What is CME®?

Cuevas Medek Exercises (CME®) is a pediatric therapy approach created by Ramón Cuevas in 1972 for children with developmental delay caused by a known or unknown non-degenerative syndrome impacting the central nervous system.  CME® therapy is defined as dynamic challenging exercises, manually applied to children to provoke automatic motor function responses.  

Main Characteristics of CME®

1. CME® provokes the appearance of “absent automatic” motor functions. Your CME® practitioner will identify the absent motor milestones during the initial evaluation. With this information, your practitioner will create a CME® program with exercises that provoke your child to produce motor responses that he/she was previously unable to produce. An appropriate CME® program will constantly challenge your child with novel tasks which provokes new brain connections. When an exercise no longer challenges your child, it is no longer deemed an appropriate CME® exercise.
 

2. The child’s cooperation and motivation are not required in CME® Therapy. Child development is largely driven by the genetic blueprint already in place when we are born as well as the surrounding environmental factors. If you watch a child as they develop within their first year of life, new motor milestones appear spontaneously.  For example, a child who begins to crawl does not first think to themself, “I think I would like to crawl now.” As a child begins to experience novel motor tasks, he/she then begins to incorporate them into their daily life and continue to build upon them. A CME® practitioner does not expect a child dealing with the frustrations of motor delay to always be cooperative or content with the challenges of CME® Therapy they are presenting.  Rather, it is the responsibility of the CME® practitioner to choose the appropriate exercises to support and provoke the best possible response from the child.
 

3. Expose the child to the natural influence of the force of gravity with gradual progression to distal support. 

• Influence of the force of gravity: Many children with developmental delays first experience anti-gravity postures through use of assistive equipment that holds them securely up against gravity. However, when children are held securely in place with these devices, they are not afforded the opportunity to learn to activate their musculature against gravity with the understanding of the consequence of falling if they are not activating the correct musculature. During CME® sessions, children are exposed to a variety of exercises that require them to activate their musculature to elevate their head, sit, and stand in an erect posture against the force of gravity without external devices to lift them. Rather, the child must rely on the force production of their own musculature to achieve anti-gravity postures.
   
• Progression to distal support: A person’s center of gravity is located in their pelvic region.  If a child is always supported at their pelvis, they do not get to experience the efforts needed to control the position of their center of gravity as they move through space. CME® utilizes a progressive distal grasping technique in which the point of contact between the practitioner and child gradually moves away from the child’s center of gravity. For example, a child who is just beginning to weight bear in their lower extremities may first be supported at one thigh and the opposite side of their trunk. As standing control progresses, the child will then be able to be supported at both thighs, below both knee joints, by ankles, and then by heels, with each point of contact moving more distally from the child’s center of gravity. This progression maximally challenges the central nervous system to provoke postural control and brain recovery.

4. Stretching maneuvers are integrated into the CME® Therapy. Exercises that target lengthening muscles are incorporated into each CME® program, which stretches the muscles in a functional manner rather than isolated passive stretching (as commonly seen in more traditional therapy approaches). When a person manually, passively stretches a muscle with high tone, they are typically unable to generate enough muscle force and stretch duration to create a tangible, lasting change in the composition of the muscle fibers.  Also, the brain interprets such passive stretching as painful and will tend to contract the muscle being stretched to a greater degree as a protective means against the pain.  The functional stretching in CME® relies on the inhibition of the muscle being stretched to allow for it to lengthen and be used in a functional context.

5. High muscle tone in the lower extremities is not an obstacle to stimulate standing position control. It is imperative that children with high muscle tone in their lower extremities weight bear to help prevent orthopedic issues such as joint contractures and hip subluxation/dislocation. A CME® partitioner will incorporate standing exercises for children with high tone in their lower extremities with focus on aligning their joints as optimally as possible and strengthening trunk musculature as the child maintains an upright standing posture.
 

6. A trial period is proposed to demonstrate the short term results of CME® Therapy. Upon initially meeting with your CME® practitioner, your child will complete a CME® evaluation to determine his or her current gross motor functional status.  You will discuss and establish short term goals with your practitioner who will implement a CME® program to achieve those goals.  If after a few weeks, the goals have been met, you will continue with the CME® program. However, if no tangible change is apparent, other therapy options may be proposed to prevent a cycle of costly therapy proving to be ineffective for your child.

Contraindications to participation in CME® Therapy 

1. Any diagnosis of a degenerative nature affecting the neuromuscular system (progressive diseases).

2. Diagnosis of Osteogenesis Imperfecta

3. Uncontrolled seizures

4. Child younger than 3 months of age, except when the therapist in charge is a CME® II or CME® III graduate