Physical Therapy

Physical Therapy Los Angeles Unified School DistrictOT PT AT Program

Background• The profession of physical therapy involves the

application of skilled treatments to help individuals improve both motor function and access to their environment.

• Physical therapists are skilled, degreed and licensed health professionals whose education encompasses a background in human anatomy and physiology, physical pathophysiology, whole body kinesiology, gait and posture analysis, physical treatment modalities, human development, motor control/learning, and cardiopulmonary, orthopedic and neurological rehabilitation.

School Physical Therapy

• In the public schools, physical therapy is used to enhance the student’s ability to function within the educational environment.

• Physical therapists use techniques that correct, facilitate or adapt the child’s functional performance in motor control and coordination, posture and balance, functional mobility, activities of daily living and use of adaptive equipment.

3

School Physical Therapy

• School physical therapists address environmental factors, a child’s physical and sensory motor needs, as well as activities that support participation and access to the child’s curriculum.

• The areas addressed by school-based physical therapists must directly relate to the child’s performance within their school setting (campus, classroom, playground, cafeteria, bathroom and library).

The Role of the School Physical Therapist

School physical therapists are involved in:

• Prevention and pre-referral activities (RtI2)

• Assessments and student program planning for individuals with exceptional needs

• Teacher, staff and parent training sessions

• Treatment

• Collaboration with all service providers

The Role of the School Physical Therapist: Pre-Referral and Response to Intervention

(RtI2)

Response to Instruction and Intervention (RtI2)

is a systemic multi-tiered framework that guides

the development of a well integrated system of

instruction, and intervention that is matched to

student need and directed by student outcome

data from Multiple measures. (BUL- 4827.1 Multi

Tiered Framework for Instruction, Intervention,

and Support)

The Role of the School Physical Therapist: Pre-Referral and Response to Intervention (RtI2)

The five essential components of RtI2:

– Multi-tiered framework to instruction and intervention

– Problem-solving process– Data-based decision making– Academic engaged time– Professional development


• The physical therapist is an integral part of the RtI2 process in the general education setting.– Contribute expertise to the problem solving

process– provide strategies for any student who may have

challenges in the area of motor development• The problem solving process includes:

– defining the problem, – analyzing the problem, – implementing intervention strategies, and– evaluating the response to the instruction

and intervention.


A Problem Solving Cycle in General Education

IdentificationPhysical therapists may be called upon to assist in theidentification of motor and educational access issues studentsmay be experiencing.

Problem AnalysisPhysical therapists are highly trained experts in theidentification of motor deficits and educational access issues students may be experiencing.

Intervention DesignPhysical therapists will assist the educational team withstrategies and accommodations for children with disabilities.

Response to Instruction and InterventionPhysical therapists will also assist the educational team withprogress monitoring, ongoing data collection, and evaluationto determine the success or failure of the intervention and tocontinually to determine the level of intensity and supportnecessary for individual students.


• In this multi-tiered approach to intervention, teachers provide instruction at each tier of service that is differentiated, culturally responsive, data-based and aligned to the grade-level content standards.

• Physical therapists may participate at each tier level, as well.


PREVENTION AND PRE-REFERRAL (EARLY INTERVENING) PRACTICES IN GENERAL EDUCATION

Tier 3: Intensive Instruction and Intervention

Tier 2: Strategic or Supplemental Instruction

Tier 1: Core Instruction


PREVENTION AND PRE-REFERRAL PRACTICES IN GENERAL EDUCATION

Tier 3: Intensive Instruction and Intervention “Intensive Intervention,” is for an estimated 1-5% of students who need individualized and/or very small-group instruction that is highly focused, in addition to Tiers 1 & 2, and designed to accelerate student progress.

Tier 2: Strategic or Supplemental Instruction It is expected that 10-15% of students will need additional time and type of instruction to learn successfully.

Tier 1: Core Instruction It is expected that of all of the students receiving core instruction, 80-85% of students will be proficient when good first instruction is delivered.


Prevention - Tier One: Core Consultation

•During Tier One, consultation is focused on increasing the general knowledge base of teachers regarding motor development, motor impairments, and the relationship to the curriculum and function within the school environment.•At this level, students have not been identified as requiring physical therapy services.


Prevention - Tier One: Core Consultation

Activities may include: • In-service training to provide general guidelines for

typical motor development• Offering suggestions for incorporating skill-building

activities to improve motor function in the classroom• Demonstrating activities that are implemented by

the classroom staff• Suggesting ideas for setting up the classroom for

student success• Assisting with environmental accommodations for

students to access the curriculum, classroom, and campus.


