The first round of certification candidates have completed their testing, and we will soon announce the test takers who will be awarded with the letters "PRPC" for Pelvic Rehabilitation Practitioner Certification. Just over 70 candidates sat for the exam during our inaugural 2014 testing window, and are now eagerly awaiting their results (we thank them for their patience!)

Each step of this vigorous (and often tedious) process has been guided by Kryterion, a company who specializes in certification development. We want to give you an update about where we are in the process as many are interested in finding out how they performed on the test.

The "cut score" for passing the exam and earning the certification can only be determined after all the examinees have completed the exam, so we could not begin our work until the testing window closed on March 1st. Then, a group of 11-14 SME's (Subject Matter Experts) are gathered together on phone and web conferences to review each item. A SME is a person who meets the criteria to take the PRPC exam but cannot be someone who took the exam this year. Many of the SME's are therapists who have been involved in the process from the beginning, others have joined the group specifically for this last step, the review process.

Prior to the phone and web conferences, the each SME completes a training in rating the difficulty of items. She then independently rates every single item based on this thought: "what percentage of minimally acceptable candidates would get this item correct?" The criteria for a minimally acceptable candidate was determined in the exam development process and constitutes what a therapist should know or be able to do at a minimum to earn the credential. During our review phone calls the SMEs are all presented with the given ratings for each item, discuss the ratings as needed, and then an average rating for each item is created. At this time, we have completed over 4 hours of conferences together and have approximately 3-4 hours more to complete. As the SMEs live across the United States (and across several time zones), work full time jobs, attend school, and are raising families, this process is quite a challenge to coordinate and a sacrifice on the part of the SME.

Despite the hard work and sacrifices, the subject matter experts are committed to finalizing the cut score process within the next couple weeks. Once this is completed the cut score is determined based on the review and rating process, and we will be able to present therapists whose exam scores meet or exceed the cut score with their new designation. Participants who meet the criteria and earn a score at or above the cut score will be notified by email of their status. If you are currently awaiting notification of PRPC status, please be patient; we are very close to having the information that we need to finalize this rigorous process. We will also announce on our Facebook page and in a newsletter once we have completed the rating process, so stay in touch with us and watch your email.

If you are considering applying for the PRPC exam, all the information that you need to know can be found here. The next opportunity to sit for the exam happens in November of 2014. Thank you to everyone who has been a part of the process, from the administrative to the clinical to the test taking side! The PRPC exam is the only certification currently available that recognizes expertise in pelvic rehabilitation, a distinction that will serve to set a therapist apart and acknowledge all of the hard work that he/she has completed.

This post was written by H&W faculty member Teri Elliott-Burke, PT, MHS, BCB-PMD. Teri will be teaching Pelvic Floor Level 2A in Maywood, IL next month.

A new product has hit the stores – Butterfly Body Liners. These pads are specifically designed to deal with fecal incontinence (aka ABL – Accidental Bowel Leakage). The good news is that advertisements for these pads bring fecal incontinence out in the open. The ads promote discussion of this topic and offer one solution for this condition. A patient first brought this product to my attention. So I thought it would be a good idea for all of you to know about them as well (as I have discussed the concept of the pad with other patients they have liked the idea). However, I would also like to voice two concerns: One is that the pads seem pricey ($.30 each) especially for patients who have to change them often or are on a fixed income. My second reaction is that for some people these small pads don’t have enough capacity to deal with the problem.

I am grateful for the development of pads for this condition, however I find myself frustrated with this advertisement, as well as advertisements for urinary incontinence pads. I find myself wanting to strangle celebrities touting the use of pads (notice so far none of them are willing to own up to fecal incontinence). The pads, which are a necessity for some, offer only a passive solution. The fact that this condition can be accurately diagnosed and treated is never mentioned. Of course, mentioning an active solution doesn’t sell the products. Therefore, we need to be the voices out there letting people know there is an active solution to this issue. This includes marketing to physicians to let them know of the treatment we can provide.

