How does Physical Therapy work in the school setting?
After my introduction last week you may be thinking how do physical therapy services work in the school setting?
You may be familiar with the medical or clinical based model of pediatric physical therapy where delivery of services happens in the hospital, home or community settings (parks, playgrounds, daycares, etc.) in order to address impairments with range of motion, strength, balance, coordination, gait (walking pattern), and/or overall gross motor skills to improve function & participation in these environments. While there are some similarities between the clinical model & the school or educational based model, the environment in which services are provided and their overall purpose differ.
The school-based model of physical therapy services is provided as a related service through the Individuals with Disabilities Education Act (IDEA). IDEA is a federal special education law that ensures public schools provide special education to and appropriately serve the educational needs of students with disabilities. Thus, school-based physical therapy is provided ONLY in the educational setting, meaning on the school campus (or school-related activities such as field trips) & during school hours. Furthermore, the child must have a disability or disorder that is negatively impacting their function or participation at school to qualify for physical therapy services. Unlike the medical model in which the physical therapist or physician determines if the child qualifies for physical therapy services, this is a team decision in the school setting. The team typically consists of the child’s parents/caregivers, special education teacher, general education teacher, and other related service providers that the child may be receiving (potentially speech therapy, occupational therapy and/or psychology or behavioral health services). This team then determines if a student is unable to learn or participate during their school day without physical therapy services. Ultimately, school-based physical therapy services must absolutely be educationally relevant and should only be provided if a student would not be able to access their education, learn, or participate in school activities without these services.
Range of motion, upper body/core/lower extremity strength, balance, coordination, endurance, and gait (walking) impairments can all impact a child’s ability to participate in their educational environment. For children with disabilities who may have some of these impairments, one of the biggest barriers can be physically accessing their school environment. Being able to ascend/descend stairs (both on/off the bus & around campus), step up/down from curbs, walk up/down ramps, negotiate obstacles or crowds in the hallways while transitioning between classes are all important functional skills that happen throughout a child’s day at school. Furthermore, these impairments can impact a child’s ability to sit & maintain erect posture at their desk, to coordinate gross motor activities in physical education (PE), to climb & utilize playground equipment, and to participate in events such as field day or field trips.
Remember though children can receive both medical & school based physical therapy services based on their needs. Just because a child receives medical based physical therapy does not mean they will qualify for school based & vice versa. Again, it all depends on how they are functioning & participating within that specific environment.
Hopefully, this post sheds some light for you about the purpose of school based physical therapy and the overall goals we pediatric therapists have for our students!
Catherine C. Skelton, PT, DPT
Pediatric Physical Therapist