Cómo citar este artículo: Gamonales, J.M., Hernández-Beltrán, V., Gámez-Calvo, L., Peguero-
Perejo, J.M., Rojas-Valverde, D., & Muñoz-Jiménez, J. (2025). Inclusion of students with
achondroplasia in the early childhood education system: a systematic review. RETOS XXI, 9, 1-
28.
INCLUSION OF STUDENTS WITH ACHONDROPLASIA IN THE EARLY
CHILDHOOD EDUCATION SYSTEM: A SYSTEMATIC REVIEW
INCLUSIÓN DE LOS ALUMNOS CON ACONDROPLASIA EN EL AULA DE
EDUCACIÓN INFANTIL. REVISIÓN SISTEMÁTICA
José M. Gamonales
1
, Víctor Hernández-Beltrán
2
, Luisa Gámez-Calvo
3
, José M. Peguero-
Perejo
4
, Daniel Rojas-Valverde
5
and Jesús Muñoz-Jiménez
6
Universidad de Extremadura (España)
Fecha de recepción: 08/09/2023; fecha de aceptación 14/08/2024
Abstract
The inclusion of people with
achondroplasia has become a
widespread educational policy
worldwide, but the inclusion of these
students is often underestimated and
overlooked. Therefore, this study aimed
to comprehensively summarise the
1
Doctor en Ciencias del Deporte. Universidad de Extremadura/Universidad Francisco de Vitoria.
martingamonales@unex.es
2
Doctorando en Ciencias del Deporte. Universidad de Extremadura. vhernandpw@alumnos.unex.es
3
Doctorando en Ciencias del Deporte. Universidad de Extremadura. lgamezna@alumnos.unex.es
4
Graduado en Educación Infantil. Universidad de Extremadura. jpeguerol@alumnos.unex.es
5
Doctor en Ciencias del Deporte. Universidad Nacional de Costa Rica. drojasv@hotmail.com
6
Doctor en Ciencias del Deporte. Universidad de Extremadura. suliwan@unex.es
available literature related to the
procedure used to include students with
achondroplasia in the Early Childhood
Education system. The evidence search
was conducted using the following
keywords: "child education" and
"Achondroplasia". For inclusion, articles
INCLUSION OF STUDENTS WITH ACHONDROPLASIA IN THE EARLY CHILDHOOD
EDUCATION SYSTEM: A SYSTEMATIC REVIEW
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2
had to be published until December
2022 and available in Web of Science,
Scopus and Pubmed as the most
commonly used databases. They were
included or excluded based on specific
established criteria to select suitable
manuscripts. After an in-depth analysis,
the systematic review finally included
seven manuscripts. The results agreed
on the fundamental role of inclusion
processes of children with
achondroplasia in Early Childhood
Education classrooms. For this, different
adaptations must respond to the
diversity of potentialities and needs of
each student, increasing participation in
learning processes and the educational
community. Some adaptations in the
school environment included classroom
chairs (e.g., size, steps), benches to
reach tables, canteens, bathrooms, and
washbasins. Also, early intervention
professionals in the classroom could
better comprehend development
limitations awareness, independence
skills development, and self-esteem
improvements.
Keyword: skeletal dysplasia, disability,
special education, adapted education.
Resumen
La inclusión de las personas con
acondroplasia se ha convertido en una
acción educativa generalizada en todo
el mundo, pero la inclusión de estos
estudiantes a menudo se subestima y se
pasa por alto. Por ello, el presente
trabajo tiene como objetivo reunir de
forma integral la literatura relacionada
con el procedimiento para incluir a los
alumnos con acondroplasia en el
sistema de Educación Infantil. La
búsqueda de evidencia científica se
realizó utilizando las siguientes palabras
clave: "Educación infantil" y
"Acondroplasia". Para su inclusión, los
documentos debían estar publicados
hasta abril de 2022 y estar disponibles
en Web of Science, Scopus y Pubmed
como las bases de datos más utilizadas.
Fueron incluidos o excluidos en base a
criterios específicos establecidos para
seleccionar los manuscritos más
adecuados. Después de un análisis en
profundidad, la revisión sistemática
finalmente incluyó siete manuscritos.
