The Role Of Physiotherapy In Inclusive Education For Children With Special Needs

Introduction to Physiotherapy in Inclusive Education

The National Education Policy (NEP) 2020 emphasises equity and inclusion as core values to be implemented in the Indian education system. It ensures that every student in every school has opportunities that are not denied because of background or ability. Inclusive education is a key goal of India’s education policy. It aims to provide equal access to quality education for children with special needs. Marginalised and disadvantaged communities cannot be denied quality education. All schools must admit Children with Special Needs (CWSN) and provide all required facilities. Schools must implement barrier-free infrastructure, hire special educators and provide accommodations and modifications for children with special needs.

As society progresses towards inclusive education, several challenges arise for children diagnosed with autism, cerebral palsy and other conditions such as Down syndrome or developmental delays. Physiotherapists play an important role in helping children with special needs become functionally independent and confident in daily life. 

Video – Introduction to Physiotherapy in Inclusive Education

What is Physiotherapy?

The Indian Association of Physiotherapists (IAP) defines Physiotherapy as follows: “Physiotherapy is a branch of modern medical science which includes examination, assessment, interpretation, physical diagnosis, planning and execution of treatment and advice to any person for the purpose of preventing, correcting, alleviating and limiting dysfunction, acute and chronic bodily malfunction including life saving measures via chest physiotherapy in the intensive care unit, curing physical disorders or disability, promoting physical fitness, facilitating healing and pain relief and treatment of physical and psychological disorders through modulating psychological and physical response using physical agents, activities and devices including exercise, mobilization, manipulations, therapeutic ultrasound, electrical and thermal agents and electrotherapy for diagnosis, treatment and prevention.
”(Source: The Indian Association of Physiotherapists)

A Physiotherapist is a qualified professional who has acquired the necessary knowledge and skills for practice after earning a bachelor’s degree in Physiotherapy from a recognised institute affiliated with a university, completing a full-time course of at least four years and six months of internship.

Physiotherapy is an intervention aimed at improving a person’s mobility. The focus of Physiotherapists is on exercises, stretches and other methods to improve a person’s strength, flexibility, coordination and general mobility. Physiotherapists, as trained healthcare professionals, specialise in improving movement so that individuals requiring assistance can move safely and confidently.

Video – What is Physiotherapy

benefits of physiotherapy for children with special needs

The benefits of physiotherapy for children with special needs include motor skill development (gross and fine), as well as pain and tone management, especially when physical deformities affect posture and position. Through physical therapy, children can learn to feed and dress themselves and gain confidence in social interactions and activities.   To achieve these goals, therapists may use neurodevelopmental treatments for neuromuscular challenges by assigning specific repetitive tasks to develop certain skills and to train nerves and muscles. A physiotherapist may also work on improving strength and balance to help a child with special needs climb stairs or complete daily tasks such as carrying books, washing their hands, going to the classroom and similar routine tasks.

Video – Benefits of Physiotherapy for Children with Special Needs

How to identify the need for a Physiotherapist in paediatric cases and in schools?  

To maximise the benefits of physiotherapy for children with special needs, it is important to introduce it early in their development. In the early years, the child grows rapidly and intervention therapies may have a deep and lasting impact.  Later, the same therapy may not be as effective. To help parents and teachers identify the need for early intervention in children who require special support, they must be aware of the markers observed in children who need special care. For this, it is important to identify red flags in developmental milestones so that therapy can be introduced when it will bring lasting improvement to the child’s quality of life.   

A red flag in physiotherapy is a warning sign that helps a parent or educator identify when a serious underlying condition may be undiagnosed in a child. Identifying these red flags early is an important first step toward providing the necessary therapy for a child with special needs in an educational setting. This is crucial because children spend a significant amount of time in the learning environment.

