Everyday Assistive Products Support Participation in Sport

Abstract

The benefits of participation in sport are widespread, and include not only improved health and wellness, but also support social participation and the realization of rights. Research on the use of assistive products in sport participation has previously focused largely on the use of specialized products in elite sport and has not addressed the importance of everyday assistive products for facilitating sport participation. This research aims to highlight the use of the 50 products on the World Health Organization’s Priority Assistive Product List for sport participation. We found that all 50 products are relevant to sport participation, and support participants to engage directly in sport, but also in social engagement with other sport participants, and as observers and fans of sport.

1. Introduction

The multiple benefits of participating in sport have been widely documented, including a wide range of physical, mental and social benefits [1,2,3,4]. On a physical level, engaging in sports by actively exercising (e.g., walking, running or swimming) is associated with reduction in obesity and a reduction in cardiovascular diseases [5]. Some of the health challenges which people with disabilities experience, such as rates of obesity compared to people without disabilities, may be partially addressed through participation in sport [6]. Research also shows a strong improvement in self-esteem amongst people with disability who engage in sport [1]. In addition, participation in sport has been linked to increased social connectedness and community life [2].

Sport is a broad concept. According to the UN’s Kazan action plan (2006), sport can be “anything, including, physical play, recreation, dance, organized, casual, competitive, traditional and indigenous sports and games in their diverse forms” [7]. For the purposes of this work, participation is understood as defined in the International Classification of Functioning, Disability, and Health (ICF) as “involvement in a life situation” [8]. Therefore, participation in sport can be understood to include both active participation, in which the individual engages directly in the sport, as well as other forms of participation, including engaging with sport as a spectator or fan. Participation in sport for people with disability is also considered to be a human right, acknowledged in the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) as the right to engage in culture through sport [9]. People both have a right to access sport, and can use sport to access rights enshrined in the UNCRPD, including the right to engage in culture, to health and well-being and to mobility [10].

A critical contributor to the achievement of these rights is the use of assistive technology. Assistive technology (AT) is an umbrella term which encompasses assistive products (APs) and the systems, services and policies necessary to make them available to those who need them [11]. Assistive products can be understood to be those products which promote participation in daily life for those with functional limitations including those associated with disability, health conditions and/or aging. People who require AT are an heterogenous group of people, comprised of people who experience difficulties in six functional domains: mobility, self-care, hearing, vision, cognition and communication. This includes not only those who have functional limitations associated with aging, but also those with health conditions and disabilities. This work considers disability through the social model of disability, which suggests that disability is the result of the interaction between a person, their health condition (including the functional limitations described above) and their environment [12].

There has been significant research on the use of assistive products within this population for sport participation, however, this has primarily focused on the use of these products in elite-level sport [13]. The Priority Assistive Product List (APL) is a list of 50 everyday assistive products which was developed by the World Health Organization and comprises those products which should be available to all individuals in WHO member states through universal health care [14]. These 50 products were selected based on their use by individuals with health conditions, older persons and people with disability to maintain or improve the quality of life or well-being [14]. Considering this definition, the WHO recognizes that assistive products are relevant for many population groups, and are not limited to those with disabilities [11]. Assistive technologies are understood to support six functional areas: mobility, hearing, vision, communication, cognition and self-care. These products differ substantially from those used in elite sport as they represent those products which support the everyday needs of those with functional limitations, and are not typically considered as sport-specific technologies.

As the majority of research relating to assistive technology and sport participation has focused on elite sport and sport-specific technologies, there is a gap in our understanding of how basic assistive products can help individuals with functional limitations to engage in sport. Furthermore, aligned with the definition of sport from the Kazan Action Plan, conceptualizing sport as broader than elite sport provides an avenue for exploration that encompasses a greater segment of the population, and speaks more of participation in sport as central to the realization of the right to engage in culture, and of sport as a conduit for accessing rights. Early research in this area conducted by this research team suggests that everyday assistive products contribute to participation in sport at all levels, across a continuum of sport participation including before (pre-participation), during and after (post-participation) the moment of participation. This thematic analysis of assistive products’ relationship to sport participation resulted in a preliminary model called the Assistive Products for Participation in Sport Model (APPS) [15].

Understanding how the 50 everyday assistive products on the WHO APL relate to sport participation could provide valuable information for promoting participation in sport at all levels, from recreational play to elite competition. Therefore, the objective of this study was to explore how the products on the WHO priority APL relate to participation in sport.

