Some Physical Therapies for Children with Neurological Disabilities Lack Scientific Support, Experts Warn

A recent review published in the journal Pediatric Physical Therapy has highlighted deficiencies in the scientific support and theoretical foundations of two neurorehabilitation methods for children with neurological disabilities – Cuevas Medek Exercises and Dynamic Movement Intervention.

Despite their increasing popularity and widespread use, both therapies are rooted in outdated reflex-hierarchical models, which run counter to contemporary principles of motor learning. The findings outlined by an international group of authors, which include Associate Professor of Orthopaedics & Rehabilitation, David Frumberg, MD, present significant ethical and financial concerns for affected families.

Cuevas Medek Exercises were developed in 1972 and are designed to elicit postural and functional reactions in children with motor impairments through manual facilitation techniques. These techniques, often based on reflexive motor responses, are performed by therapists who use hands-on guidance.

The method encourages children to perform a variety of movements such as balancing on planks and stepping exercises. Despite its decades-long history, empirical evidence supporting Cuevas Medek Exercises remains sparse.

Frumberg, who is a pediatric orthopaedic surgeon that specializes in both complex limb reconstruction and treating those with neurodevelopmental disorders, says, “Existing publications about Cuevas Medek Exercises have been limited to case reports and a small selection of biased comparative studies that lack substantial proof of efficacy.”

Dynamic Movement Intervention was recently introduced in 2021 and is similarly promoted as a contemporary approach that stimulates neuroplasticity, which is the brain's ability to reorganize and form new neural connections. Dynamic Movement Intervention shares many characteristics with Cuevas Medek Exercises however the evidence supporting Dynamic Movement Intervention is even less robust with the authors noting that the only available empirical data stems from a single conference abstract describing a case report.

Consequently, both therapeutic methods are classified at Sackett Level 5, indicating an absence of substantial evidence.

The ethical implications of promoting and utilizing these unproven therapies are substantial. Families often make significant financial sacrifices, spending thousands of dollars on intense therapies that are not covered by insurance in hopes of achieving positive outcomes for their children. These treatments can disrupt the children’s participation in essential educational and social activities, further affecting their development and well-being.

Physical and occupational therapists have a professional duty to avoid validating practices that are unsupported by empirical evidence and should instead focus on interventions backed by robust research, according to Frumberg and the co-authors.

A closer examination of current evidence reveals notable gaps. For Cuevas Medek Exercises, the scant support comes from a few case reports and what the researchers describe as deeply flawed comparative studies marred by biases. Anecdotal evidence and non-validated outcome measures are insufficient to determine whether observed improvements result from the therapy itself or by way of a child’s natural developmental progress.

The evidence base for Dynamic Movement Intervention is almost non-existent. The anecdotal nature of the data precludes any reliable assessment of its efficacy.

Physical and occupational therapists are ethically compelled to implement evidence-based interventions, which are increasingly available for conditions such as cerebral palsy and similar neurological impairments.

Fundamentally, therapy practices do not face the rigorous pre-use efficacy demonstrations that drugs or medical devices do. Therapists are expected to practice based on sound clinical judgment using the best available evidence. Promoting or using interventions without empirical support represents a serious deviation from this professional and ethical standard.

A significant professional concern surrounds some therapists blending elements of Cuevas Medek Exercises or Dynamic Movement Intervention into routine sessions, suggesting these are just tools within a broader kit that can be deployed. This approach risks misleading families about the scientific legitimacy of these methods. Frumberg believes therapists must provide transparent and accurate information to families, emphasizing the lack of evidence during shared decision-making conversations.

“Rehabilitation strategies must evolve beyond antiquated reflex-based approaches, towards methodologies that prioritize functional improvement and the child's active participation,” Frumberg adds. “Modern motor learning principles advocate for child-led, goal-oriented therapies conducted in contextually meaningful settings. These approaches support the development of motor skills through self-initiated active engagement, aligned with the principles of neuroplasticity.”

High-quality research over the past decade has consistently underscored the effectiveness of these contemporary methods. The authors also note that systematic reviews and large-scale empirical studies have validated the efficacy of evidence-based interventions for improving motor functions in children with cerebral palsy and other similar conditions.

The critique of Cuevas Medek Exercises and Dynamic Movement Intervention extends beyond their theoretical and empirical shortcomings to a broader ethical landscape.

“The modern perspective in neurodisability rehabilitation prioritizes tapping into existing abilities and integrating functional participation over striving to ‘normalize’ movement patterns,” Frumberg says. “This standpoint acknowledges disability as an inherent part of individual identity, advocating for inclusion and engagement rather than minimizing impairments.”

Intensive, unproven therapies like Dynamic Movement Intervention and Cuevas Medek Exercises can impose significant opportunity costs, detracting from crucial social, educational, and family interactions. These activities contribute immensely to a child's overall well-being and development. Allocating substantial time and resources towards questionable therapies demands scrutiny, weighing these costs against the proven benefits of alternative approaches.

Burdensome financial costs additionally underscore the ethical concerns. Families pursuing intensive therapy programs like Dynamic Movement Intervention and Cuevas Medek Exercises often incur significant expenses, sometimes upwards of several thousands of dollars per week, excluding travel, accommodation, and lost income. Given the limited evidence supporting these interventions, the authors believe that the financial strain on families in pursuit of uncertain therapeutic benefits is difficult to justify.

“Our findings underscore the need for pediatric rehabilitation to remain holistic and evidence-based, rooted in child-participatory methods,” Frumberg says. “Cuevas Medek Exercises and Dynamic Movement Intervention, lacking substantial empirical support and rooted in outdated theoretical frameworks, must be scrutinized and re-evaluated critically.”

“The pediatric rehabilitation community should embrace approaches validated by contemporary motor learning science, prioritizing the child’s holistic well-being alongside effective therapeutic outcomes,” he adds. “It’s critical for therapists, professional organizations, and insurers to commit to high ethical standards by endorsing only those interventions that are scientifically validated. Families must also be transparently informed about the evidence surrounding various therapeutic options, ensuring balanced decision-making that promotes the best possible outcomes for children with neurological disabilities.”

Frumberg and his co-authors, Ginny Paleg, PT, MPT, DScPT; Dayna Pool, PT, PhD; Álvaro Hidalgo-Robles, PT, MSc; Roslyn Livingstone, OT, MSc(RS); and Diane Damiano, PT, PhD, were recently featured on The ResearchWorks Podcast where they further discussed the financial and ethical implications of these non-evidence-based therapy methods.