PROFESSIONALS ALLIED FOR MOVEMENT

Clearing up the Confusion

Guidelines for Implementing Adapted Physical
Education, Physical Therapy, Occupational
Therapy, and Therapeutic Recreation in
Maine Schools

Prepared under the direction of
The Maine Task Force on Adapted Physical Education

Prepared by:
The Maine Task Force on Adapted Physical Education
In cooperation with:
The Maine Department of Education, Division of Special Services

Document Preparation Subcommittee:

MeRita McKenzie			Physical Educator / Adapted Physical Educator
Diane Gagnon				Physical Therapist
Cindy Brown				Early Intervention Specialist
Dave Pellegrini			Therapeutic Recreation Specialist

Task Force Members 1996-2000

Charles Andreades					Diane Gagnon
Jay Elementary School					Private Practice, Physical Therapy

Richard Bartlett					Kristin Grant
Retired, Dept. of Education				Manchester Elem. School, Windham

Cindy Brown						Debbie Gunn
Child Development Services, Dover Foxcroft		Parent, Hampden

Stephen Butterfield					Jerry Gunn
Univ. of Maine, Orono					Parent, Hampden

Becky Chase						MeRita McKenzie
Occupational Therapist/Parent 				Lyseth Elem. School, Portland

Nancy Diadone					Dave Pellegrini
Dir. of  Special Education					Director of Maine Adaptive Sports
Unorganized Territories					
Dept. of Education

Jennifer Doe						Dodi Saucier
Lunt School, Falmouth					Orono Schools

Bob Dyer						Fred Sprague
Katahdin H.S., Sherman Station				Woodland Elem. School, Baileyville

Christoph Lienert					Royal Goheen
University of Maine, Presque Isle	Professor Emeritus 
Univ. of Maine, Presque Isle

TABLE OF CONTENTS

I.	Introduction

II.	General Descriptor of Disciplines

III.	Discipline Definitions and Qualifications

IV.	Determination of Services

V.	Summary

VI.	Appendix

A.	Endorsement in Adapted Physical Education
B.	Frequently Asked Questions

I.  INTRODUCTION

Federal (IDEA) and Maine (Chpt. 101) laws mandate the provision of special education and related services to students with individualized educational programs (I.E.P.s).  Special education includes physical education as a direct educational service (Section 121a.14, Federal Register), while physical therapy, occupational therapy, and therapeutic recreation are related services.  The related services are mandated if needed, to ensure that the students with I.E.P.s receive the intended benefits of their special education programs.

Many students exhibit problems with motor performance, physical mobility, and functional independence, which interfere with their ability to participate in and benefit from their educational programs.  These students are often referred to adapted physical educators, occupational therapists, physical therapists, and therapeutic recreation specialists for individualized programs.  While these service providers share many commonalities in their roles and concerns, they are not interchangeable, and may be provided to children with disabilities only at the specific recommendation of the Pupil Evaluation Team (P.E.T.). 

The purpose of this document is to delineate the roles and professional responsibilities for adapted physical educators, physical therapists, occupational therapists, and therapeutic recreation specialists. 

II.   GENERAL DESCRIPTOR OF DISCIPLINES

Adapted Physical Education promotes physical and motor fitness, fundamental motor patterns and skills, and life time sports, skills, and games.

Physical Therapy enhances general gross motor development, posture, balance, and functional mobility. 

Occupational Therapy promotes finer functioning of the upper extremities and hands, activities of daily living, perceptual motor skill development, and sensory integration. 

Therapeutic Recreation increases access to and participation in community based recreational programs. 

III.	DISCIPLINE DEFINITIONS AND QUALIFICATIONS

PHYSICAL EDUCATION / ADAPTED PHYSICAL EDUCATION

     Physical Education is the development of physical and motor fitness; fundamental motor skills and patterns; and skills in aquatics, dance, and individual and group games and sports, including intramural and lifetime sports.  This definition includes special physical education, adapted physical education, movement education, and motor development (Chpt. 101).  

