Welcome to School-Based Physical Therapy 101! This page is dedicated to having easy to access resources all in one place for school-based physical therapists.
Be sure to join the School Based Physical Therapist Lounge Facebook Group. This has been a great collaborative group for your school based physical therapy questions!
School Versus Clinical
This can be one of the hardest things to understand coming from a clinical setting and with a strong clinical background from school.
The resources under the resource section are helpful in getting a better understanding of the role of a school based physical therapist and use when explaining this to the individuals and teams you work with.
Do not be surprised if people don’t understand the role of a school based physical therapist. You will need to be prepared to educate the people you work with on this. You may even find that other physical therapists (pediatric therapists included) outside of the school environment don’t fully understand the role.
The section on IDEA and IEP’s will give you a better understanding along with the resources on how physical therapy fits into the school setting.
School Versus Clinical Resources
There are couple good resources available to you to use and refer to. Below are links to those resources. Also be sure to read about the role of physical therapy in the schools under IDEA in the next section.
North Carolina Department of Public Instruction Clinical Versus School
Understanding IDEA and the IEP
The Individuals with Disabilities Education Act (IDEA) is a law that makes available a free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children.
An IEP is part of special education law, or the Individuals with Disabilities Education Act (IDEA).
An IEP is an Individual Education Plan. Essentially, it lays out the program of special education instruction, supports and services kids need to make progress and succeed in school. This may include physical therapy as a direct or consultative service.
Each education plan is individually designed to meet a child’s exact needs.
The term IEPis also used to refer to the written plan that directs specific types of help the child will get.
As a physical therapist, the way you service a child that has an IEP will be specifically written into that child’s IEP. This is where you will record your service time any goals/objectives you may be associated with and any accomodations that you may play a role in.
If you were to leave and a new physical therapist picked up the child you had been working with they should know how to service the child based off of the information in the IEP.
MedBridge – Medbridge has a couple school-based courses that are great at discussing the role of physical therapy in regards to IDEA and understanding an IEP. I personally have taken them.
Since I’ve been so happy with the options I’ve worked with MedBridge to offer a discount to Pink Oatmeal readers. Using the promo code PINKOATMEAL will save you $150 dollars off the membership.
Providng Physical Therapy Services Under IDEA – Many school based therapists find this book to be very helpful to understanding there role as a school based therapist!
APTA’s – Providing Physical Therapy Services Under IDEA Fact Sheet – A great fact sheet of information helpful for any school-based physical therapist.
Do I Need A Doctor’s Order?
This is a big question that is asked in the world of school based-physical therapy!
Most services on the IEP do not require any special orders from a doctor. This may cause some confusion among the team if you bring up the fact that you need one. But how do you know?
This depends on your state and your practice act. As a physical therapist your license requires you follow your practice act. What does your practice act say about direct access? Is there any special wording for a school-based physical therapist? Do you have a limit on how long you can go without a script?
Some Things to Consider
If you have a limitation such as direct access for 90 days then a doctors order is required, you must consider this when you are initiating your services. For example, say you start seeing a student without a doctors order as your practice act gives you 90 days before you need an order. Your 90 days comes up and now you need that order to continue. If you don’t continue you will be breaking the IEP and if you do continue you will be following your practice act direct access rules. You will need to take this scenario into consideration when it comes to how you handle doctors orders.
A doctor can never write a prescription for PT in a school.
All school-based physical therapy services are determined by the students need for physical therapy in the educational system.
If you need an script on a child, this is due to the team determining or referring the child for school-based physical therapy based on their needs in their educational setting.
In most cases if a script is needed it is requested after the team refers a student or determines they need services.
Documentation
According to a school-based physical therapy APTA fact sheet “Requirements for documentation in school-based settings are challenging for SBPTs and add significantly to their workload, impacting service provision and caseload assignments. Frustration about paperwork has been described as one of the greatest professional challenges for SBPTs and an impetus for leaving school-based practice.”
School-Based Physical Therapy Documentation
As school-based therapists we need to be aware of what is required of us from the school perspective, but also from a practice act perspective. APTA’s “Defensible Documentation for Patient/Client Management” states that PTs should document each PT session (including cancellations) and stipulates that the IEP may include the plan of care.
In regards to school-based physical therapy the APTA School-Based Physical Therapy: Conflicts Between Individuals With Disabilities Education Act (IDEA) and Legal Requirements of State Practice Acts and Regulation fact sheet that “Requirements of practice acts related to physical therapy documentation vary from state to state. In general, PTs must: (1) document every intervention session, (2) secure storage of records, and (3) provide copies of the documents to the families. “
Choosing A School-Based Physical Therapy Documentation System
With technology today, there are easier ways to make documentation more efficient. It is important that before you select any type of documentation that you are aware of what kind of security is in place in your district with the documentation programs you select.
School-Based Therapy Documentation Options
Paper and Pen – There is nothing wrong with this if it is the option that you choose. It may not be nearly as efficient, but for some it is still their best option. Others may choose to type up each individual note in a program such as Microsoft Word.
