At last year’s APASC25 conference, Dr Nikki Milne FACP, a Specialist Research Physiotherapist (as awarded by the Australian College of Physiotherapists in 2025) based at Bond University, presented the results of a scoping review on the Cuevas Medek Exercises (CME), which claim to improve motor skills in children affected by developmental delays. 

The review concluded that there is currently no high-quality evidence supporting therapeutic claims that CME can improve motor development, gait, mobility, posture and control, balance, communication or swallowing. 

These exercises were originally developed in the early 1970s by Ramón Cuevas, a Chilean physiotherapist. 

The CME website says it is a ‘psychomotor therapy based on dynamic challenging exercises, manually applied for children affected on their developmental motor functions’, noting that the therapy stimulates children in a safe way, starting from two months old. 

Proponents of the method claim that it can be used for a variety of non-degenerative syndromes affecting the central nervous system, including cerebral palsy, spina bifida, hydrocephalus, Down syndrome and ataxia. 

Similar therapies, including Dynamic Movement Intervention (DMI), have evolved from CME. 

The exercises are typically offered by physiotherapists who have trained in the method but they can also be delivered by other health professionals in the paediatric disability space. 

‘It’s an evolution of very hands-on manual handling of a child, where the child doesn’t even have to be engaged in the task, so they’re passively being moved and responding without necessarily taking part in the therapy itself,’ Nikki says. 

‘When children engage in goal-oriented tasks that they want to do, there is better evidence of effectiveness.’ 

However, there is increasing concern about the exercises, both in Australia and internationally. 

Nikki first started hearing about the therapy in 2021, when a paediatric physiotherapist reached out to her after noticing that more and more paediatric clinics were offering the therapy method. 

‘I looked it up and did some reading. 

‘At that time, I couldn’t find any evidence for it at all. 

‘I followed up with her a while later to see if it was still an issue and she said it was becoming a bigger issue, with an increasing number of clinics offering CME as a type of therapy.’ 

Neither Nikki nor the clinician who had contacted her could find any evidence for the therapy method. 

Internationally, clinicians were also raising concerns through the International Organisation of Physiotherapists in Paediatrics. 

‘Alarm bells were ringing for many evidence-based practitioners, who don’t want to see this treatment method adopted so quickly without research behind it. 

‘I also don’t want CME to be misinterpreted as physiotherapy – it is not. 

‘Physiotherapy has wonderful evidence behind it; the CME method does not but some physios are practising it.’ 

Around the same time that Nikki started seeing warning signs, an emergency physician contacted her about a toddler who had come into the emergency room with a fractured femur after seeing a paediatric physiotherapist. 

Nikki also heard about another child who had a dislocated hip after CME treatment. 

It was enough for Nikki to decide to do a scoping review on CME, which she is in the process of submitting for publication. 

The review was wide-ranging and in addition to the scientific literature it included newspaper articles, website articles and blog posts. 

She found that there was very little published on CME. 

The majority of the scientific studies included in the scoping review were either also literature reviews or case studies of individual patients with various conditions. 

Most of the studies didn’t mention adverse events, other than the child being irritable, upset or crying. 

In her research, the only randomised controlled trial she found on CME was published in 2024 and contained significant false reporting, including incorrect reference to Nikki’s own unpublished review, leading to suspicions about the origin of the article. 

‘There are experts all over the world being falsely quoted in that article, saying that it’s effective when they have never done any research on CME.’ 

Nikki notes that in the end she and her research team included the article but expressed their concerns about its origins. 

‘Our conclusion really came down to there being no evidence to support the effectiveness of CME or to support the therapeutic claims that are being made on many of the websites from people who are using it. 

‘We can’t say it doesn’t work yet, but we can say there is no high-quality evidence of effectiveness at this time.’ 

In fact, there are even different claims about what CME and similar therapies actually do, according to Nikki. 

Some articles she reviewed suggest it elicits an autonomic motor reaction, while others talk about addressing a neurological or developmental motor delay. 

Some claim it acts on the basis of neuroplasticity – that moving the child’s limbs around passively generates neuroplastic improvements – but this contradicts current evidence that indicates neuroplasticity is limited if the child is not engaged with the activity. 

Another proposed mechanism is that CME strengthens the patient’s natural recovery mechanism, a term that Nikki says is meaningless. 

‘When we looked at the bulk of the literature, there were a lot of therapeutic claims with a poorly defined rationale for how the researchers think it works. 

‘Prior therapies that have followed a similar kind of methodology – starting proximally with handling, moving distally and challenging a child’s movement by putting our hands on them to facilitate movements – have not gone on to have strong evidence behind them. 

‘This feels like the next wave of those kinds of interventions.’ 

Adding to the lack of evidence is the high cost of CME and similar therapies. 

Typically, the exercises are offered as an intensive program – for example, doing two 45-minute sessions of therapy every day in two-week blocks. 

‘Some of those blocks of therapy are costing families $15,000 to $20,000. 