2. Methods

2.1. Study Design

The study was conducted as a qualitative online survey on the Qualtrics survey platform (www.qualtrics.com, accessed on 31 May 2021).

2.2. Participants

Participants were included if they self-identified as individuals aged 18 or over who were assistive product (AP) users, or individuals aged 18 or older who self-identified as caregivers, coaches or teachers of persons with disabilities who participate in sport (proxy respondents). Participants were excluded if they were under age 18, were not assistive product users or were not directly engaged with one or more assistive product users. Participants were considered to have withdrawn from the study if no questions relating to assistive product use were answered.

2.3. Informed Consent

All participants were provided with information about the study, including data, confidentiality through an informed consent process at the start of the survey. Proceeding to answer survey questions indicated consent to participate. Participants were not required to answer any question they were not comfortable answering. The study was approved by the Maynooth University Social Research Ethics Committee.

2.4. Survey Distribution and Data Collection

The survey was distributed widely via social media, through personal and professional networks of the investigators, and via assistive technology umbrella and sport-specific organizations. Wherever possible, umbrella organizations were asked to share the survey with smaller partner organizations, thereby reaching a larger range of participants with a more global focus.

The survey design used branching questions to allow each participant group (assistive product users, caregivers and coaches/teachers) to exclusively answer questions relevant to them. Each branch (category of participant) had three blocks of questions: (1) demographic information; (2) assistive product use; and (3) experience with assistive products for sport participation.

The survey consisted of both closed and open-ended questions. Questions relating to age, level of education and assistive product use were multiple-choice or checkbox style questions. Questions relating to gender, primary condition/impairment and describing how the assistive product is used were open-ended questions. For each of the 50 products on the WHO APL, respondents were asked the following closed and open-ended questions: Which of the following assistive products do you currently use? [Priority Assistive Product List provided with link to images] and you indicated you use [previously selected AP]. Please describe how [previously selected AP] facilitates your engagement in sport. The survey was piloted amongst a group of assistive product users for content, language and accessibility and revised according to their feedback before distribution.

For the purpose of this study, sport participation was conceptualized broadly, and included everything from participation in sport as an observer or fan to elite-level sport participation as an athlete or competitor. The definition of sport also included a range of both individual and team-based activities (e.g., team sports, hiking, swimming, dancing, sailing etc.), and was not limited to competitive sport.

2.5. Analysis

Data were exported from the survey platform to Microsoft Excel for analysis of both closed-ended as well as open-ended questions. Records were retained for analysis if the participant had completed the demographic questions and at least one question related to assistive product use. Responses were identified in which APs facilitated engagement in sport. Both common (reported by many) and unique (reported by one or few) uses of APs for engagement in sports were identified and included. To ensure a representative survey, quotes from each participant group (AT user, coach/teacher and caregiver) were included. However, AT user responses were prioritized. Demographic questions were represented as simple counts and proportions (see Table 1). Open-ended responses regarding assistive product use for sport participation were grouped by specific product and reviewed to identify representative uses of each of the 50 products from the WHO APL (see Table 2, Table 3, Table 4, Table 5, Table 6 and Table 7). Where multiple participants answered similarly regarding how a product was used for sport participation, one response was selected as a representative quote to avoid duplication. In cases where multiple perspectives were represented in the open-ended responses for a specific product, either based on participant type (e.g., assistive product user vs. caregiver) or use of the product, multiple quotes were included for that product to ensure transparency of the data presented.

Table 1. Survey Respondent Demographics.

Participation Residence Grouped by WHO Health Regions
WHO Health Region	n = Participants (Countries)
African (AFR)	16 (12)
Americas (AMR)	18 (5)
Europe (EUR)	27 (12)
Eastern Mediterranean (EMR)	3 (2)
South East Asian (SEAR)	4 (2)
Western Pacific (WPR)	7 (4)
Not reported	6
Age and Age-groups
Respondent Group	Respondents
AP Users	Mean: 44.78 (SD 14.01)
AP Users as Reported by Caregivers 1	0–5 (22.2%) 6–12 (44.4%) 13–18 (44.4%) 19–50 (55.6%) 51–75 (44.4%) 75+ (33.3%)
AP Users as Reported by Coaches 1	0–5 (14.6%) 6–12 (43.6%) 13–18 (45.8%) 19–50 (75.0%) 51–75 (29.9%) 75+ (33.3%)

¹ Totals may add up to more than 100% if a caregiver, coach, teacher or supporter reported more than one category.

