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Physiotherapists

What is the role of a physiotherapist? What services does a physiotherapist provide?

A physiotherapist is a member of an interdisciplinary team. A paediatric physiotherapist is an expert in gross motor skill development. As part of a team, a physiotherapist ensures that your child is working towards their gross motor milestones and skills so that they are able to physically keep up with their peers. These are some of the activities a physiotherapist can help with:

 

  • Sitting
  • Crawling
  • Walking
  • Jumping
  • Hopping
  • Throwing
  • Targeting
  • Dribbling
  • Catching
  • Riding a bike

 

A physiotherapist can assist your child in improving their strength and endurance so they can keep up with their peers on the playground or when they are out in the community.

‘Children with ASD often achieve early gross motor milestones (sitting and walking) within normal timelines, but tend to fall behind their peers as the gross motor skills become more refined and sophisticated.’

A physiotherapist can also assist a child if s/he is recovering from an injury, such as, a broken ankle or arm.

A physiotherapist can provide:

 

  • An assessment of your child’s skills to determine their gross motor development.
  • 1:1 therapy.
  • Group based therapy.
  • Consultation to other professionals involved in providing a service to your child.

 

How does a physiotherapist help children with Autism Spectrum Disorder (ASD)?

Motor skill development. A physiotherapist can help children with ASD learn and achieve gross motor skills and milestones. Gross motor skills are the abilities acquired during infancy and early childhood. Typically developing children usually are able to stand, walk and run by the time they are two years of age. These skills are continuously built upon as the child develops, even into adulthood. With development, skills become more refined from practice and maturity.

Children with ASD often achieve early gross motor milestones (sitting and walking) within normal timelines, but tend to fall behind peers as their gross motor skills become more refined and sophisticated. Skills, such as handling a ball (rolling, catching, throwing, targeting, dribbling), bike riding and hopping are more difficult for children with ASD. As a result, specific instruction and training on how to achieve these goals and skills are necessary. These skills will impact a child’s overall participation in community activities, and their ability to interact positively with their peers will affect their overall development.

Endurance, strength, balance and coordination. A physiotherapist can work with a child to improve their endurance, overall strength and coordination of movements during complex activities. Children with ASD sometimes have low endurance and/or strength; therefore, they get tired quickly with physical activity and have a difficult time keeping up with the activities of their peers. A physiotherapist can support a child to improve these areas using various techniques, strategies and practices during each session.

‘A paediatric physiotherapist will have experience working with children who are non-verbal or are just learning to use words. A physiotherapist may also use communication devices to facilitate the sessions.’

What is the difference between an occupational therapist and a physiotherapist?

An occupational therapist (OT) is a specialist with regard to fine motor skill development. Fine motor skills reflect how a child uses their arms and hands. An OT is trained to work with a child’s upper extremities, specifically, to improve strength and coordination of arm and hand muscles.

Scenario 1. If a child has difficulty sitting in their desk for long periods of time, which professional would best support the child’s development? An OT may apply attention and sensory regulation strategies to help the child sit for longer periods of time. Differing, a physiotherapist may work with the child to improve their balance, coordination and core strength to assist them in sitting at a table. Depending on the specific needs of the child and why s/he is experiencing challenges, an assessment will determine if an OT and/or physiotherapist is best suited to support the child’s goals. In many cases, occupational therapists and physiotherapists work side-by-side to provide children with the best possible care – it’s a collaborative effort.

In summary, a physiotherapist typically focuses on physical skills – Endurance, strength, balance and coordination. An occupational therapist supports the regulation and development of fine motor skills in the hands and arms.

Scenario 2. If a child needs support doing up their buttons, zippers, holding a pencil and/or organizing materials, who would provide treatment? An occupational therapists skills are likely better suited to meet the needs of a child with these types of difficulties as they are educated and trained in the development of fine motor skills in the arms and hands.

Scenario 3. If a child has difficulty with sportsmanship with respect to winning and losing games, collaborating with teammates and learning from his/her mistakes, how would a physiotherapist support their needs? A physiotherapist can support a child to develop skills that will promote the development of positive sportsman-like behaviour.

A physiotherapist may incorporate activities that promote social skills development, interactions with peers and sessions about how to engage peers appropriately. Depending on the clinic, type of facility and treatment offered, a paediatric physiotherapist may provide small group sessions that facilitate peer interactions and group behaviour, specifically. The structure of the session, however, will depend on what the child’s needs are and how s/he progresses.

Scenario 4. If a child has difficulty walking to school or making it to school on time, who would support his/her needs? A physiotherapist may support the development of speed and endurance so that a child can navigate their way to school on time and without tiring quickly.

What are some signs a child may need the experience of a physiotherapist?

A child may need to see a physiotherapist if they are not meeting their gross motor milestones. A physiotherapist can do an immediate assessment of your child to tell you if s/he is meeting typical motor milestones.

