Barriers and facilitators toparticipation in physical activity for

children with disabilities

A systematic literature review

ISABEL CLEMENTE

One year master thesis 15 credits Supervisor: Karina HuusInterventions in Childhood Examinator: Margareta Adolfsson

Spring Semester 2017

SCHOOL OF EDUCATIONAND COMMUNICATION (HLK)Jönköping University

Master Thesis 15 creditsInterventions in Childhood

Spring Semester 2017

ABSTRACT

Author: Isabel Clemente

Main title: Barriers and facilitators to participation in physical activity for children withdisabilities.

Subtitle: A systematic literature review

Pages: 42

Children with disabilities need physical activity in order to correctly develop, however, finding anadequate type of physical activity for children with disabilities can be a very complicated issue.Furthermore, trying to include them in an ordinary physical education class is even more difficult. Wecome across several barriers that impede their proper inclusion in physical activity. In order to enhancechildren with disabilities´ participation, it is important to know the barriers and facilitators that exist andtake them into account. Therefore, the aim of the study is to explore what facilitators and barrierschildren with all kinds of disabilities can come across in order to get involved in physical activity. Bydoing a systematic review of articles that explain perceived barriers and facilitators, this paper isaddressed to find out the barriers and facilitators children with all kind of disabilities can have. Theresults show that each kind of disability has different barriers and facilitators. While some disabilitiesfocus more on physical facilitators and barriers, others find more important the logistical ones or thepsychological aspects. Answers given from professionals, children and parents are very different andtherefore shows a lack of communication between them as well as a need for cooperation and working.

Keywords: Barriers, facilitators, physical activity, children with disabilities, participation.

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Table of Content

1. Introduction…………………………………………………………………………… 1

2. Background …………………………………………………………………………… 1

2.1. Child …………………………………………………………………………… 1

2.2. Disability ……………………………………………………………………… 1

2.3. School context………………………………………………………………… 1

2.4. Physical activity………………………………………………………………… 2

2.5. Physical inactivity……………………………………………………………… 3

2.6. Barriers and facilitators………………………………………………………… 3

2.7. Definitions……………………………………………………………………… 4

2.7.1.Adapted physical education……………………………………………… 4

2.8. Theoretical framework………………………………………………………… 4

2.9. Rationale……………………………………………………………………… 5

3. Aim …………………………………………………………………………………… 6

4. Research questions…………………………………………………………………….. 6

5. Method………………………………………………………………………………… 6

5.1. Type of study…………………………………………………………………… 6

5.2. Search strategy………………………………………………………………… 6

5.3 Selection criteria………………………………………………………………… 7

5.4.Selection process………………………………………………………………… 8

5.4.1. Title and abstract………………………………………………………… 8

5.4.2.Full text …………………………………………………………………… 8

5.5.Quality assessment……………………………………………………………… 12

5.6.Analysis of articles……………………………………………………………… 12

5.7.Ethical consideration…………………………………………………………… 13

6. Results………………………………………………………………………………… 14

6.1. Intellectual disabilities ………………………………………………………… 15

6.1.1. Barriers………………………………………………………………… 15

6.1.2.Facilitators………………………………………………………………… 16

6.2. Physical disabilities………………………………………………………………16

6.2.1. Barriers…………………………………………………………………… 16

6.2.2. Facilitators……………………………………………………………… 18

6.3. Development disabilities…………………………………………………………19

6.3.1. Barriers…………………………………………………………………… 19

6.3.2. Facilitators…………………………………………………………………20

6.4. Every kind of disabilities…………………………………………………………21

6.4.1. Barriers…………………………………………………………………… 21

7. Discussion……………………………………………………………………………… 22

7.1. Discussion on results…………………………………………………………… 23

7.2. Differences in perspectives……………………………………………………… 24

7.3. Considerations to enhance participation………………………………………… 25

7.4. Method and limitations………………………………………………………… 26

8. Conclusion……………………………………………………………………………… 27

9. References……………………………………………………………………………… 28

10. Appendix……………………………………………………………………………… 37

Appendix 1……………………………………………………………………………37

Appendix 2……………………………………………………………………………38

Appendix 3A………………………………………………………………………… 39

Appendix 3B………………………………………………………………………… 41

Appendix 3C………………………………………………………………………… 42

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1 Introduction

The amount of participation in physical activity for children with disabilities is low as

reported in articles and therefore, the barriers and facilitators should be revised and taken into

account to study and plan an intervention to enhance the participation of children with

disabilities in physical activity. In this thesis it will be addressed by a systematic review, the

perceived barriers and facilitators children with disabilities have come across and will be

discussed how can these barriers be overcome and the facilitators used to enhance their

participation in physical activities.

2 Background2.1. CHILD:

The UN Convention of the rights of the children (1989) defines a 'child' as a person below the

age of 18, unless the laws of a particular country set the legal age for adulthood younger.

However WHO (2003) defines a child as a person 19 years or younger unless national law

defines a person to be an adult at an earlier age.

2.2. DISABILITY:

According to WHO (2011) , Disability is a term, covering impairments, activity limitations,

and participation restrictions. An impairment is a problem in body function or structure; an

activity limitation is a difficulty encountered by an individual in executing a task or action;

while a participation restriction is a problem experienced by an individual in involvement in

life situations. Disability is thus not just a health problem. It is a complex phenomenon,

reflecting the interaction between features of a person’s body and features of the society in

which he or she lives. Children with different kind of disabilities can find it very difficult to

integrate in society, to participate in different activities or to take part in physical activities

just like their normal developing peers specially due to the barriers they come across while

trying to participate.

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2.3. SCHOOL CONTEXT:

The UN Convention on the Rights of Persons with Disability (UNCRPWD), in Article 30

refers to physical activity within formal and informal educational institutions. Evidence based

on surveys among physical education teachers suggest that Intellectual disability is among the

disabilities that pose the greatest challenge when attempting inclusion in their Physical

Education classes (Rizzo, 1984; Rizzo & Vispoel, 1991; Downs & Williams, 1994; Hodge &

Jansma, 2000; Hutzler, 2003). It is the knowledge and experience that teachers have about

how to adapt instruction to the child with disability and to his or her peers and how to adapt

tasks, equipment, environmental conditions and game rules that influences their attitude about

teaching students with disabilities, and that is one of the foundations of successful inclusion in

Physical Education (Kowalski & Rizzo, 1996; Hutzler et al., 2005).

2.4. PHYSICAL ACTIVITY:

According to some researchers, physical inactivity is a global public health problem (Lamarre

& Pratt, 2006). Participating regularly in physical activity (PA) enhances body composition

(LeMura & Maziekas, 2002), bone health (Bradney, Pearce, Naughton, Sullivan, Bass & Beck,

et al., 1998) and psychological health (Trost, 2005) as well as promotes social engagement

(Jobling, 2001). Children with disabilities often have delayed gross motor development, less

proficiency in balance and coordination and poor cardiovascular fitness compared to their

peers with typical development, all of which could potentially be improved by participation in

physical activity (Horvat, Pitetti & Croce, 1997). The benefits of sports have been

documented frequently and generally include an increase in health and physical fitness and a

decrease in secondary conditions (Philpott, Houghton & Luke, 2010). Participation in PA

opportunities is a fundamental childhood experience that fosters the psychosocial

development of interpersonal skills, self-confidence, and self-efficacy (Special Olympics,

2005). Besides health benefits, sports participation also promotes personal autonomy,

community integration and life satisfaction of children with physical disability (Majnemer,

Shevell & Law, et al., 2008). Furthermore, physical activity may be a pivotal factor not only

in preventing obesity and health risks associated with weight gain but also in promoting

healthy cognitive, psychosocial, and physical development in children with special needs.

