School
Every child has the right to learn. However, many children with SCI are not receiving equal education opportunities due to their disability status and lack of accessibility within the school system. Inadequate access to quality education has a long-lasting and pervasive impact on children’s social development, as well as their abilities to lead a fulfilling life and contribute to their community in adulthood (UNICEF 2021).
To return to school is a primary rehabilitation goal for children and adolescents who have sustained an SCI and is key to a smooth transition into adulthood; High educational attainment has been shown to predict positive employment outcomes later in life in those with SCI (Anderson & Vogel 2002; Hwang et al. 2014b). When returning to school after acquiring an SCI, children may experience various challenges related to physical accessibility, psychological adjustment, and social participation. For example, they may need to cope with changes in their self-image and role in school as a result of the changes in their physical abilities; in addition, inadequate awareness and knowledge about SCI among teachers and peers may hinder their full participation in school activities, such as sports and school trips (Knight, 2008; Mulcahey 1992). This section presents an overview of the existing evidence on school re-entry in children with SCI.
Discussion
Three studies were identified from our literature search, all of which were observational studies and originated from the USA. Topics examined include school performance, recommendations for the school re-entry process, laws and legislations, services by physical or occupational therapists, assistive technology, and children’s subjective experiences with the re-entry process.
Massagli (1996) conducted the largest study to date on educational achievement and vocational participation in 53 children and adolescents post-SCI. primary school, secondary student, and postsecondary students who acquired SCI before age 18 and their teachers were surveyed. Content analysis of school records was also performed. Overall, students with SCI demonstrated adequate academic performance and school participation. This was reflected in students’ and teachers’ ratings on the students’ performance and participation, as well as the high post-secondary school enrollment rate (82%) among the high school graduates. Harder and colleagues (2013) study, in contrast, indicated that many students with SCI may experience challenges in the academic aspect of school life. Specifically, in their study, 33% of parents of children and adolescents with SCI indicated that their child experienced school problems, defined as below average or failing performance in one of four academic domains. However, it should be noted that these caregiver reports were based on a non-standardized and non-validated school history questionnaire on academic functioning. Therefore, this finding should be interpreted with caution.
Challenges related to school participation encountered by children with SCI were noted in two of the three studies (Graham et al. 1991; Massagli et al. 1996). For participants in Massagli and colleagues (1996) study, especially those who were attending secondary school, participation in physical education was limited. Likewise, Graham and colleagues (1991) study revealed a lack of availability of accessible leisure activities for adolescents with SCI. Interestingly, although peers’ negative attitudes towards people with disabilities have frequently been identified as barriers to school participation in the literature, no participants in Graham and colleagues (1991) study reported their able-bodied peers having poor attitudes or being unfriendly towards them.
Not surprisingly, the services that children with SCI receive and require in the school settings depend on their age and developmental stages. In Massagli and colleagues (1996) study, it was found that primary school students with SCI received more support from physical and occupational therapy services than secondary school students, whereas secondary and postsecondary students required more modifications to the curriculum and daily activities, possibly due to increased complexity of school work and less direct support received. As noted by Massagli et al. (1996), adolescents with SCI may benefit from transition planning services, such as employment counseling, within the school setting. However, such services for this population were found to be inadequate for study participants (Graham et al. 1991; Massagli et al. 1996)
As Mulcahey (1992) pointed out, successful rehabilitation efforts entail not only improvements in functional independence but also successful community reintegration that allows the individuals to resume meaningful lifestyles. Given the significance of school in children’s everyday life, this calls for more research, especially intervention studies, on the topic of return to school in the pediatric SCI population. Furthermore, in order to improve the quality of research in this field, multicentre studies are needed to increase the sample size, as SCI in children and adolescents is rare in many countries.
