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Language Development

Children are born ready to learn different skills in each development milestone. They are expected to learn these skills from parents/caregivers and the environment that surrounds them. Parents and caregivers are the best teachers for children to learn different skills. Children vary in reaching milestones, some are quicker than others. In this case, we are focusing on children’s speech development.

Children start learning a language at an early stage and they learn through the people who surround them. Children learn different language skills like giggles, repeating sounds, and telling stories. All these language skills that children learn in different milestones lead to language development. Skills help children to learn to understand what others are saying and communicate their thoughts ( IRIS Centre).

Some children take a long time to master the language, this might lead to speech and language difficulties ( IRIS Centre).

Speech and Language difficulties

Speech and language difficulties occurs due to language delays during speech and language development. Neurological disorders, brain injury, or intellectual disabilities can lead to speech and language difficulties. The combinations of speech and language difficulties can present negative impact on student academic development.

Some learning disorders are associated with delays in speech and language development. For example autism, emotional and behavior disorders, and specific learning disorders in language. Parents and caregivers need to observe children's development closely. To see if there are reaching the developmental milestones at the expected time.

Speech and language difficulties can be categorized into four areas which are receptive language, expressive language, social communication, and reading and spelling. A student might struggle with one or more of these areas which affect their academic performance( Belsky, Understood).

Speech and Language Therapy

This service aimes at improve communication skills , does not only deal with pronunciation however helps students who are struggling with spoken and written language. Speech and Language Pathologist are responsible with providing this service to students ( Belsky, Understood). It is a type of service provide support to assist students who have speech, language  and hearing
disabilities. The students can have a mild or severe, depending on the level of problem.

There are different types of services tha includes

Identification of children with speech or language impairments;

Diagnosis and appraisal of specific speech or language impairments;

Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

Provision of speech and language services for the habilitation or prevention of communicative impairments; and

Counseling and guidance of parents, children, and teachers regarding speech and language impairments ( IDEA, 2017)

What do they do ?
A goal of speech-language pathology services is to help students who have trouble with communication skills perform important learning and school-related activities ( IRIS, Centre).
Most of the time students struggles in these areas

Understanding verbal directions

Speaking in long sentences

Speaking fluently without stuttering

Projecting his or her voice so that others can hear

Putting words together in a meaningful way

Articulating their words

Sharing thoughts or ideas so that others can understand the communicative intent

Reading or writing (i.e., written communication)

Communicating appropriately in social situations

Hearing what others are saying

The speech and language pathologist aims at developing speech and language skills that will improve the conditions of the students. They don't only focus on academic area only , they also look on social aspect of student development.

Speech and Language Pathologist work with general teachers, special aid teachers , and parents to make sure that they know how to support the students.

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Occupational therapy (OT) is a branch of health care that helps people of all ages who have physical, sensory, or cognitive problems. (Finlan, 2020)

The word “occupational” in occupational therapy can be misleading. This profession is not about vocational counseling or work training. Occupations are defined as the activities of everyday life in which we all participate. Occupational therapists are health care professionals who help people to resume or maintain participation and independence in all areas of their lives including a variety of tasks – their jobs, leisure and social activities, getting around, caring for themselves and their home, and much more. (College of Occupational Therapists of Ontario, n.d.) The main goal of occupational therapy is to enable individuals to engage in daily activities that they
need, want, or are expected to do. (Wen et al., 2020)

Occupational therapists work in a wide range of settings. that can include hospitals, clinics, care facilities, rehabilitation centres/programs, nursing homes, recreation centres, schools, home care, private practice, vocational programs, insurance companies, health promotion, disability prevention/management, accessibility programs, and more.

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Speech Therapy becomes a related service, when there is another disability  that is related to speech  impairment.
Students with Specific learning disability that is related to language impairment , may benefit from this service. Speech and Language disorder related to reading, spelling and writing ( IRIS , centre pg 5)

Student with Childhood Apraxia of Speech ( CAS) . Is the motor speech disorder that makes hard for a child to speak. In order for speech to occur ,message has to be sent from the brain to the mouth. For the child with condition the message that is sent from the brain to the mouth is not sent correctly.Hence the child struggles with speaking properly according age (ASHA ,2021)
Children with this conditions have delays in language, struggle with  fine motor skills, reading  and writing . In additional they struggle with pronouncing words correctly , change sounds,.
Children /students with learning disabilities have speech and language  disorder

Autism

Stuttering

Specific Learning Disability in reading

These group of students will benefit to work with Speech Language Pathologist.

SLP will do assessment first.

Plan for treatment goals

Collaborating with teachers to ensure the student is supported.

Trains parents to how to support their child.

