Accommodations for a Student with a Physical Disability in a Professional

Home , Physical therapy

CASE REPORT Accommodations for a Student With a Physical Disability in a Professional Physical Therapist Education Program Nora J Francis, PT, DHS, OTR, Alice Salzman, PT, EdD, Dannee Polomsky, MA, CRC, and Eileen Huffman, PT, DPT, MS to apply for professional education programs. Background and Purpose. Since 1973, The student’s most significant impair- Often, applicants to professional physical the passage of federal laws and regula- ment was weakness in right ankle dorsi- therapist education programs have been tions has allowed increased access to ed- flexion, for which she wore an ankle foot introduced to the profession through expe- ucation and employment for individuals orthosis. Because of the spine stabiliza- riencing a personal injury. Therefore, such with disabilities. Although the number of tion surgeries, at the time of admission to programs must be prepared to address the graduate and professional students with a physical therapist program, the student needs of students with physical disabilities. disabilities has not been reported, fac- presented with functional limitations The purpose of this case report is to describe ulty in professional education programs in standing, sitting, lifting, and bend- the process used to determine reasonable ac- must be prepared to address the needs of ing. Accommodations were developed commodations and the modifications made students with disabilities. The purpose of that enabled her to participate in class- in a professional physical therapist education this case report is to describe the process room and clinical education activities. program to allow participation by a student used to determine reasonable accommo- Outcomes. The student successfully com- with a physical disability. We also describe dations and the modifications made in a pleted all required academic and clinical the challenges encountered and make rec- professional physical therapist education coursework. She is now employed in the ommendations for academic and clinical program to enable participation by a stu- outpatient physical therapy department faculty facing similar situations. dent with a physical disability. of an academic medical center where she Case Description. At the age of 17, the stu- works with patients with a wide variety of Literature Review dent in this case report sustained a Grade medical diagnoses. The Rehabilitation Act of 19732 (Rehab Act) V spondylolisthesis. She subsequently un- Discussion. The faculty faced many and the Americans With Disabilities Act3 of derwent 4 surgeries to stabilize her spine. challenges while determining and imple- 1990 (ADA) have increased opportunities for menting reasonable accommodations students with disabilities. According to Sec- that allowed the student to participate in tion 504 of the Rehab Act, students cannot Nora Francis is an assistant professor and and complete the physical therapist edu- be denied access to education at any entity assistant chair of clinical education, Depart- cation program. Many of the challenges ment of Physical Therapy and Human Move- that receives federal funding because of a arose because of physical therapists’ con- disability. The protections of the Rehab Act ment Sciences, Feinberg School of Medicine, cerns that an individual with impairments at Northwestern University, 645 North Michi- extend to programs offered jointly with enti- and functional limitations could not began Avenue, Suite 1100, Chicago, IL 60611 ties outside the academic institution, such as come a physical therapist and practice ([email protected]). Address all cor- clinical education sites. Education programs safely. This report challenges physical respondence to Nora Francis. have the authority to establish technical stan- therapists to reconsider the requirements Alice Salzman is an assistant professor and dards, based on faculty expectations and pro- to become a capable practitioner. assistant chair of clinical education, Depart- gram philosophy, that students must be able ment of Physical Therapy and Human Move- Key Words: Essential functions, Techni- to complete during their professional educa- ment Sciences, Feinberg School of Medicine, cal standards, Student with disabilities, tion.2,4 A program’s technical standards can at Northwestern University, 645 North Michi- Physical therapy education, Physical dis- be used to determine whether a student with gan Avenue, Suite 1100, Chicago, IL 60611 abilities. ([email protected]). a disability possesses the abilities necessary to participate, and is therefore a qualified stu- Dannee Polomsky is the manager of services for dent with a disability. students with disabilities, Northwestern Univer- BACKGROUND AND PURPOSE sity, Abbott Hall, Room 727, 710 North Lake The ADA allows qualified applicants Shore Drive, Chicago, IL 60611 (d-polomsky@ Since 1973, the passage of federal laws and with disabilities to apply for admission to northwestern.edu). regulations has increased access to higher education programs.3 To determine wheth- Eileen Huffman is a senior physical therapist education and employment for individuals er an individual is qualified