Physical Therapy

Physical Therapy

What Do Physical Therapists Do?

Physical therapists make sure that children can move about in their school setting, playground, bus and anywhere else that students go. Their role is to ensure that children with mPTor needs have full physical access to all aspects of their school life.

PT in School

The primary role of Physical Therapists and Physical Therapy Assistants in school-based practice is to work with a team to ensure that students are able to physically access their educational environment. This can be done by remediating and strengthening, by helping to design and implement accommodations, by working with families and community providers around equipment, and by educating and advising the staff that work with students daily. Assessment, treatment, communication, written reports, and keeping up with best practice are all parts of the job of a School-Based PT.

School-based PTA's share in all of these responsibilities as well, under the supervision of a PT.

Definition

According to the Virginia Regulations governing Special Education Programs for children with Disabilities.

“Physical therapy” means services provided by a qualified physical therapist or under the direction or supervision of a qualified physical therapist upon medical referral and direction.(Regulations Governing the Practice of Physical Therapy, 18VAC112-20; 34 CFR 300.34(c)(9))

PT’s Role In School

  • Part of the special education team
  • Helps to identify barriers to participation in and benefit from educational setting
  • Helps to make a better “match” between the student’s skills and the demands of the school setting
  • May use consultation to staff & family and/or direct work with the student

PT is a “Support Service” In Schools

  • This means that PT is added on to an IEP or 504 to support the primary service providers:
    • Special educators
    • Speech & Language Therapists
  • SO… Students must first be found eligible for special education services before schools are required to consider providing direct PT services.

Process To Determine Need For PT Services

  • Often, a request for assessment is made by the special education team.
    • This can be part of initial or triennial evaluation, if it is strongly suspected that PT will be needed.
    • It may be a result of discussion around developing an IEP.
  • Following assessment by an PT, the educational team will meet to consider the results of the assessment and determine whether it is necessary to add PT services to the student’s plan.

What Are The Criteria For PT Services?

  • IEP or 504 Team decision, given the guidance of an PT (after observation &/or assessment)
  • Services must be driven by the IEP/504 goals
    • There should not be “PT goals,” but educationally-related goals that the PT is helping to work towards

Medically-Based and School-Based Physical Therapy

Differences Between Medically-Based and School-Based Physical Therapy

Many people are familiar with Physical Therapy (PT) through a medical setting. They may have a family member who received therapy after an injury or as part of rehabilitation in a clinic or hospital in their community. Parents may receive a referral for Physical Therapy for their child from their pediatrician. However, there are some differences in PT delivery within the school setting from the medical or health-related setting.

Things You Might Observe PT's Doing

Medically-Based School-Based

PT’s may:

  • Use heat/cold, Electrical stimulation (TENS), ultrasound, etc.
  • Assign exercises for home programs to strengthen specific muscles
  • Teach patients and care-givers transfers (between chair and bed, chair and bathtub, for instance)
  • Use bars, balance boards, etc. to work on gait training and use of mobility devices
  • Perform hands-on muscle releases, wound management, massage etc (as qualified)
  • Work with people of all ages post-injury to regain strength and range-of-motion, under doctor’s guidance
  • Be part of an athletic training team with a focus on avoiding injury
  • Assess aspects of gross motor skills to find areas of dysfunction, weakness, or limited range of motion and recommend goals for those sub-skills (for example: increase strength of deltoids to “fair-plus”)

PT’s may:

  • Work with community providers to select, adjust, and monitor assistive devices for mobility and positioning (wheelchairs, for example)
  • Teach classroom assistants and students how to maintain students’ strength and range of motion through the school day
  • Teach classroom staff and student how to safely transfer in school (between chair and toilet, for ex.)
  • Work with students in actual daily setting to work on positioning & mobility (stairs, playground, doors…)
  • Help find ways that students with physical disabilities can actively participate with their peers in activities (phys. ed. class, recess, and fieldtrips are some examples)
  • Assess and modify furniture for positioning of students with special needs (add a footrest to a chair, for instance)
  • As part of a team, address safety concerns in the design and emergency plans of schools
  • Assess PT needs functionally and specifically to the school setting

Frequently Asked Questions

Q: Why do PTs work in schools?

