wiredON Development Interviews

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Evidence for Spinal Neuromodulation in Cerebral Palsy Aug 12, 2026

Show notes

Casey Gonnella was 11 years old when he started Transcutaneous Spinal Neuromodulation (TSN). Fast forward a few years and he now a published co-author on an academic publication discussing his case study in the Journal of Neurophysiology, along with the grandfather of Spinal Neuromodulation, the late Dr Reggie Edgerton, Dr Susan Hastings and his mother, Jennifer Gonnella.

In this conversation, Mindy Silva from WiredOn Development sits down with Dr Susan Hastings, Jen, and Casey to discuss their research paper, Neuromodulatory Strategies Overcome Multiple Inevitable Impairments of Cerebral Palsy, J. Neurophysiol. 2026, 136, 445–458,

They address skepticism about Casey’s diagnosis and detail his pre- versus post-TSN changes, including major gains in tactile sensation, easier movement, and new visual, auditory, cognitive, swallowing, and facial-expression awareness.

The discussion emphasizes that the paper’s key clinical contribution is proprioceptive derived intervention (PDI): training midline, alignment, head/neck control, weight shifts, and eyes-open/eyes-closed strategies to uncouple vision from movement, often using unstable surfaces.

They also cover FES and TheraTogs, hands-on versus hands-off guidance, risks of reinforcing wrong patterns, individualized dosing, and the need for experienced clinicians who have evidence of long-term outcomes from children they'v worked with.

00:00 Welcome and Paper Intro

00:49 Honoring Reggie Edgerton

01:39 How the Paper Came Together

02:50 Did Casey Really Have CP

05:46 Life Before and After TSN

08:04 Early Choices and Surgery Pressure

11:02 PDI Explained and Midline

20:49 Hands On vs Hands Off

23:24 TheraTogs Reality Check

29:24 Eyes Closed Motor Learning

31:54 FES Before TSN and Weight Shifts

34:19 Pictures in the Brain

39:16 Barefoot Proprioception Tips

40:50 Ball Sitting Midline Test

42:19 Parenting Through TSN

45:22 Alignment Cues Tongue Trick

46:55 Vision Changes and CVI

52:10 Session Flow and Breaks

55:10 One Week Withdrawal Crash

01:04:11 Dialing Stim Too High

01:07:34 Slow Skill Ownership

01:10:21 Facial Expression Practice

01:11:16 Facial Expression Practice

01:13:21 Hidden Emotions in CP

01:15:50 TSN Changes Awareness

01:18:08 What the Paper Missed

01:22:55 Biggest TSN Improvements

01:24:21 Alignment and PDI Debates

01:29:14 How to Start Safely

01:35:45 Casey’s Future Path

01:38:04 Research Still Evolving

01:41:37 Wrap Up and Resources

Sue McCabe on Pediatric Sleep: Comfort, Complexity, and Thermoregulation Feb 14, 2026

Show notes

This conversation with sleep specialist Sue McCabe will completely shift how you think about sleep.

We talk about why sleep isn't just a nighttime problem, it's a 24-hour concern woven through every aspect of your therapy outcomes. Sue introduces her C-word framework: Comfort (finding what's "just right, right now"), Complexity, Culture, Collaboration, Community, Capacity, Connections, Communication, and Clocks. We explore the types of questions that surface the real issues underlying sleep issues before throwing behavioral strategies at families. The difference between a circadian rhythm disorder and insomnia, why knowing that a child is spending 6 hours running around the park helps you solve a sleep issue and how warm feet are essential for sleep onset (yes, your mom was right).

We explore difficulties with sleep in a variety of diagnoses (CP, autism, ADHD, vision impairment, trauma history).

Sue introduces the frameworks, the questions, the resources, and the lens to address sleep into your clinical sessions with confidence.

Dynamic Thinking with Michael Workman and the Bamboo Brace Jul 24, 2025

Show notes

Michael Workman (PT, Bamboo Brace designer, and neurodevelopmental geek with 30 years of floor-time wisdom) joined me for a fascinating deep dive into the hidden power of such a seemingly simple wearable device for such a seemingly simple joint.