Table 2. Relationship of Mobility APL Products to Sport Participation.

Priority Assistive Product	#	Summary of AP Use for Sport Participation	Selected Participant Quotes
5. Canes/sticks	22	Used for mobility (getting to and from the venue independently), but also for sport participation (e.g., playing soccer for a person with CP), to support stability and mobility during practice.	“Moving to a place” (AP user) “To be independent before and after training” (Coach/Teach) “Allows balance while participating” (Caregiver) “Provides stability and mobility” (Coach/Teacher) “Enables young people with CP to ambulate during soccer” (Coach) “Hiking sticks that provide additional stability for race walking, etc.” (Coach)
8. Club foot braces	10	To support foot positioning (e.g., while running), as well as to stabilize in order to facilitate participation in sport (e.g., In a ski boot or sporting wheelchair)	“Stabilizes ankle to facilitate participation” (Caregiver) “They assist in foot positioning while seated in a sporting wheelchair.” (Coach) “Support foot positioning in running, stabilizing foot in e.g., ski boot.” (Coach)
11. Crutches, axillary/elbow	19	For independent ambulation before, during and after engaging in sport. This promotes access to sporting venues, or direct participation in sport (i.e., playing volleyball, skiing).	“Enhances balance and ambulatory ability to allow participation.” (Caregiver) “While playing volleyball if they have any muscle weakness.” (Coach) “Crutches are used to support persons with mobility challenges when moving from one point to the wheelchair.” (Coach/Teacher) “Corporal stability and balance, e.g., Alpine Ski.” (Coach/Teacher)
23. Orthoses, lower limb	21	Assist with balance, positioning, fatigue and injury prevention (e.g., reduction in falls). Used for training, competition or to access the venue.	“Some players with lower limb weakness needs these devices to … provide support to the weak limbs.” (Coach/Teacher) “Special sports orthoses used in training and competition.” (Coach) “Access to venue.” (Coach/Teacher)
24. Orthoses spinal	11	Provide support and stability during sport participation for individuals with spinal injuries or other conditions affecting trunk stability.	“Some athletes need good posture for effective control while playing wheelchair tennis.” (Coach/Teacher) “Positioning and set up in sports chair.” (Coach/Teacher) “Stability for athletes with SCI.” (Coach/Teacher)
25. Orthoses, upper limb	12	Support the position and movement of the upper limb engagement in sport (i.e., while playing tennis, grip on bike handlebar or brakes, during ski slalom). Prevention of secondary injury while wheeling.	“Grip on bike handlebar or brakes.” (Coach/Teacher) “These … support weak upper limbs whiles playing tennis.” (Coach/Teacher) “Special sports orthoses used in training and competition.” (Coach/Teacher) “Help with pushing wheelchair to reduce injury.” (Coach/Teacher) “Stability and balance, e.g., navigating ski slalom course with UL impairment.” (Coach/Teacher)
29. Pressure relief cushions	27	To protect the body, prevent pressure injuries, and provide comfort while participating in sport.	“If I didn’t have a pressure release cushion, I wouldn’t be able to sit for long periods of time when training/playing powerchair football.” (AP user) “Reduces the pain in certain yoga positions.” (AP user) “Playing pickle ball … Using skin protection/prevention techniques.” (Caregiver) “Managing seating pressure on a wheelchair in order to avoid pressure ulcers as basketball is a physical game and result in a lot of sweating.” (Coach/Teacher) “Pressure relief in bi-ski as per their own wheelchair or seating.” (Coach/Teacher)
31. Protheses, lower limb	20	To access sporting venues and provide increased independence, and for direct use in sport by the athlete.	“Rock climbing—makes it easier to climb a wall. Also allows me to cycle around or walk around. I only have one prosthesis.” (AP user) “The lower limb prosthesis provides independence for the athlete with limb loss to move about. The prosthesis compensate[s for] the limb loss and provides equal distribution of body mass which ensures balance.” (Coach/Teacher)