ROLE OF PHYSIOTHERAPIST IN SCHOOL 

The role of a physiotherapist in promoting inclusive education and supporting students with special needs in accessing mainstream education is paramount. A school physiotherapist assists these students in managing physical, motor and mobility challenges. They help improve functional independence, support navigation of the school environment and encourage participation in physical education, recreational activities and classroom tasks alongside other students. They also aid children with disabilities or motor delays by improving gross motor skills and recommending assistive and adaptive devices. Therefore, physical therapists serve as essential related service providers in educational settings. Evidence suggests that early and timely physiotherapy interventions, especially those involving individualised exercise programmes, can lead to substantial improvements in functional performance, participation, development and quality of life for students with special needs.
Physiotherapists have several responsibilities in assisting students with special needs in school:

1. Contribution to IEP:
Physiotherapists play a key role in developing a student’s Individualised Education Programme (IEP) by setting functional, school-based physical goals. They assess the student’s gross motor abilities, mobility, posture, seating, balance, coordination and movement. Examples of functional goals include sitting comfortably in a classroom chair, climbing stairs, participating in sports and walking safely in class and around the school. These goals help students with special needs gain the greatest benefit from their education. Given the diverse needs of students, physiotherapists develop individualised, evidence-based intervention programs that support each student’s participation, learning, mobility and overall development within the school environment.

2. Functional Assessment:
Physiotherapists work with children with special needs from the start by assessing their limitations and challenges. Then, they provide a structured, targeted support programme for these students.
Functional Assessments and Intervention / Strategies conducted by Physiotherapists in Schools
Assessment: Informed Interventions and Support Strategies:
Guiding Principles 
1. Early and timely intervention helps prevent secondary complications and restrictions on participation. 
2. Physiotherapy services should focus on enhancing functional participation, independence, and quality of life.
3. A supportive and accessible physical environment enables students to maximise their abilities, develop their strengths and participate meaningfully in all aspects of school life.
Areas of assessment:
1. Assessment of posture and identification of postural deformities.
2. Screening for gross motor developmental delays.
3. Evaluation of balance and coordination skills
4. Assessment of muscle strength and endurance 
5. Evaluation of joint range of motion and flexibility 
6. Assessment of gait and mobility patterns
7. Screening for musculoskeletal pain (e.g. back, neck or knee pain)
8. Assessment of functional mobility within the school environment
9. Evaluation of participation in classroom, playground and physical education activities.
10. Assessment of fine and gross motor skills affecting school performance.
11. Evaluation of sensory-motor integration and motor planning abilities.
12. Assessment of assistive device needs and effectiveness.
13. Screening for ergonomic issues related to seating, desks and backpack use.
14. Assessment of activities of daily living (ADLs) relevant to school participation.
15. Evaluation of environmental barriers and facilitators affecting participation.
Benefits of functional assessment
1. Early identification of developmental and functional difficulties.
2. Prevention of secondary complications and chronic conditions.
3. Timely implementation of individualised interventions. 
4. Improved participation in academic and extracurricular activities.
5. Enhanced independence and functional performance
6. Better social inclusion and peer interaction.
7. Reduced risk of emotional and behavioural difficulties associated with participation restrictions.
8. Improved overall health, well-being and quality of life. 
9. Support for individualised educational planning and inclusive education practices. 
10. Facilitation of collaboration among teachers, parents and health care professionals.

These assessment areas align well with the International Classification of Functioning, Disability and Health (ICF) framework by examining impairments, activity limitations, participation restrictions and environmental factors that influence a student’s educational experience.

Assistive and Adaptive solutions for Physical and Locomotor Disabilities 
Mobility and Navigation are important areas within the purview of Physiotherapy. Mobility Training is crucial for students with the following needs:
1. Cerebral Palsy
2. Muscular Dystrophy
3. Spina Bifida
4. Limb deficiencies and amputations
5. Neuromuscular disorders
6. Orthopaedic impairments
7. Traumatic brain or spinal cord injuries
Ensuring safe and independent mobility within the school campus is a key objective of physiotherapy services.

Classroom integration and Adaptive Equipment:
Students with special needs may encounter challenges while moving through classrooms, hallways, staircases, elevators and playgrounds. Physiotherapy assessment involves the mobility needs of the students and the effective use of assistive devices (e.g. walkers, wheelchairs or crutches) to enhance safety, independence and participation.

3. Intervention Strategies:
Students with special needs face a wide range of physical, functional and learning challenges. Many also possess unique strengths and exceptional abilities that should be encouraged and supported in an accessible environment. To address each student’s needs, physiotherapists collaborate with special educators and parents to develop and implement appropriate intervention strategies.
Examples of strategies include:
1. Seating and positioning strategies to promote proper posture, comfort, and participation in educational activities.
2. Classroom requirements and ergonomic modifications to enhance accessibility, safety and inclusion.
3. Mobility training to improve movement, independence and participation within the learning environment.
These individualised programmes help students overcome limitations, maximise functional capacities and fully engage in educational and extracurricular activities.

