Guest Contributor: Kathryn Rose, PT, Mahomet-Seymour CUSD #3

In the early 1990’s the Mahomet-Seymour school district followed the IDEA guidelines by bringing students with special needs back to their neighborhood school; working to include the students with special needs with their same aged peers.  However, the struggle continued to ensure each student accessed a quality education resulting in positive outcomes.  Administrators and the Board of Education supported the fact that all students should be included in PE; no adapted physical education (APE) was offered at any grade level in our district. Often, students with disabilities were accompanied in PE by support services staff to assist. The staff felt this was an adequate way to include all students in their general education PE class.

The 2003-04 school year was a real eye opener for the staff, as they faced the challenge of three students who use wheelchairs, another student with significant gross motor deficits and several students with behavioral issues.  The current system did not meet the students’ needs; the PE activities needed to be adapted significantly and we lacked staff who knew how. THIS is when collaboration between all team members, including Physical Education (PE) began! Shared expertise and integrated knowledge between professionals is critical in order to coordinate effective services for students with special needs.2

At this time, we addressed the PE curriculum by:

  • having the PE instructor share lesson plans with therapy staff
  • during therapy session, goals would be incorporated into PE activities
  • these activities (during therapy) focus on skills or adaptations needed to prepare the student for the next week’s PE class
  • therapist notes were shared with the staff (to implement any strategies during each student’s general education PE class)

This plan was implemented for one grading period of the school year. During this time, data was recorded and, overall, minimal success was demonstrated in PE. The therapists realized that therapy was still provided in isolation and did not ensure each student’s least restrictive environment. Functional skills needed for PE were rarely observed by itinerant therapists due to time constraints/travel. The PE teacher and support staff were frustrated as they were left to adapt activities based on communication from therapists. This was not effective!  Services were not supporting everyday activities or function. They were not drawn from a continuum of strategies individualized to address each student’s unique needs.

Related service providers (RSPs) and PE instructors came to realize the significant differences in seemingly similar disciplines. We better understood our roles and how each could best help each student. Here are some lessons learned:

  • Use the same equipment for PE, recess and therapy service provision
  • Practice skills in the same location, replicate the context (PE or recess) as much as possible for therapeutic interventions
  • Use common cues, feedback, language for consistency with the student (crucial for success in PE)
  • Establish a communication system that is reliable, accessible to all (Instructional staff, RSP, families, collaborators) and easy to use
  • Develop options in case of student refusal (vs. removal from PE, since staff uncertainty as to what to do)

It became apparent to the PE teacher other students, besides those with functional, behavioral or mobility issues, benefited from accommodations and extra assistance in PE.

The PE instructor found that students benefited from:

  • A quieter environment to listen to directions
  • Participating in an environment with less distractions in order to focus on the skill
  • Exposure to the large gym environment
  • Extra practice to acquire a skill

Some of our best lessons are learned from failure, this became the basis for pre-teach PE model or pre-teach. The pre-teach program is actually providing an extra PE class so that ALL students can fully participate in an LRE with their general education peers in PE.  The PE teacher had a planning period scheduled first thing on Tuesday mornings, so the gym was free for the staff to implement the trial pre-teach program. The PE teacher not only allowed us access to the gym, but she graciously gave up this prep time to work with us, the students and staff as we piloted pre-teach with our first and second grade students.

Pre-teach PE Concept

  • Class < 8 students
  • 30 min session, 1x each week
  • Instruction by the PE teacher with direct support by various staff members (e.g., Special Education Teachers, Teacher Assistants, Social Worker, Occupational Therapy staff and Physical Therapist).
  • Skills taught one on one with several repetitions at a slower pace when needed
  • All staff collaborate to adapt, modify and pre-teach the motor skills needed for the next week’s PE unit

Paraprofessionals supported instruction and service delivery which demonstrated how valuable their contribution were to the team.3 Incorporating verbal directions with fewer students, extra practice and adapting activities as needed worked very well to promote access to the PE curriculum. Not only were student needs met, participation increased and behavioral problems were reduced!!

Our new program sparked many conversations as staff as paraprofessionals began practicing PE skills with students with special needs and peer volunteers out at recess.  Previously, paraprofessionals did not know specifically what to do with the students during recess. The exposure and teaching that occurred in pre-teach, gave them confidence to take balls out to the playground to work on various skills with the students with special needs. Several of the students do well with coming the first week of a PE unit. The PE units typically run for 2-3 weeks and once the adaptations are made, the skill is learned and rules are understood; a comfort level is established to the point where the student can successfully participate with general education peers. They often don’t return to pre-teach until the next unit begins. Providing pre-teach in this manner allows students to participate and be successful in a general education PE class. Pre-teach minimizes the time each student is removed from the instructional environment and peers.

Win-Win Situation! 

  • PE skills are practiced in pre-teach, recess and during general education PE.
  • Peers are starting to offer to help peers with special needs and were very excited to see their success’. Peers are often seen as more patient than some adults.
  • Students with special needs are getting more opportunities to practice skills in the same environment as their peers rather than during weekly PT session with adults. PT sessions are still being provided but these are being done more at recess and hallway transitions.

