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

Abstract

The purpose of this article 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 that 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.

Conflict of interest statement

Declare no conflicts of interest

Figures

Figure 1

Path model for dosing interventions for children with cerebral palsy. Emphasis on the type, dose, age, plasticity of muscle, bone, and brain, and performance in everyday life. (reprinted with permission Gannotti ME, Christy JB, Heathcock JC, Kolobe TH. A path model for evaluating dosing parameters for children with cerebral palsy. Physical Therapy. Mar 2014;94(3):411–421.)

Figure 2

Path model abbreviated for harnessing plasticity driven interventions and age at time of intervention

Figure 3

Path model abbreviated for participation driven interventions and age at time of interventions