Physical activities provide school-age children with opportunities for enjoyment, relaxation,

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recreation, self-enrichment and goal achievement (Coastsworth et al., 2005; Passmore &

French, 2003; Shikako-Thomas et al., 2012; Wilkes, Cordier, Bundy, Docking, & Munro,

2011). Moreover, it is very useful for building children´s competence, self-determination and

identity, as well as for social and personal development. (Coastworth et al., 2005; Passmore &

Frenche, 2003; Shikako-Thomas et al., 2012; Wilkes, Cordier, Bundy, Docking & Munro,

2011) and participation in meaningful physical activities correlates with children´s wellbeing

(Adolfsson, 2011). Regular participation in physical activity develops body composition,

skeletal health, and contributes to the prevention or delay of chronic disease. It also improves

several aspects of psychological health including self-esteem and promotes social contacts

and friendships. It is also an important determinant of health that is associated with a range of

physiological benefits in children, including reduced cardiometabolic risk and more preferable

body size (Boddy et al., 2014). Physical activity in childhood is also positively associated

with mental health (Ahn & Fedewa, 2011) and academic achievement (Fedewa & Ahn, 2011),

and it is therefore important that children and young people accrue sufficient physical activity.

2.5. PHYSICAL INACTIVITY:

Evidence indicates that children with disabilities do not meet the recommended 60 minutes of

moderate-to-vigorous PA. Some studies have shown that children and youth with disabilities

have lower aerobic fitness and muscular strength (Mac Donncha et al., 1999; Gillespie 2003;

Golubovic et al., 2012) than their typically developing peers, which might negatively

influence children’s physical and cognitive development. Among people with physical

disabilities, participation in sport, exercise, and other forms of leisure time physical activity

(LTPA) has been shown to yield numerous health benefits (Carroll et al., 2014). Nevertheless,

the vast majority of people living with a physical disability do not participate in sufficient PA

to achieve health benefits (Carroll et al., 2014). In general, daily physical activity levels of

children with disabilities have been assumed to be lower than in children without disabilities

(Fernhall, 2002). Many children and youth who have intellectual and developmental

disabilities (IDD) do not exercise sufficiently, play sports, or have access to recreational

activities (Foley & McCubbin, 2009; Howie et al., 2012; Pitetti et al., 2009; Rimmer &

Rowland, 2008; Whitt-Glover et al., 2006).

2.6. BARRIERS AND FACILITATORS:

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In order for children with disabilities to participate in PA, we come across barriers and

facilitators that directly affect the amount and type of PA these children do. Barriers are seen

as things that prevent an individual from exercising (Lox, Martin & Petruzzello, 2003). On

the other hand, facilitators are factors that by their presence or absence improve functioning

and increase the opportunity for a child to participate in physical activity. (WHO, 2007). To

enhance participation, we should overcome the barriers and use the facilitators.

2.7. DEFINITIONS:

2.7.1. Adapted physical education:

Adapted Physical Education (APE) develops, implements, and monitors a carefully

designed physical education program for a learner with a disability, based on a comprehensive

assessment, to give the learner the skills necessary for a lifetime of rich leisure, recreation,

and sport experiences to enhance physical fitness and wellness. Adapted physical education

generally refers to school-based programs for students ages 3-21. (Auxter, Pyfer, Zittel &

Roth, 2010)

This kind of physical education should develop:

Physical and motor skills

fundamental motor skills and patterns (throwing, catching, walking, running, etc)

skills in aquatics, dance, and individual and group games and sports (including

intramural and lifetime sports)

The services provided by an APE teacher include (adapted from Sherrill, 1998):

Planning services

Assessment of Individuals /Ecosystems

Prescription/Placement

Teaching/Counseling/Coaching

Evaluation of Services

Coordination of Resources and Consulting

Advocacy

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Physical education needs to be provided to the student with a disability as part of the special

education services that child and family receive (APENS, 2008).

2.8. THEORETICAL FRAMEWORK:

The barriers and facilitators are organized according to B. Horne´s criteria in “Making Sport

and Physical Activity Inclusive for Disabled People, 2016”. B. Horne divides facilitators and

barriers into three main categories:

- Physical:

* Facilities: Barriers and facilitators addressing the state of the facilities, or anything

related to them such as not suitable facilities.

* Equipment: Barriers or facilitators addressing equipment used by the child in a

physical activity, adaptation of equipment, etc.

* Health and safety: Barriers or facilitators related to the disability, problems they

can face due to their health.

- Logistical:

* Geography: Barriers or facilitators related to transport or distance of the facilities.

* Expenses: Financial barriers or facilitators.

* Support from others: Barriers or facilitators that are addressed to the help the child

can get from professional, parents, peers etc.

* Communication: Barriers or facilitators addressing talking and communication

between professionals, parents and children or the amount of information parents or

children have. .

* Suitability: Barriers or facilitators addressing physical activity or its components

such as facilities adapted for a child with disability.

- Psychological:

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* Personal perceptions: Barriers or Facilitators that talk about how the child thinks

of himself, motivation, shyness, etc.

* Attitudes from others: Barriers or Facilitators about what other people think and

act towards a child with disability.

2.9. RATIONALE:

Physical activity is found beneficial for children with disabilities, unfortunately, it has been

studied that they do not meet the recommended amount of time spent doing physical activity.

In order to enhance children with disabilities´ participation, a physical educator should

overcome the barriers and use the facilitators to accomplish their involvement in physical

activity and therefore, these barriers and facilitators should be deeper studied and organized.

3 AIM

The aim of the study is to explore what facilitators and barriers children with different kinds

of disabilities can come across in order to get involved in physical activity.

4 RESEARCH QUESTIONS

- What barriers and facilitators do children with intellectual disability encounter in order to be

involved in physical activity?

- What barriers and facilitators do children with developmental disability encounter in order to

be involved in physical activity?

- What barriers and facilitators do children with physical disability encounter in order to be

involved in physical activity?

5 METHOD5.1. TYPE OF STUDY:

This study is a systematic literature review were the articles where analysed using a deductive

method out of B. Horns model of dividing barriers and facilitators. The data was then sorted

out, organized and discussed.

5.2. SEARCH STRATEGY:

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In order to do the search, the following search words were used; “Physical activity AND

barriers OR facilitators AND children with disability” articles that spoke about physical

activity and children with disabilities and either contained barriers or facilitators, “children

AND special needs AND barriers OR facilitators AND physical activity” articles that spoke

about children with special needs and physical activities and had either barriers or facilitators

and “sport AND disability AND barriers OR facilitators” articles that were addressed to sports

and disabilities and contained either barriers or facilitators. These search words were entered

in the data bases Primo JU library, Pubmed, Medline, Psychinfo or Aelmed. After having

done the search, 101 articles were found. Some articles where found double due to the fact

that the different data bases sometimes had the same articles. Very similar articles were also

found, that explained mostly the same subjects and articles that did not´t fit the research. For

the exclusion of those, a selection criteria was used.

5.3. SELECTION CRITERIA:

In order to select the articles that best help answer the aim of the study, an inclusion criteria

was used first and an exclusion criteria (See table 1.1). The inclusion criteria was, systematic

reviews, the article contain data about children or adolescents (age 0 to 20), different

disabilities where included and the article should explain barriers and facilitators. The article

could be from the perspective of parents, children with disabilities or teachers. The articles

should not be older than 2005 and should talk about barriers and facilitators out of a physical

activity perspective. The exclusion criteria were if the article were based on a Specific country

or place, if the evidence and citations were unsupported. Also articles that talk about general

participation in school/society from children with disabilities were excluded because they did

not support the aim of the research.

Table 1.1.. Inclusion and Exclusion criteria

INCLUSION EXCLUSION

Publication type:

Systematic reviews and empirical studies.

Specific country/Place

Ages:

Children or adolescents (0 to 20)

Do not specify barriers/facilitators

All disabilities Children with typical development

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Barriers and facilitator from parents, children orprofessional perspectives

Adults with disabilities

Publication years:

2005-2017

Focus:

General participation

Focus:

Physical activity

Languages:

English or Spanish

Peer reviewed

Access for free

5.4. SELECTION PROCESS:

5.4.1. Title and abstract:

The extraction protocol for the title and abstract was the first one used in order to screen

through the articles and exclude the obvious articles that did not accomplish the criteria and

did not answer the research questions. The extraction protocol for the title and abstract

screening included; title, author, year, disabled children related, focused on PA and includes

barriers and facilitators. After having done the title and abstract screening, 65 articles where

excluded. The reasons were:

- Were repeated: 13 articles.

