As paediatric therapists, we know the importance of encouraging physical activity for the children and young people we work with. However, it can sometimes be difficult to have these conversations when we are aware of how much families are juggling and don't want to guilt them into thinking they aren't doing enough for their child.
When the UK’s Chief Medical Officers (CMOs) first issued guidelines on physical activity recommendations for children with disabilities in February 2022, it offered a platform from which therapists could start having these conversations.
These guidelines advised that disabled children and young people should be getting 120-180 minutes of aerobic physical activity per week and doing strength and balance activities 3 times per week.
This challenged therapists and families to think about how a specific child is meeting those guidelines in their day-to-day life and, if they aren’t, what changes could be implemented to ensure that they are. The subsequent infographic that was produced, to summarise the initial report and make it easier to digest, decided to focus on the message of 20 minutes of physical activity per day, as it appeared more manageable and achievable, especially for children with more complex needs. It also advised that, for children who spent a lot of their day sedentary, making small changes to activity levels and trying to build up slowly to the recommended 20 minutes per day was recommended.
There are many ways that therapists can be involved to try and ensure children with disabilities remain active, such as:
- Tailored Exercise Plans
- Conduct thorough assessments to understand the child's capabilities and limitations
- Develop personalized exercise plans that align with the UK guidelines, ensuring both variety and adaptability
- Inclusive Activities
- Advocate for and create inclusive physical activities, considering the guidelines' recommendations for moderate to vigorous, muscle-strengthening, and bone-strengthening activities.
- Ensure that adaptations are made to accommodate different abilities within a group setting.
- Collaboration With Parents
- Educate parents on the UK guidelines and work collaboratively to integrate physical activities into the child's routine.
- Provide guidance on suitable activities that align with the child's abilities.~
- Monitoring and Adapting
- Regularly monitor the child's progress and adjust the exercise plan in accordance with both individual needs and the UK guidelines.
- Collaborate with other healthcare professionals to ensure a holistic and coordinated approach.
Paediatric therapists are also acutely aware of how a child’s motor function will affect their ability to be able to participate in different sports and activities and are able to advise on different ways activity can be integrated into their day-to-day lives
Activity ideas for children GMFCS I-III:
- Encouraging some day-to-day activities to be completed in standing rather than sitting, e.g. brushing teeth or washing face
- Reducing time spent sitting or in wheelchair, e.g. getting up and walking to retrieve a book from the bookshelf rather than an adult retrieving it for them
- Where children need time spent in a wheelchair, could they self-propel for short intervals and then take rests as needed?
- Encouraging the use of bikes and trikes or other play equipment during PE, in the playground and at home.
Activity ideas for children GMFCS IV-V:
When a child is lying on their back for their toileting programme: Can their knees be bent up and feet on the bed (crook lying) and can they lift their bottom up off the bed for a short moment (either independently or with support)? Can they be encouraged to roll to the left and to the right when their bottom half is being changed instead of both legs being held up in the air
For children who have stretching programmes to their lower or upper limbs: Can you encourage them to initiate any movement themselves? This can be by reaching for a toy, turning to look at the TV or even just gently tickling up and down their leg/arm to see if the extra sensory information will elicit some active movement.
Ensuring their equipment is optimally set-up: By ensuring that their postural management equipment is set-up as not to over support the child so that they are able to be active in the equipment rather than passively relying on the supports.
Prescribing supportive walking frames at a developmentally equivalent age and adjusting them to suit moderate or complex needs, and using new gait training technology such as the MyWay+ Pedal to help with strength or initiating movement.
As therapists, we play a pivotal role in translating national guidelines into actionable plans that empower children with disabilities to lead active and fulfilling lives. By aligning our strategies with the physical activity guidelines that are out there, we can provide tailored interventions that not only meet the unique needs of each child but also contribute to the overarching goal of promoting health and well-being. Together, let us unlock the potential within these young individuals, fostering a future where physical activity is not just a guideline but a key to a life of possibilities.
- Smith, B., Rigby, B., Netherway, J., Wang, W., Dodd-Reynolds, C., Oliver, E., ... & Foster, C. (2022). Physical activity for general health benefits in disabled children and disabled young people: rapid evidence review