4. Environmental modification
Environmental and ergonomic adaptations are essential to meeting the diverse needs of students with special needs. Physiotherapists assess classrooms, playgrounds and physical education environments from the student’s perspective to identify barriers limiting accessibility, participation, safety and independence. Based on these assessments, they recommend and support appropriate environmental modifications to create a more inclusive learning environment.
Physiotherapists also examine and modify seating arrangements, desks, and adaptive equipment to ensure correct posture and stability. These adjustments help students conserve energy and maintain proper positioning, allowing them to focus on learning and classroom participation rather than on balance or posture.

5. TEAM work
Collaboration, consultation and participation are integral to the physical therapist’s role in the school environment. School physiotherapists do not work in isolation; rather, they serve as a link between therapeutic intervention and educational participation by staying attuned to the student’s network.
Physiotherapists work closely with special educators, parents, occupational therapists, speech therapists and other professionals to ensure therapy goals are incorporated into the student’s daily school activities. This teamwork helps create consistent plans at home, at school and in therapy, which improves the student’s ability to do things independently and to take part.
For example, a physiotherapist may work with a special educator to change classroom seating for a child with cerebral palsy, helping the child sit well and pay better attention during class. They may also work with parents to set up safe ways for the child to move at home and school or talk with an occupational therapist to suggest helpful tools that support the student’s daily and school needs.
I am running a few minutes late; my previous meeting is running over.y communicating regularly, planning together and solving problems as a team, physiotherapists help build a welcoming, supportive learning environment that fosters the student’s growth and success in school.

6. Training Teachers, Staff and Parents
Physiotherapists’ observations, suggestions and ideas can be an excellent source of actionable recommendations and training for school staff on safely assisting students with physical transfers and strategies. They must train teachers in the classroom on safe lifting, transferring techniques and integrating movement routines.
Physiotherapists play a major role in guiding parents, communicating progress and challenges and providing home movement strategies that complement the skills students learn at school. Parental follow-up under their guidance can greatly impact the progress and development of students with special needs.

7. Progress monitoring and evaluation
Improving life outcomes for children with special needs must be incorporated into the structure of the educational support system.
Monitoring the child’s progress across several parameters and maintaining reports for parents and educators will contribute to physiotherapy in the learning environment. 
Continuously reviewing outcomes and reassessing strategies as needed is key to improving the quality of life for children with special needs. 

Video – Intervention Strategies, Classroom Adaptations and Working as a Multidisciplinary Team, Regulation

Teachers’ Role in School Identifying Children Requiring Assistance

Teachers in an inclusive school must recognise that every child is different. Each child has their own strengths. Though development progresses with clear markers, the time taken to reach each milestone varies from child to child. Some children excel in certain areas but may lag in others. When teachers observe that a child is displaying clear problems or difficulties in areas or significant deviations from the norm compared with other children of the same age, it is advisable to recommend a professional assessment. 

Teachers need to learn to differentiate between normal differences and red flags in a child with special needs.   
The early years of growth for all children are very important, as they progress rapidly and many changes occur each month.
The early years are especially important for their plasticity, when any steps taken to improve a child’s development can have a major lasting positive impact. The plasticity of children’s development underscores the importance of early identification and intervention. Thus, early identification of developmental and learning problems and prompt referral for assessment are crucial for ensuring better long-term outcomes for a child requiring intervention.

Developmental and learning problems of children can be associated with a combination of factors. Developmental conditions and environmental factors, such as the family, school or society, also play a part. 

Therefore, when children exhibit a particular learning, emotional or behavioural problem, in addition to being aware of the severity, duration and frequency of this problem, teachers should also gather information from different sources to understand every possible factor that may contribute to the children’s behaviour. Sometimes, a problem may be caused by different factors. For instance, if a child is inattentive and cannot concentrate in class, the possible reasons can be many and varied, such as conflicts at home or malnutrition. A noisy environment, a difficult curriculum, a wide age gap, etc., can also be factors affecting attention.