- Not focused on children with disability: 1 article.

- Were too old: 6 articles.

- Were not focused on Physical activity: 1 article.

- Did not include barriers and facilitators: 44 articles.

5.4.2. Full text:

Once the title and abstract screening was done, 36 articles were left and the full text screening

was performed applying the full text protocol (APPENDIX 1) and the inclusion and exclusion

criteria. This full text extraction protocol included; Age of children, Type of disability, School

9

these disabled children attend to, identified barriers and facilitators and who´s opinion these

barriers and facilitators come from.

After having done the full text screening, 21 articles where excluded. The reasons were:

- Age was too wide: 9 articles.

- Specific country/Place: 1 article.

- Unclear barriers and facilitators: 6 articles.

- Did not fulfil quality assessment: 9 articles.

Therefore, after having completed title and abstract review and full text screening, 15 articles

where chosen to perform the results of the study.

These where the following:

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

study by Eva A. Jaarsma, Pieter U. Dijkstra, Alida C. E. de Blécourt, Jan H. B. Geertzen &

Rienk Dekker (2014).

2. Perceived barriers and facilitators to physical activity for children with disability: a

systematic review by Nora Shields, Anneliese Jane Synnot & Megan Barr (2012)

3. Physical activity for people with disabilities by James H Rimmer & Alexandre C Marques

(2012)

4. Perceived barriers and facilitators to participation in physical activity for children with

disability: a qualitative study by Nora Shields & Anneliese Synnot (2016)

5. A systematic review of review articles addressing factors related to physical activity

participation among children and adults with physical disabilities by Kathleen A. Martin

Ginis, Jasmin K. Ma, Amy E. Latimer-Cheung & James H. Rimmer (2016)

6. Factors Predicting Physical Activity Among Children With Special Needs by Shahram

Yazdani, Chu Tang Yee & Paul J. Chung (2013)

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7. Factors associated with physical activity in children and adolescents with a physical

disability: a systematic review by Manon Bloement, Frank Backx, Tim Takken, Harriet

Wittink, Joyce Benner, Jurgen Mollema & Janke De Groot (2014)

8. Physical activity for youth with disabilities: A critical need in an underserved population by

James A. Rimmer & Jennifer L. Rowland (2009)

9. Identifying the barriers and facilitators to participation in physical activity for children with

Down syndrome by M. Barr & N. Shields (2011)

10. Perceived Barriers and Facilitators of Participation in After-School Physical Activity by

Children with Autism Spectrum Disorders by Iva Obrusnikova & Albert R. Cavalier (2010)

11. Identification of facilitators and barriers to physical activity in adolescents and children

with cerebral palsy by Olaf Verschuren, Lesley Wiart, Dominique Hermans & Marjolijn

Ketelaar (2012)

12. Physical activity engagement in young people with down syndrome; Investigating

parental believes by Marianna Alesi & Annamaria Pepi (2015)

13. Perceived barriers to and facilitators of physical activity in young adults with childhood-

onset physical disabilities by Laurien M. Buffart, Tessa Westendorp, Rita J. van den Berg-

Emons, Henk J. Stam & Marij E. Roebroeck (2009)

14. Barriers to and facilitators of sports participation for people with physical disabilities: A

systematic review by E. A. Jaarsma, P. U. Dijkstra, J. H. B. Geertzen & R. Dekker (2014)

15. An exploratory study of how sports and recreation industry personnel perceive the barriers

and facilitators of physical activity in children with disability by Nora Shields & Anneliese J.

Synnot (2014)

The data from the selection process and the reasons for exclusion is shown under figure 1.1

below.

11Figure 1.1. Selection process of articles and the reasons why the articles where excluded.

12

5.5. QUALITY ASSESSMENT:

In order to commit the quality assessment of this systematic review, a grid with statements was formed.

It was made by the researcher of the articles according to the ethical considerations and what should

an article have to be reliable and trustworthy. All articles where assessed through this grid. If the

answer to the statements was positive, the articles where ideal to be part of the systematic review. The

statements where the following:

- The purpose is clearly stated

- The results answer the research questions of this study

- The methods are adequately described

- The method commits the ethical considerations

- The data collection is clearly stated

- The selection process is described

- The participants are adequately described

- The process of analysing data was well described

- The discussion/conclusion was well funded in relation to the results

An excel with these results was made and an example of it can be found in APPENDIX 2. In order to

be used in the thesis, due to the fact that many articles had passed the stages before, the articles had to

fulfill every statement. If the articles didn´t fulfill every statement on the quality assesment, it was not

used in the systematic literature review.

5.6. ANALYSIS OF ARTICLES:

In order to organize the results, deductive analysis was used to introduce the results into B.

Horne´s model. Sometimes, existing theory or prior research exists about a phenomenon that

is incomplete or would benefit from further description. Potter and Levine-Donnerstein (1999)

categorizes this as a deductive use of theory. The data from the 15 articles chosen for the

study were analysed and carefully placed into the corresponding category.dividing them into

three different types of disabilities; intellectual, physical and developmental.

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5.7. ETHICAL CONSIDERATIONS:

When taking into account ethical considerations, there are 5 principles to consider (APA,

2010), these are:

- Beneficence and Non maleficence: The researchers of these articles strive to benefit those

with whom they work and take care to do no harm. They seek to safeguard the welfare and

rights of those with whom they interact professionally and other affected persons, they

attempt to resolve conflicts in a responsible fashion that avoids or minimizes harm and are

alert to and guard against personal, financial, social, organizational, or political factors that

might lead to misuse of their influence. Researchers also strive to be aware of the possible

effect of their own physical and mental health on their ability to help those with whom they

work.

- Fidelity and Responsibility: The researchers establish relationships of trust with those with

whom they work and are aware of their professional and scientific responsibilities to society

and to the specific communities in which they work. They uphold professional standards of

conduct, clarify their professional roles and obligations, accept appropriate responsibility for

their behaviour, and seek to manage conflicts of interest that could lead to exploitation or

harm, as well as consult with, refer to, or cooperate with other professionals and institutions to

the extent needed to serve the best interests of those with whom they work. They are

concerned about the ethical compliance of their colleagues’ scientific and professional

conduct. Researchers strive to contribute a portion of their professional time for little or no

compensation or personal advantage.

- Integrity: The researchers from the articles seek to promote accuracy, honesty, and

truthfulness. Researchers strive to keep their promises and to avoid unwise or unclear

commitments. Researchers have a serious obligation to consider the need for, the possible

consequences of, and their responsibility to correct any resulting mistrust or other harmful

effects that arise from the use of such techniques.

- Justice: Researchers exercise reasonable judgement and take precautions to ensure that their

potential biases, the boundaries of their competence, and the limitations of their expertise do

not lead to or condone unjust practices.

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- Respect for People's Rights and Dignity: The researchers from the articles respect the

dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and

self-determination. They are aware that special safeguards may be necessary to protect the

rights and welfare of persons or communities whose vulnerabilities impair autonomous

decision making and are aware of and respect cultural, individual, and role differences,

including those based on age, gender, gender identity, race, ethnicity, culture, national origin,

religion, sexual orientation, disability, language, and socio-economic status, and consider

these factors when working with members of such groups. They try to eliminate the effect on

their work of biases based on those factors, and they do not knowingly participate in or

condone activities of others based upon such prejudices.

In the articles chosen for this study and also through this systematic review, all of these

aspects are taken into account and carefully measured. All of the 15 articles chosen in the end

to commit the aim had ethical approval. This was checked as part of the quality assessment

the articles had to go through.

