Cerebral Palsy

Dr. Freeman Miller was Co-director of the Cerebral Palsy Program and the Clinical Director of the Gait Analysis Laboratory at the Alfred I. duPont Hospital for Children for 30 years. He continues as an emeritus staff member at Alfred I. duPont Hospital for Children providing consultative services and is active in the research program. His clinical practice of pediatric orthopedics is limited to children with cerebral palsy. For the past 25 years, Dr. Miller has held Adjunct Professor appointments in the Departments of Mechanical Engineering and Physical Education at the University of Delaware. He is also a member of the University BIOMS program, which is an interdisciplinary graduate program in biomedical engineering. Current and past research interests include investigation of surgical outcomes of CP surgery through gait analysis, mathematical modeling of the hip joint in children with CP, hip monitoring and management for children with CP, and management of spinal deformity inCP.Dr. Miller has published approximately 200 articles in peer-reviewed journals. He has been invited to give many lectures in over 35 different countries. As a coauthor with Dr. Bachrach, he published a book Cerebral Palsy: A Guide for Caregiving directed at families and nonmedical care providers, which was published in 1995, second edition in 2006, and in 2017 was revised and released as the third edition. A medical textbook, Cerebral Palsy, with 1080 pages outlining musculoskeletal care of the child with cerebral palsy, was written by Dr. Miller and published in 2005 by Springer-VerlagDr. Steven Bachrach was Co-director of the Cerebral Palsy Program and Chief of the Division of General Pediatrics at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, DE, for nearly 30 years. He is Board Certified in Pediatrics and Neuro-developmental Disabilities, and his clinical practice encompassed both general pediatrics and the care of children with developmental disabilities. He continues as an emeritus staff member at Alfred I. duPont Hospital for Children, primarily involved in educational and research efforts. Dr. Bachrach also served for 20 years as Medical Director of the HMS School for Children with Cerebral Palsy in Philadelphia, PA, and currently serves on their Board of Directors. He is also a consultant to the Alyn Hospital in Jerusalem, Israel.Dr. Bachrach has a faculty appointment as Professor of Pediatrics, Clinical and Educational Scholarship Track, at the Sidney Kimmel Medical College of Thomas Jefferson University. He has been a member of the American Academy of Cerebral Palsy and Developmental Medicine for over 35 years and has often been a presenter at their annual meetings. His research focus has been on children with cerebral palsy, and especially the evaluation and treatment of osteoporosis in children who are non-ambulatory.ren who are non-ambulatory. Dr. Bachrach has published over 30 articles in peer-reviewed journals, as well as a number of book chapters and abstracts. As a coauthor with Dr. Miller, he published the book Cerebral Palsy: A Guide for Caregiving, which was aimed at a lay audience and published by Johns Hopkins Press in 1995, second edition in 2006, and the third edition in 2017.Dr. Bachrach has been married for 46 years and has 4 children and 14 grandchildren, all of whom he enjoys spending time with.Ms. Nancy Lennon a physical therapist, is the manager of the Cerebral Palsy (CP) Program at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, where she works with Dr. Miller and Dr. Bachrach. She has many years of experience in the Gait Analysis Laboratory and in Nemours Biomedical Research, where she collaborates with Dr. O ’Neil. Ms. Lennon has a Bachelor of Science degree in physical therapy from the University of Delaware and a Master of Science degree from Hahnemann University. She has 30 years of clinical experience in working with children and families affected by cerebral palsy, 15 years of experience conducting clinical research, and 5 years of experience coordinating family engagement and advisory activities at the hospital.Margaret E. O ’Neil is a Professor in the Programs in Physical Therapy, Department of Rehabilitation and Regenerative Medicine at Columbia University, Vagelos College of Physicians and Surgeons. She conducts research, advises graduate students, and teaches content in pediatric physical therapy and research. She has received grant funding from several federal and professional organizations. In her research, she examines objective measures of physical activity for youth with cerebral palsy and effectiveness of activity-based interventions (including active video games and virtual reality) to promote fitness and activity. She collaborates with an interprofessional team toconduct her research and they have published widely on these topics.She co-teaches clinical workshops on measurement and intervention strategies to promote strength and fitness in children with disabilities. She serves as a grant reviewer for multiple agencies and is a member of the APTA and AACPDM where she serves on multiple committees.

