Ensuring your child receives the appropriate therapies needed to fully recover from the stroke is important to school success.

Some of the therapies your child may need include occupational, physical and/or speech therapy. Therapies provided through your child’s school may also be referred to as “related services” and will be part of the Individualized Education Plan (IEP).

Outpatient therapy (such as occupational, speech, or physical therapies) and therapy provided in school may differ greatly. 

• A school therapist is required to focus on your child’s ability to “access the school environment and learning.” For example, a child receiving occupational therapy in school may focus on goals related to handwriting or different keyboarding options and modifications to make writing more accessible within the classroom. Writing is essential to the classroom, so it is a common goal of school-based therapy.
• An outpatient therapist focuses on improving your child’s functioning so it meets the same level as before the stroke, or is developmentally appropriate for age. In outpatient therapy, children could be working on ways to independently wash their hair or different options for managing buttons and zippers on clothing. These are important life skills, but since they do not occur during school hours, a school therapist will not usually addresses them.

There may be a time that a child does not qualify for school-based services, but still may be participating in an outpatient therapy program. This would be when a child can successfully access their school environment and learning, but may need rehabilitation towards more global or self-care skills not impacting their ability to learn.

Push-in vs. pull-out therapy services

Therapies provided in school can be done within the classroom. In this case they are referred to as “push-in services.” Alternatively, the therapist can remove your child from the classroom for individual work or with a few other students with similar needs. This is referred to as a “pull-out” model.

School After Stroke

When deciding between “pull-out” services or “push-in” classroom support, your child’s team needs to consider the benefit of the services versus the classroom time that is lost. It may not be ideal to pull children from a class they are already struggling with or to pull them from the recess time they need if they are active and need unstructured play time.

There are times when a family may decline school-based therapies in order for the child to optimize  time in the classroom. Therapists can still be available on a consultative basis to the teacher in case questions or issues arise. Consultative therapy services would still be included in the student’s IEP.

Communication is key

Communication between school-based therapists, classroom teachers, parents and outpatient therapists is crucial. Therapists should be reinforcing what the classroom teacher is doing and helping to modify the current curriculum. Parents should also be given a summary of school therapy sessions and ideas or suggestions of what can be done at home to help reinforce the current therapy.

Progress will be much more consistent when everyone is working towards the same goals and using consistent ideas.

If you have questions or concerns about the services your child is receiving in school, it is important to discuss those concerns with your child’s care providers, outpatient therapists, and school team to ensure the current plan best meets his or her needs.