Pediatric Therapeutic Services

Practical Tier 1 Intervention Strategies in Physical Therapy

Female teacher stands behind students in classroom, leading them in stretch as a Tier 1 physical therapy intervention strategy.When Physical Therapists working in hospitals, rehabilitation facilities, or patients’ homes see the acronym “MTSS,” they may think of medial tibial stress syndrome—“shin splints” to the layperson.

But, in school-based therapy, MTSS means Multi-Tiered Systems of Support. It’s a framework for delivering services and supports to students so they can succeed.

At Pediatric Therapeutic Services (PTS), we know school-based Physical Therapists (PTs) play an important part in making MTSS work.

We’ll give you some specific Tier 1 intervention strategies to share when consulting with teachers. First, let’s review the PT’s role in this holistic approach to helping students achieve their potential and achieve their goals.

Physical Therapists and Multi-Tiered Systems of Support (MTSS)

Picture the MTSS approach as a three-level pyramid. Starting at the base and rising to the peak, each tier addresses a smaller segment of the school’s population:

  • Tier 1
    Teachers in the general education classroom proactively provide support and services to all students, helping 80-90% of them develop necessary skills.
  • Tier 2
    Students who don’t respond to Tier 1 intervention strategies (5-10% of students) receive more specialized supports and services, most often in small groups.
  • Tier 3
    Therapists deliver targeted supports and services to students who have the most serious disabilities and disorders (5% or fewer students) one-on-one, or in extremely small groups.

Five elementary school students stretch their right arms toward classroom ceiling during physical therapy Tier 1 intervention.

Response to Intervention (RtI) Strategies for Tiers 1, 2, and 3

A specific multi-tiered system that school-based PTs often encounter is Response to Intervention (RtI). (In fact, education professionals often use “MTSS” and “RtI” synonymously.)

The extent to which PTs take part in RtI varies by state and district. But here are some ways, tier by tier, you might be involved in implementing an MTSS/RtI approach:

In Tier 1, you’re equipping teachers with knowledge and strategies they can use to address students’ special physical needs directly in the classroom themselves.

In addition to Tier 1 intervention strategies like the ones we’ll discuss shortly, you can:

  • Lead in-service trainings about students’ expected motor development, commonly encountered motor impairments, and the effects of movement on learning—including the benefits of PE and recess!
  • Show teachers ways to incorporate more opportunities for physical movement into lessons.
  • Help teachers design the physical environment for learning in ways that promote students’ engagement and achievement.

In Tier 2, you’ll focus on finding solutions for students who need supplemental interventions to learn successfully. You might:

  • Identify ways teachers can adapt the classroom to set these students up for success (for example, preferential or adaptive desk placement).
  • Observe students in the classroom to screen for possible motor delays.
  • Lead a small group of students at a learning station during classroom instruction (when appropriate and permissible).

In Tier 3, you’re engaged with physical therapy goals for individual children, helping them master the motor skills they must to access their education. You may: 

Female teacher blows bubbles at recess with young school children as a Tier 1 intervention strategy for physical therapy.

Get Tier 1 Intervention Strategies for School-Based PT from PTS

“Healthy students are better learners,” according to the Centers for Disease Control and Prevention, “and academic achievement bears a lifetime of benefits for health.”

The more you equip teachers to attend to students’ needs for physical activity, the better!

When you give teachers Tier 1 Intervention strategies they can use with classes, you increase their ability to nurture students’ motor and sensory development, reducing unneeded therapy referrals.

Such strategies include:

  • Challenging students to create obstacle courses using items like jump ropes, traffic cones, and cardboard boxes, to strengthen motor planning, gross motor skills, and concentration.
  • Demonstrating and leading stretching exercises—shoulders and triceps, quadriceps and calves—to strengthen muscles in the upper and lower body.
  • Playing classic games like “hot potato”—maybe even combined with spelling practice—to refine hand-eye coordination.
  • Adding action like jumping on one foot while counting to promote healthy sensory processing and concentration.
  • Pulling out the ever-popular parachute for games to help students learn to cooperate with each other by coordinating movement.

When you introduce teachers to interventions like these, you’re indirectly helping more students than you ever could in groups or one-on-one. You’re also ensuring you have time and energy to directly help those who belong on your caseload for intensive interventions.

Click here to download your free set of Tier 1 Intervention Strategy cards  for Physical Therapy from PTS. These detailed and illustrated consult cards are a perfect resource to hand to teachers looking for ways to help students grow healthy and strong as they learn. 

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