Article

Dosing of pediatric rehabilitation services for children with cerebral palsy (CP)
has been identified as a national priority. Establishing dosing parameters for
pediatric physical therapy interventions is critical for informing clinical
decision making, health policy, and guidelines for reimbursement. The purpose of
this perspective article is to describe a path model for evaluating dosing
parameters of interventions for children with CP. The model is intended for
dose-related and effectiveness studies of pediatric physical therapy
interventions. The premise of the model is: Intervention type (focus on body
structures, activity, or the environment) acts on a child first through the
family, then through the dose (frequency, intensity, time), to yield structural
and behavioral changes. As a result, these changes are linked to improvements in
functional independence. Community factors affect dose as well as functional
independence (performance and capacity), influencing the relationships between
type of intervention and intervention responses. The constructs of family
characteristics; child characteristics (eg, age, level of severity,
comorbidities, readiness to change, preferences); plastic changes in bone,
muscle, and brain; motor skill acquisition; and community access warrant
consideration from researchers who are designing intervention studies. Multiple
knowledge gaps are identified, and a framework is provided for conceptualizing
dosing parameters for children with CP.

Langue : ANGLAIS