Children in Cambodia provide key design priorities for below-knee prostheses: Independence, functionality, comfort and cosmetic appearance

Children with disabilities in low-resource environments (LREs) face major barriers to education, participation, and well-being. Assistive technologies like prostheses can help, but current solutions often fail to meet child-specific needs, particularly in LREs. This study engages pediatric prosthesis users in Cambodia to identify their unique user needs. This study used a novel interactive interview with card games and functional mobility assessment. While the card games and mobility assessment provided quantitative data, the interview responses were analyzed using thematic analysis. Six themes emerged from the analysis, demonstrating children remarkable understanding of both benefits and limitations of their prostheses. They appreciated the independence and cosmetic appearance, but pointed to limited mobility, heavy components, and discomfort as major issues. These priorities were echoed in the card games, where anatomically looking prostheses were the most preferred style, and culturally important activities such as walking fast, sitting cross-legged and kneeling were ranked highest. Children clearly expressed what it is important for them and identified key areas for improvement in current prostheses to improve their social inclusion. Future prosthetic research and development must adopt a user-centered, culturally sensitive approach that actively involves children, ensuring prosthetic solutions meet their physical, emotional, and social needs.