Starfish Therapies

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

SchoolHouse

image retrieved from: www.gboe.org

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 www.kathrynbiel.blogspot.com.

 

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12 Comments »

  1. What a beautifully written blog! As a school-based PT of 10 years I have also often received inquisitive looks when I respond to the question of “where do you work?” There is also often confusion amongst the parents of the children I serve as their child moves from an Individualized FAMILY Service Plan (IFSP) in Early Intervention to an Individualized EDUCATION Plan (IEP) when entering the school system. I think you have articulated our role clearly and concisely. I look forward to having it as a reference as I move forward in my career. Best wishes~

    Comment by School based PT in VA~ — April 18, 2013 @ 5:38 pm | Reply

    • Thanks! I find, especially at this time of the year with annual reviews and transitions into kindergarten, the role of the PT in the public school is really misunderstood, even by PT’s out in the field.

      Comment by Kathryn Biel — April 18, 2013 @ 7:16 pm | Reply

  2. Kathryn: I am also a school P.T. and found your post to be right on. May I use your post as reference for when I need to discuss the clincal vs. school model differences with others? Thank you for posting it. School P.T. in Colorado

    Comment by Sarah Houger — May 3, 2013 @ 6:29 pm | Reply

  3. […] Reblogged from Starfish Therapies: […]

    Pingback by Guest Post – School-based Physical Therapy | Pediatric Therapeutic Services, Inc. — May 14, 2013 @ 2:43 am | Reply

  4. Reblogged this on Pediatric Therapeutic Services, Inc. and commented:
    Kathryn Biel, a pediatric physical therapist, recently wrote a guest post on the Starfish Therapies blog. She explains the role and value of PT in the schools in an approachable and relevant way. This may be a great resource to have on hand as a school-based PT when communicating with team members and parents!

    Comment by socialmediaatpts — May 14, 2013 @ 2:43 am | Reply

  5. […] Biel, a pediatric physical therapist, recently wrote a guest post on the Starfish Therapies blog. She explains the role and value of PT in the schools in an […]

    Pingback by School-Based Physical Therapy and free Infographic! | Pediatric Therapeutic Services, Inc. — May 14, 2013 @ 2:54 am | Reply

  6. […] B.  School Based Physical Therapy […]

    Pingback by 2013 Recap and Top Ten Posts | Starfish Therapies — January 1, 2014 @ 5:18 pm | Reply

  7. Thank you so much for this excellent post. I find that parents frequently do not understand the difference between school based and medical model physical therapy. This presents a problem especially when a child has been receiving clinical physical therapy and is now beginning to receive school based therapy. I especially appreciate the paragraph on range of motion and how the physical therapist will educate the parents to carry this over in the home. Is it possible to use this post at IEP meetings when it may be helpful for the parents to see something in writing to help clarify my explanation?

    Comment by Aisha Jackson PT — January 18, 2014 @ 8:14 pm | Reply

    • I’m glad this was helpful! Of course you can use it to support what you do. Thanks!

      Comment by Starfish Therapies — January 20, 2014 @ 5:00 pm | Reply

  8. Thank you for your post. It is very well written and addresses so many struggles that I face working in the school system. I especially have difficulty when it comes time to dismiss the direct service as children get older and PT is no longer educationally necessary. I am new to the school system and am still learning IDEA. You made reference that IDEA does not support maintainence therapy and progress must be made yearly. Can you pinpoint where that is? (specifically or generally) It would be helpful to have that reference. I find that both parents and teachers have trouble understanding this. Thanks for your help.

    Comment by Melanie Brant — February 11, 2014 @ 7:58 pm | Reply

    • IDEA does not specifically reference criteria for discharge. It references eligibility to determined by evaluations, observations and data collection. This becomes a touchy subject as each district uses different criteria for discharge. IDEA focuses mainly on initial eligibility. It is very vague in regards to physical therapy, stating only that it is service provided by a qualified physical therapist (Part B, Subpart A 300.34). I face this battle every year, and will always have at least one child on caseload that does not meet my eligibility for school-based PT, but I service in order to avoid due process and law suits. I find the districts tend to bend on this issue. I usually just stress that the law is designed to ensure a free and appropriate public education. I then have to extrapolate that maintenance skills, such as range of motion, do not directly impact a child’s ability to have a free and appropriate education.

      I wish there was more clear cut criteria for me to reference. Like I said, I fight this battle every year, and often lose. I just keep trying and presenting this case.

      Comment by Kathryn Biel — February 12, 2014 @ 3:04 am | Reply

  9. I appreciate reading this post as well. I too am a school based PT and have so much difficulty deciding on appropriateness in working with kids with gross motor delays but can still walk throughout educational environment independently. i tend to work with them early on to improve this skills bc I feel they perform these skills in the preschool and kindergarten environments like during circle time (jumping, hopping, skipping, marching, etc) and they are important to other areas of function. That’s why I feel they are “educationally relevant” but information is so vague as to how gross motor skills relate…AND how do they correlate to PE…and I don’t have Mentor to speak of in the educational environment. My sped director just says “your the expert”. I also struggle with low level functioning kids and how long to keep them on my schedule as well. I’m talking several years of little to no progress to show, but I am so scared as to if i don’t see or follow, they will regress and i hate to turn over maintenance of equipment (stander and gait trainers)…What happens in these scenerios? I would love to speak with you even converse via email if possible. I need some help…

    Comment by amy — August 8, 2014 @ 11:07 pm | Reply


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