Comparison of Cliinician-Directed and Student-Self-Directed Physical Therapy Interventions for Youth with Severe and Multiple Developmental Disabilities

Abstract

I investigated two physical therapy intervention approaches, one clinician-directed (CD) and one participant self-directed (SD) for helping five young adults with severe and multiple developmental disabilities (SMDD) gain, maintain, and generalize mobility skills while using facets of the Self-determined Learning Model of Instruction (SDLMI) in the process. The dependent variables in this small-n study included: (a) number of mobility steps accomplished, (b) frequency and type of supports required, (c) number of self-initiated supports requested by the participants, (d) percent self-evaluation match with therapist, (e) number of adjustment topics offered, and (f) number of mobility steps maintained in the familiar setting and generalized to a new applied setting.

All participants gained mobility skills steps regardless of the interventions applied, but the SD intervention proved somewhat more effective than the CD intervention. Participants maintained their mobility skills in their familiar setting, and generalized them in a less familiar applied setting. Results showed that participants learned and applied facets of the SDLMI more during generalization and maintenance, but less during the SD and CD sessions. Participants preferred the SD sessions because they could choose activities and control the course of the session, and they learned to relate the interventions to their mobility goal. Relative costs of the SD and CD sessions were comparable suggesting that implementing the SDLMI into PT sessions is beneficial for promoting self-determination and motor skill development for youth with severe and multiple developmental disabilities.