Lifespan Care for People with Disabilities
| May 2017
Revised and updated January 2026 by Lori Potts, PT
Providing activity and mobility interventions for young adults with disabilities after they leave the school system is crucial for maintaining quality of life. Unfortunately this perspective is not universally held.
A physical therapist working with young adults wrote to me, frustrated by the barriers she faces in securing adaptive equipment for her clients: “More often than not I’m told that there is no point in introducing or reintroducing the use of a gait trainer with this age group since they are no longer developing.”
To illustrate this, she described a 21-year-old student with spastic quadriplegia. While contractures prevent him from using a stander, he has succeeded in becoming mobile in a Pacer gait trainer with full trunk support by pushing off with the tips of his toes. He loves the movement.
Yet, despite his obvious engagement and independence, his interdisciplinary team raised objections that are all too common in adult disability services:
- That a gait trainer should only be used for 'gait retraining' rather than leisure or participation.
- That he might be at increased fracture risk.
- That he should instead focus on using his indoor electric wheelchair for independence.
- That aquatic exercise when available could provide similar benefit.
- That since he might not have access to the device after leaving school, he should not be introduced to it now.
This viewpoint reveals a fundamental lack of understanding: a person with developmental disabilities, like anyone else, has a life to live beyond age 21.
From a lifespan care perspective, supported upright mobility is essential not only for physical health but also for autonomy, emotional well-being, participation, and quality of life. Perhaps taking a broader view of these issues will help put the necessity of these interventions into perspective.
A Continuum of Development and Learning
Human development is the result of a complex interplay between physical, cognitive and emotional systems. Crucially, this process does not adhere to a strict timeframe.
Even two decades ago, Field and Jette noted in The Future of Disability in America that evidence strongly supports continued neurological, emotional, and intellectual development well into a person’s 20s.1 Development follows a continuum that extends far beyond the age of 21; with sufficient practice and repetition learning can occur at any stage of life.
This potential was demonstrated in a study by Dr. Whinnery involving adults with long-standing developmental disabilities and no prior weight-bearing or ambulatory skills. These individuals participated in the Mobility Opportunities Via Education curriculum (MOVE™) – a program designed to teach meaningful life skills through practice and the use of adaptive equipment to provide support where body strength is lacking.2 3
Targeting functional skills like transfers, standing, and walking, the study yielded impressive results. All five participating adults acquired independent functional sitting, standing, and walking skills with or without adaptive equipment. For instance, adults who previously required mechanical or two-person lifts learned to transfer themselves with minimal support. The impact on a person’s autonomy and quality of life from gaining such basic skills would be hard to overstate.
Current initiatives are beginning to recognize this continuum of learning, shifting focus toward healthcare that remains relevant well into adulthood. These approaches challenge the traditional “episodic” model of health care, prioritizing instead the sustained quality of life for all individuals, regardless of age.
Life-Course Health Development (LCHD)
I was first introduced to the Life Course Health Development (LCHD) framework at a conference where pediatric and neurology researchers gathered to reimagine the future of healthcare. Pioneered in the early 2000’s, this approach is reshaping how we care for people with disabilities.4
LCHD examines how early life experiences shape subsequent health and functioning. It conceptualizes health as evolving and adaptive, formed by the interplay of biological systems and external environments. It recognizes that each life stage influences the next and asks, “what interventions can be instituted to slow the progression of earlier adverse effects and reverse any potential damage.”5
By viewing health as a dynamic trajectory, we shift from reactive medical treatments to proactive strategies. The goal is to optimize factors “upstream” to prevent adverse medical conditions “downstream”. This approach spans the entire spectrum of life, from preconception through the final months of life, ensuring that our current intervention choices drive the best possible long-term outcomes.6
Applying this to our 21-year-old student, the opportunity to be upright and active at regular intervals significantly decreases his sedentary behavior now, positively influencing his future health trajectory.
Healthy People 2030
This holistic perspective is reinforced by Healthy People 2030, an initiative of the US Department of Health and Human Services with the Office of Disease Prevention and Health Promotion. Building on a nationwide effort that has set national objectives since 1979, HP 2030 establishes five overarching goals, one of which is to “promote healthy development, healthy behaviors, and well-being across all life stages.”7
Critically, HP 2030 recognizes that people with disabilities often lack access to necessary preventive health care services. To combat this, it specifically expands its focus beyond clinical health to include well-being. This broader mandate encourages making environments – homes, schools, workplaces, and public places – more accessible to improve the overall quality of life for people with disabilities.8
For our 21-year-old student, this framework is validating. Under the HP 2030 standard, his use of the Pacer gait trainer does not need to be justified by scientific metrics. The fact that he is self-mobilizing, participating in daily activities, and finding fulfillment in the process is sufficient. His well-being is a primary indicator of successful healthcare.
International Classification of Functioning
Now let’s take a look at the International Classification of Functioning (ICF), the World Health Organization’s framework for health and disability. As a biopsychosocial model applicable to all people globally, the ICF fundamentally shifts the focus from a medical diagnosis to a person's lived experience.9
Rather than defining a person by their disability, the ICF views health as a dynamic interaction between a person’s condition and their context. It emphasizes that health is improved by enhancing access to meaningful activities and societal participation—goals achieved through environmental changes, universal design, and adaptive technology.
