The Role of Physical, Occupational, and Speech Therapy in the Overall Care of Children with Special Health Care Needs
Hirsch, David, The Exceptional Parent
I have had the opportunity to work with physical and occupational therapists, and speech and language pathologists for more than 20 years. My colleagues and I consider these therapists essential team members in the care, rehabilitation, and habilitation of individuals with special health needs. The purpose of this article is not to present a technical description of the various therapies, but to describe how therapies work, how parents and therapists should communicate, and how the primary care provider and therapist should communicate. I will also talk about concerns parents and caregivers have shared with me regarding certain aspects of their child's therapy. I hope that understanding these things will assist the parent or caregiver in helping their child derive the most benefit from therapy.
Five questions are important when looking at the overall role of the therapist and traditional therapy in the care of infants, children, and young adults with a disability or chronic medical condition. I hope to give my readers some additional insight into the role of the main forms of therapy from three perspectives (physician, therapist, and parent/ caregiver). To accomplish this I enlisted the help of therapists at NovaCare [Trademark] Kids Pediatric Outpatient Therapy in Phoenix--Belinda Matthews, PT, Rachel Diamant, OTR/L, Betsy Hill, CCC-SLP, and Therese Scannell, PT. Additionally I sought input from some of the parents/ caregivers in my practice, particularly Rhonda Zieba and Nancy Calderwood For convenience, I will refer to the health care provider (typically a physician but it could be a nurse practitioner, public health nurse, or early intervention specialist) as the "primary care provider" (PCP), and I will use "therapies" to mean occupational, physical, and speech therapy.
What is the role of the therapist in the overall evaluation and treatment of an individual with special health care needs?
All of the therapies share a common goal: improving, or preventing regression of, functional abilities. They typically evaluate and treat different functions or abilities. (The exception to this is in infants and young children where there may be some overlap in what each therapy expects to accomplish.) All therapists work with individuals to help them develop or maintain age appropriate skills or tasks, and evaluate any physical limitation that could affect these skills. They may also adapt tasks or the environment to help the individual achieve maximum independence and quality of life. This can often be done using technologies such as environmental control units, adaptive toys, mobility equipment, and augmentative communication systems.
During the evaluation, all of the therapists note the pertinent medical history of the child, state the objective factors (educational placement, related school services, other therapies and equipment), and if appropriate, note the progress toward goals set in previous evaluations. Each discipline then outlines the findings in their area of expertise. All the therapists will then make recommendations for intervention (therapy), specifying short- and long-term goals and their plan to accomplish them. In the case of continuing therapy, new or modified goals, if any, are also laid out.
Some people have trouble understanding why a child would need a therapy having to do with an "occupation." The best way to think about this is by answering the following question: what age appropriate tasks does an individual do to "occupy" him or herself? For infants and pre-school children, these tasks are exploring and learning about their environment through play and manipulation, and beginning to learn how to take care of themselves through feeding, dressing, and hygiene skills.
School-age children work with the OT on skills necessary to function in a classroom such as fine-motor skills, paper and pencil tasks, hand-eye coordination, and visual-perceptual skills. …