Los resultados mostraron el papel
fundamental de los procesos de
inclusión de los alumnos con
acondroplasia en las aulas de Educación
GAMONALES, HERNÁNDEZ-BELTRÁN, GÁMEZ-CALVO, PEGUERO-PEREJO, ROJAS-VALVERDE
AND MUÑOZ-JIMÉNEZ
RETOS XXI, AÑO 2025, VOLUMEN 9
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Infantil. Para ello, diferentes
adaptaciones deben responder a la
diversidad de potencialidades y
necesidades de cada alumno,
aumentando la participación en los
procesos de aprendizaje y de la
comunidad educativa. Algunas
adaptaciones en el entorno escolar
incluyeron sillas de aula (por ejemplo,
tamaño, escalones), bancos para
alcanzar mesas, espacios para comer
adecuado, baños y lavabos adaptados.
Además, los profesionales de la
Atención Temprana en el aula podrían
ayudar a comprender mejor la
conciencia de las limitaciones del
desarrollo, el desarrollo de habilidades
de independencia y las mejoras en la
autoestima.
Palabras clave: displasia esquelética,
discapacidad, educación especial,
educación adaptada
INTRODUCCIÓN
Achondroplasia (AC) is the most common
skeletal dysplasia (Okenfuss et al., 2020),
associated with short stature and severe
anatomical disproportion (Medina et al.,
2017; Yanes et al., 2010). It is caused by a
genetic mutation in the gene that encodes
the fibroblast growth factor receptor type
3 (FGFR3) (Cialzeta, 2009; Horton, 2005).
Furthermore, other bone defects may
occur, including a disproportional skull
size, a small length of fingers and the
presence of lordosis (Vázquez & Espinoza,
2016), causing physical disability (Rincón-
Rueda et al., 2021). Due to the limitations
caused by these structural body
deformations, people with AC usually
suffer significant social difficulties,
evidenced at work and school (González &
Hernández, 2001). Besides, the incidence
of AC is estimated at 1 in 30,000 births
(Horton et al., 2007; Ireland et al., 2014).
Therefore, because of the physical and
psychological characteristics of people
with AC, some difficulties in their
participation in physical and sports
activities are also present (Haga, 2004;
Takken et al., 2007; De Vries et al., 2020).
Studies related to the physical-sports
practice of people with AC are limited (De
Vries et al., 2020). Commonly, studies
focus on physical condition profiling as the
main objective (Sims et al., 2018). Also,
most of the current investigations agree
INCLUSION OF STUDENTS WITH ACHONDROPLASIA IN THE EARLY CHILDHOOD
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that the participation of people with AC in
physical-sport activities is relatively low
(Ireland et al., 2011; Takken et al., 2007).
Therefore, children with AC must receive
early attention, with special awareness of
areas related to motor skills development
(Marco-Arenas et al., 2018). Educational
programs are ideal for motor skills training
since they positively influence students in
intellectual, affective, and social
development (Cabrera & Dupeyrón, 2019).
In addition, it is a fundamental tool for the
inclusion of students with disabilities
(Gamonales, 2016). Therefore, the training
of motor skills in students with disabilities
allows the acquisition of basic motor skills
for their development and knowledge of
their own body, improving their sense of
orientation (Gamonales, Gil-Sánchez et al.,
2018). Also, professionals must perform
some adaptations in activities for those
students with disabilities to fully develop
their abilities and skills (Gil-Espinosa,
Romance & Nielsen, 2018). In the same
way, the teacher should facilitate greater
possibilities of participation of these
students, enhancing their abilities and
skills and not their difficulties (Ríos-
Hernández, 2007). In this way, it will evolve
into an adapted and inclusive school
(Gamonales, 2016).
Therefore, it is important to work on
motor skills in the Early Childhood
Education stage (ECE) to benefit all
students. It allows the inclusion and
integration of students with disabilities,
improving their physical and mental health
(Álvarez & Pazos, 2020). The educational
system does not guarantee students real
equality in schools, with people with
disabilities being the most discriminated
group (Crosso, 2014). It will be essential to
work on positive attitudes toward diversity
in professionals, peer groups and family
members (Silva-Ortiz et al., 2020).
