Having just completed a 2-week clinical rotation with the Los Angeles Unified School District, I can comfortably say that I am NOT an expert in School-Based Physical Therapy. However, I know a lot more now than I did last month. And last month, I sure didn’t know much.
This is my attempt at creating a semi-encompassing study guide for PT/PTA students regarding Physical Therapy practice in public schools. It covers many topics that may be useful for students encountering the school-based model for the first time. Enjoy!
- Role of School-Based PT
- The IEP
- Common Assessments
Role of A School-Based PT
In school-based practice, physical therapy focuses on purposeful, goal-oriented activities that support a child’s ability to access and participate in his/her school curriculum. Physical Therapists are key members of school-based teams that ensure a free and appropriate education for students with disabilities. PTs assess and perform appropriate interventions for motor control and coordination, posture and balance, functional mobility, accessibility, and use of assistive devices, as they pertain to a child’s functional performance.
🔑 idea: Need for physical therapy in school-based settings is largely based on educational necessity, rather than medical necessity.
To receive school-based PT services, a student must require a physical therapist's unique expertise in order to safely and efficiently participate in his/her learning environment. During the evaluation, PTs must gather information from various parties (child, teacher, parent, etc.) to determine their need for PT services.
Once a need has been determined, PT intervention works towards accomplishing the goals agreed upon during the Individualized Education Plan meeting (more on this later). Here are some various examples of physical therapy intervention:
- working with the child directly to perform exercises, gait training, equipment training, etc.
- this can take place in the natural environment (recess) or in a pull-out setting (pulling the child out of the classroom)
- teaching educational personnel about safe lifting, positioning, transfers, ambulation, etc.
- serving as a liaison between the school and the medical equipment vendors
- adapting environments to promote student access and inclusion
- referring students or parents to other healthcare providers as appropriate
PT visits tend to last about 30 minutes. Some students are seen on a weekly basis, while others may be seen every 1-2 months. In any case, intervention requires coordination between the other members of the educational and medical team.
🔑 idea: For students seen less frequently, a PT's role becomes more consultative in nature (i.e. instructing caregivers how to adjust the child's equipment, or recommending to the teacher that the child rides the tricycle for 10 minutes each day)
Remember the overarching goal of ALL school-based PT interventions — to allow the student to access and to benefit from his or her educational curriculum.
The Individualized Education Program (IEP) is an important legal document developed for each public school student who is eligible for special education. The IEP is developed by a team of individuals which typically includes the child's parents, the child's teacher(s), a representative from the school district qualified to provide or supervise special education, and providers of related services to the child (PT, OT, Speech Therapy, Adapted P.E. Teacher), and others.
🔑 idea: IEPs are legal documents that contain individualized, measurable goals relating to educational needs of the child
The IEP team meets annually to determine goals and placements, discuss progress, and address concerns. The team will discuss the child's Present Level of Performance, which includes the student's Areas of Strengths, Areas of Needs, and Impact of Disability on Academic and Overall Performance. The Physical Therapist also contributes an Access or Functional Mobility goal that directly relates to the educational needs of the child.
This goal may also be accompanied by two measurable objectives that may serve as benchmarks to measure the child's progress towards the annual goal. Goal requirements may differ in each state or district, but it is essential to know how to write a clear, relevant goal.
EXAMPLE GOAL: Child will be able to descend three 8-inch steps with a handrail and close supervision using a reciprocal pattern on 4 out of 5 trials by June 2017 in order to gain access to the school environment.
ABCDE's of Goal-Writing
- A = Actor (Child)
- B = Behavior (descend three 8-inch stairs)
- C = Condition (with a handrail and close supervision using a reciprocal pattern)
- D = Degree (on 4 out of 5 trials)
- E = Expected Time (by June 2017)
- Consider also including the purpose of the goal (to gain access to the school environment)
Common Motor Assessments
- Timed Up and Go (TUG) (RehabMeasures.org)
- Student begins seated in chair with hips and knees bent at 90˚, and is asked to get up from floor, quickly walk three meters, turn around, walk back, and sit back down in the chair.
