4. In-School Physical Therapy – Interview with Natalie Spiteri

Episode Transcript

Hello and welcome to the if we knew then podcast I’m Stephen Saux and I’m Lori Saux and this episode is the second half of our two part conversation about physical therapy again we are joined here with our favorite physical therapist Natalie Spiteri in the first part Natalie talked about what physical therapy wise what early intervention physical therapy is an early intervention in general and also what to expect from these early therapies and now Natalie will move on to when our children become school age and what to expect in the school system so let’s dive right in so I am on that intake team to assess kiddos that are gonna be coming into the school system and you know when I assess them I’m looking at I would never you know I was with you guys when Liam was getting access and I wasn’t working for the school at that time and I’m looking back on that experience and what I do now and what you’re looking at and the member I told you guys I said you know Liam’s moving so well he likely won’t qualify for physical therapy because he can’t walk and run but I am as a physical therapist when I see it three year old coming and who has down syndrome I’m looking at Cannes this student now they’re considered a student versus just a child you know can the student walk into the classroom can they walk around the desks can they sit on the floor and stand up on the floor without anyone helping them and can they do it safely do I have to worry about this kiddo if they get bumped by appear will they trip and fall and hit their head or can they be bumped and still hold their balance and and I look can this the student can they walk out of their classroom maybe down three steps to a playground and keep up with their classmates or do they need an adult to hold their hand so those are things that we call restrictions of an adult has the hold your cut your child’s hand that be considered a restriction in my point of view so does your child need that or no %HESITATION and can your child be on the playground can they go up and down the stairs and down the slide without somebody right next to them so those are things I look at so if I see a kid that is tripping around the classroom the update they can’t get in the chair or if they’re in the chair they might fall out of the chair if the if I get nervous that if they’re in line with their classmates they’ll get pushed and the hit their head or if they’re on the playground and they get pushed then that student will likely qualify for physical therapy because they’re not going to be safe and a physical therapist is going to have to help the teacher and also help that student be safe and reach a point where they can be independent but if you have students that are walking everywhere they can pick up things quiet go downstairs with the amount of supervision you would typically give a three year old if you don’t you don’t let three year olds just go down a flight of stairs by themselves %HESITATION when they’re in a group so they need the reasonable supervision that you would give a typical preschool class then they wouldn’t they wouldn’t qualify for physical therapy in my experience I’ve qualified maybe half it’s like half and half its giver some are excellent summer just mile delays and then some like you said if they’re not walking at all then for sure they definitely qualify for physical therapy and we end up providing them equipment in school what did they do if they feel their child has this need but then is deemed that they don’t have the need %HESITATION can you even can you address that at all I don’t know if you can address that but if you can tell you in my experience what happens %HESITATION so if I assess the student and I think that there seems to be able to access physically access their curriculum with the supports are in place in the classroom that I’ll make that my recommendation and that sometimes parents disagree and are convinced that you know maybe you know my child what if they do fall like what is the what if that happens and then they get injured and so and where I work at we have a meeting you know because it’s a team decision at the not one person can override everyone else so I will confer with the other therapists and and also the parents and say okay if you really have these concerns then we can you know do a therapy on it I sometimes we call it a consul basis so that way physical therapy physical therapist has eyes on the student and can talk to the teacher and have an extra layer of support that is usually what we do but I encourage parents to really you know bring up their concerns at the meetings because you what happens and if you’re going to that later I repeat if you have a whole podcast on the I. E. P. O. we have lots of those yeah we talk a lot about IT when your child gets assessed to I encourage all families to ask for the reports ahead of time %HESITATION some of our families do and some don’t and maybe some don’t even know they’re allowed to ask for the reports before the day of the meeting but I think it’s very helpful to be able to read everything before you walk into a meeting and not get overwhelmed and that help you you know discuss your points better at the meeting so for physical therapy side of things you know for me it’s helpful that appearance already read my report and they can talk about their concerns with me at the meeting after having time to digest it all I think that helps for communication and helps to have a better plan for their child but definitely just know that it’s not it’s never one person’s decision and suppose the meeting at the meeting they still disagree with the parent that obviously you guys are well aware the parent can definitely take it to the next level and say we still disagree with this therapist and this team we like the service and that and they can see about getting it but usually most therapists and in my experience will try to work with