Physical Therapy

Physical Therapy Role in Educational Settings

Physical therapy as an educational support service can be quite different from physical therapy in a clinic or hospital. School-based therapists focus on removing barriers from students’ ability to learn, helping students develop skills which increase their independence in the school environment, and educating school personnel about the different considerations required for students with disabilities. Everything the therapist does with students in the school must be educationally relevant. Therapists examine and intervene to improve students’ functional abilities in school classrooms, hallways and other areas that may be part of their educational program.

The therapist works with teachers to help students acquire functional abilities necessary to access educational materials and move about the school. To help students function better in classrooms, the lunchroom, or restrooms, therapists may work with them or with school personnel on adapting or modifying their equipment/materials. Other assistance includes helping students participate in activities outside of the school through mobility on field trips, sports events, on playgrounds and within the community.

Special education students face a demanding environment at school. Presentation methods for educational materials must be modified to meet the challenges of students’ disabilities, such as their ability to communicate, view and manipulate educational materials, maintain postures, and move about the school. Therapists work closely with teachers to promote the highest level of function possible for students pursuing educational goals.

Physical Therapy under IDEA

The Individuals with Disabilities Education Act (IDEA) Part B and Connecticut General Statutes Sections 10-76a to 10-76dd, inclusive, require special education and related services for children with disabilities ages 3 through 21 “who are diagnosed with a disability, or a combination of disabilities listed in IDEA, and who, because of the disability need special education and related services. Related services are “such developmental, corrective, and other supportive services . . . as required to assist a child with a disability to benefit from special education, and includes … physical therapy.”[1] Special education means “specially designed instruction” that meets the unique needs of students with disabilities.

Who is eligible for Physical Therapy?

In order for students to receive physical therapy (PT) services under IDEA Part B, the federal law requires that the students be eligible for special education and that the related service be necessary to assist the students with disabilities to benefit from special education. In this manner, PTs serve in a supportive role, helping students participate in and benefit from special education.

Eligibility covers children with disabilities in any of the following federal classifications who may have a need for physical therapy as a related service:

  • Mental retardation;
  • Hearing impairments, including deafness;
  • Speech or language impairments;
  • Visual impairments, including blindness;
  • Serious emotional disturbance;
  • Orthopedic impairments;
  • Autism;
  • Traumatic brain injury;
  • Other health impairments;
  • Specific learning disabilities;
  • Multiple disabilities;
  • Neurological impairment;
  • Developmental delays (3-5 years).

Eligible students may include at a state’s discretion, individuals, ages 3 through 5, who are experiencing developmental delays as defined by the state. Lack of instruction in reading or math, or limited English proficiency, is not a basis for determining disability.

Will I have to pay for Physical Therapy services?

Required Services for students with disabilities include a free appropriate public education (FAPE). This means special education and related services provided at public expense, under public supervision and direction, and without charge, which meet the state standards. Preschool, elementary or secondary school education is provided in conformity with the students’ IEPs. Services include:

  • Special education;
  • Related services needed by students to benefit from special education means transportation and such developmental, corrective, and other related/supportive services including:
  • Speech pathology and audiology,
  • Psychological services,
  • Physical therapy and occupational therapy,
  • Recreation, including therapeutic recreation,
  • Social work services,
  • Counseling services,
  • Medical services (diagnostic or evaluation only),
  • Parent training and counseling,
  • Assistive technology devices and services,
  • Rehabilitation counseling, and
  • School health services.

What is the Purpose of Physical Therapy? What is the Role of the Physical Therapist?

Physical therapy can help students with disabilities resulting from prenatal causes, birth trauma, illness, or injury. Intervention can:

  • reduce the functional impact of the disability;
  • prevent secondary problems (e.g., contractions);
  • prevent or minimize impairments, functional limitations and disabilities which interfere with participation in educational activities;
  • relieve pain which may occur during educational activities;
  • develop and improve motor function needed in school;
  • control postural deviations;
  • establish/maintain educationally related performance within students’ physical capabilities.

In an educational setting, PT services enable students to benefit from special and/or regular education in the least restrictive environment. PT services develop and maintain the students’ physical potential for independence in all educationally related activities. PTs also collaborate with regular and special education teachers, physical education teachers, maintenance personnel and others to modify and adapt the student’s physical environment, enabling participation in the educational process to the fullest extent possible. The practice act under Connecticut statutes requires physical therapists to obtain a written or verbal referral from a licensed physician before commencing direct interventions.