For example : A child who is struggling reading depending with age of the child. SLP will start teaching sound and SLP make sure that the child does the movement with his mouth. For each sound has got it own movement. this will help the child to differentiate sounds.SLP will use touch , visual and listening method to help child to learn sounds.

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ST Case Example - Case study of Patty, age 10

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ST Case Example - Case study of Patty, age 10

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Current Diagnosis: seizure disorder, specific learning disability, attention-deficit hyperactivity disorder (ADHD), apraxia of speech, receptive and expressive language impairment, and below-average cognitive functioning.

A whole team consisting of an augmentative and alternative communication regional consultant, an intervention specialist, an OT, the school psychologist, an SLP, a telehealth paraprofessional, the student, and the family.

Patty has very complex communication needs and has had an IEP for 5 years, so has been receiving traditional in-person speech-language therapy for many years. As the teachers became increasingly concerned about her receptive and expressive language, her unintelligible speech for daily communication, decreased social interaction, and impaired hand/arm coordination. It was the SLP who did a trial intervention to determine if Patty would benefit from telepractice services.

The SLP was to assess Patty's language skills and assist with AAC trials. The SLP found that Patty demonstrated the ability to use a hybrid approach to communicate including those that are intelligible to others (e.g., greetings, yes/no), gestures, and messages generated with an AAC device. Through working with the team, the SLP was integral in assisting Patty to communicate. The SLP taught Patty how to use the device and the quarterly meetings showed them that she was regularly using it to respond to verbal prompts. However, not all members of the school were aware of the issue with Patty, so the SLP  explained it in more detail to them. The team also finds a gap in the use of the device at home, so work together with the parents to support home learning, including training on the use of the device and lessons.

Ultimately, Patty can use the SGD to answer questions, retell a story and participate in book discussions. SLP works to ensure that Patty uses the device with increasing language difficulty as time progresses, consistent with the plan the team has put in place.

Grogan-Johnson, S., & Bolden III, W. (n.d.). Case study: IPP team works with 10-Year-Old girl to improve communication and social interaction. ASHA. Retrieved May 29, 2022, from https://www.asha.org/public/speech/development/speech-and-language-services-in-schools/

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Belsky, G. (n.d.). What is speech therapy? Understood. Retrieved May 24, 2022, from https://www.understood.org/en/articles/what-you-need-to-know-about-speech-therapy?_sp=79313a0a-a621-4893-91a6-d44c0ea421ea.1653414052727

Centers for Disease Control and Prevention. (2022, May 11). Language and speech disorders in children. Centers for Disease Control and Prevention. Retrieved May 24, 2022, from https://www.cdc.gov/ncbddd/developmentaldisabilities/language-disorders.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fncbddd%2Fchilddevelopment%2Flanguage-disorders.html

Sec. 300.34 related services. Individuals with Disabilities Education Act. (2017, May 2). Retrieved May 25, 2022, from https://sites.ed.gov/idea/regs/b/a/300.34

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Occupational therapists often work on a team with physiotherapists, but the two roles are distinct.
Physiotherapists help people restore physical function; occupational therapists focus on how that function affects the ability to do the things that are important to them. (College of Occupational Therapists of Ontario, n.d.)

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What does Occupational Therapists do at school?

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What does Occupational Therapists do at school?

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A primary goal of occupational therapy (OT) is to support a student’s participation in school-related routines and activities, such as zippering a coat, completing a classroom assignment, or playing during recess.

Occupational therapy practitioners

identify the student’s strengths, as well as his or her challenges, during all educational activities, whether they take place in the lunchroom, classroom, or playground.

are experts in looking at the student holistically and assessing and analyzing his or her activity performance in terms of its components: cognitive, sensory, motor, perceptual, emotional, functional communication, and the social skills that are necessary for someone to participate and to be able to engage in their life routines.

use a wide range of assessment tools in order to gain a broad understanding of a student's needs. These tools include standardised assessments which are robust and provide measurable outcomes.

have specialized training in autism, assistive technology,  and in learning disabilities that include motor and process skills, sensory, behavior management, social skills, and executive functioning challenges.

are skilled in analyzing and modifying activities and environments (e.g., classroom, playground, lunchroom) so that they are conducive to learning and social participation. The main question is ' Are there barriers that need to be reduced?'

trying to provide services in the least-restrictive environment (LRE) to the extent possible. Whenever possible, they are providing service within the classroom to see genuine, naturally occurring activities and events to see how the child engages or participates during the school day.

would also be offering valuable information to support the teacher by recommending some classroom modifications to reduce the barriers and to increase the student’s ability to engage in his school activities.

provide consultation to families.

(IRIS | Page 6: Occupational Therapy Services, n.d.)

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Who might benefit from OT services in a school setting?

