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. Author manuscript; available in PMC: 2023 Jul 1.
Published in final edited form as: Pediatr Phys Ther. 2022 Jun 1;34(3):411–417. doi: 10.1097/PEP.0000000000000912

Research Summit V: Optimizing transitions from infancy to early adulthood in children with neuromotor conditions

Barbara Sargent 1, Regina Harbourne 2, Noelle G Moreau 3, Theresa Sukal-Moulton 4, Melissa Tovin 5, Judy L Cameron 6, Richard D Stevenson 7, Iona Novak 8,9, Jill Heathcock 10; Participants from RSV
PMCID: PMC9250600  NIHMSID: NIHMS1799273  PMID: 35653258

Abstract

Purpose.

The purpose of this executive summary is to review the process and outcomes of the Academy of Pediatric Physical Therapy Research Summit V, “Optimizing transitions from infancy to young adulthood in children with neuromotor disabilities: biological and environmental factors to support functional independence.”

Summary of key points.

An interdisciplinary group of researchers, representatives from funding agencies, and individuals with neuromotor disabilities and their parents participated in an intensive 2.5-day summit to determine research priorities to optimize life transitions for children with neuromotor disabilities. Recommended priorities for research included: (1) Promoting self-determination and self-efficacy of individuals with neuromotor disabilities and their families, (2) Best care at the right time: evidence-based best practice care, led and navigated by families seamlessly across the lifespan, (3) Strengthening connections between developmental domains to enhance function and participation, and (4) Optimal dosing and timing to support adaptive bone, muscle, and brain plasticity across the lifespan.

Introduction

In 2019, the Academy of Pediatric Physical Therapy held Research Summit V, “Optimizing transitions from infancy to young adulthood in children with neuromotor disabilities: biological and environmental factors to support functional independence.” Since 2004, the Academy of Pediatric Physical Therapy has sponsored interdisciplinary research summits every 3 to 4 years to foster pediatric physical therapy research on high priority topics.1,2 To identify the topic for Research Summit V, the Academy of Pediatric Physical Therapy surveyed its members to identify research topics of importance to the profession. The Planning Committee for Research Summit V then reviewed membership feedback as well as the high priority research areas from the National Center for Medical Rehabilitation Research (NCMRR) of the National Institutes of Health (NIH). Rehabilitation across the lifespan with an emphasis on key lifespan transitions emerged as a high priority area for research in children with neuromotor disabilities.

The aims of Research Summit V were to:

  1. Provide a forum for pediatric physical therapy researchers and other researchers (basic-, neuro-, movement-, biologist, engineers, and clinical scientists) to critically appraise and assimilate current and emerging knowledge on biological factors, environmental factors, and innovative approaches for optimizing transitions for children and young adults with neuromotor disabilities.

  2. Facilitate collaborations, information exchange (cross-fertilization), and networking among physical therapists, other investigators, consumers, and funding agencies to identify gaps in knowledge and research opportunities.

  3. Foster a critical debate and establish research priorities for next generation innovations for intervention and/or mechanistic research proposals.

  4. Support the development of interdisciplinary, large scale or multisite research proposals led by pediatric physical therapists.

Significance of Lifespan Transitions

Optimizing the quality of life and societal participation of children with neuromotor conditions is a high priority of individuals, families, and professionals. Children with neuromotor disabilities and their families have unique and identifiable vulnerabilities during life transitions in, for example, models of care (e.g. home to school), transitions in physical growth and development (e.g. growth spurts during puberty), and transitions in medical care (e.g. child to adult health care services) which can have profound negative impacts on a child’s functional independence over the lifespan and may have additional cascading effects on other domains such as cognition, language, or behavior. Identifying these transitions and providing appropriate intervention and support may improve the quality of life and societal participation of children with neuromotor conditions.

There are several critical transitions across the lifespan for children with neuromotor conditions, including the transition from the Neonatal Intensive Care Unit (NICU) to home, the transition from home to preschool, the transitions from preschool to elementary to middle to high school, and the transition from high school to adulthood including post-secondary education, employment, community living, and adult health care services (Figure 1A). The Planning Committee for Research Summit V acknowledged these critical transitions and sought to explore underlying themes across the transitions.

Figure 1.

