Starfish Therapies

November 11, 2014

Avoiding the ‘Container Shuffle’ with your Baby

Filed under: Developmental Milestones — Starfish Therapies @ 4:24 pm
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movement exploration  IMG_1734  problem solving3

Guest post by: Nicole M Sergent, MPT

As a new parent, I was there. Giddy excitement over the news of a baby on the way followed by showering love from family and friends in the form of gift, and gifts, and more gifts. At the time I was touched (and am still forever grateful for their generosity) but shortly after the baby came I quickly fell into a routine many new moms do. As a physical therapist, I like to call it, “the container shuffle.”

“The container shuffle” goes something like this. Sleep (crib), eat (highchair), play (exercsaucer), calm down (bouncer seat), sleep (crib), eat (highchair), play (positioning seat), calm down (swing) etc. As a mother, I related to the thoughts many of my patients’ parents have. Everyone buys us all this stuff…and baby likes them and is happy…so why not use them? As a therapist, I’d like to tell you why.

I can’t tell you how many children I have assessed with general motor delays without significant medical histories or orthopedic or neurologic impairments. These babies are very stable in an upright static position. They often even sit really well, without ever rolling, crawling, creeping, kneeling, or standing. After I have carefully assessed to make sure, nothing more significant is going on, I’ll delicately share my diagnosis: CONTAINER SYNDROME.

I realize it is not rocket science but think of it this way. When a baby plays on the floor, he/she has the ability to wiggle, squirm, and move. Each tiny movement that may seem insignificant is actually exercise. They are beautiful diagonally directed movements. And they are needed. Because our moving transitions from one position to another (floor to sit, sit to stand), require that motion. How can we expect a baby to be able to move and explore if we always have them strapped in a container? Research tells us that babies who spend less time on their tummies on the floor, have delayed motor skills in the first year of life.

In addition to the ability to practice motor coordination, allowing a child to play outside of a “container,” has additional benefits. Play on a baby’s tummy, aids in digestion, assists with hand eye coordination, and promotes typical skeletal development. The hips have the ability to develop into a more stable, mature position and the skull, free from pressure from resting against a surface, has freedom to develop typically. Did you know that 20% of all infants now have plagiocephaly (flattened appearance of the head/face)? While free play time may not prevent all of those cases, I believe the increase in “container syndrome,” plays a significant role.

I once attended a continuing education lecture, where the OT speaking suggested that infants should spend 80% of waking hours on the floor. As a therapist, I could see the benefit of this time well spent. As a mother, I felt myself slumping with guilt. My daughters did not spend that much time on their tummies, especially my youngest that had severe acid reflux. A practical balance must exist for families. And while I realize “containers” are helpful with a fussy baby and so that one can actually shower, I recommend promoting floor time throughout the day. I tell the parents of my patients, “If you find yourself going to put your baby down, choose the floor or pack-n-lay first.”

Many of those children I have evaluated that had delays with mobility and transition skills that I felt came from “container syndrome,” ended up catching up to typically expected gross motor milestones in just a few short weeks by allowing more free play time on the floor. It can be argued that it is not rocket science. My mother (and yours) might argue it is common sense and “what we did with you.” But in a commercialized world where more = better, maybe we do need a dash of common sense to help keep our infants happy and healthy as they develop and grow.

Nicole M. Sergent, MPT is a pediatric physical therapist and co-owner of Milestones & Miracles, LLC. She co-authored a unique developmental tool for therapists and parents that pairs detailed development with interactive play skills, called 1-2-3 Just Play With Me. It is available in digital and print and can be found at,, and select retailers. Follow Milestones and Miracles online for developmental support & fun



September 2, 2014

Accessible Beaches

Filed under: Uncategorized — Starfish Therapies @ 9:08 pm
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surf chair 1 surf chair 2

I was recently back in my home town in NJ and spent the day on the beach.  I was impressed as I saw multiple people being pushed down in ‘surf chairs’.  I thought it was great that so many families took the time to get chairs that would allow their loved ones to access the beach.  Imagine my surprise and delight when at the end of the day I was packing my stuff up and saw that these chairs were provided by the beach!  I went home and looked it up and not only does the beach provide them, but they are free of charge.  Its just recommended that you make a donation.

I would love to hear about other beaches in other parts of the country that have programs like this.

