There were many rumors in medicine world that approach to spasticity is changing. Now you can personally get familiar with the newest research and findings that will be presented by very important person: Beverly Cusick!

DATE:  September 13th, 2019 (Friday)



FOR WHOM? Rehabilitation team members, including orthotists, physical therapists, occupational therapists, physical medicine and rehabilitation physicians, and pediatric orthopedists.

PRICE: PLN 800 (incl. handouts in English or Polish, buffet, unlimited tea, coffee and soft drinks, access to Beverly Cusick medical library)



In children born premature and those with diplegic cerebral palsy (CP), findings obtained with diffusion tensor imaging (DTI) have brought significant challenges to the common definition of CP as “a motor disorder caused by a static lesion to the upper motor neurons resulting in spasticity”. The presenter discusses findings by researchers that question the definition and challenge the common notion that spasticity is present, that it causes contracture formation and gait pathology in children with diplegia, and that it is a suitable target for “spasticity reducing” interventions. She discusses the confusion over the difference between increased tone and hyperreflexia; challenges to the validity of the Modified Ashworth Scale and the Modified Tardieu Scale as spasticity tests; and presents abundant reported evidence of shortfalls of effectiveness of, and complications associated with commonly-administered spasticity treatments including intrathecal baclofen, botulinum toxin-A injections, and selective dorsal rhizotomy. She concludes the program with a presentation of several science-based management strategies for children with diplegic cerebral palsy and suggestions for clinical research involving clinicians in orthotics and associated rehabilitation team members.



Participants in this course are expected to be able to:
• Define tone, hypertonus, and hypotonus.
• Describe ideal human resting muscle tone and the contribution of adjacent tissues.
• Discuss the relevance of physiologic adaptation to use history in terms of muscle tone.
• Describe R1 (L1, Lo) end range on the typical passive length-tension curve.
• Define an antigravity righting reaction and discuss its significance in daily life.
• Relate the stimulation of somatosensory load receptors to antigravity righting reactions.
• Discuss the role of the tactile and somatosensory systems in movement acquisition and brain mapping.
• Discuss the proof of validity of JW Lance’s definition of spasticity (1980).
• Differentiate between hyperreflexia and muscle tone.
• Describe the status of the sensory system in children with CP.
• Define a body center of mass (COM) and describe the ideal projection of the human body COM over the base of support in static standing in typically developing children of age 4 years and in adults.
• Compare the body COM projection onto the support base in typically developing toddlers to that of children with diplegia.
• Describe the muscle recruitment strategy needed to remain upright in the presence of a chronically anterior displacement of the body COM in standing and in walking. Relate this strategy to development of common soft tissue contractures in children with diplegic CP.
• Explain the validity of EMG during stretch as evidence of “spasticity”.
• Discuss the evidence of long-term effectiveness of treating “spasticity” in children with diplegic CP using intrathecal baclofen, selective dorsal rhizotomy, and Botulinum toxin-A.
• Discuss the principle of managing degrees of freedom as a postural control and motor learning strategy, and relate this principle to serial casting and orthotic design for children with diplegic CP.
• Explain the rationale for building trunk and hip control of postural alignment and the body COM as a contracture prevention and gait management strategy.
• Suggest 2 strategies for optimizing functioning sensory input
• Suggest 2 strategies for managing degrees of freedom.


Start Contact hrs
7:45 Register and settle in
8:00 Physiologic Adaptation (Plasticity) and Typical Muscle Tone .50
8:30 Are healthy postural control and functioning joint alignment related to the development of lower extremity muscle tone? .50
9:00 Are postural control and loaded joint malalignment deficits related to lower limb contractures & diplegic gait pathology? .75
9:45 Break 00
10:15 What do we know about physiologic changes comprising common lower- extremity
soft-tissue contractures (hypertonus)?
11:00 What do we know about spasticity & its role in causing deformity & gait pathology? 1.00
12:00 Lunch 00
1:00 What do we know about spasticity, continued .50
1:30 What do we know about the long-term effects – on stability, muscle strength, deformity, and gait – of neurolytic and surgical “spasticity-reducing” interventions for children with diplegia? 1.00
2:30 Short break – 15 minutes – no food 00
2:45 Spasticity Treatment – Long-Term Effects, continued .75
3:30 New Developments in the Management of Hypertonus in Children with Diplegia: Owning Resting Postures; Optimizing Load-Receptor Input & Responses; Targeted Training
Serial Casting, Functioning Alignment Orthoses
4:00 Short Break – 15 minutes – snacks 00
4:15 New Developments in the Management of Hypertonus continued. .50
4:45 Videotaped cases 1.00
5:45 Questions and discussions .25
6:00 Adjourn                                                                                          Didactic Contact Hours





Instytut Dzielny Miś


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.
1988 to present: In private practice in California and Colorado.

Help Patients Manage Equinus Deformity. O&P Business News, 2011; April: 74-77.
Orthotic Management of Low-Toned Children: The Earlier the Better. (Co-author). O&P Edge. 2011; April: 24-29.
Serial Casting and Other Equinus Deformity Management Strategies for Children and Adults with CNS Dysfunction (2010) by Beverly Cusick, published by PG. (out of print)
Foot Talk (2009), a 2-hour lecture on functional foot anatomy and closed chain biomechanics, accompanied by a set of
Power Point handouts of the same lecture.
Legs & Feet: A Review of Musculoskeletal Assessments (1997, revised 2005 and 2015), an instructional videotape.
Lower Extremity Developmental Features (2000), a home study monograph for the APTA’s Orthopedic Section.
Progressive Casting and Splinting for Lower Extremity Deformity in Children with Neuromotor Dysfunction (1990), a fulllength text.
Serial Casts: Their Use in the Management of Spasticity-Induced Foot Deformity (1990), an illustrated manual published by Therapy Skill Builders. (out of print)
Several textbook chapters, articles for journals, conference proceedings, and professional newsletters, including a series
(2006 and 2007) on Pediatric Orthopedics for the NDTA Network.

Guest lecturer for annual conferences of the APTA, the NDTA, and the American Academy of CP and Developmental Medicine in the US and Canada; at the ISPO Consensus Conference for Orthotics in CP; the British Association of Prosthetists and Orthotists; and the American Academy of Orthotics and Prosthetics and the American Orthotics and Prosthetics Association.
Instructor of more than 450 courses and guest presentations by invitation only in 18 countries.
Associate Professor (on call) for the Rocky Mountain University of Health Professions – Pediatrics Program – Provo, Utah (2006-present).
Since 1993 Ms. Cusick has been consulting and practicing privately in Telluride, Colorado where she devotes most of her
professional effort to generating literature and educational materials, to teaching, and to developing therapeutic products, including her invention, TheraTogs™ orthotic systems.




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