School begins the minute students are picked up to be transported on the school bus. As school-based physical therapists (PTs), it is our responsibility to assist districts’ transportation staff in knowing how to work with special-needs students. Here are a few ways PTs can help the transportation staff.
An overview of students with disabilities
There is a tremendous amount of information that a PT can teach transportation personnel about children with special needs.
The medical disability that we see most often on the school bus among students is cerebral palsy (CP). CP is damage to the developing brain that affects the movement of the trunk and extremities. These students may have seizure activity and will have difficulty with their arm and leg movements. Some of these children may walk, while others use a manual or motorized wheelchair.
Spina bifida is a birth defect in which the spinal column and the spinal cord are not formed correctly. When the child is born, the nerves are actually outside the body, and the nerves from the point of the defect cannot be reattached. The child is paralyzed and has no feelings in the extremities, so transportation staff must be aware that these children cannot bear any weight on their legs. The PT will need to instruct the transportation staff on how to evacuate these students. A student with a spinal cord injury is similar to a student with spina bifida in that they are usually paralyzed and will need specialized instructions from the PT in regard to evacuations.
Another disease that the PT will need to instruct transportation employees about is Duchenne muscular dystrophy (DMD). DMD is a disease of the muscle that causes progressive deterioration of muscle tissue. These students can walk early in life; then they lose muscle strength, so they must use a manual wheelchair, and then a motorized wheelchair. When evacuating a student with DMD, the transportation staff must be taught by the PT staff how to lift the student and drag him or her out of the bus during an evacuation.
Autism spectrum disorder (ASD) is a developmental disorder that adversely affects a student’s ability to adjust to changes in routine or surroundings. ASD is characterized by problems with social interaction and communication. The student demonstrates patterns of behavior, interest or activities. These characteristics can range from mild to severe.
PTs will have knowledge of many other disabilities, and they can inform school bus drivers and other transportation staff members on ho
w the disability will affect transportation.
The wheelchair: securing, loading and unloading
Before a student is even put on the school bus, the PT and the transportation team should evaluate the student’s wheelchair. The features the team should be looking for are a head rest, a pelvic positioning belt and wheel locks. Some students need additional postural supports, such as lateral trunk supports, an anterior chest support and a medial thigh support, an arm support and footrests. Transportation staff should also be taught how a wheelchair tilts in space and why the anti-tippers are so important when the wheelchair is tilted.
If a student has a motorized wheelchair, it is critical that the PT and transportation staff examine it prior to the student riding the bus. The employees should also practice the process of loading and unloading the motorized wheelchair, and they must be able to locate the gears and learn how to disengage and engage them. The team must also practice pulling the wheelchair into the bus and how to push the wheelchair back onto the lift. The PT should emphasize that the power should never be on when a student is in a motorized wheelchair on the lift.