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Who might benefit from OT services in a school setting?

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Some examples include students who might be facing difficulties with:

Completing classroom assignments

Organizing classroom materials and workspaces

Manipulating objects or materials (e.g., scissors, paintbrush, pencil)

Turning pages in a book

Performing self-help skills (e.g., putting coats on or taking them off, changing for gym class, pulling pants up or down for toileting)

Feeding themselves (e.g., holding a spoon, chewing food, avoiding foods for sensory reasons)

Attending to tasks or following directions (e.g., in cases in which the student is easily distracted by things in the environment)

Taking notes in class or writing legibly

Tolerating sensory input (e.g., the student might have aversion to some textures, tastes, or sounds)

Carrying out tasks that involve visual-perceptual skills (e.g., tracking text when reading so as not to skip words or lines, visually identifying important information in text or on worksheets)

Participating socially (e.g., developing peer relationships, turn-taking abilities)

Transitioning from one environment to another (e.g., high school to post-secondary job or college)

(IRIS | Page 6: Occupational Therapy Services, n.d.)

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Main areas the Occupational Therapist can  support 

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Main areas the Occupational Therapist can  support 

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Fine motor skills
What?
Fine motor skills are small-muscle movements made with the hands, fingers, and toes, such as grasping. Hand-eye coordination, that is the body's ability to process information received through the eyes and use it to direct movements of the hands to complete a task or skill, belongs here as well.

Why?
It is crucial to develop fine motor skills so students can grasp and release toys and develop good handwriting or computer skills.

How?
Providing adapted writing/drawing/art tools, suggesting specialized scissors, coming up with fun fine motor activities for the student to complete throughout the day, etc.

Visual Motor & Visual Perception
What?
Visual perceptual skills enable a child to make sense of and interpret what they are seeing.  These skills include:

Visual discrimination - matching two objects that are the same

Visual memory - the ability to remember visual information

Form constancy - the ability to notice that two objects are the same even if they are different in size, color, etc.

Figure ground - the ability to find an object when it is hidden in a busy background (e.g. “Where’s Waldo”)

Visual closure - the ability to identify two objects that are the same even if part of one is missing

Why?
Visual motor skills enable a child to coordinate their eyes and hands to draw and write. Children may have difficulty with copying shapes, handwriting, lining up math problems, etc.

How?
Providing slant boards, giving special writing paper, supplying colored reading strips, suggestions for proper font size, giving visual-motor exercises to complete throughout the day, etc.

Executive functioning skills and attention
What?
Executive function and self-regulation skills are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. (Executive Function & Self-Regulation, 2020)

Why?
These skills are crucial to organize information to process, and to plan and carry out an activity from the beginning to the end. Executive function skills depend on two types of brain function: working memory, and mental flexibility. These functions are highly interrelated, and the successful application of executive function skills requires them to operate in coordination with each other.

Working memory governs our ability to retain and manipulate distinct pieces of information over short periods of time.

Mental flexibility helps us to sustain or shift attention in response to different demands or to apply different rules in different settings.

How?
Meeting with the students to create schedules and planners, creating ways for the student to stay organized, helping student declutter their desks and lockers and coming up with an organization system for them, working on time management techniques for timely completion of tasks,  modifying the environment by offering different placement of the desk or a cushion for the child to sit on, infusing more physical activity throughout the school day, breaking down a task into its key components and offering classroom instruction in parts or with simple directions, breaking down tasks into smaller steps, etc.

Behavior management/self-regulation
What?
Behavior management focuses on maintaining positive habits and behaviors and reducing negative ones.

Why?
To create an appropriate environment for learning to take place and to guide behavior management in individuals and groups toward fulfilling, productive, and socially acceptable behaviors.

How?
Coping strategies, curriculum like Zones of Regulation, positive reinforcement strategies, clear boundaries and consequences, positive self-talk, modeling,  etc.

Social skills
What?
Social skills are the skills we use to communicate and interact with each other, both verbally and non-verbally, through gestures, body language and our personal appearance. (What Are Social Skills? | SkillsYouNeed, n.d.)

Why?
To have more positive and supportive relationships with peers and community members.

How?
Social Thinking training, problem solving training, perspective taking training, positive conflict resolution strategies, functional language training, etc.