the family because we don’t we don’t want a kid getting injured so we usually try to work with the family to make sure the child is safe at school and you know everyone’s IP is different but we found that you can kind of try to choose some of these hours let’s see get certain hours of physical therapy sessions some of these may be in the classroom so may be outside the classroom maybe you could talk a bit about those two aspects of it yes for for in California anyways right so for physical therapy for us it depends on the student’s needs so if a student has a lot of hard time sitting in a chair to participate because they are poor balance or they have a hard time walking around obstacles in the classroom the net physical therapist may do the session in the classroom during class time because we’re supporting that student to participate in classroom activities %HESITATION but if the student is not safe transitioning out of the classroom not safe on the playground then the physical therapist will likely pull the student out of the classroom to work on those things outside the classroom but they also may work with that student during recess because in real life this Kato will not be on the playground by themselves all the time their craft beer on other students so the physical therapist will mix it up some sessions but no one out there some sessions with the classroom out there in some sessions in the classroom so for us it’s we’re always changing it up according to the child’s needs and what their I EP goals are and you were talking about some equipment you use and sometimes in school okay areas so the big thing if a student’s not walking by the time they enter preschool with a school is we recommend something called a gait trainer and there’s different companies that make different gait trainers and they’re very expensive %HESITATION if the family wants it in home they definitely would have to go through their private insurance the first school the school will provide it for free for the student and it will remain in their classroom and they will have access to it all the time they’re at school and we also provide things called adapted chairs which are you know if a student doesn’t have good sitting balance will provide a chair that allows them to be able to state without having an adult next to them holding them in a chair so to allow them be as independent as possible but also to be safe he described the first vice kaka you were talking about the gate the general term also sorry we call it an adapted mobility device but a gait trainer is the other term for it it’s basically like a Walker but at for children you just you need more than the basic Walker you see older adults using these typically have four wheels it has a harness around them it %HESITATION can also support their pelvis if they need that help so there’s a lot more supports to help them walk and as the kiddo gets stronger a physical therapist will take away some of the support so my kiddo needs the pelvis support as they get stronger all take away the pelvis but they’re still held in with their trunk as they get stronger again then they’ll end up just walking holding on to the handles and have nothing %HESITATION tied to their body so that’s how we progress our kiddos who aren’t quite ready to walk independently yet and and then the goal obviously especially for my kids with down syndrome because I know they will reach this goal of working independently as the definitely start with something like a gait trainer and remove the supports and so they’re walking with a little help as possible and it could be a big piece of equipment like that or also I remember Liam having just a step stool provided for him to wash his hands in the bathroom yes yes and that I I hope to it that I remember for us right accessing a bathroom so in his Liam was already not this was outside a preschool age so now the toilets are bigger so that we the physical therapist will work on providing supports for toileting as well if a student needs help with the big thing we provide as the call to doctor toiling shares Liam was already kind of too he was already had good balance and didn’t need this but you are we have adapted totaling chairs that these are these things that sit on the toilet that handles that you can allow you to put a kid %HESITATION on there and not have to hold them on the toilet as are going to the bathroom what are some of the things that parents can do at home to make sure that they’re you know they’re continuing to work with with severe with speech she was always working and I didn’t want to put her in one Morris beach class so I instead put her in improv to help her with talking to help her with articulation to help her to speak around her peers so that’s the that’s the only thing that’s what I’m trying to say if for something that they can do at home to where maybe it doesn’t seem like work let you know because I I feel like a masked on Massey there okay that’s what I’m looking for because I think you know something to where it’s like oh this is fun and they don’t we always joke that every Tory Liam has ever received his band well look this is for fine motor %HESITATION great this is for gross motor %HESITATION this is going to help him cognitively there’s never been a toy his received that hasn’t banned purposeful like he’s never received like %HESITATION that’s just blood you know just a toy just a joy yeah %HESITATION so can you there are there are some things that you can provide for parents that they can do at home that either is just something blatantly at home a physical therapy or something to wear you know these things %HESITATION are you are going to help with that like you I think when you had us get him on the trampoline trampoline this mini trampoline and he loved but it was still doing input and helping him strength them so yeah depends on the age but you know when I get school age kids I you know I saw an out patient I would start telling the parents