Due to the lack of manuscripts
related to the inclusion procedures of
students with CA in the educational
system, the purpose of this review was to
comprehensively summarise the available
literature related to the procedure used to
include students with achondroplasia in
the Early Childhood Education system.
METHOD
Design
This systematic review was based on
theoretical studies (Montero & León,
2007), carrying out a research process and
compilation of scientific papers using the
“Data accumulation and study selection”
model (Ato et al., 2013), to collect the
GAMONALES, HERNÁNDEZ-BELTRÁN, GÁMEZ-CALVO, PEGUERO-PEREJO, ROJAS-VALVERDE
AND MUÑOZ-JIMÉNEZ
RETOS XXI, AÑO 2025, VOLUMEN 9
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largest manuscripts related to the
inclusion of students with AC.
Search Strategy
The sample considered articles from
scientific journals published until
December 2022. A total of 882,203 studies
were found in the first search phase among
the three databases (PubMed, Scopus,
Web of Science), using the first term
selected, “Child Education”, and including
the second keyword “, Achondroplasia”,
using the Boolean word AND. Finally, 92
manuscripts were identified in this first
step. As expected, as the different
keywords were introduced in the search
strategy, the number of manuscripts were
considerably reduced. Finally, the inclusion
and exclusion criteria for the selection of
the studies established by the researchers
were applied (see Table 1), considering
seven studies that met the criteria and
were considered as valid for this
systematic review.
Criteria for study selection
The documents selected had to meet the
inclusion and exclusion criteria established
in the study (see Table 1).
Table 1.
Document inclusión and exclusión criteria
Nº
Inclusion criteria
1
Scientific articles
2
Mention at least some of the characteristics of students with AC (50 words minimum).
3
Wrote in Spanish, English, or Portuguese language (or allowing translation).
4
Full text or abstract available
Exclusion Criteria
5
Eliminate documents in which only the keywords entered in the databases were mentioned
6
Dismiss documents that cannot be referenced (e.g., meetings reports, presentations).
7
Exclude manuscripts that only refer to people with AC in general.
8
Eliminate duplicates
Codification of the variables
The extracted manuscripts were classified
according to different criteria (Table 2):
- General variables (Author/s, Year,
Title and Abstract).
- Manuscript-specific variables
(Keywords, Databases, Accessibility
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of the document, type of document,
type of study, Ethical Committee
from the University, Description of
the sample and Participants).
- Variables related to the subject of
study (Inclusion of students with AC
and Type of inclusive activities).
- Variable related to the quality of
the selected documents (Quality of
the documents).
Table 2.
Characteristics of the variables of the systematic review study related to the inclusion of students with AC in
the classroom of ECE.
Variable
Acronym
Description
General
variables
Author/s
Scientific name of each author of the selected document.
Year
Year of publication of the selected manuscript.
Title
Publication title of the selected document.
Resume
Brief writing that gathers the main ideas of the selected manuscript.
Manuscript-
specific
variables
Keywords
Terms that appear in the selected document.
Database
Data platform in which the manuscript is located.
Document
accessibility
Full text availability (Yes/No).
Document type
Classification of documents according to the type of manuscript
based on Gamonales, Muñoz-Jiménez et al., (2018): Doctoral thesis,
Book, Book chapter, Academic project, Congress Publication, Journal
article, Patent document.
Type of study
Classification of the manuscripts according to the type of study based
on Montero & León (2007): Theoretical studies, Empirical studies with
quantitative methodology and Empirical studies with qualitative
methodology.
University Ethics
Committee
Does the manuscript refer to an Institutional Review Board rand
approval (registration number/code)?
Sample
Description
Does the sample is described in detail (Yes/No).
Participants
Mention of the number of documents or participants that form part
of the study.
Variables
related to the
subject of
study
Inclusion of
students with AC
Mention the existence of inclusion criteria of students with CA in ECE.
classes (Yes/No).
Type of inclusive
activities
Describe the activities to include students with AC in the ECE
classroom.
GAMONALES, HERNÁNDEZ-BELTRÁN, GÁMEZ-CALVO, PEGUERO-PEREJO, ROJAS-VALVERDE
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Variable
related to the
quality of the
documents
Quality of the
selected
documents
Based on expert criteria, the quality of the selected manuscripts was
evaluated.
