Who Should Attend?
Ms Cusick is committed to the idea of fostering the collaborative and educated team management of complex neuromotor problems. Therefore, this course is open to a range of clinicians who are likely to work together as a rehabilitation team — if you are a...
...you will find this course valuable to your practice.
* Physical Therapy Assistants may attend as part of a team that includes a qualified Physical Therapist. Orthopedic Technicians are welcome if accompanied by a CO, CPO, or PT from the same facility.
Enrollment is limited to 80 for Seminar portion of the course; Lab enrollment is limited.
The seminar portion of this course features a study of the sciences of muscle physiology, pathophysiology, kinesiology, and pathokinesiology related to - and in support of - the safe and effective use of serial casting and other nonsurgical interventions to reduce foot and ankle deformities that commonly develop in the presence of central nervous system (CNS) dysfunction.
Topics include foot and ankle anatomy, biomechanics, pathomechanics, and minimum soft tissue extensibility requirements for efficient lower extremity functional mobility. Instructor addresses body weight distribution on the foot as a causative factor in contracture formation. Musculoskeletal assessment procedures are reviewed in seminar and in supervised lab sessions, as the findings apply to proper documentation of casting results and lead the clinician to a systematic approach to clinical decision-making process regarding alignment and posting in casts and orthoses.
The lab sessions feature closely-supervised reviews of several ankle and foot assessment procedures, and several below-knee cast fabrication techniques. Participants must qualify for participation in the lab sessions by either completing the seminar portion of this course. If space is available in Lab after meeting the needs of seminar portion attendees, addition lab enrollees may be recruited from the alumni of a comparable course taught by Beverly Cusick, PT, MS, since December 31, 2005.
Rationale for various conservative hypoextensibility management interventions is supported by a current literature review regarding muscle transformation secondary to chronic recruitment and the role of mechanoreceptors and cutaneous proprioceptors in maintaining balance. Spasticity is distinguished from tone and from soft tissue pathophysiologic adaptation, with clinical implications. Discussion includes Elaine Owen’s Tuned AFO/Footwear Combinations, heel lifting and loading, orthotic posting and packaging principles and strategies, positioning, stretching, and serial casting.
This course is designed for the practitioner who has experience in working with children [and/or adults] with CNS neuromotor dysfunction, including physical therapists, orthotists, pediatric orthopedists, physicians in physical medicine and rehabilitation, physical therapy assistants, and orthopedic technicians (the latter two accompanied by a therapist from their team). We believe that team education fosters more effective teamwork.
Full course attendees will also receive several essential reference resources:
- Legs & Feet Assessments DVD
- Foot Talk DVD – 2 hour lecture with Powerpoint handout and references on CD
- Serial Casting text
Participants completing the seminar portion of this course are expected to be able to:
Describe, in plane-based terminology, the motions of the joints and various bones of the foot in the open and closed kinetic/kinematic chains.
Discuss the relationship between joint alignment and related muscle function in terms of joint axis inclination, muscle and loading force vectors, lever arms, and resultant moments.
Relate the principles of Muscle Balance Theory, presented by S.A. Sahrmann, to the management of foot and ankle deformities.
Identify the deformities of the foot and ankle that occur most commonly in children or adults with CNS upper neuromotor dysfunction, and describe the components of illustrated deformities at each joint in plane-based terms.
Explain the clinical rationale for using specific assessment techniques to identify features of soft tissue extensibility, joint mobility, and structural alignment in the ankle and foot.
Discuss the physiology and functional significance of R 1 (first-catch) end range of motion encountered on assessing passive extensibility in healthy muscle groups.
Explain the physiologic and structural changes that occur in chronically over-recruited muscle and its surrounding connective tissues, relative to the active length-tension relationships and EMG output.
Explain the physiologic rationale for undertaking serial casting gradually and without force.
Associate the principles of orthotic posting and kinetics with below-knee cast design and cast fabrication.
Discuss the role of weight line training in foot and ankle deformity management.
Determine whether a deformity meets the criteria for intervention with heel-posting in ankle plantarflexion, serial casting, an R-wrap© orthosis, stretch splinting, and/or positioning.
