Table 3 Barriers regarding participation in the playground for children with PD
Emotional barrier vs. Physical barrier | General inclusion | Role of professional |
|---|---|---|
The social-emotional barrier is larger than the physical barrier. (pro) | The child has no friends in the neighborhood. (pro,par) | Parents do not know the importance of (independent) play. (par) |
Parents help too much and think for the child, causing the child not to try and experience for itself. (pro, par) | Difficult to determine the number of children with disabilities in the neighborhood. (pro) | One-off events do not encourage persistence at playing in the playground. (pro) |
Parents quit going to the playground due to negative experiences, such as being stared at by others. (pro) | Insufficient support for children with a disability in inclusive education. (pro, par) | Parents do not know the capabilities of their child and are not acquainted with how to play with their child. (pro, par) |
Parents find it difficult to delegate. (pro,par) | Inclusion is difficult to organize. (pro) | Parents do not realize that their child can enjoy playing outside. (pro, par) |
Parents have the feeling that there is no room for play without practicing motor tasks. They don’t want to feel as if they are practicing all the time. (par) | Parents of children without disabilities don’t want their children to play with a child with disabilities. They find the responsibility too great. (par) | Difficult to give a specific professional the role of improving play: this is highly dependent on the moment and involvement with the patient/client. (pro) |
Parents need to work hard caring for their child and feel that they don’t have the time. (pro, par) | The level of play of children without disabilities at a young age is already very high, especially physically. (pro) | Professionals, mainly doctors, focus too much on health instead of participation. (par) |
Growing into increasing deficit. (pro, par) | Playgrounds are not designed for all age ranges.(par) | Professionals are more focused on sport instead of play. (pro, par) |
Child is scared and insecure, caused by over-protection by the parents. (pro) | Children without disabilities do not play outside often, so there are fewer children to play with outside. (pro, par) | The therapist uses play as a method, instead of a goal. (pro, par) |
The surroundings of the playground are not safe. (par) | Not going to school in their neighborhood. (pro, par) | Professionals lack the competence to manage inclusion and stimulate play. (pro) |
Some children stay dependent on help from someone else (cognitive, physical, social, emotional). (pro,par) | Children with disabilities play better together but there are few of them in one neighborhood. (pro) | The transition from therapy to participation is difficult due to the emotional barriers of parents and child. (pro) |
The child compares itself with other children and feels ashamed. (par) | Playgrounds are physically inaccessible. (pro, par) | Therapy is directed towards the level of activities, not participation (in ICF-CY). (pro) |
Difficulty with participating in play (cognitive, physical, social, emotional). (pro,par) | People tend to help and think too much for the children with disabilities, not allowing the child to experience for itself. (pro,par) | Therapy on location is difficult to implement due to a lack of time and money. (pro, par) |
Playing inside and alone is preferred or feels safer, like playing with technology. (pro, par) | Children with disabilities do not know how to play with other children, with or without disabilities. (pro, par) | What a child needs is different for every child and remains personalized. (pro) |
There are not enough opportunities to discover and experience the capabilities of the child in outside play, due to high emotional and physical barriers. (pro) | Children with disabilities are not included in society, causing inadequate acceptance and bad behaviour (e.g. bullying) towards them. (pro, par) | Professionals do not collaborate. (pro, par) |
Child does not know its own capabilities. (pro) | Â | Â |
Parents of children with disabilities do not share experiences. (pro) | Â | Â |
Some children do not have an intrinsic motivation to explore in play. (pro, par) | Â | Â |
Wheelchair dependence. (pro) | Â | Â |
Extensive medical problems. (par, pro) | Â | Â |
Child accumulates negative experiences, like always losing, being unable to play, and bullying, causing the child to not enjoy play in the playground. (pro,par) | Â | Â |
In the first years of the child’s life, parents are emotionally not open to the idea of outside play due to mourning, processing, lots of worries, limited time, and diagnostics. (pro, par) |  |  |