32. Ramps, portable	24	To access areas of sport participation when using a wheelchair or other mobility AT, particularly when venues are not accessible.	“Access to training places, competition arena etc.” (AP user) “Use a ramp to access my pontoon powerboat.” (AP user) “Navigation of venues using a wheelchair.” (Coach/Teacher) “Access due to shitty [sic] society design.” (Caregiver)
34. Rollators	11	To provide stability and mobility for sport participation, including play.	“Helpful for … kids to participate in play.” (Coach/Teacher)
38. Standing frames, adjustable	10	To provide stability and balance during specific sport activity. To promote health and reduce risk of secondary complications associated with sitting.	“Reduced risk of pressure sores.” (AP user) “As a form of low intensity exercise and a way to play with adapted equipment.” (Coach/Teacher) “Standing frame allow them to gain weight bearing for balancing themselves during ball shooting training and used for transportation on the road for those with lower-level spinal cord injury.” (Coach/Teacher)
39. Therapeutic footwear; diabetic, neuropathic, orthopedic	14	To protect the feet of the participant and provide stability for sport participation.	“Protects feet and provides stability to enhance participation.” (Caregiver) “Protects the foot of an athlete with diabetes.” (Coach/Teacher) “They make it possible to walk, reach and move around during classes.” (Coach/Teacher)
42. Tricycles	18	To allow participation in specific sporting events and training (e.g., cycling and racing). Allows for independent mobility and participation in the community.	“I became more mobile.” (AP user) “Enables riders with poor trunk control and balance to cycle.” (Coach/Teacher) “For training … to propel longer distance to gain power in upper limbs.” (Coach/Teacher) “The team and coach also are involved in racing and sometimes use tricycle for racing due to limited racer wheelchairs in Zimbabwe.” (Coach/Teacher) “Mobility to attend trainings, for many of them [this] is their means of transport.” (Coach/Teacher)
44. Walking frames/walkers	17	Support for ambulatory mobility, as well as enhancing participation in sport.	“Allows increased ability to get around and enhances participation.” (Caregiver) “To provide support to athletes with mobility impairment.” (Coach/Teacher)
46. Wheelchairs, manual for active use	38	Allows access to sports, including sport participation in the wheelchair or mobility between locations. Means of gaining more ability of wheelchair control, balance and power in upper limbs.	“Makes me mobile and gives me accessibility in sports activities like table tennis, badminton, wheelchair cricket, wheelchair basketball.” (AP user) “It allows me to move freely in places without being seen as a burden to other, it allows me even to involve in sport like wheelchair table tennis. When I possess a manual wheelchair it allows me to enjoy sport.” (AP user) “To get between car, boats, sailing locations.” (AP user) “Specialized lighter tennis wheelchairs is the main assistive devices used to play tennis by an athlete with physical disability.” (Coach/Teacher) “The manual active wheelchair makes me mobile and gives accessibility in sports activities like table tennis, badminton, wheelchair cricket, wheelchair basketball.” (Coach/Teacher)
47. Wheelchairs, manual assistant controlled	24	For accessing sporting venues and for participation in sports.	“Freedom of movement in general.” (AP user). “When unable to use a power wheelchair due to access issues of venue, uses manual wheelchair with assist.” (Caregiver) “To attend sporting events, participate in stationary sports.” (Caregiver)
48. Wheelchairs, manual with postural support	26	To allow stability, positioning, and postural support for more effective participation in wheelchair sports and sport participation as an observer.	“It gives me a chance to relax … while enjoying sport as observer,” (AP user) “Stability and positioning for more effective participation in … wc sports” (Caregiver) “Mobility while safeguarding posture.” (Coach/Teacher)
49. Wheelchairs, electrically powered	13	For accessing sport venues or for seated positioning as a spectator. May be used for specific sport participation.	“I sit in my wheelchair anytime I am watching sport on tv or am attending a game. This is for comfort, I would not be able to sit on a standard seat in a stadium as it would be too painful and I would be unable to watch the game.” (AP user) “Used to participate in sports like bocce or powerchair football.” (Coach/Teacher)