If you're a therapists who sees the elbows as gateways to whole-body potential, you're going to love what Michael has to say! And if you're a therapist whose mostly thought about the elbow as just a hinge that needs to be stablized between two complex joints, you’re going to be fascinated by how much you can get out of working on the dynamic control of this joint.

Of course we get into a lot of detail about the Bamboo brace itself and even touch on what it takes to bring a therapy product to market, but the real gold in this interview is the deep dive into dynamic bracing, dynamic thinking and dynamic interventions - everything works better when it’s moving. We jump between joints and synergies. We revive the open chain and it’s importance in not only upper limb function, but the development of motor control that must come before the development of strength - and of course we get into the practicalities of using the brace - which kids benefit, when and where. There’s so much to take away from this interview!

Enjoy.

A Human First Approach to Seating and Wheelchair Mobility Apr 24, 2025

Show notes

Nobody becomes a pediatric therapists to make children’s lives miserable, or worse, create pain and life limiting boney deformities and yet, there’s a very real possibility that somewhere along your career path, that’s exactly what your suggestions or recommendations might have done. Now this is a confronting thought , but one that needs some airtime, with a little self-reflection and no judgement - certainly not from me, because I’m right there with you.

I think it was Maya Angelou who said ‘do the best with the knowledge you have, but when you know better, do better’ which is a lovely quote to live by. With that in mind, this conversation with Sharon Sutherland and Jenn McKee is a not to be missed deep dive into what they call a human first approach to seating and wheelchair mobility, but what I’ll call a holy smokes - our solutions may have been part of the problem here people.

Sharon and Jenn share how they support seating and wheelchair mobility with a beautiful human first approach. We discuss real clinical cases and dig into all the tricky bits we constantly run up against as therapists, managing head support and keeping feet on footplates, complex bodies, silent pain, navigating team disagreements and technology shortfalls, getting family buy-in, dynamic systems and pommels. There were so many essential topics we covered that this interview extends waaay over the usual hour. I was going to split it into two parts, but I’ve decided to try out a longer form interview. Please let me know if you like the longer interview - and if, like me, you had a couple of slap the head moments!!

There's a ton of additional links and resources for you to grab at https://www.wiredondevelopment.com related to this conversation

Enjoy!

Hippotherapy for Physical and Occupational Therapists in Pediatrics Dec 13, 2024

Show notes

This was such a fun interview for me to do but be warned, once you’ve listened to Jane and Susie explaining the benefits and mechanism of equine assisted therapy, you are going to want to go find yourself a stable with a few horses and get trained in hippotherapy if you’re not already. . I was genuinely blown away by how the the horse can be used to impact motor learning, and how as therapists we can integrate the whole sensory motor experience into our therapeutic goals. This interview will take you on a fascinating journey into hippotherapy - enjoy the ride.

Dystonia and complex disabilities in childhood development with Karen Kanga Oct 29, 2024

Show notes

From philosophy student and activist to pioneer in early childhood intervention approaches for therapists, Karen Kangas takes us on a journey of developing clinical excellence. She is an occupational therapists with over 50 years of experience, specializing in pediatrics, seating, and augmentative and alternative communication (AAC).

She has particular knowledge and expertise in working with children with significant disabilities, particularly those with dystonia and dystonic cerebral palsy.

Karen beautifully bridges the gap between ‘old school’ hands on approaches and a more contemporary hands-off focus on participation and real-life activities and engagement.

We cover seating and positioning, standing, walking and appropriate equipment use, developing clinical skills, the magic of the barrier vest and understanding movement patterns.

You'll find links to everything we discussed at https://www.wiredondevelopment.com

Enjoy!

The Real State-of-The-Evidence in Pediatric Rehabilitation with James Sulzer Aug 05, 2024

Show notes

James Sultzer is an academic neurorehabilitation engineer and a father to a child with a significant brain injury. This conversation is a raw look at the real state of the evidene in pediatric neurodisability from the someone who is living through the reality of how it supports families to make incredibly difficult decisions as they seek out the best care for their kids. We move from discussing the value of goal setting and home programs all the way to trying to uncover the fraud and the pseudoscience that parents are navigating everyday. This is a profoundly important conversation that is a must listen for everyone working with families who have children with disabilities. I know you'll get a lot out of it. Enjoy!

