A systematic review of disability’s treatment in the active school travel and children’s independent mobility literatures

Figures & data

Table 1. Disability search result totals.

Database	AST	CIM	AST/CIM total
Web of Science	10	154	164
Medline	9	27	36
PubMed	2	36	38
Scopus	82	156	238
Sociological Abstracts	2	12	14
Total	105	385	490

Note: This breakdown does not account for removed duplicates.

Source: Prepared by authors.

Figure 1. Overview of systematic review process. Source: Prepared by authors.

Table 2. Primary search result totals.

Database	AST			CIM
	1966–1990	1991–2015	Total	1966–1990	1991–2015	Total
Web of Science	12	701	713	506	6433	6939
Medline	7	437	444	13	109	122
PubMed	1	125	126	44	393	437
Scopus	21	1549	1570	1206	4181	5387
Sociological Abstracts	9	100	109	53	270	323
TOTAL:	50	2912	2962	1822	11,386	13,208

Source: Prepared by authors.

Figure 2. Secondary search result totals by social difference. Source: Prepared by authors.

Table 3. Presence of social difference in AST, CIM, and joint AST/CIM literatures.

Social difference	AST (%)	CIM (%)	AST/CIM combined (%)
Gender	61.9	16.7	24.9
Age	89.4	15.9	29.4
Race/ethnicity	24.8	5.5	9.1
Class	40.3	4.9	11.4
Disability	3.5	2.9	3.0

Source: Prepared by authors.

Figure 3. Percentages of search result totals where forms of social difference are considered in conjunction with disability in the joint AST/CIM literature. Source: Prepared by authors.

Figure 4. Where disability search totals overlap with other totals in the AST literature (%). Source: Prepared by authors.

Figure 5. Where disability search totals overlap with other totals in the CIM literature (%). Source: Prepared by authors.

Table 4. Characteristics of reviewed CIM and AST studies.