# Number of survey respondents who selected this assistive product.

Table 3. Relationship of Self-Care APL Products to Sport Participation.

Priority Assistive Product	#	Summary of AP Use for Sport Participation	Selected Participant Quotes
6. Chairs for shower/bath/toilet	29	Chairs promote independence in activities of daily living (i.e., shower after sporting event), as well as access to toilet and shower facilities in sport venues.	“Pursue sport with confidence” (AP user) “I feel peace when I get a chance to access washroom so a … chair in toilet environment attracts me to attend sport, otherwise I fear to go.” (AP user) “When at tournaments, I would need access to a shower chair to shower after games etc.” (AP user) “Ability to take shower after swimming session.” (AP user) “When away at competitions involving overnight stays” (Coach)
13. Fall detectors	5	Promoting safety and independence, to detect and alert if a fall occurs while engaging in sport alone.
15. Global positioning system (GPS) locators	17	Navigation to sport facilities, or during sport participation (i.e., hiking), and increased independence during sport participation. GPS can also help analyzing training outdoors.	“Hiking: for mapping and personal orientation on hills. Companion dog: tracking their whereabouts on walks.” (AP user) “Gives speed and distance traveled while boating or handcycling” (AP user) “Permits some freedom while carers can monitor location.” (Caregiver) “Analyzing training.” (Coach/Teacher)
16. Hand rails/grab bars	19	Promote safety and enhance access for AP users (i.e., access to toileting facilities. Facilitating transfers between surfaces, including to and from sports equipment.	“Used when using the toilet.” (AP user) “Access to toilet facilities at training.” (Coach/Teacher) “(...) to facilitate transfers.” (Caregiver) “Handrails along the stairs make it easier to navigate stairs, ramps, footpaths.” (Coach/Teacher)
19. Incontinence products, absorbent	17	Incontinence products ensure individuals can pursue sport with confidence and security.	“Pursue sport with confidence” (AP user) “Needed after bowel nights if traveling.” (AP user) “Personal confidence and security during participation.” (Caregiver) “Minimise impact bladder/bowel accidents during sport.” (Coach/Teacher)
30. Pressure relief mattresses	14	In preparation for, or recovery from, sport participation.	“My pressure relief mattress ensures that I can sleep comfortably and get good rest prior to and during tournaments for powerchair football. Without this, I would wake many times during the night which would affect my performance when playing.” (AP user) “If they want to break and take rest while lying.” (Coach/Teacher)
41. Travel aids, portable	12	To facilitate independent sport participation while traveling.	“When able to attend sports in person, uses items to maintain independence and dignity while out of the home.” (Caregiver) “They facilitate the use of transport and accommodation.” (Coach/Teacher) “Independent travel.” (Coach/Teacher)

# Number of survey respondents who selected this assistive product.

Table 4. Relationship of Vision APL Products to Sport Participation.

Priority Assistive Product	#	Summary of AP Use for Sport Participation	Selected Participant Quotes
2. Audioplayers with DAISY capability	4	Audioplayers can be used to socialize and communicate with other players.	“Socializing independently.” (Coach/Teacher) “Communication” (Coach/Teacher)
3. Braille displays (note takers)	7	Braille displays can be used to to read manuals, team strategies and newsletters.	“Reading newsletter” (AP user) “Reading the manual or team strategy” (Coach)
4. Braille writing equipment/braillers	5	Braille writing equipment can be used to support coaches in preparing for sport in visual impairment	“Rules and coaching” (Coach)
21. Magnifiers, digital hand-held	4	Review of sports documentation including manuals, newsletters, and team documentation.	“ADL functionality of athletes with vision impairment.” (Coach/Teacher)
22. Magnifiers, optical	8
35. Screen readers	7	Facilitate communication for athletes with vision impairment.	“Facilitating athletes with vision impairment.” (Coach/Teacher) “Communications.” (Coach/Teacher)
37. Spectacles; low vision, short distance, long distance, filters and protection	19	To accommodate for visual impairment during sport participation, increasing participation options, and increasing confidence. May be used for better results during sport participation (e.g., when shooting) and offer UV or flying object protection.	“I can’t see well without correction so it helps me see.” (AP user) “Aside from seeing also as eye protection from UV & flying objects.” (Caregiver) “Vision permits expansion of participation options.” (Caregiver) “They allow you to read instructions, device indicators, move around, shoot (aim).” (Coach/Teacher) “Increases confidence.” (Coach/Teacher)
50. White canes	12	For mobility around, to and from the sport venue.	“Mobility aid.” (Coach/Teacher) “Safety in mobility.” (Coach/Teacher)

# Number of survey respondents who selected this assistive product.

Table 5. Relationship of Hearing APL Products to Sport Participation.

