Young adults with intellectual disability transitioning from school to post-school: A literature review framed within the ICF

Purpose: The purpose of this review was to describe literature relating to transition for young people with an intellectual disability and identify gaps within the current knowledge base. Method: A narrative literature review was undertaken. Searches of databases Medline, CINAHL, PsycINFO, ERIC, ISI Web of Science and ProQuest 500 International provided relevant research articles. The search terms used were intellectual disability, transition, employment, and ICF as well as other terms derived from the ICF. Manual searches of reference lists identified additional studies. Furthermore, government websites were searched for relevant reports and policies. Results: Transition literature was explored by ICF domains; body functions and structures, activity and participation and contextual factors. Studies were identified in some but not all areas and included literature describing self-determination and participation in leisure activities for those with mild intellectual disability. However, significant gaps were found particularly for those with severe intellectual disability. Conclusions: The ICF is a useful tool in framing a review of transition literature for young people with intellectual disability due to the complexity and multi-faceted nature of transition. The important influence of environmental factors including family systems, post-school services and access to transport were highlighted as having considerable impacts on transition outcomes.

Implications for Rehabilitation

• The ICF is a useful tool in framing transition research to identify gaps.

• The current body of literature in transition from school for young adults with intellectual disabilities is too singularly focused and rarely considers those with moderate to severe intellectual disability.

• There has been little research on this topic in low and middle income countries.

• The scale of the impact of environmental factors on young people transitioning from school to post-school is currently under-represented.

• A holistic approach to post-school outcomes needs to be undertaken in future research.

     

Work-ability assessment in young adults with disabilities applying for disability benefits

Purpose: To investigate the impact of diagnosis, co-morbidity, secondary conditions (e.g. learning problems, subclinical mental and somatic complaints, addictions, and socio-emotional and behavioral problems) and problems in social context on work ability as assessed by Insurance Physicians (IPs) in young adults applying for a disability benefit.

Method: IPs of the Social Security Institute assessed young adults with disabilities (aged 15–27) applying for a disability benefit (n = 1755). Data were analyzed with multilevel ordinal regression techniques.

Results: Primary diagnosis, co-morbidity and subclinical mental complaints were associated with IP-assessed work ability. Persons with mental health conditions as primary diagnosis were less likely to reach a higher work ability than persons with somatic diseases. Young adults with two or more co-morbid conditions and those with psychiatric or developmental co-morbidity were less likely to reach a higher work ability level than persons without co-morbidity. Young adults with subclinical mental complaints were half as likely to reach a higher IP-assessed work ability than young adults without this condition.

Conclusion: Primary diagnosis, type and number of co-morbid conditions and subclinical mental complaints are associated with IP-assessed work ability. Work-ability assessments among adolescents with disabilities applying for disability benefits still focus mainly on medical factors.

Implications for Rehabilitation

• Work participation of young adults with disabilities is limited.

• Young adults with disabilities often need support to be able to function in social and economic life.

• Adequate work ability assessment of young adults with disabilities and subsequent support may help to improve their participation rates.

     

Community participation of persons with disabilities: volunteering,donations and involvement in groups and organisations

Purpose: This study examined similarities and differences between persons with and without disabilities on volunteering, donations and group participation. Method: A sample of 1548 individuals participated and 60% of the sample were persons with disabilities. Data for this research was drawn from a major statewide survey in a Midwestern state in the United States. Community participation was measured through involvement with civic, religious and other community-based groups, volunteering activities and donations. Logistic regression was pursued to test the effect of disability on community participation. Results: Findings support different trends in participation between persons with and without disabilities. Individuals without disabilities are more likely to volunteer, donate money and participate in civic organisations (e.g. clubs) and other groups. Employment and household income have a significant contribution in explaining these differences.

Conclusions: This study found significant differences in community participation between persons with disabilities and persons without disabilities. Regression analysis outcomes underscore the importance of employment and income in eliminating disparities in community involvement between persons with and without disabilities.

• Implications for Rehabilitation

• Policy change in rehabilitation agencies to fund supported volunteering services.

• Improve the representation of persons with disabilities in volunteering pursuits by making volunteering positions accessible to them (educate persons with disabilities to be more aware of these opportunities, provide reasonable accommodations at work sites, etc.).

• Educate stakeholders about the benefits of volunteering and being part of civic, and other community based groups in improving the quality of life of persons with disabilities.

• Identification of barriers for persons with disabilities in these pursuits (physical and attitudinal barriers, lack of resources).

