School Based Physical Therapy: Collaboration and Positioning Notes

Dr. Emily Dannen: Experience and Professional Background

Dr. Emily Dannen, PT, DPT, presents on the integration of physical therapy within the school setting, emphasizing collaboration and strategic positioning. Her professional background includes:

• Education: Earned both her Undergraduate and Doctoral degrees from Springfield College.

• Experience:

  • Holyoke Public Schools.

  • Amherst-Pelham School District.

  • Consultant for Warwick Schools.

  • Early Intervention specialist.

  • Grant Writing.

  • DESE Coursework through the PASS Institute.

Evolution of Special Education Law and Therapy Foundations

A comprehensive timeline outlines the progression of access, equity, and opportunity for students with disabilities, alongside the historical founding of therapy disciplines.

Special Education Law Timeline

• 1975 - Education for All Handicapped Children Act (P.L. 94-142): The first federal law established to ensure a Free Appropriate Public Education (FAPE) for children with disabilities.

• 1977 - The Education of the Handicapped Act Amendments (P.L. 95-256): Emphasized early intervention and introduced procedural protections for students and their families.

• 1990 - Individuals with Disabilities Education Act (IDEA): Reauthorized and renamed the previous law to reflect a broader focus on students between the ages of $3$ and $21$.

• 1997 - IDEA Amendments: Introduced requirements for transition planning and placed a heavy emphasis on accountability for results.

• 2004 - IDEA Amendments: Focused on the application of scientifically based instruction, the requirement for highly qualified staff, and improved student outcomes.

• 2008 - IDEA Amendments: Promoted the use of positive behavior support and addressed the issue of disproportionality within special education.

• 2015 - Every Student Succeeds Act (ESSA): Reaffirmed the federal commitment to students with disabilities while providing states with flexibility regarding accountability.

Foundations of Therapy

• Physical Therapy (PT): Founded in $1921$ with the establishment of the American Women's Physical Therapeutic Association (AWPTA) in $1917$.

• Occupational Therapy (OT): Founded in $1917$ with the establishment of the National Society for the Promotion of Occupational Therapy.

• Synthesis: Both special education law and the founding of PT and OT are rooted in the fundamental belief that every individual deserves the opportunity to reach their full potential.

IEP Improvement Project: Massachusetts 2024 Changes

The Massachusetts 2024 IEP Improvement Project introduced significant changes to how student needs and visions are documented.

Key Considerations addressed in the New IEP Form

• Bullying: The team must determine if the student's disability affects social skills or renders them vulnerable to bullying, harassment, or teasing. Options include addressing it in the IEP or determining it is not a concern.

• Communication and Language: Specific focus is given to whether communication is a concern, particularly for students who are deaf or hard of hearing.

• Executive Functioning/Organization: A dedicated section to address needs in these areas.

• Health Needs: Documentation of interventions, procedures, or services required for a student to access their education.

• Limited English Proficiency: Consideration of language needs in relation to the IEP.

• Present Levels of Academic Achievement and Functional Performance: Used to describe how the disability affects progress in the general education curriculum.

Shift in Vision Documentation

• The Old Form: Focused on "Parent and/or Student Concerns" regarding what they want addressed to enhance education.

• The New Form (Student's Vision):

  • Ages 3-13: Focuses on "This year, I want to learn…" and "By the time I finish (elementary or middle school) I want to…"

  • Postsecondary Goals (Ages 14-22): Focuses on high school goals, plans for education and training after high school, employment plans, and (if appropriate) independent living plans.

Professional Guidelines: APTA and AOTA Standards

APTA (American Physical Therapy Association)

• Focus on functional outcomes within natural environments.

• Ensuring access to the Least Restrictive Environment (LRE).

• Prioritizing collaboration over isolation.

• Coaching staff to ensure the carryover of strategies.

AOTA (American Occupational Therapy Association)

• Focus on participation in meaningful school occupations.

• Utilizing context-driven interventions.

• Embedding supports directly into natural routines.

• Delivering services through a collaborative model.

Focus Shifts: Body Structure and Function vs. Participation

There is a distinct shift from a medical model to an educational, participation-based model.

School-Based vs. Medical-Based Services

While both share the similarity of performing assessments, providing interventions, and coaching families, their application under IDEA differs from the medical model.

• Eligibility:

  • School: Eligibility depends on the child being determined eligible for special education services.

  • Medical: Eligibility is based on a diagnosis and the requirement for clinical expertise.

• Focus:

  • School: Promoting access to academics and participation in school activities.

  • Medical: Enhancing function at home/community and addressing medical needs.

• Timing:

  • School: When the IEP team decides the service is needed to achieve IEP goals.

  • Medical: When the therapist, family, and physician agree on a medical plan of care.

• Location:

  • School: Anywhere the child performs tasks (classroom, worksite, bathroom, lunchroom) or a separate location if necessary.

  • Medical: Clinics, hospitals, homes, or community settings.

• Delivery Method:

  • School: Embedded in school activities via coaching, consultation, collaboration, or direct intervention (individual/group).

