The everyday life of people with physical disabilities may often differ in various ways from that of able-bodied people, and several researchers have focused on the experience of disability in relation to everyday life.
On an individual level, impairments may limit the extent to which people with physical disabilities may be involved in some activities, and may imply that they spend more time on the activities of daily living than the average population (Gaskin, Andersen, and Morris 2009; Lutz and Bowers 2005).
Individuals with physical disabilities often find their social interactions and social network limited (Isaksson, Skär, and Lexell 2005), with isolation possibly affecting the range of their life experience and influencing their effectiveness in social situations (Blinde and Taub 1999). A crucial point here is how others perceive disability. People with disabilities could experience a feeling of being totalized, as their disability may make them feel that other people devalue them as human beings and see them as being inferior and abnormal. In addition, this feeling may make it difficult to integrate the experience of disability into their lives by affecting how they perceive themselves, their capabilities and self-worth (Lutz and Bowers 2005). People with disabilities might tend to internalize negative attitudes about disability, behave in a manner consistent with societal expectations and develop negative constructions of the self, and they may often experience social isolation due to the stigma attached to their disability (Blinde and McClung 1997; Blinde and Taub 1999). Thus, stigma-handling strategies are an important tool for people with disabilities to cope with situations in everyday life (Krantz, Bolin, and Persson 2008).
Due to societal and disability-related obstacles, individuals with physical disabilities may experience difficulties in mastering tasks and participating in daily life activities since barriers within society seem to prevent them from participating in social communities. A survey among 2235 adults with health problems conducted by The Danish National Centre for Social Research displayed a clear tendency that as with most types of disabilities, physical disabilities have a reducing effect on all types of participation in society, which concerns social life in relation to family and friends, as well as participation in societal areas such as education, employment and leisure-time activities (Bengtsson 2008).
A US study also pointed out that people with disabilities are twice as likely to be unemployed as persons without disabilities (Lutz and Bowers 2005). In addition, employment and participation in the labour market seem to be an important issue for people with disabilities, not only in relation to benefits in terms of money, but also for not becoming bored and providing a social status and social relationships in everyday life. Nevertheless, the challenges of the work environment, such as a fast pace and pressure, may be a barrier that prevents them from taking up the gauntlet (Alaszewski et al. 2007).
Another Danish study demonstrated that compared to the general population, very few people with disabilities are members of cultural or leisure-time activity clubs, and the reason for this is reported to be a lack of accessibility due to both physical and communicative barriers (Sandø and Gruber 2004). A survey carried out by the Danish Ministry of Cultural Affairs stated that among people with physical disabilities, only 42% regularly participated in physical activity compared to 56% of the general population (Breddeidrætsudvalget 2009). One's physical environment and accessibility seem to play an important role in the ability of people with a disability to engage in activities that are important or even necessary in their daily lives (Lutz and Bowers 2005; Blinde and McClung 1997).
Obviously, there are many parameters which decide that people with physical disabilities are not able to participate in social and societal contexts to the same extent as non-disabled people, thereby likely affecting their daily life. To improve participation, changes are demanded in the physical environment and in attitudes towards disability in society, in addition to the individual's perception of opportunities, as people with disabilities are important agents in influencing both their life situation and conditions within society, hence making participation a real option in all contexts.
Organized physical activities have the potential for being an open and inclusive arena in which people with disabilities are able to participate. The predictability and degree of control and adaptation that characterize organized physical activity makes it a proper context to overcome physical and social barriers that may hinder participation in other social contexts (Løvgren 2009). The question is therefore generated as to whether the experience of participation in physical activities may have an impact on participation in other contexts of everyday life for people with physical disabilities.
The aim of this article is to question what qualitative studies may tell about the relationship between the experiences and strategies learned in the context of physical activity and the strategies pursued in other contexts of daily life, as well as how this issue may be further elucidated by using research strategies other than those used in the reviewed studies.
The purpose of the study is to contribute to research and praxis through a review of relevant literature on the subject as published in peer-reviewed magazines from the fields of psychology, sociology, medicine, adapted physical activity, sports, health and rehabilitation.
How do we understand participation?
This study relates to the basic concepts of participation in contexts of action both in and across social practices as presented in Critical Psychology (Holzkamp 1998, 2012; Dreier 2001, 2008). In this frame of reference, the individual is regarded not only as the subject of his/her living conditions but also as the co-creator of his/her life conditions.The abilities of the subject are determined by both the living conditions at his/her disposal and the agency of the subject as reasoned in the endeavour to improve his/herlife conditions (Holzkamp 1998).
According to Dreier (1999), in order to understand actions as participation it is presupposed that the subject is always already involved in social practice, and Dreier states that ‘Individuals have a personal relation to the sociality of their actions, and human actions really exist in the pluralas parts of a social practice that is primary to the individual actions involved and gives them their identity’ (2008, 29). The person is always participating in the world and contributing to re-creating or changing it; thus, according to this conception, the person cannot be non-participatory and participation characterizes the practice and psychological processes of the individual. Human actions are therefore grounded in expanding their abilities of action by increasing the disposal of their life conditions. A person develops the powers of his/her abilities through prior participation in social practice (2008, 29), and participation is understood as human agency in relation to concrete conditions, together with others in social practice in relation to a common cause (Røn Larsen 2011).
