Beyond the Diagnosis: An Integrated Perspective on Strategic Dosing in Neurologic Motor Rehabilitation. A Scoping Review and Collaborative Viewpoint.

Abstract

BackgroundCurrent neurorehabilitation often relies on static, diagnosis-driven protocols or generic exercise administration, contributing to suboptimal long-term outcomes. There is a clinical need for a cohesive, mechanism-based framework to guide therapeutic reasoning, dosing, and longitudinal adaptation.MethodsA scoping review of neurorehabilitation literature was conducted according to PRISMA-ScR guidelines to map evidence on dosing, intensity, and longitudinal management. From 9,373 records, 42 studies were synthesized. The literature did not converge on standardized dosing parameters but supported a broad distinction between higher-intensity approaches for non-progressive conditions and more conservative, energy-conserving strategies for progressive conditions. Integrating these findings with author consensus, we developed a collaborative viewpoint proposing a hypothesis-generating clinical framework.Proposed FrameworkWe conceptualize three dynamic clinical pillars: (1) Optimization of Motor Performance, targeting behavioral restitution of activities of daily living through experience-dependent neuroplasticity; (2) Maximization of Motor Performance, promoting active neuroprotection in early degenerative diseases and structural compensation in stable lesions through high physiological effort; and (3) Preservation of Remaining Functions, prioritizing energy conservation and reduction of secondary sequelae in rapidly progressive conditions. The evidence supports the broad progressive versus non-progressive dosing distinction, while the three-pillar structure, FITT-PRO profiles, and transition triggers remain hypotheses requiring validation.Clinical ApplicationA preliminary decision-support structure is proposed around FITT-PRO parameters and longitudinal reassessment. Transition triggers, such as biological plateaus or exacerbations, are not yet operationally defined and require prospective biomarker-based validation.ConclusionThis framework differentiates conditions by functional responsiveness rather than diagnosis, supporting interdisciplinary prognostic reasoning while requiring prospective validation before clinical implementation.