• Identifying and utilising natural supports in the work site for persons with disabilities to receive peer support on the job from full-time employees.

     

Intellectual disability in Africa: implications for research and service development

Abstract

Although intellectual disability (ID) is probably the largest impairment grouping on the African continent, few indigenous research and evaluation studies have been undertaken. This article is an initial attempt to relate service delivery issues to an African research agenda. We critically analysed the available literature, drawing on academic publications and those of non-governmental agencies. In this process we identified several key issues for further investigation, namely: understanding ID in African contexts, access to education and health care, the provision of appropriate assistance and support, and income generation. We relate our analysis to the recommendations made in the World Report on Disability but with a specific focus on ID in Africa. The need for mainstreaming and prioritising ID in non-disability related and across impairment programmes is highlighted. We note the importance of families and emphasise the need to draw on informal and traditional forms of care and participation. The need for reliable research evidence to support practice is highlighted. We conclude with a call to action by and on behalf of individuals with ID to be included in the development priorities of the continent.

• Implications for Rehabilitation

• Service provision for people with intellectual disabilities in Africa is not always well served by insights obtained from western research agendas.

• Appropriate and effective rehabilitation requires an understanding of the context and the environment in which the disabled person operates.

• Indigenous research into the provision of support to families and the inclusion of persons with intellectual disability into mainstream programmes as well as disability specific provision is recommended.

     

Framing disability among young adults with disabilities and non-disabled young adults: an exploratory study

Abstract

Purpose: To explore how young adults frame disability and to compare the meanings of disability between persons with and without disabilities. Method: Snow ball sampling was used to recruit the participants. The sample comprised of 14 young adults from Upstate New York area; nine were non-disabled, five had a physical disability. Data were collected by semi-structured interviews. Qualitative content analysis was used to analyze the data. Results: Five themes emerged from the analysis: disability as a deviation from “the norm”, disability as inability, disability as something one needs to overcome, the role of the environment in disability, and disability as a negative phenomenon. The findings suggest that persons with disabilities hold somewhat different meanings of disability compared with non-disabled persons. Conclusions: While the biomedical frame of disability was somewhat challenged, disability is mainly understood via a biomedical lens. Disability should be framed as form of human diversity, not as a mark of Cain.

• Implications for Rehabilitation

• The ways through which disability is framed-as a medical issue or a social one-influences social attitudes and behaviors toward persons with disabilities as well as the shaping of disability policies and services. These, in turn, effect the well-being and impact the lives of persons with disabilities.

• In a relatively small sample which comprised of young adults with disabilities and non-disabled young adults, this study shows that while medical definitions of disability are somewhat contested, the medical definition of disability seems to prevail.

     

Facilitating employment opportunities for adults with intellectual and developmental disability through parents and social networks

Purpose: People with intellectual and developmental disability (IDD) have historically had high unemployment and underemployment rates and continue to face significant barriers to attaining and sustaining employment. The purpose of this research, conducted in Ontario, Canada was to better understand the experiences of people with IDD gaining and keeping productivity roles. Method: We used qualitative semi-structured interviews with 74 participants with IDD and their families or caregivers as proxies regarding the employment of a person with IDD. We selected a sample of persons from three different geographic regions in Ontario, Canada, and analyzed data through coding methods consistent with a grounded theory approach. Results: Our results demonstrate the importance of parents and other members of social and family networks relative to connecting with work options and sustaining work over time, especially through continued advocacy and investment. Parents helped individuals with IDD negotiate the right job fit, though they often encountered challenges as a result of their efforts. Conclusion: Practitioners must understand how to support parents to be effective advocates for their adult children with IDD, assist them to develop and maintain their social networks and help them to avoid caregiver burnout.

• Implications for Rehabilitation

• People with intellectual and developmental disability (IDD) face numerous challenges in indentifying work options and overcoming barriers to employment.

• Parents and other non-paid support members of social networks can be instrumental in ensuring that persons with IDD not only secure initial job placements, but also sustain employment and employment alternatives.

• Professionals that support persons with IDD can direct their efforts to helping persons with IDD develop strong social connections, as well as helping parents to prevent burnout.

     

The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa

Abstract

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues – particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities.

Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals – 322 persons with disability and 451 comparisons (without disability) – covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling.

Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa.

• Implications for rehabilitation

• Persons with disabilities in rural South Africa have poorer reported health outcomes.

• Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa.