• The Child, The Parent and the Goal.- Prematurity.- Congenital malformation.- Infections.- Congenital Metabolic.- In utero Stroke.- Problem during delivery.- Post natal encephalopathy.- Over-view of the past 50 Years.- American experience.- European Experience.- Asian experience.- African experience.- Physical pathology.- Current Imaging -PET.- Muscle changes at the cellular level.- Gross Anatomic Muscle changes in CP.- Neuro-motor junction changes.- Bone Alterations in CP.- Over view of when and how to evaluate.- Who should get Imaging.- Indications for metabolic work up.- Indications for full genetic work up.- Prognosis assessment - role of PE -Pathologic Reflexes.- Classification Terminology.- Over view of Normal Natural history.- The Irritable Child with CP.- Pain in The Non-communicative Patient.- Post-operative Pain Management.- Seizures - Diagnosis, Natural History.- Seizures - Medical Management.- Seizures - Ketogenic Diet - Indication and Description.- Seizures - Role of VNS.- Seizures - Role of Surgical Removal.- Seizure Surgery - Workup and technique Description.- Pseudo-seizures - Diagnosis and Treatment.- Hydrocephalus Diagnosis and treatment indications.- Shunting for Hydrocephalus.- Surgical Ventriculostomy for Hydrocephalus.- Attention Deficient associated with CP.- Autism and CP as Comorbidities.- Family Stress Secondary to Disability.- Impact on Siblings.- Depression associated with CP.- Mood disorders (Bipolar and CP) .- Thought disorder and CP.- Overview and natural of feeding issues with growth and development.- Aspiration - risks, work up, when is it a problem.- Gastrostomy feeding - when indicated.- Tracheostomy or diversion - When indicated and how done.- Weight and growth in the child with CP.- Feeding Therapy - Indications how long.- GE reflux - Work up and medical Management.- GE Reflux - Work up and Surgical Management.- Poor Intestinal Motility.- Constipation - Implications long term and treatment.- Toilet training and bladder control.- Neurogenic Bladder.- Renal stones - risks, prevention and management.- Undescended Testicles.- Drooling - diagnosis, measurement and medical management.- Drooling - management with local injections - Botulinum.- Drooling - Surgical treatment options and outcomes.- Hearing Evaluation - When and How.- Cochlear Implant Indication and role in CP.- Upper Airway Obstruction - Indication for adenoid and tonsillectomy.- Bronchopulmonary Dysplasia - Natural History, etiology and outcome.- Bronchopulmonary Dysplasia - Medical management.- Reactive airways - Chronic aspiration.- Airway obstruction - Work up and medical management.- Airway obstruction - Indication and options for surgical management.- Pitutary-hypohoseal dysfunction.- Adrenal insufficency.- Short Stature - Work up and treatment indications.- Pillow angel treatment - indication ethics approach.- Glucose intolerance due to intramuscular fat.- Premature or Delayed Sexual Maturation.- Testing Sight - how when and the outcome.- Strabismus.- Cortical blindness.- Routine hygiene, When and how for child with CP.- Dental Caries - When to treat, how often to check outcome.- Gum Hypertrophy - etiology, and management and outcome.- Malignments - when to treat and expected outcome.- Bruxism - Management and long term outcome.- Lip biting - Management and long term outcome.- Neurologic Control of the Muscluosketal System.- Muscle tone - Spasticity - Assessment.- Movement disorders - Description and assessment.- Medical Management of Spasticity.- Medical Management of Movement disorders.- Local treatment - Botulinum, Phenol, Neurectomy.- Inthrathecal Baclofen Therapy.-Dorsal Rhizotomy.- Deep Brain Stimulation.- Ataxia - Disorder of Balance, Description and Assessment.- Assessing dynamic Balance.- Normal Gait.- Overview and Natural history of CP Gait.- Use of Diagnostic Gait Analysis to Guide Treatment.- Using Gait Analysis as an Outcome Assessment.- Managing Hemiplegic Gait.- Diplegic Gait.- Torsional Malignments.