Figure 1

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A: Transitions across the life course for children with neuromotor disabilities. Figure 1B: Optimizing transitions across the life course requires continuous support in four priority areas: promoting self-determination and self-efficacy; strengthening connections between developmental domains to promote participation; providing the best care at the right time, and providing optimal dosing and timing to support adaptive bone, muscle and brain plasticity.

Organization of Research Summit V

On October 18 to 20, 2019, Research Summit V participants met to advance the science related to: Optimizing transitions from infancy to young adulthood in children with neuromotor disabilities. The planning committee purposefully invited a diverse group of scientists based on area of expertise, publications, and grant funding from the fields of genomics, muscle physiology, neuroscience, neonatology, physical activity, language, healthcare transition planning, post-secondary employment, and data analysis. Pediatric physical therapists applied and were selected based on their current research agenda and potential for successful transition-themed research activities. Invited funding agencies and individuals with neuromotor conditions and their parents shared information and insights during 2 panel discussions. The planning committee facilitated 3 small group discussions and Dr. Iona Novak facilitated a large group discussion to summarize each discussion session (Supplemental Digital Content)

Proceedings

The proceedings included summary statements of presentations and discussions from Research Summit V (Figure 2). In the keynote address titled, “Building a Healthy Brain! Early Brain Neural Plasticity,” Dr. Judy Cameron elucidated the evidence on the influence of environmental experience on brain development both during early childhood and later in life with specific focus on critical periods and timescales that support transitions. She underscored the inter-connectedness of brain areas, the importance of building brain architecture early in life that supports lifelong learning, and the role of social systems in supporting sturdy brain development and building resilience. In the keynote address titled, “Ensuring Children with Cerebral Palsy Grow Up Healthy, Happy, and Strong,” Dr. Richard Stevenson emphasized that environmental experience influences physical growth, bone and muscle development, and the potential for chronic pain. He underscored the importance of nutrition, sleep, and physical activity in supporting the growth and maturation of bone and muscle, and strongly advocated preventing and managing chronic pain to optimize health and well-being.

Figure 2.

Figure 2.

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Structure of Research Summit V.

A panel of consumers, including an adult with cerebral palsy and his mother and the mother of a child with cerebral palsy, described lived experience challenges in life transitions. When asked what transition was most difficult, one parent voiced challenges about the transition from home to preschool because the child was required to change their form of mobility from a walker to power mobility to fully participate in school, especially the walk from the bus to the school. The other parent experienced challenges in the transition from elementary to middle school because their child needed more autonomy and age-appropriate fitness activities. The adult with cerebral palsy experienced challenges in the transition from high school to community due to difficulties hiring reliable personal care assistants who consistently showed up for work. The consumers also expressed challenges underlying all transitions, including the need for coordination among medical providers, mental health support for the entire family, and resources to support parents as care navigators.

Funding agency representatives described current grant opportunities, challenges, and desired areas of focus for rehabilitation research on transitions. The National Center for Special Education Research (NCSER) representative expressed interest in proposals on investigating the efficacy of interventions, validating tests and measures, and the cost effectiveness of strategies for children birth to 21 years and their readiness to succeed in school. The NIH National Institute of Child Health and Human Development (NICHD) representative expressed interest in proposals investigating multi-modal interventions, more responsive outcome measures for rehabilitation, and health services research on the transition from adolescence to adulthood. The StrokeNet representative from the NIH National Institute of Neurologic Disorders and Stroke (NINDS) expressed interest in proposals on good small, single center studies, but also on large, multi-center studies to influence clinical practice. Using several categories of funding, NICHD and NINDS work toward funding adequately powered studies that may require several smaller grants before the larger federally-funded study. The Foundation for Physical Therapy Research provides grants including a specific grant for pediatric physical therapy research that may provide funding for pilot work that can be used to support a larger federally-funded study.

Each researcher provided a short presentation of work and identified gaps in the literature. Researchers discussed the importance of (1) promoting self-efficacy and providing the resources necessary for individuals with neuromotor disabilities and their families to make informed decisions about intervention and lifelong fitness programs; (2) supporting individuals with neuromotor conditions and their families to navigate critical transitions including the transition from the Neonatal Intensive Care Unit (NICU) to home, the transition to adulthood, and aging with a lifelong disability; (3) developing interventions that impact multiple domains and will have cascading developmental effects; (4) providing targeted intervention during critical periods when it is expected that the child will be most responsive to change; and (5) developing responsive outcome measures to quantify change with intervention.