A child may need support if they are having difficulty:

 

  • Catching and throwing a ball.
  • Hitting a target.
  • Hopping on one foot.
  • Playing with their peers.
  • Participating in community programs.
  • Learning new physical skills.
  • Sitting in a chair properly.
  • Posture.
  • Walking up stairs without relying on a railing.
  • Climbing the stairs while alternating one foot at a time.

 

Describe the structure of a physiotherapy session for a child with ASD.

A physiotherapy session for a child with ASD would be tailored to their needs. A physiotherapist will incorporate sensory or behavioural strategies depending on the needs of the child. For example, if the child benefits from using a visual schedule, this can be incorporated into their sessions. A paediatric physiotherapist will have experience working with children who are non-verbal or are just learning to use words. A physiotherapist may also use communication devices to facilitate the sessions too.

‘A physiotherapist may incorporate activities that promote social skills development, interactions with peers and sessions about how to engage peers appropriately.’

Can physiotherapists make diagnoses?

A physiotherapist can communicate a diagnosis as long as the diagnosis is related to a disease or physical disorder within the scope of their physiotherapy practice; for example, a dislocated ankle or a gross motor delay. A physiotherapist cannot provide a diagnosis of ASD.

Can a physiotherapist sign forms, such as, Assistance for Children with Severe Disabilities and the Disability Tax Credit?

Yes, a physiotherapist can generally fill out sections of these forms. A physiotherapist can fill out the Walking Section of the Disability Tax Credit form too.

Can a physiotherapist be part of an inter-professional team supporting children with ASD; for example, with occupational therapists, speech-language pathologists or applied behaviour analysts?

Yes! Physiotherapists are an important part of a team, as they address a child’s gross motor skills, balance, strength and overall endurance. They are the only professional on their team who is specialized in gross motor development. Physiotherapists can also provide consultation to your child’s applied behaviour analyst (ABA) to incorporate the development of gross motor skills; for example, physiotherapists can provide a breakdown of the skills needed to learn to ride a bike and support an instructor therapist in implementing these goals.

Can the Direct Funding Option (DFO) for an Intensive Behavioural Intervention (IBI) program be used to pay for a physiotherapist?

No, however, many private health insurance plans cover physiotherapy assessment and treatment. In some cases, charities have provided funding for physiotherapy assessment and treatment.

Are there an expected number of sessions required for children with ASD?

The number of sessions a child needs depends on the goals of the family and the child’s current skills. Typically, 1-2 sessions per week for 3 months will work towards a very specific set of gross motor skills for a child.

Where does a physiotherapist schedule sessions to work with my child?

Physiotherapists who practice in a paediatric-specific centre or clinic typically have more access to specialized paediatric equipment that is designed to meet children’s developmental needs. Alternatively, sessions can occur at the child’s home, playground, school or elsewhere in the community depending on the needs of the family and the goals of the client.

Will a physiotherapist teach parents some of the recommended rehabilitative treatments to practice at home?

Absolutely! A physiotherapist can provide support to parents or other caregivers to show them the equipment needed and/or the techniques used during physiotherapy sessions to support the child’s learning.

Physiotherapy sessions are focused on promoting independence. The activities the physiotherapist and the child work on together are completed in a clinic initially, however, these learned skills are transferrable to other environments, such as, the home, school or playground.

‘Choosing a physiotherapist who has worked with children with ASD and who has been involved with a team is also very important as s/he will be much more aware of the different professionals involved with your child.’

What else do I need to be aware of when working with or hiring a physiotherapist?

Physiotherapists can have a very broad range of training and experience. When looking for a physiotherapist to work with your child, it is important they have expertise and experience working with children. Working with children is very different than working with adults. As well, ensuring that they have access to the correct equipment is important to be able to provide the best treatment possible for your child. Choosing a physiotherapist who has worked with children with ASD and who has been involved with a team is also very important as s/he will be much more aware of the different professionals involved with your child.

‘When looking for a physiotherapist to work with your child, it is important they have expertise and experience working with children. Working with children is very different than working with adults.’

What organizations or associations should a physiotherapist be affiliated with, or regulated by?

A registered physiotherapist must be a member in good standing with the College of Physiotherapists of Ontario. As well, a physiotherapist should be a member of the professional association: Canadian Physiotherapist Association (CPA). They may also be a member of the Paediatric Division of CPA, which is a group of physiotherapists working with children across Canada.

Please describe the training and experience of those who would be working with my child.

There are many clinics and facilities that operate as a multi-disciplinary team to provide the best possible treatment for their clients. There are clinics across Ontario with a diverse team of professionals who have experience working with children with ASD. It is important to ask if the clinic’s physiotherapists work alongside other professionals to provide the best treatment possible. Other professionals include: speech-language pathologists, occupational therapists, behaviour therapists, instructor therapists, psychologists or neuropsychologist as well as music therapists. These professionals should be open to discussing their facility, their team and treatments related to providing the best possible care.

It is important that a physiotherapist has experience working with children in the past and knowledge of gross motor skill development. As well, they should be involved in continual professional development, through involvement in courses, conferences and seminars.