‘When big chunks of money like that come out of their NDIS funding packages or from their private funds, our research team’s view is that this cost in itself is an adverse event.’ 

What worries Nikki and many other physiotherapists is that the move towards CME and similar therapies like DMI (also currently the subject of a scoping review by Nikki and her team) is largely being driven by parents persuaded by social media content. 

‘Physios have got parents coming to them, asking whether they are trained in CME or DMI. 

‘When they say no, the parents say they are going to go to a different practice because they believe so strongly in the social media content they’re seeing from CME therapists – but it’s not backed by evidence.’ 

Nikki says physiotherapists have a responsibility to engage parents in shared decision-making by explaining the current evidence for CME and DMI. 

‘There seems to be a positive effect if the therapist pauses and says, “Can I talk you through the evidence?” and allows the parents to make a more informed decision. 

‘But social media powerfully influences families’ choices. 

‘When parents see non-evidence-based claims, their desperation to do the absolute best by their child leads them to believe those claims because they’re coming from reputable registered health practitioners.’ 

Nikki’s presentation at APASC25, as well as the review itself, is a call to action for physiotherapists working in the paediatric disability space. 

‘At this point our recommendation to therapists is: either avoid using CME because it’s not evidence-based or, if you choose to proceed despite this, fulfil your obligations as evidence-based practitioners and engage in research that allows independent evaluation of your findings. 

‘However, physiotherapists do have an obligation to let parents know that there’s no high-quality evidence that CME is effective and that there is some emerging evidence regarding adverse events so that parents can make an informed decision before they spend that money and critical time. 

‘Because the child’s never going to get that time back.’ 

As well as publishing the CME review and completing the DMI review, Nikki is planning to work with other countries to look at adverse events related to CME internationally. 

She is working with the International Organisation of Physiotherapists in Paediatrics, where she sits on the executive committee. 

She will continue to monitor the literature about the use of CME by the profession. 

‘At this point in time, it is not our position to say don’t do it. 

‘Our position is that if you choose to do it, follow your obligations of engaging with evidence and be careful about the observed adverse events. 

‘If we do get established evidence that says it definitively doesn’t work, move on and apply the interventions that do have substantiated evidence of effectiveness, with less risk of harm.’ 

Ethical obligations for physiotherapists considering CME or DMI 

1. Bear in mind that informed consent is a legal duty 

Under Australian law (Rogers v Whitaker, High Court of Australia 1992), physiotherapists have a duty to disclose any material risk of a proposed intervention – a risk being ‘material’ if a reasonable person in the patient’s position would likely attach significance to it. For CME and DMI, this means disclosing: 

• that there is no published high-quality evidence of effectiveness 
• the current Sackett level 5 evidence status (no empirical evidence beyond a single conference abstract) 
• known adverse events (fractured femur, hip dislocation) 
• potential risks drawn from analogous intensive paediatric motor interventions 
• the high financial cost, particularly where NDIS funding is involved. 

The APA confirms that informed consent is a communication process, not simply obtaining a signature. The family must have the opportunity to ask questions, contribute their insights and voluntarily agree based on genuine understanding. 

2. Fulfil your evidence-based practice obligations 

The APA Standards for Physiotherapy Practices identify evidence-based practice and professional accountability as hallmarks of the profession in Australia. 

Physiotherapists are required to: 

• practise in accordance with the best available evidence 
• recognise the limits of their competence and the evidence supporting their interventions 
• communicate honestly with clients about the evidence underpinning recommended treatments. 

Using an intervention at Sackett level 5 without disclosure is difficult to reconcile with these obligations. 

3. Do not misrepresent CME or DMI as physiotherapy 

CME and DMI are not physiotherapy interventions in the evidence-based sense. 

Physiotherapists practising these techniques must be careful not to allow families to conflate them with physiotherapy’s established evidence base. 

As Dr Nikki Milne FACP has stated, these interventions ‘are not physiotherapy – physiotherapy has wonderful evidence behind it; CME does not.’ 

4. Utilise shared decision-making and respect autonomy 

Ethical practice requires that families are partners in decision-making, not recipients of a predetermined plan. 

This includes: 

• presenting the evidence (or lack thereof) clearly and without bias 
• respecting the family’s right to accept or decline any intervention 
• avoiding leverage of parental hope or desperation in the decision-making process
• acknowledging that social media influence does not substitute for clinical evidence. 

5. If you proceed despite the evidence gap 

If a physiotherapist chooses to offer CME or DMI after full informed consent, professional obligations require that they: 

• use validated outcome measures (Gross Motor Function Measure, Goal Attainment Scale and Canadian Occupational Performance Measure at minimum) to track progress objectively 
• document the informed consent discussion, including disclosure of the evidence gap and risks 
• contribute to independent research – findings should be published in peerreviewed literature, not only on social media or proprietary platforms
• monitor and report adverse events to support the emerging safety literature 
• review their practice if evidence emerges that the intervention is ineffective or harmful. 

Disclaimer: the APA encourages all physiotherapists to utilise shared decision-making principles and to engage in evidence-based and consent-informed practice.