TABLE 1.

Case descriptions of children with neuromotor, developmental and chronic health conditions, illustrating the interactions of body structures and function for thermoregulation and sleep, with opportunities for therapeutic modification to activities and environments.

Child 1
6 yo Sam has cerebral palsy, with reflux, epilepsy and pain (related to muscle, joint and gastro-intestinal functions). He has severe movement impairment and cannot adjust his position, don/doff clothing or bedding or control his bedroom environment. He has a plastic mattress protector for incontinence. He has cushions in his bed, to support his body in a safe and comfortable position. He is restless and distressed before sleep. He cries out several times each night. His parents report that he is always hot and flushed, even on cold nights, with perspiration on his back and head. They are unsure how to help Sam be comfortable for sleep. They are very tired, and worried about his wellbeing.
Body functions affected	Activities affected	Opportunities for remediation of To factors through activities and environments
ANS, CVS, CNS, DS, M-SS, PNS, RS, SS, VS	Get in/out of bed adjust postures adjust clothing adjust bedding adjust lighting adjust To devices	Activities – warm or tepid shower or bath before bedtime Environments – socks or slippers before bedtime – high heat-capacity mattress or overlay – vapor permeable mattress protector – clothing and bedding made of thermoregulation material – temperature/airflow devices with timer settings – temperature/airflow devices with voice activation
Child 2
13 yo Hannah has autism, with gastro-intestinal pain, and anxiety. She has difficulty recognizing body cues of hot and cold, and has an aversion to many textures. She cannot tolerate socks or slippers. She has irregular bedtimes. Once in bed she can take 2–3 h to get to sleep. During this time, she becomes restless and agitated. She uses her iPad for calming/distracting activities. Because of delayed sleep onset she sleeps until late morning and becomes agitated when prompted to get out of bed. She frequently misses school.
Body functions affected	Activities affected	Opportunities for remediation of To factors through activities and environments
ANS, CVS, DS, ES, SS, VS	Recognize bedtime cues be calm before bedtime wear socks or slippers lie still, close eyes	Activities – warm or tepid shower or bath in the hour before bedtime – alternative to screens for calming/distraction before sleep Environments – heat pack in foot area of bed at bedtime – high heat capacity mattress or overlay – clothing and bedding made of thermoregulation material – open windows or doors, or cooling fans for airflow
Child 3
8 yo Eva has eczema. She frequently has flare-ups, causing her skin to feel hot and itchy. She finds this especially troublesome at night, and she frequently wakes and asks for parent attention. Her parents note that even when she doesn’t wake or call out, she appears very restless during sleep. She is often distressed and moody in the mornings, and needs prompts and support to eat her breakfast and get ready in time for school. Her teachers comment that she seems tired and inattentive at school.
Functions affected	Activities affected	Opportunities for remediation of To factors through activities and environments
ANS, CVS, IS	be calm before bedtime lie still, close eyes	Activities – tepid shower or bath in the hour before bedtime – relaxation techniques for calming before sleep Environments – socks before bedtime – high heat capacity mattress or overlay – clothing and bedding made of thermoregulation material – open windows or doors, or cooling fans for airflow

ANS, autonomic nervous system; CNS, central nervous system; CS, communication system; CVS, cardiovascular system; DS, digestive system; ES, endocrine system; IS, integumentary system; M-SS, musculo-skeletal system; PNS, peripheral nervous system; PVS, peripheral vascular system; RS, respiratory system; SS, sensory system; VS, vision system.