Microsoft OneNote – I personally am a huge fan of using OneNote. This option allows you to organize by section and create folders for each school or child. It literally can eliminate all paper based daily note documentation. It also allows you to easily import pictures and print from the internet directly into the note system. It is what I personally used, love, and saved tons of time. I LOVE this option so much, I have an entrie course on making your life easier.
GET THE SCHOOL-BASED DOCUMENTATION AND ORGANIZATION COURSE
Google Docs – Some school systems are set up on Google Docs and therapists have found this to be an efficient way to coordinate and track all of their documentation required for school settings.
School System Documentation – Some school systems have documentation systems where you are required to enter in information for Medicaid billing. In some cases this may be an efficient enough system for some therapists to use given their caseload and setting.
Evaluation Documentation
Evaluation write-ups can take up a huge chunk of time for school-based physical therapists and occupational therapists.
There is good news on this front as a new app is in place in regards to making evaluations more efficient.
Double Time Docs (affiliate link) is an app out that allows you to check boxes instead of writing big sentences. The app does it for you. They offer a free trial. I’ve heard a lot of good things about saving time using this app. Once you are finished you are able to get your report in Microsoft Word format. They have options for OT’s, PT’s, and SLP’s.
Documentation Resources
School-based physical therapy APTA fact sheet
Double Time Docs (affiliate link)
Dosage and Resources
When entering into the school system a big question that often comes up is how often do I see a child in the school setting. The following is a link to a resource from the APTA on dosage in the school setting along with a link to the GMFCS levels (based off of cerebral palsy) to help guide you in your decision making.
These resources along with understanding each child’s individual needs in their setting can help you to better determine the best dosage in the school setting.
Resource From The APTA – DoSES Model
Understanding Goals and Objectives
As a school based therapist you may come across a wide variety of different goals and objectives. You may even see a wide variety of differences amongst the district you work in. There are a few key points to remember when you are writing your goals and objectives.
- You are working as a team to create student based goals. You are not writing “PT Goals”. Work with the team to figure out how your services as a related service provider can best help the student benefit from their education.
- Function, Function, Function. When you are working with the team to develop goals and objectives for your students think function in the school setting. Your job as a school based physical therapist is to help with function in the educational setting. Hula hooping 5x or skipping rope backwards are not necessarily objectives that are going to help with school based function.
- Think about the format of the goals and objectives. If the goals states the student will be successful 80% of the time, the objectives associated with that goal must match that. Meaning objectives can not be aiming for 60% if the overall goal states 80%.
Goals and Objectives Resources
Equipment
Equipment Management
As a school-based physical therapist there is a good chance that you will be asked to help out with specialized equipment in the school based setting for students on your caseload.
Equipment may include but not be limited to standers, gait trainers, mechanical lifts, bikes etc.
Your job may include having to order equipment specific to the students needs in the school-setting or recommend specific equipment that the school already owns to help the child you are working with best access their environment.
If you are in need of equipment and the school doesn’t have it available you may be required to order different pieces. Often times reps in the area can help you by allowing you to trial different devices with the students you work with to see if that piece will work in their educational environment. It is a good idea to become familiar with the different equipment reps in your area.
If a student has equipment that the family is ordering for home you may even be asked to write a letter or medical necessity especially if that student has come to school with their equipment they are trialing.
Standers
Rifton – Prone, Mobile, Supine
Lecky – Squiggles, Mygo, Horizon, Pronestander, Freestander, Totstander
Easy Stand – Zing, Bantam, Glider, Evolv, Strap Stander
R82– Caribou, Meerkat, Rabbit, Toucan, Gazelle
Prime Engineering – Superstand HLT, Superstand, Kidstand III, Upright, Symmetry
Adapted Seats
Rifton – Activity Chair, Compass Chair
Leckey – Firefly, Everyday Activity, Mygo Max, Easy Seat, PAL Classroom Seat, KIT Seating System, Squiggles, Corner Sitter
R82 – Panda, Scallop, Wombat
Special Tomato – Several different seats and liners
Gait Trainers
Rifton – Pacer, E-Pacer, Tram
Prime Engineering – KidWalk
R82 – Mustang, Pony
Meywalk – 2000, Miniwalk
Ormesa – Grillo, Dynamico
Transfers
The school-based physical therapist works with the team to make decisions in regards to the safest way to transfer and lift students while in their school based setting.
As the physical therapist on the team, you are required to use your knowledge, skill, and equipment available to you to make the best decision for your students. Check out the resources section for more information on how to make this easier for you!
Things to consider when it comes to transfering and training staff.
- Inservices on safe transfer training.
- Training staff on each individual student.
- Creating safe transfer handouts for staff.
- Taking pictures of transfer set-ups where appropriate.
- Making videos of a transfer – where appropriate.
When starting the school year out, transferring and lifting of students will be one of the very first things you are out at the school doing. Be sure you have good knowledge of the equipment available to you, information on each individual student from their IEP’s, and staff that will be supporting the students you work with before making a transfer plan.
This area includes different resources to help you with your lifting, transfers, and handling of student decisions.