During the small and large group sessions, participants worked from iterative dialogue toward consensus on research priorities. The first small and large group activity considered how physical therapy can best address critical periods: (1) during typical and atypical growth and development, focusing on brain, muscle and bone; (2) linking brain activity to behavior; and (3) developmental transitions from infancy to early adulthood. The second activity identified the research gaps to support successful transitions from NICU to home, home to preschool, preschool to elementary to middle to high school, and from high school to adulthood, considering the critical determinants of successful transition in terms of the neurological system, musculoskeletal system, cardiopulmonary system, and psychosocial and physical environments. The third activity focused on the development of specific, interdisciplinary research proposals on the following topics: (1) NICU to home transition; (2) physical activity as a gateway to participation across the lifespan; and (3) optimal intervention periods to capitalize on adaptive plasticity of bone, muscle, and brain. From these three activities, 4 research priorities emerged which are summarized in the next section and in Figure 1B. These research priorities were essential components of all transitions, including the transitions from NICU to home, home to preschool, preschool to elementary to middle to high school, and from high school to adulthood, including post-secondary education, employment, community living, and adult health care services.

Outcome of the Summit: Recommended Priorities for Research

Priority #1:

Promoting self-determination and self-efficacy of individuals with neuromotor disabilities and their families.

The psychosocial concepts of self-efficacy and self-determination inform family-centered pediatric care and can guide successful transition across the life course, regardless of type and level of disability. Although distinct, the terms can be confusing and are often used interchangeably. Self-efficacy, or confidence in one’s ability to successfully complete tasks, influences behaviors related to goal setting, effort toward attaining goals, and goal achievement.3 Self-determination, defined as the ability to make choices, solve problems, set goals, evaluate options, take initiative to reach goals and accept consequences of one’s own actions, is critical to quality-of-life satisfaction.4 Self-efficacy and self-determination are interrelated constructs, and together contribute to a child and/or family’s capacity to meet current and future needs and achieve their potential for independence and life satisfaction.5

Self-determination theory and intervention within school curricula has been well studied in children with typical and atypical development.6–11 The United States Department of Education recognizes self-determination as an important outcome, funding multiple initiatives for instructional intervention designed to promote self-determination.12 There is evidence that embedding choice-making opportunities, problem-solving activities, goal setting and attainment, planning, self-management, self-advocacy, self-awareness, and self-knowledge in special education settings can positively impact self-determination for children with varied disabilities.6 Moreover, findings from numerous studies support self-determination interventions in the context of transition planning to prepare students to make purposeful decisions and choices in post-secondary settings.6,13,14

Physical therapy intervention often focuses on building capacity, supporting activity performance, and modifying the environment to optimize function and participation. While these are important, there is a lack of research on strategies to effectively promote self-determination in the context of physical therapy intervention and home programs.15 This can include giving children choices in physical therapy service delivery, including the type, content, dose, and context of intervention.

Self-efficacy theory has been applied to pediatric healthcare topics including disease management of adolescents with sickle cell disease16 and exercise of children in middle school.17 It has not been widely applied or studied in pediatric neuromotor disability.

Recommendation #1:

Develop and investigate programs and specific strategies to promote self-determination and self-efficacy of children with neuromotor disabilities and their families.

  • Identify existing evidence related to physical therapy related intervention (movement opportunity, activity performance) to promote self-determination and self-efficacy for children with neuromotor disabilities and their families. This can include scoping or systematic reviews to summarize and synthesize prior study findings, determine research gaps, and provide direction for research.

  • Investigate the impact of physical therapy intervention (e.g., movement opportunity, physical activity) on self-determination and self-efficacy for children with neuromotor disabilities and their families.

  • Develop and investigate effective strategies to promote self-determination (e.g. choice-making opportunities, problem-solving activities, goal setting and attainment, planning, self-management, self-advocacy, self-awareness, and self-knowledge) that can be embedded in physical therapy interventions and/or service delivery.

  • Determine optimal timing (e.g., key points of transition) and dosing for movement interventions incorporating self-determination and self-efficacy strategies for children with neuromotor disabilities and their families.

Priority #2:

Best care at the right time: evidence-based, best practice care, led and navigated by families seamlessly across the lifespan.

