Selected Publications


Joint moment contributions to swing knee extension acceleration during gait in children with spastic hemiplegic cerebral palsy
This study found that momentum generated by the swing limb appeared to be the primary cause of inadequate knee extension acceleration during swing in patients with spastic cerebral palsy. Stance limb muscle strength did not appear to be the limiting factor in achieving adequate knee extension in children with CP. (Gait & Posture 33:66-70, 2011)
Pediatric endurance and limb strengthening (PEDALS) for children with cerebral palsy using stationary cycling: A randomized controlled trial
This Phase I study found significant improvements in locomotor endurance, gross motor function and some measures of strength in children with cerebral palsy after a 12-week stationary cycling program. The study provides preliminary support for this intervention and guidance for future research in this area. (Phys Ther 90:367-381, 2010)
Lower extremity selective voluntary motor control in patients with spastic cerebral palsy: increased distal motor impairment
This study confirmed the common clinical finding of increasing proximal to distal selective voluntary motor control impairment in patients with cerebral palsy. These findings may have implications for treatment and research. (Dev Med Child Neurol 52: 264-9, 2010)
Stationary cycling and children with cerebral palsy: Case reports for two participants
These case reports describe a stationary cycling intervention and outcomes for two child participants with spastic diplegic cerebral palsy. Each child completed a 12-week, 30-session cycling intervention consisting of strengthening and cardiorespiratory fitness phases. (Phys Occup Ther Pediatr Vol. 30:125-138, 2010)

Selective control assessment of the lower extremity (SCALE): development, validation, and interrater reliability of a clinical tool for patients with cerebral palsy
This study describes a tool to assess selective voluntary motor control, which is an impairment found in patients with spastic cerebral palsy. The tool, developed by the team at the Center for Cerebral Palsy at UCLA, was found to be highly valid and reliable. A link to an instructional video on the use of SCALE can be obtained by clicking here. Written instructions on administration of SCALE, including a score sheet that may be copied for clinicians’ use, is provided in the Appendix. (Dev Med Child Neurol 51: 607-614, 2009)

Click here for the Appendix to this article. The Appendix includes a SCALE score sheet and directions for administering and grading the SCALE.