     Adapted physical education is a comprehensive service delivery system put in place to assure that a child with a disability and identified needs has an appropriate physical education program.  Problems within the psychomotor domain can be addressed by ecologically based assessments, individualized programming, modification of traditional physical education activities and equipment, and by providing instruction in a variety of ways.  Adapted physical education should not be conceptualized as a placement or setting; rather, it is a composite of beliefs and practices designed to assure high quality physical education for all students.  These services are delivered in many forms, ranging from regular physical education class with few modifications, to physical education class with support, adaptations, specialized equipment and compensatory rules, to physical education class augmented with additional adapted physical education instruction.  Although rare, some students with disabilities needs are best met in separate adapted physical education classes, but this last offering should be pursued only after all other options have been explored in an effort to provide quality programming for the student.  The ‘Least Restrictive Environment’ section of IDEA clearly makes this point:

To the maximum extent appropriate, children with disabilities,
including those in public or private institutions or other care 
facilities, are educated with children who do not have disabilities; 
and special classes, separate schooling or other removal of children 
with disabilities from the regular educational environment occurs 
only when the nature and severity of the disability is such that 
education in regular classes cannot be achieved satisfactorily.  

								     (Sherrill, 1998)

Qualifications:

     In Maine, teachers who hold a physical education teaching certificate may provide adapted physical education services.  However, under certain circumstances, they may be required to consult with a teacher holding an adapted physical education endorsement.  It is strongly recommended that any individual employed to provide substantial services in adapted physical education hold an endorsement in Adapted Physical Education. (See Appendix A.) 

PHYSICAL THERAPY

     Physical Therapy is a health profession whose primary purpose is to develop or restore neuromuscular and/or sensory-motor function by preventing or minimizing disability, relieving pain, developing, improving or restoring motor function, mobility and control, correcting postural deviations, and maintaining maximum performance within an individual’s capabilities.

     Physical therapy is a related service to the individualized special education program that provides assessment and habilitative or rehabilitative services to individuals with disabilities who require such support in order to participate in and benefit from their special education programs. 

     Physical therapy deals primarily with the enhancement of functional mobility development and the sensory-motor foundations which are the basis of this development (e.g. strength, posture, muscle tone, flexibility, balance, and stability).  

     Maine’s current Physical Therapy Practice Law provides the public direct access to physical therapists, requiring physician referrals/prescriptions only if treatment extends beyond 75 consecutive days, or if there is no improvement in 30 days. Because most I.E.P.s are written and reviewed annually, a physician referral will be required to continue services throughout the school year (American Physical Therapy Association, 1980).  

Qualifications:

     The physical therapist shall have graduated from an accredited physical therapy program and possess a current Maine license in physical therapy (Chpt. 101).  Pediatric experience is preferred, and therapists working in educational environments should have a working knowledge of special education rules and regulations, continuing education related to children with special needs, and experience in multidisciplinary settings.   

     

OCCUPATIONAL THERAPY

     Occupational Therapy is a health profession that utilizes purposeful, goal directed activity to facilitate, restore, and/or maintain functional performance and independent living skills in persons whose lifestyles have been altered by disease, injury, congenital defects, or developmental disability.  This therapy is centered on purposeful activity, which is where the reference to “occupation” comes from.  It may be used to prevent and mediate dysfunction as well as to elicit optimal function.  

     Occupational Therapy is a related service to a special education program that provides assessment and habilitative or rehabilitative services to individuals with disabilities who require such support in order to participate in and benefit from their special education programs. 

     Specific school related occupational therapy services may include evaluation and training in fine an perceptual motor development, general gross motor development, sensory-motor integration, social/emotional development, activities of daily living, and pre-vocational training.  The ordering, fabrication and/or adaptation of assistive prosthetic orthotic devices may also be involved (American Occupational Therapy Association, 1987). 

Qualifications:

     The occupational therapist must be a graduate of an accredited program in occupational therapy, be nationally certified by the Occupational Therapy Certification Board, and hold a current Maine Occupational Therapy license.  Pediatric experience is preferred along with a working knowledge of multi-disciplinary teamwork, special education law, and evidence of continuing education in the area of children with disabilities. 

THERAPEUTIC RECREATION

     Therapeutic Recreation is a comprehensive program designed to facilitate the development of an appropriate leisure lifestyle for individuals with disabilities by eliminating barriers to leisure, developing leisure skills and attitudes, and optimizing leisure involvement.  

