The Tyranny of Evidence…
Beverly Cusick, PT, MS, NDT, COF/BOC pushes back on the current culture of dependence on single-focus, short-term clinical studies that ignore the complex morbidities of cerebral palsy – and the sciences that address them.
The Cusick Center for Learning (CCL) has opened its doors!
The first program in the series The Golden Rule of Managing Pediatric Orthopedic and Motor Development is now available for your professional development – at your convenience, in a pre-recorded webinar!
In this hour-long webinar, Beverly (Billi) Cusick reviews key biomechanical and sensory-motor aspects of early postural control acquisition – the essential foundation for building competent limb use and movement skills. She then demonstrates her “golden rule” concept with two clinical cases, and provides a detailed Q&A segment based on the discussions from the original live webinar.
In conclusion, Ms. Cusick traces the timeline, mentors, and influences that led her to the development of the Golden Rule – a valuable review that ‘connects the dots’ between the contributions of numerous well-known pioneers in physical rehabilitation.
Kudos for Program 1:
I took a course from Billi over 20 years ago (Biomechanics) and it transformed my practice. Love how she integrated all the approaches (NDT, Sahrmann, Tschnarter etc..). Excellent information with clear application, and the science behind the art of postural control facilitation. It was concise, easy to follow, and packed full of golden nuggets. I actually bought Kathleen Porters book and will be sharing it with coworkers at the clinic including office staff!
Enjoyed the historical approach with references to the scientific basis behind the techniques. Good reminder of finding the balance between stability and mobility in order to enhance function.
In Program 2, Ms. Cusick discusses the biomechanical and somatosensory aspects of the developing infant’s progress after stabilizing the body center of mass in prone and supine positions. In this next phase of early movement acquisition, lying leads to rolling and body weight is displaced in the frontal plane and elevated off the surface into quadruped position. The instructor’s golden rule is applied in suggested biomechanical and somatosensory strategies for remediating deficits.
Attendees gave Program 2 a ‘thumbs up’:
It’s very difficult to get clear, concise information regarding infant motor development and I really appreciate the quality of information as well as the convenience of the presentation type.
Billi is a wealth of knowledge which she shares in a clear, concise and clinically applicable way… The webinar allows learning in 1 hours chunks of time, with the opportunity to watch again for the week that follows. The handout follows the slides exactly and can be downloaded ahead of time to maximize learning.
An Open Letter to Caretakers and Therapists for Children with Diplegic CP
Progressive GaitWays president and founder Beverly (Billi) Cusick writes:
“I’ve seen hundreds of families of children with diplegia, in consultation sessions in which I routinely undertake an orthopedic assessment and evaluate postural control, movement strategies, and existing orthoses. Common denominators have emerged that appear to operate to contribute to common problems of contracture development and recurrence, and to diminishing movement skills so often seen with advancing age in children with diplegia.
“I’ve composed the attached letter for caretakers and therapists of children with diplegia to bring them together in their understanding of the sources of many common musculoskeletal problems, and of the fundamental skills and strategies that are needed for effective remediation.”
Clinicians are welcome to download and share this letter with their colleagues, clients, and prescribing physicians.
¡Ahora disponible en español! (Translated by Ursula Ivancic, Kinesióloga Fisiatra Neurorehabilitación Pediátrica Buenos Aires, Argentina
Calendar of Events
Developmental Orthopedics of the Trunk & Lower Extremity:
A Review of Operating Processes with Implications for Management
Saturday, April 11, 2015
Registration: 7:30 am
Time: 8:00 am – 5:30 pm
Cost: $195.00 (Price includes an assessment kit valued at $65)
Contact Hours: 7.25
IL EI: Pending Approval
Beverly Cusick, PT, MS, NDT, COF
Hampton Inn & Suites
8936 Calumet Ave
Munster, IN 46321
Clinicians who are likely to work together to maximize physical function as a rehabilitation team, including PT, OT, Orthotists, Rehabilitation Physicians, and Orthopedists.
Intermediate- pre-course readings are assigned
This introductory program features an overview of the processes that contribute to pediatric orthopedic development, including the following:
Skeletal modeling mechanisms and influences.
Therapeutic limits on influencing the skeletal modeling process.
The influences of the biomechanics of ideal neonatal alignment on modeling the spine and lower extremity joints and on postural control acquisition.
The roles of postural control and massed practice on the orthopedic and functional development.
Developmental changes in muscle and connective-tissue extensibility.
Common errors of lower-extremity skeletal modeling in children with CNS dysfunction.
Strategies for optimizing somatosensory input, postural alignment, and postural control.
Using musculoskeletal assessment findings to gauge effectiveness of therapeutic management.
These principles are applied to pathomechanics commonly observed in children with hypotonia, cerebral palsy, excessive foot pronation, and intoed gait. The content presented in this program is considered fundamental to any (future) discussion of the specific features of orthopedic trunk and lower extremity development.