Independent living skills (including transition needs) & daily routines
What?
Life skills are those abilities that help to deal with challenges in life and to promote physical, mental, and emotional well-being and competence. There are a wide range of life skills and definitions are usually broad and generic. Life skills can be cognitive, behavioral, emotional, personal, interpersonal, or social. The five main life skills areas defined by WHO Department of Mental Health are decision-making and problem-solving; creative thinking and critical thinking; communication and interpersonal skills; self-awareness and empathy; and coping with emotions and stress. These skills may generally be classified in three basic dimensions:

cognitive skills (decision-making, problem-solving, creative thinking, and critical thinking)

emotional skills (self-awareness and self-management)

communication and interpersonal skills (interpersonal relationship skills, verbally or nonverbally communication, and social awareness including empathy, listening actively, and respecting group differences)

Why?
Achieving essential life skills is crucial in order to adapt to changing environmental conditions and meet the demands. Life skills contribute to the development of self-efficacy, self-confidence, and self-esteem by helping students to understand and respond different situations, and to work towards living independently in the future.

How?
Evidence-based life skills programs, using methods such as role play, feedback about performance, practice of skills instead of just using didactic teaching, starting with skills learning in nonthreatening situations and progressively moving on the practice of skills in high-risk situations, adapting clothes and feeding utensils for increased independence, teaching fun songs for tying shoes, washing hands; budgeting strategies, spatial adaptation to support map navigation, etc.

(Huri, 2017b)

Sensory-processing challenges
What?

Low Registration (high neurological threshold, passive response strategies): An individual experiencing low registration may not notice environmental cues and appear to be oblivious or not fully connected. However, most events are not intense enough for
them to process.

Sensory Avoiding (low neurological threshold, active response strategies): Unfamiliar or excessive sensory input may be upsetting or challenging to process. An individual may limit sensory input by having strict rules and habits, or may appear withdrawn.

Sensory Seeking (high neurological threshold, active response strategies): An individual who seeks sensory input may seem very active and energetic. New events and high levels of stimulation are often sought to meet sensory needs.

Sensory Sensitivity (low neurological threshold, passive response strategies): An individual may be much more aware of sensory input, which can be challenging in unstructured environments. Planning and forming activities that offer more predictability can be beneficial.

Why?
The occupational therapy practitioner has expertise in assessing the sensory components that are all around us, whether it’s sounds, smells, textures, movements. This is what we typically receive and filter and accommodate all day, every day. But the student with a sensory challenge might find certain smells or textures irritating, and this might lead to inattention or oppositional behavior.

How?
Slowly introduce different classroom textures and create an individualized  “sensory diet” per student needs to accommodate and remediate some of this hypersensitivity that the student is showing to sensory information, collaborate with the teachers to try to address the sensory needs throughout the school day, alternate seating options, auditory accommodations for increased focus, fidgets or weighted items for increased attention and/or transitions, providing accommodations for tactile feedback during classroom tasks, supplying oral suggestions to help quiet and calm the mouth, etc.

Transition
What?
Why?
How?

Assistance with Adapted Equipment
What?
Adaptive equipment is any tool, device, or machine that is used to help with any task associated with daily living. Assistive devices can be created or purchased so long as they achieve the end result of making tasks possible for people with disabilities.
There are various kinds of adaptive equipment. These fall under several categories depending on the type of assistance they give.

Why?
To assists individuals with daily living, and to make the job of writing, cutting, being a student in the classroom easier.

How? (some examples)

eating -adaptive utensils, non-skid bow, plate guar, scoop dish, long straw, etc.

bathing - tub or shower chai, handheld shower, grab bars, transfer board or a mechanical lift, etc.

dressing - dressing stick, sock aids, long-handled shoe horns, button hooks, elastic shoelaces, etc.

communication - communication boards, hearing aids, screen readers, speech-generating devices, and amplified telephone equipment, etc.

leisure - adaptive toys and sports equipment, etc.

safety -wearable call buttons and fall detection devices are types of assistive equipment, etc.

(BraunAbility, 2021)
(IRIS | Page 6: Occupational Therapy Services, n.d.)
(Finlan, 2020)
(Calhoun, 2022)
(Visual Motor / Perception | Occupational Therapy and Physical Therapy, n.d.)

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Occupational Therapy for Students With Disabilities

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Occupational Therapy for Students With Disabilities

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Attention Deficit Hyperactivity Disorder (ADHD)

executive functioning skills/attention

assistive technology

behavior/self-regulation - impulse control

social skills

sensory-processing

fine motor skills - writing

active listening

Autism Spectrum Disorder (ASD)

social skills

verbal and non-verbal communication skills

repetitive behavior

independent life-skills

motor skills (posture, balance, fine motor skills)

assistive technology

behavior/self-regulation

executive functioning skills/attention

sensory-processing

active listening

Sensory Processing Disorder

sensory integration

Specific learning disability (SLD)

reading

spatial awareness

writing

executive functioning/attention

Speech or language impairment/Hearing impairment/Visual impairment

verbal and non-verbal communication skills

independent life-skills

assistive technology

Orthopedic impairment/Traumatic brain injury

independent life-skills focusing on self-management

assistive technology

motor skills

Down Syndrome

social skills

verbal and non-verbal communication skills

independent life-skills focusing on self-management

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Depending on the therapist, there are a number of ways in which services can be delivered.