• Better access to health care for persons with disabilities is needed in rural South Africa.

     

Addressing the barriers to accessing therapy services in rural and remote areas

Abstract

Purpose: Throughout the world, people with a disability who live in rural and remote areas experience difficulty accessing a range of community-based services including speech-, physio- and occupational therapy. This paper draws on information gathered from carers and adults with a disability living in a rural area in New South Wales (NSW), Australia to determine the extent to which people living in rural areas may receive a person-centred therapy service. Methods: As part of a larger study in rural NSW into the delivery of therapy services, focus groups and individual interviews were conducted with 78 carers and 10 adults with a disability. Data were analysed using constant comparison and thematic analysis. Results: Three related themes emerged: (i) travelling to access therapy; (ii) waiting a long time to get therapy; and (iii) limited access to therapy past early childhood. The themes overlaid the problems of recruiting and retaining sufficient therapists to work in rural areas. Conclusions: Community-based rehabilitation principles offer possibilities for increasing person-centred therapy services. We propose a person-centred and place-based approach that builds on existing service delivery models in the region and involves four inter-related strategies aimed at reducing travel and waiting times and with applicability across the life course.

• Implications for Rehabilitation

• Therapy service delivery in rural and remote areas requires:

• Place-based and person centred strategies to build local capacity in communities.

• Responsive outreach programs working with individuals and local communities.

• Recognition of the need to support families who must travel to access remotely located specialist services.

• Innovative use of technology to supplement and enhance service delivery.

     

Parental perceptions of barriers to physical activity in children with developmental disabilities living in Trinidad and Tobago

Abstract

Background: Parents have a strong influence on their child’s engagement in physical activities, especially for children with developmental disabilities, as these children are less likely to initiate physical activity. Knowledge is limited regarding parents’ perceptions of this phenomenon in low- and middle-income countries (LMICs); yet many rehabilitation providers work with children with developmental disabilities and their parents in these contexts. Purpose: The aim of this study was to explore the barriers perceived by parents of children with developmental disabilities to their children’s engagement in physical activity. Methods: An occupational perspective was used to explore how parents speak about barriers to their child’s engagement in physical activity. Interviews were conducted with nine parents in Port-of-Spain, Trinidad and Tobago. Findings: Parent’s perceived barriers were categorized into four themes: family priorities, not an option in our environment, need to match the activity to the child’s ability, and need for specialized supports. Conclusions: Findings provide opportunities for future rehabilitation and community programming in LMICs.

• Implications for Rehabilitation

• Children living with a developmental disability may engage more in solitary and sedentary pursuits as a result of parents choosing activities that do not present extensive social and physical demands for their child.

• Therapists can play an important role in providing knowledge to parents of appropriate physical activity and the benefits of physical activity for children with developmental disabilities in order to promote children’s participation.

• In environments where there is limited social support for families, therapists need to consider and be particularly supportive of parental priorities and schedules.

     

The impact of humorous media on attitudes toward persons with disabilities

Purpose: To examine the relationship between disability-related humor and attitudes toward persons with disabilities in business students (i.e. “future employers”). Method: Students watched one of two films designed to reduce negative attitudes toward persons with disabilities (one humorous in tone and the other serious in tone) or no film at all, and completed a measure of attitudes toward persons with disabilities. Results: Results indicated that, after controlling for previous contact with persons with disabilities, age, and gender, students who watched the humorous film reported significantly more positive attitudes toward persons with disabilities. Conclusions: Disability humor may be an effective means of positively influencing attitudes toward persons with disabilities in future employers.

Implications for Rehabilitation

• The acceptance and integration of persons with disabilities into society continues to be limited by negative attitudes.

• Previous research has shown that employers with positive attitudes toward persons with disabilities may be more likely to hire a person with a disability than employers with negative attitudes.

• In this study, students who watched a humorous film reported significantly more positive attitudes toward persons with disabilities than students who watched a serious film or no film at all.

• Consequently, it may be beneficial to embed disability humor into job-placement strategies in order to improve attitudes and positively influence hiring decisions.