Distinguish between skeletal maturation and skeletal modeling.
Distinguish between mechanisms of strain and load, and apply this distinction to the “Golden Age.”
Describe the modeling effects of compression, tension, and loaded torque strains.
Describe the typical developmental changes that occur in spinal and lower-extremity alignment.
Describe the normal sequential acquisition of antigravity muscle function in the torso.
Relate normal neonatal soft-tissue constraints to the development of spine curves.
Discuss the role of somatosensory input in postural control and movement skills acquisition.
Describe the ideal features of weight distribution on the foot segments in standing position in infants, preschoolers, and adults.
Relate standing foot, spinal, and pelvic alignment to body weight distribution onto the feet and to muscle recruitment strategies needed to maintain postural control.
Discuss the normal emergence of R1 (first catch) end range of motion in the lower-extremity muscles.
Differentiate between spasticity and soft-tissue adaptation to chronic, tonic muscle recruitment.
Describe the evidence of a history of routine muscle recruitment strategies in range of motion findings.
Given the presence of excessive femoral torsion in a 9-year-old boy, explain the decision to defer corrective efforts to an orthopedic surgeon.
Explain the rationale for lifting under the heel and allowing the ankle to align in plantarflexion in the presence of equinus deformity.
Suggest strategies for delivering massed practice in improved postural alignment.
8:00 Register / Continental breakfast
8:30 Overview of Developmental Changes in the Spine and Lower Extremities
8:45 Skeletal Modeling Mechanisms
9:15 The Somatosensory System in Postural Control Acquisition (or, Where’s the Weight?
10:15 Biomechanics of Ideal Neonatal Alignment in Postural Control Acquisition
10:45 Walking as an Influence on Orthopedic Development
11:30 Developmental Changes in Lower-Extremity Muscle Extensibility
1:00 Common Problems of Postural Control in Children with Diplegic Cerebral Palsy
2:00 Videotaped case – Emilia
2:15 Short Break
2:30 Common Lower-Extremity Modeling Errors
3:30 Short Break
3:45 Using Musculoskeletal Assessment Procedures as Evidence of Skeletal Modeling, Muscle Balance, History of Use, and Success of Neuromotor Re-Education
4:45 Videotaped Case: Setting Management Priorities
5:15 Questions and Discussion
5:30 Turn In Course Evals and Adjourn
About the Speaker:
1972 – BS in PT from Bouve College at Northeastern University (Boston) in 1972, summa cum laude.
1988 – MS in Clinical and College Teaching for Allied Health Professionals – University of Kentucky in Lexington.
1 year – PT staff at (now) Spaulding Rehabilitation Center, Boston, MA
3 years – PT staff and Director for UCP Center, Lawrence, MA
9 years – PT staff at Children’s Rehab. Center (now, Kluge Center), Charlottesville, VA.
3 years – PT Education faculty, College of Health Related Professions at MUSC, Charleston, SC, and Director of PT Services for the Div. Of Developmental Disabilities at MUSC.
1 year, consultant, Cardinal Hill Hospital’s Head Trauma & Pediatrics teams – Lexington, KY.
4 years, assisting in the PT Department at Children’s Hospital at Stanford, Palo Alto, CA.
23 years in private practice.
Labs feature closely-supervised trials of several ankle and foot assessment procedures, with findings applied to orthotic posting and design. Attendees will work in groups of three with rotating assignments – practice subject, practitioner, and prompter.
Materials will be provided for 2.5 days of training in fabrication of two types of below-knee casts, and for undertaking posting trials to preview effects of proposed orthotic modifications.
REGISTRATION CLOSES ON MAY 10th
Instructor: Deborah Stack, PT, DPT, PCS
This FREE after-hours program details the scientific and clinical evidence which supports the well-known pediatric management principle: “proximal stability precedes distal mobility.”
Presenter Deborah Stack describes the ideal sequence of neuromotor acquisition and resting postures, and documents the relationship of faulty trunk control to limb muscle contracture in children with diplegic CP. She explores a number of management strategies that include positioning and orthotic aids.
Finally, Ms. Stack introduces the new, code-verified, TherAlign DragonFly™ TLSO System as an example of a modality that can effectively address postural management issues.
A light dinner is provided, starting at 5:30 pm; the lecture runs from 6:00 – 8:00 pm. 2.0 contact hours; CEU credits for orthotists and NC physical therapists are pending.
Target Audience: Rehabilitation team members, including physical therapists, occupational therapists, orthotists, physical medicine and rehabilitation physicians, and pediatric orthopedists.
Continuing professional education programs offered by TheraTogs, Inc. are available to all qualified physical therapists on a nondiscriminatory basis. Information provided should be used within scope of practice.