School Based Physical Therapy Services
Compiled by Ellen Van Vranken, PT, CAS
Definition of Physical Therapy:
Physical therapy is a medically based profession that that is oriented to improving
sensory/motor function, diminishing pain, preventing future disability, and enhancing functional
gross motor skills through the use of physical agents (modalities), specifically designed
therapeutic exercises, and patient education.
Emphasis of School-Based Physical Therapy:
School-based physical therapy is provided as a related service, i.e., a service designated
by the IEP as needed so that the student with exceptional educational needs can benefit from
their special educational program or access education within the least restricted environment.
Emphasis of physical therapy services provided within the school setting includes therapeutic
intervention and integration of that intervention into the school environment as well as consult
services to staff regarding carry over activities. Services are directed toward preventing future
disability, and developing, improving, or restoring sensory/motor function for those students
who have a disability that impacts their ability to fully participate in their educational programs
and their role as students. Services also include working with other team members to assess
gross motor skills required to participate within the school environment and to help problem
solve ways to improve accessibility and participation in school activities by developing
classroom modifications and accommodations.
Difference Between Medical and Educational Models:
Patient vs. Student
Medical (restrictive) Facility vs. School (natural) Environment
Individual / Pull-out Treatment vs. Collaborative Problem Solving with daily carryover
Concept of Role Release:
Instead of the PT providing pull-out therapy within the school setting, therapist consults with
school staff who have daily interactions with student on ways to address physical issues as they
occur naturally within the school day. These could include transitions, playground access,
navigating lunch tray, physical education expectations and accommodations, splints, walkers,
standers, braces, positioning for function, adaptive equipment, re-designing classroom for power
wheelchair function, access to special transportation, etc.).
Functions of the School Based Physical Therapist:
1. Assessment: PT evaluates and interprets evaluation findings as a member of the
multidisciplinary team and plans appropriate intervention as a participant of the IEP team
through IEP process.
2. Direct Services including treatment procedures designed to assist the student with a
disability overcome the obstacles interfering with educational program or as their many
functional expectations as a student.
- Therapeutic exercise
- Coordination training
- Strength and endurance training
- Mobility training: gait, use of a variety of walking devices, transfers, endurance,
efficiency
- Balance training / Motor planning / Motor skill development
- Sensorimotor processing
- Training in use of assistive technology
- Adaptation/modification/repair and maintenance of equipment
- Prevention of initial or future deformity or disability via early intervention
3. Indirect Services:
Consult and collaborate with parents, educational staff, administration, physicians, other
service providers to implement program planning, adapt physical environment, procure
assistive devices, develop modifications and accommodations for access and successful
participation, and integrate interventions and recommendations into child’s environment.
PT’s also collaborate with others to facilitate wellness issues and disability awareness for
the entire school population.
Train/Supervise: Physical therapy assistants, ed. techs, bus drivers, etc.
In-service training: body mechanics, transfer methods, equipment use,
surgery implications, use of assistive devices, ROM exercises
Physical Therapy Assessment:
Procedures are geared to assessing the student’s abilities in the following areas:
- Range of joint motion / presence of limitations and contractures
- Muscle Tone influencing function
- Reflex maturation
- Muscle Strength
- Equilibrium and Balance
- Sensory/Perceptual Status
- Posture/Gait
- Functional mobility status within school environment
Formal Assessment Tools Typically Used:
ROM (range of joint motion) Testing
Manual Muscle Testing
Reflex Testing
Peabody Gross Motor Development Scales
Gross Motor Functional Measure
Bruininks-Otseretsky Test of Gross Motor Skills
In Collaboration With Others:
Pediatric Evaluation of Disability Inventory (PEDI)
Callier-Azusa
School Functional Assessment (SFA)
Hawaii Development Scale
COACH Assessment
All assessments should include a direct observation within the school environment and
a statement how the student’s disability affects their ability to participate in their educational
program and to access and participate in school activities.
Informal Assessment Tools Typically Used:
Functional Mobility Check Lists
Teacher /Parent Check Lists
Parent/Teacher Interviews
Ecological Assessments
Sensory Processing Questionnaire
Direct School Based Observation: PE, cafeteria, transitioning in halls, elevator use,
transfers, positioning in classroom, mobility in class, assessment of equipment currently
being used, participation on playground, ability to use transportation
Clinical observations of joint mobility, balance, balance reactions, muscle tone and strength,
gross motor development, motor planning, sensory issues, attention, attention, response
REFERENCES
American Occupational Therapy Association, Classroom Applications for
School-Based Practice. Rockville: AOTA, 1993
American Physical Therapy Association, Physical Therapy Practice in
Educational Environments. Washington: APTA, 1990
Bobar, P. & Corbett, S., Occupational and Physical Therapy: A Resource and
Planning Guide. Milwaukee: Wisconsin Dept. of Public Instruction,
David, K. & McEwen, I.R. (2001) The individuals with disabilities education act: Roles of physical therapists in
educational environments. In D. Damiano (Ed), Topics in physical therapy: Pediatrics (pp. 3-1 to 3-16).
Alexandria, VA: American Physical Therapy Association.
King-Thomas, l. & Hacker, B., A Therapist’s Guide To Pediatric Assessment.
Boston: Little, Brown and Company, 1987
Thurlow, M., Lazarus, S., Thompson, S., & Morris, A., (2005). State policies on assessment participation and
accommodations for students with disabilities. Journal of Special Education, 38(4), 232-240.
Trower, J. et al, A Resource Handbook for Physical and Occupational Therapists
In Educational Settings. Topeka: Kansas Chapter American Physical
Therapy Association, 1993