6 RESULTS

In order to organize the results, the articles where divided according to the disability they

spoke about to further discuss the differences found. The articles where divided into the

following disabilities:

- Intellectual disabilities: “A disorder of intellectual disability is a condition characterized by

significant limitations in intellectual functioning and adaptive behaviour, originating during

the developmental period.” (AAIDD, 2013)

- Physical disabilities: “An impairment requiring the use of a wheelchair; an impariment

causing difficulty or insecurity in walking or climbing stairs or requiring the use of braces,

crutches, or other artificial supports; an impairment (partial or total) of hearing or sight,

causing likelihood of exposure to danger in public places or an impairment due to conditions

of aging or incoordination.” (Mc. Graw Hill, 2003)

- Developmental disabilities: "A diverse group of chronic conditions that are due to mental or

physical impairments. Developmental disabilities cause individuals living with them many

difficulties in certain areas of life, especially in "language, mobility, learning, self-help, and

15

independent living". (Centre for disease control and prevention, 2013). Developmental

disabilities can be detected early on, and do persist throughout an individual's lifespan.

The barriers and facilitators of each kind of disabilities are organized using B. Horne´s criteria.

6.1. INTELLECTUAL DISABILITIES:

6.1.1. Barriers:

Physical:

- Facility: Lack of sports facilities, lack of activities and programmes, waiting lists,

- Health and safety: Fatigue, longer to develop skills, lack of physical skill, becomes harder as

children get older, obesity, congenital heart defects, communication impairments, low energy

level, lack of ability to understand rules and interpret instructions, recurrent chest infection,

ear infection, asthma, vision impairments, hearing deficits, continence, arthritis, spinal

problems, leukaemia, poor motor skills, lack of coordination, hypotonicity.

Logistical:

- Geography: Distance required to reach the PA place, transportation.

- Expenses: Lack of financial resources and the extra costs associated with raising a child with

disability

- Support from others: Need of extra support to participate, lack of practical instructor training,

- Communication: limited partnerships between sectors and time restraints, lack of advertised

events, parents lack knowledge or means and the fact that children and parents are not asked

about how they can participate

Psychological:

- Personal perceptions: Frustration or loss of confidence when child compares self to peers,

non- compliance, preference for a passive activity,

- Attitudes from others: Overprotecting parents, parental exhaustion and therefore, the parents

themselves discourage, Not feeling accepted by others, negative societal attitudes towards

disability, inaccurate stereotypes.

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6.1.2. Facilitators:

Physical:

- Facility: Gyms without architectonic barriers, inclusive pathways, policies & programs,

- Equipment: Gyms with specialized sport machines

- Health and safety: Improving health, change in position of the body, increasing physical

strength, enhancement of physical skills and cognitive ability to understand rules,

Logistical:

- Geography: Local activities, transport.

- Support from others: Being with peers, and trying to them, positive influence of the child’s

environment, positive encouragement from others, family involvement, skilled instructors,

organising sports activities during school hours, disability groups and councils.

- Communication: Enjoying social interaction, good verbal communicators,, having enough

information, special schools provide information on activity and partnerships between schools,

- Suitability: Structured activity programmes, individual and team activities, meaningful and

appropriate activities

Psychological:

- Personal perceptions: Fun, internal motivation, sense of success, sense of enthusiastic and

determined individuals

- Attitudes from others: Peer acceptance, having proactive parents, parents as role models and

time spending.

6.2. PHYSICAL DISABILITIES:

6.2.1. Barriers:

Physical:

- Facility: Lack of opportunities, no place to exercise, environment not adequately adapted,

low availability of programmes, lack of appropriate facilities.

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- Equipment: Expensive or inappropriate equipment, it takes a long time to acquire the

equipment after purchasing it, carrying equipment in public transport is exhausting.

- Health and safety: Disability itself, physical injury/complication, lack of energy/fatigue,

lack of motor skills, oxygen cost of walking, lack of athletic ability, coordination and skills,

issues related to toileting,, child’s behavioural problems or lack of social skills.

Logistical:

- Geography: Bad weather, distance to facilities, transportation problems.

- Expense: Costs of transport, expensive equipment, expensive entrance of facilities, lack of

funding.

- Support from others: Lack of professional support, dependency upon others, lack of parental

support, low maternal level of education, lack of role models, lack of PA partners to play with,

relative supportness of the social and attitudinal environments, deficiency of guidance.

- Communication: Lack of information/knowledge on where to exercise or how to exercise,

resisting asking for help, don´t know to use equipment, lack of adequate communication

between staff, interpreter and child, lack of information about the benefits of physical activity,

lack of agreement between organisations about who is responsible for integration and whether

integration or segregation was preferable.

- Suitability: Too much effort, having to wake up early, opening hours, crowdedness, activity

not adequately adapted, characteristics, layout and design of built and natural environments,

lack of recreation opportunities that involve the whole family,,focus on competitive team

sports or activities not competitive enough

Psychological:

- Personal perceptions: Not perceiving any health benefits, feeling uncomfortable or ashamed,

motivational barriers, other priorities, PA/Sports not being fun, lack of interest, awareness of

differences from peers, not accepting (extent) of disability, female gender, inconvenient of

sweat/combing, previous unpleasant experience, lack of confidence, lack of independence,

fear of being stigmatised or teased, fear of injury, fear of incontinence, fear of being out of

control

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- Attitudes from others: Unequal time distribution of the parents between disabled child and

siblings, presence of bullying or social marginalization, parental actions, behaviours or

concerns, physical activity is not part of the family’s daily life or they have other family

priorities, family has a lack of energy to engage in activity, lack of friends or unsupportive

peers, peers view them as helpless or doubt their abilities, people’s misconceptions of child’s

physical condition or ability, negative attitudes by staff, lack of adequate staff who are willing

to work with children with disabilities, staff too focussed on competitive sports, institutional

conservatism.

6.2.2. Facilitators:

Physical:

- Facility: Chances to join competition, opportunities for sport/PA, sport facility (Having

good trainer, communication between trainers and coaches, training in small groups),

accessible community recreation facilities, better utilisation of existing facilities, new

facilities in rural areas.

- Equipment: Having necessary equipment, adaptative equipment

- Health and safety: Maintenance of fitness/ muscle strength, maintenance of functional

independence, walking ability, wheelchair skills, perceiving health benefits, physical

appearance, weight loss, endurance, biomechanical walking economy.

Logistical:

- Geography: Active transportation, nice weather.

- Expense: Better funding of programmes and play areas, financial assistance for parents.

- Support from others: Social supports, parental support, teachers and instructors supporting,

motivation from PE teacher and friends, parents/sibling involvement, involvement of peers,

knowledged staff, community education campaigns, special agency support to provide

information, therapeutic advice, design advice.

- Communication: Social contact, asking for help, information and awareness, information on

activity provided to parents by school, collaborative approach between organisations and

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communities, dissemination networks between parents, voluntary advocacy association to

provide demonstration programmes, political lobbying and advice

- Suitability: Activity type, access to suitable facilities, disability-adopted programs,

increased accessibility, more community-based programmes and opportunities to be active ,

better programmes, that are structured, sensitive to children with special needs, age

appropriate and include a variety of things to do, non-competitive programmes that promote

fun and socialisation, programmes that are not therapy oriented, activity relates to a game,

programme emphasis on development of social skills and development of self-confidence,

emphasis on skill development and child’s ability

Psychological:

- Personal perceptions: Fun, relaxation, attitude, motivational facilitators, feelings of

fulfilment, physical challenge, achieve goals/ wanting to win, clear the mind, happiness,

learning new skills and experience, feeling accepted as part of a group, accepting disability,

having perseverance, activity gives sense of freedom, child’s desire to be fit and active,

practice to gain skills, practice competence, gaining confidence.

- Attitudes from others: Family resilience, doing PA with parents, parental encouragement and

motivation, making friends, positive attitudes from schoolmates, teachers and other people,

praise from parents and friends, increasing awareness and education of children without

disabilities and their parents, positive encouragement from others

6.3. DEVELOPMENTAL DISABILITIES:

6.3.1. Barriers:

Physical:

- Facility: Lack of opportunities, lack of physical activity programs to join, waiting list, child

is not allowed to play matches

- Equipment: Lack or unsafe equipment

- Health and safety: Lack of energy/fatigue, an attractive sport is too difficult, pain, fear of

increased risk of an injury, learning the required motor skill is too time consuming, lack of

skill or motor control

20

Logistical:

- Geography: Lack of access to transportation, having to be driven somewhere, inclement

weather.

