Effects of Physical Education on students with intellectual disabilities. A systematic review

Efectos de la Educación Física en alumnado con discapacidad intelectual. Una revisión sistemática

Introduction

Intellectual disability (ID) is a neurodevelopmental disorder found in the Intellectual Disabilities subcategory of the American Psychiatric Association's DSM-5 manual (APA, 2013). It is characterised by significant limitations in both intellectual functioning and adaptive behaviour (in conceptual, social and practical domains), with varying degrees of severity: mild, moderate, severe, or profound, and beginning early in development.

Beyond the reductionist perspective of the intelligence quotient (IQ) and the ranges used to determine severity, ID involves a mismatch between the person's abilities and the demands of the context (Sales & Trejo, 2019), which affects their functionality and, consequently, their autonomy.

Despite the significant heterogeneity in terms of severity, comorbidity or the way it manifests, people with ID have a neurodevelopmental impairment that affects all domains: motor, sensory, basic and executive cognitive processes, and social and emotional behaviour.

Therefore, people with ID often have limitations in their intellectual abilities (reasoning, understanding, planning, learning from experience), conceptual adaptive behaviour (language, reading, writing), social relations (interpersonal and social skills), and practical (activities of daily living) limitations in their health care and participation in all contexts.

Many of these limitations may be interrelated. For example, low levels of motor development or motor skills can lead to obesity or other diseases, a refusal to exercise and/or low self-esteem (Hortal-Quesada & Sanchis-Sanchis, 2022).

In this sense, Physical Education during the school years can have developmental benefits beyond basic motor skills if we move away from deficit-based approaches. The subject focuses on motor skills, but also includes hygiene and health habits, which are closely linked to self-awareness and personal autonomy, learned through movement, through practice for practice. Through different games, tasks and activities, the development of a balanced concept of self-awareness and self-esteem, decision-making strategies, learning values, emotional regulation and other disciplinary skills can be promoted (Marín-Suelves & Ramón-Llin, 2021).

Therefore, in order to ensure access to the curriculum and learning for people with ID in school settings, these limitations need to be compensated for by providing sufficient individual support at the right intensity for each situation, or by going a step further and designing instruction with everyone in mind. This means that the school context must be inclusive and generate good teaching practices, such as programming based on Universal Design for Learning (UDL), the use of assistive technologies, and the necessary modifications to the environment (Sales & Trejo, 2019).

However, a decade ago, the educational context of PE was not as adapted as it should have been. This was due to factors such as a lack of resources, insufficient professional training, a lack of standard criteria, and teachers' attitudes towards diversity (depending on previous experience) and their sense of self-efficacy (Hernández et al., 2011).

The aims of this review are 1) to describe the interventions carried out in the last decade, 2) to analyse the strategies, measures and resources used by professionals, 3) to identify the benefits of Physical Education for students with ID, 4) to extract the key elements from the scientific evidence to make Physical Education truly inclusive, and 5) to discover reference authors, documents and sources that can guide better future actions.

Methodology

This literature review was based on the PRISMA method (Page et al., 2021) and used the Scopus database due to its recognised prestige and the number of documents it contains (Hernández et al., 2016). Keywords were combined with Boolean operators: ["Educación física" AND "Discapacidad intelectual"] for the search in Spanish and ["Physical education" AND "Intellectual disability"] for the search in English. Table 1 shows the inclusion and exclusion criteria used to select the documents that were finally included in the analysis.

Figure 1 shows the process of document selection. In the first phase, the keyword search yielded 130 documents containing the terms in the title, abstract or keywords. A total of 18 documents were removed because they were not papers and 33 because they had not been published in the last ten years. The screening was based on 79 papers, of which 44 were removed because they were not open access. Of the 35 full texts evaluated, 13 were discarded based on the criteria outlined above. Finally, 22 papers were included in the analysis.

The three authors were involved in this process, and potential bias was reduced by clearly defining and agreeing on the inclusion and exclusion criteria to be applied, and by analysing the papers individually before and then discussing them to make a decision.

The following variables were included in the content analysis (Table 2).

Results

The following table presents the main results of the variables mentioned in each of the 22 papers analysed.

