Dear Parent,
There is so much confusion about educationally and medically based physical therapy services, even amongst therapists themselves, that I would like to share a few things that should always be included in a school based PT assessment. These are areas that impact a child’s day in school, their ability to attend to their teacher in the classroom, keep up with their peers in the hallways, recess and PE and most importantly their behaviors- behaviors that are not under their control but which can be minimized with the adults in their life knowing how to address the behaviors effectively.
Sensory Motor elements of an Educationally Based PT Evaluation
Negotiating the school environment.
Assess
- need for adaptive equipment
- Ability to move around without bumping into furniture/peers
- Ability to transition in the hallways appropriately when compared to age equivalent peers
- Ability to get on and off the school bus safely.
- Ability to negotiate steps/ramps/curbs within the school environment.
Ability to sit in the classroom and attend for atleast 30 minutes
Assess
- need for adaptive equipment( cushions, ball chair etc) to decrease tendency to “fidget”.
- Need for adaptive equipment to improve upright posture.
- Need for strategies to decrease tendency towards “instant gratification” and increase strategies for turn taking.
- Need for movement breaks structured into classroom routine.
Repertoire of Play skills
Assess
- A detailed assessment of the various play equipment (s)he uses ( different play equipment stimulate different sense organs) in the indoor and outdoor gym area.
- Ability to play with different sized ball…starting first with a playground sized ball.
- Ability to run ( stop and turn at will-play tag), jump, hop, walk sideways, run sideways, walk backwards ( skills needed in the school playground etc)
- Ability to use a trike, wagon, floor scooter
- Ability to keep up with peers during PE.
- Ability to play in different developmental positions ( on the belly, back, kneeling, squatting, transition in and out of these postures etc)
Safety skills
Assess
- Body and spatial awareness ( related to bumping into things , ability to draw a stick figure, touch different parts of the body with eyes closed etc).
- Ability to “stop” and “turn” at will while running/walking fast.
- Ability to “grade” movement ( appears to “hit” others, hug people too “hard” etc)
- Balance ( frequency of falls)
Factors that impact implementation of therapy recommendations
- Teachers understanding of the student’s diagnosis on school functioning.
- Teacher’s beliefs and expectations from the resources that are available for the student.
- Therapist and teacher(s) agreeing to a mutual convenient form of communication ( email, phone, in person meeting) to discuss blocks or concerns regarding implementation of therapy recommendations.
- Identifying the frequency of consultation services and penciling the time and date into respective schedules.
- Maintaining data, notes on areas discussed and action plan. Following up on action during the next meeting.
- Making timely modifications to ensure that a decline in functioning is prevented.
Your child’s assessment should have functional baselines of the outcomes that are being targeted for that academic year. For eg- if the number of falls are being targeted, the number of falls at the start of the year should be documented and during every marking period progress note. Adults monitoring and reporting falls should be aware of the therapist’s definition of what constitutes a fall. Eg, I used to inservice my school staff that a “soft fall” whereby a student gradually lowers themselves to the floor and is able to stand up without any injury to self, does not constitute a “fall”. When in doubt, I always have an in service for all adults that interact with the student.
The amount of time a student takes to get off the bus and be seated in the classroom needs to be documented and improved upon if appropriate.
Ability to keep up with peers in the hallways and ways of tracking progress requires to be documented, so that anyone reading his report and observing him on any particular day, has an idea of his progress or lack of it.
The degree of physical, verbal and gestural assist your child needs during recess, PE, school concerts and parades should be documented and objective ways of tracking progress needs to be established.
Range of joint motion and muscle strength is important, but it needs to be translated into function and routine activities that impact your child’s functioning in school.
Hope this article helps you when you advocate for your child’s physical therapy services at school.
Dr. Pillai draws from more than 25 years of professional experience serving students from preschool to high school in multiple NJ school districts. She is a tireless advocate for children and welcomes the opportunity to help parents ensure that their child has a well written IEP. If your child has recently qualified for an IEP/504, or your school is developing a new IEP for him/her, call Dr. Pillai as she works at Playground To Learn to see how she can help you help your child.