Learning through doing: Children with cerebral palsy in the classroom

by Al Cook, PhD, and Kim Adams, PhD (Cand)

• The incidence of cerebral palsy in Canada is 65,015
• Children with disabilities need and desire full inclusion in the classroom. Passive engagement through observation is just not enough for these children.
• Research has proven that assistive technologies such as robotics in the classroom help children with disabilities learn and participate.
• Robot intervention can benefit children with other disabling conditions such as muscular dystrophy, poliomyelitis, arthritis, osteomyelitis, congenital hearing defects, absence of arms or legs, hemophilia, diabetes and spina bifida.
• Strategies for using robots can be adapted by teachers to fit individual student needs in a manner consistent with the Alberta Curriculum.

Chelsea Hagan, 14, is the only student in her class with a physical disability. She’s had cerebral palsy since she was born. Chelsea uses a wheelchair to get around and a communication device to talk to her friends and family. When she was 11 years old, Chelsea participated in a few robot projects at the Faculty of Rehabilitation Medicine. She controlled Lego robots to do play activities, taking orders and delivering toy food for a sushi party. Chelsea did another robot project with speech-language pathology students where she
used the robot to manipulate cards that had phonemes on them (sounds for making words).

To learn math and measurement, Chelsea used the robot to line up non-standard units like straws or toothpicks. Then, she would count them. She also measured the length of objects with the ruler. The robot is controlled by Chelsea’s communication device using infrared technology, much like a TV remote control.
This is how Chelsea felt about using the robots in these projects:

What did you like best about the robot?
I can do it myself. I like to do that [the activities] all by myself.
What do you like to do with the robots?
I liked to color with it. It helped me to read.
Did you like using the robot to work on math measurement?
Yes, a lot.
What else did you think about the robot?
I like the robots. They are fun. I wish I could have one.

Children with severe physical disabilities such as cerebral palsy are at great risk of developmental and academic delay. These children often have difficulty speaking, walking and using their hands for play, writing or other academic tasks. As young children these physical disabilities limit their learning experiences. It can be
difficult to assess their understanding using standardized tests. It is difficult to find activities where they can have practice to develop their skills. As they enter school their opportunities to fully engage in learning are also
significantly limited.

These limitations have been recognized by the “Setting the Direction for Special Education in Alberta Framework,” an initiative of Alberta Education. This framework identifies 12 strategic directions that are
required to reduce the problems faced by children who have severe disabilities in accessing Alberta’s education system across the province. These directions have been accepted by the Government of Alberta. Among the 12 strategic directions we will address in this article are:

Click to see full size diagram of recommendations on p. 5

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Read the publication that was sent to government and schools

The use of physical therapists in a triage role for patients: what's happening in Ontario

by Alice B. Aiken, PT, PhD (guest blogger)

President, Canadian Physiotherapy Association
Assistant Professor, School of Rehabilitation Therapy, Queen's University

View Rehab Dialogue, sent to members of Alberta Government 

The U of A Faculty of Rehabilitation Medicine has targeted an area that is of concern to the health care system in Alberta and Canada, as the number of hip and knee replacements in Canada continues to grow almost exponentially. The entire health care system is looking for ways provide optimal care for patients while containing or cutting costs. 

The use of physiotherapists in a triage role for patients who require hip or knee replacement has been enormously effective in reducing surgical wait times and containing costs in Ontario. Physiotherapists are the experts in musculoskeletal assessment, diagnosis and treatment and are the appropriate providers to manage this patient population. Approximately 30% of the patients referred for joint replacement do not require surgery. If these patients are triaged by a physiotherapist, they are referred for conservative management, such as physiotherapy, and many of these patients do not return to the system.

However, there is also a benefit for those who do require surgery. They are prioritized by the physiotherapist for how urgently they require surgery, but they are also referred for appropriate conservative management, such as prehab. The orthopedic surgeons have benefitted from the approach because they are only seeing patients who require surgery, and they see them in an appropriate time frame with respect to surgical need. In Ontario, this has allowed the surgeons more time to perform hip and knee replacements. All of this has served to reduce surgical wait times and contain the costs associated with long waits for surgery. In addition, the patient has the benefit of seeing the most appropriate health care provider to address their needs, be they surgical or conservative.

Arthritis: A pain in the joints and health-care system

by Lauren Beaupre, PhD, and Allyson Jones, PhD

34% of Albertans have arthritis. 70% of Albertans over the age of 70 have symptoms of osteoarthritis, the most common type of arthritis.