Another “product” related to fecal incontinence is the newly developed Fecal Incontinence and Constipation Questionnaire. (Check out the February 2004 Physical Therapy Journal (PTJ) article that addressed the formation of this questionnaire). This is an exciting development in the area of outcomes questionnaires to address the specific patient population of fecal incontinence and constipation. Although there are other questionnaires available this one was developed specifically for patients seeking put patient rehabilitation services for pelvic-floor dysfunction. This questionnaire has two subscales Fecal Incontinence (FI) and Fecal Constipation (FC). Analysis showed sound psychometric properties of this scale, although further fecal constipation items were recommended to increase content coverage. Reminder: For those of you how are APTA members the PTJ has a app.

If you are treating patients with urinary incontinence, but are not adequately addressing fecal incontinence or constipation you are missing out on giving relief to many people. Make your way to PF2A where issues of constipation and fecal incontinence are addressed.

This post was written by guest-blogger, H&W faculty member Michelle Lyons, PT, MISCP, who will be teaching her brand-new course, The Athlete and the Pelvic Floor, in Columbus,OH in August..

‘I approached my advisor and told him that for my PhD thesis I wanted to study the pelvis." He replied ‘That will be the shortest thesis ever…there are three bones and some ligaments. You will be done by next week.’ I told him ‘I think there is more to it’. (Andry Vleeming Phd 2002)

In sports medicine, the primary source of specialist consultation is the orthopaedic surgeon, who may perform a wide ranging assessment of the musculo-skeletal system with no real evaluation of the pelvic girdle or pelvic floor musculature. The patient is unlikely to be asked about urinary, bowel or sexual dysfunction and often does not volunteer this information unless prompted (Jones et al 2013)

The patient will more than likely then be referred to physical therapy but again, unless we as therapists have the knowledge to combine our orthopaedic, sports medicine and pelvic rehab skillsets, we may not be meeting the needs of our athletic patients.

In my new course for Herman & Wallace, The Athlete and the Pelvic Floor, I will be looking at how specific hip and groin injuries can impact the pelvic girdle and pelvic floor. We know that the most common site of strain is the musculo-tendinous junction of the adductor longus or gracilis muscle, and this is also the most common cause of groin pain in the athlete (Reid 1992). In cases where the athlete recalls a specific traumatic event, the diagnosis is more straightforward, but care must be taken to differentiate between muscle strains and tendonoses/ tendonitis from osteitis pubis, sports hernias and nerve entrapment, which can present with similar symptoms, especially if the athlete presents with insidious onset.

We will investigate differential diagnoses including acetabular tears, a recently recognised source of anterior hip, groin and pelvic pain (Lewis and Sahrmann 2006). Studies have indicated that 22% of athletes with groin pain (Narvani et al 2003) and 55% of patients with mechanical hip pain of unknown aetiology (McCarthy et al 2001) have a labral tear. Athletic pubalgias or sports hernias, are another controversial diagnosis. Although more commonly seen in men, but the female proportion, age, number of sports and soft tissue structures involved have all increased recently (Meyers et al 2008) We will also take into account nerve compressions and look specifically at cycling and genito-urinary symptoms in men and women, the potential mechanisms involved and how we as pelvic therapists can intervene.

It will be an intense two days in Ohio this August as we look at integrating the best of current practices in sports medicine with pelvic assessment and rehabilitation – I hope to see you there!

References:

Reid, D.C. (1992) Sports Injury Assessment and Rehabilitation. Churchill Livingstone, Edinburgh

Lewis, C.L. & Sahrmann (2006) Acetabular labral tears. Physical Therapy 86 (1), 110-121 Narvani et al (2003) Prevalence of acetabular labral tears in sports patients with groin pain Knee surgery, Sports Traumatology & Arthroscopy 11 (6) 403-408

Meyers et al (2008) Experience with sports hernias spanning two decades Annals of Surgery 248 (4)

This post was written by guest blogger, H&W instructor Ramona Horton, MPT. Ramona teaches the Visceral Mobilization series of courses, as well as Myofascial Release for Pelvic Dysfunction course.