August 11, 2014

Tummy Time – More Than Just a Buzz Word (A Blog Hop)

Filed under: Developmental Milestones — Starfish Therapies @ 10:00 am
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Tummy Time Therapy Blogger Blog Hop

Is Tummy Time Important A Therapy Blogger Blog HopBelow you will find all the posts in the Tummy Time therapy blogger blog hop. So many great ideas and thoughts on tummy time from Occupational Therapist and Physical Therapists.

The Importance of Tummy Time for Babies – Golden Reflections Blog

Tummy Time & Baby’s First Year - The Recycling OT

How to Use a Therapy Ball to Make Tummy Time Easier and More Fun for Baby – Mama OT

5 Awesome Toys for Tummy Time! – The Inspired Treehouse

Terrific Tummy Time Positions – Your Kids OT

Tips For Tummy Time From A Physical Therapist - Pink Oatmeal

Tummy Time : The Basics - Therapy Fun Zone

Tummy Time: Developmental Consequences & Future Implications - Tools to Grow, Inc.

Tummy Time Tips - Pedatric OT Tips

Tummy Time Just Isn’t For Babies – Your Therapy Source

Tummy Time – More Than Just A Buzz Word – Starfish Therapies

Tummy Time Never Gets Old – Playapy Platform

Tummy Time has become a common phrase in the last decade or so as a result of the NICHD Back to Sleep Campaign.  Prior to this time most parents put their children to sleep on their stomachs so Tummy Time was never an issue.  Now, with children sleeping on their backs they are spending 12 or more hours a day (if a parent is lucky and their child sleeps that much) on their backs which used to be devoted to time on their stomach.

And, in my opinion, another factor is the rise of innovative baby equipment that has been produced to make some aspects of parenting easier.  I know as a baby sitter I loved having the car seat that clicked into the car and then clicked into the stroller, or even the bouncy seats.  As a therapist I now see how all that equipment was taking away from time the child could have been equipment free, exploring their body and environment.

I’m not saying get rid of all equipment or put your child to sleep on their stomach, but I think its important to make sure you are balancing things out.  For instance, if you went to the gym and lifted weights, and only used your right side, you would be disproportionately strong on one side.  This is the same for infants.  When they are on their back, they are working the muscles on the front side of their body (abs, neck flexors, hip flexors) and learning how to lift them against gravity so that they are getting stronger.  However, the muscles on the back side of their body are getting forgotten about.  Those include their back extensors, neck extensors and gluts (tush muscles).  The muscles on both sides of their body are important to their gross motor development as they learn new skills and move through the developmental milestones.

Some of the benefits of Tummy Time are:

  • Improved head control – ability to hold their head stable so that they can observe the world
  • Improved trunk control – ability to hold their body stable so they can begin to sit on their own and develop balance reactions
  • Stretching – After 9 months in the womb, babies have tight muscles on the front of their body and by being on their stomach they are naturally stretching out so that they can begin to balance out the front and back of their bodies.  In addition, the more time they spend in carriers and other pieces of equipment, it keeps them in a slightly flexed position.
  • Decreased chance of developing plagiocephaly – This is when they develop a flat spot on their head.  Some babies get it in the back or on the side of their head.  This is because the back of their skull is still ‘soft’ and when they have decreased neck strength to move their head, they often lie with their head in one position so it flattens out in that area.  When spending time on their belly, the facial muscles are firm and less likely to flatten out/deform.  It also gives the back of their head a break from constant contact with a surface.
  • Hip development – When babies are born their femurs (thigh bones) are rotated.  Natural development allows a derotation to happen as their gluts get stronger and place a pull on their bones.  While on their belly, they are naturally developing their glut strength by activating their trunk and leg muscles against gravity.  This promotes the natural development that is supposed to occur!
  • Arm strength – While on their tummy, babies begin to experiment with pushing up on their arms which develops their upper extremity strength as well as eventually leads into rolling over and further exploration of their environment and movement.  This is also a precursor to crawling as they learn how to coordinate their arm use.

Tummy Time

These are just a few of the reasons why I like tummy time.  I know it isn’t easy to find time in busy days but I also look at it as ways to get down on the same level as your baby and interact with them.  You can even get some good ‘face time’ in!



April 3, 2014

The Ins and Outs of Pencil Grips

child at desk

A pencil grip can be a quick and easy fix for an awkward grasp. There is such a huge variety of them out there, but how do you know what ones to choose. Here’s some quick tips on how to choose a pencil grasp for your child.