Delivery mode:

Face to face

One on One

Virtual consultations which can be effective for low intensity and ongoing support, or can be used to supplement face to face services. They may use:

Virtual/video conferencing

Online platforms

Phone

Small groups

Classroom and all school

Training workshops and webinars

Delivery Frequency:

One off session

Ongoing (ie. Weekly session for the period of a school term or year)

Educational/professional development program series, short and long

(Occupational Therapy Fact Sheet, n.d.)

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Schools may use specialist allied health services through this scheme to support students and the professional development of their teachers and school staff.

Allied Health professionals are not part of the medical, dental or nursing professions, but are university qualified practitioners with specialised expertise in preventing, diagnosing and treating a range of conditions and illnesses

What is Occupational Therapy?

Occupational therapists (OTs) focus on promoting health and wellbeing by enabling people to participate in the everyday occupations of life. The term 'occupation' is used to describe the everyday things that we do in our life roles and that make us who we are.

Occupational Therapy services can be used to meet the specific and individual needs of students with disability that affect what they need to do at school. An OT can support a student's well-being, participation and success across many aspects of school life from building skills for concentration, fine and gross motor skills, and support behavioural needs.

There are two ways in which allied health providers may deliver services on school grounds:
1. Parent funded services for individual students:
A parent/carer may request permission from the Principal to allow their OT to deliver services during school hours to their child. In most cases, this service will be funded out of the student's NDIS (National Disability Insurance Scheme) plan. NDIS funding does not fund group programs or services of any kind.
2. School initiated and funded services for small groups, whole of class/school and staff professional development:
Direct engagement of an OT by the school, paid for with RAM funding. These services will largely be linked to learning outcomes. Schools can use OT services to meet the specific and individual needs of students with disability that affect what they need to do at school. They may engage OT services to support identified groups of students or to provide professional development to their staff. Schools may also engage providers for the support of individual students if they believe these services are required and are not being funded through the NDIS.

Who does an occupational therapist work with?

The list below provides some examples of students who may benefit from OT support, but it is not exhaustive.

Children and young people with developmental disabilities including, but not limited to: Autism Spectrum Disorder, Cerebral Palsy, Downs Syndrome, specific genetic disorders and birth injuries or birth defects.

Children and young people with learning and/or behavioural difficulties including, but not limited to: ADHD, executive functioning difficulties, dyspraxia, sensory processing differences, Oppositional Defiance Disorder and anxiety as a consequence of underlying skill deficits.

Children with injuries that will require temporary supports such as post-surgical conditions, burns and injuries

Occupational therapists may also work with parents, carers, teachers and others in support roles to provide training, professional development and mentoring.

What services can a school engage an occupational therapist to deliver?

For students

When working with students, OTs aim to develop their skills and abilities so they can learn and safely and independently access the school environment. This can include:
Assessments:

Assess and analyse a student's movement, sensory needs and cognitive and psychosocial skills to determine a treatment and support plan

Assess the school or classroom environment to identify modifications that improve a student's safety and independence of access and navigation

Assess the suitability of existing available lifting equipment for a student's specific needs

Supports:

Support the setting up of equipment to support students in completing their class work more comfortably and efficiently (e.g. setting up an iPad mounted to a student's wheelchair)
Recommendations:

Designing tasks and environments to support students to achieve improved participation in their education

identify personalised adaptive equipment reasonably necessary for a student's school attendance (e.g. change tables, shower and toileting arrangements) and any required modifications

For teachers and school staff

OTs work with teachers and school staff to provide expertise and training and ensure that they are equipped to best support students with specific needs. This can include:
Training and education:

Providing training in mobility support, positioning, manual handling or use of lifting or other adaptive equipment.

Work collaboratively to develop and implement a student's Personalised Learning and Support Plan.

Specific education on specific needs ie. Understanding sensory processing disorders.

Team Teaching and classroom support:
How are services delivered?

Depending on the therapist, there are a number of ways in which services can be delivered.
Delivery mode:

Face to face

One on One

Virtual consultations which can be effective for low intensity and ongoing support, or can be used to supplement face to face services. They may use:

- Virtual/video conferencing

- Online platforms

- Phone

Small groups

Classroom and all school

Training workshops and webinars

Delivery Frequency:

One off session

Ongoing (ie. Weekly session for the period of a school term or year)

Educational/professional development program series, short and long

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Schools may use specialist allied health services through this scheme to support students and the professional development of their teachers and school staff. Allied Health professionals are not part of the medical, dental or nursing professions, but are university qualified practitioners with specialised expertise in preventing, diagnosing and treating a range of conditions and illnesses Occupational therapists (OTs) focus on promoting health and wellbeing by enabling people to participate in the everyday occupations of life.