Monitoring a child identified as having challenges involves investigating the child’s environment. Teachers must interact closely with Parents and the child to understand the factors at play in a child’s home and school environments. Continuous observation will show whether the concern is transient or whether the child has slightly weaker performance in only one or two developmental domains (e.g., language, cognitive ability, gross and fine motor abilities). There is no cause for undue alarm. However, persistent developmental discrepancies compared with peers are a red flag that should alert teachers and parents to the need for follow-up.

Only certified professionals can formally diagnose a child with special needs. Teachers can identify children who need a professional evaluation, as they are in a position to compare their progress with other children and have a general understanding of the normal standard and what deviates from it in terms of a child’s behaviour and abilities. Thus, teachers are often the first to recognise key signs. Though they see the signs that children need additional support, parents may often remain in denial. Teachers observe students daily. They see the child struggling to cope and match with peers, as well as the behavioural changes and developmental gaps that indicate the child may need educational or intervention support.

Vigilant teachers in the classroom and those involved in extracurricular activities can observe and monitor a wide range of developmental and behavioural areas to identify children with potential special needs and alert their parents. They can suggest steps to support the child and recommend professional help when appropriate. Thus, teachers must be made aware of the signs to look for in children so that children with special needs receive timely support and attention.

To ensure early and accurate intervention, teachers have to act objectively and use specific processes that involve objective documentation, recording evidence and behaviour and documenting the child’s struggles. This must be followed by discussions and consultation with experts such as counsellors or a special needs coordinator. Parents have to be included in the process, concerns shared with them, and observations validated. 

The following are red flags that may indicate the need for a professional evaluation of the child.

1. Academic & Learning Difficulties: They indicate skill gaps in which a child’s performance in an area is noticeably below their general intelligence (e.g., strong verbal skills but no reading comprehension). Memory Issues occur when the child fails to recall instructions, daily routines or recently learned information. Slow Processing Speed, taking an unusually long time to complete tasks or respond to questions, is another possible red flag.
1. If the child cannot hold the pencil correctly and has difficulty writing.
2. Frequent fatigue when doing regular activities. 
3. Difficulty in reading the textbook clearly.
4. Turning the pages of text while using it.

2. Communication & Language: This is a major area where children suffering from conditions such as autism face challenges such as speech delays, difficulty articulating words, limited vocabulary or trouble understanding spoken directions. Non-Verbal indicators include lack of eye contact, difficulty understanding facial expressions or difficulty interpreting social cues from peers.
1. If the child is unable to follow instructions along with other children.
2. If they are unable to respond to others or have difficulty giving their answers.
3. Unable to show or control their emotions.

3. Abnormal social & emotional behaviour: In situations where the child displays emotional dysregulation such as extreme outbursts, excessive frustration or unusual anxiety when faced with minor changes that they are unable to deal with easily. Such children experience social isolation and thus consistently withdraw from group activities or struggle to form relationships with peers. The child might be observed frequently fidgeting, unable to stay seated for extended periods, and/or constantly interrupting during class, thus lacking focus and concentration.

4. Motor Skills & Sensory Processing: These challenges may be exhibited by some children with special needs. They may face fine Motor Challenges, including difficulty holding pencils, using scissors or manipulating small objects and Gross Motor challenges affecting their gait, posture, seating, endurance and performance at play, as well as visual-spatial perception issues such as frequent clumsiness, stumbling or awkwardness when running or playing. Sensory Overload, such as extreme sensitivity to loud noises, bright lights or certain textures, sometimes leading to tantrums and extreme emotional breakdown, can be seen with some children with special needs. 

Teachers’ Role and Physiotherapy in an Inclusive School.
In India, the Rights of Persons with Disabilities (RPwD) Act, 2016 implies multidisciplinary collaboration to provide inclusive education and reasonable accommodation to maximise academic and social development. 
Physiotherapy is a vital component of comprehensive, multidisciplinary support for students with special needs. Thus, teachers and Physiotherapists must work in coordination to address physical challenges that may negatively affect a student’s ability to access education, participate in school activities and achieve overall development goals. As an integral part of an inclusive education programme, physiotherapy enhances educational opportunities, independence and well-being.
Within an inclusive school environment, the teacher acts as the primary facilitator and a bridge between a student’s academic progress and support provided through rehabilitation services. Thus, one important area for children with special needs is the interaction between the teacher and the physiotherapist. Together, they must collaborate as a team to assist the child in dealing with challenges in areas such as motor skills, mobility and access, posture, seating and safety and health by implementing adaptive and ergonomic changes in the classroom and developing individual strategies for each child’s specific requirements. Thus, their coordinated efforts can ensure a healthy holistic environment which can maximise the potential of a child with physical challenges. The Teacher and Physiotherapist work together in the following areas:  

