Developmental Exercises for Improved Arm Function: The Fascia Therapy Techniques

One of the most overlooked and under-appreciated aspects of any rehabilitation strategy is paradoxically the most important:  the human developmental process. 

Although people generally have some intuitive understanding about development and developmental stages, it often gets clouded and blurred when we are dealing with complex conditions characteristic of many neurodevelopmental disorders.  This is understandable...if a parent is presented with some level of distortion in their childs arms, extreme muscular tension, reduced fine motor skills, or even complete lack of gross motor skill, this will be the object of much attention, focus, and intervention.

As it should be.

However, beyond these valuable interventions, it is important to remember that alot of these manifestations are in reality symptomatic.  In other words, they reflect the underlying condition of developmental delay.  Therefore, an added strategy of "re-starting" and potentiating the developmental process is a direct way of addressing the root as well as the symptoms.  This may sound relatively straightforward, but the next logical question is:  what is the specific developmental process and HOW do we actively re-start it?

To put this into complete context, we would need a much more comprehensive exchange than is permitted within the context of a "blog" format...however, I will deliver the fundamental tenets of the Fascia Therapy philosophy which is that the key to efficient and effective rehabilitation of neurodevelopmental disorders is to follow and adhere to the fundamental laws of human development.  In essence, the human organism (and, in fact, all biological organisms) go through a specific process of developmental evolution...the result of which is a fully formed, fully functional person.  When there is an alteration / injury / event that influences the developmental process (regardless of whether they occur in utero or after birth) there will always be a delay or cessation of said process. Therefore, children with neurodevelopmental disorders (Cerebral Palsy, Miller-Diekers, West Syndrome, etc...) are often never exposed to the environmental triggers that facilitate and potentiate healthy development.

To put this into a more specific context (and to keep within the mandate of this particular post), a significant part of the reason there are so many complex (and progressive) challenges with the arms and arm function is that the shoulder girdle itself (the space where the arm sits and is made up of the collar bone and the shoulder blade) was never properly and sufficiently exposed to the two main mechanical catalysts for development:  Traction and Compression.


Traction and Compression


Traction is the term used to express a tensional (pulling) stress that attempts to separate one element from the other.

As illustrated in the adjacent image, a tractional stimulus is something we have seen and experienced ourselves throughout our lifetime...and most likely never paid any attention to (the formal term is called 'brachiation').  WHY do children like to hang from things?  This is a multi-layered answer that generally extends into the exploration of motor and sensory limits...but there is a very IMPORTANT stimulus being imposed on the shoulder joint.

Children with neurodevelopmental disorders have either very limited or NO exposure to this type of stimulus.  Tractional (tensional) integrity is essential, not only for gross motor and fine motor skill, but for those "lifestyle-essential" skills that involve pulling (either objects or oneself).

Compression is a term that can be considered the polar opposite of traction...meaning that there is some external stress (force) that attempts to bring two elements much closer to each other.

Although both tractional AND compressional stimulus are essential, the compressional stimulii is the most fundamental...in other words, it is the one that comes FIRST in the developmental process.  The act of crawling / creeping generates vital micro-stimulus directly into the shoulder joint which ultimately potentiates and develops shoulder integrity and strength...which then get re-activated during the tractional phase a little later on.

Once again, neurodevelopmental disorders limit (and in more severe cases, eliminate) the exposure of the shoulder joint to this critical form of stimulus.

To capsulate all of this information into a more practical narrative, beyond the more common and familiar interventions designed to improve arm function, there are specific techniques that have the specific goal of mimicking the fundamental tractional and compressional stimulii in a safe and passive way with the explicit objective of re-initializing the developmental process.  Of course, these techniques require some basic level instruction, but they are fundamentally user-friendly and can be taught to both professionals as well as parents...but beyond the knowledge of knowing WHAT can be done and HOW you do it, it is fundamentally critical to understand WHY it is done. 

More technical rants to come!
Cheers...
G.

