Cusick's Corner

Author: Beverly (Billi) Cusick, PT, MS, NDT, COF/BOC

The popular notion that bare feet are best for babies does not apply to babies with overpronation. The sensory input the pronated foot delivers is altered and pathological. The strategies used all day for maintaining balance with pronated feet are altered and pathomechanical. These children benefit from the more ideal sensory input afforded by foot joints that are in more ideal alignment, whereby the weight loads on the feet are appropriate for fostering foot development and stability skills.

In 2020, PJ Bresnahan published this statement: “Pediatric flatfeet should not be ignored or downplayed. The sooner effective treatment is prescribed, the less damage will occur to other parts of the body.  When possible, a more conservative corrective procedure should be performed prior to irreversible, joint destructive [i.e. surgical] options.” [1] 

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Author: Beverly (Billi) Cusick, PT, MS, NDT, COF/BOC

SUBTALAR JOINT ANATOMY & FUNCTION
The calcaneus (heel bone) is the loading base of the hindfoot. The medial process of the posterior tuberosity contacts the ground.

The talus is the upper bone of the hindfoot. The talar body is boxed between the tibial and fibular malleoli like a mortise forming a mechanical connection between the talus and the leg bones in the frontal (mediolateral) and transverse (rotational) planes.

The calcaneus bears a projection on the upper inner surface known as the sustentaculum tali (ST) which means “sustains or supports the talus”. Using this projection, the calcaneus operates like a doorknob that can “open and close” the hindfoot. With the posterior calcaneus aligned in or near vertical position, the ST supports the medial talus. Calcaneal eversion – rotation of the tuberosity laterally – causes the ST to drop out from under the medial talus. Under bodyweight (BW), the unsupported talus falls forward and medially into the gap, and the “open” foot collapses into pronation, gaining momentary flexibility needed to soften the force of heel strike in gait. Inverting the calcaneus restores foot stability.

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Author: Beverly (Billi) Cusick, PT, MS, NDT, COF/BOC

FOOT FEATURES AND DEVELOPMENTAL FACTORS
Whereby much information is published pertaining to typical changes in the developing foot anatomy and load distribution, the biomechanical and kinesiologic elements and methods that foster those changes are largely unknown. All aspects of this discussion regarding those methods represent my science-based – and working - hypotheses.

In my nearly 50 years as a pediatric PT and student of developmental orthopedics, I have learned the significance of three major factors that appear to me to contribute to early foot development:

1. The presence of the apparently innate drive to achieve and maintain the upright position while awake
2. The organized achievement of neck and trunk muscle strength and control against gravity, beginning with antigravity extension, and
3. The demands on the foot joints and muscles to support the verticality drive.

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Author: Beverly (Billi) Cusick, PT, MS, NDT, COF/BOC

Skeletal muscle tissues in children and adults with neuromotor dysfunction such as cerebral palsy and stroke commonly exhibit decreased volume and increased stiffness over time. Hypertonus, defined as an increased resistance to passive stretch, can occur because of secondary non-neural changes in muscle fibers, collagen tissue, and tendon properties.[1] Viscoelasticity is a tissue property whereby the faster the change imposed on fascia-coated muscle length, the greater is the passive tension generated in the absence of evidence of muscle
activation.

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Podcaster: Dr. Mindy Silva, Guest Contributor

There are many brilliant and passionate therapists in our world of neuromotor development, but few come close to Beverly Cusick in their ability to shape the lives of the children we see. I mean that both at the most pragmatic level, where Billi’s teaching of serial casting and orthotic prescription has literally shaped thousands of feet for the better, and her brilliance in developing TheraTogs has contributed to the improved alignment and development of a thousand more little bodies.

But I also mean this as a more theoretical level where Billi's relentless drive to make sense of the science as it relates to growing bodies and her pedantic attention to detail has given us the most impactful tools in our therapy toolbox to really understand, measure, and monitor the work that we do reliably, repeatably and meaningfully.

Listen in on the conversation.

Download 2023 TheraTogs Research References

Author: Billi (Beverly) Cusick, PT, MS, COF, NDT

The great idea I want to pass on to you is the adapted plastic barrel you see in the photos. Elizabeth spends ~20-30 minutes/day standing in this barrel and playing ball while wearing her tuned AFOs and shoes — and at the time of this photo — her SWASH orthosis (no longer needed).

The advantages of this barrel as a postural control and strengthening aid include:

• A safe and controlled environment in which to practice self-initiated and self-controlled body weight shifting and recovery skills while engaged in a game that requires overhead throwing.
• The interior diameter of the upper barrel can be adjusted down by lining it with foam rubber.
• Daily strengthening of antigravity musculature needed for trunk and hip control.

 Read on for the materials you'll need and the how to assemble the barrel.

Podcaster: Dr. Mindy Silva, Guest Contributor

WiredON Development's podcast "Spinal Neuromodulation in Cerebral Palsy" has been described as DROP EVERYTHING ELSE YOU'RE DOING AND LISTEN.

Did we need to shout that? Yes. And rightfully so. 

Dr. Mindy Silva has an in-depth chat with her guests Dr. Reggie Edgerton and Dr. Susan Hastings as they pull the curtain back on the mechanism of cerebral palsy, motor learning, neuroplasticity, and so much more.

If you’re not familiar with Dr. Reggie Edgerton, Dr. Silva describes him as the father of using neuromodulation to reorganize neural networks after spinal cord injury. And Dr. Susan Hastings is the physical therapist who discovered the application of spinal neuromodulation in the recovery of function for children with cerebral palsy. 

So pop those white earbuds in and get ready as Dr. Silva digs into their theories and hypotheses, practical applications, and current understandings of how the spinal cord is able to change the brain and deliver truly unbelievable outcomes in children with cerebral palsy.

And note, it's a two parter. Part 2 is a continuation of their conversation, where they get into the nitty-gritty details about ​​the benefits of low-intensity amplitude with spinal neuromodulation. Enjoy!

Listen in on the conversation.

Author: Dr. Mindy Silva, Guest Contributor

Evidence based practice (EBP) has become an aversive phrase for me over the past few years, even as I immersed myself in writing up a thesis for my PhD.

It’s a little surprising to reflect on this actually, considering one of the significant factors influencing my decision to undertake a PhD was that I love nothing more than immersing myself in the research. I started a PhD so I could have legitimate reason to sit on my but and read publications all day.

So how’d we go from loving research to being allergic to the phrase EBP?

Read on.