DMI Frequently Asked Questions

1. “You don’t know what you are talking about; DMI works, I see the evidence of it everyday in my clinic. Children who couldn’t walk, walk, children who couldn’t sit, sit, children who were hunched over, stand tall. This might be nice theory but it fails the real world test.”

Actually, the failure is the lack of ability to distinguish between maturation (the act of children maturing, growing up) and the intervention. The proliferation of manual facilitation techniques is rooted in the 1950’s. The reason why it has taken so long to convince practitioners to move on from NDT, CME and Vojta is because practitioners and families cannot tell the difference between maturation and the intervention.

Why is CME and DMI not widely adopted in adulthood? It’s because the results are often conflated with maturation, which has already occurred at this stage of (adult) life. Research, evidence, RCT’s and more give us confidence that the active ingredient in the intervention is responsible (or not). This gives us confidence to make claims - without research it is irresponsible.

Continued claims that this type of manual facilitation is different does not hold true. We know that this whole process has inherent drawbacks - the feedback loop gets interrupted - the child becomes dependent on assistance, there is a lack of motivation/intrigue by the client when actions are completed for them, not to mention the reports of fractures in manual facilitation techniques. Keep in mind, the patient is not making these rapid and uncontrolled movements, it is inherently more dangerous in vulnerable populations with neurological conditions and injuries. Reports by families that children are psychologically scarred due to the no pain no gain mentality - these are factors that are never discussed.

2. “DMI (founders and practitioners) not adequately consulted for balance”

Yes they were. The history of CME and DMI were thoroughly investigated and the creators and founders of these interventions were quoted directly for a balanced view.

3. “Current and planned projects not noted and DMI community not consulted”

Consultation with the community is not necessary - adding endless dialogue with practitioners who are not researchers nor are they prepared to go on record about scientific efficacy only delays publication and adds unnecessary complications for projects that are not confirmed.

4. “Researchers critiquing clinicians rather than asking why does the evidence not exist” “this is a problem for our patients and families”

The problem for families is that blanket claims are made without any scientific evidence, declaring that in the face of modern science and repeated debunking of manual facilitation in prior works (NDT, Vojta, CME etc) that this therapy is different.

Families and now clinicians are unable to tell maturation from efficacy as the studies do not show any evidence for this intervention. It takes families away from more effective treatments or expends much needed resources on less effective or ineffective therapies and interventions.

5. APA sums it up “not all evidence is worth reading just because it’s published” “Publication does not imply absolute truth”

This is a lazy misrepresentation of the paper. We go through a vigorous peer review process, consulted with industry leaders and was authored by renowned experts in the field. This paper is of the highest quality and standard.

6. “Did not review all the available evidence because you did not consult the DMI community”

The DMI / CME founders were consulted. Just because the finding does not meet your expectation does not mean this did not occur. This a lazy mischaracterisation.

7. “Made up your own judgment and are heavily biased”

On the available evidence on manual facilitation techniques and where the evidence points in regards to neuroplasticity, it is a reasonable and logical conclusion. As for bias, the main critique of this paper highlights the bias for any intervention that is closed source, does not publish its protocols and that clinicians use as a very lucrative revenue stream. The bias is almost solely at the feet of those that critique this paper without reservation.

8. “Lack of evidence is not evidence of lack of efficacy”

This is a catchphrase that makes no sense. It literally applies to everything. Saying that 2 bananas a day improves neuroplasticity fits this phrase - as one that you cannot prove is ineffective. It is reliant on good ethical practice that you must prove your claims when you promote its efficacy and train thousands of others to do the same. Not being able to prove inefficacy is not the same as proving efficacy.

9. “You are hiding behind a brand X (declaring ulterior motives)”

Researchers must state their bias, conflicts of interest - The DMI claims that they have no bias, complete efficacy and full adherence of scientific standards is marred by an allegiance to a commercial product that cannot prove any of these factors - it is solely based on anecdotal evidence. There are conflicts of interest on the DMI side - which are never acknowledged.

10. “We want support from the research community. You should be genuinely interested in asking what is the clinical efficacy of DMI compared to standard care.”

You wish for a commercial intervention (for-profit endeavour) to be supported and underwritten by non profit education and tertiary institutes to prove the claims of entrepreneurs that failed to do the research themselves and actively promote an intervention without any scientific evidence?

11. “A big jump was made calling for de-implementation”

It is a small but logical case that all previous forms of manual facilitation techniques are failing the evidence test - from Vojta, NDT, CME to DMI, they all exhibit the same intrinsic issue that the movements are done for the patient rather than finding ways for self initiation. The interventions have been taking credit for maturation.

12. “Why would you make such bold and accusational claims without all the facts, thoughts,

plans and ideas of DMI practitioners - or at least take a course or sit in on a joint session.” We would go through this process every time that someone comes up with another variation of the same manual facilitation methodology. It is intrinsically flawed in the same way.

13. “You should be more inquisitive”

Researchers devote their time and effort in being inquisitive. This is why we have found better and more effective ways to intervene for children. The evidence points away from manual facilitation.