Cannabis and Neurological Disorders

Likely one of the most debated and examined topic of the last couple of years.  When I started this blog in 2011, Cannabis wasn't even part of the rehabilitative lexicon...let alone something that should recieve any attention or study.  However, it has become extremely relevant...and paradoxically controversial. 

I won't assume that I am an expert at discussing the pharmaceutical aspects of medicinal use of cannabis...this is well beyond my current scope of practice.  However, being immersed in the the world of neurological disorders and "on the ground" for the last 9 years, I have experience and seismic shift in perception...not only within the landscape in general but within my own perception as well.  The instinctive "hesitation" from the world in general is understandible...but this initial reaction is something we should understand as being shaped by social perception not by fact.  The reality is that medical uses have been in place for quite some time.  Depending on the literature and sources, it can be traced back to 50 A.D. in China.  Regardless, there is likely only one way to truly understand the relevance of cannabis oil:

Go to the front lines...talk to the people, talk to the parents...see how it's made, see how it's administered...see the results.

You will surely be amazed.

There are so many "tracks" to take regarding this discussion...so I have decided to make this first entry rather short.  I fully expect to expand on this topic and be able to dig into some of the more specific topics revolving around this "hot button" topic.  But in order to look at the details with the proper perspective, you need to have a good "view" of the larger picture...

"What would YOU do?" 

Your child experiences 5-10 seizures per day...does not eat, cannot sleep...there is more fear than joy, more pain than comfort, and more sadness than hope.  Yet here you have the possibility of moving all of those metric with something that has demonstrated countless precedent...is completely natural...and can be prepared, not by a pharmaceutical company but, by YOU.   Would you not try anything?

From a professional perspective, having seen the process from cultivation, preparation, extraction, and delivery...I can confidently and responsibly say that without question it is a careful, complex, and comprehensive process that likely surpasses anything being currently rolled out by any pharmaceutical company...and more importantly, the results are nothing short of incredible.

From a personal perspective, I can only defer to my parental instincts and ask myself the very question posed a few paragraphs prior:  "what would I do?"  

Case closed.

It isn't a political, legal, or even moral debate...the stuff just plain WORKS.  

Much respect and reverence for those people and families on the front line (you know who you are).  You represent the purest definition of "soldier" there is.



 

Respiration and Neurodevelopmental Disorders: Part 2

This second installment comes after a solid 3 months after the first one...intentional simply because there is always a certain amount of time needed to take in, "chew", and digest information when it involves important and otherwise complex topics. 

Although each part will essentially stand on it's own, I recommend that everyone read / re-read part 1 so that the information within this brief post will have more impact and relevance. 

In the previous installment, I went into some small detail with respect to certain key mechanical realities regarding respiration.  This particular dialogue will simply attempt to highlight some additional elements that provide some added insight into the importance of the respiratory mechanism...not only within the relatively specific topic of neurodevelopmental disorders (NDD's) but within the entire human experience context as well.  With this objective in mind, I will identify 2 fundamental realities that should amplify the relevance respiration has on BOTH systemic and mechanical development. 

1.  Respiration / Breathing is the earliest critical biomechanical action that takes place following birth. 

In order to understand this statement more clearly, we need to ask a fundamental question:  "what does every human organism do as soon as they are born?"  That's not too difficult to answer...drink, eat, breathe, and evacuate.  Nothing more.  The systemic necessities are relatively simple and straightforward...these are things that are essential for survival. The MECHANICAL relevance of respiration is not so obvious, but it is none-the-less equally important. 

The above video extract is simply a demonstration of the  fundamental phenomenon of "hydraulic brassage" or hydraulic pumping.  In short, the breathing action generates what can be considered as a "hydraulic massage and pumping" that is directed upwards towards the upper chest and downwards into the pelvis and into the pelvic floor.  Why is this important? 

It is the direct action of this hydraulic brassage that drives the further development and architecture of the pelvis (pelvic girdle) and the upper chest (shoulder girdle). 