Children with or at high risk of neuromotor disabilities and their families often require specialized medical care, ongoing monitoring, and anticipatory guidance throughout childhood and into adulthood to optimize functional outcomes. Throughout their child’s life, parents face the challenging burden of determining their child’s needs, the best resources to meet these needs, and how to access needed resources. This is particularly challenging during critical transitions, such as the transition from the NICU to home, the transition from home to preschool, the transitions from preschool to elementary to middle to high school, and the transition from high school to adulthood, including post-secondary education, employment, community living, and adult health care services. The changes in environmental factors such as philosophy of service provision, service providers, location of services, and funding of services all contribute to the added stress and vulnerability experienced by families during these critical transitions. Current rehabilitation research focuses on how to best support children and their families as they navigate the transition from NICU to home with early intervention18 and the transition from pediatric to adult rehabilitative services,19,20 however, this research is in its early stages. Research on the transition from home with early intervention to preschool and the many transitions from preschool through high school is present in the educational literature,21 but is almost non-existent in the rehabilitation literature.22 Further rehabilitation research on how to best support children with neuromotor disabilities and their families to navigate critical transitions is needed.

Recommendation #2:

Develop and investigate programs to support children with neuromotor disabilities and their families to successfully navigate critical life transitions.

  • Develop and investigate the efficacy of continuity of care programs among service providers to assure that the child and their family have been referred to the next service provider and are receiving appropriate rehabilitative services.

  • Develop educational or coaching programs and resources to provide anticipatory guidance and support the child and their family on the next critical transition in a way that is easily accessible and provides the support necessary for them to access appropriate services. This can include web-based resources that can be accessed from a smart phone or computer but may also include individual or group support programs when the transition is more complicated and requires changing funding sources or providers, such as the transition from early intervention to preschool or the transition from child to adult services and providers.

  • Investigate the efficacy of intensive bouts of rehabilitation before or after a critical transition to support the child and family in successfully navigating the transition. This may be particularly useful in the many transitions from preschool through high school and the transition from high school to adulthood which may require progressively higher levels of functional independence.

Priority #3:

Strengthen connections between developmental domains to enhance function and participation.

Traditionally, developmental domains, such as language, cognition, emotion, and motor have been studied separately under the assumption that they develop relatively independently of one another. Pediatric physical therapy research has followed this trend with most interventions focused on only the motor domain. However, recently there is a much stronger appreciation that developmental domains are strongly interrelated and that skills in one domain can scaffold and influence skills in other domains through experience.23–25 For example, the emergence of independent walking precedes an increase in language skills, that may be due to parents implicitly providing richer language opportunities to infants who walk versus crawl.26 Evidence is also emerging that interventions that support multiple domains may be more effective than interventions targeting a single domain for developmental advancement.27,28 A focus solely on motor skills for individuals with neuromotor conditions is not supported by current neuroscience or developmental science because of the interdependence of brain areas and the pathways routing information within functioning brain architecture. The challenge for researchers is to document how changes in one domain influence another domain and how motor intervention can impact other domains for children with neuromotor conditions over time. Current rehabilitation research has documented some developmental cascades for children with neuromotor conditions and investigated how motor intervention can impact other domains, but developmental cascades between areas are under-studied in older children and young adults.

Recommendation #3:

Investigate the interrelationship of developmental domains for children with neuromotor disabilities and how this can be harnessed to optimize function and participation.

  • Investigate the relationship of motor development with other skill areas for children with neuromotor conditions. Intervention studies targeting the motor system should not study motor gains in isolation but should consider intervention and measurement of other domains as outcomes, such as language, cognition, social, and behavior.

  • Conversely, developmental conditions that are not movement disorders, for example, autism spectrum disorders, should be studied to determine how other developmental domains may drive or interact with the motor system.

  • Studies of developmental intervention, particularly those occurring in transitional time periods (e.g., NICU to home, home to school, high school to adulthood) should be multi-factorial and consider outcomes that will enhance learning by harnessing the inter-dependence of the motor system with other domains (e.g., cognition, sensory, language, social, overall health), as well as the multiple spheres of influence (e.g., family, school, community).

  • Longitudinal studies should be encouraged as the strongest design to capture developmental change and the factors that connect and drive not only the motor system, but also other systems, including cognition, that are critical for overall functional success and societal participation as the child becomes an adult.