14. “If there was genuine interest in understanding DMI then more dialogue would have taken place - talking to the DMI practitioners and families that witness real change.”

The issue at hand is that perceived change and gains are not correctly attributed to the intervention. Without being able to identify the active ingredients scientifically, it cannot be attributed to the intervention. Maturation - the child simply growing up is a huge part of why interventions can never be taken at face value. Even when a task or skill is newly gained, it is strict scientific protocols and standards that allow you to give attribution (or not) to the intervention.

15. “You choose to criticise without trying to understand why there aren’t published studies.”

DMI is founded on half a century of CME - the same critique of CME applies to DMI. If it is so new (“only 2 years old”), it is irresponsible to teach this to thousands of clinicians and clinics across the globe without a study of efficacy, of adverse events (which we know occur) and none of this is recognised nor discussed. It is dangerous and unethical.

16. “The paper is exactly what the APA summarises that not everything that gets published reflects clinical reality. Don’t attack clinicians that are achieving results rather than collaborating to build the missing evidence.”

This is a lazy misrepresentation of the APA stance. The APA's "Choosing Wisely" advises appraising all research critically, not dismissing challenges. Their post: "Not all published research is equal—separate robust from fluff" aligns with Paleg et al. for promoting high-value care. It's all about accountability.

17. “DMI is a completely different approach - it integrates task oriented training, family centred care, high intensity practice - using electrical stimulation and whole body vibration - all with strong scientific evidence.”

DMI is founded on the basis of CME with a heritage spanning back 50 years - the claims of task oriented training, high intensity practice, whole body vibration - none of this is evidentiary. There are no protocols, no standard that is subject to scrutiny. This wholly different to a peer review process with strict analysis and standards.

18. “if you read the paper the authors admit they don’t understand how so many clinicians seek DMI training despite the lack of published studies. Lack of studies is not evidence of inefficacy.”

Nice catchphrase that means very little. It rings true for any and every non science based tool. Given that the research community is adamant that we have moved beyond manual facilitation techniques, it is genuinely puzzling that clinicians choose DMI training due to anecdotal evidence that relies on ambiguity from a maturation point of view as it is never taken into account. Also a lack of evidence for adverse events is a concerning omission.

19. “those of us who work with children every day see the progress with our own eyes, measurable functional changes”

This is wholly in dispute - if you do not have the scientific evidence, you do not have the standards and protocols to differentiate between maturation and efficacy.

20. “the growing global interest in DMI should not be dismissed - it should be seen as opportunity for researchers to conduct studies - only then can we have a fair discussion not before”

It is an opportunity for the DMI/CME community to prove their claims. Until that time, the anecdotal evidence does not form a strong enough argument for efficacy. Requiring researchers to support the claims of a closed commercial product is patently absurd. We are not dismissing the spread of DMI and find it greatly concerning that without scientific evidence it has become a defacto standard for intervention - and especially in light of potential adverse effects, it is wholly irresponsible.

21. “while evidence is important, so is the curiosity, open mindedness and respect for the individuality of each child”

This is a lazy mischaracterisation of the intentions of the research community. It may be time better spent if the DMI community refrain from libeling researchers who have no vested commercial interest in DMI - they are just seeking the truth.

22. “bias exists and its worrying that researchers choose to attack professionals who are producing results rather than collaborating to build the missing evidence”

It is not our responsibility - it is the responsibility of clinicians to use the most effective means at their disposal. The research community offers an insight into the future of neuroplasticity and because it requires a re-think of decades held beliefs about manual facilitation, it dismissed by those that advocate for the status quo.

Consider your own bias in holding on to those beliefs that only DMI provides a comprehensive intervention for all neurological conditions and injuries, despite the lack of evidence.

23. “its concerning to see Paleg et al criticising DMI, CME, Therasuit without ever being trained. Critique without a foundation in knowledge or practice do not advance science or patient care. Families witness meaningful gains every day, theory cannot dismiss this”

Researchers cannot simply revisit the same tired ground - disproven theories and debunked methodologies every time that someone comes up with a variation on the same theme. You are choosing not to look at the future of therapy because of an allegiance to the old way of doing things. Critique is a normal part of science - it is not optional, it is essential.

24. “clinical experience and practical outcomes with DMI demonstrate a value that articles like this cannot disprove”

Evidence based practice is fundamentally based on the premise of the best available evidence. The clinical expertise and the values of the patient are vital components that rely upon the best available evidence. We provide evidence, you provide anecdotes - they are different things. Only one of these provides peer reviewed scientific evidence of the highest standards.

25. “DMI is better than what Dr Paleg is doing, sitting on a chair criticizing those that are making it happen”

This is a lazy mischaracterisation of Dr Paleg. She has devoted her entire professional life in the community and contributing to the field in research. Critique is a necessary part of advancing the field. Never challenging sacred cows is not how we advance the field. This is a personal attack that has absolutely no basis.

Dr Paleg has taken the time to learn, explore, consult, communicate, challenge and redefine the field. From personal exploration of non evidence based interventions to contributing to new understandings in the field, she has exhibited great curiosity and the highest of integrity and ethics in her work, both clinically and in the field of research.