  • Medical: Individual or group direct intervention, coaching/consultation, or embedded in home activities.

Goal Writing and Practice Principles

Comparison of Goal Samples

• School-Based Goal: "Given two verbal cues, Student will navigate the classroom and hallway environment, including turns and obstacle negotiation, to access learning areas in $4/5$ opportunities."

• Medical-Based Goal: "Patient will improve lower extremity strength to $4/5$ to support functional mobility."

Practice Evaluation Philosophy

According to Clark, Fioux, & Chandler (2019), evaluations should identify strengths and needs regarding access and participation. Therapists must apply professional knowledge with best-practice processes to assist teams in determining "educationally relevant and necessary programming."

Collaboration and The School-Based Team Structure

The student remains the central focus of a multi-faceted team involving:

• Administration: Team Leaders, Principals, Assistant Principals, and Directors of Special Education.

• Related Service Providers: BCBA, OT, PT, Speech & Language Pathologists, School Psychologists, Vision Specialists, Teachers of the Deaf, Assistive Technology Specialists, and Adapted PE instructors.

• Teachers: General Education, Special Education, Reading Specialists, Paraprofessionals, and "Specials" (PE, Music, Art) teachers.

• Home/Community: Parents/Guardians, Family, Department of Children and Families (DCF), Early Intervention providers, Outpatient therapists, Special Education Advocates, and Interpreters.

Service Delivery Models and Collaboration Tools

• Tools: Digital platforms like Google Docs are utilized for collaborative documentation.

• Service Models:

  • $1:1$ (Individual sessions).

  • Groups.

  • Cotreatment (Two disciplines working together).

  • Coteaching (Therapist and teacher leading together).

Therapeutic Interventions and Their Developmental Benefits

Common Interventions and Targeted Skills

1. Obstacle Course: Addresses gross motor strength, balance (dynamic/static), motor planning (sequencing), bilateral coordination, core stability, postural control, proprioception (body awareness), vestibular processing, and attention/task completion.

2. Candy Land: Addresses gross motor strength, balance, postural control, motor planning (praxis), bilateral coordination, proprioception, visual-motor integration, social skills, scanning, following directions, and task engagement.

3. BINGO: Addresses gross motor strength, static and dynamic balance, motor planning (praxis/sequencing), bilateral coordination, core stability, postural control, proprioception, motor imitation, visual-motor integration, following directions, and endurance/activity tolerance.

4. Aiming & Throwing: Addresses hand-eye coordination, upper extremity strength, shoulder stability, motor planning (aiming/sequencing), bilateral coordination, visual tracking, postural control, and core stability.

5. Bowling: Addresses hand-eye coordination, motor planning (sequencing), bilateral coordination, dynamic balance, postural control, visual-motor integration, upper extremity strength/control, and problem-solving.

6. Balance Activities: Specifically targets postural control, ankle strategies, weight shifting, and core stability.

7. Open Ended Play: Utilized to address specific individual deficits through customized setups.

Positioning Strategies for Student Participation

Strategic positioning is used to support P.E. and classroom activities:

• Supine Activities: Exercises performed lying on the back.

• Prone Activities: Exercises performed lying on the stomach (e.g., using a wedge or therapist support).

• Side Lying Activities: Useful for stretching a shortened side; often used for children with Cerebral Palsy to manage muscle tone.

• Seated Activities: Focused on stability during desk work or floor time.

• Anchor Activity: A motivating, familiar activity used consistently across sessions to increase engagement, practice opportunities, and participation.

Adaptive Equipment and Purposeful Implementation

Adaptive equipment in schools (e.g., specialized seating, standers, gait trainers) must serve a specific diagnostic purpose. Questions for implementation include:

• What are the physical demands of the curriculum?

• What can the student access, and what are the barriers?

• What modifications ensure safe participation?

• What skills can be taught to promote student success?

• How can classroom staff be trained to alter lesson plans or provide suggestions?

Case Study: Eddie (8-Year-Old with Cerebral Palsy)

Student Profile

• Diagnosis: Cerebral Palsy (Quadriplegia).

• Physical Presentation: High muscle tone, extensor preferences, low neck control, flexed wrists, and clenched hands.

• Support: Dedicated $1:1$ adult aide for building navigation, equipment transitions, and activities of daily living (ADLs).

• Current Team Goals:

  • PT: Identify postural stability for table-top access.

  • OT: Modifications for tools used in paper-based school work.

  • SLP: Improving breath support for sound production and switch access for AAC/requests.

Team Challenges for Eddie

1. Identify two additional possible members for Eddie’s school team (e.g., Assistive Technology Specialist, Adapted PE).

2. Identify a collaborative method (e.g., shared data on Google Docs).

3. Write a collaborative OT and PT goal (e.g., accessing a switch through improved trunk stability and wrist positioning).

4. Select an intervention tool and create a cotreatment session.

5. Choose one type of adaptive equipment for mobility (e.g., power wheelchair with head array control) and necessary accessories.