The Simpler the Better: If your child needs a pencil grip, they are most likely having difficulty planning how to hold the pencil in the first place. Keep it simple so the grip doesn’t become as frustrating as the pencil initially was to hold. It will also make it easier to transfer from pencil to pencil if needed and recall how to hold it correctly each time.

Look at the concerns: The type of pencil grasp that your child will use is going to depend on what the areas of concern are when they are holding the pencil. Here are some common concerns, along with which direction to possibly take:

  • Low tone (fine motor weakness): This can be observed one of 2 different ways. One such way is when your child is holding the pencil too loosely and often resorts to an awkward grasp to compensate. The other way is they will look like they are actually applying too much force when writing and are using it as an over-compensation for the weakness. Thicker or jumbo grips are usually easier for these kiddos to hold onto and can cut back on some of the force when writing concerns. Weighted pencils or grips can also help in some cases, so the child doesn’t feel the need to push down the pencil so hard when writing.
  • Motor Planning: This is when your child just can’t seem to get the motor patterns correct for holding the pencil. These are the kids that the more simple the grip the better. Single grips or crossover grips would be most beneficial for these kids.
  • Kinesthetic feedback: These kids usually grip the pencil with a tight fisted grasp or barrel grasp. They’re looking for input when writing in order to fill a sensory need, as well as give them some proprioceptive feedback to assist with guiding the pencil. Wider or jumbo pencil grips or textured ones may be most beneficial for these kids.

Make it Fun: There’s different colors, shapes and even grips with glitter. You want to get the right type of grip, but you want your child to be excited about using it as well. Let them choose colors or other features of the pencil grip as long as it doesn’t impede overall function of what you wanted it to do originally.

It’s not forever: Pencil grips are just to encourage the use of an appropriate grasp for the time being and not to use as a permanent fix. It should assist your child in making the grasp more of a habit and you should be able to eventually end up with no use of no grasp at all. Just another helpful trick along the way.

March 5, 2014

Muscle Memory and Movement

Filed under: Developmental Milestones — Starfish Therapies @ 7:00 am
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I recently spent a week skiing after almost two years off.  And while I wouldn’t say I was a superstar, I was amazed at how easily the movements came, and how little thought had to go into me successfully completing the basics of skiing.  At some point and time, my body had committed the movements to it muscle memory.  Now, add massive amounts of fresh powder and I was glad for that muscle memory because powder is not my strong point (I learned to ski on the east coast) so I had to think about how to build on the basics so that I could successfully get down the mountain.

How is this pertinent?  Well when your child is learning a new movement they practice it over and over so that their body can commit the movement to its muscle memory.  Once this happens, its an automatic movement and you can start adding in variations to the movement.  For instance, a baby learning to crawl will practice on flat ground over and over until they are the crawling masters.  Once they get that down they can start experimenting with crawling on different surfaces, such as cushions, or crawling over obstacles, or up stairs.  These variations will be more work for them because they have to expand on their movement bank and think about how to be successful.  Eventually with practice these will become automatic as well.

When muscle memory happens, a person can go a while without doing a skill and when they try it again, they will need to practice a bit but it will come back that much faster than if they were learning it for the first time.  I know when I teach someone to use crutches, it is that much easier for a person who has used them before.  This is an example of a skill that isn’t used every day but once its learned, it comes back that much faster when the skill is needed again.

So, the premise of this is repetition is important when kids are learning new skills because they are committing the movement to their muscle memory so that they can expand on that movement and continue to progress to higher level skills.  So the next time you wonder why your child who is just learning a skill does it over and over again, its because they are committing it muscle memory.  For kids that need extra help to learn movements its essential that repetitions are built in to their learning.


February 12, 2014

Straighten Up: Helpful Hints for Posture at School


It’s at least halfway through the school year and a great time to think about posture!  More often than not, children tend to pay little attention to their posture while focusing on something else such as school work, television, or video games. Most commonly, you will see them slouching forward, leaning to one side, propping on one or both elbows, propping their head in their hands or even lying their head on the desk while writing or drawing. They may appear unaware of this  when corrected because unlike adults, most kids do not experience back and neck pain related to poor posture. It is also difficult to help them why good posture matters in order to prevent habits that could potentially cause problems later in life.