Registration procedure
The guidelines to perform a systematic
review is quite accepted in different areas
(Benet-Rodríguez et al., 2015; Benito-
Peinado et al., 2007; Moher et al., 2009;
Schmid et al., 2020). However, these
methodologies and procedures not always
are as simple, intuitive, and easy to use as
preferred. For this reason, some recent
literatures have been considered, as they
propose a useful, easy, and affordable
systematic review model Gámez -Calvo et
al. (2020), and Gamonales, Muñoz-Jiménez
et al. (2018). This systematic review
followed a series of phases based on well-
known evidence (Thomas, Nelson &
Silverman, 2015) (Figure 1).
Figure 1. Search procedure related to the inclusion and selection of manuscripts.
Phase 0. Topic selection. It is one of
the most important steps to organize the
most significant information to be
reviewed and the objectives that justify the
systematic review. Also, it establishes the
seach procedure. In addition, in this
process, researchers have the
responsibility to systematically review the
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scientific and non-scientific literature
available and communicate the most
important advances (Benet-Rodríguez et
al., 2015), since it can help and determine
future research (Gamonales et al., 2021).
Phase 1: Planning and selection of
keywords. The identification of keywords is
critical in a systematic review process.
Therefore, for the selection of keywords,
the proposed objectives and their
agreement with the selected keywords
were considered. For this reason, two
keywords were selected for the search.
These words have been selected in English
to increase the potential included papers,
obtaining greater results, since the titles
and abstracts of the documents are usually
written in several languages but mostly in
English. The chosen terms were: “Child
education” and “Achondroplasia”. These
words were entered in the same order in
the different databases, in order to obtain
the greatest number of results, as has been
done in previous reviews (Gámez-Calvo et
al., 2020; Gamonales et al., 2021;
Hernández-Beltrán et al., 2021).
Phase 2: Search in databases. Two
searches were performed considering the
inclusion of students with AC in the ECE
system in the following databases: WOS,
Scopus, and PubMed. For this, the same
Boolean search (AND) was used in the
different digital platforms. The final search
phrase was: “Child education - and -
Achondroplasia”. Figure 2 shows the
search procedure in each of the databases,
as well as the manuscripts identified.
Finally, the inclusion and exclusion criteria
were applied, and the duplicate
documents were eliminated. Therefore,
the final number of selected manuscripts
was 7 after a full text review and analysis.
However, the number of documents was
not large, allowing the treatment of
information and avoiding contamination
by researchers (Benito-Peinado et al.,
2007).
GAMONALES, HERNÁNDEZ-BELTRÁN, GÁMEZ-CALVO, PEGUERO-PEREJO, ROJAS-VALVERDE
AND MUÑOZ-JIMÉNEZ
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Figure 2. Search procedure of manuscripts by data base.
Phase 3: Access to documents. The
manuscripts were assessed using the
institutional library service. When the
access using this mean was not possible,
the authors contacted the main authors of
the papers using other scientific spreading
platforms such as ResearchGate, where
the published data is usually available
(Gámez-Calvo et al., 2020; Gamonales et
al., 2021; Hernández-Beltrán et al., 2021;
Jenkin et al., 2017).
Phase 4: Information Treatment.
Each of the documents selected in the
search was analysed and classified
according to different variables (Table 2).
All this flow of information was compiled in
an Excel file, for a more affordable data
management, making easier future
handling and analyses (Gamonales et al.,
2018). In this sense, to facilitate the data
organization, a bibliographic manager was
used (e.g., Mendeley).
Phase 5: Analysis of the document’s
quality. To assess the quality of the
selected documents, a questionnaire
developed by Law et al., (1998), and
previously used in the scientific literature
(Gamonales et al., 2021; Hernández-
Beltrán et al., 2021) was used. Two
different experts conducted the review,
giving a score for each paper. The selected
manuscripts were evaluated according to:
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• Purpose (Q1).
• Relevance of the background literature
(Q2).
• Adequacy of the study design (Q3).
• Sample included (Q4 and Q5).
• Informed consent procedure (Q6).
• Outcome measures (Q7 and Q8).
• Description of the method (Q9).
• Importance of the results (Q10).