that what you said about improv you know how about an extracurricular you know he doesn’t need to be coming here to do therapy so the big thing I recommend %HESITATION martial arts for down syndrome for anyone for my kids I have you know low coordination martial arts is a big one I’d like because it’s a non contact you know the one you know at this age at the younger age it’s non contact there’s always a mere you know it’s not it’s super fast paced and you the the end structure can adapt it toward the kiddos needs but something like that is always good always a fan of swimming gymnastics which means are all activities that more and more staff are becoming more familiar with adapting it to individual needs and %HESITATION I would also just tell parents you know do what you would do with any other kid on terms of going to the park lane %HESITATION don’t let don’t come home if there’s no homework and let your kids just sit there and watch TV like let’s go to the park you know how we would go on walks in the neighborhood over especially if there’s lots of tree roots walking over uneven sidewalks up and down hills I would always try to do lots of fun walks if you are stuck home that I’m a fan again of obstacle courses throwing couch cushions on the floor having you know if you’re doing an activity putting the puzzle pieces on one end and the puzzle on the other end or anything with pieces and just put a lot of obstacles on the way because that works on motor planning strengthening balance %HESITATION just getting the moving versus just sitting because again you always are wanting to work on strengthening if you’re if you want your could have better balance however got obviously a big activity I love soccer because again that’s outside on grass you can let your kid will fall for the most part and not be too concerned but it’s a good whole body activity %HESITATION depending on the age suppose you’re a three year old having a water table or a learning tower something where they planned standing is very good because you’re just working on standing balance and also just standing up is working on trying to string band you know posture so that’s always a good activity to have at home basically any activity that keeps them from sitting on their bottom you know just doing nothing is good and that we are moving away from just doing PT activities but they’re doing you know age appropriate activities that are standing up versus just sitting down yes %HESITATION given us those things to do at home is is do you have any suggestions for lamb now aged ten now is he doing extracurricular is outside the school or what is he doing after school he he what you OB to be honest he has a lot of homework and that takes up a lot of his after school window he wasn’t karate and he loves to play ball a ball that he likes to swim %HESITATION during the summer he can swim and we play ball outside and Liam isn’t cable swimming unaided so that some for parents to know that either he can stand he’s gonna stand in the shallow end and he enjoys that bouncing up and down or if it’s a deeper pool or he wants a little more freedom we’ll put a life preserver on him and then he moved his legs arms and throws the ball and has to move around even in a deeper part and we don’t have to be so concerned that we need to be there all the time we’re still in the pool with them but %HESITATION we can actually throw the ball with a back and forth and that seems to work we have some stairs in our in our home so he’s always going up and down the stairs but we’re trying to get ourselves a little bit more of a routine of actually taking walks around the block if you go with what he enjoys the most we’ll put on music and just say dance off and who does take turns dancing and Liam gets a lot of time to dance and move his body around so that’s one way to try to stay active as well if you’re looking for creative ways and that’s what I recommend is to also yep when you hit that age or older you know say what is your kids like to do because I can do PT all day long but if I’m not here all the time so what is your kid like to do and try to incorporate that into a movement activity versus just doing P. T. you know repetitions back and forth try to incorporate the the child’s interests then they’re more you know into what you’re gonna be doing versus you know going up and down stairs to do my activity do you think there’s anything else you like to add to his R. sum that you thought that that people could really get information you thought that people could use I would say the big thing is just advocating for yourself when I I have I feel so awful for parents especially when I work with lower income parents and families who don’t have pediatricians who are that great I just try to encourage parents that there’s no bad questions to really advocate for yourself and push your pediatrician’s for the help that you need it and then also once you get that help to not be afraid to ask your therapist and question your therapists because you know you are for me Mike Mike stood my patients parents were my number one people I need to make sure I was connecting with because you’re the ones that are with the patient all the time so if I’m not connecting with you then we’re not getting everything we can to help you know it is still a student or child progress so I always tell parents you know don’t be afraid to ask questions to anyone I always push ask anything because you’ll lose out just by staying quiet so I always think that’s the number one thing to do and then also now just all show media Instagram is a really great resource if you really have nobody in your community that has down syndrome for you to connect with that inst Instagram is really a great way to find families especially for a kid %HESITATION your particular age there’s a lot more resources out there to connect now with social media I think you’re probably going to enough IPCC that sometimes a parent can come from a place of well I’m