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Occupational Therapy and Physical Therapy

Services in the School

Occupational and Physical Therapy are related services available in the school setting if a child qualifies for special education services through the Exceptional Children’s Program. Occupational Therapy and Physical Therapy must be educationally relevant. Unlike and OT or PT in a clinical or medical setting who identify and treat the motor deficits, a school therapist can only address those deficits that inhibit the child to benefit from his/her specially designed educational program or independence accessing the school environment. The need for therapy services is not determined by clinical diagnosis, low test scores, or other indication of a gross or fine motor deficit. Related services are selected because the team agrees that they can best support the IEP team generated educational goals.

If there are not educational concerns that warrant special education services, then OT or PT services are not indicated. There are exceptions to this if a child has a genetic, neuromuscular, orthopedic or degenerative disorder. These children may not have cognitive impairments but have significant motor or visual impairments that affect their ability to access materials in the school, or to be safe and independent in the school environment.

With children who are identified as Speech/Language impaired only, OT or PT services are not indicated, unless they can support the Speech/Language goals. This may apply to a child with significant apraxia or significant sensory processing difficulties.

Occupational Therapy in the school settinglooks at areas a child is not fully participating in such as:

  • Personal Care (feeding/lunchroom, toileting, clothing management, set-up/clean-up)
  • Student Role/Interaction Skills ( managing classroom materials, general classroom skills, work behaviors/organization, social skills)
  • Learning/Process Skills (following directions, attention, initiation, visual perceptual skills)
  • Play (individual play skills, exploring new play ideas/opportunities, sharing materials, working in groups)
  • Community Integration/Work (fieldtrips, school-related vocational training)
  • Graphic Communication (handwriting, keyboarding, drawing, artwork)

Occupational therapists provide expertise in the areas of fine motor/visual-motor skills, visual perceptual skills, ocular motor skills, sensory processing/regulation, equipment adaptations/modification, assistive technology, vocational assessment, and self-help skills.

Areas most often addressed by the Physical Therapist are:

  • Functional mobility/gait
  • Gross motor skills as they relate to safety and a child’s ability to participate with peers
  • Postural control/seating
  • Balance
  • Equipment and/or environment adaptations/modifications
  • Transfer skills

Assessment

There are many ways on OT or PT can evaluate/assess a child to help identify deficits and problems the child may be experiencing in the school. These can include:

  • Concerns of the teachers, parents, and other school personnel
  • Observation of the child in the classroom, lunchroom, art, PE, playground, etc.
  • Assessment of class work
  • Functional school assessments which look at a wide range of task performance skills needed in the school environment
  • Clinical Observation/Assessments that look at underlying performance components (muscle strength/tone, sensory, bilateral skills, gait, balance, postural control, shoulder/arm/hand control, etc.)
  • Standardized testing which can identify developmental level in relation to peers
  • Review of information/testing by other disciplines or outside therapists

Determination for Services and/or Level of Services

This is based on many factors such as:

  • Child’s eligibility for special education services with educational concerns
  • Deficits significantly impact child’s ability to benefit from his special education goals
  • Amount of difficulty a child has accessing school environment and materials
  • The ability of other personnel to carry out goals or manage fine motor/gross motor concerns
  • Overall progress rate over the term of the IEP
  • Whether continued skill development can be best met through the classroom, adaptive PE, regular PE, home program, etc.
  • Behavior issues, medical issues, or other factors that may make therapy counterproductive
  • Previous attempts to improve the deficit have not been successful in other settings, and the unique expertise of a therapist is required to meet student’s needs

IEP and Service Models

After determining performance deficits, OT’s and PT’s collaborate with the team on the best way to address these areas. We strongly advocate looking at the child as a whole versus a child with “OT/PT issues”, or “fine motor/gross motor” problems. We are most effective when our services focus on inclusion (least restrictive environment), consultation, and serving the children through a collaborative IEP. If therapy services are warranted, they can be delivered in several ways:

Direct: This can be done individually, in a small group, within the classroom, or any combination of this that would benefit the child most. The amount of services can vary from weekly to monthly.

Consultative: Consultative services are used for students with minimal therapy needs and to help the child transition from a therapy emphasis to teacher assist, supervision or independence in the classroom. Consultation is providing advice, assistance or an opinion based on expertise, knowledge and judgment to assist other personnel with the student’s goals. It can involve the training and supervision of other persons involved with the implementation of therapy programs. The requesting professional or parent has the responsibility to follow through with the recommendations of the therapist. Most often in these cases a separate OT or PT IEP is not appropriate as it supports the identified fine or gross motor concerns through the special education IEP. The OT/PT is not responsible for the carry through of these goals but supports the staff who are responsible.

Related Services Support Plan: This is also used for students with minmal therapy needs, and is a means to provide necessary support to other personnel working with the student without the need for an IEP goal page. It outlines what areas a therapist will support in the classroom/school environment and is used most often with children who need ongoing monitoring for adaptations, prevention of deteriorating conditions, or monitoring of equipment.

Regarding Occupational Therapy services with a Sensory Processing or Sensory Integrative Emphasis

As with other OT services, intervention with a sensory integrative emphasis can be provided only as it relates to the student’s school function and interferes with a child reaching his special education goals. A school OT can provide education regarding sensory processing and its impact on learning, strategies/modifications for the classroom/curriculum and school environment to help a child participate, and use of sensory modalities during treatment or in the class to enhance attention, etc.

Union County Public Schools

Occupational/Physical Therapy Departments

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