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Teach Me Please! What is Dynamic Movement Intervention (DMI) Therapy?

If your child isn’t sitting, crawling, rolling, or walking as expected, a new “next level” physical therapy called dynamic movement intervention or DMI might help. Physical therapists (PTs) and occupational therapists (OTs) worldwide, along with other pediatric healthcare practitioners, use DMI to help children who experience delays in gross motor skills.

That means they struggle to master physical movements because their large muscle groups—arms, legs, and torso or trunk—are weak or have muscle tone issues, either too much or too little. DMI also improves fine motor skills, using small muscles in the hands and wrists. Sufficient trunk strength helps a child use small muscles to push, pull, or grasp.

You won’t find medical studies about DMI yet because it was only recently “founded” in 2021. But many healthcare professionals have seen it help children with certain types of challenges in addition to motor delays, including disorders associated with global developmental delays that affect speech, vision, or learning. It may help children with hypotonia or poor muscle tone and other symptoms associated with chromosomal abnormalities or genetic disorders, spinal cord lesions, or acquired brain injury.

The originators of DMI, pediatric PTs Jake Kreindler and Jo-Anne Weltman, say DMI has gained an enthusiastic following as children gain more independence with each DMI session. The two strive to share as much knowledge as possible and to expand the number of therapists who offer DMI therapy so more children can meet their expected milestones of development in how they play, learn, speak, act, and move.

Kreindler founded his practice, Get Your Baby Moving, on Long Island, New York, while Weltman founded her practice, SMILE Therapy for Kids, in Thornhill, Ontario. They also train therapists around the world.

The pair, with more than 50 years of combined experience, developed DMI to respond to families pleading for more help for their children. “We saw some deficits in how services were being conducted within traditional pediatric physical therapy,” says Kreindler.

Jake Kreindler with a toddler practicing DMI therapy
Credit: Jake Kreindler | Jake with a patient

Kreindler and Weltman consider the brain’s development alongside physical movement through utilizing effective techniques they and other therapists have used with hundreds of clients. By incorporating these techniques along with current research in pediatric physical therapy, they created DMI therapy.

By popular demand, in 2018, they began traveling the world to practice DMI, “and that’s when this therapy really ‘exploded,’” Kreindler says. “Children reached developmental milestones more quickly than with traditional therapy.”

If you wonder “how long” DMI might take to be effective, Weltman says every child and the severity of their condition is different. “Parents tell us their child reaches, or surpasses, their expected potential and milestones much faster than with other therapy,” she says.

“Intensives” can involve multiple sessions a day, versus typical one-hour sessions scheduled days or weeks apart. She’s seen children progress more quickly in an intensive than in six months of traditional, weekly therapy.

What to Expect with DMI

Kreindler says DMI may not be for every child, especially if they have fragile bones, hip dislocations or dysplasia, or certain degenerative diseases.

As a first step, your DMI therapist will complete a full evaluation of your child, including a medical history. They will perform assessments of range of motion, strength, and gross motor skills to observe what your child can do independently by themselves. Then they’ll review it all and map out a two-month plan. After the initial evaluation, sessions usually run 45 minutes, but hour-long sessions are common with many practitioners.

DMI therapy doesn’t just focus on moving body parts, Kreindler says, but on targeting the developing brain’s ability to make changes, also called neuroplasticity. “With DMI, those changes can be more efficient, stronger, long-lasting, and profound, not possible in other ways.”

Therapists make that happen in methodical and persistent ways, gradually exposing your child to gravity and weight bearing, which is different from traditional physical therapies conducted on the floor on a mat. DMI exercises often take place on a tabletop but can be done on the floor if your child’s abilities require that or if additional equipment is incorporated. “It’s a gravity-dependent world,” he says.

The therapist works alongside your child to encourage correct muscle use and strengthen balance and posture. A wide variety of exercises may be repeated as many as five times per session until therapists document better balance and function.

They support your child safely during an exercise, often at the ankles and not just the hips, to encourage more independent action, Kreindler says. Imagine a gradual progression of steps that teaches your child’s brain, “Yes, I can do this myself!”

Jo-Anne Weltman practicing DMI therapy with a young girl patient
Credit: Jo-Anne Weltman | Jo-Anne and patient

This all “seems to jump-start the brain and gets other sensory areas of the brain to connect,” Weltman says. It helps prevent possible future orthopedic problems and helps sharpen and quicken a child’s reflex responses.

She says DMI helps children become more alert and awake and more receptive to communication from others around them. Active stretching is also a part of DMI to improve range of motion—how far a joint can flex and extend.

What Are the Benefits of DMI?

Though every child and case is different, as is time commitment and outcome, both Weltman and Kreindler enthusiastically share reports of their results from DMI therapy.

Weltman shares a story about a 3-year-old girl who began DMI when she still wasn’t eating on her own and was using a feeding tube. A year after starting, she could sit independently, interact and play with others, and could be fed orally, she says.

A boy at 19 months old had been “cruising” on furniture, or walking while holding on to it, a stage between crawling and walking independently, says Kreindler. “He wouldn’t take his first step and was falling behind on milestones.” After his first DMI session, he walked across the room.

Another girl, with cerebral palsy and spastic quadriplegia, had done physical therapy since infancy for head control and a weak neck. DMI’s “opposite” approach, allowing limbs to move freely as the child sits and stands with support, helps her hold her head up well now, Kreindler says.