getting this service and just getting it seems great I should be thankful for that and then not pushing for more or asking for what else is there available it’s it and I think that mindset is something that can hinder the the your capability of being an advocate for your child you need to get past that and know that this isn’t this isn’t some gift this is just like you brought up idea this is something that is federally funded and is is a requirement for that school in that district to provide your child and if you come from that that angle you’re more apt to ask those questions and push to have adequate therapies for your child don’t be afraid to ever ask a question because from our perspective I’m used to being questioned and you know we don’t get offended and it’s it’s which part of my my role as a clinician to be questioned and make sure that who I’m speaking to is understanding what I’m talking about so I don’t want parents to be afraid to question anybody about their child well that’s the difference and you and that’s why we always felt so fortunate not that I and I know that there are great PT’s out there but that’s one of the things that we’ve always felt so fortunate and was that the group of people that lamb had to it was you it was Nathan who is is %HESITATION Tay and Caroline who was the early interventionists and we just felt so fortunate because the level that the three of you worked on and the place that you came from was really a place of communication and concern and you had the same goals for our child that we did which is sometimes hard to match and do so I think that that it was it was great for us because that was our foundation and so anytime anybody brings anything less than that to the table we’re like no no because we know how great the support can be and we know how beneficial they are to you know how they how beneficial they were telling him it was I mean it just it changed his life it changed his ability to change his confidence and it it changes work ethic you know at home we’ve been we’ve we’ve been so fortunate and when you guys were talking about idea in advocating the thing I think we forget sometimes is that people fought for that they fought really hard someone’s gone before and fought for that so then now we can advocate and and utilize those services man I wish everybody had you as a physical therapist and I wish they had you I wish they had you early on too because you are just such a bright light and so passionate and so so good at what you do like you really care and I hope my hope is that anybody who ever has any kind of a support and physical therapy just get someone like here if not gets you make they get because even just the way you talk about sitting in and it being %HESITATION a conversation and I A. P. and telling people to not be afraid to question you and that’s I’m not everybody has that not and that’s not where everyone comes from and it’s just it’s it’s great for parents to hear that that’s what it should be and like you said at the beginning we you were either our second or third I think you are third PT so we are happy we didn’t settle with the first two yes make sure parents know that they can always in school it’s a little bit different but in early intervention you can definitely find a better match for someone who could be on your home all the time yes that’s true and if they’re gonna you’re gonna walk into the front door you wanna make sure there’s a good chemistry there I think what what parents what could know too is that we watched you do we were there at all times when every you you did your sessions and we watched and we tried and you would give us things to do after and what kind of homework and we would try to mimic you in our little session therapy sessions weekly %HESITATION you know we would have times where we would be one on one with him and say Hey I saw Natalie do this and it was something he’s really working on let’s let’s work on this together and so it’s really beneficial for parents to especially the inner that early intervention time when someone’s in your home to to to it’s it could be very easy to say great here’s your time with with a therapist and and I’ll go get some stuff done and that might be something you you do do for half of the time but it’s understandable today there’s no judgment but if you can if you can take some of that that that when they leave you can take some of that and incorporate in the rest of your your life because those those times that you with the therapists are so my new compared to the rest of your your time your child it’s really a for us it it not only I think benefit Liam it benefit us for peace of mind just what do we do and I think that’s an you both of you were wonderful to work with because you’re so receptive and open to it what I was showing you and then you were really great I also you’re out you’re all great PT providers yourselves by doing everything and really putting everything into practice so you made it easy also it was okay with me if some parents weren’t available but definitely at the end of the session I would bring a band back in and say okay this is what we did let me show you and then to add I’d want the parents to try it themselves and I’d have them do it just before I finish we learned I think one thing that just with with parents and your and your you have a child who has a physical challenge whatever that may be %HESITATION that has an impact on you as a human as a parent and so just as I think my goal is to empower parents and give them a but like I always say find he was then if I could give them that little bit of a brass or he’s to know it’s gonna be okay it’s going to come and you’re going to get there and to not jump to the next milestone to be where you are and I think with these things that you’ve given us and given them I think that’s a gift that will be able to do that thank you so much for joining us thank you for having me.

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