• Analysis (Q11).
• Practical importance (Q12).
• Description of dropouts (Q13).
• Conclusions (Q14).
• Practical implications (Q15).
• Limitations (Q16).
All quality criteria were scored on a
binary scale (Yes=1/No=0). Once the score
was obtained, the documents were
classified according to their
methodological quality, being (Sarmento
et al., 2018):
(A) Excellent methodological
quality (score >75%).
(B) Good methodological
quality (score between 51%
and 75%).
(C) Low methodological quality
(score <50%)
Statistical analysis
A descriptive analysis related to the
following variables was conducted: Year,
Keywords, Database and Type of study to
obtain relevant information related to the
selected documents. For this, the software
used for the analysis was the Statistical
Package of Social Science software (version
27, 2021; IBM Corp., IBM SPSS Statistics for
MAC OS, Armonk, NY, USA).
RESULTS
Table 3 shows the documents selected for
the systematic review related to the
inclusion of students with AC in the ECE
classroom based on the study variables.
GAMONALES, HERNÁNDEZ-BELTRÁN, GÁMEZ-CALVO, PEGUERO-PEREJO, ROJAS-VALVERDE AND MUÑOZ-JIMÉNEZ
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Table 3. Selected documents related to the inclusion of students with AC in the classroom of ECE.
Id
Author
/s
Yea
r
Title
Resume
Keywords
DB
AD
TD
TEA
EC
DM
P
IA
TIA
Q
1
Pfeiffer
et al.
2022
Functioning
and well-being
in older
children and
adolescents
with
achondroplasi
a: A qualitative
study
The aim of this work is
to know how
achondroplasia
influences children and
adolescents in their
daily lives.
Achondroplasi
a; teenagers;
physical
functioning;
quality of life;
school
WOS,
Scopus,
PM
Yes
JA
Emp.
Q.
Yes
Yes
32
Ye
s
Location of objects in
more accessible places
due to short stature,
difficulty sitting in
conventional seats due
to their great length.
Encourage physical
activity in this
population, to improve
general well-being and
increase inclusion in
society.
A
2
Make
et al.
2013
Education and
related
support from
medical
specialists for
Japanese
patients with
major skeletal
dysplasias.
In this study, using
questionnaires in
patients with CA/
hypochondroplasia and
osteogenesis
imperfecta, aimed to
clarify what types of
schools they attend,
what kind of support
they need, and how
medical advice is
passed on to schools.
Achondroplasi
a
Hypochondro
plasia;
osteogenesis
imperfecta;
Special needs
education.
WOS
Scopus
Yes
JA
Emp.
Stu.
Yes
Yes
202
Ye
s
Walking without
crutches or prostheses,
stairs with low
handrails, remodelling
of classroom and
bathroom furniture,
personal assistant for
motor activities and
advice from specialist
doctors.
B.
3
Make
2004
Management
of disabilities
associated
with
achondroplasi
a.
Document that collects
the main
characteristics of
patients with CA,
defending that their
social maturity is equal
to that of the rest, but
not their maturity in
terms of locomotion.
Achondroplasi
a; disabilities;
Complications
.
WOS
Scopus
P.M
Yes
JA
T
Yes
Do
not
Do
not
Ye
s
It does not mention any
type of activity.
A
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4
Gollust
et al.
2003
Living with
achondroplasi
a in an
average-sized
world: An
assessment of
quality of life.
In the study, the vital
challenge that AC
patients have is
analysed: medical,
social, and physical
difficulties. Also, he
proposed future
research that relates
self-esteem and quality
of life, as well as
looking for effective
interventions.
Short stature;
Quality of life;
Achondroplasi
a; self-esteem;
Illness
perception;
Social
functioning.
WOS
Scopus
Yes
JA
Emp.
Q
Do
not
Yes
325
Ye
s
Equitable access to
public facilities,
employment and
education.
B.
5
Castigli
a
1996
Achondroplasi
a
The article showed the
physical characteristics
of patients with AC, the
motor possibilities that
promote their
development and the
habits to work from the
family for their correct
socialization.
Achondroplasi
a; Short
stature;
Quality of life.