- Expense: Financial restrictions

- Support from others: Lack of a peer exercise partner, parents do not have time, trainer often

not aware of the complexity of the child.

- Communication: Hesitating to ask a trainer to support their child, lack of awareness of

possibilities, not knowing what “suits” the child.

- Suitability: Time of training is inconvenient, teams are too big, not “open” for children with

disabilities, no team that “suits” the child (level and age).

Psychological:

- Personal perceptions: Having the opinion that being active is not good for the body, attitude

of the child, feeling insecure or ashamed, child does not accept the disability, perception of

physical activity and sports as not being ‘fun’, fear of child not fitting in, lack of time, other

preferences, feeling tired, feeling bored.

- Attitudes from others: Parent not accepting the extent of the disability, parental

dissatisfaction with the environment, not being accepted by peers, not being accepted by other

parents, being bullied, parental challenges with observing the child struggling with sport,

being underestimated

6.3.2. Facilitators:

Physical:

- Facility: Access to physical activity or sports in the community, good surface for walking or

running, parks and playgrounds available in the community, school prepares for after-school

physical activity.

- Equipment: Direct exercise equipment, supportive exercise equipment

21

Logistical:

- Geography: Good weather

- Support from others: School encourages physical activity, having a good trainer, friends are

supportive or physically active, family is supportive or physically active, doing chores at

home, pets are physically active.

- Communication: Awareness of opportunities for sport and physical activity, good

communication between trainers/coaches

- Suitability: Training in small groups, playing individual/dual sports, playing Wii sports/Fit,

playing team sport, involving favourite figures/interests.

Psychological:

- Personal perceptions: Perception of relaxation, belief that exercise has health benefits,

desire to be active, positive attitude towards being challenged, acceptance of the disability,

view of sports and physical activity as an opportunity for social interaction, having

perseverance, feeling accepted as part of a group, feeling confident, experience of enjoyment,

view of exercise as an opportunity to ‘clear the mind’, feeling rewarded, feeling refreshed

- Attitudes from others: Parental awareness of the benefits of physical activity, parental

perseverance, parental assertiveness, being accepted by peers, being accepted by other parents.

6.4. EVERY KIND OF DISABILITY:

6.4.1. Barriers:

Physical:

- Facility: No accessible buildings/facilities

- Equipment: Lack of accessible exercise equipment, lack of suitable equipment

- Health and safety: Pain, lack of energy, health conditions, lack of strength

Logistical:

- Geography: Lack of transportation, buildings or facilities located far away.

22

- Expense: Programme and equipment costs

- Support from others: Unqualified staff who cannot modify or adapt individual and group

exercise classes for people with disabilities, no encouragement from rehabilitation services,

not having necessary staff or support, not having knowledgeable staff, lack of interest from

the administration to adapt activities

- Communication: Lack of specific knowledge about the benefits of physical activity, lack of

knowledge about how to exercise, lack of information about physical activity, no counselling

- Suitability: High level competition, emphasis on winning

Psychological:

- Personal perceptions: Self-consciousness about exercising in public, perception that

exercise is too difficult, negative mood, depression, anxieties, fears.

- Attitudes from others: Discriminatory practices at fitness centres and other recreational

venues, other people´s negative attitudes, not having a role model

When comparing the results with the ones obtained in the articles that spoke about all type of

disabilities included it was found that none included facilitators, they only spoke about

barriers, therefore, compared to the results obtained from the articles that included all types of

disabilities in its study, the articles show that that the barriers are similar.

As a sum up of the results, looking at the barriers, all three types of disabilities spoke about

facilities, health and safety, geography, expenses, support form others, communication,

personal perceptions and attitudes from others. Only physical and developmental disabilities

pointed out barriers that had to do with equipment and suitability. Looking at the facilitators,

all three kinds of disabilities spoke about facilities, equipment, geography, support from

others, communication, suitability, personal perceptions and attitudes from others. Intellectual

and physical disabilities were the only ones that pointed out health and safety and only

physical addressed expenses as a facilitator.

7 DISCUSSION

In the discussion part several aspects will be addressed. First of all, results will be discussed.

Which are the most and the least expressed barriers and facilitators in each type of disabilities.

23

Results found according to perspectives (from children, professionals and parents) will also be

further discussed. Some considerations to take into account when wanting to enhance

participation, besides thinking about the barriers and facilitators found in the results will be

stated and finally a discussion about method and limitations will be explained.

7.1. DIFFERENCES IN DISABILITIES:

The results achieved in each article were similar when the article spoke about the same type

of disability. The articles were divided in three different types of disabilities; Intellectual

disabilities, physical disabilities and developmental disabilities and when looking at the

results, common categories for each disability were found. As it can be seen through the

results, each disability type has a different perception of each factor and focuses more on one

of the aspects according to the needs of a child with either intellectual, developmental or

physical disability.

While articles that talk about intellectual disabilities focus more on barriers about health and

safety and attitudes from others and facilitators about health and safety and support from

others, physical disabilities focus deeper on barriers such as support from others, suitability or

communication as well as personal perceptions and attitudes from others. The facilitators

these articles about physical disabilities focus more on are support from others, suitability and

personal perceptions. With the developmental disability articles, we find they focus more on

barriers such as personal perceptions and attitudes from others and facilitators about facilities

and personal perceptions.

On the other hand, results according to intellectual disabilities show less interest in barriers

about geography, expenses and support from others and facilitators about geography and

equipment. Physical disability articles focus less on barriers about expenses as well as

geography and equipment and finally articles about developmental disabilities don´t focus

much on equipment and expenses as barriers and don´t even mention expenses and health and

safety as facilitators. These results compared to the barriers showed in the general disabilities

articles show a strong similarity.

According to N. Shields, A. Synnot & M. Barr, (2012), “the barriers to participation have

been studied more comprehensively than the facilitators and include a lack of knowledge and

skills, the child’s preferences, fear, parental behaviour, negative attitudes to disability,

inadequate facilities, lack of transport, lack of programmes and staff capacity, and cost. In the

24

case of physical activity, reported facilitators include the child’s desire to be fit and active,

skills practice, involvement of peers, family support, close and accessible facilities,

opportunities sensitive to the needs to children with disability, skilled staff and information

dissemination”. The results obtained in this study are the same as the ones reported by their

study and therefore it can be called a general opinion.

7.2. DIFFERENCES IN PERSPECTIVES:

On another basis, the different perspectives obtained from parents, professionals and children

is very important in order to see aspects such as amount of communication between

professionals-parents, parents-children and children-professional. Also the knowledge

professionals and parents have about PA, and how a child with disability feels about it,

because in the end, its the child the one who takes part on the activity so his perception and

feelings should be the most important results to be taken into account. N. Shields, A. Synnot

& M. Barr, (2012), found in their study that the reported barriers and facilitators to

participation can differ according to whose views are elicited. Children with disability tend to

focus on personal factors, while parents focus on familial, social and policy and programme

factors. The barriers and facilitators of physical activity for children with disability,

highlighted personnel, social, environmental, policy and programme-related factors that

influence whether or not a child with disability participates in physical activity and

community sports. These include a lack of knowledge and skills, the child’s preferences, fear,

parental behaviour, negative attitudes to disability, inadequate facilities, lack of transport,

programmes and staff capacity, and cost. G. Bedell, W. Coster & M. Law, et al., 2013 stated

that children with disabilities may be limited in terms of motor abilities and social skills, thus

impacting their ability to participate in physical activities. They are thought to include social,

cultural and environmental factors that can act as barriers to a child’s participation.

The results obtained in this systematic review support these researchers´ investigations

because from the parents perspective, it is seen that the main focus of their results are health

and safety, communication and attitudes from others as barriers and support from others and

attitudes from others as facilitators. On the other hand, they focus the least on facilities and

equipment as barriers and facilities, equipment, geography and expenses as facilitators.

