Developmental Orthopedics of the Trunk & Lower Extremity

April 11, 2015 all-day
Wee Care Therapy, Ltd.
440 Edmond Drive
Dyer, IN 46311
Michelle Barrett

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

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.


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:


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.

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