Barriers and facilitators of sports in children with physical disabilities: a mixed-method study

Abstract

Purpose: This study explored barriers and facilitators of sports participation of children with physical disabilities from the perspective of the children, their parents and their health professionals. Method: Thirty children and 38 parents completed a questionnaire, and 17 professionals were interviewed in a semi-structured way. Data from the three groups were combined in a mixed-method design, after which the results were triangulated. Results: Mean age (SD) of the children was 14.1 (2.9) years old, 58% were boys. Sixty-seven percent of the children had cerebral palsy and 77% participated in sports after school. Most commonly practiced sports were swimming, cycling and football. Children specifically experienced dependency on others as a barrier, parents did not have enough information about sports facilities, and professionals observed that the family’s attitude had influence on the child’s sports participation. Facilitators were health benefits, fun and social contacts. Conclusion: Sports participation of children with physical disabilities is a complex phenomenon because children, their parents and professionals reported different barriers. Sports participation is more physically challenging for children with severe physical disabilities, as their daily activities already require much energy. However, the psychosocial benefits of sports are applicable to all children with physical disabilities.

• Implication for Rehabilitation

• Perceived barriers seemed to differ for children, parents and health professionals, suggesting that sports participation is a complex phenomenon.

• Sports might be more physically challenging for children with severe physical disabilities, as their daily activities already take much energy.

• The psychosocial benefits of sports should be emphasized by rehabilitation professionals when advising children with physical disabilities about sports.

     

Perceived environmental barriers to recreational, community, and school participation for children and youth with physical disabilities

Law M, Petrenchik T, King G, Hurley P. Perceived environmental barriers to recreational, community, and school participation for children and youth with physical disabilities.

Objective

To comprehensively describe parent perceptions of environmental barriers to recreational, community, and school participation for children with physical disabilities.

Design

Secondary analysis of cross-sectional data gathered in the first wave of a longitudinal study of the child, family, and environmental factors affecting the recreational and leisure participation of school-age children with physical disabilities.

Setting

General community.

Participants

Parent-child pairs (N=427). Child participants included 229 boys and 198 girls with physical disabilities in 3 age cohorts (6–8, 9–11, 12–14y).

Interventions

Not applicable.

Main Outcome Measure

Craig Hospital Inventory of Environmental Factors.

Results

Barriers to participation were encountered in school and work environments (1.54±1.88), physical and built environments (1.36±1.35), within institutional and government policies (1.24±1.71), services and assistance (1.02±1.2), and attitudes and social support (.87±1.17). Age, socioeconomic status, level of physical functioning, and behavioral difficulties were related to the impact of barriers reported in certain areas. No significant differences by the sex of the children or rural versus urban community were found.

Conclusions

Parents report environmental barriers in several areas, providing valuable information about the environmental factors that support or hinder participation while showing the complexity of these issues. Future research is required to further identify potential avenues for intervention.     

Self-modeling: Rapid skill training for children with physical disabilities

After more than three decades of studies, video is still a vaguely understood medium for training. In this study, self-modeling (self-observation of videotapes that show only adaptive behavior) was compared with videotaping only, using a within-subject type of design. Subjects were 18 boys and girls aged 5 to 13 years with various disabilities including cerebral palsy and spina bifida. Each child was assigned two target behaviors for potential intervention. One behavior was treated with video self-modeling and the other was videotaped without further intervention, resulting in a significant treatment effect. Self-model recordings were produced by planning and selectively editing two minutes adaptive-oly behavior, which subjects reviewed on six occasions over two weeks for a total of 12 min intervention. Progress was confirmed one year later. The study supports the efficacy of self-modeling for selected behaviors of these children with physical disabilities, and suggests further investigation of structured video replay as an active agent of change.     

Participation-based therapy for children with physical disabilities

Purpose: Optimizing home and community participation of children with physical disabilities is an important outcome of rehabilitation. Method: A review of literature identified research and theory on participation of children with physical disabilities. The authors’ incorporated current knowledge to conceptualize the experience of optimal participation, formulate principles of participation-based physical and occupational therapy, and develop a five-step process for intervention. A case report was completed to illustrate application to practice. Results: Optimal participation involves the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation. Real-life experiences enable children to learn new activities and develop skills that optimize their participation and self-determination. Interventions are: goal-oriented, family-centered, collaborative, strengths-based, ecological, and self-determined. A distinguishing feature of intervention is that the therapist’s primary role is to support the child and family to identify challenges to participation and solutions to challenges. The therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity. Conclusion: The model may have utility for collaboration with families and community providers, determining goals for participation, and providing evidence-informed interventions.

Implications for Rehabiliation

• Home and community participation of children with physical disabilities is an important outcome of rehabilitation.

