Disabilities

Inclusion has become a central concept in disability policy, education, and welfare state reform, yet its practical implementation remains ambivalent. While inclusion is promoted as a rights-based ideal grounded in equality, it can also function as an administrative label that obscures persistent exclusion. Drawing on critical disability studies, this article analyses inclusion as a contested, power-laden concept and develops a three-stage framework—access, participation, and agency—to distinguish formal inclusion from substantive belonging and influence. The framework is applied to key domains of disabled people’s lives—education, housing, service systems, working life, crises, and digitalised everyday life—showing how ableist norms, managerial governance, and institutional logics can reproduce exclusion within ‘inclusive’ reforms, including forms of transformed institutionalisation. The article argues that meaningful inclusion requires dismantling ableist norms, addressing structural power relations, resourcing supports, and strengthening disabled people’s agency in decision-making. Full article

Objective: To analyse the rhetorical strategies employed in formal complaints regarding adult Attention Deficit Hyperactivity Disorder and Autism assessments, specifically where no service failure was identified. Methods: A rhetorical analysis was conducted on 48 complaints determined to be not upheld overall, submitted to a UK NHS Trust between 2024 and 2025. Results: Complainants demonstrated high rhetorical sophistication, frequently deploying a “Triple Core” strategy: Causal Attribution (blaming the service for life failures), Emotional Impact Description (framing dissatisfaction as medical trauma), and Procedural Challenge (alleging administrative breach). A minority (18.8%) employed economic arguments, whilst 81.2% included specific outcome demands, such as a prescription or a specific diagnosis. Conclusions: Complaints in this area of clinical practice demonstrate sophisticated rhetorical construction, functioning as instruments of organisational pressure. The “Triple Core” strategy creates an epistemic conflict where clinical judgement is contested by the patient’s lived experience narrative. These findings suggest that high complaint volumes may reflect a systemic gap between public expectation and clinical criteria rather than safety failures. Full article

Stress is increasingly recognised as a key factor underlying health and behavioural problems in people with intellectual disabilities. However, little is known about chronic stressors embedded in residential care environments. This study aimed to identify chronic stressors in residential care for people with intellectual disabilities from the perspective of stakeholders. A group concept mapping design was used, combining qualitative data generation with quantitative clustering analyses. Direct support workers, family members, and experts by experience generated statements describing situations perceived as stressful in residential care settings. After data cleaning, 125 unique statements were retained. Participants subsequently clustered and rated these statements on frequency, impact, and controllability. Thirty-eight statements were identified as daily stressors with high frequency and impact. Ward’s hierarchical cluster analysis grouped the statements into eight clusters representing broader conditions within residential care environments. Several clusters contained multiple high-frequency, high-impact stressors and were therefore interpreted as potential chronic stressors. These clusters reflected structural characteristics of residential care, including dependence on support staff, limited autonomy, and shared living environments. Identifying chronic stressors provides a framework for studying chronic stress in people with intellectual disabilities and may inform organisational and environmental interventions aimed at reducing exposure to such stressors. Full article

Purpose: Recent studies have shown that high-intensity interval training (HIIT) can improve cardiometabolic health in individuals with spinal cord injury (SCI); however, many barriers remain for individuals with spinal cord injury to participate in exercise such as lack of time, accessible equipment and facilities, and transportation. The use of telehealth interventions may be a form of exercise delivery that can ease the burden on the participant and lead to greater exercise participation. Thus, the purpose of this study was to determine the feasibility and efficacy of a home-based telehealth HIIT arm crank exercise training program for individuals with spinal cord injury. Methods: Participants were randomly assigned to 16 weeks of telehealth HIIT arm crank exercise training or a no-exercise control group. Body composition, resting energy expenditure (REE), blood lipids, insulin sensitivity, blood pressure, aerobic capacity (VO₂ max), and a qualitative interview were assessed at baseline and at 16 weeks post intervention. Results: Six individuals (four male and two female, mean age 52.7 ± 10.2 years) with spinal cord injury were recruited for this study. Four out of five HIIT participants showed improvements in aerobic capacity, insulin sensitivity, and resting energy expenditure. Three qualitative themes emerged: (1) convenience and perceived benefits were critical elements of engagement; (2) high-intensity exercise elicited time-sensitive responses; and (3) trainers played a key role in promoting strong program adherence. Conclusions: Overall, we found that this program could be easily implemented and per-formed at home in individuals with spinal cord injury. We also found that participants enjoyed the 1:1 training sessions with a telecoach and that the intervention was easy to adhere to, as demonstrated by participant attendance. There is a need for future randomized controlled trials to determine the efficacy of telehealth exercise training for improving cardiometabolic health in spinal cord injury. Full article

