Defining Moment A Constructive Approach Adapting furniture to meet schoolchildren's special needs. By Michael Konstalid, PT, DPT | September 2015 Listen to 'Defining Moment' Working as a school-based pediatric physical therapist (PT) is incredibly rewarding, particularly when I have time to reflect on the big picture. As I write this essay in June, the school year is winding to a close. I'm looking back to last September with pride in how far each of my students has progressed over the last 10 months. The small advances achieved during each of their physical therapy sessions have built upon one another and come into full focus. I treat students with conditions that can make progress slow, painstaking, and difficult to detect from 1 session to the next. That's the most challenging part of my job, and it's what led to a pilot program I developed within the New York City Department of Education (DOE)—designing and building customized adaptive equipment for students who receive physical therapy. I come from a long line of craftsmen. My father, uncles, grandfather, and his father before him were talented carpenters and all-around handymen. Handymen are problem solvers. Drafty rooms get insulated. Squeaky wheels get oiled. Dark corners get wired for light fixtures. It was into this tradition that I was born and raised. I was swinging a hammer in my father's shop almost as soon as I could walk and talk. In 2008, I began working for the DOE as a PT. While I knew I was helping students, their progress often was incremental. So, I found myself wondering what I could do to make their lives easier today. How could I help make their conditions a little more manageable, their lives a little more joyful? How could I bring light into the dark corners of their present circumstances while we were working together to meet longer-term goals? I got my answer pretty early on in my career, when I began integrating the skills I'd learned in my formal education with those of my informal education in my father's shop. I began by repairing wheelchairs, then designing and building specialized equipment to help achieve the therapy goals I'd set. To improve my students' balance and coordination, for example, I built balance beams out of discarded doors, hurdles out of PVC pipe, and scooters out of old shelves. Next, I began designing and building specialty chairs—customized to fit particular students and to address their specific needs. One of these custom chairs led to my defining moment, which came after I read a heartfelt letter from one student's mother. For quite some time, the student's condition had kept her from comfortably joining her classmates on the floor at "rug time." The student's parents and teachers had experimented with several different chairs over the years. None had solved the problem. After analyzing what was needed, I built a custom "floor chair" from an old plastic classroom chair—removing the legs and placing the seat on a platform with wooden feet. Then, I built a second one for another child to use, so my student wouldn't feel singled out. The floor chairs worked so well, and looked so cool, that other children in the class wanted to sit in them at rug time, too. The teacher had to start a sign-up sheet. I built several more. In her letter to me, the student's mother movingly described how the custom chair I'd built had made an immediate and profound difference in her daughter's life. When I put down the letter, there were tears in my eyes—and I am not a big crier. At that moment, I decided I had to find a way to use my design and construction skills to reach more students. Shortly thereafter, I pitched a formal program to the DOE. The program began in fall 2014. Now, 2 days a week I travel to schools throughout Brooklyn, collaborating with other PTs to design customized adaptive equipment for their students. I work with a $0 budget. I use discarded DOE materials—old desks, bookcases, chairs, and so on—to build every item I create. Typically, a PT reaches out to me for support with a student who is on the PT's caseload. We schedule a site visit to discuss the PT's concerns, review the student's IEP (Individualized Education Plan), speak with pertinent school staff, and observe the student in his or her school environment. The PT and I then collaborate on possible options to address the therapist's concerns. Using a sketching program on my laptop computer, I create 3-dimensional design options. Once we've settled on a design, I get to work building the equipment, either onsite or at a designated high school wood shop. Older students with special needs sometimes participate in the building process—cutting, sanding, and painting wood, driving screws during final assembly, and performing quality assurance tests before delivery. The turnaround time from initial visit to finished piece of equipment can range from the same day to several weeks, depending on the project's complexity. I make a point of introducing myself to custodians at every school I visit, asking them about furniture or other materials being discarded, so I can continue to source materials for future projects. During the 2014-2015 school year I designed and built more than 80 pieces of customized adaptive equipment. These included lunch tray holders for students who use wheelchairs and were having difficulty navigating the lunchroom after getting their food, and a mobile staircase for students who were having difficulty getting on and off the school bus. Each of these students now has a degree of independence he or she didn't have before." I hope this program will produce many more defining moments for the students it serves: moments in which their focus can shift from the difficulties they've experienced to the joys of learning about themselves and the world around them. Michael Konstalid, PT, DPT, is a senior physical therapist at the New York City Department of Education and founder and coordinator of the department's Universally Designed and Adapted Classroom Program.