Basic observation will demonstrate that every child is born with a comparatively small pelvis and upper thorax (chest) in relation to the rest of the body...and this essential respiratory action of breathing within a gravitational field (under the weight of their own body) that is THE key catalyst for pelvic and shoulder development.  If we extrapolate this reality further, we come to the nex tlevel of practical question:  Why is the development of the pelvic and shoulder girdle so fundamental and relevant? 

The pelvis (and the health thereof) determines and regulates EVERYTHING biomechanically relevant to the legs.  Likewise, the shoulder girdle (and the health thereof) is critically relevant to the function and performance of the arms. 

This sheds some valuable light into the otherwsie complex world of NDD's.  In other words, one of the most dominant characteristics of any neurodevelopmental disorder is the presence of a comparatively small pelvis and upper chest.  Therefore, it is not unusual that they also manifest common challenges with gross and motor performance of the arms and legs.  This identifies the developmental importance of addressing respiration as a fundamental objective within any and all treatment strategies. 

2. Respiration is one of the most powerful catalysts / stimulus for biomechanical symmetry

Given that it is the most primitive and earliest mechanical stimulus, as well as the fact that it is present during the most "plastic" stages of life, respiration is one of the main drivers in the establishment of symmetry and homogenous development.  Many of the structural distortions (particularly in the chest / thorax) have their roots in a deficient / inefficient respiratory mechanism during early stages of life. 

In summary, the main message is as follows:  EVERY neurodevelopmental disorder, whether mild or severe, will manifest some deficit in respiratory mechanics.  Therefore a careful and comprehensive assessment of breathing patterns and underlying challenges will always ultimately generate a high "rate of return" with respect to progress and long-term rehabilitation strategy.  

More to come...

Cheers!

  

 

Respiration and Neurodevelopmental Disorders: Part 1

This is a topic that is quite "heavy" and therefore needs to be broken into more disgestible parts.  The first part will focus on the fundamental theory behind why the respiratory mechanism is the most important stimulus / catalyst for the efficient development of a child with a neurodevelopmentsal disorder.  This is essentially an expanded exploration of The Fascia Therapy Theorem I wrote about last year.  I will also provide the fundamental information about respiration in healthy newborns so that a working understanding of "how it is supposed to work" can be established in an effort to make the link into the more complex nature of neurodevelopmental disorders.  My intention is to keep this as "user-friendly" as possible...as I am know to occasionally engage in more technical vocabulary...so that this important understanding can be absorbed and assimilated by a larger number of people.  Most important of which is the immediate family unit. 

Mechanics of respiration:

Most people overlook respiration (breathing) because it is something that occurs in the background and outside of any conscious effort or consideration.  The paradox is that breathing is a very complex mechanical marvel.  It isn't merely a case of the lungs "inflating and deflating"...the lungs are elastic organs that are continuous with the entire thorax (chest wall).  Therefore, the act of inflation / deflation involves more than the lungs...it involves an active contribution of the chest wall itself as well as the diaphragm.  In other words, the ability for the lungs to draw in air (oxygen) is dependant on the integrity of the chest wall and the performance of the diaphgram.

In the newborn child, the relationship between the lungs and the chest wall is an exponentially more intimate one.  To explain this with more clarity, we need to introduce a very important term: 

COMPLIANCE.

Compliance is defined as the opposite of stiffness.  In the context of respiration, the lungs AND the chest wall (ribs, sternum) are very compliant.  What does this mean in practical terms?

When the newborn infant breathes, the lungs and the chest wall experience elastic deformation

In other words, the chest wall is essentially "soft" and is easily influenced by the mechanics of breathing.  This characteristic of compliance becomes more relevant as the infant grows.  To be precise, at approximately 18-24 months of age, the chest wall stiffens considerably.  In essense, the chest wall loses compliance at a rapid rate as the child enters into this range of 18-24 months.  This is perhaps the most significant and important process in a childs development.  The gradual stiffening of the chest wall (which actually begins BEFORE 18 months and accelerates after) results in the increased development of what is called a "hydraulic pumping"  stimulus that is directed up into the upper thorax and down into the pelvis and pelvic floor.  To be precise, the reduced compliance of the chest wall causes the majority of the mechanical movement to be re-directed upwards and downwards.

