Welcome to Progressive GaitWays…

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!

Program 1: Early Postural Control Acquisition

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.

Register Now | Download the course description

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.

Coming Next – Session 2: Expanding Postural Control into Movement

In Session 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 the live webinar 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 feels intimate and allows interaction at the end through questions and comments in real time. 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.

Registration coming soon… | Download course description

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Or, download the PGW Order Form to place your order offline.

An Open Letter to Caretakers and Therapists for Children with Diplegic CP

BCusick_OutsideProgressive 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.
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¡Ahora disponible en español! (Translated by Ursula Ivancic, Kinesióloga Fisiatra Neurorehabilitación Pediátrica Buenos Aires, Argentina

Calendar of Events

Nov
11
Wed
New Paradigms in Pediatric Foot & Ankle Deformity Management / LABS: Foot & Ankle Assessments, Posting Trials @ Metin Sabancı Spastik Çocuklar Merkezi (Turkey)
Nov 11 @ 8:00 am – Nov 15 @ 5:15 pm

Billi_Teach_red

Part 1: New Paradigms in Pediatric Foot & Ankle Deformity Management – A 2.5-Day Program

Part 2: LABS: Foot & Ankle Assessments, Posting Trials – A 2.5-Day Program

 Download Course Description

Target audience: This course is designed for the practitioner who has experience in working with children with CNS neuromotor dysfunction, including physical therapists, orthotists, pediatric orthopedists, and physical medicine and rehabilitation physicians. We believe that team education fosters more effective teamwork.

Level: Intermediate – Pre-course readings and review materials are assigned – Enrollees are expected to arrive prepared.

The content covered in this program includes the following topics:

  • The emerging sciences of postural control acquisition and maintenance, including the role of the somatosensory system as it is currently understood in relation to load-bearing alignment of the torso, lower limbs, and feet.
  • Foot and ankle functional anatomy, biomechanics, development, and pathomechanics in relation to body weight orientation over the base of support and to designing orthotic modifications to optimize foot development and function.
  • Body weight distribution on the foot and through load-bearing joints as a causative factor in contracture formation, early onset of pain, and degenerative joint disease.
  • Muscle physiology and pathophysiology in the presence of chronic use of compensatory postural control mechanisms while distinguishing spasticity from connective–tissue contractility and muscle transformation.
  • Skeletal modeling mechanisms underlying the process of use-related ankle and foot development.
  • Characteristics of and factors contributing to healthy foot development.
  • Elements of gait development that relate to and support foot development.
  • The kinesiology and pathokinesiology related to – and in support of – the safe and effective use of below-knee casts and orthotic interventions designed to improve postural alignment and control and to reduce developmental, flexible foot and ankle deformities that commonly develop in the presence of central nervous system dysfunction, hypotonia, and ligament laxity in childhood. Discussion of orthotic options includes Elaine Owen’s Tuned AFO/Footwear Combinations, heel lifting and weight-line training, orthotic posting and foot packaging principles and strategies.
  • Hypoextensibility management is distinguished from the alteration of movement strategies, and includes discussions of interventions such as positioning, resting splints, manual stretching, neurolytics, and serial casting.
  • Labs feature closely-supervised trials of several ankle and foot assessment procedures, with findings applied to orthotic posting and design. Assessment tools and materials will be provided for undertaking posting trials to preview effects of proposed orthotic modifications.
  • Common developmental foot deformities are identified and described in terms of plane-based anatomical components. Musculoskeletal assessment procedures are reviewed as the findings lead the clinician to a systematic clinical decision-making process regarding orthotic design in terms of desired load-bearing foot and limb joint alignment, magnitude of segment enclosure, degrees of freedom provided or restrained, and posting options. Soft-tissue extensibility findings are also used in the documentation of the effects of assorted orthotic intervention strategies.

Course Objectives

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.
  • Describe the role of the foot and ankle sensory receptors and weight distribution on the foot in the achievement and maintenance of postural control in standing and gait.
  • 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 reported reliability and validity of common clinical tests for spasticity.
  • Distinguish between spasticity, connective-tissue contractility, and soft-tissue transformation, and discuss management implications.
  • Discuss the physiology and functional significance of R1 (first-catch) end range of motion.
  • Explain the physiologic and structural changes that are known to occur in chronically over-recruited muscle and surrounding tissues following a history of recruitment for maintenance of verticality.
  • Distinguish between dominance and strength within a muscle force couple.
  • Upon discovering a dominant muscle, name 3 related areas of concern.
  • Describe orthotic posting in sagittal and frontal planes, and discuss posting objectives.
  • Discuss the purposes of weight line training in foot and ankle deformity management re proprioception and muscle recruitment strategies used for postural control.
  • Name 5 features that identify a sound developing foot.
  • 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.
  • 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 stretching exercise as a deformity management tool.