     

An emancipatory research on CBR and the barriers faced by persons with disabilities

Abstract

Purpose: The aim of this research was to understand the barriers faced by persons with disabilities in their daily lives and the role of CBR projects in overcoming them. Method: A group of persons with disabilities involved in CBR activities was identified and trained in participatory research methodologies. Research was carried out, with support from a scientific advisory group, through sharing of life stories in residential meetings focusing on specific themes. These meetings were attended by 368 persons with disabilities. Results: The barriers identified ranged from isolation, neglect, abuse and violence to lack of access to social, health, education and livelihood opportunities. People faced their first barriers in their own families. Families also played an important role in overcoming some barriers at the individual level. CBR projects assisted people in overcoming barriers mainly by providing information, by facilitating access to existing support and by helping persons in communities to take collective action against the barriers. The research also stimulated DPOs and CBR projects to identify some gaps in tackling the barriers and to start action to overcome them. Conclusions: CBR projects can play a role in overcoming some barriers faced by persons with disabilities. Emancipatory research yields rich data, facilitates ownership and possibly future sustainability.

• Implications for Rehabilitation

• Community-based rehabilitation (CBR) programmes can promote mainstreaming and helping in overcoming some barriers faced by persons with disabilities in the communities.

• CBR programmes can facilitate collective action by persons with disabilities in overcoming barriers to inclusion and participation.

• Participatory research approaches such as emancipatory research can play a role in understanding disability issues and at the same time, help CBR programmes to identify gaps and strengthen activities.

     

Level of agreement between physical activity levels measured by ActiHeart and the International Physical Activity Questionnaire in persons with intellectual disability

Purpose: The purpose of this study was to determine the level of agreement between objective physical activity (PA) (ActiHeart^®) and subjective proxy-respondent International Physical Activity Questionnaire-short version (IPAQ-S) data in adults with intellectual disabilities (IDs).

Method: Fifty-eight participants wore ActiHeart^® monitors for seven consecutive days. Caregivers of each participant completed the IPAQ-S on behalf of the participant. Total PA, time spent in light, moderate, and vigorous activity as well as time spent being sedentary were assessed by the IPAQ-S and the ActiHeart^®. Results were compared by means of correlation analyses. The level of agreement was presented with Bland–Altman plots.

Results: Objective PA (ActiHeart^®) was higher (225.57?±?91.96?min/week) than IPAQ-S PA reported by care-givers (177.06?±?309.17?min/week). Weak significant correlations were observed between the ActiHeart^® and IPAQ-S instruments for sedentary behavior (r?=?0.31; p?=?0.04); no significant correlations for light (r=??0.04; p?=?0.8), moderate (r=??0.07; p?=?0.63), or vigorous PA (r=??0.2; p?=?0.18) were found. Limited agreement between objectively determine PA (ActiHeart^®) and IPAQ-S was found.

Conclusion: IPAQ-S is inaccurate when determining PA in persons with ID as it significantly underestimates the true levels of PA in this cohort.

• Implications for Rehabilitation

• Persons with intellectual disability (ID) report insufficient physical activity for health benefits.

• Physical activity is often determined by means of subjective proxy reporting.

• Objective physical activity measurements by means of combined heart rate and accelerometer are necessary to determine accurate levels of physical activity in persons with ID.

• Exercise interventions should be based on objective physical activity measurements.

     

Implementation of inclusive education for children with intellectual and developmental disabilities in African countries: a scoping review

Abstract

Purpose: To advance understanding of practices that support inclusion of children with intellectual and developmental disabilities in inclusive education classrooms in Africa by conducting a review of the extant literature.

Methods: Five academic databases were searched supplemented by a hand search of key journals and references of included studies. Two authors independently screened studies via a reference manager (Covidence) which allowed for blinding. A third author was consulted in cases of conflict.

Results: Thirty articles that provided empirical evidence of inclusive education implementation were included. Eight articles highlighted practices that support inclusion of children with intellectual and developmental disabilities. Using Bronfenbrenner’s bioecological framework, findings revealed that inclusive education implementation is influenced by factors on the bio level, micro level, meso level, and macro level. Recommendations for promoting inclusive education implementation are provided.

Conclusions: Inclusion goes beyond teachers and requires strong commitment of other stakeholders such as families and governments. To guarantee the smooth inclusion of children with special education needs and particularly with intellectual and developmental disabilities, a set of practices validated through rigorous research as supportive and unique and that can be universal to Africa is wise.

• Implications for rehabilitation

• A number of strategies were identified that can improve the classroom inclusion of children with intellectual and developmental disabilities. Development of policies that support such strategies could improve implementation.

• Inclusion goes beyond teachers. Rehabilitation professionals (i.e. occupational therapists) and educational professionals should partner to identify practical solutions to the challenges of creating inclusive environments for children with special education needs.