Tips to Improve Your Child’s Posture:

  • Lead by Example: Draw attention to your own posture and show your child what sitting up tall looks like.
  • Mirror: Using a mirror is a great way to show your child what their posture looks like or what it should look like.  Specifically, having them stand sideways can making slouching more apparent.
  • Chair: The chair your child uses can make a huge difference in their posture.  It is important for their feet to rest flat on the floor and that their knees are bent roughly 90 degrees.  It is also important to look at the length of the seat.  If the back of the chair does not touch your child’s back while their feet are on the ground place a pillow in between the space for support.  If the only chair you have to use is so high that your child’s feet are dangling in the air, place a stool or wooden block underneath for their feet to rest flat on.
  • Desk:  The height of the desk is also important.  It should hit slightly above your child’s belly button in the middle of their trunk.  If it is too low, your child will slouch forward to reach their work.  If it is too high, your child will have to elevate their shoulders towards their ears raise their arms up to reach what they are doing and will therefore, be overusing certain neck and shoulder muscles.  If your child is too low at the table, you can place pillows or cushions under their bottom but then again may need to place something under their feet so they do not hang.
  • Set Limits:  It is important to set time limits on computer/television/video game sessions.  Try limiting bursts of these activites to 20 minutes at a time.  After 20 minutes, encourage your child to get up and move around for a while.

If you have been working on your child’s posture and do not see improvement or if your child complains of pain or seems unable to sit still for periods of time, they may have some underlying muscle tightness or weakness that makes a good, neutral posture very difficult to achieve and they may need some targeted strengthening or stretching.

How do you work on your kiddo(s)’ posture?

January 22, 2014

Fine Motor Group Ideas

IMG_2871 IMG_2870

This past summer we did a fine motor group and each of the participants left with a basket of goodies for things they could work on after the group ended.  Here is what was included on the worksheet that went with it:

What Your Fine Motor Baskets Contain



The benefits – Encourages a tripod grasp, builds up hand endurance, allows children to work on increasing and decreasing the amount of force used, encourages isolation of wrist and fingers.

Recommendations – Have your kids break the crayons to encourage a tripod grasp. Vary the sizes and textures that they are coloring on. Encourage coloring on slanted surfaces or standing at an easel to build on endurance and strength of wrist extensors.



The benefits – Texture tolerance if your kids have tactile concerns. Visual motor and pincer grasp encouragement, proprioceptive input to hands for those sensory seekers.

Recommendations – Hide beads or small items in the floam to encourage more manipulation of it. Have them squeeze it with their whole hand or pick up the small individual beads to encourage use of a pincer grasp.



The benefits – Eye-hand coordination, pincer grasp, body spatial awareness, midline crossing.

Recommendations – Stick the stickers on the back of their hands to encourage them to cross midline to get the sticker off with their other hand. Peeling the stickers off also encourages use of a pincer grasp to complete this. Sticking the stickers on different parts of their body can help their overall body awareness as they are looking for the stickers.



The Benefits: Increases grasping strength, eye-hand coordination and bilateral hand use.

Recommendations: Play some silly games to get the interest going with clothespins. Have them pin them onto your clothes so they get to make you look silly or make hair for their baskets. If they are not ready to pinch them on, you can create a game where they have to pull them off of themselves, you or another surface to work on more whole hand grasping.


Balloon Fidget:

The Benefits – Overall hand strength, regulation, sensory input.

Recommendations – Demonstrate different ways that you can utilize the fidget (pull, twist, squeeze). Use it as a regulatory tool when children are dis-regulated or over-stimulated.



The Benefits: Eye-hand coordination, bilateral hand use, pincer grasp, motor planning.

Recommendations: There are both pipe cleaners and string in the basket to match the level at which your child may be at for beading. Starting with the pipe cleaner is easier and allows them a stiffer material to work with. When ready they can progress to the string. There are large beads included but smaller ones can be threaded on as well to increase to another level of difficulty.


Finger crayon:

The Benefits – Finger isolation, quadrapod grasp.

Recommendations – Allows more stabilization when coloring for some children and gives them more control when coloring. It may not work well for some kids, but allow them to explore.