Based on APTA guidelines, intervention in all settings includes three major elements:

  1. Coordination, communication and documentation;
  2. Patient/client (i.e. student)-related instruction; and
  3. Direct intervention.

Who Refers my child for Physical Therapy?

IDEA and the Connecticut General Statutes mandate that the local education agency (LEA) identify, locate and evaluate all students in their jurisdiction who have disabilities and need special education and related services. The IEP team may refer students to physical therapy services who demonstrate dysfunction in areas affecting educational participation, such as:

  • Posture and positioning;
  • Range of motion;
  • Equilibrium and protective reactions;
  • Manipulative skills;
  • Mobility;
  • Muscular and cardiopulmonary systems strength.

Since referral procedures vary among school systems, therapists should become thoroughly familiar with the process in their assigned school(s). Many schools have an established referral protocol, which may include data collection and introducing alternate educational interventions so that unnecessary referrals can be avoided altogether. This process is sometimes called “pre-referral” and examines work samples, preferred strategies, and problem-solving strategies.

Collaboration remains the foundation for procedure development and implementation. School staff members or parents may initiate referrals in the educational setting. Assessment priorities should focus on the referral concern or complaint. Parents should be included in development and implementation of all aspects: alternate educational interventions, referral strategies, evaluation and intervention. The latter might include: providing equipment and/or strategies for teachers to enhance student performance, and limited direct intervention.

Federal law requires that the LEA obtain informed parental consent before conducting an evaluation. Further, consent for evaluation cannot be assumed as consent for placement. When a physician prescribes physical therapy services, a determination would then need to be made whether the prescription is for educational or medical services. Federal (IDEA) mandates are that school-based PT services must be educationally related. In addition, Section 504 indicates that as teams determine appropriate accommodations for children to access programs, they may need to call upon the physical therapist to provide services. For best practice in referrals, physical therapists should:

  • Assume responsibility for determining the appropriateness of the scope, frequency and duration of services within the parameters of the law;
  • Suggest other appropriate resources to the IEP team when therapists determine that the knowledge and expertise of other professionals are indicated;
  • Educate current and potential referral sources about the process of initiating physical therapy referrals.

Intended to facilitate student learning in regular educational settings, alternate educational interventions are introduced and documented. Sometimes called pre-referral, the intent is to support regular education teachers. LEAs are legally required to document pre-referral, and provide strategies or adaptations to regular education settings before initiating a referral for student evaluation. Sometimes teachers can make simple changes in classroom environments rather than going through a relatively complex referral to the IEP team, which would result in the same change.

How will my child be assessed?

In medical clinics, physical therapists typically assess their clients’ impairments, which might influence movement behavior, such as pain, muscle strength, endurance, etc. Treatment objectives focus on reducing impairments and improving function. In schools, physical therapists identify impairments and functional limitations, which interfere with students’ ability to participate fully in the educational program.

School PTs use evaluation results to:

  • Instruct teachers how to avoid risks for students;
  • Inform parents about problems which must be monitored;
  • Establish baseline data for comparative measurements at the end of the IEP term. School PTs assess students’ functional performance during the school day, rather than conduct “impairment specific” examinations.

School therapy intends to help students and teachers compensate for and accommodate students’ impairments so that students can participate in school as much as possible.

Assessment within the educational setting is a continuous process where the physical therapist works in collaboration with the team to:

  1. Determine eligibility for service within students’ natural environment;
  2. Establish baselines for documenting progress, and
  3. Help plan intervention strategies. An important objective of the assessment/evaluation process is to re-clarify the presenting problem by integrating information from a combination of assessments related to function, environment and curriculum.

School PTs use basic information from assessments to:

  • Document impairments and their degree of severity;
  • Document students’ functional performance level at school;
  • Modify students’ positioning, and methods of functional performance and mobility;
  • Modify the environment to compensate for, or accommodate, existing impairments;
  • Instruct parents, students and teachers about precautions that students with disabilities need to take at school;
  • Advise parents about what they can do at home to maintain or promote educational performance of their children, including incorporating equipment, positioning, and exercise into family routines and activities;
  • Establish a line of communication with therapists and physicians who are seeing the student in a medical clinic;
  • Coordinate with the multiple agencies serving children with disabilities and their families.[2]

[1] 34 C.F.R 300.16.
[2] State of Connecticut, Department of Education, Guidelines for Physical Therapy in Educational Settings (1999) http://www.sde.ct.gov/sde/lib/sde/PDF/DEPS/Special/PTGuidelines.pdf.

 

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