Study	Methods	Participants/location	Aim	Finding(s)
CIM
Ahl et al. (2005)	Four-day family intervention; observe/ measure physical testing	14 children (3F, 11M; 18 months–6 years) with spastic diplegia or tetraplegia/Sweden	Evaluate the effect of training in everyday life settings for preschool children with CP. Examine interventions’ effects on parents’ and assistants’ perceptions of family centredness and competence in the care and training of their child.	Children with CP benefit from a functional goal-directed training approach in their development of gross motor function and everyday activities. Parents positively perceive ecological intervention.
Alriksson-Schmidt et al. (2006)	Questionnaire	159 adolescents (11–18 years) and parents/U.S.A.	Study the influence of life stress, social competence, family functioning, and peer social engagement on the quality of life (QL) in adolescents with mobility disabilities using a stress–resilience model.	Interventions to improve QL in adolescents with mobility disabilities may focus on reducing life stress and developing resilience by enhancing personal/social resources.
Douglas et al. (2012)	Large-scale social surveys	960 people with visual impairments/UK	Obtain and analyse participant-centred data from visually impaired people relating to their own interpretation of barriers they encounter.	Participants identified a range of barriers/enablers to mobility. Participants focusing on individually based explanations had more severe visual impairment. Professionals must not reinforce visually impaired people’s perceptions of individual barriers and any associated sense of helplessness.
Gibson et al. (2012)	Face-to-face qualitative interviews	6 children with CP (9–18 years) and 6 parents/Ontario, Canada	Describe beliefs about the value of walking held by children with CP and their parents, and how such beliefs inform rehabilitation choices and perceptions of “success”.	Parents try anything to be a “good” parent and maintain hope. They feel guilt/doubt about tapering of walking interventions. Children viewed walking as exercise, not functional. They internalised negative attitudes toward disability
Gürsel and Koruç (2011)	Questionnaire	58 adolescents (24F, 34M; 16–18 years); half had some form of acquired mobility disability (AMD)/Turkey	Determine if differences exist between adolescents with and without AMD regarding body image, and if physical activity influences these differences.	People with AMD evaluate their health and fitness levels as being lower than non-AMD adolescents. They are less concerned with fitness compared to non-AMD adolescents.
Hanisch (2011)	Case study; interviews	One 15-year-old female and her mother/Norway	Argue that rejection of Giddens in disability studies should cease because its use can be fruitful.	Disability studies should incorporate “Giddensian” strands of modernisation theory, rather than dismiss them.
Harper, Wacker, and Seaborg Cobb (1986)	Picture ranking test	358 non-disabled children and 60 children with physical impairments/U.S.A.	Assess disabled and non-disabled children’s social preferences and acceptance towards visibly physically impaired peers.	The order of preference is a complex response and depends on several variables, including the type of disabilities present in the ranking, the sample tested, the social context of the task, and the type of questions asked.
Jemta et al. (2009)	Interviews; demographic analyses; use of Snoopy scale	138 children (7–18 years) with impaired mobility/Sweden	Consider the self-esteem of children/adolescents with mobility impairments. Analyse self-esteem and demographic data with disability characteristics. Identify the impact of 5 self-esteem dimensions on well-being and coping strategies.	Awareness of vulnerability factors for low self-esteem in children/adolescents with mobility impairments can offer healthcare professionals specific opportunities to enhance self-esteem in this group.
Jemta et al. (2005)	Interviews; demographics; motor capacity assessment	141 children (7–18 years) with impaired mobility/Sweden	Describe the well-being of children and adolescents with mobility impairments in relation to demographic data and disability characteristics.	No significant differences in well-being were found regarding the diagnostic-related group, additional disorder/disability, or the degree of disability. The impairment per se did not necessarily influence well-being negatively.
Jemta, Dahl, Nordahl, and Fugl-Meyer (2007)	Interviews; demographics; self-report inventory tool	133 children (7–18 years) with impaired mobility/Sweden	Evaluate a four-dimensional model of coping strategies that considers “active”, “distraction”, “avoidance”, and “support-seeking” coping strategies.	The identification of coping strategies among children and adolescents with mobility impairments should form basis of our understanding of how they face complex challenges while growing up.
McKeever et al. (2013)	Structured, open-ended, one-hour interviews	20 parents of children with CP who received hands-free walker between 5 and 12.5 years/Ontario, Canada	Question how parents of children with CP value their children’s ability to walk and its effects on rehabilitation.	Parents’ symbolic value of a child having upright comportment may help explain their positive perception of hands-free walkers, and their motivation to devote time/effort to improving a child’s independent, walking-based mobility.
Østensjø et al. (2005)	Cross-sectional	95 children (55M, 40F)/ Norway	Describe the use of assistive devices and environmental modifications, and their impact on everyday activities/care in young children with CP.	There is need for assistive technology assessments that consider the needs of child, family, and technology/service system factors.
Palisano et al. (2009)	14 interviews	10 adolescents (17–20 years) with CP/Ontario, Canada	Describe how youth with CP experience mobility in their daily lives using a phenomenological approach	Mobility was viewed as important for self-sufficiency, safety, and efficiency when making choices. Mobility preferences varied depending on social circumstance and environment. There is dissatisfaction with public transit, especially the need for constant planning before making trips.
Porcelli et al. (2014)	Qualitative, cross-cultural, visual methods approach	4 youth (14–16 years) with visual or auditory impairments/Quebec, Canada, and Guwahati, India	Explore the daily (micro)mobilities that youth with visual or auditory impairments use to sustain well-being.	Everyday patterns of (micro)mobilities can help to develop positive identities. More ecological or strength-based approaches are needed to recognise the resources of physically disabled youth and opportunities offered by environments.
Skär and Tamm (2001)	Semi-structured interviews	13 children/adolescents (8–19 years) requiring mobility aids/Sweden	Describe how children/adolescents with restricted mobility perceive their assistant with a focus on their relationships with one another.	Five perspectives of assistants were identified: assistant, mother/father, professional, friend, and the ideal. Establishing relationships with assistants is difficult and time-consuming.