WOS,
Scopus,
PM
Yes
JA
T
Do
not
Do
not
Do
not
Ye
s
Adaptations in the
physical environment
of the home (switches,
stools, toilets, etc.), and
of the school (doors),
adaptations in tricycles,
bicycles or cars and
supervised swimming.
B.
6
Shakes
peare
1988
Social
implications of
achondroplasi
a-A public
health view.
In this document, the
possible reactions of
the parents of patients
with AC are shown.
Also, some premises
were given in terms of
education,
socialization, and
motor aspects.
Achondroplasi
a; Short
stature;
Quality of life.
WOS,
Scopus
Yes
JA
T
Do
not
Do
not
Do
not
Ye
s
Ordinary education and
schooling, search for
job opportunities and
non-contact sports
activities.
B.
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7
Veter
1988
Social
implications of
achondroplasi
a-A public
health review.
This article explains the
origin of AC, the
importance of a good
diagnosis, the methods
to treat it and the
guidelines for the
correct socialization of
patients.
Achondroplasi
a; Short
stature;
Quality of life.
WOS,
Scopus,
PM
Yes
JA
T
Do
not
Do
not
Do
not
Ye
s
Physiotherapy and
adapted exercise plan.
C
Id: Identifier; DB: Database; AD: Document Accessibility; TD: Type of Documents; ST: Type of study; EC: University Ethics Committee; SD: S ample Description; P: Participants;
IA: Inclusion of students with AC; TIA: Type of inclusive activities; Q: Document quality; WOS: Web of Science; PM: Pubmed; JA: Journal article; Emp. Stu.: Empirical studies
with quantitative methodology; T: theoretical study; Emp. Q.: Empirical studies with qualitative methodology.
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Figure 3 shows the characterization
of the selected documents according to
the Year of publication of each scientific
document, to facilitate understanding and
reading. Being, the year 1988 (n = 2), the
year with the highest number of
publications related to the object of study.
Figure 3. Characterization of the documents according to the Year of publication.
Figure 4 shows the characterization
of the selected documents based on the
Keywords of each manuscript. Shown as
“Achondroplasia” (n =7), “Quality of life” (n
= 5), and “Short stature” (n = 4) the most
used terms.
Figure 4. Characterization of the documents based on the keywords.
GAMONALES, HERNÁNDEZ-BELTRÁN, GÁMEZ-CALVO, PEGUERO-PEREJO, ROJAS-VALVERDE
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Figure 5 shows the number of
documents selected based on the
Database. All the selected manuscripts are
written in English and, mainly, in the WOS
(n = 7) and Scopus (n = 7) data platform.
The number of documents that appear in
the figure is higher than that used in the
systematic review, because of the
existence of repeated manuscripts on
different platforms.
Figure 5. Characterization of the documents based on the Database.
Figure 6 shows the Type of study
developed by the author(s) of the selected
documents. Being, Theoretical Studies (n =
4), the most predominant Type of study.
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Figure 6. Characterization of the documents according to the Type of study.
Finally, Table 4 shows the different
scores given to each of the documents
selected by external observers, taking as a
reference the quality questionnaire
prepared by Law et al. (1998). Once the
different scores were obtained, the
average of the scores was made to obtain
the methodological quality of each of the
documents (Sarmento et al., 2018).
Table 4. Quality analysis of the documents related to the inclusion of students with AC in the classroom of ECE
Id
Observer 1
Observer 2
Average
Quality
1
87.5
87.5
87.5
A
2
75
75
75
B
3
81.3
81.3
81.3
A
4
75
75
75
B
5
68.8
68.8
68.8
B
6
62.5
56.3
59.4
B
7
43.8
37.5
40.6
C
DISCUSSION
This systematic review aimed to present
work aims to comprehensively summarise
the available literature related to the
procedure used to include students with
achondroplasia in the Early Childhood
Education system. This information could
serve as the initial proposal procedures to
develop a real inclusion and redirect future
initiatives. As the main feature of the
search, it is worth highlighting the scarcity
of manuscripts (n = 7), which reveals the
lack of published knowledge and research
on this subject.