1. Collaborative Support: Teachers and the physiotherapist together formulate the IEP goals based on each child’s requirements.  Teachers then implement the individual support strategies prescribed by the physiotherapist into daily school routines. Thus, teachers play an important role in ensuring consistency (e.g., proper wheelchair posture and regular stretching breaks). Teachers are also responsible for classroom ergonomics. Teachers arrange classroom furniture to accommodate mobility aids and to create specialised, accessible spaces for the child’s physical therapy routines. Teachers and physiotherapists adapt the Individualised Education Plans (IEPs) based on feedback and the child’s progress.  Teachers thus work alongside physiotherapists to establish targeted, functional goals that align with both academic expectations and the child’s physical condition. 

2. Monitoring & Feedback: This is an ongoing process based on the teacher’s observations. These observations are shared with the physiotherapist, and the implementation, review and adjustment of the IEP are carried out collaboratively. Together, the teacher and physiotherapist work to maximise the child’s progress. Teachers track how physical limitations, such as fatigue, muscle spasticity or reduced fine motor control, affect learning and regularly communicate this information to the physiotherapist. This ongoing feedback helps the physiotherapist refine the intervention programme better to match the child’s stamina and school routine.

3. Fostering Independence: This is an important goal of the therapy that the teacher and Physiotherapist seek to achieve.  Success in activities of daily living (ADLs) can be achieved by children with special needs through practising functional movements learned with the physiotherapist. These include activities such as independent feeding, dressing and navigating the campus. Encouraging Participation in activities such as playing and extracurricular activities is another area where teachers and therapists motivate and assist a child with special needs. Children with special needs are helped to engage safely and build self-confidence on the playground and in the classroom. 

4. Psychosocial & Family Support : This is another area where teachers and physiotherapists assist the child to feel a part of the family and social group. It is important for the mental and emotional health of the child that they do not feel isolated or alone. The sense of belonging is fostered by teachers and physiotherapists. Peer Integration is thus an important area for teachers to foster an empathetic, inclusive environment, thereby reducing the emotional distance between the child and their peers. This often requires Parent Counselling. Teachers and therapists often team up to communicate realistic, achievable goals to parents, thus preventing frustration, depression and emotional burnout.  It is important to put in place a unified support system for the child at home and at school for the child.

To facilitate teachers in schools understanding situations where special needs children can be identified and appropriate support is given in time, the following checklists are attached for reference:  

Video – Recognising Red Flags and Teacher–Physiotherapist Collaboration

Comprehensive Teacher Referral Questionnaire

Inclusive Education Observation Checklist
Sensory integration, Attention & Classroom Participation
For School-Age Learners (NEP 2020 Inclusive Education Support)

Student Name: ____________________________
Class/Section: ____________________________
Age: ____________
Date of Observation: _____________________
Observer/Teacher: ________________________
School: _________________________________

objective of the Checklist
This checklist is designed to help special teachers observe classroom participation, sensory regulation, attention, communication, and self-management behaviors in an inclusive educational setting.
Note: This checklist is observational and supportive in nature. It is not intended for identification. Observations should be interpreted within the child’s developmental, linguistic, cultural, and environmental background.

Rating Scale

Section 1: Attention & taking part

Section 2: Sensory Processing & Regulation
Auditory Responses

Visual Responses

Touch and Movement Responses

Section 3: Communication & Social interactions

Section 4: Emotional Regulation & Overload Indicators

Section 5: Strengths & Supportive Strategies
Observed Student Strengths
__________________________________________________
__________________________________________________
__________________________________________________
Helpful Classroom strategies
☐ Visual schedules
☐ Movement breaks
☐ Quiet corner/low sensory space
☐ Peer support
☐ Simplified instructions
☐ Sensory tools/fidgets
☐ Reduced noise environment
☐ Extra processing time
☐ Positive reinforcement
☐ Flexible seating

Other strategies:
__________________________________________________
__________________________________________________