When I first began working as a pelvic floor PT in the early 90’s (the 1990’s that is), I spent a great deal of time marketing my program to physicians with less than stellar results. Sure, I got the odd referral here and there, but they were mostly the desperation patients that had run out of options. Not to be daunted by lack of success, I opted to present my message directly to the public; I took my “dog and pony show” on the road to senior health fairs, medical study groups and even civic organizations. Any group that was willing to put their comfort level aside and talk about their nether regions was fair game. Over time, the word got out to the physicians (mostly through their patients); our program grew and the need for marketing became a distant memory.

While reading a recent blog post on the subject of students in the pelvic floor rehab clinic by HW faculty member Bridgid Ellingson, I reflected on my current relationship with students in that same setting. Although I have had the traditional senior PT students, I am currently working with those of other medical professions. Yes, it seems the world has come full circle; one of those physicians I annoyed incessantly 20+ years ago until she started sending me patients is now serving as a preceptor for several medical schools. She supervises 4th year medical and PA students for their OB-GYN rotation. During this 6 week rotation, they have clinic hours, deliver babies, observe surgeries and spend a day with me in a pelvic rehab clinic. I try to arrange my schedule to have both male and female patients, a full new patient evaluation, sEMG session, manual therapy, use of RTUS imaging, and exercise programs.

The best part of this arrangement is that the medical students are from two Osteopathic schools. I will unashamedly admit that I am an osteopath wannabe and freely share this with my students. The DO students have a tremendous appreciation for the application of manual therapy techniques such as fascial release and visceral mobilization in the treatment of the uro-gyn patient; this is not a part of their curriculum in osteopathic medical school and are impressed at the level of manual therapy PTs are performing on this population. Both the medical and PA students give positive feedback to their preceptor that they feel this is a worthwhile experience. They are quite amazed to discover the extent to which a pelvic PT can impact bowel, bladder and pain issues, all report that this is completely new, useful information and will impact their referral patterns.

While I occasionally have the reticent patient, in general they are quite willing to allow the students to be present during their treatment session, in fact some even invite the students to palpate or observe their dysfunctions. A number of my patients have been on a long journey to find help for their pelvic issues and welcome the knowledge that they are assisting in educating practitioners of the future. I schedule an observation student about every 6 weeks. There is no paperwork or student evaluation to deal with, all of the education and explanation makes for a long day, but the return is more than worth it. I strongly encourage any who know physicians that precept medical, NP or PA students to offer them time in your pelvic rehab clinic.

This experience has made me realize that students of other professions may indeed be the best untapped marketing tool we can harness without ever opening a single power point file. This experience carries with it a two-fold gain. By educating future practitioners about the value of PT for the treatment of pelvic dysfunction, not only are we planting a seed that will further our profession but more importantly we are providing a more direct route for those seeking care in the maze that is our medical system.

You can catch Ramona teaching a number of events this spring, including Visceral Mobilization Level One in Winfield, IL and the Myofascial Release course in Portland, OR.

This post was written by guest-blogger, H&W faculty member Michelle Lyons. You can catch Michelle teaching our Pregnancy and Postpartum series courses, Pelvic Floor Series courses, as well as our new courses on Oncology and the Pelvic Floor and the Athlete and the Pelvic Floor. Michelle lives in Ireland and was an integral part of bringing Institute founder, Holly Heman, to the UK to teach two courses this spring.

Two weeks ago, Institute founder Holly Herman took London by storm and presented Pelvic Floor Level 3 to an enraptured audience. Twenty one unsuspecting British and Irish physiotherapists gathered in the Chelsea and Westminster Hospital for an unprecedented weekend of pelvic health assessment and treatment techniques. They may have been surprised at the breadth and width of topics covered, from orthopaedics, hormones and surgery, but they weren’t the only ones who got a surprise that weekend.

