The Value of Incorporating Inclusive Sports in Schools: An Exploration of Unified Sport Experiences.

School sports programs intentionally created for students with and without disabilities may increase social participation of students with intellectual disabilities (IDs). Special Olympics Unified Sports is one program where students with and without ID participate on one team. Guided by a critical realist paradigm, this study explored the perceptions of students with and without ID and coaches of in-school Unified Sports. Interviews were conducted with 21 youths (12 with ID) and 14 coaches. Thematic analysis resulted in four developed themes (identified is outdated language): Inclusion-Is it a "we" or a "they?" Roles and Responsibilities, Educational Context for Inclusion, and Buy-In. Findings suggest students with and without ID and coaches value the inclusive nature of Unified Sports. Future research should explore training for coaches on inclusive practices (e.g., language), and optimal methods for consistent training (e.g., use of training manuals) to foster the philosophy of inclusion within school sports.

Quality of Participation Experiences in Special Olympics Sports Programs.

This cross-sectional study examined experiential elements facilitating quality sport experiences for youth (ages 12-24 years) in Special Olympics, and the associated influences of sport program and sociodemographic characteristics. A total of 451 athletes involved in the 2019 Special Olympics Youth Games completed a survey assessing elements of quality participation (autonomy, belongingness, challenge, engagement, mastery, and meaning). The t tests investigated whether athletes with intellectual and developmental disabilities rated elements differently across Traditional and Unified Sport programs. Regression analyses explored whether sport program and sociodemographic characteristics were predictors of these elements. Youth reported high mean scores across the elements, with no significant differences between athletes with intellectual and developmental disabilities in Traditional or Unified Sport. Athletes with no reported disability rated higher autonomy than those who reported disability (p = .01). Women tended to report greater engagement in sport than men (p = .07). Findings provide theoretical and practical insights into quality sport participation among youth in Special Olympics.

Belonging through sport participation for young adults with intellectual and developmental disabilities: A scoping review.

BACKGROUND: Research suggests that sport facilitates belonging for diverse athletes. This scoping review characterizes literature on sport participation and belonging for young adults with intellectual and developmental disabilities. MATERIALS AND METHODS: A search of five databases identified 17,497 articles. Selected articles (N = 39) underwent data extraction and analysis guided by a theoretical framework of belonging, outlining four processes through which belonging is experienced by individuals with intellectual and developmental disabilities. RESULTS: Articles originated from developed countries and in the context of Special Olympics (N = 17). Studies commonly used qualitative interviews with proxy respondents. While all studies described at least one belonging process, only 11 studies applied the term "belonging," and no study defined the construct. CONCLUSION: Belonging is not well-conceptualized in sports literature for athletes with intellectual and developmental disabilities. Understanding belonging through sport participation for this population may inform sport-based policies and programming.

Physical activity participation among adolescents with autism spectrum disorder.

LAY ABSTRACT: Adolescents with autism spectrum disorder are less likely to be physically active compared to their age-related peers. Despite the lower levels of physical activity observed among adolescents with autism spectrum disorder, it is unknown why they are predominantly inactive. Much of the research so far has focused on understanding how biological aspects influence physical activity participation. But there is little research that has examined how social and cultural components influence their physical activity participation. There is also little research that has sought the perspectives and experiences of adolescents with autism spectrum disorder. In this study, 10 adolescent boys with autism spectrum disorder created a digital story, and also participated in two face-to-face interviews. The purpose of the study was to examine how individual, social, and cultural forces influenced physical activity participation. Analysis of the data highlight that bullying, challenges in community programs, and the prioritization of therapeutic interventions limited participation. On the contrary, participants were more likely to be active when physical activity generated meaning, purpose, a sense of identity, and affective pleasures. The findings add new knowledge suggesting that adolescents with autism spectrum disorder are not simply unmotivated. Rather, physical activity participation was shaped by wider social experiences, norms, values, and practices in which they were immersed. The findings suggest a need for directed efforts to create policies and practices which are individualized and reflective of the needs and abilities of adolescents with autism spectrum disorder to promote physical activity participation and potentially enhance physical health and wellbeing.