With reference to social learning theory, both Dreier (1999) and Lave (1999) state that what a person does and learns in one context of action is changing through its movement into another context of action, as a so-called transformation takes place. However, to understand this process, one has to investigate the practice taking place in the different situations, and how each of them exists within each other. A certain practice may transform participation in other situations, but in order to engage in participating in a profound transformative practice the person is presupposed to be aware of the potential trajectories of participation and of certain forms of alternating participation. Lave describes it as ‘the opportunity to get deeper into the matter, become more of something, do things differently in ways that gradually change how you objectively are, how you are understood by others and how you understand yourself as a socially situated social subject’ (Lave 1999, 50), which is sometimes, though not always, possible. The relations of participation seem to be more or less at the disposal of the person; therefore, participation may be more or less accessible.
People with physical disabilities are often restricted in moving between locations, and their actions are curtailed. Many contexts for participation are not at their disposal and the scopes of possibilities are restricted. Hence, it may be difficult for the person to come to understand the arrangement of possibilities and relationships and the ability to use them, which may limit the person's experience and understanding of himself as an individual who is able to affect his/her life situation and conditions in society.
Physical activity as social practice
Physical activity can be regarded as a social practice carried out in certain places with a particular set of participants, such as with many other social practices. The question is therefore: if participation in this certain social practice is possible for people with physical disabilities, may the experience of participation and ability that the person achieves in this context change the person's way of participating and acting in other kinds of social practice as well?
Over the course of the last few decades, several researchers have focused on the impact of physical activity on people with physical disabilities. Themes such as empowerment (Hutzler 1990; Hutzler and Bar-Eli 1993), meaning (Ashton-Shaeffer et al. 2001, Gaskin, Andersen, and Morris 2009), self-perception (Blinde and McClung 1997; Huang and Brittain 2006), well-being (Campbell and Jones 1994), quality of life (Giacobbi et al. 2008), social competence (Goodwin et al. 2009), perception of bodily competence (Kasser 2009; Page, O'Connor, and Peterson 2001) and community integration (Hanson, Nabavi, and Yuen 2001) have all been the focus of these studies. If and how these experiences and competencies exert an impact on participation in other contexts of daily life are rarely articulated. In these studies, the term physical activity is rarely explicitly defined, although Hutzler and Bar-Eli (1993) clarify that it should be regarded as athletic activity in various forms, including health-related exercise performed for medical or fitness purposes, recreational physical activity and high-level competition.
As defined by Lave (1999), social learning might take place in the context of all types of athletic activities though different aspects that may be in focus for the persons involved due to the purpose of the current activities. However, the above-mentioned definition of physical activity seems to be a bit limited compared to how physical activity is conceived of in a Scandinavian context. According to the Danish physical activity researchers Eichberg and Bøje (1994), all physical activities hold the option of being practised for the purpose of competition, health or recreation depending on the individual's concerns. Only the organizational setting in society and the context in which the activities are carried out tend to separate the three perspectives of physical activities, and we will see later how the concept of physical activity may possess significance for the discussion of social learning and transformative practice.
As practitioners and researchers of physical activity, we must question the widespread assumption that the experience and competence achieved in the context of physical activity by people with physical disabilities may be immediately transferred to other contexts of daily life.According to the theory of social learning, the immediate transfer of competencies is not likely, although a transformation may take place (Dreier 1999; Lave 1999). Nonetheless, to assess this process one must investigate how the practice of physical activity is created in other practices of the person's everyday life and vice versa. Knowledge in this respect could contribute to the discussion as to what extent participation in physical activity may be a means of developing options in general for people with physical disabilities to participate in the various communities of society, thereby facilitating a general improvement of activity in everyday life.
- The identification of published articles of a quality adequate for inclusion in this study;
- a quality appraisal and identification of themes relating to key concepts of the question of the study;
- a summary, synthesis and headlines.
Identification of published articles
The databases searched included SPORTDiscus, PsycInfo, Soc INDEX, PubMed, Eric, Sociology of sport online (sosol) and the International Review for the Sociology of Sport, and the search process took place from 15 September to 15 December 2009 (see Table 1 for text phrases).
|Physical disability OR employment OR everyday life OR rehabilitation OR participation OR empowerment OR socialization OR self-efficacy OR identity OR political activity OR leisure time activity OR voluntary activity OR occupation|
All volumes from 1987 to 2009 of the journal, Adapted Physical Activity Quarterly, as well as reference lists from the reviewed articles, were manually examined for pertinent perspectives, with articles published in English, Danish, Norwegian and Swedish from 1987 to 2009 being reviewed.
The initial search identified 71 studies that seemed relevant to the problem, and both qualitative and quantitative studies were screened. Pragmatic reading included articles that immediately seemed to deal with aspects concerning the impact of participation in physical activity on the daily life of people with disabilities. Within this process, no differentiation was made between the participants’ motives for participating or the purpose of the physical activities (e.g. competition, health or recreation).
Everyday life is defined in this respect as the practical social lifeworld that the individual shares with others and in which he/she practises his/her activities (Bengtsson 2006).
Only studies with informants between the ages of 18 and 60 were included. As opposed to children and adolescents, adults are assumed to present a variety of daily activities likely to be current for most people in Western society, for example work, education, partnership/family and leisure-time activities, interest groups, professional organizations and NGOs. Articles were included if they merely used qualitative methods, while the intention of the study was to explore the experienced impact of participation in physical activity on everyday life. The focus is on the lived experience of the complexity of everyday life and not the statistical correlations between the various occurrences of daily life. Qualitative research is therefore relevant, as it produces knowledge about the ‘hanging togetherness’ of things in social practice (Dreier 2007, 3). Mixed-method studies, in which qualitative findings could be distinguished, were included as well. Quantitative studies were not included as data, but instead used as survey and background to describe and define the relevance of the themes, and reviews were used in the same way.