to enter a pro- at Loyola University Medical Center, Loyola with disabilities. In 2000,1 over 66,000 college fessional education program, an admission Rehabilitation Services–Maywood, 1219 freshmen reported having learning, sensory, committee can compare the applicant’s West Roosevelt Road, Maywood, IL 60153 or physical disabilities, and in the following abilities with the program’s admission stan- ([email protected]). year, 57% of undergraduates indicated that dards, which can be academic or technical The Institutional Review Board at Northwestern they were attending college to prepare for in nature. A student who does not meet ad- University approved this case report. graduate or professional school. Although mission criteria can be denied entry. Once Received September 28, 2006, and accepted the number of graduate and professional stu- a student is admitted, the ADA requires January 16, 2007. dents with disabilities has not been reported, that “reasonable accommodation should faculty can expect students with disabilities be made to allow a qualified disabled per-

60 Journal of Physical Therapy Education Vol 21, No 2, Fall 2007 son to achieve the essential functions of the the ability to make decisions based on clini- physical disabilities in classroom and clini- job.”5 Essential functions define the abili- cal judgment and the ability to judge one’s cal settings. Approval for this case report was ties required to participate in and complete limitations. received from the Institutional Review Board a program in a manner that does not com- Academic program faculty can define at Northwestern University and the student promise others’ safety;4 the nature of the job specific essential functions related to the gave informed consent for this report to be must change if the essential functions are program’s philosophy. The objective of the written. Throughout the report, the student removed.5 Essential functions for a profes- program in this case report was to “produce is referred to by the pseudonym, Mary. sional education program can be defined physical therapists who can respond to based on faculty expectations, program phi- complex patient/client needs quickly, sci- CASE DESCRIPTION losophy, and educational setting. Techni- entifically and independently.”10 (p 2) Admit- cal standards or essential functions may be ted students needed to demonstrate, with Student and Physical Therapist described in physical therapist education or without reasonable accommodation, the Program Description program mission statements, student hand- ability to practice in a manner that ensured At the age of 17, Mary sustained a Grade V books, admission materials, or in course the safety of the patient/client, self, and spondylolisthesis. Approximately 3 years after syllabi. If an admitted student cannot meet others.10 Because program graduates were the initial injury, pain and spinal instability the essential functions or components of a expected to meet the needs of clients in all led to 2 surgeries to complete a spinal fusion program with or without reasonable accom- areas of physical therapy, students were re- with rods and pedicle screws placement. Af- modations, a program may determine that quired to complete full-time clinical educa- ter a period of rehabilitation, Mary required student to be unqualified for participation. tion experiences in diverse clinical settings a manual wheelchair and bilateral forearm Academic institutions can determine the and to work with patients/clients with a vari- crutches for ambulation, due to lower ex- manner in which reasonable accommoda- ety of medical problems. While the concept tremity and trunk weakness. Because she was tions are provided to qualified students with of preparing graduates to enter any area of interested in becoming a physical therapist, disabilities. Acceptable program modifica- practice has not been debated in the physi- she volunteered at a physical therapy clinic tions might include changes in the courses cal therapist education literature, it has been and began to research physical therapist edu- required for a degree or adaptation in the discussed in the literature on medical education programs. One year-and-a-half after requirements for completion of a specific cation. A 1979 report8 to the Association of the first spinal surgeries, Mary was diagnosed course.6 Programs are not expected to make American Medical Colleges from a Special with rod failure secondary to pseudarthrosis modifications that would compromise the Advisory Panel on Technical Standards for and underwent 2 more spinal surgeries. Fol- health or safety of others4 or to revise require- Medical School Admission stated that medi- lowing recovery from the surgeries, includ- ments essential to obtaining the degree or cal schools should prepare “undifferentiated ing further intensive rehabilitation, her most related to licensing requirements.6 graduates”(p725) who are prepared to enter significant impairments were limited trunk Ingram7 explored the opinions of physi- any field of medical practice. In 2004, Van flexibility and weakness in right ankle dor- cal therapist education program academic Matre et al11 investigated beliefs about the