Whose job is it to teach children to sit, stand, and walk?
TEACH is the key word in this question. Most children learn to sit, stand, and walk, without any formal instruction. Traditionally, physical therapy has followed the medical disease-oriented approach of treating the underlying problem so that learning can proceed in an automatic manner. The best treatment method is the one that makes a positive, functional difference in the life of the student, the parents, and the community today as well as when the student graduates from the public school system. When it became apparent that students with chronic, severe disabilities were not generalizing their skills from the therapy environment to the school and home environment, teaching the skills became a necessity and involved parents, teachers, and therapists.
Bleck, 1984, observed that therapists have traditionally taken a disease-oriented approach to treating children with motor dysfunction. In other words, an attempt has been made to "cure the disease" in order for normal development to progress. Unfortunately, according to Bleck, the child with cerebral palsy will become an adult with cerebral palsy because there is no known cure for brain damage. Disease-oriented treatment approaches can be considered a failure if the child grows into adulthood with virtually the same disabilities and the same or greater limitations for participating in activities. On the other hand, the function-oriented approach can help the student resolve dependence on others by assigning priorities to learning experiences. These include, according to Bleck, communication, activities of daily living, mobility, and walking (in order of decreasing importance).
There is a general consensus of opinion among leading therapists and medical personnel that therapy services have very little value unless the procedures for management and movement are incorporated into every facet of the student's life.
In 1984, Campbell defined management programs as including passive activities which would insure bone and joint health. These activities might include supported sitting with proper alignment, standing in standing frames or similar equipment, and being moved or held in positions that reduce the likelihood of abnormal muscle tone and resulting deformities. Instructional or active programs, on the other hand, involve teaching the student specific movement responses that can be used functionally in daily living. Management programs are necessary until the student has acquired enough independent movement skills to become self-managing.
The MOVE Program is based upon the teaming of special education instruction with therapeutic methods and includes the ecological inventory, prioritization of goals, chronologically age-appropriate skills, task analysis, prompts for partial participation, prompt reduction, and the four different stages of learning: acquisition, fluency, maintenance, and generalization. Education and therapy share in the responsibility for teaching these four stages of learning. Leadership is determined by the availability of therapy services to individual students. If therapy is available, the therapist can do the initial assessment. The educational team meets with the parents to determine long and short-term goals using the top-down model. The therapist and the educational staff then meet to coordinate the program.
Parental involvement in teaching can be included in any of the four stages of learning. By the time the student enters the maintenance stage, even the busiest of parents are usually willing to participate because it is so much easier than the previous methods of physical management they were using.
Even though the therapists, teachers, and caretakers share information and decision-making regarding the student and the learning activities, parents or caretakers are not required to do the actual teaching unless they choose to do so.
Bleck's study (1984) noted several factors that impact the family. First, home-therapy schedules can consume enormous amounts of time and energy and may even destroy the traditional relationship of parent and child. If the therapy recommended by the therapist is mere busywork the tragedy is even greater.
In the same study, Bleck also criticizes home therapy programs for further complicating the already complex situation in homes that include handicapped children. He suggests further that medical and therapy providers need to remember those complexities and avoid assigning needless home treatments and programs.
Karl and Bertha Bobath (in Scrutton, 1984) strongly suggest that management techniques be explained to the caretakers of the student so that deformities and abnormal movements are not encouraged. This is particularly important to very young children who spend the majority of the time with their parents and do not have access to other teachers. At this time, is it natural for the parents to provide the major educational opportunities. When the student begins attending school for the majority of the day, however, the emphasis for learning shifts to the classroom teacher.
Even though Snell, 1987, agrees that parents should have opportunities for decision making, each parent should decide the degree to which he or she will be involved in the decision-making and in the actual teaching of the child.
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