Several of the initially identified studies did not address the subject of the study directly, so these studies were excluded, used as background or drawn into the discussion. Moreover, studies that explicitly focused on enhancing athletic performance in relation to high-level competition were also excluded.
Fourteen studies were found that explicitly reflected on the significance of participation in physical activity for daily life occurrences for adults with physical disabilities, and which met the criteria for quality appraisal. These studies were included for data extraction (see Table 2 for an overview of the included studies).
|Authors and year||Journal||Participants||Study design||Study focus|
|Rudell and Shinew (2006)||Journal of Leisure Research||11 female athletes from the USA aged 20 to 28 with physical disabilities. Playing wheelchair basketball several times a week||Qualitative study. Semi-structured face-to-face interviews. Kvale's interview analysis (1996)||To identify personal attributes, significant others and situations that contributed to their involvement in sport|
|Guthrie and Castelnuovo (2001)||Sociology of Sport Journal||34 women form the USA aged 20 to 72 with physical mobility disabilities. Regularly participating in sports or exercise, but at various levels||Qualitative study. Standardized interviews with open-ended questions, face-to-face or by phone. Inductive content analysis||To identify how the women used physical activity to manage their disabilities|
|Taub, Blinde, and Greer (1999)||Human Relations||24 male college students from the USA aged 20 to 51 with physical disabilities. Diverse participation patterns in physical activity.||Qualitative study. In-depth interviews, open-ended and with supplementary questions. Content analysis and coding||To explore how an involvement in sports and physical activity may be one strategy to manage the stigma of a disabled body.|
|Page, O'Connor, and Peterson (2001)||Journal of Sport & Social Issues||6 athletes from the USA, aged 24 to 51, with physical disabilities. All nationally ranked in their respective sports (track and field, powerlifting, swimming, fencing and basketball)||Qualitative study. Semi-structured interviews focusing on a detailed description of each athlete's experiences in sport. Thematic analysis||To explore the meaning of sports participation for individuals with physical disabilities and why they participate|
|Sousa, Corredeira, and Pereira (2009)||Adapted Physical Activity Quarterly||14 persons from Portugal aged 17 to 42 with arm or leg amputations, wearing prosthetics. Half of them were engaged in sport, half of them were not||Comparative qualitative study. Semi-structured interviews with open ended questions. Coding and classification||To investigate how people with an amputation view their bodies and how a participation in sports influences how they perceive their body.|
|Blinde and McClung (1997)||Adapted Physical Activity Quarterly||23 persons from the USA aged 20 to 36 with physical disabilities. Participation in recreational programme 5–24 weeks||Interventional study, data collection 2 weeks after intervention. Semi-structured interviews with open-ended questions. Content analysis||To explore the impact of participation in recreational activities on the perception of the physical and social selves of individuals with physical disabilities.|
|Huang and Brittain (2006)||Sociology of Sport Journal||21 persons from GB and Taiwan aged 22 to 39 with physical disabilities or visual impairments. Taking part in track and field and powerlifting at a high competitive level||Qualitative study. Interviews with focused life history approach. Analysis through multiple readings/crystallization method||To explore the multiplicity and complexity of identity construction for elite disabled athletes within disability sports|
|Goodwin et al. (2009)||Adapted Physical Activity Quarterly||11 athletes from Canada aged 22 to 48 with physical disabilities, playing wheelchair rugby at an elite level||Qualitative study. Focus group interviews with interview guide and photographs as initiators. Inductive thematic analysis||To explore the social experience of the wheelchair rugby players from the perspective of the players|
|Blinde and Taub (1999)||Journal of Sport Behaviour||28 male college students from the USA aged 20 to 51 with physical or sensory disabilities. Various experience with participation in physical activity||Qualitative study. In-depth interviews, standardized interview schedule. Coding and categorization.||To examine the empowering capability of participation in physical fitness activity|
|Ashton-Shaeffer et al. (2001)||Sociology of Sport Journal||15 persons from the USA aged 20 to 50 with physical disabilities. Participated in a 2-day disability sports camp with various aerobic sports||Qualitative study. In-depth semi-structured interviews 6 months after the camp. Constant comparison techniques with a grounded theory approach||To examine the perceived impact of the camp experience on the camper's lives|
|Henderson and Bedini (1995)||Research Quarterly for Exercise and Sport||16 women from the USA aged 29 to 53 with physical disabilities. Had physical activity as part of their leisure-time activity||Qualitative study. Interview following a guide with probes to encourage informal conversation. Constant comparison and analytic induction||To understand the experiences and meanings of physical activity for women with physical disabilities|
|Gaskin, Andersen, and Morris (2009)||International Journal of Disability, Development and Education||A 25-year-old woman from Australia with severe cerebral palsy. Physically active||Case study, life history approach. Psychodynamically oriented interpretation of material||To investigate the meanings and experiences of physical activity in the informant's life|
|Kasser (2009)||Adapted Physical Activity Quarterly||12 adults from the USA aged 32 to 56 with multiple sclerosis (MS). Participating in a university-based exercise programme 2–3 times a week||Qualitative study. Face-to-face interviews with open-ended questions, observations of activities, reflections of informal interactions. Thematic analysis||To understand how individuals with MS create and understand their own experience in terms of exercise and exercise participation|
|Giacobbi et al. (2008)||Adapted Physical Activity Quarterly||26 adults from the USA aged 18 to 54 with physical disabilities. Highly active or formerly active in wheelchair basketball||Mixed method study. Physical activity scale (PASIPD). Semi-structured interview with open-ended questions. Grounded theory procedures||To examine links between physical activity and quality of life experienced by the participants|
Quality appraisal and identification of themes
The identification of articles qualified for inclusion in the final sample of studies was made based on the following criteria:
The article must (1) have been peer-reviewed; (2) argue for a choice in qualitative method(s) for data generation; (3) argue for a choice in qualitative method(s) for analysis and interpretation of the data; (4) discuss the issue of generalizability; (5) have used cogent and transparent qualitative method(s) to generate the data; (6) have made a cogent and transparent analysis and interpretation of the data described; (7) have described a clear connection between the research question and/or the hypothesis and results; (8) have accounted clearly for the type of knowledge produced by means of the qualitative methods for generation, analysis and interpretation of the data (Hansen 2007).