Background: Autism Spectrum Disorder (ASD) is characterized by social communication deficits, restricted/repetitive behaviors, sensory processing atypicalities, and impaired adaptive functioning. Neuropsychomotor Therapy of Early Development (TNPEE) integrates motor, cognitive, and socio-emotional domains, promoting functional skills, while Therapy in Aquatic Motor Activities (TAMA) targets motor and sensory engagement. This multicenter, 18-month study compared TNPEE, TAMA, and their combination, hypothesizing that TNPEE would drive core symptom and adaptive improvements, with TAMA providing complementary benefits. Methods: Seventy-seven children with Autism Spectrum Disorder (31.6% females) were recruited from four Italian centers (Palermo, Perugia, Sarno, Messina) and allocated to three groups: TAMA only, TNPEE combined with TAMA, and TNPEE only. Assessments included the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), the Childhood Autism Rating Scale, Second Edition (CARS-2), Vineland Adaptive Behavior Scales, Sensory Processing Measure and HAARS at baseline, 6, 12, and 18 months. Results: By 18 months, children receiving TNPEE, alone or combined with TAMA, exhibited significant reductions in autism severity, significant improvements in adaptive functioning, and enhanced sensory processing. In contrast, the TAMA-only group demonstrated improvements in aquatic competence (HAARS) but no statistically significant changes in ASD severity or adaptive functioning. Conclusions: TNPEE was the intervention most consistently associated with improvements in ASD severity, adaptive functioning, and sensory processing, whereas TAMA alone showed a more limited impact on broader developmental outcomes. Full article

Despite the known benefits of workforce participation, many individuals with disabilities remain excluded. This exploratory study utilises selected analytical tools from constructivist grounded theory to investigate how 46 diverse stakeholders perceive disability during the transition from higher education to employment. Additionally, it examines how these perceptions influence efforts toward inclusion and the advice given regarding disability disclosure. Six workshops were conducted to facilitate dialogue on pathways to work for students with disabilities. The constructivist approach to analysis leads to the development of several concepts that capture stakeholders’ perspectives on disability, their strategies for promoting inclusion, and their recommendations regarding disclosure. Disabilities are conceptualised as an asset, a liability, or as insignificant. The views of disability as an asset or a liability influence advocacy strategies and disclosure recommendations, ranging from celebrating to concealing. These attitudes also shape how individuals who disclose disabilities are perceived. Society often expects people with disabilities to disclose their conditions to promote inclusion, even though performing such can involve risks like stigma and exclusion. At the same time, employers share responsibility for creating inclusive environments through universal design and supportive practices. The findings show that both disclosure and concealment can lead to inclusion or exclusion, emphasising the importance of universally designed institutions. Full article

The Disability Royal Commission in Australia has reinforced concerns that segregated employment settings can increase risks of exploitation, violence and abuse, including within Australian Disability Enterprises (ADEs), strengthening the case for community-based employment options for people with intellectual disability. This qualitative study examined how features of supported employment might inform the design of an inclusive job guarantee (JG) model. Drawing on 77 interviews with supported employees and staff, we identified enabling conditions that support wellbeing and participation (including customised roles, structured routines, peer connection, and holistic support), alongside structural constraints that can limit inclusion and progression. While participants and staff described clear well-being benefits from supported employment, they also highlighted frustrations associated with disconnection from the wider community, low pay, and limited pathways to advancement or transition. Given that transition rates between supported and mainstream employment remain very low, the findings emphasise that any JG model seeking to include people with intellectual disability will need investment in supports and credible transition pathways. This paper concludes by outlining how these design implications intersect with the broader economic logic of unemployment and what an inclusive JG could contribute as part of a wider disability employment reform agenda. Full article