Discussion

The results allow us to analyse the identification, methodological and content variables.

Firstly, with regard to the identification variables, we record the date, journal and language of publication, as well as the authorship of the works analysed.

In terms of the number of papers published on the subject, the field has clearly grown in recent years. It has become an emerging topic in our current society, which promotes inclusive policies. The year with the highest number of identified documents is 2020, with 29.2% of the total (Cañadas & Calle-Molina, 2020; Carvalho et al., 2020; Furrer et al., 2020; Jang, 2020; Krutsevich et al., 2020; Muñoz et al., 2020; Xu et al., 2020). This may be due to the impact of the Covid-19 health crisis, which led to lockdowns and school closures. The exceptional nature of the situation has attracted considerable interest from researchers.

In terms of authorship, a total of 76 authors were involved in the 24 papers analysed. As in previous studies (Marín & Ramón-Llin, 2021), it is noteworthy that all the authors are minor producers, since all of them have only one paper on the subject of Physical Education for students with intellectual disabilities. In terms of co-authorship, most of the documents were written by several authors, so the degree of collaboration is high. Papers written by a single author are a minority, representing only 12.5% of the sample (Hsu, 2016; Jang, 2020; Montesano, 2014). This is in contrast to what happens, for example, in the field of music education (Marín et al., 2022). From a gender point of view, it should be noted that there are no major differences in the number of men and women studying this subject. In both cases, the percentage is close to 50%.

In terms of sources, the information available on the SCImago Journal & Country Rank (SJR) portal, which is based on the information contained in the Scopus database, highlights the quality of the journals in which the articles analysed are published, as can be seen from their quartile rankings.

Finally, the language chosen for the dissemination of the results continues to be English (70.8%), despite the fact that the interventions were carried out in countries on different continents with a wide variety of mother tongues.

On the other hand, regarding the methodological variables in the analysis of the context, the weight of this research topic in Europe stands out, especially in Spain, which is the country where the most work has been carried out (Abellán et al., 2018; Cañadas & Calle-Molina, 2020; Moreno et al., 2019; Vílchez et al., 2018). It should also be noted that a significant number of studies in school contexts have been conducted in specific special education centres or units (Fernandes et al., 2022; Ferreira & Munster, 2017; Hansen et al., 2021; Jang, 2020; Priyono et al., 2021; Wu et al., 2021).

Research designs are extremely diverse, including experimental and quasi-experimental work, studies with interventions and/or control groups, and quantitative data collection techniques such as questionnaires, but also qualitative techniques such as interviews.

This diversity is also evident in the characteristics of the samples: in terms of size, some actions were carried out with groups of less than ten participants (Ferreira & Munster, 2017), while others had more than a thousand students (Furrer et al., 2020); in terms of age or educational level of the participants, there were no studies with pre-school students, and secondary school students (Abellán et al., 2018) and university students (Muñoz et al., 2020) predominated.

The final dimension analysed is content, looking at research objectives, content, and findings. In terms of objectives, the approaches demonstrate the potential of Physical Education. In addition to the development of physical skills (Fernandes et al., 2022; Hansen et al., 2021; Priyono et al., 2021; Wu et al., 2021; Xu et al., 2020), there are studies that focus on social (Cañadas & Calle-Molina, 2020; Carvalho et al., 2020; Ferreira & Munster, 2017), moral (Vilchez et al., 2018), emotional and cognitive (Krutsevich et al., 2020), and vital issues such as inclusion (Furrer et al., 2020; Muñoz et al., 2020), attitudes towards diversity (Abellán et al., 2018), and quality of life (Agarwal et al., 2021).

