Movement is Medicine 1-3
Physical activity provides a wealth of health benefits for individuals of all ages. For children, it is a vital component of healthy development. Physical activity can improve cognition, psychosocial wellbeing and physical health. Regular fitness helps support healthy body composition and bone health while reducing cardiovascular risk factors.
The U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion recommends children 3-5 years old should be active at least 3 hours per day and those 6-17 years old require a minimum of 60 minutes of moderate to vigorous physical activity per day. Recommended activities include aerobic exercise to increase heart rate (e.g., swimming, running) and those focused at building muscle and bone development (e.g., basketball, jump rope, climbing equipment in the playground). Every child deserves access to this necessary aspect of development, however, not all do.
Access to Physical Health 4-6
Access to physical activity plays a large role in the overall health of children. Lower health outcomes and increased obesity levels are evident in children of lower socioeconomic status. Insufficient nutrition, participation in physical activity, support and resources are among the negative influential factors.
For children with limb loss and limb difference (LLLD), access takes on a whole different meaning. A child who wears a lower limb prosthesis for walking requires specialty prosthetic components to participate in the evidence-based recommended aerobic activities. A prosthesis designed for gait cannot meet the mechanical and physical demands of running and swimming. This requires activity-specific prostheses which are not covered by medical insurance. Additionally, high performance prosthetic componentry is primarily manufactured for adult populations thereby reducing access to youth who could greatly benefit from and utilize activity-specific prostheses.
How does a child with limb loss and limb difference achieve these required goals for healthy living if they don’t have the means to do so?
Children to Adolescents: Limb Loss & Limb Difference 6-10
Children with disabilities have a significantly low participation rate (17.5%) in the recommended dose of physical activity. Pediatric and adolescent youth with LLLD have functional differences compared to age-matched peers experiencing typical development. These include but are not limited to decreased walking speed, higher heart rates, altered weight distribution and increased energy cost with more proximal levels of lower limb loss. Generally, the higher the level of amputation, the greater the decline in sports and physical functioning.
Additional societal demands are placed on the growing child including acceptance, exposure to peer pressure and being stigmatized. Body image perception holds great weight during adolescence. Negative self-image has been associated with not only low self-esteem but depression and anxiety. For adolescents with LLLD, this not only means reduced quality of life, but potential functional and social implications.
Maximizing availability of specialized pediatric prosthetic technology provides opportunities to children with LLLD to reach their functional potential and promotes healthy living. While some recreational prostheses are activity-specific (e.g., cycling, swimming), others allow a young prosthetic user access to a variety of physical activities. Running-specific prostheses avail a child with the chance to participate in a wealth of activities (e.g., skipping, jumping, playing at recess, basketball, gymnastics, soccer). Unlike daily-use prostheses, specialty prosthetic technology grants a child the ability to properly engage in physical activity necessary for healthy development.
Advocacy 11-13
A vital national movement was initiated in 2022 titled So Kids Can Move. This campaign focused on increasing access to specialty orthotic and prosthetic interventions for children with limb loss and limb difference. The campaign has since evolved into advocacy for all, regardless of age, So Every BODY Can Move. To date, 5 states have enacted legislation to ensure greater insurance coverage of activity-specific prostheses with additional states taking action.
Stay tuned for the next entry in The O&P PT So Every BODY Can Move series to learn more about health benefits of activity-specific prostheses and how you can get involved in supporting the @soeverybodycanmove campaign.
References
- U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. “Top 10 Things to Know About the Second Edition of the Physical Activity Guidelines for Americans.” Health.gov, 25 August 2021, https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines/top-10-things-know
- Veldman, Sanne L.C., Chin A Paw, Mai J M, and Teatske M. Attenburg. “Physical Activity and Prospective Associations with Indicators of Health and Development in Children Aged <5 Years: A Systematic Review.” The International Journal of Behavioral Nutrition and Physical Activity, vol. 18, no. 1, 2021, pp. 6.
- Poitras, Veronica Joan et al. “Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth.” Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme vol. 41,6 Suppl 3 (2016): S197-239. doi:10.1139/apnm-2015-0663
- Hillier-Brown, Frances C., et al. “A Systematic Review of the Effectiveness of Individual, Community and Societal Level Interventions at Reducing Socioeconomic Inequalities in Obesity Amongst Children.” BMC Public Health, vol. 14, no. 1, 2014, pp. 834.
- A. Batley, P. Sewell and B. Dyer, “Facilitators and barriers for participation in sports and physical activity for children with lower-limb absence: A systematic review,” Prosthetics and Orthotics International, vol. 47, (4), pp. 368, 2023.
- Eshraghi, Arezoo, et al. “Walking and Balance in Children and Adolescents with Lower-Limb Amputation: A Review of Literature.” Clinical Biomechanics (Bristol), vol. 59, 2018, pp. 181-198.
- Physical Activity Alliance Move With Us. “The 2022 United States Report Card on Physical Activity for Children and Youth.” PAAMoveWithUs, https://paamovewithus.org/wp-content/uploads/2022/10/2022-US-Report-Card-on-Physical-Activity-for-Children-and-Youth.pdf Accessed 4 January 2024.
- McQuerry, Jessica, et al. “Effect of Amputation Level on Quality of Life and Subjective Function in Children.” Journal of Pediatric Orthopaedics, vol. 39, no. 7, 2019, pp. e534.
- Demirdel, Senem, and Özlem Ülger. “Body Image Disturbance, Psychosocial Adjustment and Quality of Life in Adolescents with Amputation.” Disability and Health Journal, vol. 14, no. 3, 2021, pp. 101068.
- Hadj-Moussa, Firdous, et al., “It’s More than just a Running Leg: A Qualitative Study of Running-Specific Prosthesis use by Children and Youth with Lower Limb Absence.” Disability and Rehabilitation, vol. 44, no. 23, 2022, pp. 7190-7198.
- So Every BODY Can Move. SEBCM, https://soeverybodycanmove.org/ Accessed 6 January 2024.
- American Orthotic & Prosthetic Association So Every BODY Can Move. AOPA, https://www.aopanet.org/so-kids-can-move/ Accessed 7 January 2024.
- Amplitude. “Insurance Coverage for Amputees: 2024 Legislation Tracker.” Amplitude, 1 January 2024, https://livingwithamplitude.com/insurance-coverage-for-amputees-2024-legislation-tracker/