Once again, what does this mean in practical terms?  It means that the stffening of the chest wall is the primary catalyst for the development of the pelvis and the shoulder girdle.  In other words, it is this precise hydraulic "pumping" of the pelvic floor and upper thorax that DRIVES the growth of the pelvis (crucial for the later development of the legs) and the shoulder girdle (crucial for the later development of function of the arms).  

Altered mechanics in newborns / children with neurodevelopmental disorders:

The important reality to take away from part 1 of this discussion is the following: 

All children / newborns with a neurodevelopmental disorder manifest altered respiratory mechanics and therefore are not fully exposed to this critical "hydraulic pumping" action.  

Why is this?  

One of the most prevalent characteristics of  neurodevelopmental disorders is profound connective tissue weakness.  In more laymans terms, everything from the tendons, ligaments, bones, organs, etc...are formally weak and remain weak throughout growth and maturation.  In the context of respiration, this is represented explicitly in the chest wall...

The chest wall REMAINS compliant (elastic) long after  18-24 months...therefore the fundamentally critical hydraulic pump never reaches the pelvis and upper thorax.  This is manifested almost unanimously in all affected children by the common characteristic of a small pelvis and small upper thorax.  This ultimately reflects in the considerable delay (or arrest) or functional development of the arms and legs.  Furthermore, it plays a significant role in the altered respiratory mechanics which lead to a multitude of systemic challenges due to altered oxygen saturation. 

In summary, the vicious cycle of deterioration takes place as such: 

1. Significant Prolonged Chest Wall Compliance (Thoracic Weakness)

2. Irregular Respiratory Mechanics and Altered Synchronicity (Active or Laboured Breathing)

3. Abnormal circulating Oxygen levels, Hypocapnia, Reduced cerebral blood flow, smooth muscle constriction in the intestines (constipation), Magnesium and Calcium imbalances in muscles (muscular tension)

**** The consequences of #3 can be a catalyst for further impaired neurological development ***

4. Repetitive deformation and subsequent distortion of the chest wall (sometimes manifested as a caved-in sternum or asymmetry)

5. Permanent structural distortion and chronic systemic distress

All of the above should represent some familiar challenge(s) in children with neurodevelopmental disorders.  Regardless of the specific diagnosis, these challenges are universal because of the immediate impact on respiration.  Paradoxically, this understanding actually improves our ability to positively affect the trajectory of improvement and essentially reduce the negative effects of this altered mechanism.  The upcoming posts will further explain this process as well as (perhaps more importantly) introduce strategies to essentially "re-start" the respiratory "hydraulic pump" with some very safe and simple practical exercises.  

Stay tuned!

 

Think Small: How the little things make the biggest difference

Definitely counter-intuitive...especially when you view it from the rehabilitation perspective.  The instinctive thing is to think BIG...what will be the singular plan towards my rehabilitative goals.

I recently saw an interesting report on television that studied the decline in some pre-school kids in China.  The researchers were examining scholastic teaching habits, pre-school formats and scheduling, even down to the books themselves.  One day, one of the researchers noticed that none of the children they were using as their test group were wearing glasses.  Was it because children in China has inherently better eyesight?  What they found was that almost 45% of the kids actually NEEDED glasses but could not afford them.  So they embarked on a different trajectory and split their study group into two parts: one group were given glasses (those who needed them) and the other group remained as previous.  The results were surprising...the group that were given glasses experienced a significant increase in test scores and overall performance.  Indeed, this is an example of how tackling the small things can yield exponential results.

This can fundamentally be extrapolated into the rehabilitation domain.  The search for the "wonder drug" will always continue...and the discovery of a "super-technique" will always be in the works...but the small things are the most immediate and accessible resources at our disposal (both as practitioners and patients).  In fact, most empirical evidence demonstrates that the addition of the "small things" potentiates the effectiveness of any and all other strategies...essentially making them the most important catalyst for improvement, especially when the subject is a child.

