1. School- Based Physical Therapy Compiled by Ellen Van Vranken, PT, CAS

2. Definition Physical therapy – a medically based profession oriented to: Improving sensory/motor function Diminishing pain Preventing future disability Enhancing functional motor skills

3. School-Based P.T. Related service as defined by IDEA. Provided to help students benefit from their special education program and/or to access educational activities within the least restricted environment. Services include direct intervention and integration of that intervention into the school environment.

4. School Based P.T. Services directed toward:  Prevention of future disability  Developing, improving, restoring sensory/motor function  Collaborating with others to improve accessibility and participation in all school activities

5. Medical Model Educational Model Patient Medical Facility Individual /Pull-out Treatment Student School Environment Collaborative problem solving with daily carryover

6. Concept of Role Release Best practice initiative whereby PT provides training and consultation with school staff who have daily interactions with student on ways to consistently address physical issues that naturally occur within the school day. Examples: Transitions, playground access, navigating lunch tray, PE expectations and accommodations, therapeutic exercise, splints, walkers, stander use, braces, positioning for function, transfers, re-design of classroom for wheelchair user, access to transportation, evacuation procedures etc.

7. Functions of School-Based PT  Assessment: evaluate and interpret findings as a member of multidisciplinary team.  Direct Services: treatment procedures and interventions designed to help student overcome obstacles interfering with educational program or in functional expectations as a student.  Indirect services: consultation and collaboration with parents, school staff, other medical professionals.

8. Assessment Procedures Formal Assessment Tools Typically Used: ROM (range of motion)Testing Manual Muscle Testing Reflex Maturation Testing Peabody Scales of Gross Motor Development Bruininks-Oseretsky Test of Motor Proficiency Assessments should include observation within the school environment!

9. Assessment Procedures Formal assessments used in collaboration with others: - Pediatric Evaluation of Disability Inventory (PEDI) - Callier-Azusa - School Functional Assessment (SFA) - Hawaii Developmental Scale - COACH Assessment Assessments should also address how student’s disability affects progress in their educational program or in access/participation in school activities.

10. Assessment Procedures Informal Assessment Tools Used: - Functional mobility Check Lists - Teacher/Parent Check Lists - Parent/Teacher Interviews - Sensory Processing Questionnaire - Ecological Assessments - Direct school based observation ( PE, playground, school transitions, positioning in classroom, mobility in class, equipment assessment, ability to use transportation) - Clinical observations of joint mobility, muscle tone, posture, strength, coordination, motor planning, balance, attention, response, gross motor skills, adaptive equipment

11. Direct Services Direct Services: treatment procedures designed to help the student overcome obstacles interfering with their educational program or in the many functional skills expected as a student. - Therapeutic exercise - Coordination training - Strength and endurance training - Mobility training (gait, walking devices, transfers, efficiency, endurance) - Balance / Motor Planning - Motor Skill Development

12. Direct Services (cont.)  Training in use of adaptive equipment  Adaptation/modification/ repair of equipment  Early intervention

13. Indirect Services Indirect services:  Consult and collaborate with parents, school staff, other related service and medical providers.  Facilitate wellness and disability awareness within the school environment.  Train/Supervise PT assistants, students, school staff.  In-service education: body mechanics, transfer methods, equipment use, surgery implications, ROM exercises, therapeutic positioning, etc.

14. Art of Collaboration PT services dovetail with other professionals Must be flexible and aware of specific needs of both student and teaching staff. Input from team members is crucial for effective assessment and intervention.

15. Collaboration Discussion How does the model of referral for PT/OT services in your system support a collaborative approach? Discuss the delivery of related services in your system. Positives and negatives. Share experiences of collaborative problem solving. Share ideas for promoting a more collaborative approach in meeting the needs of your students vs. a more traditional “pull-out” system for treatment sessions.