The MEDEK Therapy, an alternative physical therapy intervention
The Dynamic Method of Kinetic Stimulation (MEDEK) is a mode of physical therapy used to develop gross motor skills in infants and children with movement disorders due to neurological dysfunction. MEDEK was developed by Chilean physical therapist, Ramon Cuevas between 1971-1976.
MEDEK was brought to North America via a young baby diagnosed with cerebral palsy, spastic quadriplegia. She was treated by Ramon in Caracas, Venezuela, and by myself in Toronto, Canada. Impressed by the dramatic improvements in this girl’s motor functioning after each return from South America I decided to visit Ramon. Upon my return to Toronto I started using the technique with my patients in my clinic and at the Zareinu Educational Centre, a private school for children with special needs. Sooner than expected, therapists realised that my clients were achieving the established goals earlier than anticipated. Paediatricians and orthopaedic surgeons wrote clinical reports stating that some of these clients exceeded their expectations.
One of the MEDEK assumptions is that in a gravitational environment, movement and manipulative skills require postural control or the ability to pull up against gravity and to stabilize the body in space. Gravity is considered the main stimulus that triggers the neuromuscular systems to react.
MEDEK does not focus at modifying muscle tone, primitive reflexes or abnormal patterns of movement. In MEDEK therapy these abnormal movements can be used to estimate the neural maturation of the central nervous system and are approached as compatible with the development of functional motor skills. The MEDEK therapy focuses on training movements leading to sitting, standing and walking. Muscles are trained in postural and functional tasks rather than in isolation. Tight muscles are stretched in dynamic situations. The motor developmental sequence (rolling, crawling, sitting, standing etc) is not used. MEDEK assumes that different skills require different movement strategies. Unlike other interventions, tasks are performed without the child’s attention, conscious thought or cooperation. It is assumed that motivation will increase temporary performance only but will not create a permanent change.
The therapist’s task is to provoke automatic postural reactions that contribute to the postural control needed for functional tasks. There are many medek exercises. Each one has a name, is well defined and provokes a very specific reaction. The therapist has to be skilled in MEDEK to know which goal she is aiming for and to provoke the desired response. We work on a medek table and as soon as the child is able to make steps with ankles support only we move to the floor and use the MEDEK equipment.This consists of seven different wooden pieces that can be arranged in different ways. The goal is to develop stability by challenging the child’s balance in the upright position.
The home program, which includes about eight exercises performed twice daily, is an important component of the therapy program. Medek assumes that learning or the acquisition of a skill requires practice, practice and practice! Our experience with medek has shown that parents like to have a structured program with clear goals. The usual comment from parents is: “this makes so much sense!”
The medek evaluation protocol consists of 46 items including postural and functional tasks and they cover the motor development from newborn to sixteen months of age. The efficacy of the program on a particular child is evaluated after an eight-week trial program. If no changes are made, the parent is advised to look for another form of intervention.
We use the medek approach with children diagnosed with developmental motor delay, hypotonia, Down’s syndrome and cerebral palsy. It seems that the therapy outcome depends on the degree of the dysfunction, the experience of the medek trained therapist, the frequency of the intervention and the age at which the therapy is initiated.
Ideally this intervention should be initiated in the first six months of life. Medek advocates for early assessment and early intervention as soon as “warning signs” are seen. It is well documented that the brain structure is affected by activity. The child’s inability to control the head and the trunk at an early age causes more severe motor deficits, muscular weakness and deformities and limits cognitive and social development.
Our clinical experience is promising. At this moment we are only collecting data. The next step is to perform well designed studies to confirm our clinical findings.
At the Canadian Medek Centre and Physiotherapy Clinic TM we provide therapy, as well as lectures for parents and therapists and courses for paediatric physical and occupational therapists. We also offer support to paediatric therapists.
I feel a great deal of gratitude and accomplishment that this therapy is now being used by physical therapists around the world. My passion has been to share my knowledge with parents, professionals and students in order that children with movement disorders have a chance for a better life.