This framework is divided into two primary components. Part 1 includes Body Functions and Structure (anatomy and physiology where problems are “impairments”) and Activities and Participation (executing tasks and involvement in life situations). Difficulties here are termed “activity limitations” and “participation restrictions”. This expansion effectively broadens our definition of health to include a person’s day-to-day reality.
Part 2 incorporates Contextual Factors, – external influences that can serve as either facilitators (e.g., assistive technology, supportive policies) or barriers (e.g., inaccessible buildings, negative attitudes). It also includes Personal Factors such as age, coping styles, and education.
Applying this to our 21-year-old student, the Pacer gait trainer acts as a crucial contextual facilitator. It enables him to perform the activity of upright ambulation and facilitates engagement at peer-level, effectively reducing his participation restriction.
Together, LCHD, HP2030, and the ICF provide a unified, alternative framework for addressing long-term disability. They move us away from a deficit model and toward a lifespan approach. Furthermore, as we will explore next, there is emerging evidence that physical activity in adults with disabilities is not just philosophically sound, but clinically beneficial.
Physical Activity and Health
It is well recognized that adults with intellectual disability (ID) are at high risk for sedentary behavior, which precipitates a range of adverse health conditions. A 2022 scoping review by Lynch and colleagues links this inactivity to the poor health profiles common in this population, citing increases of metabolic syndrome, obesity, diabetes, reduced bone mineral density, cardiovascular issues, and adverse anti-oxidant status.
On the other hand, evidence shows benefits of physical activity. A 2025 systematic review noted that while 90% of children and adolescents with cerebral palsy lead sedentary lifestyles, physical activity improved balance, postural control, strength, socialization, and self-confidence.11 A 2025 umbrella review of systematic reviews found that progressive resistance training and general physical activity increases muscle strength, while task-oriented training leads to large improvements in gross motor function and functional independence among individuals with cerebral palsy.12 A 2023 systematic review found that physical activity has a moderate-to-strong positive impact on weight loss, reduction of sedentary behavior, and overall quality of life for adults with intellectual disabilities.13
These findings align with the 2020 World Health Organization guidelines on physical activity, published in the British Journal of Sports Medicine. Affirming that some physical activity is better than none, the guidelines strongly recommend physical activity for people living with chronic conditions. They emphasize that tailored activity carries no major risks and that the health benefits generally outweigh any potential concerns.14
We can conclude that incorporating physical activity into the lives of adults with disabilities is urgent if we are to help them maintain optimal functional status.
Returning to the 21-year-old student described at the beginning: this conversations is about far more than a specific piece of equipment like a Pacer gait trainer. It represents a necessary paradigm shift toward a larger vision of healthcare. As individuals with developmental disabilities live longer, fuller lives, it is our professional obligation to provide them the means to remain healthy and active. We must advocate not just for medical necessity, but for the dignity, joy, and fulfillment that every human being deserves.
References
1. Field MJ, Jette AM, eds. The Future of Disability in America. National Academies Press; 2007:105.
2. Whinnery SB, Whinnery KW. Effects of functional mobility skills training for adults with severe multiple disabilities. Educ Train Autism Dev Disord. 2011;46(3):436-453.
3. MOVE International. Center for Disability Services. Accessed January 15, 2026. https://cfdsny.org/move-international
4. Halfon N, Hochstein M. Life course health development: an integrated framework for developing health, policy, and research. Milbank Q. 2002;80(3):433-479. doi:10.1111/1468-0009.00019.
5. Yu S. The life-course approach to health. Am J Public Health. 2006;96(5):768.
6. Halfon N, Forrest CB, Lerner RM, et al, eds. Handbook of Life Course Health Development. Springer; 2018. doi:10.1007/978-3-319-47143-3.
7. Healthy People 2030 Framework. Office of Disease Prevention and Health Promotion. Accessed January 25, 2026. https://odphp.health.gov/healthypeople/about/healthy-people-2030-framework
8. People with Disabilities. Office of Disease Prevention and Health Promotion. Accessed January 25, 2026. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/people-disabilities
9. International Classification of Functioning, Disability and Health (ICF). World Health Organization. Accessed January 25, 2026. https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
10. Lynch L, McCarron M, Eustace-Cook J, Burke E, McCallion P. Physical health effects of sedentary behaviour on adults with an intellectual disability: A scoping review. J Intellect Disabil. 2022;26(1):167-193. doi:10.1177/17446295221107281
11. Andrés-Pérez F, Bru-Luna LM, Hidalgo-Fuentes S, Llamas-Salguero F, Martí-Vilar M. Influence of physical activity in children and adolescents with cerebral palsy: a systematic review. Children. 2025;12(7):853. doi:10.3390/children12070853
12. Alhumaid M, Asiri F, Said M, Haegele J. The efficacy of physical activity or exercise among individuals with cerebral palsy: An umbrella review of systematic reviews. Complement Ther Med. 2025;103228. doi:10.1016/j.ctim.2025.103228
13. Jacob U, Pillay J, Johnson E, Omoya O, Adedokun A. A systematic review of physical activity: benefits and needs for maintenance of quality of life among adults with intellectual disability. Front Sports Act Living. 2023;5:1184946. doi:10.3389/fspor.2023.1184946
14. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. doi:10.1136/bjsports-2020-102955
