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This course 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 selected aspects of the extremities.

Instructor describes selected musculoskeletal assessments and the clinical implications of their findings and brings them to therapeutic and orthotic management planning designed to optimize bone and joint development via building postural control and movement skills. The relevance of the findings obtained in the musculoskeletal assessment to target selected interventions is made evident in videotaped cases.

Objectives :

1. Describe these features of normal, postnatal immaturity of skeletal structure and alignment: thoracolumbar kyphosis, hip flexion contracture, increased femoral anteversion, increased femoral antetorsion, coxavalga, genu varum, and leg and foot rotation
2. Distinguish between strain and load and apply this distinction to the skeletal modeling process and to modeling potential in an aging child
3. Relate movement-based loading history to bone growth rate in children
4. Explain the significance of the innate drive for verticality
5. Explain the presence of symmetry in supine and prone positions at age four months as evidence of fundamental postural control
6. Describe how the normal neonatal hip flexion contracture influences the early modeling of the lumbar spine in the sagittal plane
7. Relate ideal, full-term neonatal lower limb joint alignment to the acquisition of skilled transitions between quadruped and sitting positions
8. Relate the achievement of competent weight shifting in the frontal plane to emerging limb use
9. Relate the ideal early lower limb alignment to early foot development
10. Relate early movement history to changes in shape of the pelvis and proximal femur in the frontal plane
11. 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
12. Relate segmental foot loading history to the development of the medial longitudinal arch
13. Relate foot alignment – pronation and supination – to body weight (COM) projection onto the feet
14. Name the five body segments included in examining relative limb lengths in the prone position
15. Name four LE musculoskeletal assessments that can identify the source of the foot progression angle in gait
16. Differentiate between femoral anteversion and femoral antetorsion and explain the relevance of the distinction to the safe use of orthotic interventions
17. Explain why measurements of “hip” medial and lateral rotation range of motion (ROM) do not represent hip joint motions
18. Describe the anatomical components of the thigh-foot angle and its typical developmental progression
19. 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
20. Name four features of hypertonic lower-limb muscle tissue that appear to contribute to a loss of strength
21. Explain the potential somatosensory and therapeutic benefits of optimizing functioning joint alignments in daily life