siflexion, for which she wore an ankle foot administrators regarding the essential func- undifferentiated medical school graduate in orthosis (AFO). tions for physical therapist students. Most a survey of attending physicians, residents, Returning to college, Mary completed a program administrators who responded to a and students from various specialties at an Bachelor of Science degree in health scienc- survey that was sent to all accredited physical academic medical center and affiliated sites. es and a Master of Science degree in exercise therapist education programs in 1997 agreed Respondents indicated that communication physiology. She continued to be interested in that physical therapist students needed to and observation skills were more impor- physical therapy as a career. Because of her practice safely and ethically and commu- tant than various technical skills, and over- medical history and functional limitations, nicate effectively. Examination procedures whelmingly disagreed that students should she explored careers in various health care were considered more essential for physical be “undifferentiated graduates,” having “all professions and began working in medical therapist students to perform than treatment of the technical skills required to enter any research. She tried to contact the American procedures, since physical therapist assistants specialty.”11(p4) The authors recommend that Physical Therapy Association special-interest can complete treatment procedures.7 Physi- rather than focusing on technical skills, the group for physical therapists with disabili- cians have examined the essential functions goal of medical education should be expo- ties to seek their guidance about pursuing required for medical students. Similar to the sure to all areas of medicine so graduates can a career in physical therapy. However, the work of Ingram, they emphasized cognitive focus on any area of practice.11 group had dissolved and she found little and interpersonal skills more than techni- During our literature search, we found information about how a person with a dis- cal abilities. In 1996, Reichgott8 proposed no articles on the topic of physical therapist ability might function as a physical therapist. that there are 3 essential functions required students with physical disabilities, though When she called physical therapist educa- for medical school: intelligence, in order to we did discover literature discussing nurs- tion programs to inquire about physical and synthesize and apply the knowledge of medi- ing, occupational therapist, and medical admission requirements for students with cine; a professional attitude, or “a degree of students with learning disabilities12-15 and disabilities, she learned that there was a high selflessness and commitment to the service medical students with physical disabilities.8, degree of variability in programs’ physical re- of others”8(p728); and the ability to “commu- 11 Though helpful, this literature does not quirements. She ultimately chose a program nicate and interact effectively.”8(p728) Stiens,9 address issues unique to physical therapist whose technical standards did not emphasize recognizing that individuals with disabilities students with physical disabilities. This case physical abilities, applied for admission, and such as blindness have successfully com- report may serve as a resource for physical was accepted to enter. pleted medical school and become well-re- therapist education program administra- When Mary began the program, the cur- spected physicians, concludes that the most tors and faculty as they encounter questions riculum consisted of 7 trimesters over 26 important aspects of work in medicine are related to accommodating students with months, included 4 full-time clinical expe-

Vol 21, No 2, Fall 2007 Journal of Physical Therapy Education 61 riences (CE I–IV), and led to a Master of Table 1. Functional Limitations Physical Therapy degree. Shortly after she began, the program received approval for Position Limitation a new curriculum leading to a Doctor of Physical Therapy degree. Students who had Standing 1. Standing in place — 1 hour maximum begun the Master of Physical Therapy pro- 2. Walking/standing — unlimited gram were given the opportunity to complete Sitting 1. Supported — 2 hours maximum additional coursework, including an addi- 2. Unsupported — 2 hours maximum tional 5 weeks of clinical education (CE V), Lifting 1. Load — 20 pounds and receive a transitional Doctor of Physical 2. Load to be lifted infrequently, not to be a repetitive pattern Therapy degree. Mary accepted the oppor- Bending 1. Proper body mechanics are to be used at all times tunity to complete the necessary coursework ‡"Qr"ehqglqj"dw"wkh"wuxqn"gxh"wr"vslqdo"ixvlrq for the transitional Doctor of Physical Ther- ‡"Ehqglqj"wr"eh"shuiruphg"dw"wkh"klsv"dqg"nqhhv apy degree. Spinal support 1. Soft lumbar corset to be worn when deemed necessary by student Interventions—Academic Course Work 2. Hard lumbosacral orthosis to be worn when deemed necessary by student Determining reasonable accommodations to allow Mary to participate in physical therapist education began during the admissions process, when she informed the director