Barriers, facilitators and solutions for active inclusive play for children with a physical disability in the Netherlands: a qualitative study.

BACKGROUND: Children with physical disabilities (PD) are less physically active than typically developing peers. The most important contributor to physical activity for primary school-aged children is outside play and therefore this should be part of every child's life. However, children with PD experience multiple barriers to participation in playgrounds. Despite recent improvements in the accessibility of Dutch playgrounds, the participation of children with PD has not increased. This study aims to explore facilitators, barriers and solutions influencing the participation of children with PD in Dutch outdoor playgrounds, from parents' and professionals' perspectives. METHODS: Twelve semi-structured interviews with parents of children with PD aged 2-12 years and five focus group meetings with professionals working with these children were conducted. To ensure data saturation, we performed three member-check meetings. Two independent researchers analyzed the data using an inductive thematic approach. RESULTS: Similar barriers, facilitators and solutions were mentioned by parents and professionals. Three main themes were identified: the emotional barrier versus the physical barrier, play as a part of an inclusive society and the role of professionals in facilitating active inclusive play. The most important personal factors were physical and social problems experienced when children with PD wanted to join outdoor play. Interestingly, parents and professionals believed the social barrier was far more important than the physical one. The most important environmental factor was that the Dutch society is not sufficiently inclusive. CONCLUSIONS: According to both parents and professionals, the most important barrier to active inclusive outdoor play was social, hindering the participation of children with PD in play with typically developing peers. To overcome such problems, professionals should take an active role in empowering children with PD and their parents. Furthermore, it is important to introduce outdoor active play early, so it becomes part of normal daily life. In addition, a change in the mindset of typically developing children and their parents seems essential to achieve true inclusive active play.

Monoclonal antibodies for epidermal population analysis.

Three keratin antibodies (RKSE 60, Clone 77, and a rabbit polyclonal) and 2 vimentin antibodies (Vim ab and a rabbit polyclonal) were investigated using frozen sections of normal and psoriatic skin. Of these, the monoclonals RKSE 60 and Vim ab were selected for quantitative population analysis of healthy epidermis, psoriatic uninvolved epidermis, and psoriatic lesions. Suspensions of isolated cells were prepared from biopsy specimens by trypsinization, and stained with RKSE 60 or Vim ab using an indirect immunofluorescence assay. Our results showed an increase in the germinative fraction from the normal value of 30% to almost 50% in the psoriatic lesion; in absolute terms this corresponds to a 6-fold increase in the size of the germinative compartment. More interesting, the germinative psoriatic uninvolved epidermis (38%) was also significantly higher than normal. The percentage of vimentin-positive cells (Langerhans cells and melanocytes) was nearly double that of normal in both the lesion and the uninvolved psoriatic epidermis. We conclude that, in contrast to statements frequently encountered in the literature, the "uninvolved" skin of the patient is morphologically and functionally different from that of the healthy individual.