From the professionals´perspective, the results show that they give more importance to

facilities, health and safety, communication and attitudes from others as barriers and support

25

from others and personal perceptions as facilitators. The professionals mention at least once

every barrier, however, they don´t mention equipment as a facilitator.

The child´s most focused barriers are health and safety, attitudes from others, geography and

support from others and the facilitators are support from others and personal perceptions. The

least are expenses, communication and personal perceptions as barriers and just expenses as

facilitators.

These results show that there is a lack of communication and a lack of knowledge from

parents and professional about a child with disability´s thoughts and opinions due to the fact

that parents and professionals focus their perceptions on aspects such as geography and

expenses instead of thinking about the child´s personal perception or his communication with

peers.

7.3. CONSIDERATIONS TO ENHANCE PARTICIPATION:

In order to enhance participation of children with disabilities in PA, besides the barriers and

facilitators stated in the results, that should be very carefully examined, there are some

considerations that should be taken into account. It is important that children are empowered

with an “I can do” attitude rather than discouraged by the message “you can’t do

that.”(Wilson, 2002). Properly designed and implemented programs of sports and physical

activities for children with disabilities should target cardiovascular endurance, flexibility,

balance, agility, and muscular strength and accessibility, safety, and enjoyment. (Durstine,

Painter, Franklin, Morgan, Pitetti & Roberts, 2000). Strategies to minimize the risks of illness

or injury to children with disabilities during sporting activities should be implemented before

participation. Exercise that is of longer duration, greater frequency, and lower intensity

compared with programs for typically developing children is recommended. (Durstine,

Painter, Franklin, Morgan, Pitetti & Roberts, 2000). Latex-safe environments should be

provided, and resuscitation medications should be readily accessible. (Patel & Greydanus,

2002). Careful attention must be directed at proper training, hydration, clothing, and

equipment. Some children with disabilities have impaired motor coordination, decreased

endurance, limited mechanical efficiency, and osteopenia, factors that can predispose to

musculoskeletal injuries and overuse syndromes. (Wilson, 2002). Conditions that may limit a

child’s participation or predispose the child to injury, individual preferences, and the

availability of appropriate local programs must be individually considered. The child’s current

26

health status, the level of competition, the specific sport and position to be played, availability

of protective or adaptive equipment, whether the sport can be modified to allow safer

participation, and the ability of child and parent to understand and accept the risks involved

must all be addressed before participation. (American Academy of Paediatrics, Committee on

Sports Medicine and Fitness, 2001). With the proper guidance, the risk of injury to physically

challenged children is no greater than that to athletes without disability (Patel & Greydanus,

2002).

7.4. METHOD AND LIMITATIONS:

When discussing the method of this study, a systematic review is ideal when wanting to find

information that has been researched on a certain topic. The research that had been done in

this topic was quite complete, however, the inclusion and exclusion criteria had to be changed

several times. The initial idea was to limit the age range from 6 to 12 and to divide the results

into the different perspectives from parents, children and professional in mainstream schools.

However, there was not enough research that was based only on children from 6 to 12 and

that spoke only about mainstream schools. Therefore, the criteria had to be changed to age 0

to 20 and physical activity in general instead of only physical education at school. The article

extraction protocol was also changed several times due to this fact, there was not´t enough

information to extract from certain topics.

On the other side, a limitation I found was the fact that the results show that more articles

were found that spoke about barriers than about facilitators and a big overlapping comes up of

categories into which these barriers and facilitators are organized. Some articles are divided

into more general categories (Personal and environmental factors) while other articles are

divided into deeper specific categories such as policies, social factors or community factors.

This makes the researcher think about how should barriers and facilitators be categories and

how important it is to have a general and uniform division of barriers and facilitators as these

affect directly a child´s participation and are necessary to analyse and plan an intervention in

order to enhance participation.

Even though the barriers and facilitators were divided using B. Horne´s criteria, a universal

and united division criteria is still necessary in order to be able to make a systematic review of

future articles and research about barriers and facilitators to participation. It is also believed

that the fact there is no criteria makes inclusion and the enhancement of participation even

27

harder for children with disability due to the difficulties on planning an intervention or

assessment of what should be changed.

Another limitation of the method could be the inclusion of Spanish articles into the research,

some articles, when translated to English could miss or miss understand some words and that

would make it more difficult when analysing results.

Trustworthiness is also an issue to address. According to Lincoln & Guba, (1985)

trustworthiness of a research study is important to evaluating its worth. Trustworthiness

involves establishing: I. Credibility; Confidence in the 'truth' of the findings, II.

Transferability; Showing that the findings have applicability in other context. III.

Dependability; Showing that the findings are consistent and could be repeated, IV.

Confirmability; The extent to which the findings of a study are shaped by the respondents.In

this paper, being just one researcher studying the topic, it was hard to commit this due to the

lack of perspectives and the amount of articles needed to explain the aim. It was difficult to

be attentive to every single data on the articles researched. However, on the other hand, it

was the same person reading articles so the knowledge about the topic was very high and

well documented.

8 CONCLUSION

Lack of physical activity in children with disabilities is a very important aspect to be

improved due to the amount of benefits they can obtain. However, the problem is not only the

fact of them not wanting to do exercise but the amount of barriers they can come across while

trying to participate. Luckily, facilitators are also there to enhance their participation by

making it a bit easier for them to exercise. After having done the systematic literature review,

we now have a clear idea of which barriers we should work on and overcome in order to get

disabled children to do physical activity as well as having a good vision of which facilitators

can help us motivate a child to exercise.

28

9 REFERENCES

* Alesi, M., & Pepi, A. (2015). Physical activity engagement in young people with Down

syndrome: Investigating parental beliefs. Journal of Applied Research in Intellectual

Disabilities.

American Psychological Association. (2002). Ethical principles of psychologists and code of

conduct. American Psychologist, 57, 1060-1073., Amended June 1, 2010).

Anderson, L. S., & Heyne, L. A. (2010). Physical activity for children and adults with

disabilities: An issue of “amplified” importance. Disability and Health Journal, 3(2), 71-

73.

Arim, R. G., Findlay, L. C., & Kohen, D. E. (2012). Participation in Physical Activity for

Children with Neurodevelopmental Disorders. International Journal of Pediatrics, 2012,

460384.

Auxter, D, Pyfer, J, Zittel, L, & Roth, K. (Ed.). (2010). Principles and Methods of Adapted

Physical Education and Recreation. New York, NY: McGraw-Hill.

Ayers, S. F. (2010). In-School Physical Activity for Children with Intellectual

Disabilities. Journal of Physical Education, Recreation & Dance, 81(7), 11-11.

Badia, M.m Orgaz, B. M,. Verdugo, M.A., Ullán, A. M., & Martínez, M. M. (2011. Personal

factors and perceived barriers to participation in leisure activities for young and adults

with developmental disabilities. Research in Developmental Disabilities, 32(6), 2055-

2063

Bandini, L., Danielson, M.& Esposito, L. (2015). Obesity in children with developmental and

/ or physical disabilities. Disability and Health Journal, 8 (3), 309–316.

Barg, C. J., Armstrong, B. D., Hetz, S. P., Latimer, (2010). Physical Disability , Stigma , and

Physical Activity in Children. International Journal of Disability Development and

Education 57 (4):371-382

29

* Barr, M. and Shields, N. (2011), Identifying the barriers and facilitators to participation in

physical activity for children with Down syndrome. Journal of Intellectual Disability

Research, 55: 1020–1033.

* Bloemen, M. A., Backx, F. J., Takken, T., Wittink, H., Benner, J., Mollema, J., & Groot, J.

F. (2015). Factors associated with physical activity in children and adolescents with a

physical disability: a systematic review. Developmental Medicine & Child

Neurology, 57(2), 137-148.

Boddy, L. M., Downs, S. J., Knowles, Z. R., & Fairclough, S. J. (2015). Physical activity and

play behaviours in children and young people with intellectual disabilities: A cross-

sectional observational study. School Psychology International, 36(2), 154-171.