PRIORITY REFERRAL GUIDE LINES 
HIGH PRIORITY (Immediate referral)
1. Frequent falls 
2. Severe mobility limitations 
3. Pain affecting participation 
4. Sudden regression 
5. Significant asymmetry 
6. Unsafe mobility 

MODERATE PRIORITY (Refer within weeks)
1. Persistent posture issues 
2. Difficulty with Physical Education /play ground 
3. Fatigue /tiredness  
4. Delayed motor coordination 
5. Limitations in Functional participation  

MONITOR & SUPPORT
1. Mild posture issues 
2. Occasional clumsiness (slowness of movement) 
3. Mild activity avoidance 
4. Observed over 6–8 weeks

QUICK TEACHER OBSERVATION TOOL
Key Questions
1. Can the student move safely around school? 
2. Can the student participate like other students? 
3. Does the student uncomfortable in movement activities?
4. Is physical difficulty affecting learning or confidence?
5. Has the teacher observed repeated concerns over time?
If “YES” to 2 or more → Consider physiotherapy referral.

Scope of school physiotherapy  for Teachers
“The purpose of school physiotherapy screening is not to label students, but to identify barriers affecting participation, mobility, posture, independence, and access to learning within an inclusive educational environment.”
Suggested Multidisciplinary Referral Pathway
Teacher Observation
↓
Documentation Checklist
↓
Discussion with Inclusive Education Team
↓
Parent Communication
↓
Physiotherapy Screening
↓
Intervention / Accommodation / Referral

Important Principle for Teachers
“Participation is the key indicator.”
If a child cannot participate comfortably, safely, independently, or confidently in school activities, further support assessment is warranted.

Teacher Summary
Areas of Concern
__________________________________________________
__________________________________________________
__________________________________________________
Recommended Classroom rearrangements
__________________________________________________
__________________________________________________
__________________________________________________

Internal Referral Suggested (if needed)
☐ School Counselor
☐ Special Educator
☐ Parent Consultation

Others
Teacher Signature: _________________________
Date: _________________________

Role of Physiotherapist in Home Setting 

Children with special needs will benefit from adaptations in their home and learning environments. Home is a place where children feel more comfortable and secure. Providing the required modifications at home will give them ample scope for active engagement and gradual independence. Simple ways like organisation of things and setting up routines can help children strengthen their confidence.

MODIFICATIONS THAT MAY HELP AT HOME SET UP

1. Arrangement and Visual Support
1. Follow a consistent routine for keeping and picking up things so the child becomes familiar with the process.
2. Keep materials and belongings organised so they are easily accessible to the child.
3. Use labelled containers, colour coding or picture symbols to help the child identify items independently.
4. Keep visual guide cards or step-by-step picture cues that help the child understand and complete activities.
5. Display simple daily schedules with pictures or symbols to prepare the child for upcoming activities and transitions.
6. Reduce unnecessary clutter in the environment to help the child stay focused and less overwhelmed when transitioning from one activity to another.
7. Place commonly used items within comfortable reach to encourage self-help skills and independence.

2. Safety and Hazard Control
1. Use heavy furniture anchors and secure furniture properly to prevent tipping or falling. This helps create a safer environment for children while they move, play or use nearby furniture for support.
2. Use corner protectors or edge guards on tables, shelves and other sharp surfaces. These safety additions help reduce injuries caused by accidental bumps or falls.
3. Use magnetic locks and soft-close shelves to improve safety and make storage easier to manage. Soft closures also help protect children’s fingers from injury when opening or closing shelves.
4. Clearly label shelves, drawers and storage areas using words, pictures or symbols. Keep medicines and unsafe items stored safely away from children’s reach.
5. Use child-safe latches and safety fasteners on cabinets, drawers and doors to help prevent accidents. These safety measures reduce the likelihood that children will access harmful or unsafe items.
6. Install safety alarms that help kids during emergencies. Caregivers or Parents can reach the child immediately in an emergency.

3. Sensory Supportive Space
1. Use a cosy corner where kids feel comfortable and enjoy spending time independently.
2. Avoid bright lighting and place lights so they do not obstruct mobility.
3. Replace standard knobs on doors and shelves with child-friendly, easy-to-use handles.
4. Use motion-activated faucets to support independence and make daily activities easier for kids (including children with physical disabilities, children who use wheelchairs or mobility aids, and children with visual impairments).

