Introduction

This article describes practical tools for paediatric physiotherapists to facilitate physical activity behaviour and participation in children with disability. Children with disabilities often experience decreased physical activity, leading to higher risks for health issues and reduced quality of life and therefor it is important to find practical tools for children and adolescents to enhance activity and participation.

Background

Children with disabilities often experience decreased physical activity, leading to higher risks for health issues and reduced quality of life (Carbonne et al. 2021). To address this, behaviour change techniques that focus on both personal and environmental factors—along with physical fitness and motor development training—are crucial (El Kirat et al. 2024). Research shows that early promotion of physical activity improves psychosocial health, including self-concept and quality of life, in children with disabilities. Interventions that involve both school and family or community participation help to increase physical activity (van Sluijs et al. 2007). However, effective interventions available for physiotherapists to significantly increase physical activity in this group are scarce (Lund et al. 2020, Reedman et al. 2018)

Tools to Enhance Participation and Physical Activity

There are some tools available, such as the F-words, DigiMetku application and What Makes You Move toolkit, specifically developed to support enhancing participation and physical activity in children with disabilities. These tools are often designed to address both personal and environmental factors, equipping professionals like paediatric physiotherapists to engage effectively with children and their families.

F-words

F-words’ are based on an article, published in 2012 “I swear this is how we should think.” In the article, Rosenbaum & Gorter argued for a biopsychosocial model in which treatment and rehabilitation focuses on what the child can do (the child knows how), rather than on finding problems and ‘fixing’ them (Rosenbaum & Gorter, 2012). The F-words are Fitness, Function, Fun, Friends, Family, and Future and are integrated in the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) (WHO 2001). The aim of the F-words is to strengthen the child and family and equality in the planning of services and supports (Cross et al., 2015). They examine the life of the child and family through strengths and opportunities. What the child can do is essential, not how he or she does it. F-words also emphasize the fun and meaningfulness of the activity; factors that make it meaningful for the child to pursue things and build a positive future. Favorite words enable a future-oriented, holistic view of the child and his or her family. (Rosenbaum et al., 2022.)

The F-words framework helps paediatric physiotherapists integrate the behavioral change techniques into practice (Rosenbaum & Gorter 2012), alongside tools like the Digimetku app (Kinnunen et al. 2024) and the What Moves You toolkit (Bolster et al. 2021). Identifying and utilizing meaningful issues in the child’s daily life through collaboration increases the child’s commitment and motivation and thus may enhance the benefits and effects of rehabilitation. Through co-development, the child and his/her family can be active and equal partners not only in development projects but also in the rehabilitation process. (Vänskä et al. 2021).

DigiMetku Application

The child and young person own the app and use DigiMetku to promote their rehabilitation together with their loved ones and professionals. In the app, children can describe things that are important to them, their daily life, their wishes and goals through photos, videos, drawings, writing or audio recordings. DigiMetku guides you to identify the things that are important to your child in everyday life as a starting point for the rehabilitation process and is used to develop a rehabilitation goal together with the child.

The aim of the application is to promote the child’s and young person’s ability to function in accordance with the individual goal. The DigiMetku app is used to record the individual’s rehabilitation goal and a plan to achieve it. Videos, instructions or illustrations can be added to the app to help you complete and remember the agreed tasks. In this way, the app promotes the achievement of your rehabilitation goal, encourages the completion of tasks with rewards and strengthens motivation. DigiMetku allows the rehabilitation and cooperation process to be linked and made concrete in order to rehabilitate the child in everyday life. DigiMetku can be used to anticipate rehabilitation planning, in joint planning situations between the child, family and professionals, and to concretise the implementation of the plan in everyday life, in the way chosen by the child and family.

For children and youth, DigiMetku App serves as a facilitative tool, easing the often challenging conversations surrounding health issues. It provides a platform for them to be acknowledged and heard, empowering them to set and track their objectives. The application is crafted to encourage emotional expression and engagement, offering a user-friendly and enjoyable method for them to map and engage with their rehabilitation journey. Importantly, it enables them to visualize and celebrate their progress, fostering a sense of achievement. DigiMetku is developed together with children and young people receiving rehabilitation, their parents, and rehabilitation professionals. Metropolia University of Applied Sciences, Arcada University of Applied Sciences, and Savonia University of Applied Sciences have been involved in the development with funding from Kela (The Social Insurance Institution of Finland). The National Association for Children and Youth Rehabilitation is involved in the development and responsible for the maintenance of the application.

What Makes You Move -Toolkit

To support paediatric physiotherapists with the integration of behaviour change techniques in their treatment plans, the ‘What Moves You?!-Toolkit’ was developed (Bolster et al. 2021). During the development of the ‘What Moves You?!-Toolkit’, a participatory design approach (co-design) was applied involving designers, developers, researchers, and other stakeholders such as paediatric physiotherapists, parents, children and care sports connectors. The design process, involving three co-creation sessions, four one-week design sprints, living-lab testing and two triangulation sessions, led to the development of ten intervention tools. Four physical tools to improve paediatric physiotherapists physical activity coaching and four physical tools and two information videos to facilitate children’s physical activity in their own life settings.

By targeting various personal (behavioral/motivational) and environmental components, the tools aim to increase participation in PA in children with physical disability in daily living, such as active transport, playing outside, and sports participation by e.g. stimulating perceived self-efficacy or mapping the child’s physical and social environment. An extensive description of the design process and the WMY Toolkit is available (Bolster et al. 2021). Paediatric physiotherapists, parents and children experienced the WMY Toolkit as feasible in daily practice and were positive about the possibilities. The tools facilitated creativity, were easily adaptable to specific situations and thus aligned with personalized care (Sol et al. 2023).

Discussion

For shifting from solely improving functions (i.e., physical fitness) and activities (i.e., motor skills) towards supporting determinants of behavior by paediatric physiotherapist practical, concrete tools are needed. When facilitating a physically active lifestyle, an individually tailored approach, focusing on the needs of the individual child and setting meaningful goals are often mentioned in the literature. Both the DigiMetku app and the ‘What Moves You?!-Toolkit’ are promising tools to include the aspects in our rehabilitation programs. Behaviour modification techniques, integrated in both tools, focusing on both personal and environmental factors, promote the physical and motor development of children and young people.

Authors:

Anu Kinnunen, Principal lecturer, Savonia University of Applied Sciences, Master School, Kuopio, Finland

Eline Bolster, Researcher, University of Applied Sciences Utrecht, research center Healthy and Sustainable Living, research group Moving, Growing and Thriving together, Utrecht, The Netherlands

Manon Bloemen, Professor, University of Applied Sciences Utrecht, research center Healthy and Sustainable Living, research group Moving, Growing and Thriving together, Utrecht, The Netherlands

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