• Committing more resources and time towards the development and implementation of special education policies can advance the successful inclusion of children with special education needs.

     

Validation of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in persons with disabilities and chronic illnesses for Chinese population

Abstract

Purpose: The aim of this study is to test the psychometric properties and validity of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in Traditional Chinese-speaking persons with disabilities and chronic illnesses. Method: The WHODAS II CT has been administrated to a sample of 1020 persons with disabilities and chronic illnesses. The construct validity, internal consistency, concurrent validity and convergent validity were evaluated. Results: WHODAS II CT showed a satisfactory model fit for the second-order confirmatory factor analysis model (χ²/df?=?3.05, root means square error of approximation?=?0.053, comparative fit index?=?0.912, standardized root mean square residual?=?0.076), high internal consistency (Cronbach’s α?=?0.98), high correlation with all domains of Dartmouth Primary Care Cooperative Research Network/World Organization of National Colleges, Academies, and Academic Associations of General Practices/Family Physicians (COOP/WONCA) charts (partial correlation coefficient ranged from 0.26 to 0.74) and significance between persons with and without co-morbidity (all regression coefficients >0). Conclusions: WHODAS II CT is a reliable and valid instrument to measure the disability in persons with disabilities and chronic illnesses among Traditional Chinese-speaking population. A further study is required to validate the short version of WHODAS II in order to enhance its applicability in usual and clinical practices.

• Implications for Rehabilitation

• This is the first study to evaluate the reliability and validity of WHODAS II in persons with disability and chronic illnesses among Traditional Chinese-speaking population.

• The WHODAS II CT is a valid instrument in Chinese adults with disabilities and chronic illnesses.

• The WHODAS II CT is recommended to be used in population-based survey to investigate the health needs of persons with disabilities and chronic illnesses as well as in the rehabilitation programs as an outcome measure.

     

Representations of disability in the Canadian news media: a decade of change?

Abstract

Purpose: To assess stability and change in representations of disability and persons with disability in the Canadian news media between 1998 and 2008. Method: The study replicated research conducted in 1998 that assessed the representation of disability in the Canadian news media. Following the earlier study, three newspapers were selected (Globe and Mail, Toronto Star and Toronto Sun) and all articles from a three-month period in 1998 and 2008 were assessed for disability content. In total, 362 articles were found in the two time periods. These were coded for structure and content using a schema developed in the earlier research. Results: Between 1998 and 2008, there was a significant increase in the proportion of stories using “person first” language, and a significant increase in the proportion of “progressively” themed articles (e.g. dealing with barriers to participation, or disability awareness and inclusion). At the same time, there were significant differences between newspapers, with the Toronto Sun (a tabloid) maintaining a strong focus on “traditional” themes (e.g. special education, charitable provision). Conclusions: The differences in news media representations between 1998 and 2008 suggest a positive change in the way people with disabilities are represented, with greater attention to the complexity of their identity and their multiple social roles.

• Implications for Rehabilitation

• The participation of persons with disabilities in society continues to be limited by negative attitudes.

• Media reporting has a significant influence on public attitudes toward disability.

• In a content analysis of three Canadian newspapers, this study found several significant changes in the language and content of disability-related articles.

• Together, these changes provide some evidence of more favorable media representations of disability. Further research in rehabilitation is needed to understand how such changes may both reflect and facilitate ongoing efforts to enhance people with disabilties’ participation in social life.

     

“This is my way”: reimagining disability,in/dependence and interconnectedness of persons and assistive technologies

Purpose: Postmodernism provides a radical alternative to the dominant discourses of Western societies that emphasize autonomy and independence. It suggests a reimagining of the relationship between the self and the body and the increasingly blurred boundaries between biology and machine. The purpose of this article is to explore in/dependence through a discussion of interconnectedness of persons and assistive technologies. Key messages: Drawing on postmodern theories, we discuss the interconnections inherent in disability experiences through the case example of Mimi, an adolescent girl with severe physical disabilities. We consider how Mimi, her assistive technologies and her parents can be viewed as assemblages of bodies/technologies/subjectivities that together achieve a set of practices. An examination of these various couplings suggests different understandings of disability that open up possibilities for multiple connections and reimagines dependencies as connectivities. Conclusions: Connectivity can be embraced to explore multiple ways of being-in-the-world for all persons and problematizes the goals of independence inherent in rehabilitation practices.

Implications for Rehabilitation

• “Dependency” has a negative social connotation that is challenged by postmodern ideas of dynamic connectivity.

