Physical Therapy
Los Angeles Unified School District
OT PT AT Program
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.
School Physical Therapy
• In the public schools, physical therapy is used to
enhance the student’s ability to function within
the educational environment.
• Physical therapists use techniques that correct,
facilitate or adapt the child’s 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
child’s
physical and sensory motor needs, as
well as activities that support
participation and access to the child’s
curriculum.
• The areas addressed by school-based
physical therapists must directly relate
to the child’s performance within their
school setting (campus, classroom,
playground, cafeteria, bathroom and
library).
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
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)
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
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.
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
necessary for individual students.
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.
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
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, 8085% of students will be proficient when good first instruction is
delivered.
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.
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.
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 student’s
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.
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.
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.
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
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.
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.
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.
The Educational Framework
For Child Success
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
If a Physical Therapy
Assessment is Requested…
• Upon parent permission to assess, a school
physical therapist completes an assessment.
• The Physical Therapist:
– Assesses the child’s 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
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
Physical Therapy Assessment
Physical Therapists:
Analyze the Environment:
–
–
–
–
–
–
–
–
Campus
Classroom
Playground/Yard
Cafeteria
Bathroom
Library
Cafeteria
Auditorium
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
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
child’s 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.
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 child’s goals and desires, affect
participation
• Determine how services will impact the child’s 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
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.
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.
Physical Therapy Intervention
in Special Education
• Treatment may also be provided as a cotreatment 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).
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
student’s core academic program needs:
•Consultation
•Collaboration
•Direct Service
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
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.
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, reteach, pre-teach, and scaffold instruction to
support student goals and objectives and to
access the curriculum.
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.
When is a Child Ready to
Graduate from Physical Therapy?
Possible Factors Include:
•The student’s 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 student’s needs will be better served by an
alternative program and/or service, as determined
by the IEP team.
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.
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 child’s academic
career.
Physical Therapy Program
Contact Information
OT PT AT Program
Beaudry Building—18th Floor
333 South Beaudry Ave
Los Angeles, CA 90017
Phone: 213-241-6200
Fax: 213-241-8435