hierarchical models rather than contemporary motor learning principles, and the article notes that their empirical and theoretical support is contested.

What ethical concerns are raised about using nonevidence-based therapies?

Families may pay thousands for intensive therapies that are not covered and may displace participation in education and social life. The authors argue therapists have a professional responsibility to avoid legitimizing unproven practices.

Sep 29, 2026

Uploaded by Mabel