This case study will focus on the school-based physical therapy provided for Salomon, a 7-year-old boy with myelodysplasia at the thoracolumbar level. He is currently attending a public school, receiving services by a special education teacher in a pullout model for part of his day, and he attends regular first-grade classes for the rest of his day. Salomon's physical therapy will be discussed from age 15 months through 7 years of age, with consideration of possible physical therapy needs in adolescence and transition to adulthood.
Children with myelodysplasia present many challenges for the pediatric physical therapist working in the school setting. The role of the physical therapist includes evaluating and implementing appropriate environmental adaptations and assistive technology for the child in collaboration with the school personnel. The physical therapist will provide direct intervention services to maximize function and promote optimal positioning to prevent skin breakdown and deformity. School personnel may not be familiar with the particular problems these students have. The physical therapist must provide information concerning not only the medical and physical issues that the student with myelodysplasia presents with, but also how these issues can impact the student's success in the school environment.
Salomon's physical therapy evaluation/diagnosis was addressed based on the American Physical Therapy Association's Guide to Physical Therapist Practice (2001) by Preferred Practice Pattern 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—Congenital Origin or Acquired in Infancy or Childhood. This pattern was selected because the impairments occurred in the prenatal period and the resulting manifestations affect the muscular, sensory, neurological, and skeletal systems. Practice Pattern 7A: Primary Prevention/Risk Reduction for Integumentary Disorders will also be included due to the presence of neuromuscular dysfunction, obesity, vascular disease, and spinal cord involvement.
Working with students in their natural environment can provide the therapist with an opportunity not only to be creative in intervention planning but also to be innovative in finding solutions to problems. Ideally, the physical therapist uses a collaborative model in this natural setting and provides the necessary ecological modifications and assistive technology to promote the maximal independence for the student (Palisano, 2006). Along with considerations in the school setting, the impact of the home setting also needs to be considered.
The model of collaboration within the natural setting can be challenging. There can be funding issues involved with implementing ecological changes. Assistive technology within the school environment is sometimes dependent on outside resources to make the needed modifications. Despite these obstacles, there can be simple solutions to immediate problems that require creativity, innovation, and staff collaboration to accomplish the stated goals. School staff and teacher attitudes concerning independence need to be considered, especially with preschool-aged children, as there can be tendencies to foster dependence in areas of daily living. The physical therapist relies on the classroom staff to follow through with mobility and transfer activities ...