In relation to Keywords, it is
observed that the most used words are
“Achondroplasia” (n =7), “Quality of life”
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(n=5) and “Short stature” (n=4). In the
scientific literature, there are no studies
that corroborate these results, and the
studies did not specify how and why the
keywords were selected. However, these
three terms were the most frequently used
in the studies, confirming that the key
features of subjects with achondroplasia
are described in the different manuscripts.
However, the statistical analysis has served
as support for researchers when selecting
the Keywords in this work (Gamonales,
Muñoz-Jiménez et al., 2018). Nevertheless,
good planning and selection of the key
terms is fundamental when it comes to
obtaining successful results in the studies
(Benito-Peinado et al., 2007).
According to the Year of publication,
the documents of the authors Shakespeare
(1988), and Vetere, (1988), are the first
manuscripts related to the subject under
study. Furthermore, the study conducted
by Haga et al., (2013), and Pfeiffer et al.,
(2022), are the only documents published
in the last 10 years that meet the inclusion
and exclusion criteria established.
Therefore, it is an incipient field as a result
of the lack of sample, since an incidence of
between 1 in 30,000 births is estimated
(Horton et al., 2007; Ireland et al., 2014).
Therefore, the sample has a significant
impact on the reliability of the studies.
Regarding the documents selected
for the systematic review, documents have
been in the following databases: WOS
(n=7) and Scopus (n=7), as well as in
Pubmed (n=4). There are many existing
databases, however, not all of them have
the necessary manuscripts to conduct a
correct investigation and reflection,
limiting the researchers access to the signs
and developmental milestones of people
with AC. For this reason, theoretical
background alone is not enough to seek
solutions for this minority group in our
society. Therefore, it is important to search
for documents in those databases in which
there is a larger number of specialized
studies. Due to this, researchers in the field
of Education and Disability are
recommended to conduct publications in
indexed journals, to give visibility to
studies related to the field of education
and inclusion in the classroom. In addition,
writing the documents in English, since it
facilitates collaborations and research, as
well as having a greater probability of
publishing in a journal with a high impact
factor, which allows the authors to achieve
a greater impact of their work at an
international level (Gamonales et al.,
2021).
Regarding the Bioethics Committee
of the studies, it should be noted that the
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studies conducted by Pfeiffer et al., (2022),
Haga et al., (2013), and Haga (2004), are
the only works presented with committee
approved by the University of the authors.
This ethic is understood as the rules that
govern scientific publication; rules that
must be met in all original works that
conduct a study with human beings (Dorta,
2013). For this reason, it is recommended
that future research should present said
Code of Ethics, since all studies that carry
out experiments with human beings must
be previously approved by the Ethics
Committee of the University.
In relation to the Type of study that
has been conducted in the selected
documents, the predominant category is
Theoretical Studies (n = 4). According to
Montero & León (2007), Theoretical
Studies are those manuscripts in which the
authors do not show their own collected
data but conduct research using data
already published by previous authors,
among which this work is framed. The rest
of the works are framed within the
Empirical Studies with Quantitative
Methodology (n =1). Being the manuscript
of Haga et al., (2013), the only one that
analyses the quality of information
transmitted to doctors through a
questionnaire, as well as proposing a
battery of inclusive activities to be
developed in the classrooms. On the other
hand, Gollust et al., (2003), developed an
Empirical Study with a Quantitative
Methodology, since they collect the
difficulties presented by subjects with AC
when conducting daily activities, through
individual interviews. In addition, the work
of Pfeiffer et al., (2022), is an Empirical
Study with Quantitative Methodology,
where they seek to know how BA
influences children and adolescents in
their daily life. Therefore, it is important to
highlight that the number of studies
related to the experimental methodology
in the subject is small, which is why the
tools to improve the inclusion of students
with AC in the ECE classroom are unknown.
Therefore, it is recommended to conduct
studies with experimental methodology
that do not focus solely on the theoretical
component of disability, but more on the
intervention with subjects with CA and on
the evaluation of their possibilities of
action and development. Also, the seven
valid documents for conducting the
systematic review have a common
Document Type, all of them being Journal
Article. This Type of document is seen by
experts as having greater value and validity
than the others, such as Books or Book
Chapters. However, it is recommended to
increase the number of scientific
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contributions in relation to people with AC
in the ECE. stage, through the publication
of: Doctoral Thesis, Books, Book Chapters,
Academics Projects, Congress Publication,
Journal article, Patent document
(Gamonales, Muñoz-Jiménez et al., 2018).
