Occupational and Physical Therapy Services in Wissahickon School District

1. Occupational and Physical Therapy Services in Wissahickon School District Carol Mulligan, PT Kerri Braun, OTR/L Kim Hartranft OTR/L

2. Therapists • Carol Mulligan PT, CMulligan@wsdweb.org • Kim Hartranft OTR/L KHartranft@wsdweb.org • Kerri Braun OTR/L KBraun@wsdweb.org

3. PT versus OT: Physical Therapy -Gross Motor Skills -Functional Mobility Occupational Therapy -Fine Motor Skills -Functional Handwriting -V-P skills -Sensory Motor -ADL’s in the school environment

4. Evolution of Therapy Services (Historical Continuum) Formerly • Focus on Disabilities and Problems • Pullout Isolated Service • Families Given Information, Little Involvement • Students’ Segregated from other Students • Therapy-specific Student Goals not educationally relevant • Therapist Provides Service Independently Currently • Abilities • Support to Student from all School Personnel • Families Team with School Personnel as Partners • Students Included with other Students • Curriculum-based Educational Student Goals

5. What do PT and OT do in the educational setting? • Assist children and adolescents in “achieving the educational goals…and accessing and participating in the educational environment.” • Not related to “rehab” • We are educationally based; not medical • Services need to be integrated, not isolated

6. Current research supports an “Integrated Model” for delivery of service • The entire team participates in developing the student’s goals • Evidence supports the effectiveness of the following: • consultation as an intervention method • Implementation in the child’s natural environment, especially for generalization • Taking what we know to be effective and implementing it in the classroom

7. What does research tell about PT and OT in the schools presently? • Research comparing direct versus consultation with OT is finding differences in motor outcomes, indicating consultation is in the forerunner if strategies are consistently carried through versus pulling a child for “x” number of times a week. Again this is because more repetition of practice is happening in the natural environment versus just when a therapist is there.

8. It is very important to realize • That the only way that our services can be effective is if the educational teams and families follow through on strategies offered on a daily and consistent basis.

9. How do we determine level of service? • Team input • Based on evaluation results and how the individual child will respond best to services, i.e. direct or consultincluding strategies in place • Level of service is also determined by the extent of support involving very specialized therapeutic techniques that can only be delivered by an OT or PT (i.e.- PNF techniques, NDT techniques, specific exercises etc.)

10. “INTEGRATED TOOLBOX” • We are here to help support the student and the educational team to put strategies in place, not necessarily pull children out of the natural, academic environment. • Goal is for child to learn meaningful tools and actively apply what works for them to benefit meaningfully within the educational environment.

11. TEAM WORK AND MORE TEAM WORK!! • What we are trying to get away from is:

12. The Dysfunctional Team Fragmented Approach: OT get the hands, Speech the head, PT the legs!!

13. Educationally based OT and PT • The goal is for the services to become integrated so the recommended strategies are being carried out across all environments and not just in a therapy situation. • Direct Service: individualized interventions carried out individually or in a small group. Therapy in the natural setting is most preferable. • Consultative or Indirect Service: Therapist and team (teacher, parent, support staff etc.) members share identification and possible solutions. While the expertise lies with the therapist, programming and techniques are implemented by the entire team.

14. Related Services (PT, OT, and Speech)

15. Once a student is of transition age (14 or older) • PT and OT goals become part of transition planning and every goal must relate to the child’s post secondary planning so again, it’s important they are developed with the team which includes the student.

16. Can total remediation always be achieved? No, but we sure can help educational teams with strategies to assist a student throughout their academic career to be as independent as possible…

17. Research regarding handwriting has shown that -It is very hard to change a grip after about 2nd grade (age 8). -Handwriting habits are generally formed by grade 3

18. Research Regarding Grasp • Research has shown that normal handwriting performance can be achieved with a variety of grasps • Therefore, therapists should focus on the functional implications of the student’s grasp and not on changing the grasp

19. Additional Resources: • Typing Resource: • http://www.bbc.co.uk/schools/typing/flash/stage1.shtml • http://www.onlytypinggames.com • http://www.typing-games.com

20. Out of School Activities to Improve Motor Skills: • Yoga • Martial arts • Swimming • Therapeutic riding • Therapy Pet activities • Modified sports/activities • Special Olympics

21. Questions about PT and OT in the schools? Thank you so much for coming!