Complimentary and alternative methods in cerebral palsy
This review article discusses some of the complimentary and alternative methods used in children that may be continued into adulthood. The pitfalls for patients and conventional physicians, as well as suggestions as to what may be helpful and harmful are discussed. (Dev Med Child Neurol 51 Suppl 4: 122-129, 2009)
The physical therapy clinical research network (PTClinResNet) methods, efficacy, and benefits of a rehabilitation research network
This article describes the vision, methods and implementation strategies used in building the infrastructure for PTClinResNet, a clinical research network designed to assess outcomes for health-related mobility associated with evidence-based physical therapy interventions across and within four different disability groups. (Am J Phys Med Rehabil 87:937-950, 2008)
The effect of lower extremity selective voluntary motor control on interjoint coordination during gait in children with spastic diplegic cerebral palsy
Selective voluntary motor control is the ability to move a joint independent of other joints in that limb. This is often impaired in cerebral palsy. Using instrumented gait analysis, this study found that a patient’s selective voluntary motor control related to a measurement of interjoint coordination, or the ability to move the hip and knee independently during swing. (Gait & Posture 29:102-107, 2009)
Pediatric endurance and limb strengthening for children with cerebral palsy (PEDALS) – a randomized controlled trial protocol for a stationary cycling intervention
This paper presents the rationale, design and protocol for Pediatric Endurance and Limb Strengthening (PEDALS); a Phase I randomized controlled trial evaluating the efficacy of a stationary cycling intervention for children with spastic diplegic cerebral palsy. (BMC Pediatrics 7:14-22, 2007)
Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: Section on pediatrics research summit proceedings
This article highlights the content and recommendations of a Pediatrics Research Summit developed to foster collaborative research in this area. Two components of physical fitness – muscle strength and cardiorespiratory fitness – were emphasized. Current intervention protocols and outcome measurements were critically evaluated and recommendations were made for future research. (Phys Ther, 87:1495-1510, 2007)
Growth hormone therapy improves bone mineral density in children with cerebral palsy: A preliminary pilot study
This small pilot study showed suggests that 18 months of growth hormone is associated with statistically significant improvement in spinal bone mineral density and linear growth in children with cerebral palsy and low bone mineral density. (J Clin Endocrinol Metab 92:932–937, 2007)
Spinal bone mineral density, IGF-1 and IGFBP-3 in children with cerebral palsy
This cross-sectional pilot study provides preliminary evidence that the growth hormone-insulin-like growth factor (GH-IGF) axis plays an important role in bone growth in children with cerebral palsy. Results indicate that in osteopenic patients, but not in the 4 patients who had normal bone density of BMD, there was a significant correlation between the IGFBP-3 Z-scores and spinal BMD Z-scores. (Horm Res 68:316–320, 2007)
Is treatment with growth hormone effective in children with cerebral palsy?
This case report presents three children with cerebral palsy and short stature who were treated with growth hormone and demonstrated significantly increased linear growth rate without side effects. Growth improved to a greater extent in the two children with apparent growth hormone deficiency than in the child with no apparent growth hormone deficiency. (Dev Med Child Neurol 46: 569-571, 2004)
The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy
This study found no evidence that resistive exercise in patients with spastic cerebral palsy increased spasticity. The long-held belief that increased effort would increase spasticity had been the rational for limiting strengthening programs for patients with spastic cerebral palsy. (Phys Ther 81:1215–1223, 2001)
This paper won the Jack Walker Award for the best article on clinical research published in the journal Physical Therapy in 2001.
Functional assessment of children with cerebral palsy following limited (l4-s1) selective posterior rhizotomy – A preliminary report
Using instrumented gait analysis, improved joint motion during walking was observed in subjects with spastic cerebral palsy one year after undergoing limited selective posterior rhizotomy. Reduced spasticity and increased passive range of motion were measured and strength and motor control were not adversely affected. (Acta Neurochir (Wien) 143: 865-872, 2001)
Sensitivity of the pendulum test for assessing spasticity in persons with cerebral palsy
This study concluded that the pendulum test is a valid tool for assessing spasticity in persons with CP and that the first swing excursion is the most sensitive outcome measure. (Dev Med Child Neurol 42:182-189, 2000)
The role of selective posterior rhizotomy in the management of cerebral palsy
This article reviews the history, rationale, patient selection, surgical technique and post-operative management of selective posterior rhizotomy in children with spastic cerebral palsy. (Inf Young Children 3:48-58, 1990)
Perioperative complications in children undergoing selective posterior rhizotomy: a review of 105 cases
In this review, the incidence and clinical significance of adverse events related to anesthesia and surgery are described. Neither intra-operative or post-operative events with potential for lasting morbidity, nor life-threatening events occurred. Early surgical complications were absent in this series. (Paediatric Anaesthesia 6:479-486 1996)
The management of childhood spasticity
This chapter reviews the neurophysiological basis of spasticity, its measurement and clinical effects. The medical and surgical management of spasticity is discussed. (in Advances in Operative Orthopaedics Vol 1:313-335, 1993)
Functional outcome following selective posterior rhizotomy in children with cerebral palsy
The authors performed clinical examination and gait analysis on children with cerebral palsy before and after selective posterior rhizotomy. The data indicate decreased spasticity and improved range of motion that contribute to improvement in active functional mobility following selective posterior rhizotomy. (J Neurosurg 74:380-385, 1991)
Spasticity in cerebral palsy and the selective posterior rhizotomy procedure
This article discusses the surgical procedure to reduce spasticity by selective posterior rhizotomy. A review of the neurophysiological basis of spasticity is presented. (J Child Neurol 5: 179-185, 1990)
Selective posterior rhizotomy for treatment of spastic cerebral palsy
This article is directed at physical therapists treating children with spastic cerebral palsy. It describes the assessment and patient selection for selective posterior rhizotomy in the treatment of spastic cerebral palsy (Pediatr Phys Ther 1:3-9 1989)




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