Priority #4:

Optimal dosing and timing to support adaptive bone, muscle, and brain plasticity across the lifespan in children and young adults with neuromotor disabilities.

Optimal timing of interventions targeting specific tissues is critical for development of healthy bone, muscle, and brain architecture. The first few years of life is the optimal period for developing and strengthening brain circuity responsible for sensory and motor development via use-dependent plasticity.29–31 For bone, childhood is the optimal time for developing bone architecture, prior to reaching peak bone mineral mass at 25 to 30 years of age.32 Childhood and adolescence are also the optimal periods to begin building strong muscles as muscular strength, similar to bone, peaks in early adulthood and then slowly declines.33,34 However, in those with neuromotor disabilities such as cerebral palsy, trajectories may differ. For example, in cerebral palsy, muscle strength peaks earlier in adolescence and is accompanied by ambulatory and functional decline in early adulthood.35,36 This further emphasizes the importance of intervening during this critical period of childhood and pre-adolescence to alter the trajectory of declining strength and functional decline that is known to be the natural trajectory of cerebral palsy. It should also be emphasized that even if a critical period for intervention has passed, bone, muscle, and brain architecture are capable of adaptive plasticity across the lifespan.37–39

In addition to the timing of intervention, the optimal dosing for interventions differs depending on the target tissue. Dosing parameters for interventions targeting bone, muscle, and brain architecture are well established in the typically developing population. However, identifying the optimal dosing and key ingredients for children and young adults with neuromotor disabilities is still in its early stages.2 For example, is the strain magnitude that is necessary to elicit a change in bone architecture in a typically developing child the same for that of a child who does not walk and with cerebral palsy? How many repetitions of a motor skill task are necessary to strengthen neural pathways in a child with a brain injury? The answers to these questions are largely unknown. In summary, despite the fact that the fundamental physiological principles of bone, muscle, and brain plasticity are well established, more research in children with neuromotor disabilities is needed with regards to both the optimal dosing and the optimal timing for intervention during critical periods. Long-lasting adaptive changes in bone, muscle, and brain architecture will ultimately lead to improved activity and participation in daily life.

Recommendation #4:

Investigate optimal dosing and timing to support adaptive bone, muscle, and brain plasticity across the lifespan in children and young adults with neuromotor disabilities.

  • Determine optimal dosing, key ingredients, and timing of delivery of interventions for muscle, bone, and brain plasticity for children and young adults with different functional and ability levels across the lifespan (For whom, what, and how much?)

  • Develop multi-modal interventions that target multiple tissues (bone, muscle, and brain) during critical periods across the lifespan that are centered around individualized, personal goals to improve participation in meaningful life activities.

  • Longitudinal studies to document trajectories of bone, muscle, and brain architecture across the lifespan for individuals with specific neuromotor disabilities.

  • Investigate long-lasting lifestyle changes that emphasize physical activity and exercise to support optimal bone, muscle, and brain architecture to positively impact function and participation across the lifespan

Conclusion

Research Summit V was conducted as the first step in addressing questions regarding transitions through the lifespan and research needs for children with neuromotor disabilities, including movement delays or disability. This paper summarizes the process and outcomes of the summit, with 4 focus areas recommended.

The overall consensus was that the multi-faceted topic of transitions through critical developmental time points requires both interdisciplinary investigations and interventions. Serving children and families by siloed models of care (school system, health system), disciplines and age-ranges potentially provides inadequate support for successful transitions through childhood to achieve adult self-efficacy and societal participation. To support successful life transitions for children with neuromotor conditions, multiple layers must be addressed both within the individual child and within the environmental framework supporting growth to adulthood. The findings from the summit reinforced the interdependence of systems and the importance of examining and addressing multiple areas simultaneously across developmental transitions, and with longitudinal research designs.

Supplementary Material

Supplemental Data File (.doc, .tif, pdf, etc.)