Participants completing the lab sessions of this course are expected to be able to:

  • Demonstrate novice skill level in musculoskeletal assessment procedures of the ankle and foot in the open and closed chains.
  • Bring the principles of orthotic posting to the findings obtained in assessment lab, and formulate an orthotic design plan.
  • Demonstrate novice skill in undertaking an informed, targeted, temporary and exploratory posting trial.
  • Participate in a workshop designed to generate ideas for promoting optimum body COM distribution over the feet in standing and walking.
Feb
26
Sun
Pediatric Neuromotor Rehabilitation LAB (Part 2) @ KidZ TherapEZE
Feb 26 all-day
Pediatric Neuromotor Rehabilitation LAB (Part 2) @ KidZ TherapEZE | Killeen | Texas | United States

Lab for Pediatric Neuromotor Rehabilitation (Part 2)

On Day 4, fifteen lab participants will execute 8 musculoskeletal assessments under supervision. These participants will complete the program by participating in a case presentation, in which they will be asked at random to explain ongoing procedures, to try executing an assessment procedure. Instructor will undertake orthotic modifications and interventions as are indicated by the child’s function and findings.

Participants completing the lab sessions on Day 4 are expected to be able to:

  • Acquire novice-level skill in executing 8 LE musculoskeletal assessment procedures:
    • sacral angle
    • 2-Joint hip flexor test
    • hip rotation in extension
    • Modified Ryder’s Test
    • hamstring muscle length test (R1)
    • patella angle
    • thigh/foot angle
    • passive Ankle DFOM with knee extended – R1 & R2.
  • Case presentation: be prepared to execute one assessment procedure upon request, and explain the
    assessment procedure.

 

May
19
Sat
Posture & Torso Alignment for Pediatric Neuromotor Training (CTF 1) @ Four Points by Sheraton Pleasanton
May 19 all-day

Sponsored by

Course Summary

This introductory program features a review of relevant pediatric orthopedic issues and sciences pursuant to neuromotor re-education for posture and torso alignment, including:

  • Skeletal modeling mechanisms and influences
  • The role of the somatosensory system in postural control acquisition and movement
  • Fundamentals of S.A. Sahrmann’s muscle balance theory
  • Practice-related skills acquisition

Attendees will validate their understanding of these principles and issues in the afternoon lab session, using the TheraTogs Posture & Torso Alignment system. Grouped in teams of three, attendees will be guided through a series of donning and strapping applications that demonstrate the biomechanical principles and management techniques reviewed in the morning session.

ProCert has awarded certification to Certified TheraTogs Fitter Level 1 (CTF 1).

Approval pending through FSBPT for Certified TheraTogs Fitter Level 2 (CTF 2).

May
20
Sun
Pediatric In-toeing & Out-Toeing Management for Neuromotor Training (CTF 2) @ Four Points by Sheraton Pleasanton
May 20 all-day

Course Summary

This program builds upon the foundation laid in the Posture & Torso Alignment (CTF Level I) workshop. It features a brief review of pediatric orthopedic lower-extremity (LE) skeletal and joint development as it occurs in the transverse plane – i.e. medial and lateral joint rotation and medial and lateral long bone torsion – and in relation to deviations in foot progression angle (FPA) – i.e. in-toeing and out-toeing.

Lecture content includes these topics:

  • Transverse-plane (TP) LE skeletal and joint modeling events with rotation strapping precautions
  • A review of elements of postural control acquisition and maintenance that pertain to TP LE bone and joint development and alignment
  • An implementation of SA Sahrmann’s muscle balance theory in the context of the kinesiology of LE rotation strapping applications
  • A review of three musculoskeletal assessment procedures used to identify sources of deviations in FPA and to document changes in a replicable manner.

Mar
2
Sat
Wearable Therapy: TheraTogs™ Systems, Uses, & Scientific Foundations
Mar 2 – Mar 5 all-day

Wearable Therapy: TheraTogs™ Systems, Uses, & Scientific Foundations

A 3.5-Day Didactic Program

Facilitator: Beverly Cusick, PT, MS, NDT, COF/BOC

Day 1 of this program features an overview of sciences of neuromotor and orthopedic development including established principles of kinesiology and biomechanics, physiologic adaptation of body tissues to routine use, new developments in motor learning, and the role of the somatosensory system in this process. The instructor demonstrates the implementation of the sciences in an introduction to TheraTogs Orthotic Garment and Strapping Systems as a modality for expanding successes in therapy sessions into daily life to optimize functioning alignment and stability, and reviews published research.