This process was followed by a qualitative assessment and identification of key themes related to the problem of the study, which were made the subject of a thematic presentation and conclusion.
Summary, synthesis and headlines
Each of the included articles was carefully read and the essence abstracted, in addition to being initially mentioned by a theme that was considered to be indicative to the contention of the study and in accordance with the research topic. After all the articles were abstracted and categorized, some under the same theme, the full range of the themes was clustered into groups under six overall themes assumed to contain the initial – now – subthemes of all the studies, while some of the studies were represented in various themes since they dealt with more than one focus.
The following themes were crystallized from the selected studies: socialization through sport; being part of a community, being disabled in an able-bodied society; perception of identity, psychological empowerment; maintenance and independence. The themes cover what is suggested in the reviewed articles concerning the research question: how may people with physical disabilities experience the impact of participation in physical activities on participation in other contexts of everyday life?
To convey the results, a qualitative presentation was chosen, and it was considered to be of importance that the various nuances of the theme given by the studies were visible. It was not considered to be important in relation to how many studies represented the current theme, but rather that the theme was presented by somebody.
In introducing each theme, some general perspectives were given with reference to theory and studies that dealt with the theme from a less specific viewpoint than the studies included.
Socialization through sport
Disability sport socialization has been investigated by many researchers over the past few decades, primarily from the perspective of the socialization of individuals with disabilities into sports roles using a structural-functionalist approach (Williams 1994; Rudell and Shinew 2006).
Socialization is seen as an active process of learning and social development that occurs when we interact with others and become familiar with the social world we live in (Rudell and Shinew 2006). Disability sport socialization is not only concerned with how individuals with disabilities internalize the rules of the sports society and acquire their sporting identity, it also ‘focuses our sociological attention upon sport and the development of individuals with impairments as participants in specific sport groups and, at the same time, upon the more general development of individuals with impairments as social beings’ (Williams 1994, 15). Hence, it is a matter of socialization both into and through sport.
Rudell and Shinew (2006) found that multiple agents in persons’ everyday life play a role concerning socialization into sport for persons with physical disabilities, including peers with disabilities, parents, therapists, coaches, camps and magazines. In research into the area of disability sport socialization, sports is often pointed out as a socializing factor, while it is assumed to contribute to the ability to work with others in the achieving of common goals, in teaching discipline and in generally promoting many of the traits and qualities recognized as being important in society (Rudell and Shinew 2006). That persons may be socialized through sport is supported by Lave (1999), who states that what the individual learns while participating in a certain context is transformed when moving into another context. Information relevant to these specific aspects of socialization through sport aspect has not revealed itself in the search process of this review. However, the more general perspective of development as a social being, being able to use ones abilities in communities, has been addressed in the research, as the next theme points out.
Being part of a community
The experience of living with a physical disability can be regarded as a minority experience. Even if it may be assumed that a certain sense of belonging to a community of disabled persons who have a certain group identity would be common, this is not necessarily the case (Ville et al. 2003; Watson 2002). A sense of belonging to a community could possibly facilitate the breaking down of barriers facing disabled persons in the public arena, and the community might serve as a place for a unique exchange that permits the emergence of a culture of disability and a construction of a positive identity. In this respect, the grouping together of disabled persons may favour emancipation and positive identification (Ville et al. 2003).
Participation in team sports seems to facilitate a sense of community experience, as Goodwin et al. (2009) found that wheelchair rugby players expressed various aspects concerning their sense of community, and that it was of great value to be in a community with people with common interests. The fact that all of them were in a wheelchair provided a shared understanding of their disability, their camaraderie both on and off the court and a bond that made it okay to be a quad, both for themselves and for their immediate families. The feeling of isolation in daily life of being the only one in a wheelchair disappeared when the athletes were together with other people in wheelchairs, and the sports community was one in which you were allowed to share your feelings and experiences on being quadriplegic and feeling comfortable about it. The family of the athletes was helped in accepting the quadriplegic life by seeing the athlete being able to participate independently in the sports community. Being part of a community and playing a part in generating and sustaining the culture of their sport was essential to the athletes, and they felt that the image of quadriplegics being fragile, passive, sedentary and ill was challenged by the hard hitting and aggressive nature of the sport, which also allowed them to experience physical contact. According to Goodwin, wheelchair rugby offers a sense of community in which participatory processes for solutions may be mobilized, and which contributes to a quality of life that encourages individual well-being as well as facilitating social relationships. Page, O'Connor, and Peterson (2001) also found that belonging to a sports club or team helped disabled athletes to feel that they were part of a certain special culture, to be comfortable and to share a common language that differentiated them from others.