For resources mentioned jump to https://www.wiredondevelopment.com

An eye opening journey into neuroplasticity with Dr Susan Barry for pediatric OTs and PTs Jul 02, 2024

Show notes

When it comes to understanding how the work that we try to do every day in the clinic actually works, this interview with Dr Susan Barry may be one of the most eye-opening interviews I have done so far - excuse the pun. Dr Barry is a a Professor Emeritus of Biological Sciences, Professor Emeritus of Neuroscience and Behavior and (as she calls herself) a recovered Strabismic. Her story of fixing her gaze which started at age 48 gives us unmatched insight how neuroplasticity can be harnessed in every day therapy to drive recovery. WE cover so many topics that are near and dear to my beating therapy heart, and from the value of clinical wisdom and the cautionary tales of over interpreting published research to the importance of not being distracted by the obvious problems you see, but rather understanding the reason behind why you are seeing them. There’s so many nuggets to take away from this interview, you are going to love it - enjoy!

Child-Led Therapy with Kelsie Olds for Occupational and Physical Therapists May 08, 2024

Show notes

This interview with the OccuPLAYtional Therapist, Kelsie Olds, is an absolute treat. We cover the realities, practicalities and benefits of child-led therapy, the integration of play in therapeutic practices, push-in vs pull out services, balancing the conflicts that arise from staying true to your core values as a therapist with meeting your service requirements and so much more

For links and resources, visit https://www.wiredondevelopment.com

04:45 A uniquely rich learning environment

13:32 Regcognising and addressing underlying difficultes

22:46 Finding the best learning opportunities

27:44 Whose actually my client?

31:26 The magic of a trust and values based approach

37:34 Navigating School Systems and Advocating for Child-Led Therapy

>> 39:13 Be Informed

>> 41:20 Value the team

>> 42:21 Keeping the child at the center

44:38 Push in vs Pull out

50:53 Gaining Respect and Buy-In from Teachers

52:58 Understanding motor skill levels through play vs standardized testing

59:32 Stop asking questions

01:04:27 Everybody is unique and we are all the same

01:08:54 Neurodiverse Conversations and Activism

01:11:06 Interoception

Specializing in Neudodisability: Bobath Therapy for Pediatric PTs and OTs Mar 26, 2024

Show notes

More than a decade ago, I asked a question which finally gets answered today. The question was

'Why, despite the poor evidence, do intelligent, scientifically minded, educated and experienced therapists still value it?

Or do they?'

Prof Margaret Mayston exemplifies the intelligent, scientifically minded, educated and experienced therapist.

She trained initially as a physiotherapist in Melbourne, Australia, and then specialised in childhood neurodisability at the Bobath centre in London before pivoting to a career in science by the completion of an MSc in Human & Applied Physiology (Kings College London), a PhD in neurophysiology, and a 3-year Wellcome Trust funded postdoctoral fellowship, both at University College London (UCL).

She has combined her clinical and academic careers, and is currently a Professor (teaching) in the Division of Biosciences at UCL teaching neuroscience and general physiology on undergraduate programmes. She also gives sessions on Typical Child Development for the MSc Advanced Pediatrics (UCL) and as a Senior Bobath Tutor (pediatrics) she also teaches on Foundation courses globally and is involved in tutor training.

We cover so much more than Bobath therapy in this interview, from basic physiology to philosophy and everything in between, but essentially this interview explores why the call to deimplement Bobath NDT is so misguided and captures why intelligent, scientifically minded, educated and experienced therapist think all over the world think the call to deipmlement Bobath NDT is not only ignorant and misguided, but detrimental to our profession as a whole, and a disservice to the kids and families that we are tasked with caring for.

Check out the resouces and article discussed in this paper https://www.wiredondevelopment.com

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