Special Populations

AUTISM

Patients with Autism sometimes have sensory problems that could cause them to respond to normal sensory experiences in different ways than people without Autism. We need to understand as physical therapist assistants that punishing these patients is not an appropriate response. If we have patients with Autism that are exhibiting problematic behavior during the treatment session, it might be because they want something or they want to avoid something. Instead changing the environment or providing sensory integration therapy may be the best option.

As physical therapist assistants, to have a successful treatment session with patients with autism, the treatment session needs to be:

Structured: There must be a clear system of rewards for desired behaviors and consequences for inappropriate ones.
Consistent: Consistently rewarding appropriate behavior and giving consequences for inappropriate behavior is essential to success. Ignoring inappropriate behaviors or forgetting to reward positive ones will undermine the behavioral plan. Consistency is the key to success!
Clear: The child must understand what the problem behavior is, what the consequence will be if they exhibit the problem behavior and what will happen if they exhibit the desired behavior.

Applied Behavioral Analysis, or ABA
ABA is an intensive behavioral approach that expands on the basic reward-consequence model. ABA behavioral trains a child in small, incremental steps to meet larger goals, with each step along the way rewarded. ABA can teach appropriate social behaviors, language skills, and academics. ABA is most effective its started before the age of five and is done in an intensive program that involves at least twenty hours a week of one-on-one training with therapists.

More Behavioral Strategies: Create a Routine
Children with autism tend to behave better with structure, because they know what to expect and what is expected of them. Routines can help decrease anxiety and make transitioning from one activity to another easier. Introducing small changes to your child's routine can help your child develop coping strategies to deal with transitions. When changes to the routine need to be made, use strategies like social stories to help lessen the anxiety that transitions often present.

Set Meaningful Consequences
Many times people on the spectrum have problems understanding the concept of a time out or why things are being removed. It is imperative that the child understands the consequences the caregivers have set for specific behaviors. Furthermore, time out in their room may not be a negative consequence for your child. Be sure the consequence you provide does not accidentally reinforce the negative behavior.

What Does a Physical Therapist Do for People with Autism?

When we are treating patients with Autism, we need to focus on their lack of coordination, muscular strength, and especially balance.

Perhaps most significantly, autistic children are likely to have difficulty with "motor planning." In other words, they may have the skills to climb onto a swing and be able to hang on-but they may have a very difficult time coordinating their bodies to "pump" and get the swing moving.

Physical therapists and physical therapist assistants may work with very young children on basic motor skills such as:

Sitting
Rolling
Standing
Running
Strength
Coordination
Gross motor skills

As children grow older, physical therapists are more likely to treat young clients at the child's preschool or school. There, they may work on more sophisticated skills such as:

Skipping
Kicking
Throwing
Catching

These skills are not only important for physical development, but also for social engagement in sports, recess and general play.

www.nationalautismresources.com/autism-behavior-interventions-strategies/

www.verywellhealth.com/physical-therapy-as-a-treatment-for-autism-260052

School-Based Physical Therapy

In school settings, physical therapists may pull children out to work with them one-on-one, or "push in" to typical school settings such as gym class to support children in real-life situations. It's not unusual for a physical therapist to create groups including typical and autistic children to work on the social aspects of physical skills. Physical therapists may also work with special education teachers and aides, gym teachers, and parents to provide tools for building social/physical skills. School-based therapy is provided to give children with disabilities and delays improved access to education and to help each child reach their educational potential.

The role of the Physical Therapist (PT), the Occupational Therapist (OT) and Speech and Language Pathologist (SLP) is to integrate therapeutic strategies and interventions that coordinate with the student's curriculum, rather than providing related services as a "special subject" during the school day. Therapy services provide support and adaptations to allow function in the school.

School based physical therapy focuses on a child's ability to safely negotiate the school environment as independently as possible.

Physical therapy interventions are designed to enable the student to travel throughout the school environment; participate in classroom activities; maintain and change positions in the classroom; as well as manage stairs, restrooms; the cafeteria, more fully utilize the playground equipment; and participate in physical education.

Physical therapists and physical therapist assistants also work with adaptive equipment to assist children with day-to-day tasks.

The school team along with the child's family work to determine whether a child has a need for special education, and/or requires related services such as physical therapy. A physician's prescription is needed to start the evaluation process.

School-based therapy is provided to give students improved access to education. It is not a substitute for medically-based therapy.

Physical Therapists focus on Gross Motor Skills. Gross Motor Skills are large movements of the body, which relate to mobility and active play.

Activities that promote the development of gross motor skills:

Playground equipment
Endurance activities
Swimming
Ball Toss
Kick Ball
Jump Rope, Skipping, galloping, hopping
Playing outside
Imitating animals
Wheelbarrow walking
"Simon Says"
Log Rolling
Riding bicycles
General exercises

careforchildren.info/understanding-school-based-therapy/

Cerebral Palsy

Cerebral Palsy is a non-progressive movement disorder that results from brain damage and is the most common cause of permanent disability in children. Autopsy reports have indicated lesions that include hemorrhage below the lining of the ventricles, damage to the central nervous system that caused neuropathy and anoxia, and hypoxia that caused encephalopathy.

80% -Prenatal: Rh incompatibility, maternal malnutrition, hypothyroidism, infection, diabetes, and chromosome abnormalities.
20% Perinatal/Postnatal:
Premature births, breech deli, low birth weight, prolapsed cord, placenta abruption, and asphyxia.
Postnatal: CVA, head trauma, neonatal infection, and brain tumor.