In terms of content, 38% of the studies include specific activities related to gamification and sports, such as hockey and gymnastics (Cañadas & Calle-Molina, 2020) badminton (Erofevaa et al., 2019, Vilchez et al., 2018), frisbee (Kao & Wang, 2018), volleyball, handball, acrobatic gymnastics (Vilchet et al., 2018). Of the studies in the sample, 14% used body expression activities, where the use of different types of dance was predominant (Carvalho et al., 2020; Jang, 2020; Muñoz et al., 2020), while 16% of interventions focused on motor skills (Fernandes et al., 2022; Xu et al., 2020; Montesano, 2014) and 16% on balance (Hsu, 2016) and tennis (Tsimaras et al., 2014) exergames. Wu et al. (2021) used activities such as aerobic step, while Krutsevich et al. (2020) chose activities in the natural environment. Finally, 16% of the studies used other types of activities such as peer tutoring (Gobbi et al., 2018), cooperative skills (Furrer et al., 2020) or dance mixed with games and sports (Ferreira & Munster, 2017).

In terms of findings, all interventions showed positive results. Up to 43% of the studies showed physical improvements, both in health aspects (Priyono et al., 2021) and in conditional physical abilities such as strength and/or flexibility (Xu et al., 2020; Erofeeva et al., 2019), as well as in coordinative abilities such as balance (Wu et al., 2021; Hsu, 2016) and coordination (Montesano, 2014).

In addition, 38% of the interventions resulted in emotional benefits, such as improved motivation for motor activities (Fernandes et al., 2022), improved effort (Gobbi et al., 2018), improved psychoemotional state (Krutsevich et al., 2020), and improved perceived self-efficacy (Jang, 2020). Also, 38% of the interventions improved participants' social skills (Priyono et al., 2021; Ferreira & Munster, 2017), promoted interpersonal relationships (Wu et al., 2021), civic behaviour and teamwork (Cañadas & Calle-Molina, 2020), inclusion, recognition and social participation (Carvalho et al., 2020), and attitudes towards student inclusion (Abellán et al., 2018). On the other hand, 24% of the interventions had an effect on cognitive aspects (Priyono et al., 2021), improved reasoning skills (Vilchez et al., 2018) or reduced student distractions (Tsimaras et al., 2014). Finally, other interventions reported improvements in students' values, increasing commitment, honesty and respect (Vilchez et al., 2018) or responsibility and self-control (Ferreira & Munster, 2017).

Conclusions

In a fair, equitable and inclusive society such as the one we aspire to, it is essential that we base our actions on scientific evidence to draw conclusions about what measures can ensure inclusion in the different learning situations in the classroom. We must design our programmes so that people with ID can achieve not only basic curricular knowledge, but also greater independence, greater participation in all contexts and, in short, a better quality of life.

The implementation of intervention programmes specifically designed for students with ID allows for significant improvements in the motor development of the participants, as observed in the work of Fernandes et al. (2022), as well as in other cognitive abilities such as memory or attention (Vega & González, 2022). However, it would be advisable for these interventions to be carried out in the first years of schooling in order to improve different motor aspects, such as hypotonia, which is characteristic of some syndromes.

It is necessary to go further, with the implementation of UDL, which makes it possible to respond to all students and achieve benefits for each one of them. For this, teacher training is essential, which is the basis of teachers' self-efficacy to make inclusion possible (Grassi-Roig et al., 2022).

Regarding the limitations of this work, the choice of a single database and the lack of introduction of altmetrics in the analysis stand out. These issues are considered as prospective and future lines of research, to which we must add the analysis of the impact of PE on students with functional diversity, beyond intellectual diversity.

Bibliography

Notes

Funding The translation of the text, by Manuel Gil Fernández, was funded by the Department of Education and School Management, University of Valencia.

Author notes

*Correspondence: Jesús Ramón-Llin, jesus.ramon@uv.es

Additional information

Short title:: Review in Physical Education and intellectual disabilities

How to cite this article: Marín-Suelves, D., Ramón-Llin, J., y Tijeras-Iborra, A. (2023). Effects of Physical Education on students with intellectual disabilities. A systematic review. Cultura, Ciencia y Deporte, 18(58), 139-161. https://doi.org/10.12800/ccd.v18i58.2021

Cultura, Ciencia y Deporte
ISSN: 1696-5043
Vol. 18
Num. 58
Año. 2023

Effects of Physical Education on students with intellectual disabilities. A systematic review

DianaJesúsAmparo Marín-SuelvesRamón-LlinTijeras-Iborra
Universitat de ValènciaUniversitat de València,EspañaEspaña