A faculty spotlight on Erica Vitek and her upcoming remote course at Herman & Wallace.

Pelvic rehab and neurorehab have traditionally lived in separate clinical silos. Pelvic clinicians manage incontinence, prolapse, and pelvic pain from a primarily musculoskeletal frame. Neuro clinicians work on gait, ADL, and cognition. The patient sitting across from you with multiple sclerosis, spinal cord injury, or Parkinson disease lives at the intersection, and their pelvic floor symptoms are often the ones quietly eroding their quality of life.

Erica Vitek, MOT, OTR, BCB-PMD, PRPC, has spent her career at that intersection. Her two-day remote course at Herman & Wallace, Neurologic Conditions and Pelvic Floor Rehabilitation, returns on June 27 and 28, 2026, and it is the rare course that gives pelvic rehab clinicians a neuroanatomy-forward framework for these patients.

How common is pelvic floor dysfunction in neurologic disease?

Far more common than referral patterns would suggest. In the North American Research Committee on Multiple Sclerosis (NARCOMS) survey of 9,397 patients, moderate-to-severe pelvic floor symptoms were reported by roughly one in three respondents, including 41% with bladder symptoms, 30% with bowel symptoms, and 42% with sexual dysfunction (Browne et al., 2015). Lower urinary tract symptoms in Parkinson disease run between 27 and 80% across studies, driven by dopaminergic degeneration in pathways that govern autonomic and pelvic floor function (Cheng et al., 2023). Spinal cord injury reliably produces neurogenic bladder and bowel patterns that depend on the level and completeness of the lesion.

The clinical gap is wider than the prevalence gap. Most patients with these conditions have never been offered pelvic rehabilitation, and many of the clinicians treating their gait and balance issues have never been trained to evaluate the pelvic floor in a neurologic context.

One in three people with MS reports moderate-to-severe pelvic floor symptoms. Most have never been offered pelvic rehabilitation.

What changes in the nervous system affect the pelvic floor?

The pelvic floor is governed by an unusually long and vulnerable neural chain that runs from cortical micturition centers down through the pontine micturition center, spinal cord, sacral plexus, and pudendal and pelvic nerves. Damage anywhere along that chain produces a different clinical picture. Cortical and subcortical lesions, demyelinating disease, and dopaminergic degeneration each disrupt different aspects of storage, voiding, and pelvic floor coordination.

That is why an orthopedic-style pelvic assessment, on its own, will miss the diagnosis in these populations. A neurogenic bladder is not a tight pelvic floor. A sphincter dyssynergia is not a coordination problem in the conventional sense. The course gives clinicians the neuroanatomy and pathophysiology they need to read the picture correctly before deciding on intervention.

What conditions does this course cover?

The course goes in depth on three conditions and offers a generalizable framework for others:

• Multiple sclerosis. Demyelination across the central nervous system produces a wide range of bladder, bowel, and sexual health patterns. Up to 80% of women with MS experience bladder and sexual dysfunction within ten years of diagnosis.
• Spinal cord injury. Lesion level and completeness determine whether the clinical picture skews toward upper motor neuron, lower motor neuron, or mixed bladder and bowel patterns. The course covers assessment and management for each.
• Parkinson disease. Dopaminergic degeneration drives lower urinary tract symptoms in 27 to 80% of patients, with orthostatic hypotension and constipation often appearing years before the motor diagnosis is made.
• General neurologic considerations. A foundation participants can extend to stroke, traumatic brain injury, and other neurologic populations they may encounter.

What will you learn in this course?

The course runs over two days on Zoom and is built for clinicians with prior pelvic floor coursework or treatment experience. Participants leave with:

• A working knowledge of neuroanatomy and pathophysiology of the central and peripheral nervous system as it relates to pelvic structures
• Assessment frameworks for neurogenic bladder, neurogenic bowel, and neurogenic sexual health considerations
• Pelvic floor external evaluation considerations adapted to neurologic populations
• Treatment planning and intervention strategies for MS, SCI, and Parkinson disease
• Applications of biofeedback and TENS in the neurologic population
• An Ask the Experts Q&A session for problem-solving complex neurologic patient cases

References

Browne, C., Salmon, N., & Kehoe, M. (2015). Pelvic floor disorders and multiple sclerosis: Are patients satisfied with their care? International Journal of MS Care, 17(1), 6 to 12.