Priority Assistive Product	#	Summary of AP Use for Sport Participation	Selected Participant Quotes
1. Alarm signallers with light/sound/vibration	8	Alarm signallers can be used to alert AP users during their performance in sport (e.g., the start of timed events), and for communication of officials during sports participation.	“If I was playing international deaf basketball match they were supposed to have flashing lights on the court to alert the players if the referee blew the whistle as you were not allowed to wear your hearing aids” (AP user) “Early morning starts for sports participation.” (AP user)” “Visual starting gun for timed events. Conveying if personal time on track within the event.” (AP user)
7. Closed captioning displays	8	Closed captioning displays can be used to communicate, and to support access to live proceedings at sports events, ceremonies, and commentary for team events.	“I use subtitles on TV so any matches/sport on TV they have commentators, the live captions picks up on what they are saying.” (AP user) “Live proceedings at sports ceremony events. Commentary at team games in progress. Following TV sports and analysis around games.” (AP user) “Communication” (Coach/Teacher)
14. Gesture to voice technology	5	To promote communication between sport participants and coaches/teachers, carers, and other sport participants
17. Hearing aids (digital) and batteries	12	To promote communication during sport participation, including commands, coaches’ words, communication from teammates, and sporting officials.	“I used to play mainstream sport this was important so I could hear my team mates/coach/referee etc.” (AP user) “I am able to better hear players and coaches when they need to communicate with me.” (AP user) “Permits auditory involvement including commands, start signals, coaches words.” (Caregiver)
18. Hearing loops/FM systems	9	Hearing loops/FM systems can be used to better hear players and coaches when they need to communicate with the AP user both during sports performance but also before or after sport participation (e.g., during presentations/conferences).	“I am able to better hear players and coaches when they need to communicate with me.” (AP users) “Hearing loops: for hearing in loud sports halls and for salsa dance classes. FM systems: for hearing coach/teacher/instructor in different sports. E.g., badminton, hockey, swimming.” (AP user) “Attendance at talks/presentations etc.” (Coach/Teacher)

# Number of survey respondents who selected this assistive product.

Table 6. Relationship of Communication APL Products to Sport Participation.

Priority Assistive Product	#	Summary of AP Use for Sport Participation	Selected Participant Quotes
9. Communication boards/books/cards	10	Communication boards/books/cards can be used when introducing new vocabulary about a certain activity or to communicate about sport with coaches/teachers/caregivers.	“Yes/no cards [to support communication during sport participation].” (Caregiver) “Introducing new vocabulary about the activity, communication with instructors.” (Coach/Teacher)
10. Communication software	17	Communication software can be used to communicate (e.g.,chatting with friends) or to introduce new vocabulary about an activity.	“Chatting with friends” (AP user) “To communicate.” (Caregiver) “Introducing new vocabulary about the activity, communication with instructors.” (Coach/Teacher)
12. Deafblind communicators	6	Communication with coaches, teachers, caregivers and other sport participants during sport.
20. Keyboard and mouse emulation software	10	Participation in sports on the internet, communication between athletes.	“Viewing, commentary, following idols.” (Caregiver) “Needs tools to access internet so they can watch sports.” (Caregiver) “Facilitating [visually impaired] athletes in communication.” (Coach/Teacher)
43. Video communication devices	8	To enable communication about sport, and specific sport training.	“They facilitate interpersonal contacts and information sessions.” (Coach/Teacher) “It helps them to visualize all the exercises.” (Coach/Teacher)

# Number of survey respondents who selected this assistive product.

Table 7. Relationship of Cognition APL Products to Sport Participation.

Priority Assistive Product	#	Summary of AP Use for Sport Participation	Selected Participant Quotes
26. Personal digital assistant (PDA)	5	Participation in sports as a fan, time and life management tool for participation in sport organizations.	“Enjoying sports broadcast.” (AP user) “Time, life management. Permits active participation as an officer of a governing board.” (Caregiver)
27. Personal emergency alarm systems	6	To request assistance during sport participation.	“A help button.” (Caregiver) “ADL activity for athletes with high support needs.” (Coach/Teacher)
28. Pill organizers	9	Support access to necessary medication during tournaments and while traveling for sport participation.
33. Recorders	4	Memory aid for instructions related to sport participation, memory of events during sport participation.
36. Simplified mobile phones	6	For engagement with others, for instance communication with carers and coaches. They can also provide easier access to relevant information.	“Permits engagement with others, and communication with carers and coaches.” (Caregiver); “Easy access to info.” (Coach/Teacher)
40. Time management products	7	To support time management tasks, including sport management, and enjoyment of sport.	“Client now provides programming of sport for bodies.” (Caregiver) “It helps them to enjoy the Activity in present Time.” (Coach/Teacher)
45. Watches, talking/touching	13	To access relevant information before, during or after participation in sport, and to monitor useful information about the moment of sport performance (e.g., physiological factors such as BP and heart rate).	“There are features on the watches for biking and for race walking. They can be used for information.” (Coach/Teacher) “Records activities, monitoring of physiological factors (e.g., BP, heart rate).” (Coach/Teacher)