Engagement in community life: perspectives of youths with intellectual and developmental disabilities on families' roles.

Purpose: The main objectives of this study were to learn from youths with intellectual and developmental disabilities about the ways their families were involved in their engagement in community life and to capture how they felt about such involvement.Method: The current study is a secondary analysis of a larger study, the Voices of Youths Research Project, framed by inclusive research methods. Thirty-eight semi-structured interviews that discussed perspectives on friendship, social inclusion, and quality of life from 20 participants (ages 13 to 24 years) were included in this paper. All interviews were video-recorded and coded using NVivo 10. Thematic analysis of the coded segments was guided by a constructivist grounded theory approach.Results: Three major themes emerged from the experiences of youths with intellectual and developmental disabilities on family involvement in their social and community engagement: (1) complex of supports and influences, (2) community engagement with and through family, and (3) points of tension.Conclusions: These thematic findings offer insights into the lived experiences of youths with intellectual and developmental disabilities about engagement in community life. These findings provide an understanding, outside of conventional schemas, of transition into young adulthood for these youths.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals often work with youths with intellectual and developmental disabilities who face barriers to reaching transition goals identified either by themselves or others.Family members' views that may focus on goals of maximizing functional independence and/or decreasing caregiver demands can often overshadow the goals or views of youths with intellectual and developmental disabilities themselves.Rehabilitation professionals should find ways to explore with youth their family's roles in engagement and belonging in community life so that they can link youths to appropriate community resources and plan optimal interventions/programs.Rehabilitation professionals need to be aware of and respond to points of tension that can emerge between youths with intellectual and developmental disabilities and their family during transition.

"Having friends is like having marshmallows": Perspectives of transition-aged youths with intellectual and developmental disabilities on friendship.

BACKGROUND: The literature emphasizes that friendships are essential to youths' successful transition to and adjustment in adulthood. Few studies have explored the friendships of transition-aged youths with intellectual and developmental disabilities (IDD), and even fewer include youths' own perspectives. This qualitative study explored the perspectives of transition-aged youths with IDD regarding their own experiences of friendship. METHOD: A subset of video-recorded data of 21 interviews with seven participants (20-24 years) was extracted from a larger study for secondary analysis. Data were analysed using thematic analysis, informed by constructivist grounded theory methods. RESULTS: Three themes were revealed: meanings of friends and friendship, deepening self-knowledge and negotiating in(ter)dependence. CONCLUSIONS: The findings expand existing knowledge about friendships of transition-aged youths with IDD. Findings can potentially inform development of new services or enhancement of existing services aimed at facilitating transition to adulthood for youths with IDD and point to key areas for future research.

Meaning of Staring and the Starer-Staree Relationship Related to Men Living With Acquired Spinal Cord Injuries.

When in public places, many individuals with physical disabilities experience staring. Although staring is typically seen as uncomplicated and something to be "ignored," it has consequences for the person being stared and the staree. Few studies have focused on staring experienced by men following spinal cord injury (SCI). Accordingly, this study explored how adult men with SCI give meaning to the staring from others, the consequences for them, and their responses to the staring and to the starer. Principles of modified grounded theory methods were used to conduct a secondary analysis of interview data for 30 male participants from a larger study of community-dwelling individuals with SCI. Themes revealed through analysis related to context-dependent meanings of staring, negative consequences of staring for some men, and positive opportunities for self-growth and interaction with the public. These findings contribute to a more complex understanding of staring and the relationship between the starer and staree in various social circumstances which can support people living with differences in their public interactions, and improve their quality of life.

"Why would I want to go out?": Age-related Vision Loss and Social Participation.

