Opportunities for early intervention based on theory, basic neuroscience, and clinical science

Therapeutic approaches in the pediatric population have generally been less aggressive than those implemented for younger and older adults. Several factors contribute to this, starting with the challenge of engaging infants in the "goal" of therapy, their resistance to initiating behaviors that are uncomfortable or fatiguing, the desire to make therapy as functionally relevant as possible when many functional skills have yet to emerge, and residual history of outdated theoretical concepts. On the practical side of who will pay for this more aggressive approach, there is limited empirical evidence based on randomized controlled trials to convince third-party payers to fund more extensive services. This article outlines a theoretical perspective prominent in developmental science that argues not only for the importance of frequent bouts of functionally relevant activity on the self-organization of behavioral patterns, but also for the impact that should be expected from the use of rigorous interventions on underlying subsystems, such as neural organization, that support these outcomes. In order to propose some future opportunities for clinical research and application, examples from recent activity-based clinical studies are presented, along with theoretical principles, neuroscience, and other tissue science data concerning mechanisms that contribute to behavioral changes. One such opportunity is to increase the structured engagement of caregivers, guided by therapists, in administering well-defined activity intervention programs focused on the development of specific functional skills. Such an approach may be one of the few financially feasible options for generating sufficient therapy that adheres to principles for optimizing development of neuromotor control.