• Maria Ambuehl, van HedelHubertus J AHJA, and Rob Labruyère.
• From the Rehabilitation Center for Children and Adolescents, Children's University Hospital Zurich, Affoltern am Albis, Switzerland (MA, HJAvH, RL); Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland (MA); and Children's Research Center, Children's University Hospital Zurich, Zurich, Switzerland (HJAvH, RL).
• Am J Phys Med Rehabil. 2020 Mar 1; 99 (3): 224-232.

ObjectiveWhen investigating dose-response relationships in rehabilitation studies, dose is often equated with duration of therapy. However, according to the American College of Sports Medicine, dose consists of the factors frequency, intensity, time, and type. Thereby, especially quantification of intensity needs improvement to have a more precise estimate of the dose. Thus, the aim was to investigate the intensity during mobility-focused, real-life pediatric rehabilitation therapies.DesignEleven participants (5 girls, 12.5 ± 2.1 yrs old) with neurological disorders and independent mobility wore accelerometers at wrists and ankles and a portable heart rate monitor during several of the following therapies: sports therapy, mobility-focused physiotherapy, medical training therapy, and robot-assisted gait training. Intensity of physical activity was quantified by activity counts (measured via accelerometers) and heart rate.ResultsTherapy duration did not correlate with intensity. At the same time, we found significant differences between intensities of different therapies.ConclusionDifferent therapies elicit different levels of intensity in children with neuromotor disorders. Heart rate and activity counts are suited to estimate the intensity of a therapy and provide complementary information. We recommend against using the duration of a therapy as a proxy for the dose to make statements about dose-response relationships.To Claim Cme CreditsComplete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Appraise the importance of measuring the intensity of various types of inpatient rehabilitation therapy for determining the dose; (2) Describe the differences in intensities between different training forms and name factors that influence this intensity; and (3) Discuss the influence of the functional level of a patient on his/her potential to engage in physically intensive therapy sessions.LevelAdvanced.AccreditationThe Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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