According to these studies, team sport athletes at the elite level may perceive the experience of fully participating in a community as having great value for both themselves and others. The way the athlete is positioned in this context seems to provide the option for pursuing his/her concern in relation to being a member of a collective (Dreier 2008), which presumably for people with physical disabilities, may be a much greater challenge in most other social contexts of society. He/she may therefore experience his/her abilities and usefulness in the community and learn how the community may facilitate their ability to participate.
One might suppose that the experience of being a capable participant in a sports context could provide a launching pad for the person in developing his/her abilities in order to expand his/her participation in other social contexts. Furthermore, it might make him/her able to choose contexts appropriate for his/her venture, having a sense of what is needed to enter the community in question and how to act in it.
To know more about how athletes with physical impairments participate in communities across contexts, one must listen to their narratives and observe their actions in various social practices in order to acquire a picture of their lifeworld as represented in their everyday life. An interesting point might be how the strategies of participation are used across contexts, for example if team sport participation implies strategies different than individual physical activities.
Disabled in an able-bodied society
The management of disability in an able-bodied culture is one of the great challenges in the daily lives of people with physical disabilities. Living with a disabled body, one must realize that the body tends to present itself as an oppositional force that curtails activities and disrupts a person's involvement with the surrounding world (Toombs 1992). When the body functions without problems, it disappears from consciousness and is hardly noticeable, but when a person is sick, impaired or feels aches and pains, the body becomes the focus of attention (Leder 1990).
Furthermore, discourses of the body in society have a profound impact on the way people constitute themselves, as well as on how attitudes to disability are constituted among people without disabilities. Persons with disabilities may then be exposed to the values and attitudes of society that see them as being less valuable people (Foucault 1990), and they are stigmatized (Goffman 1990), which may urge them to use stigma-handling strategies in their everyday life.
For people with physical disabilities, this may challenge their identity construction in general, as the question is to what extent physical activity can play a role in the process of disability management in everyday life in general.
According to Guthrie and Castelnuovo (2001), physical activity may be used by women with physical disabilities to manage their disability in at least two different ways: (1) as exercise done alone to serve an external purpose such as beauty, normalization, health and function, and (2) to serve in the management of disabilities and disability oppression at the personal level. Still, most of the women in this study did not find physical activity helpful in coping with disability discrimination or accepting disability in general, as they were not participating in physical activity to challenge internalized ableism, and they had no interest in being social change agents via their activities.
Taub, Blinde, and Greer (1999) investigated how a participation in physical activity may be one technique of stigma management for male college students with physical disabilities. The study explored how the benefits of sports and physical activity involvement may be used as a means of compensating for a discrediting attribute, as the students believed that participating in physical activity can help facilitate physical competence and enhanced bodily appearance. The respondents found that they were generally met with the able-bodied community's doubt about their physical capabilities and skills, and the assumption that sports participation was outside the physical domain of individuals with physical disabilities. For several of them, it was an important goal to show the able-bodied community that people with a disability can participate in sports and be very good at it. Sports and physical activity provided opportunities for demonstrating a variety of physical skills, and they believed that this would help in countering stereotypes of their physical incompetence.
In a study by Page, O'Connor, and Peterson (2001), the issue of competence was also at stake, and the athletes felt that sports negated the perceptions of incompetence that others held about people appearing to be disabled and that sports could change the stereotypical view of disabled people. Giacobbi et al. (2008) also found that wheelchair basketball players perceived their participation in sports as a way of presenting to the able-bodied world how disabled people can be active, which was expected to contribute to a change in the perception of disabled people in society in terms of being seen as not just disabled persons, but as athletes and active members of a sports team.
Sousa, Corredeira, and Pereira (2009) found that being engaged in sports seemed to stimulate a positive attitude towards the body for people with amputations, and the researchers assumed that this could be transferred to other domains of social interaction in daily life and might be an element that facilitates social inclusion. Those involved in adapted sports competitions felt that context to be an environment in which everyone is equal and has the opportunity to share experiences and common disability biographies. Sports and physical activity participation seemed to be an involvement that could reaffirm ability rather than disability, and serve as a means to affirm one's bodily competence. The authors concluded that a participation in sports influences how people with an amputation perceive their body, as they live with their body in more positive way and better accept their new bodily condition and their being-in-the-world. They observed less discomfort among participants in sports in showing their body and exhibiting themselves to the stares of other people, and were not much influenced by the power of the media with regard to the body beautiful.
Blinde and McClung (1997) found that a participation in physical activity impacted four aspects of the physical self: experiencing the body in new ways, enhancing perceptions of physical attributes, redefining physical capabilities and increasing perceived competence to pursue new physical activities in the future. Modifications in the respondent's perceptions of the social self were reflected in two themes: expanding social interactions and experiences in the activity context, and initiating social activities in other contexts. The gains discussed by the respondents suggested that the individuals developed and enhanced a sense of control in both their physical and social lives, although this does not reflect if and how the participants actually used these perceived physical competencies in other contexts of everyday life, even though they expressed a willingness or desire to continue their involvement in sports or recreational activities in the future. Additionally, it does not clearly reveal if and how their confidence in their social skills was really used in other life settings.
According to these studies, physical activity may be used as a means to demonstrate an image of the active, competent and skilled disabled person. This may help to counter societal stereotypes of incompetence which, according to Goffman (1990), are implied in the stigma ascribed to people who vary from the norm, thereby possibly opening up for a more inclusive attitude in society towards people with physical disabilities. According to Murphy et al. (1988), the social isolation and ‘invisibility’ that are the consequence of the ambivalence of other people towards people with disabilities might also decrease. It seems likely that the conditions will therefore be changed for the person, as his/her access to participation in other social contexts may be facilitated and options provided for utilizing the power of his/her abilities developed through physical activity in other social practices. The personal recognition and respect experienced might encourage him/her to go for extended social participation, as might the enhanced positive perception of the body reported in the studies, the latter by releasing the person from the influences of the evaluating normative stares of other people (Garland-Thomson 2009) and the concept of the body beautiful (Sheper-Hughes and Lock 1987).