Day 2 of this program expands upon the introductory content presented on Day 1 with a discussion of skeletal modeling mechanisms and the achievement of postural control as a foundation for movement acquisition. She explores the nature of muscle tone and the relationship of muscle tone to routine use, both typical and pathologic. The program ends with suggestions for using TheraTogs in early intervention to optimize resting postures and the acquisition of essential ingredients for postural control.

Day 3 of this program applies the content from Days 1 and 2 and delves into functioning alignment issues related to the spine, the ankles, and unequal limb length. After demonstrating the Dragonfly TLSO and the molding and fitting process, the instructor reviews the assessment of ankle dorsiflexion range of motion as an important component of optimizing the support base with orthotics. She brings ankle ROM to discussions of postural control deficits and functioning malalignment as they occur in children with idiopathic toe walking, equinus deformity, hemiplegic cerebral palsy, and scissor gait. The program ends with a discussion of the typical development of the hip joint and femur in the transverse plane with a lab session devoted to distinguishing between femoral anteversion and antetorsion.

Day 4 is a half-day program that applies the content from Days 1-3 and is devoted to the biomechanical and developmental factors inherent in intoed and out-toed gait. Instructor reviews the related – and refined – musculoskeletal assessment procedures of hip rotation ROM, modified Ryder’s Test for femoral torsion, and the Thigh-Foot Angle and applies the findings to the safe use of TheraTogs strapping applications. The didactic program ends with suggestions for further research.

Oct
21
Mon
SOLD OUT • Pediatric Foot & Ankle Deformity Management with Serial Casting @ The River Club
Oct 21 – Oct 26 all-day
SOLD OUT • Pediatric Foot & Ankle Deformity Management with Serial Casting @ The River Club | Telluride | Colorado | United States

SOLD OUT  • October 21 – 26, 2019

Instructor: Beverly Cusick, PT, MS, NDT, COF/BOC

A PRIVATE TUTORIAL FOR SIX IN SENSATIONAL TELLURIDE, COLORADO

Who Should Attend: Physical therapists, certified orthotists, physicians in physical medicine & rehabilitation, and pediatric orthopedists. (Sorry, no PTAs or ortho techs.)

Six days, six colleagues, world-renowned instructor, practice-changing content, hands-on labs… and a killer location at off-season rates. How could you miss it?

In a collegial living-room setting, Beverly (Billi) Cusick relates the role of postural alignment and control to developing foot alignment and function, equinus deformity development, and management strategies using tuned AFOs and casts. In lab sessions, participants assess the ankle and foot, optimize postural alignment and function from the foot up, and fabricate below-knee casts that support neuromotor training.

Go home with a solid introduction to pediatric foot & ankle development, normal and pathomechanical foot function, and novice-level skills in: a) assessing the foot and ankle; b) posting orthoses to optimize postural control and foot function; and c) fabricating 3 types of below-knee cast used progressively.

Bonus: You receive two training DVD’s, fully-referenced handout materials, and an assessment tool kit.

Double-Bonus: Get trained for TheraTogs Fitter Certification Level-I, Posture and Torso Alignment, at no additional cost (optional).

 Interested? Read More…

 

Oct
28
Mon
SOLD OUT • Pediatric Foot & Ankle Deformity Management with Serial Casting @ The River Club
Oct 28 – Nov 2 all-day
SOLD OUT • Pediatric Foot & Ankle Deformity Management with Serial Casting @ The River Club | Telluride | Colorado | United States

October 28 – November 2, 2019

Instructor: Beverly Cusick, PT, MS, NDT, COF/BOC

A PRIVATE TUTORIAL FOR SIX IN SENSATIONAL TELLURIDE, COLORADO

Who Should Attend: Physical therapists, certified orthotists, physicians in physical medicine & rehabilitation, and pediatric orthopedists. (Sorry, no PTAs or ortho techs.)

Six days, six colleagues, world-renowned instructor, practice-changing content, hands-on labs… and a killer location at off-season rates. How could you miss it?

In a collegial living-room setting, Beverly (Billi) Cusick relates the role of postural alignment and control to developing foot alignment and function, equinus deformity development, and management strategies using tuned AFOs and casts. In lab sessions, participants assess the ankle and foot, optimize postural alignment and function from the foot up, and fabricate below-knee casts that support neuromotor training.

Go home with a solid introduction to pediatric foot & ankle development, normal and pathomechanical foot function, and novice-level skills in: a) assessing the foot and ankle; b) posting orthoses to optimize postural control and foot function; and c) fabricating 3 types of below-knee cast used progressively.

Bonus: You receive two training DVD’s, fully-referenced handout materials, and an assessment tool kit.

Double-Bonus: Get trained for TheraTogs Fitter Certification Level-I, Posture and Torso Alignment, at no additional cost (optional).

 Interested? Read More…

 

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