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Mobility and Fitness Interventions for Children and Adults with Medical Complexity



School-based therapists are integral in fostering the development of gross motor skills and enhancing mobility opportunities for students. This role is particularly critical for children with medical complexity (CMC), a group characterized by significant healthcare needs due to one or more chronic conditions, often necessitating the use of medical technology and extensive environmental modifications. Typically, CMCs are identified as operating at level IV or V of the Gross Motor Functioning Classification System (GMFCS), which indicates a higher degree of mobility impairment.


Importance of Physical Activity for CMCs

Physical activity, as defined by the World Health Organization (WHO), encompasses any bodily movement produced by skeletal muscles that results in energy expenditure. This broad definition underscores the importance of inclusive physical activity opportunities for all children, including those with severe mobility challenges and health complications associated with CMC. Despite their limitations, children with CMC benefit significantly from tailored physical activities that address their unique needs, enhancing their strength, cardio-pulmonary health, and bone mineral density.


Research Highlights on Exercise and Fitness for CMC

Recent studies and systematic reviews highlight the positive impact of fitness activities on reducing sedentary behaviors and promoting gross motor activity participation among children and adults with cerebral palsy. For instance, weight-bearing activities and specially designed movement programs have shown promise in improving bone health and overall physical well-being in this population. Moreover, innovative approaches to physical activity, such as the use of vibrating platforms and whole-body vibration training, have been identified as effective strategies for increasing bone mineral density, albeit with a call for more creative and inclusive movement programs tailored to individuals with the most severe gross motor impairments.



The Role of Adaptive Equipment

To support the participation of CMCs in physical activities, school-based physical therapists often rely on a variety of adaptive equipment. Devices such as the Rifton Dynamic Pacer and the Rifton Adaptive Tricycle are engineered to provide the necessary postural support, facilitating upright mobility opportunities and enabling dynamic weight bearing and shifting. These tools not only assist in the physical development and strengthening of the students but also contribute to their emotional well-being and social enjoyment by promoting greater participation in school activities and peer interactions.

Adaptive Trike (Rifton)

Monitoring and Goal Setting

A critical aspect of integrating physical activity and mobility opportunities for CMCs involves careful monitoring for pain and comfort, utilizing scales like the Individualized Numeric Rating Scale (INRS) and the Face, Legs, Activity, Cry, Console Scale (FLACC). Additionally, setting specific, measurable, achievable, relevant, and time-bound (SMART) or Goal-Attainment Scaling (GAS) goals is essential for tracking progress and ensuring that the activities are tailored to meet the individual needs of each student. These goals focus on incremental achievements, such as reducing caregiver assistance or improving the ability to navigate obstacles independently, which are significant for the students' mobility and independence in the school environment.


The collaborative efforts of school-based therapists in providing tailored physical activity and mobility support for children with medical complexity are foundational to enhancing their quality of life and success both within the educational setting and into adulthood. By leveraging adaptive equipment, innovative movement programs, and a focused approach to goal setting and monitoring, therapists can significantly impact the physical and social development of these students. Embracing the holistic interventions for Children and Adults with Medical Complexity with the "F-words" approach ensures that therapeutic interventions are not only about improving function but also about enriching the lives of CMCs with meaningful activities and interactions, preparing them for a future of greater independence and participation.

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