“The car is my extra legs” – Experiences of outdoor mobility amongst immigrants in Sweden with late effects of polio

Autoři: Helena Selander aff001;  Iolanda Santos Tavares Silva aff001;  Felicia Kjellgren aff001;  Katharina S. Sunnerhagen aff001
Působiště autorů: Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden aff001;  The Swedish National Road and Transport Research Institute (VTI), Gothenburg, Sweden aff002;  Department of Occupational Therapy and Physiotherapy, The Sahlgrenska University Hospital, Gothenburg, Sweden aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224685



The aim of the study was to describe the experience of outdoor mobility among immigrants with late effects of polio living in Sweden. There is a need to understand more about this young group of persons since they often have problems with mobility and gait, but they may also face participation restrictions due to issues associated with integration into a new community and culture.


A total of 14 young immigrants with late effects of polio participated and were interviewed individually. The study used a qualitative method to explore personal experiences and the interviews were analyzed through an inductive approach, using qualitative content analysis.


The analysis led to a major theme; self-image and acceptance, that comprised a changeable process and experiences of cultural, social, and gender-specific barriers, but also of environmental and personal factors that impacted their outdoor mobility. By using a car, the participants felt they could come across as normal which also increased their self-esteem.


Independent mobility is a major enabler for ongoing employment and being able to use a car increases the chances for integration into society for young immigrants with late effects of polio. Public transport is not considered to be adequate or efficient enough due to the participants’ mobility impairments, but driving can prevent involuntary isolation and facilitate participation. A car can increase quality of life but may also be a facilitator for work and reduce the demand for societal support.

Klíčová slova:

Culture – Disabilities – Emotions – Sweden – Transportation – Walking – Wheelchairs – Poliomyelitis


1. Post-Polio Health International. St. Louis, MO: PHI; 2019 [cited 2019 May 1]. Available from: http://www.post-polio.org/edu/pabout.html

2. Trojan DA, Cashman NR. Post-poliomyelitis syndrome. Muscle Nerve. 2005;31(1):6–19. doi: 10.1002/mus.20259 15599928

3. Halstead LS, Rossi CD. New problems in old polio patients: results of a survey of 539 polio survivors. Orthopedics. 1985;8(7):845–50. 3867865

4. Gawne AC. Post-polio syndrome: pathophysiology and clinical management. Crit Rev Phys Rehabil Med. 1995;7(2):147–188.

5. Farbu E, Rekand T, Gilhus NE. Post‐polio syndrome and total health status in a prospective hospital study. Eur J Neurol. 2003;10(4):407–413. 12823493

6. Udd L. Everything you need to know about post-polio syndrome (PPS): a guide for people who have had polio or who work in the health service. Sundbyberg: Personskadeförbundet; 2009.

7. Santos-Tavares I, Thoren-Jonsson AL. Confidence in the future and hopelessness: experiences in daily occupations of immigrants with late effects of polio. Scand J Occup Ther. 2013;20(1):9–20. doi: 10.3109/11038128.2012.660193 22353041

8. Statistics Sweden (SCB). Swedish and foreign-born population by region, age and sex. Year 2000–2018. Available from: https://www.scb.se/BE0101-en

9. Vreede KS, Sunnerhagen KS. Characteristics of Patients at First Visit to a Polio Clinic in Sweden. PLoS One. 2016;11(3):e0150286. doi: 10.1371/journal.pone.0150286 26981623

10. Werhagen L, Borg K. Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic. Neurological Sciences. 2016;37(10):1597–601. doi: 10.1007/s10072-016-2629-3 27299427

11. Thoren-Jonsson AL, Willen C, Sunnerhagen KS. Changes in ability, perceived difficulty and use of assistive devices in everyday life: a 4-year follow-up study in people with late effects of polio. Acta neurologica Scandinavica. 2009;120(5):324–30. doi: 10.1111/j.1600-0404.2009.01186.x 19519806

12. Vreede KS, Broman L, Borg K. Long-term follow-up of patients with prior polio over a 17-year period. J of Rehabil Med. 2016;48(4):359–64.

13. Brogardh C, Lexell J. How various self-reported impairments influence walking ability in persons with late effects of polio. NeuroRehabilitation. 2015;37(2):291–8. doi: 10.3233/NRE-151261 26484520

14. Bickerstaffe A, Beelen A, Nollet F. Circumstances and consequences of falls in polio survivors. J of Rehabil Med. 2010;42(10):908–15.

15. Appelin K, Lexell J, Månsson Lexell E. Occupations that People with Late Effects of Polio Perceive Difficult to Perform. Occup Ther Int. 2014;21(3):98–107. doi: 10.1002/oti.1368 24619836

16. Towards a Common Language for Functioning, Disability and Health. Geneva:World Health Organization; 2002 [cited 2019 May 1]. Available from: http://www.who.int/classifications/icf/icfbeginnersguide.pdf?ua=1:

17. Pellerito JM. Driver Rehabilitation and Community Mobility, Principles and Practice. Missouri: Elsevier Mosby; 2006.

18. Unsworth CA. Community mobility promotes participation for people of all ages and abilities. Aust Occup Ther J. 2012;59(1):1–1. doi: 10.1111/j.1440-1630.2011.00994.x 22272876

19. Ellaway A, Macintyre S, Hiscock R, Kearns A. In the driving seat: psychosocial benefits from private motor vehicle transport compared to public transport. Transp Res Part F Traffic Psychol Behav. 2003;6(3):217–31.