of Table 2. Accommodations for Mary professional education (DPE) that she had ฀฀฀If a patient is not sufficiently stable or requires greater than minimal assistance, Mary will a back condition. Once she enrolled in the arrange to have an aide available for assistance. In class or during practical examinations, program, her physician, with input from her the aide may be another student or faculty member. physical therapist, provided written confir- ฀฀฀Mary may “perform verbally” when appropriate. In situations that she cannot reasonably mation of Mary’s disability, medical diagno- be expected to manage alone, she can instruct an untrained aide sufficiently to manage sis, and functional limitations to the Office the patient safely. For example, rather than perform a 2-person transfer, Mary would for Services for Students With Disabilities instruct two untrained aides in the skill. The aides must be able to transfer the patient safely and effectively based on her instructions. Each course in which clinical skills are (SSD) and the DPE (Table 1). taught will generate a list of which skills may be done using “verbal performance” and The DPE, working with the SSD repre- which must be fully demonstrated. sentative and the faculty, developed a written ฀฀฀A plinth will be provided at the rear of the classroom for Mary to recline during lectures, agreement to define appropriate accommo- if needed. dations for Mary (Table 2) and determined ฀฀฀The directors of clinical education (DCEs) will work with Mary and the clinical sites during that the DPE would inform faculty of Mary’s the clinical education selection process. The sites will be contacted to determine whether accommodations as appropriate. The agree- they can provide the accommodations that Mary requires. Written confirmation will be ment briefly described Mary’s medical di- secured and copied for Mary. agnosis and relevant medical history, her functional limitations and responsibilities, trimester of Year 1 in the course Physical followed. Subsequently, another meeting and the necessary accommodations. Mary Therapy Care. Course content included was held with Mary, her faculty advisor, a was expected to use safe and effective body bed positioning, bed mobility, wheelchair director of clinical education (DCE), and mechanics at all times; accurately assess her mobility, wheelchair prescription, transfers, the course coordinator, during which her abilities to sit, stand, lift, and perform patient adaptive equipment, and gait training. Ac- accommodations were reviewed and clari- transfers; and use good judgment regarding cording to the accommodations agreement, fied. For the remainder of the course, an the need for assistance. She was also ex- Mary was expected to assess her ability to aide was available during practical exami- pected to assess whether a patient’s/client’s perform the required psychomotor skills in- nations and Mary determined whether she status was sufficiently stable for her to work dependently or with assistance of an “aide,” could perform the selected activities safely, safely with that patient/client. Last, Mary was role-played by classmates and faculty. When with or without an aide. With these modi- expected to inform classmates and faculty she chose to use an aide, Mary was expected fications to her performance expectations, of the nature of her injury as appropriate, of to explain the rationale for her choice of the Mary successfully completed the course. specific procedures that should not be per- selected activity and appropriately instruct Throughout subsequent clinical course formed on her (eg, shortwave diathermy or the aide to safely, effectively, and efficiently work, Mary was expected to determine vertebral mobilizations), and whether her accomplish the task. During the first practi- whether she could function safely as physical symptoms increased during any class activ- cal examination in the course, the evaluat- therapist or simulated patient, and request ity. After finalizing the accommodations ing faculty member was not aware that Mary assistance if needed. When practicing some agreement, the DPE notified the course was able to request an aide’s assistance. An physical agents and manual therapy tech- coordinators that Mary had a back condi- aide was not available in the room and niques in clinical courses, she was not able tion requiring accommodation during some Mary did not request one. To protect herself to serve as a simulated patient. She gradually classroom activities. from injury, she demonstrated poor body learned her physical capabilities through ac- Although the DPE notified course coor- mechanics and ineffective skills, which led tive experimentation, and the faculty learned dinators about Mary’s situation, the faculty to failure of the examination. Immediately the necessity of teaching her how to perform discovered later that not all of them were following the exam, Mary talked to her tasks using the specified accommodations. fully aware of her need for accommoda- faculty advisor about her concern that the Mary ultimately completed all academic tions, leading to problems in the spring established accommodations had not been course work safely and successfully.