Population aging requires residential environments that go beyond basic accessibility. This study theorizes and validates the Accessibility Gap (the divergence between regulatory compliance and the functional lived experience of older adults) using a Multi-Criteria Decision Analysis (MCDA) tool. The research uses a weighted linear aggregation model based on user-centered design and the International Classification of Functioning, Disability, and Health (ICF). Thirty dwellings—apartments, single-story, and two-story houses—were evaluated in Chile’s Metropolitan Region. The model applies 40 indicators, normalized on a 0–100% scale across six dimensions, and weighted by older adults and caregivers. Results reveal fragmented accessibility gap: basic features often meet standards; yet important deficits remain in highly prioritized areas—autonomy, safety, and communication. The Global Performance Index (GPI) identifies “accessibility gaps” that traditional assessments miss. By combining objective metrics with subjective experiences, this study delivers a replicable, evidence-based framework. It shows that specific design choices, rather than architectural configuration, better support functional independence. The MCDA approach provides a robust tool for guiding housing rehabilitation and public policies that support aging in place and ensure homes meet the needs of an aging population. Full article

People with disabilities continue to face significant barriers when flying, despite decades of policies enacted to protect their rights and ensure equitable and dignified access. These challenges are often linked not to a lack of policy but to inconsistencies, fragmentation, and unclear responsibilities across operators and jurisdictions. This review examines international, U.S., and Canadian air travel policies to assess their comprehensiveness, coherence, and alignment across jurisdictions, to promote accessible air travel for travelers with disabilities. We conducted a structured policy review following Arksey and O’Malley’s framework. We systematically identified, selected, charted, and analyzed 28 U.S. policies, Canadian policies, and international guidelines. Policy content was compared using the themes of a scoping review on air travel experiences of people with disabilities and the Disability Policy Lens to examine definitions, aims, and coverage. Findings highlighted substantial variation across jurisdictions in the allocation of responsibilities among actors and the specificity of policy provisions. These variations contribute to uneven interpretation and implementation of accessibility measures, shaping inconsistent travel experiences for people with disabilities. International guidelines have the potential to serve as an important reference point, but currently lack comprehensiveness. There is a need for greater cross-jurisdictional coherence in air travel policies. Full article

This study aimed to explore athletes’ experiences of transitioning out of sport following spinal cord injury (SCI). Using a multiple-case study design, three former nondisabled competitive athletes participated in one-on-one semi-structured interviews. The participants’ interview responses were informed by quantitative measure data collected prior to the interviews using the Athletic Identity Measurement Scale, the Social Support Questionnaire-6, and the Satisfaction with Life Scale. The thematic analysis of the interviews revealed that participants experienced a range of cognitive, emotional, social, and behavioral influences during the transition process. These influences contributed to outcome-related appraisals of post-SCI transition. Balanced self-identity, adaptive sport participation, and peer-mentor relationships were common factors influencing athletes’ transition with spinal cord injury. The results partially support the conceptual model of adaptation to career transition and extend it to account for athletes’ experiences following SCI. The results also benefit rehabilitation professionals and athletes with spinal cord injury by providing insight into psychosocial factors and resources that may influence the transition experience. Full article

Background: Adults with disabilities living in low-resource communities experience persistent inequities in access to healthcare, mental health services, and community participation. However, qualitative data capturing lived experiences in the Deep South remain limited. This study aimed to identify priority needs among adults with mobility disabilities residing in economically distressed communities near Birmingham, Alabama, to inform future telehealth programming. Methods: Fifteen adults (mean age = 60 ± 10 years), predominantly African American and female, completed semi-structured phone interviews exploring basic needs, neighborhood accessibility, health priorities, and perceived supports. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s six-phase thematic analysis. Results: Five themes emerged: (1) seeking stability amid severe mental health strain and inadequate supports; (2) constrained food environments shaped by cost, location, and safety; (3) feeling forgotten: systemic neglect and restricted participation in community life; (4) physical health deprioritized by competing needs and structural barriers; and (5) remote support as a viable but unrealized option. Participants described how safety concerns, transportation barriers, and rising food costs constrained daily functioning, while unmet mental health needs compounded isolation. Despite widespread cardiometabolic disease, immediate needs related to mental health, food, and housing consistently superseded physical health. Mental health support was identified as the most feasible area for remote delivery, though poor awareness of available resources limited engagement with any service model. Conclusions: Findings demonstrate that disability-related disparities in low-resource communities are driven largely by structural and environmental factors rather than individual choice. Telehealth and mobile-based services may provide a feasible access strategy for mental health and supportive care in under-resourced settings, particularly when integrated with broader community supports. Addressing foundational needs is essential for advancing health equity among people with disabilities in the Southeast. Full article