Lewie Wilson in DMI therapy
Credit: Ashley Wilson | Lewie Wilson

For registered nurse Ashley Wilson and her son, 17-month-old Lewie, in Missouri, DMI “flipped a light switch on in his brain and muscles, and his whole outlook changed,” she says. She took Lewie to Weltman’s clinic in October for a two-week DMI intensive, where they focused on core strength to benefit his scoliosis or sideways spinal curvature.

Lewie is diagnosed with Prader-Willi syndrome, a complex genetic condition that causes, among other symptoms, hypotonia and can make a child “floppy,” like a rag doll.

Born July 11, 2022, he spent 66 days in the neonatal intensive care unit (NICU) and later entered Missouri’s First Steps Program, an early intervention system for children from birth through 3 years with disabilities or developmental delays. Lewie began DMI at the Special Learning Center SKIP Clinic in Jefferson City, Missouri, with both a PT and OT who see Lewie two days a week. Work there initially began with holding his head up and transitioning from standing to sitting.

Wilson and her wife, Abbi, remain laser-focused on continuing Lewie’s DMI and supporting his growth journey. “We just want him to be able to run and play like his peers—to have a happy life.”

Further east in Westchester, New York, at 3.5 years old, Brett B., born 31 weeks premature with delays in gross and fine motor skills and speech, takes to DMI like a champ.

Mom Lisa knew she “had to get him moving independently,” and then she heard about DMI intensives. She started working with Weltman’s clinic in July 2022 and has completed her eighth trip, where she embraces the sense of community from parents and practitioners alike.

She says Brett does receive ongoing services from the New York’s Committee on Preschool Special Education, which includes PT without DMI, OT, and speech, but DMI has been the most effective therapy. Intensives are offered in Connecticut and New Jersey, but it’s a long drive, and she’s seen Brett get the most from the concentrated intensives.

“Progress has been amazing; he’s taking steps now and figuring out balance,” says his mom. “His body control is a world of difference. Now there’s no such thing as ‘I can’t do,’ and it’s all unbelievably inspiring and encouraging. I never thought I’d be able to walk hand-in-hand with my child.”

Why isn’t there research on DMI?

The American Physical Therapy Association told Rare Parenting that it has no official position on DMI at this time and notes that physical therapies are evidence-based in practice. Cassandra Ruff, DPT, NCS, a physical therapist certified in DMI therapy at NYU Langone’s Rusk Rehabilitation Center, explains that DMI is essentially only practiced in private clinics. “Hospital systems are hesitant to allow clinicians to practice DMI due to lack of research, or evidence-based practice,” she says.

The kinds of studies that hospitals want to see are challenging to design, particularly in children with severe neurological disabilities. That’s largely because there isn’t a stable pool of patient-participants, and each has a different set of symptoms and needs. It’s also difficult to outline what, exactly, it means for a therapy to “work” and pinpoint its effects when children are often undergoing multiple other treatments at the same time, says Ruff.

A lack of research-based evidence doesn’t mean that DMI isn’t worth trying. In fact, many parents sing its praises. If you do decide to try DMI, Ruff encourages you to ask your practitioner if your child might be eligible to enroll in any ongoing studies.

How to Find a Therapist and Determine DMI Costs

Just like the cost of other physical therapies, prices for DMI therapy vary depending upon location and practice or practitioner. You can find a therapist on Weltman’s and Kreindler’s DMI website under Registered DMI Practitioners listed by state. No matter the therapist, be prepared to be patient because DMI therapy is in high demand, and you may be waitlisted.

You’ll also see DMI certification levels, starting with Introductory Levels A, B, and C, and moving to Intermediate Levels A and B, then to Masters/Teachers Levels—the highest. For regular sessions, therapists certified at A or B are recommended, and for intensives, Levels C and above, says Weltman. DMI practitioners generally have a certification in PT or OT, though other pediatric health professionals such as kinesiologists, exercise physiologists, and doctors can take DMI courses.

Parents often ask to take classes, but it’s required they are first trained to make clinical decisions and understand the background and knowledge that licensed PTs and OTs take years to assimilate, Weltman says. You may be able to direct your child’s home program after completion of an intensive, Weltman says, and that’s recommended if you’re comfortable. Be sure to ask your practitioner about this. Kreindler says telehealth works well with this since “each exercise has a clear starting point and ending point.”

As for price, Rare Parenting found that the PT and OT cash rate for one session at NAPA Center in Los Angeles, Boston, Austin, Denver, and Chicago is $140. At Milestone in San Diego, two weeks, four days a week of intensive sessions cost $1,200. As for private sessions, in-home sessions can go up to $250 a session or more, depending on your practitioner’s qualifications and their location. Some practitioners, such as Kreindler, offer virtual consultations prior to booking sessions.

Variability exists with insurance, depending upon your state. It also depends on whether the clinic or practitioner accepts insurance, Weltman says. DMI therapy is considered physical therapy or occupational therapy, depending on the practitioner’s background. Sessions are sometimes paid directly by parents.

What is the Future of DMI?          

“Our primary goal is to make a difference in this world, to improve services for families, to support more accessibility and funding, and more research,” says Weltman. She and Kreindler also want to improve levels of therapist training.

Research can take years, and no long-term, evidence-based studies have been completed. But globally, DMI research continues in different stages of development.

The two want to make DMI available for children discharged from the NICU as part of their routine therapy program. They’d like to see more PTs and OTs being trained by universities since DMI is not currently part of pediatric coursework at the graduate or doctorate level, Kreindler says. They’re committed to providing the educational information from their vast archives that’s needed to fulfill that goal.


References and Further Reading

DMI official website, Parent Resources and FAQ

Center for Disease Control, Jun 2023, CDC’s Developmental Milestones

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