CONTINUING EDUCATION

Developmental Orthopedics of The Trunk and Lower Extremities Beverly Cusick PT, MS, COF

This two-day course is designed for experienced Rehabilitation team members, including orthotists, physical therapists, occupational therapists, physical medicine and rehabilitation physicians, and pediatric orthopedists currently working with babies and younger children. This program features an overview of somatosensory function and development, the role of postural control in movement acquisition and physiologic adaptation, skeletal modeling mechanisms and influences with ideal and pathomechanical features of orthopedic development of the trunk and lower extremity. Please see below for a more detailed course description and overview with course objectives or refer to course brochure which is available for download.

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Beverly (Billi) Cusick, PT, MS, COF is an internationally known pediatric physical therapist whose specialty is the management of lower extremity deformity, particularly in children with cerebral palsy and other CNS deficits. She is the founder of Progressive GaitWays, LLC and the inventor, President, and Chief Medical Officer of TheraTogs™ Inc.

Ms. Cusick received her BS in PT from Bouve College at Northeastern University (Boston), and her MS in Clinical and College Teaching for Allied Health Professionals from the University of Kentucky in Lexington. She has worked at Spaulding Rehabilitation, UCP Center, Kluge Center, PT Education faculty at MUSC, Cardinal Hill Hospital Head Trauma & Pediatrics Team, Children’s Hospital Stanford CA and has been in private practice for 23 years. Ms. Cusick is an Associate Professor for the Rocky Mountain University of Health Professions – Pediatrics Program – Provo, Utah (2006-present) and is NDT basic- and baby-trained.

Since 1978 she has written or co-authored over a dozen publications. She has guest-lectured at annual conferences of the APTA, the NDTA, and the American Academy of CP and Developmental Medicine; at the ISPO Consensus Conference for Orthotics in CP; for the British Association of Prosthetists and Orthotists; and most recently at the International Conference on Cerebral Palsy in Sydney, Australia.

This program features an overview of somatosensory function and development, the role of postural control in movement acquisition and physiologic adaptation, skeletal modeling mechanisms and influences, and ideal and pathomechanical features of orthopedic development of the trunk and lower extremity. Instructor describes selected musculoskeletal assessments and the implications of their findings and brings them to therapeutic and orthotic management planning designed to optimize bone and joint development via movement. The relevance of the findings obtained in the musculoskeletal assessment to target selected interventions is made evident in videotaped cases.

Normal developmental events related to:

• The operations of the somatosensory system
• Postural control acquisition and body weight management
• Biomechanical influences of full-term gestation
• Functioning postural and limb joint alignment
• Elements of Sahrmann’s approach to analysis of the Movement System
• The process of physiologic adaptation of bone, soft tissues, and the sensorimotor cortex

Deformity development is discussed in relation to:

• Spasticity
• Ligament laxity
• Premature birth
• Movement strategies in the presence of inadequate postural control and innate righting reactions
• Use history in postural malalignment
• Skeletal modeling errors

Management strategies are covered related to:

• Body weight distribution onto the functioning base of support
• Functioning joint alignment and related muscle lengths
• Weakness
• Skeletal modeling potential
• Musculoskeletal assessment findings

Participants completing this course are expected to be able to:

• Describe these features of normal, postnatal immaturity of skeletal structure and alignment: thoracolumbar kyphosis, hip flexion contracture, increased femoral anteversion, increased femoral antetorsion, coxa valga, genu varum, and leg and foot rotation.
• Distinguish between strain and load and apply this distinction to the skeletal modeling process and to modeling potential in an aging child.
• Relate movement-based loading history to bone growth rate in children.
• Explain the significance of the innate drive for verticality.
• Discuss the primary purpose of acquiring postural control.
• Explain the presence of symmetry in supine and prone positions at age 4 months as evidence of fundamental postural control.
• Describe how the normal neonatal hip flexion contracture influences the early modeling of the lumbar spine in the sagittal plane.
• Relate the contributions of ideal, full‐term neonatal lower limb joint alignment to postural control acquisition in prone, supine, sitting, and standing positions.
• Describe the typical progression of the primary locus of body weight loading in the prone position in early infancy.
• Relate ideal, full‐term neonatal lower limb joint alignment to the acquisition of skilled transitions between quadruped and sitting positions.
• Relate the achievement of competent weight shifting in the frontal plane to emerging limb use.
• Describe the typical progression from postural control acquisition to movement acquisition in typical sequential play postures in infancy.
• Relate the ideal early lower limb alignment to early foot development.
• Relate early movement history to changes in shape of the pelvis and proximal femur in the frontal plane.
• Explain the apparent relationship between frontal‐plane weight shift skill, the swing limb torque generator in gait, and long bone torsion reduction in the lower extremities.
• Relate segmental foot loading history to the development of the medial longitudinal arch.
• Relate foot alignment – pronation and supination – to body weight (COM) projection onto the feet.
• Describe the defining alignment feature of genu varum and genu valgum.
• Name the 5 body segments included in examining relative limb lengths in the prone position.
• Differentiate between femoral anteversion and femoral antetorsion and explain the relevance of the distinction to the safe use of orthotic interventions.
• Explain why measurements of “hip” medial and lateral rotation range of motion (ROM) do not represent hip joint motions.
• Describe the anatomical components of the thigh‐foot angle and its typical developmental progression.
• Give an example of normal massed practice in sensorimotor learning.
• Discuss SA Sahrmann’s proposed management sequence after identifying dominant muscles.
• Explain the apparent impact of direction‐specific postural responses on the development of common contractures in ambulatory children with diplegic cerebral palsy and idiopathic toe walking.
• Name 4 features of hypertonic lower-limb muscle tissue that appear to contribute to a loss of strength.
• Explain the potential somatosensory and therapeutic benefits of optimizing the postural base of support and functioning joint alignments in daily life.

Lois Bly PT 2 Day Infant Course Based on NDT Principles
(An Intermediate Level Course)

This two-day course is designed for experienced physical and occupational therapists and speech language pathologists currently working with babies and younger children. Lecture information will focus on NDT Infant Treatment Principles. Labs and videotapes will be used to problem solve system impairments for infants in general, and for the specific infants who will be treated in demonstration sessions. Labs with dolls will augment the therapist’s understanding of infant treatment techniques. Participants should wear comfortable clothes for labs. The book by Lois Bly, Baby Treatment Based on NDT Principles will be used as the text.

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Lois Bly, PT, MA, C/NDT, is an NDTA Coordinator Instructor and clinician who has offered seminars, workshops and NDT certification courses throughout the United States, and many other countries. Ms. Bly was certified in Neuro-Developmental Treatment by the Bobaths in London, and received her NDT Instructors Certification from Mary Quinton and Dr. Elsbeth Koeng of Switzerland. She received her Masters Degree in Motor Learning at Teachers College, Columbia University.

Ms. Bly is the author of the monograph, Components of Normal Movement During the First Year of Life and Abnormal Motor Development, and the Book & Checklist: Motor Skills Acquisition in the First Year, and Baby Treatment Based on NDT Principles, and co-author with Allison Whiteside of the book Facilitation Techniques Based on NDT Principles. Most recently, 2011, she published a monograph, Components of Typical and Atypical Motor Development.

In 2000 she received the NDTA Award of Excellence.

In 2009 she received the APTA Pediatric Section Jeanne Fischer Mentorship Award.

Baby Treatment Based on NDT Principles, Lois Bly, M. A PT, copyright 1999. Published by Therapy Skill Builders.