Please provide a breakdown of the services you provide and their costs; for example, some of the services may include:

A Formal Assessment of your child’s gross motor skills includes completion of a standardized test that allows you to see exactly where your child’s gross motor skills are compared to their peers. This assessment will give you scores and provide you with percentiles so you can see your child’s current level of skills. You may receive a full report detailing your child’s skills, scores and areas for improvement. This type of assessment can be very helpful in getting support for your child, as it will give specific information about your child’s skills and current capabilities, in addition to areas requiring support for improvement. This information may assist with getting additional education assistant (EA) support at school during recess, gym class or during other activities.

An Informal Assessment includes an observation of your child’s gross motor and physical skills. This assessment will give you a general idea of where your child is compared to his or her peers, but it will not provide you with exact scores and/or tell you how far ahead or behind your child is compared to his/her peers. This type of assessment is good if you have very specific goals that need to be worked on.

1:1 Treatment and Therapy involves the physiotherapist working 1:1 with your child. Treatment typically is focused on building your child’s skills towards the goals that you have set together with your team. Treatment may sometimes look like ‘play’ but it includes pushing your child’s physical skills to improve their gross motor skills.

Small Group Therapy provides children with an opportunity to engage their peers in small group settings. These groups may be run by a physiotherapist or physiotherapy assistant and may also include other professionals, such as, an occupational therapist or speech-language pathologist. These groups vary in price and length depending on the physical goals of the group.

Clinical Consultation can be provided by a physiotherapist to other members of your child’s team in order to assist them in supporting your child. An example of this would be consulting to your child’s IBI team to assist them in teaching your child how to catch a ball or ride a bike. A physiotherapist would generally need a few hours of time with your child and the team to support them and provide a breakdown of activities to promote his/her development. This service is typically billed at $125.00 per hour.

What specific skills/experience should a physiotherapist have to effectively support children with ASD?

The therapist should be trained and have experience working with children with ASD and other developmental challenges. The therapist should have an understanding of the challenges that children with ASD face, including sensory integration and possesses behaviour management techniques for different situations and environments.

‘Parents should feel free to ask a physiotherapist about their specific paediatric experience and coursework; specifically, how their skills apply to supporting children with ASD.’

What education must a physiotherapist have? Is there any specific education that makes a physiotherapist competent in supporting children with ASD and other challenging developmental disabilities?

Physiotherapists must complete a university degree in an accredited physiotherapy program. In most parts of Canada, university physiotherapy programs are at a Master’s level of education. All graduating physiotherapists must pass a national exam to enter professional practice. Physiotherapists who are working with children should complete continuing education, and there are a variety of courses that physiotherapists may take. Parents should feel free to ask a physiotherapist about their specific paediatric experience and coursework, specifically how their skills may apply to helping a child with ASD. It is necessary to understand their overall comfort-level before working with your child.

The Interviewee: Andrea Switzer, MScPT. Andrea received her Master’s of Science in Physical Therapy from Queen’s University. Upon graduation, she was presented with the Canadian Physiotherapy Association’s Paediatric Division Award for achievement in paediatrics. Andrea also holds an Honors Bachelors of Science Degree in Human Kinetics from the University of Guelph. Her Master’s degree explored the impact of a community based swimming program on children with cerebral palsy. Prior to joining the team at Blue Balloon Health Services, Andrea worked in Calgary, AB serving children with complex neuromotor conditions. Through this position, she treated children in both preschool and home settings, providing direct therapy support as well as assistance in attaining appropriate adaptive equipment and consultation to parents, teachers and teaching assistants. Andrea has also taken post graduate courses in sensory integration and the assessment and treatment of praxis. As well, she has taken courses in kinesiotaping, functional exercise for the neurologically impaired child, sign language and is CME Level l certified. Andrea loves working as part of a multidisciplinary team and incorporating a variety of therapeutic goals to assist a child in reaching his or her potential.

 

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Interviewee: Andrea Switzer MScPT.

Andrea Switzer, MScPT. Andrea received her Master’s of Science in Physical Therapy from Queen’s University. Upon graduation, she was presented with the Canadian Physiotherapy Association’s Paediatric Division Award for achievement in paediatrics. Andrea also holds an Honors Bachelors of Science Degree in Human Kinetics from the University of Guelph. Her Master’s degree explored the impact of a community based swimming program on children with cerebral palsy. Prior to joining the team at Blue Balloon Health Services, Andrea worked in Calgary, AB serving children with complex neuromotor conditions. Through this position, she treated children in both preschool and home settings, providing direct therapy support as well as assistance in attaining appropriate adaptive equipment and consultation to parents, teachers and teaching assistants. Andrea has also taken post graduate courses in sensory integration and the assessment and treatment of praxis. As well, she has taken courses in kinesiotaping, functional exercise for the neurologically impaired child, sign language and is CME Level l certified. Andrea loves working as part of a multidisciplinary team and incorporating a variety of therapeutic goals to assist a child in reaching his or her potential.

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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