Disability management can be regarded as an ability developed in a dialectical movement between external and internal properties (Dreier 2008), and the act of being physically active as a person with a physical disability may obviously impact both properties. In measuring whether the ability to manage a disability in an able-bodied society in general is enhanced for physically active persons, one could appropriately make observations of the persons’ participation across contexts in order to notice the strategies used.
Perception of identity
Individuals with physical disabilities must continually negotiate the relationship between body, socially constructed disability and identity. The construction of identity requires a deconstruction of existing negative societal perceptions of the impaired body and a struggle to reframe them in a more positive way, while at the same time taking into account individual experiences resulting from specific bodily impairments. Individuals are made into social subjects, both by the way they are defined in society and by the way they present themselves (Foucault 1990), and have multiple identities related to a number of social contexts. In the sporting arena, multiple notions of identity may be embodied while the participants experience themselves interacting with other subjects in various settings, thus obtaining the option to reflect their own perceived identity through the views and reactions of others, which is one of the sources from which individuals can draw their sense of self-identity (Huang and Brittain 2006). According to Watson (2002), it may be questioned whether people with disabilities share a common group identity based on their impairments, and whether they share a notion of the normal body. He states that having an impairment may become a part of the everyday experience for some, a fact of life, their ontological existence.
Huang and Brittain (2006) stated that elite athletes with physical and visual impairments appear to have complex feelings about their self-identity in relation to the notion of impairment and disability. In their study, most of the athletes identified themselves as disabled people, and incorporated impairment into their identity. They were aware of their impairments as being visible identifiers that distinguished them from non-disabled people and of often being used by both able-bodied and disabled people to help identify them. In addition to the difficulties of everyday life, the discriminatory treatment they received had become normal to them, and they internalized the dominant perception about disability in society, while passively accepting the identity of being disabled and different from other people, even if they did not like being disabled.
Few of them, however, did not identify themselves as disabled people. They did not deny their impairment, but claimed that it made little if any difference to them as a person and that they did not feel fundamentally different from others. Nevertheless, they clearly constructed parts of their identities in relation to societal norms even if they did not accept the labels that able-bodied society ascribed to them, though the presence of impairment did not negatively affect their senses of self. Their self-definition was connected to what they were able to do, and what they could not do was regarded as being due to environmental or social barriers. Hence, the respondents adopted various identities depending upon the specific situation in which they found themselves.
This study indicates that the identity as a high competition athlete may be a more empowered alternative to the disability identity, and that identity is contextual. Regarding persons as participants and part of social practice implies that we see identity and self-understanding as being based on the person's options of actions in that practice. When a physically impaired person is able to take part in high-level competitive sports and develops his/her abilities in the actual context, he/she obtains the opportunity to become deeply acquainted with the matter and gradually change his/her self-understanding (Lave 1999). As with ability, disability is a matter of social practice, and in that certain social practice the person is not disabled. Self-understanding, in terms of being a participant and experiencing which forms of practice, arrangements, technologies and artefacts are needed in the social context to make him/her able to participate, might enable the person to transform the strategies of participation from a sports context to other contexts of social practice, thereby leading to an extended participation in society. To understand if that is the way it works, we are urged to ask people what they are part of and how they involve themselves in it (Dreier 2008).
The process whereby members of a disadvantaged group acquire the self-perceptions and skills to achieve mastery over their lives and become proactive in improving their life situation has been termed empowerment (Gutierrez 1990), which implies that what is considered to be poor functioning is based on a lack of personal resources that hinders competent action (Hutzler and Bar-Eli 1993). The development of qualities such as positive self-esteem, perceived competence, self-efficacy and an internal locus of control may facilitate empowerment at the personal level (Rappaport 1987). Psychological empowerment may generally be described as ‘the connection between a sense of personal competence, a desire for, and willingness to take action in the public domain’, and there is a slight indication that psychological empowerment may be related to actual participation in the life of one's community (Zimmerman and Rappaport 1988).
One possible means to empower individuals with physical disabilities is through physical activity, which emphasizes qualities such as achievement and mastery, and often encourages the development of self-efficacy, goal setting, cooperation and competiveness (Hutzler 1990; Greenwood, Dzewaltowski, and French 1990; Adnan, McKenzie, and Miyahara 2001; Martin 2008). In the context of physical activity, the person can respond to challenges and engage in problem-solving behaviour; hence, individuals may therefore develop personally empowering skills that contribute to success in physical activities (Hutzler and Bar-Eli 1993). The question then is whether these skills also enhance effectiveness in other situations of daily life, while providing empowerment at both the group and societal levels.
Blinde and Taub (1999) examined the empowering capability of the physical activity context among adults with physical or sensory disabilities, and their responses indicated that activity participation was associated with three empowerment outcomes that individuals with disabilities often have limited opportunities to achieve: perceived competence as a social actor, the facilitation of goal attainment and social integration. Participants were empowered at the individual level, as these outcomes enhanced perceptions of their effectiveness as social actors and provided a greater sense of control in their lives. In general, the respondents emphasized the participation experience itself as being of great value in heightening their sense of participatory competence and their beliefs about being effective social actors.