Soulis and Andreou (2007)	Exploratory semi-structured interviews	16 women and 8 men (20–35 years) with CP since childhood/Greece	Question Greek social policy assumptions that families are the best and only providers to children and adolescents with impaired mobility.	Greek children with impaired mobility have limited life experiences due to development being hindered by over-attachment to family, which arises from dominant Greek cultural assumptions about family and parents.
Van Wely et al. (2014)	Implement, observe, and test a 6-month programme	49 walking children (28M, 21F; 7–13 years)/Netherlands	Test if a physical activity stimulation programme helps children with CP to improve physical activity, mobility, fitness, fatigue, and attitude towards sports more than usual paediatric physiotherapy	The six-month physical activity stimulation program, combining fitness training, counselling and home based therapy, was not effective in children with CP.
Wiart et al. (2003)	Structured phone interviews	66 families: 14 children/youth and 52 parent/caregivers (4.5–27 years). 51 had CP/Alberta, Canada	Describe and evaluate the use of powered mobility by young individuals with physical disabilities.	Younger children are now receiving powered wheelchairs. Findings suggest powered mobility is reserved for children with most severe disabilities. Physical/occupational therapists can work with more families to explore powered mobility as an option for early movement.
Ytterhus, Wendelborg, and Lundeby (2008)	In-depth interviews	37 parents of disabled children/Norway	Explore turning points and transitions emerging in the life course of children and their parents.	Change appears in disabled children’s social participation/ belonging at roughly 8 years of age for children with learning difficulties and 10 years for children with mobility difficulties.
AST
Anaby et al. (2014)	Survey; cross-sectional study; model testing	282 children/youth (5–17 years) with disabilities and 294 without; 576 parents/Canada and U.S.A.	Using three models, test the effects of personal and environmental factors (e.g. barriers and supports) on children’s participation across 3 settings (home, school, and community).	Findings highlight the unique role of environment in explaining children’s participation across different settings and, therefore, support development of interventions focused on modifiable environmental factors.
Einarsson et al. (2015)	Questionnaire; anthropometric measurements; ActiGraph accelerometers	91 children (6–16 years) with intellectual disability/Iceland	Investigate physical activity (PA) and patterns among Icelandic school children with mild-to-severe intellectual disability (ID), including their school travel.	PA of children with ID is considerably lower than their typically developed peers. There do not seem to be sex differences in PA and PA patterns among children with ID. No children with ID were found to meet recommended daily moderate to vigorous physical activity levels. This calls for special PA measures in this group. Only 16% of children with ID walked or biked to school, whereas this proportion is 74% for their “typically developed” peers.
Falkmer and Gregersen (2002)	Mail questionnaire	1060 families with a child born between 1983 and 1997 with CP, spina bifida, osteogenesis imperfecta, muscular diseases, short stature, and multiple disabilities/Sweden	Describe the perceived risk among parents concerning the travel situation for children with disabilities, including school travel, and their self-reported knowledge of regulations and standards.	The use of safety belts and tie downs for technical aids on school transportation and Special transport Systems is currently inadequate and not aligned with the “Vision Zero” set up by the Swedish government. Entering/exiting vehicles viewed as risky to parents due to manual assistance required. Poor postural sitting positions and professional drivers’ lack of knowledge about child are key concerns. Parents lack information about regulations/standards, which causes worries. Informing parents better could reduce their worries.
Falkmer et al. (2004)	Questionnaires	1631 parents of children with autism spectrum disorders/Sweden	Investigate the transport mobility situation for children with autism spectrum disorders, including school travel.	Parents worry when their child is transported in school transport and family vehicles. Children being driven by unfamiliar drivers and alongside unknown passengers is problematic. There is need to develop well-structured approach among drivers towards children.
Falkmer et al. (2014)	Interviews using video scenarios	14 children with cognitive disabilities and a control group of 23 children/Sweden	Assess SAFEWAY2SCHOOL programme, which is intended to enhance school transportation safety for children. Focus on whether or not children with cognitive disabilities notice, realise, understand, and accept it.	Very few differences were found in the visual scanning patterns of children with disabilities compared to those in the control group. Findings indicate that SAFEWAY2SCHOOL system is as useful for children with cognitive disabilities as it is for those in control group.
Foley and McCubbin (2009)	Demographic, BMI, and activity log data; accelerometers	9 children (7–12 years) with ID and 9 without ID/U.S.A.	Investigate if children with ID spend more time after school being sedentary by logging physical activity and screen time.	There might be different patterns of sedentary behaviours between children with/without ID; in turn, unique interventions may be needed for children with ID.
Oreskovic, Sawicki, Kinane, Winickoff, and Perrin (2009)	Questionnaire	176 families with children (5–15 years) with asthma/U.S.A.	Identify travel patterns/parental perceptions concerning school trips for children with asthma.	Few children with asthma travel to school actively. Asthma-specific concerns do not appear to guide parents’ decisions about mode choice for school trips.
Pivik (2010)	Students with/ without disabilities evaluate schools	29 children/youth with physical disabilities and 22 children without disabilities/ Ontario, Canada	Conduct two studies to explore the contribution of different stakeholder groups in identifying architectural barriers in schools by having principal, special education teacher, and student independently identify barriers. For 29 schools, student evaluator had a physical disability; in 22, the student did not.	Youth with and without disabilities being involved in collaborative assessments are efficacious in terms of producing inclusive environmental assessments and identifying issues.
Pivik, McComas, and Laflamme (2002)	Focus groups	15 students (9–15 years) with mobility impairments; 12 parents/Ontario, Canada	Examine how inclusive schools are after 25 years of educational reform.	Four categories of barriers were identified: physical environment, intentional attitudinal, unintentional attitudinal, and physical limitations.
Stephens et al. (2015)	Participatory techniques, in-depth case study, cross-sectional mail survey)	Survey: 406 children (8–14 years); case study 13 children (10–14 years) with mobility impairments/Canada	Determine/question the accessibility and inclusivity of Ontario schools for children living with disability.	Disabled children face significant barriers getting to, into and around schools. Major challenges include navigating classrooms, washrooms and playgrounds.

Source: Prepared by authors.

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