Related Services: Physical Therapy

9 Aug

In case you haven’t guessed, we have been a bit short on the sort of drama that this program has been famous for over the last 7+ years. This is good. Too good. I’m waiting for that other shoe to drop.

So I thought I might do a series on the related services that I work with. I chose to start with PT because this was one of the first services I came into contact with that is not considered direct. When I first came, physical therapists developed their own goals and objectives. However, now they merely support goals and objectives developed by the IEP team, which in practice usually means the teacher.

In Georgia and probably throughout the country, there is a shortage of physical therapists. Magnolia County has only 2 (Loraine and Elaine) that are serving over 100 students. This means that the amount of time a therapist actually spends doing therapy is minimal. And this is something that became a hard lesson for me learn; that PT is more of a consultative job in our system than an actual service. They come by, answer teacher’s questions, teach them how to do various daily exercises and move on.

The first few years of teaching, I was ready to throw almost all of the related service providers out of my room. They came in at odd times, interrupted, expected undivided attention and then left me with a pile of extra work. Basically PT became a part of MY job description as these fly-by-night characters came through my room. Every time the PT would open her mouth it meant at least 2 more hours of work for me. Per child. It has taken me some time and some education to learn to appreciate these folks who stay just long enough to get my kids upset with their turning, twisting, stretching exercises.

I have since learned that by following their programs, the students do better with us. For instance, Larry has an absolutely hideous case of CP, and his limbs are so tight we can barely position him in his wheelchair. But by working him over a bit, he does relax more and moving him is less stressful for him and all of us.

My son, Thomas, did get PT services his first year or two of school. He had some delays negotiating steps and he did have a sort of funny gait, especially when he ran. But he was just getting consultative services, meaning that Loraine talked with his teacher as well as talked with me when she came through my school to work with my students. It does sometimes feel weird talking to these folks about my own children while serving my students. I can’t explain why it feels weird, but it does. Part of it might be that I wonder if I get preferential treatment because of who I am. I know it has happened at times, as I’m not sure Thomas really qualified for PT, and I have some doubts about Percy’s whole eligibility for special ed.

PT in the educational setting is different from PT in the medical or private setting. Basically, PT assists with areas that directly impact a child’s access to education which includes mobility, posture and body movement and orientation. A student may have difficulties walking, but if they can get to class independently they may not necessarily qualify for PT services. Also some benefit must be derived from the services, which is why I have seen non ambulatory students dropped from the PT caseload. However, Loraine and Elaine both will retain a student if the parent insists.

I can not think of one single high school student who has PT who is on anything other than a consultative basis. Because Loraine and Elaine only work for the county 2 days per week (they also have a thriving private practice) we have numbers like “0.025 hours per week” for this service on the IEP. The joke is that we’ll just line the kids up by the road and they can drive by and wave! However they really do put in more hours than indicated because they are both dedicated.

The logic behind having so few hours goes something like this: A student can not possibly obtain meaningful benefit from seeing someone one time for 30 minutes per week. Most exercises can be done by a para or teacher once they are showed how to do them. So the best context for PT is integrated into the daily routine and schedule where the teacher consults with the PT and obtains guidance as needed. Over the years I’ve come around to this point of view more and more. I’m there everyday, I communicate with the parents more and get to know the students better. I can do it on a more regular basis than they can.

I’m saying all of this because many parents of students with severe disabilities wonder why their child gets discharged from a related service when they clearly have not mastered even fundamental skills. How can a student who has two legs but can not walk be discharged from PT? Because there is no evidence of improvement. However Loraine and Elaine have both been good about helping with all students.

Physical Therapists have the big toys/implements of torture (depending on your point of view). I’m looking at an incline prone pad that looks like something from a dungeon or torture chamber Loraine brought today. Larry’s in for it tomorrow!LOL! This equipment is not cheap, as most run in the hundreds and thousands of dollars. That torture rack I’m looking at runs about $3,000. Of course, it seems like anything marketed through a disability catalog costs huge dollars. Bean bag chairs in the disability catalog I was looking at were running $100 or more. I bought 3 at Big Lots for less than $50. Loraine has some influence with the system’s maintenance people so they will often help construct some things for her or make adaptations to equipment. As she tells it, they actually like doing it because it is a pleasant diversion from bookshelves.

Over time I’ve come to respect the expertise and professionalism of our physical therapists. They are welcome additions to an IEP team. Since they travel to every school in the system, they get to see a lot of parents and experience a lot of meetings. When a student transitions from elementary or middle school, the physical therapist is often the only constant. Loraine has been doing this in our county for over 20 years and has known Spaz since he was in preschool! Which means she has also known his mother forever. This is a great source of consistency in addition to information for a new teacher. I’m sure many systems don’t enjoy this level of continuity so we’re lucky to have it.

The science of physical therapy is pretty straight forward. Posture, positioning and movement influences all sorts of things you can’t imagine from attention and behavior to eating issues and continence. With wheelchairs it becomes a huge job keeping up with positioning needs. PT can also help give tips on lifting, which we do a lot in our room. Doing it safely becomes very important as kids get older, bigger and sometimes more frail.

For students with orthopedic impairments and mobility issues, physical therapists are going to be important resources for parents and teachers. Since they are in such short supply, their time is often at a premium so it can be difficult getting much time with them. Make the most of it by paying attention and preparing a list of questions and issues in advance.

D.

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