Grant support:

Research Summit V was supported by the American Physical Therapy Association Academy of Pediatric Physical Therapy. Barbara Sargent’s salary was supported by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under award number K12-HD055929 (PI: Ottenbacher), website: www.nih.gov. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Footnotes

Conflict of Interest statement: The authors declare no conflict of interest

References

  • 1.Christy JB, Lobo MA, Bjornson K, et al. Technology for children with brain injury and motor disability: executive summary from research summit IV. Pediatr Phys Ther. 2016;28(4):483–489. [DOI] [PubMed] [Google Scholar]
  • 2.Kolobe TH, Christy JB, Gannotti ME, et al. Research summit III proceedings on dosing in children with an injured brain or cerebral palsy: executive summary. Phys Ther. 2014;94(7):907–920. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215. [DOI] [PubMed] [Google Scholar]
  • 4.Palmer S, Wehmeyer M, Shogren K. The development of self-determination during childhood. In: Wehmeyer M, Shogren K, Little T, Lopes S, eds. Development of Self-Determination through the Life-Course. Springer, Docityrdrecht; 2017. [Google Scholar]
  • 5.Bergqvist L, Öhrvall A, Himmelmann K, Peny-Dahlstrand M. When I do, I become someone: experiences of occupational performance in young adults with cerebral palsy. Disabil Rehabil. 2019;41(3):341–347. [DOI] [PubMed] [Google Scholar]
  • 6.Burke KM, Raley SK, Shogren KA, et al. A meta-analysis of interventions to promote self-determination for students with disabilities. Remedial Spec Educ. 2020;41(3):176–188. [Google Scholar]
  • 7.Ivey JK. What do parents expect?: A study of likelihood and importance issues for children with autism spectrum disorders. Focus Autism Other Dev Disabl. 2004;19(1):27–33. [Google Scholar]
  • 8.Field S, Hoffman A. The importance of family involvement for promoting self-determination in adolescents with autism and other developmental disabilities. Focus Autism Other Dev Disabil. 1999;14(1):36–34. [Google Scholar]
  • 9.Kingsnorth S, Rudzik AEF, King G, McPherson AC. Residential immersive life skills programs for youth with disabilities: a case study of youth developmental trajectories of personal growth and caregiver perspectives. BMC Pediatrics. 2019;19(1):413. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Wehmeyer M, Schwartz M. Self-determination and positive adult outcomes: a follow-up study of youth with mental retardation or learning disabilities. Except Child. 1997;63(2):245–255. [Google Scholar]
  • 11.White K, Flanagan TD, Nadig A. Examining the relationship between self-determination and quality of life in young adults with autism spectrum disorder. J Dev Phys Disabil. 2018;30(6):735–754. [Google Scholar]
  • 12.Algozzine B, Browder D, Karvonen M, Test DW, Wood WM. Effects of interventions to promote self-determination for individuals with disabilities. Rev Educ Res. 2001;71(2):219–277. [Google Scholar]
  • 13.Taylor WD, Cobigo V, Ouellette-Kuntz H. A family systems perspective on supporting self-determination in young adults with intellectual and developmental disabilities. J Appl Res Intellect Disabil. 2019;32(5):1116–1128. [DOI] [PubMed] [Google Scholar]
  • 14.Wehmeyer ML, Palmer SB, Williams-Diehm K, Shogren KA, Davies DK, Stock S. Technology and selfdDetermination in transition planning: The impact of technology use in transition planning on student self-determination. J Spec Educ Technol. 2011;26(1):13–24. [Google Scholar]
  • 15.Shogren KA, Turnbull AP. Promoting self-determination in young children with disabilities: the critical role of families. Infants Young Child. 2006;19(4):338–352. [Google Scholar]
  • 16.Crosby LE, Hood A, Kidwell K, et al. Improving self-management in adolescents with sickle cell disease. Pediatr Blood Cancer. 2020;67(10):e28492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Manley D, Cowan P, Graff C, et al. Self-efficacy, physical activity, and aerobic fitness in middle school children: examination of a pedometer intervention program. J Pediatr Nurs. 2014;29(3):228–237. [DOI] [PubMed] [Google Scholar]
  • 18.Kang SR, Cho H. Research trends of follow-up care after neonatal intensive care unit graduation for children born preterm: a scoping review. Int J Environ Res Public Health. 2021;18(6). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Levy BB, Song JZ, Luong D, et al. Transitional care interventions for youth with disabilities: a systematic review. Pediatr. 2020;146(5). [DOI] [PubMed] [Google Scholar]
