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Connie C Johnson, PT, DScPT, PCS  is a school-based physical therapist who enjoys sharing knowledge to support best practice for children and youth with disabilities. She recently published a case report in Pediatric Physical Therapy and a book entitled Fit4Work: Fitness for Vocational Tasks for Youth with Disabilities. We enjoyed hearing her presentation on Fit4Work last year. So we shine the light on the mid-Atlantic region this month by interviewing Connie Johnson. Take in her thoughts, utilize the resources in her website, and together let’s all help prepare our students for adult life.

What made you choose to become a physical therapist?

I’ve always been a very practical person. For me, PT came into my life when I had a knee injury when I was 15. It was a short orthopedic thing. I had chondromalacia patella and they  shaved the back of my patella, which is what they did decades ago. And I started thinking about what I wanted to do. I was looking for a healthcare profession, where I will always have a job – which was my main criteria.

Curiously enough, I tried to change my major in college because I got frustrated with the pre-professional content – chemistry physics, and all of that. I was frustrated of not taking anything PT-related in the first 3 years. I had a professor who refused to sign the paper to get me out of PT. I contacted him years later to thank him.

What drew you to school-based practice?

I was doing home health and I always interacted with a delightful OT, who told me, “you need to come to school-based practice.” When my first child was born, I was drawn to the school schedule. I interviewed with Peggy Belmont who has been one of my mentors. She was instrumental in supporting my professional growth.

When I interviewed with her, I knew I found the right fit! I knew that I can work with kids in a grassroots kind of way. I like working with kids in real-life scenarios, on things they would have to do every day. I really didn’t like working in a private clinic. I had one 6-year old kid who missed a birthday party because she had to come to PT. At that clinic, parents had to pay a fee for not showing up. Also, her mother did not want to lose her coveted after-school “spot.”

Is it valuable to not jump in straight to school-based practice right away, and experience different settings first?

It really depends on your mindset, what is it that you want to do? Certainly in a clinical setting you can refine your evaluation and treatment skills because you have mentors that are more easily accessible than in the school setting. Where I work, we have a fair number of therapists in one county. But I know there are places in the country with one therapist covering 2 or 3 counties, so they don’t get that mentoring.

So I think it’s more important to find the mentoring that you need because that will help you develop, regardless of the actual setting or population that you are working with.

I work for a large school system in Virginia where we have about 110 therapists – 26 of whom are PTs. So if you are dealing with something unfamiliar or difficult, you can collaborate, mentor and work with each other to support your learning. We are employed by the school system, so we have the opportunity to directly collaborate with teachers, other related services. Everyone is just an email or phone call away.

What is exciting you right now in school-based practice?

I’ve always had interest in assessment tools, and how we evaluate. In my experience evaluating in our early childhood team, all the measures we used were developmentally-based. That has its strengths. But I am really excited with all the other measures being published that has value for addressing a variety of impairments. I am thinking of tests like the 5-reps sit-to-stand test that was recently published, some of the walking tests we have like the 6-minute walk test or the shuttle run test.

We are getting all of these measures that are looking at fitness; it is important for us to look at fitness of the students we are working with in the context of the activity that they need to do and in terms of participation. Traditionally, we didn’t use or have those measures. These measures give us more information on how students are functioning, and what we can do to help them. I’m glad that we are going in that direction. I’m not negating developmental batteries, but I really think we need to expand the scope of what we are looking at, and put equal weight on other tests.

I know your interest in this is related to a program you created. Can you tell us about Fit4Work?

The idea is to look at students in middle and high school from a work capacity perspective. Many of those kids are no longer in our caseloads because they have already mastered their mobility goals, and their gross motor skills are addressed in physical education. Those kids are going to need to engage in competitive work after they finish school.

So, I began to look at occupational health literature. Therapists in ergonomics and occupational health conduct work capacity evaluations for injured workers. They evaluate the physical attributes of a worker and match it to the job to see if they are safe to return to work. Are there certain activities that the workers need to engage in to be able to return to work? Do they need direct PT to get them to the point of returning to work?

In the school setting, one of the goals for students we see in special education is work. I began to ask the question, Do they have the physical fitness to engage in work? Do they have barriers to accessing a job? And when I talk to the teachers about these students, they say, “Well, we are going to have a student go to this job site, but they cannot do some parts of the job. They cannot walk a long distance without getting tired. They can’t bend down to reach the bottom of the shelf.”

So I began to do task analyses to look at what the students need to do, what they cannot do, and why? And I found the following:

  1. The students do not have the adequate physical fitness.
  2. Obesity is a big problem that may or may not be addressed.
  3. There are information gaps with parents as to what they can do and how to do it.
  4. A lot of kids have lost the ability to squat. They don’t have the body strength to get down to the floor. They may have some range of motion or balance limitations.

With support from my administrators, I started putting students on my caseload (who have not had PT for years) for one IEP cycle, and we do focused interventions. I say “we” because I have an amazing PTA. I do all the supervisory work, but she does all the work. She was working specifically on neuromuscular impairments to work on functional skills that will help kids with job performance. It may be reaching high shelves, squatting – a lot of lower body strength, balance. We did not do any stretching with these kids, but a lot of their range of motion are getting better.