Prevention - Tier Two: Strategic or Supplemental Instruction and Intervention

• During Tier Two, it is the responsibility of the physical therapist to screen a student for possible motor delays.

• Screenings are conducted in a natural environment to elicit a representative sample of the student’s motor abilities.

• Screenings must not involve pull-out or any activity which removes the student from his/her regular school activities.

• Screenings may include observation of a student in a peer group if it does not single-out the student who is being observed.


Prevention - Tier Two: Strategic or Supplemental Instruction and Intervention

Activities may include: • Observing the student in classroom or other school

environments• Consulting with parents, teachers, and other school

staff regarding concerns about the student• Reviewing teacher data regarding the outcomes of

classroom accommodations from Tier One• Follow-up screening, as appropriate• Reviewing of educational records.


Prevention - Tier Three: Intensive Instruction and Intervention

• The purpose is to focus on specific motor skills that are required for the student to access the educational program

• Tier Three continues as long as the student continues to make progress in the development of targeted skills.


Prevention - Tier Three: Intensive Instruction and Intervention

Activities may include: • Consulting with the classroom teacher and/or parent on

a regular basis to monitor the recommended supports and accommodations and to adjust these, as needed. (The classroom teacher implements and documents progress for the recommended targeted interventions)

• Providing follow-up consultation to the classroom teacher, staff, and parents if during the SST meeting, targeted intervention strategies and accommodations are deemed necessary based on identified goals

The Role of the School Physical Therapist : Pre-Referral and Response to Intervention (RtI2)

• Throughout all of these phases, progress is continuously monitored.

• If a student continues to struggle with motor skills after targeted interventions and accommodations are in place and documented for a reasonable amount of time (as determined by the SST), a referral for a special education evaluation should be made.

Referral To Special Education

• The purpose of an initial special education eligibility evaluation is to determine whether a child has a disability and the nature and extent of the special education and related services that the child needs

• This evaluation may or may not include an physical therapy assessment, depending on the areas of concern.

School Physical Therapy in LAUSD

• Within Los Angeles Unified School District the school physical therapist participates in the identification of appropriate referrals, assessment, and student program planning.

• The physical therapist develops and implements intervention, and collaborates with the educational team members, utilizing the philosophical framework of the Ecological Model of Student Success.

The Educational Framework For Child Success

What are the Possible Indicators for a Physical Therapy Referral?

Children who demonstrate:• Difficulty in accomplishing tasks without the use of adaptive

equipment, environmental modifications, or assistive technology

• Poor balance or frequent falling• Postural, orthopedic abnormalities • Delayed gross motor skills• Difficulty learning new motor tasks• Difficulty in moving or moving unsafely in the school

environment• Difficulty in maintaining an appropriate sitting posture

If a Physical Therapy Assessment is Requested…

• Upon parent permission to assess, a school physical therapist completes an assessment.

• The Physical Therapist: – Assesses the child’s strengths and needs

(foundational components) that support or limit his participation in school and access to the curriculum

– Analyzes the environment, the curriculum and tasks, in order to determine if the child is able to successfully participate in his/her educational program

Physical Therapy Assessment

Physical Therapists:• Assess Foundational Components:

– Gross Motor Skills– Endurance– Postural Control– Motor Control and Coordination– Strength and Stability– Balance– Functional Mobility– Tolerance for Positioning and

Movement– Environmental Adaptations and

Modifications


Physical Therapists:Analyze the Environment:

– Campus– Classroom– Playground/Yard– Cafeteria– Bathroom– Library– Cafeteria– Auditorium

http://www.otda.state.ny.us/main/FSNEP/images/cafeteria.gif

http://www.cleansafeenergy.org/Portals/0/Classroom.jpg

http://www.moreland.k12.ca.us/schools/Baker/GIFfolder/library.jpg


Physical Therapists:Analyze the Curriculum and Tasks:

– Sitting upright in a chair or on the floor during circle time

– Keeping up with peers when walking from the classroom to the play yard

– Moving within the school environment with minimal need for assistance

– Negotiating obstacles within school setting

– Navigating the play structure with the least amount of supervision necessary for safety