20. Selander H, Kjellgren F, Sunnerhagen KS. Self-perceived mobility in immigrants in Sweden living with the late effects of polio. Disabil Rehabil, 2019. https://doi.org/10.1080/09638288.2019.1585488

21. Di Stefano M, Stuckey R, Lovell R. Promotion of safe community mobility: Challenges and opportunities for occupational therapy practice. Aust Occup Ther J. 2012;59(1):98–102. doi: 10.1111/j.1440-1630.2011.00993.x 22272888

22. Zeilig G, Weingarden H, Shemesh Y, Herman A, Heim M, Zeweker M, et al. Functional and environmental factors affecting work status in individuals with longstanding poliomyelitis. J Spinal Cord Med. 2012;35(1):22–7. doi: 10.1179/2045772311Y.0000000048 22330187

23. Sjödin L, Buchanan A, Mundt B, Karlsson E, Falkmer T. Do vehicle grants and vehicle adaptations grants promote transport mobility and community access for children with disabilities in Sweden? Aust Occup Ther J. 2012;59(1):10–6. doi: 10.1111/j.1440-1630.2011.00972.x 22272878

24. Atwal A, Spiliotopoulou G, Coleman C, Harding K, Quirke C, Smith N, et al. Polio survivors' perceptions of the meaning of quality of life and strategies used to promote participation in everyday activities. Health Expect. 2015;18(5):715–26. doi: 10.1111/hex.12152 24438097

25. Gupta J. Human displacement, occupational disruptions, and reintegration: a case study. World Federation of Occupational Therapists Bulletin. 2012;66(1):27–9.

26. Santos Tavares Silva I, Thorén-Jönsson A-L, Sunnerhagen KS, Dahlin-Ivanoff S. Processes influencing participation in the daily lives of immigrants living with polio in Sweden: A secondary analysis. J Occup Sci. 2017;24(2):203–15.

27. Coogan MA, Campbell M, Adler TJ, Forward S. Examining behavioral and attitudinal differences among groups in their traffic safety culture. Transp Res Part F Traffic Psychol Behav. 2014;26:303–316.

28. DePoy E. Introduction to research: understanding and applying multiple strategies. 5 ed. St. Louis: Elsevier Mosby; 2016.

29. Taylor SJ. Introduction to qualitative research methods: the search for meanings. 2 ed. New York: Wiley; 1984.

30. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. doi: 10.1093/intqhc/mzm042 17872937

31. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12. doi: 10.1016/j.nedt.2003.10.001 14769454

32. Farbu E, Rekand T, Gilhus NE. Post-polio syndrome and total health status in a prospective hospital study. Eur J Neurol. 2003;10(4):407–13. 12823493

33. Gray DB, Hollingsworth HH, Stark S, Morgan KA. A subjective measure of environmental facilitators and barriers to participation for people with mobility limitations. Disabil Rehabil. 2008;30(6):434–57. doi: 10.1080/09638280701625377 17943511

34. May E, Garrett R, Ballantyne A. Being mobile: electric mobility-scooters and their use by older people. Ageing Soc. 2010;30(7):1219–37.

35. Labbé D, Mortenson B, Rushton PW, Demers L, Miller WC. Mobility and participation among ageing powered wheelchair users: using a lifecourse approach. Ageing Soc. 2018;1–17. doi: 10.1017/S0144686X17001490

36. Santos Tavares Silva I, Thorén-Jönsson A-L. Struggling to be part of Swedish society: Strategies used by immigrants with late effects of polio. Scand J Occup Ther. 2015;22(6):450–61. doi: 10.3109/11038128.2015.1057222 26107773

37. Salminen AL, Brandt A, Samuelsson K, Toytari U, Malmivaara A. Mobility devices to promote activity and participation: a systematic review. J Rehabil Med. 2009;41(9):697–706. doi: 10.2340/16501977-0427 19774301

38. Gupta J. Enabling immigrants to overcome participation challenges. OT Pract. 2008;31:25–32.

39. Akhavan S, Bildt CO, Franzen EC, Wamala S. Health in relation to unemployment and sick leave among immigrants in Sweden from a gender perspective. J Immigr Health. 2004; 6(3):103–18. 15269514

40. Rechel B, Mladovsky P, Ingleby D, Mackenbach JP, McKee M. Migration and health in an increasingly diverse Europe. The Lancet. 2013;381(9873):1235–45.

41. Bennett KM, Scornaiencki JM, Brzozowski J, Denis S, Magalhaes L. Immigration and its impact on daily occupations: a scoping review. Occup Ther Int. 2012;19(4):185–203. doi: 10.1002/oti.1336 22987528

42. Meekosha H. What the hell are you? An intercategorial analysis of race, ethinicity, gender and disability in the Australian body politic. Scand J Disabil Res. 2006;8:161–76.

43. Wretstrand A, Ståhl A, Petzäll J. Wheelchair users and public transit: eliciting ascriptions of comfort and safety. Technol Disabil. 2008;20(1):37–48.

44. Lewin C, Gustafsson S, Nyberg J. Utlandsföddas mobilitet och resvanor i svensk trafikmiljö. Linköping: VTI rapport 546; 2006.

45. Oxley J, Whelan M. It cannot be all about safety: the benefits of prolonged mobility. Traffic Inj Prev. 2008;9(4):367–78. doi: 10.1080/15389580801895285 18696394

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2019 Číslo 10
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