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According to the American Physical Therapy Association (APTA), physical therapists are trained and licensed movement experts. They are able to diagnose and treat a range of injuries, disabilities, and health conditions.

Physical therapists main goal is to improve a person’s quality of life, range of movement and  and prevent further injury or disability.

Physical therapists work in a number of different settings - private practices, hospitals, nursing homes, hospices and schools amongst others.

This article will focus on school-based physical therapy (PT).

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According to Dr. Fox (2017), 'School-based physical therapists (PT) are part of a team of related service providers who support a student’s ability to access his/her educational environment. As specialists in movement, they assist a student’s physical participation in a variety of settings throughout the school day. '

In a school setting PT are part of a collaborative teams that aims to support a child with disability. They can work as part of the IEP team that can be made up of the following :
- child's general education teacher
- school psychologist
- occupational therapist
- speech language pathologist
- parents
- special education coordinator

These are the fundamental differences between medical PT and school based PT:

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School-based PT aims to increase access to the curriculum by giving solutions to physical issues that may cause limitation in participation and socialization.
The role of the PT will therefore be to improve skills in  the following areas:
• Walking or wheelchair skills
• Stair climbing
• Balance
• Coordination
• Sensory Awareness
• Self care skills
• Large motor skills
• Positioning
• Assistive technology

Physical therapy can use direct or indirect interventions. Direct interventions  involve the PT working directly with the student on a regular basis either individually or in a group setting. These direct interventions can be provided in the gym, therapy room, multi-sensory room or any other suitable location.
Indirect interventions happen when the PT consults with the general education teacher and other members of the IEP team to make recommendations and suggestions of strategies that can enhance the students' participation and independence in school.

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Students with disabilities in any of the following areas may be eligible for school-based PT :

Cerebral palsy - difficulty in negotiating the school  - walking patterns, stair climbing, opening/closing doors, up/down ramps, wheelchair skills

Autism spectrum disorder (ASD) - difficulty with sensory processing - dislikes touching different objects, craves movement, fearful of movement, poor body awareness

Autism spectrum disorder (ASD) - decline in gross motor skills (large motor skills) - jumping, skipping, hopping,

Scoliosis - gives poor posture and  an abnormally rounded or “humpback” appearance - does not sit properly, slumps on desk frequently

Arthrogryposis - students have stiff joints that don't move well. they lack self care skills - transferring on/off toilet, getting backpack on/off

Dyspraxia - causes poor balance skills - falls frequently, stumbles when walking

Developmental coordination disorder - causes poor coordination skills - difficulties throwing, catching and kicking

Guillain-Barre Syndrome - causes issues with transition skills as it can cause muscle weakness, pain, and short-term  paralysis of the muscles in the face chest, and leg- on/off school bus, walking in classroom line, going from sitting to standing

Who determines eligibility for this service?
Eligibility falls under two laws - IDEA and ESSA. IDEA, Individual with Disability Act, guarantees free and public  education to students with disabilities. It also states that to students should receive interventions in the least restrictive environment (LRE) which means PT services can be provided within the school.
ESSA, Every Student Succeeds Act, that holds schools accountable for providing high-quality education for all students. This means schools should plan for and provide services for students with disabilities to ensure that they have full access to education programs provided by the school.
Students with disabilities and have limitations in accessing education qualify or are eligible for school-based PT.

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COLLABORATION IN SCHOOL-BASED PHYSICAL THERAPY WITH CFISD CARPENTERS

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COLLABORATION IN SCHOOL-BASED PHYSICAL THERAPY WITH CFISD CARPENTERS

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Students with disabilities receive a variety of activities at school with the PT. These can include:

strengthening exercises for the body

stretching exercises

instruction and practice of functional skills such as stair climbing, carrying books or backpack, open/close doors

walking activities in the classroom, hallway, cafeteria, gym class,

assessment/ modification of adaptive equipment such as classroom desks and chairs, bathroom modifications, positioning equipment

activities to improve the large motor skills necessary for physical education or recess

coordination activities

activities to improve sensory processing such as obstacle courses, swinging, jumping

instruction and practice of wheelchair use

activities to improve balance

instruction to other staff that works with the student

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PT Case Example - Elementary student with ASD

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PT Case Example - Elementary student with ASD

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A student with ASD could need the services of a PT in school according to their IEP. The ways to help a student with ASD are many and varied.