# Number of survey respondents who selected this assistive product.

3. Results

The 78 survey respondents who were included in the analysis represented 37 different countries of residence, and were from all WHO Health Regions. The highest percentage of the respondents (67.9%) were coaches/teachers, followed by assistive product users (29.5%) and caregivers (11.5%). Of those, 5 assistive product users and 2 caregivers also identified as coaches/teachers/supporters, resulting in a total greater than 100%. The assistive product user respondents’ average age was approximately 45 years. Over half (59.10%) of the assistive product users self-defined as men, and the remainder as women. The majority of assistive product users had been using assistive products for over 15 years. Participants reported engaging in a wide range of different sport disciplines. All survey respondent demographics relating to location and age are also depicted in more detail in Table 1.

All survey respondents indicated either they, or the individual(s) they provided caregiving, coaching, teaching, or support services for, used at least one product in the list of 50 priority products on the WHO Assistive Product List. Of the 50 priority products, all products were used by 4 or more respondents. Specific comments regarding how the product was used for sport participation were provided for 45 of the 50 products on the APL, excluding only deafblind communicators, fall detectors, gesture to voice technology, digital handheld magnifiers and voice recorders.

Table 2, Table 3, Table 4, Table 5, Table 6 and Table 7 provide a description of how each of the 50 products on the APL promote participation in sport, with selected quotes from participant responses. Each of the tables represents a domain of functioning: mobility, self-care, hearing, vision, cognition and communication. Where a product may fit in multiple domains, it is provided in the domain most closely aligned with the identified purpose during sport participation.

The number of respondents who selected each product as being important for sport participation is indicated in the second column. In the final column, direct quotes from participant responses are provided. Wherever possible, responses from assistive product users were prioritized for presentation. For five of the products on the APL, no written response was provided by participants regarding their use of the product for sport participation, although the product was selected by the participant as supporting participation in sport. For each of these five cases, we have provided a narrative of how the product may be used, based on the authors’ experiences in the fields of assistive technology and adaptive sport, but no participant quotes have been provided.

Mobility products (Table 2) were the most used products for sport participation, with manual wheelchairs for active use being selected by nearly half (48.7%) of survey respondents. Mobility products served a variety of roles including access to, around and from venues, as well as use during individual sport participation. Mobility products also provided support for seating and positioning during sport participation—both during sport play, or as a fan or observer.

Self-care products (Table 3) include those products necessary for ensuring one’s physical health and wellness, including bathing and toileting. Chairs for the shower/bath/toilet were the most selected self-care product for use in sport participation, and were selected by 37.2% of respondents. Self-care products were typically identified as important for use before and after sport participation, as well as for use to enhance access to toileting facilities in sporting venues. In the case of both chairs for the shower/bath/toilet and absorbent continence products, several participants specifically noted the importance of these products for confidence in sport participation.

Vision assistive products (Table 4) support those athletes who have visual impairment in a variety of ways. Magnifiers and screen readers may support access to information about sports, including team manuals or instructions, and white canes support access to sporting venues. Spectacles, the most selected product used by sport participants (24.4%), may accommodate for visual impairment and provide support for specific sport participation.

Assistive products for hearing, including products designed to enhance hearing or compensate for hearing loss, are used primarily to support communication between sport participants and other participants or coaches and officials. Hearing aids were the most selected hearing assistive product by survey respondents (15.4%) They may also be used for specific sport participation to signal the start and end of play, or other player notifications.

Communication products are used primarily to support communication between sport participants and others participating in sport, while also supporting learning and engagement with sport for those with communication impairments. Communication software was the most selected communication product, with 21.8% of respondents indicated it could be used to support sport participation.

Finally, products to support cognition were used for sport participation to support participation in sport programming and management, as well as to facilitate day-to-day participation as an athlete or sports fan.

