Medical Students in the Pelvic Rehab Clinic

Medical Students in the Pelvic Rehab Clinic

Ramona C Horton, MPT

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.

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Pelvic Floor course in London, UK

Pelvic Floor course in London, UK

Michelle Lyons

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.

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Assessing Co-Morbities with Pelvic Floor Dysfunction

Assessing Co-Morbities with Pelvic Floor Dysfunction

Elizabeth Hampton PT, BCIA-PMDB

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!

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Sexual Medicine course in Dublin, Ireland!

Sexual Medicine course in Dublin, Ireland!

Michelle Lyons

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!

irish pts

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!

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Childhood Obesity, Pregnancy and the Pelvic PT

Childhood Obesity, Pregnancy and the Pelvic PT

Jenni Gabelsberg  DPT, MSc, MTC

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.

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Movement and the Pelvic Patient

Movement and the Pelvic Patient

Tracy M. Spitznagle

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!

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Pediatric Patients and the Pelvic Rehab Therapist

Pediatric Patients and the Pelvic Rehab Therapist

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?

Dawn Sandalcidi

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?

Robin Lund

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.

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Manual Movement Therapy and Biomechanics and the Pelvis

Manual Movement Therapy and Biomechanics and the Pelvis

Lila

Last August, H&W sponsored a brand-new course, Biomechanical Assessment of the Hip & Pelvis: Manual Movement Therapy and the Myofascial Sling System. This course is written and instructed by Steve Dischiavi, MPT, ATC, MTC, CSCS, and covers advanced training in hip and pelvic biomechanics, functional “slings” created by the myofascial system, and use of high level sports medicine theory and applied science.

The course received excellent feedback from participants, so we are thrilled to be offering this course again in 2014. The course will be offered: August 16-17, 2014 in Arlington, VA. We sat down with Steve to see what he learned from his first time teaching with H&W, and what participants can look forward to in 2014.

PRR: You taught this course for H&W for the first time in 2013. What did you learn from your first time teaching this course with H&W?

I honestly was pleasantly surprised. The initial goal of the class was to bring a sports medicine approach to the women’s health arena. I really wanted the women’s health therapist to see how important that specialty area is to orthopedic and sports medicine type clients. The feedback was great. The class was made up mostly of traditional women’s health type therapists who treat women’s health clients almost exclusively. There were a couple of people who do women’s health and ortho clients and there were a couple sports medicine outpatient orthopedic therapists. The whole spectrum of clinicians was represented and the feedback was just as I hoped it would be. The woman’s health PTs seem to take away a lot of the exercises and maybe gave some consideration to the theory I was presenting. I felt the class was engaged and offered great questions. The thing I learned the most after my first class with Herman & Wallace is that there is a place for this class at H&W and hopefully more outpatient orthopedic PTs will take this class and realize their traditional approaches need to have more of a women’s health influence or they will be missing a huge opportunity at better outcomes with their clients.

Were there any surprises? How did feedback from participants inform the evolution of this course as you prepare to teach in 2014?

The biggest surprise to me was that the class was almost all traditional women’s health PTs. I thought there would be more sports medicine type therapists. I think this will take time because I don’t think the traditional sports medicine PT would look to H&W for continuing education. This is exactly the reason for this class. I am very excited, passionate, and proud to be representing H&W as they help the sports medicine and orthopedic PTs integrate more of the realm of women’s health into their existing practice patterns.

What were the most common questions asked by participants during the course? How does the course address frequent questions/misconceptions therapists might have about this topic?

Most everyone in the course wanted me to continually give examples and discuss cases that were not professional athletes. I work with a pro sports team so the majority of my videos and case examples come from this population. I have tried extremely hard to make sure the theories and ideas I am presenting can be extrapolated to the young and elderly clients. I have done a better job integrating videos from these populations and taking time to extrapolate the exercises progressions for all patient populations. This will continue as I tweak the class materials and I am aware of this and I do make specific efforts to make sure the course covers all ages.

This class is based in human movement and neurology: something all of our clients have in common. There are a great number of examples from the athletic community in the class but this is only because these are the types of clients I work with on a daily basis. As I mentioned I have used clients in my private practice who are both young and old and tried to use these clients as examples as well. This way the class participant can see the thoughts, theories, and exercises with clients of all ages.

If you'd like to read what a past participant thought of her experience at this course, check out the Pelvc Rehab Report by guest blogger Janna Trottier, PT, DPT, CSCS. If you'd like to hear more from Steve, consider joining us in August for this course.

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Meet the Instructor of the new Business of Pelvic Rehab Course!

Meet the Instructor of the new Business of Pelvic Rehab Course!

Fatima Hakeem, PT

This June, H&W is thrilled to be partnering with our dear friend, Fatima Hakeem, PT to bring a new course, The Business of Pelvic Rehab, to Denver, CO! This two-day course is intended for the clinician establishing or currently operating a women's health practice who would like to learn concrete skills for running his/her practice, including how to create a Business Plan, marketing to the community as well as physicians and hospital administrators, and recruiting and managing staff.

We sat down with Fatima to hear more about this great, new course.

PRR: What inspired you to create this course?

