REASON CP: a systems-based framework for clinical reasoning to support participation across the lifespan in childhood-onset neurodisability

Abstract

Cerebral palsy, a common example of childhood-onset neurodisability (COND), is a heterogeneous neurodevelopmental condition characterized by complexity and variability across individuals. Children, families, and clinicians must navigate a maze of potential interventions, a challenge compounded by inconsistent quality of systematic reviews and lack of evidence for certain sub-groups, resulting in clinical decision-making uncertainty. Existing frameworks tend to focus on what intervention to use, rarely addressing the underlying reasoning processes that determine why a particular approach is most appropriate for a specific individual at a given point in time. This gap in clinical reasoning (CR) represents a significant barrier to optimizing outcomes for people with movement disorders. REASON CP an acronym for Reflect, Evaluate, Activate, Support, Optimize, Navigate via Clinical reasoning for Participation was developed with the aim to address this gap. It is an innovative, structured, systems-based approach to CR, designed to support the selection of the right intervention for the right person at the right time, for the right reason. By integrating systems science with the International Classification of Functioning, Disability and Health (ICF), REASON CP is particularly well suited to the complexity of COND. By making the reasoning process explicit and collaborative, the framework strengthens shared decision-making between clinicians, families, and individuals, while supporting individualized, lifespan-oriented care across diverse settings. By explicitly defining and operationalizing CR, REASON CP addresses a critical limitation in current practice, particularly the challenge of decision-making when robust evidence is unavailable. The framework supports individualized, family-centered care in any context and provides a transparent foundation for more relevant and rigorous research. A training module to support therapists in utilizing REASON CP in clinical practice is currently under development.