Chapter 5 E-materials
Author profiles
Appendix 5.1 Issues to consider in a nursery setting
| Possible barriers | Possible solutions | |
|---|---|---|
| Daily therapy programmes | Time | Programmes constructed to integrate into nursery activities Some aspects of programmes to be delivered by parents at home |
| Someone to carry out the programme | Several staff trained to deliver the programme so it can be shared In-service training for nursery staff delivered by therapist | |
| Training for staff | Attendance at relevant external courses Provision of a statement if special educational needs should provide financial support towards individual input for a child | |
| Using postural management equipment | Finance | Funded via statutory or possibly charitable provision (health or education) Look for pieces of kit that may provide multiple functions Keep kit as small as possible |
| Provision of equipment Storage space Manual handling training of staff for effective, efficient and safe use | Staff should attend manual handling training but a therapist should advise on use of equipment for individual children (how to get children in and out, the time equipment should be used for, how to check regularly to keep in good order, etc.) | |
| Use of orthotics | Staff are afraid they might hurt a child Occasionally staff link orthotics to handling that they associate with child protection issues | Staff should be given very clear instructions on the use of orthotics – how they should be taken off and put on, duration of use, what to do if they have any problem |
| Use of mobility equipment | Crowded environment with lots of toys on the floor Staff are often initially worried that a child my fall | Choose kit that is stable and a child is fairly confident to use Practice therapeutic walking in a clear uncongested area Use a buggy or wheelchair in situations where it is just not safe to use walkers Ensure that staff are aware of policies to follow if a child hurts himself Teach a child how to get up from the floor and ensure staff know how this should be encouraged |
Appendix 5.2 Some issues to consider in a primary setting
| Barriers | Solutions | |
|---|---|---|
| Small and often crowded classrooms | Little space for the use of positioning equipment Difficulty moving around with mobility aids | Consider the place a child sits in the classroom Being near the door offers easy access and is nearer to a toilet should this be necessary in a hurry Use of equipment and mobility aids |
| Sitting on the floor | Not always possible to be able to work at the same height as peers If only able to sit with legs out, others may trip over and not enough space | Sit on a small chair Sit on a floor cushion used to mark a place with enough space Specifically identify a suitable space for a wheelchair or supportive seating which ensures safe access for the whole class |
| PE and swimming | Health and safety issues for both child and staff Child not able to keep up with peers Child cannot cope with the cold for some outdoor activities Not able to access standard equipment | Appropriate training for staff in both manual handling and differentiation of activities Alternative activities to do with a small group when it is cold outside Possible alternative activities – swimming or horse riding Plan, e.g. swimming, choose a pool with suitable access and ensure that pool staff are aware of the special needs of the child |
| Break and lunch times | Crowded situations where children often like to rush around Specific difficulties with controlling food in the mouth Difficulty managing dinner trays and cutlery | Health and safety training |
| Liaise with OTs and SALT | ||
| Position at the beginning or end of the queue Identify a place in which a wheelchair or supportive seating will fit | ||
| May have some kind of tube feeding | Training for staff for tube feeding and the identification of a suitable place for this to happen | |
| Personal care | Child protection issues Manual handling Access to toilets is often difficult | Appropriate training in many of these areas is essential OT advice re hoisting and suitable adaptations Track hoisting may help small space issues |
| Unable to toilet independently Incontinence | More than one person trained to manage all personal care situations | |
| Catheterisation Unable to change independently for swimming or PE | Try to have PE or swimming first lesson of the day so children can come ready changed under their clothes |
Appendix 5.3 Issues to consider in a secondary setting
| Barriers | Solutions | |
|---|---|---|
| Access | Large sites with more than one building | Try to identify smaller schools Advice from OTs |
| Multiple floors with many steps and stairs | Lifts | |
| Needing to change rooms for different lessons Specific furniture for labs, etc. | Consider timetabling, group lessons into 1 building or on 1 floor Extra time to move around Wheelchair accessible furniture | |
| Increased demand on work output | Poor hand function Needing to use specialised equipment | Advice from OT Scribe for exams and everyday work Assessment for and provision of specialist kit with the training for staff and child – e.g. computers with tailored access |
| Fatigue | Identified space for rest periods Shorter days Extra time to complete tasks | |
| Peer pressure and no peer group | Poor understanding of disability | Specifically targeted PSME Not to be the only child with a disability in school |
Case Study 5.1
HPC
• John was knocked from his bicycle by a hit-and-run driver.
• He sustained a head injury including a fractured skull, multiple fractures of the upper and lower limbs and thoracic cage.
• John was taken by helicopter to the nearest trauma unit and was in ITU initially for 5 weeks.
• He was transferred to the rehabilitation ward and remained there for 4 months.
• John continued rehabilitation as an outpatient, and by 9 months it was thought that improvement from rehabilitation had slowed and that he would benefit from the teaching provided by a special school, where he would be able to receive intensive rehabilitation alongside his schooling.
School
• At this stage John had little in the way of independent function apart from head control and he had communication difficulties.
• The special school enabled John to have daily physiotherapy and to receive input from different specialists within the school.
• John showed significant improvement during the year in his function and ability to communicate and was showing signs of improving academic abilities.
• Therefore it was considered appropriate to transfer John back to his mainstream school as it was felt that this would provide the stimulus and challenge to enable him to maximise his potential.
• Planning and meetings were crucial to ensuring a smooth transition.
• The team necessary to support John included: physiotherapists, speech and language and occupational therapists, teachers and non-teaching staff, educational psychologists.
• A joint professional approach was important to ensure the provision of the required level of ongoing rehabilitation and treatment that John needed alongside the school work.
• The physio- and occupational therapists provided training for the school staff and helped to problem solve any issues involving the integration of John into the normal routines of the school.
• Following the preliminary meetings any equipment that had been identified as being required was ordered.
• The physiotherapist and one of the school staff began the process of preparing school staff for their roles in helping to integrate John back into the school.
• John made steady progress in his independent function, communication and academic abilities over a 2-year period.
• Ongoing therapy sessions at school and attendance at aquatic pysiotherapy sessions and rehab sessions outside of school meant that John achieved the ability to stand with support and walk with walking aids and the support of 2.
• John has a teaching assistant who is dedicated to him at school who is able to ensure school staff are updated on any new approaches to his management that are undertaken by the therapists in or outside of the school.
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