Focused assistance on the targeted functional areas is the key to recovery. (Hogan, Ulrich, Taub, etc.) However, treatment must be based on understanding how that injury results in a “undesired” movement pattern becoming the stable attractor. Opportunities must be presented and facilitated to allow new more desirable patterns to de-stabilize the undesirable pattern and become the stable pattern. (Thelen, Ulrich)
Plasticity is not time dependent. (Taub, Hogan) However, once abnormal patterns become stable they become very difficult to replace. (Thelen, Ulrich) Therefore, early intervention is critical. With the first year of life being the most important. The second year less so, and so on.
Functional achievement and intervention strategy needs to be matched to appropriate developmental opportunity windows. (For example, unsupported walking can not be expected until sufficient muscle strength is achieved) (Thelen, Ulrich)
Measurement and understanding of the factors leading to undesirable patterns is the key to developing a treatment program. Stable patterns are almost always the optimized solution to the interplay of all factors (neurological, physiological, environmental, etc.) The intervention program should provide focused intervention to the factors that are allowing an undesirable pattern to emerge. (Thelen, Ulrich, Hogan, Taub, Merzenich)
The complexity of the functional skill and degree of stability that the abnormal pattern has achieved, are the two factors determining the level of intensity and duration needed in order to de-stabilize the undesirable pattern and establish the desirable pattern. (Thelen, Ulrich, Hogan, Taub, Merzenich)
