# Practical tools for paediatric physiotherapists to facilitate physical activity behaviour and participation in children with disability.

> This article describes practical tools for paediatric physiotherapists to facilitate physical activity and participation.

## Introduction
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).

## The F-words Framework
The ‘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, rather than on finding problems and ‘fixing’ them (Rosenbaum & Gorter, 2012). 

The F-words are:
*   **Fitness**
*   **Function**
*   **Fun**
*   **Friends**
*   **Family**
*   **Future**

These are integrated into 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. F-words also emphasize the fun and meaningfulness of the activity, enabling a future-oriented, holistic view of the child and his or her family (Rosenbaum et al., 2022).

## DigiMetku Application
The DigiMetku app allows children and young people to describe things that are important to them, their daily life, their wishes, and goals through photos, videos, drawings, writing, or audio recordings. 

*   **Goal Setting:** It is used to develop a rehabilitation goal together with the child and record a plan to achieve it.
*   **Implementation:** Videos, instructions, or illustrations can be added to help complete and remember agreed tasks.
*   **Motivation:** The app encourages the completion of tasks with rewards and strengthens motivation.
*   **Collaboration:** It serves as a facilitative tool for joint planning situations between the child, family, and professionals.

DigiMetku was developed by Metropolia University of Applied Sciences, Arcada University of Applied Sciences, and Savonia University of Applied Sciences with funding from Kela (The Social Insurance Institution of Finland). The National Association for Children and Youth Rehabilitation is responsible for the maintenance of the application.

## What Moves You?!-Toolkit
To support paediatric physiotherapists with the integration of behaviour change techniques, the ‘What Moves You?!-Toolkit’ was developed (Bolster et al. 2021). The toolkit was created using a participatory design approach (co-design) involving designers, developers, researchers, paediatric physiotherapists, parents, children, and care sports connectors.

The toolkit includes:
*   Four physical tools to improve paediatric physiotherapists' physical activity coaching.
*   Four physical tools and two information videos to facilitate children’s physical activity in their own life settings.

By targeting personal and environmental components, the tools aim to increase participation in daily living activities such as active transport, playing outside, and sports participation.

## Conclusion
For shifting from solely improving functions and activities towards supporting determinants of behaviour, practical and concrete tools are needed. Both the DigiMetku app and the ‘What Moves You?!-Toolkit’ are promising tools to include in rehabilitation programs, as they integrate behaviour modification techniques that focus on both personal and environmental factors.

## 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

## References
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