OT vs PT at school: who does what

By the IEP Atlas editorial teamLast updated November 1, 2026

Short answer

At school, occupational therapy helps a student use their hands, manage self-care and take part in class routines, while physical therapy helps a student move around school safely: walking, stairs, balance and getting on the bus. To tell them apart, ask whether the task is done mostly at a desk or table, or by moving the whole body through the building.

Occupational therapy (OT) and physical therapy (PT) are both related services under IDEA. Both use motor skills, and both therapists may work with the same student. But they look at different parts of the school day. Knowing who does what helps families ask the right questions and helps teams avoid gaps and overlaps.

This page gives the deciding question, a side-by-side table, examples by situation, 3 short scenarios and the cases where a student needs both. For OT goals, see the occupational therapy IEP goals pillar. For PT goals, see physical therapy IEP goals.

The deciding question

Ask: is the task done mostly at a desk or table, or by moving the whole body around school?

At a desk or table: writing, cutting, typing, opening lunch, managing materials, buttoning a coat. That is usually OT.
Moving the whole body: walking between classes, climbing stairs, getting on the bus, keeping balance in a crowded hallway, joining recess games. That is usually PT.

Some tasks sit in the middle, such as sitting upright in a chair or using the bathroom. Those are often shared. The team decides who leads.

Side-by-side table

	School OT	School PT
Main focus	Hand skills, self-care, sensory and school routines	Moving safely and efficiently around school
Basis	A related service under IDEA	A related service under IDEA
Typical school tasks	Writing, cutting, keyboarding, fasteners, lunch, materials	Walking, stairs, curbs, bus steps, balance, playground
Example goal	Copies 3 sentences with correct spacing	Climbs a flight of stairs with one rail in under 60 seconds
Common equipment	Pencil grips, slant boards, adapted scissors, seating cushions	Walkers, gait trainers, standers, orthotics, adapted chairs
Who decides	The IEP team, including parents	The IEP team, including parents
Professional group	AOTA^[3]	APTA, with a pediatrics academy^[4]
Where it is documented	IEP goals, services and supports	IEP goals, services and supports, plus safety plans if needed

Both are listed among the related services in the federal rules, and both are provided when the student needs them to benefit from special education.^[1] The IEP states which services the student gets, how often and where.^[2]

Examples by situation

Situation at school	Usually OT	Usually PT	Often shared
Cannot write legibly or keep up with written work	Yes
Falls often on stairs or in the hallway		Yes
Cannot open lunch containers	Yes
Cannot get on and off the bus safely		Yes
Slumps in the chair and tires during seated work			Yes
Needs help in the bathroom because of balance and fasteners			Yes
Covers ears and leaves during assemblies	Yes
Cannot keep up in PE or on the playground		Yes	Adapted PE may also help
Needs a wheelchair or walker to be positioned for class		Yes	OT for desk setup

Adapted physical education is a separate service. It is special education, not a related service, and it teaches PE skills. The adapted physical education entry explains it.

Three scenarios

1. A 1st grader who trips on the stairs. She holds the rail with both hands, takes one step at a time and falls behind the class at every transition. Her handwriting is on grade level. Answer: PT. The need is moving safely through the building. A PT goal might target stairs with one rail within a set time.

2. A 4th grader whose writing falls apart by the end of a page. He walks, runs and plays without problems. His letters are well formed for 2 lines and unreadable by line 10. Answer: OT. The need is a desk task. An OT goal might target legibility across a full page, as in the OT IEP goals for handwriting.

3. A 2nd grader with cerebral palsy who uses a walker. He needs help getting into his chair, sitting upright, holding a pencil and moving to the cafeteria. Answer: both. PT leads on walker use, transfers and moving between rooms. OT leads on desk setup, pencil skills and opening lunch. They share seating, because posture affects both moving and writing.

When a student needs both

Students with physical disabilities often get OT and PT, and the services work best when they are planned together.

Agree on who leads each shared task. Seating, toileting and bus routines are common overlaps. Name one lead and one supporting therapist in the IEP notes.
Coordinate equipment. A new chair from PT changes the desk height OT planned for. Decide together.
Write separate goals. Each goal should measure one task. Do not write the same goal twice under two services.
Share one schedule. Two therapists pulling the same student out at different times can cut into class time. Push-in sessions in the same lesson can help. The push-in vs pull-out guide covers the trade-offs.

How the decision gets made

A parent or teacher who sees a concern can ask for an evaluation. The school OT or PT evaluates the student in school tasks, and the IEP team reviews the results. The OT evaluation report template shows what a school OT report covers. The team then decides which services the student needs, how often and where, and records them in the IEP. The IEP services and minutes guide explains how services are written.

School therapy differs from clinic therapy in the same way for both disciplines. For OT, see school-based OT vs clinical OT.

Questions families often ask

"My child has both OT and PT at a clinic. Will the school provide both?" Only if each service is needed for school. The team looks at function at school.
"Can the OT and PT work on the same goal?" They can both support it, but one service usually owns each goal and its data.
"Who helps with the wheelchair at school?" Usually PT for mobility and transfers, with OT helping with desk setup and reaching materials.

Rules vary by state, and this page is general information. See occupational therapy, physical therapy and related services in the glossary. Goal templates are on the goals for the OT role and goals for the PT role pages, with PT-led areas on the gross motor goals and functional mobility goals pages.

Frequently asked questions

What is the difference between OT and PT in schools?

School OT helps with hand skills, self-care, sensory needs and class routines. School PT helps a student move safely around school, including walking, stairs, balance and the bus. Both are related services, and the IEP team decides which a student needs.

Who works on handwriting, OT or PT?

OT. Handwriting is a desk task that uses hand and visual motor skills. PT may help indirectly if posture or seating affects writing, but OT usually owns the handwriting goal.

Can a student get both OT and PT at school?

Yes, if the student needs both to benefit from special education. This is common for students with physical disabilities. The therapists should agree on who leads shared tasks such as seating and toileting.

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Sources

34 CFR §300.34: Related services, Legal Information Institute, Cornell Law School
34 CFR §300.320: Definition of individualized education program, Legal Information Institute, Cornell Law School
American Occupational Therapy Association, AOTA
APTA Pediatrics, Academy of Pediatric Physical Therapy, American Physical Therapy Association
Specifying Related Services in the IEP, CPIR

Written and checked by the IEP Atlas editorial team under our editorial policy. This guide describes general practice and federal rules. It is not legal advice; your state may add requirements, and the IEP team makes the decisions for each student.