62 Journal of Physical Therapy Education Vol 21, No 2, Fall 2007 Table 3. Schedule of Clinical Experiences and 3) the lengthy process to train and as- sure competence of the physical therapy aide Fall Trimester Winter Trimester Spring Trimester provided by the university. Of the 9 hospital CCCEs contacted, 5 reported immediately Year 1 Clinical Experience I (4 weeks) or after discussions with their supervisors that individuals with Mary’s limitations did Year 2 Clinical Experience II Clinical Experience III (4 weeks) (8 weeks) not meet the site’s essential functions for a physical therapist, with or without accom- Year 3 Clinical Experience IV (9 weeks) modations. CCCEs at 3 acute care hospitals Clinical Experience V and 1 rehabilitation hospital were willing to (5 weeks) create learning experiences for Mary. She selected an inpatient acute care placement in an academic medical center and an adult Table 4. Clinical Experience Requirements During CE II–IV inpatient acute rehabilitation experience in ‡"""D"plqlpxp"ri"6"zhhnv"ri"ixoo0wlph"h{shulhqfh"zrunlqj"zlwk"lqsdwlhqwv"zkr"kdyh" a freestanding rehabilitation hospital, dur- problems that change abruptly; usually met in an acute care setting. ing which she would split her time between ‡"""D"plqlpxp"ri"6"zhhnv"ri"ixoo0wlph"h{shulhqfh"lq"dq"rxwsdwlhqw"vhwwlqj1 administration/education activities and pa- ‡"""Zrunhg"zlwk"sdwlhqwv"zlwk"qhxurorjlfdo"frqglwlrqv"dqg"sdwlhqwv"zlwk"pxvfxorvnhohwdo" tient care, focusing on aquatics. The DCEs conditions, in any setting. later learned that Mary’s choice of an acute ‡"""Qr"pruh"wkdq"45"zhhnv"pdqdjlqj"sdwlhqwv"ri"vlplodu"djhv/"zlwk"vlplodu"sureohpv"dqg" care placement had required assistance from levels of acuity. classmates, who chose not to select a facility that had agreed to accept Mary and provide Interventions—Clinical Education clinical education (CCCE) at the facility accommodations. The curriculum included 5 full-time clini- and determined that she was able to accept Prior to each experience, the DCEs con- cal education experiences, integrated across a student requiring accommodations. Mary tacted the CCCE to request a meeting to the 7-trimester program (Table 3). For most provided information about her relevant plan the experience and answer any ques- students, CE IV and V occurred at the same medical history and current physical status tions that the CCCE and CI might have. facility. Prior to the clinical education se- in her letter of introduction to the CCCE. Mary, the university SSD coordinator, one lection process, one of the DCEs posted She met the course objectives and passed her or both DCEs, the CI, and the CCCE were an e-mail message on the physical therapy first full-time clinical experience. present at all meetings. Expectations for education listserve requesting advice from The selection process for CE II–V was Mary, the CI, and CCCE were defined us- other DCEs who had previous experience more challenging. Students selected all of ing the university’s objectives for each clini- with students who have physical disabilities these experiences during a 2-week period cal experience, specific information about and who are ready to begin full-time clinical in fall trimester of the second year. During the facility provided by the CI and CCCE, education experiences. The message yielded the selection process, Mary spoke frequent- and the student’s accommodations agree- 2 responses, neither of which changed our ly with the DCEs, who in turn contacted ment. Memos outlining the expectations plan for assisting Mary with her clinical edu- CCCEs at facilities that she was considering were written by the SSD coordinator and cation schedule. to determine whether they could provide were distributed to all parties. Each clinical Students selected their clinical place- accommodations. For experiences in acute education planning meeting was completed ments from a list of available facilities. In care and pediatric or adult rehabilitation, the in approximately 1 hour. Due to facility li- the lottery method used for selecting place- university offered to provide a physical thera- ability concerns, the administrators for each ments, students were expected to collaborate py aide to assist Mary with patients requiring clinical facility declined the opportunity for with their classmates to create schedules moderate or maximal assistance. The DCEs a physical therapy aide to be provided by the that allowed all students to meet program contacted CCCEs at 6 acute care hospitals, university. Aside from the increased time to requirements. The DCEs oversaw the selec- 2 pediatric hospitals, 1 rehabilitation hos- arrange and conduct these meetings, no ad- tion process and were available for advice pital, and 1 outpatient private practice. No ditional financial resources were expended and counsel as needed. Because the curricu- concerns were expressed by the CCCE at in granting the student’s accommodations. lum prepared graduates to meet the needs the outpatient private practice; the majority The meetings with the CIs and CCCEs of patients/clients in all areas of physical of patients at this facility had musculoskele- prior to CE III and CE IV–V went smoothly. therapy, students were expected to complete tal problems, and the clinical instructor (CI) Mary was scheduled to complete CE III CE II–IV in a variety of clinical settings (Table could be readily available, since the staff at an outpatient private practice, working 4). Interventions to assist Mary to successfully worked in close proximity to each other. mainly with patients with musculoskeletal complete all clinical education experiences The CCCEs at acute care and pediatric problems. Because the clinic was small, the began during the selection process. hospitals expressed several concerns about CI was always readily available, so the aide Students chose their sites for CE I during accepting a student with a disability and offered by the university was not needed. CE fall trimester of the first year; minimal DCE providing accommodations. Their concerns IV and V were to occur in a large, inpatient intervention was required to assist Mary dur- and comments focused on 3 areas: 1) the rehabilitation hospital. Because the aquatic ing this process. She met with the DCEs to student’s ability to meet the facility’s defined physical therapist and at least 1 staff person discuss the best choices for her, and she se- essential functions because no reasonable were immediately available when patients lected an outpatient facility where patients accommodations were available; 2) the were in the pool, the CCCE determined that primarily had musculoskeletal problems. facility’s liability, should the student or a pa- an additional physical therapy aide was not A DCE phoned the center coordinator of tient be injured during a treatment session; needed for that portion of the experience.

