Physical Therapy

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Physical Therapy

• Los Angeles Unified School District
• OT PT AT Program

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Background

• The profession of physical therapy involves the
  application of skilled treatments to help
  individuals improve both motor function and
  access to their environment.
• Physical therapists are skilled, degreed and
  licensed health professionals whose education
  encompasses a background in human anatomy and
  physiology, physical pathophysiology, whole body
  kinesiology, gait and posture analysis, physical
  treatment modalities, human development, motor
  control/learning, and cardiopulmonary, orthopedic
  and neurological rehabilitation.

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School Physical Therapy

• In the public schools, physical therapy is used
  to enhance the students ability to function
  within the educational environment.
• Physical therapists use techniques that correct,
  facilitate or adapt the childs functional
  performance in motor control and coordination,
  posture and balance, functional mobility,
  activities of daily living and use of adaptive
  equipment.

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School Physical Therapy

• School physical therapists address environmental
  factors, a childs physical and sensory motor
  needs, as well as activities that support
  participation and access to the childs
  curriculum.
• The areas addressed by school-based physical
  therapists must directly relate to the childs
  performance within their school setting (campus,
  classroom, playground, cafeteria, bathroom and
  library). 

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The Role of the School Physical Therapist

• School physical therapists are involved in
• Prevention and pre-referral activities (RtI2)
• Assessments and student program planning for
  individuals with exceptional needs
• Teacher, staff and parent training sessions
• Treatment
• Collaboration with all service providers

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention (RtI2)

• Response to Instruction and Intervention (RtI2)
• is a systemic multi-tiered framework that guides
• the development of a well integrated system of
• instruction, and intervention that is matched to
• student need and directed by student outcome
• data from Multiple measures. (BUL- 4827.1 Multi
• Tiered Framework for Instruction, Intervention,
• and Support)

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention (RtI2)

• The five essential components of RtI2
• Multi-tiered framework to instruction and
  intervention
• Problem-solving process
• Data-based decision making
• Academic engaged time
• Professional development

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention (RtI2)

• The physical therapist is an integral part of the
  RtI2 process in the general education setting.
• Contribute expertise to the problem solving
  process
• provide strategies for any student who may have
  challenges in the area of motor development
• The problem solving process includes
• defining the problem,
• analyzing the problem,
• implementing intervention strategies, and
• evaluating the response to the instruction
• and intervention.

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention (RtI2)
A Problem Solving Cycle in General Education

• Identification
• Physical therapists may be called upon to assist
  in the
• identification of motor and educational access
  issues students
• may be experiencing.
• Problem Analysis
• Physical therapists are highly trained experts in
  the
• identification of motor deficits and educational
  access issues
• students may be experiencing.
• Intervention Design
• Physical therapists will assist the educational
  team with
• strategies and accommodations for children with
  disabilities.
• Response to Instruction and Intervention
• Physical therapists will also assist the
  educational team with
• progress monitoring, ongoing data collection, and
  evaluation
• to determine the success or failure of the
  intervention and to
• continually to determine the level of intensity
  and support

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention (RtI2)

• In this multi-tiered approach to intervention,
  teachers provide instruction at each tier of
  service that is differentiated, culturally
  responsive, data-based and aligned to the
  grade-level content standards.
• Physical therapists may participate at each tier
  level, as well.

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention (RtI2)
PREVENTION AND PRE-REFERRAL (EARLY INTERVENING)
PRACTICES IN GENERAL EDUCATION
Tier 3 Intensive Instruction and Intervention
Tier 2 Strategic or Supplemental Instruction
Tier 1 Core Instruction
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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention (RtI2)
PREVENTION AND PRE-REFERRAL PRACTICES IN
GENERAL EDUCATION
Tier 3 Intensive Instruction and Intervention
Intensive Intervention, is for an estimated
1-5 of students who need individualized and/or
very small-group instruction that is highly
focused, in addition to Tiers 1 2, and designed
to accelerate student progress.
Tier 2 Strategic or Supplemental Instruction It
is expected that 10-15 of students will need
additional time and type of instruction to learn
successfully.
Tier 1 Core Instruction It is expected that of
all of the students receiving core instruction,
80-85 of students will be proficient when good
first instruction is delivered.
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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention
(RtI2) Prevention - Tier One Core Consultation

• During Tier One, consultation is focused on
  increasing the general knowledge base of teachers
  regarding motor development, motor impairments,
  and the relationship to the curriculum and
  function within the school environment.
• At this level, students have not been identified
  as requiring physical therapy services.

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention
(RtI2)Prevention - Tier One Core Consultation

• Activities may include
• In-service training to provide general guidelines
  for typical motor development
• Offering suggestions for incorporating
  skill-building activities to improve motor
  function in the classroom
• Demonstrating activities that are implemented by
  the classroom staff
• Suggesting ideas for setting up the classroom for
  student success
• Assisting with environmental accommodations for
  students to access the curriculum, classroom,
  and campus.