January 1, 2014

2013 Recap and Top Ten Posts

Filed under: Developmental Milestones — Starfish Therapies @ 5:18 pm
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I have to admit, 2013 was not our best year for consistency with publishing blog posts, however our New Year’s Resolution is to publish minimum 1 post per week (anything above that we consider gravy)!  What we did accomplish in 2013 was to have some great guest posts from some amazing bloggers!

Here are our Top Ten most read posts in 2013:

10.  Great Songs For Therapy

9.  Torticollis:  What Is It?

8.  DIY Lycra Swing

7.  Core = More Than Just Abs

6.  What Does Low Tone Mean?

5.  Having a Ball With Core Muscle Strength

4.  A Glossary of Sitting

3.  A Multi-Tasking Activity

2.  Why is W-Sitting a Four Letter Word?

1.  Motor Learning:  Stages of Motor Learning and Strategies to Improve Acquisition of Motor Skills

And here are the Amazing Guest Posts we’ve had this year:

A.  I Can Do It Myself:  Messy Steps to Self Feeding

B.  School Based Physical Therapy

C.  Play This, Not That

D.  Olympic Game Day

Here’s to an amazing 2014!


July 9, 2013

Guest Post – I Can Do it Myself: Messy Steps to Self Feeding

Filed under: Developmental Milestones — Starfish Therapies @ 7:26 pm
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by Melanie Potuck


Chapter Three

Isaac’s grandmother diligently swiped his chin with the tip of the spoon after every bite, ensuring that no puree remained on his face. She kept a wet washcloth nearby for swiftly wiping down soiled fingers and the high chair tray should any food drip off the spoon. “He likes to be neat and clean,” she stated proudly. Isaac was 18-months-old and had yet to touch a spoon or any food on his tray. Thankfully, this grandmother was open to my suggestions and, months later, Isaac, Grandma and I were elbow-deep in chocolate as we played pudding car wash on his back patio! That grandmother later told me: “If you haven’t played pudding car wash, you’re missing out on life!”

I always turn my radar up a bit when I see a one-year-old sitting in his high chair, being fed by his parent and spotless — not a mess under the high chair, not a stain on his bib, not a speck on his tray. Well-meaning parents try to spare their child (and themselves) the mess by continuing to spoon feed their little one. Not only is the mess part of the learning curve for self-feeding, it’s essential for children to encounter the sensory experience of each and every food. Many children need to first explore new foods with their eyes, ears, nose and hands before putting it in their mouths. Please refer to Chapter 4 for more information on sensory experiences with food.

Once your child is sitting on her own or with a bit of support and you have her properly positioned in her high chair (see Chapter 1), she is ready to begin more independent feeding. This stage of the game is all about you providing a variety of safe foods for her to try, engaging with her as she eats and letting her get messy as she explores all of the new foods.

Self-spoon feeding is an art. You can support your child by encouraging her to hold the handle of the spoon fairly close to the bowl. This varies depending on the shape of the handle, but, in general, the closer her little fist is to the bowl, the easier she will be able to guide the bowl into her mouth with less mess. Keep in mind that the closer her fist is to the bowl, the messier her hand will get when she scoops up that first spoonful of applesauce!

Try coloring a wide circle around the handle with a permanent marker so that she has a consistent spot to aim for when she grasps the handle. Pick a spot for her grasp about one inch from the bowl, or, if the handle is curved, have her grasp it at the top of the curve. A short, fat handle with a curve or “hill” built into the handle is often ideal. The deeper bowl will hold the puree or chopped food as it travels the long trek up to your child’s mouth, but the child may not be able to clean the spoon with his top lip as easily.

Some spoons come with holes in the bowl to allow liquid to drain and solids to stick to the bowl. Other spoons have textured bowls for those children who need the added tactile input to their mouths in order to tell where the spoon is about to dump the food. Some spoons come with bendable “necks” where the handle and the bowl meet, so that parents can adjust the angle of the neck to facilitate better hand to mouth coordination.

Provide extra traction beneath the slippery bowl with a sheet of shelf liner (see Chapter 1) or use a suction cup bowl. Suction cup bowls that are deep with high sides are ideal, especially if filled with non-slippery foods such as cottage cheese, oatmeal or chopped, room temperature macaroni and cheese.

I am not sure which is messier — independent spoon feeding or independent finger feeding! A washable mat under the high chair tray is a must. Finger feeding is the perfect opportunity for your little foodie to begin to develop his pincer grasp, where he engages his thumb and forefinger to pick up pea-sized foods, such as halved blueberries and cheerios.