Bradney M, Pearce G, Naughton G, Sullivan C, Bass S, Beck T, et al. (1998) Moderate

exercise during growth in prepubertal boys: changes in bone mass, size, volumetric

density, and bone strength: a controlled prospective study, Journal of bone and mineral

research, 13:1814–21.

* Buffart, L. M., Westendorp, T., van den Berg-Emons, R. J., Stam, H. J., & Roebroeck, M. E.

(2009). Perceived barriers to and facilitators of physical activity in young adults with

childhood-onset physical disabilities. Journal of Rehabilitation Medicine, 41(11), 881-

885.

Cannella-Malone, H. I., Mizrachi, S. B., Sabielny, L. M., & Jimenez, E. D. (2013). Teaching

physical activities to students with significant disabilities using video

modeling. Developmental neurorehabilitation, 16(3), 145-154.

Center for Disease Control and Prevention. (2013). Developmental disabilities. Retrieved

October 18, 2013

Chien, C., Rodger, S., Copley, J., & Skorka, K. (2014). Comparative Content Review of

Children ’ s Participation Measures Using the International Classification of

Functioning , Disability and Health e Children and Youth. Archives of Physical Medicine

and Rehabilitation, 95 (1), 141–152.

30

Davis, K., Hodson, P., Zhang, G., Boswell, B. & Decker, J (2013). Providing Physical

Activity for Students with Intellectual disabilities. Journal of Physical Education,

Recreation and Dance, 23-28

Driver, S., Ede, A., Dodd, Z., Stevens, L., & Warren, A. M. (2012). What barriers to physical

activity do individuals with a recent brain injury face?. Disability and health

journal, 5(2), 117-125.

EFDS. (2014). Engaging disabled people in sport and physical activity.

Fragala-Pinkham, M. A., O'Neil, M. E., Bjornson, K. F., & Boyd, R. N. (2012). Fitness and

physical activity in children and youth with disabilities. International journal of

pediatrics, 2012.

George, V. A., Shacter, S. D., & Johnson, P. M. (2011). BMI and attitudes and beliefs about

physical activity and nutrition of parents of adolescents with intellectual

disabilities. Journal of Intellectual Disability Research, 55(11), 1054-1063.

Gibson, B. E., King, G., Teachman, G., Mistry, B., & Hamdani, Y. (2016). Assembling

activity/setting participation with disabled young people. Sociology of Health & Illness.

Harding, J., Harding, K., Jamieson, P., Mullally, M., Politi, C., Wong-Sing, E., ... &

Petrenchik, T. M. (2009). Children with disabilities' perceptions of activity participation

and environments: A pilot study. Canadian Journal of Occupational Therapy, 76(3),

133-144.

Hartman, E., Smith, J., Westendorp, M., & Visscher, C. (2015). Development of physical

fitness in children with intellectual disabilities. Journal of Intellectual Disability

Research, 59(5), 439-449.

Hayakawa, K., & Kobayashi, K. (2011). Physical and motor skill training for children with

intellectual disabilities. Perceptual and Motor Skills, 112 (2), 573–580.

https://doi.org/10.2466/06.13.15.PMS.112.2.573-580

31

Hinckson, E. A., & Curtis, A. (2013). Measuring physical activity in children and youth living

with intellectual disabilities: a systematic review. Research in developmental

disabilities, 34(1), 72-86.

Hinckson, E. A., Dickinson, A., Water, T., Sands, M., & Penman, L. (2013). Physical activity,

dietary habits and overall health in overweight and obese children and youth with

intellectual disability or autism. Research in developmental disabilities, 34(4), 1170-

1178.

Horvat, M., Pitetti, K. H., & Croce, R. (1997). Isokinetic torque, average power, and

flexion/extension ratios in nondisabled adults and adults with mental retardation. Journal

of Orthopaedic & Sports Physical Therapy, 25(6), 395-399.

Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content

analysis. Qualitative health research, 15(9), 1277-1288.

* Jaarsma, E. A., Dijkstra, P. U., de Blécourt, A. C., Geertzen, J. H., & Dekker, R. (2015).

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

study. Disability and rehabilitation, 37(18), 1617-1625.

* Jaarsma, E. A., Dijkstra, P. U., Geertzen, J. H. B., & Dekker, R. (2014). Barriers to and

facilitators of sports participation for people with physical disabilities: A systematic

review. Scandinavian journal of medicine & science in sports, 24(6), 871-881.

Jobling A. (2001). Life be in it: lifestyle choices for active leisure. Down Syndrome Research

Practice, 6(3):117–22.

Katartzi, E. S., & Vlachopoulos, S. P. (2011). Motivating children with developmental

coordination disorder in school physical education: the self-determination theory

approach. Research in developmental disabilities, 32(6), 2674-2682.

Keeton, V. F., & Kennedy, C. (2009). Update on physical activity including special needs

populations. Current opinion in pediatrics, 21(2), 262-268.

Kim, S. Y. (2008). Promoting lifelong physical activity in children with disabilities. Journal

of Physical Education, Recreation & Dance, 79(4), 4-54.

32

Lauruschkus, K., Nordmark, E., & Hallström, I. (2015). “It’s fun, but…” Children with

cerebral palsy and their experiences of participation in physical activities. Disability and

rehabilitation, 37(4), 283-289.

Lawson, L. M., & Foster, L. (2016). Sensory Patterns, Obesity, and Physical Activity

Participation of Children With Autism Spectrum Disorder. American Journal of

Occupational Therapy, 70(5), 7005180070p1-7005180070p8.

LeMura L, Maziekas M. (2002). Factors that alter body fat, body mass and fat-free mass in

pediatric obesity. Medical Science Sports Exercise.34:487–96.

Li, R., Sit, C. H., Jane, J. Y., Duan, J. Z., Fan, T. C., McKenzie, T. L., & Wong, S. H. (2016).

Correlates of physical activity in children and adolescents with physical disabilities: A

systematic review. Preventive medicine, 89, 184-193.

Lin, J. D., Lin, P. Y., Lin, L. P., Chang, Y. Y., Wu, S. R., & Wu, J. L. (2010). Physical

activity and its determinants among adolescents with intellectual disabilities. Research in

developmental disabilities, 31(1), 263-269.

Lincoln, YS. & Guba, EG. (1985). Naturalistic Inquiry. Newbury Park, CA: Sage

Publications

Lotan, M., Isakov, E., Kessel, S., & Merrick, J. (2004). Physical fitness and functional ability

of children with intellectual disability: effects of a short-term daily treadmill

intervention. The scientific world journal, 4, 449-457.

Lox CL, Martin KA, Petruzzello SJ., (2003). The psychology of exercise: integrating theory

and practice. Scottsdale, AZ: Holcomb Hathaway.

Majnemer, A., Shevell, M., Law, M., Birnbaum, R., Chilingaryan, G., Rosenbaum, P., &

Poulin, C. (2008). Participation and enjoyment of leisure activities in school‐aged

children with cerebral palsy. Developmental Medicine & Child Neurology, 50(10), 751-

758.

33

Malone, L. A., Barfield, J. P., & Brasher, J. D. (2012). Perceived benefits and barriers to

exercise among persons with physical disabilities or chronic health conditions within

action or maintenance stages of exercise. Disability and health journal, 5(4), 254-260.

* Martin Ginis, K. A., Ma, J. K., Latimer-Cheung, A. E., & Rimmer, J. H. (2016). A

systematic review of review articles addressing factors related to physical activity

participation among children and adults with physical disabilities. Health psychology

review, 10(4), 478-494.

Martin, J. J., & Choi, Y. S. (2009). Parents’ physical activity− related perceptions of their

children with disabilities. Disability and health journal, 2(1), 9-14.

Morris, F. L., Naughton, G. A., Gibbs, J. L., Carlson, J. S., & Wark, J. D. (1997). Prospective

ten‐month exercise intervention in premenarcheal girls: positive effects on bone and lean

mass. Journal of bone and mineral research, 12(9), 1453-1462.

Morris, P. J. (2008). Physical activity recommendations for children and adolescents with

chronic disease. Current sports medicine reports, 7(6), 353-358.

