One of the greatest barriers a student with physical or mental impairments can face is the inability to negotiate their school environment. A student’s inability to access their school environment directly impacts their ability to participate in their education! Title II under the Americans with Disabilities Act (ADA), mandates state & local governments follow specific architectural standards with the construction of new public buildings, such as public schools. Furthermore, Title II of the ADA also mandates that state & local governments must also increase access to older buildings with limited accessibility. HOWEVER, if this results in an ‘undue financial and/or administrative burden’ then they are not required to take action!
While public schools work exceedingly hard to accommodate the needs of their students with disabilities, they unfortunately often lack the financial resources to make significant structural changes to their old, inaccessible school buildings. This is especially true of smaller school districts with limited funding. However, even when schools have been updated or are built initially according to these accessibility standards, sometimes children with physical disabilities still struggle to get around campus. This is where school-based physical therapy comes in!
So where are the problem areas around campus? Yep… you guessed it. Stairs. Stairs can be extremely challenging for children with strength or balance impairments or for children whose primary means of mobility is their wheelchair. For children who utilize a wheelchair this is where ramps or elevators come into play! If ramps or elevators are not an option then the school is responsible for accommodating the needs of the child whether this is through requesting that the teacher come to the child for lessons or relocating the class or activity to a more accessible area. For children who are able to walk as their primary means of mobility but struggle with navigating stairs we work repetitively on improving performance & increasing safety during this activity.
Ramps can also pose their fair share of challenges to kids with strength and balance deficits or to kids who utilize wheelchairs and may still be finessing their ability to propel their wheelchair. For children who struggle to negotiate a ramp, we repetitively emphasize ascending & descending (on feet or wheels) any ramps in physical therapy sessions to improve their performance & safety with this skill.
Another problem area can be anywhere that becomes congested, such as the lunchroom, hallways, or even in the classroom. Again, children who struggle with strength or balance may often find it challenging to negotiate through obstacles such as desks or through large crowds of people such as when moving between classes. This becomes especially challenging when you are carrying items such as your backpack, books, your lunch tray/lunch box, etc. Kids who utilize an assistive device such as crutches, a walker, etc. may find this even more challenging and be at a significant risk for falling. So how do we address this? Depending on the child & their level of physical impairment, we may provide accommodations such as leaving class at least 5 minutes earlier to beat the crowd. The child may require a 1 on 1 aid who can assist in making sure they safely get around during their daily activities. They may need another set of books that they can leave at school or in a particular class to prevent having to carry them around. We may work on strength & balance practicing isolated exercises meant to address these deficits or we may practice these exact scenarios modified in physical therapy sessions or in real time to improve their performance.
Accessing the school environment can also be tricky outside around campus on uneven terrain (such as cracked pavement, grass, gravel, mulch, etc.) or when negotiating curbs or graded terrain (such as bumps, hills, inclines/declines, etc.). This outdoor terrain can pose challenges when kids are transitioning to/from recess, having class outside, or are arriving/leaving for the day. Uneven terrain can ultimately increase a child’s risk of falling, especially those that require assistive devices to get around. Again, this is an area we address during physical therapy sessions whether by working on isolated exercises, performing obstacle courses designed to mimic the terrain, or by working in real time on the exact area/terrain on which they are struggling.
While this list isn’t exhaustive, it should hopefully give you an idea of some of the challenges that children with special needs face in the school environment and how school-based physical therapists address these issues!
Catherine C. Skelton, PT, DPT
Pediatric Physical Therapist