     Therapeutic Recreation is a related service to a special education program that provides assessment of recreation and leisure functioning as well as leisure education.  Leisure education strives to develop positive skills and attitudes, promotes the purposeful use of recreational activities to ameliorate deficits in students with disabilities, and brings to light recreational opportunities for these students in the least restrictive environment.  

     School related therapeutic recreation services are provided on a continuum of care from leisure education, social skills training, adaptive equipment identification, community awareness, community integration, and activity participation.  Placement and level of intervention is at the discretion of the P.E.T; based on the multi-disciplinary assessment of the impact of a child’s physical functioning, on activities of daily living, independence, and education (National Council for Therapeutic Recreation Certification, 1993).  

Qualifications:

     Certified Therapeutic Recreation Specialists shall have graduated from a four year program with a degree in Therapeutic Recreation, and pass a written examination from the national Council for Therapeutic Recreation Certification receiving a five year certification. 

IV.	DETERMINATION OF SERVICES

Which Professional Do You Need?

     The Pupil Evaluation Team recommends special education and related services based on needs identified by a multi-disciplinary assessment.  It is possible that one or more professionals may be qualified to provide the required service due to such factors as differences in university programs, level of expertise and special interests, past work experiences, continuing education and advanced course work.  While special education directors often rely on the professional judgement of the adapted physical educator or therapist, they should be familiar with the level of expertise among their professionals, identifying limitations and overlapping skills when assigning appropriate personnel. 

The following questions may assist in identifying appropriate service providers.

A.	Indicators of a need for Adapted Physical Education Services:

1.	Does the student exhibit substantial delays in the development of fundamental movement skills, and/or skills in aquatics, dance, individual, dual and team sorts, and lifetime physical activities?

2.	Is the student’s physical and motor fitness substantially below that of same age peers?

3.	Does the student require special support (e.g. a paraprofessional, modification of 
rules, tasks, equipment) in order to participate safely and effectively in regular physical education?

4.	Does the student require an individualized program in physical education in order 
to achieve the physical education standards of the Maine Learning Results?

B.	 Indicators of a Need for Physical Therapy Services

1.	Is there a current recommendation for physical therapy?

2.	 Does the student have a medical diagnosis indicating a need for physical therapy?

3.	Does the student have difficulty moving through his/her environment(s)?

4.	Does the student use crutches or a wheelchair as his/her primary mode of mobility?

5.	Does the student have postural concerns?

C.	Indicators of a Need for Occupational Therapy Services

1.	Is there a current recommendation for occupational therapy?

2.	Does the student have fine motor, sensory, or perceptual motor concerns?

3.	Does the student have a decreased rate production of “desk work” when compared to his/her peers?

4.	Does the student have difficulty positioning his/her paper, placement of letters, numerals, etc. on the page?

5.	Can the student find his/her way to a variety of locations?

6.	Does the student have difficulty with problem solving?

7.	Does the student have difficulty accomplishing normal daily tasks such as dressing and personal hygiene?

8.	Does the student have difficulty organizing desk materials?

9.	Does the student have the need for upper extremity prosthetic, orthotic, or assistive devices?

D.	Indicators of a Need for Therapeutic Recreation Services

1.	Does the student have knowledge of leisure resources?

2.	Does the student need assistance in developing social and leisure skills?

3.	Does the student access community based sports and recreation programs?

4.	Is there knowledge of what adaptive equipment or skills are needed to accommodate this student in community based recreational activities?

V.  Summary

Physical education is a direct educational service.  Consequently, the physical educator/adapted physical educator is responsible for appropriate physical education programming for all students.  The therapies (O.T., P.T., T.R.) constitute related services and are employed to help the student with an individualized education plan achieve his/her educational goals.  Physical education/adapted physical education, occupational therapy, physical therapy, and therapeutic recreation may not substitute for one another.  However, it may be necessary as well as helpful for the professionals to consult with or collaborate with each other.  For instance, while a physical education teacher may make appropriations for a child with significant mobility issues, he/she may need the services of a therapist to facilitate in such areas as positioning, handling, and use of specially designed adapted equipment.  In transitioning a student to the community, the physical educator may or may not have the expertise, but collaboration between physical education and therapeutic recreation would most likely be appropriate.  

Through multi-disciplinary assessments, clear understanding of professional roles, knowledge of special education laws, and ongoing input from all Pupil Evaluation Team members, appropriate service delivery can be attained. 

