Back to Basics – Alignment Comes First
The basic rule “Alignment Comes First”, applies to hands as much as it does to the legs, yet in my experience, very few children with brachial plexus injury (BPI) and/or cerebral palsy (CP) affecting the upper limb has consistent use of splints or taping to maintain alignment. This is not “Good Enough”. Look at the difference in this child with [...]
Core Support Options
As I have discussed last week, every pediatric therapy intervention that I am aware of aims, in part, to strengthen the core. And the exercises used should strengthen the core. The sad truth is that in most cases, the exercises are ineffective. The reason is that they are not done enough times every day. In order to properly strengthen the [...]
Minimize Maladaptive Motor Habits
Whatever you do, your body will learn to do better. If you are walking badly, your body will learn how to do badly better. Over a long period of time I have asked parents why they go to physical therapy. In one form or another the answer is nearly always “So that he/she can walk normally.” Here are some facts. [...]
Movement Starts With The Core
The overwhelming majority of small babies with damaged brains have perfectly normal posture during sleep. When they are awake and attentive, looking at you, but not moving, they are similarly normal. The abnormal signaling from their brains is only evident when you move them or later when they try to move spontaneously. A normal child gains head control first, then [...]
A New Year Starts
Will this one be better than the last? Your choice. “Each of us guards a gate of change that can be opened only from the inside.” Stephen R. Covey How do you change? Nike has it right…Just Do It. Make a choice to do the best you can do at any particular moment in time. This is my only resolution [...]
Billi Cusick’s Thoughts on Managing Children with Diplegic Cerebral Palsy
The following is a guest blog from Billi Cusick, PT, MS, COF, President of Progressive GaitWays, LLC and Developer of the TheraTogs System. Billi wrote this informative letter for her regular newsletter, The Pacesetter. She has kindly given me permission to reproduce it for the readership of this site. I post it with my full endorsement. Supporting the core (trunk [...]
The Good, the Bad & the Ugly Facts About Growth and Recovery
The Good – The first 3 to 4 years are a period of active neuroplasticity in humans. Brain growth is explosive and there are many available neural networks. One of the best examples of early neuroplasticity is the exposure to language. If a child is raised hearing 2 or more languages, they are able to learn them all. In certain areas of Switzerland it is commonplace for children to be fluent [...]
Is Malalignment Malpractice?
All early neurological injuries, like cerebral palsy and brachial plexus injury (BPI) have some degree of unbalanced muscle action. Unbalanced muscle pull leads to unbalanced growth of bones and joints. When this happens the body is in malalignment. This leads to chronic musculoskeletal PAIN. No parent or therapist would knowingly wish a life of pain on a child, but that [...]
Wheelbarrow Walking – A Bad Old Idea for BPI
There are old ideas that are good. They are based on reasonable hypotheses and work. There are also old ideas that are bad. These ones are based on unreasonable hypotheses and actually cause damage. Wheelbarrow walking is a great example of a bad old idea. This exercise is frequently recommended to strengthen the muscles about the shoulder in children with [...]
Unintended Consequences of Wheelbarrow Walking in BPI & Hemiplegia
Richard has a mild to moderate right sided Brachial Plexus Injury (BPI). I first saw him at 12 years of age. His initial nerve injury had partial recovery and he had reasonable use of the right arm and hand. His major complaint was that both of his scapulae stuck out at the back and the right arm and shoulder were [...]
The Concise Book of Muscles by Chris Jarmey and The Anatomy Coloring Book by Wynn Kapit & Lawrence M. Elson
The Concise Book of Muscles by Chris Jarmey – Chichester: Lotus Publishing and Berkley: North Atlantic Books, 2003 The Anatomy Coloring Book by Wynn Kapit & Lawrence M. Elson – San Francisco: Benjamin-Cummings Publishing, 2002 I wrote about the need for greater patient knowledge in the post Anatomy 101 – Why You Should Know Your Body. The concept of the empowered [...]