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.
BilliSig_75

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

Calendar of Events

Apr
11
Sat
Developmental Orthopedics of the Trunk & Lower Extremity @ Wee Care Therapy, Ltd.
Apr 11 all-day

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

Presented by:
Beverly Cusick, PT, MS, NDT, COF

Location:
Hampton Inn & Suites
8936 Calumet Ave
Munster, IN  46321

Target Audience:
Clinicians who are likely to work together to maximize physical function as a rehabilitation team, including PT, OT, Orthotists, Rehabilitation Physicians, and Orthopedists.

Course Level:
Intermediate- pre-course readings are assigned

Seminar Description:
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.

Seminar Objectives:

Participants will:

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.

Schedule:

8:00  Register / Continental breakfast
8:25  Introductions
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?
9:45  Break
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
12:00 Lunch
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:

EDUCATION:

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.

WORK EXPERIENCE:

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.

Sep
18
Fri
Introduction to New Paradigms in Pediatric Equinus Deformity Management @ Wyndham Baltimore Mt. Vernon Hotel
Sep 18 all-day
Introduction to New Paradigms in Pediatric Equinus Deformity Management @ Wyndham Baltimore Mt. Vernon Hotel | Baltimore | Maryland | United States

A One-Day Review of Sciences & Strategies for Optimizing AFO’s

The landscape of considerations of ankle function in balance and gait, and of strategies for managing ankle plantarflexion contracture – i.e., equinus deformity – is changing to embrace the roles of the somatosensory system and postural control both as causative factors and intervention strategies. Instructor Beverly Cusick, PT, MS, COF, C/NDT reviews the relevance of ankle function in postural control, and discusses the physiology of muscle transformation and the role of spasticity in contracture formation.

The content features challenges to the rationale and effectiveness of common equinus deformity intervention paradigms including stretching, blocking ankle plantarflexion at 0° with orthoses, injecting the gastrocnemius muscle with toxin, and surgically lengthening any aspect of the triceps surae muscle-tendon unit. The course presents new orthotic and training strategies, based upon the work of Shirley Sahrmann, Mary Weck, and Elaine Owen, with emphasis on children with pyramidal-types of cerebral palsy.

A full Course Description is available for download.

7.0 contact hours
CEUs for PT’s & Orthotists
LEVEL: Intermediate

Oct
16
Fri
Posture & Torso Alignment for Pediatric Neuromotor Training (CTF Level I ) @ Mercy Hospital - McAuley South in the Von Gontard Conference Center
Oct 16 all-day
Posture & Torso Alignment for Pediatric Neuromotor Training (CTF Level I ) @ Mercy Hospital - McAuley South in the Von Gontard Conference Center | Saint Louis | Missouri | United States

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

Save $20 – Bring a colleague with you!

A full Course Description is available for download.

8.0 contact hours
CEUs for PT’s & Orthotists
LEVEL: Intermediate

Dec
4
Fri
Posture & Torso Alignment for Pediatric Neuromotor Training (CTF Level I ) @ UNC Charlotte - Center City, RM 1104
Dec 4 all-day
Posture & Torso Alignment for Pediatric Neuromotor Training (CTF Level I ) @ UNC Charlotte - Center City, RM 1104 | Charlotte | North Carolina | United States

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

Save $20 – Bring a colleague with you!

A full Course Description is available for download.

8.0 contact hours
CEUs for PT’s & Orthotists
LEVEL: Intermediate

Apr
8
Fri
Introduction to New Paradigms in Pediatric Equinus Deformity Management @ Quinnipiac University - North Haven Campus
Apr 8 @ 8:00 am – 5:30 pm
Introduction to New Paradigms in Pediatric Equinus Deformity Management @ Quinnipiac University - North Haven Campus | North Haven | Connecticut | United States

A One-Day Review of Sciences & Strategies for Optimizing AFO’s

The landscape of considerations of ankle function in balance and gait, and of strategies for managing ankle plantarflexion contracture – i.e., equinus deformity – is changing to embrace the roles of the somatosensory system and postural control both as causative factors and intervention strategies. Instructor Beverly Cusick, PT, MS, COF, C/NDT reviews the relevance of ankle function in postural control, and discusses the physiology of muscle transformation and the role of spasticity in contracture formation.