Physical therapists can help provide direction and coordination for the conservative management of arthritis, improving function and reducing pain for the patient. 50% of arthritis patients seen by orthopedic surgeons on their first visit are not considered to be candidates for hip and knee replacement surgery. Physical therapists can be part of the Assessment team, a group of health professionals who determine whether or not a patient should be referred on to a surgeon for hip or knee replacement surgery.


Arthritis is truly ‘a serious chronic disease’ in Alberta and Canada due to its impact on quality of life, mobility and the huge demand it places on heath care resources. In fact, bone and joint health conditions are leading causes of morbidity and disability worldwide, costing billions in health care expenditure and lost earnings.

In keeping with Alberta Health Service’s Quality Matrix for access, safety, effectiveness, efficiency, acceptability and appropriateness, a clinical pathway known as the “Alberta Bone and Joint Network’s Hip and Knee Care Continuum” has been recently approved for adoption across the province. Here’s how it works (click on image for full size):



People experiencing pain from arthritis start their journey of care with their primary care physician. When pain and difficulty doing activities related to the arthritis become too great after a period of treatment, the primary care physician refers the patient to “Assessment,” where an orthopedic surgeon will consider them for joint replacement. Those who are not yet ready or not in need of surgery may require physical therapy, medications changes, lifestyle and diet changes and more.

And there’s strong evidence, including recommendations from the Osteoarthritis Research Society International (OARSI), that physical and exercise therapy are some of the most effective non-operative interventions for arthritis. Thankfully, physical therapists are trained specifically in the area of exercise prescription for improving function and reducing pain for people with this condition.

Navigating the care pathway

Even though their role in Alberta is still evolving, in several other Canadian provinces, physical therapists are now taking a central role in the Assessment process. In response to the long wait times patients experience to consult with orthopedic surgeons for joint replacement surgery, some centres in Ontario employ specialist physical therapists to assist with “triaging” patients to help streamline appropriate care. They can also make an initial assessment to determine if the patient should consider conservative management, prehabilitation or be recommended for surgery, directing patients to the appropriate health service providers. The role of physical therapists as part of the Assessment team would be very effective in Alberta, reducing wait times and also assisting the general practitioner by providing effective treatment when a patient is told that surgery in not yet a recommended option.

Conservative management

Currently, physical therapists are involved in the pre- and post-operative management of patients with joint replacement and play an integral role in providing conservative management when surgery is not indicated. They can assist patients as they navigate the health system and receive either conservative or surgical management. A physical therapists’ multidisciplinary skills can also help guide patients to the most effective care. They can also provide “prehabilitation” to prepare patients for surgery.


Within the Alberta Bone and Joint Network’s care pathway, patients have well-defined points of contact to start their journey for hip and knee replacement surgery. Yet no clear pathway exists for patients who are not surgical candidates and find themselves “swirling” between options of care, methods and levels of funding and the different professionals offering services. The Network is currently looking for solutions. As musculoskeletal specialists, physical therapists can provide direction and coordination for these patients by working closely with and within primary care networks. Primary care physicians need physical therapists to coordinate and connect with them.

“Prehabilitation”: rehabilitation before surgery

Another facet of the Conservative Management stage is “prehabilitation,” preparing patients for surgery. Some who are deemed surgical candidates may need a specific preparation program, provided by experienced physical therapists, to optimize their recovery and surgery outcomes. Successful recovery after joint replacement is, in part, dependent upon the patient’s level of pre-operative health and function—the patient’s condition before surgery.

One of the authors of this dialogue, Allyson Jones, has shown that patients who were in what was considered poor physical condition before undergoing hip or knee replacement didn’t fare as well as other patients. They were less mobile and experienced more pain at six months after surgery. A prehabilitation program to prepare patients is intended to help them gain more benefit from hip or knee surgery.

Future directions

Given the growing demand for arthritis treatment due to the province’s aging population, the involvement of physical therapists in the Assessment phase, to provide care and help patients navigate the care pathway, will go a long way to ensure efficient and excellent patient outcomes. Physical therapists can also help the Network establish a care pathway within the Conservative Management phase, working closely with primary care networks to allow patients with arthritis to enjoy better quality of life. When end-stage arthritis is reached, a prehabilitation program may help patients prepare for knee or hip replacements and help them recover more quickly.

View entire issue that was sent to Alberta government.