Explain the rationale for instituting strengthening and range-maintenance measures after restoring soft tissue extensibility.
- Discuss the limitations of casts as a management tool.
Participants completing the lab sessions of this course are expected to be able to:
Achieve novice skill level in musculoskeletal assessment of the ankle and foot in the open and closed chains.
Bring the principles of orthotic posting to below-knee cast design and cast fabrication.
Achieve novice skill in fabricating at least 1 of 3 types of below-knee cast for contracture reduction: the plaster and 3M™ SoftCast combination cast and the Flexcast© Preparatory AFO, the latter with or without a posted footbed insert.
Anticipated Course Schedule
Day 1: Seminar
8:00 Registration, Pre-Test, and Continental breakfast 9:00 Review of Anatomy and Closed-Chain Function of the Subtalar and Midtarsal Joints Using Plane-Based Terminology 10:30 Break 11:00 Biomechanics of the Closed Kinetic Chain - continued 12:00 Lunch and Library Time 1:00 Ideal Ankle, STJ and MTJ Function in Gait 2:00 Kinesiologic and Physiologic Requirements for Optimum Muscle Function 2:15 Short Break 2:30 Pathophysiology: Muscle Transformation in the Presence of Chronic Recruitment 3:00 Muscle Balance Theory: Implications for Foot Deformity Management 3:30 Short Break 3:45 Hypoextensibility Management: Orthotic Interventions (Owen’s “Tuned” AFO/Footwear concepts; the R-Wrap AFO); Weight Line Training; Positioning 4:45 Questions and discussion Post-Session Adjourn
Optional Independent Study
Day 2: Seminar
Independent Study/ Library Review8:15
Breakfast and settle in
Assessing the Foot and Ankle: Review of Open- Chain Assessments
10:00 Break 10:15 Pathomechanics of Triceps Surae Hypoextensibility and Various Foot Design Problems: Implications for Posting Casts and Follow-up Orthoses 12:00 Lunch, library, and videotaped casting case (at 12:30 pm)
Hypoextensibility Management: Positioning, Orthotic Interventions (Owen’s Tuned AFO/Footwear concepts; the R-Wrap AFO; Weck’s weight-line training approach.
2:30 Short Break 2:45 Serial Casting: Precautions, Contraindications, Limitations, Guidelines, and Principles of Management; Fabrication options (Combination cast, FlexCast©, contoured footboard) 3:45 Short Break 4:00 Videotaped Case Presentations 4:45 Questions / discussion 5:00
Seminar-only attendees turn in course evaluations; adjourn -
Optional Independent Study
Day 3: Lab Session
Lab participants, bring shorts today and tomorrow. 7:15 Independent study 8:15 Breakfast and settle in 8:30 LAB: Open-Chain Assessments of the Foot and Ankle 10:00 Short Break 10:15 LAB: Resume Open Chain Assessments 12:00 Lunch, library time 1:00 LAB: Closed-Chain Assessments of the Foot 2:30 Short Break 2:45 LAB: Resume assessments 3:45 LAB: Positioning the Patient and Rehearsing the Cast Molding Grip 4:15 Review of Casting Materials 5:00 Adjourn Post-Session Optional Independent Study
Day 4: Lab Session Cast Fabrication
Lab participants, bring shorts today - wear clothes you can get plaster on!. 8:00 Breakfast (snacks available all day - graze at will) 8:30 DEMO: Plaster/Soft Cast Below-Knee Cast Fabrication 9:30 LAB: BK Cast Fabrication - first team makes this one 11:00 DEMO: Insole posting 11:30 DEMO: FlexCast Fabrication Demo 12:00 Working lunch on premises. 12:30 LAB: Participants make cast(s) of choice: plaster/Soft Cast combo, footboard, and/or FlexCast, as time permits. 5:30 Clean-up/ Turn in Evaluations 6:00 Adjourn
Capacity: Enrollment in the seminar segment of the course is limited to 80 attendees. Enrollment in the lab segment is limited - contact sponsor for details.
Video Recording policy: Videotaping of this program is prohibited. Audiotaping for personal review is permitted with permission from the Instructor.