The "small things" are numerous...so it would be next to impossible to list them, but they are fundamentally based in the idea that the senses and emotions carry an important weight in the rehabilitation equation. 

-Aromas and scents
-soft music
-massage
-mindful nutrition
-purposeful activities that generate feelings of accomplishment
-exposure to sunlight, sea, and the earth

Each situation is a unique environment and therefore each "small things list" will reflect a different flavour...but the idea has been proven to yield excellent benefits. 

The small things are equivalent to the stitching in any fabric.  Even though the quilt is a marvelously beautiful and functional product, it's effectiveness lies in the intricacy and collective contribution of each individual stitch and thread.  

There is a best-selling book called "Don't Sweat the Small Stuff"...an eloquent self-help read that is both entertaining and useful.  But within the more complex world of rehabilitation...you don't need to "sweat" the small things, but most certainly be purposeful and mindful.  

 

Nutrición y Fascia Therapy

Pamela Estay Castillo

Nutricionista y Dietista
Fascia Therapy  

La buena alimentación es fundamental para tener una nutrición adecuada y permitir el óptimo funcionamiento y desarrollo del cuerpo.  Cada persona, ya antes de nacer, tiene impreso un programa genético que, ajeno a nuestra voluntad, se va desarrollando a lo largo de toda su vida. El correcto desarrollo y potencialidad de este programa genético depende, entre otros factores, de una buena nutrición.

Cada etapa de la vida tiene distintas necesidades nutricionales.  Desde el embarazo la buena nutrición es fundamental para potenciar el desarrollo del feto en formación; en esta etapa todo lo que come, bebe o siente la madre influirá en el niño/a. Fundamental es el consumo de alimentos nutritivos como verduras, frutas, semillas, legumbres, cereales; entre otros y limitar el consumo de alimentos altamente azucarados, con exceso de sodio, colorante, químicos, colesterol o  grasas saturadas y/o trans, que pueden afectar el desarrollo fetal y/o la salud de la madre .Desde el útero materno el niño/a ya percibe el sabor de todos los alimentos que consume su madre a través del liquido amniótico, por lo que es fundamental que la mujer embarazada consuma variedad de alimentos sanos y una dieta balanceada.

En los primeros 6 meses de vida el bebe solo necesita de la Lactancia materna para estar bien nutrido, ya que esta aporta todos los nutrientes, vitaminas, agua y minerales que necesita para crecer adecuadamente .Existen ciertos casos en que la Lactancia materna no puede ser posible y se recurre a formulas lácteas especiales para tratar de cubrir los requerimientos nutricionales del niño/a.

Luego se comienza con la introducción de otros alimentos; como cereales, verduras, frutas y cárneos, con el fin de cubrir todas las necesidades nutricionales .A medida que el niño va creciendo la alimentación debe ir variando en  consistencias, horarios y frecuencias de consumo, pero siempre se debe mantener una alimentación variada, saludable y nutritiva.

Los niños/as con necesidades especiales necesitan mantener un estado nutricional normal, ya que al igual que en los otros niños, la desnutrición y sobrepeso, dificultan la rehabilitación, aumentan complicaciones metabólicas e incluso puede agravar la enfermedad base. En estos casos cada niño puede necesitar una alimentación en particular, con inclusión y/o exclusión de ciertos alimentos con el fin de mejorar su estado nutricional.

Una adecuada nutrición tiene múltiples beneficios ;optimiza el crecimiento, colabora en una mejor evolución de la enfermedad, disminuye infecciones, ayuda a disminuir irritabilidad y espasticidad, aumenta estado de alerta, mejora disposición a participar en terapias, puede contribuir a mejorar su desarrollo psicomotor.

Fascia Therapy in Argentina

Some small promotion happening here:  The Fascia Therapy concept will be presenting in Buenos Aires, Argentina at the end of June. 

Many have asked me "what is it...why is it different?"...

The presentation will hopefully shed some light on that in great detail, but to summarize it's less of a "therapy" per se and more of a philosophy.  This philosophy is based on the idea that, beyond the conventional "disease fighting" strategies, there is a significant opportunity to affect health and well-being by placing some focus on the physiological systems that contribute to efficient systemic function...in essence, potentiating an organic (from within) response that will facilitate self-healing and auto-regulation.