At about six months, your child will begin to rake up objects by using his whole hand and curling all four fingers around the desired item. Letting go of the food can be tricky.  You may see your child use his mouth to grab the food while he fists it in between his little fingers.

Slowly, between seven and nine months, the pincer grasp will begin to emerge. This is also the time that children have enough trunk stability to sit in a high chair and focus on this new skill. Typically, by the end of the first year, the pincer grasp is perfected! At that time, you will see your child begin to pick up small pieces of food and place them in her mouth with more precision and thankfully, less mess.

Support the natural progression of finger feeding by offering soft or meltable foods first, such as a buttery cracker. It’s relatively easy to grasp and mouth until a soft, mushy piece falls into his mouth. Over time, he will develop his ability to grade his jaw movement and truly bite into the cracker in a controlled, even manner. As his skills improve, offer pea-sized pieces of soft and/or meltable foods that expose your child to a variety of tastes, safe temperatures and textures. Small chilly blueberries cut in half, warm, buttery pieces of pasta or tofu or cheerios spritzed with apple juice are all good starters.  See Chapter 15 for additional ideas.

To encourage pincer grasp development, try the following games with your favorite round cereal or pea-sized pieces of soft food:

1.    Using a plastic “shot glass” or similar sized narrow container (about two inches tall and just wide enough for your child’s thumb and forefinger), put a few pieces of cereal in the bottom and encourage him to get them out by reaching in and picking up the pieces using a pincer grasp.

2.    Take a round plastic coffee stirrer and thread three pieces of circular cereal on it. Hold it perpendicular to the high chair tray and let your child pull off the cereal one by one using his thumb and forefinger.

3.    When giving your child a piece of the cereal, hold it in your pincer grasp (with half sticking out and available for his little fingers to grab onto) as you move it toward his hand. Wait. Let him take it from your grasp before putting it in his mouth on his own.

As your child learns to feed himself with fingers and/or spoon:

·      Rejoice in the mess! It’s good for his sensory system and just part of the learning curve.

·      Position little fists near the bowl of the spoon.

·      Layer shelf liner under a small, deep plastic bowl or use a suction cup bowl.

·      Offer pea-sized soft and/or meltable foods to encourage pincer grasp.

Melanie Potock, MA, CCC-SLP is a certified speech language pathologist, a national speaker on the topic of picky eating, and the author of the award winning parenting book,  Happy Mealtimes with Happy Kids: How to Teach Your Child About the Joy of Food! With over 15 years’ experience treating children with feeding difficulties, Mel’s approach to developing feeding skills includes the fundamentals of parenting in the kitchen, such as how to avoid mealtime debates and creating more joyful mealtimes, even with a hesitant eater. Mel embraces her work with families with an open heart and a touch of humor.  After all, the journey to more adventurous eating should be celebrated each step of the way!  She has also produced the award winning children’s CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food as a tool to keep mealtimes joyful and family centered.  Connect with Melanie at My Munch Bug on facebook and twitter or email her at

April 18, 2013

Guest Post – School-based Physical Therapy

Filed under: Developmental Milestones — Starfish Therapies @ 4:11 pm
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By Kathryn R. Biel, PT, DPT


image retrieved from:

I am a physical therapist.  It often surprises people when I tell them that I work in a school district (a large, urban one, to be exact).  I usually get the follow-up question of, “doing what?” Many people do not understand the role of physical therapists in the educational system.  Those who have led a sheltered life surrounded only by typically developing children think that I must be there to work with children who are injured playing sports.  Many parents of the preschool set know someone receiving some kind of service (speech therapy, occupational therapy or physical therapy), and can relate that my job is an extension of preschool services.  School-based physical therapy is a related service provided through the Individualized Education Plan (IEP), which is part of the Individuals with Disabilities Education Act (IDEA).  The legislation for IDEA was passed in 1990, stemming from the 1975 Education for All Handicapped Children Law.  IDEA was reauthorized in 2004 and guarantees a “free and appropriate public education” for students.



