PT Question

[autiemom]

Hi, my daughter is 13, autistic, has ADHD and is a toe walker.  Because she has been toe walking for years, and we didn't intervene (I know, I didn't know, and I should have known), she has lost almost all of her mobility in her Achilles and calves.  She cannot flex her foot at all almost.  She finally has started getting private PT and I put in for a PT eval through school.  In the eval, they acknowledged the issue, but said since it does not impact my daughter educationally that she was not eligible for PT services, even on consult.  Basically, she navigates fine so there's no need for school to intervene.  I do understand this.  That being said, I am concerned.  Our medical PT plan is to work intensively on the toe walking, with a foot plate, exercise and redirection.  If that doesn't work, she will need to be casted two weeks on, two weeks off for months in order to force the return of the flexibility, which is apparently painful and will dramatically impact her mobility during the process.  Her PT has expressed concern that without school support, she will be able to continue to toe walk as she pleases for the hours she is at school, which is a considerable part of her day.  Is this something to fight for?  Has anyone had success with accessing school PT in a similar situation?  I do understand the school's stance, but I also would like to see support for the toe walking now, before we have to cast her feet.  Any advice would be amazing.  Thank you!

[JSD24]

It sounds like you want an accommodation at school that she gets redirected to not toe walk/do what your outside PT wants her to do so she might be able to avoid getting casted.  In other words, you don't want PT at school, you want the adults at school to redirect.  Request an IEP meeting and ask for this accommodation to be added to the IEP.

The school is right.  PT at school isn't needed.  They could have let you known about redirection as an accommodation though.

[Lisa Lightner]

What Judi said.

And I would ask about adaptive PE. That class may have some flexibility as to what they can do in class, and work on practicing this.

 

Acknowledging, I was in adaptive pe as a kid and I was bullied relentlessly for it. Not sure times have changed.

[Angela Tyszka]

My son has Cerebral Palsy and he lost his PT eligibility in school when he was about 5 (he's almost 12 now). However, our school PT agreed to provide consultation because he wears orthotics and was transitioning from AFOs to SMOs and he also needed more individualized accommodations in his adaptive PE class. I'll share with you the language she used in his Present Levels. Maybe you can adapt it to fit your daughter's situation.  (Full disclosure, before our school PT came to our district, she was at a private therapy clinic and my son was her patient for several years. She has a soft spot for helping us, I believe but the IEP team has approved it for two years now). Hope this helps you get a little creative.

Gross Motor

Impact: [Child] utilizes bilateral AFOs. He is in a transition period in which his physician would like to try increasing the available movement at [Child's] ankle; however, [child] has show instability with this in the past. 

Resulting Need: [child] and staff would benefit from physical therapy consultative service to educate in orthotic use and management, as well as to assess best fit and function of orthoses in the school setting.

Impact: [child] is unable to fully participate in same-aged, general education PE. He is limited in his ability to fully participate in his reduced-size PE class with adult support and generalized accommodations of activities. 

Resulting Need: [Child] would benefit from physical therapy consultative service to provide more individualized accommodations to activities in PE for increased participation in daily lesson plans and increased growth in PE curriculum.

[Otchic]

I am an OT that has worked in a collaborative setting for many years. I work very closely with our PT and I would be very wary of PT alone reversing the damage of 13 years of toe walking. In my experience, after age 6-7 orthopedics usually do heal-chord release surgery and then do physical therapy afterwards to strengthen all the muscles in the legs they haven’t been using all of these years. 
Also, from an OT standpoint, I would get your child’s vision assessed from a behavioral optometrist if you haven’t already. I see many children in my caseload with vision issues that toe-walk. 

[Jenny Keesee]

My daughter had PT much longer than most students with her level of ability. I kept it because she was in a multi level school. If there was a fire and she would have needed to go down steps, she would have been trampled. That’s how I tied it to education. There may be some way ti think outside the box and keep services. But I know it varies. 

[MommaBear]

Did the school PT actually do a formal evaluation? If so, did they not recommend accommodations at school? Is your daughter already on an IEP for other services?