PTs who work with students in public schools are employed by the schools. Their services are mandated by the Individuals with Disabilities Educational Act (IDEA), and by Section 504 of the Americans with Disabilities Act (ADA). The scope of these services are guided by these laws.

Q: How can my child receive PT services?

Anyone can access PT services within their community. There are procedures that must be followed to have these services covered by health insurance, and PT is stipulated in Virginia to be “upon medical referral and direction,” so that a referral by a physician is requested. But there is no official “qualification” process to access medically-based PT. This access usually begins with an evaluation to determine whether services are recommended to work on related needs and goals.

By contrast, Physical Therapy within the school setting is part of a child’s Special Education programming, through an Individualized Educational Plan (IEP) or a 504. In order to receive direct PT, a student must first qualify for Special Education services through the Eligibility Process. This means that a student must have a learning or other disability that interferes with his or her participation and/or progress in the school setting. PT services never “stand alone” on an IEP. They are “Support Services,” meaning that they are included in an IEP if they needed to support the primary Special Education services (such as Speech Therapy or services from an Exceptional Education teacher).

If he or she does is not found eligible under IDEA, a student may qualify for a 504 if he or she has any disability, long-term illness, or various disorder that “substantially” reduces or lessens his or her ability to access learning in the educational setting. For example, a student with a missing limb may need accommodations in the cafeteria, PE class, and in accessing equipment in the classroom but may not have any learning problems per se.

If a student is not found to qualify for either an IEP or a 504, the school is not required to provide OT & PT services. In fact, the school cannot provide those services without written permission from parents.

Q: Why won’t the school therapist do what my clinic-based therapist does?

A second difference between medically-based and school-based PT is the scope of the focus of services. A clinic or hospital-based therapist may evaluate, recommend services, treat and monitor progress for any impairments that can be measured. A clinic-based physical therapist may work on strengthening and range of motion on a teenager’s knee after a soccer injury, so that she can return to playing this extracurricular sport.

Within the school setting, however, PTs address disabilities, skill deficits, and/or injuries that directly impact that student’s ability to participate in and benefit from school-related tasks and roles. In the above examples, even if the students may qualify for Special Educational services due to learning differences, they may still not qualify for school-based PT. They do not need to be able to play guitar or soccer or tolerate a bath to be able to benefit from their educational setting. The skill deficits would need to be such that their educational performance or participation in school activities is significantly impacted.

Q: But my doctor wrote a prescription for the school to provide PT.

Doctors will sometimes write a recommendation or even a prescription for PT services through the public schools for a particular student. A private professional who evaluated the child may make recommendations of services or accommodations that they feel may be helpful in the school setting. The educational team (which includes the parent) for that student does need to consider that request, but it remains up to the team to determine whether the student requires those services within the actual serving school setting. Information specific to that student and how he or she is performing within his or her classroom and other school setting should guide this decision.

Q: Might a PT work with my student even though she doesn’t qualify for special education?

Some school districts do choose to utilize the expertise of their PTs beyond IDEA/IEP and 504 requirements. This is sometimes used as part of a Response to Intervention (RtI) model, a tiered approach, or a collaborative model. A school district may have staff OTs demonstrate to teachers how different teaching methods for visual-motor tasks may benefit students who learn differently, for example. They may arrange to have PTs share the importance of movement breaks for best learning. They may utilize both OTs and PTs in designing physical plants, emergency planning, curriculum design, and supply lists. PTs may even work directly with whole classrooms of students to demonstrate helpful techniques for classroom staff or to help conduct regular screenings. This level of inclusion of Therapists within the Regular Education environment may benefit students who do not qualify for direct therapy services.