  • 20.Campbell F, Biggs K, Aldiss SK, et al. Transition of care for adolescents from paediatric services to adult health services. Cochrane Database Syst Rev. 2016;4:Cd009794. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Fontil L, Gittens J, Beaudoin E, Sladeczek IE. Barriers to and facilitators of successful early school transitions for children with autism spectrum disorders and other developmental disabilities: a systematic review. J Autism Dev Disord. 2020;50(6):1866–1881. [DOI] [PubMed] [Google Scholar]
  • 22.Myers CT, Effgen SK, Blanchard E, Southall A, Wells S, Miller E. Factors influencing physical therapists’ involvement in preschool transitions. Phys Ther. 2011;91(5):656–664. [DOI] [PubMed] [Google Scholar]
  • 23.Cramer SC, Sur M, Dobkin BH, et al. Harnessing neuroplasticity for clinical applications. Brain. 2011;134(Pt 6):1591–1609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Adolph KE, Hoch JE. Motor development: Embodied, embedded, enculturated, and enabling. Annu Rev Psychol. 2019;70:141–164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Iverson JM. Developmental variability and developmental cascades: Lessons from motor and language development in infancy. Curr Dir Psychol Sci. 2021;30(3):228–235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.West KL, Iverson JM. Communication changes when infants begin to walk. Dev Sci. 2021;24(5):e13102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Harbourne RT, Dusing SC, Lobo MA, et al. START-Play physical therapy intervention impacts motor and cognitive outcomes in infants with neuromotor disorders: a multisite randomized clinical trial. Phys Ther. 2021;101(2). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Inguaggiato E, Sgandurra G, Cioni G. Brain plasticity and early development: implications for early intervention in neurodevelopmental disorders. Neuropsychiatrie de l’Enfance et de l’Adolescence. 2017;65(5):299–306. [Google Scholar]
  • 29.Greenough W, Black J, Wallace C. Experience and brain development. Child Dev. 1987;58:539–559. [PubMed] [Google Scholar]
  • 30.Paterson S, Heim S, Friedman J, Choudhury N, Benasich A. Development of structure and function in the infant brain: Implications for cognition, language and social behavior. Neurosci Biobehav Rev. 2006;30(8):1087–1105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Johnson MH. Functional brain development in humans. Nat Rev Neurosci. 2001;2:475–483. [DOI] [PubMed] [Google Scholar]
  • 32.Heaney RP., Abrams S, Dawson-Hughes B, et al. Peak bone mass. Osteoporos Int. 2000;11:985–1009. [DOI] [PubMed] [Google Scholar]
  • 33.Lloyd RS, Faigenbaum AD, Stone MH, et al. Position statement on youth resistance training: the 2014 International Consensus. Br J Sports Med. 2014;48(7):498–505. [DOI] [PubMed] [Google Scholar]
  • 34.Larsson L, Grimby G, Karlsson J. Muscle strength and speed of movement in relation to age and muscle morphology. J Appl Physiol Respir Environ Exerc Physiol. 1979;46(3):451–456. [DOI] [PubMed] [Google Scholar]
  • 35.Davids JR, Oeffinger DJ, Bagley AM, Sison-Williamson M, Gorton G. Relationship of strength, weight, age, and function in ambulatory children with cerebral palsy. J Pediatr Orthop. 2015;35(5):523–529. [DOI] [PubMed] [Google Scholar]
  • 36.Opheim A, Jahnsen R, Olsson E, Stanghelle JK. Walking function, pain, and fatigue in adults with cerebral palsy: a 7-year follow-up study. Dev Med Child Neurol. 2009;51(5):381–388. [DOI] [PubMed] [Google Scholar]
  • 37.Lu L, Mao L, Feng Y, Ainsworth BE, Liu Y, Chen N. Effects of different exercise training modes on muscle strength and physical performance in older people with sarcopenia: a systematic review and meta-analysis. BMC Geriatr. 2021;21(1):708. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Pinheiro MB, Oliveira J, Bauman A, Fairhall N, Kwok W, Sherrington C. Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act. 2020;17(1):150. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Ploughman M, Austin MW, Glynn L, Corbett D. The effects of poststroke aerobic exercise on neuroplasticity: a systematic review of animal and clinical studies. Transl Stroke Res. 2015;6(1):13–28. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplemental Data File (.doc, .tif, pdf, etc.)
NIHMS1799273-supplement-Supplemental_Data_File___doc___tif__pdf__etc__.pdf (84.5KB, pdf)

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