The content features challenges to the rationale and effectiveness of common equinus deformity intervention paradigms including stretching, blocking ankle plantarflexion at 0° with orthoses, injecting the gastrocnemius muscle with toxin, and surgically lengthening any aspect of the triceps surae muscle-tendon unit. The course presents new orthotic and training strategies, based upon the work of Shirley Sahrmann, Mary Weck, and Elaine Owen, with emphasis on children with pyramidal-types of cerebral palsy.

A full Course Description is available for download.

Want to register offline?  Download the New Paradigms Registration Form (BDL).

7.25 contact hours
CEUs for PT’s & Orthotists
LEVEL: Intermediate

May
21
Sat
Introduction to New Paradigms in Pediatric Equinus Deformity Management @ Easter Seals DuPage
May 21 @ 8:00 am – 5:30 pm
Introduction to New Paradigms in Pediatric Equinus Deformity Management @ Easter Seals DuPage | Villa Park | Illinois | United States

A One-Day Review of Sciences & Strategies for Optimizing AFO’s

The landscape of considerations of ankle function in balance and gait, and of strategies for managing ankle plantarflexion contracture – i.e., equinus deformity – is changing to embrace the roles of the somatosensory system and postural control both as causative factors and intervention strategies. Instructor Beverly Cusick, PT, MS, COF, C/NDT reviews the relevance of ankle function in postural control, and discusses the physiology of muscle transformation and the role of spasticity in contracture formation.

The content features challenges to the rationale and effectiveness of common equinus deformity intervention paradigms including stretching, blocking ankle plantarflexion at 0° with orthoses, injecting the gastrocnemius muscle with toxin, and surgically lengthening any aspect of the triceps surae muscle-tendon unit. The course presents new orthotic and training strategies, based upon the work of Shirley Sahrmann, Mary Weck, and Elaine Owen, with emphasis on children with pyramidal-types of cerebral palsy.

A full Course Description is available for download.

7.5 contact hours
CEUs for PT’s & Orthotists
LEVEL: Intermediate

Jun
26
Sun
Introduction to New Paradigms in Pediatric Equinus Deformity Management @ Vanderbilt Children's Hospital - Pediatric Rehab
Jun 26 @ 8:00 am – 5:30 pm
Introduction to New Paradigms in Pediatric Equinus Deformity Management @ Vanderbilt Children's Hospital - Pediatric Rehab | Nashville | Tennessee | United States

A One-Day Review of Sciences & Strategies for Optimizing AFO’s

The landscape of considerations of ankle function in balance and gait, and of strategies for managing ankle plantarflexion contracture – i.e., equinus deformity – is changing to embrace the roles of the somatosensory system and postural control both as causative factors and intervention strategies. Instructor Beverly Cusick, PT, MS, COF, C/NDT reviews the relevance of ankle function in postural control, and discusses the physiology of muscle transformation and the role of spasticity in contracture formation.

The content features challenges to the rationale and effectiveness of common equinus deformity intervention paradigms including stretching, blocking ankle plantarflexion at 0° with orthoses, injecting the gastrocnemius muscle with toxin, and surgically lengthening any aspect of the triceps surae muscle-tendon unit. The course presents new orthotic and training strategies, based upon the work of Shirley Sahrmann, Mary Weck, and Elaine Owen, with emphasis on children with pyramidal-types of cerebral palsy.

A full Course Description is available for download.

7.5 contact hours
CEUs for PT’s & Orthotists
LEVEL: Intermediate

Dec
1
Thu
New Paradigms in Foot & Ankle Deformity Management @ Nicklaus Children's West Kendall Outpatient Center
Dec 1 – Dec 2 all-day
New Paradigms in Foot & Ankle Deformity Management @ Nicklaus Children's West Kendall Outpatient Center | Miami | Florida | United States

This course is designed for the practitioner who has experience in working with children or adults 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. The didactic content can be adapted for an audience that is concerned with an adult population, substituting live case presentations for videotaped cases.

Course Brochure and Registration Info

The content covered in this program includes the following topics:

  • Foot and ankle 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.
  • 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 occur 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, and orthotic posting and foot packaging principles and strategies.

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.

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.

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