Evacuation Planning
As a physical therapist you may find yourself in the role to help with evacuation planning. The amount you are involved will likely depend on your district. You will most likely be involved at least to help with any lifting or consult on any mobility questions.
Considerations
- Likely, you are not at the building everyday and not as familiar with the building as other team members. It is important to have someone very familiar with the building assisting you with evacuation planning.
- Consulting with the Fire Marshall for optimal evacuation planning is important – as a physical therapist this may not be your job, but someone on the evacuation planning team.
- There are options available to assist students with decreased mobility including Tuk-N-Kari’s and Evacuation Chairs.
- A plan may need to include that an adult or a team of adults knows that they have been assigned to assist a student in the case that an evacuation takes place.
- Knowing the schedule of the student you are working with and where they are going to be during the day to plan evacuations appropriately is necessary.
Evacuation Resources
Activity Ideas
Before we get started on talking about school based physical therapy activities we must remember what our job is as a school-based physical therapist. According to federal IDEA guidelines, physical therapy in school is considered a related service. A related services is provided to children in special education, primarily to ensure the child is able to participate in learning tasks. Related services are only required to the extent that the services provided are necessary for the child to benefit from their education.
School-Based Physical Therapy Activities
Many school based physical therapy activities may be utilized for teaching and training. Different staff members that are great to collaborate with are physical education/adapted PE teachers, case managers, occupational therapists, and paraprofessionals.
As school based physical therapists we often work in several different schools (possibly districts) and don’t usually have our own dedicated space to work in. Having ideas for small spaces is helpful. Having ideas that are easy to use in collaboration with staff is very important as well.
Core Strengthening Ideas
Incorporating core strengthening into a students day may come in the form of directly working with the student, working with the students team such as an adapted physical education professional to put in place a program, educating staff on motor room ideas and resources for younger children and education on opportunities such as recess or tummy down time or stability balls in the classroom. These are some of my favorite creative ways to work on pediatric core strengthening that can be implemented into exercise programs that are carried out by the team. I also love kids yoga cards or posters for an area in a motor room or direct intervention.
It’s important to remember when working on core strengthening as a school-based physical therapy activity – what is the function we are trying to achieve. Does the student need improved core strength to help maintain a seated posture? What in the students educational environment requires that core strengthening be worked on?
Balance Ideas
Much like core strengthening, balance activities may be part of direct intervention. Working on balance skills can easily be achieved in motor rooms (for younger kids), physical education/adapted PE programming, direct intervention, or programs carried out by team members. Some of my favorite balance exercises for kids are these. They can be adapted for a wide range of ages and populations. Implementing ideas like kids yoga cards or brain break cards are another way to work on balance especially in small spaces.
Like core strengthening, it’s important to remember what the purpose is of working on balance as a school-based physical therapy activity – what is the function we are trying to achieve. Does the student need to improve balance so they aren’t falling while walking or ascending/descending the stairs? What in the students educational environment requires balance to be worked on?
School-Based Physical Therapy Activities – Natural Environment
There are great areas around a school to work on activities. Are there any hills around the school? Hills and inclines are a great option for working on several different strengthening and balance activities. They are also very helpful when working on learning to ride bikes/trikes/adapted bikes. Read more about strength and balance exercises using a hill or incline.
The playground is a great place to work on physical therapy activities. This includes navigating uneven terrain and climbing. Even walking around the edging on playgrounds (if available) is a great option for a natural balance beam already out in the environment.
School-Based Physical Therapy Activities In The Classroom
School-based physical therapy activities that can happen directly in the classroom will likely involve collaboration with the team. There are so many great ways to add strengthening, balance, body awareness and physical activity into learning. Alphabet based movement is easy with ideas like alphabet yoga poses for each letter of the alphabet or alphabet movement cards. Number based movement ideas can easily go along with calendar time. Even talking about the weather can incorporate movement with weather yoga and movement. Even having kids move their bodies into different shapes can be done right in the learning environment.
School-Based Physical Therapist Printable Resources
Imagine how great it would feel to have all of your gross motor and movement activities created and ready to use! Not only would you have it all, but you could feel confident knowing that your kids (and you!) are having fun with physical activity and movement! You will have activities to use year round. You will have screen free activities to promote movement. You will have fun activities for your therapy sessions or when collaborating with the team. You will never get bored with all the choices. You won’t have to be spending time searching and creating your own resources, it’s all done for you!
The shop at Pink Oatmeal includes so many fun movement based resources that are perfect for school based physical therapy activities whether working directly with a student or teaming with staff to implement a program.
School-Based Physical Therapy Activities Resources
There are several different free resources for school-based physical therapy activities resources available on the website.
There are a variety of different resources including brain break cards, yoga cards for kids, movement games, fine motor activities that you can implement with your gross motor, and much more!
If you really want it all with major savings- membership option ideal for school-based physical therapists. Lifetime access allows you to get any activity you could ever want for digital and printable yoga, brain breaks, planning calendars and videos!
Freebie Library
Pink Oatmeal has a giant freebie library full of resources for a school based physical therapist! Please be sure to visit the freebie library for all of the resources.