Ashton-Shaeffer et al. (2001) investigated the experience and significance of participating in sport at an adult disability sports camp for wheelchair users. The participants faced surveillance in their everyday interactions with the able-bodied, but also in their interactions with other disabled people, which frequently resulted in exclusion from various social spaces and in their interactions with other camp participants. The participants used sports and the camp experience as resistance and as a means of confronting the stereotypes imposed by surveillance, with psychological empowerment identified as an outcome of the sports experience that seemed to reach well beyond that experience.
It seems likely from the studies that physical activity may imply empowerment at the individual level in the sports context for people with physical disabilities, and it is assumed to also have an impact in other contexts of daily life such as an increased confidence to participate in social activity and interact with the world. However, the focus of the concept of empowerment is the individual and a lack of personal resources. The question could be posed as to whether it is a task of the individual alone to carry these increased resources out into the social world, and according to Dreier, personal abilities are only abilities in relation to possibilities in contexts (2008, 33). It might then consequently be presumed that the social context in which the empowered person should display his/her resources is crucial. A context that is appropriate for the pursuit of his/her concerns would presumably be a supportive social context in which the person's process of participating and interacting is recognized by co-participants. Likewise, a common interest should probably exist that a person should be able to pursue his/her own as well as the community's concerns in that specific context. In order to assess what significance the social context may have regarding the transformation of psychological empowerment achieved in the sports context to everyday life, observations of various social practices of the person's lifeworld should be conducted, and questions asked about the person's understanding of the way various social practices in their everyday life are connected.
Maintenance and independence
The maintenance of physical and mental functioning seems to be a crucial issue for people with physical disabilities, in addition to maintaining the ability to lead as independent a life as possible (Goodwin et al. 2009), as participating in physical activity on a regular basis may have an impact on both issues. Moreover, many studies demonstrate a significant improvement of functional efficiency in subjects with disabilities who actively participate in sports programmes (Hutzler and Bar-Eli 1993).
Henderson and Bedini (1995) found that for women with mobility impairments, physical activity served the purpose of therapy to a large extent in so far as they had to exercise in order to not suffer the physical consequences of their disability, which also served in relation to the maintenance of mind and body, to rehabilitation and for daily functioning.
Page, O'Connor, and Peterson (2001) identified that a major motivation for participating in physical activity among elite athletes was the maintenance of physical and/or mental fitness, which was important in keeping the potentially detrimental effects of their disability in check, and that maintaining an active lifestyle was a means of maintaining physical independence and a sense of individual capability. Among other benefits, Sousa, Corredeira, and Pereira (2009) found that sports helped to provide motor efficiency, thus allowing a person with an amputation to improve his/her lost functionality, and among the participants engaged in sports, they also identified a perception of a greater control over the impairment.
Gaskin, Andersen, and Morris (2009) investigated the meanings and experiences of physical activity in the life of a 25-year-old woman with severe cerebral palsy, and concluded that physical activity was intimately connected to her psychosocial development. She seemed to gain a stronger sense of competence, and was able to maintain her relationships with her family as she maintained the ability to live in her flat due to her physical functioning. Alternatively, she would have had to live in a home for people with disabilities. Likewise, Kasser (2009) found that the meaning of regular exercise for adults with multiple sclerosis was to maintain functioning and health, which enhanced their exercise self-efficacy, and helped them to feel hope and optimism.
Giacobbi et al. (2008) also stated that physical maintenance and the prevention of health risks were important implications for physical activity.
It seems evident that the physical competencies achieved through physical activity have an impact on the everyday life of physically active people with physical disabilities as a means to stay fit and be in control of the potentially detrimental effects of disability, to stay socially connected, to establish or maintain the ability to participate in activities and to stay independent in daily living. Personal abilities are the personal pre-conditions that enable a person to participate in social practice, and they are developed through activity in the world (Dreier 2008). For this reason, the context must provide a setting in which personal abilities comprise necessary and sufficient pre-conditions of participation (Dreier 2008).Within that perspective, disability is a matter of social practice, although since the personal abilities in this respect are closely linked to the body, and since participation is embodied (Dreier 2008), the physically impaired body must also be regarded as part of the person's conditions. It is thus necessary to regard how the body is conceived. In social practice, the body must be considered interpersonal in a phenomenological sense (Merleau-Ponty 2009; Leder 1990). Hence, the bodily pre-conditions for participation are not only connected to the physical body but also to the body as existence and as represented in the consciousness of the individual. Studying the interplay between the bodily capabilities of the individual and participation in the social practices of everyday life would therefore be an interesting focus of research.
Conclusion and discussion
This review of the literature was intended to elucidate what research has to say about the experienced impact of participation in physical activity on the everyday life of people with physical disabilities.
A key concept of the study concerning everyday life is participation, with the theoretical framework for the discussion of the themes being critical psychology and social learning theory. According to critical psychology, participation reflects the basic social character of human existence (Dreier 2008), as the person is always participating in the world and contributing to re-creating or changing it. Participation is understood as human agency in relation to concrete conditions, together with others in social practice in relation to a common cause (Røn Larsen 2011). Social learning theory states that what a person does and learns in one context of action may change through its movement into another context of action through transformation.
In this theoretical framework, physical activity is seen as one social practice out of many that constitute human action. The question is raised as to whether experience and competence achieved through participation in this specific context is likely to be transformed in the process of moving into other social practices, thereby resulting in a change of participation and a new self-understanding.