Social participation, a key determinant of healthy aging, is often negatively impacted by age-related vision loss (ARVL). This grounded theory study aimed to understand social participation as a process negotiated in everyday life by older adults with ARVL. Interviews, audio diaries, and life space maps were used to collect data with 21 older adults in two Ontario cities. Inductive data analysis resulted in a transactional model of the process of negotiating social participation in context. This model depicts how environmental features and resources, skills and abilities, and risks and vulnerabilities transacted with values and priorities to affect if and how social participation occurred within the context of daily life. The findings point to several ways that research and services addressing the social participation of older adults with ARVL need to expand, particularly in relation to environmental features and resources, risk, and the prioritization of independence.

A value-based practice model of rehabilitation: consumers' recommendations in action.

The purpose of this paper is to present a model of rehabilitation practice that is based on the recommendations of consumers who used rehabilitation services and have a life-changing physical impairment (spinal cord injury - SCI). This value-based practice model is based on two qualitative studies. The first study developed the framework (social adaptation) for a new practice model based on values. The second study, described in this paper, used the framework to learn about recommendations for change in the rehabilitation process. Participants in the second study were 80 volunteers who live with a SCI in the community, across the province of Ontario, Canada. A snowball strategy was used to recruit interested participants. Participants were involved in face-to-face interviews which included questions on what helped and hindered their initial rehabilitation process, and their recommendations for change. In this paper, we described a model that demonstrates how consumer input is essential in shaping a comprehensive rehabilitation process. The model is based on overarching value statements that express the worthiness of all individuals, the value of the lived experience of disability and the responsibility of the rehabilitation process to enable client autonomy. Four "values in action" are articulated: caring and respect for the individual and his/her personhood; applying the lived experience of disability; fostering autonomy; and promoting hopefulness. These values have been initially described in another paper based on a specific subset of 15 women living with SCI related to body issues during rehabilitation. This paper builds on this value work and we develop key practices for a progressive rehabilitation culture and model, based on the larger study group of 80 participants (men and women with SCI). This value-based model, when integrated with traditional, physical improvement-focused rehabilitation, has the potential to create a more effective process by offering clients better support as they go through the complex process of re-building their lives and making the transition back to the community. Implications for Rehabilitation We suggest that the Values in the Action Rehabilitation Practice Model that emphasized social adaptation be used along side the physical rehabilitation approach to enhance client-based practice. That peers with disabilities work collaboratively with rehabilitation professionals within a culture that acknowledges and reimburses their knowledge and expertise. Rehabilitation professionals learn about the lived experience of disability and systemic issues by being involved in grass-roots community organizations.

Hollywood takes on intellectual/ developmental disability: cinematic representations of occupational participation.

Adults with intellectual/developmental disability (IDD), and their occupational participation, are vastly under-represented in Hollywood films. Because films often provide individuals' only experience of people with IDD, cinematic representations can influence audience perceptions. Thus, films can help inform public perceptions about desired and appropriate occupational participation for people with IDD, potentially impacting their access to meaningful occupational participation and achievement of occupational potential. Accordingly, this research examined occupational portrayals of adults with IDD in contemporary Hollywood films. Occupational portrayals, as defined here, refer to representations of the dynamic process of the person participating in occupation(s) in a context. Grounded theory methods guided coding and analysis of qualitative data collected from eight contemporary films using an occupation-focused tool. Two major, striking themes emerging from the qualitative analysis--infantilization and simplification of participation in complex occupations (with three associated sub-themes)--are discussed. Implications of the findings and future research directions are considered.

Getting on with life: positive experiences of living with a spinal cord injury.

Currently, the dominant cultural beliefs toward disability are negative, and the existing literature is limited with respect to examining how people are using and/or viewing their disabilities positively. The purpose of this study was to identify how individuals living with a spinal cord injury (SCI) viewed and/or used their disability positively, and what contextual influences facilitated this positive approach. This study was a secondary analysis of qualitative data from a larger study. The findings revealed three levels at which disability was viewed and/or used positively by people with SCI: self, peers, and disability community. In addition, several aspects of the participants' situations were found to facilitate this positive view and/or use of disability: personality, spirituality, support systems, and acceptance of one's disability. The findings reveal that individuals with SCI are viewing and/or using their disabilities positively in many different ways. This study has significant implications for the direction of future research and for health care professionals who need to increase their advocacy and facilitating roles.

