Pediatric Physical Therapy Intervention Activities
School Physical Therapy Interventions for Pediatrics (S-PTIP) Data Form
McCoy, Jeffries, Effgen, Chiarello, Gregory, Smarrs, Stoner 2/15/2012
Student ID _EX1 Monday date for Week Reported 11/14/11 Therapist ID 00 No Services Due to: (check one below)
|INTERVENTION CODES |Type of Activity: | |
|Neuromuscular Interventions: |Enter the duration of each activity in |No services this week per IEP plan ____; |
|Balance |5-minute increments. | |
|Postural awareness | |Absence of Student___; Absence of PT/PTA___; |
|Motor learning |Pre-Functional minutes | |
|Hands-on facilitation techniques | |School closed____; Schedule conflict____; |
|Constraint-induced MT |Sitting minutes | |
|Oral motor facilitation | |Other (note)_________________________________ |
|Aquatic therapy |Standing minutes | |
|Musculoskeletal Interventions: | |Interventions: |
|Strengthen (PRE) |Transitions & minutes |Enter one 2-digit INTERVENTION CODE |
|Strengthen (Functional) |Transfers |per box |
|PROM/Brief Stretch | | |
|Prolonged Stretch |Classroom Activity 10 minutes ||03| |66| |22| |04| |62| |
|Manual Therapy | | |
|Massage |Classroom Mobility minutes ||70| |01| |09| |70| | | |
|Use of modality: | | |
|Cardiopulmonary Interventions: |School Mobility minutes || | | | | | | | | | |
|Breathing |Indoors | |
|Aerobic/conditioning ex. | || | | | | | | | | | |
|Postural Drainage |School Mobility 10 minutes | |
|Integumentary Interventions: |Outdoors || | | | | | | | | | |
|Pressure release | | |
|Position changes |Community Mobility minutes || | | | | | | | | | |
|Skin checks | | |
|Orthoses: | | |
|Shoe insert |PE/Recreation || | | | | | | | | | |
|LE plastic orthoses: |Activity 10 minutes | |
|Knee Immobilizer | || | | | | | | | | | |
|Trunk orthosis (elastic) |Self-Care Activity 10 minutes | |
|Elbow/Hand splint | || | | | | | | | | | |
|Taping |Communication minutes |__________________________________________ |
|Elastic wraps/suits | |Services Delivered by: (check one) |
|Mobility Assistive Devices: |Other Activity minutes | |
|BWS harness system | |PT: PTA: Both PT & PTA: X |
|Treadmill |Describe: | |
|Wall/railing/furniture for support | |Notes: _______________________ |
|Push toy |Total Time with Student: 40 min. |_____________________________ |
|Walker, type: | | |
|Crutches, type: | | |
|Canes, type: | | |
|Dowels/sticks | | |
|Wheelchair, type: | | |
|Mobility Interventions: | |Service Delivery Duration: (5-minute increments) |
|Hall training |Sensory Interventions: | |
|Stairs training |Visual training |Services to the Student: |
|Doors training |Sensory integration ex. | |
|Curbs training |Sensory processing |A. Individual: |
|Bus/car training |Educational Interventions: |20 |
|Ramp training |Student | |
|Elevator training |Family/caregiver |Group: 20 |
|Bathroom access |Teacher |B. With students who are non-SpEd: 10 |
|Cafeteria access |PT Assistant | |
|Library access |Aide |With students who are SpEd: 30 |
|Playground access |IEP Team |With students in both SpED/non-SpED: |
|Positioning & Devices: |Other | |
|Seating |Assessment: |With no other students: |
|Sidelyers |Major |C. Within a school activity: 10 |
|Standers: prone, supine |Ongoing | |
|Prone over wedge |Other Interventions |Separate from school activity: 30 |
|Other |Fine motor |D. Co-treatment: 0 |
|Equipment Interventions: |Cognitive training | |
|Equipment Application/training |Behavioral training |With whom: OT:__ SLP:__ Teacher:__ Aide:__Other:__ |
|Equipment Maintenance |Speech/Language | |
|Equipment Fabrication |Social/Emotional |Not in Co-treatment: 40 |
|Adapted switches/toys |Adaptive PE |Services on behalf of the Student: |
|Communication Devices |Orientation and Mobility | |
|Other |Other |E. Consultation/Collaboration: 10 |
| |Other | |
| | |With whom: Family:____ Staff:____ Others:____ |
| | | |
| | |F. In-service: |
| | | |
| | |G. Curriculum development: |
| | | |
| | |H. Documentation Time: 35 |
| | | |
| | |I. Total Services on behalf of Student: 45 |
| | |Setting: School _X_; Home ___; Other (note) _______ |
| | | |
| | |Student Participation Rating: |
| | |0----—1—----2—----3—----4—----5-------6 |
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