Named approach
MAES therapy
Mobilisation of Awareness, Exploration and Strategies
Theoretically the most modern of the named approaches — it is built on current motor-learning thinking — and the one with the least published evidence, because it is also the newest.
Evidence is limited to laboratory work, animal studies, small uncontrolled series or single case reports. These can justify further research. They cannot tell you whether your child will benefit.
Origin. Developed by Marianne Hielkema, a paediatric physiotherapist, as a reaction against handling-led approaches; taught through postgraduate courses since the 2010s.
What a session looks like
- The therapist sets up a situation in which the child must work out a movement for themselves, and then deliberately does less rather than more.
- Handling is minimal and used to create a problem rather than to guide a solution. Long pauses are normal; the therapist waits while the child tries, fails and adjusts.
- Parents are coached to recognise and stop their own instinct to help, which is often the hardest part.
- Sessions tend to look unimpressive to an observer, because very little is being done to the child. That is intentional.
The reasoning behind it
The premise is that children with cerebral palsy develop a limited repertoire of movement strategies, and then rely on them because they work well enough.
Each time an adult completes the movement for the child, that repertoire is reinforced rather than expanded.
The therapeutic aim is therefore to interrupt the habitual strategy and create the conditions for the child to discover an alternative — awareness, exploration, new strategies.
This aligns closely with contemporary motor-learning science, which is the strongest thing that can be said for it.
What the evidence shows
- There are no published randomised trials. The approach is young, and its evidence base consists of case reports, course material and clinical reasoning.
- The underlying principles — active problem-solving, variability, reduced guidance — have good support in the wider motor-learning literature.
- Those are two different claims, and they should not be conflated. Sound principles do not guarantee that a particular packaged method delivers them better than good ordinary therapy.
The argument on each side
In its favour
- Theoretically coherent and consistent with how motor learning is currently understood.
- The child is unambiguously the active agent.
- It explicitly addresses something many families recognise — that helping too much can hold a child back.
Against it
- No controlled evidence at all.
- Requires a therapist skilled enough to judge when waiting is productive and when it is simply frustrating.
- Progress can be slow and hard to see, which makes it difficult for families to judge whether it is working.
Who it tends to suit
Families whose child has plateaued on a passive programme, and who are willing to tolerate sessions that look like very little is happening. The principles are sound; ask for the same goal-setting and review discipline you would demand of anything else.
Practical burden
- Trained therapists are uncommon outside a few countries.
- Lower physical burden on the child than provocative approaches, higher patience burden on the parent.
Questions to ask
- How do you decide when to intervene and when to let my child keep struggling?
- What is the goal, and what is the review date?
- What should I change in how I help at home?
Other approaches
Bobath / NDT
The most widely taught approach in the world, and the one whose evidence has been examined most closely. It has not been shown to outperform goal-directed therapy of the same intensity.
Early research onlyMEDEK / CME
A deliberately provocative, gravity-based approach that draws strong loyalty from families and has almost no controlled evidence behind it.
Early research onlyAnat Baniel Method
Gentle, attention-focused movement work with a clear conceptual framework, a devoted following, and no controlled trial evidence of functional benefit in children.
Early research onlyVojta therapy
Pressure applied at defined body points to trigger whole-body movement patterns. Long-established in some countries, little tested, and the child's distress is a serious part of the discussion.
In clinical trialsConductive education
An education-based, whole-day, group model rather than a therapy technique — and one of the few named approaches with a reasonable body of comparative study behind it.
Not supported by evidencePatterning
The one approach on this site that has been tested, rejected, and formally advised against — repeatedly, over more than fifty years.