International agreements require reducing and eliminating the exclusion faced by persons with disabilities. Achieving this goal depends on having reliable data on persons with disabilities, yet a wide variety of instruments are used to identify who is counted as disabled. This literature review aims to investigate different approaches to disability identification in terms of the prevalence rates they produce, the population they capture, and their defining characteristics. We searched five databases and identified fifteen studies conducted in an international development context. The results show that prevalence estimates and populations vary considerably across instruments. We inductively identify four main approaches to disability identification and discuss key characteristics of each. The results reiterate that there is no ‘gold standard’ for identifying disability; there are multiple conceptualizations of what disability is, each reflected in different instruments and assumptions. Promoting greater reflexivity amongst practitioners can foster transparency and accountability in data collection and use. Full article

In 2007, Ecuador ratified the United Nations Convention on the Rights of People with Disabilities and introduced a national social programme to improve access and quality of life for people with disabilities. This study assessed disability prevalence and socioeconomic inequalities in three social protection outcomes: household visits, benefits received during visits, and official disability accreditation. A cross-sectional study analysed data from the 2014 national population-based survey, which showed a 3.84% disability prevalence. Overall, 37% of respondents reported at least one household visit among them, 77% received a benefit and 60% had official accreditation. Marked socioeconomic disparities expressed in absolute differences were observed. Visits were less frequent among individuals without formal education (AD: −30.41; 95% CI: −37.15, −14.09) and those in the poorest households (AD: −17.74; 95% CI: −23.01, −12.48). Participants with primary education were less likely to receive benefits (AD: −19.51; 95% CI: −32.83, −6.19), while Afro-Ecuadorian (AD: 20.07; 95% CI: 4.20, 35.95) and Indigenous individuals (AD: 19.61; 95% CI: 6.99, 32.24) were more likely to receive them. Conversely, those with basic education (AD: 21.38; 95% CI: 13.53, 29.23) were more often accredited than those with higher education. Although the programme has reached many individuals, access remains unequal. Full article

Career assessment instruments for children with special needs are not fully inclusive and precise. This study uses both quantitative and qualitative methods to identify the key problems students face, refine the career matching stages, and assess the desirability, feasibility, and viability of the services developed. This study found that co-design in the preparation and validation of the career matching platform has integrated several aspects, namely people with disabilities’ behavior, interests, and career paths, and has been adjusted to national competency standards, according to the group. The development of this platform uses the Double Diamond approach, including focus group discussions with several extraordinary school teachers across two activities. The existing analysis shows that the fifteen-stage career development model has prepared students for career paths, making it a potential reference for career services for people with disabilities. In addition, implementing a career development model integrated with the platform can make it easier for students to find a job profile that best suits the world of work. The results of this research can be the basis for disability career development policies, programs that bridge students to the world of work, and the formation of an industrial ecosystem that cares more about children with special needs. Full article

One of the main focuses of social innovation is the fight for social inclusion for all. The prevalence of violence against women with disabilities shows how the lack of recognition of diversity hinders real equality for these individuals. This violence is a structural problem that is caused by a combination of gender and disability dynamics, the perpetuating inequalities and social exclusion. Researchers have analyzed specific vulnerabilities in the areas of work, education and health, and point out that only by addressing diversity can we overcome the consequences of such discrimination. Using a qualitative methodological approach, this study utilized critical documentary analysis and a thematic review of recent scientific, academic, and institutional literature, alongside empirical data, to identify the most prevalent forms of violence faced by women with disabilities: sexual (affecting up to 80% of women with disabilities), economic (with wage gaps exceeding 24%), and institutional (a lack of accessibility to basic services). The barriers hindering these women’s access to resources and services are also highlighted. The results point to the urgent need to develop innovative public policies and social strategies that value social diversity as a driver of change. This study concludes with specific recommendations for implementing inclusive approaches that promote equality, universal accessibility, and comprehensive protection in order to move toward more just, cohesive, and innovative societies. Full article