Exploring body image and self-concept of men with acquired spinal cord injuries.

Qualitative research has rarely explored gender-based concerns of men with disabilities. Accordingly, this research investigates body image and self-concept for men with an acquired spinal cord injury (SCI). Modified grounded theory analysis was conducted for secondary, qualitative interview data of 64 male participants from a study of community dwellers living with SCI. Three major themes related to body image and self-concept emerged: consequences for self due to bodily changes, interactions with the public, and decisions and actions people take. Findings indicate that rehabilitation services should include ongoing research to explore the unique needs of male clients. Findings also have implications for rehabilitation therapists and their roles in addressing gender-based concerns of the male client.

Negotiating participation: how women living with disabilities address barriers to exercise.

Exercise participation among women living with disabilities can be limited as a result of pain, decreased muscle strength, and limited mobility. More "disabling" than these symptoms, however, is a lack of accessible exercise facilities in women's communities. Our study explores how material and social structures and functions existing and operating within women's communities and at community-based exercise facilities affect their participation. Interviews with 15 women living with disabilities were conducted and qualitatively analyzed. Participants discuss the benefits of their exercise participation, in addition to how they experience and negotiate structural and attitudinal barriers within community-based facilities.

Leisure participation for individuals living with acquired spinal cord injury.

Traditionally, rehabilitation professionals have viewed and studied leisure participation in terms of quantifiable activities. Advances in leisure studies have, however, led to recognition of the need for and value of examining leisure as a subjective experience too. Accordingly, this study used a qualitative approach to explore postinjury leisure participation for individuals living with acquired spinal cord injury. A secondary analysis was performed for data from a primary study that examined social adaptation needs related to community living after rehabilitation. Participants who had completed their initial rehabilitation at least 3 years earlier took part in in-depth, personal interviews. The analysis identified specific leisure activities participants had done and/or are doing after spinal cord injury. It also provided insight into how and why these activities are being done and/or not being done. Major findings are illustrated by participants' personal verbatim quotes. Implications and recommendations for further research and professional practice in rehabilitation are outlined.

Women living with a spinal cord injury: perceptions about their changed bodies.

In this article we illuminate the narratives of women living with a spinal cord injury (SCI) with regard to (a) learning how to live with a changed body and (b) exploring the factors that influence how they feel toward their new bodies. An SCI produces immediate physical impairments resulting in a changed body, which can then have physical, emotional, and social consequences to these women. Through its focus on enhancing the body, physical therapy can help to promote a positive view of the self within the changed body. Our analysis of these women's experiences resulted in a fluid, three-phase framework of learning to live with a changed body that generally moves from (a) discomfort, to (b) moving toward comfort, to (c) comfort. Physical therapy can potentially influence the process of women's gaining comfort with their changed bodies following an SCI. The framework provides a basis for future research on adaptation following SCI.

Personal relationships after a spinal cord injury.

The objective of this study was to examine the perspectives of individuals living with spinal cord injury (N=14) concerning the changes that occur in personal relationships after the injury. A qualitative study was completed and a finer-grained analysis of data collected from a primary study took place. The primary study had a cross-sectional and retrospective design in which participants with an acquired spinal cord injury were interviewed. Data collection took place in five regions of Ontario, Canada. A modified grounded theory analysis was performed on data related to relationships that was extracted from a primary study. Many study participants believed that their relationships with others provided them with support to assist in their recovery; however, for some participants this support led to their feeling overassisted by their family and friends. Study participants also discussed the barriers they experienced that limited the formation of new relationships; some participants also discussed the strategies they employ to deal with these barriers. Finally, many participants discussed how their relationships with others helped them to view their own spinal cord injuries positively and to take on new life roles. The findings of this study indicate that occupational and physical therapists and other health professionals should assist individuals with spinal cord injury to continue to participate in their relationships. Directions for future research are also discussed.