The night before we started, Holly and I were at the hotel, preparing slides and tweaking the schedule, when a very familiar head popped around the corner – Diane Lee! To say that Holly was surprised would be something of an understatement (I had been sworn to secrecy for months beforehand – dire threats had been issued!) The hilarity and bonhomie that ensued set the tone for the rest of the weekend.

We had a mix of clinicians – physiotherapists who just treated women, those who specialised in all areas of pelvic health and a couple of brave musculoskeletal physios for whom this was their first pelvic floor course! We were lucky to have a great presentation by Jenny Burrell, of Burrell Education, the UK’s leading provider of continuing education to fitpro’s, who highlighted how her profession works with pelvic floor issues with an entertaining and dynamic presentation, and the legendary Diane Lee also gave a presentation on her latest work and research on diastasis. Diane was generous with her time and knowledge throughout the course and I think gained a new insight into the world of pelvic rehab!

Holly also gave a three hour presentation during her time in London, to a large audience containing physiotherapists, doctors, midwives and fitpro’s, including a very dynamic theraband demonstration of the role of the pelvic floor in all aspects of health and function. Special mention must go to Mr Gerard Greene, who played the role of the clitoris with aplomb!

Holly worked tirelessly throughout the weekend to make sure that everyone left on Sunday evening enthused and excited about pelvic rehab and our role as part of the multi-disciplinary team. While British and Irish physiotherapists have traditionally enjoyed more autonomy in the private practice setting (there is a long history of direct access), there is common ground between US therapists and their Irish & English counterparts when it comes to highlighting the broad role of pelvic rehab providers to our medical colleagues and our communities – a great deal of enthusiasm for the international roll out of the PRPC process was observed.

Compliments were flowing throughout the weekend, not only regarding Holly’s fantastic teaching style but on the hugely beneficial resource that the PF3 manual was sure to become. Plans are already afoot for future HW courses on this side of the pond.

This post was written by H&W faculty member Elizabeth Hampton, who will be debuting her course, Finding the Driver in Pelvic Pain, in May at Marquette University. 

Your client presents with a referral from an OBGYN for evaluation and treatment of vulvodynia. During your evaluation, you confirm that she has pubic symphysis instability and that her vulvar pain reduces by 90% with use of a pelvic compression belt. How do you screen for musculoskeletal dysfunction as well as specific urogyn/colorectal and pelvic floor issues in these complex clients? How do you develop the clinical reasoning methods to prioritize evaluation and treatment interventions? If you send a report back relating her pain to pubic symphysis instability, will the physician think that they sent this client to a PT who doesn’t understand the pelvic floor?

Your next client presents with stress urinary incontinence during box jumps and running, however she has no pelvic floor laxity and her strength is 4/5 bilaterally. She denies leaking with coughing, sneezing, lifting, bending. You notice that she has failed load transfer with jumping, weak abductors and marked anterior pelvic tilt that becomes more exaggerated with jumping. Her thorax is rigid and her habitual breathing method is with full abdominal wall relaxation. She demonstrates that a ‘core contraction’ means to her and she holds her breath and bears down. Is this an unstable urethra due to fascial incompetence, poor motor control or is it driven by her poor shock absorbtion with plyometrics?

Part of the joy of working with clients with pelvic floor dysfunction is the ability to sleuth out musculoskeletal dysfunctions as a contributor and (at times) the primary driver of pelvic floor dysfunction. How do you assess a client who may have much co-morbidity that contributes to her pain? It can feel like there is so much to do and it is hard to know where to start.

The good news is that Herman Wallace has many educational resources to fill your toolbox relating to this topic. In the new course I am debuting through H&W, Finding the Driver in Pelvic Pain, fundamental screening tests for spine, pelvic ring, hip tests are integrated with direct PFM assessment to determine all factors in the evaluation of pelvic floor dysfunction.