Cheng, B., Chen, Z., Yang, K., & colleagues. (2023). Lower urinary tract symptoms in Parkinson disease: Prevalence, mechanisms, and management. Frontiers in Aging Neuroscience.

Tornic, J., & Panicker, J. N. (2018). The management of lower urinary tract dysfunction in multiple sclerosis. Current Neurology and Neuroscience Reports, 18(8), 54.

Parkinson's Foundation. (n.d.). Autonomic dysfunction and orthostatic hypotension in Parkinson disease. Parkinson's Foundation Clinical Resources.

The Voice and the Pelvic Floor: Why Three Diaphragms Belong in Your Assessment

A faculty spotlight on Dr. Ginger Garner and her upcoming remote course at Herman & Wallace.

The respiratory diaphragm and the pelvic floor have been clinical neighbors in pelvic rehab for decades. The vocal diaphragm, sitting at the top of the same fascial highway, has been largely missing from the conversation. Dr. Ginger Garner, PT, DPT, ATC-Ret, is changing that with her Voice to Pelvic Floor (V2PF) Method, and her short-format remote course at Herman & Wallace returns on Saturday, June 27, 2026.

What is the Voice to Pelvic Floor Method?

The Voice to Pelvic Floor approach is a systems-based, trauma-informed framework for evaluating and treating three connected diaphragms: the vocal and oropharyngeal complex, the respiratory diaphragm, and the pelvic diaphragm. These structures share fascial connections, neuromuscular pathways, and pressure regulation responsibilities. Vocalization, continence, and core stability all depend on how those three systems coordinate.

Dr. Garner developed V2PF to give pelvic health clinicians a more comprehensive lens, particularly for complex cases involving trauma, hormonal transitions, hypermobility, and persistent pain that has not responded to standard pelvic interventions.

The respiratory diaphragm has been part of pelvic rehab for decades. The voice has been missing from the same conversation.

Why should pelvic health clinicians assess the voice?

The voice is a clinical biomarker for pressure regulation. Hormonal shifts, particularly the estrogen decline of perimenopause and menopause, alter vocal endurance, pitch range, and tissue hydration in patterns that mirror changes in pelvic tissue elasticity and continence. Trauma also leaves footprints on the voice, with research linking psychogenic voice disorders to traumatic stress histories (Baker, 2003). When voice is missing from the assessment, those signals get missed too.

Polyvagal pathways and the emotional motor system connect vocalization to the same autonomic and somatic networks that govern pelvic organ function (Holstege, 2016). For patients carrying trauma histories, pressure pain conditions, or stress-driven voiding patterns, the voice is often the clearest window into the system you are already trying to treat.

What will you learn in this course?

The Voice and the Pelvic Floor is a short-format remote course delivered through Zoom, with didactic content followed by interactive lab activities. Participants leave with:

• The anatomy and physiology of the three diaphragms and the fascial and neuromuscular links between them
• A four-pronged V2PF assessment covering respiratory mechanics, core and pelvic floor, orofacial and vocal function, and psychosocial determinants
• Evidence-based vocal techniques you can apply as clinical interventions for pelvic floor and core dysfunction
• A trauma-informed, polyvagal-informed framework for sensitive cases, including survivors of intimate partner violence, sexual trauma, and birth trauma

References

Baker, J. (2003). Psychogenic voice disorders and traumatic stress experience: A discussion paper with two case reports. Journal of Voice, 17(3), 308 to 318.

Garner, G. (2024). The voice and the pelvic floor. The Pelvic Rehab Report, Herman & Wallace Pelvic Rehabilitation Institute.

Holstege, G. (2016). How the emotional motor system controls the pelvic organs. Sexual Medicine Reviews, 4(4), 303 to 328.

Holstege, G., & Subramanian, H. H. (2016). Two different motor systems are needed to generate human speech. Journal of Comparative Neurology, 524(8), 1558 to 1577.