Vol 21, No 2, Fall 2007 Journal of Physical Therapy Education 63 In addition to working in aquatic physical by the curriculum and was awarded the pist education program required a change in therapy, the CCCE and CI expected that degrees of Master of Physical Therapy and these values. Mary had sustained a severe in- Mary would have the opportunity to work transitional Doctor of Physical Therapy. In jury; the subsequent impairments and func- with some patients outside of the pool with addition, she passed the licensure examina- tional limitations required her to balance the CI providing supervision and serving as tion on the first attempt. Because she met the her own physical needs and limitations with an aide as needed. The DCEs agreed that physical requirements needed for a physical decisions about how to provide safe and ef- the objectives of CE IV and V could be met therapist in an outpatient setting, she ac- fective care for patients. Physical therapists during the planned experience. cepted a position in the outpatient physical who were unable or unwilling to examine The meeting held prior to the acute care therapy department of an academic medical their deeply held beliefs were unable to see experience (CE II) in the academic medi- center where she works with patients with a how she might function safely in the clinical cal center was more difficult. The physical wide variety of medical diagnoses. She utiliz- setting and become a physical therapist. therapy inpatient supervisor and the manager es the assistance of PTAs and physical ther- Physical therapy educators must consider of inpatient rehabilitation services were in- apy aides with tasks that are outside of her the unique perspective that students with dis- cluded in the meeting at their request. They physical abilities infrequently, approximately abilities may bring to their education. Velde expressed concerns about Mary’s ability to 2% of the time, and has become certified as et al17 reported that occupational therapy complete the experience successfully given a lymphedema therapist. students with disabilities had a strong moti- the physical demands of the inpatient acute vation to master required skills despite their setting. They also reported that it would be DISCUSSION disability and believed that having a disabil- difficult to devote a facility-trained physical The faculty faced many obstacles while de- ity would enhance their practice because therapy aide to Mary and were concerned that veloping and implementing the reasonable they understood disability at a personal level. an aide provided by the university might not accommodations that allowed Mary to par- Similarly, Losh and Church5 reported that meet the facility’s competencies. Eventually, ticipate in and complete the physical thera- medical residents with disabilities bring a all parties agreed that the experience could pist education program successfully. Many unique perspective and special attributes continue as planned, as long as Mary and her of the obstacles arose because of physical that enhance patient care. Students with dis- CI always worked together, with the CI serv- therapists’ concerns that an individual with abilities may experience additional stress if ing as an aide when Mary needed assistance. her functional limitations could not become faculty members are unwilling to work with Mary finished all clinical experiences a physical therapist and practice safely. In them to create solutions for potential prob- without any incidents, met the objectives, seeking to become a physical therapist, lems. Students may then see their disabilities and successfully completed CE II–V. Dur- Mary challenged some of physical therapists’ as barriers between faculty and themselves.17 ing CE II, Mary worked with her CI on deeply held professional values. Physical Rather than seeing only barriers, faculty are general medical, surgical, trauma, cardiac, therapists view themselves as “fit and able” encouraged to partner with the student to and intensive care units of the hospital. A and different than their patients, who are achieve academic success. meeting was held at the facility early in the individuals needing assistance.16 Mary was The faculty learned many practical lessons experience to discuss her progress and any required to acknowledge her physical limi- by working with Mary. First, it is important to unanticipated problems that may have aris- tations in order to request accommodations have and follow a process for managing the en. The CI reported that Mary was able to that allowed her to practice safely, which education of students with physical disabili- appropriately determine when she needed challenged physical therapists’ perceptions ties. Once students disclose the presence of assistance and correctly direct the CI how to of themselves as strong and healthy individu- a disability, we recommend that they be re- assist her. An onsite meeting was also held als. We believe that some academic and clin- ferred to the university office providing ser- during CE III. Mary and the CI reported ical faculty could not see Mary becoming a vices for students with disabilities. Personnel that she was progressing toward entry-level physical