The Role of the Therapist

We can divide the responsibilities of therapists into four broad areas


In the community, physically impaired children need to travel great distances and to be active for long periods. Children with some ability to walk become exhausted after the first hour of community travel. Their perceptual/cognitive skills decrease as their physical strength drains. Therefore, almost all the children in the community travel program who have moderate to severe physical impairments use power wheelchairs.

As we entered the technology age, wheelchairs suddenly became sophisticated and expensive. Children who previously had no hope of self movement because of severe physical problems could now be taught to drive. Therapists became high technology specialists. They learned how to assemble and repair the complex systems (and when to send them back to the factory), and; they learned ways to teach children how to use the sophisticated systems. Because high technology evolves very rapidly, therapists must sign on to continual re-education. Sophisticated wheelchair technologies have made the therapy team indispensible; no one else has the expertise to handle this complex job.

Physically impaired children (starting as young as three years old) learn to drive wheelchairs just as 16 year olds learn to drive cars. They learn how to pass pedestrians, how to move down narrow aisles without knocking bottles of perfume on the floor, how to back onto a lift bus, which side of the hall or mall to drive on, how to be safe on ramps, and how to adjust speed for different conditions. Therapists teach drivers training to wheelchair users.

The old rule "If something can go wrong, it will," applies to wheelchair travel. Wheelchairs are always breaking down, usually ten miles from the nearest allen wrench. Therapists are the resident wheelchair mechanics.

Wheelchairs are custom built for individual students. Therapists decide which seat molds, braces and pads to use for the specific physical problems of impaired children. When traveling, the therapist is constantly monitoring a student's posture and repositioning the child as necessary. A student's comfort level and physical well being depend upon the skill of the therapist.

Daily Living Skills

During community lessons, the therapist works with the mobility specialist to teach basic skills. Time and money management are recurrent themes. Social skills are stressed: appropriate interaction with store clerks, strangers, and peers. Eating, dressing, and toileting skills are daily concerns. Grooming is addressed, as is appropriate clothing for conditions. Asking for assistance, problem solving, and teamwork are additional themes stressed by the therapist.


In the community, clothing must be constantly taken off and put back on (coats at mall lockers, pants in the public bathrooms). Caution and skill are required to remove clothing without breaking arms or dislocating joints.

Mealtimes are especially busy. Therapists teach the use of adaptive utensils, as well as basic techniques for eating and drinking. Therapists also know what foods can and cannot be eaten by specific students. They are trained to respond quickly to choking.

Most trips into the community involve shopping for personal items or food. These activities require reaching, grasping, and bending. Students need to reach toward store shelves, grasp the object they need and place it on their wheelchair. They need to pick up dropped objects. They need to get out their money, hand it to the cashier, and retrieve change. They need to push the buttons to make the elevator work. These are monumental tasks for most physically impaired children. Therapists have a bag of tricks and a satchel full of tools for solving these problems.

Toileting is another huge problem. Students need to move in and out of tight public bathrooms with people constantly coming and going. They need to remove adaptive clothing and put it back on. They need to transfer from chair to toilet and back. They need to wash and dry their hands. Many children must learn how to cath themselves, and to do so at times in public bathrooms. A therapist is needed to teach every one of these skills.

Gait Training

Blind children and many severely visually impaired children will develop a walking pattern called a blind gait. Therapists understand the mechanics of this gait and know ways to teach students how to walk normally. Physically impaired children who can walk do so with crutches or with abnormal gaits. The therapist is the expert on these walking patterns, and on the postures that result from various kinds of motor impairments. These abnormal motor patterns are very noticeable in public, and students are usually more motivated to correct these habits.