Boundary work in the implementation of an assistive exercise product to facilitate physical activity for children with cerebral palsy.

Purpose: Children gain increased health and well-being by participating in physical activity (PA) and exercise. Globally, only 19% of children meet the World Health Organisation recommendations on PA and the rates are even lower among children with disabilities. Children with disabilities are often dependent on assistive exercise products (AEP) to be able to perform PA and exercise. The aim was to identify facilitating and hindering factors for PA of children with cerebral palsy, and additionally to identify conditions for implementation of an AEP for PA in this group. Materials and methods: Interviews were conducted with healthcare professionals, decision-makers and researchers (N = 11 about experiences of implementing an AEP to support PA for children with cerebral palsy who are non-ambulant), until saturation was sustained. Interviews were transcribed verbatim and analysed through directed content analysis.

Results

Factors that influenced PA in this population were related to the child and the child's immediate environment, characteristics of the AEP itself and the assistive technology system. Findings indicate that severe disabilities contribute to increased complexity affecting implementation. Implementation in this assistive technology system was made more difficult due to boundaries between a development coalition focusing on hope and innovation and a professional bureaucracy coalition, focusing on professional accountability.

Conclusion

Communication across boundaries between stakeholders cannot rely only on transfer of information (dissemination) but depend on skilful management and transformation of boundaries concerning more fundamental differences involving interests.