Movement/motor concerns

The PT would provide support for transitions including moving through the school.  Provide strategies for independence vs. handheld assistance when students walk in the hallway (e.g., recommend preferred position in line, identify and cue attention to the specific peer that student follows, reinforce maintaining personal space between peers such as being able to place a hand on the student in front with the elbow straight) building with classmates. To help expand gross motor skills/play repertoire with peers, the PT could introduce games and even stand a bridge to encourage participation in gross motor play vs sedentary play during recess. The PT can also help to promote motor imitation skills through specific songs, rhymes, and games to promote body connection, control, and awareness.

Safety concerns

The PT can work with both the student and the school team to create plans for emergency evacuations, ensuring the student knows how to maneuver around any obstacles. The PT can also work to embed concrete safety rules for school outings and in school activities to prevent wandering off.

Programming concerns

The PT can help the student to improve their coordination of self, at the same time they can assess the classrooms to assist the teacher in putting appropriate gross motor activities in the daily schedule. They can also assess the corridors and doorways to remove any distractions or prohibitive objects. The PT could also provide opportunities for the students to undertake physical activities before class to ensure the appropriate use of energy during class e.g swimming before class.

Behavior concerns

The PT can work with students to help develop self-regulation, self-control, and emotional control as well as collaborate with the OT and board-certified behavior analysts to develop an appropriate behavior plan. The PT is an important part of the IEP team and should also keep data and supply to the relevant departments on what activity is most beneficial for which instance. This includes the best way for the student to be ready to learn; how to sit, in what chair, and how to maintain their own personal space.

APPT. (n.d.). Strategies for physical therapist collaboration with school-based teams for children with autism spectrum disorder. Pediatricapta. Retrieved May 29, 2022, from https://pediatricapta.org/includes/fact-sheets/pdfs/16%20School-based%20Teams%20and%20ASD%201216%20rev.pdf

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A third grader in a primary school  has social skill challenges that impact occupational performance and social participation at school. He participated in Multi-Tiered Systems of Support (MTSS) services through whole group and small group social skills instruction, but his teachers and parents still have concerns about his social participation. He is currently being referred for a special education evaluation because he continues to demonstrate challenges when participating socially.

Strengths and Needs:

He has high energy at school and is excited to be around his teacher and peers. He is experiencing challenges with social interaction skills. He struggles with understanding and demonstrating expected social behaviors in the classroom and other school contexts. These social interaction challenges are affecting his occupations while at school – formal education participation, community participation, and peer group participation. He keeps getting up during class to talk to his classmates,” and is having a hard time maintaining a safe physical distance from his peers. Additionally, his teacher reported that he frequently talks without raising his hand or being called on. When talking to his classmates, he tends to dominate conversations, and does not pay attention when other students are talking to him.

Overall goals:

He will become aware of social rules in the classroom by listening to his teacher and following the  classroom instructions.

He will become more aware of others’ perspectives by respecting their space and demonstrating cooperative interaction during activities with peers.

He will demonstrate improved executive function, specifically self-management skills such as keeping his hands/feet to himself and reduced interfering behaviors, in the classroom.

Intervention tools that can be used to address the overall goals:

Social scripts: Allow for children to practice what to do in social situations that may be awkward or challenging. The therapist works with the child to identify a script appropriate for that specific situation, and the script is written so the child can rehearse it. The child may keep a notebook to write scripts to refer to when necessary.

Social stories : This method helps children establish healthy routines and develop new social skills. Each story addresses a social skill or issue. The four types of sentences used in social stories include descriptive sentences (explains what happens and why, who is involved, and provides background), directive sentences (provides direction to the child and teaches them how to do something or how to respond), perspective sentences (describes the reactions of others and their feelings), and control or affirmative sentences (written by the child to help them remember information).

Video modeling: Involves an individual watching a video demonstration of a specific behavior and then copying the behavior of the model. Video self-modeling allows children to observe and model from their own behaviors. This may be effective for improving social communication skills (i.e., social interaction skills such as looks, regulates, places self), functional skills, and behavioral functioning.

Self-management: May be used to increase social interactions and decrease off-task behaviors in children. Children are taught to differentiate between appropriate and inappropriate behaviors (i.e., appropriate physical distancing), examine and record their own behaviors, and reward themselves for behaving appropriately.

Ways the Occupational Therapist would contribute to the intervention process:

The OT has the overall responsibility for the development and implementation of the intervention plan.

Collaborate with all stakeholders to develop the plan.

Choose, implement, and make modifications to therapeutic activities and interventions that are consistent with competency levels, goals, and the practice setting.

The OT will contribute to the school team’s determination of the need for continuing, modifying, or discontinuing therapy services

Occupational therapy services might be discontinued when he no longer has adverse needs impacting his education that would need to be addressed through occupational therapy. This might happen after he has met his short- and long-term goals or other services are implemented that would sufficiently meet his needs. OT services may also be discontinued if his parents choose for him to no longer have an IEP.

