P HYSIOTHERAPY R ELATED T ALKING P OINTS Heather Cleveland-Physical Therapist Soldiers Memorial Hospital Nick Warzee-Physical Therapist Valley Regional Hospital Carolyn Longmire-Physical Therapist Annapolis Community Health Center

R ANGE OF M OTION We do not provide general range of motion programs Range of motion programs are typically developed prior to school starting in an outpatient setting and then carried out by EA’s Usually have been ongoing at home in summer or prior to starting school We do provide training for EA’s responsible for carrying out student specific range of motion/stretching programs We request multiple EA’s be present for training to optimize our school visit times/resources

B ALANCE AND F ITNESS We do not provide general fitness or balance programs A comprehensive Phys. Ed. Program will address the fitness and balance needs of the majority of students who fall within the normal range. In general this will challenge each student while allowing them to succeed We will assess those students who fall below the normal range, especially as pertaining to issues of safety/ falls and inclusiveness We are available for consultation if the goals/needs cannot be met by the teachers background or the unique challenges present

L IFTING AND T RANSFERS What is a Lift? A lift is performed when a child is physically unable to weight bear or cognitively unable to participate in the moving task. The caregiver(s) takes all the weight of the child.

W HAT IS A T RANSFER ? A transfer is a cooperative movement between the caregiver and the child. The child assists in the transfer by weight bearing through his/her lower extremities and/or upper extremities if possible. The goal is to move the child from one surface to another.

W HY C HOOSE A L IFT OVER A T RANSFER ? The child cannot bear their own weight The child is uncooperative/aggressive during moves The child is cognitively unable to assist to do a safe transfer

W HY C HOOSE A T RANSFER OVER A L IFT ? Having the child as an active participant in the transfer has many benefits: Encourages weight bearing Important for bone and muscle development Encourages problem solving Gives the child a sense of independence Less work for the caregiver Independent or minimal assist transfers are important for eventual adult placement

We do not provide general mechanical lift or transfer in-service training Transfers can be taught on a student specific basis We as a district discourage any lifting of students If a student weighs over 35lbs then a two person transfer can sometimes be completed, but mechanical assists are recommended at that time (with appropriate training) 35lbs is the recommended max lift for patient handling in the hospital sector based on years of research

B EHAVIORAL I SSUES Often PT’s are brought in for patient handling issues as it relates to lifts or carries E.g: sudden drops, refusal to move or carry out a task, head banging etc. Behavioral strategies must be used first and foremost If there is no direct harm posed to student Do Not Lift! If problem persists or expected to be longer term then mechanical lifts or other ‘no lift’ solutions can be implemented with consultation

It is these students that often provide a grey area as they can be extremely inconsistent in transitioning and transfers (some days they require nothing more than supervision, but on other days if they refuse, it is “easy” just to lift them). The best option is through consultation, but there is no guaranteed solution.

A NY Q UESTIONS ?