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention
(RtI2)Prevention - Tier Two Strategic or
Supplemental Instruction and Intervention

• During Tier Two, it is the responsibility of the
  physical therapist to screen a student for
  possible motor delays.
• Screenings are conducted in a natural environment
  to elicit a representative sample of the
  students motor abilities.
• Screenings must not involve pull-out or any
  activity which removes the student from his/her
  regular school activities.
• Screenings may include observation of a student
  in a peer group if it does not single-out the
  student who is being observed.

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention
(RtI2)Prevention - Tier Two Strategic or
Supplemental Instruction and Intervention

• Activities may include
• Observing the student in classroom or other
  school environments
• Consulting with parents, teachers, and other
  school staff regarding concerns about the student
• Reviewing teacher data regarding the outcomes of
  classroom accommodations from Tier One
• Follow-up screening, as appropriate
• Reviewing of educational records.

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention
(RtI2)Prevention - Tier Three Intensive
Instruction and Intervention

• The purpose is to focus on specific motor skills
  that are required for the student to access the
  educational program
• Tier Three continues as long as the student
  continues to make progress in the development of
  targeted skills.

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention
(RtI2)Prevention - Tier Three Intensive
Instruction and Intervention

• Activities may include
• Consulting with the classroom teacher and/or
  parent on a regular basis to monitor the
  recommended supports and accommodations and to
  adjust these, as needed. (The classroom
  teacher implements and documents progress for the
  recommended targeted interventions)
• Providing follow-up consultation to the classroom
  teacher, staff, and parents if during the SST
  meeting, targeted intervention strategies and
  accommodations are deemed necessary based on
  identified goals

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The Role of the School Physical Therapist
Pre-Referral and Response to Intervention (RtI2)

• Throughout all of these phases, progress is
  continuously monitored.
• If a student continues to struggle with motor
  skills after targeted interventions and
  accommodations are in place and documented for a
  reasonable amount of time (as determined by the
  SST), a referral for a special education
  evaluation should be made.

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Referral To Special Education

• The purpose of an initial special education
  eligibility evaluation is to determine whether a
  child has a disability and the nature and extent
  of the special education and related services
  that the child needs
• This evaluation may or may not include an
  physical therapy assessment, depending on the
  areas of concern.

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School Physical Therapy in LAUSD

• Within Los Angeles Unified School District the
  school physical therapist participates in the
  identification of appropriate referrals,
  assessment, and student program planning.
• The physical therapist develops and implements
  intervention, and collaborates with the
  educational team members, utilizing the
  philosophical framework of the Ecological Model
  of Student Success.

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The Educational Framework For Child Success
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What are the Possible Indicators for a Physical
Therapy Referral? 

• Children who demonstrate
• Difficulty in accomplishing tasks without the use
  of adaptive equipment, environmental
  modifications, or assistive technology
• Poor balance or frequent falling
• Postural, orthopedic abnormalities
• Delayed gross motor skills
• Difficulty learning new motor tasks
• Difficulty in moving or moving unsafely in the
  school environment
• Difficulty in maintaining an appropriate sitting
  posture

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If a Physical Therapy Assessment is Requested

• Upon parent permission to assess, a school
  physical therapist completes an assessment.
• The Physical Therapist
• Assesses the childs strengths and needs
  (foundational components) that support or limit
  his participation in school and access to the
  curriculum
• Analyzes the environment, the curriculum and
  tasks, in order to determine if the child is able
  to successfully participate in his/her
  educational program

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Physical Therapy Assessment 

• Physical Therapists
• Assess Foundational Components
• Gross Motor Skills
• Endurance
• Postural Control
• Motor Control and Coordination
• Strength and Stability
• Balance
• Functional Mobility
• Tolerance for Positioning and Movement
• Environmental Adaptations and Modifications
•  

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Physical Therapy Assessment 

• Physical Therapists
• Analyze the Environment
• Campus
• Classroom
• Playground/Yard
• Cafeteria
• Bathroom
• Library
• Cafeteria
• Auditorium
•  

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Physical Therapy Assessment 

• Physical Therapists
• Analyze the Curriculum and Tasks
• Sitting upright in a chair or on the floor during
  circle time
• Keeping up with peers when walking from the
  classroom to the play yard
• Moving within the school environment with minimal
  need for assistance
• Negotiating obstacles within school setting
• Navigating the play structure with the least
  amount of supervision necessary for safety
• Navigating and engaging in movement exploration
  during playground activities
•  

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Determination of Need for Physical Therapy
Services

• Physical Therapists
• Determine the supports and barriers to learning
  in the educational environment by assessing the
  child across the school campus in order to paint
  an accurate picture of the childs ability to
  access and make progress in his/her program
• Consider the curriculum, and relate foundational
  skills to the child's ability to function in
  his/her program
• Gather all the evidence including observations in
  context, teacher and family input, formal and
  informal assessments, etc.