Based on the inclusion of students
with AC, the answer was affirmative and
unanimous in all documents (n = 7). The
experts recommend the inclusion of the
student with AC in the ordinary classroom,
although integration is not mentioned.
These two concepts differ from each other
and today inclusion is not truly valued,
being the social integration of people in
their peer group and in society more
valued. For this reason, inclusion must be
the prior step to the total integration of
students with AC in the ECE classroom and
in daily life participation in general. To
achieve the full inclusion of students, there
must be collaborative work between
members of the educational community,
doctors, families, and students to improve
their quality of life and the care received by
the different professionals (Haga et al.,
2013). Therefore, inclusive methodological
strategies must advocate for equal
opportunities for students with disability
to develop the necessary skills and
attitudes to learn (Gamonales, 2016).
Regarding the Type of inclusive
activities, there are several common
aspects to most of the selected
manuscripts. On the one hand, experts
recommend renovating and adapting all
types of furniture for students with AC to
be accessible (Castiglia, 1996), and
adapted to the short stature of students
(Pfeiffer et al., 2022). On the other hand,
they mention the importance of
introducing low handrails on the stairs, as
well as providing a personal assistant for
the student with AC when conducting
motor activities (Haga et al., 2013). Finally,
Gollust et al. (2003) propose to carry out a
modification to allow equitable access to
public facilities. Also, inclusion in ordinary
school and equal employment
opportunities are aspects to highlight
(Shakespeare, 1988). In addition, activities
such as unsupported walking and adapted
sports and exercise plans are essential
(Haga et al., 2013; Vetere, 1988).
Therefore, it is essential to encourage
physical activity in this group (Pfeiffer et
al., 2022). However, Haga (2004) does not
mention any type of inclusive activity.
Consequently, it suggests that this group is
not as visible as it should be. For this
reason, it is recommended to increase the
number of investigations related to people
with AC in the ECE classroom. In addition,
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the evidence shown above reflects the
need to include students with AC in the
ordinary ECE classroom and make them
responsible for their own development
with the help of the corresponding
professionals.
Finally, in relation to the Quality of
the documents, four of the studies selected
for the systematic review have a Good
methodological quality (Sarmento et al.,
2018). On the other hand, the Vetere
manuscript (1988) is the only one that
presents a low methodological quality due
to its time. On the contrary, the journal
article by Haga (2004) and (Pfeiffer et al.,
2022) are the documents that present an
excellent methodological quality.
Therefore, for future research, it is
recommended to consider the
questionnaire prepared by Law et al.,
(1998), and expand it when preparing the
document to guarantee the quality of the
studies. In addition, it is recommended to
increase the number of experts, to
maximize the reliability of the scores, and
reduce the bias between the different
documents. On the other hand, it would be
advisable to design and validate a new
document quality questionnaire for future
systematic reviews.
CONCLUSIONS
This document is one of the first works
related to the inclusion opportunities and
analysis of students with AC, and the
knowledge of the type of inclusive activities
that should be developed in the ECE
classroom. However, there are few
documents that investigate about the
different possibilities of action to develop
an inclusive methodology in the students
with AC. In addition, the selected
manuscripts are written in English and are
Theoretical Studies found mainly on the
Scopus platform. For this reason, it is
recommended to carry out new research in
which the different possibilities of action in
the classroom are collected when
attending to students with AC.
Limitations
One of the main limitations of this
systematic review is the lack of documents
related to the Types of inclusive activities
for students with AC in the ECE stage, being
essential the work of professionals in early
care in said students to avoid the delay in
the acquisition of physical capacities or
abilities.
Acknowledgments and funding
This work has been partially subsidized by
the Aid to Research Groups (GR21149) of
the Junta de Extremadura (Ministry of
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Employment and Infrastructures); with the
contribution of the European Union
through the European Regional
Development Funds (FEDER). In addition,
the author José M. Gamonales is a
beneficiary of an Aid from the
Requalification Program of the Spanish
University System, Field of Knowledge:
Biomedical (Aid Ref.: MS-18).
Conflict of interests
Authors reported no conflict of interests.
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