Murphy, N. A., & Carbone, P. S. (2008). Promoting the participation of children with

disabilities in sports, recreation, and physical activities. Pediatrics, 121(5), 1057-1061.

Nyquist, A., Moser, T., & Jahnsen, R. (2016). Fitness, Fun and Friends through Participation

in Preferred Physical Activities: Achievable for Children with

Disabilities?. International Journal of Disability, Development and Education, 63(3),

334-356.

* Obrusnikova, I., & Cavalier, A. R. (2011). Perceived barriers and facilitators of

participation in after-school physical activity by children with autism spectrum

disorders. Journal of Developmental and Physical Disabilities, 23(3), 195-211.

Özer, D., Nalbant, S., Aglamis, E., Baran, F., Kaya Samut, P.., Aktop, A., & Hutzler, Y.

(2013). Physical education teachers ’ attitudes towards children with intellectual

disability : the impact of time in service , gender , and previous acquaintance, Journal of

Intellectual Disability Research, 57: 1001–1013.

34

Physical disability. (2003) McGraw-Hill Dictionary of Architecture and Construction.

Retrieved from http://encyclopedia2.thefreedictionary.com/physical+disability

Pitetti, K., Beets,M., & Combs, C. (2009). Physical Activity Levels of Children with

Intellectual Disabilities during School. Medicine+ Science in Sports+ Exercise. 41 (8)

1580–1586.

Poulsen, A. A., & Ziviani, J. M. (2004). Can I play too? Physical activity engagement of

children with developmental coordination disorders. Canadian Journal of Occupational

Therapy, 71(2), 100-107.

Reina, R. (2014). Inclusión en deporte adaptado: dos caras de una misma moneda.

* Rimmer, J. H., & Marques, A. C. (2012). Physical activity for people with disabilities. The

Lancet, 380(9838), 193-195.

Rimmer, J. H., Riley, B., Wang, E., Rauworth, A., & Jurkowski, J. (2004). Physical activity

participation among persons with disabilities: barriers and facilitators. American journal

of preventive medicine, 26(5), 419-425.

* Rimmer, J. A., & Rowland, J. L. (2008). Physical activity for youth with disabilities: a

critical need in an underserved population. Developmental Neurorehabilitation, 11(2),

141-148.

Rivilis, I., Hay, J., Cairney, J., Klentrou, P., Liu, J., & Faught, B. E. (2011). Physical activity

and fitness in children with developmental coordination disorder: A systematic

review. Research in developmental disabilities, 32(3), 894-910.

Rosenbaum, P. (1998). Physical activity play in children with disabilities: A neglected

opportunity for research?. Child development, 69(3), 607-608.

Ross, S. M., Bogart, K. R., Logan, S. W., Case, L., Fine, J., & Thompson, H. (2016). Physical

activity participation of disabled children: A systematic review of conceptual and

methodological approaches in health research. Frontiers in Public Health, 4.

35

Roth, K., & Columna, L. (2012). Physical education for children with disabilities in

segregated classes. Journal of Physical Education, Recreation & Dance, 83(5), 3-56.

Schreuer, N., Sachs, D., & Rosenblum, S. (2014). Participation in leisure activities:

Differences between children with and without physical disabilities. Research in

developmental disabilities, 35(1), 223-233.

* Shields, N., Synnot, A. J., & Barr, M. (2012). Perceived barriers and facilitators to physical

activity for children with disability: a systematic review. British journal of sports

medicine, 46(14), 989-997.

* Shields, N., & Synnot, A. J. (2014). An exploratory study of how sports and recreation

industry personnel perceive the barriers and facilitators of physical activity in children

with disability. Disability and rehabilitation, 36(24), 2080-2084.

* Shields, N., & Synnot, A. (2016). Perceived barriers and facilitators to participation in

physical activity for children with disability: a qualitative study. BMC pediatrics, 16(1),

9.

Sit, C. H., Mckenzie, T. L., Cerin, E., Chow, B. C., Huang, W. Y., & Yu, J. (2016). Physical

Activity and Sedentary Time among Children with Disabilities at School. Medicine &

Science in Sports & Exercise.

Sit, C., McKenzie, T., Cerin, E., & McManus, A. (2010). Physical activity for children in

special school environments. Improving health and recognising excellence: Proceedings

of the 2010 Health Research Symposium (pp. 73-73)..

Sit, C. H., McManus, A., McKenzie, T. L., & Lian, J. (2007). Physical activity levels of

children in special schools. Preventive medicine, 45(6), 424-431.

Special Olympics (2005), Changing lives through sport: a report card on the impact of

Special Olympics.

Tassé, MJ., Luckasson, R. & Nygren, N., (2013) AAIDD Proposed Recommendations

for ICD11 and the Condition Previously Known as Mental Retardation. Intellectual and

Developmental Disabilities: April 2013, Vol. 51, No. 2, pp. 127-131.

36

Terms, F. (2011). Should Children with Disabilities be Graded in Should children with

disabilities be graded in physical education?, Journal of Physical Education, Recreation

and Dance, 11-12

UN. (1989). UN Convention on the Rights of the Child, New York: United Nations.

Verschuren, O., Darrah, J., Novak, I., Ketelaar, M., & Wiart, L. (2014). Health-enhancing

physical activity in children with cerebral palsy: more of the same is not

enough. Physical therapy, 94(2), 297.

* Verschuren, O., Wiart, L., Hermans, D., & Ketelaar, M. (2012). Identification of facilitators

and barriers to physical activity in children and adolescents with cerebral palsy. The

journal of pediatrics, 161(3), 488-494.

WHO (2011) World report on disability. 3--5

WHO (2013) Definition of key terms. Consolidated ARV guidelines.

*Yazdani, S., Yee, C. T., & Chung, P. J. (2013). Factors Predicting Physical Activity Among

Children With Special Needs. Preventing chronic disease, 10.

37

10 APPENDIXAPPENDIX 1: EXAMPLE OF EXTRACTION PROTOCOL

AUTHOR YEAR TITLE PAGES AGE OF

CHILDREN

SEVERITY OF

DISABILITY

Nora Shields

and

Anneliese

Synnot

2016 Perceived barriers and

facilitators to participation

in physical activity for

children with disability: a

qualitative study

10 6 to 18 Intellectual

disabilities

BARRIERS FACILITATORS WHO´S

OPINIONS

*Longer to develop skills *Lack of physical

skill *Frustration or loss of confidence when

child compares self to peers *It’s harder as

children get older *Need extra support to

participate *Extra costs associated with

raising a child with disability *Parents lack

knowledge or means *Lack of practical

instructor training *Negative societal

attitudes towards disability *Disability a low

priority *Parents doubt child’s safety or

ability *Parental exhaustion *Children and

parents are not asked about how they can

participate *Lack of transport *Distance

*Lack of activities *One-off programs

*Waiting lists *No quorum *Poor

advertising of programs *Difficulty for

program providers finding families *Limited

partnerships between sectors.

*Positive encouragement from others

*One-on-one instruction *Children

that are motivated to keep fit

*Happy-go-lucky, confident child

*Naturally active child *Proactive

parents *Skilled instructors *Peer

acceptance *Understand disability

*Inclusive policies & programs

*Family involvement *Inclusive

pathways *Fun & sense of success

*Transport *Local activities

*Meaningful, appropriate activities

*Opportunities at school *Word of

mouth between parents *Special

schools provide information on

activity *Partnerships between

schools, activity providers, disability

groups and councils.

Child with a

disability

aged 10–18

years, the

parent of a

child with

disability

aged between

6–18 years,

or a

professional

working in

the sports and

recreation

sector with

people with

disability.

38

APPENDIX 2: EXAMPLE OF QUALITYASSESSMENT

39

APPENDIX 3A: TABLE OF RESULTS SORTED BY ARTICLES

40

41

42

APPENDIX 3B: TABLE OF RESULTS SORTED BY DISABILITIES

43

APPENDIX 3C: TABLE OF RESULTS SORTED BY PERSPECTIVES: