Youth athletes are ideal candidates for novel therapeutic motor learning interventions that leverage the plasticity of the central nervous system to promote desirable biomechanical adaptions. We summarize the empirical data supporting the three pillars of the Optimizing Performance Through Intrinsic Motivation and Attention for Learning (OPTIMAL) theory of motor learning and expand on potential neurophysiologic mechanisms that will support enhanced movement mechanics in youth to optimize prevention programs for reduced injury risk, injury rehabilitation, exercise performance, and play (Prevention Rehabilitation Exercise Play; PREP). Specifically, we highlight the role of motivational factors to promote the release of dopamine that could accelerate motor performance and learning adaptations. Further, we detail the potential for an external focus of attention to shift attentional allocation and increase brain activity in regions important for sensorimotor integration to facilitate primary motor cortex efficiency. This manuscript serves to provide the most current data in support of the application of OPTIMAL PREP training strategies of the future.

There are numerous physical, social, and psychological benefits of exercise, sport and play for youth athletes. However, dynamic activities come with a risk of injury that has yet to be abated, warranting novel therapeutics to promote injury-resistance and to keep an active lifestyle throughout the lifespan. The purpose of the present manuscript was to summarize the extant literature and potential connecting framework regarding youth brain development and neuroplasticity associated with musculoskeletal injury. This review provides the foundation for our proposed framework that utilizes the OPTIMAL (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning to elicit desirable biomechanical adaptations to support injury prevention (injury risk reduction), rehabilitation strategies, and exercise performance for youth physical activity and play across all facets of sport (Prevention Rehabilitation Exercise Play; PREP). We conclude that both young male and females are ripe for OPTIMAL PREP strategies that promote desirable movement mechanics by leveraging a unique time window for which their heightened state of central nervous system plasticity is capable of enhanced adaptation through novel therapeutic interventions.

Youth may be particularly responsive to motor learning training strategies that support injury-resistant movement mechanics in youth for prevention programs that reduce injury risk, injury rehabilitation, exercise performance, and play more generally (Optimizing Performance Through Intrinsic Motivation and Attention for Learning Prevention Rehabilitation Exercise Play; OPTIMAL PREP) One purpose of the present manuscript was to provide clinical applications and tangible examples of how to implement the proposed techniques derived from OPTIMAL theory into PREP strategies for youth. A secondary purpose was to review recent advances in technology that support the clinical application of OPTIMAL PREP strategies without extensive resources/programming knowledge to promote evidence-driven tools that will support practitioner feedback delivery. The majority of examples provided are within the context of anterior cruciate ligament (ACL) injury rehabilitation, but we emphasize the potential for OPTIMAL PREP strategies to be applied to a range of populations and training scenarios that will promote injury resistance and keep youth active and healthy.