Hopefully we will see Fascia Therapy in your neck of the woods sometime soon!

Cheers!

Walking and Cerebral Palsy: What evolution tells us...

This is certainly a topic of great discussion, debate, and concern...so it shouldn't be a surprise that I would eventually get down to writing something more specific about it. I would have done so sooner, but the reality is that it is such a complex subject...with multiple layers and considerations...that it was difficult to even decide on a worthy starting point in which to begin this dialogue.  However, I recently came across an interesting image that essentially served to crystallize some aspects to the point where I was comfortable to start my attempt at presenting my specific theory with respect to Cerebral Palsy (CP) and the ever-elusive goal of walking.

Again, given that this is such a complex biomechanical function, I can only present it in a somewhat "generic" fashion...that is, to present a broader perspective from which we can all then begin to plug in the holes and begin the process of further formulation and evaluation.  In my opinion, anything worthy of presentation should manifest some fact, extrapolation of fact, or theory that can be relatively easy to explain.  Let's see if it pans out!


Developmental Evolution

A potentially strange title that can lead to some confusion...but my intent is to simply point of that development and evolution are essential frameworks that hold fundamentals truths and realities that often go overlooked.  

Evolution itself is a construct that effectively states that we as humans evolved from the oceans, then to land, and essentially began our journey as quadrupedal beings...meaning we walked on all fours.  In fact, the interesting part is that we still maintain some aspects of this "early evolution" today...as babies and toddlers, we move on all fours.  This leads to the first fundamental reality:

Bipedal locomotion must first pass through the process of quadrupedal development.

The Pelvis

When we understand the process of quadruped-to-biped with respect to human locomotion, it makes sense to identify the specific characteristics that define (or differentiate) the quadruped versus the biped.  Although there are likely to be many, my theory revolves around 2 main considerations:  the pelvis and the spine.

We therefore come to a fundamental question: What is the difference between a quadruped pelvis and a biped pelvis?  The answer to this raises quite a few interesting points: 

1. The quadrupedal pelvis is proportionally alot smaller than a bipedal pelvis

This means that, in relation to the rest of the body, the pelvis occupies a smaller percentage of the entire body mass and frame.

Canine Skeleton

Feline Skeleton

If we take 2 examples of our most popular domesticated animals (dogs and cats) we are immediately struck with the fact that, although they are amazingly agile creatures, their pelvis is realtively small in comparison to the rest of their body.  In fact, it is almost comparable to the shoulder blade.  This shouldn't be too much of a shocker...afterall, their weight is designed to be transmitted through 4 limbs, so the shoulder blade and pelvis would naturally be of comparable size.  However, when we put it into the context of HUMAN development, this begs the question: Is it that the shoulder blade is that much bigger in proportion, or is it that the pelvis is that much smaller?   I think the answer is clearly skewed towards a small pelvis.

We can even extrapolate this theory even further to include our most genetically similar cousin, the primate.  The interesting thing about the primate (beyond the fact that it shares almost 90% of our genetic makeup) is that it is paradoxically considered as BOTH quadruped and biped.

Gorilla Skeleton

We can therefore safely assume that the primate is a reflection of the transition from quadruped to biped.  This is quite a luxury to be be able to examine this animal within this context.  When we have a look at the above image, we can identify that there is indeed a larger pelvis (in comparison to the rest of the body), but it remains somewhat smaller in comparison to our own representation within the human frame.  This is a strong indication that the transfer process from 4 limbs to 2, requires significantly more structural consideration with respect to the pelvis...in other words, its formal "architecture" needs to change.

To supplement all of the above images, the pelvis is also quite narrow...which completes a more 3-dimensional understanding of how the pelvis plays a role in the understanding of our evolution.


The Spine

Using all of the images previously posted above, the spine becomes the second area of focus.  What is it?