Clinical Reasoning is an essential tool in the evaluation and treatment of clients with pelvic floor dysfunction as it enables differential diagnosis and prioritization of treatment interventions. The majority of clients with pelvic floor dysfunction have associated co-morbidities which may include labral tear, femoral acetabular impingement (FAI), discogenic low back pain (LBP), altered respiratory patterns, nerve entrapments, fascial incompetence or coccygeal dysfunction. These complex clients require the clinician to have a comprehensive toolbox to screen both musculoskeletal as well as pelvic floor dysfunctions in order to design an effective treatment regimen. This intermediate- level, 3-day course is designed for rehabilitation professionals treating pelvic pain and elimination disorders who seek additional skills in the evaluation and treatment of musculoskeletal co-morbidities as well as clinical reasoning with prioritization of interventions. Participants will be provided with differential diagnosis and clinical reasoning that can be applied to their clients immediately. Internal and external pelvic floor assessment is critical for evidence based evaluation and treatment of pelvic pain and elimination disorders. This data, along with the musculoskeletal screening, can determine if the pelvic floor dysfunction is the outcome or the cause of the problem. This intermediate level course is an excellent adjunct for clinicians interested in learning how to evaluate and prioritize the treatment interventions of clients with pelvic floor associated musculoskeletal dysfunction.

Want more from Elizabeth? Join us at Marquette University in Milwaukee, WI in May!

This post was written by guest-blogger, H&W faculty member Michelle Lyons. You can catch Michelle teaching our Pregnancy and Postpartum series courses, Pelvic Floor Series courses, as well as our new courses on Oncology and the Pelvic Floor and the Athlete and the Pelvic Floor. Michelle lives in Ireland and was an integral part of bringing Institute founder, Holly Heman, to the UK to teach two courses this spring.

As a longtime fan of Holly Herman's work, it has been my pleasure to help bring her depths of knowledge and unforgettable teaching style first to London to teach Pelvic Floor Level 3 and then on to Dublin to allow us Irish PT’s the honor of being the first to attend her new course, Sexual Medicine for Women & Men.

We had 26 therapists travel to Dublin from all over Ireland, Northern Ireland, Scotland and England as well as one intrepid PT who flew to us from Saudi Arabia!

This is a course unlike any other I have attended – over the course of two intense days, we explored our own sexual perceptions and biases and how by challenging those notions, we can provide even better healthcare to our patients as part of a multi-disciplinary team dealing with sexual health issues.

It is an enormously practical course, not only in exploring the anatomy and physiology of sexual function and dysfunction but also in looking at the essential role therapists must play if we want optimal outcomes for all of our patients.

This course provides the framework for all aspects of assessment and treatment of sexual health issues, all the way from interviewing skills, to building awareness and acceptance of alternative lifestyle choices, and a strong influence on the role of orthopaedic concerns in sexual health. Gender specific issues such as hormonal changes in postpartum and perimenopasual women, and erectile dysfunction and Peyronie’s disease in men were also covered in depth. Participants will leave this course well equipped to understand the different sexual health issues that present to women and men throughout the lifespan, as well as an understanding of transgender, LGBT and heterosexual practices and preferences.

Of course we had to show Holly some Irish hospitality during her visit – a substantial number of us went out to Temple Bar in Dublin’s city centre for feasting and frolics and we introduced Holly to Irish dancing – a true functional test of our pelvic floor integrity! In the late 19th century, Benjamin Jowett said ‘What I don’t know isn’t knowledge’ and the same can be said of Holly Herman. She brings not only an engaging and insightful teaching style, but an incredible depth of knowledge in orthopaedics, pelvic health and sexual function, knowledge which she generously shares with all of her class attendees. Don’t miss the first opportunity to experience this course in the US is coming up soon in Rhode Island – as one of the participants in Dublin commented in her feedback form: ‘it is a life altering course!’

If you would like to catch the Sexual Medicine course in the US, it will be offered in Newport, RI on April 5-6. We hope we can look forward to having you there!

This blog was written by H&W faculty member Jenni Gabelsberg DPT, MSc, MTC, WCS, BCB-PMD. You can catch Jenni teaching Care of the Postpartum Patient later this month in Oakland, CA.