therapist because they focused on from that office will obtain documentation performance as expected. the physical aspects of the profession, with of the disability from relevant health care Mary’s final clinical experience occurred which she needed assistance. providers and information about the require- in a rehabilitation hospital. During the expe- While examining the experiences of ments for participation in the education rience, the CCCE and DCEs had frequent physical therapists who had work-related program from the academic department. If discussions via telephone. Mary provided di- musculoskeletal injuries, Cromie et al16 re- the SSD representative determines that a stu- rect therapy services in the therapeutic pool ported that physical therapists valued their dent’s limitations may interfere with require- for a variety of patients, with the CI present unique knowledge base, the importance of ments for participation, SSD, the student, at all times. Mary also worked with another caring for patients, and working hard. Physi- and the academic program can collaborate CI on an inpatient unit with adult and pe- cal therapists believed that they knew how to delineate the student’s limitations and diatric patients with a variety of diagnoses. to prevent work-related musculoskeletal in- propose reasonable accommodations. Since During the administrative portion of the juries and how to treat work-related injuries clinical educators are vital to the completion experience, Mary created and provided edu- if they did occur. They put their patients’ of physical therapist education, it is impor- cational experiences for facility employees, needs before their own, and emphasized the tant to consider the needs and expectations physical therapist students, and staff physi- need to care for patients above the need to of clinical sites when developing reasonable cal therapists. These diverse learning activi- care for themselves, even if a patient’s care accommodations. We also recommend that ties allowed her to meet the objectives of the placed the physical therapist at risk for per- accommodations that modify student expec- clinical experience. sonal injury. “Participants…described feel- tations or those provided jointly with an out- ing pressure from colleagues and patients side entity be reviewed and approved by the OUTCOMES to be caring and hardworking, even when it university’s legal counsel. Mary successfully completed all required could be detrimental to their own health.”16 Students can play an important role by coursework in the usual time frame required (p 464) Allowing Mary to enter a physical thera- disclosing their disabilities early and re-

64 Journal of Physical Therapy Education Vol 21, No 2, Fall 2007 questing the accommodations they need.18 and equality, and we encourage educators to REFERENCES Disclosure allows for provision of the agreed- consider how programs can be more accept- 1. College Freshmen With Disabilities. Washing- upon accommodations and protection from ing of students with disabilities. As health ton, DC: American Council on Education; discrimination.19 Once the student has con- professionals, physical therapists are expected 2001. sented to disclose a disability, academic and to promote acceptance of people with dis- 2. Rehabilitation Act of 1973, 29 USC, §794, 34 clinical faculty who will be involved in pro- abilities. Viewing disability through the so- CFR, Part 104 (1973). viding accommodations must be notified. cial model requires educators to adapt tasks 3. Americans With Disabilities Act of 1990, 42 Academic faculty may need reminders at the and environments to facilitate the success of USC, ch 126 (1990). beginning of each term about the student’s qualified students with disabilities. Through 4. Southeastern Community College v Davis, 442 accommodations. Finally, students may partnerships with students, educators can US 397, S Ct 2361 (1979). choose not to disclose their disability to any- promote positive attitudes among educational 5. Losh DP, Church L. Provisions of the Ameri- one. They should not be expected to notify constituents.17 By exploring creative options cans with Disabilities Act and the development classmates about a disability, but can decide for providing reasonable accommodations, of essential job functions for family practice if and when disclosure to classmates is neces- both the facilities’ essential functions and the residents. Fam Med. 1999;31(9):617-621. sary. Students who have chosen to disclose to students’ learning needs may be met. 6. Enright MS, Conyers LM. Career and ca- academic faculty may choose not to disclose reer-related education concerns of college to clinical faculty because of a fear of stigma. Recommendations for Future Study students with disabilities. J Counseling & Dev. 1996;75(2):103-114. Students who do not disclose a disability to DeLisa and Thomas20 recently provided sev- 7. Ingram D. Opinions of physical therapy educa- clinical faculty are not eligible to receive ac- eral recommendations for an agenda to in- tion program directors on essential functions. commodations in the clinical setting. corporate qualified individuals with disabili- Phys Ther. 1997;77(1):37-45. ties into the physician