Social support and quality of life over time among adults living with HIV in the HAART era.

Stability in perceived social support and associations between social support and health-related quality of life for a sample of 41 adult outpatients living with HIV/AIDS (PHA) in Canada were assessed longitudinally. Construct-specific dimensions of the Medical Outcomes Study Social Support Survey (SSS), the Physical and Mental components of the Short-Form-36 (SF-36) quality of life measure, as well as clinical factors (i.e., symptomatology, immunologic/virologic variables), were measured in three waves: initial consecutive registration (T1, 1997), 2-year (T2, 1999) and 4-year (T3, 2001) follow-up, and evaluated for changes using repeated-measures analysis of variance, supplemented by Friedman tests for SSS and SF-36 ratings. Proportions of the PHA sample with clinically significant SSS changes (i.e., greater than 0.5 standardized effect size) were also calculated. Effects of improvement versus deterioration in SSS ratings on SF-36 ratings, and vice versa, were explored. Associations between SSS and SF-36 ratings, as well as between changes in SSS ratings and SF-36 ratings, were assessed using multiple regression analyses controlling for clinical factors. Cross-lagged analyses were conducted to examine predictive potential between SSS and SF-36 ratings. Clinical outcomes suggested immunologic improvement tempered by symptoms and/or treatment side effects. SSS and SF-36 mean ratings were moderately stable over time, but clinically significant 4-year decrements in SSS ratings occurred for approximately 40% of patients. A trend occurred in which poorer SF-36 mental outcomes portended poorer emotional and informational support. Otherwise, relations between SSS and SF-36 ratings appeared to be reciprocal. Cross-sectional associations between SSS and SF-36 ratings were more pronounced at T2 compared to baseline and T3. Changes in SSS and SF-36 ratings were somewhat related over the consecutive 2-year periods but not over the long term. T1-T2 SSS changes were associated with changes in the SF-36 mental component. T2-T3 SSS changes were associated with changes in the SF-36 physical component. Cross-lagged analyses yielded little explanation concerning direction of causation in terms of associations between social support and quality of life for the PHA in this study.

Quality of life for people with physical disabilities: a new instrument.

This article describes the development and validation of the Quality of Life Profile for Adults with Physical Disabilities (QOLP-PD). This new cross-disability instrument is grounded in a well-developed conceptual framework. It reflects the underlying assumption that quality of life issues are the same for people with and without disabilities, although adults living with chronic physical disabilities may address those issues somewhat differently during the course of their daily lives. This instrument was developed on the basis of in-depth interviews, item review and refinement, and pilot testing with adults who have chronic acquired and life-long physical disabilities. Preliminary validation studies were carried out in separate studies with two Canadian samples for which separate results are reported. In Study 1, interviewer-administered items were completed by a cross-disability sample from a large city in Ontario (n = 27). In Study 2, self-administered items were completed by adults with spinal cord injuries from urban and rural Saskatchewan (n = 40). Alpha coefficients for the QOLP-PD ranged from 0.67-0.97 (Ontario sample) and from 0.84-0.98 (Saskatchewan sample). Validation coefficients are also reported. Although the samples were small, the psychometric properties of the instrument are generally sound. Future research directions are discussed.

Experiences of contemplating returning to work for people living with HIV/AIDS.

In the mid-1990s, medical advances dramatically altered the experience of living with HIV/AIDS. The shifting medical climate spurred new social and financial questions, such as the possibility of returning to work. In this qualitative study, the authors examine how people living with HIV/AIDS perceive, attach meaning to, and approach the experience of returning to work. Findings demonstrate that the participants are influenced by, and wrestle with, both the dominant societal perspective that "people should return to work," and the oppositional perspective that people living with HIV/AIDS "should not return to work." Theoretical understanding of the results is enhanced using the concepts of the "sick role" and the "hierarchy of identities." Findings have conceptual and methodological implications for literature in HIV/AIDS, return to work, and identity.