Summary of the findings
Fourteen studies were included in the review due to the criteria of inclusion: eight of them encompassed recreational physical activities at various levels and six covered high-level disability team sport. No studies were found that focused on activities in which people both with and without disabilities took part.
Below, a brief summary of the findings in the reviewed studies is presented.
Although it is assumed that a person may be socialized through sport, no evidence is found in this review that the learned role of participation experienced in the sports socialization process may be transformed through its movement into other contexts. Physical activity seems to have some impact on the process of disability management, that is being disabled in a non-disabled society. Athletes with physical disabilities being visible in society seem to produce a more positive impression and a more inclusive attitude in society towards people with physical disabilities, thus making the possibilities for participation more accessible. Together with an enhanced positive perception of the body experienced by disabled athletes, one may presume a development in social participation for the individual, even if it is not evident from the current studies.
The more empowered athletic identity seems to challenge the disability identity, which could offer the potential for a changed self-understanding and an increased sense of personal power. The included studies do not make it evident as to whether a person might be able to transform the strategies of participation from a sports context to other social contexts. Disabled athletes participating in high-level team sports seem to feel they are part of a certain culture, and belong to a specially valued community. Being a capable member of a collective may further facilitate the athlete in developing his/her abilities in order to expand his/her participation in other social contexts, though this is not directly evident from the included studies. Participation in physical activity seems to imply psychological empowerment in the sports context for people with physical disabilities, and it is assumed from the current studies that this may impact their sense of personal power, hence leading to a change of participation in other contexts of everyday life.The physical competence and fitness achieved through physical activity seem to be pre-conditions that enable the person to participate in other social practices. Since abilities are further developed through activity in the world, being a participant in physical activity is presumed to promote participation in other social contexts as well.
Physical activity and social learning
In the studies included in this review, the term physical activity is not precisely defined. It is apparent which specific activities they are dealing with, and the context tells if the purpose of participating may be high-level competition or recreation. However, this does not clarify the motives of the participants, as it is not clear what concerns the individuals pursue in the social practice of physical activity, which also makes the answer to the question of this review somewhat unclear. If we are to grasp its significance for their everyday life, it must be clarified what the participants are talking about and what they expect from their participation in physical activity and sport.
As for the matter of transformation of the experience from the context of physical activity to other social contexts, it is not likely that the included studies take social learning as a frame of reference. In most of the studies, interviews were conducted outside the context of physical activity, and often typically a week or a month after the certain activity had taken place, which indicates that learning is conceived as a simple transfer of experience or abilities from one context to another, and that the learned experience may be expressed in words. According to social learning theory, abilities are only abilities in relation to possibilities in contexts. Persons develop their abilities through activity in the world and modify and change them, and in so doing, change themselves and the world (Dreier 2008, 33). A transformation takes place, which may be grasped in the best way by looking into the various practices of the persons’ everyday lives.
Limitations of the study
This study is subject to certain limitations. Because quantitative studies were not included and discussed as data in the study, the study provides no insight into statistical correlations between participation in physical activity and everyday life in general. This was not the purpose of the study, but it might have provided certain interesting knowledge about the field, which could have led to further discussions about further research. No studies were found that directly investigated the experienced impact of participation in physical activity on the everyday life of people with physical disabilities. The included studies all broached this issue in some way, although the concept of everyday life and participation as dealt with in critical psychology is not explicit in any of these studies. As a result, it has been necessary to make some interpretations of the studies to elucidate the question, which may cause a limitation in the results in this review.
Reflections about further research
All studies included in the review used qualitative interviews to collect data, though only one of them was supplemented with observations. The data collection was conducted on the basis of the informant's experience of participating in physical activity, either as part of their daily life or as a consequence of a course conducted for the purposes of the study. Semi-structured interviews and a few narrative interviews were used for the data collection, both of which fit well with the purposes of the included studies, though they were not adequate for investigating the questions of this review. Nonetheless, some knowledge has been revealed that can be built upon in further research on the topic, though supplementary methods could be needed. Interviews account for some of this, but observations and studies of occurrences in everyday life may also be necessary to help achieve a deeper understanding of the field. We might only find out how participation in physical activity impacts everyday life if we observe the practices of everyday life, but by closely following what happens in several of the contexts that constitute the everyday life of the person, this relationship may be identified. A method combining, for example, narrative interviews and close observations would seem appropriate for this task.
In order to understand the actions, thoughts and emotions of a person, we must understand the way in which that person participates in social practice. The concept of participation as presented in critical psychology urges us to understand persons by asking what they are a part of and observing how they involve themselves in it. We have to study the interplay between participation in physical activity and the person's ongoing daily life between the physical activity sessions (Dreier 2008), and materials are needed that cover what takes place in the physical activity sessions, as well as in other contexts of the person's life.
Why is this perspective important?
One could relevantly question whether physical activity and sports must be expected to have an effect other than simply its meaning for the athlete. Why expect physical activity to be used as an instrument to facilitate enhanced participation in other contexts? The utility of physical activity has been the focus of research for decades, and there is good reason to assume that physical activity holds various potentials that may improve the quality of life, making life easier for people with physical disabilities. To know whether the knowledge and experience about oneself and one's possibility for physical activity can imply changed actions in other contexts of living is important in relation to the life and development of disabled persons as human beings, as well as in relation to the usefulness of physical activity and sports in rehabilitation and health promotion.
If taking part in physical activity qualifies those with disabilities to participate in other contexts of everyday life, there would be good reasons to focus on the existing barriers to participation in physical activity in order to improve accessibility, appropriate activities and inclusive attitudes for people with disabilities in the society of sports.