(Kim & Ponsolle-May, 2021)

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Calhoun, T. (2022, April 4). OT Month – Helping Children Within a School Setting | PT Services. PT Services Rehabilitation, Inc. https://www.ptsrehab.com/ot-month-helping-children-within-the-schools/

College of Occupational Therapists of Ontario. (n.d.). What Occupational Therapists (OTs) Do. COTO. Retrieved May 26, 2022, from https://www.coto.org/you-and-your-ot/what-occupational-therapists-do

Executive Function & Self-Regulation. (2020, March 24). Center on the Developing Child at Harvard University. https://developingchild.harvard.edu/science/key-concepts/executive-function/#:%7E:text=Executive%20function%20and%20self%2Dregulation,and%20juggle%20multiple%20tasks%20successfully.

Finlan. (2020, January). Occupational Therapy (for Parents) - Nemours KidsHealth. KidsHealth. Retrieved May 26, 2022, from https://kidshealth.org/en/parents/occupational-therapy.html

Huri, M. (2017b). Occupational Therapy - Occupation Focused Holistic Practice in Rehabilitation. InTechOpen.

IRIS | Page 6: Occupational Therapy Services. (n.d.). Iriscenter. https://iris.peabody.vanderbilt.edu/module/rs/cresource/q2/p06/#content
Kim, & Ponsolle-May. (2021). Case Example – Occupational Therapy in School-Based Practice. Case Example- School-Based Practice, 1(1), 1–9. https://www.ilota.org/assets/Case%20Example-%20School-Based%20Practice%20041421.pdf

Occupational Therapy Fact Sheet. (n.d.). NSWgov. https://education.nsw.gov.au/teaching-and-learning/disability-learning-and-support/programs-and-services/specialist-allied-health-service-provider-scheme/user-guide-for-schools/scheme-details/allied-health-in-schools/occupational-therapy-fact-sheet#What2

Visual Motor / Perception | Occupational Therapy and Physical Therapy. (n.d.). Cincinnati’s Children. Retrieved May 26, 2022, from https://www.cincinnatichildrens.org/service/o/ot-pt/visual-motor-perception#:%7E:text=Visual%20perceptual%20skills%20enable%20a,ability%20to%20remember%20visual%20information

Wen, Craig, Gottlob, Kneuer, Perry, Piper, Read, Romero, Roush, Sale, & Wimmer. (2020). Occupational Therapy Manual for the EASA Model. Early Assessment& Support Alliance, 1(1), 1–13. https://easacommunity.org/PDF/OT-Manual.pdf

What are Social Skills? | SkillsYouNeed. (n.d.). SkillsYouNeed. https://www.skillsyouneed.com/ips/social-skills.html

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Medical services are prescribed a licensed physician and usually provided by a licensed nurse to service a child's medically related disability to assure a child has access to education and school facilities.  Without these services thousands of students would not be able to attend school.

A child who has been diagnosed with a medical condition must also be eligible as a "child with a disability" as defined by the Individual with Disabilities Education Act (IDEA) or Section 504 of the Rehabilitation Act. To receive medical services the diagnosis must adversely impact the child's educational progress.

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Some Examples of Medical Services in Schools

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Some Examples of Medical Services in Schools

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Asthma - inhaler

Allergies - Epi pen, medicine

Diabetic - blood test, insulin

ADHD - medicine

Epilepsy - aid during seizures, medicine

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Eighth grader John was experiencing shakiness and blurred vision in second period history, and the teacher realized it may be time to have John escorted to the nurses office.

John wears a medical ID indicating that he has Diabetes 1.

A guest nurse was on duty in the office. The nurse consulted John’s 504 plan and reviewed what his insulin schedule was and what his treatment plan was if his blood sugar was low from too much insulin being in his system.

In addition to shakiness and blurred vision, other symptoms that were notated in John’s plan included: anxiety, swating, chills, fatigue when his blood sugar became too low. The nurse knew that other things such as nausea, hunger, anger, stubbornness can also be signs that a diabetic student needs treatment for diabetes in order to remain in school.

The nurse checked John’s blood sugar and confirmed that John had too much insulin in his system, a sure sign that his blood sugar was too low. The nurse gave John 4 ounces of orange juice and rechecked his blood sugar in 15 minutes. It was still low so he decided to provide two glucose tablets and check again in 15 minutes.

The nurse then proceeded to call John’s parents, but told them that John should be ready to go to his next class, and that proved to be the case that John could go to his next class about 40 minutes after entering the office.

Without a nurse on campus, John may have missed the rest of the day.