AACPDM special: Effects of Power Training combined with interval treadmill training on walking capacity versus performance in real world settings in youth with cerebral palsy.

This paper is a contender for the AACPDM’s highest abstract honour - the Gayle G Arnold Award - to be presented at The American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) Conference - the 79th Annual Meeting!

“Celebrating Resilience” October 15-18, 2025, to be held in New Orleans, LA.

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

Paleg, Ginny PT, MPT, DScPT; Pool, Dayna PT, PhD; Hidalgo-Robles, Álvaro PT, MSc; Frumberg, David MD; Livingstone, Roslyn OT, MSc(RS); Damiano, Diane PT, PhD

Open Access!
https://journals.lww.com/pedpt/fulltext/9900/where_s_the_evidence__challenging_therapists_to.204.aspx

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are promoted as innovative neurorehabilitation methods for children with neurological disabilities, yet both rely on outdated reflex-hierarchical models rather than contemporary motor learning principles.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 non evidence-based methods.

Karina A Zapata, Rosa H Cooksey, Daralyn K Fulton, Hayley B Shelton, Chan-Hee Jo, Richard C Adams

Affiliations Expand

• PMID: 40556501
• DOI: 10.1111/dmcn.16397

Abstract

Aim: To determine the baseline pediatric reference values of the 6-minute walk test (6MWT) distance (6MWD) across spina bifida functional lesion levels, the associations between the 6MWD and the distances of the 1-minute and 2-minute walk tests, and assess the impact of social determinants on the 6MWD.

Method: This prospective cohort study collected the 6MWD of 145 ambulatory children (72 male, 73 female; mean age = 11 years 2 months [range: 6 years 0 months-17 years 11 months]) with mid-lumbar-level (n = 59), low-lumbar-level (n = 28), and sacral-level (n = 58) myelomeningocele at a pediatric hospital. Proxies of social determinants included insurance type and Area Deprivation Index (ADI). Pairwise comparisons evaluated the 6MWD according to lesion level and myelomeningocele functional classification (MMFC) group.

Results: The mean 6MWD was shorter for myelomeningocele at the mid-lumbar versus low-lumbar versus sacral lesion levels (p < 0.001), and MMFC2 versus MMFC3 versus MMFC4 (p < 0.001). The mean 1-minute and 2-minute walking distances were strongly associated with the 6MWD. Children with public insurance and a high ADI walked significantly fewer meters than children with private insurance (p = 0.023) and a low ADI (p = 0.048).

Interpretation: Children with higher anatomical functional lesion levels walked shorter distances than those with lower levels and according to MMFC group. The 1-minute and 2-minute walk tests are adequate substitutes for the 6MWT. Lower socioeconomic status affecting decreased walking capacity merits interventions to maximize opportunities for activity.