FH: For several years, I have been receiving calls and emails from therapists regarding the administrative piece of running a women’s health practice: questions on marketing, billing, regulatory requirements and business planning as they relate to women’s health. In addition, instructors that teach clinical courses consistently share with me that questions about the “admin” piece come up in every course. This course is a way to meet with these therapists face to face and help them start up and grow their women’s health service lines.

What resources and research were used when writing this course?

There are several text books on employee satisfaction, marketing to women, business planning, from which I have taken information and made it relevant to women’s health. I have attended several seminars put on by the Private Practice Section and bought several of their publications. I also have completed Billing and Coding courses.

Most importantly, I have set up two women’s health practices from “scratch” and have many years of experience dealing with regulatory requirements, physicians and patients. I have to say the mistakes I have made setting up two practices “from scratch” have been on my list of things to share with participants.

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

The course is designed, above all, to be practical and problem solving. We will spend time doing “labs”, meaning participants will not only leave with didactic information but with outlines of Business Plans and Marketing Plans.

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

To have an effective practice that is financially viable, the business goals/skills and the clinical services must move in parallel. This seminar will help the therapist PLAN and EXECUTE a clinical women’s health program. The clinical courses offered are fabulous and allow the therapists to leave the courses with ready- to- implement clinical skills. However, those therapists may then find themselves stuck on the administrative aspects related to billing, G Codes, how to convince physicians to refer patients, how to handle patient complaints, and how to meet the corporate goals of productivity and quality. The skills learned in this course are effective, easy to implement and will help minimize these mistakes that are so easy to make along the way.

Want to learn more from Fatima? Join us in Denver in June!

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Breast Oncology Rehabilitation

Breast Oncology Rehabilitation

Susannah Haarmann

In 2013, H&W debuted a brand new course on Rehabiltation for the Breast Oncology Patient. This coming year, we are thrilled to be offering this course on the West Coast, in San Diego in April. Pelvic Rehab Report talked to course author and instructor Susannah Haarmann, PT, CLT, WCS about what she learned from teaching this course for the first time and what she looks forward to sharing with participants this year.

PRR: You developed and started teaching this course for the first time in 2013. What did you learn from your first time teaching this course?

SH: I learned that the breadth of topics that ought to be covered in order to present a holistic approach to rehabilitation and breast oncology is gigantic! I was inspired to teach this course because, from my perspective, in most clinics and hospitals, the vast concerns of breast survivors regarding physical well-being and quality of life are not being addressed. I turned to mentors for guidance, but their knowledge had holes. I probed the research, but the information pertaining to rehabilitation seemed disjointed. I sought out continuing education, however, the topics covered were not as complete and detailed as I would have preferred.

In summary, I learned teaching in 2013 that I bit off a lot to chew! Feedback from the course was largely optimistic, however, I have made huge modifications. The course material has been reorganized from a 3-day to 2-day course. Although the course is still steeped in research, the content has been stream-lined. I have also included more labs with pertinent case scenarios for didactic learning and skills development.

Were there any surprises? How did feedback from participants inform the evolution of this course as you prepare to teach in 2014?

I was surprised by the variability in course participants! There were physical therapists and occupational therapists, women’s health practitioners, travelling physical therapists and certified lymphedema therapists, outpatient practitioners and acute care therapists…the perspectives that we had during the debut course was incredible! I treat breast cancer survivors on an outpatient basis, but feedback from the acute care therapists helped me address post-surgical and inpatient issues. Furthermore, I am a certified lymphedema therapist (CLT) trained by the Norton School of Lymphedema, however, there were also Leduc trained CLTs present as well. Interacting with these practitioners broadened my awareness of lymphedema treatment approaches.

Finally, the labs included in this course are broad in scope; they require us to pull from our basic knowledge of cardiopulmonary, integumentary and neuromuscular systems knowledge. Many participants were glad to sharpen their skills in orthopedic testing of the shoulder or vitals assessment and interpretation. In order to be experts, sometimes we have to perfect the basics- Be prepared to call on your generalist wisdom!

What were the most common questions asked by participants during the course? How does the course address frequent questions/misconceptions therapists might have about this topic?

I would say that many of the therapists were inspired by the idea of a health care team that became familiar with the client from the time of diagnosis through the ‘re-entry’ phase into long-term survivorship. Participants wanted to know how to facilitate the practice of the prospective surveillance model in their communities and develop relationships with physicians.

I think that a frequent misconception about breast oncology rehabilitation is that it just addresses lymphedema. In most cases, all bodily systems are affected by treatments related to breast cancer; some rear their heads during the acute phase, whereas other side effects become noticeable with the aging process. We as rehabilitation professionals are able to work with various body systems across the continuum of care. If you take this course be prepared to learn about treating post-surgical side effects such as lymphatic cording, muscle imbalances and post-mastectomy pain syndrome. Get ready to dig into treating side effects of chemotherapy such as peripheral neuropathy, fatigue, osteoporosis and dyspareunia. Learn about rehabilitation considerations pertaining to radiation such as integumentary and potential cardiopulmonary changes. But, we won’t stop there! Behind every ‘body’ is a person; you will also be exposed to what the research says about how medical interventions can affect the psyche and how methods such as mindfulness based stress reduction can not only improve personal well-being, but also affect cancer outcomes.

Want to learn more from Susannah? Check her out in San Diego, April 12-13!

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