How Physical Therapists Utilize Universal Design For Learning

Back at it today to discuss how school-based physical therapists use the principles & framework of Universal Design for Learning (UDL) in their practice. Remember UDL is a framework based on scientific research about how human beings learn that seeks to optimize teaching & learning for all individuals. While I am not an educator or teacher in the traditional sense I am still involved in teaching students whether that be how to perform a specific gross motor skill or an exercise/activity, how to regulate their nervous system, how to utilize orthotics or a piece of adaptive equipment, how to position their body in order to maintain good posture, how to be more aware of their body (its position and its position in relation to others & their surroundings – i.e. body awareness), etc. I even educate teachers as well as parents/caregivers about these things in regards to their child/student. In order to do that I have to understand how human beings learn and what is the most effective way to engage them & present information. To the best of my ability, I attempt to utilize these principles to reach all my students, teachers, and parents/caregivers to ensure true learning that is accessible to all individuals is taking place. 

3 Principals of Universal Design for Learning

There are 3 principles of UDL¹: engagement, representation, and action & expression. Each principle has 3 guidelines and each guideline has at least 2 checkpoints. In order to not get too lost in the weeds, I’ll cover the 3 principles and the 3 guidelines of each principle.

First Up: Engagement

Today I’ll focus on the first principle… engagement!

Engagement: Engagement is the ‘why’ of learning and involves the affective networks of the brain (i.e. amygdala, orbitofrontal cortex, temporal cortex, pallidum, & insular cortex). Individuals are motivated by different factors and differ greatly in the manner in which they are engaged to learn. There are also a variety of factors that influence engagement such as background/culture, neurology, personal relevance, subjectivity, prior knowledge about the topic, etc.

How a School-Based Physical Therapist Utilizes Engagement

• Recruiting Interest: If information does not engage a learner in such a way that they can attend to it and interact with it then it is considered inaccessible. 
  • I really try to give my students a choice in what activity we work on for the day; typically I will give 2-3 options and then let them decide. If there is something in particular I really need us to work on then I let them choose the toy they want to play with for the activity. For example, if we need to work on catching I let them choose what we will use to catch & throw such as a bean bag, ball, stuffed animal, etc. and will even let them choose characteristics down to the color, texture, weight & size.

• Sustaining Effort & Persistence: Being able to sustain attention and effort is imperative to the learning process. Individuals especially children & adolescents differ significantly in their ability to sustain attention & effort. Building the ability to sustain attention & effort is an important goal that will improve the learning process and maximize learning opportunities.
  • In order to sustain effort & attention I often talk to students about their goals in therapy and why these are important. Sometimes if an activity is too challenging I will modify it or scaffold my support (give just exactly enough support so they can complete the activity – this can be physical assistance and/or visual, verbal and/or tactile cueing) so that the child has more success; if the child never has success with an activity they will often tire of it and begin to dread it.

• In order to sustain attention I also try to base all of my activities in play (play based therapy), so for example if I need us to practice kicking a ball instead of having the child just kick back and forth with me, I may have them kick towards something like bowling pins, cones, or stacked blocks, etc. in order to knock it over which is a lot more motivating. Furthermore, oftentimes children, especially younger ones, like the toddler age, aren’t as motivated to participate in an activity until they see their peers do it. So if I am having trouble getting them to participate I will try to include peers for collaboration & community to really help build the sense of importance & the why behind the game, activity or skill we are completing. 

• I also try to give a lot of verbal feedback & encouragement about how important & awesome the level of effort they are putting into the activity versus just their ability to complete it. Encouraging & praising effort along the way even in a modified performance of the activity or even if they are unable to complete the full activity & can only complete a portion can go a long way in their realization that building these skills takes time & effort and that that’s okay. 

• Self Regulation: One of the most important aspects of human development is the ability to self-regulate one’s emotional state & reactions in order to be successful in coping and engaging with one’s environment. If our nervous systems aren’t in a calm, regulated state we do not have the capacity to learn or take in new information effectively.
  • One of the ways I work on self-regulation with students is by teaching them ways to calm their nervous system either through sensory techniques & input such as deep pressure (through bear hugs, weighted items – blankets, balls, vests, lap pads), vibration (vibrating toys that they can hold), slow vestibular rocking (swing, rocking chair, rocking themselves back in forth in sitting), and/or through breath work. I also do my best to empathize & listen as sometimes what makes us as humans feel more safe & regulated is to just feel heard and understood by others.

• If there is a certain activity or task we do that is potentially more challenging for a student then I give a lot of encouragement & praise to them while they are engaging in it. I also may suggest we do that activity first so that it’s out of the way or work on it for a smaller portion of time (sometimes maybe setting a timer) so that it doesn’t become so overwhelming to the point where the child begins to dread and avoid it. 

• I also may try to pull a child for PT to work on a less preferred activity during a time when I know they may have a better tolerance for it such as earlier in the morning, after breakfast or lunch when they’ve eaten, or during a time when they can do it with other children (such as recess or PE). On the flip side it may be more overstimulating for a child to practice & work on something hard in front of other children and if this is the case then I take that into consideration and we work on it alone. 

• Typically after the child has practiced whatever the activity is I will usually try to help them self reflect to see how they felt it went as well as what parts they enjoyed about it and what parts were less enjoyable. I try to help them problem solve how we can make it a better experience overall and how they can improve with it. 

This is how I utilize the UDL principle of engagement in my practice. I hope this was helpful and illustrates just how much school-based PTs care and what lengths we are willing to go to for our students! I’ll be back next week to discuss the next UDL principle, the principle of representation. 

Stay tuned,

Catie

Catherine C. Skelton, PT, DPT

Pediatric Physical Therapist

1. For more information about CAST’s UDL follow this link (CAST.ORG). ↩︎