Signs a Child May Need Physical Therapy

Hey y’all!

What are some signs that your child will need school based physical therapy services?

Remember your child must have a disability or functional limitation that prevents them from participating in and accessing their education. If your child does then they may be a candidate for physical therapy services in the school setting. The process for initiating physical therapy services differs between states and school districts but typically a physical therapy evaluation will be performed and data collected. This data is then presented to a team consisting of the child’s parents or caregivers, the physical therapist, the special education teacher, a general education teacher, and other related service providers who may see the child (speech therapy, occupational therapy, or a psychologist/behavioral health service provider). The team then makes a joint decision on whether the child requires these services to learn as well as function & participate appropriately in their education. 

Here are some signs that your child may need physical therapy services to support their learning & participation at school:

  • They have poor postural strength and endurance. In order to develop & participate in handwriting or other table top activities, a child must be able to maintain an erect seated position, stabilize the paper on their desk, maintain an appropriate amount of pressure while gripping the pencil, maintain an appropriate amount of pressure when putting pencil to paper, write in controlled small strokes, cross midline, and shift their gaze back & forth from their paper to the board all while listening to the teacher & following directions. If the shoulder girdle & core/pelvis are not strong enough to maintain the child in an erect position which is first & foremost to this process then it all falls apart.
  • They have difficulty physically accessing their school. If a child is unable to ascend/descend stairs safely; step up/down from curbs; open/close doors; walk or propel their wheelchair up/down ramps; walk or propel their wheelchair through doorways, around obstacles, through crowds or around people; or transition between classes then they are unable to physically access their educational environment and require school-based physical therapy intervention. This also includes physically accessing the school bus, the cafeteria, the gym, and outdoor areas around campus (bleachers & various sports fields) and physically accessing their environment on school field trips. 
  • They have difficulty participating in physical education (PE). If a child is unable to coordinate certain gross motor activities such as skipping, hopping on one leg, ball skills (catching/throwing/kicking), animal walks (bear crawls, crab-walks, etc.), running, and other gross motor skills due to strength, balance or just the inability to coordinate & mimic a series of movements (motor planning) then they are unable to fully participate in their education. 
  • They have difficulty participating at recess. Sometimes children with disabilities have difficulty accessing playground equipment such as swings, slides, stairs up & down from the jungle gym, rock walls, balance beams, etc. due to strength, balance, and/or coordination impairments. They require physical assistance and practice to improve their access to this equipment so they can fully access and participate in this facet of their education. Recess provides a needed sensory break that allows children to move & strengthen their bodies improving gross motor skills, body awareness, and promotes learning. Furthermore, children in special education often have limited opportunities to interact with their typically developing peers which is so important for their overall development. Recess is a time period in their school day that they have this interaction with the general education students which makes their participation in it that much more important. 
  • They have difficulty with transitions or transfers. Some children with disabilities struggle with transitions. They are unable to walk in a straight line impacting their ability to walk in the classroom line with their peers while transitioning between classes or struggle to stand up from a seated position from their desk or the floor which can greatly impact their safety during emergency drills or emergency situations (tornadoes, fire, active shooters). Furthermore, children who utilize wheelchairs as their primary means of mobility often need breaks from their wheelchair to move on the floor, sit in their desk, or to access restroom facilities. They often need physical assistance or education on how to perform these transfers to and from their wheelchair safely & efficiently. It is also a school-based therapists job to provide training to teachers, teachers aids, and other support staff on how to safely perform transfers for a child who is unable to do so on their own. 
  • They require modifications to seating options or adaptive equipment. Many children with significant physical disabilities require adaptive equipment such as wheelchairs, walkers, gait trainers, standers, and activity chairs to participate in their school day. It is often the job of the school physical therapist to assess a child for this need and assist in acquiring/maintaining this equipment to support them in their school environment. For students who do not require adaptive equipment but have trouble maintaining an appropriate posture at their desk, a physical therapist may provide modifications to the size, position, or type of chair or desk. 

This list is not entirely comprehensive and there may be other signs or reasons your child requires school-based physical therapy intervention. It is important for parents & teachers to be aware of these signs and refer to physical therapy early for screenings if there are concerns!


Catherine C. Skelton, PT, DPT

Pediatric Physical Therapist

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