What We Learned:

Successful pilot/student data improves administrative support

Our first three quarters that school year were successful. The following year, our administration supported our request to use the pre-teach concept again for a second year. The first and second grade building administrators has since designated a time slot for pre-teach PE over the past 15 years!! The administrators supported this program because they were able to review the data and clearly see the positive outcomes for students with and without special needs.

Collaboration provides the best adaptation, ideas, carryover and outcomes

A recent study supported the fact that many teachers and paraprofessionals who are enthusiastic about inclusive programs and understand the continual need for adapting. 5 However, instructional staff does struggle to correctly make adaptations for each student with various special needs.

Crucial aspects of the pre-teach PE class,

  • All of the staff collaborating together to provide adaptations that best fit each student.
  • Creativity is rampant during pre-teach as everyone is encouraged to suggest ideas.
  • Each team member offers a different perspective, since they know or see the child in various environments and routines throughout the school.
  • Therapists are present at each session to provide hands-on assistance, demonstrate adaptations and/or brainstorm with other team members.
  • Instructional staff and especially paraprofessionals need to be involved as they know the students best!

Positive attitudes of our instructional staff lead to program success and growth.

Due to success in the first and second grade building, the pre-teach program has spread to kindergarten, and the third through fifth grade buildings in our district. The program spread from school’s staff request…asking if they could have it in their building! Having willing staff to actively participate is a huge part of the success of the pre-teach program. Our program did not happen overnight. Extra work was done initially by some staff to get it rolling. However, once benefits are apparent, most staff hopped on board.  I can’t neglect the wonderful administration support. Without their support this program would not be as successful.  We need them to help with scheduling and to find space in the PE teacher’s gym that will work for the staff and student’s schedules.

It CAN be done!

The pre-teach program is not a guaranteed program every year, due to schedule and class sizes. Typically, what is written on the student’s IEP, is pre-teach PE services, as if gym space is available. If unavailable, the student will participate in a small group in the therapy room to address PE/ recess skills. Parents like the pre-teach program. When students move out of our district, parents and students want it to be continued. In these cases, our staff typically explain the pre-teach PE concept to the school district receiving the student. Others see the benefits as well but are not really sure how to start this program and often can’t. To be honest, it can happen if there are two or three staff members (one must be the PE instructor) who are interested in doing it.

Skills are generalized!!

Recent research demonstrates when students with and without special needs work together in PE, social skills and friendships develop and carry over into recess and other aspects of the students’ school day.4 This has clearly been happening with our students since the pre-teach program was initiated.

  • Students learn varied motor, social and communication skills
  • Full participation in general education PE classes and recess is enhanced
  • Students are included more often by neighborhood friends for activities outside of school
  • Staff hear frequently about birthday parties and participating in a community co-rec sports program

 

Participation in physical play and leisure is supported in the literature as helping to produce positive outcomes (regarding behavioral and therapeutic approaches) for students with disabilities.6 Over the past 15 years, a myriad of adaptations with all types of equipment have afforded success in PE and recess for students with special needs.

  • Often students with special needs are participating in the same or similar PE activities as their peers incorporating shorter distances, fewer repetitions, or more time to process and execute the skill
  • Students with special needs are using items such as 3D printed assisted hands to hold jump ropes as peers participate in long rope jumping or hold a ball to throw with peers.
  • Peers volunteer to help students with special needs at recess or PE; just helping a friend!
  • Sometimes it’s the peers who come up with great ideas for adaptations!

As a physical therapist I believe designing interventions that include physical play and leisure can be incorporated in several settings (i.e., PE, recess, neighborhood environments). These interventions are crucial to attain positive outcomes for student with disabilities.

Pre-teach PE Concept Summary- Take Home Message!

  • Effective way to deliver instruction and services to student
  • Results with positive outcomes in an LRE.
  • Students are able to transfer acquired skills to other settings in order to participate more fully with peers.

References

  1. Torreno S. The History of Inclusion: Educating Students with Disabilities. Bright Hub Educ. June 2012.
  2. Effgen SK, Kaminker MK. Nationwide Survey of School-Based Physical Therapy Practice. Pediatr Phys Ther. 2014;26(4):394-403. doi:10.1097/pep.0000000000000075.
  3. Wilhelmsen T, Sørensen M. Inclusion of Children with Disabilities in Physical Education: A Systematic Review of Literature From 2009 to 2015. Adapted Phys Activity Q. 2017;34(3):311-337. doi:10.1123/apaq.2016-0017.
  4. Haegele JA, Sutherland S. Perspectives of Students with Disabilities Toward Physical Education: A Qualitative Inquiry Review. Quest. 2015;67(3):255-273. doi:10.1080/00336297.2015.1050118.
  5. Maciver D, Hunter C, Adamson A, Grayson Z, Forsyth K, Mcleod I. Supporting successful inclusive practices for learners with disabilities in high schools: a multisite, mixed method collective case study. Disabil and Rehabil. 2017;40(14):1708-1717. doi:10.1080/09638288.2017.1306586.
  6. Kolehmainen N, Ramsay C, Mckee L, Missiuna C, Owen C, Francis J. Participation in Physical Play and Leisure in Children With Motor Impairments: Mixed-Methods Study to Generate Evidence for Developing an Intervention. Phys Ther. 2015;95(10):1374-1386. doi:10.2522/ptj.20140404.