Narrative Review of the Theoretical-Methodological Foundations of the TREINI Program

Abstract

Scientific knowledge has advanced in the implementation of safe and beneficial interventions for children and adolescents with cerebral palsy (CP). Although the importance of interdisciplinary interventions that integrate all components of the International Classification of Functioning, Disability and Health (ICF) into family-centered practices is widely recognized, this approach is not yet widely adopted. Instead, many programs remain focused on isolated domains. This study presents the theoretical and methodological foundation of TREINI, an interdisciplinary and family-centered program developed for children and youth with CP and other neurodevelopmental disorders. TREINI incorporates intervention strategies that address all ICF domains. It is grounded in the biopsychosocial model of health and utilizes principles based on the best evidence in pediatric rehabilitation, including intensive training, task-oriented training, and a naturalistic learning environment. Unlike traditional rehabilitation approaches, the care provided by the TREINI program is delivered through an intensive and interdisciplinary approach, by a team working collaboratively in a single location. In addition to including evidence-based interventions, the TREINI program features two innovative components: the "City of Tomorrow", a naturalistic learning environment, and the "TREINI Exoflex" therapeutic suit, specifically designed to address deficiencies in the body functions and structures of children with CP and other neurodevelopmental disorders. This program has been carefully designed to support the process of neurological re-education and rehabilitation for children and adolescents with neuropsychomotor developmental delays.

Keywords: cerebral palsy; family-centered practice; intensive intervention; interdisciplinary program; therapeutic suit.

Figure 1

City of Tomorrow units. Image (a) shows the entrance hall of the City of Tomorrow. Images (b,c) illustrate the Market unit, where participants can engage in simulated shopping experiences. This unit is crucial for practicing daily living skills, enhancing cognitive functions, and promoting social interaction in a controlled and supportive environment. Image (d) presents part of the School unit, which replicates a classroom setting. This unit is essential for educational activities and cognitive rehabilitation, allowing participants to work on academic skills and social behaviors in a natural context. Images (e,f) show the Fitness Space unit, a space used to promote physical fitness. This unit supports the development of motor skills and encourages an active lifestyle. Images (g–i) provide external views of some units of the City of Tomorrow, highlighting the interconnectedness and accessibility of the different therapeutic spaces. These views emphasize the holistic approach of the environment, where various aspects of daily life are integrated into the rehabilitation process. Finally, images (j,k) illustrate the Home unit, a space designed to mimic a residential setting. This unit allows participants to practice essential daily tasks and self-care activities in a realistic yet controlled environment, fostering independence and confidence in their abilities.

Figure 2

TREINI Exoflex therapeutic suit in anterior, lateral, and posterior views. The assembly of the suit is carried out by connecting the viscoelastic strips, or myofascial strips, to the fixation points, called nodes. Initially, a basic assembly is performed, after which modifications are made according to the postural correction needs of each child (determined through structural analysis).

Figure 3

Myofascial meridians (lateral lines, spiral line, functional lines, superficial back line, and superficial front line) being stimulated by TREINI Exoflex during the execution of functional movements. This stimulation aims to allow muscles to work more efficiently, improving movement and coordination. (A) The lateral lines run along each side of the body. These lines provide balance between the front and back lines (see (B)), connecting torso and legs. They also limit excessive rotation and slow down the lateral oscillation of the body when walking. The spiral line and functional lines are also integrated in an alternating manner during walking. (B) The superficial back line is stimulated during body extension and the superficial front line is stretched. The energy stored through stretching is used to facilitate movements. From hyperextension onwards, all the pathways of the superficial front line are united.