A child may present with high tone, low tone or athetoid movement. CP is classified as monoplegia, hemiplegia, and quadriplegia.

Interventions for Movement Difficulties

Medication

Medical specialists may prescribe medications that assist movement issues. Some medications are taken orally (e.g. diazepam) and others are injected or delivered through surgically implanted pumps (e.g. Baclofen). Many children with cerebral palsy benefit from Botulinum toxin type A injections into muscles affected by spasticity. This intervention is used from about two years of age and is most effective when used in conjunction with therapy.

Botulinum Toxin-A injections for supporting pain and comfort
Occupational therapy following botulinum toxin-A injections

Surgical procedures

Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure that is used in a small percentage of children with cerebral palsy to permanently reduce spasticity in their legs.

Physical Therapy and occupational therapy

Physiotherapists and occupational therapists focus on encouraging a person's day-to-day movement skills such as sitting, walking, playing, dressing and toileting. They will use a range of specialist interventions such as movement training and equipment, e.g. walking frames, wheelchairs, supportive seating, footwear and orthotics.

Ankle Foot Orthoses
Bimanual upper limb therapy
Conductive education
Constraint-induced movement therapy for the leg (CIMT-Leg)
Goal directed training
Home programs
Hydrotherapy for adolescents and adults
Massage for pain and movement
Powered mobility
Treadmill training for people with cerebral palsy

Interventions for muscle, bone and joint difficulties

Surgical procedures

Orthopaedic surgeons correct joint deformities and lengthen muscles. Surgery usually takes place in a child's late primary years or early adolescence to improve walking quality and reduce pain. Paediatric rehabilitation specialists support the management of some of the conditions associated with cerebral palsy, such as spasticity, musculoskeletal issues and growth.

Casts, splints and muscle strengthening

Physical therapists and occupational therapists may also focus on preventing impairments that might affect movement. They use casts, orthotics and muscle strengthening exercises.

Hydrotherapy for adolescents and adults
Strength training of the arm
Treadmill training for people with cerebral palsy

What is IDEA?

The Individuals with Disabilities Education Act (IDEA) ensures that all children with disabilities are entitled to a free appropriate public education to meet their unique needs and prepare them for further education, employment and independent living. Prior to IDEA, over 4 million children with disabilities were denied appropriate access to public education. Many children were denied entry into public school altogether, while others were placed in segregated classrooms, or in regular classrooms without adequate support for their special needs (Katsiyannis, Yell, Bradley, 2001; Martin, Martin, Terman, 1996; U.S. Department of Education, 2010).

There are four distinctive parts:

Part A

Part A of IDEA lays out the basic foundation for the rest of the Act. This section defines the terms used within the Act as well as providing for the creation of the Office of Special Education Programs, which is responsible for administering and carrying out the terms of IDEA (IDEA, 1997).

Part B

Part B of IDEA is the section which lays out the educational guidelines for school children 3-21 years of age. By law, states are required to educate students with disabilities (Martin, Martin, & Terman, 1996). IDEA provides financial support for state and local school districts. However to receive funding, school districts must comply with six main principles set out by IDEA:

Every child is entitled to a free and appropriate public education (FAPE).
When a school professional believes that a student between the ages of 3 and 21 may have a disability that has substantial impact on the student's learning or behavior, the student is entitled to an evaluation in all areas related to the suspected disability.
Creation of an Individualized Education Plan (IEP). The purpose of the IEP is to lay out a series of specific actions and steps through which educational providers, parents and the student themselves may reach the child's stated goals.
That the education and services for children with disabilities must be provided in the least restrictive environment, and if possible, those children be placed in a "typical" education setting with non-disabled students.
Input of the child and their parents must be taken into account in the education process.
When a parent feels that an IEP is inappropriate for their child, or that their child is not receiving needed services, they have the right under IDEA to challenge their child's treatment (due process). (DREDF, 2008; Kastiyannis, Yell, Bradley, 2001; Turnbull, Huerta, & Stowe, 2004).

Part C

Part C of IDEA recognizes the need for identifying and reaching very young children with disabilities. This portion of IDEA provides guidelines concerning the funding and services to be provides to children from birth through 2 years of age. Families are entitled to several services through part C of IDEA (IDEA, 1997).

Every family is entitled to appropriate, timely, and multidisciplinary identification and intervention services for their very young child. These services must be made available to all families with infants and toddlers.
Families are required to receive an Individualized Family Service Plan (IFSP). This plan lays out the priorities, resources and concerns of the family. In addition it describes the goals of the child, the services to be provided to the child, and steps for eventual transitioning of the child into formal education.
Families have a right to participate in the creation of the IFSP, and must give consent prior to the initiation of intervention services.
Lastly, parents are entitled to timely resolution of all conflicts or complaints regarding the evaluation or services provided to their child.

Part D

The final section of IDEA, part D, describes national activities to be undertaken to improve the education of children with disabilities. These activities include grants to improve the education and transitional services provided to students with disabilities. In addition this section provides resources to support programs, projects and activities which contribute positive results for children with disabilities (IDEA, 1997).

In 2010 the U.S. Department of Education published a report acknowledging the 35th anniversary of IDEA

The report highlighted many of the achievements gained as a result of this legislation including the increase in college enrollment and decrease in high school dropouts.