Therapeutic Models for Pediatric Physical Therapy

When a child has a physical impairment, he/she often benefits from working with a skilled physical therapist in order to work towards attaining the skills that he/she lacks. Physical therapy can be practiced either in a medical clinic, in the child's home, or within the school system, and each relates to a different "model" of practice, with different goals and objectives.

The medical model of practice is what is typically thought of when one thinks of physical therapy. It can include going to an outpatient clinic where an array of different equipment can be utilized, including treadmills, weights, swings, ball pits, etc. The medical model can also be practiced in a child's home, if the child is homebound due to medical issues. The goals must be measurable and attainable, and therapists typically have to show progress towards these goals in order to be reimbursed by insurance companies. Often times, children with lifelong physical disabilities will have to take a break from therapy if they are not making progress towards the goals that have been established. This is known as an "episode of care", meaning that a child is not necessarily receiving services continually throughout his/her life.

Alternatively, by law, students are able to receive physical therapy services through their school system. These services would fall under the educational model of practice, and are part of a child's Individualized Educational Plan (IEP). This means that the physical therapist is a part of the special education team, which includes the student and the parents, that helps the student function within his or her "least restrictive environment", which is typically the school setting for school age children. Goals in the educational model will focus more on routines in the school day, adaptations for the classroom, and equipment needs. Services can be direct (working one on one with the student), which might resemble the medical model. However, services can also be indirect, integrated, or consultative, meaning that the therapist is working mainly with teachers, staff, and/or parents, providing ideas and training for how to manage the student's physical impairments so that he or she is still able to be functional in the classroom setting.

Before children are school aged, they can qualify for Early Intervention services. This is typically from birth through the age of three. Each state has different qualification standards, but typically a medical diagnosis that indicates need or low scores on a standardized test can qualify a child. Early Intervention services can be provided by the school district or the state, and the services are free to the family. Early Intervention services follow an Individualized Family Service Plan (IFSP), which is similar to an IEP in that it involves a whole team approach. The difference is that an IFSP is family focused and the least restrictive environment is typically in the child's home. Education and training of the parents and family is the main focus.