4. Accessibility Modifications
1. If the child uses a wheelchair, make sure the pathways are wheelchair accessible (approximately 30–36 inches wide), which promotes emotional and physical independence.
2. For children using crutches, make sure the floor is non-slip and level to make walking easier.
3. Install rails and handles wherever required for their support.
4. Make the bathrooms adaptive for them and provide grab bars for sitting and standing. If possible, provide walk-in showers without assistance.

Video – Supporting Children at Home

How do I know, as a parent, that my child needs support and should seek professional help?

Physical development includes both a child’s growth and their ability to use muscles. Monitoring developmental milestones from birth to age 4 is essential. Observing how children interact with objects helps identify any developmental abnormalities. (Refer to the chart below to understand if the child is not reaching milestones.)

When to get help from a Physiotherapist for delayed progress in ADL activities
1. If the child is having difficulty performing age-appropriate self-care activities.
2. If the child is not showing developmental progress according to the suggested age-appropriate milestones.
3. If the child is experiencing sensory sensitivities that affect developmental activities.
4. If the child is tripping often or is unable to support themselves properly.
5. If the child becomes annoyed, frustrated or scared while performing daily activities.
6. If the child refuses activities such as eating, dressing or feeding.
7. If the child has challenges getting Ready for school.

Points to consider and evaluate to determine that the child may have challenges in physical development.

Brushing
1. Unable to hold the toothbrush and move it inside the mouth in all directions without any restrictions and rotate the brush up and down. 
2. Difficulty lifting the toothbrush to the mouth. 

Bathing
1. Unable to stand and enjoy bathing. 
2. Not taking part in bathing and learning bathing techniques at a very young age. 
3. Restricted movement of muscles throughout the body without restrictions. 

Dressing 
1. The child cannot dress independently and button up their shirt. 
2. The child cannot tie their shoelaces independently. 
3. The child cannot zip up the trousers or put them on independently. 

Eating
1. Unable to eat independently and use cutlery properly. 
2. Unable to mix and eat food independently. 
3. Unable to lift and hold a plate properly. 

Homework
1. Unable to arrange books and hold a pencil properly. 
2. Doesn’t have good eye coordination while studying. 
3. Unable to focus on objects while watching. 
4. Unable to navigate through pages independently. 

Emotional Quotient and general posture observation
1. Unable to understand and respond appropriately to the feelings of others.
2. Has difficulty smiling, communicating and expressing thoughts or needs.
3. Unable to maintain eye contact during interactions with people
4. Shows little interest in sharing toys, activities or experiences with friends and siblings.
5. Unable to stand upright comfortably for a longer period.
6. Frequently shows signs of fatigue during physical activities.
7. Falls often and is more likely to get injured during daily activities.

Hyperactivity and impulsivity
1. Children with hyperactivity may frequently run into people due to impulsivity and difficulty controlling their actions.
2. May display aggressive behaviour when responding to situations or interacting with others.
3. May react more intensely than expected to everyday situations and experiences.

What to expect from a physiotherapist when you visit them for your child’s evaluation

A child’s physiotherapist’s evaluation helps in understanding the child’s strengths and challenges as well as their progress in gross motor skills.

1. Enquiry about medical history: The physiotherapist might enquire about the child’s medical history, birth details and developmental milestones to understand the child’s development.
2. Check the daily routine: The therapist may enquire about the child’s participation and interest in daily activities, and the child’s ability to perform them.
3. Movement-based observation: Therapist might enquire about the child’s ability to walk, participation in games and transitions from pose to pose.
4. Physical Examination: You can expect the therapist to conduct a physical examination to assess the child’s muscle tone, joint range of motion, coordination, balance, walking stability and posture.
5. The therapists may also administer age-appropriate standardised tests to determine the cause of the challenges.
6. After thorough examination, the physiotherapist will review the report with you and provide you with the next event plan.

Video – Developmental Milestones, Motor Red Flags & When to See Physiotherapy

Multi-Disciplinary Approach:

Sometimes, even when the problems seem physical, multidisciplinary or transdisciplinary approaches might help kids develop confidence faster. Based on the evaluation, the physiotherapist might suggest that you visit other therapists for a holistic approach. A proper multidisciplinary approach can be followed to better support the child’s development. The multidisciplinary approach involves specialists with different expertise who treat the child separately.

Teacher Resource Document – Crawling Barrel