workforce. Most of We also recommend that students with 8. Reichgott MJ. “Without handicap”: issues of disabilities work closely with the DCE when their recommendations also can be applied medical schools and physically disabled stu- designing their clinical education schedule. to physical therapist education. Therefore, dents. Acad Med. 1996;71(7):724-729. A DCE might determine that making chang- we recommend that the profession reexam- 9. Stiens S. The physically disabled medical stu- es in the clinical selection process and re- ine what it means to be a physical therapist in dent. Int Disabil Stud. 1987;9(3):140-141. quirements are reasonable accommodations. order to develop technical standards that can 10. Northwestern University Medical School, Frequent communication about a student’s be used by all physical therapist education Department of Physical Therapy and Human clinical choices allows the DCE to discuss programs. Are physical therapists in a doc- Movement Sciences. Physical Therapy Student required accommodations with CCCEs dur- toring profession simply practitioners with Handbook. Evanston, Ill; Northwestern Uni- ing the clinical selection process. Discussing physical skills or clinicians who critically versity; 2001. the required accommodations with CCCEs analyze human movement in order to direct 11. VanMatre RM, Nampiaparampil DE, Curry allows them to choose to accept students and supervise patient care? There is a need RH, Kirschner KL. Technical standards for the with disabilities, leading to a more welcom- for more research that examines the number education of physicians with physical disabili- ing environment at the clinical facility. of qualified individuals with disabilities ap- ties: perspectives of medical students, residents, and attending physicians. Am J Phys Med Reha- The DCEs were surprised by the variabil- plying to physical therapy school, and their rates of admission, graduation, and resultant bil. 2004;83(1):54-60. ity in responses from clinical sites when seek- 12. Kolanko KM. A collective case study of nursing ing clinical education experience options professional experiences. Additional research is also needed to identify the primary barriers students with learning disabilities. Nurs Educ for this student, and by the discovery that Perspect. 2003;24(5):251-256. the academic program’s technical standards to physical therapist education programs that people with disabilities encounter. 13. Faigel HC. Changes in services for students and the accompanying accommodations for with learning disabilities in U.S. and Canadian the student did not always match facilities’ medical schools, 1991 to 1997. Acad Med. Dec CONCLUSION essential functions. Believing that a CCCE 1998;73(12):1290-1293. willing to pursue the possibility of accommo- This case report is the first in the physical 14. Rosebraugh CJ. Learning disabilities and medi- dations was a key component of an effective therapy literature to discuss the professional cal schools. Med Educ. 2000;34(12):994-1000. learning experience, the DCEs chose not to education of a student with a physical dis- 15. Little D. Learning disabilities, medical question CCCEs’ reports that they were un- ability. We have described the accommoda- students, and common sense. Acad Med. able to provide accommodations and worked tions that allowed a student with a disability 1999;74(6):622-623. only with CCCEs who were willing to con- to successfully complete a physical therapist 16. Cromie JE, Robertson VJ, Best MO. Work-re- sider accommodations. education program and the process used to lated musculoskeletal disorders and the culture of physical therapy. Phys Ther. 2002;82(5):459-472. Working with Mary caused us to carefully determine and provide those accommoda- reconsider what is needed to become a ca- tions. Finally, we have offered recommen- 17. Velde BP, Chapin MH, Wittman PP. A working around “it”: the experience of occupa- pable practitioner. As Mary discovered when dations for academic and clinical faculty to consider when a student with a physical tional therapy students with a disability. J Allied exploring education programs, there is great Health. 2005;34(2):83-89. variety among education programs’ techni- disability participates in a physical therapist education program. 18. Manders K. Disabled medicine. CMAJ. cal standards and essential functions. We 2006;174(11):1585-1586. challenge the profession to consider what it ACKNOWLEDGEMENTS 19. Brown K, Griffiths Y. Confidentiality dilem- means to be a physical therapist, and devel- mas in clinical education. J Allied Health. op technical standards that can be accepted We would like to thank Karen Hayes, PT, 2000;29(1):13-17. by all education programs. We agree with PhD, FAPTA, and Marjorie Johnson Hill- 20. DeLisa JA, Thomas P. Physicians with dis- 20 DeLisa and Thomas that incorporating and iard, PT, MS, for their contributions to abilities and the physician workforce: A need to accommodating people with disabilities into the development to and review of this case reassess our policies. Am J Phys Med Rehabil. health professions is a matter of social justice report. 2005;84(1):5-11.

Vol 21, No 2, Fall 2007 Journal of Physical Therapy Education 65