- Nicolini-Panisson RD, Donadio MV. Normative values for the Timed “Up and Go” test in children and adolescents and validation for individuals with Down syndrome. Dev Med Child Neurol. 2014;56(5): 490-497.
- Timed Floor to Stand (TFTS) (A modification of the TUG)
- Student begins seated on floor in cross-legged position and is asked to get up from floor, walk three meters, turn around, walk back, and sit back down in a cross-legged position
- Timed Up and Down Stairs (TUDS)
- Student stands 1 ft from bottom of one flight of stairs (14 steps), and is instructed to quickly but safely go up all the stairs, turn around at the top, and come back down until both feet land on the level of the starting position
- Zaino CA, Marchese VG, Westcott SL. Timed up and down stairs test: preliminary reliability and validity of a new measure of functional mobility. Pediatr Phys Ther. 2004;16:90–98.
- 30-second Walk Test
- Instruct student to walk (not run) at a comfortable speed for thirty seconds in (ideally) a straight line. PT measures the total distance walked.
- Knutson LM, Schimmel PA, Ruff A. Standard task measurement for mobility: thirty-second walk test. Pediatr Phys Ther. 1999;11:183–190.
- 6-minute Walk Test (6MWT) (RehabMeasures.org)
- Mark a walking course in a large open space and place cones or markers at the starting point of each lap. Student walks as far as they can, with PT providing verbal encouragement every minute. At the end, measure the number of laps completed and convert to total distance walked.
- Lammers AE, Hislop AA, Flynn Y, Haworth SG. The 6-minute walk test: normal values for children of 4–11 years of age. Arch Dis Child. 2008;93:464–468.
- Pediatric Reach Test (PRT)
- Similar to Functional Reach Test but also includes lateral reach. Measures distance one or both hands can reach forward and laterally while maintaining sitting or standing balance
- Bartlett D, Birmingham T: Validity and reliability of a pediatric reach test. Pediatr Phys Ther. 2003;15:84–92.
- Pediatric Balance Scale (PBS) (RehabMeasures.org)
- A modification of the Berg Balance Scale; a 14-item test of static and dynamic balance activities
- Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the Berg Balance Bcale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther. 2003;15:114–128.
Common Standardized Assessments
Gross Motor Function Measure (GMFM-88, GMFM-66): To assess gross motor function of children with cerebral palsy (CP) or Down Syndrome (aged 5 months - 16 years) with gross motor function at a level of less than 5 years. (GMFM-66 only valid for CP)
Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition (BOT-2): To assess fine and gross motor skills of children aged 4-21.
Peabody Development Motor Scales, 2nd Edition (PDMS-2): To assess fine and gross motor development in children less than 5 years old.
School Function Assessment (SFA): To assess level of activity, function, and participation in school in children aged 5-12 years.
Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT): To globally assess daily activities, mobility, function, and responsibility in children aged 0-20 years.
Physical Therapy in School Settings: Quick 2-page handout from the American Physical Therapy Association (APTA) covering the basics of PT in schools.
Pediatric Fact Sheets: Comprehensive list of fact sheets compiled by the Pediatrics Section of the APTA. Find the "School-Based" section.
Pinterest: A Pinterest search for "pediatric school physical therapy" that generates hundreds of exercise ideas, infographics, and tips.
Guidelines for Occupational Therapy and Physical Therapy in California Public Schools: 174-page MONSTER of a resource for everything you'll ever need to know about CA School-Based PT/OT.
Special Education Acronyms and Glossary: Helpful list of important terms and acronyms.
Individuals with Disabilities Education Act (IDEA) – A federal law that ensures that children who have disabilities receive a free and appropriate public education (FAPE) designed to meet their unique needs.
- PT is listed as a "related service" under Part B of IDEA.
Section 504 of the Rehabilitation Act – Prohibits all recipients of federal funds from discrimination against individuals with disabilities.