This gives them more job opportunities. Walmart is not going to hire you if you are only able to do half the job – only able to reach the middle shelf.

It’s been a very interesting journey. I am trying my best to share the information I have come across. I spend a lot of time summarizing research and information. If anyone wants to access them, there is a website: www.fit4workpt.com that makes information easy to access and use.

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Fit4Work in Action

I’m curious about why, as you observed many of these kids, are losing skills such as squatting?

I need to look more into this. I feel that in pre-school, there is a lot of squatting and playing in that position – and you work on this skill if you have pre-school students in your caseload. But, I think it is not something that we do a lot in our culture. I would venture to guess that if you ask 10 people in the street to squat for 20 seconds, not many can do it. And yet, that is what many adults should be able to do. Our kids already lack physical fitness and activities. These can impact work possibilities later on.

And also low back pain later on. Lift with your legs,not with your back!

That is a really curious thing. If you take a student with intellectual disabilities and try to teach them correct body mechanics for squatting (which is what we are actually doing), you are using all the motor learning tricks that you know.

We have one student with autism, who now just needs one verbal cue to squat correctly. That’s where the educational piece comes in. We know kids need frequent repetition to learn. We take photos and share them with teachers. We go see these kids in the job site and make sure that people who works with the student in the job site know how to do it correctly. We educate the parents, as well.

I’m interested in the opportunities that students will have by increasing these skills right now. And I know that it will also prevent injuries later, because this is the classic training for those who had work injuries.

Educational programming for teachers are important. I have one inservice that I provide about proper body mechanics and motor learning strategies that they can use with students. It is great if we can embed ourselves in school and provide direct training and support.

I have a long list of resources that I would like to create in my spare time.

Speaking of spare time, what do you do for fun?

I love to travel. I’m going to Spain and Ireland with my daughter this summer. I do not have a lot of family nearby, so I spend a lot of time in Colorado and the Jersey Shore. I’m pretty active, I’m a runner. I spend a lot of time reading and writing. I volunteer time with the Academy of Pediatric Physical Therapy, I really enjoy engaging in activities that really support our practice.

And you are also busy with your website. How do you find time to do all that?

I am pretty efficient with my time. If you love something, the opportunity to do it just presents itself.

What are your next steps for Fit4Work?

I am engaged right now in a research with Joyce Maring of George Washington University and Deb Rose. We are testing the Household Participation Checklist, which looks at chores and physical activities at home. We are partnering with Special Olympics in disseminating the checklist to parents. Our goal is to establish its construct validity, and publish it on open access because I want people to use it.

My hope for the website is to start a fire and use the website to share information. So, if anyone applies this information, has an infographic, writes a blog – I would like to link it to my website. If anybody has access to grants and would like to work on any of the content or idea on the website, I would love to consult with them. It is an idea – I do not own it. And, it is not yet backed by research, so I would like other therapists to use it, and let me know how it worked out. If they develop tools and resources, I would love to share it on the website.

Lastly, I have this Fit4Work Screen which includes items that look at different tasks. You can use it for a whole class. If someone is working on their PhD, I would love to give them work (laughs).

Here at SeekFreaks, we like this idea of sharing. We have actually asked many researchers if we can share their work, and they always say “Yes!” Why do you think those in the educational field are always generous to share their work?

I think that we are all altruistic people. We don’t do this work because we are going to make a lot of money. You do it to help someone else. We would all like to make this world a better place. And many of us share this common trait. And that’s why we do it.

Who is your professional role model?

I would say, I do not have a role model, but I have a long trail of mentors. And that’s one thing that is very important to me – to be able to mentor somebody else, the way I was mentored. It’s a way to raise our practice and to raise somebody up.

So, you are paying back?!

(Laughs) Paying back, while I am still receiving!

What do you think is the number one lesson you have learned from your practice?

To spend as much time listening, and less time talking. There is a lot of time that we are in situations where all the clues about what needs to be done and what you can do are already present in the situation if you just listen and wait.

Often we get wrapped up with a parent who came in asking you to do a test, a teacher who is frustrated because the child cannot do something, a child who started a new medication. Instead of talking, spend more time listening and you will find all the clues you need.

Is there anything else that you would like to share before we wrap up?

Thank you for this opportunity to talk to other SeekFreaks. I love the work that you do. I have heard a lot of people saying, have you heard about this website? At Combined Sections last year, there was a lot of chitchat about you. I think making information accessible to people via infographics, that digest information, and provide knowledge translation is so valuable for our practice. So thank you for including me in your journey.

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Connie Johnson is a member of the APTA, serving as Region V Director for Academy of Pediatric Physical Therapy. She is also a member of the Practice Committee, School and Adult Adolescent with Developmental Disabilities Special Interest groups. She recently published a case report in Pediatric Physical Therapy and a book entitled Fit4Work: Fitness for Vocational Tasks for Youth with Disabilities. Since our interview, Connie just published her book Fit4Work: Fitness for Vocational Tasks for Youth with DisabilitiesFor more information visit her website http://fit4workpt.wixsite.com/fit4workpt or email her at Fit4workPT@gmail.com.

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