Physical Therapists specializing in Women’s Health are in a unique position to help guide and inspire women during their perinatal years, affecting both the health of the woman, as well as the long-term health of any unborn children.

In a recent study published in The Journal of Perinatal and Neonatal Nursing, early onset childhood obesity was determined to be one of the leading pediatric health concerns in the US. Women in their peripartum years need to be educated on what the risk factors for childhood obesity are, and how their personal health decisions can affect their children even before they are conceived. These risk factors are stated as being: maternal obesity at time of conception; excessive weight gain during pregnancy; smoking before, during, and/or after pregnancy; and bottle-feeding the infant after birth.

If a child is born of an obese mother, it has been shown that by four years of age, 24% of children were already obese (and only 9% of children born to mothers of normal weight during first trimester of pregnancy). If a mother gained more than the recommended amount of weight during her pregnancy, it has been shown that there is a 6 times increased risk of that child being overweight or obese by preschool. According to the WHO, an obese mom who gains more than the WHO recommended 11-20 pounds during pregnancy has a 48% increased risk of having an overweight or obese child by age 7. Children who are exposed to smoke in utero were both higher risk of being obese in childhood, and also being of shorter stature. And finally, infants who were fed by bottle were shown to have three times greater risk of rapid weight gain compared to those breast-fed in the first three years of life.

These risk factors not only affect the infant’s birth weight, but can also influence their weight as toddlers and preschool ages. According to the WHO, “Childhood obesity is one of the most serious public health challenges of the 21st century. “ The prevalence of childhood obesity globally is increasing at a rapid rate and has serious implications into adulthood. If children begin life as overweight or obese, they are much more likely to remain obese into adulthood, and also more likely to develop lifelong chronic conditions such as diabetes and heart disease.

More information about childhood and adult obesity can be obtained by watching the HBO series “Weight of the Nation”, which has interviews of many researchers who are focusing their studies on the secondary complications of obesity and how we can fight them. As physical therapists treat women during their childbearing years, it is critical that we use that time to educate women on the long term impact of their health choices and inspire them to make positive changes that will impact both their health and their children’s health for the long term.

This blog was written by H&W instructor, Tracy Spitznagle,PT, DPT, MHS, who instructs the Movement Systems Approach course with Herman & Wallace. You can catch Tracy in the next offering of her course, April 12-13 in Houston, TX.

Should pelvic health practitioners be concerned about movement? Based on personal conversations this month, I would argue an emphatic “yes!”

The first part of 2014 has been exciting for me for understanding movement impairment education. Recently, I attended the Washington University Program in Physical Therapy MSI retreat, where discussion focused on movement and the hip. It was an amazingly cool dialog! The retreat was hosted by Dr. Shirley Sahrmann and guest speaker Dr. Donald Neumann. After the retreat, the University had a visiting lectureship and I had the pleasure of having a breakfast meeting with guest speaker Dr Chris Powers. It has been a movement system educational smorgasbord.

Consider this: the physiological system for which physical therapists are responsible is the movement system. Pain in the pelvic region is commonly associated with myofascial pain, but why did the neural muscular system develop the problem pain to touch? I believe the therapist needs to consider how the neuro-muscular components of the lumbopelvic region could be foremost in the cause of the pain.

At this retreat, I had great reaffirmation of my ideas related to movement. According to Chris Powers, “Increased hip adduction with medial rotation is the most common movement impairment during cutting, jumping and running in women with ACL injuries, there is a huge body of research to support this.”

However, the female athlete is not the only one who moves improperly and develops pain and tissue injuries. Women of all ages are more likely to adduct and medially rotate their hip, simply the habit of leg crossing when sitting re-enforces this issue. This movement impairment can be partially explained by the shape of the female pelvis and the architecture of the muscles. Believe it or not, my favorite muscle, (Don Neumann’s, too) the obturator Internus, is implicated in the movement impairment of the female with an ACL injury as well as the female with pain with intercourse.

Don Neumann PT PhD agrees; according to Dr Neumann, “it is logical to consider that the obturator Internus is more susceptible to strain due to the 130 degree turn it takes out of the pelvis.”

