The First Years of Life as the Period of Maximum Effectiveness of Neurorehabilitation: Biological Foundations and Practical Approaches

Early pediatric neurorehabilitation is a healthcare priority because it leverages the high neuroplasticity of the brain during the first years of life and helps reduce the risk of persistent motor, cognitive, and behavioral impairments. This paper summarizes the biological determinants of the effectiveness of early interventions (synaptogenesis, myelination, critical periods) and highlights that, in the absence of timely support, neuroplasticity may consolidate ineffcient compensatory strategies, increasing the likelihood of secondary complications. The “first 1000 days” concept is discussed as a clinically meaningful window of opportunity, emphasizing the need to initiate rehabilitation as early as possible after medical stabilization, ensure regular practice, and actively involve the family. We systematize the main groups of children who should be referred to early neurorehabilitation: infants at perinatal risk of central nervous system injury, preterm infants, children with neurodevelopmental disorders, congenital and genetic/metabolic conditions affecting development, sequelae of acquired brain injury, and sensory impairments, as well as children exposed to combined biological and psychosocial risk factors. The paper underscores that effective early intervention requires a multidisciplinary model, continuity of care pathways, and a focus on functional goals.