Effects of Functional Mobility Skills Training for Young Students with Physical Disabilities. (Exceptional Children)
Barnes, Stacie B., Whinnery, Keith W., Exceptional Children
Since the passage of P. L. 94-142, students served in special education programs have had the right to related services (e.g., occupational therapy and physical therapy) as needed to benefit from their educational program (Beirne-Smith, Ittenbach, & Patton, 2002). Therapists in educational settings who are typically trained under the medical model of disability traditionally have provided therapy services separate from educational goals (Craig, Haggart, & Hull, 1999; Dunn, 1989; Rainforth & York-Barr, 1997). Treatment within this traditional approach is based on the developmental model in which therapists attempt to correct specific deficits and remediate underlying processes of movement to promote normalization (Campbell, McInerney, & Cooper, 1984; Fetters, 1991). As a result, these treatment programs typically do not focus on the development of functional motor skills in natural environments because students often are viewed as not ready to perform such high level skills (Rainforth & York-Barr). Until recently, this traditional approach to therapy was considered acceptable in school settings because educational programming for students with disabilities also relied on a developmental model. It has been only in the past 15 to 20 years that educational programs for individuals with disabilities have begun to move away from instruction based on a developmental model to curriculum approaches emphasizing functional outcomes (Butterfield & Arthur, 1995).
Current educational practices promote the use of a support model that emphasizes an individual's future potential rather than an individual's limitations (Barnes, 1999). While earlier practices that focused on deficits often limited an individual's access to environments and activities (Brown et al., 1979), current practices employ a top-down approach to program planning designed to teach an individual to function more independently in his or her natural environments. Top-down program planning typically incorporates the concept of place then train, promoting instruction in the environments in which the skills will be used (Beirne-Smith et al., 2002). Individuals served under a support model are not excluded from activities because they lack prerequisite skills; rather they are supported to participate to their highest potential. A support model approach to programming provides a framework for identifying adult outcomes, determining current levels of functioning, and identifying supports needed to achieve the targeted outcomes.
As educational practices change, therapy approaches that stressed remediation of individual skills in isolated environments are being replaced by the practice of integrated therapy in which services are provided in natural settings where skills will be functional and performance meaningful for individual students (Rainforth & York-Barr, 1997). Integrated therapy breaks from the more traditional, multidisciplinary model where team members conduct assessments and set goals in relative isolation (Orelove & Sobsey, 1996). Parents, teachers, and therapists collaborate as a team to assess the student, write goals, and implement intervention. The team develops the IEP together by setting priorities and developing child-centered goals through consensus (Rainforth & York-Barr). In this way, all team members are aware of the IEP goals and can work cooperatively to embed them into the child's natural activities.
As the fields of physical therapy, occupational therapy, and education have begun to move away from a developmental approach toward a functional model that emphasizes potential and support, the link between special education and pediatric therapy has been strengthened (McEwen & Shelden, 1995). Recent research suggests that when therapy is integrated into the student's natural environments, treatment is just as effective as traditional therapy and that the integrated approach is more preferred by the school team (Giangreco, 1986; Harris, 1991). …