2. The quadruped spine manifests a single-curve.

If we look at the overall "layout" of the spine, it definitely represents what would be considered a primary curve within the human context...meaning that the lumbar and cervical spine do not manifest the secondary convex curve.  Perhaps more interesting is the observation of the larger pelvis in conjunction with the disappearance (reduction) of the length of the tail.  The tail is essentially an extension of the spine, therefore there is an inverse relationship...smaller tail, larger pelvis.  This can be attributed to the changes in center of gravity and equilibrium.


...So what in the world does all of this mean?

Let's have a look at how we humans play into this theory.  Take a look at the picture below...given the explicit observations mentioned in the previous sections, what do you notice?

Human Baby Skeleton

For the sake of formality, I will detail my specific observations:

In the earliest developmental stages, the human organism manifests a singular curve of the spine and a pelvis that is proportionally smaller to the rest of the body. 

Therefore, as developmental evolution dictates, the human organism is formally prepared for quadruped locomotion BEFORE entering into bipedal locomotion.   As the baby develops into a toddler, the pelvis will transform into a more substancial load-bearing structure (and therefore grow volumetrically and circumferentially) and the spine will begin its journey towards the characteristic secondary curves.  All of this will converge at the 10-14 month period when the toddler eventually begins to walk.  

Links to Cerebral Palsy 

The fundamental objective of this post is to tie this theory into some practical understanding of how CP is manifest and to hopefully provide some clarity on an otherwise overwhelming confusion.  The realities of CP play directly into this theory in some very straightforward ways: 

Cerebral Palsy falls under the umbrella of "developmental delay", therefore the early developmental phases (quapruped phase) persist well beyond the first year of life and can still be manifest into puberty.  We therefore are confronted with a confusing reality: chronological age is not congruous with developmental age.  This "mismatch" potentiates a possible deviation from developmental priorities and some potential misinterpretation of "progress".  

The expectation, if the individual is older than 2 years, is that they should be walking and therefore a large proportion of strategic planning (and expectation) is skewed towards verticalization, casting, and cosmetic "straightness".  However, if the developmental manifestation remains that of a quadruped, then bipedal locomotion is not only unrealistic, but also counterproductive.  In other words, if the pelvis in relation to the rest of the body remains small and the spine persists in a singular curve (or even straight), then developmental evolution dictates that ANY load-bearing strategy should be oriented towards quaprupedal equilibrium / stability / locomotion.

The truth about walking and CP is that it formally has nothing to do with the legs...which is paradoxical! 

The pelvis is the essential architectural weight-bearing structure that needs to be in place if any realistic expectations are to be considered.  Further, it has been long studied and determined (largey by the works of Gracovetsky) that movement is derived from the spinal "engine"... meaning that the spine is functionally the genesis for all motion and that the legs simply "magnify or amplify" that motion.  

Links to Practical Rehabilitation Strategy

There are countless "ideal" strategies populating the landscape, however if you apply these fundamentals of evolution, you will be left with some tangible frameworks to derive an appropriate and effective strategy: 

1. Promote systemic development and function

Any mechanical performance depends on effective absorption and utilization of all systemic assets (nutrition, oxygen, blood, etc...) therefore promotion of the respiratory, digestive, immune, and circulatory systems will contribute exponentially. 

2. Implement strategies that help to potentiate pelvic health and integrity

3. Reduce / avoid any unnecessary load-bearing or verticalization 

The notion that simple vertical positioning will resolve the issue is formally simplistic when placed against the evolutionary litmus test. 

4. Always refer to developmental milestones as a blueprint for priorities.

Development in the human organism always follows the same sequence...meaning that development from basic postural performance to more complex movements has a very explicit order.  This order is not revolutionary, nor is it some unknown "secret"...it is the gradual progression from simple horizontal exposure to gravity straight through to a completely vertical position.  This sequence can readily be found and searched as "developmental milestones".  

As always, these rants tends to evolve into "mini-novels", but the hope and expectation is to shed some light and to tie in some well understood realities...not to attempt to generate full understanding, but more importantly to provide some basic idea of "direction".  

Cheers!