– Navigating and engaging in movement exploration during playground activities

http://images.google.com/imgres?imgurl=http://www.highlands.k12.fl.us/~eseweb/MCj02921020000%255B1%255D.gif&imgrefurl=http://www.highlands.k12.fl.us/~eseweb/&h=172&w=193&sz=4&hl=en&start=138&um=1&tbnid=1StGMUoeUsGKxM:&tbnh=92&tbnw=103&prev=/images%3Fq%3Dstudent%2Bsitting%2Bin%2Bdesk%2Bimage%26start%3D126%26ndsp%3D18%26um%3D1%26hl%3Den%26safe%3Dactive%26rlz%3D1T4SUNA_enUS239US239%26sa%3DN

Determination of Need for Physical Therapy Services

Physical Therapists:• Determine the supports and barriers to learning in the

educational environment by assessing the child across the school campus in order to paint an accurate picture of the child’s ability to access and make progress in his/her program

• Consider the curriculum, and relate foundational skills to the child's ability to function in his/her program

• Gather all the evidence including observations in context, teacher and family input, formal and informal assessments, etc.


Physical Therapists:• Use evidence-based practice by integrating child factors,

professional expertise and research evidence• Consider how the child’s goals and desires, affect

participation• Determine how services will impact the child’s ability to

access and make progress in his/her program• Make recommendations to reduce the barriers to learning

(e.g., accommodations, adaptive devices, etc.) • Use the assessment process to predict future needs


• If the child is supported within his educational environment and is accessing and benefitting from his curriculum, physical therapy is not required.

• If needs are identified in accessing and making progress in his curriculum, physical therapy is recommended as a related service.

• The therapist uses his professional expertise and scientifically based research to determine the intensity and frequency of intervention.

31School Physical Therapy

Physical Therapy Intervention in Special Education

• Physical therapy services are defined as a continuum of intervention strategies including individual and/or small group, consultation, monitoring and collaboration in order to achieve a desired goal for the child.

• All strategies consist of working directly with the student to one extent or another.

• Treatment session time, frequency, and location of services are determined on an individual basis.


• Treatment may also be provided as a co-treatment with other related services (Occupational Therapy, Adapted Physical Education, and Language and Speech).

• School physical therapy, as a related service, requires a medical diagnosis in order to provide treatment (California Business and Professional Code: Sections 2620-2621).


Physical therapy services may fall into three categories, and

like a pendulum, service delivery may swing back and forth

between the more intense to less intense depending on the

level of support needed at any given time to meet the

student’s core academic program needs:

•Consultation

•Collaboration

•Direct Service


• Consultation– Provided directly and indirectly to the student

consisting of regular review of student progress, observation, accommodations and modifications of core material, developing and modeling of instructional practices through communication between the general education teacher, the special education teacher, parent and/or related service provider


• Collaboration– General education teachers, special education

teachers and/or related service providers work together to teach students with and without disabilities in the classroom

– All are responsible for the direct instruction, planning and delivery of instruction, student achievement, progress monitoring and discipline to support the student goals and objectives and to access the curriculum.


• Direct Service– Instruction or service by a single special education

provider designed to support, bridge and strengthen student skills.

– Opportunity to provide specific skill instruction, re-teach, pre-teach, and scaffold instruction to support student goals and objectives and to access the curriculum.

When is a Child Ready to Graduate from Physical Therapy?

• The recommendation for continuation or graduation of physical therapy services is determined by the professional expertise of the physical therapist in collaboration with the IEP (Individualized Education Program) team.

• There are several factors to consider when making decisions regarding physical therapy service completion.


Possible Factors Include:•The student’s needs being addressed by physical therapy no longer negatively affect his/her educational performance in the regular education or special education program.•The student no longer requires PT as a related/DIS service in order to benefit from his/her special education program.•Therapy is contraindicated because of the change in medical or physical status.•The student’s needs will be better served by an alternative program and/or service, as determined by the IEP team.


Possible Factors Include (continued…):•The student consistently demonstrates behaviors that inhibit progress in physical therapy:

•such as lack of cooperation, motivation, or chronic absenteeism. •IEP team should consider the initial eligibility decision since these behaviors may reflect social maladjustment, environmental, cultural, or economic factors rather than an actual disability.•IEP team may also explore alternative services or strategies to remedy the interfering behaviors or conditions.

•He/she graduates from high school and/or reaches the age of 22 years.

Physical therapy services are intended to target specific areas of weaknesses related to educational access. They are not necessarily intended to be ongoing services for the duration of the child’s academic career.

Physical Therapy ProgramContact Information

OT PT AT Program

Beaudry Building—18th Floor

333 South Beaudry Ave

Los Angeles, CA 90017

Phone: 213-241-6200

Fax: 213-241-8435

Documents

Physical Therapy