• Optimal participation is conceptualized as the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation.

• Participation-based physical and occupational therapy is based on the assumption that real-life experiences enable children to learn new activities and develop skills and that the empowerment of families enables them to advocate for the full inclusion and integration of their children in society.

• In participation-based therapy, the therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity.

     

A pilot study of a web-based physical activity motivational program for adults with physical disabilities

Purpose. Develop, deliver, and assess the efficacy of a 4-week web-based leisure-time physical activity (LTPA) motivational program based on the Transtheoretical Model and tailored to inactive adults with physical disabilities.

Method. This was a pilot-based study incorporating a true experimental design with one treatment and one control group. The intervention program was delivered on the web and was based on the constructs of the Transtheoretical Model. From the 151 individuals who completed the LTPA standardized questionnaire at baseline, 75 people participated in the 1-month post-test assessment.

Results. The results of the analysis confirmed the pretest LTPA scores as the study covariate for the post-test assessment (F (1,72) = 16.06, p = 0.001, η² = 0.18). Based on the one-way ANCOVA, there were no statistically significant differences in LTPA scores between the treatment and control groups at post-test. However, the corresponding effect size and variance explained by the treatment approached a moderate level of significance (d = 0.34 and η² = 0.04).

Conclusions. Although conclusive statements about program effectiveness cannot be secured, several 'lessons learned' from this project may be 'key factors' for program improvement. Given the pilot nature of the study and the limited resources for program development and monitoring, continued examination of such motivational materials and delivery mechanisms for people with physical disabilities appear warranted.     

A pilot study of a web-based physical activity motivational program for adults with physical disabilities

Purpose.?Develop, deliver, and assess the efficacy of a 4-week web-based leisure-time physical activity (LTPA) motivational program based on the Transtheoretical Model and tailored to inactive adults with physical disabilities.

Method.?This was a pilot-based study incorporating a true experimental design with one treatment and one control group. The intervention program was delivered on the web and was based on the constructs of the Transtheoretical Model. From the 151 individuals who completed the LTPA standardized questionnaire at baseline, 75 people participated in the 1-month post-test assessment.

Results.?The results of the analysis confirmed the pretest LTPA scores as the study covariate for the post-test assessment (F (1,72) = 16.06, p = 0.001, η² = 0.18). Based on the one-way ANCOVA, there were no statistically significant differences in LTPA scores between the treatment and control groups at post-test. However, the corresponding effect size and variance explained by the treatment approached a moderate level of significance (d = 0.34 and η² = 0.04).

Conclusions.?Although conclusive statements about program effectiveness cannot be secured, several ‘lessons learned’ from this project may be ‘key factors’ for program improvement. Given the pilot nature of the study and the limited resources for program development and monitoring, continued examination of such motivational materials and delivery mechanisms for people with physical disabilities appear warranted.     

Correlations between motor competencies,physical activity and self-concept in children with intellectual disabilities in inclusive education

Background

Reciprocal relationships exist between motor competencies, physical activity and self-concept.

Aims

Using a structural equation model, this study examined whether these relationships also appear in children with intellectual disabilities, how they can be validly measured, and if there are differences between children with and without intellectual disabilities.

Materials & Methods

Data from a cross-sectional research project involving 121 children with intellectual disabilities and 1721 without intellectual disabilities were analysed.

Results

The results demonstrate that reciprocal relationships also apply to children with intellectual disabilities and can be elucidated if inverse items are omitted.

Discussion

Children with intellectual disabilities have less developed motor competencies and are less physically active but have a higher general self-concept compared to children without intellectual disabilities. The sport-related ability self-concept of both groups is comparable.

Conclusions

The results are broadly consistent with extant research and illustrate that the development of motor competencies, physical activity and self-concept in children with intellectual disabilities must be encouraged.     

Measuring participation of children with disabilities: Issues and challenges

Purpose. The aim of this paper is to examine conceptual issues that challenge development of valid and useful measures of children's participation.

Method. Ambiguities in the current definition of participation in the International Classification of Functioning, Disability and Health (ICF) are examined along with their implications for developing valid measures for children and youth.

Results. Developers of new measures must address three key issues that will affect the ultimate meaning of participation data obtained from these instruments: uncertain criteria to distinguish activity from participation; lack of consensus on whether measures should address objective or subjective aspects of participation or both; and appropriate choice of respondent when children are the focus. Variations in how the participation construct is operationalized challenge one's ability to develop a coherent body of knowledge about children's participation and the factors that influence it.

Conclusion. Given current variations in how participation is being defined, both developers and users of measures of participation need to be explicit about the definition of participation that a particular measure represents and the inferences that can be drawn from the scores.     

