Coupling Timing of Interventions With Dose to Optimize Plasticity and Participation in Pediatric Neurologic Populations

Abstract

The purpose of this paper is to propose that coupling of timing of interventions with dosing of interventions optimizes plasticity and participation in pediatric neurologic conditions, specifically cerebral palsy. Dosing includes frequency, intensity, time per session, and type of intervention. Interventions focus on body structures and function and activity and participation, and both are explored. Known parameters for promoting bone, muscle, and brain plasticity and evidence supporting critical periods of growth during development are reviewed. Although parameters for dosing participation are not yet established, emerging evidence suggests participation at high intensities has the potential for change. Participation interventions may provide an additional avenue to promote change through the life span. Recommendations for research and clinical practice are presented to stimulate discussions and innovations in research and practice.

Stepping Up to Rethink the Future of Rehabilitation: IV STEP Considerations and Inspirations

“…34,35 In addition to the promotion of skilled movement, physical activity and exercise interventions are beneficial for premature infants. Exercise that benefits bone health can begin in the neonatal intensive care unit within days after birth.…”

GEARing smart environments for pediatric motor rehabilitation

“…Exposure during infancy is optimal, as the major developmental milestones and the majority of brain changes occur during the first two years of life [9][10][11]. Training in enriched environments can lead to experience-dependent brain and behavioral changes; at the same time, high-dose training increases the potential for change [12][13][14]. In animal studies, environments are enriched with inclined surfaces and objects to promote variability in the motor repertoire.…”

Toward Evaluation of The Subjective Experience of A General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability

“…[3] Current gait-therapeutic options for children with CP are insufficient to provide consistent and adequate stretching and strengthening of the muscles that cause walking disorders. [4,5] Targeting key muscles in the ankle is critical to gait remediation, [6][7][8][9] but treatment best practice often requires extensive bracing or complex constraint mechanisms. [10] As a result, intervening to stretch and strengthen key muscle groups currently requires time-intensive, in-clinic therapies as well as an intensive home exercise regimen to provide an optimal program for improving gait.…”

“…[10] As a result, intervening to stretch and strengthen key muscle groups currently requires time-intensive, in-clinic therapies as well as an intensive home exercise regimen to provide an optimal program for improving gait. [5,11,12] Compliance is difficult to maintain and children often do not receive the level of care needed. [13,14] The challenge optimal intervention presents, both in terms of clinic scheduling and travel time on the part of the child and family/caregiver, could be lessened through leverage of a home-based robotic platform that delivers stretching and strengthening exercises in proper form, at frequency and intensity most appropriate to the child with CP.…”