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Determination of Need for Physical Therapy
Services

• Physical Therapists
• Use evidence-based practice by integrating child
  factors, professional expertise and research
  evidence
• Consider how the childs goals and desires,
  affect participation
• Determine how services will impact the childs
  ability to access and make progress in his/her
  program
• Make recommendations to reduce the barriers to
  learning (e.g., accommodations, adaptive devices,
  etc.)
• Use the assessment process to predict future needs

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Determination of Need for Physical Therapy
Services

• If the child is supported within his educational
  environment and is accessing and benefitting from
  his curriculum, physical therapy is not required.
• If needs are identified in accessing and making
  progress in his curriculum, physical therapy is
  recommended as a related service.
• The therapist uses his professional expertise and
  scientifically based research to determine the
  intensity and frequency of intervention.

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School Physical Therapy
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Physical Therapy Intervention in Special
Education

• Physical therapy services are defined as a
  continuum of intervention strategies including
  individual and/or small group, consultation,
  monitoring and collaboration in order to achieve
  a desired goal for the child.
• All strategies consist of working directly with
  the student to one extent or another.
• Treatment session time, frequency, and location
  of services are determined on an individual
  basis.

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Physical Therapy Intervention in Special
Education

• Treatment may also be provided as a co-treatment
  with other related services (Occupational
  Therapy, Adapted Physical Education, and Language
  and Speech).
• School physical therapy, as a related service,
  requires a medical diagnosis in order to provide
  treatment (California Business and Professional
  Code Sections 2620-2621).

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Physical Therapy Intervention in Special
Education

• Physical therapy services may fall into three
  categories, and
• like a pendulum, service delivery may swing back
  and forth
• between the more intense to less intense
  depending on the
• level of support needed at any given time to meet
  the
• students core academic program needs

• Consultation
• Collaboration
• Direct Service

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Physical Therapy Intervention in Special
Education

• Consultation
• Provided directly and indirectly to the student
  consisting of regular review of student progress,
  observation, accommodations and modifications of
  core material, developing and modeling of
  instructional practices through communication
  between the general education teacher, the
  special education teacher, parent and/or related
  service provider

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Physical Therapy Intervention in Special
Education

• Collaboration
• General education teachers, special education
  teachers and/or related service providers work
  together to teach students with and without
  disabilities in the classroom
• All are responsible for the direct instruction,
  planning and delivery of instruction, student
  achievement, progress monitoring and discipline
  to support the student goals and objectives and
  to access the curriculum.

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Physical Therapy Intervention in Special
Education

• Direct Service
• Instruction or service by a single special
  education provider designed to support, bridge
  and strengthen student skills.
• Opportunity to provide specific skill
  instruction, re-teach, pre-teach, and scaffold
  instruction to support student goals and
  objectives and to access the curriculum.

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When is a Child Ready to Graduate from Physical
Therapy? 

• The recommendation for continuation or graduation
  of physical therapy services is determined by the
  professional expertise of the physical therapist
  in collaboration with the IEP (Individualized
  Education Program) team.
• There are several factors to consider when making
  decisions regarding physical therapy service
  completion.

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When is a Child Ready to Graduate from
Physical Therapy? 

• Possible Factors Include
• The students needs being addressed by physical
  therapy no longer negatively affect his/her
  educational performance in the regular education
  or special education program.
• The student no longer requires PT as a
  related/DIS service in order to benefit from
  his/her special education program.
• Therapy is contraindicated because of the change
  in medical or physical status.
• The students needs will be better served by an
  alternative program and/or service, as determined
  by the IEP team.
•  

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When is a Child Ready to Graduate from Physical
Therapy? 

• Possible Factors Include (continued)
• The student consistently demonstrates behaviors
  that inhibit progress in physical therapy
• such as lack of cooperation, motivation, or
  chronic absenteeism.
• IEP team should consider the initial eligibility
  decision since these behaviors may reflect social
  maladjustment, environmental, cultural, or
  economic factors rather than an actual
  disability.
• IEP team may also explore alternative services or
  strategies to remedy the interfering behaviors or
  conditions.
• He/she graduates from high school and/or reaches
  the age of 22 years.

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Physical therapy services are intended to target
specific areas of weaknesses related to
educational access. They are not necessarily
intended to be ongoing services for the duration
of the childs academic career.
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Physical Therapy ProgramContact Information 

• OT PT AT Program
• Beaudry Building18th Floor
• 333 South Beaudry Ave
• Los Angeles, CA 90017
• Phone [phone]
• Fax [phone]