Workplace accommodations for persons with physical disabilities: evidence synthesis of the peer-reviewed literature

Purpose: To identify and synthesize research evidence on workplace accommodations used by employers to recruit, hire, retain, and promote persons with physical disabilities.

Method: A structured search of six electronic journal databases was undertaken to identify peer-reviewed literature on the topic published from January 1990 to March 2016. Articles describing or evaluating workplace disability accommodation policies and practices were given a full-text review. Topic experts were contacted to identify additional studies.

Results: Details on specific accommodations described in 117 articles were synthesized and organized into three groups comprised of a total of 12 categories. The majority of studies did not rigorously evaluate effectiveness or cost-effectiveness of the accommodations under study.

Conclusions: This evidence synthesis provides an overview of the peer-reviewed literature of value to occupational rehabilitation professionals and employers seeking guidance on workplace accommodation policies and practices for persons with physical disabilities. A wide range of accommodation options is available for addressing physical, social, and attitudinal barriers to successful employment. Besides physical/technological modifications, accommodations to enhance workplace flexibility and worker autonomy and strategies to promote workplace inclusion and integration are important. More comprehensive reporting and evaluations of the effectiveness of accommodations in research literature are needed to develop best practices for accommodating persons with disabilities.

• Implications for rehabilitation

• There is a substantial peer-reviewed literature that provides insights into the barriers for persons with physical disabilities and the workplace accommodation practices to address them, though rigorous evaluations of effectiveness and cost-effectiveness are uncommon.

• Attitudinal and social barriers stemming from stereotypes, ignorance and lack of knowledge are as important as physical barriers to employment for persons with physical disabilities.

• In addition to physical/technological modifications, accommodations to enhance workplace flexibility and autonomy of a worker, as well as strategies to promote workplace inclusion and integration may facilitate successful employment of persons with physical disabilities.

     

Job satisfaction of people with intellectual disabilities: the role of basic psychological need fulfillment and workplace participation

Purpose: Knowledge on what contributes to job satisfaction of people with intellectual disabilities is limited. Using self-determination theory, we investigated whether fulfillment of basic psychological needs (i.e., autonomy, relatedness, competence) affected job satisfaction, and explored associations between workplace participation, need fulfillment and job satisfaction.

Method: A total of 117 persons with intellectual disabilities, recruited from a Dutch care organization, were interviewed on need fulfillment at work and job satisfaction. Data on workplace participation was obtained from staff. Questionnaires were based on well-established instruments.

Results: Basic psychological need fulfillment predicted higher levels of job satisfaction. Level of workplace participation was not associated with need fulfillment or job satisfaction.

Conclusions: Allowing workers with intellectual disabilities to act with a sense of volition, feel effective, able to meet challenges, and connected to others is essential and contributes to job satisfaction. It is needed to pay attention to this, both in selection and design of workplaces and in support style.

• Implications for rehabilitation

• Knowledge on factors that contribute to job satisfaction is necessary to improve employment situations and employment success of people with intellectual disabilities.

• In order to achieve job satisfaction, it is essential that workplaces allow for fulfillment of the basic psychological needs for autonomy, relatedness, and competence of people with intellectual disabilities.

• People with intellectual disabilities are able to report on their needs and satisfaction, and it is important that their own perspective is taken into account in decisions regarding their employment situation.

     

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.

     

Attitudes towards people with physical or intellectual disabilities: nursing students and non‐nursing peers

Title. Attitudes towards people with physical or intellectual disabilities: nursing students and non‐nursing peers. Aim. This paper is a report of a study of the attitudes of Dutch nursing students towards people with physical or intellectual disabilities. Background. Attitudes of healthcare professionals are a major factor in the rehabilitation and self‐acceptance of persons with disabilities. Consequently, it is important that nurses develop or maintain positive attitudes towards people with disabilities during their education. However, more knowledge is needed about current attitudes of nursing students and factors influencing these attitudes. Methods. A sample of Dutch nursing students (n = 81) and an age‐matched group of non‐nursing peers (n = 48) completed standardized scales measuring attitudes about physically or intellectually disabled people. Data were collected in 2006. Findings. Nursing students were more positive towards physically disabled people than their peers, and more strongly endorsed empowerment and similarity of intellectually disabled people. These attitudinal differences generally remained statistically significant after multivariate adjustment for demographic variables and experience and contact with individuals with disabilities. An important independent determinant of a positive attitude towards physically disabled people in the total sample was having a relative or friend with a physical disability. This association, however, was not apparent in attitudes towards intellectually disabled persons. Conclusion. Educational interventions aimed at improving attitudes towards people with disabilities should include focus on forms of contact beyond the context of formal care relationships.