Appendix A
ENDORSEMENT:  ADAPTED PHYSICAL EDUCATION

I.	Authorization:  Teaches adapted physical education K-12.

II.	Academic Requirements:  Eligibility for this endorsement shall be established by:

A.	Graduation from an accredited baccalaureate or master’s degree program approved for the education of adapted physical education teachers with the formal recommendation of the preparing institution.

B.	Preparation which includes:

1.	Holding a valid provisional or professional Maine teaching certificate with a K-12 physical education endorsement.

OR

2.  A minimum of 18 semester hours that includes all of the following:
a)	Anatomy and physiology
b)	Kinesiology
c)	Physiology of Exercise
d)	Adapted physical education
e)	Motor development
f)	Assessment in adapted physical education

3.	Evidence of a basic level of knowledge appropriate to this certificate in the following areas:
a)	Child development
b)	Special Education

4.	Supervised practicum in adapted physical education.

III.	Renewal Requirements

A Professional Certificate may be renewed upon completion of 6 hours of approved study.  It is recommended that the approved study be in the endorsement area. 

Appendix B

FREQUENTLY ASKED QUESTIONS

1.	Are schools required to retain P.T.s, O.T.s, and T.R.s on staff?
No, but they must make such services available to special education students if so determined by the P.E.T.  The need for such services is addressed through the P.E.T. process on a case by case basis. 

2.	We have a certified Adapted P.E. teacher on staff.  Can s/he do P.T./O.T. ‘exercises’ with students who have disabilities?
While it is recognized that there is the overlap between the disciplines, under no circumstances should the P.E./Adapted P.E. teacher be responsible for delivery of O.T., P.T., or R.T. services.  Since there is some overlap between disciplines, there will be times when the team agrees that motor activities/interventions will benefit the student and those can be delivered by the P.E./Adapted P.E. teacher if it is in an area that the teacher is properly trained.  There will be times that these will be done in conjunction with the P.T. or O.T.  However, the P.E./Adapted P.E. teacher is not to be an aide for P.T. or O.T. therapy.

3.	Can O.T./P.T./T.R. services take the place of physical education in some instances?
No.  All children with disabilities must receive physical education. If regular physical education is not appropriate, they must receive a specialized program in physical education.  P.T. and O.T.  must be made available as needed to provide supportive services (if determined by the P.E.T.) to access educational programs. 

4.	We have a P.T. on staff, but do not have an O.T. available to us.  Can the P.T. serve in place of the O.T.?
No.  The need for services is clearly defined by the assessment process and determined by the P.E.T.  While there is some overlap, one therapeutic service cannot substitute for another. 

5.	Our physical education teacher does not have the adapted P.E. endorsement; can s/he provide adapted physical education?
Yes.  Each state has different requirements.  In the state of Maine, properly certified physical educators can teach all students.  The adapted P.E. endorsement is not mandatory, but it is recommended that every system employ at least one person with the adapted P.E. endorsement. 

6.	Where does Therapeutic Recreation fit into the P.E.T. process?
This, of course, will vary greatly in each situation.  It will depend on the assessed needs.  If the P.E.T. sees that a T.R. specialist is needed, one may be called in at any time.  T.R. specialists are called upon most often when transition plans go into effect. 

References

American Physical Therapy Association. (1980).  Physical Therapy Practice	in Educational Environments: Policies, Guidelines, and Background	Information.  Washington, D.C.

American Occupational Therapy Association. (1987). Guidelines for	Occupational Therapy Services in School Systems.  Rockville, Maryland.

Federal Register, 1997, PL 105-17, Amendments to the Individuals with	Disabilities Education Act (IDEA).

Federal Register, 1990, PL 101-476, the Individuals with Disabilities Education	Act.

Federal Register, 1977, PL 94-142, the Education for All Handicapped Children	Act.

Maine Department of Education.  (1999).  Maine Special Education Regulations,	Chapter 101.  Augusta, Maine.

National Council for Therapeutic Recreation Certification.  (1993).  Certification. 	Standards Information.  Theills, New York.

Sherrill, Claudine.  (1998).  Adapted Physical Activity, Recreation, and Sport	Crossdisciplinary and Lifespan.  (5th ed.)  Dubuque, Iowa: Brown &	Benchmark.