- Stance phase - Crouch and Back Kneeing.- Swing Phase - Toe drag.- Gait with Movement Disorders.- Gait in Ataxia.- Complications of Gait Management and Gait Analysis.- Overview of Natural History and Outcome.- Assessment of the Upper Extremity for Diagnostic Assessment.- Assessment of the Upper Extremity for Outcome Evaluation.- Tone Management - Botulinum, Neurectomy, Rhizotomy.- Single Event Multi-level Surgery Approach.- Shoulder.- Elbow.- Forearm and Wrist.- Thumb.- Fingers.- Overview and Natural History.- Non-operative Management of CP scoliosis.- Surgical Planning - Medical Evaluation Pre-op.- Role and Response to Spinal Cord Monitoring.- Anesthesia for CP Spinal Fusion.- Surgical Management of Scoliosis (operative Procedure).- Surgical Management of Kyphosis and Lordosis.- Post-operative Management.- Managing Early Onset Scoliosis in CP.- Managing Complications related to Spinal Fusion.- Cervical Spinal Problems in CP.- Lumbar Spondolethesis.- Ambulatory child CP and Scoliosis.- Scoliosis and Hip dislocation - Management considerations.- Summary Overview.- Etiology and Natural History.- Screening and Surveillance.- Prophalactic Treatment.- Reconstruction of Common Posterior Lateral Displacement.- Reconstruction of the Atypical- Anterior or Inferior Displacement.- Palliative or Salvage Treatment.- Complications of CP hip Management.- Summary of Knee problems.- Patella-femoral instability.- Apophositis and stress fractures.- Rotatory or torsion Instability.- Fixed knee flexion Contracture.- Hyper-extension knee deformity.- Knee extension Contracture and Stiff Knee Gait.- Tibial Torsion and Bowing.- Over view of the FOOT in CP.- Natural History of Foot posture in Children with CP.- Equinus.- Ankle Varus and Valgus.- Planovalgus.- Varus.- Calcaneovalgus.- Hallux.- Claw toes, Over Lap, and Crossing Toes.- Toe Nail Problems.- Complications of Managing Foot Problems.- Over view and history of therapy for CP.- Early Intervention - techniques and outcome.- Habilation therapy - in middle childhood - role and outcome.- Short High Intensity VS Long-term Low frequency.- Rehabilitation Therapy -(Post op) Frequency and Approach.- Role of Therapy in Teenagers to prevent function loss.- Educational Therapy - Technique outcome, how not medical therapy.- Therapy Theories - NDT ECT outcome expectations.- Hydrotherapy.- Strength Training.- Cardiovascular Endurance training.- Hippotherapy.- Robotic training, Suspended Treadmill training.- Over view theories and expectations.- Early intervention expectations and outcome.- UE Habilation techniques - Outcomes.- Constrained use - Enforced use Therapy Techniques and expected outcome.-  UE splinting VS use encouragement.- Evaluation for Driver Training and adaptations.- Over view of ST and expect outcome.- Feeding Therapy Indications, techniques, outcome.- Speech therapy, When techniques and expected outcome.- Augmentative communication, When and expected outcome how to evaluate.- Training oral control for Drooling - Techniques and outcome.- Overview of the wide range.- Swimming with Dolphins.- Hyperbaric Oxygen.- Acupuncture.- Pressure suits and vests.- Elastic Space suits.- Votja Technique.- ECT ECT ECT.- Standers - Which, when how long, who and what is the benefit.- Reclining - Side Lyers, wedges, beds - Benefit for who and when.- Gait trainers - Who when how long - Benefit.- Walkers - WHO WHEN how long and what is the benefit.- Crutches, and canes and sticks.- UE - Self feeders - WHO W WH outcome.- General Over view of issues to be considered.- Wheel chair VS stroller - difference and why and when and outcome.- Power Wheel chair - WHEN WHO outcome.- Early power wheeled toy mobility - Benefit outcome.- Consideration of the appropriate WHEEL chair for permanent use.- One arm drive chair for who and when.- General Overview when indicated benefits and risks.- Control Foot posture - Arch supports, UCBL and SMO.- Ankle control.- Knee control options.- Hip control.- UE orthotics.