4. Discussion

The findings of our research suggest that all 50 assistive products on the WHO APL support sport participation in some way. This is the first research of its kind to demonstrate the link between assistive products intended for daily use and participation in sport. These findings clearly link assistive products with the realization of Article 30 of the UN Convention on the Rights of Persons with Disabilities, the right to “Participation in cultural life, recreation, leisure, and sport”.

Products on the APL facilitated participation in sport in a variety of ways. These products not only facilitated active sport participation, but also facilitated engagement with other sport participants, preparation for sport and enjoying sports as a fan or observer. For many respondents, participation in sport is contingent not only on their ability to participate in the sport itself, but also to access sporting venues, communicate with other participants and coaches and to engage in self-care related activities at home, in sporting venues and while traveling for tournaments or other activities.

Our findings also suggest significant diversity and variation within our population regarding their use of AT. This included not only the diversity of participants, but also the diversity of disabilities, the diversity of AT use and the diverse ways of engagement in sports. This study supports and re-emphasizes the statement about AT users, including people with disability being an heterogenous group. This includes the heterogenous nature of the population of AT users, of the different types of ATs used and of the diverse ways in which the AT users engage in sport. This diversity is shown in the results of this study and reflects the diverse nature of people with disabilities and their engagement in sport. However heterogenous or diverse, engagement in sport seems to be highly relevant, and it is clear from our findings that basic and everyday products play a critical role in that engagement.

A theoretical model which describes broadly how assistive technologies contributes to participation in sport has also been developed from thematic analysis of a larger set of qualitative data collected in this study [15]. The Assistive Products for Participation in Sport (APPS) Model explores the importance of assistive technology, broadly, to different levels of sport participation, proposing a model of the interconnected relationship between assistive products and sport participation at all levels. In contrast, this work specifically describes the ways in which each of the 50 basic and everyday assistive products on the WHO APL contribute to participation in sport. The recently developed Rights In and Through Empowering Sport Questionnaire (RITES-Q) [10] has demonstrated how the concepts of promoting rights both in sport and through sport are distinct, but complimentary. Thus, the use of assistive products in sport can also enhance human rights through sport.

The breadth of products selected is also an important finding. Out of the 50 products on the APL, respondents provided specific examples of how 45 of those products contribute to participation in sport. This strengthens the validity of the APL on the list, not only as everyday products, but highlights how those products may be critical for the realization of human rights and participation in daily life beyond basic needs.

In many cases when assistive technology is discussed in relation to disability and sport within the research literature, or even within public discourse, the discussion is focused primarily on athletes competing in elite-level sport with sport-specific assistive products. The conversation has largely not included the breadth of assistive technologies that are needed to engage in sports. Moreover, most of the literature considers participation in sport merely as actively exercising/playing [16,17] and measures participation by looking at frequency and intensity of sport participation [18,19]. However, research that considers participation in sport more broadly, including everything from participation in sports as a fan, occasional recreational play and competitive sports, as defined in the Kazan Action plan [7], seems to be missing. This study shows that assistive product users engage in a great range of sports and are highly interested in following and participating in sports in a much broader variety of ways.

Efforts to promote greater inclusion in sport should consider the mediating and moderating effects of assistive technology [20]. Many of the non-sport-specific products are critical to performance and participation in other ways. Assistive technology, including assistive products, should not simply be an object to help people with disabilities or functional impairments fit into the existing society, but rather to also create new opportunities for them [21].

It is clear that more research is needed to understand and explore many aspects surrounding everyday assistive products in relation to disability and sport. Future research may help to address some of the limitations of this study. First, due to the small sample size, we have provided indicative rather than representative data. The results of this survey serve as a starting point for discussion on how to improve participation in sports for assistive product users. Further, the study was conducted only in English and may not reflect a global reality. Finally, this survey did not specifically address issues surrounding access to assistive products, which is understood to be a significant barrier. Further research may consider how access to assistive products (or lack thereof) may promote or hinder access to sport participation.

5. Conclusions

All 50 everyday assistive products from the WHO APL are relevant in facilitating participation in sport. This paper clearly demonstrates the specific roles everyday assistive products play in sport participation. Since each AT user is unique, their usage varies according to their individual needs. Assistive product users require assistive products not only to engage in the moment of sport participation, but also to support access to venues, engagement with other sport participants and to prepare for and recover from sport participation. Access to assistive products is, therefore, critical to ensuring the realization of Article 30 of the UNCRPD.