Background: The Mobility and Quality of Life-7 Dimension (MobQoL-7D) is a new patient-reported outcome measure for mobility-related quality of life. Our aim was to translate and test a Dutch-language version. Methods: A cross-sectional psychometric evaluation study was undertaken. The sampling frame was community-dwelling adults living in the Netherlands who had a long-term (>6 months) mobility impairment. Participants were recruited through a Dutch research agency, and data were collected via online survey. Statistical and psychometric analyses were undertaken to assess the interpretability, validity and reliability of the MobQoL-7D Dutch, including assessment of missing data, floor/ceiling effects, test–retest reliability, structural validity, known-group validity and convergent validity. Results: n = 308 respondents completed the survey; sub-group sample sizes ranged from n = 29 to n = 87. No issues with missing data were found. Despite ceiling effects per item (ranging from 23.1% to 56.5%), there were no floor/ceiling effects for overall index values (12.3% and 0%, respectively). The findings show excellent test–retest reliability of the index value over a two-week period (n = 37; ICC = 0.95), and potential discriminative ability to detect differences between known groups. Factor analyses confirmed unidimensionality. Conclusions: The results provide promising evidence of the validity and reliability of the MobQoL-7D Dutch; further research is needed to confirm these findings. Full article

Digital transformation has profoundly reshaped caregiving practices, yet its influence on family cohesion within disability contexts remains underexplored, particularly in Arab societies. This qualitative phenomenological study examines how digital technologies shape family cohesion among Jordanian caregivers of children with disabilities. In-depth, semi-structured interviews were conducted with 22 primary caregivers, and data were analyzed using reflexive thematic analysis. The findings reveal a central tension of being “between connectivity and care,” articulated through four interrelated themes: (1) a digital double-bind in which online support networks function as a vital “virtual village” while simultaneously contributing to intra-familial fragmentation; (2) the reconfiguration of care labor, whereby digital management emerges as an invisible and gendered form of caregiving work, often positioning mothers as primary digital coordinators; (3) the translation of traditional social capital (wasta) into digital spaces to navigate systemic resource constraints, producing new moral and emotional burdens; and (4) the strategic use of digital platforms to preserve cultural, religious, and familial identity in the face of stigma, thereby reinforcing internal cohesion. These findings suggest that digital technologies do not merely facilitate connection but actively reconfigure family dynamics through ongoing negotiation between support and strain. The study underscores the need for family-centered digital inclusion policies and support interventions that mitigate digital burdens while harnessing technology’s potential to strengthen culturally grounded resilience among families of children with disabilities. Full article

Caring for children with physical disabilities can be a daunting responsibility, often placing significant financial, psychological, social and health-related strains on the primary caregivers. This qualitative study explored the experiences of caregivers caring for children with physical disabilities in the Hardap region of Namibia. Using purposive sampling, twenty caregivers were selected as participants in the study. Data was collected using semi-structured interview schedules. Following the interviews, the data were manually analysed and categorised into distinctive themes and sub-themes and summarised in the final report as verbatim quotations. Study findings reveal that caregivers are motivated and determined to provide optimum care for children with physical disabilities under their care by acquiring assistive devices for them and assisting the children with activities of daily living. However, poverty and the general shortage of assistive devices, mostly wheelchairs, provide adverse conditions that are inimical to the development of children’s functional independence in daily living tasks. The burden of carrying the children was noted to be potentially deleterious to the caregivers’ physical health. The study concluded that providing assistive equipment for the children will ease the caregivers’ burden of care while equalising socioeconomic opportunities for both children with physical disabilities and their caregivers. The study only covered a small sample size in a small geographical area of Namibia. Therefore, interpretation and generalisation of the findings need to account for the specific context in the Hardap region of Namibia. Therefore, there remains scope for conducting further research with a larger sample size and one that is more geographically representative of Namibia. Full article

Parents’ priorities significantly influence decisions regarding their children’s support, reflecting parental attitudes, knowledge, and experiences. This research aimed to identify parents’ priorities when choosing professional support for their children, examine the link between these priorities and children’s current abilities, and examine which developmental domains children receive professional support and whether these domains align with parental priorities. The sample consisted of 82 parents of children aged three to six years, divided into two groups: 41 parents of children with developmental disabilities and 41 parents of children without. All participants completed a Treatment Priorities Questionnaire (TP). The results showed that parents of children with developmental disabilities prioritize Communication skills, Social relationships, and Pre-Academic skills. In contrast, parents of children without developmental disabilities focus on Self-Care and Pre-Academic skills. These priorities often relate to the child’s areas in need of improvement. While children with developmental disabilities receive appropriate support, those without often do not receive support in the areas their parents prioritize. This highlights the need for parents to also recognize and build on their child’s strengths, creating a more balanced approach to their development. Full article