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.
Course Description
This course features a review of the development, biomechanics, and pathomechanics of the foot and ankle complex in the open and closed chain, with implications for designing casts and orthoses for optimum effectiveness. Musculoskeletal assessment procedures are reviewed in seminar and in supervised lab sessions, as the findings apply to documentation of casting results and to systematic clinical decision-making regarding foot and ankle alignment and posting in casts and orthoses.
Rationale for various hypoextensibility management strategies is supported by a discussion of current theories concerning muscle transformation secondary to chronic recruitment. Spasticity is distinguished from tone and from soft tissue pathophysiologic adaptation, with clinical implications. The Instructor discusses the relationship between contracture formation and habitual distribution of the body center of mass and the load-bearing foot in standing and gait, and reviews heel-wedging, the contoured plaster footboard, the R-Wrap© orthosis, positioning, stretching, and serial casting.
Gait kinetics principles are presented and applied to a review of orthotic posting options.
This course is designed for the practitioner who has experience in working with children with foot and ankle alignment problems associated with CNS dysfunction and ligament laxity. Physical therapists, orthotists, pediatric orthopedists, physicians in physical medicine and rehabilitation are welcome. Ms. Cusick believes that team education fosters more effective teamwork.
Participants in the seminar program receive a comprehensive set of handouts with current references, a copy of the Ms. Cusick's instructional videotape entitled Legs & Feet: A Review of Musculoskeletal Assessments (1997); and a monograph entitled Serial Casting to Restore Soft Tissue Extensibility in the Ankle and Foot (2007).
Participants in the lab sessions will receive a set of handouts, a set of 4 tools used in musculoskeletal assessments, a copy of the Ms. Cusick's illustrated manual entitled Serial Casts: Their Use in the Management of Spasticity-Induced Foot Deformity (1990); and an instructional videotape with accompanying manual entitled Cast Fabrication Techniques #1: The FlexCast© Preparatory AFO (2000).
Course Objectives
Participants completing 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 arm, and resultant moment.
- 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.
- Identify the deformities of the foot and ankle that occur most commonly in children with upper neuromotor dysfunction, and describe the components of deformity at each joint.
- Relate the primary planar bias of a foot deformity to optimum orthotic design.
- Discuss the physiology and functional significance of R1 (first-catch) end range encountered on assessing passive extensibility in healthy and in chronically over-recruited muscle groups.
- Discuss the relationship between muscle imbalance and strength.
- Bring the principles of orthotic posting and kinetics to below-knee cast and orthotic design.
- Explain the physiologic rationale for undertaking serial casting and comparable orthotic interventions gradually and without force.
- Name the 5 attributes of normal gait according to Perry and Gage.
- Explain the contribution of ankle plantarflexion at propulsion to energy cost in gait.
Lab Session participants:
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Achieve novice skill level in musculoskeletal assessment of the ankle and foot in the open and closed chains.
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Achieve novice skill in fabricating a FlexCast© Preparatory AFO, with or without a footboard insert.
Anticipated Course Schedule
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Day 1: Seminar
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8:15 Registration and settle in. 9:00 Review of Anatomy and Closed-Chain Function of the Subtalar and Midtarsal Joints Using Plane-Based Terminology 10:00 Break 10:30 Biomechanics of the Closed Kinetic Chain 12:00 Lunch and Library Time 1:00 Ideal Ankle, STJ and MTJ Function in Gait - Power Sources, Load Line Characteristics 1:30 Pathomechanics of Triceps Surae Hypoextensibility: Implications for Posting Casts and Orthoses 2:00 Short Break 2:15 Kinesiologic and Physiologic Requirements for Optimum Muscle Function / Pathophysiology: Muscle Transformation in the Presence of Chronic Recruitment 2:45 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 -
7:45
Independent Study/ Library Review/ Breakfast
8:30
Assessing the Foot and Ankle: Review of Open- Chain Assessments
10:00 Break 10:30 Developmental Features of the Foot and Ankle 12:00 Lunch and library time 1:00
Name That Foot Deformity!
2:00 Short Break 2:15 Pathomechanics of Various Foot Design Problems: Implications for Posting Casts and Follow-up Orthoses 3:15 Short Break 3:30 Serial Casting: Precautions, Contraindications, Limitations, Guidelines, and Principles of Management/ Fabrication Options 4:30 Videotaped Case Presentations 5:00 Questions / discussion Post-Session Seminar-only attendees turn in evals; adjourn -
Optional Independent Study
Day 3: Lab SessionLab 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 FabricationLab 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: Footboard Fabrication demo 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. 2:45 Break 3:00 Resume lab 5:30 Clean-up/ Turn in Evaluations 6:00 Adjourn
Restrictions
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.
