A Path Model for Evaluating Dosing Parameters for Children With Cerebral Palsy

Dosing of pediatric rehabilitation services for children with cerebral palsy (CP) has been recognized as a national priority. Establishing dosing parameters for pediatric physical therapy (PT) interventions is essential for informing clinical decision-making, health policy, and guidelines for reimbursement. The aim of this paper 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 PT 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 produce structural and behavioral changes. Because of this, 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 (e.g. age, level of severity, comorbidities, readiness to change, and 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 offered for conceptualizing dosing parameters for children with CP.

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