• Connectivity offers an alternative lens for conceptualizing relationships between disabled people, their technologies and caregivers.

• Connectivity suggests a rethinking the goals of independence inherent in rehabilitation practices.

     

An integrated methods study of the experiences of youth with severe disabilities in leisure activity settings: the importance of belonging,fun, and control and choice

Abstract

Purpose: The aim was to examine the leisure activity setting experiences of two groups of youth with severe disabilities – those with complex continuing care (CCC) needs and those who have little functional speech and communicate using augmentative and alternative communication (AAC). Method: Twelve youth took part in a mixed methods study, in which their experiences were ascertained using qualitative methods (observations, photo elicitation and interviews) and the measure of Self-Reported Experiences of Activity Settings (SEAS). Data integration occurred using a “following a thread” technique and case-by-case analysis. Results: The analysis revealed several highly valued aspects of leisure activity setting experiences for youth, including engagement with others, enjoying the moment, and control and choice in selection and participation in activity settings. Conclusions: The findings provide preliminary insights into the nature of optimal activity settings for youth with severe disabilities, and the mediators of these experiences. Compared to other youth, the data illustrate both the commonalities of experiences and differences in the ways in which these experiences are attained. Implications for research concern the utility of mixed methods approaches in understanding the complex nature of participation experiences. Implications for clinical practice concern the importance of not assuming the nature of youths’ experiences.

• Implications for Rehabilitation

• Service providers can lose sight of the importance of broader concepts of belonging, fun, and control and choice when providing interventions that focus on “participating” in an “activity” to build specific skills.

• In addition to the skill-based outcomes for youth with disabilities that are valued by the rehabilitation system, we suggest that consideration needs to be given to other types of outcomes that matter to youth, such as participating in a leisure activity for the sake of belonging or having fun.

• It is important not to assume that youth with severe disabilities are not enjoying their participation or are not benefiting from their leisure experiences.

• It is important not to “over-therapize” youth with disabilities and promote a balanced approach to therapy and leisure participation, by discussing with youth and families the beneficial developmental outcomes that can accrue from leisure activities.

     

Assisted normality – a grounded theory of adolescent’s experiences of living with personal assistance

Purpose: The purpose of the study was to explore how adolescents with disabilities experience everyday life with personal assistants. Method: In this qualitative study, individual interviews were conducted at 35 occasions with 16 Swedish adolescents with disabilities, in the ages 16–21. Data were analyzed using grounded theory methodology. Results: The adolescents' main concern was to achieve normality, which is about doing rather than being normal. They try to resolve this by assisted normality utilizing personal assistance. Assisted normality can be obtained by the existing relationship, the cooperation between the assistant and the adolescent and the situational placement of the assistant. Normality is obstructed by physical, social and psychological barriers. Conclusion: This study is from the adolescents’ perspective and has implications for understanding the value of having access to personal assistance in order to achieve assisted normality and enable social interaction in everyday life.

• Implications for Rehabilitation

• Access to personal assistance is important to enable social interaction in everyday life.

• A good and functional relationship is enabled through the existing relation, co-operation and situational placement of the assistant.

• If the assistant is not properly sensitized, young people risk turning into objects of care.

• Access to personal assistants cannot compensate for disabling barriers in the society as for example lack of acceptance.

     

The effect of adaptive sports on employment among people with disabilities

Purpose: The purpose of this study is to analyse the role of adaptive sport in predicting employment for individuals with physical disabilities. Method: This study is cross-sectional. We collected survey data on employment and other covariates including education, age, age at disability onset, veteran status and athletic classification from 140 mobility impaired athletes who play either wheelchair rugby or wheelchair basketball. Results: One hundred and thirty-one participants were studied. Our analysis shows that playing an additional year of adaptive sport is associated with an approximately 4% increase in likelihood of employment. Education and duration of disability are found to be positive predictors of employment, while veteran status and severity of injury are negative predictors of employment. Age of disability onset is not found to be a predictor of employment when other controls are included. Conclusions: This result indicates that a substantial economic benefit would result from increased participation in adaptive sport, and therefore may justify additional funding to expand adaptive sport programs.

• Implications for Rehabilitation

• Employment rates are very low among individuals with physical disabilities, despite research indicating extensive benefits from employment.

• Participation in adaptive sport is associated with a higher likelihood of employment.

• Efforts to increase participation in adaptive sport could have a large economic benefit.