This is where and why school-based physical therapy diverges from preschool therapy and pediatric outpatient-based physical therapy.  School-based physical therapy is not intended to meet all of the therapeutic needs of a child.  Rather, it is available to ensure that a child is able to access his or her education in a safe and efficient manner.  What does that mean?  It means we are looking at function.  This includes how a child is transported to school, how a child can enter and exit the building, how the child can enter and exit the building during evacuation/emergency procedures, how a child moves around the school building, how a child moves around the classroom, and how a child sits in the classroom.  In essence, what is the best, most efficient and safe way for a child to get to school, get around in school, and in what position will he or she receive his or her education.



School-based physical therapy generally focuses on the following skill sets:  walking, running, stair climbing, walking in line, balance (one foot, with feet together), jumping, posture, strength and ball play (to participate in physical education).  Strength, particularly in the postural and core muscles and muscles of the shoulder girdle is especially important.  Just like a house needs a solid foundation, a child needs a strong and stable core to be able to develop the skills needed to write.  In order to write a word down on paper, the following skills are needed:   the strength and endurance to sit upright, stabilize the paper on the writing surface with one hand while crossing midline with the other hand, move the dominant hand in small, meaningful and controlled strokes (writing) while applying appropriate pressure and grading, listening to the instructions, reading the directions and shifting gaze from the board to the paper.  If a child lacks the strength to sit upright, all of the other pieces fall apart, and the child will have immense difficulty with writing, attending and ultimately learning.



Being able to walk with a narrow base of support (follow in line), respect personal space (and not bump into everything) and navigate the stairs are skills necessary to access one’s education.  For most children, with physical therapy services, these skills develop nicely in a short period of time, within 1-2 school years.



Generally speaking, PT services the children in the primary grades mostly (K, 1, 2).  This is because these children, due to their gross motor delays, are still learning to navigate their environment and developing the skills in the large muscle groups that allow them to sit upright and learn.  That is not to say that we never service older children.  But, generally, as a child ages, the amount of physical therapy services are gradually decreased in the public school setting.  This is usually due to the fact that a child is able to access his or her education through equipment and accommodations.  For example, a child with cerebral palsy who is not a functional ambulator (cannot walk independently or with an assistive device more than 300 feet) will have a wheelchair.  The wheelchair will be the child’s primary means of transport to and from school and within the school building.   By the time the child is in fourth grade (about 10 years old), the role of the physical therapist shifts from helping the child work on walking and trunk control skills to making sure that the child has the appropriate equipment (wheelchair, adaptive chairs, adaptive toileting) and that staff is well educated in how to transfer the child in and out of said equipment.  The wheelchair (for the non-ambulatory student) is the most safe and efficient way for that child to access his or her education.  Physical therapists work in Consultation mode (with the staff), rather than by providing direct service, or treatment to the student.



This concept is hard for parents to understand, especially when a child has a significant diagnosis, such as cerebral palsy or muscular dystrophy.  While these students benefit from physical therapy, the regulations of IDEA do not provide for maintenance therapy.  Progress must be made on a yearly basis (and this progress is measured by the goals written yearly on the IEP).  Yes, a child with increased muscle tone or spasticity would benefit from range of motion.  However, daily range of motion is not deemed educationally relevant in most cases.  This means that providing range of motion to a child’s feet and ankles does not help provide a free and appropriate education for the child.  That being said, most physical therapists are more than happy to work with families to show some techniques for carryover at home. 



In the public school setting, we are looking to minimize the time a child is taken out of the education setting.  It is very difficult to provide PT within the classroom, although it is sometimes possible. As such, generally, physical therapy frequencies are not as high as those of speech therapy or occupational therapy.  Those two therapies play a much larger role in a child’s education (the child must understand language to learn, must output some form of communication to show what he or she knows, and generally requires writing or other fine motor skills to assist in expressive knowledge). 



School-based physical therapy is a wonderful adjunct to the public education process.  It opens doors and removes barriers that for so long prevented physically disabled children from receiving a public education.   It is meant to work in conjunction with, but not as a replacement for medically-based  outpatient physical therapy. 


About the Author:


I am a pediatric physical therapist.  I attended school at Boston University, and received my doctoral degree from The Sage Colleges.  I have worked in a variety of settings, including special education schools, a pediatric residential care facility, Early Intervention, preschool and now in the public school setting, with some brief dabbling in an adult outpatient rehab clinic.  When I’m not busy treating, writing IEP’s, attending meetings and fixing wheelchairs, I am the mother to two school-aged children and wife to a very patient husband.  I can often be found releasing my stress through dance and writing for my own personal blog, Biel Blather, which can be found at


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