Special Education Physical Therapy Services

Special Education

Physical Therapy Services

Chapter 11 of the book, An Introduction to Early Childhood Special Education, focuses on Physical Therapy Services; the authors (Susan Ward and Linda Seto) point out that physical therapy (PT) is an "intervention on gross motor skills," which is different than "occupational therapy" which focuses on "fine motor skills." And what the authors emphasize on page 217 is that children who have "gross motor delays" between birth and six years of age are limited in all other areas of development. In other words, if a child has a disability that prevents he or she from using legs, then the PT help that child receives should include braces, show molds, or walkers, along with the training which enables that child to use those devices.

One of the jobs of a physical therapist is assess what the child may need by "analyzing the physical environments" of the child; this ensures that the child who is receiving PT has as much "independent mobility" and safety factored into that environment as possible. This is an assessment; and by paying close attention to the physical environment that the child with special needs lives and plays in, the therapist knows how the large muscle movements are functioning as the child jumps, climbs, runs, plays ball and so forth.

The process of assessing children is done in two steps, the authors write on page 219-220. The first is informal, called a physical therapy screening; the second is more like a "full formal assessment," and it is given if the first step indicates "the likelihood of a gross motor delay." When a parent notices that their child is having difficulty in balance or in running or dancing, they usually would notify their doctor, and the doctor then notifies a qualified physical therapist, who does the full formal assessment.

The book provides an in-depth review of "Billy" - a child who has gross motor delays - (p. 221) as a way of describing how a teacher should notice when a child has gross motor skill problems. While simply taking his jacket and backpack off, Billy knocks other children's belongings on the floor; and he has a problem just sitting straight in a chair. He can't finish his little art project, and has a big problem in just getting out of his chair. He knocks things over, appears very clumsy, and makes his playmates upset with him because he keeps knocking over the blocks the other children are using to build a playhouse. Needless to say, the child needs therapy, because he has "slower balance responses" than the other children, and "motor delays." It would not be fair for Billy's parents to let him go on being awkward and alienating his playmates in school and in the neighborhood.

On page 225, the authors point out that some parents, however, are reluctant to commit their child to physical therapy because they fear "therapy is painful." If done properly, however, therapy should not cause "excessive pain," although the authors are nor saying there will be no pain. And although children themselves sometimes resist physical therapy, because it tires them out, they "are generally eager to participate in individual therapy because they receive the undivided attention of the therapist," the authors write on page 225.

Physical therapy is not inexpensive, and so parents who are paying for therapy themselves have a right to "negotiate a change in the frequency of therapy" with the professional; but when the child is receiving therapy that is paid for by public funds, parents should discuss the frequency and kind of physical therapy with the therapist and the classroom teacher. Is there a stigma attached to a child who receives therapy? Yes, this is true; but the authors suggest that when therapists work with perhaps two or three children at the same time, those children are less likely to feel like they are being "singled out" as in need of special services. "It is important for parents to realize that it is generally more stigmatizing to appear 'clumsy' than to receive therapy," the chapter points out on page 225.

What are some of the specific skills that are addressed through physical therapy? An example of a need among some children is when they "cannot turn their head without moving their whole body" (p. 229). And when they do turn their head and their body moves along with that movement of the head, "they may need to take steps forward to maintain their balance." There are helpful things a therapist can do in this instance, such as specifically helping children develop "head movements separate from other body movements" (p. 229).

Another problem that children with motor disabilities show to teachers (who are paying close attention) is their inability to "spontaneously use energy-conserving positions." For example, children without motor challenges often show a variety of body positions that help them concentrate on a story being read by the teacher. They may lie on their stomach with their heads supported by their hands, "legs spread wide apart," in order to "conserve energy while listening" to the story. But children who do have motor disabilities will just sit up straight, because their muscles are too weak to allow them to take those more creative positions. So, what can a therapist do to help that struggling child? The authors say children with motor problems should indeed by encouraged to "assume varied positions" that will help them build strength rather than be encouraged just to sit still.