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For many years, 24-hour postural management has been at the heart of children’s therapy programmes, ensuring that every position a child adopts throughout the day, and night supports healthy alignment, comfort, and function. While this approach remains essential, as a therapy community we are now expanding our focus to reflect new evidence and national guidance: moving from 24-hour Postural Management to 24-hour Posture and Activity Management (PAM).
This evolution reflects growing recognition that movement is medicine, not only for musculoskeletal health but also for cognitive, cardiovascular, and emotional wellbeing.
Why the Shift?
- New Government Guidelines on Physical Activity
Recent UK government guidance (UK Chief Medical Officers’ Physical Activity Guidelines, 2019) emphasises that all children and young people, including those with disabilities, should be active every day.
The guidance for children and young people age 5 to 18 years highlights:
- At least 60 minutes of moderate to vigorous activity daily (brisk walking, swimming, cycling, climbing)
- Engage in a variety of activities which develop skills, muscle and bone strength and cardiovascular health
- Reducing prolonged periods of sitting or lying down
For children with physical disabilities, these targets must be adapted but the principles remain: movement, however it is achieved, matters.
- Movement Shapes the Developing Body
The musculoskeletal system not only benefits from movement but is shaped by it, and the difference it makes is profound. Early and regular activation of the hip abductor muscles plays a crucial role in re-shaping healthy hip joint development.
Without typical loading patterns, the acetabulum does not deepen, the femoral head will be less spherical, femoral anteversion and femoral neck-shaft angle remains high (coxa valga) thereby increasing the risk of hip displacement.
By encouraging movement and embedding activity into postural management programs, we’re not just maintaining alignment, we’re actively stimulating bone and joint development through muscle action and weight-bearing.
- Activity Supports the Heart and Mind
Beyond posture, physical activity reduces sedentary behaviour, supports cardiovascular fitness, and promotes mental health and wellbeing.
Even small changes like a brief standing session, a powered movement device, or assisted cycling can increase heart rate, improve circulation, and boost alertness and engagement.
Where can we as therapists help?
For children who spend much of their day supported by equipment, the activity must be intentional built into daily routines, therapy goals, and educational plans.
- In school, include standing sessions within the educational plan for instance, standing during choir practice or class reading time. This not only supports bone health but allows participation in group activities.
- For children with complex disabilities, even small, supported movements like assisted standing transfers or hoisted transfers will provide a change in position and brief cardiovascular stimulation.
- Passive mobility, such as being pushed in the Leckey | MyWay Pedal | Personalised Walking Programmes or moving in a powered device such as the Innowalk, offer repetitive lower limb activity that increases muscle activation, vestibular stimulation and heart rate.
Each of these moments adds up to valuable activity minutes that reduce sedentary time and promote physiological and social benefits.
In Summary:
The move from 24-hour Postural Management to 24-hour Posture and Activity Management recognises that movement is essential, not optional.
It protects joint integrity, supports cardiovascular health, and promotes participation in everyday life no matter how a child achieves that movement.
By combining thoughtful positioning with purposeful activity, we can help every child reach their full potential.