Thus, I believe it is logical to test for hip lateral rotation weakness as well as excessive movement in to adduction and medical rotation as a common movement habit of women, and especially women with pain located deep in the pelvis over the region of the obturator internus.

Motion analysis based on the methods developed by Chris Powers requires a lot of expensive equipment to analyze movement and only those who can run, jump and cut benefit from his information. On the other hand, movement testing of simple tasks that you already know how to do (i.e. bending, standing on one leg, and reaching up overhead) are inexpensive tools to evaluate movement. The hardest part is learning what to look for. Once you recognize kinesiological-based movement impairments you can provide corrective activities at a very low overhead!

The Movement course I teach for Herman and Wallace provides the opportunity to learn a basic movement exam that can be used for women of all ages. The course provides an overview of the anatomy of the hip, spine and SIJ and how impairment movement of these regions relate to common pelvic pain conditions you may be treating. This course provides a means for you to specifically educate your patient on how to move with less pain!

Want more from Tracy? Check her out in Houston in April!

In 2011, H&W was thrilled to add a new course to our list of offerings. Pediatric Incontinence and Pelvic Floor Dysfunction was a much-needed addition to our pelvic floor courses. Despite the growing number of pelvic rehab specialists treating men and women with PF dysfunction, children in this patient population remain woefully under-served, which can cause undo stress for the child and family, as well as the development of internalizing and externalizing psychological behaviors. Dawn Sandalcidi, the author of this course, and Robin Lund, her co-instructor, sat down with Pelvic Rehab Report to talk more about this course and their work with children.

PRR: Dawn, you developed this course many years ago. What initially inspired you to write this course?

When I set out to create this course, there were no courses offered in pediatrics for pelvic health. There was also nobody doing any pediatric courses when I began this quest.

PRR: How has this course evolved over the years?

My first class had only eight people that attended. I was shocked to see that half of the class were pediatric physical therapists looking to help their patients. At that point in time I realized I needed to rewrite the class to accommodate those learning the pelvic floor information for the first time

PRR: Robin, you will be joining Dawn as a co-instructor of this course in 2014. What pearls of wisdom have you picked up in your clinical practice that you'd like to pass onto course participants?

The only population I work with is pediatrics, usually up to 18 years of age, but sometimes up to mid 20's. Children coming to me for treatment of pelvic floor dysfunction are usually between the ages of 5 and 14 years old, but sometimes I treat children slightly younger or older than this. I am specialized in the treatment of torticollis also, so I work with babies a lot. What i've learned is:

1.) Most incontinence symptoms I see are caused or worsened by constipation and most of the time parents don't know their children are constipated because they are "going" every day. If you don't hit constipation management hard in your treatment plan, you will rarely be 100% successful.

2.) Another thing I have learned is that pediatricians and pediatric gastroenterologists often just treat the symptoms and are not always aggressive enough in their management of constipation. I educate my parents on constipation and its effect on bladder and bowel dysfunction and he;p them become good advocates for their child so they can get more action from their doctor.

3.) Work extra hard to earn your pediatric patient's trust and friendship. You will soon become their favorite person and they will want to please you and will work harder on their home program.

PRR: What can you tell us about this course that isn't covered in the description and objectives?

Dawn: It will change your life and the lives of your patients. Pediatrics is a career changing specialty that you will fall in love with!

Why should a therapist take this course? How can these skill sets benefit his/ her practice?

Dawn: Most of us see patients who are adults who also have children with bowel and bladder issues. The pediatric patient suffers most. Not only is a problem for the child but it's also a problem for his/her entire family. We know, based on the literature, that children suffer significantly with psychological disorders related to bowel and bladder issues. The change you see in the child and the family when their discharge from therapy is remarkable!

If you'd like to learn more from Dawn and Robin, we will be offering the Pediatric course twice in 2014. The first offering will be in Nashua, NH in April. The second event will take place in Greenvile, SC in August.